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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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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. frailty signs
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Map of people - perceptions - etc - varies by perspective
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids

2. delirium predisposing rf
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Serum Cr: used for Cr clearance equation

3. nutrition syndromes
Cachexia - PEM - FTT - obesity
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Environment modification: obstacles - mobility - -bladder fcn ok
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor

4. Approach to idioPx - recurrent syncope
Consider responsibilities - drivin
Cachexia - PEM - FTT - obesity
Treat underlying disease/lack resources
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible

5. memantine
Insiduous onset
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
NMDR antagonist - use: dementia

6. falls epidemiology
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Prescribing - monitoring - patient adherence
Serum Cr: used for Cr clearance equation
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M

7. advanced directive/care plan

8. How does aging affect Rx renal elimination?
Make sure to discuss with patient - some states require reporting
Consider responsibilities - drivin
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
Phenytoin

9. what professional is least likely to report abuse?
Used to calculate renal fcn - clearance of Cr adjusted for age
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Doctors
P2-metab: Lorazepam - Trazepam - Oxazepam

10. What are the common causes of lightheadedness?
IdioPx - psychiatric: depression - anxiety - somatoform
Hyperuricemia -> gout
Pressure ulcer - fecal impaction - dehydration
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient

11. red flags for further inquiry
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Treat underlying disease/lack resources
Figure out a good diet - social aspect - resources - dental/oral comfort
Intrinsic: chronic dx - postural: changing position - mediating: risk taking

12. ACE inhib + K+: interaction outcome
^K+
^ANS tone -> ^periph vasoconstriction - ^HR
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Determined by Dr for a patient - -> used to determine competency

13. Alb-bound Rx
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
Phenytoin
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants

14. What is the natural history of syncope?
ANF: Na+ retention - disinhib vasoconstriction
Injury - neglect - physical/psychosocial - financial - violation of rights
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
Hypotension - ^K+

15. driving considerations
Make sure to discuss with patient - some states require reporting
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
Doctors
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity

16. galantamine
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
Cholinesterase inhib - use: dementia
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI

17. What are rf for osteoporosis?
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Insiduous onset
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
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx

18. vertigo
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
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals

19. What are the 3 sentinel events for LT care?
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
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
Pressure ulcer - fecal impaction - dehydration
Confusion - sedation - falls

20. psychological abuse
Threats/ terrorizing - isolation - denying food/privileges/liberty
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP

21. lipid-soluble Rx
ANF: Na+ retention - disinhib vasoconstriction
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
^SV (diastolic stroke volume)

22. What are the hazards of elderly hospitalization?
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
^morbidity + mortality - -frailest @ greatest risk
Therapy - SSRI
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych

23. What is a mattering map?
Doctors
Map of people - perceptions - etc - varies by perspective
Hypothetical plan - serves as patient's last competent indicated wishes
Make sure to discuss with patient - some states require reporting

24. BZD + antipsychotic: interaction outcome
Confusion - sedation - falls
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Cholinesterase inhib - use: dementia
Delayed absorption - like competitive inhib

25. ADR rf
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Universal - progressive - partially encoded (genetic) - destructive -

26. antiarrhythmic + diuretic: interaction outcome
Electrolyte imbalance - arrhythmia
P2-metab: Lorazepam - Trazepam - Oxazepam
Confusion - sedation - falls
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation

27. How does renal nerve prevent syncope?
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
1/2
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD

28. rivastigmine
Cholinesterase inhib - use: dementia
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
Beers criteria - medication appropriateness index (12 ?)
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL

29. What is the preferred depression treatment in elderly?
Hypothetical plan - serves as patient's last competent indicated wishes
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Therapy - SSRI
CNS suppression -> cholinesterase inhibitors

30. What are the key points of safe prescription for elderly - lecture
F>M (until 80yo) - stress incontinence #1 - $26B/yr
CNS suppression -> cholinesterase inhibitors
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Diagnosis - risk/benefit analysis to choose Rx

31. Syncope prognosis based on etio
No: chest pain - yes: fatigue - nausea - low functional status - SOB
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Worse for cardiac causes v noncardia
^morbidity + mortality - -frailest @ greatest risk

32. osteoporosis etio
P2-metab: Lorazepam - Trazepam - Oxazepam
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
Falls - delirium - malnutrition - P ulcers - opportunistic i2

33. thiazide diuretic may lead to what prescription cascade?
Hyperuricemia -> gout
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Confusion - sedation - falls
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx

34. delirium: Rx that contribute
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
F>M (until 80yo) - stress incontinence #1 - $26B/yr

35. lightheadedness
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Catch-all of unspecified dizziness

36. What are the narrative elements of clinical ethics?
Voice - character - plot - context - time - reader
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Confusion - sedation - falls
Respect for autonomy - nonmaleficence - beneficence - justice

37. What is the bone deterioration cascade?
Hyperuricemia -> gout
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Bone loss -> osteopenia -> osteoporosis -> Fx
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2

38. incontinence complication
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Delayed absorption - like competitive inhib
Electrical: change in HR - structural: aortic outflow obstruction
80% of hospital admission for syncope for >65yo

39. MI + atypical Sx
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
No: chest pain - yes: fatigue - nausea - low functional status - SOB
Temporalis muscle wasting = temporal wasting

40. physical neglect
Begin @25-50% recommended dose - APAP may be dose-limiting
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Universal - progressive - partially encoded (genetic) - destructive -

41. donepezil
Cholinesterase inhib - use: dementia
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Figure out a good diet - social aspect - resources - dental/oral comfort

42. How to prevent pressure ulcers?
Vertigo - presyncope - disequilibrium - lightheadedness
Mechanical loading - skin care - avoid friction/shear
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient

43. urinary incontinence types
Doctors
Stress: #1 - functional - urge - overflow
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Catch-all of unspecified dizziness

44. how is cachexia different from wasting?
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Phenytoin
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear

45. elderly abuse epidemiology
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Legal: Cruzan v Hamon
5% - underreported

46. LBW equation
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP

47. What are common scenarios of untreated indications in elderly?
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Worse for cardiac causes v noncardia
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Serum Cr: used for Cr clearance equation

48. cachexia
Legal: Cruzan v Hamon
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction

49. which benzodiazepines are most appropriate for elderly?
^morbidity + mortality - -frailest @ greatest risk
Environment modification: obstacles - mobility - -bladder fcn ok
P2-metab: Lorazepam - Trazepam - Oxazepam
Worse for cardiac causes v noncardia

50. using long-acting opioids in elderly
Therapy - SSRI
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Multisystemic vulnerability - -lowered reserves
Pressure ulcer - fecal impaction - dehydration