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Aging Physiology And Pharmacology

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. Alb-bound Rx
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Phenytoin
Threats/ terrorizing - isolation - denying food/privileges/liberty
5% - underreported

2. Disequilibrium
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
Diagnosis - risk/benefit analysis to choose Rx
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Multisystemic vulnerability - -lowered reserves

3. osteoporosis
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Respect for autonomy - nonmaleficence - beneficence - justice
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
Constipation -> laxatives

4. falls epidemiology
Pressure ulcer - fecal impaction - dehydration
Legal: Cruzan v Hamon
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
^morbidity + mortality - -frailest @ greatest risk

5. NSAID may lead to what prescription cascade?
28% - ADR: 17% - non-compliance 11%
^BP -> a-HTN
CNS suppression -> cholinesterase inhibitors
Stress: #1 - functional - urge - overflow

6. driving considerations
CVA: stroke - AMI: acute MI - HF
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
30% preventable - of these - 40% serious - of these 40% preventable
Make sure to discuss with patient - some states require reporting

7. what illnesses are underreported in elderly?
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction

8. What are the key points of safe prescription for elderly - lecture
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
Stress: #1 - functional - urge - overflow
Catch-all of unspecified dizziness
Diagnosis - risk/benefit analysis to choose Rx

9. metoclopramide may lead to what prescription cascade?
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Parkinsonism -> l-DOPA

10. osteoporosis epidemiology
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
High mortality - esp + Fx - very common in elderly
Cholinesterase inhib - 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

11. How does aging affect GI absorption of Rx?
P2-metab: Lorazepam - Trazepam - Oxazepam
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
P2-metabolite - phase 1 biotx much more affected than phase 2
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope

12. What is polypharmacy
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
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
>9 Rx
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids

13. delirium incidence
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Cholinesterase inhib - use: dementia
Hypothetical plan - serves as patient's last competent indicated wishes
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD

14. Beers criteria
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
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
Beers criteria - medication appropriateness index (12 ?)

15. pressure ulcer: staging
Legal: Cruzan v Hamon
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Hypothetical plan - serves as patient's last competent indicated wishes

16. delirium predisposing rf
Environment modification: obstacles - mobility - -bladder fcn ok
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment

17. what drugs can cause dizziness?
Mechanical loading - skin care - avoid friction/shear
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics

18. frailty raises vulnerability to...
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
Bone loss -> osteopenia -> osteoporosis -> Fx

19. how is the CAM used to diagnose delirium?
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
>9 Rx
Begin @25-50% recommended dose - APAP may be dose-limiting
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness

20. What is a mattering map?
^K+
Hyperuricemia -> gout
Temporalis muscle wasting = temporal wasting
Map of people - perceptions - etc - varies by perspective

21. delirium: medical rf
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
^BP -> a-HTN
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
Diagnosis - risk/benefit analysis to choose Rx

22. clues of neglect
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
^K+

23. incontinence epidemiology
IdioPx - psychiatric: depression - anxiety - somatoform
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other

24. What is START criteria?
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
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
Hypothetical plan - serves as patient's last competent indicated wishes
CNS suppression -> cholinesterase inhibitors

25. What are the rf for elderly abuse?
Confusion - sedation - falls
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Cachexia - PEM - FTT - obesity
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration

26. What are the common causes of lightheadedness?
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Breast cancer + 2o LBP
IdioPx - psychiatric: depression - anxiety - somatoform

27. What is the best approach to malnutrition
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
Treat underlying disease/lack resources
IdioPx - psychiatric: depression - anxiety - somatoform

28. stress incontinence tx
Tx underlying etio - + Kegels - pessary - surgery
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Beers criteria - medication appropriateness index (12 ?)

29. depression + atypical Sx
Cholinesterase inhib - use: dementia
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep

30. which benzodiazepines are most appropriate for elderly?
P2-metab: Lorazepam - Trazepam - Oxazepam
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
Cholinesterase inhib - use: dementia
Voice - character - plot - context - time - reader

31. how is syncope related to elderly admission to hospital?
1/2
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
^BP -> a-HTN
80% of hospital admission for syncope for >65yo

32. what can enhance reporting in elderly?
Screen for potentially embarrassing dx - patient/Dr trust
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
Orthostatic hypotension - vagal stimulation (vasovagal reflex)

33. What is the bone deterioration cascade?
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Bone loss -> osteopenia -> osteoporosis -> Fx
F>M (until 80yo) - stress incontinence #1 - $26B/yr

34. osteoporosis etio
Cachexia - PEM - FTT - obesity
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
Temporalis muscle wasting = temporal wasting
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx

35. opioid tx in elderly
Begin @25-50% recommended dose - APAP may be dose-limiting
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo

36. i2 + atypical Sx
No: fever - leukocytosis - yes: falls - appetite change - low functional status
^BP -> a-HTN
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment

37. delirium: mgmt
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
Consider responsibilities - drivin
Screen for potentially embarrassing dx - patient/Dr trust

38. what mechanical loading helps to prevent pressure ulcers?
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Cachexia - PEM - FTT - obesity

39. How does the aging heart compensate for lower HR to maintain unchanged CO?
Screen for potentially embarrassing dx - patient/Dr trust
^SV (diastolic stroke volume)
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible

40. How does aging affect Rx renal elimination?
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
Tx underlying etio - + Kegels - pessary - surgery
Cholinesterase inhib - use: dementia

41. preventing malnutrition
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Electrolyte imbalance - arrhythmia
Figure out a good diet - social aspect - resources - dental/oral comfort

42. who is a good candidate for opioid tx?
Environment modification: obstacles - mobility - -bladder fcn ok
Stress: #1 - functional - urge - overflow
>60yo - low abuse risk - ^ monitoring possible
Receptors changes: # - sensitivity - counter-regulatory moa

43. delirium: Rx that contribute
ANF: Na+ retention - disinhib vasoconstriction
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Stress: #1 - functional - urge - overflow

44. How does aging affect pharmacokinetics?
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
Injury - neglect - physical/psychosocial - financial - violation of rights
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction

45. lightheadedness
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
Catch-all of unspecified dizziness
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid

46. galantamine
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
^ANS tone -> ^periph vasoconstriction - ^HR
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Cholinesterase inhib - use: dementia

47. Aging descriptors
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted

48. conservator
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Confusion - sedation - falls
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals

49. what ADR are common in elderly patient?
Serum Cr: used for Cr clearance equation
Vertigo - presyncope - disequilibrium - lightheadedness
Voice - character - plot - context - time - reader
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych

50. What are the vascular changes of presyncope?
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies