Test 1

Question 1

NSAIDs

Answer 1

Mainly used for arthritis, pain, inflammation
Clinical use: Anti-inflammatory, antipyretic, analgesic

Adverse effcets: GI bleeding, impaired renal function, platelet inhibition, decreased effects of antihypertensive drugs

Question 2

Acetaminophen

Answer 2

Analgesic of choice for elderly
Antipyretic and analgesic normal dose is 4g but 2-3 g for elderly

Reduces hepatic function

Question 3

Sedatives
(Benzodiazepam)

Answer 3

Benzodiazepams depress the CNS increase chances of falls
Diazepam (long half life of 80 hours in elderlyt and 20 hours in young) and Lorazepam

Lorazepam is the drug of choice for elderly

Question 4

Barbiturates
Phenobarbital

Answer 4

Prolonged half life and causes drowsiness and CNS depression
Warfarin metabolism increases with barbiturate

Question 5

Chloral hydrate

Answer 5

treatment of insomnia

Question 6

Anticonvulsants
Block Na channels

Answer 6

Carbamazepine - Liver toxicity
Phenytoin - Gingival hyperplasia
Valproic acid -Hepatotoxicity

Question 7

Orthostatic hypotension

Answer 7

Drop in systolic blood pressure by 20 mm Hg due to blood pooling in the legs due to gravity

Question 8

Antibiotic prophylaxis to prevent bacterial endocarditis

Answer 8

Amoxicillin 2g
Cephalexin 2g
Clindamycin 600mg

Question 9

Abuse vs Neglect

Answer 9

Abuse- Omission of acts which threaten the well being of an older person

Neglect- Omission of acts that maintain an older person’s well being

Question 10

Geriodontics

Answer 10

Deals with knowledge, attitude and technial skills required in provision of oral health care to older adults

Question 11

Causes of death amongst elderly

Answer 11

Heart disease 33%
Malignant neoplasm 21%
Berbrovascular 8.2%
Chronic respiratory 5.9%
Pneumonia 3.3%
Diabetes 2.9%
Alzheirmer’s 1.7%

Question 12

Teeth

Answer 12

1. Occlusal attrition
2. Pulpal fibrosis (decreased number and size of fibroblasts) due to a persistent connective tissue sheath in an increasingly narrow pulp space
3. Decreased cellularity -acellular and dehydrated dentin

4.Root surface caries
-Gingival recession
-Salivary gland dysfunction
-Less oral hygiene
-Diminished oral motor function

Question 13

Dry mouth can be due to

Answer 13

1. Systemic diseases
2. Medications
3. Radiation therapy

Question 14

Aging theories

Answer 14

Aging- irrevrsible time dependent changes which occur in biological systems once peak vatilality has been reached

Error catastrophe- protein synthesis
Cross-linking- nucleic acids and proteins
Wear and tear- body
Immune function impairment
**Waste product accumulation **
**Pacemaker **
**Genetic theories **

Question 15

Two theories of aging

Answer 15

1. External- environmental factors such as radiation, pollutants, nutritional status and disease are the cause of aging
2. Internal- changes in DNA, failure of the immune system, inability to detoxify harmful substances resulting in aging

Question 16

Molecular Basis of aging

Answer 16

1. Genetic linkage to the age of mother:

2. Late acting deleterious genes:
– aging is the result of random accumulation of deleterious mutations in the DNA
3. Codon Restriction:
– Fidelity/accuracy of mRNA translation is impaired due to inability to decode codons in mRNA

4. Error Accumulation:
– Fidelity of gene expression declines with age, resulting in increased
fraction of abnormal proteins
5. Somatic Mutations:
– Accumulation of molecular damage, primarily to DNA/genetic material
6. Gene Regulation:
– Aging caused by changes in gene expression regulating both aging and
development

Question 17

Cellular Basis of Aging

Answer 17

1. Wear and tear:
– due to accumulation of normal injury that cannot be repaired e.g. resorbed bone, neurons etc.

2. Accumulation of free radicals:
– Oxidative metabolism produces highly reactive free radicals that subsequently damage protein and DNA.

3. Protein cross‐linking:
– changes in properties of protein may cause aging. For example cross‐linking of proteins can occur due to presence of heavy metals
– collagen and elastin can be cross‐linked resulting in loss of strength of connective tissue and destruction of tissue elasticity

4. Lipofuscin Accumulation:
– also called the “age pigment’
– consists of large amount of lipid and accumulates in the cell
– this decreases the functional capacity of the cell

5. Alterations in DNA methylation:
– A global decrease in 5‐methyl‐cytosine levels is commonly observed in aging
cells
– hypomethylation may contribute to chromosomal instability and to increased
expression of selected genes

Question 18

Systemic Basis of Aging

Answer 18

• 1. Accumulation of toxic materials:
  – increase in amount of toxic substances in the body.
  – For example, due to reduced liver function.
• 2. Accumulation of Fat:
  – abnormal deposition of fat can occur within cells (mostly liver)
  – impairs liver function
• 3. Endocrine changes:
  – Alterations in neuroendocrine control of homeostasis results in
  age‐related physiological changes.
  * 4. Immune system changes:
  – decline in immune competence with age
  – increased incidence of disease
  – development of autoimmunity
  * 5. Faulty Nutrition:
  – failure to supply essential amino acids in the diet can result in not
  being able to synthesize essential building blocks (e.g. proteins,
  neurotransmitters etc.)

Question 19

Aging and bone/mineral metabolism

Answer 19

With age there is a progressive decrease in
the active vitamin Ddependent calcium
absorption from the GI tract

Question 20

Aging and the Nervous System:

Answer 20

Brain is the ideal system to study the effects of aging (no new nerve cells formed
after 6 months)

Our brains shrink as we age, losing 5 to 10% in weight between the age of 20 and
90 years

The number of dendrites and dendritic spines decrease with age

Neurotransmitter synthesis and the receptors for these chemicals are reduced and/or changed with age

Extracellular plaques appear in certain regions of the brain (e.g. hippocampus, amygdala etc.)

Number of glial cells increases with age