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. incontinence complication
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
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
Cellulitis - P ulcers - UTI - sleep deprivation - falls - sexual dysfcn - depression - social withdrawal - v QoL
Sensation of impending faint - etio: v cerebral perfusion (cardiac - vascular or postural +/- orthostatic hypotension)

2. memantine
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
NMDR antagonist - use: dementia
^BP -> a-HTN
Social restraint - sitter/family - avoid physical restraint - if necessary: haloperidol - remove tethers: cathethers - IV - orientation aids: glasses - hearing aids

3. How does aging impact syncope-preventing reflexes
Relfexes less responsive -less ability to ^HR - less sens to dehydration - comorbidities - Rx: a-blockers - B-blockers - TCA
Benzodiazepenes - amiodarone - digoxin - huge majority of Rx - ^Vd in elderly
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
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

4. What are the 3 stages of ADRs?
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Prescribing - monitoring - patient adherence

5. What are the 4 basic ethical principles?
Electrolyte imbalance - arrhythmia
Bone loss -> osteopenia -> osteoporosis -> Fx
Respect for autonomy - nonmaleficence - beneficence - justice
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear

6. clues of neglect
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
Screen for potentially embarrassing dx - patient/Dr trust
Figure out a good diet - social aspect - resources - dental/oral comfort
Malnutrition/dehydration - frequent visits to ER - same proglems - delay in seeking care - inadequate Rx taking/ noncompliance - poor hygiene - P ulcers

7. What are the 4 forms of dizziness?
1/3 elderly hospital admisions - 10* risk death in hospital - complications: poor outcome - i2 - COD
Vertigo - presyncope - disequilibrium - lightheadedness
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment
EtOH - antibiotics - anticholinergics - anticonvulsants - antidepressants - antihistamines - anti-PD - antipsychotics - barbituates - BZD - chloral hydrate - H2-blockers - Li - opioid

8. functional incontinence tx
Physical abuse - least common - physical neglect #1 - psych abuse - financial exploitation - violation of rights
Make sure to discuss with patient - some states require reporting
Stress: #1 - functional - urge - overflow
Environment modification: obstacles - mobility - -bladder fcn ok

9. how may hypertension compensate for aging?
Phenytoin
Substance abuse - frustration/burnout - cognitive impairment - prior history of violence in FHx
HTN may prevent orthostatic hypotension - -> lower fall risk (and maybe v morbidity)
Consider responsibilities - drivin

10. 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
Prescribing - monitoring - patient adherence
Bone loss -> osteopenia -> osteoporosis -> Fx
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted

11. What are common medical causes of syncope?
^SV (diastolic stroke volume)
Consider responsibilities - drivin
3 reflexes: baroreceptor - renal nerve - ANF
Arrythmia - aortic stenosis - carotid sinus hypersensitivity: vasovagal reflex - hypoglycemia - orthostatic hypotension - postprandial hypotension - psychogenic - PE - vasovagal: #1 etio - 1/3-1/2 idioPx

12. How does aging affect pharmacokinetic Rx distribution?
P2-metab: Lorazepam - Trazepam - Oxazepam
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
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

13. what drugs can cause dizziness?
BMD (bone mineral density): T-score 1-2.5 std dev below normal 1 - Z-score age-adjusted
Consider responsibilities - drivin
>orthostasis/CNS: anticholinergics - a1-blockers - CV/anti-HTN Rx: B-blockers - a1-blockers - psychotropics
ANF: Na+ retention - disinhib vasoconstriction

14. How does aging affect GI absorption of Rx?
Failure to provide services: healthcare - goods: food - clothing - shelter - hydration - prevention of risks/hazards
Worse for cardiac causes v noncardia
Constipation -> laxatives
Decreased: gastric emptying rate - intestinal motility - BF - surface area - gastric acid secretion - increased: gastric pH - outcome: delaye onset - peak; quant abs similar

15. vision changes: elderly
Beers criteria - medication appropriateness index (12 ?)
V contrast sensitivity: target + bg - v visual acuity - lat motion - depth perception - ^ glare sensitivity
Therapy - SSRI
EtOH/substance abuse - cognitive dysfcn - v exercise - depression/mental status - immobility - resources: inadequate $ - transport

16. urinary incontinence types
Stress: #1 - functional - urge - overflow
NSAID/ COX2 inhib - anticholinergics (inc OTC) - antipsychotics - anxiolytics/insomnia: some - muscle relaxant - DM Rx: avoid glyburide - sliding scale insulin - digoxin - meperidine (Demerol) - estrogen
^ANS tone -> ^periph vasoconstriction - ^HR
Constipation -> laxatives

17. What are the pharmacodynamic changes associated with aging?
Receptors changes: # - sensitivity - counter-regulatory moa
^morbidity + mortality - -frailest @ greatest risk
Pressure ulcer - fecal impaction - dehydration
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

18. what Rx are commonly monifoted in elderly for ADR?
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
P2-metabolite - phase 1 biotx much more affected than phase 2
CV - diuretics - esp loop - non-opioid analgesics - hypoglycemics - anticoagulants
^K+

19. Cockcroft Gault equation
Temporalis muscle wasting = temporal wasting
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Constipation -> laxatives

20. What are the key points of safe prescription for elderly - lecture
Diagnosis - risk/benefit analysis to choose Rx
Parkinsonism -> l-DOPA
Treat underlying etio: BPH - cancer - sacral n dx - -BPH: a1-blockers (finasteride - doxazosin...) - sacral nerve stimulation
Advanced ae - dementia - ADL/IADL impairment - comorbidity - EtOH - M>F - sensory impairment

21. How does sliding scale glycemic control relate to elderly?
Threats/ terrorizing - isolation - denying food/privileges/liberty
Estrogen deficiency - androgen deficiency - vCa2+ - ^PTH - changes in bone formation - 2o causes/Rx
IdioPx - psychiatric: depression - anxiety - somatoform
Avoid sliding scale - it is reactive - no proactive -will cause hyper/hypoglycemia -control carb intake instead

22. BZD + antipsychotic: interaction outcome
Legal: Cruzan v Hamon
1 most alike at birth - 2 ^ frailty - 3 risk dx - 4 homeostenosis: reduced reserve
Decreased: TBW - CO - muscle mass - increased: body fat - altered: regional BF - outcome: ^Vd lipid-sol Rx; v Vd H2O-sol Rx
Confusion - sedation - falls

23. when selecting an P1-metabolite or P2-metabolite safer in elderly?
Electrolyte imbalance - arrhythmia
P2-metabolite - phase 1 biotx much more affected than phase 2
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Receptors changes: # - sensitivity - counter-regulatory moa

24. what receptors increase sensitivity with aging?
Voice - character - plot - context - time - reader
Appointed by court if no substituted judgment -conservator of finance -conservator of person
Rec for: benzodiazepines - CNS depressants - anticholinergics - VKORC (Warfarin) - Na+/K+ ATPase (digozin) - -> ^tardive dyskinesia - parkinsonism
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other

25. Approach to idioPx - recurrent syncope
Consider responsibilities - drivin
Orthostatic hypotension - vagal stimulation (vasovagal reflex)
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
Phenytoin

26. anticholinergic drugs may lead to what prescription cascade?
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
CNS suppression -> cholinesterase inhibitors
>9 Rx
Environment modification: obstacles - mobility - -bladder fcn ok

27. using long-acting opioids in elderly
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Caution in opioid-naive patient - less serum Rx availability - prescribe short-acting for BTP - upward titration
Palliative care will -relieve discomfort/suffering -may hasten death (resp depression)
P2-metab: Lorazepam - Trazepam - Oxazepam

28. How does aging affect Rx pharmacokinetic distribution?
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Worse for cardiac causes v noncardia
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
IdioPx - psychiatric: depression - anxiety - somatoform

29. BZD + antidepressant: interaction outcome
Overactive detrussor contraction/spasm - tx: anticholinergice --| overactive detrusor
BMD (bone mineral density): T-score >2.5 std dev below normal 1
Tx underlying etio - + Kegels - pessary - surgery
Confusion - sedation - falls

30. What are the common causes of lightheadedness?
Pressure ulcer - fecal impaction - dehydration
Falls - delirium - malnutrition - P ulcers - opportunistic i2
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other
IdioPx - psychiatric: depression - anxiety - somatoform

31. How does ANF prevent syncope?
ANF: Na+ retention - disinhib vasoconstriction
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Voice - character - plot - context - time - reader
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV

32. how is syncope related to elderly admission to hospital?
3 reflexes: baroreceptor - renal nerve - ANF
80% of hospital admission for syncope for >65yo
^ANS tone -> ^periph vasoconstriction - ^HR
Recurrent in 25% dizzy patient - common etio: psych - vestibulo/somatosensory - no ^morbidity/mortality - ^risk syncope - falls - depression - self-rated health

33. Disequilibrium
Loss of balance wo head mvmt - factors: vestibuloPx - visual - M/S - gait - somatosensory
Oral nutrition + supplements - tube feeding - parenteral nutrition - refeeding
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
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. incontinence epidemiology
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2
Respect for autonomy - nonmaleficence - beneficence - justice
F>M (until 80yo) - stress incontinence #1 - $26B/yr

35. ADR rf
Polypharmacy - female gender - age - small body size; BMI <22 - hepatic/ renal insufficiency - prior ADR
Used to calculate renal fcn - clearance of Cr adjusted for age
Legal: Cruzan v Hamon
Diagnosis - risk/benefit analysis to choose Rx

36. what professional is least likely to report abuse?
Rx use wo indication - untreated indication - failure to receive Rx - subtherapeutic Rx - OD Rx - improper Rx selection - ADR - drug interaction
Doctors
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Hyperuricemia -> gout

37. substituted judgment
Determined by Dr for a patient - -> used to determine competency
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Health care agent/proxy - may have durable power of attorney - may be next of kin/other family/other
^ANS tone -> ^periph vasoconstriction - ^HR

38. advanced directive/care plan

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

39. frailty raises vulnerability to...
Falls - delirium - malnutrition - P ulcers - opportunistic i2
CrClm= ((140-age)LBW/ Scr72) - CrClf=CrClm*0.85
Severe wt loss + low nutrition intake - cytokine-mediated response - etio: RA - CHF - COPD - HIV
Wt loss - fatigue - impaired grip strength - impaired activity/slow gait

40. red flags for further inquiry
Mechanical loading - skin care - avoid friction/shear
Decreased: Alb - prot affinity - increased: a1-acid glycoprot (^i2) - outcome: ^free fraction of prot-bound Rx; especially significant for phenytoin
Multisystemic vulnerability - -lowered reserves
Change in cognitive status - personality - Rx discrepancy - change in somatic Sx - recurrent falls - hospitalizations - other

41. fall sequelae

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

42. violation of rights
Personal liberty -living at home - personal property - speech - assembly - privacy - voting
Age - psychosocial: depression - isolation - lack resources:education - $ - minority - substance abuse
Electrolyte imbalance - arrhythmia
Hyperuricemia -> gout

43. metoclopramide may lead to what prescription cascade?
Delayed absorption - like competitive inhib
Parkinsonism -> l-DOPA
Decreased: hepatic mass - BF - outcome: vPhase 1 biotransformation (redox) - Phase2 biotx unchanged - CYP450 activity varies - enz inhib/induction varies
Falls - delirium - malnutrition - P ulcers - opportunistic i2

44. 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
Mechanical loading - skin care - avoid friction/shear
Isolated systolic HTN
Routes: nasoenteric - PEG - jejunostomy - required high level of care - formula depends on nutritional status - risk: aspiration - i2

45. What are common physical abuse Sx in elderly?
1+2 +3 or 4 - 1 acute mental status change or fluctuation - 2 inattention - 3 disorganized thinking - 4 altered consiousness
Injury - neglect - physical/psychosocial - financial - violation of rights
Assault/battery - pattern injuries - sexual assault - prolonged deprivation of food - H2O - restraint: physical - chemical
Respect for autonomy - nonmaleficence - beneficence - justice

46. 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
Depression + nursing home - osteoporosis + nursing home - aFib/anti-coagulant - HTN - MI 1o/2o prevention - opioids: addiction fear
Hypothetical plan - serves as patient's last competent indicated wishes
Cholinesterase inhib - use: dementia

47. What is abuse?
Injury - neglect - physical/psychosocial - financial - violation of rights
Wasting: no cytokine-mediated response - etio: marasmus - cancer - AIDS - critical illness
Protein-energy malnutrition - biochemical: Alb <3.5g/dL - clinical: wasting - low BMI
Acute MI/pulm events - immobility - i2 - drug withdrawal: CNS depressant - EtOH - fecal impaction

48. What are the 3 sentinel events for LT care?
Pressure ulcer - fecal impaction - dehydration
Treat underlying disease/lack resources
Delayed absorption - like competitive inhib
Hyperthyroid: apathetic thyrotoxicosis - hypothyroid: confusion + agitation

49. documenting elderly abuse

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

50. MI + atypical Sx
Decreased: renal BF - tubular sec - GFR - CrCl -stable sCr due to v muscle mass - avg renal fcn 80yo ~50% of 20yo
No: chest pain - yes: fatigue - nausea - low functional status - SOB
F>M (until 80yo) - stress incontinence #1 - $26B/yr
'long lie' decline in functional status - ^ risk of being in nursing home - ^ Use of medical services - fear