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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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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. violation of rights
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
Hypothetical plan - serves as patient's last competent indicated wishes

2. delirium predisposing rf
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Treat underlying disease/lack resources

3. BZD + antipsychotic: interaction outcome
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead
Confusion - sedation - falls

4. What are common physical abuse Sx in elderly?
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly

5. osteoporosis etio
Phenytoin
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
A-blockers - B-blockers - TCA
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx

6. ADR rf
CNS suppression -> cholinesterase inhibitors
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable

7. Syncope prognosis based on etio
Insiduous onset
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Worse for cardiac causes v noncardia
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable

8. i2 + atypical Sx
>60yo - low abuse risk - ^ monitoring possible
No: fever - leukocytosis - yes: falls - appetite change - low functional status
Insiduous onset
CVA: stroke - AMI: acute MI - HF

9. rivastigmine
>60yo - low abuse risk - ^ monitoring possible
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)
Cholinesterase inhib - use: dementia
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)

10. who is a good candidate for opioid tx?
Beers criteria - medication appropriateness index (12 ?)
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Used to calculate renal fcn - clearance of Cr adjusted for age
>60yo - low abuse risk - ^ monitoring possible

11. delirium: Rx that contribute
Phenytoin
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
#1 patient's last competent indication of wishes - substituted judgment - beneficence

12. dementia tx
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
Hyperuricemia -> gout
CNS suppression -> cholinesterase inhibitors
Catch-all of unspecified dizziness

13. How does an 80yo renal fcn compare to that of a 20yo?
1/2
Universal - progressive - partially encoded (genetic) - destructive -
Environment modification: obstacles - mobility - -bladder fcn ok
Personal liberty -living at home - personal property - speech - assembly - privacy - voting

14. Approach to idioPx - recurrent syncope
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
Diagnosis - risk/benefit analysis to choose Rx
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
Consider responsibilities - drivin

15. Presyncope
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)
Tx underlying etio - + Kegels - pessary - surgery
>9 Rx
Prescribing - monitoring - patient adherence

16. NSAID may lead to what prescription cascade?
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
Treat underlying disease/lack resources
Diagnosis - risk/benefit analysis to choose Rx
^BP -> a-HTN

17. How does ANF prevent syncope?
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych
1/2
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
ANF: Na+ retention - disinhib vasoconstriction

18. which benzodiazepines are most appropriate for elderly?
P2-metab: Lorazepam - Trazepam - Oxazepam
Hyperuricemia -> gout
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
Lack of identification - victim isolation - reluctance to confront offenders - consequences for reporting - subtle presentation by patient

19. What is the STOPP criteria?
Vertigo - presyncope - disequilibrium - lightheadedness
Isolated systolic HTN
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
3 reflexes: baroreceptor - renal nerve - ANF

20. Beers criteria: what 10 Rx should elderly avoid or use + caution?
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
3 reflexes: baroreceptor - renal nerve - ANF
Consider responsibilities - drivin

21. How does renal nerve prevent syncope?
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness

22. delirium diagnosis
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
High mortality - esp + Fx - very common in elderly
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction

23. depression + atypical Sx
5% - underreported
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
ANF: Na+ retention - disinhib vasoconstriction
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep

24. physical neglect
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Prescribing - monitoring - patient adherence

25. How does the aging heart compensate for lower HR to maintain unchanged CO?
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Must be signed by attending daily -medical necessity/patient liberty -as minimal as possible
^SV (diastolic stroke volume)

26. frailty
Multisystemic vulnerability - -lowered reserves
Beers criteria - medication appropriateness index (12 ?)
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2

27. urinary incontinence types
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
^BP -> a-HTN
Stress: #1 - functional - urge - overflow
Threats/ terrorizing - isolation - denying food/privileges/liberty

28. how is syncope related to elderly admission to hospital?
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
80% of hospital admission for syncope for >65yo

29. How does aging affect GI absorption rate of Rx?
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Environment modification: obstacles - mobility - -bladder fcn ok
Delayed absorption - like competitive inhib
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration

30. How does aging affect Rx renal elimination?
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
NMDR antagonist - use: dementia
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics

31. What is the bone deterioration cascade?
Bone loss -> osteopenia -> osteoporosis -> Fx
BMD (bone mineral density): T-score >2.5 std dev below normal 1
^ANS tone -> ^periph vasoconstriction - ^HR
Electrolye/renal - GI - hemorrhagic - metabolic/endocrine - neuropsych

32. How does aging impact syncope-preventing reflexes
Diagnosis - risk/benefit analysis to choose Rx
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
CVA: stroke - AMI: acute MI - HF
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve

33. delirium: medical rf
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
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

34. what receptors decrease sensitivity with aging?
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics
Electrical: change in HR - structural: aortic outflow obstruction
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
Injury - neglect - physical/psychosocial - financial - violation of rights

35. What are common scenarios of untreated indications in elderly?
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
Map of people - perceptions - etc - varies by perspective
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Consider responsibilities - drivin

36. cachexia
Confusion - sedation - falls
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx

37. what drugs can cause dizziness?
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids

38. lipid-soluble Rx
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
F>M (until 80yo) - stress incontinence #1 - $26B/yr

39. what receptors increase sensitivity with aging?
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
Consider responsibilities - drivin
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health

40. nutrition syndromes
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Begin @25-50% recommended dose - APAP may be dose-limiting
Cachexia - PEM - FTT - obesity
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport

41. How does aging affect pharmacokinetic protein binding?
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
Hypotension - ^K+
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor

42. LBW equation
Insiduous onset
Cholinesterase inhib - use: dementia
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
LBWm=50kg + (2.3*inches >5ft) - LBWf=45kg + (2.3*inches>5ft)

43. What are the vascular changes of presyncope?
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
^renin from JGA -> ang 2: vasoconstriction -> aldo: Na+ retention (-> H2O retention)
Orthostatic hypotension - vagal stimulation (vasovagal reflex)

44. PEM
30% preventable - of these - 40% serious - of these 40% preventable
#1 COD from injury in >65yo - 10-15% result in Fx - highest mortality in elderly white M
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Stress: #1 - functional - urge - overflow

45. What are the hazards of elderly hospitalization?
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
^morbidity + mortality - -frailest @ greatest risk
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics

46. What is a PE sign of cachexia?
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
^morbidity + mortality - -frailest @ greatest risk
Temporalis muscle wasting = temporal wasting

47. What are the pharmacodynamic changes associated with aging?
Begin @25-50% recommended dose - APAP may be dose-limiting
Therapy - SSRI
Receptors changes: # - sensitivity - counter-regulatory moa
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation

48. 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
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Universal - progressive - partially encoded (genetic) - destructive -
Cholinesterase inhib - use: dementia

49. malnutrition
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
Constipation -> laxatives
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec

50. Disequilibrium
1/2
Isolated systolic HTN
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Orthostatic hypotension - vagal stimulation (vasovagal reflex)