Week 3 Flashcards

Question

Which 3 drugs cause hypocalcaemia?

Answer 1

- bisphosphonates - loop diuretics - phenytoin

Answer 2

- Has a weight been recorded on initiation & repeated a minimum of 3 monthly - Do they have a MUST score, if so what is it? - Has food first advice been given? - Has an aim of treatment been set? - Which supplements are being prescribed? Is this working, preferred, cost-effective? - Is patient taking in prescribed dose? - Who initiated the supplement & who is responsible for its review?

Answer 3

- N National guidelines - A Valid and activate indication - W Is medicine achieving outcome? - S Any safety risks?

Answer 4

- Is the patient’s treatment in line with current national or local guidance? - If previous guidance , why was guidance was changed? - Doses optimal and evidence based? - Any medicines missing? - Most cost-effective?

Answer 5

- Documented, current indication? - Is the medicine essential ans still necessary? - Is the dose normal, has it been titrated etc - Is it preventative and is this necessary?

Answer 6

- Is the medicine achieving the outcomes that matter to the patient? - Are symptoms controlled? - Does the dose need to be intensified or are additional medicines needed? - Adherance

Answer 7

- Any immediate clinical concerns - Is it a high-risk medicine? - Appropriate tests and monitoring? - Any new symptoms/ADRs - Documented medicine allergies? - Increased risk of adverse drug reactions (ADRs)?

Answer 8

Bleeding risks - NSAIDs/Anticoagulants/antiplatelets Falls risk - drugs that lower BP/HR, or have a sedative effect Renal restrictions - DOACs, metformin, bisphosphonates Electrolyte Disturbance

Answer 9

- eGFR assumes stable creatinine and normal body weight - Reduced muscle mass in the elderly can result in reduced creatinine levels despite levels of renal impairment. - In 75 years+ we should use Cockcroft Gault to calculate renal function if patient is on a DOAC and CKD-EPI for patients with chronic kidney disease. - eGFR can often significantly overestimate renal function in frail elderly patients.

Answer 10

(140 − age) × body weight (kg)/plasma creatinine (μmol/L) x 1.23 if male (1.04 if female)

Answer 11

Amitriptyline Promethazine Oxybutynin Procyclidine Atropine Hydroxyzine

Answer 12

Is there are risk of patient harm? What are the risks of doing nothing? What are the patient’s preferences? What does National and local guidance suggest? What about cost implications?

Answer 13

- Ask people if treatments intended to relieve symptoms are providing benefits or causing harms - Discuss reducing or stopping any treatments - Plan a review to monitor effects and decide whether any further changes to treatments are needed

Answer 14

- HTN - CAD - ACS - congenital heart defects - hyperthyroidism - stimulants - sleep apnoea - sick sinus syndrome - lung diseases

Answer 15

- over 1.5 million in UK - estimated 270,000 with asymptomatic AF - That is 7 out of 100 people over 65 years old - More men than women have AF - More common in patients with other co-morbidities

Answer 16

- Breathlessness - Syncope / fainting - Fatigue - Palpitations - Chest discomfort - Stroke/TIA - Irregularly irregular pulse

Answer 17

Full patient history Full CV examination Bloods inc. TFTs, FBC, U&Es, TFTs, LFTs and lipid panel 12-lead ECG 24 hour ambulatory ECG if suspected paroxysmal AF

Answer 18

The results of the WATCH AF trial suggest that detection of AF using a commercially available smartwatch is in principle feasible, with very high diagnostic accuracy e.g. Apple Watch users received a notification if a rapid heart rate was detected, around 84% of those notified had confirmed AF with an ECG

Answer 19

RATE CONTROL (1st line for most): Beta blockers (BISOPROLOL) or rate-limiting CCB (e.g. diltiazem or verapamil) Reduce HR: must monitor for pulse and BP and aim to maintain pulse above 55. Digoxin Increases parasympathetic tone and slows heart rate More suitable for patients who cannot tolerate other rate-limiting options OR do little physical activity If monotherapy not effective can consider dual therapy with 2 out of following: Beta-blocker/ diltiazem/digoxin

