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Test your basic knowledge |
Aging Physiology And Pharmacology
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Subject
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health-sciences
Instructions:
Answer 50 questions in 15 minutes.
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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. Approach to idioPx - recurrent syncope
Consider responsibilities - drivin
^morbidity + mortality - -frailest @ greatest risk
ANF: Na+ retention - disinhib vasoconstriction
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
2. frailty raises vulnerability to...
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
3. How does sliding scale glycemic control relate to elderly?
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Cholinesterase inhib - use: dementia
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Catch-all of unspecified dizziness
4. What are the key points of safe prescription for elderly - lecture
Threats/ terrorizing - isolation - denying food/privileges/liberty
Diagnosis - risk/benefit analysis to choose Rx
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Hypotension - ^K+
5. what ADR are common in elderly patient?
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
Treat underlying disease/lack resources
Electrolyte imbalance - arrhythmia
6. osteoporosis etio
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
7. Cockcroft Gault equation
Cholinesterase inhib - use: dementia
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
8. osteoporosis
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
28% - ADR: 17% - non-compliance 11%
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Map of people - perceptions - etc - varies by perspective
9. How does aging impact syncope-preventing reflexes
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Injury - neglect - physical/psychosocial - financial - violation of rights
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
10. delirium diagnosis
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
ANF: Na+ retention - disinhib vasoconstriction
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
^K+
11. pressure ulcer: staging
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
CVA: stroke - AMI: acute MI - HF
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
12. osteopenia
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
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
Insiduous onset
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
13. What are the 4 basic ethical principles?
Respect for autonomy - nonmaleficence - beneficence - justice
3 reflexes: baroreceptor - renal nerve - ANF
Tx underlying etio - + Kegels - pessary - surgery
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
14. conservator
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
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Appointed by court if no substituted judgment -conservator of finance -conservator of person
#1 patient's last competent indication of wishes - substituted judgment - beneficence
15. What are the rf for caregiver to abuse elderly?
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Injury - neglect - physical/psychosocial - financial - violation of rights
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
16. frailty signs
Mechanical loading - skin care - avoid friction/shear
Pressure ulcer - fecal impaction - dehydration
Respect for autonomy - nonmaleficence - beneficence - justice
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
17. i2 + atypical Sx
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Temporalis muscle wasting = temporal wasting
Map of people - perceptions - etc - varies by perspective
No: fever - leukocytosis - yes: falls - appetite change - low functional status
18. describe the % of ADR considered preventable - and of those serious
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
30% preventable - of these - 40% serious - of these 40% preventable
19. falls epidemiology
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Hypotension - ^K+
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
20. How does aging affect Rx renal elimination?
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
Respect for autonomy - nonmaleficence - beneficence - justice
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
ANF: Na+ retention - disinhib vasoconstriction
21. What are common scenarios of untreated indications in elderly?
Constipation -> laxatives
ANF: Na+ retention - disinhib vasoconstriction
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Determined by Dr for a patient - -> used to determine competency
22. What are the vascular changes of presyncope?
Delayed absorption - like competitive inhib
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
No: fever - leukocytosis - yes: falls - appetite change - low functional status
23. incontinence epidemiology
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Bone loss -> osteopenia -> osteoporosis -> Fx
24. What are the common types of elder mistreatment?
Appointed by court if no substituted judgment -conservator of finance -conservator of person
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
25. anticholinergic drugs may lead to what prescription cascade?
CNS suppression -> cholinesterase inhibitors
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Stress: #1 - functional - urge - overflow
Universal - progressive - partially encoded (genetic) - destructive -
26. frailty
80% of hospital admission for syncope for >65yo
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Multisystemic vulnerability - -lowered reserves
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
27. Aging principles
Determined by Dr for a patient - -> used to determine competency
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
28. red flags for further inquiry
Pressure ulcer - fecal impaction - dehydration
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
29. physical neglect
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
^SV (diastolic stroke volume)
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
30. what % of hospitalizations of elderly are due to ADR + noncompliance?
Parkinsonism -> l-DOPA
Prescribing - monitoring - patient adherence
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
28% - ADR: 17% - non-compliance 11%
31. elderly abuse epidemiology
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
30% preventable - of these - 40% serious - of these 40% preventable
5% - underreported
32. restrain requirements
BMD (bone mineral density): T-score >2.5 std dev below normal 1
No: fever - leukocytosis - yes: falls - appetite change - low functional status
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
33. surrogate decision making heirarchy
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34. which benzodiazepines are most appropriate for elderly?
P2-metab: Lorazepam - Trazepam - Oxazepam
Cachexia - PEM - FTT - obesity
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
35. metoclopramide may lead to what prescription cascade?
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Parkinsonism -> l-DOPA
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Receptors changes: # - sensitivity - counter-regulatory moa
36. How does aging affect Rx pharmacokinetic metabolism?
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Injury - neglect - physical/psychosocial - financial - violation of rights
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
37. opioid tx in elderly
Doctors
Begin @25-50% recommended dose - APAP may be dose-limiting
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
No: fever - leukocytosis - yes: falls - appetite change - low functional status
38. thiazide diuretic may lead to what prescription cascade?
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Hyperuricemia -> gout
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
^K+
39. delirium: medical rf
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
40. tube feeding
Cachexia - PEM - FTT - obesity
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
41. using long-acting opioids in elderly
Isolated systolic HTN
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
High mortality - esp + Fx - very common in elderly
42. delirium: tx approach
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
43. ACE inhib + diuretic: interaction outcome
Hypotension - ^K+
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
44. galantamine
80% of hospital admission for syncope for >65yo
Worse for cardiac causes v noncardia
Cholinesterase inhib - use: dementia
Injury - neglect - physical/psychosocial - financial - violation of rights
45. What is abuse?
Insiduous onset
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Injury - neglect - physical/psychosocial - financial - violation of rights
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
46. malignancy + atypical Sx
Injury - neglect - physical/psychosocial - financial - violation of rights
Breast cancer + 2o LBP
>9 Rx
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
47. pulm edema + atypical Sx
Breast cancer + 2o LBP
Insiduous onset
Electrolyte imbalance - arrhythmia
Injury - neglect - physical/psychosocial - financial - violation of rights
48. What are the rf for elderly abuse?
1/2
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Bone loss -> osteopenia -> osteoporosis -> Fx
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
49. who is a good candidate for opioid tx?
^SV (diastolic stroke volume)
>60yo - low abuse risk - ^ monitoring possible
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
50. how is syncope related to elderly admission to hospital?
Make sure to discuss with patient - some states require reporting
30% preventable - of these - 40% serious - of these 40% preventable
80% of hospital admission for syncope for >65yo
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
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