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Test your basic knowledge |
Aging Physiology And Pharmacology
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Subject
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health-sciences
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. fall sequelae
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2. What is polypharmacy
>9 Rx
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Worse for cardiac causes v noncardia
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
3. falls epidemiology
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
80% of hospital admission for syncope for >65yo
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
4. osteoporosis etio
P2-metabolite - phase 1 biotx much more affected than phase 2
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
5. acute abdomen + atypical Sx
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Used to calculate renal fcn - clearance of Cr adjusted for age
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
6. osteopenia
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
A-blockers - B-blockers - TCA
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
7. surrogate decision making heirarchy
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8. What are common scenarios of untreated indications in elderly?
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
IdioPx - psychiatric: depression - anxiety - somatoform
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
9. delirium incidence
Stress: #1 - functional - urge - overflow
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Therapy - SSRI
Constipation -> laxatives
10. How does aging affect Rx pharmacokinetic metabolism?
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
^BP -> a-HTN
11. ACE inhib + diuretic: interaction outcome
Hypotension - ^K+
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Cholinesterase inhib - use: dementia
Begin @25-50% recommended dose - APAP may be dose-limiting
12. MRP: medication related problems
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
13. rule of doable effect
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Confusion - sedation - falls
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
14. depression + atypical Sx
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Beers criteria - medication appropriateness index (12 ?)
15. malignancy + atypical Sx
Breast cancer + 2o LBP
^BP -> a-HTN
Written doc - don't alter it - pertinent +/- - use patient/caregiver's own words - photos - report: concise - precise - likeliness of abuse: definite/accident/indeterminate - body map for forensic documentation
Constipation -> laxatives
16. What drugs can contribute to syncope?
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Consider responsibilities - drivin
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
A-blockers - B-blockers - TCA
17. How does aging affect Rx renal elimination?
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
Map of people - perceptions - etc - varies by perspective
18. How does renal nerve prevent syncope?
Legal: Cruzan v Hamon
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
19. Aging features
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Universal - progressive - partially encoded (genetic) - destructive -
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Hyperuricemia -> gout
20. frailty
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Multisystemic vulnerability - -lowered reserves
21. refusing intervention
80% of hospital admission for syncope for >65yo
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Legal: Cruzan v Hamon
22. what % of hospitalizations of elderly are due to ADR + noncompliance?
Electrical: change in HR - structural: aortic outflow obstruction
28% - ADR: 17% - non-compliance 11%
^K+
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
23. What are the 3 stages of ADRs?
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Prescribing - monitoring - patient adherence
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
24. thyroid dx + atypical Sx
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
^morbidity + mortality - -frailest @ greatest risk
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
25. what ADR are common in elderly patient?
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Prescribing - monitoring - patient adherence
26. What is the preferred depression treatment in elderly?
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
Therapy - SSRI
Confusion - sedation - falls
PPI: PUD uncomplicated >8wk - aspirin wo CAD/CVA/PVD - duplicate Rx - loop diuretics LT: HTN; can use for ankle edema - LT NSAID use (>3mo): mild OA - falls: BZD - opiates - neuroepileptics - vasodilators: orthostatic patient risk
27. How does aging affect Rx pharmacokinetic distribution?
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
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Treat underlying disease/lack resources
Serum Cr: used for Cr clearance equation
28. stress incontinence tx
Hypothetical plan - serves as patient's last competent indicated wishes
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Tx underlying etio - + Kegels - pessary - surgery
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
29. elderly abuse epidemiology
Mechanical loading - skin care - avoid friction/shear
5% - underreported
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Catch-all of unspecified dizziness
30. malnutrition
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
NMDR antagonist - use: dementia
Catch-all of unspecified dizziness
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
31. lipid-soluble Rx
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Falls - delirium - malnutrition - P ulcers - opportunistic i2
32. What are common physical abuse Sx in elderly?
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
33. delirium: mgmt
^morbidity + mortality - -frailest @ greatest risk
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
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
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
34. how is syncope related to elderly admission to hospital?
80% of hospital admission for syncope for >65yo
Prescribing - monitoring - patient adherence
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
35. conservator
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
Receptors changes: # - sensitivity - counter-regulatory moa
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Appointed by court if no substituted judgment -conservator of finance -conservator of person
36. advanced directive/care plan
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37. Approach to idioPx - recurrent syncope
Cholinesterase inhib - use: dementia
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Consider responsibilities - drivin
Falls - delirium - malnutrition - P ulcers - opportunistic i2
38. ADR rf
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
NMDR antagonist - use: dementia
39. What is sCr?
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
Serum Cr: used for Cr clearance equation
40. Alb-bound Rx
Phenytoin
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Temporalis muscle wasting = temporal wasting
Confusion - sedation - falls
41. LBW equation
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Appointed by court if no substituted judgment -conservator of finance -conservator of person
42. How does ANF prevent syncope?
Map of people - perceptions - etc - varies by perspective
30% preventable - of these - 40% serious - of these 40% preventable
ANF: Na+ retention - disinhib vasoconstriction
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
43. what normally prevents syncope?
ANF: Na+ retention - disinhib vasoconstriction
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
3 reflexes: baroreceptor - renal nerve - ANF
44. antiarrhythmic + diuretic: interaction outcome
Electrolyte imbalance - arrhythmia
Hypotension - ^K+
Catch-all of unspecified dizziness
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
45. dementia tx
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
PPI: PUD uncomplicated >8wk - aspirin wo CAD/CVA/PVD - duplicate Rx - loop diuretics LT: HTN; can use for ankle edema - LT NSAID use (>3mo): mild OA - falls: BZD - opiates - neuroepileptics - vasodilators: orthostatic patient risk
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
46. nutrition syndromes
Cachexia - PEM - FTT - obesity
CVA: stroke - AMI: acute MI - HF
Screen for potentially embarrassing dx - patient/Dr trust
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
47. preventing malnutrition
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Figure out a good diet - social aspect - resources - dental/oral comfort
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
48. what Rx are commonly monifoted in elderly for ADR?
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
Vertigo - presyncope - disequilibrium - lightheadedness
Universal - progressive - partially encoded (genetic) - destructive -
Isolated systolic HTN
49. Disequilibrium
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
80% of hospital admission for syncope for >65yo
50. What are the narrative elements of clinical ethics?
Voice - character - plot - context - time - reader
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
#1 patient's last competent indication of wishes - substituted judgment - beneficence
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
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