Medicine for the Elderly

Question 1

Problems resulting from constipation (4)

Answer 1

Overflow diarrhoea
Urinary retention
Delirium
Abdominal pain/nausea and vomiting

Question 2

Examples of Osmotic Laxatives

Answer 2

Laxido - prepared in solution

Lactulose

Question 3

Examples of Stimulant Laxatives

Answer 3

Senna

Biscodyl

Question 4

Examples of Softener Laxatives

Answer 4

Docusate

Question 5

Examples of PR solutions

Answer 5

Glycerine suppositories
Microenemas
Phosphate enemas

Question 6

Groups of Drugs Causing Constipation (2)

Answer 6

Opiates
Anti-Cholinergics
Including Anti-Muscarinics, Anti-Psychotics and Sedating Anti-Histamines

Question 7

Examples of Bulk Forming Agents

Answer 7

Husk

Have both stimulant and softening actions

Question 8

Pain Medications avoided in MFE

Answer 8

NSAIDs - GI ulceration

Dihydrocodeine, tramadol - tramadol can cause dizziness

Question 9

Side Effects of Anti-Cholinergics (6)

Answer 9

Agitation 
Blurred Vision 
Constipation 
Confusion 
Dry Mouth 
Stasis of urine/inability to sweat

Question 10

Examples of Anti-Cholinergics

Answer 10

Anti-Depressants - amitriptyline, imipramine
Anti-Psychotics - clozapine, quetiapine, risperidone, haloperidol
Anti-Emetics - metoclopramide, prochlorperazine
Anti-Spasmodics - oxybutynin
Anti-Allergic - cetirizine, loratadine
Anti-Parkinson’s Drugs - levodopa, procyclidine

Question 11

Signs in Opioid Toxicity (3)

Answer 11

Jerking/twitching movements
Vivid hallucinations
Sedation (less specific)

Question 12

If need to switch from morphine, what would be the next opioid choice?

Answer 12

Oxycodone

Question 13

Managing Breathlessness at End of Life

Answer 13

Non-Pharmacological - breathing exercises, physiotherapy, relaxation
Pharmacological - oral low dose opioid, lorazepam (helps anxiety around SOB), long term oxygen

Question 14

Contraindications to using laxatives (5)

Answer 14

Intestinal obstruction or perforation 
Paralytic ileus 
Faecal impaction 
IBD 
Toxic megacolon

Question 15

How do bulk forming laxatives work?

Answer 15

Contain fibre, act by keeping fluid in the stool to produce distension

Question 16

How do osmotic laxatives work?

Answer 16

Increasing the amount of fluid in the large bowel producing distension

Question 17

How do stimulant laxatives work?

Answer 17

Causes peristalsis by stimulating colonic nerves

Biscodyl also stimulates rectal nerves

Question 18

Lactulose is also helpful in what other condition?

Answer 18

Hepatic encephalopathy

Question 19

Causes of post-operative hypoxia (4)

Answer 19

Infection
Pulmonary Embolism
Post-operative MI
Pulmonary Oedema

Question 20

Causes of hypothermia (2)

Answer 20

Long lie

Sepsis - worse prognosis as suggests derangement of physiology

Question 21

Causes of post-operative tachycardia

Answer 21

Infection
Pulmonary Embolism
Atrial Fibrillation

Question 22

What is overflow incontinence?

Management

Answer 22

Unable to fully empty the bladder which causes frequent leaking
Ix: bladder scanning and urology referral
Mx: relieve obstruction, instruct individuals in self catheterisation

Question 23

Investigations (and justification) in Falls

Answer 23

Bloods 
- FBC = anaemia 
- U&Es = electrolyte imbalance 
- LFTs = alcohol 
- TFTs 
- B12 = peripheral neuropathy, cognitive 
- RBG = hypo or hyperglycaemia 
ECG
Echo 
Visual Assessment 
Appropriate X-Rays

Question 24

Osteoporosis and T-score

Answer 24

<2.5 = osteoporosis 
1.5-2.5 = osteopenia

Question 25

Side Effects of Bisphosphonates

Answer 25

Gastritis/GORD symptoms | Osteonecrosis (of jaw)

Question 26

eGFR consideration bisphosphonates

Answer 26

<35 should NOT be given

Question 27

Criteria for CT in Acute Confusion (5)

Answer 27

``` Focal neurological signs Anti-coagulation therapy History of recent falls Head injury Reduced level of consciousness ```

Question 28

1st Pharmacological Intervention in Delirium

Answer 28

Haloperidol

Question 29

Other options in delirium

Answer 29

Can use benzodiazepines if alcohol withdrawal is causing the delirium Can also be used in Parkinson's Disease May worsen the delirium

Question 30

Electrolyte Disturbance caused by steroids

Answer 30

Hypokalaemia

Question 31

Presentation of Heart Failure - elderly

Answer 31

Often fatigue dominates | Reduced exercise tolerance + other 'classical' features

Question 32

Management of rate in AF

Answer 32

Digoxin 250mg | Can also use bisoprolol

Question 33

Transudate pleural effusion | Causes

Answer 33

<30 | Causes: cardiac failure, hypoalbuminaemia, nephrotic syndrome

Question 34

Exudate pleural effusion | Causes

Answer 34

>30 | Causes: malignancy, empyema