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Bpt > Geriatrics > Flashcards

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
Q

Bone changes with aging

A

Loss of osteoblast numbers, but same osteoclasts
Ca levels maintained by bone resorption not diet
Vit D def accelerates bone loss

26
Q

Endocrine changes with age

A

Increased insulin due to insulin resistance
Increased PTH and bone resoprtion
Increased vasopressin
Rise in FSH and LH

27
Q

Haeme changes with age

A

Increased fat in BM
WCC count same, but reduced function
Increased risk of DVT
Increased bleeding due to anticoagulants

28
Q

Brain changes with age

A

Decreased white matter compared to grey matter
DEcreased cerebral blood flwo
Decrease in cholinergic and muscarinic neurons

29
Q

Effects of aging on drug distribution

A

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
Q

Effects of aging on metabolism

A

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
Q

3 major criteria for sarcopenia

A

loss of muscle mass, strength, and function

-measure gait speed, muscle mass, and grip strength

32
Q

Tx of sarcopenia

A
  • 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
Q

Fried Model

A

To assess for frailty (need 3 or more)

  • Unintentional weight loss
  • Exhaustion
  • Weakness
  • Slow walking speed
  • Low physical activity
34
Q

Evidence for Cognitive Geris Ax

A

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
Q

DSM 5 Criteria for delrium

A
  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
Q

What is attenuated delirium syndrome

A

Patient that doesnt meet the full criteria for delirium - can precede or follow delirium

37
Q

6 factors that best predict delirium

A
  • Prior cognitive impairment
  • Sleep deprivation
  • Immobility
  • Visual impairment
  • Hearing impairment
  • Dehydration
38
Q

Delirium is an independent predictor of:

A 
Increased LOS
Poor functional recovery
Lasting cognitive impairment predicted by duration of delirium in ICU
RACF admission
All cause mortality
39
Q

MMSE does not assess:

A

Executive function

40
Q

What is MOCA better at then MMSE

A

Cut off score 26

Higher sensitivity in detecting MCI and ALz than MMSE

MMSE has higher specificity

41
Q

Prognosis for MCI

A

May progress to dementia, remain stable, or revert to normal

Exercise training fo r6 months may improve cognitive outcomes

42
Q

Definition of Major neurocognitive disorder

A

Significant cognitive decline in one or more cognitive domains

Cognitive decline interferes with independence in every day activities

43
Q

RUDAS is useful in what situations

A

Language barrier or low education background

44
Q

What areas of the brain do lewy bodies typically affect

A

brainstem, limbic areas, cortex

45
Q

Indicative biomarkers in DLB

A

Low dopamine transporter uptake in basal ganglia demonstrated by SPECT or PET imaging
•
Abnormal MIBG myocardial scintigraphy
•
Polysomnicconfirmation of REM sleep without atonia

46
Q

Name the 3 cholinesterase inhibitors

A

Donepezil
Rivastigmine
Galantamine

47
Q

MOA Cholinesterase inhibitors

A

Increase acetylcholine by preventing breakdown by acetylcholinesterase

48
Q

SE of Cholinesterase inhibitors

A 
N+D+LOA
WEight loss
Muscle cramping
Vivid dreams
Bradycardia and conduction defects
49
Q

PBS indications for Cholinesterase inhibitors

A

Mild to mod ALZ
MMSE 10-24
Specialist approval

-Side note: May benefit in LBD

50
Q

Benefit of Cholinesterase inhibitors

A

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
Q

MOA Memantine

A

NMDA antagonist

52
Q

SE Memantine

A

constipation, dizziness, headache, hypertension

53
Q

PBS indication for memantine

A

Mod-severe ALZ
MMSE 10-14
Can use with donepezil

54
Q

Benefit of memantine

A

Mod to severe AD

  • Improved cognition and function (?significant)
  • No evidence for added benefit with donepezil
  • Helps with aggression and agitation
55
Q

Bladder emptying physiology

A

S2-4 parasympathetic innervation via pelvic N’s mediated by M2 & 3receptors

56
Q

Bladder Filling phsyiology

A

sympathetic T11-L2 innervation via hypogastric nerve mediated by β3receptors

57
Q

Urethra closure physiology

A

external sphincter -S2-4 pudendal N (somatic) originating in Onuf’s nucleus
–
Closure: ♂bladder neck -α1Aadrenergic

58
Q

Antimuscarinics for OVeractive Bladder

A

Oxybutynin
Solifenacin
Darifenacin
Tolterodine

59
Q

SE of Antimuscarinics

A 
Dry mouth
Constipation
Cognitive changes - Delirium 
Long term use assocaited with increased risk of dementia
Assocaition with falls
Rare: Closed angle glaucoma
60
Q

Mirabegron MOA

A

Beta3 agonist - bladder relaxation

For Overactive bladder

Fewer SE than Antimuscarinics and just as effective

61
Q

Dutasteride and Tamsulosin MOA

A

αblockers & 5 α-reductase inhibitors

62
Q

Tx of stress incontinecne

A

Weight reduction
Constipation Mx
Mainstay: Pelvic floor exercises

Bpt (15 decks)

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