Year 3: Ageing Flashcards

Physiology, Vaccinations, Screenings, Sarcopenia, Falls, Delirium, Drugs, Palliative Care (57 cards)

1
Q

In elderly albumin

A

Decreases

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2
Q

In elderly alpha acid glycoprotein

A

Increases

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3
Q

In elderly acidic drugs

A

Work better (due to decreased albumin, as it binds acids)

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4
Q

In elderly basic drugs

A

Have decreased action

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5
Q

In elderly stomach acid

A

Decreases

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6
Q

In elderly body water %

A

Decreases

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7
Q

In elderly the GFR is

A

Decreased

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8
Q

In elderly the therapeutic window for drugs is

A

Decreased

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9
Q

A tool to use in elderly for prescribing

A

STOP START tool

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10
Q

In elderly lipids are

A

Increased

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11
Q

Lipophilic drugs have an

A

Increased half life (due to increased lipids)

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12
Q

Infuenza vaccination is given to

A
  • Ages 65 +
  • Once per year
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13
Q

Pneumococcal vaccination is given to

A
  • Ages 65+
  • As a once off
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14
Q

Shingles vaccination is given to

A
  • At age 70
  • As a once off
  • “Varicella zoster”
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15
Q

Abdominal Aortic Aneurysm

A
  • Ages 65+
  • USS
  • 3-4.4cm = annual screening
  • 4.5-5.4cm = 3 monthly scan
  • >5.4cm = refer for an operation
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16
Q

Colorectal cancer (bowel) screening is for

A
  • Ages 50-75
  • Every 2 years
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17
Q

Breast cancer screening is for

A
  • Ages 50-70 (women)
  • Every 3 years
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18
Q

Age-related loss of muscle mass and function

A

Sarcopenia

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19
Q

Muscle mass declines from

A

Age 30

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20
Q

Muscle mass degradation accelerates at

A

Age 60

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21
Q

Sarcopenia happens due to

A
  • Decreased sex hormones (oestrogen)
  • Increased apoptosis
  • Increased mitochondrial dysfunction
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22
Q

3 pharmacological interventions for elderly people

A
  • Creatine/ protein supplements + weight exercise
  • ACE Inhibitors (reduce inflammation and increase mitochondrial function)
  • Ca2+ and Vit D (for bone strength)
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23
Q

Diagnosis of postural hypotension

A
  • Systolic is <90mmHg
  • Systolic has reduced by >20mmHg
  • Diastolic has reduced by >10mmHg

Measure after 3 mins of standing up

24
Q

Management of falls

A
  • Stop medications if underlying cause
  • Treat underlying cause
  • Strength and balance training (3/7 for 12/52)
  • Attend hobbies like Tai Chi
25
Triad of Delirium
* Disturbance in attention "Disoriented" * Change in cognition "Disorganised thinking" * Acute and fluctuating course
26
Pathophysiology of Delirium
* Derangement of ACh * Caused due to stress *
27
Two types of Delirium
* Hyperactive * Hypoactive *
28
Hyperactive
* Aggitated * Aggressive * Wandering
29
Hypoactive
* Withdrawn * Apathetic * Sleepy
30
Assessments of Delirium
* 4AT * CAM Assessment
31
4AT
* Alertness * Attention: Months of the year backwards * Acute and fluctuating * AMT4 (Acute mental test): Age, DoB, Place, Year
32
What should you always do in delirium
* Reassure * Re-orientate * Help patient with sensory aids etc
33
1st line treatment for Delirium
Haloperidol (Typical antipsychotic)
34
Haloperidol is contraindicated in
Patients with Parkinson's Disease and Lewy Body Dementia
35
2nd line for Delirium
Quetiapine (Atypical antipsychotic)
36
3rd line for Delirium
(Lorazepam) BZD
37
1st line for Delirium in Parkinson's and LBD patients
Quetiapine
38
1st line for Delirium in Alcohol Withdrawal
Lorazepam (BZD)
39
If you prescribe Opioids
Prescribe Laxatives alongside this (due to side effect of constipation from opioids)
40
If you prescribe Steroids
Prescribe * Biphosphonates * Vit D * Ca2+
41
Side effects of bisphosphonates
Necrosis of jaw
42
Side effects of levothyroxine
Hypocalcaemia
43
If prescribing antiplatelets or SSRIs
Then prescribe PPIs * Antiplatelets can increase GI bleeds * SSRIs can increase stomach acid
44
Do not prescribe Metoclopramide in
Parkinson's patients * Metoclopramide is a D2 receptor antagonist
45
In Heart failure or post-MI prescribe
ACE inhibitors
46
In elderly patients suffering from Osteoarthritis
Switch NSAIDs for Paracetamol
47
The truth about statins and the elderly
They take years to actually work... and they area long-term prophylactic- so whats the point? They interfere with a lot of shit Not indicated for use \> age 75
48
Palliative care for pain/SOB
Morphine
49
Palliative care for distressed patients
Midazolam
50
Palliative care for nausea
Levomepromazine
51
Palliative care for trouble with respiratory secretions
Buscopan
52
Morphine (oral) is
10 times the strength of Codeine (15mg of Codeine = 1.5mg of Morphine)
53
Morphine (SC) is
twice the strength of Morphine (oral) (2mg of Morphine (oral) = 1mg Morphine (SC))
54
Oxycodone is
twice the strength of Morphine (oral) 2mg of Morphine (oral) = 1mg Oxycodone
55
Oramorph is
of similar strength to Morphine (oral) but is **immediate release**
56
Oramorph is used for
* Breakthrough pain * It is taken PRN * Is 1/6th the dosage of background dosage
57
7 steps of a death certificate
1. Check for spontaneous movement 2. Check for reaction to voice and pain 3. Palpate 2 major pulses for 1 min 4. Inspect eyes (fixed, dilated, absence of corneal reflex, dry) 5. Auscultate heart and lungs for 1 min 6. Check for implantable devices 7. Record date and time of death