Term
| What are the DEFINITIVE risks for dementia? (4) What are the POSSIBLE risks for dementia? |
|
Definition
| DEFINITIVE - Age, Down syndrome, family history, APOE4 allele POSSIBLE - Head injury, fewer yrs of schooling, late onset of depression, cardiovascular dx, HTN, DM, hyprlipidemia. |
|
|
Term
| What factors have been determined to be PROTECTIVE and reduced the risk of Dementia? |
|
Definition
| NSAID, Antioxidants, statins, exercise, intellectual activity |
|
|
Term
| How can delirium be distinguished from dementia? |
|
Definition
| Delirium has an acute onset in which cognitive function declines over hours to days. LOC of a pt with delirium is impaired as well as their attention, a patient with dementia is usually alert even if they are not responsive. Delirium also presents with altered sleep cycles. |
|
|
Term
| Although depression and dementia often have overlapping symptoms, what separates depressed individuals from those with dementia? |
|
Definition
| 1) Depressed pts demonstrate DECREASED MOTIVATION during cognitive testing 2) Depressed individuals express cognitive complaints that exceed measured deficit. 3) Depressed individuals maintain language and motor skills |
|
|
Term
| What are the key features of Lewy-Body Dementia that help distinguish it from the other types? |
|
Definition
| Visual hallucinations, delusions, as well as Parkinsonism motor dysfunction |
|
|
Term
| What are the triad of symptoms that are key to the presentation of Normal-Pressure Hydrocephalus? |
|
Definition
| Progressive Dementia Urinary Incontinence Apraxic Gait |
|
|
Term
| What are the key feature of fronto-temporal lobe dementia that distinguish it from the others? |
|
Definition
| Preservation of memory and visual-spatial skills Excessive eating and drinking and personality changes |
|
|
Term
| What is the pharmacologic treatment for Alzheimer's disease and Lewy Body Dementia? |
|
Definition
| Donepezil (aricept) - for mild to moderate |
|
|
Term
| T/F - Dementia is common in older adults but is not an inherent part of aging |
|
Definition
| T - Dementia is not a normal finding and should be investigated |
|
|
Term
| Which type of dementia is MC? |
|
Definition
|
|
Term
| What are the MC ADE that occur with cholinesterase inhibitors used in the treatment of dementia? What laboratory monitoring should be done when someone is prescribed cholinesterase inhibitors? |
|
Definition
| N/V/D NO monitoring needs to be done |
|
|
Term
| What is the benefit of cholinesterase inhibitors in treating dementia? |
|
Definition
| They have been shown to have minimal to modest improvement in cognition, and seem to slow the progression of the disease. |
|
|
Term
| If a patient has progressive symptoms, including "not being able to find a word", but his memory and ADLs are unaffected, what condition should you suspect? |
|
Definition
| MCI - Mild Cognitive Impairment |
|
|
Term
| If a pt presents with slight memory dysfunction, spontaneous parkinsonism as well as visual hallucinations, what condition should you suspect? |
|
Definition
|
|
Term
| What findings on a PET is supportive of Lewy-Bodied Dementia? |
|
Definition
| Occipital lobe hypometabolism on PET is a supportive feature for the diagnosis |
|
|
Term
| With what type of dementia should anti-psychotic meds NEVER be used? |
|
Definition
|
|
Term
| What is the basis of the diagnosis of delirium based on? (what deficits are shown) What tests are used to determine these deficits? |
|
Definition
| changes in cognitive function and attention deficit Tests: Digit-span memory, Montreal Cognitive Assessment, Confusion Assessment Method, Delirium Rating Scale - Revised 98 |
|
|
Term
| How can delirium caused by anticholinergic drug overdose be reversed? |
|
Definition
| reversed by physostigmine |
|
|
Term
| What is the strongest risk factor for developing delirium? |
|
Definition
|
|
Term
| What are the predisposing risk factors for delirium? |
|
Definition
| Dementia Advanced age Functional Impairment Medical Comorbidity Hx of alcohol abuse Male Sex Sensory Impairment |
|
|
Term
| What are the precipitating factors for delirium? |
|
Definition
