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. MI + atypical Sx
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
No: chest pain - yes: fatigue - nausea - low functional status - SOB
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
Injury - neglect - physical/psychosocial - financial - violation of rights

2. BZD + antipsychotic: interaction outcome
Electrical: change in HR - structural: aortic outflow obstruction
Confusion - sedation - falls
^ANS tone -> ^periph vasoconstriction - ^HR
Bone loss -> osteopenia -> osteoporosis -> Fx

3. frailty signs
Universal - progressive - partially encoded (genetic) - destructive -
Bone loss -> osteopenia -> osteoporosis -> Fx
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait

4. what drugs can cause dizziness?
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Screen for potentially embarrassing dx - patient/Dr trust

5. vertigo
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
28% - ADR: 17% - non-compliance 11%
Treat underlying disease/lack resources
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals

6. What is a mattering map?
Map of people - perceptions - etc - varies by perspective
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Cachexia - PEM - FTT - obesity
Consider responsibilities - drivin

7. osteoporosis
Delayed absorption - like competitive inhib
Worse for cardiac causes v noncardia
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Treat underlying disease/lack resources

8. anticholinergic drugs may lead to what prescription cascade?
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
5% - underreported
CNS suppression -> cholinesterase inhibitors
Mechanical loading - skin care - avoid friction/shear

9. What are the key points of safe prescription for elderly - lecture
Diagnosis - risk/benefit analysis to choose Rx
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
Tx underlying etio - + Kegels - pessary - surgery
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx

10. How does renal nerve prevent syncope?
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
Tx underlying etio - + Kegels - pessary - surgery
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)

11. Alb-bound Rx
Tx underlying etio - + Kegels - pessary - surgery
Mechanical loading - skin care - avoid friction/shear
Serum Cr: used for Cr clearance equation
Phenytoin

12. What are common medical causes of syncope?
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
Tx underlying etio - + Kegels - pessary - surgery
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx

13. urinary incontinence types
Bone loss -> osteopenia -> osteoporosis -> Fx
Stress: #1 - functional - urge - overflow
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
Temporalis muscle wasting = temporal wasting

14. functional incontinence tx
Environment modification: obstacles - mobility - -bladder fcn ok
Bone loss -> osteopenia -> osteoporosis -> Fx
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear

15. restrain requirements
Tx underlying etio - + Kegels - pessary - surgery
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Stress: #1 - functional - urge - overflow

16. elderly abuse epidemiology
5% - underreported
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction

17. which benzodiazepines are most appropriate for elderly?
P2-metab: Lorazepam - Trazepam - Oxazepam
Pressure ulcer - fecal impaction - dehydration
Bone loss -> osteopenia -> osteoporosis -> Fx
Begin @25-50% recommended dose - APAP may be dose-limiting

18. what Rx are commonly monifoted in elderly for ADR?
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
Isolated systolic HTN
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

19. opioid tx in elderly
#1 patient's last competent indication of wishes - substituted judgment - beneficence
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Begin @25-50% recommended dose - APAP may be dose-limiting

20. How does aging affect Rx pharmacokinetic metabolism?
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
Delayed absorption - like competitive inhib
Receptors changes: # - sensitivity - counter-regulatory moa

21. what nutritional interventions help underweight?
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
Bone loss -> osteopenia -> osteoporosis -> Fx
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness

22. how is cachexia different from wasting?
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Stress: #1 - functional - urge - overflow
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait

23. osteoporosis epidemiology
Screen for potentially embarrassing dx - patient/Dr trust
Beers criteria - medication appropriateness index (12 ?)
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
High mortality - esp + Fx - very common in elderly

24. using long-acting opioids in elderly
Cholinesterase inhib - use: dementia
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Vertigo - presyncope - disequilibrium - lightheadedness

25. What are the 3 sentinel events for LT care?
Pressure ulcer - fecal impaction - dehydration
Temporalis muscle wasting = temporal wasting
P2-metabolite - phase 1 biotx much more affected than phase 2
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)

26. how is the CAM used to diagnose delirium?
Diagnosis - risk/benefit analysis to choose Rx
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
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

27. who is a good candidate for opioid tx?
>60yo - low abuse risk - ^ monitoring possible
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
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Respect for autonomy - nonmaleficence - beneficence - justice

28. how may hypertension compensate for aging?
Electrolyte imbalance - arrhythmia
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR

29. How to prevent pressure ulcers?
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
Mechanical loading - skin care - avoid friction/shear
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
Beers criteria - medication appropriateness index (12 ?)

30. advanced directive/care plan

31. frailty
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Multisystemic vulnerability - -lowered reserves
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health

32. delirium diagnosis
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
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
Universal - progressive - partially encoded (genetic) - destructive -

33. How does an 80yo renal fcn compare to that of a 20yo?
1/2
Constipation -> laxatives
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych

34. galantamine
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
Cholinesterase inhib - use: dementia
Delayed absorption - like competitive inhib

35. fall causes
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
CVA: stroke - AMI: acute MI - HF
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Tx underlying etio - + Kegels - pessary - surgery

36. refusing intervention
Legal: Cruzan v Hamon
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory

37. What are the 4 basic ethical principles?
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
Respect for autonomy - nonmaleficence - beneficence - justice
Begin @25-50% recommended dose - APAP may be dose-limiting
Parkinsonism -> l-DOPA

38. red flags for further inquiry
Cholinesterase inhib - use: dementia
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
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other

39. delirium: tx approach
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Temporalis muscle wasting = temporal wasting

40. What is capacity?
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Constipation -> laxatives
Serum Cr: used for Cr clearance equation
Determined by Dr for a patient - -> used to determine competency

41. delirium predisposing rf
IdioPx - psychiatric: depression - anxiety - somatoform
Voice - character - plot - context - time - reader
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment

42. What is a PE sign of cachexia?
Temporalis muscle wasting = temporal wasting
Bone loss -> osteopenia -> osteoporosis -> Fx
Confusion - sedation - falls
Figure out a good diet - social aspect - resources - dental/oral comfort

43. What is abuse?
P2-metabolite - phase 1 biotx much more affected than phase 2
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Injury - neglect - physical/psychosocial - financial - violation of rights
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory

44. How does aging affect Rx pharmacokinetic distribution?
CNS suppression -> cholinesterase inhibitors
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
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

45. Cockcroft Gault equation
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
^BP -> a-HTN
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85

46. stress incontinence tx
Respect for autonomy - nonmaleficence - beneficence - justice
Receptors changes: # - sensitivity - counter-regulatory moa
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Tx underlying etio - + Kegels - pessary - surgery

47. substituted judgment
Cachexia - PEM - FTT - obesity
Respect for autonomy - nonmaleficence - beneficence - justice
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
A-blockers - B-blockers - TCA

48. What is the Cockcroft Gault equation?
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Voice - character - plot - context - time - reader
Figure out a good diet - social aspect - resources - dental/oral comfort
Used to calculate renal fcn - clearance of Cr adjusted for age

49. 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
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
Hyperuricemia -> gout
Cachexia - PEM - FTT - obesity

50. ADR rf
Serum Cr: used for Cr clearance equation
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation