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Geriatrics > midterm 1 > Flashcards

midterm 1 Flashcards

1
Q

5 RF for acute MI

A 
SOB (most common complaint)
Fatigue
Weakness
Epigastric pain
Low energy
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2
Q

8 common sites for ulcers

A 
Occiput
Spine
Sacrum
Ischium 
Heels 
Trochanter
Knee
Ankle
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3
Q

Non-modifiable RF for dementia (4)

A

Age (prevalence of AD doubles every 5 yrs >60)
Family hx
APOE-4 gene
Down Syndrome

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4
Q

4 modifiable RF for dementia

A 
Head trauma 
HTN 
DM 
Smoke 
Depression
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5
Q

word finding issues, apathy/indifference, delusion, disorientation

all specific to

A

AD

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6
Q

only dementia that is specifically subcortical

A

Parkinson’s

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7
Q

multiple stroke like events put you at risk for what dementia

A

Vascular

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8
Q

fluctuating attention
fidgety
agitated
tremulous or apathetic

are all characteristic of what type of dx

what type of dx material would you see

A

delirium

hx of toxin, infx, or metabolic etiology

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9
Q

progressive memory deficits are characteristic of

A

AD

could be seen with apraxia

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10
Q

behavioral
personality
language changes seen with apraxic gait

A

Frontotemporal dementia

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11
Q

limb rigidity

bradykinesia and potential gait disturbance or intential tremor

A

LBD

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12
Q

fluctuating attention with gait motor and sleep disturbances

A

lbd

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13
Q

impulsive, hypersexual characteristic of

A

frontotemporal

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14
Q

Typical age of onset with FTD

A

<60

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15
Q

hallmark of dementia

A

Loss of recent memory

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16
Q

early vs late dementia

A

impaired ADLs, subtle language errors, impaired spatial perception

phasia, apraxia, agnosia, inattention, left-right confusion.

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17
Q

risk of SSRI for depression in elderly

how to avoid

A

you run the risk of serotonin syndrome

Check Na in 2 weeks if on other meds that effect ADH (diuretics, NSAIDS, monitor for GIB/NSAID/ASA)

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18
Q

buproprian for tx of depression in elderly

A

No sexual side effects, no weight gain, no GIB

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19
Q

problems with using TC in elderly

A

anticholinergic, increase HR, orthostasis, monitor EKG

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20
Q

SPLATT

A 
Symptoms - before/after
Previous falls 
Location of the fall
Activity 
Time of day
Trauma
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21
Q

Trendelenburg what does it look like and what causes it

A

Drop in pelvis/weight to unaffected side

Cause = hip abductor weakness, eg: gluteus medius minimus piriformis, QL)

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22
Q

Gluteus Maximus Lurch

what does it look like and what causes it

A

Backward trunk lurch persists to maintain center of balance

Cause = hip extensor weakness; eg, gluteus maximus

23
Q

Steppage what does it look like and what causes it

A

Excess hip flexion to clear food

Cause = foot drop

24
Q

Ataxic what does it look like and what causes it

A

Unsteady, uncoordinated, wide base, feet thrown out coming down on heel then toes
Cause = injury to cerebellum, sensory deficits of lower limb.