| Catheter Use Dehydration Environmental Change >3 new meds >6 total meds Iatrogenic Event ICU admission, infection, psychotropic meds, malnutrition, restraint use |
|
|
Term
| Which Meds are the MC cause of reversible delirium? (ACDDDHLLM) |
|
Definition
| amitriptyline codein digoxin diphenhydramine diazepam haloperidol lithium, levodopa meperidine |
|
|
Term
| Which med should be used as a pharmacological restraint, if one is found necessary? In which types of pts should you not use this drug? |
|
Definition
| Haloperidol; AVOID in pts with Parkinsonism |
|
|
Term
| If a pt is in sedative or alcohol withdrawl or has a hx of neuroleptic malignant syndrome what type of pharmacological treatment should be used? |
|
Definition
|
|
Term
| What can delirium be diagnosed with, with a high sensitivity and high specificity? |
|
Definition
| CAM - Cognitive Assessment Model |
|
|
Term
| What is the best treatment for delirium? |
|
Definition
|
|
Term
| If a pt presents with acute delirium, what is MANDATORY to review in order to look for possible causes? |
|
Definition
| MED REVIEW, Hx, physical and focused labs |
|
|
Term
| When is a CT of the brain in a pt who has new onset delirium? |
|
Definition
| most useful in the presence of new focal neurologic symptoms or falls to exclude intracranial or subdural hemorrhages, structural lesions (meningiomas or metastatic brain tumors), or strokes, may be indicated if the patient’s laboratory and other tests are unremarkable |
|
|
Term
| Which drugs have STRONG anticholinergic properties and should have limited use in elderly? |
|
Definition
| Amitriptyline, codeine, oxybutynin, paroxetine |
|
|
Term
| Which disease causes a pt to have a greater propensity for developing delirium, due to their impaired cholinergic systems? |
|
Definition
|
|
Term
| What are the MC causes of acute confusion? What tests should be done if a pt presents with acute delirium and new onset symptoms ie falls, confusion and new onset incontinence? |
|
Definition
| medical illness, metabolic disturbance, and medications Lab tests - Basic metabolic panel, CBC, and pulse oximetry |
|
|
Term
| What psychological factors can affect an older women's sexuality? |
|
Definition
| Married to older men Outlive their spouses, spend later years alone Lack of privacy due to living situation |
|
|
Term
| What is the treatment for postmenopausal atrophic vaginitis? |
|
Definition
| Longer Foreplay Regular Intercourse Water-soluble lubricants Topical Estrogen |
|
|
Term
| What common disease can cause sexual dysfunction due to its neurological effects?? |
|
Definition
|
|
Term
| How can psychological sexual dysfunction in a women be treated? |
|
Definition
| Cognitive-behavioral therapy Masturbation Kegel Exercises |
|
|
Term
| What are the normal age-related changes in the sexual function of men? Excitement - Plateau - Orgasm - Resolution - Refractory - |
|
Definition
| Excitement - delayed erection Plateau - Prolonged Orgasm - diminished duration and intensity; decreased quantity and force of seminal emission Resolution - rapid detumescence Refractory - Prolonged period between erections |
|
|
Term
|
Definition
| Anticholinergics - Antidepressants, Antipsychotics, Antihistamines Antihypertensives - Beta-blockers, Clonidine, Thiazide Diuretics OTC Meds - Cimetidine, Ranitidine |
|
|
Term
| How does testosterone affect sexual health in the elderly? |
|
Definition
| low testosterone levels decreases libido more than it being the cause of ED |
|
|
Term
| What are the risk factors for the development of ED? |
|
Definition
| DM HTN Hyperlipidemia Smoking |
|
|
Term
| What category of drugs is used to treat erectile dysfunction in older men? |
|
Definition
| Phosphodiesterase-5 inhibition -Sildenafil (Viagra) -Vardenafil -Tadalafil |
|
|
Term
| What meds are phophodiesterase inhibitors contraindicated with? |
|
Definition
|
|
Term
| What are typical adverse events that are caused by Phosphodiesterase-5 Inhibitors? |
|
Definition
| Flushing, HA, loss of vision or hearing |
|
|
Term
| What accounts for the difference in knowledge about sexual dysfunction in older men versus older women? |
|
