Clinmed: Geriatrics

Front 1

What is polypharmacy and the complications associated with polypharmacy?

Back 1

taking many medications at the same time;
possible complications include:
1. more medications prescribed than clinically necessary
2. too many medications to adhere properly
3. too much confusion to adhere properly
4. high cost
5. altered drug metabolism in geriatric patients
6. adverse side effects
7. drug-drug interactions
8. low adherence

Hint 1

http://en.wikipedia.org/wiki/Polypharmacy

Front 2

Which patient population has the highest rate of polypharmacy?

Back 2

geriatric due to higher prevalence of disease

Front 3

What does MMSE stand for?

Back 3

mini-mental state examination

Front 4

What is the MMSE used for?

Back 4

screening for cognitive impairment

Front 5

Can you diagnose dementia with the MMSE?

Back 5

no, the MMSE is used to RULE OUT cognitive impairment, but the MMSE may indicate that further testing is necessary

Front 6

What are the age ranges for young old, middle old, and old old geriatric patients?

Back 6

young old = 65-74
middle old = 75-84
old old = ≥85

Front 7

Diseases often present atypically in geriatric patients, true or false?

Back 7

true

Hint 7

Current p61

Front 8

What does GDS stand for?

Back 8

geriatric depression scale

Front 9

What is the GDS used for?

Back 9

screening for depression in elderly patients

Front 10

Can you use the GDS to diagnose depression?

Back 10

no, GDS is used to RULE OUT depression, but GDS may indicate that a diagnostic interview with a mental health professional is necessary

Front 11

How is the GDS interpreted?

Back 11

0-9 = normal
10-20 = mild depression
21-30 = severe depression

Front 12

Which patient population has the highest rate of depression?

Back 12

geriatric

Front 13

What must you consider when deciding on treatment for a geriatric patient?

Back 13

1. prognosis
2. values/preferences
3. ability to function independently

Hint 13

Current p61

Front 14

List instrumental activities of daily living (IADLs).

Back 14

shopping
cooking
housecleaning
managing money
taking medications
using telephone
using transportation

Hint 14

Current p62

Front 15

Lists basic activities of daily living (ADLs).

Back 15

transferring
toileting
bathing
dressing
grooming
eating

Hint 15

Current p62

Front 16

What is the GET UP AND GO TEST used for?

Back 16

evaluating gait instability/fall risk

Front 17

Describe the GET UP AND GO TEST.

Back 17

1. rise from chair
2. walk 10 feet
3. turn around
4. return to chair
5. sit in chair
*patient may use any customary walking aid

Front 18

How long should a normal GET UP AND GO TEST take?

Back 18

<10 sec

Front 19

List the components of the geriatric functional assessment.

Back 19

ADLs
IADLs
Get Up and Go (gait instability/fall risk)
MSME (cognition)
GDS (depression)

Front 20

Define iatrogenesis.

Back 20

illness resulting from a medical procedure or therapeutic intervention

Front 21

Define apraxia.

Back 21

inability to perform motor tasks despite intact motor function

Hint 21

Current

Front 22

Define agnosia.

Back 22

inability to recognize objects

Hint 22

Current

Front 23

How is drug metabolism altered in geriatric patients?

Back 23

1. ↓ total body water leads to ↑ concentrations of water-soluble drugs
2. ↑ body fat leads to ↑ half-life of fat soluble drugs
3. ↓ serum albumin leads to ↑ concentrations of protein-binding drugs
4. ↓ hepatic clearance
5. ↓ GFR

Front 24

When prescribing for geriatric patients, what saying should you keep in mind?

Back 24

start low, go slow

Front 25

What medications may cause false-positive urine glucose in geriatric patients?

Back 25

vitamin C
morphine
penicillin G
nalidixic acid (antibiotic)
isoniazid (anti-tubercular)
levodopa (Parkinson's)

Hint 25

http://www.merck.com/mkgr/mmg/appndxs/app1.jsp

Front 26

What does POLST stand for?

Back 26

Physician's Orders for Life Sustaining Treatment

Front 27

When performing a functional assessment of ADLs, what questions should you ask?

Back 27

"Do you have any trouble ... ?"
... transfering?
... walking?
... bathing?
... dressing?
... grooming?
... eating?
... toileting?

If no, "How do you do it?"

