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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. Beers criteria: what 10 Rx should elderly avoid or use + caution?
1/2
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Pressure ulcer - fecal impaction - dehydration
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
2. What are the rf for caregiver to abuse elderly?
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Beers criteria - medication appropriateness index (12 ?)
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
Used to calculate renal fcn - clearance of Cr adjusted for age
3. What is the best approach to malnutrition
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Treat underlying disease/lack resources
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
4. delirium: tx approach
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Screen for potentially embarrassing dx - patient/Dr trust
5. clues of neglect
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
6. ADR rf
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
IdioPx - psychiatric: depression - anxiety - somatoform
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
7. What are rf for osteoporosis?
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
Electrical: change in HR - structural: aortic outflow obstruction
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
8. malignancy + atypical Sx
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
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Breast cancer + 2o LBP
9. ACE inhib + diuretic: interaction outcome
Parkinsonism -> l-DOPA
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
Hypotension - ^K+
10. What are the narrative elements of clinical ethics?
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
#1 patient's last competent indication of wishes - substituted judgment - beneficence
Voice - character - plot - context - time - reader
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
11. how is the CAM used to diagnose delirium?
Therapy - SSRI
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
Injury - neglect - physical/psychosocial - financial - violation of rights
Serum Cr: used for Cr clearance equation
12. What is the bone deterioration cascade?
Appointed by court if no substituted judgment -conservator of finance -conservator of person
No: fever - leukocytosis - yes: falls - appetite change - low functional status
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
Bone loss -> osteopenia -> osteoporosis -> Fx
13. How does aging impact syncope-preventing reflexes
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
Catch-all of unspecified dizziness
14. what mechanical loading helps to prevent pressure ulcers?
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Hyperuricemia -> gout
Respect for autonomy - nonmaleficence - beneficence - justice
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
15. malnutrition
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
Receptors changes: # - sensitivity - counter-regulatory moa
16. What are the 3 stages of ADRs?
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
Prescribing - monitoring - patient adherence
Tx underlying etio - + Kegels - pessary - surgery
Used to calculate renal fcn - clearance of Cr adjusted for age
17. nutrition syndromes
Voice - character - plot - context - time - reader
>9 Rx
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Cachexia - PEM - FTT - obesity
18. lightheadedness
#1 patient's last competent indication of wishes - substituted judgment - beneficence
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
Catch-all of unspecified dizziness
Cachexia - PEM - FTT - obesity
19. What is the preferred depression treatment in elderly?
>9 Rx
Therapy - SSRI
^K+
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
20. PEM
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
No: chest pain - yes: fatigue - nausea - low functional status - SOB
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
21. Aging features
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
Universal - progressive - partially encoded (genetic) - destructive -
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
22. vertigo
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Cholinesterase inhib - use: dementia
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
23. ACE inhib + K+: interaction outcome
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Confusion - sedation - falls
^K+
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
24. What are common physical abuse Sx in elderly?
NMDR antagonist - use: dementia
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
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
25. surrogate decision making heirarchy
26. What is capacity?
Determined by Dr for a patient - -> used to determine competency
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
3 reflexes: baroreceptor - renal nerve - ANF
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
27. MRP: medication related problems
IdioPx - psychiatric: depression - anxiety - somatoform
Injury - neglect - physical/psychosocial - financial - violation of rights
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
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
28. What is the Cockcroft Gault equation?
Used to calculate renal fcn - clearance of Cr adjusted for age
Vertigo - presyncope - disequilibrium - lightheadedness
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
29. What are the hazards of elderly hospitalization?
Multisystemic vulnerability - -lowered reserves
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Confusion - sedation - falls
^morbidity + mortality - -frailest @ greatest risk
30. rivastigmine
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
A-blockers - B-blockers - TCA
Treat underlying disease/lack resources
Cholinesterase inhib - use: dementia
31. Beers criteria
80% of hospital admission for syncope for >65yo
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
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
32. acute abdomen + atypical Sx
Temporalis muscle wasting = temporal wasting
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
33. opioid tx in elderly
Begin @25-50% recommended dose - APAP may be dose-limiting
Pressure ulcer - fecal impaction - dehydration
CVA: stroke - AMI: acute MI - HF
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
34. frailty
Multisystemic vulnerability - -lowered reserves
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
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
35. What is abuse?
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Injury - neglect - physical/psychosocial - financial - violation of rights
36. incontinence complication
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
^SV (diastolic stroke volume)
Hypotension - ^K+
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
37. Disequilibrium
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Constipation -> laxatives
38. what Rx are commonly monifoted in elderly for ADR?
Injury - neglect - physical/psychosocial - financial - violation of rights
Legal: Cruzan v Hamon
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
39. psychological abuse
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Receptors changes: # - sensitivity - counter-regulatory moa
Threats/ terrorizing - isolation - denying food/privileges/liberty
40. thiazide diuretic may lead to what prescription cascade?
Hyperuricemia -> gout
#1 patient's last competent indication of wishes - substituted judgment - beneficence
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
P2-metabolite - phase 1 biotx much more affected than phase 2
41. cachexia
^K+
Map of people - perceptions - etc - varies by perspective
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
42. What drugs can contribute to syncope?
A-blockers - B-blockers - TCA
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
Legal: Cruzan v Hamon
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
43. How does aging affect GI absorption rate of Rx?
No: fever - leukocytosis - yes: falls - appetite change - low functional status
Delayed absorption - like competitive inhib
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Pressure ulcer - fecal impaction - dehydration
44. What are the key points of safe prescription for elderly - lecture
Screen for potentially embarrassing dx - patient/Dr trust
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Diagnosis - risk/benefit analysis to choose Rx
Tx underlying etio - + Kegels - pessary - surgery
45. frailty signs
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Cholinesterase inhib - use: dementia
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
46. falls epidemiology
Delayed absorption - like competitive inhib
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
A-blockers - B-blockers - TCA
No: chest pain - yes: fatigue - nausea - low functional status - SOB
47. what drugs can cause dizziness?
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
Mechanical loading - skin care - avoid friction/shear
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Determined by Dr for a patient - -> used to determine competency
48. pulm edema + atypical Sx
80% of hospital admission for syncope for >65yo
A-blockers - B-blockers - TCA
Insiduous onset
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
49. thyroid dx + atypical Sx
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
Receptors changes: # - sensitivity - counter-regulatory moa
Catch-all of unspecified dizziness
50. describe the % of ADR considered preventable - and of those serious
Multisystemic vulnerability - -lowered reserves
Confusion - sedation - falls
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
30% preventable - of these - 40% serious - of these 40% preventable