Care of the Elderly Flashcards
Name the three most common types of dementia
Alzheimers disease, vascular dementia and lewy body dementia
Name 5 uncommon types of dementia
Pick’s disease, Fronto-temporal dementia, CJD, dementia associated with downs syndrome and dementia associated with cerberal tumours and extrapyramidal syndromes
Name 6 ‘reversible’ causes of dementia
- Normal pressure hydrocephalus
- Alcohol abuse
- Neurosyphillis
- Hypothyroidism
- Vit B12 deficiency
- psuedo-dementia of depression
What is semantic memory?
Semantic memory concerns general and highly learned information such as facts, meaning, concepts and knowledge.
Prevalence of dizziness?
13-38%
How does drug absorption change with age?
Drug absorption is unchanged (exception of calcium and iron which are absorbed more slowly)
How do body fat levels in older people change volume distribution?
In older people there is increased proportion of fat compared with water.
Reduced volume distribution of water-soluble drugs giving a higher initial concentration e.g. digoxin
Increased volume distribution of fat soluble drugs, e.g. benzos, causing accumulation and prolonged effect
In older patients there is reduced plasma protein binding of drugs; what effect does this have?
Increases the free fraction of protein bound drugs e.g. warfarin and furosemide
Also in sick patients, reduced albumin so more free drug
Reduction of what liver enzyme leads to reduced drug metabolism in elderly?
Reduced cytochrome P450
Decreased hepatic mass and decreased blood flow to the liver also
What are the risk factors for adverse drug reactions?
Old age (particularly >80 y/o) Undernutrition Renal or hepatic impairment Polypharmacy (3 or more drugs) High risk drugs with small therapeutic margin e.g. warfarin Previous adverse drug event
What is the triad associated with normal pressure hydrocephalus?
Dementia, urinary incontinence and gait abnormality
What types of innervation does the bladder have?
Somatic, parasympathetic and sympathetic innervation
What nerve is the somatic (voluntary) innervation to the bladder?
The pudendal nerve - it innervates the external sphincter causing it to contract strongly for short periods of time e.g. coughing/sneezing
Which nerve roots does parasympathetic innervation of the bladder arise from? What does it innervate?
S2-S4 (“S2,3,4 keeps the piss off the floor”)
Innervates detrusor muscle (contraction)
What innervates the internal sphincter of the bladder?
Sympathetic NS
Name two loop diuretics
Furosemide and bumetanide
In patients on loops diuretics, what advice can you give to increase QOL?
Tell them they can delay taking their tablet on mornings that they’re going out so that they don’t have to be fearful of having an accident whilst out shopping or whatever….
What effect do alpha agonists have on the bladder?
Increase tone of internal sphincter
What % of strokes are ischaemic?
80%
What % are of strokes are due to primary intracerebral haemorrhage?
10%
What % of strokes are due to sub arachnoid haemorrhage?
5%
How soon after a stroke can you see signs on the CT?
Haemorrhage is always apparent early after symptom onset
Up to 30% of ischaemic strokes may have normal scan on presentation
What are the four types of stroke according to oxford/bamford classification?
TACI (total anterior circulation infarction)
PACI (Partial anterior circulation infarction)
POCI (Posterior circulation infarction)
LACS (lacunar syndromes)
What % of stroke does SAH account for?
5%
