Exam 2

Question 1

Palliative Care

Answer 1

Care for patients with serious, life limiting illness

“To cloak”
To make less severe or intense, to relieve or sooth the symptoms of a disease or disorder

Question 2

Frailty

Answer 2

State of increased vulnerability to poor resolution of homeostasis after a stressor event which increases risk of adverse outcomes.

Gradual decreases in physiological reserve occurs with aging, but in frailty decrease is accelerated & homeostatic mechanisms start to fail.

Question 3

3 common things seen with frailty

Answer 3

Falls
Delirium
Fluctuating disability

Question 4

Altered presentation risk factors

at greatest risk for atypical presentation

Answer 4

• Over age 85
• Multiple co-morbidities
• Multiple medications
• Cognitive or functional impairment

Question 5

INDICATORS of frailty

Answer 5

Presence of 3 or more:

• Self-reported exhaustion
• Unintentional weight loss >10lbs/yr
• Muscle weakness
• Walking slowly
• Low physical activity

Question 6

Geriatric Syndromes

Answer 6

MOST COMMON:

• Falls
• Dehydration
• Pain
• Decrease in appetite
• Dizziness
• Loss of functional ability
• Incontinences

Other

• Adverse drug reactions
• Skin breakdown
• Sleep disorders

Question 7

Pharmacokinetics

Answer 7

How BODY acts on DRUG

how drugs move thru body & how quickly this occurs. Gradual progressive decline in organ function affects pharmacokinetics

Question 8

Pharmacokinetics - Elements

Answer 8

• Absorption
• Distribution
• Metabolism
• Excretion

Question 9

.

Answer 9

.

Question 10

Absorption

Answer 10

Movement of drug from site of administration into general circulation

Question 11

Rate of absorption may be slowed due to:

Answer 11

• Delayed gastric emptying
• Reduced blood flow
• Substances such as food & inert drug ingredients

Question 12

Distribution

Answer 12

-Movement from plasma into cells

Question 13

Four factor that alter distribution

Answer 13

1. Increased % body fat
2. Decreased lean body mass
3. Decreased total body water
4. Reduced concentration serum albumin

Question 14

Metabolism

Answer 14

Hepatic metabolism declines due to:

• reduced blood flow to liver
• decreased liver mass, decreased enzyme activity

Question 15

How many half-lives to eliminate a given drug

Answer 15

5 half-lives

Question 16

Factors that effect metabolism more than age-related changes:

Answer 16

• Diet
• Caffeine
• Smoking
• Alcohol
• Genetics/pathology

Question 17

Excretion

Answer 17

Drug accumulation due to decrease in RENAL function is most important cause of adverse drug reactions in elders

Question 18

Most important cause of adverse drug reactions in elders

Answer 18

Decreased renal function

Question 19

Index of renal function (best reflection of kindey function)

Answer 19

Creatinine Clearance

Question 20

Pharmacodynamics

Answer 20

What the DRUG does to the BODY

Interaction between chemicals introduced into body & receptors. When chemical binds to receptor therapeutic effect begins

Question 21

What changes pharmacodynamics

Answer 21

-Number and sensitivity of the receptors

Question 22

Meds that Increase receptor sensitivity

Answer 22

• Benzos
• CNS depressants
• Warfarin
• Anticholinergic

Question 23

Meds that decrease receptor sensitivity

Answer 23

• Beta adrenergic
• Vasodilators
• TCAs
• Antihypertensives

Question 24

Most common drugs for Adverse Drug Events

Answer 24

Oral hypoglycemics
Cardiovascular
anticoagulants
diuretics
Taking > 7 meds

Question 25

Risk Factors for Adverse Drug Reaction

Answer 25

- Polypharmacy - Female - Small Body - Hepatic or renal insufficiency - Previous ADRs

Question 26

Prescribing Cascade

Answer 26

Prescribing a drug to Tx the AE of another Rx'd drug. | -Prevent this by ALWAYS considering new S/S as consequence of current drug Tx.

Question 27

Risk Factors for Polypharmacy

Answer 27

-Multiple providers _HCP's lack of info about meds from other sources & pt's non-adherence -Elder fearful of disclosing folk remedies/other meds -Elder not reporting self-directed changes -Pt assume meds are indefinite -Think same dose always appropriate -Lack of early AE, assume wont have any AE -Changes in habits, mental/emotional status -Hoarding meds/insist on taking meds no longer Rx'd

Question 28

Three types of Blood draw

Answer 28

1. Random Level 2. Trough level- right before dose is due 3. Peak- drawn at set time after given dose

Question 29

How often should meds be review with pt

Answer 29

At least ANNUALLY

Question 30

Functional Status

Answer 30

The capacity to safely perform daily tasks that enable a person to live & function. Sensitive indicator of health or illness of an elder.

Question 31

Iatrogenic events

Answer 31

falls, fx, adverse drug reactions, nosocomial infections, use of chemical & physical restraints, diagnostic tests

Question 32

Cascade to Dependency

Answer 32

Process that leads to disability in person who has normal aging changes and is on bedrest in hospital.

Question 33

Deconditioning

Answer 33

Decrease in muscle mass & other physiologic changes that result from aging or immobility or both & contribute to overall weakness

Question 34

Goals of a functional assessment

Answer 34

.

Question 35

Contributors to functional decline

Answer 35

.

Question 36

Long-term care

Answer 36

services & support, formal & informal that help people function in community settings as well as possible despite long term disability or chronic illness

Question 37

Aging in Place

Answer 37

Range of services that allow older adults to remain in one setting and receive different levels of care as needs change. ``` PACE programs (Program of All-inclusive Care for the Elderly) ```

Question 38

Culture change/person-centered care

Answer 38

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