Conditions of Geriatrics Flashcards
What is the usual age of onset of Alzheimer’s disease?
> 60 years old
What are the features of Alzheimer’s disease?
Progressive memory loss
Loss of ability to perform ADL
Personality Changes
What are the diagnostic parameters of alzheimers dementia as defined by the DSM-V?
1) Gradual development of multiple cognitive deficits including:
2) Memory impairment accompanied by at least 2 of the following: Aphasia, apraxia, agnosia, disturbance in executive function
3) Not due to CNS conditions, systeme conditions, or substance abuse
What are other diseases/causes of dementia that would be on the DDx for Alzheimer’s disease?
1) Parkinson’s Disease
2) Vascular dementia
3) Schizophrenia
4) Neurosyphilis
5) Hypothyroidism
6) Niacin, B12 or folic acid deficiency
What herbs might be indicated for Alzheimer’s disease?
Ginkgo biloba
Centella asiatica
What drug may be prescribed for a patient with Alzheimer’s dementia?
Donepezil
What is senile dementia?
Mental deterioration associated with age, 2 types;
Generalized Atrophy: Alzheimer’s disease
Vascular: Stroke associated
What are some of the risk factors for osteoporosis?
1) Soda and caffeine intkae
2) Sedentary lifestyle
3) Heavy alcohol use
4) Smoking
5) Glucocorticoid use
6) Early menopause
7) Family hx of osteoporosis
What are some of the preventative strategies for osteoporosis?
1) Weight-bearing exercise
2) Smoking cessation
3) Reduce soda and alcohol intake
4) Calcium supplementation
What are the amounts of calcium recommended to help prevent osteoporosis in premenopausal and postmenopausal women and in men?
Premenopausal: 1000 mg
Post menopausal:1200 mg
Men: 1000-1500 mg
What are some of the common signs and symptoms of osteoporosis?
Often asymptomatic
Fractures
Kyphosis
Loss of height
What is a urinary test for osteoporosis?
Serial urinary N-telopeptide
How is osteoporosis diagnosed?
Bone mineral density scans
Dual energy X-ray absorptipmetry (DEXA)
Elevated urinary N-telopeptide
What elements may be increased on labs in patients with osteoporosis?
Alkaline phosphatase
Calcium
What is a hallmark of osteoporosis seen on x-ray?
Cortical thinning
What category of drugs can cause osteoporosis ? Name a common drug.
Corticosteroids, Prednisone
A deficiency in what vitamins and minerals are associated with an increased risk of osteoporosus?
Vitamin K
Vitamin D
Calcium
What minerals are indicated for osteoporosis?
Boron
Calcium
Manganese
Magnesium
What amino acid is indicated for osteoporosis?
Lysine
What are the signs and symptoms of polymyalgia rheumatica PMR?
1) Pain and stiffness of the neck, pectoral, and pelvic girdles
2) Stiffness in the morning and after inactivity
3) Systemic complaints: including malaise, fever, depression, and weight loss
4) In most patients ESR is incresed
What is on the DDx for PMR and how would your differentiate PMR from them?
RA: PMR has no synovitis, is RF (-), and has no rheumatoid nodules
Polymyositis: PMR has normal muscle enzymes
Hypothyroidism: PMR will have normal TSJ
Multiple Myeloma: Absence of monoclonal gammopathy in PMR
Fibromyalgia: PMR has systemic features and elevated ESR
What are the signs and symptoms of cataracts?
1) Gradual painless vision loss
2) Lens Opacity
3) Halos seen around lights
What herb is used for treatment for cataracts?
Cineraria Maritima- topical use only
What is the definition of glaucoma?
Elevated intraocular pressure that results in abnormal fluid dynamics in the flow of aqueous humor from the posterior to anterior chamber of the eye
What are the types of glaucoma and which has a worse prognosis?
Primary open angle ( most common) , primary angle- closure and secondary angle-closure glaucoma. Acute primary angle-closure has the worse prognosis and is a medical emergency as it can lead to permanent blindness
What are the common signs and symptoms of primary open angle glaucoma?
Gradual, bilateral vision loss, frequent changes in glasses, mild HA, poor night vision, blurry vision, painless
What herb is used to treat primary open angle gluacoma?
Cannabis sativa- requires very frequent use due to short half life of action
What drugs are indicated for treatment of primary open angle glaucoma?
Topical beta blocks ie: Timolol, Prostaglandin analog ie: Latanoprest
What are the common signs and symptoms of primary acute closed- angle glaucoma?
Acute attack on corneal and scleral injection, peri-orbital pain, HA, blurred vision, halos seen around objects, optic cupping, mild-dilated non-reactive pupil, increased intra-ocular pressure ontonometry
How is acute angle-closure glaucoma diagnosed?
