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. cachexia
Hypotension - ^K+
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
Electrical: change in HR - structural: aortic outflow obstruction
^morbidity + mortality - -frailest @ greatest risk

2. what drugs can cause dizziness?
Universal - progressive - partially encoded (genetic) - destructive -
Confusion - sedation - falls
Appointed by court if no substituted judgment -conservator of finance -conservator of person
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics

3. galantamine
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Cholinesterase inhib - use: dementia
Diagnosis - risk/benefit analysis to choose Rx

4. incontinence complication
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Legal: Cruzan v Hamon
Catch-all of unspecified dizziness
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly

5. What is the Cockcroft Gault equation?
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Prescribing - monitoring - patient adherence
Used to calculate renal fcn - clearance of Cr adjusted for age
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait

6. What are the 4 basic ethical principles?
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
Isolated systolic HTN
Respect for autonomy - nonmaleficence - beneficence - justice
Pressure ulcer - fecal impaction - dehydration

7. Beers criteria: what 10 Rx should elderly avoid or use + caution?
CNS suppression -> cholinesterase inhibitors
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec

8. LBW equation
Begin @25-50% recommended dose - APAP may be dose-limiting
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
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
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding

9. psychological abuse
Universal - progressive - partially encoded (genetic) - destructive -
Threats/ terrorizing - isolation - denying food/privileges/liberty
CVA: stroke - AMI: acute MI - HF
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)

10. How does baroreceptor reflex prevent syncope?
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Beers criteria - medication appropriateness index (12 ?)
^ANS tone -> ^periph vasoconstriction - ^HR
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants

11. Cockcroft Gault equation
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Figure out a good diet - social aspect - resources - dental/oral comfort
Bone loss -> osteopenia -> osteoporosis -> Fx

12. using long-acting opioids in elderly
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
>60yo - low abuse risk - ^ monitoring possible
80% of hospital admission for syncope for >65yo
IdioPx - psychiatric: depression - anxiety - somatoform

13. 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
^SV (diastolic stroke volume)
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids

14. How does sliding scale glycemic control relate to elderly?
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
Isolated systolic HTN
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable

15. Syncope prognosis based on etio
Vertigo - presyncope - disequilibrium - lightheadedness
Cholinesterase inhib - use: dementia
Electrolyte imbalance - arrhythmia
Worse for cardiac causes v noncardia

16. What is abuse?
Environment modification: obstacles - mobility - -bladder fcn ok
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Electrolyte imbalance - arrhythmia
Injury - neglect - physical/psychosocial - financial - violation of rights

17. 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
Bone loss -> osteopenia -> osteoporosis -> Fx
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR

18. delirium: tx approach
Phenytoin
Electrolyte imbalance - arrhythmia
Injury - neglect - physical/psychosocial - financial - violation of rights
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids

19. ACE inhib + diuretic: interaction outcome
ANF: Na+ retention - disinhib vasoconstriction
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Hypotension - ^K+

20. how can you determine whether Rx is appropriate to use in elderly patient?
Mechanical loading - skin care - avoid friction/shear
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Beers criteria - medication appropriateness index (12 ?)
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead

21. lipid-soluble Rx
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
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Confusion - sedation - falls

22. what receptors decrease sensitivity with aging?
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Tx underlying etio - + Kegels - pessary - surgery
ANF: Na+ retention - disinhib vasoconstriction
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve

23. i2 + atypical Sx
No: fever - leukocytosis - yes: falls - appetite change - low functional status
IdioPx - psychiatric: depression - anxiety - somatoform
Delayed absorption - like competitive inhib
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport

24. What is the best approach to malnutrition
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
Cholinesterase inhib - use: dementia
Treat underlying disease/lack resources
Orthostatic hypotension - vagal stimulation (vasovagal reflex)

25. MRP: medication related problems
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Voice - character - plot - context - time - reader
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction

26. antiarrhythmic + diuretic: interaction outcome
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Electrolyte imbalance - arrhythmia
Respect for autonomy - nonmaleficence - beneficence - justice
1/2

27. BZD + antidepressant: interaction outcome
Insiduous onset
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Confusion - sedation - falls
Doctors

28. lightheadedness
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
1/2
Catch-all of unspecified dizziness
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid

29. advanced directive/care plan

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

30. clues of neglect
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Screen for potentially embarrassing dx - patient/Dr trust
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Respect for autonomy - nonmaleficence - beneficence - justice

31. vision changes: elderly
Consider responsibilities - drivin
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
5% - underreported
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity

32. Approach to idioPx - recurrent syncope
Cholinesterase inhib - use: dementia
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
Consider responsibilities - drivin
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory

33. documenting elderly abuse

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

34. What are rf for osteoporosis?
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
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
Receptors changes: # - sensitivity - counter-regulatory moa
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness

35. How does aging affect Rx pharmacokinetic metabolism?
BMD (bone mineral density): T-score >2.5 std dev below normal 1
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
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health

36. delirium predisposing rf
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
Cholinesterase inhib - use: dementia
Cachexia - PEM - FTT - obesity

37. What is the STOPP criteria?
80% of hospital admission for syncope for >65yo
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
Voice - character - plot - context - time - reader
Serum Cr: used for Cr clearance equation

38. how is syncope related to elderly admission to hospital?
Multisystemic vulnerability - -lowered reserves
80% of hospital admission for syncope for >65yo
CVA: stroke - AMI: acute MI - HF
Beers criteria - medication appropriateness index (12 ?)

39. How does aging affect pharmacokinetics?
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Tx underlying etio - + Kegels - pessary - surgery
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease

40. stress incontinence tx
Cholinesterase inhib - use: dementia
Tx underlying etio - + Kegels - pessary - surgery
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding

41. What is capacity?
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Determined by Dr for a patient - -> used to determine competency

42. what can enhance reporting in elderly?
Injury - neglect - physical/psychosocial - financial - violation of rights
Screen for potentially embarrassing dx - patient/Dr trust
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2

43. How does aging affect GI absorption of Rx?
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
ANF: Na+ retention - disinhib vasoconstriction
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar

44. Aging descriptors
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Injury - neglect - physical/psychosocial - financial - violation of rights
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR

45. metoclopramide may lead to what prescription cascade?
Doctors
Parkinsonism -> l-DOPA
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)

46. which benzodiazepines are most appropriate for elderly?
P2-metab: Lorazepam - Trazepam - Oxazepam
5% - underreported
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Hypothetical plan - serves as patient's last competent indicated wishes

47. pressure ulcer: staging
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Appointed by court if no substituted judgment -conservator of finance -conservator of person

48. delirium incidence
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals

49. physical neglect
Legal: Cruzan v Hamon
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx

50. delirium: Rx that contribute
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Stress: #1 - functional - urge - overflow
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine