Exam 3 Review (PPT) Flashcards

Question

Changes egg cell numbers over life cycle

Answer 1

Most before birth Declines afterwards None left at menopause

Answer 2

GnRH -\> FSH LH -\> 17-Estradiol Progesterone -\> (negative feedback to GnRH)

Answer 3

High GnRH FSH LH -\> Low 17-Estradiol Progesterone -\> (positive feedback to GnRH)

Answer 4

Estrogen and Progesterone high during teen, drops during perimenopause

Answer 5

Steroid Hormones - Estrone, Andrgens (testosterone)

Answer 6

Treatment of Menopausal symptoms Prescription drugs – hormone replacement - other medications Lifestyle approaches. Hormone replacement- estrogen/progesterone **Benefits** reduce hot flashes, decreases vaginal dryness, decreases bone loss **Risks** heart disease/stroke, breast cancer

Answer 7

Growth - More osteoblasts than osteoclasts Postmenopause - Less osteoblasts, more osteoclasts

Answer 8

Other medications 1. Hot Flashes / Depression. 2. Low Dose Antidepressant 3. Low Bone Density (see Osteoporosis slides) 4. Bisphosphonates 5. Hormonal agents

Answer 9

Lifestyle approaches **A) Healthy practices** - avoid smoking, avoid excessive alcohol, balance, adequate diet, maintain healthy weight, exercise regularly, practice stress reduction **B) Dietary practices** - adequate Vitamin D / Ca, low to moderate caffeine, avoid excessive alcohol, phytoestrogens as soy isoflavanones & flaxseed lignans, herbs (inconclusive).

Answer 10

Andropause Gradual decline male hormones (testosterone); - erectile dysfunction & decreased sex drive, loss of muscle mass, anxiety & irritability, sleep disturbance, loss bone density, CVD. **Andropause treatment Hormone Therapy - Testosterone** * *Benefits** - improved sex drive - improved muscle mass / strength * *Risks** - prostate / breast enlargement - erythrocytosis / stroke - infertility

Answer 11

Active Growth until 20s Peak bone mass 12 - 30 Bone loss 35 until death

Answer 12

**Bone loss with age is associated with:** 1) Loss of estrogen 2) Inadequate intake of Calcium Bones become porous – risk of bone fractures. **Non-modifiable risk factors:** Older age Female Early Menopause Race Genetics & family history **Modifiable risk factors:** Nutritional status– body weight, physical activity, & nutrient intake Smoking High caffeine intake Alcohol abuse Some medications

Answer 13

Prevent in white women Occurs in individuals with low bone mass

Answer 14

Dual energy X-ray absorptiometry (DEXA)

Answer 15

Osteoporosis - loss of trabecular bone

Answer 16

Below 0 = Normal Below -1 = osteopenia Below -2.5 = osteoporosis

Answer 17

**Warning signs of Osteoporosis** Any fracture after 40 Loss of height Back pain Dowager’s back (kyphosis) Bone density test T-score below - 2.5. ## Footnote

Answer 18

Mortality rate increases with age \>90 = 50%

Answer 19

Meds that Decrease Risk Fracture Most drugs DECREASE OSTEOCLAST ACTIVTY: **Bisphosphonates** - Fosamax, Boniva, Actonel, Reclast * *Hormonal** - Estradiol - Selective Estrogen Receptor * *Modulators as Evista** - Calcitonin - Parathyroid Hormone -- Parathyroid Hormone - increases osteoplast activity, synthetitic form - intermitent frequency - injection - releases calcium into the blood - blood calcium increases - Vitamin D goes to liver and becomes hydroaxlated, Kidney hydroxylates and activates Vitamin D - increases blood calcium - increase calcium reabsorbtion and retention of calcium

Answer 20

Lifestyle and Bone Health Weight Bearing Exercise Diet – Minerals, protein, vitamins, alkaline diet, & Soy (??) Sun exposure Ca supplements: • high % of calcium • easily absorbable calcium • supplement between meals • low dose supplements -- Calcium carbonate - most common - 40% calcium - requires acid for absorption - elderly people have gastritis ``` Calcium citrate (23%) - contains less calcium but requires less acid - good for elderly people - in fortified orange juice ``` Calcium gluconate (9%) - not worth it

Answer 21

Elderly population will increase significantly by 2050. Over 90 million people 65 years and over Over 20 million people 85 years and over

Answer 22

Physiological changes 1. Body composition 2. Senses 3. Organ systems Body composition: – Sarcopenia; Muscle mass, body fat, and BMR – Weight changes – Bone loss ## Footnote Physiological changes Senses; Vision, Hearing, Taste & Smell Organ systems; GIT - – Oral; xerostomia & dysphagia – Stomach; atrophic gastritis – Intestinal; reduced absorption & motility. Others - Cardiovascular, respiratory, renal, skin, hair, nails, neuromuscular, skeletal, endocrine, & immune System.