Answer 20

- Patients wil reversible AF - Heart failure caused by AF - Atrial flutter considered suitable for an ablation strategy to restore sinus rhythm - When rhythm‑control strategy would be more suitable

Answer 21

- Less dependent on pharmacological intervention - Often ablation or electronic (DC) cardioversion which will cause reversion to sinus rhythm - In hard to manage can consider drugs such as flecainide, amiodarone or dronedarone - Cardiology involvement

Answer 22

Stroke risk in AF - Age - Sex - CHF history - HTN history - Stroke/TIA history - Vascular history - Diabetes

Answer 23

- no anticoagulation in male = 0 or female = 1 - male =1/female = 2 is up to patient - should be started in male =2+ and female = 3+

Answer 24

- Offer anticoagulation with a DOAC to women with atrial fibrillation and a CHA2DS2‑VASc score of 2+ (1+ for men), taking into account the ORBIT score (high is not always CI - If DOACs are contraindicated or not tolerated offer warfarin - Do not offer oral anticoagulation to patients under 65 years old and no other risk factors other than their sex (i.e. CHA2DS2‑VASc score of 0 for men or 1 for women)

Answer 25

bleeding risk - sex - haemoglobin <12g/dl or haematocrit <36% - Over 74? - Bleeding history - GFR <60ml/min/1.73m2 - Treated with antiplatelets

Answer 26

- Consider CHADSVAS and ORBIT at each review appointment (dependent on anticoagulation) - Patient-centred discussion around the results - for most people the benefit of anticoagulation outweighs the bleeding risk - Consider any medications which may contribute to a bleed risk e.g. NSAIDS, SSRIs, anti-platelets - Any new co-morbidities which may increase stroke risk? - Discuss lifestyle, including alcohol intake and smoking - Full annual bloods (FBCs, LFTs, U&Es, eGFR and serum creatinine) - Calculation of CrCl - Must assess bleed risk at least annually - BP monitoring - Annual weight check (especially important in more elderly patient) - Are they compliant with meds, are meds correct? - If on warfarin for AF, could they be switched to a NOAC? What is their TTR?

Answer 27

- Warfarin is a very effective anticoagulant but has it’s own issues - Very long half life. Takes a long time to achieve steady state and effective anti-coagulation - INR – need to stay in range (2.5) - TTR often very hard to achieve - Lots of factors can alter the INR – need to investigate cause Follow up - Check U&Es, LFTs and FBC completed within last 3M - At next INR visit – check INR, weight, take bloods (if needed or unstable) - Calculate creatinine clearance (CrCl) - Prescribe DOAC at appropriate dose - Advise patient when to stop their warfarin (INR should be < 2.5 when DOAC started) - Provide written instructions to patient/ carers - Counsel patient and/ or carer using a checklist - Provide an up-to-date Anticoagulation Alert card - Provide information about routine monitoring requirements - Good practice: F/U appt 1-2 weeks post initiation to check patient progress

Answer 28

- Individual decision and consideration of risk benefit - Prevention of stroke is a high benefit and stroke risk is not going to reduce - Tend not to withdraw until nearing end of life unless signs of active bleeding - But you must be aware of renal function and minimise the risks in the frail and elderly - Difficult when patients lack capacity

Answer 29

- Heart failure can de defined as an abnormality of cardiac structure or function leading to failure of the heart to deliver oxygen at a rate slower than required - Patients presenting with signs and symptoms resulting from an abnormality in cardiac structure or function - Median age of presentation is 76 - Twice as common in males than females - Often the result of damage to heart from previous MI Other causes - Uncontrolled hypertension, valve disease, medication (cytotoxics, NSAIDs, chemotherapy), toxins e.g. alcohol and cocaine, diabetes. - Poor prognosis – 50% will die suddenly mainly due to arrhythmia Common symptoms - Dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, oedema, fatigue, malaise, peripheral oedema, depression (due to reduced cerebral perfusion), bendopnea - Diagnosed using structural or functional cardiac dysfunction on imaging - Prior to referral for imaging patients needs a pro-BNP blood test, chest x-ray (to rule out lung cancer; normal does not exclude HF) and ECG (if normal unlikely there is significant HF) in primary care → will then get Echo depending on BNP results within 2 or 6 weeks in HF clinic

