April 8th Flashcards

1
Q

what might happen to lithium levels if an elderly individual is on a low sodium diet

A

higher blood lithium levels

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2
Q

what might happen to an elderly individual if they’re on cyclosporine and consuming a low sodium diet?

A

potential for nephrotoxicity

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3
Q

what’s special about grapefruit?

A

increases absorption of certain medications (antiacids, statin-type drugs). therefore grapefruit juice is prohibited with these kinds of drugs as to avoid liver toxicity

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4
Q

why do the elderly in particuar need to be careful with their diet?

A

they often take multiple medications which have additive/conflicting effects

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5
Q

what is polypharmacy?

A

having adverse reactions to taking multiple medications

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6
Q

what is glomerulonephritis?

A

when there is type 3 hypersensitivity in which immune factors (immunoglobulin G and complement), where drug metabolites are not properly excreted, then there are immune complexes that bind to these metabolites and cause an inflammatory response that causes kidney damage

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7
Q

describe what happens to kidney mass with aging?

A

30% decrease in renal mass by age 90

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8
Q

what’s the problem with vitamin D when you’re old?

A

smaller kidney –>the metabolically active form of vit D requires the 1-alpha hydroxylase enzyme that bioactivates vit D into the 1,25-dihydroxy vit D.

this ability to bioactivate goes down, so even if they’re consuming enough vit D, they can still experience a deficiency

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9
Q

what’s special about dehydration with elderly?

A

increased risk, especially with muse of diuretics and laxatives

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10
Q

in what ways can drugs block actions of vitamins?

A
  • inhibit absorption
  • bind them
  • enhance their catabolism
  • enhance their excretion
  • inhibiting their activation
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11
Q

effect of cholestryamine

A

meant to lower cholesterol (bile acid sequestrants) but can decrease fat soluble vitamin absorption

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12
Q

effect of antibiotics

A

affects GI and bioavailability of nutrients by inhibiting action of enzymes on epithelium, can damage mucosa’s villi and microvilli
–> nutrient deficiencies when used long-term

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13
Q

effect of anti-inflammatory drugs

A
  • inhibits lactase

- damage gut itself to decrease absorption of fats and micronutrients

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14
Q

effect of laxatives

A
  • loss of fat-soluble vitamins

- faster transit time means less absorption esp for Ca and K

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15
Q

effect of anti-ulcer drugs

A
  • less HCL production
  • decreased B12 released from food
  • less B12 available for binding with intrinsic factor for absorption
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16
Q

effect of loop diuretics (furosemide)

A
  • increased excretion of thiamin

- cardiac abnormalities

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17
Q

effect of non loop diuretics

A
  • potassium depletion

- risk of cardiac arrhythmias

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18
Q

effect of asprin

A

increases folate excretion by binding to plasma albumin involved with transport of vitamin to tissues. leads to increased urinary excretion of the now free folate in the blood.

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19
Q

what is diarrhea?

A

3 or more unformed bowel actions in 24 hours

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20
Q

acute diarrhea lasts for how long?

A

less than 2 weeks

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21
Q

chronic diarrhea lasts for how long?

A

3-6 weeks

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22
Q

why are the elderly more susceptible to diarrhea?

A

diminished immune response and they tend to have more systemic bowel diseases (IBS, colitis) and others like pneumonia, hypothyroidism

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23
Q

list drugs commonly associated with diarrhea

A
  • antibiotics (most common)
  • osmotic agents (laxatives, antacids)
  • antimetabolites
24
Q

how do antimetabolites cause diarrhea?

A

direct damage to epithelial cells

25
Q

mechanism of grapefruit juice?

A

the juice inhibits cytochrome p450 enzyme which is involved in the inhibition of the metabolism of the drugs (inhibition of inhibition –> enabling); this is present on the level of the intestines where absorption of the drug will be increased

26
Q

what is bone remodeling

A

replacement of old bone with newly synthesized bone

27
Q

what kind of cells synthesizes the bone matrix?

A

osteoblasts

28
Q

what kind of cells break down the old bone mineral

A

osteoclasts

29
Q

what removes the proteins in bones?

