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. documenting elderly abuse

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

2. PEM
Respect for autonomy - nonmaleficence - beneficence - justice
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
Intrinsic: chronic dx - postural: changing position - mediating: risk taking

3. what nutritional interventions help underweight?
ANF: Na+ retention - disinhib vasoconstriction
^morbidity + mortality - -frailest @ greatest risk
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
Breast cancer + 2o LBP

4. what Rx are commonly monifoted in elderly for ADR?
ANF: Na+ retention - disinhib vasoconstriction
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Falls - delirium - malnutrition - P ulcers - opportunistic i2

5. frailty
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Multisystemic vulnerability - -lowered reserves
Confusion - sedation - falls

6. rivastigmine
Cholinesterase inhib - use: dementia
Stress: #1 - functional - urge - overflow
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Catch-all of unspecified dizziness

7. how is cachexia different from wasting?
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible

8. What are the vascular changes of presyncope?
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
NMDR antagonist - use: dementia
Hypotension - ^K+

9. red flags for further inquiry
Threats/ terrorizing - isolation - denying food/privileges/liberty
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Hypotension - ^K+

10. refusing intervention
Hypotension - ^K+
A-blockers - B-blockers - TCA
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
Legal: Cruzan v Hamon

11. surrogate decision making heirarchy

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

12. ACE inhib + K+: interaction outcome
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
^K+
^BP -> a-HTN
^SV (diastolic stroke volume)

13. malnutrition
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
No: chest pain - yes: fatigue - nausea - low functional status - SOB
Cholinesterase inhib - use: dementia
Constipation -> laxatives

14. falls epidemiology
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
Injury - neglect - physical/psychosocial - financial - violation of rights
Begin @25-50% recommended dose - APAP may be dose-limiting
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M

15. MI + atypical Sx
BMD (bone mineral density): T-score >2.5 std dev below normal 1
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
^BP -> a-HTN
No: chest pain - yes: fatigue - nausea - low functional status - SOB

16. restrain requirements
CNS suppression -> cholinesterase inhibitors
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85

17. How does baroreceptor reflex prevent syncope?
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
^ANS tone -> ^periph vasoconstriction - ^HR
#1 patient's last competent indication of wishes - substituted judgment - beneficence

18. opioid tx in elderly
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
28% - ADR: 17% - non-compliance 11%
Begin @25-50% recommended dose - APAP may be dose-limiting
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx

19. driving considerations
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
CVA: stroke - AMI: acute MI - HF
Make sure to discuss with patient - some states require reporting

20. clues of neglect
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
NMDR antagonist - use: dementia
Electrolyte imbalance - arrhythmia

21. lipid-soluble Rx
Mechanical loading - skin care - avoid friction/shear
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Make sure to discuss with patient - some states require reporting

22. urinary incontinence types
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
Stress: #1 - functional - urge - overflow
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Screen for potentially embarrassing dx - patient/Dr trust

23. 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
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
3 reflexes: baroreceptor - renal nerve - ANF
5% - underreported

24. osteopenia
Receptors changes: # - sensitivity - counter-regulatory moa
P2-metabolite - phase 1 biotx much more affected than phase 2
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Diagnosis - risk/benefit analysis to choose Rx

25. Approach to idioPx - recurrent syncope
Threats/ terrorizing - isolation - denying food/privileges/liberty
^SV (diastolic stroke volume)
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Consider responsibilities - drivin

26. How does aging affect pharmacokinetic Rx distribution?
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
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2

27. vision changes: elderly
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
Temporalis muscle wasting = temporal wasting
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity

28. Cockcroft Gault equation
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
IdioPx - psychiatric: depression - anxiety - somatoform
ANF: Na+ retention - disinhib vasoconstriction
CVA: stroke - AMI: acute MI - HF

29. what receptors decrease sensitivity with aging?
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Threats/ terrorizing - isolation - denying food/privileges/liberty
Confusion - sedation - falls
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics

30. what professional is least likely to report abuse?
Doctors
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Electrolyte imbalance - arrhythmia
Appointed by court if no substituted judgment -conservator of finance -conservator of person

31. How does an 80yo renal fcn compare to that of a 20yo?
Mechanical loading - skin care - avoid friction/shear
CVA: stroke - AMI: acute MI - HF
1/2
Orthostatic hypotension - vagal stimulation (vasovagal reflex)

32. how is syncope related to elderly admission to hospital?
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
P2-metab: Lorazepam - Trazepam - Oxazepam
Doctors

33. Syncope prognosis based on etio
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
Worse for cardiac causes v noncardia
3 reflexes: baroreceptor - renal nerve - ANF
Constipation -> laxatives

34. delirium: tx approach
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Bone loss -> osteopenia -> osteoporosis -> Fx
Treat underlying disease/lack resources

35. Beers criteria: what 10 Rx should elderly avoid or use + caution?
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Delayed absorption - like competitive inhib
High mortality - esp + Fx - very common in elderly
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)

36. tube feeding
Map of people - perceptions - etc - varies by perspective
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
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

37. anticholinergic drugs may lead to what prescription cascade?
Threats/ terrorizing - isolation - denying food/privileges/liberty
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
Cholinesterase inhib - use: dementia
CNS suppression -> cholinesterase inhibitors

38. what % of hospitalizations of elderly are due to ADR + noncompliance?
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
28% - ADR: 17% - non-compliance 11%
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
No: chest pain - yes: fatigue - nausea - low functional status - SOB

39. what mechanical loading helps to prevent pressure ulcers?
Receptors changes: # - sensitivity - counter-regulatory moa
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Constipation -> laxatives
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism

40. dementia tx
Hyperuricemia -> gout
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Figure out a good diet - social aspect - resources - dental/oral comfort

41. delirium: medical rf
Therapy - SSRI
Treat underlying disease/lack resources
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
P2-metab: Lorazepam - Trazepam - Oxazepam

42. Aging features
80% of hospital admission for syncope for >65yo
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Universal - progressive - partially encoded (genetic) - destructive -
28% - ADR: 17% - non-compliance 11%

43. pulm edema + atypical Sx
1/2
Insiduous onset
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
Phenytoin

44. What are the risks of uncontrolled ISH?
Constipation -> laxatives
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
CVA: stroke - AMI: acute MI - HF

45. Alb-bound Rx
P2-metabolite - phase 1 biotx much more affected than phase 2
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Phenytoin

46. How does ANF prevent syncope?
Hypothetical plan - serves as patient's last competent indicated wishes
No: chest pain - yes: fatigue - nausea - low functional status - SOB
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
ANF: Na+ retention - disinhib vasoconstriction

47. what drugs can cause dizziness?
Electrolyte imbalance - arrhythmia
Constipation -> laxatives
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics

48. How does aging impact syncope-preventing reflexes
CVA: stroke - AMI: acute MI - HF
Diagnosis - risk/benefit analysis to choose Rx
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment

49. What are the possible cardiac causes of presyncope?
Electrical: change in HR - structural: aortic outflow obstruction
Receptors changes: # - sensitivity - counter-regulatory moa
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Vertigo - presyncope - disequilibrium - lightheadedness

50. What is sCr?
>9 Rx
5% - underreported
Serum Cr: used for Cr clearance equation
Therapy - SSRI