Body So Bootylicious
(GI & GU disorders)
(GI & GU disorders)
Name 2 factors that may contribute to urinary incontinence.
What are...
Delirium, Infection, Meds, Psychological, Excess Urine Output, Reduced Mobility, Stool Impaction
USPSTF Guidelines for Osteoporosis Screening
Women >65yo, Q2 years.
Name a cognitive testing modality
What is:
MOCA, MME, SLUMS
What is the recommended minimum frequency with which goals of care conversations should take place in the clinic?
Annually
Name an indication for estrogen therapy
•Treatment of vasomotor symptoms of menopause
•Treatment of genitourinary syndrome of menopause ( previously known as vaginal and vulvar atrophy)
•Prevention of osteoporosis
This class of laxatives should NOT be used in opiate-induced constipation
The only laxatives that should be avoided are the bulk-forming laxatives, like psyllium.
These laxatives increase the bulk of the stools, distend the colon, and augment peristalsis. Opioids prevent peristalsis of the increased bulk which worsens abdominal pain and can contribute to bowel obstruction
Recommended type of exercise for patients with osteoporosis
weight bearing and resistance
walking, hiking, jogging, climbing stairs, playing tennis, dancing, and lifting weights
Name 5 labs you would obtain for work up in a patient you suspect has a new dx of dementia.
CBC, UA, CMP, Vitamin B12, folic acid, TFTs, lipids, syphilis, and HIV. Ask about ETOH hx & family hx.
Could also consider: ESR, LP, heavy metal screen, ceruloplasmin levels, Lyme disease titer, or serum protein electrophoresis. Brain imaging if young age or concerning features (rapid progression, associated sx).
What are the USPSTF recommendations on breast cancer screening? (give ages and frequency) How about older adults?
Women who are 50 to 74 years old and are at average risk for breast cancer get a mammogram every two years.
After 75, it should be a risk and benefit assessment. It is reasonable to continue screening in patients who have at least a 10 year life expectancy and would undergo biopsy/treatment if a breast cancer was found.
Name 2 adverse symptoms of estrogen therapy
•Abnormal uterine bleeding
•Fluid retention
•Breast tenderness
•Headaches
•Mood changes
•VTE
***No scientific evidence links HRT with significant weight gain.***
This non-pharmacologic intervention can be used to treat chronic obstructive constipation.
What is BIOFEEDBACK-GUIDED PELVIC FLOOR EXERCISES
RTC OF 88 ppl w/ obstructive constipation found that biofeedback-guided pelvic floor exercises were superior to polyethylene glycol (PEG; Miralax) in improving constipation symptoms at six-month follow-up
Name a patient population in which you would consider obtaining a secondary osteoporosis workup? (Osteoporosis due to another etiology)
What are:
- premenopausal women with osteoporosis
- men aged less than 50 years old who present with fragility fractures or osteopenia
Work up consists of evaluating for endocrinopathies (thyroid, PTH, DM1), autoimmune conditions (RA, SLE)
Interpret a score of 21/30 on MOCA.
(Normal, Mild, Moderate, or Severe)
What is Mild Cognitive Impairment
>25=normal, 18-25=MCI, 10-17=moderate, <10=severe
Difficult to interpret for highly educated people.
Slums scoring: 25–30: Indicates regular cognitive function. 20–24: Indicates mild cognitive impairment. 1–19: Indicates dementia.
The preferred screening tool for depression in older populations.
Geriatric Depression Screen OR PHQ-9.
GDS has been thought to be more sensitive in older populations. However, when compared w/ PHQ9, multiple studies have proven no significant difference in dx of depression. Some studies found PHQ9 to be easier and shorter to complete.
This formulation of estrogen does not confer increased risk of VTE
What is TOPICAL ESTROGEN
Any estrogen administered orally results in increased activated protein-C resistance, increasing the risk of a blood clot. Transdermal Estrogen bypasses the hepatic metabolism that produces activated protein-C resistance, and the risk for blood clotting is negated.
This method of recurrent UTI ppx is considered to be superior to others. (Frequency of dosing, not abx names)
What is PATIENT DRIVEN SINGLE DOSE.
RCT of post-menopausal women showed patient-initiated single dose ppx was as effective as low dose daily ppx, and had less GI side effects.
Explain what a bisphosphonate holiday is (timing & duration), and what adverse effects it is helping to avoid.
2-3 year break in bisphosphonate therapy after 3-5 years of treatment.
AE: atypical femoral fractures and osteonecrosis of the jaw
Donepezil & memantine have the following clinical benefit:
a) increase life span
b) slow progression of disease
c) reverse memory loss
d) improve behavior
b) Slows progression of disease. Thought to delay institutionalization by approximately 1 year in patients with mild-moderate dementia.
Using a definition of marked clinical worsening for a subject showing any cognitive decline plus any decline in both activities of daily living and global function, 30% of patients on placebo showed clinical worsening in comparison with only 14% of those on donepezil. For memantine, 21% of patients showed a significantly greater degree of worsening on placebo in comparison with 11% on memantine.10
Demonstrate a Get Up & Go Test
It uses the time that a person takes to rise from a chair, walk three meters, turn around 180 degrees, walk back to the chair, and sit down while turning 180 degrees.
During the test, the person is expected to wear their regular footwear and use any mobility aids that they would normally require.
<10s = normal, 11-20s = nl for frail old ppl, >20s requires further eval, >30s = inc risk for falls
Contraindications for oral OR transdermal estrogen-based therapies (name 3)
•Known, suspected, or history of breast cancer
•Known or suspected history of other estrogen-based cancer, i.e., uterine cancer. Women who have had a hysterectomy and have no remaining evidence of disease are still candidates for HRT
•Active deep venous thrombosis (DVT) or a history of DVT or pulmonary embolism (PE) (oral)
•History of blood clotting disorder, the most common being Factor V Leiden mutation carriers (oral)
•Active or history of arterial thrombotic diseases such as myocardial infarction or stroke
•Chronic liver disease or dysfunction
•Migraine with aura
These contraindications do not apply to transvaginal based estrogen therapies, as the serum concentration of estrogen from this route is extremely low. The North American Menopause Society (NAMS) has recommended that the black-box warning that applies to conventional HRT not be applied to transvaginal estrogen treatments.
Name the chloride channel activator medication effective for chronic constipation.
What is LUBIPROSTONE (Amitiza).
Both this, and Linaclotide (Linzess) were shown to be better than placebo.
Name 5 labs that are a part of a secondary osteoporosis workup
tests for bone and mineral metabolism (calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D, parathyroid hormone), liver and kidney function, CBC and thyroid-stimulating hormone
Name a common adverse effect of Donepezil
Nausea, diarrhea, and vomiting.
Other common side effects include insomnia, muscle cramps, fatigue, and anorexia, which are more common with higher doses. These side effects are mild and transient in most patients, lasting up to three weeks and usually resolving even with continued use.
MOA: Acetylcholinesterase Inhibitor
This specialist can conduct an assessment that can be used to help determine if an older adult is safe to drive.
Occupational Therapy Driving Assessment
People age 70 and older are more likely to crash than any other age group besides drivers age 25 and younger.
The Timing Hypothesis
The "Timing Hypothesis" refers to the theory that when starting HRT closer to the time of the menopause transition, a cardiovascular benefit is seen compared with later initiation.
WHI study showed significantly increased CV risk, especially with >5 years of use (inc by 24%). Subsequent studies have shown this risk is highest in those initiated on tx >10 years after initiation of menopause. Initiation within 4 years of menopause transition actually DECREASES CV risk & mortality.