Most sympathomimetic decongestants such as pseudoephedrine and phenylephrine can be problematic in elderly patients because they can:
Correct Answer C:
Sympathomimetic agents can elevate blood pressure and intraocular pressure, may worsen existing urinary obstruction, and adversely interact with beta-blockers, methyldopa, tricyclic antidepressants, and oral hypoglycemic agents and MAOIs. They also speed up the heart rate or may cause severe reflex bradycardia. First-generation nonprescription antihistamines can enhance the anticholinergic and sedative effects of other medications.
Which one of the following is a significant side effect of varenicline (Chantix)?
Correct Answer D:
Education, support, and medications are all valuable tools in assisting patients with a smoking habit. Varenicline, a clinically effective smoking-cessation product, has been associated with patient mood changes following the initiation of therapy, including suicidal thoughts and aggressive and erratic behaviour.
In prescribing an exercise program for elderly, community-dwelling patients, it is important to note that:
Initial exercise routines for the elderly can be as short as 6 minutes in duration. Even 30 minutes per week of exercise has been shown to be beneficial. Graded exercise testing need not be done, especially if low-level exercise is planned. A target heart rate of 60%-75% of the predicted maximum should be set as a ceiling. Patients with peripheral neuropathy should not perform treadmill walking or step aerobics because of the risk of damage to their feet.
One year after being diagnosed with early Alzheimer’s disease, one of your long-time patients develops symptomatic carotid stenosis. A vascular surgeon has recommended surgical treatment, but the patient’s family is uncertain whether he should have the surgery or whether he is capable of making the decision. The children are evenly split in their opinion regarding the surgery, and they ask your opinion about this decision.
Which one of the following is true regarding this situation?
Correct Answer E:
The primary care physician can assess a patient’s decision-making capacity based on ability to reason, communicate, understand the proposed treatment, and grasp the consequences of accepting or declining the suggested treatment.
Formal mental status testing and determination of capacity are different functions. However, there is a certain level of cognitive impairment where a patient simply lacks any ability to receive and process health information. At somewhat higher levels of cognition a patient might lack specific mental abilities, but still be able to satisfy the requirements for making treatment decisions.
Accurate mental status testing is helpful for assessing the capacity to choose; however, there is not a specific score that determines capacity. Determination of capacity does not require legal intervention or psychiatric expertise. There is no specific test for decision-making capacity.
Competence is a legal term in this situation. Decisions regarding competence are judicial determinations when evaluating the capacity of a person to make nonmedical decisions such as financial decisions. Under the law, adults are presumed to be competent until a specific action of the appropriate court finds them otherwise.
A 76-year-old male has fallen twice as a result of buckling of the left knee during ambulation. Neither fall resulted in injury, and he is advised to use an offset walking cane. The patient is left hand-dominant and has normal strength in all four extremities. Crepitus is present in both knees, but is much more pronounced in the left knee.
Which one of the following describes the best method for use of a cane by this patient?
The standard walking cane generally is designed as a tool to aid in balance and, to a lesser degree, reduce weight bearing on a specific leg. The offset cane design results in the downward force vector being placed directly over the shaft, making this choice ideal where improved balance and reduction of weight bearing on a particular leg is desired. Mechanical advantage produces maximum benefit when the cane is placed in the hand opposite the most severely affected leg, and the movement of the cane tracks the movement of the affected leg, consistent with normal gait.
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