geriatrics: TXs

Question 1

what drugs can cause orthostatic hypotension

Answer 1

anti-hypertesnives, diuretics antidepressants and antipsychotics (e.g. venlafaxine, duloxetine, risperidone, haloperidol)

Question 2

what drug can cause permanent cerebellar damage and unsteadiness in long term use at therapeutic dose

Answer 2

phenytoin

Question 3

orthostatic hypotension
non medical management

Answer 3

• avoid sudden movement

-water loading

• increase salt in diet
• compression stocking

keep legs elevated

• calf muscle excersises

Question 4

orthostatic hypotension medical management and when given

Answer 4

fludocortisone, midodrine

only given when everything else has failed (eg taken off drugs that cause postural hypotension and had non medical management)

Question 5

what drugs should be stopped in postural hypotension

Answer 5

diuretics, anti hypertensive, dopamine agonists, pregabalin, review anti-depressants

Question 6

just in case medication for pain/sob

Answer 6

morphine 2mg hourly scut

Question 7

just in case medication for distress/agitation

Answer 7

midazolam 2mg hourly scut

Question 8

just in case medication for nausea

Answer 8

levomepromazine2.5mg hourly scut

Question 9

just in case medication for respiratory secretions

Answer 9

hyoscine butylbromide 20mg hourly scut

Question 10

if already on established background opioid?

Answer 10

use same opioid. 1/6 background dose as breakthrough prn dose

Question 11

contraindications to opioids

Answer 11

severe renal function- talk to senior, consider alfentanil

Question 12

how to work out scut dose of morphine

Answer 12

divide daily dose of morphine by two

Question 13

alzheimers mild/moderate treatment

Answer 13

1st line: the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)

2nd- memantine

Question 14

alzheimers tx moderate/severe

Answer 14

moderate- memantine + anticholinesterase inhibitors
or just memantine if anti is contraindicared

severe- monotherapy of memantine

Question 15

what is morphine contraindicated in

Answer 15

CKD

Question 16

1st line pain medication for patients with CKD

Answer 16

oxycodone

Question 17

delerium pharmacological management

Answer 17

(Only to be used in extreme cases)

Oral is the preferred route for all of the following

1st: haloperidol

If parkinsons/typical antipsychotics contraindicated- lorazepam

Risperidone can be used in caution sometimes.

Question 18

urge incontinence in old people

Answer 18

mirabegron

oxybutnin associated with confusion as it is an anticholinergic