what drug can you add in to 1st line treatment for Alzheimers that continues to progress?
Drug and class
memantine
NMDA receptor antagonist
BP change for a diagnosis of postural hyoptention
- a fall of 20mmHg or more in systolic blood pressure [at least 30 in HTN]
AND/OR - a fall of 10mmHg or more in diastolic pressure.
- WITHIN 3 MINS
postural hypotension Mx
- ensure adequate hydration
- check polypharmacy to identify medication-related causes
- behavioural changes: standing up slowly from a sitting/ lying position. dorsiflexing the feet first before standing upright.
- drugs: 1st = fludrocortisone 2nd = midodrine
what is pseudo-dementia
cognitive deficits seen in elderly pts with depression
pseudo dementia mx
manage the underlying depression with drugs and CBT
options for sedation of pts with delirium
- haloperidol [PO or IM]
- lorazepam IM
- olanzapine - use with caution in elderly pts due to risk of SEs.
why might a subdural haemorrhage have a delayed presentation
subdural haemorrhage involves the bridging veins rather an artery ∴ there is lower pressure and blood accumulates slower.
what is an advanced decision
- An Advanced Decision, short for Advanced Decision to Refuse Treatment, is a legally binding document.
- Its purpose is to ensure that an individual can refuse a specific treatment(s) that they do not want to have in the future.
what is an advanced statement
- “Statement of Wishes and Care Preferences”.
- It allows an individual to make general statements about their wishes, beliefs, feelings and values and how these influence their preferences for their future care and treatment
what can an advanced decision cover
- refusal of any treatments including life-sustaining ones
- CANNOT refuse basic care including cleaning, food and drink + MH care.
- CANNOT request specific treatment or illegal Tx - euthanasia
what anti-emetic is given in parkinsons + why
domperidone as it doesn’t cross the BBB
what is the first line drug for sedation in delirium and why
- Haloperidol as it has a rapid onset of action + a short half life which makes it easier to titrate and adjust to pt response.
- lorazepam is 2nd line as it has a long half life and can worsen pt confusion.
key feature of lewy body dementia
- fluctuating attention and concentration
- visual hallucinations - Classically, patients complain of seeing small mammals around them
- spontaneous Parkinsonism
side effect of trimethoprim related to blood
megaloblastic anaemia + ↑ eGFR.
because trimethoprim affects folate metabolism, it can –> megaloblastic anaemia which can in turn affect eGFR by ↑ creatinine levels
which diuretic is most likely to cause dehydration and reduced intravascular volume
furosemide
a potent loop diuretic
name some seizure threshold lowering drugs
- Antibiotics: Imipenem, penicillins, cephalosporins, metronidazole, ciproflocain, isoniazid
- Antipsychotics
- Antidepressents: Bupropion, Tricyclics, Venlafaxine
- Tramadol
- Fentanyl
- Ketamine
- Lidocaine
- Lithium
- Antihistamines
what is benserazide
Benserazide is a decarboxylase inhibitor which prevents the peripheral breakdown of levodopa. This means that levodopa is decarboxylated into dopamine in the brain,
hypodense Vs hyperdense on CT
hypOdense = Old bleed and is dark on CT
hyper dense = acute bleed and is bright on CT
timings for acute, sub-acute and chronic subdural haemorrhage
- Acute: develops within 3 days of traumatic incident
- Chronic: >21 days old, slow onset with no obvious cause of symptoms
- Sub-acute 3-21 days old.
opioid use in renal failure
- avoid morphine as it produces metabolites that accumulate in the kidney and further any renal failure
- oxycodone is safe to use in renal failure as it doesn’t produce these metabolites.
how might vascular dementia show up on an MRI
White matter hyperintensities on MRI are commonly associated with vascular dementia as they represent chronic small vessel ischemic changes in the brain.
how might Alzheimer’s show up on an MRI
generalised cortical atrophy
contraindications for memantine
- asthma it may exacerbate airway hyperresponsiveness
- uncontrolled hypertension due to the risk of hypertensive crises as memantine can increase BP
- severe renal impairment
contraindications for acetylcholinesterase inhibitors
Bradycardia is a contraindication as these medications can exacerbate or cause bradycardia by increasing vagal tone, potentially leading to heart block or syncope.
