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Peds and Geriatrics > Week 4 > Flashcards

Week 4 Flashcards

1
Q

define elderly

A

“young old” 65-74
“middle old” 75-84
“old” old >85 y.o

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2
Q

effects of covid on the baby boomer population

A

has possibly hasten the death of the baby boomer populatoin. either directly through COVID-19 or other factors

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3
Q

physiologic changes that occur in aging

A

Fat: increase in fat goes form 15 to 30%

Skelatel muscle decreases

bone density decreases

intracellular water decrceases
extracellular water remains the same

in genral, FATTER, WEAKER, DRIER

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4
Q

physiologic changes that occur in aging

CV system

A

anatomical: decreased contraction and filling capacity

physiological:
changes in conduction, decreased efficiency, decreased catacholamines

conduction system:
decrease d/t fibrosis or ischemia
“irritable”

Arteirla
*increased stiffness
*atherosclerosis

Venular:;
*decreased valves
*thrombosis, PE

Dx R/T aging cv system
*HTN
*TIA/CVA

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5
Q

physiologic changes that occur in aging

central nervous system

A

decreased rate of conduction

decreased strength of transmission

threshold for arousal blurred

reduced adaptation to physiologic stressors

increased recovery time in autonomic system

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6
Q

physiologic changes that occur in aging

Respiratory system

A

normal at rest,compromised at stress (known as duspena on exertion)

anatomical:
*decreased elasticity,
*muscle weakness
*skelatal deformities

function
*decreased ventilation
*decreased PaO2

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7
Q

physiologic changes that occur in aging

genitourinRY KIDNEYS

A

anatomic:
*nephron degeneration

Physiologic
*decreased ability to concentrate urime
decresed renal blood flow
decreased acid base adaptation when sressed

kidneys and problems w. aging kidneys

inadequate fluid intake
fluid loss d/t vomiting or diarrhea

shock d/t hemorrhage
cardiac failure
sepsis
injudicious use of diuretics
sod phosphate enemas

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8
Q

Genitourinary-bladder changes

A

gyno changes in women
*estrogen deprivation
atrophy
decreased secretions
results in urinary incontinance, dyspareunia, s/s menopause

reproductive chanhges in man
*gradual decrease of testosterone
decreased libido and sexual function, decreased energy and increased bodyfat,osteoporosis, decreased muscle mass, and decreased body hair

associated: diabetes mellitus, CV disease, and metabolic syndrome
*BPH
*erectile dysfunction

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9
Q

physiologic changes that occur in aging

GI

A

geenral: dentition and nutrition

esophageal: decreased motility, hiatal hernia

stomach: decreased acid production, intrinsic factos and motility

colon: decreased motility

pancreatic: decreased secretions

liver: decreased size, blood flow and CYP450

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10
Q

physiologic changes that occur in aging

Musculoskelatal

A

sturcutre and function
*atrophy
*decreased O2

joints:
erosion
degenration
calcification/ossification

skelatal degeration
*OP
*kyphosis

*fracturs and falls

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11
Q

physiologic changes that occur in aging

skin and derm sensory

A

change in skin, nails and hair
*decreased elasticity
decreased turgor
increased pigmentation

decreased vision
decreased hearing
other

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12
Q

leading causes of death in elderly

A

heart disease

malgnant neoplasms

chromic lower respiratory diseases

cerebrovascular diseases

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13
Q

define geriatric

A

*diminished homeostatic reserve capacity of all organ systems called homeostasis

in absence of stressors, homestasis causes no symptoms and very few restrictions on routine activities

progressive risk of homeostatic failure w. increasing age
(DECREASE OF FUNCTIONAL RESERVE)

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14
Q

define geriatric syndromes

A

multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render an older perosn vulnerable to situational challenges

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15
Q

facotrs of geriatric syndromes

A
  1. multiple risk factors and organ systems involved
  2. dx strategies to identify underlying causes sometimes ineffective, burdensome, dangerous, and costly

3.tpx mgmt of clinical manifestations can be helpful even in the absense of a firm dx or clarification of the underlying cause

could have a multiple etiologic factors and multiple pathogenic pathways causing SS

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16
Q

Geriatric Syndromes AGS GRS

A

DEMENTIA
DELERIUM
URINARY INCONTINENCE
FALLS
PRESSURE ULCERS
POLYPHARMACY

and others

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17
Q

delerium vs dementia

A

onset:
delerium: sudden w. deifnite beginning point
dementia: slow and gradual

duration:
delerium: days-weeks
dementia: usually permanent

cause:
delerium:almost always another ocnditions (infection, drugs, dehydration
dementia:: usualy chronic brian disorder

course:
delerium:usually reversible
dementia: slow progressive

attentioin
delerium: greatly impaires
dementia: unimpaire duntil dementia is severe

LOC:
delerium: variabily impaired
dementia: unimpaired until severe

orientation time/place
delerium: varies
dementia: impaired

memory
delerium: varies
dementia: lost, especially for recent events

need for medical attention:
delerium: immediate
dementia: required but less urgent

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18
Q

define frailty

A

occurs more in >90 y.o (>32%)

excess vulnerability to stressors, w. reduced abilty to maintain or regain homestasis after destabilizing event

(cdue to cumaltive decline in many phsyiologic sytems.vdpeletes homeostatic reserves

