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 are common physical abuse Sx in elderly?
Voice - character - plot - context - time - reader
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL

2. Disequilibrium
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Screen for potentially embarrassing dx - patient/Dr trust
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory

3. What are the key points of safe prescription for elderly - lecture
Diagnosis - risk/benefit analysis to choose Rx
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
High mortality - esp + Fx - very common in elderly
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health

4. malignancy + atypical Sx
Hyperuricemia -> gout
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
^ANS tone -> ^periph vasoconstriction - ^HR
Breast cancer + 2o LBP

5. Aging descriptors
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Determined by Dr for a patient - -> used to determine competency
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
CNS suppression -> cholinesterase inhibitors

6. What are the common causes of lightheadedness?
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
IdioPx - psychiatric: depression - anxiety - somatoform
Cholinesterase inhib - use: dementia

7. surrogate decision making heirarchy

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

8. What are the pharmacodynamic changes associated with aging?
>9 Rx
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
Receptors changes: # - sensitivity - counter-regulatory moa

9. elderly abuse epidemiology
28% - ADR: 17% - non-compliance 11%
Delayed absorption - like competitive inhib
5% - underreported
Confusion - sedation - falls

10. delirium: Rx that contribute
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
P2-metab: Lorazepam - Trazepam - Oxazepam
5% - underreported
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics

11. Cockcroft Gault equation
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Vertigo - presyncope - disequilibrium - lightheadedness
High mortality - esp + Fx - very common in elderly
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)

12. what Rx are commonly monifoted in elderly for ADR?
^SV (diastolic stroke volume)
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
30% preventable - of these - 40% serious - of these 40% preventable

13. what receptors increase sensitivity with aging?
^ANS tone -> ^periph vasoconstriction - ^HR
Serum Cr: used for Cr clearance equation
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation

14. Beers criteria
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
28% - ADR: 17% - non-compliance 11%
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Beers criteria - medication appropriateness index (12 ?)

15. MRP: medication related problems
ANF: Na+ retention - disinhib vasoconstriction
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Falls - delirium - malnutrition - P ulcers - opportunistic i2

16. substituted judgment
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M

17. frailty raises vulnerability to...
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Catch-all of unspecified dizziness
>9 Rx
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD

18. BZD + antipsychotic: interaction outcome
Confusion - sedation - falls
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
CVA: stroke - AMI: acute MI - HF
Hypotension - ^K+

19. depression + atypical Sx
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Isolated systolic HTN
NMDR antagonist - use: dementia
Multisystemic vulnerability - -lowered reserves

20. fall sequelae

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

21. What are the rf for caregiver to abuse elderly?
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Confusion - sedation - falls
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Treat underlying disease/lack resources

22. What are the 3 sentinel events for LT care?
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Pressure ulcer - fecal impaction - dehydration
No: fever - leukocytosis - yes: falls - appetite change - low functional status

23. How does aging affect Rx pharmacokinetic metabolism?
Tx underlying etio - + Kegels - pessary - surgery
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
^SV (diastolic stroke volume)
CNS suppression -> cholinesterase inhibitors

24. How does aging affect pharmacokinetic protein binding?
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Serum Cr: used for Cr clearance equation
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory

25. how is cachexia different from wasting?
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Cholinesterase inhib - use: dementia
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness

26. What are the 4 basic ethical principles?
Respect for autonomy - nonmaleficence - beneficence - justice
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
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
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait

27. What are rf for osteoporosis?
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
Injury - neglect - physical/psychosocial - financial - violation of rights

28. ADR rf
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
NMDR antagonist - use: dementia
Appointed by court if no substituted judgment -conservator of finance -conservator of person
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid

29. What are the narrative elements of clinical ethics?
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Used to calculate renal fcn - clearance of Cr adjusted for age
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
Voice - character - plot - context - time - reader

30. ACE inhib + K+: interaction outcome
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
^K+
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin

31. How does aging affect pharmacokinetic Rx distribution?
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
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

32. fall causes
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2

33. using long-acting opioids in elderly
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
Used to calculate renal fcn - clearance of Cr adjusted for age
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration

34. incontinence epidemiology
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Screen for potentially embarrassing dx - patient/Dr trust
Hypothetical plan - serves as patient's last competent indicated wishes

35. What is the natural history of syncope?
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
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope
High mortality - esp + Fx - very common in elderly
Begin @25-50% recommended dose - APAP may be dose-limiting

36. what mechanical loading helps to prevent pressure ulcers?
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
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Treat underlying disease/lack resources

37. What are the vascular changes of presyncope?
Electrical: change in HR - structural: aortic outflow obstruction
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
Receptors changes: # - sensitivity - counter-regulatory moa

38. How does aging affect GI absorption of Rx?
Electrical: change in HR - structural: aortic outflow obstruction
5% - underreported
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar

39. What is a mattering map?
80% of hospital admission for syncope for >65yo
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
>9 Rx
Map of people - perceptions - etc - varies by perspective

40. delirium: medical rf
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
^BP -> a-HTN

41. How does aging impact syncope-preventing reflexes
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
>9 Rx
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA

42. preventing malnutrition
30% preventable - of these - 40% serious - of these 40% preventable
^K+
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Figure out a good diet - social aspect - resources - dental/oral comfort

43. advanced directive/care plan

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

44. dementia tx
Electrical: change in HR - structural: aortic outflow obstruction
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
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
Used to calculate renal fcn - clearance of Cr adjusted for age

45. What is the epidemiology of dizziness?
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
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
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health

46. red flags for further inquiry
Legal: Cruzan v Hamon
No: chest pain - yes: fatigue - nausea - low functional status - SOB
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Figure out a good diet - social aspect - resources - dental/oral comfort

47. what receptors decrease sensitivity with aging?
Cholinesterase inhib - use: dementia
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Isolated systolic HTN

48. Syncope prognosis based on etio
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Phenytoin
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Worse for cardiac causes v noncardia

49. What is the best approach to malnutrition
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
Treat underlying disease/lack resources
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids

50. rivastigmine
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Multisystemic vulnerability - -lowered reserves
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Cholinesterase inhib - use: dementia