Prescribing, Parkinson's & continence flashcards
9 high-yield MRCP Part 1 cards from the Intellect Medicos Geriatrics & Palliative Care course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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What are the STOPP/START criteria used for?
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Medication review in older people: STOPP flags potentially inappropriate drugs; START flags beneficial drugs that are missing.
Why? They give a structured way to tackle polypharmacy, both over- and under-prescribing.
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Name three adverse outcomes of a high anticholinergic burden in older people.
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Any three of: confusion/delirium, cognitive decline, falls, constipation, urinary retention, blurred vision.
Why? Effects of several anticholinergic drugs add up; scores such as the ACB scale quantify the total.
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Why must levodopa doses be given on time when a person with Parkinson's disease is admitted?
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Missed or delayed doses cause rapid loss of mobility and swallowing and can trigger a life-threatening parkinsonism–hyperpyrexia (NMS-like) syndrome.
Why? Levodopa is a time-critical medicine; doses should be given within 30 minutes of the usual time.
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A patient with Parkinson's disease is nil by mouth. Which dopaminergic treatment can be used?
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Rotigotine transdermal patch (dose converted from the oral levodopa-equivalent dose).
Why? It avoids the gut entirely; a nasogastric tube for usual medicines is the other option.
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Which antiemetic is preferred in Parkinson's disease?
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Domperidone.
Why? It is a peripheral D2 antagonist that does not cross the blood–brain barrier, so it does not worsen parkinsonism.
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What is the first-line treatment for urge (overactive bladder) urinary incontinence in women?
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Bladder training for at least 6 weeks.
Why? NICE NG123 recommends bladder retraining before drugs. Also advise on caffeine and fluid intake.
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Which antimuscarinic should NOT be offered to frail older women with overactive bladder?
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Immediate-release oxybutynin.
Why? It has a high anticholinergic burden and readily crosses the blood–brain barrier, causing confusion and falls (NICE NG123).
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What is the mechanism of action of mirabegron?
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β3-adrenoceptor agonist — relaxes the detrusor muscle.
Why? It treats overactive bladder without anticholinergic side effects, so it suits older people at risk of confusion.
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What is the key contraindication to mirabegron?
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Severe uncontrolled hypertension (systolic 180 or more and/or diastolic 110 or more).
Why? It can raise blood pressure; the MHRA advises checking BP before and during treatment.