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Geriatrics Flashcards

1
Q

What is nociplastic pain

A

Fibro, TMJ, IBS tension headaches

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2
Q

Hypoesthesia

A

Decreased sensitivity to normal stimulation

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3
Q

Allodynia

A

Pain due to a stimulus that does not normally provoke pain

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4
Q

Hyperalgesia

A

Increased pain from a painful stimulus

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5
Q

Hyperpathia

A

Abnormally painful rxn to a stimulus, especially a repetitive stimulus as well as an increased threshold

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6
Q

Tramadol MOA

A

Mu opioid agonist

Serotonin and NA reuptake inhibition

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7
Q

Tapentadol MOA

A

Mu opioid agonist

NA reuptake inhibition

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8
Q

Age related sensory changes

A

Proprioceptive loss
Hearing loss
Vestibular impairment

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9
Q

Age related CNS changes

A

Neuronal loss, decreased neurotransmitters in the basal ganglia

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10
Q

Age related MSK changes

A

Activation of prox muscles before distal
Delay in onset of muscle activation
Increased muscle adiposity

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11
Q

Age related BP changes

A

Decline in baroreflex sensitivity to hypotensive stimuli

Reduction in total body water

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12
Q

Order of medications associated with falls

A
  1. Antidepressent
  2. Antipsychotics
  3. Benzos
  4. Sedatives
  5. Antihypertensives
  6. NSAIDs
  7. Diuretics
  8. BB
  9. Narcotics
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13
Q

Timed up and go test - cut off time for increased risk of falls

A

> 13.5 seconds (walking 3 m and back)

Normal <10 seconds

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14
Q

In which cases does cardiac pacing reduce risk of falls

A

Those in the community with carotid sinus hypersensitivity and a history of syncope and falls

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15
Q

Cataract surgery in falls prevention

A

First eye cataract surgery reduces falls, second does not

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16
Q

Falls with glasses

A

Increased risk of falls when adjusting to new spectacles.
Single lens glasses reduce risk of falls in those that spent more time outdoors, but increased outdoor falls in frailer people

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17
Q

Preventing falls in hospital/RACF

A

no evidence that there is any intervention that can improve falls risk

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18
Q

Barthel index

A

measures ADLs

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19
Q

How to use a SPS

A

Hold SPS in good hand and advance SPS with the bad leg

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20
Q

CVS changes in aging

A

Decreased max HR
Decreased response to parasympathetic antagonist and beta agonists
Decreased baroreceptor sensitivity - leads to orthostatic hypotension
Loss of atrial pacemaker cells (increased risk of AF)

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21
Q

Resp changes with age

A

Decreased FEV1 and FVC
Decreased PaO2
Decreased ventilatory response to hypoxia and hypercapnia

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22
Q

Renal changes with age

A 
Decreased renal blood flow
Decreased CrCl
Decreased concentrating and diluting capacity
Decreased renin and aldosterone
Decreased Vit D activation
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23
Q

Hepatobiliary change with age

A

Decreased liver mass
Decreased hepatic perfusion
Slight decline in albumin
Decreased cytochrome p450 leads to decreased metabolic clearance of drugs
Decreased synthesis of vit K dependent clotting factors
Decreased LDL receptors

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24
Q

Type of muscle loss with aging

A

Sarcopenia:

