Final Flashcards
What % of Americans will be over the age of 65 by 2030?
22% (70.2M)
What is the average age of life expectancy in women (US)?
79.5 years
What is the average age of life expectancy in men (US)?
72.7 years
5 Theories of Aging
Cellular "supply limits" theory Free radical damage theory Autoimmune theory Programmable cell death theory Telomere length theory
What % of cancers have a p53 mutation?
50%
What is a telomere?
Non-coding DNA at the end of each chromosome, which assist in a limited number of cell divisions
How can the finite activity of telomeres be altered?
The enzyme telomerase, present in embryonic stem cells and cancer cells, allows for unlimited cell growth.
What are the effects of H2 blockers and PPIs in patient on long-term NSAIDs?
H2 blockers accelerate ulcer formation.
PPIs decelerate ulcer formation.
Long-term PPI use is linked to what skeletal deformity?
hip fractures
What condition can be caused by Metformin that was previously not thought possible?
lactic acidosis
SSRIs - associated deficiencies
B6, B12, folic acid
PPIs/H2 blockers - associated deficiencies
B12, Ca, Fe, Mg
Metformin - associated deficiencies
B12
OCPs - associated deficiencies
B5, B6, B12
Seizure medications - associated deficiencies
folic acid
Age - Effect on lean body mass, water, and body fat
Dec. body mass, Dec. water
Inc. body fat
Fosomax is associated with what adverse skeletal change?
Decreased bone mass in facial bones, esp. mandible
Subcutaneous deposition of fat underneath the eyes leads to ____ in the elderly?
enophthalmos
Presbyopia
age-related farsigthedness
Changes to eyesight in the elderly
Impaired accommodation, decreased night vision, decreased tear production, presbyopia, arcus senilis
Arcus senilis
benign pigment accumulation
Glaucoma - Central or Peripheral deficit loss?
Peripheral
Macular degeneration - Central or Peripheral deficit loss?
Central
Cataracts - Central or Peripheral deficit loss?
Central
Population: Glaucoma
Rare under 40 yo
1% of population 40-60 yo
5% >65 yo
At what age is there a shift from increasing bone mass to loss of bone?
40
1 in __ Americans have arthritis.
7
Pattern: OA vs. RA
OA affects DIPs and PIPs
RA spares DIPs
Morning stiffness: OA vs. RA
OA - 30 min
Exostosis
formation of new bone on the surface of existing bone, often leading to chronic pain
What lifestyle change is important for stroke prevention, esp. in F?
Smoking cessation
What was the goal of the Framingham Study?
Evaluate relationship between lowering BP and incidence of MI/stroke
Which drug class requires a PARQ about the high potential for inducing orthostatic hypotension upon rising?
Alpha agonists
If orthostatic changes are apparent, always ___
check BP in standing position
In what populations should you use caution with diuretics and beta blockers?
Diabetics –> blunts glycemic response
COPD –> worsens COPD
AFAM
The magnitude of the benefit of antihypertensive drugs is proportional to the reduction in ___
Systolic BP
What is the first-line drug of choice in treating elderly patients who present with isolated systolic HTN?
Calcium channel blocker
What is the main side effect of CCBs?
LE edema
What is the most population CCB?
Amlodipine (Norvasc)
What is the MC cause of acute onset incontinence?
UTI
What are the 4 main causes of acute urinary incontinence?
Delirium
Restricted mobility
Infection, inflammation, impaction
Pharmaceuticals
What is the main difference between delirium and dementia?
Delirium is reversible
What common drug class most commonly causes incontinence?
diuretics
When is acute onset of incontinence a medical emergency?
Pt w/ a known or suspected malignancy
In a pt with acute urinary incontinence, acute/sub-acute dementia, and wide-based gait, think ___.
Normal pressure hydrocephalus
4 types of incontinence
Stress
Overflow
Urge
Functional
Which type of incontinence is also described as “spastic bladder”?
Urge
What is the MC type of chronic incontinence in the geriatric population?
Urge
What conditions can lead to urge incontinence d/t their effect on nerves/muscles?
MS, Parkinson’s, Alzheimer’s, stroke, local injury (surgery)
What conditions can lead to urge incontinence d/t their irritative effect to the bladder wall?
Cystitis
Bladder stones
Bladder carcinoma
Constipation
What type of drugs can lead to atonic bladder and overflow incontinence?
narcotics, anticholinergics
What conditions can lead to overflow incontinence?
B12 deficiency, disk compression, diabetes, BPH, urethral fibrosis
What are common triggers for stress incontinence?
coughing, sneezing, laughing, bending over
What is the initial lab evaluation for all patients with incontinence?
urine analysis
In a pt who presents with hematuria after starting anti-coagulation tx, think ___.
possible malignancy in the GU tract
What is a good suggestion for all pts with incontinence?
Kegel exercises
What are the MC cause of injury-related morbidity in the elderly?
Falls
What is the MC major injury sustained during falls?
Hip fracture
Physiologically, deterioration of ___ significantly contributes to falls in the elderly.
Cervical mechanoreceptors
The risk of falling increases with increased ___
of comorbidities
Contraindication: anticholinergic drugs for urge incontinence
Untreated angle closure glaucoma
