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. 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