Answer 23

Nutritional needs; Energy, macronutrients, fluids & fiber. Micronutrients: • Bone health – Vit. D, K, P & Mg, vitamin C, Ca • Cognition - Folic acid, B6, B12 • Immunity – Zn, Vitamin C, vitamin D Other health problems/concerns: Vision Problems, decreased mobility, cognitive Decline

Answer 24

**Vision problems**; cataracts, glaucoma, & macular Degeneration. **Prevention or Delay of Vision Problems:** Diet high in antioxidants; Vitamins C & E, and carotenoids as lutein / zeaxanthin Protect eyes from sunlight. **Decreased mobility** – arthritis. **Rheumatoid** - autoimmune - attacking your joints, joints become deformed **Osteoarthritis** - degenerative - wear and tear - most people have this one -- Cataracts - clouding of the lens Glaucoma - increased pressure in eye, can cause damage to optic nerve, fluid plugged up. Seen more in Black population. Treatable with medicine Macular Degeneration - Retina - Macula - photosensitive cells start to degrade - can cause blindness - 30% of age 65 are affected by this - seen more in people with inflammatiory diseases diabetes obestity, and cardivascular disease atherosclerosis

Answer 25

Osteoarthritis ** - Risk factors:** Advancing age Obesity Female Injuries / overuse Maligned bones, rheumatoid arthritis & gout ** - Signs and Symptoms:** Pain Stiffness, swelling, numbness, decreased mobility, crepitus * *Osteoarthritis** - Treatment: medications, supplements, exercise, relaxation, diet & surgery. **Dietary Treatment** 1) Maintain healthy weight 2) Consume diet high in: - anti-inflammatory compounds - antioxidants; phytochemicals, and vitamins E & C. **Social Impact of Aging**: income, dependent living, & depression

Answer 26

* *Nutrition Programs for Aging:** 1) Older Americans Act - nutrition services to low income - congregate meals - home - delivered meals 2) Food Stamps 3) Nutrition Screening Initiative. ## Footnote **Nutritional Screening Initiative: (DETERMINE)** Disease, eat poorly, tooth loss, reduced social support, multiple medicines, involuntary weight loss, needs assistance, economic, \>80 years **Healthy Aging:** Be active Meditate & Relax Eat well Stimulate your Brain Connect with Others

Answer 27

Prevalence: About 6.8 million cases in U.S., at least1.8 million severe Alzheimer’s and Vascular Dementia by far most common About 4 million due to Alzheimer’s Disease Over 1 million due to Vascular Dementia Signs: – Shrunken brain, amyloid plaques, & tangled fibers

Answer 28

Alzheimer * *Pathophysiology:** * *Amyloid** plaques between neurons (unusual clumps of beta amyloid protein and bits of degenerating cells) Neurofibrillary tangles within neurons (twisted filaments largely made of tau protein). Shrinkage in brain size Prevalance by age Over 85 years = 45%

Answer 29

**Alzheimer life course** Progressive disease, usually 7 - 10 yr; course, up to 20 years Fatal; a leading cause of death in U.S. after heart disease, cancer, stroke. **Alzheimer Common Early Signs** • Forgetful (repeats question, stories; taking medication; leave stove on) • Trouble balancing checkbook • Getting lost **Advanced Alzheimer** • Difficulty speaking • Unable to recognize family • Loss of bowel and bladder control • Difficulty swallowing, often causing death due to aspiration pneumonia

Answer 30

**Dementia** is deprivation of mind Not a disease, but descriptive term for collection of symptoms involving significant decline in mental functioning caused by factors affecting the brain Multiple possible causes **Senile = old age** **Human brain:** Weighs 2% of body wt; uses 20% O2 & glucose

Answer 31

**Dementia symptoms:** Decline in Cognitive Functions: • Intellectual (Problem solving, judgment) • Memory, Language, & Math • Orientation (person, place, time) • Personality change (e.g., anxiety, agitation, hostility) • Behavior problems (wandering, getting lost, irregular sleep) • Delusions (people stealing, spouse unfaithful) • Hallucinations (e.g., people in house)

Answer 32

**Vascular Dementia** History often includes high BP, vascular disease (e.g., type 2 DM), heart attack Deficits often “focal” or localized Multi-infarct dementia = multiple small strokes Can co-occur with Alzheimer’s 2nd most common cause; up to 20% of cases Stroke most common Usually sudden onset Patient may improve or get worse Worsening usually stepwise ## Footnote

Answer 33

Dementia - Other Causes (Many are treatable) • Medication/Drug reaction • Metabolic imbalance • Endocrine abnormality(e.g.,hypoglycemia) • Nutritional deficiencies (e.g., folate, B12, B6)

Answer 34

**Risk Factors of Dementia:** • Age • Genetics & Family History (not definite) • Smoking (dementia & atherosclerosis) • Atherosclerosis (plaques in artery wall) • Alcohol (increased risk for heavy & non-drinkers) • High LDL cholesterol • Elevated plasma homocysteine (amino acid) • Diabetes, stroke & HTN • Mild cognitive impairment

Answer 35

**Prevention of Dementia:** • Control diabetes • Lower blood pressure • Lower cholesterol • Lower homocysteine (Folic acid, B6, B12) • Control inflammation - long term use of NSAID(s) may prevent or delay onset • Education • Intellectual stimulation (e.g., puzzles, social interaction, learn new things) • Exercise, control weight • Lower stress

Answer 36

**Not Dementia** • Age-related cognitive decline • Mild cognitive impairment • Depression • Delirium (confusion, rapidly changing mental state)

Answer 37

Need folate and B12 ## Footnote Low B6 = hyper homecysteine - bad for alzheimer B6 - vegetables B12 – fatty foods

Exam 3 Review (PPT) Flashcards

(62 cards)