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Ageing mads > Ageing > Flashcards

Ageing Flashcards

1
Q

Difference in an MI in a young person and old person

A

can have no chest pain. Can get SE from stating and antiplatelets so need diff dose to a younger person

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2
Q

Sepsis in an old person

A

vasodilation rather than vasoconstriction, low temp, may not have a tachycardic response, CRP and WCC may not be high, AB targeted as higher risk of C.diff

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3
Q

diagnosis of sarcopenia

A

low muscle mass + low muscle strength/low physical performance

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4
Q

when does muscle mass decline

A

age 30, accelerates at age 60

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5
Q

consequences of sarcopenia

A

less energy used so more fat so insulin resistance and diabetes and less exercise. muscle weakness so more falls and fractures and more bone loss so again less activity. all means they have to depend on others more

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6
Q

interventions for sarcopenia

A

exercise - resistance training and strength, endurance and functional measures
nutrition - calcium, vit D, protein
creatinine
ACEi can improve muscle function

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7
Q

target of physical activity for >65

A

same as 18-64. 150 moderate exercise in bouts of 10 mins or more across the week (walking for 30 mins 5x week). or 75mins of vigorous activity.
Also want 2x of strength/balance training per week

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8
Q

what is habilitation

A

helping an individual achieve their goals

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9
Q

what is rehabilitation

A

process. whole individual. max potential to live a ful and active life

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10
Q

what is reablement

A

active process of an individual regaining the skills, confidence and independance to do things for themselves

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11
Q

framework for classifying and assessing health and disability

A

ICF

physio, occ health, speech and lang therapist

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12
Q

how can we measure outcome of rehabilitation

A

Rivermead motor assess scale - imparement/activity specific

ADL scales - Barthel index, functional independence measure

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13
Q

features of delerium

A

disturbance in attention
change in cognition
develops over a short period and fluctuates during the day
some evidence that something is underlying and causing delirium

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14
Q

pathophysiology of delerium

A

variable derangement of multiple neurotransmitters - partic ACh
direct toxic insults - drugs, hypoxia etc
abberant stress response - cortisol

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15
Q

what to check for in delerium

A

hydration, stop nephrotoxic drugs, optimise BP, perfusion, look for intrinsic renal disease, review

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16
Q

drugs not to use in elderly

A

trimethoprim, haloperidol

anticholinergics bad for the brain

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17
Q

if you have to give meds in delirium what do you give?

A

haloperidol - orally
quetiapine in parkinsons/lewy body
benzos if alcohol/benzo withdrawl or if seizure - use lorazepam but lorazepam can worsen delirium

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18
Q

delirium follow up

A

PTSD common after
higher risk of developing dementia
risk of more episodes

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19
Q

tests to do in someone presenting with tiredness

A

B12, folate, Hb, thyroid

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20
Q

tests to do when suspect dementia

A

B12, folate, FBC, thyroid

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21
Q

how is morphine excreted

A

renally

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22
Q

presecribing morphine

A

oromorph 2.5mg 2x day, 2x day long active morphine (MST) + oral immediate effect (oromorph)
prescribe a laxative too, prn antiemetic (metaclopramide - but not in parkinsons)
breakthrough dose is usually 1/6 of total daily dose - eg if patient taking 50mg bd breakthrough dose would be 15mg oramorph

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23
Q

in end of life care how are durgs best administered

A

oral often not an option so SC continuous infusion using a syringe driver is best. up to three meds can be mixed in the syringe and infused over 24 hours

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24
Q

how to change from oral to SC morphine

A

SC morphine is twice as potent as oral, so divide dose by two

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25
Q

what to presecribe in EOLC for pain/SOB

A

morphine

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26
Q

what to presecribe in EOLC for distress

A

midazolam

27
Q

what to presecribe in EOLC for nausea/agitation

A

levomepromazine

28
Q

what to presecribe in EOLC for resp secretions

A

buscopan

29
Q

present with suspected stroke - management?

A

CT scan. thrombolysis if <4.5hrs - risk vs benefit - high risk of bleeding

30
Q

management after thrombolysis

A

rescan after 24 hours, assess cognitive function, assess swallow, stroke unit care and DVT prevention from immobility - intermittent pneumatic compression (heparin is outweighed by bleeding risk and TED stockings show no benefit)

31
Q

acute stroke care

A

nutrition and hydration
MUST score - social factors
refer to dietician - thickened liquids/diff textures can help reduce chance of aspiration

32
Q

describe a cardioembolic stroke

A

fibrin dependent - red thrombus

33
Q

describe an atheroembolic stroke

A

platelet dependent - white thrombus

34
Q

small vessel disease

A

atherosclerosis, embolism

35
Q

secondary prevention?