Slit lamp exam shows shallow anterior chamber
What is a complication of glaucoma?
Blindness
Which drugs used in emergency medicine are contraindicated in acute angle closure glaucoma?
Atropine and epinephrine
What herbs are contraindicated in glucaoma?
Anti-cholinergic herbs:
Atropa Belladona
Datura stramonium “ Jimson weed”
Hyoscyamus niger “Henbane”
Veratrum viride
What direct-acting parasympathomimetic drug is used in glaucoma?
Pilocarpine ophthalmic solution
How will parasympathomimetic drugs be effective in glaucoma?
Glaucoma is caused by increased intra-ocular pressure. Parasympathetic action on the eye causes pupillary constriction. This causes the sphincter in the iris to constrict, which allows Shelmm’s canal to open and the vitreous humor to escape
What are some of the side effects of directing parasympathomimetic drugs, i.e pilocarpine?
1) Cardiovascular: causes vasodilation that can lead to bradycardia
2) Respiratory: Bronchoconstriction
3) GI: Diarrhea
4) Diaphoresis
5) Salivation
What indirect- acting parasympathomimetic drug is used to treat glaucoma?
Physostigmine
You have a patient with glaucoma and depression. What antidepressant is contraindicated?
Tricyclic antidepressants and MAO inhibitors
Would you use a sedating antihistamine in your patients with glaucoma?
Of course you wouldn’t, you’re a naturopath. Plus, it contraindicated.
What are some common causes of macular degeneration?
Oxidative damage: Smoking, UV exposure, hypertension, atherosclerosis
What is the difference between wet (exudative) and dry (atrophic) macular degeneration?
Dry progresses more slowly, it is more common (85-90% of cases). Dry can progress to wet in 10-15% of cases
What is the hallmark PE finding in someone with dry macular degeneration?
Drusen: small white or yellow deposits form on the retina
Which type of macular degeneration is associated with severe acute vision loss?
Wet macular degeneration
What nutrients might be indicate in treatment of dry macular degeneration?
Antioxidant nutrients: Vitamin C, E, Carotinoids, Zn and Cu
What herb is high in antioxidants and can be helpful for poor night vision?
Vaccinium myrtillus : Billberry/Blueberry
What are the 2 types of hearing loss?
1) Conductive: Failure in the transmission of sound to the sensory apparatus
2) Sensorineural: Nerve Deafness, sound travels to the sensory apparatus, which insensitive. Lesions in inner ear or CN VIII
What side does the sound lateralize to using the Weber’s test with conductive hearing loss? What side with sensorineural?
Conductive: Sound is louder on side with obstructed hearing.
Sensorineural: Lateralizes to the unaffected
In the Rinne test, what would bone conducting lasting longer than air conduction indicate?
A conductive hearing, i.e.; the sound can’t travel through the ear because it is blocked so it travels longer through the bone
What is the patient’s voice like with sensorineural and conductive hearing loss?
Sensorineural: Loud because they cannot hear themselves
Conductive: Soft. Their voices are louder to them because there is blockage somewhere
What conditions would you consider present with unilateral sensorineural hearing loss with tinnitus?
Acoustic neuroma
Meniere’s Disease
Labyrinthitis
Conductive hearing loss may be caused by what conditions affecting the middle ear?
Perforated TM
Disruption of ossicle chain from trauma
Otosclerosis: fixation of ossicles
Otitis media with effusion
What are the 3 main areas that are affected in sensorineural hearing loss?
1) Damage to the hair cells of the organ of Corti
2) Damage to CN VIII
3) Damage or dysfunction in central auditory system in brain
What are some symptoms and concerns commonly associated with aging?
1) Immobility
2) Loss of balance and flexibility
3) Urinary incontinence
4) Urinary Tract infections
5) Constipation
6) Malnourishment
7) Muscle and joint pain
8) Hearing and vision impairment
9) Social isolation, grief, depression
What is polypharmacy and why does this adversely affect the elderly?
1) Taking multiple prescription medication, most elderly take 4-5 prescription drugs per day
2) Taking multiple OTC medication along with prescription medications, most elderly take 1-2 OTC meds per day
3) Aging affects the body’s metabolism and excretion of medications leading to increase adverse effectes
4) Including dietary supplements and herbs can interact with the medication and/or tax the body’s system
5) Reviewing medications/ supplements at each visit is essential to prevent polypharmacy
Regarding depressed geriatric patients, list some of the potential contributors that should be assessed
Retirement
Reduced physical functioning
Memory Loss
Dementia
Physical Abuse
Death of Spouse
Mortality