Definition
| Difficulty in measuring female sexual response Exclusion of older adults from research |
|
|
Term
| What are the signs and symptoms of vaginal atrophy in elderly women? |
|
Definition
| Vaginal pH becomes higher than 4.5 Shift toward coliform organisms Vaginal rugae smooth out Mucosa thins Fissures may develop |
|
|
Term
| Which bacteria cause the highest risk of worsening pressure ulcers? |
|
Definition
| Pseudomonas, P. Aeruginosa and anerobic bacteria |
|
|
Term
| What tools are used to asses a geriatric patient’s risk for pressure ulcers? |
|
Definition
| Norton Scale Braden Scale |
|
|
Term
| What device is contraindicated in a pt who is at high risk for developing pressure ulcers? |
|
Definition
|
|
Term
| Which stage is an pressure ulcer that is described as Purple or maroon localized area of discolored intact skin or blood-filled blister? |
|
Definition
| Suspected deep tissue injury |
|
|
Term
| Which stage pressure ulcer is described as Intact skin with nonblanchable redness of a localized area that may be painful, firm, soft, and warmer or cooler than adjacent tissue? |
|
Definition
|
|
Term
| What stage of pressure ulcer is described as Partial-thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed? |
|
Definition
|
|
Term
| What is the treatment for a Stage I pressure ulcer? |
|
Definition
| Dressing: Transparent Film |
|
|
Term
| What is the treatment for a Stage II pressure ulcer? |
|
Definition
| Dressing: Foam Island, Hydrocolloid, petroleum-based non-adherent, hydrogel, amorphous |
|
|
Term
| What is the treatment for a Stage III pressure ulcer? |
|
Definition
| Dressing: Foam Island, hydrocolloid, petroleum-based non-adherent, Alignate, hydrogel, amorphous, gauze packing Surgical Repair: (skin grafting, skin flaps, musculocutaneous flaps, free flaps) |
|
|
Term
| What is the treatment for a Stage IV pressure ulcer? |
|
Definition
| Dressing: Alignate, hydrogel, amorphous, gauze packing Surgical Repair: (skin grafting, skin flaps, musculocutaneous flaps, free flaps) |
|
|
Term
| What is the treatment for a pressure ulcer classified as unstageable? |
|
Definition
| Debridement of Eschar then appropriate staging and treatment determined |
|
|
Term
| Which stage of pressure ulcer is described as full-thickness tissue loss with sub-q fat visible, but no bone, muscle or tendon destruction, slough may be present as well as undermining? |
|
Definition
|
|
Term
| Which stage of pressure ulcer is described as Full-thickness tissue loss with exposed bone, tendon, or muscle with slough or eschar as well as undermining? |
|
Definition
|
|
Term
| Which stage of pressure ulcer is described as Full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed? |
|
Definition
|
|
Term
| What is the best method for cleansing the wound bed of the pressure ulcer? |
|
Definition
| Normal saline irrigation is standard for wound cleansing |
|
|
Term
| When are Hydrocolloid dressings contraindicated? |
|
Definition
| contraindicated in infected ulcers |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Sensation of impending fainting |
|
|
Term
|
Definition
| Feeling of imbalance on standing or walking |
|
|
Term
| What are some cardiac causes of presyncope? |
|
Definition
tachy or brady cardia
aortic outlet obstruction |
|
|
Term
| What are some vascular cause of presyncope? |
|
Definition
orthostatic hypotension
vagal stimulation |
|
|
Term
| What are some postural causes of presyncope? |
|
Definition
|
|
Term
|
Definition
| Sensation of being unsteady when standing or in particular walking |
|
|
Term
| What are some provocative vestibular tests that should be done on physical exam to help in the diagnosis of dizziness and syncope? |
|
Definition
Head-thrust Test
Fukuda Stepping Test
Dix-Hallpike maneuver |
|
|
Term
| What are the treatment for Benign paroxysmal positional vertigo? |
|
Definition
|
|
Term
| What are the treatments for Ménière disease? |
|
Definition
| Salt restriction, diuretics; vestibular suppressants may be helpful during acute attacks |
|
|
Term
| What are the treatments for dizziness and syncope caused by meds? |
|
Definition
