Ageing Flashcards
Avoid statin and
grapefruit juice
Avoid metronidizole and
alcohol
Avoid warfarin and
cranberry
Calcium and thyroxine
decreased absorption from the gut
Alzheimer’s disease treatment
donezapil, rivastigmine
(acheltylcholinesterase inhibitors)
memantine (NMDA receptor antagonist, blocks glutamate)
Pathological changes in AD?
neuritic/amyloid plaques (extracellular aggregates of AB amyloid)
diffuse cerebral atrophy
neurofibrillary tangles in cytoplasm of neurons (hyperphosphorylated tau proteins)
Pathological changes in picks disease/frontotemporal dementia?
pick bodies (round aggregates of tau in cytoplasm of neurons)
What are lewy bodies
build up of alpha synuclein
What conditions are lewy bodies and what is the key difference
PD and lewy body dementia
PD has lewy bodies primarily in the substantia nigra and later may develop dementia as lewy bodies appear in cortex
LB dementia has lewy bodies in cortex early on (dementia symptoms before, at the same time as or <1yr of parkinson symptoms)
Parkinsons disease key symptoms
tremor (pill rolling) rigidity akinesia/bradykinesia postural instability shuffling gait
Drugs used in PD?
levodopa (used to make dopamine, crosses BBB)
carbidopa (dopa carboxylase inhibitor - acts peripherally to increase levodopa concentrations in the brain)
bromocriptine, pergoline (dopamine agonists)
Drugs used for dementia in PD?
memantine (NDMA antagonist blocking glutamate)
Why must haloperidol and chloromazine never be used in PD or LBD?
both conditions have a loss of dopaminergic neurons in substantia nigra so causing further blockage of dopamine worsens symptoms
How does a cerebeller tremor differ from a BG tremor?
cerebeller is an action tremor
BG is a resting tremor
Warfarin and NSAID
bleeding
ACEi and spironolactone
hyperkalaemia
dogoxin and verapamil
digoxin toxicity
fluoxetine and phenelzine
serotonin syndrome (excess serotonin - hyperthermia, tremor, sweating, dilated pupils, diarrhoea, seizures and muscle breakdown)
when are triptan contraindicated
IHD, uncontrolled hypertension, if with lithium, SSRI or ergor derivative drugs (cabergoline)
what is wernickes encephalopathy?
neurological symptoms caused by lesions due to B1/thiamine deficiency (common in alcoholics)
can progress to korsakoffs
What is korsakoffs syndrome?
chronic memory disorder caused by severe thiamine deficiency
What is the classical triad seen in wernickes encephalopathy?
ophthalmoplagia (weakness of extraocular muscles)
ataxia (lack of voluntary coordination of muscle movements, cerebellar lesion)
confusion
Why is thiamine important for the brain?
helps produce energy from sugar (co-factor for enzymes)
What are is the confusion assessment method for delirium diagnosis?
acute & fluctuation + inattention
AND at least one of:
disorganised thinking or altered level of consciousness
Management of delirium?
treat underlying cause, environmental and supportive factors
sedation if harm to self (must document): halperidol (typical antipsychotic blocks dopamine) 0.5mg. if PD or LB dementia use quietipine (atypical antipsychotis less blockade of dopamine) lorezapam 0.5mg if alcohol or benzodiazepine withdrawal
Management of acute AF?
unstable (shock, HF, myocardial ischaemia, syncope) then synchronised DC cardioversion
stable: BBlocker or diltiazam (CCB) to slow rate
consider digoxin or amioderone in HF
How does dabigatran work?
direct thrombin inhibitor
How does rivaroxiban and apixaban work?
direct factor Xa inhibitor
What are the vitamin K dependant clotting factors?
1 9 7 2 and protein C
becks triad therapy
cbt depression (self is worthless, world/environment is unfair, future is hopeless)
What scan is recommended for someone with prostate cancer and back pain?
technetium bone scan (isotope bone scan)
What scan is recommended for someone with prostate cancer and back pain?
technetium bone scan (isotope bone scan)
Why are drugs with anticholinergic effects e.g. amitriptiline (TCA) used with caution in BPH?
BPH has an increased risk of urinary retention and anticholinergics increase this risk further
