I&E Week 3 Flashcards
(89 cards)
1
Q
Spots on the retina that are an early sign of dry macular degeneration:
A
Drusen
2
Q
When do you need to start treating diabetic retinopathy? What’s the treatment?
A
- Stage 4 (proliferative)
- Laser surgery
3
Q
What’s one reason why a person with no vision loss and good visual acuity might have trouble carrying out ADL?
A
Decreased contrast sensitivity
4
Q
Are PA’s required to report patients that don’t meet the DMV vision standards?
A
Yes
5
Q
What does an audiogram measure?
A
Pitch and volume
6
Q
How do you treat sudden sensorineural hearing loss?
A
Steroids
7
Q
How do cochlear implants work?
A
- Bypass hair cells and stimulate auditory nerve directly.
- Convert acoustic signals into electrical signals
- Useful when hearing aids no longer work
8
Q
Define frailty:
A
- Geriatric syndrome characterized by weaknes, weight loss and low activity that is associated with poor outcomes
- Age-related, biological vulnerability to stressors and decreased physiologic reserves, leading to limited capacity to maintain homeostasis.
9
Q
How does frailty differ from aging?
A
- Frailty is a multi-system dysregulation associated with energy metabolism and neuromuscular changes, leading to weakness, weight loss, and decreased capacity to deal with stressors.
- Aging is similar, but the failure of homeodynamics is global and not just associated with energy and neuromuscular changes
10
Q
PK changes associated with aging:
A
- Decreased total body water and albumin –> increased serum concentration, delayed clearance of lipophillic drugs
- Decreased first pass metabolism –> increased bioavailability of drugs with extensive first pass metabolism
- Decreased GFR –> increased concentration of renally cleared drugs
11
Q
What’s one class of drugs that older patients are more sensitive to?
A
Centrally acting drugs like:
- Narcotics
- Neuroleptics
- Antidepressants
- Benzodiazapenes
12
Q
Define polypharmacy:
A
- Using multiple medications
- Using medications that aren’t clinically indicated or necessary
13
Q
Some reasons for polypharmacy:
A
- Multiple health issues
- Multiple providers
- Transition of care
14
Q
What are some of the implications of polypharmacy?
A
- Increased drug interactions and risk of adverse events
- Increased risk of medication errors
- Patients more likely to suffer falls
- Patients more likely to be on ineffective or high risk medications: e.g., warfarin, digoxin, anticholinergics, benzos, narcotics
15
Q
MOA for dopenezil:
A
Acetylcholinesterase inhibitor
16
Q
MOA for memantine:
A
NMDA receptor antagonist
17
Q
MOA for revastigmine:
A
Acetylcholinesterase inhibitor
18
Q
Why should 1st generation antihistamines be avoided in the elderly?
A
- Highly anticholinergic
- Reduced clearance
- Tolerance
- Increased risk of dry mouth, confusion, constipation, other anticholinergic effects
19
Q
Why should the anti-Parkinsonian drugs benztropine and trihexyphenidyl be avoided in the elderly?
A
- More effective anti-Parkinsonian drugs
- Not recommended for treatment of EPS
20
Q
Why shouldn’t you use TCA’s in the elderly?
A
- Highly anticholinergic
- Sedating and cause orthostatic hypotension
21
Q
Why shouldn’t you use alpha blockers in the elderly?
A
- High risk of CNS effects
- Orthostatic hypotension and bradycardia
22
Q
Why shouldn’t you use antipsychotics for behavior problems related to dementia?
A
Risk of CVA and mortality in patients with dementia
23
Q
Why shouldn’t you use benzos in elderly patients?
A
- More sensitive to them
- Metabolize them more slowly
- Increased risk of cognitive impairment, falls, fractures
24
Q
Is it ok to use zolpidem or other non-benzo hypnotic in older patients?
A
No. Benzo receptor agonists have same effect as benzos.
25
Why shouldn't you use NSAIDS in the elderly if other alternatives are available?
Increased risk of GI bleeding
26
List two sources of inflammation related to aging:
- Lower ATP production in old age leads to a shift towards necrosis and oncosis, rather than apoptosis, as mechanisms of cell death, which leads to cytokine release and chronic inflammation.
- Depleted adaptive (cellular) immunity leads to increased low level activity of innate immunity, leading to chronic inflammation.
27
- Describe some GI changes associated with aging:
| - What are the clinical implications?
- Decreased HCl and GI absorption
- Difficulty swallowing
- Decreased GI motility
- Results in decreased iron, B12, Ca absorption, increased diverticula, constipation, anemia
28
- Describe some kidney changes associated with aging:
| - What are the clinical implications?