| Discontinue, substitute, or reduce the dosage of offending medication |
|
|
Term
| What are the treatments for orthostatic hypotension? |
|
Definition
| Treatment of specific cause (eg, proper hydration); slow rising from sitting or lying down position; graduated support stockings; PT and/or OT; midodrine (med to tx orthostatic hypotension) |
|
|
Term
| What are the treatments for Postprandial hypotension? |
|
Definition
| Frequent small meals; avoid exertion after meals; slow rising from sitting position; avoid antihypertensive drugs at or near meal time |
|
|
Term
| What are the treatments for Vertebrobasilar ischemia and/or cerebellar infarcts? |
|
Definition
| Low-dose aspirin Clopidogrel (Plavix) Dipyridamole - Blood Clot Reduction |
|
|
Term
| What is the treatment for acoustic neuroma? |
|
Definition
|
|
Term
| What are some factors that occur as we age that can cause syncope? |
|
Definition
1) reduced baroreflex control
2) reduced left-ventricular compliance
3) changes in renal function that impair salt and water handling and predispose to dehydration |
|
|
Term
| What are some common causes of syncope in the geriatric population? |
|
Definition
Aortic Stenosis
Dehydration
Hypoglycemia
Orthostatic Hypotension
Postprandial Hypotension
Vasovagal faint |
|
|
Term
| Which cause of syncope is described as having a <5sec warning prior to onset, during event pt is flaccid with absent/faint pulse, blue or ashen skin, but has a rapid and complete recovery? |
|
Definition
|
|
Term
| Which cause of syncope is described as being aborted if person lies flat, has seconds to minutes of warning, is accompanied commonly by nausea/diaphoresis, during the event pt is described as motionless, relaxed tone with pale color and dilated reactive pupils and recovers commonly with faint fatigue, nausea and diaphoresis without amnesia? |
|
Definition
|
|
Term
| Which cause of syncope is described as having NO warning or prodrome, during event pt has rigid tone, rapid pulse, elevated BP, as well as commonly having tonic eye deviation and frothing at the mouth and during recovery has amnesia, is disorientated, and has focal neurologic finding? |
|
Definition
|
|
Term
| When is carotid massage contraindicated? |
|
Definition
| in pts with carotid bruits, CVD and recent MI |
|
|
Term
| What is the treatment for Vasovagal syncope? |
|
Definition
| Avoidance of triggers; medical therapy is somewhat controversial (β-blockers, clonidine, paroxetine, midodrine) |
|
|
Term
| What is the treatment for Carotid sinus hypersensitivity? |
|
Definition
| Avoid stimulating factors (tight collars or rapid neck movements); pacemaker |
|
|
Term
| What are the symptoms of Dorsolateral medullary stroke (Wallenberg’s syndrome)? |
|
Definition
| ipsilateral Horner’s pupil, ipsilateral facial pain and loss of temperature sensation, ipsilateral central facial (lower face only) weakness, and contralateral pain and loss of temperature sensation in the arms and legs |
|
|
Term
| What diagnostic procedure can be done to confirm a diagnosis of orthostatic hypotension? |
|
Definition
|
|
Term
| When should pharmacologic therapy to treat orthostatic hypotension be used? |
|
Definition
| Pharmacologic therapy (eg, fludrocortisone and midodrine) should be used only if other measures fail. |
|
|
Term
| What is the MC type of UI in the elderly? |
|
Definition
|
|
Term
| Which type of UI is described as an abrupt or compelling need to urinate, frequent urination and nocturia? |
|
Definition
|
|
Term
| Which type of UI is described as episodic leakage with increased inter-abdominal pressure or continual leakage may occur with sitting or standing? |
|
Definition
|
|
Term
| Which type of UI is described as small but continual leakage, weak urinary system, intermittency, hesitancy, frequency, and nocturia? |
|
Definition
|
|
Term
| What are some causes of nocturia? |
|
Definition
| Fluids late in the day Pedal Edema Heart Failure Obstructive Sleep Apnea Meds Detrusor overactivity BPV Impaired Bladder Emptying |
|
|
Term
| What are some tests that can be performed to aid in the diagnosis of UI? |
|
Definition
| bladder diary, stress test, urinalysis, 24-hr urine, renal function |
|
|
Term
| What treatment has the highest cure rate for stress incontinence? |
|
Definition
|
|
Term
| What is the pharmacological treatment for Urge incontinence? |
|
Definition
| Anti-muscarinic Meds- OXYBUTIN |
|
|
Term
| What behavioral treatment can be used to treat pts with UI who are cognitively impaired? |
|
Definition
|
|
Term
| What is the treatment for overflow incontinence caused by obstruction? |
|
Definition
|
|
Term
| What is the treatment for stress incontinence? |
|
Definition
| Kegel exercises Biofeedback training with Kegel exercises Med: Pseudoephedrine (contraindicated in HTN) Surgery |
|
|
Term
| What is an antalgic gait? |
|
Definition
| Pain-induced limp with shortened phase of gait on affected side. |
|
|
Term
|
Definition
| Outward swing of leg in semi-circle from the hip |
|
|
Term
|
Definition
| Excessive plantar flexion and inversion of the ankle |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Loss of ankle dorsiflexion secondary to weakness of ankle dorsiflexors |
|
|
Term
|
Definition
| Early, frequent audible foot-floor contact with steppage gait compensation |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Tendency to fall backward |
|
|
Term
|
Definition
| Hip adduction such that the knees cross in front of each other with each step |
|
|
Term
|
Definition
| Exaggerated hip flexion, knee extension, and foot lifting, usually accompanied by foot drop |
|
|
Term
| What is trendelenburg gait? |
|
Definition
| Shift of the trunk over the affected hip, which drops because of hip abductor weakness |
|
|
Term
|
Definition
| Moving the whole body while turning |
|
|
Term
| If a pt has a proprioceptive peripheral sensory dysfunction, what type of gait will they have? |
|
Definition
|
|
Term
| If a pt has a vestibular peripheral sensory dysfunction, what type of gait will they have? |
|
Definition
|
|
Term
| If a pt has a visual peripheral sensory dysfunction, what type of gait will they have? |
|
Definition
|
|
Term
| What type of gait is suggestive of a proprioceptive or sensory deficit? |
|
Definition
| Wide-based steppage gait with loss of position sense |
|
|
Term
| If a pt presents with a gait that has leg circumduction and loss of arm swing unilaterally, what condition do you suspect? |
|
Definition
| Hemiplegia or Hemiparesis |
|
|
Term
| If a pt presents with a gait that has bilateral circumduction and possible scissoring, what condition do you suspect? |
|
Definition
| Paraplegia or Paraparesis |
|
|
Term
| If a pt presents with a gait that has small, shuffling steps, hesitation, propulsion, turning en block and absent arm swing, what condition do you suspect? |
|
Definition
|
|
Term
| If a pt presents with a gait that has a wide-based gait with increased trunk sway and irregular stepping, what condition do you suspect? |
|
Definition
|
|
Term
| What type of gait is associated with dementia? |
|
Definition
| cautious gait, fear of falling |
|
|
Term
| Describe the classic gait associated with NPH? |
|
Definition
| hesitation, gait ignition failure, small steps, straighter legs (not much bend) |
|
|
Term
| What are some critical parts of a gait screening? |
|
Definition
| Dix-Hallpike = test vestibular integrity BP Sitting and Standing = Orthostatic Hypotension Visual Acuity MM test (ROM, strength) Neurologic assesment Rhomberg = postural control CAM = Cognitive Function |
|
|
Term
| With the Timed-get-up-&-go test, what time is normal, what time is indicative of an increased risk of falls and what time is indicative of a high need for further evaluation? |
|
Definition
| <10 sec = Normal >14 sec- high fall risk >20 sec - high need for further evaluation |
|
|
Term
| What is the MC incident or injury among the elderly? |
|
Definition
|
|
Term
| What is the leading COD from injury in pts over 65y/o? |
|
Definition
|
|
Term
| What is the #1 contributing factor for fractures associated with falls? |
|
Definition
|
|
Term
| What is "long lie" a predictor of? |
|
Definition
| predictor of lasting decline in functional status |
|
|
Term
| Which meds increase a pts risk of falls? |
|
Definition
Benzodiazepines
Anti-depressants