A

phagocytes

30
Q

why are osteoblasts important?

A

adapts bone to various mechanical needs, repairing microdamages or old bones; allows secretion of calcium stores to maintain homeostatic blood levels

31
Q

what happens to the capacity for bone remodeling with age?

A

decreases –> secondary to decline in muscle mass

32
Q

why is osteoporosis more common in elderly?

A
  • decrease of estrogen/androgens in both males and females
  • increased oxidative stress
  • less activity of osteoblasts
  • excessive inflammation that causes bone resorption
33
Q

at what ages do older ppl have accelerated rates of bone loss?

A

women: after 55
men: after 65

34
Q

define osteoporosis

A

having a bone density <2.5 SD below mean for young ppl

35
Q

what is osteopenia?

A

bone density with SD < 1 to 2.5 of the mean for young ppl

36
Q

what is type 1 osteoporosis?

A

postmenopausal osteoporosis (ages 50-70); due to drop in estrogen levels leading to rapid bone loss

37
Q

role of estrogen and bones?

A

inhibits the activity of osteoclasts

38
Q

what is type II osteoporosis?

A

senile osteoporosis; involves both cortical and trabecular bone loss; associated with underactivity of osteoblasts due to accumulation of fat in bone marrow –> inadequate bone formation relative to bone resorption

39
Q

how much accretion of bone after age of 30?

A

1% per year til menopause

40
Q

how much accretion of bone after menopause?

A

3-5% for 6 to 8 years after which accretion is more gradual

41
Q

when is peak bone mass?

A

age 30

42
Q

how much bone mass can a post-menopausal woman lose?

A

up to 20%

43
Q

factors increasing likelihood of the development of osteoporisis

A
  • sex (men have greater bone mass)
  • being small
  • age/menopause
  • family history
  • irregular menstruation
  • anorexia nervosa
  • low Ca diet
  • medication (corticosteroids, anticonvulsants)
  • inactive lifestyle (esp lack of weight-bearing exercise)
  • cigarette smoking
  • excessive alcohol consumption
  • being Caucasian or asian
44
Q

role of vit D in prevention/treatment of osteoporosis?

A

decreases risk of bone resorption, enhances calcium absorption, enhances mineralization of bone matrix

45
Q

why is vit D levels lower in older folks?

A
  • drop in renal mass and decreased capacity to metabolically activate cholecalciferol or 1,25 dihydroxy vitamin D
  • decrease in ability to synth from sunlight decreased amounts of 70-dehydrocholesterol (precursor to cholecalciferol) in skin and less time spent outdoors
46
Q

how to counteract drop in vit D seen in old ppl?

A

give calcitriol

47
Q

what happens if blood concentration of vit D goes too high?

A

risk of hypercalcemia and hypercalcuria

48
Q

why is vit D absorption lower for postmenopausal women and elderly?

A
  • diminishment of ability to synth metabolically form of vit D
49
Q

risk factors for bone loss

A
  • low calcium intake
  • excessive phosphorous intake
  • high animal protein diet
  • vit D deficiency
  • low PA
  • excessive alcohol
  • excessive caffeine intake
  • smoking
50
Q

how to counteract bone loss?

A
  • weight baring exercise
  • walking
    stimulates osteogenesis (stimulation of osteoblasts)
51
Q

recommendations for preventing bone loss?

A
  • PA: aerobic activity for 20 mins, 3 times a week AND weight training
52
Q

why is weight training important?

A

stimulates and enhances bone health

  • having sufficient muscle strength and coordination for daily activities
  • decreases risk of fall-related fractures
  • enabling sufficient muscle to prevent chronic
53
Q

why is osteoporosis associated with chronic pain?

A

compression of the ribs and bones on nerve cells

54
Q

how to prevent osteoporosis?

A
  • maximize bone mass in premenopause
  • screening
  • control of bone mineral loss during postmenopause
  • calcium (1.2g) and vitamin D (800 IU) supplements
  • hormone replacement therapy (HRT)
55
Q

why is HRT controversial?

A
  • associated with adverse health risks when given for a prolonged period
  • seems to be fine short-term