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3rd year > Ageing > Flashcards

Ageing Flashcards

1
Q

What is sarcopenia?

A

The age-related loss of muscle massand function

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2
Q

What percentage of over 65s in the UK report elder abuse?

A

3%

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3
Q

What proportion of older people have no chest pain in MI?

A

One third

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4
Q

How might sepsis present differently in an older person?

A

BP drops early
Low temp rather than high
Lack of tachycardiac response
Delirium

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5
Q

Which features distinguish delirium from dementia?

A

Acute nature and fluctuating course

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6
Q

Predisposing factors for delirium

A 
Age
Sensory impairment
Dementia
Polypharmacy
Comorbidity
Depression
Alcohol dependence
Malnutrition
Post-op state (esp. hip fracture)
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7
Q

Precipitating factors for delirium

A 
Infection
Urinary retention
Hypoxia
Medication use
Alcohol
Catheterisation
MI
Glycaemic disturbances
Changes in environment
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8
Q

Features of hyperactive delirium

A

Agitation, aggression

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9
Q

Features of hypoactive delirium

A

Withdrawn behaviour, apathy, sleepiness

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10
Q

Which type of delirium has the highest mortality rate?

A

Hypoactive - twice as high as hyperactive

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11
Q

Which screening tool can be used at the bedside to identify potential delirium?

A

4AT

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12
Q

What score on the 4AT is suspicious of delirium?

A

4+

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13
Q

What are the four components of the 4AT?

A

Alertness
AMT
Attention
Acute course

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14
Q

Which type of diuretic can contribute to delirium?

A

Thiazides

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15
Q

Which drug is used to manage agitation in delirium?

A

Haloperidol

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16
Q

How many people are affected by sarcopenia worldwide?

A

50 million

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17
Q

How much exercise should old people do?

A

Same as all adults - 150m a week moderate activity, strength and balance 2x weekly.

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18
Q

What percentage of older adults meet minimum activity targets?

A

10-15%

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19
Q

Which drugs have been shown to reduce immobility?

A

Calcium, vit D, creatine, ACE inhibitors

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20
Q

What percentage of over 80s fall each year?

A

60%

21
Q

What is appropriate management for mildpain (step 1 WHO ladder)?

A

Paracetamol 1g 4x daily, or NSAID+adjuvant as necessary

22
Q

What is appropriate management formoderatepain (step 2 WHO ladder)?

A

Weak opioid e.g. codeine, + adjuvant where needed

23
Q

What is appropriate management forseverepain (step 3 WHO ladder)?

A

Strong opioid - generally morphine + paracetamol/NSAID and adjuvants as needed

24
Q

How is the dose calculated when switching from codeine to morphine?

A

TDD/10

25
Q

How are morphine doses modified for SC use?

A

Twice as potent, so dose is halved

26
Q

How is gastric pH affected in old age?

A

Older people have a highergastric pH due to decreased numbers of gastric parietal cells

27
Q

Which two factors increase absorption of basic drugs in the elderly?

A

Higher gastric pHIncreased levels of alpha-1 acid glycoprotein, which binds basic drugs

28
Q

How do albumin levels change in old age?

A

Decrease

29
Q

Why do lipophilic drugs have a greater volume of distribution and half-life in older people?

A

There is increased fat in proportion to muscle mass

30
Q

How does the decreased body water in older people affect drug distribution?

A

Hydrophilic drugs (lithium, digoxin, etc.) have a lower volume of distribution

31
Q

Why is reduced hepatic metabolism in older people important?

A

It results in a reduced first-pass metabolism, so drugs such as propranolol which are greatly effected by first-pass metabolism can be toxic in regular doses

32
Q

Drugs most frequently associated with adverse reactions in the elderly

A 
Warfarin
Digoxin
Insulin
Benzodiazepines
Diuretics
NSAIDs
Corticosteroids
Opioids
Anti-hypertensives
Theophylline
33
Q

Which supplements should not be taken at the same time as levothyroxine?

A

Calcium - it reduces levothyroxine absorption

34
Q

Which intrinsic, or person, factors increase the risk of falling?

A

Pathologies - CVD, cognitive impairment, vision problems, vestibular diseasePhysiology of ageing - sarcopenia, lens thickening, decreased reaction time, decreased proprioception leading to postural sway

35
Q

Drugs which increase fall risk

A 
Benzodiazepines
Neuroleptics
Antihypertensives
Antidepressants
Anticholinergics
Antiarrhymics
36
Q

How many times can a cell divide, and what is this limit called?

A

Around 50 - Hayflick limit

37
Q

What are the four main cellular responses to damage?

A

Repair
Apoptosis
Senescence
Malignant transformation

38
Q

What is the disposable soma hypothesis?

A

Repairing and maintaining the body past reproduction uses loads of resources and not worth it, so evolution dun care.

39
Q

What is antagonistic pleiotropy?

A

The theory that genes which are beneficial in early life can be detrimental in later life, and will be inherited but contribute to cell senescence and death

40
Q

What morphine dose is used in an opioid naive patient at the end of life?

A

2mg sc hourly as needed

41
Q

What is an appropriate dose of levomepromazine in end of life care?

A

2.5mg

42
Q

What drug can be used for distress in end of life care?

A

Midazolam 2mg sc hourly

43
Q

What drug can be used to decrease secretions at end of life?

A

Hyascine butylbromide 20mg hourly

44
Q

What is the most common side effect of calcium supplementation?

A

GI upset

45
Q

Which dementia has step-wise deterioration?

A

Vascular

46
Q

Why do people with t21 develop alzheimer’s?

A

Gene dose effect of amyloid precursor protein gene on chromosome 21

47
Q

Acetylcholinesterase inhibitors used in AD

A

Donepezil
Galantamine
Rivastigmine

48
Q

Important advice for taking bisphosphonates

A

Take on empty stomach to ensure absorption

Remain upright for 30 mins to reduce risk of oesophageal ulceration

3rd year (6 decks)

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