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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.
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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. pressure ulcer: staging
Universal - progressive - partially encoded (genetic) - destructive -
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Respect for autonomy - nonmaleficence - beneficence - justice
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
2. What is ISH?
Isolated systolic HTN
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
P2-metab: Lorazepam - Trazepam - Oxazepam
3. memantine
Map of people - perceptions - etc - varies by perspective
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
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
NMDR antagonist - use: dementia
4. delirium incidence
IdioPx - psychiatric: depression - anxiety - somatoform
Beers criteria - medication appropriateness index (12 ?)
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Prescribing - monitoring - patient adherence
5. urinary incontinence types
Stress: #1 - functional - urge - overflow
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
6. incontinence epidemiology
>60yo - low abuse risk - ^ monitoring possible
Parkinsonism -> l-DOPA
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
7. frailty signs
Hypotension - ^K+
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Pressure ulcer - fecal impaction - dehydration
Cholinesterase inhib - use: dementia
8. What is the epidemiology of dizziness?
Vertigo - presyncope - disequilibrium - lightheadedness
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
9. nutrition syndromes
Threats/ terrorizing - isolation - denying food/privileges/liberty
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Cachexia - PEM - FTT - obesity
10. functional incontinence tx
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
Environment modification: obstacles - mobility - -bladder fcn ok
11. delirium: Rx that contribute
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
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
Cachexia - PEM - FTT - obesity
Universal - progressive - partially encoded (genetic) - destructive -
12. What is the bone deterioration cascade?
Bone loss -> osteopenia -> osteoporosis -> Fx
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
^SV (diastolic stroke volume)
13. dementia tx
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
P2-metab: Lorazepam - Trazepam - Oxazepam
Confusion - sedation - falls
14. rule of doable effect
Temporalis muscle wasting = temporal wasting
No: chest pain - yes: fatigue - nausea - low functional status - SOB
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
15. metoclopramide may lead to what prescription cascade?
Doctors
Serum Cr: used for Cr clearance equation
Parkinsonism -> l-DOPA
Isolated systolic HTN
16. incontinence complication
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
17. What are the rf for caregiver to abuse elderly?
Cholinesterase inhib - use: dementia
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Confusion - sedation - falls
Serum Cr: used for Cr clearance equation
18. lipid-soluble Rx
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
30% preventable - of these - 40% serious - of these 40% preventable
19. What is sCr?
Serum Cr: used for Cr clearance equation
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Doctors
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
20. documenting elderly abuse
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21. What is a mattering map?
Map of people - perceptions - etc - varies by perspective
Confusion - sedation - falls
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
22. physical neglect
No: chest pain - yes: fatigue - nausea - low functional status - SOB
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
P2-metabolite - phase 1 biotx much more affected than phase 2
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
23. How does renal nerve prevent syncope?
Voice - character - plot - context - time - reader
Isolated systolic HTN
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Multisystemic vulnerability - -lowered reserves
24. What is abuse?
Cholinesterase inhib - use: dementia
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Injury - neglect - physical/psychosocial - financial - violation of rights
25. How does aging affect pharmacokinetic Rx distribution?
Constipation -> laxatives
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Screen for potentially embarrassing dx - patient/Dr trust
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
26. how is the CAM used to diagnose delirium?
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
Delayed absorption - like competitive inhib
27. osteoporosis epidemiology
3 reflexes: baroreceptor - renal nerve - ANF
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
High mortality - esp + Fx - very common in elderly
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
28. How does aging affect pharmacokinetics?
Used to calculate renal fcn - clearance of Cr adjusted for age
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Parkinsonism -> l-DOPA
29. What is the STOPP criteria?
Cholinesterase inhib - use: dementia
Breast cancer + 2o LBP
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
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
30. What are the 4 forms of dizziness?
Therapy - SSRI
Vertigo - presyncope - disequilibrium - lightheadedness
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
>9 Rx
31. Aging descriptors
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
32. What are the hazards of elderly hospitalization?
Electrolyte imbalance - arrhythmia
Environment modification: obstacles - mobility - -bladder fcn ok
Breast cancer + 2o LBP
^morbidity + mortality - -frailest @ greatest risk
33. What are the pharmacodynamic changes associated with aging?
IdioPx - psychiatric: depression - anxiety - somatoform
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Receptors changes: # - sensitivity - counter-regulatory moa
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
34. restrain requirements
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
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
Determined by Dr for a patient - -> used to determine competency
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
35. What drugs can contribute to syncope?
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
A-blockers - B-blockers - TCA
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
36. What is a PE sign of cachexia?
Temporalis muscle wasting = temporal wasting
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
Phenytoin
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
37. What is polypharmacy
>9 Rx
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Appointed by court if no substituted judgment -conservator of finance -conservator of person
38. What are the risks of uncontrolled ISH?
CVA: stroke - AMI: acute MI - HF
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
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
39. How does aging affect GI absorption of Rx?
Environment modification: obstacles - mobility - -bladder fcn ok
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
40. what normally prevents syncope?
Prescribing - monitoring - patient adherence
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
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
3 reflexes: baroreceptor - renal nerve - ANF
41. malnutrition
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
P2-metab: Lorazepam - Trazepam - Oxazepam
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
42. What are the narrative elements of clinical ethics?
Cholinesterase inhib - use: dementia
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Voice - character - plot - context - time - reader
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
43. when selecting an P1-metabolite or P2-metabolite safer in elderly?
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
P2-metabolite - phase 1 biotx much more affected than phase 2
Cachexia - PEM - FTT - obesity
Therapy - SSRI
44. MRP: medication related problems
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
Cholinesterase inhib - use: dementia
45. delirium predisposing rf
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
^ANS tone -> ^periph vasoconstriction - ^HR
Cachexia - PEM - FTT - obesity
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
46. how is syncope related to elderly admission to hospital?
High mortality - esp + Fx - very common in elderly
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
80% of hospital admission for syncope for >65yo
47. NSAID may lead to what prescription cascade?
No: chest pain - yes: fatigue - nausea - low functional status - SOB
Make sure to discuss with patient - some states require reporting
^BP -> a-HTN
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
48. vision changes: elderly
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
Receptors changes: # - sensitivity - counter-regulatory moa
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
49. falls epidemiology
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Bone loss -> osteopenia -> osteoporosis -> Fx
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
50. surrogate decision making heirarchy
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