Answer 30

- ACE-I (usually Ramipril) - Beta-blocker (only if stable heart failure, usually bisoprolol) - MRA’s (usually Spironolactone) - SGLT2 inhibitors - dapagliflozin In addition, can consider…. Sababutril / valsartan (Entresto) - specialist initiation Diuretic (usually loop diuretic such as furosemide or bumetanide) – no prognostic benefit, only symptomatic Can consider digoxin as an add on for those in sinus rhythm already on optimised therapy

Answer 31

Sababutril / valsartan (Entresto) - specialist initiation Diuretic (usually loop diuretic such as furosemide or bumetanide) – no prognostic benefit, only symptomatic Can consider digoxin as an add on for those in sinus rhythm already on optimised therapy

Answer 32

- 1st class of drugs to show reduction in mortality and morbidity in HF in the 1980s - Within 3 months, see improved symptoms, exercise performance and QOL - SE: Cough, angio-oedema, hyperkalaemia and can worsen renal function - Reduce efferent pressure in renal arterial system - Start low and titrate upwards every 2 weeks until max tolerated dose - Monitor U&Es, eGFR and BP 1-2 weeks post initiation and after every dose increment

Answer 33

- Reduce mortality and morbidity in LVSD - direct effect on cardiac re-modelling to improve structure and function - Introduce to patients when they are clinically stable and euvolaemic - SE: Bradycardia, confusion, peripheral coldness, fatigue, headaches - Introduce in a ‘start low, go slow’ manner - Monitor heart rate, BP and clinical status at each dose titration - If patients already on a beta-blocker for another co-morbidity, once stable, swap to a beta-blocker licensed for HF (bisoprolol, metoprolol, nebivolol, carvedilol)

Answer 34

- Reduce mortality and morbidity - Offer an MRA, in addition to an ACE inhibitor and beta-blocker, to people who have HF-REF if they continue to have symptoms of heart failure - SE for spironolactone: Breast pain, dizziness, electrolyte disturbances, hyperkalaemia, gynaecomastia (around 10% men -can switch to eplenerone) - Monitor U&Es (particularly sodium and potassium), eGFR and BP before and after starting and after each dose titration

Answer 35

DAPA-HF Landmark trial in 2019 - Over 4,700 patient with EF < 40% - 55% people in trial did not have T2DM - Primary endpoint: CV death, HF hospitalisation and urgent HF visit - Benefitted patients with or without T2DM - Benefits seen from 28 days of treatment - Inhibit SGLT2 receptors from re-absorbing glucose (and water) in the nephron - Glucose excreted in urine, along with water (diuresis) - Patients lose calories (and therefore weight, around 1-5kg) - Beneficial in HF and for organ protection. Also licensed in CKD - Can start if eGFR >15ml/min - SE: Common – polyuria, thirst, hypotension, genital infections (balanitis and thrush); Rare – DKA. Must counsel on Sick Day Rules CI: Type 1 Diabetes

Answer 36

- LVSD is most often the result of a NSTEMI/STEMI or years of uncontrolled hypertension - Evidence base supports titration of beta- blocker and ACEI to max dose however be aware that many patients cannot tolerate these at max dose (sfx, bp, falls risk, renal function) - The beta blocker and ACEI increase the function of the heart, the diuretics improve symptoms of oedema such as swollen ankles, orthopnoea - Care with potassium levels - Titration should be done slowly - Always consider symptoms and QoL

