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Geriatrics Flashcards

1
Q

What are some reasons why people are living longer ?

A

Increased resource availability.
Better economic conditions.
Improved screening programmes.
Better outcomes following major events.

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2
Q

What is the Stochastic theory of ageing ?

A

Cumulative damage

Random

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3
Q

What is the programmed theory of ageing ?

A

Predetermined

Changes in geneexpression during various stages

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4
Q

How can frailty be defined ?

A

A susceptibility state that leads to a person being more likely to lose function in the face of a given environmental challenge

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5
Q

Name 4 frailty syndromes

A

Falls
Delirium
Immobility
Incontinence

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6
Q

What are some causes of incontinence ?

A

Extrinsic and intrinsic

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7
Q

What is an example of extrinsic factors causing incontinence ?

A 
Environment
Habit
Physical fitness
Diuretics
Constipation
Confusion
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8
Q

What is an example of Intrinsic factors causing incontinence ?

A

Problem with urinary outlet or bladder

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9
Q

What are the functions of the bladder ?

A

Urine storage (400-600ml)

Voluntary Voiding 
(Voluntary relation of external sphincter and involuntary relaxation of internal sphincter and contraction of the bladder)
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10
Q

What segments of the sacral plexus increases the strength and frequency of bladder contractions ?

A

S2-S4

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11
Q

Which spinal segments provides the bladder with sympathetic innervation to the Beta adreno-receptors?

A

T10-L2 (Causes detrusor to relax)

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12
Q

Which spinal segments provides the bladder with sympathetic innervation to the Alpha adreno-receptors?

A

T10-S2 (Causes contraction of the neck of the bladder and internal urethral sphincter)

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13
Q

Which spinal segments provide the urogenital system with somatic innervation ?

A

S2-S4

Contraction of pelvic floor muscles and external urethral sphincter

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14
Q

What are some characteristic features of the bladder outlet being too weak ?

A

Urine leak on movement, coughing, laughing, squatting.

Weak pelvic floor muscles

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15
Q

How do you treat it when the bladder outlet is too weak ?

A

PT
Oestrogen cream
Duloxetine

Surgical:
TVT/Colposuspension

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16
Q

What are the characteristic features of the bladder outlet being ‘too strong’ ?

A

Poor urine flow, double voiding, hesitancy and post micturation dribbling.

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17
Q

How do you treat the bladder outlet being ‘too strong’ ?

A

Alpha blocker (Tamsulosin)
Anti-androgen (shrinks prostate).
Surgery (TURP).

May need catheterized often supra-pubic

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18
Q

What kind of incontinence occurs when the bladder muscle is ‘too strong’ ?

A

Urge incontinence

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19
Q

What kind of features are present when the bladder muscle is ‘too strong’ ?

A

Sudden urge to pass urine immediately.

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20
Q

What can cause urge incontinence ?

A

Bladder stones or stroke

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21
Q

How do you treat urge incontinence ?

A

Bladder re-training

Anti-muscarinics

22
Q

What are the 3 types of incontinence ?

A

Overflow
Stress
Urge

23
Q

Which drugs relax the detrusor muscle ?

A

Antimuscarinics (Oxybutinin) and Beta-3 adrenoceptor agonists (Mirabegron)

24
Q

Which drugs relax the sphincter and bladder neck ?

A

Alpha-blockers (Tamsulosin)

25
Q

Which drugs shrink the prostate ?

A

Anti-androgen drugs (Finasteride and dutasteride)

26
Q

What is neuropathic bladder ?

A

Underactive bladder usually secondary to neurological disease i.e. MS or stroke.

Can also be due to prolonged catheterisation.

27
Q

What are some of the key features of delirium ?

A

Disturbed consciousness
Change in cognition
Acute onset and fluctuant.

Disturbance of sleep/wake cycle.

28
Q

What are some things which can precipitate delirium ?

A 
Infection
Dehydration
Biochemical disturbance
Pain
Drugs
Constipation/Retention
Hypoxia
Alcohol/drug withdrawal 
Brain injury
29
Q

What are some non-pharmacological treatments for delirium ?

A

Re-orientate and reassure patient.
Encourage early mobility and self-care.
Ensure continuity of care.
Avoid catheterisation and venflons

30
Q

How can you reduce the risk of developing delirium ?

A 
Promoting sleep hygiene
Early mobilization
Pain control 
Maintaining optimal hydration
Regulation of bowel and bladder function
Provision of supplementary oxygen if appropriate
31
Q

How do drugs cause falls ?

A

Decrease:
BP
HR
Awareness

Increase:
Urine output
Sedation
Hallucinations
DIzziness
32
Q

Drugs often responsible for falls

A 
Antihypertensives
Beta blocker
Sedatives
Anticholinergics
Opioids 
Alcohol
33
Q

If the patient states syncope on exertion what should you think ?

A

Aortic stnosis

34
Q

If the person has an ataxic gait what is the likely cause?

A

Cerebellar damage

35
Q

If the person has a arthralgia gait what is the likely cause ?

A

Arthritis

36
Q

If the person has a hemiplegic gait what is the likely cause ?

A

Stroke

37
Q

If the person has a Shuffling gait what is the likely cause ?

A

Parkinsons

38
Q

If the person has a high stepping gait what is the likely cause ?

A

Peripheral neuropathy

39
Q

What are the top 3 drugs most heavily associated with adverse drug reactions ?

A

NSAIDs
Diuretics
Warfarin

40
Q

In polypharmacy in the elderly what about absorption of drugs may change ?

A

Physiological changes occur that affect the rate but generally not the extent of absorption from the GI tract - delay in onset of action.

41
Q

What kinds of body composition changes occur which could affect the distribution of drugs ?

A

Reduced muscle mass = Increased adipose tissue which increases the duration of action.

Reduced body water = Decreased distribution.

42
Q

What kinds of protein binding changes can occur which could affect the distribution of drugs ?

A

Decreased albumin which decreases binding

43
Q

Hepatic metabolism is affected by what ?

A

Decreased liver mass

Decreased liver blood flow

44
Q

What are the consequences of disturbed hepatic metabolism ?

A

Txocity due to reduced metabolism/excretion.

Reduced first pass metabolism - increased bioavailability

45
Q

How does excretion and clearance of drugs change in older people ?

A

Renal function decreases with age

Reduces clearance and increases half-life of many drugs leading to toxicity

46
Q

What are some prescribing tools and guidelines used in prescribing for the elderly ?

A

Beer’s criteria

START-STOPP citeria

NHS Scotland Polypharmacy Guidance

47
Q

What kind of analgesia is not recommended for the elderly ?

A

Opiods
-more sensitive to effects, lower doses needed.

NSAIDs
-Increased adverse effects such as renal impairment and GI bleeding.

48
Q

What kind of cardiovascular drugs are not recommended in the elderly ?

A

Digoxin

  • Increased toxicity
  • Lower doses needed

Diuretics
-Decreased peak effect but reduced clearance

49
Q

Why should you be careful when prescribing anti-hypertensives in elderly patients ?

A

Exaggerated effects on BP and HR.
More likely to be issues with postural hypotension.
ACE inhibitors oftwn pro-drugs which may not be metabolized to the active form.
Renal adverse effects.

50
Q

How does an elderly patient cope with warfarin ?

A

More sensitive to this drug.

Greater risk from warfarin related falls and GI bleeding.

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