Hint 27

handout

Front 28

When performing a functional assessment of IADLs, what questions should you ask?

Back 28

"Do you have any trouble ... ?"
... using telephone?
... driving or taking bus?
... shopping?
... cooking?
... doing housework?
... taking medications?
... managing money?

If no, "How do you do it?"

Hint 28

handout

Front 29

When performing a functional assessment of ADLs and IADLS, what should you ask the patient to demonstrate?

Back 29

1. put hands together behind head (bathing, grooming)
2. put hands together behind back (bathing, dressing)
3. sitting, touch great toe with opposite hand (dressing, grooming)
4. squeeze my two fingers with each hand (cooking)
5. hold paper between thumb and index finger while I try to pull it out (eating)
6. Get Up and Go test (gait abnormalities/fall risk)

Hint 29

handout

Front 30

What does the Get Up and Go Test evaluate?

Back 30

hip strengh
gait step height, velocity, symmetry
balance, ability to withstand sudden changes in position
fall risk

Hint 30

handout

Front 31

What medications should you avoid in geriatric patients?

Back 31

antihistamines
antiemetics
narcotic analgesics
benzodiazepines
tricyclic antidepressants

Hint 31

http://tiny.cc/MedsToAvoidInElderly

Front 32

When are providers required to report medical impairments to DMV?

Back 32

when functional/cognitive impairment is severe and uncontrollable (i.e. cannot be corrected by medication, therapy, surgery, or adaptive devices) and likely to render it unsafe for patient to operate motor vehicle

Hint 32

http://www.oregon.gov/ODOT/DMV/ATRISK/index.shtml

Front 33

Providers are required to report medical impairments to DMV, even if patient has voluntarily given up driving, true or false?

Back 33

true

Hint 33

http://www.oregon.gov/ODOT/DMV/ATRISK/index.shtml

Front 34

What are the indications for donepezil (Aricept)?

Back 34

treatment of dementia, specifically Alzheimer's disease

Front 35

What are the indications for tacrine (Cognex)?

Back 35

treatment of dementia, specifically Alzheimer's disease

Front 36

What are the indications for memantine (Namenda)?

Back 36

treatment of dementia, specifically moderate to severe Alzheimer's disease

Front 37

What are the indications for rivastigmine (Exelon)?

Back 37

treatment of dementia, specifically mild to moderate Alzheimer's disease

Front 38

What are the indications for galantamine (Razadyne)?

Back 38

treatment of dementia, specifically mild to moderate Alzheimer's disease

Front 39

What is legal blindness?

Back 39

20/200

Front 40

Tolterodine tartrate: MOA, indications, contraindications, adverse effects, dosing, patient education

Back 40

MOA:
antagonist of muscarinic receptors → increasing residual urine volume and decreases detrusor muscle pressure

INDICATIONS:
overactive bladder with sxs of frequency, urgency, or urge incontinence

CONTRAINDICATIONS:
hypersensitivity
urinary retention
gastric retention
uncontrolled narrow-angle glaucoma

ADVERSE EFFECTS:
dry mouth
HA
constipation

DOSING:

PATIENT EDUCATION:
may cause drowsiness or blurred vision

Front 41

Oxybutynin: MOA, indications, contraindications, adverse effects, dosing, patient education

Back 41

MOA:
direct antispasmotic effect on smooth muscle → increases bladder capacity, decreases uninhibited contractions, delays desire to void

INDICATIONS:
antispasmodic for neurogenic bladder (frequency, urgency, urge incontinence)

CONTRAINDICATIONS:
hypersensitivity
urinary retention
gastric retention
untreated glaucoma

ADVERSE EFFECTS:
dry mouth
constipation


DOSING:

PATIENT EDUCATION:

Front 42

Trospium chloride: MOA, indications, contraindications, adverse effects, dosing, patient education

Back 42

MOA:
antagonist of muscarinic receptor → reducing smooth muscle tone of bladder

INDICATIONS:
overactive bladder with frequency, urgency, incontinence

CONTRAINDICATIONS:
hypersensitivity
urinary retention
gastric retention
uncontrolled narrow-angle glaucoma

ADVERSE EFFECTS:
dry mouth
constipation
HA

DOSING:

PATIENT EDUCATION:
take 1 hour prior to meals or on empty stomach