SPECONLEC_S1_L3 - P14-P29 Flashcards by Andre Neri Valencia

Reaction to drugs is always the same as in younger
age groups t or f

f, Reaction to drugs not always the same as in younger age groups

How well did you know this?

Not at all

Perfectly

MEDICATION METABOLISM: Adverse effects
more frequent and may be more severe t or f

How well did you know this?

Not at all

Perfectly

adipose tissue causes larger
volume of distribution for fat-soluble drugs

inc

How well did you know this?

Not at all

Perfectly

increased adipose tissue leads to _

prolonged biologic
half-life

How well did you know this?

Not at all

Perfectly

More diffused in the body for meds means

more fat stored in the body

How well did you know this?

Not at all

Perfectly

Decreased total body water means that the meds are_

decreased volume of distribution of water-soluble

How well did you know this?

Not at all

Perfectly

Since the hydration is low, you would expect
(inc or decrease) volume of water

decrease

How well did you know this?

Not at all

Perfectly

low hydration means there will be
concnetration of drugs

higher

How well did you know this?

Not at all

Perfectly

more concentrated drug means _

more potency and adverse effects of drug

How well did you know this?

Not at all

Perfectly

Hepatic drug clearance decreased up to what percent

30%

How well did you know this?

Not at all

Perfectly

Renal clearance decreased up to what percemt

50%

How well did you know this?

Not at all

Perfectly

decrease in renal and heaptic clearance means that _

longer duration of drug in the body

How well did you know this?

Not at all

Perfectly

GAIT: speed,
double limb support, stride length

dec, inc, shorter

How well did you know this?

Not at all

Perfectly

gait is affected by:

vision,
cognition,
motor control,
balance,
peripheral sensation,
strength,
joint health,
metabolic demands

How well did you know this?

Not at all

Perfectly

predictor of survival, possibly a biomarker of
health status in older adults

Gait speed

How well did you know this?

Not at all

Perfectly

If able to walk faster > what are the chances of survival

more chances of survival

How well did you know this?

Not at all

Perfectly

If slower than normal >what can be the prognosis

poor prognosis

How well did you know this?

Not at all

Perfectly

Indicators of gait speed: what are the OMTs to be used

6-minute walk test
(6MWT)

How well did you know this?

Not at all

Perfectly

gait speed that has relatively good function

1.0 m/sec

How well did you know this?

Not at all

Perfectly

gait speed for predicitng median life expectancy for age &
sex

0.8m/sec

How well did you know this?

Not at all

Perfectly

CONDITIONS & DISEASES IN THE ELDERLY (16)

frailty
disuse and immobilization
falls
osteoarthritis
osteopenia and osteoporosis
hip fx
stroke
TBI
SCI
dementia
delirium
normal pressure hydrocephalus
parkinson disease
amputation
cancer
polypharmacy

How well did you know this?

Not at all

Perfectly

Age and disease-related loss of adaptation, such that
events of previously minor stress result in disproportionate
biomedical and social consequences

FRAILTY

How well did you know this?

Not at all

Perfectly

Clinical Syndrome for frailty (5) (US WSL)

○ Unintentional weight loss of at least 10 lb over the
past year
○ Self-reported-exhaustion
○ Weakness (grip strength)
○ Slow walking speed
○ Low physical activity

How well did you know this?

Not at all

Perfectly

Clinical Syndrome should have how many to be considered
as frailty

3 or more

How well did you know this?

Not at all

Perfectly

frailty can be attributable to _ _ _

aging, diseases, and comorbidity

Exacerbates decline in body systems

DISUSE AND IMMOBILIZATION

DISUSE AND IMMOBILIZATION is a combination of _ + _

inactivity, lack of mechanical loading

Combination of inactivity and lack of mechanical loading lead to _

negative effects of bed rest

what will pt lose if he is predosposed to disuse and immobilization

● Loss of muscle mass ● Loss of strength and power

disusue and immobilization: muscle insulin resistance

increased

disusue and immobilization: bone loss

increased

disusue and immobilization: pulmonary function and exercise capacity

decreased

Inability of blood vessels to adapt

there is _ venous return in OH

low

Impaired balance and coordination for disuse and immob t or f

Increased/decreased risk for pressure ulcers for disuse

increased

Low nutrition can contribute to pressure ulcers t or f

Immobility from bed rest, predictor of decline in ADLs, institutionalization & death in hospitalized older patients

DISUSE AND IMMOBILIZATION

as you age, there's lower physiological capacity is lower t or f

Major cause of morbidity

falls

falls causes the majority of fx of the _ _ _

foreamr, pelvis, hip

Risk factors for falls in the elderly (8)

○ Age ○ Physical impairments ○ Cognitive impairment, dementia, depression ○ Previous falls ○ Medications ○ Comorbid conditions ○ Chronic pain & arthritis ○ Poor functional status

