Geriatrics – Flashcards
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Over the age of 65 what is the number one killer?
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Heart Disease
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Over the age of 65 what is the number two killer?
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Cancer
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Over the age of 65 what is the number three killer?
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Stroke
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Over the age of 65 what is the number four killer?
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Chronic Lower Respiratory Disease (CLRD)
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Over the age of 65 what is the number five killer?
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Flu/Pnuemonia
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Over the age of 65 what is the number six killer?
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Alzheimer's
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Over the age of 65 what is the number seven killer?
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Diabetes
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Over the age of 65 what is the number eight killer?
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Renal Disease
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Over the age of 65 what is the number nine killer?
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Trauma
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Over the age of 65 what is the number ten killer?
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Septicemia
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What percentage of population in 2020 will be over 65 years old?
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20%
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T/F: The >85 is the fastest growing segment of the population
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True
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What percentage of >65 year olds have some form of heart disease?
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34%
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Heart Rate x Stroke Volume =
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Heart Rate x Stroke Volume = Cardiac output
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T/F: EF%= EDV/SV (EF = Ejection Fraction)
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False; EF% = SV/EDV
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Do cardiac stents require antibiotics?
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No
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T/F: NSAIDS raise blood pressure
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True
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For a patient with hypertension or stable angina, what moderate dosages of LA are recommended?
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72mg lido 36 mcg epi Or 40mg lido/ 36 mcg epi (maybe if severe CHD?)
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What does climbing one flight of stairs equal on the MET scale?
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4 METs
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With a patient that has a history of cardiac arrhythmias, what INR is the limit to proceed with surgery using local measures?
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INR 3.0 or less is safe to proceed with surgery with local measures
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T/F: A patient with a history of infective endocarditis should have antibiotic prophylaxis?
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True
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T/F: A patient with a repaired congenital defect with graft material that treated years ago needs a antibiotic prophylaxis
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False Does not need antibiotic prophylaxis unless it was within 6 months, the graft material prevented epithelization, or MD orders
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Local Anesthetics conversions: 1:1000 = _mg/mL
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1:1000 = 1mg/mL
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Local Anesthetics conversions: 1:10,000 = _mg/mL
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1:10000 = 0.1mg/mL
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Local Anesthetics conversions: 1:100,000 = _mg/mL
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1:100,000 = .01mg/mL or 10mcg/mL
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Local Anesthetics conversions: 1% = _g/ 100mL = _mg/mL
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1% = 1g/ 100mL = 10 mg/mL
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Local Anesthetics conversions: 2% = _mg/mL
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2% = 20mg/mL
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Local Anesthetics conversions: 3% = _mg/mL
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3% = 30 mg/mL
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Local Anesthetics conversions: 4% = _mg/mL
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4% = 40 mg/mL
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Local Anesthetics conversions: 1 ppm = _mg/mL
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1 ppm = 1mg/L
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How much should one reduce LA dosage for a healthy elderly individual over the age of 65?
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Reduce dose by 20%
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What is the max dosage of 2% lidocaine with 1:100k epi = _mg/kg
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2% lidocaine with 1:100k epi = 7mg/kg
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What is the max dosage of 4% articaine with 1:200k epi = _mg/kg
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4% articaine with 1:200k epi = 7mg/kg
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What is the max dosage of 0.5% Bupivicaine with 1:100k epi = _mg/kg
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0.5% Bupivicaine with 1:100k epi = 1-2 mg/kg (Increase in cardiotoxicity)
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What is the max dosage of 3% mepivicaine (plain) = _mg/kg
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3% mepivicaine (plain) = 4-5 mg/kg
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What does IMRT stand for?
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Intensity Modulated Radiation Therapy
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What level of radiation is it a concern for osteoradionecrosis?
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50 Gy or 5000 rads increases risk
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When is it safest to treat a patient with chemotherapy?
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One week prior to their next dose of chemo treatment (or 17-20 days after dose)
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For a patient on chemotherapy, what are the lower lab limit values for: 1) ANC 2) Platelets
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ANC > 500 Platelets > 50,000
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For a patient undergoing chemotherapy, at what ANC level do you consider pre/post antibiotics?