25
Antalagic what does it look like and what causes it
Walking with pain | Short stance 2/2 pain.
26
RF for falls
``` History of falls Gait deficit Balance deficit Strength deficit Restraints (they fight their restraints and fall) Arthritis Uses assistive devices Impaired ADLs Depression Cognitive impairment Postural hypotension ```
27
nitrates BB CCB and estrogens all have what changed in elderly
decreased first pass increased serum concentration
28
furosemide in elderly
decreased absorprtion leads to decreased effect
29
digoxin and lithium in elderly
decrease in lean madd and body water leads to decrease in volume of distribution
30
diazepam chlordiazepoxide | flurazepam and alprazolam are all at risk for what in elderly
increased half life because of decreased CYP metabolism can cause falls
31
AG vancomycin digoxin and salicylates are all risky in elderly because
decrease renal elimination and increased half life
32
cimetidine
inhibits cyp and increases risk of ADR of other drugs
33
better benzos for elderly
Lorazapam and oxazepam
34
increased risk of ototoxicity due to decreased CrCl with this meds
TCA and AG
35
AchE inhibitors
can cause liver toxicity avoid with CYP inhibitors use Donepezil, rivastigmine, and galantamine instead of tacrine
36
problem with digoxin
narrow range | needs renal adj
37
CN damage ototoxicity nephrotoxicity all a problem in elderly with this drug class
AG
38
4 things to consider when writing precriptions
a patient’s life expectancy (2) the time until benefit from medication (3) goals of care (4) treatment targets.
39
factors that increase drug effects
Take more drugs than younger people Prescription errors due to lack of consideration of pharmacokinetics Multiple physicians treating same pt Increased usades of OTCs among elderly Cimetidine CYP450 Pt compliance decreases with the number of drugs Increase in dosage requirements
40
abnx that require dose adjustments .
(Beta lactams and AG) ``` AG: Kanamycin A. Amikacin. Tobramycin. Dibekacin. Gentamicin. ``` ``` bl Amoxicillin/clavulanic acid# Imipenem/cilastatin# Ampicillin/flucloxacillin. Ampicillin/sulbactam (Sultamicillin) Ceftazidime/avibactam. Piperacillin/tazobactam. ```
41
curare like effects seen with what drugs? what does this lead to
AG respiratory paralysis Curare-like effects at NMJ → respiratory paralyses but reversible w/ neostigmine
42
What are the considerations when prescribing Analgesic
opioid --> CNS depression Corticosteroids → osteoporosis → fractures NSAIDS (COX-1 COX-2, selective and non-selective) → renal damage
43
7 sxs of neglect
``` Pressure ulcers **** Weight loss/malnutrition Dehydration Poor hygiene/elongated toenails Depression/Inappropriate attire/disheveled Abrasions/lacerations Failure to seek care in timely fashion ```
44
5 rextrinsic RF for ulcers
Pressure (standard mattress. Wheelchair that is too small or too large. Wheelchair seating) Shearing forces (rubbing from diaper change) Friction (rubbing heels in bed) Moisture (diaphoresis caused by pyrexia, autonomic instability) Urinary/fecal incontinence
45
7 intrinsic RF for ulcers
``` Nutritional statu Age Immobility or limited activity Sensory impairment Neuropathy (think individuals with DM) Paraplegics Incontinence (fecal > urinary) This is why we see ulcers on sacrum and coccyx Dry skin Obesity Body temp, Blood pressure? ```
46
4 medical RF for ulcers
``` Dm Kidney failure PVD Dzs that require prednisone (thins) RA COPD ```
47
how to prevent ulcers
Turn the patient every 2 hours!!! Although bed rails are a form of restraint, benefits may exceed the risks of restraint injuries Keep the patient dry Use special beds to prevent pressure ulcers
48
how to treat ulcers
REMOVE PRESSURE Medical Treatment Nutrition: High Protein, Vitamin C, Zinc Monitor albumin and prealbumin/ nutritional consult Treat primary medical condition/comorbidity Manage incontinence Specialized beds and mattresses (air loss and air fluidized mattresses), doughnut cushion Local wound care Surgery Pain management
49
factors to consider in writing rx for elderly
“Start low and go slow” Begin at 1/2 the usual adult dose and titrate to the desired effect. Prescribe the fewest drugs possible and use the simplest dosing regimen. Patient instruction and education about dose and dosing schedule require more time than expected. Keep cost in mind. Work with patient’s on fixed income and limited or no insurance. Review patient’s drug list periodically. Have patient bring all drugs. OTC and herbal medicines to office once a year. Provide patient with a portable prescription record to take to other physicians. This helps avoid drug-drug ADRs and duplication. Make home health nurses and aides aware of your need to know about any ADRs observed in your patient.
50
3 Gait changes with advanced age
Decline in gait speed Stride length diminishes Not due to decrease in cadence
51
Characteristics of gait abnormalities
Shorter, broad strides Longer stance Shorter swing duration
52
Common Dx leading to Gait disorder
Degenerative Joint Disease → #1 reason Sensory Impairment Neurological Diseases Stroke Parkinson's Postural Hypotension/Rx induced Fear of Falling
53
heel hits ground first as trunch arches back
Gluteus Maximus Lurch
54
foot falls flat on floor
Steppage gait

Geriatrics (12 decks)

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