- Decreased number of glomeruli and renal tubules
- Decreased kidney size
- Decreased renal blood flow
- Results in decreased GFR, glucose resorption and ability to concentrate urine
29
- Describe some respiratory changes associated with aging:
| - What are the clinical implications?
- Decreased elastin, increased collagen
- Decreased alveolar elasticity
- Decreased intercostal strength
- Results in decreased vital capacity, increased residual volume, lower exercise tolerance
30
- Describe some endocrine changes associated with aging:
| - What are the clinical implications?
- Hypothalamus hormones stay the same, but organ response changes
- Increased fasting glucose, decreased sensitivity
- Nodular thyroid, increased TSH, decreased metabolism
- Increased parathyroid hormone leads to osteoporosis
- Decreased cortisol
- Decreased aldosterone leads to lower BP but higher orthostatic hypotension
31
- Describe some reproductive changes associated with aging:
| - What are the clinical implications?
- Decreased sex hormones leads to decreased muscle mass, increased fat
- Increased vaginal pH leads to risk of urogenital atrophy and bladder infections
32
Describe some of the pulmonary changes associated with immobility:
- Atelectasis
- Aspiration pneumonia
- Decreased ventilation
33
Describe some of the GU changes associated with immobility:
- Bladder calculi and infection
- Urinary retention
- Incontinence
34
Describe some of the metabolic changes associated with immobility:
- Impaired glucose tolerance
- Altered drug PK
- Altered body composition
35
Describe some of the psychological changes associated with immobility:
- Delerium
| - Depression
36
Why should you never use an anticholinergic in a patient treated with dopenezil?
Dopenezil is an acetylcholinesterase inhibitor, which works by increasing acetylcholine in the synaptic cleft. Anticholinergic meds block acetylcholine, which negates the effects of the dopenezil.
37
What is the function of AAA?
- Umbrella organization connecting seniors with community resources
- Advocacy for seniors
- Focus on helping senior stay in their homes and live as independently as possible
38
What is the function of SHIBA?
- Senior Health Insurance Benefits Assistance Program
| - Statewide network of trained volunteers who educate and advocate for people with medicare
39
Describe the Gatekeeper program:
Educates non-mandatory reporters about the signs of elder abuse and neglect.
40
Describe the Family Caregiver Support Program:
- Assists unpaid family caregivers caring for someone 60 or older who is not medicaid eligible.
- Provides case management for the caregiver and possible stipend.
41
Describe the Star Caregiver Program:
Provides support to caregivers of someone with Alzheimer's or dementia
42
Describe the Care Transitions Program:
- Medicare funded program that helps individuals avoid hospital readmission after discharge
- Focus on education to help clients become active in their own health care
43
Describe Oregon Project Independence:
Helps people over 60 who need in-home assistance but who don't qualify for medicaid
44
Describe the PEARLS mental health program:
- Program to Encourage Active Rewarding Lives for Seniors
| - In-home counseling and maintenance (phone) sessions.
45
One reason why citalopram isn't used in older adults:
Possible QT prolongation
46
One reason why paroxetine isn't used in older adults:
Highly anticholinergic
47
Why is mirtazipine (Remeron) a good choice for some patients?
One of its side effects is increased appetite, so a good choice for patients who are undernourished.
48
Leading causes of death and disability in geriatrics:
Death: Cardiovascular dz, cancer, chronic lower respiratory dz
Disability: Arthritis/other MSK, CV dz, hearing/vision loss, dementia, lungs
49
What result in the "get up and go" test suggests an increased risk for falls?
Taking more than 13.5 seconds to complete
50
Immunization recommendations for seniors:
- Flu every year starting at 65
- No live flu vaccine (nasal spray) after 49
- PCV23 once after 65
- Zoster once after 60
- Td/Tdap booster every 10 years, Tdap if contact with infant
51
What sort of diet would you recommend for a patient at risk of macular degeneration?
- Diet rich in green leafy vegetables and fish. - Possibly high dose antioxidant supplements and zinc.
52
Should you order polysomnography for a patient with sundowning symtoms?
No. Not useful for detecting sleep changes in patients with dementia.
53
Does bereavement exclude a diagnosis of depression in the elderly?
No
54
What does DIAPPERS stand for?
Delirium, Infection, Atrophic (urethritis/vaginitis), Pharm, Psych, Excess (output), Restricted (mobility), Stool (impaction)
55
What drugs should you be mindful of when assessing someone's oral health?
