Geriatrics Flashcards
Age related changes to cardiovascular system
- Unchanged cardiac output and cardiac index at rest
- Increased myocardial hypertrophy
- Decreased arterial elasticity
- Reduced HR responsiveness to stress and respiration
Age related changes to respiratory system
- Reduced lung volume due to loss of elastic recoil
- Reduction in FEV1 and FVC
- Increased RV
- Increased V/Q mismatch
- Decreased ventilatory response to hypoxia and hypercapnia
- Reduced mucociliary clearance
Age related changes to GI system and liver
- Decreased oesophageal peristalsis
- Delayed gastric emptying
- Decreased pancreatic enzyme secretion
- Reduced liver volume, weight and blood flow
- No changes to LFTs
Age related changes to endocrine system
- Increased insulin resistance
- Increased incidence of AI thyroiditis
- Increased vasopressin with increased risk of hyponatraemia
- Decreased basal renin level
- Decreased aldosterone and increased risk of hyperkalaemia
- Increased FSH/LH
Age related changes to immune system
- Immunoglobulin levels remain stable
- Diminished antibody response
- Impaired T cell response, especially to viral infections
Features of renal artery stenosis
Resistant hypertension
Flash pulmonary oedema
Young women –> fibromuscular hyperplasia
Advanced age –> atherosclerotic disease of renal artery
Patients at risk of refeeding syndrome
- poor oral intake > 5 days
- exisiting electrolyte disturbance
- low BMI
- recent unintentional significant weight loss
- history of alcohol abuse
What is fludrocortisone not recommended for?
Synthetic mineralocorticoid
Increased blood volume and improved blood vessel sensitivity to pressor agents
Not recommended for patients with nocturnal hypertension and CCF
MOA of midodrine
a1-adrenergic agonist
Increases BP by stimulating arterial and venous adrenoceptors to increase peripheral resistance
Risk associated with HRT
Breast cancer
VTE (no risk with transdermal HRT)
Cardiovascular disease and stroke risk (higher in those who start after 60 years old or 10 years after onset of menopause)
Management of venous ulcers
Compression is mainstay - graded multi-component > single component ones
Should be modified if ABI 0.6-0.9
Contraindicated if ABI < 0.6 (severe PVD)
Surgery can be done to promote healing