Elderly care

Question 1

Long-term PPI use dosing and side effects?

Answer 1

40mg is trial dose and patient should be weaned down to 20mg and PRN where tolerable Side effects relate to achlorhydria and hypochlorhydria which increase the risk of enteric infections, B12 malabsorption, osteoporosis

Question 2

Benzodiazepines among elderly - indications - adverse effects - precautions - alternatives

Answer 2

Generalized anxiety disorder, adjustment disorder, anxiety, insomnia Prefer short-half life benzos for elderly A/E - cognitive decline, physical decline, risk of falls, risk of dependence (esp when drug is stopped abruptly) Interactions - additive effects with etoh and other CNS depressants

Question 3

Withdrawal symptoms of BDZ use

Answer 3

Tremors, confusion, anxiety, insomnia Severe symptoms - abrupt rise of arterial pressure, MI

Question 4

MOA of benzodiazepine

Answer 4

potentiates action of GABA at the GABA receptor

Question 5

What are criteria of competency

Answer 5

> 18 yo URBEW: Can Understaind, Retain, Believe, Evaluate and Weigh the information relevant

Question 6

DSM IV criteria for delirium

Answer 6

Consciousness, cognition, fluctuation and secondary to medical condition

1. disturbance in consciousness with reduced attention
2. changes in perception and cognition that is not better accounted for by pre-existing established/evolving dementia
3. Acute onset (hours to days) and fluctuation over the course of the day
4. Secondary to medical condition (not primarily due to psychiatric illness)

Question 7

Causes of delirium

Answer 7

I WATCH DEATH

Infections - intracranial (abscess, meningitis, encephalitis), extracranial (UTI, pneumonia)

Withdrawal (etoh, BDZ, barbituate)

Acute metabolic disorder (electrolytes esp hypercalcemia, hyponatremia, AKI/acute liver failure)

Toxins/drugs - etoh, BDZ, opiates, anticholinergics, NSAIDS, steroids, dopamine agonists

CNS pathology - stroke, seizure

Hypoxia (anemia, heart failure, PE)

Deficiences (B12, thiamine, folate)

Endocrinopathy - thyroid (storm, myxedema), diabetes (ketoacidosis, HONK), adrenal insufficiency

Acute vascular (shock, hypertensive encephalopathy)

Trauma (head injury)

Heavy metal (arsenic, lead, mercury); Heavy bladder (urinary retention)