- Methotrexate, phenytoin and Ca channel blockers can cause gingival hyperplasia
- Beta blockers, Ca channel blockers, nitrates and progesterone can cause reflux, which erodes teeth
56
Two scales used to screen for alcohol use disorders:
- AUDIT
| - SMAST-G
57
What are the recommendations for alcohol use for seniors?
No more than 1 drink/day if over 65
58
Common neuro findings in geriatric pts with hypothyroidism:
- Dementia
- Ataxia
- Carpal tunnel
- Delayed relaxation of DTR
59
Scales commonly used to screen for malnutrition:
- Mini Nutritional Assessment
- SCREEN
- SNAQ
60
How do you manage DM in older adults?
- A1c
61
Common atypical symptoms of HF in older adults:
Altered sensorium, irritability, lethargy, abd discomfort/GI problems, anorexia
62
Usual medical management of HF in seniors:
- ACE inhibitors
| - Beta blockers
63
Side effects of dopenezil (Aricept):
GI
64
Side effects of tacrine (Cognex):
GI, hepatotoxicity
65
Side effects of galantamine (Razadyne):
GI, SJS
66
Side effects of revastigmine (Exelon):
GI
67
Side effects of memantine (Namenda):
Confusion, restlessness, agitation (can mimic Sx of Alzheimer's)
68
Some meds that can cause QT prolongation:
- Citalopram
- Oxybutynin/Tolterodine
- Haloperidol
69
Side effects of tolterodine (Detrol) and oxybutynin (Ditropan):
- Angioedema
- Anticholinergic effects
- QT prolongation/worsening of cardiac issues
70
What is a Medicare Advantage Plan?
A private company contracts with medicare to provide Part A & B benefits. Usually offer rx drug plans, unlike medicare.
71
Life expectancy of someone in hospice:
6 mo.
72
Young-old
Middle-old
Old-old
65+
75+
85+
73
Difference between gerontology and geriatrics?
Geriatrics (medical science, diseases) falls under larger Gerontology category (understanding aging)
74
Effect of aging on creatinine clearance and serum creatinine:
Decreased creatinine clearance without corresponding rise in serum creatinine because of reduced muscle mass.
75
Crystallized Intelligence vs Fluid Intelligence?
Crystallized Intelligence: "wisdom", well practiced knowledge. stable into 70s-80s
Fluid Intelligence: problem solving in novel situations. gradual declines after 50s
76
Signs of cortical atrophy with aging:
Widened sulci
Narrowed gyri
Thinning of cortical mantle
Ventricular dilation
77
What are the MOLECULAR theories of aging? (3)
Epigenetic/genetic control
Somatic mutation
Error-catastrophe
78
What are the CELLULAR theories of aging? (3)
Free Radical (leads into Mitochondrial Damage theory)
Mitochondrial Damage
Replicative Senescence / Telomere Senescence
79
According to the Telomere Senescence Theory, what is the name of the max number of cell divisions a cell can undergo?
The Hayflick Limit
80
What are the SYSTEMATIC theories of aging? (2)
Wear-and-Tear / Rate of Living (oldest theory, rejected)
| Immunologic
81
What is the only EVOLUTIONARY theory we have to know?
Natural Selection
82
What does BATTED stand for, and when do you use it?
| or BATHED
Use it for ADLs.
```
Bathing/grooming
Ambulation
Transfers
Toileting (or "help toileting" in the case of BATHED)
Eating
Dressing
```
83
What does MASTER stand for, and when do you use it?
Use it for medications.
```
Minimize # of meds
Alternatives
Start low, go slow
Titrate therapy to individual
Educate pt/caregiver
Review meds regularly
```
84
What does SPICES stand for, and when do you use it?
Use it for geriatric syndromes.
```
Sleep disorders
Pain or problems eating
Incontinence
Confusion
Evidence of falls
Skin breakdown
```
85
Classic triad of Alzheimer symptoms?
Memory impairment
Visuospatial problems
Language impairment
86
Severe sensitivity to antipsychotics is suggestive of which type of Major Neurocognitive Disorder?
Lewy Body Dementia (results in dystonic rxns / stiffness)
87
In Lewy Body Dementia, which occurs first: cognitive decline or motor symptoms?
Cognitive decline usually precedes parkinsons symptoms, or follows w/in a year.
88
Which is the only type of dementia that can be distinguished by EEG?
Creutzfeldt-Jakob (shows characteristic triphasic bursts)
89
4 Parkinson motor symptoms?
```
TRAP:
Tremor
Rigidity
Akinesia/Bradykinesia
Postural instability & gait disturbance
(Dx made by bradykinesia + 1 other)
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