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CaMDucky Derby AnswersCMDA President: Leslie EberTreasurer: Sing Palat-TsaiAdmin Asst: Holly BodineExecutive Board: Travis Neill, Allison VossPast CMDA Presidents: Greg Gahm, Lee Anneberg, Cari Levy, Karyn Leible-Prochoda, Fred Feinsod, Bill SolomonPast CMDA Members who have been President of AMDA: Karyn Leible-Prochoda; Cari LevyRegular CDPHE Leaders: Jo Tansey, Margaret Mohan, Randy Kuykendall, Jeff Beckman, MDRegular Telligen Participants: Christine Larocca, Elizabeth Mullins-SchulteRegular CHCA Participant: Ann KokishRegular Ombudsperson Participant: Anne MeierCMDA Meeting Time: 12 – 1:30 PMDate: First Tuesday MonthlyLocation: CDPHEVivage Geriatric Journal Club Time: 12:30 – 1 PMDate: First Thursday MonthlyWhen treating Parkinson Disease in the elderly, typically the best ‘first’ choice of an agent would be low dose Sinemet 2–3 times daily separated from meals.An elderly Parkinsons patient who has been stable for 6 months begins developing dyskinetic movements. The best initial approach is to decrease the dose of PD agents.Relative to when a provider is contacted by a facility, IMPACT Reviews require a documented action or response by midnight the next calendar day.For dialysis patients, Nepro and similar supplements are high calorie, high protein, low electrolyte.In dialysis patients, Calcium Carbonate, Calcium Acetate, Sevelamar, Velphoror and Lanthanum carbonate all bind phosphorous.When considering anemia in the elderly, as defined by the WHO, 34.3% of anemic patients are due to nutritional deficiencies such as iron, B12 and/or folate.In an elderly patient with significant anemia and iron deficiency, the best way to replace iron is using an iron supplement once daily on an empty stomach with vitamin C.The Colo Board of Medicine adopted a maximum dosage of 50 Morphine Milligram Equivalents as acceptable for chronic use.Older adults with hearing loss are at greater risk of dementia than those with normal hearing.For an Octogenarian, the most efficacious vaccine known to date is Shingrix.Dopaminergic medications relieve symptoms of restless leg syndrome, but may cause iatrogenic worsening of RLS at doses >0.25 mg q hs with long-term treatment.Kratom supplements do contain opiates.A study in JAMA Neurology in April 2018 noted that only Vitamin D has sufficient evidence to support routine supplementation for patients with Multiple Sclerosis. There is an effective reversal agent available for Xa InhibitorsA BMJ review of 23 RCTs comparing Direct Acting Oral Anticoagulants to warfarin in patients with Atrial Fibrillation in October 2017 found that compared to warfarin, DOACs reduced the risk of stroke or systemic embolic events.The same review found that DOACs may be safer with respect to risk of bleeding.The same review found that once all related costs were included, DOACs were more affordable.The FDA determined that fluoroquinolones should not be used in patients with acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis and uncomplicated UTIs unless there are no alternative treatment options.Calculation of the 10-year risk of atherosclerotic cardiovascular disease events does not include frailty.Primary prevention using statins is not indicated for males or females with family history of CAD or for everyone with a 10-year risk of a cardiovascular event >10%.From JAMDA, in regard to communicating with elders, CHAT is CHAnging Talk to avoid babytalk or elderspeak.The 3 anchors of “A Fine Balance” in regard to prescribing antipsychotics are Human Suffering, Power and Knowledge.In seniors, the dose of Melatonin necessary to promote sleep onset is 0.1 – 0.3 mg.A review of English-language trials >6 months duration in patients without dementia found NO OTC agents reviewed were better than placebo in regard to cognitive outcomes, including Omega-3 Fatty Acids, Ginkgo biloba, Vitamin D + Calcium, Vitamin E, soy and Beta-Carotene.A review of English-language trials >6 months duration in patients without dementia found that there were NO pharmacologic treatments when the underlying condition was present that were better than placebo in regard to cognitive outcomes, including Antihypertensives, Diabetes Medications, Statins, aspirin, NSAIDs, Estrogen and Testosterone.The Women’s Health Initiative found that the ideal time to use oral bisphosphonates in older women at high risk for fractures, in order to reduce fractures of any kind was 2 years.The 4 main types or mechanisms of Drug-Induced Diarrhea are osmotic, secretory, motility and inflammatory.When using TPN or PPN, an average adult should receive 30-40 ml / kg / day.The GOLD Guidelines for COPD found that long-term use of oral glucocorticoids has numerous side effects with no evidence of benefits.According to the 2018 IDSA Guidelines for C Diff, Vancomycin or Fidaxomicin are the initial drugs of choice.According to the same Guidelines for C Diff, contact isolation should be continued for 48 hours after resolution of loose stools.Studies in JAGS (2011), JAMA Internal Medicine (2015) and BMJ (2018) all noted that cumulative use of Anticholinergic drugs were associated with an increased risk for dementia.A 2017 NEJM articled noted that the Gabapentinoid Pregabalin (Lyrica) has been approved for and found to be more effective than placebo for treating Postherpetic Neuralgia, Diabetic Neuropathy and fibromyalgia.The same NEJM article noted that the Gabapentinoid Gabapentin (Neurontin) has been approved for and found to be more effective than placebo for treating only postherpetic neuralgia.A study in JAMA Internal Medicine in 2016 noted that Quetiapine was used in 13% of hospitalized, older patients, of which 64% was for sleep and 58% were discharged with a prescription for it.Several NEJM articles in October 2018 reviewed the use of aspirin or placebo for primary prevention of a combination of endpoints, including cardiovascular events, dementia, death, persistent physical disability and major hemorrhage. By 4 ? years, there was a numerically higher rate of death from any cause in the ASA groups and there was not a statistically significant decrease in the primary endpoints listed.A fourth NEJM reviewed the use of aspirin for primary prevention of cardiovascular events and major hemorrhage in diabetics. The primary findings were significantly fewer vascular events in ASA group, significantly more major bleeding in the ASA patients and absolute benefits were largely counterbalanced by bleeding hazard, ie, all-cause mortality was neutral.The ESCAPE Organisms are a group of clinically important, predominantly health care-associated organisms that have the potential for substantial antimicrobial resistance and which have evolved largely as a result of overuse of antibiotics. They are: Enterococcus faecium, Staphylococcus aureus [MRSA], Clostridioides?(formerly?Clostridium) difficile, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae.According to a February 2019 article in Annals, none of the compounded pain creams reviewed (ketamine, gabapentin, clonidine, lidocaine, ketoprofen, baclofen, cyclobenzaprine) were better than placebo creams at relieving pain compared to placebo creamsThe 13 Triple Crown winners to date are: Sir Barton, Gallant Fox, Omaha, War Admiral, Whirlaway, Count Fleet, Assault, Citation, Secretariat, Seattle Slew, Affirmed, American Pharoah and Justify.Gregory Gahm, MD ................
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