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ANC<1000
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T/F: Elective dental treatment can be performed on a patient with TIAs within the past six months?
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False No elective treatment
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__% of >65 year olds and __% of > 85 year olds have diabetes
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10% of >65 year olds and 25% of > 85 year olds have diabetes
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T/F: Patients with diabetes are at four times the risk for a myocardial infarction
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True
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T/F: Non-dialysis days should be treatment day for a patient with stage III chronic kidney disease (CKD)
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True
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T/F: You can have a normal ejection fraction and have diastolic heart failure
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true
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T/F: For chronic kidney disease patients there is no dosage adjustment for local anesthesia
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True (no dosage adjustment per se judicious use warranted)
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What is the peak age of diagnosis for Parkinson's disease?
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55-65 years old
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What are the three major types of arthritis?
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1) Rheumatoid arthritis 2) Osteoarthritis 3) Crystal arthroathies
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T/F: The proximal interphalangeal joints are known as Herberdeen's nodes
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False: The proximal interphalangeal joints are known as Bouchard's nodes
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T/F: Subjective is what the patient says
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True
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What percentage of diagnoses are made or suggested by history?
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90%
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What do the vital signs tell us?
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The general metabolic status of the patient
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T/F: The history is given by the patient
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True
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T/F: The historian (dentist) records the history
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True
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Difference between subjective and objective
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Subjective = what the patient says, personal interpretations Objective = what you can view, see or test,
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What is the difference between signs and symptoms?
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Signs - Visual cues to other people, something witnessed Symptoms - something felt/experienced by the patient
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What do you need from a patient that is on immune modulators before rendering treatment?
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Labs (platelets, CBC, ect.)
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What is the function of pacemaker?
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To control heart rhythms, uses electric pulses to make the heart beat at a normal rate
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Is it your duty to change the dosage of medications that a patient is prescribed by a physician?
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No
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T/F: In the elderly, the first pass metabolism is diminished therefore there is a decrease in bioavailability
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False: In the elderly, the first pass metabolism is diminished therefore there is an INCREASE in bioavailability
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In terms of fat and the elderly, what pharmacokinetic changes in distribution should be considered?
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Increased fat reduces volume of distribution for hydrophilic meds, and the opposite for lipophilic
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T/F: Pharmacokinetic changes in the elderly such as protein binding are equivocal
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True
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T/F: There is a decreased elimination of drugs due to a lower renal clearance in the elderly
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True
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What is "ejection fraction"?
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Stroke volume/end diastolic volume
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With congestive heart failure (CHF) at what ejection fraction (in percent) is CHF considered mild, moderate, severe?
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Ejection fraction Mild <55% Moderate <45% Severe <30%
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T/F: An increase in afterload lessens stroke volume
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True
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What is preload?
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Preload is the end diastolic volume that stretches the right or left ventricle of the heart to its greatest dimensions under variable physiologic demands
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What is afterload?
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Afterload is the pressure in the wall of the left ventricle during ejection.
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What is homeostenosis and what are its implications?
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The progressive constriction of homeostatic reserve that happens with aging in each organ system. Can lead to frailty, increased susceptibility to infection; can cause heart attack, confusion, death
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What are the implications of a DNR order?
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Do not give CPR or intubate the person if they need it
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What documentation is necessary for a DNR?
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DNR form filled out and signed by the patient, attorney, and medical provider
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What percentage of patients take less than the prescribed dose (non-compliance)?
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90%
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What percentage of patients take drug holidays?
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20%
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T/F: Patient and MD agree only 1/3 of the time as to what meds the patient is taking
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True
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What percentage of patients make omissions in dosing?
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40%
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T/F: NSAIDs can interact with multiple Rx medications and cause hypertension
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True
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How many people over the age of 65 reside in nursing homes? What percent of elderly?
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1.5 Million people ~5% of the elderly
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What is the average length of stay in a nursing home?
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830+ days
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Of the 5% elderly living in nursing homes (give the breakdown): Ages 65-74 = __% Ages 75-84 = __% Ages 85+ = __%
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Ages 65-74 = 14% Ages 75-84 = 36% Ages 85+ = 50%
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By 2040, __ million people age 65 and older will require nursing home care
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By 2040, 4 million people age 65 and older will require nursing home care
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T/F: More males than females in nursing homes
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False; More females (~75%)
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What cardiovascular changes occur in the elderly?
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Heart pumps less effectively
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What happens to renal function as we age?
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Renal function decreases Declines 1% per year after age 30 Decreased mass by 30% in elderly Glomerular filtration declines 10% per decade
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What are adverse drug reactions?
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Result of therapy that was neither intended or elected which causes significant issues
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T/F: Allergies are a type of adverse drug reaction
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True (6-11% of adverse drug reactions)
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How will left ventricular hypertrophy affect afterload directly?
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Decreases afterload
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If heart muscle contractility decreases, how does that affect the afterload?
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Increases afterload
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How do aortic stenosis and aortic valvulopathy affect afterload?
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Increases aortic pressure and increases afterload
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What does ADL's stand for?
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Activities of Daily Living
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What does IADL's stand for?
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Instrumental Activities of Daily Living
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What is the definition of ADL?
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A range of common activities whose performance is required for personal self-maintenance and independent community residence
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Preparing meals, managing money and shopping are IADL's or ADL's?
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IADL's Complex abilities needed for independent living.
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T/F: Chronological age is a poor indicator of functional ability
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True
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T/F: Ejection fractions under 55% are abnormal
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True
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T/F: Some patients in diastolic heart failure have a normal ejection fraction (65%)
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True
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What is the maximum amount of lidocaine/epinephrine?
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72 mg lidocaine 36 mcg epinephrine
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What are the two critical things you need to know about radiation?
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1. Where did they irradiate (FOV)? 2. What was the dosage of radiation?
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What follow up questions would you ask for diabetes?
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What type of diabetes do you have? When was it diagnosed? What medications do you take for it? How often do you check your glucose? Do you ever pass out due to low blood glucose?
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What level HbA1c do you want?
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Ideally <6.5
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If patient with diabetes, what would you do prior to an appointment where you are prepping for a 6 unit anterior bridge?
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-Might consider altering insulin dose (no regular + 1/2 NPH) - GET MD CONSULT - Take pre-operative blood sugar level -have patient eat breakfast and schedule AM appointments -Post operative nutrition such as Glucerna
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What patients are prone to latex allergies?
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1. Cystic Fibrosis 2. Spina Bifida/Neural tube defects 3. Pts with multiple drug and/or food allergies 4. Sulfite drug allergies (sulfite in anesthetic with epi.)
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What is the aspirin triad?
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Asthmatic + Aspirin Allergy + Nasal Polyps
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What is a safety implication for medications for BP control?
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Orthostasis
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What is a safety implication for medications for depression?
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Low BP
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What is are safety implications for medications such as beta blockers/glycosides/CaChannel Blockers?
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Be careful with epinephrine vasoconstrictors
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What is a safety implication for medications for medications with rhythm control (amiodarone)?
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Caution epinephrine vasoconstrictors
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For a 1 person transfer, what angle should the wheelchair be positioned at to the dental chair?
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30 degrees (with wheels locked and leg supports out of the way)
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T/F: The aortic valve gets the most damaged over time, leading to aortic stenosis which increases afterload
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True
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What is P-E congruence?
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Person-environment congruence--the fit between the person's abilities and the environment he/she lives in (needs versus demands of environment basically)
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___ of dentate residents have significant oral problems requiring care in nursing homes
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3/4
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___ of edentulous patients had oral health problems requiring care in nursing homes
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2/3
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___ of teeth requiring follow up care were ROOT TIPS already in nursing homes
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1/5
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What is the S1 sound?
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Closure of AV valve
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What is S2 sound?
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Closure of pulmonic valve
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What is S3 sound?
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Not a normal sound, fluid back-up thus CHF
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What is S4 sound?
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contraction of the atria
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What is DHPOA?
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Durable health care power of attorney = you do not need permission to perform treatment unless the person becomes disabled and incompetent
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Ejection fraction is normal between what percentages?
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55-70%
