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CDM1 > Exam 1: Geriatrics > Flashcards

Exam 1: Geriatrics Flashcards

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1
Q

Respiratory Aging: Increase/decreased energy of breathing

A

Increased

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2
Q

Respiratory Aging: Increase/Decrease airway resistance

A

Increased

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3
Q

Respiratory Aging: Increase/Decrease dead space

A

increased

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4
Q

Respiratory Aging: Increase/Decrease respiratory muscle

A

Decreased

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5
Q

Respiratory Aging: Increase/Decrease total alveolar space

A

Decreased

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6
Q

Respiratory Aging: Increase/Decrease vital capacity

A

Decreased

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7
Q

Vision aging: increase/decrease opacity

A

Increased

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8
Q

Vision aging: increase/decrease elasticity

A

Decrease

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9
Q

Vision aging: increase/decrease sensitivity to glare

A

Increased

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10
Q

Vision aging: 4 conditions

A
  1. light/dark adaptation
  2. accommodation/presbyopia (노안)
  3. contrast sensitivity
  4. depth perception (increase risk of fall)
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11
Q

Hearing aging: Hearing loss: 2 points

A
  1. High pitched sound (speaking in lower voice can help)

2. Background noise (harder to focus)

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12
Q

Hearing aging: 3 conditions

A
  1. hearing loss
  2. vertigo
  3. cerumen impaction
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13
Q

What is cerumen impaction?

A

Earwax blocks the ear

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14
Q

Hearing aging: ototoxic drugs

A
  1. aminoglycosides
  2. high dose salicylates
  3. diuretics
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15
Q

CV aging: Effects on HR

A
  1. decrease max HR

2. decrease sensitivity to beta stimulation

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16
Q

CV Aging: Effects on Vasculature

A

Blunted barorecptor reflex

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17
Q

CV Aging: what does baroreceptor reflex do?

A

Aids in homeostasis of BP

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18
Q

What can cause orthostatic hypotension?

A

Blunted baroreceptor reflex and HTN meds (diuretics and alpha blockers) and tricyclic antidepressants

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19
Q

What is orthostatic hypotension?

A

Low BP, when you stand up you feel dizzy/faint

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20
Q

CV Aging: 2 Conditions

A
  1. orthostatic hypotension

2. HFpEF

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21
Q

What does HFpEF stand for and what is it?

A

Heart failure with preserved ejection fraction – isolated systolic HTN (?)

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22
Q

Renal aging: Effects on function

A

Decrease glomerular filtration rate

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23
Q

Renal aging: Effects on hormones

A

Decrease aldosterone and antidiuretic hormone (ADH)