A

if cardioembolic/AF - anticoagulant
if not cardioembolic - antiplatelets - clopidogrel
stop smoking, statins, manage BP, diet advice

36
Q

describe the telomere and how it can be used to assess age

A

telomere is the end of a chromosome. it is made of a repeating motif (TTAGGG) which form DNA loop. it progressively shortens with DNA replication until its too short to be able to replicate - senesence (useless cells)- hayflick limit.
telomerase can reextend telomeres - active in stem cells and immune cells

37
Q

what is frailty

A

loss of homeostasis + resilience. increased vulnerability to decompensate after a stressor event. increased risk of falls, delirium, disability and death

38
Q

models for frailty

A 
deficit accumulation (rockwood) - no of deficits/no of body systems 
phenotypic - one point for - wt loss, low grip strength, exhaustion, low physical activity, slow walking speed (0=no frailty, 1-2 =pre frail, 3=frail)
39
Q

neuro disorders causing falls

A 
cervical myolopathy
cerebellar ataxia
peripheral neuropathy
parkinsons - can cause arthostatic hypotension too (<20 SBP or <10 in DBP after 3 mins of standing)
lumbar stenosis
stroke
vestibular disease
BPPV
varifocal lenses
gait disturbance
muscle weakness
40
Q

medications that can cause falls

A 
benzos, neuroleptics and anti HTN biggest risk
also class 1a antiarrthymics, anticholinergics, antidepressants
41
Q

other things that can cause falls that should be screened for

A

alcohol, footwear, polypharmacy >4 meds

42
Q

interventions for people at risk of falls

A

strength and blaance training 3x week for minimum 12 weeks
footwear etc
med review
start calcium/vit D?
manage postural hypotension (salt, encourage to drink)

43
Q

what does capacity measure

A

understanding, able to retain, weigh up info, communicate

assesses a particular issue

44
Q

how can absorbtion of a drub be affected in elderly

A

incraesed gastric ph, decreased small bowel SA

45
Q

how is distribution of a drug affected in elderly

A

pritein binding - have low albumin and higher A-1AG so wont transport acidic drugs well
lipid binding - more fat so liphophilic drugs (diazepam, anaesthetics) have a higher volume of distribution
decreased body water lowers the volume of distribution in hydrophilic drugs eg lithium, digoxin

46
Q

how is metabolism/excretion of a drug affected in elderly

A

decreased liver function due to decreased liver size so first pass metabolism is decreased eg propanolol
renal metabolism - decreased GFR

47
Q

how to work out if a drug is dangerous

A

theraputic index - LD50/ED50
(ratio of the dose that elicits a lethal response in 50 percent of treated individuals (LD50) divided by the dose that elicits a therapeutic response in 50 percent of the treated individuals (TD50))

48
Q

drugs most commonly associated with adverse effects in the elderly

A

warfarin, digoxin, insulin, benzos

49
Q

drug to stop in someone with iron deficiency

A

aspirin

50
Q

drug to stop in someone with falls

A

zopiclone

51
Q

drug to stop in someone with cramps

A

quinine

52
Q

drug to stop in someone with indegestion but no ulcers

A

omeprazole

53
Q

drug to stop in someone with breast cancer

A

simvastatin

54
Q

specific dangerous drugs in elderly

A

sedatives, acid-suppressant drugs, anti psychotics, antiplatelets, combo of ACEi/ABR/diuretic, anticholinergic, NSAIDs, opioids

55
Q

what environment do acidic drugs need in order to be absorbed? name some acidic drugs and what binds to acidic drugs

A

acidic environment pH <7.35
phenytoin, aspirin, penicilins
ablumin binds

56
Q

what environment do basic drugs need in order to be absorbed? name some basic drugs

A

require basic pH for absorbtion (pH>7.35)
diazepam, morphine
A1-AG binds to basic drugs
elderly often have low albumin but high A1-AG

57
Q

do the elderly have a higher or lower volume of distribution of lipophilic drugs

A

higher

58
Q

drugs that cause falls

A

benzos, neuroleptics, anti HTN, AD, anticholinergics, anti-arrhythmias

59
Q

grapefruit juice and simvastatin interaction

A

Cytochrome P450 - interacts with statins causing myalgia

60
Q

what is pharmacokinetics

A

absorbtion, distribution, metabolism, excretion

61
Q

what is pharmacodynamics

A

drug action in the body

62
Q

screening programmes in UK

A

AAA - all men >65 - USS aorta. if 3-4.4cm you get yearly scans, if 4.5-5.4 you get thee monthly scans, if >5.4cm - refer for op assessment
breast
bowel

63
Q

vaccinations old people are offered

A

influenza >65 - yearly
pneumoccocal >65 - one off
shingles 70 years old - one off

Ageing mads (1 decks)

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