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Infants and Elders > I&E Week 3 > Flashcards

I&E Week 3 Flashcards

1
Q

Spots on the retina that are an early sign of dry macular degeneration:

A

Drusen

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2
Q

When do you need to start treating diabetic retinopathy? What’s the treatment?

A
  • Stage 4 (proliferative)

- Laser surgery

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3
Q

What’s one reason why a person with no vision loss and good visual acuity might have trouble carrying out ADL?

A

Decreased contrast sensitivity

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4
Q

Are PA’s required to report patients that don’t meet the DMV vision standards?

A

Yes

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5
Q

What does an audiogram measure?

A

Pitch and volume

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6
Q

How do you treat sudden sensorineural hearing loss?

A

Steroids

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7
Q

How do cochlear implants work?

A
  • Bypass hair cells and stimulate auditory nerve directly.
  • Convert acoustic signals into electrical signals
  • Useful when hearing aids no longer work
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8
Q

Define frailty:

A
  • Geriatric syndrome characterized by weaknes, weight loss and low activity that is associated with poor outcomes
  • Age-related, biological vulnerability to stressors and decreased physiologic reserves, leading to limited capacity to maintain homeostasis.
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9
Q

How does frailty differ from aging?

A
  • Frailty is a multi-system dysregulation associated with energy metabolism and neuromuscular changes, leading to weakness, weight loss, and decreased capacity to deal with stressors.
  • Aging is similar, but the failure of homeodynamics is global and not just associated with energy and neuromuscular changes
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10
Q

PK changes associated with aging:

A
  • Decreased total body water and albumin –> increased serum concentration, delayed clearance of lipophillic drugs
  • Decreased first pass metabolism –> increased bioavailability of drugs with extensive first pass metabolism
  • Decreased GFR –> increased concentration of renally cleared drugs
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11
Q

What’s one class of drugs that older patients are more sensitive to?

A

Centrally acting drugs like:

  • Narcotics
  • Neuroleptics
  • Antidepressants
  • Benzodiazapenes
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12
Q

Define polypharmacy:

A
  • Using multiple medications

- Using medications that aren’t clinically indicated or necessary

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13
Q

Some reasons for polypharmacy:

A
  • Multiple health issues
  • Multiple providers
  • Transition of care
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14
Q

What are some of the implications of polypharmacy?

A
  • Increased drug interactions and risk of adverse events
  • Increased risk of medication errors
  • Patients more likely to suffer falls
  • Patients more likely to be on ineffective or high risk medications: e.g., warfarin, digoxin, anticholinergics, benzos, narcotics
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15
Q

MOA for dopenezil:

A

Acetylcholinesterase inhibitor

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16
Q

MOA for memantine:

A

NMDA receptor antagonist

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17
Q

MOA for revastigmine:

A

Acetylcholinesterase inhibitor

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18
Q

Why should 1st generation antihistamines be avoided in the elderly?

A
  • Highly anticholinergic
  • Reduced clearance
  • Tolerance
  • Increased risk of dry mouth, confusion, constipation, other anticholinergic effects
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19
Q

Why should the anti-Parkinsonian drugs benztropine and trihexyphenidyl be avoided in the elderly?

A
  • More effective anti-Parkinsonian drugs

- Not recommended for treatment of EPS

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20
Q

Why shouldn’t you use TCA’s in the elderly?

A
  • Highly anticholinergic

- Sedating and cause orthostatic hypotension

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21
Q

Why shouldn’t you use alpha blockers in the elderly?

A
  • High risk of CNS effects

- Orthostatic hypotension and bradycardia

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22
Q

Why shouldn’t you use antipsychotics for behavior problems related to dementia?

A

Risk of CVA and mortality in patients with dementia

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23
Q

Why shouldn’t you use benzos in elderly patients?

A
  • More sensitive to them
  • Metabolize them more slowly
  • Increased risk of cognitive impairment, falls, fractures
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24
Q

Is it ok to use zolpidem or other non-benzo hypnotic in older patients?

A

No. Benzo receptor agonists have same effect as benzos.

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25
Q

Why shouldn’t you use NSAIDS in the elderly if other alternatives are available?

A

Increased risk of GI bleeding

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26
Q

List two sources of inflammation related to aging:

A
  • Lower ATP production in old age leads to a shift towards necrosis and oncosis, rather than apoptosis, as mechanisms of cell death, which leads to cytokine release and chronic inflammation.
  • Depleted adaptive (cellular) immunity leads to increased low level activity of innate immunity, leading to chronic inflammation.
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27
Q
  • Describe some GI changes associated with aging:

- What are the clinical implications?

A
  • Decreased HCl and GI absorption
  • Difficulty swallowing
  • Decreased GI motility
  • Results in decreased iron, B12, Ca absorption, increased diverticula, constipation, anemia
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28
Q
  • Describe some kidney changes associated with aging:

- What are the clinical implications?

