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. What are common scenarios of untreated indications in elderly?
Temporalis muscle wasting = temporal wasting
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear

2. How does sliding scale glycemic control relate to elderly?
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
^K+
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Diagnosis - risk/benefit analysis to choose Rx

3. galantamine
Cholinesterase inhib - use: dementia
Parkinsonism -> l-DOPA
^ANS tone -> ^periph vasoconstriction - ^HR
#1 patient's last competent indication of wishes - substituted judgment - beneficence

4. antiarrhythmic + diuretic: interaction outcome
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Electrolyte imbalance - arrhythmia
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport

5. ACE inhib + diuretic: interaction outcome
Stress: #1 - functional - urge - overflow
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Hypotension - ^K+
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD

6. MRP: medication related problems
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
Figure out a good diet - social aspect - resources - dental/oral comfort

7. malnutrition
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other

8. osteoporosis
Screen for potentially embarrassing dx - patient/Dr trust
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
BMD (bone mineral density): T-score >2.5 std dev below normal 1

9. what receptors decrease sensitivity with aging?
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
Legal: Cruzan v Hamon
Intrinsic: chronic dx - postural: changing position - mediating: risk taking

10. 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
Hypothetical plan - serves as patient's last competent indicated wishes
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep

11. BZD + antipsychotic: interaction outcome
Confusion - sedation - falls
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics

12. how can you determine whether Rx is appropriate to use in elderly patient?
Beers criteria - medication appropriateness index (12 ?)
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding

13. narcotics may lead to what prescription cascade?
Constipation -> laxatives
Pressure ulcer - fecal impaction - dehydration
Doctors
Treat underlying disease/lack resources

14. nutrition syndromes
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
Cachexia - PEM - FTT - obesity
IdioPx - psychiatric: depression - anxiety - somatoform
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory

15. delirium: tx approach
A-blockers - B-blockers - TCA
ANF: Na+ retention - disinhib vasoconstriction
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Stress: #1 - functional - urge - overflow

16. What is a mattering map?
Map of people - perceptions - etc - varies by perspective
Make sure to discuss with patient - some states require reporting
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve

17. what nutritional interventions help underweight?
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Injury - neglect - physical/psychosocial - financial - violation of rights
Environment modification: obstacles - mobility - -bladder fcn ok
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding

18. acute abdomen + atypical Sx
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
Confusion - sedation - falls
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding

19. What are the 4 forms of dizziness?
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
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
Mechanical loading - skin care - avoid friction/shear
Vertigo - presyncope - disequilibrium - lightheadedness

20. opioid tx in elderly
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
Begin @25-50% recommended dose - APAP may be dose-limiting
Universal - progressive - partially encoded (genetic) - destructive -
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD

21. What is capacity?
Determined by Dr for a patient - -> used to determine competency
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding

22. NSAID may lead to what prescription cascade?
Hypothetical plan - serves as patient's last competent indicated wishes
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
^BP -> a-HTN
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar

23. thiazide diuretic may lead to what prescription cascade?
Hyperuricemia -> gout
Breast cancer + 2o LBP
Receptors changes: # - sensitivity - counter-regulatory moa
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity

24. fall causes
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
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
Consider responsibilities - drivin

25. delirium diagnosis
Cholinesterase inhib - use: dementia
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec

26. What is the bone deterioration cascade?
#1 patient's last competent indication of wishes - substituted judgment - beneficence
Bone loss -> osteopenia -> osteoporosis -> Fx
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
Hypotension - ^K+

27. LBW equation
Catch-all of unspecified dizziness
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)

28. who is a good candidate for opioid tx?
Pressure ulcer - fecal impaction - dehydration
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
>60yo - low abuse risk - ^ monitoring possible

29. What is abuse?
Hyperuricemia -> gout
Worse for cardiac causes v noncardia
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
Injury - neglect - physical/psychosocial - financial - violation of rights

30. using long-acting opioids in elderly
Consider responsibilities - drivin
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
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

31. Presyncope
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
IdioPx - psychiatric: depression - anxiety - somatoform
Cachexia - PEM - FTT - obesity
>9 Rx

32. How does aging affect pharmacokinetic Rx distribution?
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Isolated systolic HTN
Orthostatic hypotension - vagal stimulation (vasovagal reflex)

33. lightheadedness
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Catch-all of unspecified dizziness
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

34. What are the hazards of elderly hospitalization?
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
^morbidity + mortality - -frailest @ greatest risk

35. preventing malnutrition
P2-metabolite - phase 1 biotx much more affected than phase 2
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Electrolyte imbalance - arrhythmia
Figure out a good diet - social aspect - resources - dental/oral comfort

36. What is the natural history of syncope?
High mortality - esp + Fx - very common in elderly
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope

37. What are common medical causes of syncope?
Serum Cr: used for Cr clearance equation
Screen for potentially embarrassing dx - patient/Dr trust
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR

38. What is sCr?
Serum Cr: used for Cr clearance equation
CVA: stroke - AMI: acute MI - HF
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
>60yo - low abuse risk - ^ monitoring possible

39. incontinence epidemiology
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
#1 patient's last competent indication of wishes - substituted judgment - beneficence
Temporalis muscle wasting = temporal wasting

40. what mechanical loading helps to prevent pressure ulcers?
Universal - progressive - partially encoded (genetic) - destructive -
Phenytoin
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Electrolyte imbalance - arrhythmia

41. How does renal nerve prevent syncope?
Pressure ulcer - fecal impaction - dehydration
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Prescribing - monitoring - patient adherence

42. What are the 4 basic ethical principles?
Breast cancer + 2o LBP
Respect for autonomy - nonmaleficence - beneficence - justice
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)

43. thyroid dx + atypical Sx
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
Hypothetical plan - serves as patient's last competent indicated wishes
Respect for autonomy - nonmaleficence - beneficence - justice
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation

44. advanced directive/care plan

45. restrain requirements
Pressure ulcer - fecal impaction - dehydration
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible

46. MI + atypical Sx
Threats/ terrorizing - isolation - denying food/privileges/liberty
No: chest pain - yes: fatigue - nausea - low functional status - SOB
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
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)

47. What are rf for osteoporosis?
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
>60yo - low abuse risk - ^ monitoring possible
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA

48. what ADR are common in elderly patient?
Insiduous onset
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych

49. what Rx are commonly monifoted in elderly for ADR?
Falls - delirium - malnutrition - P ulcers - opportunistic i2
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
Vertigo - presyncope - disequilibrium - lightheadedness
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health

50. Beers criteria
^ANS tone -> ^periph vasoconstriction - ^HR
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
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