Intro

Question 1

What makes a Px frail?

Answer 1

-increased vulnerability
-decline (age related) in functional + psychological reserve
-Acopia (unable to cope) to everyday stressors

Question 2

What are the 5 gerries GIANTS?

Answer 2

Iatrogenesis
Immobility
Instability + inanition (poor nutrition)
Intellectual impairment
Incontinence

Question 3

What are the 5 gerries M’s?

Answer 3

-Mind (maintaining mental activity)
-Mobility (help walk and prevent falls)
-Medications (reduce poly pharmacy)
-Multicomplexity (multiple conditions)
-Matters most (advanced care planning)

Question 4

What roles are in the MDT?

Answer 4

MFPSE
Medical
Functional
Psych
Social
Environmental

Question 5

Who is involved in the medical side of MDTs?
what do they discuss/assess?

Answer 5

Dr, Nurse, Pharmacist, Dietician
pMHx, Drug Hx, nutrition

Question 6

Who is involved in the functional side of MDTs?
what do they discuss/assess?

Answer 6

OT, PT, SALT
ADL’s, frailty

Question 7

Who is involved in the Psych side of MDTs?
what do they discuss/assess?

Answer 7

Dr, psychiatry, Nurse
GCS, 4AT (AMS?), PHQ-9

Question 8

Who is involved in the social side of MDTs?
what do they discuss/assess?

Answer 8

OT, social worker
reintegration post DC

Question 9

Who is involved in the environmental side of MDTs?
what do they discuss/assess?

Answer 9

community nurse, NHS appointed house assessor eg. social worker

Question 10

What is poly pharmacy?

Answer 10

5+ meds concurrently

Question 11

what is pharmacokinetics?

Answer 11

body effect on drug (ADME)

Question 12

What is pharmacodynamics?

Answer 12

drugs effect on body

Question 13

What is appropriate and inappropriate poly pharmacy?

Answer 13

Appropriate = 5+ meds and needed eg. MI prophylaxis

Inappropriate = Lots of unnecessary meds - sequential prescribing, high co morbidities, pain Hx

Question 14

What does anticholinergic burden (ACB) mean?

Answer 14

Taking multiple drugs with anticholinergic effects creates an anticholinergic burden

Question 15

What score is high in ACB and what Sx does it cause in elderly?

Answer 15

3 or more
Causes increased falls, AMS + Morbidity in elderly (>65) - 70% chance adverse effect

Question 16

Ach syndrome, how does it affect the PNS + CNS?

Answer 16

PNS = Can’t SEE, PEE, SPIT, SHIT + flushing

CNS = Agitation, low GCS, AMS, Ataxia

Question 17

What are some examples of ACB 1?

Answer 17

codeine, prednisolone, warfarin

Question 18

What are some examples of ACB 3?

Answer 18

Paroxetine, amitryptilline, clozapine, promethazine, quetiapine, oxybutynin

Question 19

What 2 medications interact with warfarin? what do they cause?

Answer 19

warfarin + NSAIDS = increase bleed risk

Warfarin + macrolide (erythromycin, clarythromycin) / metronidazole = Increases INR

Question 20

What does omeprazole interact with to cause?

Answer 20

Omeprazole + clopidogrel = low clopidogrel effect

Question 21

what do SSRIs interact with to cause?

Answer 21

SSRI + NSAIDs = high GI bleed risk = co prescribe PPI

Question 22

what do ACE-i interact with to cause?

Answer 22

ACE-i + spironolactone = high AKI risk + High K+

Question 23

What does methotrexate interact with to cause?

Answer 23

Methotrexate + trimethoprim = myelosuppression

Question 24

what 2 meds/other do statins interact with to cause?

Answer 24

statin + macrolide
statin + grapefruit juice

Question 25

When was the mental capacity act instated and what does it do?

Answer 25

MCA 2005 Empowers 16 and over decision making in lacked capacity

Question 26

what does Fe interact with to cause?

Answer 26

Fe + tetracycline (reduce tetracycline effect)

Question 27

what principles are upheld in the mental capacity act?

Answer 27

impaired brain? enough to lack capacity? Principles: Best interests, assume capacity till otherwise proved, no harm principle, Give all info, least restrictive option

Question 28

What does IMCA stand for? What are they and what do they do?

Answer 28

Independent mental capacity advocate NHS appointed for non LPA Px Can inquire medical decisions but cannot make decisions on patients behalf

Question 29

LPA: What is it? What are the 2 types? what can they do?

Answer 29

Lasting power of attorney Appointed by Px to make decisions on their behalf if lack capacity Financial + health (regulated with office of pub guard)

Question 30

What is an Advanced Directive?

Answer 30

written statement by 18+ detailing Tx preferences should they lack capacity in future Applicable to situation, CAN'T demand Tx (only refuse) and CAN'T refuse basic Tx (food, hydration)

Question 31

what is a Court appointed decision (CAD)?

Answer 31

No LPA + dispute over best interests - apply to court for temp decision maker

Question 32

What does DoLs stand for?

Answer 32

deprivation of liberty safeguards

Question 33

What does DoLs do? Principles?

Answer 33

Px unfree to leave 24hr supervised residence for 7 or less days if pose risk to self or others least restrictive option, Px lacks capacity, can do <12m total Principles: best interests, pose risk to self, deprivation-risk of harm is proportionate

Question 34

If a Px with capacity is wanting to self discharge, what 4 pieces of info is needed?

Answer 34

1. Drug Hx update 2. OT 3. PT 4. GP f/u and letter to GP