A
  • Decreased number of glomeruli and renal tubules
  • Decreased kidney size
  • Decreased renal blood flow
  • Results in decreased GFR, glucose resorption and ability to concentrate urine
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29
Q
  • Describe some respiratory changes associated with aging:

- What are the clinical implications?

A
  • Decreased elastin, increased collagen
  • Decreased alveolar elasticity
  • Decreased intercostal strength
  • Results in decreased vital capacity, increased residual volume, lower exercise tolerance
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30
Q
  • Describe some endocrine changes associated with aging:

- What are the clinical implications?

A
  • Hypothalamus hormones stay the same, but organ response changes
  • Increased fasting glucose, decreased sensitivity
  • Nodular thyroid, increased TSH, decreased metabolism
  • Increased parathyroid hormone leads to osteoporosis
  • Decreased cortisol
  • Decreased aldosterone leads to lower BP but higher orthostatic hypotension
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31
Q
  • Describe some reproductive changes associated with aging:

- What are the clinical implications?

A
  • Decreased sex hormones leads to decreased muscle mass, increased fat
  • Increased vaginal pH leads to risk of urogenital atrophy and bladder infections
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32
Q

Describe some of the pulmonary changes associated with immobility:

A
  • Atelectasis
  • Aspiration pneumonia
  • Decreased ventilation
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33
Q

Describe some of the GU changes associated with immobility:

A
  • Bladder calculi and infection
  • Urinary retention
  • Incontinence
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34
Q

Describe some of the metabolic changes associated with immobility:

A
  • Impaired glucose tolerance
  • Altered drug PK
  • Altered body composition
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35
Q

Describe some of the psychological changes associated with immobility:

A
  • Delerium

- Depression

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36
Q

Why should you never use an anticholinergic in a patient treated with dopenezil?

A

Dopenezil is an acetylcholinesterase inhibitor, which works by increasing acetylcholine in the synaptic cleft. Anticholinergic meds block acetylcholine, which negates the effects of the dopenezil.

37
Q

What is the function of AAA?

A
  • Umbrella organization connecting seniors with community resources
  • Advocacy for seniors
  • Focus on helping senior stay in their homes and live as independently as possible
38
Q

What is the function of SHIBA?

A
  • Senior Health Insurance Benefits Assistance Program

- Statewide network of trained volunteers who educate and advocate for people with medicare

39
Q

Describe the Gatekeeper program:

A

Educates non-mandatory reporters about the signs of elder abuse and neglect.

40
Q

Describe the Family Caregiver Support Program:

A
  • Assists unpaid family caregivers caring for someone 60 or older who is not medicaid eligible.
  • Provides case management for the caregiver and possible stipend.
41
Q

Describe the Star Caregiver Program:

A

Provides support to caregivers of someone with Alzheimer’s or dementia

42
Q

Describe the Care Transitions Program:

A
  • Medicare funded program that helps individuals avoid hospital readmission after discharge
  • Focus on education to help clients become active in their own health care
43
Q

Describe Oregon Project Independence:

A

Helps people over 60 who need in-home assistance but who don’t qualify for medicaid

44
Q

Describe the PEARLS mental health program:

A
  • Program to Encourage Active Rewarding Lives for Seniors

- In-home counseling and maintenance (phone) sessions.

45
Q

One reason why citalopram isn’t used in older adults:

A

Possible QT prolongation

46
Q

One reason why paroxetine isn’t used in older adults:

A

Highly anticholinergic

47
Q

Why is mirtazipine (Remeron) a good choice for some patients?

A

One of its side effects is increased appetite, so a good choice for patients who are undernourished.

48
Q

Leading causes of death and disability in geriatrics:

A

Death: Cardiovascular dz, cancer, chronic lower respiratory dz

Disability: Arthritis/other MSK, CV dz, hearing/vision loss, dementia, lungs

49
Q

What result in the “get up and go” test suggests an increased risk for falls?

A

Taking more than 13.5 seconds to complete

50
Q

Immunization recommendations for seniors:

A
  • Flu every year starting at 65
  • No live flu vaccine (nasal spray) after 49
  • PCV23 once after 65
  • Zoster once after 60
  • Td/Tdap booster every 10 years, Tdap if contact with infant
51
Q

What sort of diet would you recommend for a patient at risk of macular degeneration?

A
  • Diet rich in green leafy vegetables and fish. - Possibly high dose antioxidant supplements and zinc.
52
Q

Should you order polysomnography for a patient with sundowning symtoms?

A

No. Not useful for detecting sleep changes in patients with dementia.

53
Q

Does bereavement exclude a diagnosis of depression in the elderly?

A

No

54
Q

What does DIAPPERS stand for?

A

Delirium, Infection, Atrophic (urethritis/vaginitis), Pharm, Psych, Excess (output), Restricted (mobility), Stool (impaction)

55
Q

What drugs should you be mindful of when assessing someone’s oral health?

