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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. urge incontinence tx
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor

2. What is a PE sign of cachexia?
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
NMDR antagonist - use: dementia
Temporalis muscle wasting = temporal wasting
80% of hospital admission for syncope for >65yo

3. What are the 4 basic ethical principles?
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Prescribing - monitoring - patient adherence
Respect for autonomy - nonmaleficence - beneficence - justice
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD

4. physical neglect
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Determined by Dr for a patient - -> used to determine competency

5. How does aging affect GI absorption of Rx?
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
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx

6. psychological abuse
^SV (diastolic stroke volume)
Cholinesterase inhib - use: dementia
Threats/ terrorizing - isolation - denying food/privileges/liberty
Pressure ulcer - fecal impaction - dehydration

7. Presyncope
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
Cholinesterase inhib - use: dementia

8. fall causes
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
CNS suppression -> cholinesterase inhibitors
Doctors
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient

9. memantine
Voice - character - plot - context - time - reader
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Receptors changes: # - sensitivity - counter-regulatory moa
NMDR antagonist - use: dementia

10. Aging descriptors
Vertigo - presyncope - disequilibrium - lightheadedness
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity

11. donepezil
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx
Cholinesterase inhib - use: dementia

12. functional incontinence tx
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Environment modification: obstacles - mobility - -bladder fcn ok
3 reflexes: baroreceptor - renal nerve - ANF
Treat underlying disease/lack resources

13. Approach to idioPx - recurrent syncope
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
80% of hospital admission for syncope for >65yo
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Consider responsibilities - drivin

14. cachexia
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Insiduous onset
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
1/2

15. How does sliding scale glycemic control relate to elderly?
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Electrolyte imbalance - arrhythmia

16. How does an 80yo renal fcn compare to that of a 20yo?
>60yo - low abuse risk - ^ monitoring possible
1/2
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 - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid

17. ADR rf
NMDR antagonist - use: dementia
Cholinesterase inhib - use: dementia
Pressure ulcer - fecal impaction - dehydration
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR

18. describe the % of ADR considered preventable - and of those serious
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
30% preventable - of these - 40% serious - of these 40% preventable
Treat underlying disease/lack resources
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity

19. stress incontinence tx
Universal - progressive - partially encoded (genetic) - destructive -
Tx underlying etio - + Kegels - pessary - surgery
Temporalis muscle wasting = temporal wasting
Cholinesterase inhib - use: dementia

20. What is START criteria?
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
28% - ADR: 17% - non-compliance 11%
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet

21. 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
Constipation -> laxatives
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo

22. What are the 3 sentinel events for LT care?
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient
Pressure ulcer - fecal impaction - dehydration
Threats/ terrorizing - isolation - denying food/privileges/liberty
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear

23. What are the hazards of elderly hospitalization?
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
^morbidity + mortality - -frailest @ greatest risk
Confusion - sedation - falls
5% - underreported

24. thiazide diuretic may lead to what prescription cascade?
Tx underlying etio - + Kegels - pessary - surgery
Diagnosis - risk/benefit analysis to choose Rx
Hyperuricemia -> gout
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction

25. elderly abuse epidemiology
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Insiduous onset
BMD (bone mineral density): T-score >2.5 std dev below normal 1
5% - underreported

26. How to prevent pressure ulcers?
Diagnosis - risk/benefit analysis to choose Rx
Begin @25-50% recommended dose - APAP may be dose-limiting
Mechanical loading - skin care - avoid friction/shear
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness

27. delirium diagnosis
Hypotension - ^K+
1/2
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers

28. What is the epidemiology of dizziness?
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse

29. Cockcroft Gault equation
Confusion - sedation - falls
CNS suppression -> cholinesterase inhibitors
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85

30. urinary incontinence types
Stress: #1 - functional - urge - overflow
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
^BP -> a-HTN

31. How does aging affect pharmacokinetics?
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
^K+

32. malnutrition
CNS suppression -> cholinesterase inhibitors
Phenytoin
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR

33. what normally prevents syncope?
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
3 reflexes: baroreceptor - renal nerve - ANF
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Cachexia - PEM - FTT - obesity

34. Disequilibrium
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
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
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx

35. What are the 3 stages of ADRs?
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
1/2
Prescribing - monitoring - patient adherence
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

36. metoclopramide may lead to what prescription cascade?
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Parkinsonism -> l-DOPA
Constipation -> laxatives

37. How does aging affect Rx pharmacokinetic distribution?
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Vertigo - presyncope - disequilibrium - lightheadedness
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
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

38. How does aging affect Rx renal elimination?
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
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
Bone loss -> osteopenia -> osteoporosis -> Fx

39. LBW equation
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics

40. what nutritional interventions help underweight?
80% of hospital admission for syncope for >65yo
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Isolated systolic HTN
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding

41. osteopenia
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
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
3 reflexes: baroreceptor - renal nerve - ANF
Falls - delirium - malnutrition - P ulcers - opportunistic i2

42. thyroid dx + atypical Sx
Cholinesterase inhib - use: dementia
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
Delayed absorption - like competitive inhib
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear

43. how is cachexia different from wasting?
Appointed by court if no substituted judgment -conservator of finance -conservator of person
AFib: Warfarin - CAD/CVA/PVD wo contraindications: Statin - osteoporosis: Ca2+ - Vit D - DM + CVD rf: Statin - Depression: a-Depressant - arterial dx: a-platelet
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers

44. ACE inhib + diuretic: interaction outcome
Temporalis muscle wasting = temporal wasting
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Universal - progressive - partially encoded (genetic) - destructive -
Hypotension - ^K+

45. vertigo
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
Cholinesterase inhib - use: dementia
Electrolyte imbalance - arrhythmia
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals

46. What is a mattering map?
Isolated systolic HTN
Legal: Cruzan v Hamon
Map of people - perceptions - etc - varies by perspective
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen

47. how can you determine whether Rx is appropriate to use in elderly patient?
Threats/ terrorizing - isolation - denying food/privileges/liberty
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Beers criteria - medication appropriateness index (12 ?)
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly

48. What are rf for osteoporosis?
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
Mild discomfort - constipation - tachypnea - vague resp Sx - fewer bowel sounds
Legal: Cruzan v Hamon

49. PEM
^BP -> a-HTN
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
CVA: stroke - AMI: acute MI - HF
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI

50. depression + atypical Sx
5% - underreported
Constipation -> laxatives
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep