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Flashcards in Monster mash Deck (43):
1

Out of the 54,000 people that died in scotland in 2010 what percentage where:

in hospital

in a hospice

at home

60% hospital

4% hospice

36% at home

2

What are the 10 key elements in the care of the dying?

  1. recongition that the patient is dying
  2. communication with the patient
  3. spiritual care
  4. anticiapte prescribing for pain and agitation
  5. review clinical interventions
  6. hydration review
  7. nutritional review
  8. full discussion of care plan with patient and relatives
  9. regular reassessment of the patiendignified and
  10. respectful care after death

3

How do you diagnose dying?

Worsening weakness and preformance

worsening physiological status

struggling to manage oral medicines

losing intrest in food and fluid

sleeping more, eventual unconsciousness

4

How is morphine used in the elderly?

Oramorph 2.5mg twice daily as background analgesia

 

plu oral immediate release morphine for breakthrough pain

 

Laxative also required and maybe an antiemetic

5

How do you work out the breakthrough dose required?

 

1/6 of the daily dose

6

What provides subcutaneous access for syringe drivers?

Butterfly needle with connector tubing

7

Whats the difference between giving oral morphine and morphine from a syringe driver?

SC dose is twice as powerfull so you have to give half as much

8

In end of life care what do you prescribe for Pain?

Morphine

9

In end of life care what do you prescribe for distress?

Midazolam

10

In end of life care what do you prescribe for nausea/agitation?

Levomepromazine

11

In end of life care what do you prescribe for respiratory secretions?

Buscopan

12

What are the three different types of strokes?

Haemorrhage

Subarachnoid haemorrhage

Infarct

13

How do you treat acute stroke?

Thrombolysis

14

What are the different classes of haemorrhagic stroke?

Structural abnormality

Hypertensive

15

What are the different classes of infarct stroke?

Atheroembolic

Small vessel

Cardioembolic

Other

16

What is the difference between cardioembolic stroke and atheroembolic stroke?

Cardioembolic- fibrin dependant (red thrombus)

 

Atheroembolic- platelet dependent (white thrombus)

17

What are the principles of investigations in stroke care?

find infarct/haemorrhage

 

aeitiology of stroke

 

risk factors

18

What is ageing?

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

19

What is a telomere?

A loop at the end of each chromosome arm.

 

Gets shorter with each replication untill it can no longer replecate

20

What is the Hayflick limit?

The point at which your telomeres would no longer be able to replicate.

( not normally a limiting factor)

21

What is Telomerase?

A ribnucleoprotein that can re-extend telomeres.

 

Found in stem cells and immune cells etc

22

What are the 4 cellular responses to cell damage?

Repair

Apoptosis

Senescence

Malignant transformation

23

What is the disposable soma theroy ?

After you reproduce you arent much use.

 

No point in repairing yourself, you are better off saving energy and resources so that your kids can make use of them

24

What is the antagonistic pleiotropy theroy of ageing?

Genes act like timebombs

 

they are usefull early but turn out to be shit when you are old

25

How common in are falls in older people?

 

65s

80s

65s- 30% each year

80s- 50% each year

26

What is involved in a Falls Assessment?

History

Examination including gait and balance

 

establish all risk factors

 

targetted investigations and MDT assessment

27

What questions do you ask to screen for falls?

Have you had 2 or more falls in the last 12 months?

 

Have you presented acutely with a fall?

 

Do you have problems with walking or balance?

28

How do you measure lying and standing BP?

1st BP after lying for 5 minutes

2nd BP after standing in the 1st minute

3rd BP after standing for 3 minutes

29

How often do you have to do strength and balance training to get a benefit from it?

3x a week for a minimum of 12 weeks

30

What are the two principles regarding absorption and pH?

Acidic drugs require acidic enviroments

 

Basic drugs require basic enviroments

31

So in what cases would acidic drugs struggle to be absorbed?

Decreased gastric acid levels or shortined small bowel surface

 

GI surgery

NG tube or PEG fed

 

32

Give examples of acidic drugs

Phenytoin

Aspirin

Penicillin

33

Give examples of basic drugs

Diazepam

Morphine

Pethidine

34

What happens to lipophylic drugs in older people?

Increased fat to mucles mass ratio

 

Increases half life

35

What must you remember about hepatic metabolisim of drugs in older people?

Its probably going to be reduced

36

What is a good general prinicple to remember regarding pharmacodynamics in older people?

Lower doses achieve the same effect in older people

37

In older people is the therapeutic window usually larger or smaller than in young people?

Usually smaller

38

What is a NNT ( Number needed to treat)

NNT tells you how many people need take a treatment for a given amount of time to prevent one event

39

what are the buzzword meds for side effects?

Sedatives

Acid-suppressant drugs

Antipsychotics

Antiplatelets

ACE/ARB/diuretics

NSAIDs

Opioids

Anticholinergic medications

40

What are the 4 characterisitcs of Lewy body dementia?

Visual hallucinations

Fluctuating cognition

REM sleep disorder

Movement problems

41

What is the borderline for a worrying addenbrooks score?

Below 80 ish

42

"medial temporal lobes dont take up the x-ray tracer" 

 

what type of dementia is this?

Alzhemiers 

43