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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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study here
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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. how may hypertension compensate for aging?
Electrical: change in HR - structural: aortic outflow obstruction
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Breast cancer + 2o LBP
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
2. What are the pharmacodynamic changes associated with aging?
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Injury - neglect - physical/psychosocial - financial - violation of rights
Receptors changes: # - sensitivity - counter-regulatory moa
3. incontinence complication
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
Receptors changes: # - sensitivity - counter-regulatory moa
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
4. What is the epidemiology of dizziness?
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Cholinesterase inhib - use: dementia
Phenytoin
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
5. What are the common types of elder mistreatment?
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Phenytoin
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
6. what can enhance reporting in elderly?
Universal - progressive - partially encoded (genetic) - destructive -
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
Screen for potentially embarrassing dx - patient/Dr trust
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
7. What is a mattering map?
Cholinesterase inhib - use: dementia
Map of people - perceptions - etc - varies by perspective
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Beers criteria - medication appropriateness index (12 ?)
8. PEM
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Phenytoin
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
9. pressure ulcer: staging
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
Prescribing - monitoring - patient adherence
10. delirium: Rx that contribute
Legal: Cruzan v Hamon
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Tx underlying etio - + Kegels - pessary - surgery
Isolated systolic HTN
11. acute abdomen + atypical Sx
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
IdioPx - psychiatric: depression - anxiety - somatoform
Therapy - SSRI
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
12. lipid-soluble Rx
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
1/2
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Beers criteria - medication appropriateness index (12 ?)
13. What is the bone deterioration cascade?
Bone loss -> osteopenia -> osteoporosis -> Fx
CNS suppression -> cholinesterase inhibitors
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
14. What are the key points of safe prescription for elderly - lecture
Figure out a good diet - social aspect - resources - dental/oral comfort
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
Diagnosis - risk/benefit analysis to choose Rx
15. Cockcroft Gault equation
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Legal: Cruzan v Hamon
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
16. thyroid dx + atypical Sx
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Determined by Dr for a patient - -> used to determine competency
17. elderly abuse epidemiology
5% - underreported
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
18. lightheadedness
Voice - character - plot - context - time - reader
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
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
19. refusing intervention
Legal: Cruzan v Hamon
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
80% of hospital admission for syncope for >65yo
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
20. incontinence epidemiology
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Temporalis muscle wasting = temporal wasting
30% preventable - of these - 40% serious - of these 40% preventable
F>M (until 80yo) - stress incontinence #1 - $26B/yr
21. urge incontinence tx
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
No: chest pain - yes: fatigue - nausea - low functional status - SOB
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
22. what normally prevents syncope?
3 reflexes: baroreceptor - renal nerve - ANF
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Environment modification: obstacles - mobility - -bladder fcn ok
Confusion - sedation - falls
23. metoclopramide may lead to what prescription cascade?
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Parkinsonism -> l-DOPA
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
24. delirium: tx approach
30% preventable - of these - 40% serious - of these 40% preventable
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Pressure ulcer - fecal impaction - dehydration
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
25. How does baroreceptor reflex prevent syncope?
IdioPx - psychiatric: depression - anxiety - somatoform
^ANS tone -> ^periph vasoconstriction - ^HR
Confusion - sedation - falls
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
26. dementia tx
Breast cancer + 2o LBP
Respect for autonomy - nonmaleficence - beneficence - justice
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
27. What is the natural history of syncope?
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
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
28. violation of rights
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
CNS suppression -> cholinesterase inhibitors
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
29. frailty signs
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Electrolyte imbalance - arrhythmia
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
30. how is syncope related to elderly admission to hospital?
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
80% of hospital admission for syncope for >65yo
Stress: #1 - functional - urge - overflow
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
31. driving considerations
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
Tx underlying etio - + Kegels - pessary - surgery
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Make sure to discuss with patient - some states require reporting
32. osteopenia
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
^morbidity + mortality - -frailest @ greatest risk
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Treat underlying disease/lack resources
33. surrogate decision making heirarchy
34. advanced directive/care plan
35. memantine
NMDR antagonist - use: dementia
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
^BP -> a-HTN
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
36. opioid tx in elderly
Begin @25-50% recommended dose - APAP may be dose-limiting
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Worse for cardiac causes v noncardia
Diagnosis - risk/benefit analysis to choose Rx
37. functional incontinence tx
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
Serum Cr: used for Cr clearance equation
Environment modification: obstacles - mobility - -bladder fcn ok
Isolated systolic HTN
38. What are the hazards of elderly hospitalization?
^morbidity + mortality - -frailest @ greatest risk
Consider responsibilities - drivin
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
Confusion - sedation - falls
39. How does aging affect pharmacokinetics?
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
40. What are common scenarios of untreated indications in elderly?
Hyperuricemia -> gout
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
41. Beers criteria: what 10 Rx should elderly avoid or use + caution?
Respect for autonomy - nonmaleficence - beneficence - justice
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Diagnosis - risk/benefit analysis to choose Rx
42. osteoporosis epidemiology
CNS suppression -> cholinesterase inhibitors
ANF: Na+ retention - disinhib vasoconstriction
High mortality - esp + Fx - very common in elderly
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
43. what mechanical loading helps to prevent pressure ulcers?
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
Treat underlying disease/lack resources
Electrical: change in HR - structural: aortic outflow obstruction
44. How to prevent pressure ulcers?
Doctors
^morbidity + mortality - -frailest @ greatest risk
Mechanical loading - skin care - avoid friction/shear
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
45. donepezil
Cholinesterase inhib - use: dementia
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Bone loss -> osteopenia -> osteoporosis -> Fx
46. red flags for further inquiry
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
>9 Rx
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
47. What is a PE sign of cachexia?
^ANS tone -> ^periph vasoconstriction - ^HR
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Beers criteria - medication appropriateness index (12 ?)
Temporalis muscle wasting = temporal wasting
48. delirium predisposing rf
A-blockers - B-blockers - TCA
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
1/2
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
49. osteoporosis
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Therapy - SSRI
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
50. BZD + antidepressant: interaction outcome
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Doctors
Confusion - sedation - falls
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M