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ADELE-Noodles of Neurology > Ageing > Flashcards

Ageing Flashcards

1
Q

What is delirium?

A

An acute confusional state that can lasts for 4-6 weeks

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2
Q

What are the 4 components of delirium?

A

Disturbance in attention
Change in cognition
Over a short period
Fluctuates during the day

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3
Q

What are the other DDx with delirium?

A

Anxiety

Depression

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4
Q

What are the two pathophysiological reasons for delirium?

A

Direct toxic insults e.g. drugs, hypoxia, low Na, low glucose
Aberrant stress response e.g. cortisol

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5
Q

What are the 4 predisposing factors to delirium?

A
  1. Dementia/Stroke/Learning difficulties
  2. Post-op (esp Hip)
  3. Elderly
  4. Co-morbidity
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6
Q

Precipitating factors for delirium

A

P-Pain
I-Infection
N-Nutrition and neurological insults
C-Constipation and catheterisation (due to urinary retention)
H-Hypoglycaemia, hypoxia, hydration, hypo/hyperthyroidism

M-Medication (polypharmacy)
E-Environment

ALCOHOL

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7
Q

What does hypoactive delirium look like?

A

Withdrawn, Apothetic, Sleepy

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8
Q

What does hyperactive delirium look like?

A

Agitated, aggressive, wandering, insomnia

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9
Q

What is used to diagnose delirium?

A

4AT, CAM

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10
Q

What are the components fo 4AT?

A

Alertness
Abbreviated mental test
Attention
Acute change or fluctuating course

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11
Q

What are the components of CAM

A

1+2 + 3 OR 4

1- Acute onset and fluctuations
2- Inattention
3-Disorganised thinking
4-Altered level of consciousness

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12
Q

Management for delirium?

A

Nurse in a well lit quiet room with the same nursing team present
Check they have hearing aids and glasses with them
Minimise medication when possible

Haloperidol if v agitated

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13
Q

What word described the body reaction to the drugs

A

Pharmokinetics

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14
Q

What word describes the drug action on the body?

A

Pharmodynamics

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15
Q

What does DOACs stand for?

A

Direct Oral anticoagulant

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16
Q

3 examples of acidic drugs

A

Phenytoin
Aspirin
Peniclillin

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17
Q

3 examples of basic drugs

A

Diazepam
Morphine
Pethidine

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18
Q

What is the basic principle for absorption?

A

Acidic drugs need an acidic environment

Basic drugs need a basic environment

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19
Q

In older people there is a much more basic environment. Why is this?

A

Less gastric parietal cells therefore they absorb they absorb more of basic drugs

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20
Q

TRUE/FALSE

There is decreased small bowel surface area in elderly people

A

TRUE

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21
Q

What protein binds to acidic drugs?

A

Albumin

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22
Q

What protein binds to basic drugs?

A

a-1 acid glycoprotein

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23
Q

TRUE/FASLE

Elderly tend to have low albumin but higher a-1 AG

A

TRUE

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24
Q

Why is there an increase in volume of distribution (and therefore longer half-lives) of lipophilic drugs in elderly patients?

A

As elderly people in proportion to muscle mass have more fat

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25
What is the most important change in terms of distribution of drugs?
Decreased body water (10-15%) | Therefore lower volume fo distribution of lipophilic drugs
26
With all these changes why is the t1/12 usually unchanged in the elderly?
the Volume of distribution and CrCL are both lower
27
What does it mean if there is a huge volume of distribution?
Very lipophilic, very little in plasma
28
Why are drugs that have a high volume of distribution potentially dangerous?
Sit in fatty tissues for a long time | If then become cachexia this will start to be released
29
Why do older patients have longer half-lives?
Poorer renal and hepatic functions
30
What is the equation for calculating the half-life?
0.693 x VD ------------------ CL R+L
31
What is the equation to calculate CrCL?
(140-age) x body weight -------------------------------- Serum Creatinine x1.23 men OR x1.04 women
32
SE of opioids
Constipation
33
What is the worrying SE of Steroids in elderly?
Osteoporosis
34
What does calcium interfere with the absorption of?
Levothyroxine
35
NSAIDs pose a big risk in elderly, what should you use instead if possible?
Paracetamol
36
What can opioids and benzodiazepines have as side effects?
Impair psychomotor function, falls and confusion
37
What is Beers Criteria?
Potentially Inappropriate Medication Use in Older Adults
38
TRUE/FALSE | Once the diagnosis is confirmed dementia patients no longer are classed as having capacity
FALSE | Dementia patients do have capacity
39
Elderly patients often have atypical presentations of typical diseases e.g. in MI what percentage of people do not have chest pain?
1/3 (eey not a percentage)
40
Why do older people fall?
Physiology of ageing | Pathology commonly associated with ageing
41
What fraction of patients who fall fear falling again?
1/3
42
What is a common presentation of falls in 50s and 60s?
Osteoporotic Wrist Fractures
43
What is a common presentation of calls in 60+?
Hip fracture (as not reaching out hand)
44
What is sarcopenia?
age related loss of muscle mass and function
45
What are 20% pf unexplained falls due to?
Syncope
46
What is the definition of postural hypotension?
Fall in SBP >20mmHg or DBP >10mmHg after 3 minutes of standing
47
What are the 5 causes of syncope?
1. Arrythmias 2. Postural hypotension 3. Neurogenic (vasovagal) 4. Carotid sinus hypertrophy 5. Valvular heart disease (aortic stenosis)
48
Why are you more likely specifically to fall if you have dementia?
Frontal part of the brain affected - Judgement and Visuo-spatial perception
49
High stepping gait and Romberg's positive is characteristic of which condition?
Cervical Myelopathy
50
What is altered sensation and gait wide-based characteristic of?
Peripheral neuropathy
51
Pain/Paraesthesia legs and wide-based gait is characteristic of which condition?
Lumbar stenosis
52
Wide-based gait and cerebellar signs occur in which condition?
Cerebellar ataxia
53
Shuffling gait, tremor, rigidity, bradykinesia and postural hypotension are characteristic of which disease?
Parkinsons disease
54
How do you confirm BPPV?
Dix-Hallpike manouvre
55
How is BPPV treated?
Epley manouvre
56
Why are those who use bifocal or varifocal lenses at high risk of falls?
They have altered depth perception
57
What are the 5 main reasons that people fall?
1. Medication-Polypharmacy 2. Alcohol 3. Environmental hazards 4. Inappropriate clothing/footwear 5. Inappropraite walking aids
58
What is the Fracture score?
prediction algorithm which estimates the 10 year absolute risk of osteoporotic fractures and hip fractures
59
When does muscle mass and function start to decline? When is the loss accelerated?
Starts to decline 30 years | Loss accelerated >60 years
60
What is the criteria for diagnosis of sarcopenia?
1 +2/3 1. Low muscle mass 2. Low muscle strength 3. Low physical performance
61
What is sarcopenia obesity?
Loss of muscle mass with an increase in fat levels
62
Which group of patients is cachexia often found with?
Cancer patients
63
TRUE/FALSE | Muscle power declines more rapidly than muscle strength
TRUE | therefore need resistance training
64
Where is 95% of creatinine stored?
Skeletal muscles

ADELE-Noodles of Neurology (38 decks)

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