Geriatric Potpurri 4

Question 1

Common causes of pain in the elderly?

5

Answer 1

1. Osteoarthritis & other joint diseases
2. Night time leg cramps
3. Claudication
4. Neuropathies: (Diabetic, Herpetic, Idiopathic)
5. Cancer

Question 2

Chronic pain is undertreated in the elderly because?

Answer 2

1. They underreport

2. Health care providers hesitant to prescribe opiates for non-cancer pain

Question 3

WHO Guidelines for medication:

1. Mild?
2. Mod?
3. Severe?

Do not use which drugs? 2

Answer 3

1. Mild: Nonopioid or/- adjuvant
2. Moderate: or/- Opioid or/- adjuvant
3. Severe: or/- stronger Opioid or/- adjuvant

DO NOT USE:

1. Amitriptyline
2. Propoxyphene

Question 4

5-7% hospitalizations due to adverse effects of drugs
30% of those because of what? 2

Increased chance of toxic effects in those > 65YO. What are these? 4

Answer 4

1. aspirin and
2. non-aspirin NSAIDS
3. Renal toxicity—relative intravascular volume depletion
4. GI—much more prone after age 60
5. Cardiotoxicity—can worsen CHF & HTN
6. Interacts w/ aspirin and warfarin (Coumadin)

Question 5

Managment of chronic pain?

1. First line mild?
2. First line opioid?
3. Severe pain?
4. Neuropathic pain FL? 2
5. Second line?

Answer 5

1. nonsteroidal anti-inflammatory drugs [NSAIDs]
2. codeine
3. Morphine, fentanyl
4. • tricyclic antidepressants,
   • gabapentin
5. Tramadol

Question 6

1. What is osteoporosis?
2. These lead to fragility fractures. Can occur how? 2
3. Screening for osteoporosis involves what? 2

Answer 6

1. Disease characterized by low bone mass w/ microarchitectural disruption & skeletal fragility
2. • Occur from standing height or less
   • Occur with no trauma
3. • fracture risk assessment and
   • measurement of BMD

Question 7

Fracture risk assessment; Risk factors independent of BMD are? (two most important)
7

Answer 7

1. Advanced age*
2. Previous fracture*
3. Long-term glucocorticoid therapy
4. Low body weight (less than 127 lb)
5. Family hx of hip fracture
6. Smoking
7. Excess alcohol intake

Question 8

Treatment for osteoporosis
For fractures:
1. Hip?
2. Vertebral? 3

Answer 8

1. Hip: surgery
2. Vertebral
   - Analgesics
   - Calcitonin
   - Vertebroplasty and kyphoplasty