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Abnormal Uterine Bleeding Acute and Chronic Cognitive Diseases

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Abnormal Uterine Bleeding Acute and Chronic Cognitive Diseases Abnormal Uterine Bleeding Would you be able to obtain repeat endometrial bx after inserting IUD Slide 18 Yes How long would would you treat AUB with medroxy-progesterone, also when stopping the therapy does it need to be tapered Clinically - I treat for three months. The data is VERY limited on duration. choice for young women with hirsutism who do not want to become pregnant. Spironolactone, in daily doses of 50-200 mg, blocks androgen receptors. Spironolactone also decreases testosterone production, making it additionally effective for hirsutism. Sexually active women taking spironolactone should ensure that contraceptive measures are adequate. In some cases, spironolactone can be combined with an OC for added effect on the hirsutism. With current systemic therapies for hirsutism, 6 months to a year of therapy is usually required before results are noticeable. Even then, only approximately one half to three quarters of patients show improvement. The problem may lie partially in the nature of the hair follicle, which persists for 6 months to a year even after androgen levels have been normalized. Ineffectiveness may also be due to the inability of treatment to completely normalize elevated tissue dihydrotestosterone levels. Newer therapies directed at inhibition of 5-alpha-reductase or blockade of the androgen receptor may improve the ability to treat what is the dose for spironolactone for hirsutism patients. Acute and Chronic Cognitive Diseases Common Issues in the Elderly I would be most appropriate because they wouldn't be rushed to further intervention. Certainly, if there are other red flags on exam or sx don't improve with conservative management, imaging is an appropriate next For lumbar stenosis, why would you not do an MRI first step is post prandial hypotension common in younger people too Not as common because younger people typically have better overall blood flow For lumbar stenosis, what if conservative therapy (i.e. PT, medications) does not work Then MRI, etc and further is very appropriate Big one for clozapine is severe neutropenia. All have some anticholinergic effect and increased fall risk. Quetiapine and clozapine have lower risk of extrapyramidal sx compared to others, but that risk still isn't Side effect of clozapine and quetiapine that we need to know for test zero. Common Issues in the Elderly II Not necessarily. BUT...paroxetine specifically is highly anticholinergic and shouldn't be used in elderly Are SSRI's associated with developing dementia patients what about the Frax score When do we need that on the board exam It's worth knowing about and reviewing the site for sure. I wouldn't worry about intricate details regarding calcitonin not useful for pain in acute hip fx, only vertebral compression Also helpful for any osteoporotic fx actually How much do OAB meds contribute to dementia (central anti-cholinergic effects) Emerging data that it raises the risk, but this is also all still fairly early data it's effective in decreasing fx. Also remember if someone is on osteo treatment they need to be on cavit d what is the data for ca and vid supplementation benefit for patients already have osteo too Even if there is >100,000 colonies of whichever bacteria, on urine Cx, still not treating if Correct. Colonization is pretty common as we age and our treatment with abx causes more harm than asymptomatic good if no sx. What is your approach with UTI treatment in patients with intellectual disability who can't communicate effectively Good physical exam and sorting through new urinary sx (frequency, difficulty, behavior changes, etc). when treating for RLS w sinimet, when would you recommend stopping & what potential risks As they get older and from time to time, I would try to wean it. Side effects and risk are related to would you be most concerned about dopaminergic activity. Also some rare cardiac risks with sinimet Not necessarily. Based on risk factors, it's still reasonable to screen a male (i.e. on chronic steroid therapy, Are the only men that need screening with DXA age >50 and a fracture long term PPI, etc) Do we have data on falls secondary to medication side effects (i.e. how many femoral neck fractures do WE cause) I can't give specifics, but there is definitely good data out there, particularly related to falls in general What to do when pt having cognitive decline, no family involvement, and refuses home health or This could be a situation for APS or some other entity to come in and evaluate. But there are no great moving into assisted living options and it will be messy USPSTF does not recommend to check BMD for pt receiving RX for osteoporosis, then how do we assess the efficacy that we need to change rx or not If you think it will change management, certainly getting a dexa is appropriate just want to clarify if pt is going into hospice.. stopping statin (with hx of CVD) would increase per the data, yes. But worth discussing with the patientfamily for shared decision making. In an elderly that cannot swallow appropriately (I.e. stroke) but was previously able to swallow, They would be appropriate for PEG potentially. The recommendation against feeding tube is for advanced what are the options for feeding dementia patients. Would you perform BMD testing in an African-American male with hip fracture I would treat anyway but probably would to get a baseline why stop biphosphanate after 5yrs tx side effects go up the longer someone is on Do Patients taking Biphosphonates should DC it for tooth extraction I would as the risk for jaw necrosis goes up with invasive dental procedures how often do you check vitamin dcalcium levels I only check vit D if there is a fracture or someone is osteoporotic on DXA. That helps me choose vit d Do you need to obtain a DXA in postmenopausal woman after a hip fracture or can you start treatment for osteoporosis You can start. However, it would be reasonable to get a DXA for bl You could, but they're not going to move the needle. And potentially cause more harm than good if the Why can't you use high-calorie supplements in older, demented pts who are not eating patient shows no interest in food. No great guidelines on this. Hopefully more to come. There are bisphosphonate dosing options for How do we treat osteopenia based on new guidelines osteopenic patients. I have not seen gastric bypass as a contraindication for oral biphosphonates. Since pt unable to drink full glass of water and risk of reflux is greater, What is your opinion definitely a pt that either iv bisphosphonate or prolia would be better choices Lots of evidence for Vit D decreasing fall risk in nursing home patients. This isn't true for community What studyevidence is there for Vitamin D in nursing home patients dwelling adults The challenge is if the person takes a po bisphosphonate and synthroid. You'd have to find a regimen that is consistent and doesn't overlap so both could be taken on "empty" stomachs. IV bisphosphonate would What about with hypothyroid patients how often be reasonable if approved by insurance too. what is the next step if pt is on treatment and gets a compression fx I would switch to an agent with different mechanism probably. So Cal-VitD not for primary prevention, but ok for pt with Osteoporosis, right correct when would you use z score in BMD result Probably doesn't affect treatment decisions. Mainly t score Diabetes They are 3rd line. metformin 1st line 2nd line is GLP1SGLT2 if you can afford it, sulfonylurea or pioglitazone if you can't Metformin, then GLP1SGLT2. You said then sulfonylureas. Where do DPP4 meds come in DPP-4s are more expensive but not as good at lowering A1c as GLP1 or SGLT2 lantus vs toujeo.. is there a difference other than higher concentration is toujeo better for CKD They are the same thing, just a different concentration So, SGLT 2 inhibitors should not be used with patients already with peripheral neuropathy No, they can be used if not screening for microalb, how to know of CKD that is a concern for meds. Theoretically they are on the correct medicine Hmmm, not sure of the question, but ACEARB are the drugs of choice for hypertension with ARB better ACEARB in Dm tolerated. Continue one of them if you can. Don't give both. Reglan versus erythromycin for gastroparesis For the test it is Reglan. Erythromycin is also fine 30-300 mgdL day of albumin in the urine. We usually just do a microalbumincreatinine ratio. If this is elevated, then we consider it to be microalbuminuria. Start treatment when it is positive or in the how diagnose for microalbuminuria and when do you start treatment presence of hypertension since we are using the same drugs. Asian Americans it says bmi of 24 Earlier talk said bmi less than or equal to 23. Which is correct they tend to develop diabetes at 24. Recommend screening at 23 The comment on statins over age 10 on the treatment in children slide - is that only if lipids indicate treatment yes, thank you so we do not focus of Cr when it comes to metformin test should not ask Yes, they will ask about GFR Are the diabetes medications on boards name brand, generic or both They will give you generics for the old ones and both for the new ones Why do we avoid stoping metformin with sulfonyurea Increases morbidity Should DPP-4 Inhibitors be avoided in patients with inflammatory and osteoarthritis because of the side effect of joint pain No it is very rare, but just be aware of it if they develop new joint pain, they should come off If over age 70 and on testosterone therapy, is screening PSA recommended NO How often should you screen for thyroid disease and celiac disease in children with diabetes Usually just after diagnosis and then if you have any indications If a patients A1c is controlled and in non-diabetic range would you still recommend keeping metformin on bc of benefits YES!!!! at what level of renal failure would you give Prevnar The recommendation is just "chronic renal failure".
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