Potpourri
First line treatment of Cdiff
What is oral Vancomycin
The most common cause of leg ulcers.
What is chronic venous disease?
T or F
Strong evidence exists that artificial nutrition prolongs life in patients with advanced dementia.
What is false?
A major tenet of prescribing for the elderly: Start low and ___ and _____.
What is go slow and go all the way?
Definition of Osteoporosis
What is a hx of fragility fracture OR/AND Tscore <-2.5
May start this supplement if serum albumin < 2.8
What is prostat
Double Jeopardy
Pressure ulcer characterized by partial thickness skin loss with exposed dermis
What is stage 2 pressure ulcer?
T or F
Good evidence exists that SSI is neither effective in meeting the body's physiolic insulin needs nor is it efficient in the long term care setting.
What is True?
This cardiac drug has a narrow therapeutic index, has a specific toxicity syndrome, is eliminated renally, and has several documented drug-drug interactions. Geriatric patients can occasionally exhibit s/s of toxicity even at therapeutic levels.
What is digoxin?
1st line treatment for osteoporosis
What is Bisphosphonates?
Estimated fluid requirement for elderly in LTC
What is 30ml/kg of body weight per day?
These type of ulcers have well-demarcated edges, giving them a "punched-out" appearance, often with an overlying necrotic eschar. These ulcers are typically painful
What are Arterial Insufficiency Ulcers?
T or F
An alert patient in LTC appears lethargic. She denies uti symptoms. A urinalysis shows + leuk esterase and pyuria. Urine culture grows E-Coli. The patient has a GFR >90. This patient should be treated with antibiotics.
What is False?
Colonization, asymptomatic bacteriuria and pyuria is common in PALTC setting.
Should not be treated unless signs of uncomplicated cystitis present: frequency, urgency, suprapubic pain, gross hematuria, dysuria
This treatment for constipation should be avoided as it is associated with complications including hypotension and volume depletion, hyperphosphatemia, hypo- or hyperkalemia, metabolic acidosis, severe hypocalcemia, renal failure, and EKG changes
What is Sodium Phosphate Fleets Enema?
Double Jeopardy
A major osteoporotic fracture is considered a fracture to these bones (4)
What is a fracture of the hip, spine, wrist or humerus(upper arm)?
Double Jeopardy
The mneumonic Meals on Wheels, the reversible causes of malnutrition in elderly in nursing home
What is
Medication
Emotional
Anorexia, abuse, alcoholism
Late life paranoia
Swallowing disorders
Oral problems
Nosocomial infections (c. diff, h. pylori)
Wandering (dementia)
Hyperthyroidism, Hypercalcemia
This wound treatment is Clostridium fibrinolytic. It iis used as an enzyme to dissolve slough and eschar.
What is Santyl? (collagenase)
True or False
All benzodiazepines should be withdrawn gradually if taken for more than 4 weeks as there is a risk of causing a benzodiazepine withdrawal syndrome if stopped abruptly
What is True?
Double Jeopardy
These 3 antibiotic classes have the highest association with Cdiff and should be avoided in the elderly.
What are Clindamycin, Flouroquinolones and 3rd and 4th generation Cephalosporins
Double Jeopardy
Adverse risk of bisphosphonates that increases with prolonged use (over 5yrs)
What is atypical femur fracture?
Check serum _______ before starting an SSRI in the elderly, and after a few weeks of treatment.
What is Sodium?
A patient with suspected arterial ulcer should have this study done to confirm peripheral artery disease?
What is ankle brachial index?
True or False
PPI use on prolonged basis is indicated and beneficial for patients in LTC
What is False?
Prolonged use associated with risk of fractures, pneumonia, Clostridium difficile diarrhea, hypomagnesemia, vitamin B12 deficiency, chronic kidney disease, and dementia
This class of anti-depressants is associated with dose dependant diastolic hypertension, especially this drug____. (this was on the boards)
What are SNRI's, what is effexor?
Calcitonin decreases bone pain in this type of fracture_____ and not this type of fracture_____.
What is vertebral fracture and not hip fracture?