Ageing Flashcards
what is sarcopenia?
loss of muscle mass and function as a result of ageing
why can silent MIs occur in older people?
may have some degree of autonomic nervous system dysfunction
why do old people suffer from hypothermia more often than younger people during illness?
because old people suffer more from gram negative bacteria- can cause hypothermia
what are the 5 broad spectrum antibiotics with a high C. diff risk?
- cephlasporins
- co-amoxiclav
- ciprofloxacin
- clindamycin
- clarithromycin
what is the SEPSIS 6 protocol?
GIVE -oxygen -antibiotics -fluids TAKE -bloods for culture -bloods to measure lactate -measure urine output
where are telomeres found?
the end of each chromosome arm
what happens to telomeres with each cell replication?
progressively shorten
what happens when a telomere becomes too short to sustain cell replication?
cell senescence
what is a hayflick number?
a number which represents the maximum number of times a cell can divide (ie before telomeres become too short)
why can stem cell undertake continuous replication?
they contain telomerase which re-extends shortened telomeres
what are the 4 main cellular responses to damage?
- repair
- apoptosis
- senescence
- malignant transformation
at what age does muscle mass start to decline?
around 30 years old
what is sarcopenic obesity?
when sarcopenic wasting of muscles is combined with an infiltration of fat into the muscle
compare primary and secondary sarcopenia?
primary: sarcopenia is solely related to age
secondary: sarcopenia is due to contibuting factors in addition to age
what metabolic condition can arise as a consequence of sarcopenia?
insulin resistance and diabetes
what is the only proven intervention for sarcopenia?
exercise
- resistance training
- aerobic training
what is the suggested physical activity levels for people over 65?
same as target for 18-64
150 minutes of moderate intensity activity a week
or 75 minutes vigorous activity a week
strength and balance work twice a week
how does a syringe driver administer medicines?
continuous subcutaneous infusion
what is the access for a syringe driver?
butterfly needle with connector tubing
how many medicines can be mixed in a syringe driver?
up to 3
what is a stroke?
rapidly developing symptoms or signs of focal or global loss of brain function lasting longer than 24 hours with a vascular cause
compare a transient ischaemic attack to a stroke?
symptoms last less than 24 hours
what are the 3 types of stroke?
- haemorrhage
- subarachnoid haemorrhage
- infarct
what are the 4 classification of an infarct stroke?
- cardioembolic
- atheroembolic
- small vessel disease
- other
compare cardioembolic and atherembolic strokes?
cardioembolic: fibrin dependent- red thrombus
atheroembolic: platelet dependent- white thrombus
what is the frontal lobe responsible for?
personality
emotional response
social behaviour
what is the dominant parietal lobe responsible for?
calculations
language
planned movement
appreciation of size, shape, weight and texture
what is the non-dominant parietal lobe responsible for?
spatial orientation
constructional skills
what is the occipital lobe responsible for?
analysis of vision
what is the dominant temporal lobe responsible for?
auditory perception
speech and language
verbal memory
smell
what is the non-dominant temporal lobe responsible for?
auditory perception
music
non-verbal memory
smell
what investigations will reveal the presence of a stroke? (infarct/haemorrhage)
CT scan
MRI scan
what is the acute management of a stroke?
thrombolysis/thrombectomy imaging swallow assessment antiplatelets stroke unit care
what is the time limit for IV alteplase/tissue plasminogen activator (tPA)?
within 4.5 hours from onset of symptoms
when is endovascular therapy used for the treatment of strokes?
- alternative/additional therapy for patients who respond poorly to thrombolysis
- if patient cannot have thrombolysis due to very high bleeding risk
what class of drugs are used as secondary prevention for a cardioembolic stroke?
anticoagulants
what class of drugs are used as secondary prevention for ischaemic, non-cardioembolic strokes?
antiplatelets (first line clopidogrel)
what scoring system calculates the risk of strokes in a patient with AF?
CHA2-DS2-VASC score
at what CHA2-DS2-VASC score is antithrombotic therapy recommended?
1- oral anticoagulant or aspirin
2 or more (or 1 major)- oral anticoagulant
what is the 1 month, 6 month, 1 year mortality rate after a hip fracutre?
1 month- 10%
6 months- 20%
1 year- 30%
what is the most common valvular heart disease?
aortic stenosis
why can aortic stenosis lead to falls?
reduced cardiac output, reduced brain perfusion leading to syncope
compare the falls assessment tools ‘Berg Balance Test’ and ‘Tinetti Score’?
berg balance test only assesses balance, tinetti score also assesses gait
when the timed up and go test (TUG) is longer than what time does the falls risk increase?
20s
what is the evidence based treatment for falls?
-strength and balance training
(minimum three times per week for 12 weeks)
-environmental modifications
-medication review
-calciuim/vit D supplements if vit D deficient
what BP measurements should you take in a patient presenting with falls?
lying and standing BP
what is delirium?
acute change in cognition and attentitivity which tends to fluctuate
what is the time period of the cognition change in delirium?
hours to days
compare the onset of dementia, delirium and depression?
dementia- slow, insidious
delirium- sudden
depression- abrupt with life changes
compare the course and reversibility of dementia, delirium and depression?
dementia- progressive, irreversible
delirium- fluctuating, usually reversible
depression- worse morning, reversible with treatment
what are the types of delirium?
hyperactive delirium
hypoactive delirium
mixed type
what are 10 predisposing factors to delirium?
- age
- pre-existing dementia
- co-morbidities
- post-op
- terminal illness
- sensory impairment
- polypharmacy
- depression
- alcohol dependency
- malnutrition
what are the 2 subtypes of dementia?
- Alzheimers
- vascular
what are the 4 main hallmarks of delirium?
acute and fluctuating
inattention
altered level of consciousness
disorganised thinking
what does the 4AT tool for delirium assess?
- alertness
- AMT4 (simple questions)
- attention
- acute change/fluctuating course
if medication is needed in delirium, what is first line?
haloperidol
when is haloperidol contraindicated in delirium?
alcohol withdrawal
parkinsons disease
if medication is needed in a patient with parkinsons with delirium, what is first line?
quetiapine
if medication is needed in a alcohol withdrawn patient with delirium, what is first line?
benzodiazepines (lorazepam)
why must you be careful when using lorazepam for delirium?
once it wears off the patient can become paradoxically more agitated
with AAA screening, at what size of aneurysm is the patient sent for op assessment?
greater than 5.4cm
who is eligible for AAA screening?
all men over 65 years old
who is eligible for bowel screening?
between 50 and 74 years old
after 75 you can still be screened if you would like to be
who is eligible for breast screening?
women aged 50 -70
after 60 you can still be screened if you would like to be
at what age are you eligible for the annual flu vaccine?
65 and over
at what age are you eligible for the one off pneumococcal vaccine?
65 and over
at what age are you eligible for the one off shingles vaccine?
70 years old
plus catch up cohorts
what type of environment do acidic drugs require for absorption?
acidic environment
pH less than 7.35
what type of environment do alkaline drugs require for absorption?
basic environment
pH more than 7.35
what is the main carrier of basic drugs?
alpha-1-acid glycoprotein
aka orosomucoid ORM
what is the main carrier of acidic drugs?
albumin
how do you calculate the therapeutic index?
lethal dose 50 / effective dose 50
as age increases what happens to the therapeutic window of most drugs?
becomes smaller