A
  • Methotrexate, phenytoin and Ca channel blockers can cause gingival hyperplasia
  • Beta blockers, Ca channel blockers, nitrates and progesterone can cause reflux, which erodes teeth
56
Q

Two scales used to screen for alcohol use disorders:

A
  • AUDIT

- SMAST-G

57
Q

What are the recommendations for alcohol use for seniors?

A

No more than 1 drink/day if over 65

58
Q

Common neuro findings in geriatric pts with hypothyroidism:

A
  • Dementia
  • Ataxia
  • Carpal tunnel
  • Delayed relaxation of DTR
59
Q

Scales commonly used to screen for malnutrition:

A
  • Mini Nutritional Assessment
  • SCREEN
  • SNAQ
60
Q

How do you manage DM in older adults?

A
  • A1c
61
Q

Common atypical symptoms of HF in older adults:

A

Altered sensorium, irritability, lethargy, abd discomfort/GI problems, anorexia

62
Q

Usual medical management of HF in seniors:

A
  • ACE inhibitors

- Beta blockers

63
Q

Side effects of dopenezil (Aricept):

A

GI

64
Q

Side effects of tacrine (Cognex):

A

GI, hepatotoxicity

65
Q

Side effects of galantamine (Razadyne):

A

GI, SJS

66
Q

Side effects of revastigmine (Exelon):

A

GI

67
Q

Side effects of memantine (Namenda):

A

Confusion, restlessness, agitation (can mimic Sx of Alzheimer’s)

68
Q

Some meds that can cause QT prolongation:

A
  • Citalopram
  • Oxybutynin/Tolterodine
  • Haloperidol
69
Q

Side effects of tolterodine (Detrol) and oxybutynin (Ditropan):

A
  • Angioedema
  • Anticholinergic effects
  • QT prolongation/worsening of cardiac issues
70
Q

What is a Medicare Advantage Plan?

A

A private company contracts with medicare to provide Part A & B benefits. Usually offer rx drug plans, unlike medicare.

71
Q

Life expectancy of someone in hospice:

A

6 mo.

72
Q

Young-old
Middle-old
Old-old

A

65+
75+
85+

73
Q

Difference between gerontology and geriatrics?

A

Geriatrics (medical science, diseases) falls under larger Gerontology category (understanding aging)

74
Q

Effect of aging on creatinine clearance and serum creatinine:

A

Decreased creatinine clearance without corresponding rise in serum creatinine because of reduced muscle mass.

75
Q

Crystallized Intelligence vs Fluid Intelligence?

A

Crystallized Intelligence: “wisdom”, well practiced knowledge. stable into 70s-80s
Fluid Intelligence: problem solving in novel situations. gradual declines after 50s

76
Q

Signs of cortical atrophy with aging:

A

Widened sulci
Narrowed gyri
Thinning of cortical mantle
Ventricular dilation

77
Q

What are the MOLECULAR theories of aging? (3)

A

Epigenetic/genetic control
Somatic mutation
Error-catastrophe

78
Q

What are the CELLULAR theories of aging? (3)

A

Free Radical (leads into Mitochondrial Damage theory)
Mitochondrial Damage
Replicative Senescence / Telomere Senescence

79
Q

According to the Telomere Senescence Theory, what is the name of the max number of cell divisions a cell can undergo?

A

The Hayflick Limit

80
Q

What are the SYSTEMATIC theories of aging? (2)

A

Wear-and-Tear / Rate of Living (oldest theory, rejected)

Immunologic

81
Q

What is the only EVOLUTIONARY theory we have to know?

A

Natural Selection

82
Q

What does BATTED stand for, and when do you use it?

or BATHED

A

Use it for ADLs.

Bathing/grooming
Ambulation
Transfers
Toileting (or "help toileting" in the case of BATHED)
Eating
Dressing
83
Q

What does MASTER stand for, and when do you use it?

A

Use it for medications.

Minimize # of meds
Alternatives
Start low, go slow
Titrate therapy to individual
Educate pt/caregiver
Review meds regularly
84
Q

What does SPICES stand for, and when do you use it?

A

Use it for geriatric syndromes.

Sleep disorders
Pain or problems eating
Incontinence
Confusion
Evidence of falls
Skin breakdown
85
Q

Classic triad of Alzheimer symptoms?

A

Memory impairment
Visuospatial problems
Language impairment

86
Q

Severe sensitivity to antipsychotics is suggestive of which type of Major Neurocognitive Disorder?

A

Lewy Body Dementia (results in dystonic rxns / stiffness)

87
Q

In Lewy Body Dementia, which occurs first: cognitive decline or motor symptoms?

A

Cognitive decline usually precedes parkinsons symptoms, or follows w/in a year.

88
Q

Which is the only type of dementia that can be distinguished by EEG?

A

Creutzfeldt-Jakob (shows characteristic triphasic bursts)

89
Q

4 Parkinson motor symptoms?

A 
TRAP:
Tremor
Rigidity
Akinesia/Bradykinesia
Postural instability & gait disturbance
(Dx made by bradykinesia + 1 other)

Infants and Elders (3 decks)

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