Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Medicine for the Elderly > General > Flashcards

General Flashcards

(55 cards)

Start Studying
1
Q

Define ageing

A

Progressive, generalised impairment of function resulting in a loss of adaptive response to disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hw does ageing occur?

A

Random molecular damage during cell replication
Inactivity, poor diet, inflammation increase damage
Reduction in body’s adaptive reserve capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the telomere ageing concept and hayflick limit

A

Progressively shortens with each cell replication, and eventually becomes too short to sustain cell replication
– this then leads to cell senescence

No times a normal cell can divide before division ceases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Defne sarcopenia

A

Age related loss of muscle mass, strength and muscle quality
- presence of low muscle quantity or quality, if also low performace = severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mechanisms of sarcopenia

A

Decr motor units
Decr no. msucle fibres
Incr mucle fibre atrophy

PLUS

Other factors incl:
Nutrition
Hormones
Metabolic/immune
RAAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management sarcopenia

A

Exercise
- improve muscle strength
Medications
- maybe ACEs, vit D, AA supplements
Nutrition
- promote protein synethesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define frailty

A

Loss of homeostasis and resilience
Increased vulnerability to decompensation after a stressor event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define ageism

A

Ageism is unacceptable behaviour that occurs as a result of the belief that older people are of less value than younger people.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Medical component of CGA

A

Problem list
Co-morbid conditions and disease severity
Medication review
Nutritional status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Functioning component of CGA

A

Basic ADLs
Extended ADLs
Activity/exercise status
Gait and balance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Psychological component of CGA

A

Mental status/cognitive function
Mood/depression testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Social/environment component of CGA

A

Informal needs and assets
Social circle
Care resource eligibility & resources
Safety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Main frailty syndromes

A

Off legs (poor mobility)
Falls
Confusion
Continence issues
Polypharmacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a problem list?

A

Like differential diagnoses but lists problems important to pt e.g.
- falls
- confusion
- frailty

Uses syndromes rather than diseases
Delivered at MDT, v pt centred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does acute illness present differently in older people?

A

Atypical/masked presentation
Delayed/wrong diagnosis
Pathophysio response varies
Poor immune response
Comorbidity increases
Inv/management tailored to individual
Med review med reviw med review!!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pathophysiology presentation in older peopl

A

BP drops early
Absent tachycardia response
Temp low, not always high
CRP/WCC may not rise
Fluid balance difficult
Antibiotics prescribe as high risk C diff and resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How can you recognise a pt might be dying?

A

Prog weakness, usually bed bound
Progressive fatigue, eventual unconsciousness
Loss of interest in food/fluid, unable to take oral meds
Changes in breathing, apnoeic spells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

LAST BREATH signs of active dying

A

Lethargy
Altered mental state
Skin changes
Tablets
Breathing changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Treatable conditions that may look like dying

A

Opioid toxicity
Sepsis
Hypercalcaemia
Hypoglycaemia
Uraemia/AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Prioritising comfort in palliative pts

A

STOP
- unnecessary meds e.g. statins
- routine obs
- unused cannulas

START
- anticipatory medicatiosn for dying symptoms

DON’T FORGET
- plan for essential oral meds
- catheter to prevent urinary retention
- approp environment e.g. not ward bay
- holistic/spiritual support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PRN?

A

Pro re nata
- if required
- just in case subcut meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Anticipatory meds in palliative care

A

Pain/SOB - morphine/opioid
Distress/agitation - midazolam
Nausea - levomepromazine
Resp secretions - hyoscine butylbromide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Things to think ab when prescribing opioids as anticipatory med for pain

Study These Flashcards
A

Ensure they have preserved renal function
- high risk of opioid toxicity
Not opioid naive
Check if they’re on background opioid
- use same background as PRN
Switch oral pain meds to syringe driver
Subcut morphine is 2x stronger than oral morphine
- divide by 2 for syringe driver dosing

24
Q

Hydration/fluids at end of life

Study These Flashcards
A

Fluid intake reduces, pts can’t tolerate oral fluids
Very few pts are thirsty at death
Ensure proper mouth care, dry mouth is really common
IV/subcut fluids not really used, risks more than benefits
Trial artificial hydration if distressed by thirst

