Test your basic knowledge |

Aging Physiology And Pharmacology

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. How does ANF prevent syncope?
ANF: Na+ retention - disinhib vasoconstriction
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids

2. What is capacity?
Determined by Dr for a patient - -> used to determine competency
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration

3. rule of doable effect
P2-metabolite - phase 1 biotx much more affected than phase 2
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
80% of hospital admission for syncope for >65yo

4. clues of neglect
Map of people - perceptions - etc - varies by perspective
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
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

5. How does aging impact syncope-preventing reflexes
CNS suppression -> cholinesterase inhibitors
Determined by Dr for a patient - -> used to determine competency
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
3 reflexes: baroreceptor - renal nerve - ANF

6. what Rx are commonly monifoted in elderly for ADR?
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
Confusion - sedation - falls
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor

7. how is syncope related to elderly admission to hospital?
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
80% of hospital admission for syncope for >65yo
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted

8. restrain requirements
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
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
80% of hospital admission for syncope for >65yo
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible

9. What is the STOPP criteria?
Cachexia - PEM - FTT - obesity
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
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

10. i2 + atypical Sx
^BP -> a-HTN
No: fever - leukocytosis - yes: falls - appetite change - low functional status
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
1/2

11. Aging descriptors
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Respect for autonomy - nonmaleficence - beneficence - justice
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity

12. What is the Cockcroft Gault equation?
Used to calculate renal fcn - clearance of Cr adjusted for age
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
Confusion - sedation - falls

13. delirium incidence
Legal: Cruzan v Hamon
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid

14. using long-acting opioids in elderly
Screen for potentially embarrassing dx - patient/Dr trust
Confusion - sedation - falls
Hypotension - ^K+
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration

15. BZD + antidepressant: interaction outcome
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Confusion - sedation - falls
Worse for cardiac causes v noncardia
Receptors changes: # - sensitivity - counter-regulatory moa

16. What drugs can contribute to syncope?
80% of hospital admission for syncope for >65yo
A-blockers - B-blockers - TCA
Cholinesterase inhib - use: dementia
Threats/ terrorizing - isolation - denying food/privileges/liberty

17. What are the risks of uncontrolled ISH?
CVA: stroke - AMI: acute MI - HF
80% of hospital admission for syncope for >65yo
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
#1 patient's last competent indication of wishes - substituted judgment - beneficence

18. What is the preferred depression treatment in elderly?
Therapy - SSRI
Cachexia - PEM - FTT - obesity
Legal: Cruzan v Hamon
Worse for cardiac causes v noncardia

19. dementia tx
Treat underlying disease/lack resources
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
Map of people - perceptions - etc - varies by perspective

20. What is sCr?
Serum Cr: used for Cr clearance equation
Therapy - SSRI
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep

21. What are common medical causes of syncope?
Electrical: change in HR - structural: aortic outflow obstruction
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
Electrolyte imbalance - arrhythmia
Universal - progressive - partially encoded (genetic) - destructive -

22. anticholinergic drugs may lead to what prescription cascade?
Determined by Dr for a patient - -> used to determine competency
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
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
CNS suppression -> cholinesterase inhibitors

23. driving considerations
1/2
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
Make sure to discuss with patient - some states require reporting
IdioPx - psychiatric: depression - anxiety - somatoform

24. what receptors increase sensitivity with aging?
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
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
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
P2-metabolite - phase 1 biotx much more affected than phase 2

25. describe the % of ADR considered preventable - and of those serious
30% preventable - of these - 40% serious - of these 40% preventable
^K+
Appointed by court if no substituted judgment -conservator of finance -conservator of person
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

26. How does baroreceptor reflex prevent syncope?
Make sure to discuss with patient - some states require reporting
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
^ANS tone -> ^periph vasoconstriction - ^HR
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA

27. How does aging affect Rx pharmacokinetic metabolism?
^ANS tone -> ^periph vasoconstriction - ^HR
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Prescribing - monitoring - patient adherence
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies

28. which benzodiazepines are most appropriate for elderly?
P2-metab: Lorazepam - Trazepam - Oxazepam
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
80% of hospital admission for syncope for >65yo
Orthostatic hypotension - vagal stimulation (vasovagal reflex)

29. Approach to idioPx - recurrent syncope
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Consider responsibilities - drivin
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Cholinesterase inhib - use: dementia

30. ACE inhib + diuretic: interaction outcome
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
1/2
Hypotension - ^K+

31. delirium diagnosis
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Screen for potentially embarrassing dx - patient/Dr trust
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
>60yo - low abuse risk - ^ monitoring possible

32. frailty
Multisystemic vulnerability - -lowered reserves
Hypothetical plan - serves as patient's last competent indicated wishes
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding

33. pulm edema + atypical Sx
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Threats/ terrorizing - isolation - denying food/privileges/liberty
Insiduous onset
5% - underreported

34. preventing malnutrition
Figure out a good diet - social aspect - resources - dental/oral comfort
#1 patient's last competent indication of wishes - substituted judgment - beneficence
Voice - character - plot - context - time - reader
Make sure to discuss with patient - some states require reporting

35. acute abdomen + atypical Sx
3 reflexes: baroreceptor - renal nerve - ANF
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Screen for potentially embarrassing dx - patient/Dr trust

36. physical neglect
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
Diagnosis - risk/benefit analysis to choose Rx
Used to calculate renal fcn - clearance of Cr adjusted for age

37. overflow incontinence tx
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
3 reflexes: baroreceptor - renal nerve - ANF
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Cholinesterase inhib - use: dementia

38. How does aging affect pharmacokinetic protein binding?
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Hyperuricemia -> gout
Beers criteria - medication appropriateness index (12 ?)
Begin @25-50% recommended dose - APAP may be dose-limiting

39. What are the 4 basic ethical principles?
Respect for autonomy - nonmaleficence - beneficence - justice
Falls - delirium - malnutrition - P ulcers - opportunistic i2
^K+
Cachexia - PEM - FTT - obesity

40. incontinence complication
Cholinesterase inhib - use: dementia
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
P2-metabolite - phase 1 biotx much more affected than phase 2

41. delirium: tx approach
P2-metabolite - phase 1 biotx much more affected than phase 2
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Hyperuricemia -> gout
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids

42. opioid tx in elderly
5% - underreported
Electrolyte imbalance - arrhythmia
Worse for cardiac causes v noncardia
Begin @25-50% recommended dose - APAP may be dose-limiting

43. what professional is least likely to report abuse?
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
Confusion - sedation - falls
Doctors

44. What is a mattering map?
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
Map of people - perceptions - etc - varies by perspective

45. narcotics may lead to what prescription cascade?
Constipation -> laxatives
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
Diagnosis - risk/benefit analysis to choose Rx
No: fever - leukocytosis - yes: falls - appetite change - low functional status

46. what ADR are common in elderly patient?
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
28% - ADR: 17% - non-compliance 11%
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants

47. What is the natural history of syncope?
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
Hypothetical plan - serves as patient's last competent indicated wishes
Serum Cr: used for Cr clearance equation
Doctors

48. What are the 3 sentinel events for LT care?
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Pressure ulcer - fecal impaction - dehydration

49. What are the pharmacodynamic changes associated with aging?
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Receptors changes: # - sensitivity - counter-regulatory moa
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
Parkinsonism -> l-DOPA

50. depression + atypical Sx
Parkinsonism -> l-DOPA
^morbidity + mortality - -frailest @ greatest risk
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Falls - delirium - malnutrition - P ulcers - opportunistic i2