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Aging Physiology And Pharmacology

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. frailty signs
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health

2. fall sequelae

3. Syncope prognosis based on etio
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Worse for cardiac causes v noncardia
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration

4. How does aging impact syncope-preventing reflexes
Prescribing - monitoring - patient adherence
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
No: chest pain - yes: fatigue - nausea - low functional status - SOB

5. preventing malnutrition
Figure out a good diet - social aspect - resources - dental/oral comfort
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Vd v plasma prot-binding: usually ^Vd - when prot-binding significant: changes in enzymes - changes in metab/elim - lab value interp (total v free) - ^t1/2
Receptors changes: # - sensitivity - counter-regulatory moa

6. How does aging affect pharmacokinetic Rx distribution?
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory

7. What is capacity?
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Determined by Dr for a patient - -> used to determine competency
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
Reduce exposure to PIM: pot inapprop med - category 1: avoid in elderly regardless of dx - category 2: pot inapprop dept on dx - category 3: used with caution

8. What is abuse?
Injury - neglect - physical/psychosocial - financial - violation of rights
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Determined by Dr for a patient - -> used to determine competency
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait

9. vertigo
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)

10. what Rx are commonly monifoted in elderly for ADR?
Cholinesterase inhib - use: dementia
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
F>M (until 80yo) - stress incontinence #1 - $26B/yr
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants

11. urge incontinence tx
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
Serum Cr: used for Cr clearance equation
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals

12. lightheadedness
Catch-all of unspecified dizziness
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
No: chest pain - yes: fatigue - nausea - low functional status - SOB
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR

13. rivastigmine
Cholinesterase inhib - use: dementia
High mortality - esp + Fx - very common in elderly
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
No: fever - leukocytosis - yes: falls - appetite change - low functional status

14. Disequilibrium
Electrical: change in HR - structural: aortic outflow obstruction
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
Serum Cr: used for Cr clearance equation

15. How does aging affect GI absorption rate of Rx?
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Serum Cr: used for Cr clearance equation
Delayed absorption - like competitive inhib
No: chest pain - yes: fatigue - nausea - low functional status - SOB

16. urinary incontinence types
Stress: #1 - functional - urge - overflow
Determined by Dr for a patient - -> used to determine competency
Hypothetical plan - serves as patient's last competent indicated wishes
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction

17. LBW equation
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
Threats/ terrorizing - isolation - denying food/privileges/liberty

18. Beers criteria: what 10 Rx should elderly avoid or use + caution?
Breast cancer + 2o LBP
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar

19. restrain requirements
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar

20. tube feeding
Multisystemic vulnerability - -lowered reserves
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2

21. falls epidemiology
Electrolyte imbalance - arrhythmia
Figure out a good diet - social aspect - resources - dental/oral comfort
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
^ANS tone -> ^periph vasoconstriction - ^HR

22. How does aging affect GI absorption of Rx?
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Electrolyte imbalance - arrhythmia
Constipation -> laxatives
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable

23. What are the common causes of lightheadedness?
Appointed by court if no substituted judgment -conservator of finance -conservator of person
IdioPx - psychiatric: depression - anxiety - somatoform
Mechanical loading - skin care - avoid friction/shear
^SV (diastolic stroke volume)

24. nutrition syndromes
Confusion - sedation - falls
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Cachexia - PEM - FTT - obesity
No: chest pain - yes: fatigue - nausea - low functional status - SOB

25. What is ISH?
Isolated systolic HTN
Prescribing - monitoring - patient adherence
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Therapy - SSRI

26. dementia tx
Prescribing - monitoring - patient adherence
Consider responsibilities - drivin
Phenytoin
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine

27. What are the hazards of elderly hospitalization?
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Diagnosis - risk/benefit analysis to choose Rx
^morbidity + mortality - -frailest @ greatest risk

28. what mechanical loading helps to prevent pressure ulcers?
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals

29. What are common physical abuse Sx in elderly?
NMDR antagonist - use: dementia
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical

30. Approach to idioPx - recurrent syncope
Consider responsibilities - drivin
Breast cancer + 2o LBP
Determined by Dr for a patient - -> used to determine competency
Voice - character - plot - context - time - reader

31. how is cachexia different from wasting?
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Catch-all of unspecified dizziness
Confusion - sedation - falls

32. conservator
No: chest pain - yes: fatigue - nausea - low functional status - SOB
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Tx underlying etio - + Kegels - pessary - surgery
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible

33. What are the rf for caregiver to abuse elderly?
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet

34. substituted judgment
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
Environment modification: obstacles - mobility - -bladder fcn ok
Phenytoin

35. Alb-bound Rx
Phenytoin
Electrolyte imbalance - arrhythmia
Vertigo - presyncope - disequilibrium - lightheadedness
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation

36. how can you determine whether Rx is appropriate to use in elderly patient?
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Beers criteria - medication appropriateness index (12 ?)
Tx underlying etio - + Kegels - pessary - surgery
Personal liberty -living at home - personal property - speech - assembly - privacy - voting

37. How does aging increase incontinence?
Destrusor overactivity -> urge - BPH -> overflow - more urine output later in day - atrophic vaginitis - ^PVR: post-void residual -> overflow - v total bladder capacity -> overflow - v sphincter tone -> stress
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Map of people - perceptions - etc - varies by perspective

38. What is the Cockcroft Gault equation?
High mortality - esp + Fx - very common in elderly
Used to calculate renal fcn - clearance of Cr adjusted for age
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
Respect for autonomy - nonmaleficence - beneficence - justice

39. delirium: Rx that contribute
Pressure ulcer - fecal impaction - dehydration
A-blockers - B-blockers - TCA
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve

40. How does the aging heart compensate for lower HR to maintain unchanged CO?
^ANS tone -> ^periph vasoconstriction - ^HR
Respect for autonomy - nonmaleficence - beneficence - justice
^SV (diastolic stroke volume)
Confusion - sedation - falls

41. documenting elderly abuse

42. delirium: mgmt
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Therapy - SSRI
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
Electrical: change in HR - structural: aortic outflow obstruction

43. driving considerations
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Threats/ terrorizing - isolation - denying food/privileges/liberty
Cholinesterase inhib - use: dementia
Make sure to discuss with patient - some states require reporting

44. osteopenia
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Confusion - sedation - falls

45. how may hypertension compensate for aging?
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
^SV (diastolic stroke volume)
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Consider responsibilities - drivin

46. what receptors decrease sensitivity with aging?
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
>9 Rx
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid

47. depression + atypical Sx
BMD (bone mineral density): T-score >2.5 std dev below normal 1
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
No: chest pain - yes: fatigue - nausea - low functional status - SOB
Beers criteria - medication appropriateness index (12 ?)

48. What are the rf for elderly abuse?
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Prescribing - monitoring - patient adherence

49. refusing intervention
Temporalis muscle wasting = temporal wasting
Legal: Cruzan v Hamon
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids

50. memantine
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
NMDR antagonist - use: dementia
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet