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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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1. Aging principles
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
High mortality - esp + Fx - very common in elderly

2. violation of rights
Bone loss -> osteopenia -> osteoporosis -> Fx
>9 Rx
Temporalis muscle wasting = temporal wasting
Personal liberty -living at home - personal property - speech - assembly - privacy - voting

3. What drugs can contribute to syncope?
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Pressure ulcer - fecal impaction - dehydration
Worse for cardiac causes v noncardia
A-blockers - B-blockers - TCA

4. physical neglect
Worse for cardiac causes v noncardia
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Determined by Dr for a patient - -> used to determine competency
Prescribing - monitoring - patient adherence

5. delirium: tx approach
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
Doctors
Cholinesterase inhib - use: dementia

6. elderly abuse epidemiology
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
^BP -> a-HTN
5% - underreported
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other

7. What is the preferred depression treatment in elderly?
28% - ADR: 17% - non-compliance 11%
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Beers criteria - medication appropriateness index (12 ?)
Therapy - SSRI

8. Aging features
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Universal - progressive - partially encoded (genetic) - destructive -
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85

9. substituted judgment
80% of hospital admission for syncope for >65yo
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
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other

10. What is START criteria?
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Intrinsic: chronic dx - postural: changing position - mediating: risk taking

11. delirium incidence
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Pressure ulcer - fecal impaction - dehydration
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD

12. urinary incontinence types
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Stress: #1 - functional - urge - overflow
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable

13. What is capacity?
Map of people - perceptions - etc - varies by perspective
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Determined by Dr for a patient - -> used to determine competency
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)

14. what professional is least likely to report abuse?
Catch-all of unspecified dizziness
Doctors
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
Intrinsic: chronic dx - postural: changing position - mediating: risk taking

15. anticholinergic drugs may lead to what prescription cascade?
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
CNS suppression -> cholinesterase inhibitors
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx

16. PEM
Diagnosis - risk/benefit analysis to choose Rx
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
NMDR antagonist - use: dementia
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted

17. ACE inhib + K+: interaction outcome
Insiduous onset
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
^K+
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar

18. osteopenia
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Cholinesterase inhib - use: dementia

19. osteoporosis epidemiology
Phenytoin
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
High mortality - esp + Fx - very common in elderly

20. galantamine
Voice - character - plot - context - time - reader
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Cholinesterase inhib - use: dementia

21. nutrition syndromes
Pressure ulcer - fecal impaction - dehydration
Cachexia - PEM - FTT - obesity
Electrolyte imbalance - arrhythmia
Appointed by court if no substituted judgment -conservator of finance -conservator of person

22. NSAID may lead to what prescription cascade?
Multisystemic vulnerability - -lowered reserves
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
No: chest pain - yes: fatigue - nausea - low functional status - SOB
^BP -> a-HTN

23. thyroid dx + atypical Sx
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation

24. What are the pharmacodynamic changes associated with aging?
Receptors changes: # - sensitivity - counter-regulatory moa
#1 patient's last competent indication of wishes - substituted judgment - beneficence
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards

25. What are the risks of uncontrolled ISH?
CVA: stroke - AMI: acute MI - HF
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Voice - character - plot - context - time - reader
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2

26. What are the hazards of elderly hospitalization?
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
CNS suppression -> cholinesterase inhibitors
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
^morbidity + mortality - -frailest @ greatest risk

27. antiarrhythmic + diuretic: interaction outcome
Electrolyte imbalance - arrhythmia
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Orthostatic hypotension - vagal stimulation (vasovagal reflex)

28. malnutrition
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych

29. memantine
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
Doctors
Serum Cr: used for Cr clearance equation
NMDR antagonist - use: dementia

30. frailty
Map of people - perceptions - etc - varies by perspective
^K+
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Multisystemic vulnerability - -lowered reserves

31. cachexia
Voice - character - plot - context - time - reader
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
CVA: stroke - AMI: acute MI - HF
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV

32. how is the CAM used to diagnose delirium?
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
Isolated systolic HTN
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Insiduous onset

33. How does the aging heart compensate for lower HR to maintain unchanged CO?
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
^SV (diastolic stroke volume)
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient

34. osteoporosis
Falls - delirium - malnutrition - P ulcers - opportunistic i2
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Therapy - SSRI
28% - ADR: 17% - non-compliance 11%

35. red flags for further inquiry
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other

36. MRP: medication related problems
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
^K+
Tx underlying etio - + Kegels - pessary - surgery
Respect for autonomy - nonmaleficence - beneficence - justice

37. when selecting an P1-metabolite or P2-metabolite safer in elderly?
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Make sure to discuss with patient - some states require reporting
P2-metabolite - phase 1 biotx much more affected than phase 2
Voice - character - plot - context - time - reader

38. What is the Cockcroft Gault equation?
Used to calculate renal fcn - clearance of Cr adjusted for age
Mechanical loading - skin care - avoid friction/shear
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
Voice - character - plot - context - time - reader

39. How does an 80yo renal fcn compare to that of a 20yo?
Pressure ulcer - fecal impaction - dehydration
1/2
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

40. What is the epidemiology of dizziness?
Pressure ulcer - fecal impaction - dehydration
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
Serum Cr: used for Cr clearance equation

41. what drugs can cause dizziness?
Delayed absorption - like competitive inhib
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids

42. documenting elderly abuse

43. delirium predisposing rf
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
CVA: stroke - AMI: acute MI - HF
28% - ADR: 17% - non-compliance 11%

44. vertigo
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
Tx underlying etio - + Kegels - pessary - surgery
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals

45. who is a good candidate for opioid tx?
Pressure ulcer - fecal impaction - dehydration
5% - underreported
F>M (until 80yo) - stress incontinence #1 - $26B/yr
>60yo - low abuse risk - ^ monitoring possible

46. How does aging affect GI absorption of Rx?
Phenytoin
Stress: #1 - functional - urge - overflow
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Beers criteria - medication appropriateness index (12 ?)

47. What are the 4 forms of dizziness?
P2-metabolite - phase 1 biotx much more affected than phase 2
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Vertigo - presyncope - disequilibrium - lightheadedness

48. Disequilibrium
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
>9 Rx

49. functional incontinence tx
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Environment modification: obstacles - mobility - -bladder fcn ok
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity

50. What are the key points of safe prescription for elderly - lecture
CNS suppression -> cholinesterase inhibitors
Prescribing - monitoring - patient adherence
Cholinesterase inhib - use: dementia
Diagnosis - risk/benefit analysis to choose Rx