Answer 37

I - no limitations of physical activity, regular exercise doesn't result in SOB, fatigue etc II - slight limitation of physical activity, no symptoms at rest, regular exercise causes fatigue, SOB, palpitations III - limitations of physical activity, no symptoms at rest, mild activity results in fatigue, palpitations etc IIII - HF at rest - unable to engage in any physical activity without discomfort, physical exercise increases discomfort

Answer 38

- A clinical assessment of functional capacity, fluid status, cardiac rhythm (pulse) cognitive status and nutritional status - HR of around 60-70 bpm is optimal in HF treatment - A review of medication, including need for changes and possible side effects - Can any medications be up-titrated or reduced/ taken away? Are they on the 4 pillars of HF therapy? - An assessment of renal function - Check FBC. If EF < 45% would check ferritin, if < 100 need IV iron therapy - More detailed monitoring will be needed if the person has significant comorbidity or if their condition has deteriorated since the previous review - May need to re-echo in 3-6/12 after optimising medication (would refer for this)

Answer 39

- Hypertensive patient – manage BP through ACEI, B- blocker preferentially rather than CCB (not ideal in HF as will contribute to peripheral oedema) - IHD – beta blocker preferential to nitrates - Asthma – check the patient is not sensitive to a cardioselective beta blocker - Atrial Fibrillation and heart failure - Common combination, sometimes patients are on digoxin which can be used in both but it’s a higher risk drug. - Depression – often a hidden co-morbidity - Pregnancy – many meds will not be appropriate. Need to plan ahead

Answer 40

- Around 1 in 2 women and 1 in 5 men aged over 50 years will break a bone; the vast majority of which will be the result of a fall. - A third of people aged over 65 years fall at least once per year, and this increases to half of those aged 80 years and over. - Falls can have a significant impact on an older person — they are a cause of pain, loss of confidence and loss of independence. - Around 53% of patients with a hip fracture are unable to live independently and 28% will die within a year of fracture - Fragility fractures cost the NHS an estimated £4.4bn per year — around half of which are hip fractures

Answer 41

- Falls and fall-related injuries are a common problem for older people. - Multiple reasons why the elderly are at increased risk of falling some medicine related and some not. - Within a medication review of an elderly person, it is worth asking about falls frequency

Answer 42

- Impaired balance or gait. - Mobility problems including arthritis and motor disorders such as Parkinson’s disease. - Muscle weakness. - Visual impairment. - Impaired cognition. - Home hazards (unsuitable footwear, rugs, pets). - Postural hypotension. - Polypharmacy - Infection.

Answer 43

- Fractures of the hip, femur, humerus, wrist and rib - Soft tissue injuries - Haematoma - Transient confusion - Loss of confidence, independence or social and physical activity - Sudden ageing - Hospitalisation and immobilisation - Disability - Death

Answer 44

- Taking a psychotropic medicine approximately doubles the risk of falling. - Sedatives, antipsychotics and sedating antidepressants cause drowsiness and slow reaction times. - Some antidepressants and antipsychotics also cause postural hypotension

Answer 45

- Maintaining consciousness and upright posturenrequires adequate blood flow to the brain, this requires adequate pulse and blood pressure - In older people, systolic blood pressure of 110 is associated with incresed risk of falls - Any drug that can reduce blood pressure or slow the heart can cause falls - Stopping these medications can decreases syncope and falls

Answer 46

- The fall: history, circumstances, immediate risks - Physical exam (pulse, BP, neurological impairment, infection, gait) - Review meds (anticoagulants, sedatives) - Investigations (bloods: FBC, U+E, TSH, B12/folate, LFTs, calcium, HbA1c, ECG) - Multi-factorial considerations (vision, footwear, continence)

Answer 47

- Identify individual risk factors with plan to address each of them - Identify Osteoporosis risk factors & decide if need further tests(DEXA) or treatment. - Balance course or home exercise programme

Answer 48

- Fall of 20 mmHg in SBP or 10 mmHg in DBP on assuming upright position - Prevalence 30% in > 75 years of age - Increased all-cause mortality - Impaired capacity to increase vascular resistance on standing - Mostly treatable but easily missed

Answer 49

- Postural dizziness or pre-syncope - Falls - Syncope - Visual disturbance - Weakness, lethargy - “Coathanger” ache

Answer 50

Medication - Anti-hypertensives: especially diuretics & doxazosin - TCA’s, PD meds, antipsychotics Autonomic dysfunction - DM, PD, Addison’s, post infective autonomic dysfunction, alcohol

Answer 51

- Medication Review (remove the cause) - Conservative measures - Increase fluid input -TED stockings Medication - Fludrocortisone - Midodrine - Pyridostigmine

Answer 52

- In England and Wales, around 180,000 of the fractures presenting each year are the result of osteoporosis. - More than 1 in 3 women and 1 in 5 men will sustain one or more osteoporotic fractures in their lifetime. - White men and women are at increased risk of fragility fracture compared with other ethnic groups. - Vertebral fractures are often unrecognised and undiagnosed and are therefore not included in routinely collected statistics. Most of these are osteoporotic fractures.

Answer 53

- Osteoporosis is a long-term condition characterised by low bone mass and micro-architectural bone deterioration, leading to an increased risk of fracture. - The three most common fracture sites are the wrist, spine (vertebrae) the hip. - Estimated that the number of osteoporotic fractures may double in the next 50 years Pharmacists have a key role in identifying those who are at risk and promoting preventative measures - Lifestyle advice - Pharmacological therapy - Medication related falls prevention

Answer 54

- Active process, constant remodelling - Controlled by osteoclasts, osteoblasts and osteocytes Normal adult skeleton - Balance between new bone being made by osteoblasts and old bone being resorbed by osteoclasts Osteoporotic skeleton - Bone loss occurs because bone resorption (osteoclasts) is greater than bone formation (osteoblasts). - Peak bone mass is between 25 and 35 normal bone density loss is 1% per year after the age of 40 years in both men and women - In women, menopause accelerates the decline in BMD to 3–4% per year

Answer 55

- Bone Mineral Density is a measure of the amount of minerals (mainly calcium and phosphorous) contained in a certain volume of bone - Osteoporosis is defined by WHO as having BMD of ≥2.5 standard deviations below the average value for a young adult (i.e. T-score ≤–2.5) - A DEXA scan is the most used imaging in diagnosing osteoporosis; it measures an individual’s BMD by estimating the amount of bone at certain sites

Answer 56

- Osteopenia is defined as a reduction in bone density. - The term is often used radiologically when it describes a qualitative appearance of bone on a radiograph. - Increasingly however the term refers to a quantitative loss of bone mineral density usually measured either at the hip or spine with dual energy X ray absorptiometry. - Osteopenia is defined when bone density at the spine or hip between 1.0 and 2.5 standard deviations below the average for healthy young adults (T-score between -1 and -2.5).

Answer 57

- Diagnosis may be assumed in women aged 75 years or older if the responsible clinician considers a DEXA scan to be clinically inappropriate or unfeasible. - If an elderly person presents with a fracture from a very low impact injury, it is usually fair to assume that they are osteoporotic, and treatment will be initiated if appropriate.

Answer 58

- postmenopausal women - low BMI - inactive lifestyle - drinking and smoking - certain medicines (PPIs, anticonvulsants, loop diuretics,

Answer 59

- Take regular exercise to improve muscle strength - Walking, especially outdoors, as this will increase exposure to sunlight, increasing vitamin D production. - Strength training of different muscle groups - A combination of exercise types, for example balance, flexibility, stretching, endurance, and progressive strengthening exercises. - Eat a balanced diet as this may improve bone health (including Calcium and Vit D) - Stop smoking if needed, as it is a risk factor for fragility fracture. - Drink alcohol within recommended limits, as alcohol is a dose-dependent risk factor for fragility fracture. - Maintain a healthy weight