Anti-psychotics
Cardiac Meds
Hypoglycemic agents |
|
|
Term
| If a pt has a history of a single recent fall and no others, what type of evaluation is warranted? |
|
Definition
| gait analysis and balance (Rhomberg) |
|
|
Term
| If a pt has a history of a two recent falls and no others, what type of evaluation is warranted? |
|
Definition
|
|
Term
| If a pt presents with difficulty starting to walk, has a slow gait with decreased foot clearance, and the tendency to fall backward, what condition should you suspect? |
|
Definition
|
|
Term
| If a pt has complaints of painful gait, and her legs "giving way" and the gait dysfunction is asymmetrical, what condition might you suspect? |
|
Definition
|
|
Term
| What are some tips for identifying opportunities to prevent mistreatment? |
|
Definition
Identify Risk Factors for elder abuse
Identify and Aid in relieving Caregiver Stress
Identify Family Conflict or Concerning Family History |
|
|
Term
| What are the risk factors for elder abuse? |
|
Definition
| Poverty, Dependency on caregiver, Age, Race, Functional disability, Frailty, Cognitive Impairment |
|
|
Term
| What are some common signs of neglect? |
|
Definition
Clothing that is inappropriate, soiled or in disrepair.
Poor hygiene,
Deficient nutritional status, dehydration or malnutrition
Diarrhea, fecal impaction or urine burns
Med use that is inadequate, excessive or otherwise inappropriate
Pressure Ulcers |
|
|
Term
| What are some common signs of caregiver abuse? |
|
Definition
Anxiety or nervousness in the presence of the caregiver.
Excessive deference (submission) to the caregiver.
Bruises or welts in various healing stages especially bilateral or on inner arms or thighs.
Repetitive injuries, head injuries, hair loss or hemorrhages beneath the scalp as a consequence of hair pulling. |
|
|
Term
| What are some common signs of financial exploitation? |
|
Definition
Recent disparity between appearance and financial assets.
Inability of pt to account for money or property or to pay for medical care
Reports of money or goods in exchange for care |
|
|
Term
| What are some common signs of financial exploitation? |
|
Definition
Recent disparity between appearance and financial assets.
Inability of pt to account for money or property or to pay for medical care
Reports of money or goods in exchange for care |
|
|
Term
| How often are meds required to be reviewed by a physician for a nursing home resident? |
|
Definition
| Required at minimum 1 time per month, review should be done in concert with the pharmacist in regard to SE, lab monitoring and potential interactions |
|
|
Term
| What occurs with the VD of gentamycin (and other aminoglycosides) in the elderly? How must you address this change? |
|
Definition
| VD decreased so the LD of gentamycin should be reduced in the elderly |
|
|
Term
| What occurs with the VD of Diazepam in the elderly? How must you address this change? |
|
Definition
| Higher VD, which extends the half-life Lower dosage needed |
|
|
Term
| What condition affects the metabolism of Warfarin? |
|
Definition
| Hepatic congestion from heart failure reduces the metabolism of Warfarin |
|
|
Term
| What happens to serum creatinine concentrations and creatinine clearance in the elderly? |
|
Definition
| Serum creatinine remains relatively normal as individuals age, but the creatinine clearance declines 50% as a patient ages |
|
|
Term
| What are the two clinically relevant consequences of altered renal clearance in the elderly? |
|
Definition
| (1) the half-lives of renally excreted drugs are prolonged (2) the serum levels of these drugs are increased |
|
|
Term
| How is creatinine clearance in the elderly calculated? |
|
Definition
|
|
Term
| Which drug MC causes side effects in the elderly? |
|
Definition
|
|
Term
| How do the effect of Benzodiazepines change with aging? |
|
Definition
| May cause more sedation and poorer psychomotor performance in older adults |
|
|
Term
| How do the effects of morphine change with aging? |
|
Definition
| Older pts may experience longer pain relief with morphine. |
|
|
Term
| What are the most common meds involved in ADEs in the geriatric population? |
