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ACC - GERI 2

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banannie's version from 2016-06-23 02:21

Pain

Question Answer
medications for nauseadopaminergic antagonists, antihistamines, anticholinergics, serotonin antagonists, prokinetic agents, steroids
dopaminergic antagonistsuse for nausea due to drugs, toxins etc
haloperidol
serotonin antagonistsnausea due to drugs, toxins, metabolic
ondansetron
a/e serotonin antagonistsconstipation, expensive
a/e dopaminergic antagoniststardive dyskinesia, increased QT
anticholinergicanausea due to travel ("motion sickness") ex scopalamine
a/e anticholinergicsdry mouth, urinary retention, delirium
histamine antagonistsnausea due to vestibular disorders, cough-induced vomiting
a/e histamine antagnoiistssedation/delirium
NK1 receptor antagonists usenausea due to chemotherapy
pharm management of cachexiaprogestin
pharm management of dyspnealow dose opioids
not hypoxic bedside fan equally effective
initial dosestanding dose plus PRN dose
PRN dose10% of 24 hour standing dose
fentanyl patchonly for those who have used opioids before
opioid tolerant patientmay need to decreased calculated PRN dose by 25 to 50% to account for cross tolerance.
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Depression and Dementia

Question Answer
reversible causes of dementiahyp/hyperthyroid, NPH, drugs, high Na/Ca, B12 levels, depression, infection, mass effect
alzheimers clinical symptomsgradual decline, loose verbal fluency, and naming
Vascular dementia clinical symptomsstepwise decline
LBDdelusions, hallcuinations, orthostatic
PSPissue with orthostasis
Frontal lobe dementiabehavorial issues, atrophy, disinhibited, urination
screening indications for CA50-75 screen; 75-85 clinical decision; greater than 85 not recommended
clinical features of Parkinson's diseasepill-rolling tremor at rest, bradykinsia, cogwheel rigidity
PSPlike Parksinson but mostly affects men and does not cause tremor but does cause opthalmoplegia
Parksinson's tremor occurs atrest
essential tremor occurscertain postures
treatment for essential tremorpropanolol and alcohol improves it
treatment for Alzheimer'scholinesterase inhibitors. have lower levels of acetylcholine, vitamin E, ginko
dementia risk factorsdepression, age, family history, hyperlipidemia, HTN, lower education, head trauma, women
mild cognitivie impairmentissue with cognition, memory type versus non-memory type, doesn't impair function
age associated memory impairmentchange in memory that is normal, not a functional issue, compared with young it takes longer to learn new tasks etc
Alzheimer'sgradual decline, loose verbal fluency and naming
vascularstepwise decline
LBDassociated with PK. delusions, hallucinations, orthostatic
PSPissue w/orthostasis
Frontal lobe dementiabehavorial issues. become disinhibited, urination
death and alzheimer'saspiration, fall, infection
Pick's dztype of frontal lobe dementia. not focused speech, repeat things
tests for dementiaMMSE, neuropsych testing, clock drawing, animal naming
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thyroid

Question Answer
half life of levothyroxine7 days
check TSH levels2-3 months after initiation of therapy since TSH levels usually require at least 8 weeks stead state
Graves disease disproprationately high T3 compared to T4
anti-thyroid medications requires 1-2 years of therapy; 40% recur after discontinutation of meds
PTU safer in pregnancy but risk for hepatic failure
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polypharmacy

Question Answer
4 meds implicated in 67% of hospitalizationswarfarin
insulin
oral antiplatelets
oral hypoglycemics
potentially inappropriate MSK drugsNSAIDS, muscle relaxants
potentially inappropriate CNS drugsbenzos
urinary incontinence drugs
TCA
antihistamines
antispasmodics
potentially inappropriate cardiovascular drugsantihypertensives
antiarrhythmics
narrow safety margin drugswarfarin
insulin
digoxin
3 types of inappropriate prescribingmisuse
inapproriate use
underuse
Beers criteriaa list of medications that should be used with caution or avoided in older adults
- developed by American geriatrics society
age related changes that can affect drug pharmacokinetics in older adultsdecreased renal clearance
decreased hepatic metabolism
low albumin
increased fat:lean mass ratio
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lower back pain

Question Answer
70% of the time cause of back painlumbosacral strain/sprian
spinal stenosispain relieved by sitting down and bending forward
disc herniationmade worst by coughing, sneezing, leaning forward or sitting
straight leg raisesciatica test
compression fractureacute back pain cause by minor stress. pain at level of fracture
test for compression fracturex-ray
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geriatric assessment

Question Answer
deliriumacute onset, fluctuating course, inattention, disorganized thinking, altered level of consciousness
outcomes4% have complete resolution of delirium at D/C
20% clear of SXS at 3 months
17% cleared at 6 months
clock completion testfourth quadrant is most sensitive
MMSENormal: 27+
Severe cognitive impairment: <10
fallsbalance more important than strength in terms of fall risk
start asking about fallsevery year starting at 65
Tinetti Balance and gait<16/28 shows 6X increase in fall risk in 1 year
remove psych drugs60% falls are removed
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