16 articles Geriatric

Apathetic Hyperthyroidism – Hyperthyroidism in the elderly

Diagnose apathetic hyperthyroidism: In the elderly, hyperthyroidism (over activity of the thyroid gland – hypermetabolic state), may present with only depression, slow Afib, CHF, weakness, weight loss, and a small goiter. A high index of suspicion is needed to make the diagnosis. A masked hyperthyroidism, more common in depressed older patients – psychological withdrawal (depression,…

Osteoarthritis

Osteoarthritis: Noninflammatory Pain in the hands, knees, and hips X-ray of joints: Joint space/articular narrowing, osteophytes, subchondral degenerative cysts and sclerosis Worse: At the end of the day and with activity Improves: With rest Treat osteoarthritis: Mild to moderate pain: Tylenol or NSAIDs Voltaren gel (NSAID) used for the relief of joint pain of osteoarthritis…

Generalized Weakness

Generalized Weakness: Differential diagnosis: Anemia: Ordered CBC. Assess for recent blood loss. Hypothyroidism: Order TSH. Hypoglycemia: Order bedside Accu-Check BG. Dehydration: Order IV fluids. Deconditioning: Assess ability to ambulate. Place on fall precautions. Order PT/OT. Depression. Infection: UTI (order UA) or PNA (chest x-ray to assess for consolidation). Medications: Sedatives (Xanax, Ativan), narcotics (Lortab, morphine…

Stroke

Stroke: (long-term management) Must be on Aspirin 81mg PO qd + Plavix 75mg PO qd [secondary-prevention of stroke] If recurrent Strokes: Change Aspirin to Aggrenox. Aggrenox vs. Plavix. New info suggests that Plavix alone is superior**** Aggrenox: May cause syncope! (Dipyridamole vasodilates à increase orthostatic hypotension) Must also be on a statin. Check bilateral carotid…

Shingles

Shingles: (herpes zoster infection: red patches of skin with white/clear papules, typically very painful, and rash follows a dermatome) PE: Vesicles on a red base starting in center of chest, on bottom of right breast, wrapped around right side and into mid upper back. Dermatomal distribution. Tx Plan: Start Valacyclovir 1g tablets – take 1…

Restless Legs Syndrome (RLS)

Restless Legs Syndrome: http://www.nhs.uk/Conditions/Restless-leg-syndrome/Pages/Treatment.aspx Often a side effect of medications (especially psych meds). Ropinerole or Pramipexole (start low dose and titrate up) Start: Pramipexole (Mirapex)125mg PO at bedtime. Give patient instructions that if her symptoms still continued after 1 week of Pramipexole 0.125mg PO every night that she is to increase this medication to 2…

Peripheral Neuropathy

Peripheral Neuropathy: Gabapentin (Neurotin) 100mg PO. Can titrate up dose as tolerated. Lyrica (Pregabalin) 150mg PO. Take 1 capsule bid. SNRIs (specifically: venlafaxine and duloxetine = Cymbalta), topical capsaicin, anticonvulsants (specifically carbamazepine), and TCA (specifically: amitriptyline) are more effective than placebo. Pregabalin is less effective than venlafaxine and duloxetine. Ex: Lyrica 200mg – 1 capsule…

Overactive Bladder – Incontinence

Overactive Bladder: Sx: urinary urgency, frequency, or urge incontinence [person feels the need to urinate often but only small amount of urine each time] Stress incontinence: Recommend Kegel exercises. http://www.mayoclinic.org/healthy-living/womens-health/in-depth/kegel-exercises/art-20045283 Urge incontinence: Recommend Oxybutynin – relaxes detrusor muscles (allows the bladder to relax). Tx: Vesicare (Solifenacin) 5-10 mg PO qd Muscarinic receptor antagonist: inhibits detrusor…

Nocturia

Nocturia: May be secondary a UTI. Order UA and treat accordingly. Look at BG. May be secondary to Diabetes Mellitus. Order a CMP. The patient is encouraged to not drink large quantities of fluid at night before she goes to sleep and to empty her bladder before lying down at night. Keep a small light…