Answer 60

- Calcium is the major component in bone and is required for bone mineralisation - Vitamin D increases the intestinal absorption of calcium and has a role in bone mineralisation. Maintaining adequate calcium intake (700mg/day) and vitamin D status (>50 nanomol/L), either by diet or supplements, is an essential part of bone health. - Increasing calcium intake has been shown to have some small effects in increasing BMD - No evidence to show it reduces fracture risk. - Follow sensible dietary advice and if low intake supplement. - Adcal D3 One twice daily (1200mg +800iu Vit D3) - Accrete Once daily (1000mg calcium + 880iu Vit D3)

Answer 61

- Bisphosphonates are the mainstay of treatment - Inhibit osteoclast mediated resorption - Poor oral absorption - Taking in upright position minimises gastro-oesophageal irritation. - CI in those unable to sit upright, those with oesophageal abnormalities. - Renal excretion: CI if CrCl < 30 – 35ml/min due to risk of renal failure. - Common side effects: GI disturbance - Rare side effect: osteonecrosis of jaw or atypical femoral fractures - Bone density maintained for a period after discontinuation - Alendronate weekly unlicensed in men

Answer 62

- Not the easiest medication to adhere to, especially in the elderly or those with cognitive or physical impairment - Oral bisphosphonates should ideally be taken after an overnight fast, at least 30 minutes before the first food or drink and any other medicines. - The patient should be sitting upright or standing and swallow the tablet whole with a full glass of water. - The patient must remain upright for at least 30 mins - Usually taken on a weekly basis

Answer 63

- Human monoclonal antibody, inhibits osteoclast recruitment, maturation and development which causes a reduction in bone resorption. - Specialist prescribing (usually secondary care initiated), given 6 monthly. Recommended as primary prevention in postmenopausal women at increased risk of fractures who are: - Unable to comply with the administration instructions, or are intolerant of oral bisphosphonates, or in whom bisphosphonates are contraindicated - And who also have a set combination of a given T-score, age and number of independent risk factors - Side effects include skin infection (mainly cellulitis) and hypocalcaemia. - Hypocalcaemia is a contraindication to treatment with denosumab and risk increases in those with renal impairment. - Prior to treatment, adjusted serum calcium and vitamin D levels should be measured, and adequate supplementation provided. Calcium levels should be rechecked within two weeks if a patient is predisposed to hypocalcaemia (creatinine clearance < 30mL/min) or if symptoms of hypocalcaemia are suspected (e.g., if there are muscle spasms, numbness, muscle cramps and confusion) - No benefit after discontinuation

Answer 64

- Recombinant human parathyroid hormone used in severe osteoporosis under specialist guidance - Stimulates bone formation by osteoblasts. - CI in patients with hypercalcaemia, metabolic bone diseases other than osteoporosis, severe renal impairment, prior radiation to the skeleton, or malignant disease effecting bone. - Side effects include headache, nausea, dizziness and postural hypotension. - Daily subcutaneous injection, via self-administration.

Answer 65

- A study showed that at least 91% of female patients and 61% of male patients with Parkinson’s disease (PD) have either osteoporosis or osteopenia. - Gait disturbances, low BMD, recurrent falls, postural instability, postural hypotension and polypharmacy all contribute to increased fracture risk in patients with PD. Owing to the high incidence of osteoporosis in patients with PD, a holistic approach to the management of osteoporosis is required. This includes: - Identifying and treating reversible factors — reducing the contributory effects of postural hypotension leading to falls and reducing muscle deconditioning via in-depth occupational therapy and physiotherapy assessment; - Modifying patients’ lifestyle — providing dietary and smoking cessation advice - Ensuring correction of vitamin D and calcium levels - Recommending bone-protection agents upon confirmation of osteoporosis on DEXA scan or for high-risk individuals.

