Ageing Flashcards
Which is dominant hemisphere in most people?
Left
LOC and stroke
Bad prognosis
Not a common presentation
Which drug to thrombolyse stroke?
Alteplase
Post-stroke % of patients fully independent at 6 months?
50% of those who do not die
Post-stroke % of patients dead in a month?
20%
Time cut-off for thrombolysis being useful treatment for stroke
4.5 hours
Cerebellar disease features?
Nystagmus Poor balance Negative Rhomberg's Normal or reduced muscle tone Normal deep tendon jerks Broad gait
Proximal myopathic gait?
Waddling
Define postural hypotension
Drop of more than 20 mm/Hg SBP or 10 mm/Hg DBP on standing compared to sitting.
What % of institutionalised older people have postural hypotension?
40%
Motor features of Parkinson’s disease
Unilateral initially Bradykinesia Rigidity Tremor Increased tone Normal tendon reflexes Short stepping gait with reduced arm swing
Cockcroft-Golt Equation?
To work out actual creatinine clearance
140-age) x (weight kg) x (?
Divided by
eGFR x1.04 if female and 1.23 if male
Non motor-features of Parkinson’s disease
Speech Swallow Bowel movements Sleep Depression
What drugs could have tremor as a side effect?
Caffeine, lithium, salbutamol
Cyclosporins:
Neuroleptics: sodium valproate etc
Example of how disease presents differently in old age? ADD TO
PE - syncope?
ACS - SOB
Pneumonia - low temperature
Pain thresholds lower
- Aspirin at analgesic doses?
2. Aspirin at overdose?
- Can cause confusion
2. Can cause tinnitus
What kind of dementia chronically fluctuates?
Lewy Body Dementia
When is the only situation that laxido and lactulose would be used concurrently?
Hepatic encephalopathy - to reduce ascites
Particular drug ageing red flags?
NSAIDs, unnecessary antibiotics, bendroflumethiazide, psycotropic drugs, PPIs
PPIs - why so bad?
Infection risk
Mg/Ca reduction -> increases osteoporosis/malabsorption
Cognitive impairment
Why is bendroflumethiazide so bad?
24 hours acting - do not split dose if for chronic heart failure or they just pee all the time/leads to incontinence
Reduces sodium which can increase confusion etc
Which is superior laxido or lactulose?
Laxido acts quicker
Which opioids to be avoided?
Tramadol/dihydrocodeine (delirium/constipation)
Why might prostate hypertrophy be implicated in a fall?
alpha blockers - drop BP
Onset of action of quetiapine
Slow onset of action
Big 5 infections in Ageing?
Cellulitis
UTI
Gastroenteritis/diverticulitis (GI stuff due to PPIs reducing stomach acid so less bacteria are killed, c. diff risk and other infections due to use of lots of antibiotics. Other thing is cognitive impariment re hygiene/food prep)
Pneumonia
Cholecystitis - incompetent sphincter/stents/gallstones
Volume of?
10% dextrose?
20% dextrose?
50% dextrose?
100ml infusion
50ml
20ml bolus
Why might SSRIs make you confused?
Can cause SIADH
Can cause serotonin syndrome
Can make constipated
All centrally acting drugs can cause confusion in the elderly
Side effect of tolterodine?
Urinary retention
Reasons for elderly becoming dehydrated?
Cognitive impairment
Anxiety re continence/mobility issues
Reduced thirst reflex
Common side effect of amlodipine?
Swollen ankles
Explanations of raised urea without raised creatine?
Dehydration
Big Bleed - GI
Lansoprazole effect on electrolytes?
Reduces sodium and magnesium
all PPIs and some anti-ds
Marker of stroke severity?
Hypertension
How treat hypertension in stroke?
If DBP over 110, or SBP over 205 - labetalol 10mg or GTN
For stroke patients who have been thrombolysed, what % bleed?
6%
What can happen if give folate without adequate B12?
Acute spinal cord compression