|
Definition
| Cardiovascular drugs, diuretics, NSAIDs, hypoglycemics and anticoagulants |
|
|
Term
| Which drugs have narrow theruputic ranges and should be monitored closely when used in the elderly population? |
|
Definition
| digoxin, coumadin, dilantin, quindine, theophylline |
|
|
Term
| What is the list of medications that have been identified as potentially problematic in older patients called? |
|
Definition
|
|
Term
| What are some drugs that are commonly under-prescribed? |
|
Definition
| ACE inhibitors for patients with diabetes and proteinuria β-blockers for patients after MI or with heart failure |
|
|
Term
| What are the risk factors for ADE? |
|
Definition
| 6 or more concurrent chronic conditions 12 or more doses of drugs/day 9 or more medications Prior adverse drug event Low body weight or low BMI Age 85 or older Estimated CrCl < 50 mL/min |
|
|
Term
| Which drugs induce the CYP3A4 system? What does this cause? |
|
Definition
| rifampin, phenytoin, and carbamazepine May cause some meds to decrease effectiveness |
|
|
Term
| Which drugs inhibit the CYP3A4 system? What does this cause? |
|
Definition
| Macrolides, Azoles, grapefruit juice Can enhance the effects of med, even causing toxicity |
|
|
Term
| What are the MC adverse effects caused by Drug-Drug Interactions? |
|
Definition
| Confusion/delirium Cognitive Impairment Hypotension Acute Renal Failure |
|
|
Term
| What are some common manifestations of acute drug reactions? |
|
Definition
| restlessness, falls, depression, confusion, loss of memory, constipation, incontinence |
|
|
Term
| Which drugs types are MC involved in drug/drug interactions? |
|
Definition
|
|
Term
| What are some helpful tips for managing polypharmacy? |
|
Definition
| -M – Minimize the number of drugs -A- Alternatives should be considered -S- Start low and go slow with meds -T- Titrate therapy to the desired goal -E- Educate the patient, their family or caregiver -R- Review drug plan at each visit |
|
|
Term
| What med can cause SE including Nausea, Palpitations and Yellow vision? |
|
Definition
|
|
Term
| What anti-arrhythmics should be avoided when pt is already on Digoxin? Why? |
|
Definition
| Verapamil, Quinidine and Amiodarone as they may increase serum digoxin levels by 50% - 70%. |
|
|
Term
| Which drug reduces the pain relieving effect of codeine? |
|
Definition
|
|
Term
| What effect can ibuprofen have on the kidney? |
|
Definition
| may cause renal function to deteriorate. |
|
|
Term
| What can Propoxyphene, a pain reliever, increase the risk of in elderly adults? |
|
Definition
| it has narcotic-related adverse events, including an increased risk of hip fracture. |
|
|
Term
| How can Atherosclerotic Changes affect a pts vital signs? |
|
Definition
| May cause bouncing or decreased pulses and may cause elevated systolic HTN |
|
|
Term
| What are some common findings on cardiac exam of an elderly pt? |
|
Definition
| Systolic ejection murmurs are common in 50% of patients older than 80y/o) |
|
|
Term
| What are some common cardiac diseases prevalent in the elderly population? |
|
Definition
| Common cardiac disease in elderly are arrhythmias, dissecting aneurysms, Angina, MI & CHF |
|
|
Term
| What are some common GI complaints prevalent in the elderly population? |
|
Definition
| Increased GERD, Dysphagia, Dysphonia |
|
|
Term
| What is the most accurate office screening tool for physiologic hearing loss in older adults? |
|
Definition
|
|
Term
| What are some methods for assessing a patients Quality of Life? |
|
Definition
Short Form - 36 Health Survey
Barthel Index |
|
|
Term
| What can poor nutrition be a reflection of? |
|
Definition
| illness, depression, functional losses or financial hardship |
|
|
Term
| What is the Goal of a Comprehensive Geriatric Assessment? |
|
Definition
| o determine a patient’s medical status, functional capabilities, psychosocial status. (important to help you develop an overall treatment plan based on pts needs) |
|
|
Term
| What are the key elements of a rapid screening? |
|
Definition
Functional status
Nutrition
Hearing
Vision
Mobility
Cognitive Function
Depression |
|
|