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24
Q

Genitourinary aging: Increased ___ and ____

A

Residual urine volume and activity of detrusor muscle

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25
Genitourinary aging: What does the detrusor muscle do?
Pushes urine out
26
Genitourinary aging: 2 Conditions
1. urinary frequency (overactive bladder) | 2. urinary retention/obstruction (retention - can't empty bladder completely, obstruction - doesn't let urine leave)
27
Genitourinary aging: Women: Menopause: When and what happens
~52 decrease in estrogen ovaries, uterus, vagina atrophy
28
Genitourinary aging: Women: Effects on the vagina
Vagina atrophy, decreased lubrication, painful intercourse (dyspareunia)
29
Genitourinary aging: Women: 2 conditions
1. UTI | 2. Dyspareunia
30
Genitourinary aging: Men: 2 conditions
1. BPH (benign prostatic hyperplasia) | 2. erectile dysfunction
31
Skeletal aging: Effects on bones
Decreased mass and density
32
Skeletal aging: Conditions
1. Osteoporosis 2. Arthritis 3. Gait changes 4. Loss of balance 5. Falls 6. Fractures
33
Skin aging: Loss of ____ between __ and __
Loss of INTERDIGITATIONS between EPIDERMIS + DERMIS
34
Skin aging: What causes tearing/breakdown of the skin?
Loss of interdigitations b/t epidermis + dermis | Drier and thinner > breakage
35
GI Aging: Effects on the esophagus
Decrease taste sensation
36
GI aging: Effects on stomach
Decreased gastric acid secretion
37
GI aging: effects on small intestine
Decrease absorption of calcium, folic acid, and vit b12
38
GI Aging: effects on colon
Slow transit time | Increased water reabsorption
39
GI Aging: Conditions relating to effects on esophagus and stomach
Dysphagia (difficult swallowing) Aspiration (choking) GERD (acid reflux)
40
GI aging: Conditions relating effects on small intestine and colon
Nutrient depletion Diverticulosis (small bulging pouches in colon) Constipation Incontinence (fecal/urine) -- loss of bladder/colon control
41
PK Changes with Aging: Effects on body water, body mass, and body fat
Decrease on body water, body mass | Increase body fat
42
PK Changes with Aging: changes in absorption and exceptions
Potential DELAY in absorption, no significant change in extent Exceptions: - decreased gastric acid secretion > increased stomach pH (decrease absorption of acid-dependent drugs, early dissolution of EC drugs) - drug induced changes (pH: PPIs/antiacids, gastric motility/emptying: opioids, anticholinergics)
43
PK Changes with Aging: Changes in distribution for hydrophilic drugs
``` Decreased Vd (can be further impacted by drugs that affect extracellular water Increase in plasma concentration Greater swing within dosing interval ``` Ex. ethanol, lithium, aminoglycosides
44
PK Changes with Aging: Changes with distribution of lipophilic drugs
Increased Vd Increased t1/2 Increased duration of therapeutic/toxic effects Ex. diazepam, phenothiazine, phenyoin
45
PK Changes with Aging: Changes with distribution and protein binding
Decreased albumin and increase % of unbound free drug Interactions: highly protein-bound drugs (ex. warfarin, phenytoin, benzodiazepines)
46
PK Changes with Aging: Changes in metabolism
1. Decreased first pass metabolism (drugs undergoing first pass > increased bioavailability, prodrugs > decreased bioavailability) 2. Phase 1 (oxidative) metabolism (decreased drug clearance, increased t1/2) 3. CYP450 unchanged? > be careful of CYP450 inhibitors/inducers
47
PK Changes with Aging: Changes with excretion
CrCl (Cockcroft-Gault) may not be accurate | Decrease clearance and increase of t1/2 for drugs with renal elimination and active metabolites
48
Which renal exam estimates CrCl?
Cockcroft-Gault
49
Which renal exam estimates GFR?
MDRD
50
Cockcroft-Gault: Does it overestimate/underestimate CrCl
Overestimates especially for frail and reduced muscle mass
51
Which renal exam is used for most drug dosing?
Cockcroft-Gault (CrCl)
52
What is the use of MDRD renal exam?
Stages chronic kidney disease (CKD) | Drug dosing for new meds
53
PD Changes with Aging: Increased sensitivity and side effects of which drugs?
- Benzodiazepines - Opioids - Alcohol - Neuroleptics - Anticholinergics - H1 antihistamines (1st gen)
54
PD Changes with Aging: Beta-blockers
Decreased response
55
PD Changes with Aging: Warfarin
Increased risk of bleeding
56
PD Changes with Aging: Cardiac drugs
Increased risk of orthostatic hypotension
57
PD Changes with Aging: Diuretics
Decreased effectiveness
58
Aging: Functional loss: Common reasons for institutionalization
- 80% problems with mobility | - 65% difficulty with bowel control
59
Aging: Functional loss: Causes
- Heart disease - Stroke - Diabetes - Other chronic diseases
60
What are examples of activities of daily living (ADL)?
- bathing - ambulation - toileting - transfers - eating - dressing - taking meds
61
What are examples of instrumental ADLs (IADLs)?
- shopping - cooking/cleaning - using telephone or transportation - managing money and medications
62
What is polypharmacy?
Use of any unnecessary medication
63
T/F: research shows that any symptom in an elderly person should be considered an ADVERSE EFFECT unless proven otherwise
True
64
What is START/STOPP for inappropriate prescribing?
Mostly used in Europe START -- omissions of therapy STOPP -- potentially inappropriate/duplication of therapy
65
AGS Beers Criteria: Sedating antihistamines potential harm
Highly anticholinergic | Clearance reduced in older patients
66
AGS Beers Criteria: Sedating antihistamines examples
``` Brompheniramine Chlorpheniramine Dimenhydrinate Diphenhydramine Doxylamine ```
67
AGS Beers Criteria: Sedating antihistamines: Exceptions and notes
Diphenhydramine may be used for acute allergic reactions Tolerance develops when used as a hypnotic
68
AGS Beers Criteria: PPI examples
omeprazole esomeprazole lansoprazole
69
AGS Beers Criteria: PPI potential harm
C difficile infection | Bone loss and fractures
70
AGS Beers Criteria: PPI: Exceptions and notes
Chronic NSAID or corticosteroid use Erosive esophagitis Failure of drug discontinuation or H2 blocker trial Conditions: avoid use >8 weeks
71
AGS Beers Criteria: CV: Digoxin: Potential harm
Higher doses have no added benefit > toxicity Other agents have evidence of mortality and hospitalization Benefits in HFrEF
72
AGS Beers Criteria: CV: Digoxin: Conditions
Conditions: When used first line for rate control for Afib When used first line for HF doses > 125mcg/day
73
AGS Beers Criteria: CV: Alpha blockers: Examples
Doxazosin Prazosin Terazosin
74
AGS Beers Criteria: CV: Alpha blockers: Potential harm
orthostatic hypotension (high risk)
75
AGS Beers Criteria: CV: Alpha blockers: Conditions
When used for treatment of HTN
76
AGS Beers Criteria: CNS: Benzodiazepines: potential harm
cognitive impairment delirium fall/fractures
77
AGS Beers Criteria: CNS: Benzodiazepines: Exceptions
Seizure disorders, REM sleep behavior disorder, alcohol withdrawal, severe anxiety
78
AGS Beers Criteria: CNS: Benzodiazepines: Rationale
Increased sensitivity and decreased metabolism
79
AGS Beers Criteria: CNS: Tricyclic antidepressant: Examples
Amitriptyline Nortriptyline Protriptyline
80
AGS Beers Criteria: CNS: Tricyclic antidepressants
Highly anticholinergic Sedating Orthostatic hypotension
81
AGS Beers Criteria: Disease specific: HF: Medications and potential harm
NSAIDs (all) | Fluid retention may exacerbate HF
82
AGS Beers Criteria: Disease specific: CKD: Medications and potential harm
NSAIDs (all) and H2 receptor blockers NSAIDs: May cause acute kidney injury or worsen renal function H2 blockers: may need to reduce dose if CrCl <50ml/min
83
AGS Beers Criteria: Disease specific: Delirium: Medication and potential harm
H2 receptor blockers | May cause/increase confusion
84
AGS Beers Criteria: Disease-specific: Dementia: Medication and potential harm
Anticholinergics Adverse CNS effects
85
What does MAI stand for
Medication appropriateness index
86
What is the saying for dosing in geriatrics?
Start low, go slow, but go

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