19
Q

contributing factors of frailty

A

chornic malnutrition
sarcopenia
decreased metabolic rate and activity
decreased appetite

other effects of stressor events
*falls
delerium (BOTH OF THESE OFTEN TRIGGERED BY ADMIN OF DRUGS)
fluctuating disability
increased care needs
admission to hospital
admission to long term care

20
Q

five phenotypical model indicators of frailty and their associated measures

A

weightloss (>4-5 kg or recorded wieghtloss of >/5% /year

self reported exauhstion

low energy expenditure (<383 kcal/weel) or <270 kcal/week in women

slow galt speed (standardized cutoff times to walk 4-57m

weak grip strength

21
Q

medications and frailty

A

polypharmacy could have a potential effect on frai.ty, however it being adirect cause is unclear

22
Q

clinical geriatric approach

A

maintenance of independence and prevent disability

multiple comorbidites

atypical presentation

*NOTE any symptom in an elderyly pt should be considered a drug side effect until proven otherwise

23
Q

iatragenic cascade

A

drug thats can cause side effects, and they are put on more drugs to treat other SE.

that i swhy it is important to identify potential side effects of drugs and don tlet them go unrecognized

24
Q

tools for comprehensive geriatric assessment

A

TIMER: tool to impromve medications in the elderly via review

geenral approach:

a. cost and coverage
b. adherance
c. safety
d. attain tpx goals

25
Q

other things to conside rin comprehensive geriatric assessment

A

history taking problems (communication, underreporting, etc.

medicaiton organinzation (pillbox, reminders, etc)

non adhearance
(intentional and nonintentional)

assessing and monitoring drug therapy

26
Q

drug related problems in elderly

A

underuse

over use

innapropriate prescribing (Beers, STOPP, STOPPFrail): r/t age and disease state)

27
Q

Geriatric 5 m’s

A

MIND
MOBILITY
MEDICATIONS
MULTICOMPLEXITY
MATTERS MOST

28
Q

determinging med appropriateness in elderly

A

at younger elderly ages: more drugs are appropriate because they have a longer time of benefit of the drugs

as they get older, time of benefit decreases and goal of careis more palliative instead of preventative

29
Q

Physiologic changes associated w. aging

Absorption

A

somtach emptying time-
*delayed retention of indigestibles solids
decreased rate of absorption (can be effected by analgesics and hpynotics)
*acid-labile drugs

intestinal motility:
*some have increased or decreased motility
*more commonly decrease dmotility

gastirc acid secretion
*reduced, can cause hypochlorydria/achlorhydria

gastirc bloodflow
*may decrease absorption of high permeability drugs

REDUCED FIRST PASSED EFFECT
*reach systemic circulations at higher concentrations (ex: morphine, lidociane, propanolol, verapamil)

***however, overall, no significant effect on rate or extent of absorption

30
Q

absoprtion from transdermal route

A

dryer skin
fatter skin
less perfused skin

effects: same absorption of lipophilic compounds
decreased absoprtion of hydrophyllic compounds

cachexia: loss of muscle , can effect absorption of durgs

ex: use of fentanyl patches
* absoption is longer and degree of pain tolerance effects how long the fentanyl patch is effective in pts

31
Q

absorption form a mucosal standpoint

A

sublingual
buccal
rectal stomal

all remian inteact

32
Q

Physiologic changes associated w. aging

Distribution

A

decrease lean body mass

increased fat: increase lipophyllic drug vd

decreaed water: decreased vd of hydrophillic drugs (lthium, theophylline, AG, etoh)

33
Q

metabolism in elderly

A

reduced 3a4

no change in 2d6

decrease in hydroxylation and decreased demethylation in phase 1 metabolism

some evidence of decrease in >80yo of phase 2 metabolism glucornonidation

decrease mass and volume of liver

34
Q

drugs that won emetabolize well

A

benzos

35
Q

changes in renal function due to

A

decrease volume, weight, renal bloodflor, and glomerular function and tubular functoin

ALWAYS CALCULATE CrCl

accumaltion of toxic metabolite accumulation

36
Q

DURGS EFFECTED BY DECREASED RENAL FUNCTION

A

ACE
beta blockers

37
Q

change sin pharmacodynamics

A

info limited: some drugs can increase sensitivty, some can blunt response

38
Q

drug classes innaprporpaite in oldr adultas

A

ACH confusion, other systemic adr

BENZOS: falls, delerium

AD-increased risk of falls, tca’s, ach (paroxetine)

NSAIDS- gi toxicity, cv risks( mi, hf), aki

39
Q

ACH effects

A

common ach meds:
antihistmaines
TCAs
PAROXETINE
atropine
oxybutnin
tolteridine

40
Q

process of deprescribing

A
  1. ascertain info on all meds currently taking, and adherance for each and why
  2. assess pt drug regimen for risk for drug induced harm
  3. assess eligiabilty for d/c

4, prioritize d/c list stareting from highest harm and lowest benefit,

41
Q

tisk factors to fals

A

age releated muscle weakness

comorbidities

42
Q

consequences of falls

A

fear o f falling

loss of confidence, mobility and the ability to live independently

43
Q

itnerventions in preventing falls

A

multimodal interventions cause better reduction of falls

medication management
home

44
Q

goald of med mgt to prevent falls

A

Peds and Geriatrics (5 decks)

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