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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. violation of rights
Hypotension - ^K+
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
Mechanical loading - skin care - avoid friction/shear

2. osteoporosis epidemiology
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
BMD (bone mineral density): T-score >2.5 std dev below normal 1
High mortality - esp + Fx - very common in elderly
Bone loss -> osteopenia -> osteoporosis -> Fx

3. urinary incontinence types
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Stress: #1 - functional - urge - overflow
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
Treat underlying disease/lack resources

4. what drugs can cause dizziness?
High mortality - esp + Fx - very common in elderly
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Diagnosis - risk/benefit analysis to choose Rx
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease

5. What drugs can contribute to syncope?
Doctors
Begin @25-50% recommended dose - APAP may be dose-limiting
^BP -> a-HTN
A-blockers - B-blockers - TCA

6. falls epidemiology
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Legal: Cruzan v Hamon
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych

7. What is sCr?
Hyperuricemia -> gout
Screen for potentially embarrassing dx - patient/Dr trust
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
Serum Cr: used for Cr clearance equation

8. what % of hospitalizations of elderly are due to ADR + noncompliance?
28% - ADR: 17% - non-compliance 11%
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
F>M (until 80yo) - stress incontinence #1 - $26B/yr

9. How does aging increase incontinence?
Cachexia - PEM - FTT - obesity
Confusion - sedation - falls
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
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

10. frailty
1/2
Multisystemic vulnerability - -lowered reserves
Receptors changes: # - sensitivity - counter-regulatory moa
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M

11. What is the bone deterioration cascade?
Delayed absorption - like competitive inhib
Bone loss -> osteopenia -> osteoporosis -> Fx
Map of people - perceptions - etc - varies by perspective
Falls - delirium - malnutrition - P ulcers - opportunistic i2

12. pressure ulcer: staging
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)

13. What are rf for osteoporosis?
Map of people - perceptions - etc - varies by perspective
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx

14. memantine
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Mechanical loading - skin care - avoid friction/shear
NMDR antagonist - use: dementia
Confusion - sedation - falls

15. describe the % of ADR considered preventable - and of those serious
Falls - delirium - malnutrition - P ulcers - opportunistic i2
30% preventable - of these - 40% serious - of these 40% preventable
Figure out a good diet - social aspect - resources - dental/oral comfort
Consider responsibilities - drivin

16. pulm edema + atypical Sx
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Voice - character - plot - context - time - reader
Insiduous onset
Appointed by court if no substituted judgment -conservator of finance -conservator of person

17. acute abdomen + atypical Sx
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Hypotension - ^K+

18. BZD + antipsychotic: interaction outcome
CNS suppression -> cholinesterase inhibitors
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Confusion - sedation - falls
Delayed absorption - like competitive inhib

19. How does renal nerve prevent syncope?
Legal: Cruzan v Hamon
Worse for cardiac causes v noncardia
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo

20. What is capacity?
Determined by Dr for a patient - -> used to determine competency
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Bone loss -> osteopenia -> osteoporosis -> Fx

21. driving considerations
^K+
Make sure to discuss with patient - some states require reporting
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable

22. depression + atypical Sx
Stress: #1 - functional - urge - overflow
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep

23. Approach to idioPx - recurrent syncope
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Breast cancer + 2o LBP
Consider responsibilities - drivin
Parkinsonism -> l-DOPA

24. vision changes: elderly
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
Environment modification: obstacles - mobility - -bladder fcn ok
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2

25. metoclopramide may lead to what prescription cascade?
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
Parkinsonism -> l-DOPA
Electrolyte imbalance - arrhythmia
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP

26. NSAID may lead to what prescription cascade?
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
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
^BP -> a-HTN

27. What is the epidemiology of dizziness?
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
Receptors changes: # - sensitivity - counter-regulatory moa
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness

28. how can you determine whether Rx is appropriate to use in elderly patient?
Beers criteria - medication appropriateness index (12 ?)
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Cholinesterase inhib - use: dementia
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych

29. preventing malnutrition
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
Figure out a good diet - social aspect - resources - dental/oral comfort
Cholinesterase inhib - use: dementia
Temporalis muscle wasting = temporal wasting

30. rule of doable effect
Universal - progressive - partially encoded (genetic) - destructive -
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
Begin @25-50% recommended dose - APAP may be dose-limiting
Threats/ terrorizing - isolation - denying food/privileges/liberty

31. red flags for further inquiry
Receptors changes: # - sensitivity - counter-regulatory moa
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other

32. What are the vascular changes of presyncope?
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Hypotension - ^K+
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Orthostatic hypotension - vagal stimulation (vasovagal reflex)

33. nutrition syndromes
>60yo - low abuse risk - ^ monitoring possible
Cachexia - PEM - FTT - obesity
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Electrolyte imbalance - arrhythmia

34. What are the key points of safe prescription for elderly - lecture
Diagnosis - risk/benefit analysis to choose 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
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
Worse for cardiac causes v noncardia

35. delirium: tx approach
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
Make sure to discuss with patient - some states require reporting
Voice - character - plot - context - time - reader
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids

36. ACE inhib + K+: interaction outcome
Make sure to discuss with patient - some states require reporting
^K+
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve

37. BZD + antidepressant: interaction outcome
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Treat underlying disease/lack resources
Confusion - sedation - falls
Legal: Cruzan v Hamon

38. What is the preferred depression treatment in elderly?
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Therapy - SSRI
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
Cachexia - PEM - FTT - obesity

39. which benzodiazepines are most appropriate for elderly?
No: chest pain - yes: fatigue - nausea - low functional status - SOB
P2-metab: Lorazepam - Trazepam - Oxazepam
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope

40. galantamine
Cholinesterase inhib - use: dementia
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
5% - underreported
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism

41. 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
Prescribing - monitoring - patient adherence
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Cachexia - PEM - FTT - obesity

42. urge incontinence tx
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction

43. lipid-soluble Rx
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Cholinesterase inhib - use: dementia
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
5% - underreported

44. Beers criteria: what 10 Rx should elderly avoid or use + caution?
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen

45. ACE inhib + diuretic: interaction outcome
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
Threats/ terrorizing - isolation - denying food/privileges/liberty
Hypotension - ^K+

46. What are the common causes of lightheadedness?
NMDR antagonist - use: dementia
IdioPx - psychiatric: depression - anxiety - somatoform
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Vertigo - presyncope - disequilibrium - lightheadedness

47. i2 + atypical Sx
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
1/2
No: fever - leukocytosis - yes: falls - appetite change - low functional status
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport

48. stress incontinence tx
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
Cholinesterase inhib - use: dementia
Tx underlying etio - + Kegels - pessary - surgery
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)

49. MI + atypical Sx
Treat underlying disease/lack resources
High mortality - esp + Fx - very common in elderly
Respect for autonomy - nonmaleficence - beneficence - justice
No: chest pain - yes: fatigue - nausea - low functional status - SOB

50. LBW equation
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
Breast cancer + 2o LBP
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory