Geriactrics Flashcards
In 2000 how many people were over the age of 65?
14% or 35.3 mil Americans
In 2030 how many people will be over the age of 65?
22% or 70.2 mil Americans
What is the average life expectancy for women?
79.5
What is the average life expectancy for men?
72.7 (7 years less than women)
Why do we age? 4 theories.
- Supply limits: decreased supply of nutrients to cell
- Free radical damage: uncontrolled build up of free radicals
- Autoimmune: B & T cells weaken w age, then malfunction
- Programmable cell death: signals induce or suppress apoptosis
- Telomere length theory: Cell division permanently destroys tiny fragment of the telomere w each cell division
Can we add telomerase or drugs that mimic the effects to a cell culture to lengthen telomeres?
Yes
Inflammaging
What it sounds like
Metformin- vitamin deficiency and side effect?
B12 deficiency & lactic acidosis
Posture change seen in females
Kyphosis, bent knees, cervical extension
Skin changes? (2)
Vitiligo & Decubitus ulcer predisposition dt diminished number and function of sweat glands
3 Eye changes
- Reduction in tear formation & dry cornea
- Glaucoma: PERIPHERAL loss. affects 1% 40-65yo, 5% >65
- Cataracts/Macular degeneration: CENTRAL loss
Is it better to speak in a loud voice or low pitch?
Low pitch
Exostosis
formation of new bone on surface of a bone-can cause a range of pain mild to debilitating depending on size shape and location (related to Osteoarthritis)
Two consequences of H2 Blockers
Increase gastritis and ulcers
What two things are cyto-protective?
PPI and Mesoprosal
What should be used as initial anti hypertensive? Except in which two disease states?
Low dose diuretic tx. Except in DM (blunts hypoglycemic response and COPD as it exacerbates dz)
When drug tx is indicated for HTN what is considered first line drug of choice in pt who present w isolate systolic HTN
Low acting Ca channel blocker
Is incontinence a normal part of aging?
No
Main causes of acute urinary incontinence?
DRIP: Delirium, Restricted mobility, Infx/inflammation/impaction, Pharmaceuticals
MC cause of acute urinary incontinence?
Bladder infx
MC drug class that causes incontinence?
Diuretics
Is acute onset of incontinence w known/suspected malignancy an emergency?
Duh
Normal P Hydrocephalus: what is the triad assoc?
Acute urinary incontinence, acute or subacute dementia, wide based gait
MC form of chronic incontinence?
Urge
How do you work up Hematuria (Sx3)
- Scope - visualize bladder, look for CA
- Cytology - collect morning void, look for RCC
- Sonogram - US of bladder & KI
What exercises can be done at home for incontinence?
Kiegels
What meds are CI in acute angle glaucoma?
Oxybutynin and other anti-cholinergics (think mydriasis)
Are elderly more likely to be febrile or afebrile w pneumonia?
Afebrile
What two lung PE findings would clue you to pneumonia?
Dull on percussion, Tachypnea >26/m
In what 3 ways are elderly likely to respond differently to pneumonia than the young?
- Bacteremia
- Empyema/ Meningitis
- Death :( RIP grandma foster. <3
How does cystitis present, particularly in Females?
Frequency & urge incontinence (dysuria not common)
Which is a more common presentation of Cardiac Ischemia? Angina or Dyspnea?
Dyspnea
Atypical presentations of MI? There are lots, one in bold.
Acute renal failure *** Acute CHF Exacerbation of previously stable CHF Vomiting w or without abdominal pain Vertigo Confusion Syncope or near syncope Falling
What percent of the elderly will have silent ulcers?
30-50%
Sx of fecal impaction?
Anorexia, N/V*
Others: Paradoxical diarrhea, incontinence of stool, abdominal pain present or absent, Bladder sx (retention, frequency, overflow incontinence)
Sx of hypothyroidism
Depression*
Failure to thrive, Weight loss , Constipation, Falling, Weakness, CHF, Dementia, Coma, Edema, Carpal tunnel syndrome, Anemia
Sx of hyperthryoidism
Apathy & inactivity
What is the MC sx of hyperparathyroidism?
GI complaints (N/V, anorexia, weight loss, abd pain, dyspepsia, constipation)
Other sx of hyperparathyroidism?
Emotional & mental (Depression, anxiety, decreased recent memory, personality change, delirium, acute psychosis)
Causes of Delirium
Meds*
Also; Pneumona, CHF, MI, PE, Sepsis (urosepsis),. Surgical abd/fecal implantation, Endocride d/o, dehydration, electrolyte imbalance, hypoxemia
How do you dx dementia?
At least 2 of the following affected: Personality Language Emotion Memory Motor
What are the hormonal changes in elderly men called and why does it occur?
Andropause dt increased conversion of T to E dt increased aromatase enzyme
What causes increased growth?
Estradiol interacts w SHBG to cause 8 fold increase in intracellular cAMP in human prostate tissue
Effects of hormonal shifts in men?
Reduced libido, disturbed sleep, depression, fatigue, irritability, hot flashes
Adverse events related to testosterone administration?
Exacerbation of heart disease dt acceleration of atherogenesis***
Acne, breast enlargement/tenderness, erythrocytosis, sleep apnea, leg edema, cardiac hypertrophy, prostate CA
Number of vertebral fractures?
700,000
What does secondary osteoporosis imply?
Decreased bone mass dt other condition
Conditions that may result in increased risk of osteoporosis
Hyperthyroid, excess thyroid supp, Cushing’s, Gluccocorticoid use, Hyperparathyroidism (think excess all over)
What is a Tscore?
Number of standard deviations above or below the mean for a healthy 30yo adult w same sex and ethnicity as pt
What is a Zscore?
Number of standard deviations above or below the mean for same AGE sex and ethnicity as pt
What is the Tscore for osteopenia?
-1 to -2.5
What is the Tscore of osteoporosis?
When does conventional tx for osteoporosis begin in a pt (depending on their DEXA)?
T score -2
T score -1.5 w risk factors
FRAX
Diagnostic tool used to evaluate 10yr probability of bone fracture- integrates clinical risk factors w bone mineral density at the femoral neck to calculate 10 year probability of hip fracture as well as spine, shoulder, extremity fracture
Can Vit D protect against osteoporosis?
Yes when combined w Ca
_____ have been proven to reduce risk of spinal and hip fractures…
Bisphosphonates
Potential side effects of bisphosphonates?
Erosive esophagitis, osteonecrosis of the jaw (but who needs a jaw?), myalgia
Action of SERMs
Selective Estrogen Receptor Modulators: selectively block conformational changes of estrogen receptors
What is indicated for the tx and prevention of osteoporosis?
Raloxiphene (Evista) —BUT no statistically significant decrease in non-vertebral fractures
Side effects of Raloxiphene?
DVT & PE
What nutrients should be looked at before starting pt on Denosumab (Prolia?)
Vit D & Ca
Is Calcitonin approve for prevention of osteoporosis?
NO
Explain the paradoxical reaction of PTCH
Intermittent administration of recombinant human PTH in low doses results in increased amount of bone remodeling/increased bone density. This is paradoxical bc excess PTH or continuous exogenous PTH has been show to result in severe bone loss
Which drugs are for Osteoporosis prevention?
Raloxifene: Evista Estrogen Conjungated Premarin Esterified Estratab Menest Estradiol Estrace Estropipate Ortho-Est Ogen Estrogen + progestin: Premphase (cyclic & continuous)
What drugs are for Osteoporosis treatment?
Calcitonin: Miacalcin
Calcimar
What drugs are for both Osteoporosis treatment and prevention? DOUBLE DUTY.
Alendronate: Fosamax