Loss of Type 2 fast twitch muscle fibres are more affected than Type 1

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25
Bone changes with aging
Loss of osteoblast numbers, but same osteoclasts Ca levels maintained by bone resorption not diet Vit D def accelerates bone loss
26
Endocrine changes with age
Increased insulin due to insulin resistance Increased PTH and bone resoprtion Increased vasopressin Rise in FSH and LH
27
Haeme changes with age
Increased fat in BM WCC count same, but reduced function Increased risk of DVT Increased bleeding due to anticoagulants
28
Brain changes with age
Decreased white matter compared to grey matter DEcreased cerebral blood flwo Decrease in cholinergic and muscarinic neurons
29
Effects of aging on drug distribution
Increased VoD of lipophilic drugs due to increased adipose tissue Higher plasma concentration of water soluable drugs due to decreased total body water Less protein binding and more free drug due to reduction in albumin
30
Effects of aging on metabolism
Reduced first pass metabolism Reduced phase 1 metabolic rxns (oxidation via cytochrome P450 - longer half life of drugs like diazepam) Phase 2 conjugation unaffected (glucyronidation - Oxaze, temaze, loraze not affected)
31
3 major criteria for sarcopenia
loss of muscle mass, strength, and function -measure gait speed, muscle mass, and grip strength
32
Tx of sarcopenia
- resistive training and weight bearing - Vit D: direct effect - improves factors required for muscle growth - Protein intake - Testosterone in older man with profound hypogonadism - GH replacement increased muscle size not strength
33
Fried Model
To assess for frailty (need 3 or more) - Unintentional weight loss - Exhaustion - Weakness - Slow walking speed - Low physical activity
34
Evidence for Cognitive Geris Ax
Patients that underwent CGA were more likely alive and in their own homes at 6 months and 1 year Less likely to experience death or deterioration
35
DSM 5 Criteria for delrium
1. Disturbance in attention and awareness 2. Disturbance over a short period of time and tends to fluctuate throughout the day 3. An additional disturbance in cognition 4. No preexisting condition can explain it 5. Due to a direct physiological consequence of another medical condition, substance intoxication or withdrawal Also: -Impaired sleep, hypo or hyperactivity
36
What is attenuated delirium syndrome
Patient that doesnt meet the full criteria for delirium - can precede or follow delirium
37
6 factors that best predict delirium
- Prior cognitive impairment - Sleep deprivation - Immobility - Visual impairment - Hearing impairment - Dehydration
38
Delirium is an independent predictor of:
``` Increased LOS Poor functional recovery Lasting cognitive impairment predicted by duration of delirium in ICU RACF admission All cause mortality ```
39
MMSE does not assess:
Executive function
40
What is MOCA better at then MMSE
Cut off score 26 Higher sensitivity in detecting MCI and ALz than MMSE MMSE has higher specificity
41
Prognosis for MCI
May progress to dementia, remain stable, or revert to normal Exercise training fo r6 months may improve cognitive outcomes
42
Definition of Major neurocognitive disorder
Significant cognitive decline in one or more cognitive domains Cognitive decline interferes with independence in every day activities
43
RUDAS is useful in what situations
Language barrier or low education background
44
What areas of the brain do lewy bodies typically affect
brainstem, limbic areas, cortex
45
Indicative biomarkers in DLB
Low dopamine transporter uptake in basal ganglia demonstrated by SPECT or PET imaging • Abnormal MIBG myocardial scintigraphy • Polysomnicconfirmation of REM sleep without atonia
46
Name the 3 cholinesterase inhibitors
Donepezil Rivastigmine Galantamine
47
MOA Cholinesterase inhibitors
Increase acetylcholine by preventing breakdown by acetylcholinesterase
48
SE of Cholinesterase inhibitors
``` N+D+LOA WEight loss Muscle cramping Vivid dreams Bradycardia and conduction defects ```
49
PBS indications for Cholinesterase inhibitors
Mild to mod ALZ MMSE 10-24 Specialist approval -Side note: May benefit in LBD
50
Benefit of Cholinesterase inhibitors
Modest improvement in cognitive function, symptomatic improvement only Also helps with apathy and psychosis a bit Ongoing benefit in patients with mod to severe ALZ - Slowed decline of cognitive function and ADLs - Delayed entry to nursing home
51
MOA Memantine
NMDA antagonist
52
SE Memantine
constipation, dizziness, headache, hypertension
53
PBS indication for memantine
Mod-severe ALZ MMSE 10-14 Can use with donepezil
54
Benefit of memantine
Mod to severe AD - Improved cognition and function (?significant) - No evidence for added benefit with donepezil - Helps with aggression and agitation
55
Bladder emptying physiology
S2-4 parasympathetic innervation via pelvic N’s mediated by M2 & 3receptors
56
Bladder Filling phsyiology
sympathetic T11-L2 innervation via hypogastric nerve mediated by β3receptors
57
Urethra closure physiology
external sphincter -S2-4 pudendal N (somatic) originating in Onuf’s nucleus – Closure: ♂bladder neck -α1Aadrenergic
58
Antimuscarinics for OVeractive Bladder
Oxybutynin Solifenacin Darifenacin Tolterodine
59
SE of Antimuscarinics
``` Dry mouth Constipation Cognitive changes - Delirium Long term use assocaited with increased risk of dementia Assocaition with falls Rare: Closed angle glaucoma ```
60
Mirabegron MOA
Beta3 agonist - bladder relaxation For Overactive bladder Fewer SE than Antimuscarinics and just as effective
61
Dutasteride and Tamsulosin MOA
αblockers & 5 α-reductase inhibitors
62
Tx of stress incontinecne
Weight reduction Constipation Mx Mainstay: Pelvic floor exercises

Bpt (15 decks)

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