RECOMMENDATION for fall and injury prevention in the elderly (9)

● Fall risk assessment by qualified healthcare professionals or teams ● Individualized, group, and home-based exercise ● Balance, strength, & gait training exercise (e.g tai chi) ● Home safety evaluations and modifications ● Medication review and reduction program with family physician & patient involvement ● Careful, medically directed tapering of high-risk medications ● Addressing foot/ankle pain and dysfunction ● Treating vitamin D deficiency (at least 700 international units per day) ● Cataract surgery and dual chamber cardiac pacing if indicated.

in treating vitamin D deficiency, how many international units per day

at least 800 internaltional units per day

Criteria for falls

berg balance scales

OSTEOARTHRITIS is common amoong older adults t or f

Most common affected in OA

hands and knees

what are the signficant source of pain and disabilitty for OA

hips and spine

_ can lead to spinal stenosis which can cause _

Disc desiccation,nerve root impingement

Risk factors. for OA (4)

obesity, genetics, inadequate nutritional content, muscle strength

Low bone density

OSTEOPENIA AND OSTEOPOROSIS

OSTEOPENIA AND OSTEOPOROSIS is more comon in _

postmenopausal women

men can also get osteopenia or osteoporosis t or f

inc or dec? risk for fractures leading to pain, immobility, and functional dependence

increased

bone mineral density score -01.0 and 2.5

Osteopenia

bone mineral density T score -2.5 or less

Osteoporosis

Risk factors for osteopenia and osteoporosis

increasing age, family hx, glucocorticoid therapy, smoking

HIP FRACTURES are also more common in older adults t or f

hip fx is associated with _ _ _

increased mobility, mortality, and health care use and cost

HIP FRACTURES result in _ _

long-term disability and increased functional dependence

Not all elderly are recommended for hip arthroplasty t or f

Risk factors for hip fx

falls, associated risks of falls, osteoporosis, skeletal fragility

Rehab should emphasize weight-bearing as soon as possible with goals of pain control & early loading while avoiding fracture dislocation & implant failure t or f

Rehab should emphasize _ as soon as possible with goals of pain control & _ while avoiding fracture dislocation & implant failure

WB, early loading

Leading cause of acute neurologic admissions to hospitals and death

stroke

Health outcomes are worse among older adults because of age-related comorbiditiess and frailty

STROKE

Rehab begins in the _ setting for stroke

acute

what interventions for stroke?

Strengthening, ROM, spasticity management, low-vision, cognitive, and urinary incontinence interventions can be performed

Risk factors for stroke:

previous stroke, transient ischemic attack (TIA), HtN, hyperlipidemia, heart disease, DM

TRAUMATIC BRAIN INJURY: age

>75 y/o

highest incidence of hospitalizations and death is d/t _

TBI

traumatic brain injury is more attributable to _ than MVA

falls

_ outcomes assoc. with increasing age for TBI

poorer

Risk factors for TBI

physical and cognitive impairments

Loss of bone mass and changes in body composition increase risk for _

SCI

Traumatic SCI likely d/t _

falls

Nontraumatic SCI attributable to _

cervical or lumbar spinal stenosis

Nontraumatic SCI attributable to cervical or lumbar spinal stenosis d/t

degenerative joint processes disc herniation, or mass effect from hematoma or tumor growth

Spinal stenosis is degenrative t or f

First-year survival is bad in SCI t or f

f, First-year survival is good

Mortality rates increase dramatically with age in SCI t or f

Group of symptoms that affect the patient’s daily function

DEMENTIA

dementia affects

Executive cognitive dysfunction, memory impairment, mood, personality, and behavior changes

Reversible causes of dementia

SDH NPH depression, hormonal imbalances, drug and alcohol abuse, vit D Deficiency

Irreversible causes of dementia

alzheimer’s, parkinson’s, huntington’s disease, AIDS, repeated neurovascular insults, severe or repetitive TBIs

Early identification for dementia is critical t or f

Mild cognitive impairment (MCI), clinically identifiable precursor to AD

DEMENTIA

dementia isnt noticed immediately t or f

Hallmark of Alzheimer’s:

plaques are seen in MRI – point of no return

dementia pts need to start early c increased physical activity: how many minutes per week

150 mins of moderate physical activity and resistance exercises

Acute neurocognitive disorder

DELIRIUM

delirium is _ and _

transient, reversible

delirium occurs more commonly among the elderly t or f

Diagnostic criteria of delirium

○ Disturbance in attention and awareness that develops over a short period of time and waxes and wanes during the course of the day ○ Disturbances in cognition ○ Disturbances in attention and cognition are not better explained by a pre-existing neurocognitive disorder ○ Evidence that the disturbance is directly d/t a pathophysiologic process such as a medical condition or drug-related toxicity

treatment for delirum:

Treatment is pharmacologic & should be referred back to MD