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Finals Club (Dundee Medicine Master Summary Deck) > Year 3: Ageing > Flashcards

Year 3: Ageing Flashcards

Physiology, Vaccinations, Screenings, Sarcopenia, Falls, Delirium, Drugs, Palliative Care

1
Q

In elderly albumin

A

Decreases

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2
Q

In elderly alpha acid glycoprotein

A

Increases

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3
Q

In elderly acidic drugs

A

Work better (due to decreased albumin, as it binds acids)

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4
Q

In elderly basic drugs

A

Have decreased action

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5
Q

In elderly stomach acid

A

Decreases

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6
Q

In elderly body water %

A

Decreases

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7
Q

In elderly the GFR is

A

Decreased

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8
Q

In elderly the therapeutic window for drugs is

A

Decreased

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9
Q

A tool to use in elderly for prescribing

A

STOP START tool

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10
Q

In elderly lipids are

A

Increased

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11
Q

Lipophilic drugs have an

A

Increased half life (due to increased lipids)

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12
Q

Infuenza vaccination is given to

A
  • Ages 65 +
  • Once per year
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13
Q

Pneumococcal vaccination is given to

A
  • Ages 65+
  • As a once off
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14
Q

Shingles vaccination is given to

A
  • At age 70
  • As a once off
  • “Varicella zoster”
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15
Q

Abdominal Aortic Aneurysm

A
  • Ages 65+
  • USS
  • 3-4.4cm = annual screening
  • 4.5-5.4cm = 3 monthly scan
  • >5.4cm = refer for an operation
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16
Q

Colorectal cancer (bowel) screening is for

A
  • Ages 50-75
  • Every 2 years
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17
Q

Breast cancer screening is for

A
  • Ages 50-70 (women)
  • Every 3 years
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18
Q

Age-related loss of muscle mass and function

A

Sarcopenia

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19
Q

Muscle mass declines from

A

Age 30

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20
Q

Muscle mass degradation accelerates at

A

Age 60

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21
Q

Sarcopenia happens due to

A
  • Decreased sex hormones (oestrogen)
  • Increased apoptosis
  • Increased mitochondrial dysfunction
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22
Q

3 pharmacological interventions for elderly people

A
  • Creatine/ protein supplements + weight exercise
  • ACE Inhibitors (reduce inflammation and increase mitochondrial function)
  • Ca2+ and Vit D (for bone strength)
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23
Q

Diagnosis of postural hypotension

A
  • Systolic is <90mmHg
  • Systolic has reduced by >20mmHg
  • Diastolic has reduced by >10mmHg

Measure after 3 mins of standing up

24
Q

Management of falls

A
  • Stop medications if underlying cause
  • Treat underlying cause
  • Strength and balance training (3/7 for 12/52)
  • Attend hobbies like Tai Chi
25
Q

Triad of Delirium

A
  • Disturbance in attention “Disoriented”
  • Change in cognition “Disorganised thinking”
  • Acute and fluctuating course
26
Q

Pathophysiology of Delirium

A
  • Derangement of ACh
  • Caused due to stress
    *
27
Q

Two types of Delirium

A
  • Hyperactive
  • Hypoactive
    *
28
Q

Hyperactive

A
  • Aggitated
  • Aggressive
  • Wandering
29
Q

Hypoactive

A
  • Withdrawn
  • Apathetic
  • Sleepy
30
Q

Assessments of Delirium

A
  • 4AT
  • CAM Assessment
31
Q

4AT

A
  • Alertness
  • Attention: Months of the year backwards
  • Acute and fluctuating
  • AMT4 (Acute mental test): Age, DoB, Place, Year
32
Q

What should you always do in delirium

A
  • Reassure
  • Re-orientate
  • Help patient with sensory aids etc
33
Q

1st line treatment for Delirium

A

Haloperidol (Typical antipsychotic)

34
Q

Haloperidol is contraindicated in

A

Patients with Parkinson’s Disease and Lewy Body Dementia

35
Q

2nd line for Delirium

A

Quetiapine (Atypical antipsychotic)

36
Q

3rd line for Delirium

A

(Lorazepam) BZD

37
Q

1st line for Delirium in Parkinson’s and LBD patients

A

Quetiapine

38
Q

1st line for Delirium in Alcohol Withdrawal

A

Lorazepam (BZD)

39
Q

If you prescribe Opioids

A

Prescribe Laxatives alongside this

(due to side effect of constipation from opioids)

40
Q

If you prescribe Steroids

A

Prescribe

  • Biphosphonates
  • Vit D
  • Ca2+
41
Q

Side effects of bisphosphonates

A

Necrosis of jaw

42
Q

Side effects of levothyroxine

A

Hypocalcaemia

43
Q

If prescribing antiplatelets or SSRIs

A

Then prescribe PPIs

  • Antiplatelets can increase GI bleeds
  • SSRIs can increase stomach acid
44
Q

Do not prescribe Metoclopramide in

A

Parkinson’s patients

  • Metoclopramide is a D2 receptor antagonist
45
Q

In Heart failure or post-MI prescribe

A

ACE inhibitors

46
Q

In elderly patients suffering from Osteoarthritis

A

Switch NSAIDs for Paracetamol

47
Q

The truth about statins and the elderly

A

They take years to actually work… and they area long-term prophylactic- so whats the point?

They interfere with a lot of shit

Not indicated for use > age 75

48
Q

Palliative care for pain/SOB

A

Morphine

49
Q

Palliative care for distressed patients

A

Midazolam

50
Q

Palliative care for nausea

A

Levomepromazine

51
Q

Palliative care for trouble with respiratory secretions

A

Buscopan

52
Q

Morphine (oral) is

A

10 times the strength of Codeine

(15mg of Codeine = 1.5mg of Morphine)

53
Q

Morphine (SC) is

A

twice the strength of Morphine (oral)

(2mg of Morphine (oral) = 1mg Morphine (SC))

54
Q

Oxycodone is

A

twice the strength of Morphine (oral)

2mg of Morphine (oral) = 1mg Oxycodone

55
Q

Oramorph is

A

of similar strength to Morphine (oral) but is immediate release

56
Q

Oramorph is used for

A
  • Breakthrough pain
  • It is taken PRN
  • Is 1/6th the dosage of background dosage
57
Q

7 steps of a death certificate

A
  1. Check for spontaneous movement
  2. Check for reaction to voice and pain
  3. Palpate 2 major pulses for 1 min
  4. Inspect eyes (fixed, dilated, absence of corneal reflex, dry)
  5. Auscultate heart and lungs for 1 min
  6. Check for implantable devices
  7. Record date and time of death

Finals Club (Dundee Medicine Master Summary Deck) (8 decks)

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