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. what nutritional interventions help underweight?
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
Confusion - sedation - falls
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid

2. what receptors decrease sensitivity with aging?
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers

3. What is the preferred depression treatment in elderly?
Therapy - SSRI
Isolated systolic HTN
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity

4. metoclopramide may lead to what prescription cascade?
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Parkinsonism -> l-DOPA

5. memantine
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
NMDR antagonist - use: dementia
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers

6. What is the natural history of syncope?
Determined by Dr for a patient - -> used to determine competency
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope

7. What are the 4 basic ethical principles?
Respect for autonomy - nonmaleficence - beneficence - justice
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
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
Serum Cr: used for Cr clearance equation

8. documenting elderly abuse

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

9. ADR rf
IdioPx - psychiatric: depression - anxiety - somatoform
^SV (diastolic stroke volume)
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR

10. elderly abuse epidemiology
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
5% - underreported
Serum Cr: used for Cr clearance equation
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards

11. What are the common causes of lightheadedness?
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
IdioPx - psychiatric: depression - anxiety - somatoform
Cholinesterase inhib - use: dementia

12. What is the epidemiology of dizziness?
Screen for potentially embarrassing dx - patient/Dr trust
No: chest pain - yes: fatigue - nausea - low functional status - SOB
1/2
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health

13. refusing intervention
Legal: Cruzan v Hamon
Environment modification: obstacles - mobility - -bladder fcn ok
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds

14. antiarrhythmic + diuretic: interaction outcome
Used to calculate renal fcn - clearance of Cr adjusted for age
Electrolyte imbalance - arrhythmia
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
P2-metabolite - phase 1 biotx much more affected than phase 2

15. What is polypharmacy
>9 Rx
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)

16. osteoporosis etio
Beers criteria - medication appropriateness index (12 ?)
Hypothetical plan - serves as patient's last competent indicated wishes
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
Receptors changes: # - sensitivity - counter-regulatory moa

17. Disequilibrium
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Electrical: change in HR - structural: aortic outflow obstruction
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Environment modification: obstacles - mobility - -bladder fcn ok

18. What are the common types of elder mistreatment?
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
A-blockers - B-blockers - TCA

19. what receptors increase sensitivity with aging?
28% - ADR: 17% - non-compliance 11%
Threats/ terrorizing - isolation - denying food/privileges/liberty
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism

20. stress incontinence tx
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
>9 Rx
Tx underlying etio - + Kegels - pessary - surgery
Consider responsibilities - drivin

21. incontinence complication
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Catch-all of unspecified dizziness
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
CNS suppression -> cholinesterase inhibitors

22. rivastigmine
Catch-all of unspecified dizziness
Cholinesterase inhib - use: dementia
Used to calculate renal fcn - clearance of Cr adjusted for age
>60yo - low abuse risk - ^ monitoring possible

23. malignancy + atypical Sx
Breast cancer + 2o LBP
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Hypotension - ^K+

24. Beers criteria: what 10 Rx should elderly avoid or use + caution?
Respect for autonomy - nonmaleficence - beneficence - justice
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Multisystemic vulnerability - -lowered reserves
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR

25. Presyncope
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers

26. functional incontinence tx
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
Mechanical loading - skin care - avoid friction/shear
Environment modification: obstacles - mobility - -bladder fcn ok
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers

27. What is the STOPP criteria?
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
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Tx underlying etio - + Kegels - pessary - surgery

28. 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
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Screen for potentially embarrassing dx - patient/Dr trust

29. urinary incontinence types
High mortality - esp + Fx - very common in elderly
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Stress: #1 - functional - urge - overflow

30. What are the possible cardiac causes of presyncope?
Electrical: change in HR - structural: aortic outflow obstruction
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Tx underlying etio - + Kegels - pessary - surgery
Mechanical loading - skin care - avoid friction/shear

31. tube feeding
Doctors
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
80% of hospital admission for syncope for >65yo
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2

32. How does aging affect GI absorption of Rx?
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Confusion - sedation - falls
Figure out a good diet - social aspect - resources - dental/oral comfort
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar

33. delirium: tx approach
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
^ANS tone -> ^periph vasoconstriction - ^HR

34. What are common scenarios of untreated indications in elderly?
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
ANF: Na+ retention - disinhib vasoconstriction
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)

35. What are common physical abuse Sx in elderly?
Prescribing - monitoring - patient adherence
Consider responsibilities - drivin
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical

36. delirium: Rx that contribute
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Electrolyte imbalance - arrhythmia
Appointed by court if no substituted judgment -conservator of finance -conservator of person
High mortality - esp + Fx - very common in elderly

37. pulm edema + atypical Sx
P2-metab: Lorazepam - Trazepam - Oxazepam
Insiduous onset
Cholinesterase inhib - use: dementia
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR

38. delirium: medical rf
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
3 reflexes: baroreceptor - renal nerve - ANF
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Serum Cr: used for Cr clearance equation

39. thyroid dx + atypical Sx
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
A-blockers - B-blockers - TCA
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics

40. How does the aging heart compensate for lower HR to maintain unchanged CO?
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Isolated systolic HTN
^SV (diastolic stroke volume)
Phenytoin

41. Aging descriptors
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Used to calculate renal fcn - clearance of Cr adjusted for age
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)

42. How does aging affect pharmacokinetic Rx distribution?
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Breast cancer + 2o LBP
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

43. Aging principles
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible

44. What is capacity?
A-blockers - B-blockers - TCA
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
Mechanical loading - skin care - avoid friction/shear

45. ACE inhib + diuretic: interaction outcome
Voice - character - plot - context - time - reader
Figure out a good diet - social aspect - resources - dental/oral comfort
Cachexia - PEM - FTT - obesity
Hypotension - ^K+

46. What are the narrative elements of clinical ethics?
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
Voice - character - plot - context - time - reader
5% - underreported
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

47. NSAID may lead to what prescription cascade?
^BP -> a-HTN
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable

48. surrogate decision making heirarchy

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

49. driving considerations
Begin @25-50% recommended dose - APAP may be dose-limiting
Make sure to discuss with patient - some states require reporting
>60yo - low abuse risk - ^ monitoring possible
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)

50. psychological abuse
IdioPx - psychiatric: depression - anxiety - somatoform
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Threats/ terrorizing - isolation - denying food/privileges/liberty