Answer 66

- Fragility fractures and dementia often co-exist in older people; the consensus is that dementia increases the risk of falls and fractures. - Patients with dementia have reduced dopamine activity, which causes a decline in motor function, leading to impairment of gait and balance. The use of medicines such as antipsychotics, sedatives and cholinesterase inhibitors used in Alzheimer’s disease can increase the risk of falls and fractures. - Patients with dementia have a higher prevalence of vitamin D deficiency and this should be addressed

Answer 67

- Healthy bones require mechanical stress to maintain their mass and strength; therefore, immobilisation for prolonged periods of time can result in bone atrophy and osteoporosis. - Patients who are completely bedbound are at greatest risk of osteoporosis. - Ordinary forces encountered during wheelchair transfers, physical therapy activities or minor falls may cause fractures. - BMD of the vertebral column decreases by around 1% per week of bed rest — nearly 50 times that of normal age-related bone loss

Answer 68

- Old age itself does not define frailty. - Some patients remain vigorous, despite advanced age, while others have gradual yet unrelenting functional decline in the absence of apparent disease states, or failure to rebound following illness or hospitalisation

Answer 69

- It is common, progressive and expensive - Higher risk of acute hospital admission, care home admission - Social care support - High users of healthcare systems - Frail older adults are less able to adapt to stressors such as acute illness or trauma than younger or non-frail older adults. - Increasingly, frailty in older patients is considered the hallmark geriatric syndrome and a forerunner to many other geriatric syndromes, including falls, fractures, delirium, and incontinence. - Death

Answer 70

symptoms - weakness - fatigue - anorexia - malnutrition signs - physiological changes increasing risk - decreased muscle mass - balance and gait abnormalities outcomes - falls - injuries - acute illness - hospitalisation - disability

Answer 71

- Not standardised but a good way to assess frailty is to ask someone to stand up and turn around and sit back down. - This should take around a tenth of their age in seconds - If it takes longer, you can probably assume some degree of frailty and you should take this into consideration when completing a medication review

Answer 72

- 4m walk test (under 5s) - grip strength - get-up-and-go test (under 12s) - clinical frailty scale

Answer 73

1 - very fit 2 - well 3 - managing well 4 - vulnerable 5 - mildly frail 6 - moderately frail 7 - severely frail 8 - very severely frail 9 - terminally ill

Answer 74

Adverse effects of frailty can be mitigated-for example: - Timely medication review can reduce risk of ADR, drug interaction, non-compliance - In patients taking medicines known to contribute to falls, medication review can play an important role in falls prevention - One study (2016) found that 65% people admitted to hospital after a fall were taking at least one medication associated with falls ALSO: strength and balance training home hazard assessment and intervention vision assessment and referral Improved nutrition

Answer 75

- process of rationalising medication - requires time with patient and family/carers - likely to be ongoing process, 1-2 drugs at a time - ombined with advanced care planning

Answer 76

- Constipation, delirium and general weakness most common symptoms - Pain can be poorly expressed - Constipation may manifest as overflow diarrhoea or poor appetite, lack of use laxatives can result in hospital admission - These patients are more susceptible to side effects from medication – think carefully about risk v benefit especially, consider review of preventative medication - Reduce medication burden - Prescribe anticipatory medication

Answer 77

“Healthy ageing” reduces the risk of developing frailty: - Good nutrition - Not too much alcohol - Staying physically active - Remaining engaged in local community/ avoiding loneliness

Answer 78

co-mobidity - more than one multi-morbidity - more than two

Answer 79

- Care for people with multi-morbidity is complicated because different conditions and their treatments often interact in complex ways. - Despite this, the delivery of care for people with multiple long-term conditions is still often built around the individual conditions, rather than the person. - As a result, care is often fragmented and may not consider the combined impact of the conditions and their treatments on a person’s quality of life.

Answer 80

- SSRIs - Diuretics - Sodium channel blockers

Answer 81

- corticosteroids

Answer 82

- loop + thiazide diuretics - insulin

Answer 83

- MRAs - ACEis/ARBs - NSAIDs

Answer 84

- bisphosphonates - loop diuretics - Phenytoin

Answer 85

- Thiazides - Calcium supplements

Week 3 Flashcards

(109 cards)