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. when selecting an P1-metabolite or P2-metabolite safer in elderly?
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
P2-metabolite - phase 1 biotx much more affected than phase 2
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
A-blockers - B-blockers - TCA

2. What is sCr?
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine
Serum Cr: used for Cr clearance equation
Therapy - SSRI

3. which benzodiazepines are most appropriate for elderly?
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Consider responsibilities - drivin
Temporalis muscle wasting = temporal wasting
P2-metab: Lorazepam - Trazepam - Oxazepam

4. MRP: medication related problems
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
Confusion - sedation - falls
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers

5. delirium: mgmt
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
Tx underlying etio - + Kegels - pessary - surgery
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers

6. narcotics may lead to what prescription cascade?
CVA: stroke - AMI: acute MI - HF
Threats/ terrorizing - isolation - denying food/privileges/liberty
30% preventable - of these - 40% serious - of these 40% preventable
Constipation -> laxatives

7. red flags for further inquiry
CVA: stroke - AMI: acute MI - HF
Hyperuricemia -> gout
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
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

8. What is ISH?
Isolated systolic HTN
CNS suppression -> cholinesterase inhibitors
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment

9. What are rf for osteoporosis?
Map of people - perceptions - etc - varies by perspective
Cholinesterase inhib - use: dementia
Early menopause - white/Asian race - sedentary - smoking - vBMI - EtOH - hyperPTH - hyperthyroidism - GC Rx
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids

10. frailty raises vulnerability to...
No: chest pain - yes: fatigue - nausea - low functional status - SOB
Stress: #1 - functional - urge - overflow
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction
Falls - delirium - malnutrition - P ulcers - opportunistic i2

11. what illnesses are underreported in elderly?
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
Injury - neglect - physical/psychosocial - financial - violation of rights
CVA: stroke - AMI: acute MI - HF
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)

12. what mechanical loading helps to prevent pressure ulcers?
Reposition/2h - movement if possible - look @heel - 20% all pressure ulcers
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics

13. 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
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Screen for potentially embarrassing dx - patient/Dr trust
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait

14. opioid tx in elderly
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Respect for autonomy - nonmaleficence - beneficence - justice
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
Begin @25-50% recommended dose - APAP may be dose-limiting

15. What are the rf for caregiver to abuse elderly?
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
Consider responsibilities - drivin

16. What is a mattering map?
Map of people - perceptions - etc - varies by perspective
Depression - incontinence - M/S stiffness - falls - EtOH/Rx abuse - hearing loss - dementia - dental dx - malnutrition - sexual dysfcn - OA - OP
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR

17. BZD + antidepressant: interaction outcome
Hypothetical plan - serves as patient's last competent indicated wishes
^SV (diastolic stroke volume)
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
Confusion - sedation - falls

18. dementia tx
Bone loss -> osteopenia -> osteoporosis -> Fx
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Cholinesterase inhib: donepezil - rivastigmine - galantamine - NMDR antag: memantine

19. What are the risks of uncontrolled ISH?
F>M (until 80yo) - stress incontinence #1 - $26B/yr
CVA: stroke - AMI: acute MI - HF
Figure out a good diet - social aspect - resources - dental/oral comfort
Injury - neglect - physical/psychosocial - financial - violation of rights

20. what receptors decrease sensitivity with aging?
IdioPx - psychiatric: depression - anxiety - somatoform
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
B-adrenergic - ACE inhib - baroreceptors - -> ^K+ with NSAIDS - ACEI - K+ sparing diuretics

21. What are the common causes of lightheadedness?
Screen for potentially embarrassing dx - patient/Dr trust
IdioPx - psychiatric: depression - anxiety - somatoform
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2

22. What is the epidemiology of dizziness?
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation
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
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx

23. How does aging affect GI absorption of Rx?
Environment modification: obstacles - mobility - -bladder fcn ok
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar
Tx underlying dx - review Rx - avoid complications: hygiene - constip - pain - orientation aids

24. Aging descriptors
Temporalis muscle wasting = temporal wasting
Normal: progressive - universal - usual: normal + common dx (CAD) - successful: preserved fcn wo morbidity
Receptors changes: # - sensitivity - counter-regulatory moa
P2-metabolite - phase 1 biotx much more affected than phase 2

25. What is the bone deterioration cascade?
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Bone loss -> osteopenia -> osteoporosis -> Fx
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport

26. How does ANF prevent syncope?
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
Confusion - sedation - falls
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
ANF: Na+ retention - disinhib vasoconstriction

27. describe the % of ADR considered preventable - and of those serious
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids
30% preventable - of these - 40% serious - of these 40% preventable
Receptors changes: # - sensitivity - counter-regulatory moa
Begin @25-50% recommended dose - APAP may be dose-limiting

28. What drugs can contribute to syncope?
A-blockers - B-blockers - TCA
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
^ANS tone -> ^periph vasoconstriction - ^HR
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration

29. How to prevent pressure ulcers?
Hyperuricemia -> gout
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
Mechanical loading - skin care - avoid friction/shear
Change in systemic BP/ ^cerebral vasc rest -> low cerebral perfusion -> syncope

30. vertigo
Map of people - perceptions - etc - varies by perspective
Rotational sensation - usual etio: BPPV - benign paroxysmal positional vertigo - tx: Epley manuever - dislodge otolith crystals
^BP -> a-HTN
Respect for autonomy - nonmaleficence - beneficence - justice

31. psychological abuse
F>M (until 80yo) - stress incontinence #1 - $26B/yr
Delayed absorption - like competitive inhib
Prescribing - monitoring - patient adherence
Threats/ terrorizing - isolation - denying food/privileges/liberty

32. What is a PE sign of cachexia?
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
Delayed absorption - like competitive inhib
Breast cancer + 2o LBP
Temporalis muscle wasting = temporal wasting

33. stress incontinence tx
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
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
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Tx underlying etio - + Kegels - pessary - surgery

34. Aging principles
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
CNS suppression -> cholinesterase inhibitors

35. Aging features
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Universal - progressive - partially encoded (genetic) - destructive -
A-blockers - B-blockers - TCA
BMD (bone mineral density): T-score >2.5 std dev below normal 1

36. how may hypertension compensate for aging?
Receptors changes: # - sensitivity - counter-regulatory moa
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
Cholinesterase inhib - use: dementia

37. lipid-soluble Rx
Insiduous onset
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
Isolated systolic HTN
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly

38. what can enhance reporting in elderly?
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
Therapy - SSRI
Screen for potentially embarrassing dx - patient/Dr trust
Breast cancer + 2o LBP

39. pressure ulcer: staging
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
I: peristent erythema - II: partial thickness - III: full thickness - IV: full thickness + extensive damage - unstageable
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
Undocumented >50% - CAM: Confusion Assessment Method - -95% sens - spec

40. cachexia
Prescribing - monitoring - patient adherence
Abs: delayed onset - peak - distrib: more fat - less H2O - metab: phase 1 more affected v phase 2 - excr: renal - liver fcn decrease
#1 patient's last competent indication of wishes - substituted judgment - beneficence
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV

41. What is the best approach to malnutrition
A-blockers - B-blockers - TCA
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Figure out a good diet - social aspect - resources - dental/oral comfort
Treat underlying disease/lack resources

42. advanced directive/care plan

43. fall causes
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Diagnosis - risk/benefit analysis to choose Rx
Intrinsic: chronic dx - postural: changing position - mediating: risk taking
Falls - delirium - malnutrition - P ulcers - opportunistic i2

44. How does aging affect GI absorption rate of Rx?
BMD (bone mineral density): T-score >2.5 std dev below normal 1
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
Delayed absorption - like competitive inhib
Cachexia - PEM - FTT - obesity

45. nutrition syndromes
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Breast cancer + 2o LBP
Cachexia - PEM - FTT - obesity
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness

46. overflow incontinence tx
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
P2-metab: Lorazepam - Trazepam - Oxazepam
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights

47. How does the aging heart compensate for lower HR to maintain unchanged CO?
Determined by Dr for a patient - -> used to determine competency
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait
^SV (diastolic stroke volume)

48. driving considerations
Make sure to discuss with patient - some states require reporting
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
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

49. What is polypharmacy
+/- sadness - hyperactivity - somatic Sx: appetite - vague GI - constip - sleep
>9 Rx
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
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

50. How does aging impact syncope-preventing reflexes
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Constipation -> laxatives
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness