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. acute abdomen + atypical Sx
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
28% - ADR: 17% - non-compliance 11%

2. What are the pharmacodynamic changes associated with aging?
Receptors changes: # - sensitivity - counter-regulatory moa
#1 patient's last competent indication of wishes - substituted judgment - beneficence
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
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

3. How does aging affect pharmacokinetic protein binding?
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
#1 patient's last competent indication of wishes - substituted judgment - beneficence
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin

4. what nutritional interventions help underweight?
Tx underlying etio - + Kegels - pessary - surgery
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding

5. substituted judgment
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
P2-metabolite - phase 1 biotx much more affected than phase 2
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx

6. what mechanical loading helps to prevent pressure ulcers?
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Legal: Cruzan v Hamon
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers

7. how may hypertension compensate for aging?
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)

8. delirium diagnosis
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
5% - underreported
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec

9. what receptors increase sensitivity with aging?
>60yo - low abuse risk - ^ monitoring possible
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
P2-metab: Lorazepam - Trazepam - Oxazepam
Make sure to discuss with patient - some states require reporting

10. urge incontinence tx
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
No: fever - leukocytosis - yes: falls - appetite change - low functional status

11. what normally prevents syncope?
3 reflexes: baroreceptor - renal nerve - ANF
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
Universal - progressive - partially encoded (genetic) - destructive -

12. What are the common types of elder mistreatment?
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Temporalis muscle wasting = temporal wasting
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M

13. How does aging affect GI absorption rate of Rx?
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Delayed absorption - like competitive inhib
Consider responsibilities - drivin
Injury - neglect - physical/psychosocial - financial - violation of rights

14. What is abuse?
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Diagnosis - risk/benefit analysis to choose Rx
Injury - neglect - physical/psychosocial - financial - violation of rights
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical

15. describe the % of ADR considered preventable - and of those serious
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
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
30% preventable - of these - 40% serious - of these 40% preventable

16. using long-acting opioids in elderly
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP

17. how is syncope related to elderly admission to hospital?
80% of hospital admission for syncope for >65yo
ANF: Na+ retention - disinhib vasoconstriction
High mortality - esp + Fx - very common in elderly
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical

18. ADR rf
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
Cholinesterase inhib - use: dementia
80% of hospital admission for syncope for >65yo
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR

19. delirium: medical rf
Environment modification: obstacles - mobility - -bladder fcn ok
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
Figure out a good diet - social aspect - resources - dental/oral comfort
BMD (bone mineral density): T-score >2.5 std dev below normal 1

20. antiarrhythmic + diuretic: interaction outcome
Electrolyte imbalance - arrhythmia
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
Mechanical loading - skin care - avoid friction/shear
Determined by Dr for a patient - -> used to determine competency

21. violation of rights
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
CNS suppression -> cholinesterase inhibitors
#1 patient's last competent indication of wishes - substituted judgment - beneficence

22. What are the 4 basic ethical principles?
Respect for autonomy - nonmaleficence - beneficence - justice
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Multisystemic vulnerability - -lowered reserves
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve

23. How does aging affect Rx renal elimination?
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
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
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo

24. how can you determine whether Rx is appropriate to use in elderly patient?
Beers criteria - medication appropriateness index (12 ?)
#1 patient's last competent indication of wishes - substituted judgment - beneficence
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Tx underlying etio - + Kegels - pessary - surgery

25. 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
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers

26. What is the bone deterioration cascade?
Electrolyte imbalance - arrhythmia
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
Injury - neglect - physical/psychosocial - financial - violation of rights
Bone loss -> osteopenia -> osteoporosis -> Fx

27. What are common medical causes of syncope?
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
Vertigo - presyncope - disequilibrium - lightheadedness
Figure out a good diet - social aspect - resources - dental/oral comfort
Receptors changes: # - sensitivity - counter-regulatory moa

28. What is capacity?
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
Constipation -> laxatives
Determined by Dr for a patient - -> used to determine competency
80% of hospital admission for syncope for >65yo

29. what receptors decrease sensitivity with aging?
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
3 reflexes: baroreceptor - renal nerve - ANF
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Catch-all of unspecified dizziness

30. What is a PE sign of cachexia?
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
Temporalis muscle wasting = temporal wasting
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
Bone loss -> osteopenia -> osteoporosis -> Fx

31. osteoporosis epidemiology
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
High mortality - esp + Fx - very common in elderly
Prescribing - monitoring - patient adherence

32. conservator
1/2
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
Appointed by court if no substituted judgment -conservator of finance -conservator of person
NMDR antagonist - use: dementia

33. How does aging affect Rx pharmacokinetic metabolism?
Hypothetical plan - serves as patient's last competent indicated wishes
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Prescribing - monitoring - patient adherence

34. malignancy + atypical Sx
Breast cancer + 2o LBP
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
80% of hospital admission for syncope for >65yo

35. How to prevent pressure ulcers?
^ANS tone -> ^periph vasoconstriction - ^HR
Confusion - sedation - falls
Mechanical loading - skin care - avoid friction/shear
Multisystemic vulnerability - -lowered reserves

36. vertigo
Constipation -> laxatives
Screen for potentially embarrassing dx - patient/Dr trust
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids

37. opioid tx in elderly
ANF: Na+ retention - disinhib vasoconstriction
Hypotension - ^K+
Respect for autonomy - nonmaleficence - beneficence - justice
Begin @25-50% recommended dose - APAP may be dose-limiting

38. how is the CAM used to diagnose delirium?
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Electrical: change in HR - structural: aortic outflow obstruction
Confusion - sedation - falls

39. rule of doable effect
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
Electrical: change in HR - structural: aortic outflow obstruction
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
BMD (bone mineral density): T-score >2.5 std dev below normal 1

40. ACE inhib + diuretic: interaction outcome
Hypotension - ^K+
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
^SV (diastolic stroke volume)
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation

41. What is START criteria?
BMD (bone mineral density): T-score >2.5 std dev below normal 1
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
Confusion - sedation - falls
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar

42. How does sliding scale glycemic control relate to elderly?
Legal: Cruzan v Hamon
Catch-all of unspecified dizziness
28% - ADR: 17% - non-compliance 11%
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead

43. Disequilibrium
Hyperuricemia -> gout
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory

44. What drugs can contribute to syncope?
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
Legal: Cruzan v Hamon
A-blockers - B-blockers - TCA

45. Aging features
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
^K+
Universal - progressive - partially encoded (genetic) - destructive -
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable

46. What is a mattering map?
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
NMDR antagonist - use: dementia
Map of people - perceptions - etc - varies by perspective
Hyperuricemia -> gout

47. pressure ulcer: staging
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable

48. frailty
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Multisystemic vulnerability - -lowered reserves
No: fever - leukocytosis - yes: falls - appetite change - low functional status
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear

49. lightheadedness
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
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
P2-metabolite - phase 1 biotx much more affected than phase 2

50. What are rf for osteoporosis?
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)