25
Clincial signs to confirm death
Absence of carotid pulse over 1 min Absence of heart sounds over 1 min Absence of resp sounds/efforts over 1 min No response to painful stimuli e.g. trap squeeze Fixed dilated pupil, no response to bright light
26
Short term anticholinergic side effects
Confusion and hallucinations Tachycardia Blurred vision Urinary retention Constipation Dizziness
27
Long term anticholinergic side effects
Incr risk of dementia
28
Easy drug STOPs in managing polypharmacy
Bleeding ulcer – stop NSAID Kidney failure – stop ACE inhibitor Severe hyponatraemia – stop antidepressant
29
Caution for prescribing DOACs in elderly
Increased drug plasma level so advise dose reduction
30
2 principles of drug absorption
Acidic (<7.35) drugs req acidic environment for absorption - phenytoin, aspirin, penicillin Basic drugs req basic environment for absorption - diazepam, morphine, pethidine
31
Changes affecting drug absorption in old peopl
Increased gastric pH, decrease small bowel surface area - basic drugs will absorb more - important if prev GI surgery, NJ tube, transdermal patches Think about method of delivery
32
2 main transporter molecules
Albumin (Basic) binds to acidic drugs Alpha-1 Acid Glycoprotein (acidic) binds to basic drugs
33
Why is it important to think about distribution in older pts?
Elderly often low albumin but higher A-1 AG - incr binding of basic drugs and incr basic environment as well Incr fat compared to muscle - incr vol distribution of lipophilic drugs
34
Define volume of distribution
Theoretical volume into which all of drug is fully dissolved in plasma Indicates lipophilicity of drug - high Vd means stays in fatty tissues of body e.g. if 100mg drug given at 0.1mg/L 0.1mg = 1L 100mg -> 1000L Vd
35
Define half life
Time for drug concentration to fall to half of its maximum concentration - limited clearance by liver or renal system causes longer half-life, more common imapairment in older people
36
Why is owe body water significant in older pt prescribing?
Lower VD of hydrophilic drugs (e.g Lithium, Digoxin)
37
Half life if lower Vd and CrCL
Unchanged esp in elderly - caution in renal problems e.g. CKD/AKI
38
How does liver function affect first pass metabolism?
Reduces liver function (due to size, blood flow, disease) causes reduced first pass metabolism (mainly phase 1) Older pts rely on phase 2 metabolism, break down drug more slowly in liver, more likely hepatotoxicity
39
General principle on dosing in elderly people
Lower doses achieve same effect in the elderly (common e.g. alcohol) Some effects e.g. beta blockers are decr (START LOW GO SLOW)
40
Key drugs with narrow therapeutic index
Theophylline Vancomycin Warfarin Phenytoin Lithium Cyclosporin Digoxin Carbamazepine Gentamicin Levothyroxine
41
Therapeutic window in elderly people
More narrow - beware of drugs with narrow therapeutic index
42
Managing common drug side effects (opiod, steroid, levothyroxine)
Opioid - begin laxatives prophyllactically Steroid - bone protection, monitor blood sugars for diabetes Levothyroxine - no calcium, interferes with absorption
43
Antibiotic prescribing in elderly people
Use as narrow-spectrum antibiotic as possible Only use if confirmed infection/pos cultures Risks of resistance and C.diff as a result of broad-spectrum wiping out microbiome - low body water mass and reduced kidney injury in diarrhoea will cause crazy bad AKI
44
Changes to bladder control in elderly
Decr in - bladder capacity - urethral closure pressure Incr in - post void residual vol - detrusor overactivity
45
Key transient causes of incontinence
Delirium Infection – Urinary (symptomatic) Atrophic urethritis/vaginitis Pharmaceutical/Prostate Psychological, especially depression Endocrine (or excess fluid intake/output) Restricted mobility Stool impaction
46
5 types of urinary incontinence
Stress Urge Mixed Overflow Functional
47
Examinations in incontinent pt
General appearance – including BMI General mobility General Cognitive examination Abdominal examination Pelvic examination Urinalysis?
48
Investigations for urinary incontinence - after bladder diary
Post void bladder scan Bladder Diaries Consider PSA, U&Es, glucose Urodynamic studies (conservative management first)
49
Management stress vs urge incontinence
Stress - pelvic floor exercise Urge/mixed - bladder training
50
Pharm management urge incontinence
3 month trial conservative 1st line - tolteridine 2mg bd 2nd line - solifenacin 5mg once daily 3rd line - mirabegron 50mg once daily
51
Management nocturia
Late afternoon diuretic Desmopressin (not with HT, heart disease, watch sodium levels)
52
When to refer to specialist in incontinence?
Symptomatic prolapse at or below introitus Microscopic haematuria aged >50 Frank haematuria Recurrent or persisting UTI Suspected malignant mass Chronic retention Men with stress UI Failure of conservative Rx
53
Indications for catheters
Unable to manage self cath Med management failed, surgery not appropriate Skin wounds/pressure sores contaminated by urine Pts distressed by changes of bed linen/clothing
54
Exertional syncope preceding a fall?
Aortic stenosis - ejection systolic (slow rising pulse, low cardiac output)
55

Medicine for the Elderly (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions