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NUNP 547 - Older Adult > Approach to older adult > Flashcards

Approach to older adult Flashcards

1
Q

9 geriatric giants

A 
Delerium
Depression
Dysphagia
Dizziness
Frailty
Falls
Urinary incontinence 
Syncope
Polypharmacy
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2
Q

ADLs

A 
DEATH
Dressing
Eating
Ambulation
Toileting
Hygiene
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3
Q

IADLs

A 
SHAFTTT
Shopping
Housework
Accounting
Food prep
Telephoning
Transportation
Taking medications
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4
Q

If asymptomatic patient has >____ year survival, screening is warranted

A

5 year surivival

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5
Q

Osteoporosis screening

A

Female, DEXA >/= 65 years

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6
Q

Tinetti balance and gait evaluation

A

getting up from chair without using arms, walking 10 feet, turning around and returning to seated. Normal if < 16 seconds

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7
Q

Pneumovax 23

A

1 dose if > 65 years, booster 5 years following if high risk (CKD, immunocompromised, liver disease, etc.)

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8
Q

Prevnar 13

A

1 dose if HIGH RISK given 8 weeks prior to pneumovax 23. If given after pneumovax, wait 1 year

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9
Q

Shingrix

A

Recommended over age 50 years, not covered, 2 doses 2-6 months apart. Wait 1 year if patient had shingles or received Zostavax.

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10
Q

Breast cancer screening average risk 50-74 years

A

Q2 years

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11
Q

Higher than average risk for breast cancer (first degree relative)

A

40-74, Q 1 years

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12
Q

When to screen for breast cancer between 30-40 years

A

if BRCA gene in 1st degree relative

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13
Q

All of the following are examples of what?
Pregnant/breastfeeding
Have breast implants
Previous hx of breast cancer
New breast complaints
Had mammogram on both breasts < 12 months ago

A

Mammogram ineligibility

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14
Q

Cervical cancer screening frequency and when to start

A

Every 3 years >/= 25 years to 69 years

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15
Q

If 2 negative screens in past 10 years and 69 years, can cervical cancer screening be stopped?

A

No, requires 3 negative screens in previous 10 years

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16
Q

Colon cancer screening, average risk - age and frequency

A

50-74, FIT Q2 years or colonoscopy Q10 years

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17
Q

All of the following are examples of increased risk of colon cancer. When to screen these individuals for colon cancer?

  • One 1st degree relative < 60 years with colon ca
  • Two 1st degree relatives at ANY age
A

Colonoscopy Q5 years starting at age 40 or 10 years earlier than youngest affected relative

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18
Q

If previous IBD involving most of colon for + 8 years of left colon for 15+ years, how often should this person be screened for colon cancer?

A

Colonoscopy Q1-2 years

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19
Q

True/False

Screening is not reccomended if > 85 years for colon cancer

A

True

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20
Q

True/false

PSA is indicated for men < 55 years or > 69 years with < 10 year life expectancy with no risk factors

A

False

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21
Q

True/False

PSA testing may be considered every 2 years if >/= 40 years with additional risk factors

A

True

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22
Q

If you intend to order PSE, what physical exam should be performed in combination?

A

DRE

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23
Q

All of the following are risk factors for what type of cancer?

  • Age > 40
  • Male gender
  • Caucasian
  • overuse of analgesic drugs
  • environmental exposure ie. tobacco workers, nurses, electricians, hairdressers, etc.
A

bladder cancer

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24
Q

If + microscopic hematuria on UA, what is the next tests you would order and what component of PE is important to complete?

A

serum Cr
Urine ACR
Consider KUB US

BP

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25
Q

If > 40 and + imaging findings on KUB with presence of additional risk factors for cancer, what would be your next step?

A

Refer to urology for cystoscopy

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26
Q

Loss of 10 lbs in 6 months is concerning. True/False

A

True

27
Q

Primary stroke prevention if 10 year risk of CAD is > 6 %

A

ASA

28
Q

Dietary calcium intake reccomendation

A

1200-1500 mg day

29
Q

Vitamin D reccomendation

A

600IU -1000 IU/day

30
Q

What pharmacokinetic factor is least impacted by age?

A

Absorption

31
Q

True/False
Increased body fat results in shorter elimination phase and lower therapeutic effect with phenytoin, valproic acid, diazepam and amiodarone (fat soluble)

A

False, longer elimination phase and higher therapeutic effect/toxic effect

32
Q

True/False

Albumin increases with chronic illness

A

False, it decreases

33
Q

What test/calculation is useful for determining medication excretion ability in older adults?

A

Creatinine clearance

34
Q

Creatinine is a reliable measure of renal function in older adults. T/F?

A

False, decreased creatinine with decreased muscle mass

35
Q

True/False

Thyroid abnormalities impact digoxin kinetics as well as CHF and renal impairment

A

True

36
Q

> 0.125mg dose of digoxin is safe to administer in elderly for HF. T/F?

A

False

37
Q

Yellow/green vision, haloes and photophobia are all ocular signs of what?

A

Dig toxicity

38
Q

What screening tools for frailty should be used:
General screening (1)
Mobility (2)
Cognitive impairment (2)

A

General - PRISMA-7 (>/= 3 is frail)
Mobility - gait speed test (> 5 seconds over 4 m is abnormal) or TUG (>10 seconds indicates frailty)
Cognitive impairment - MOCA, MMSE

39
Q

What is the therapeutic range for digoxin in older adults?

A

0.5-0.9 nmol/L, < 1 has reduction in morbidity and mortality

40
Q

HR changes are seen in acute and chronic toxicity with digoxin. Explain what these are.

A

Brady in acute

Tachy in chronic

41
Q

What is the target range for older adults for TSH?

A

0.5-7.5 instead of 0.5-5 in adults

42
Q

What pharmacokinetic is more affected in the elderly?

A

Excretion

43
Q

T/F
In older adults, decreased albumin results in higher rates of unbound drugs/free drugs that can increase risk of toxicity

A

True

44
Q

First pass metabolism is ___ in older adults

A

Decreased

45
Q

Decreased CYP450 metabolism starts to occur at what age

A

40

46
Q

Digoxin - no adjustment if CrCl >/= ____
Ramipril = no adjustment if CrCl >/= ____
Bisoprolol = no adjustment if CrCl >/= ____

A 
Digoxin = no adjustment if CrCl >/= 60
Ramipril = no adjustment if CrCl >/= 40
Bisoprolol = no adjustment if CrCl >/= 20
47
Q

Adverse drug effects of HCTZ

A

hypotension
photosensitivity (BCC risk)
Acute angle glaucoma
Gout

48
Q

Adverse drug effects of ramipril

A

cough
angioedema
hypotension

49
Q

S&S of thyrotoxicosis

“SWEATING”

A 
sweating
weight loss
emotional lability
appetite increased
Tremor/tachycardia
Intolerance to heat/ irregular menses
Nervousness
Goitre/GI disturbance
50
Q

Dig ADE

A

N/V
Visual changes
Hypotension, dysrhythmias (v. fib), palpitations

51
Q

BB ADE

A 
fatigue
insomnia/vivid dreams
sexual dysfunction
depression
bronchospasm
heart block
52
Q

T/F

High calcium and low magnesium can increase dig toxicity?

A

True

53
Q

Tight control of TSH can decrease bone density in older adults. T/F?

A

True

54
Q

TSH is lower at night and higher during the day. T/F?

A

False.

TSH is higher at night and lower during the day

55
Q

How to take synthroid. Instructions for patients.

A

Empty stomach. 30-60 minutes before breakfast. 4 hour sbefore or after iron, calcium or antacids

56
Q

Bisoprolol is often tolerated better if taken in the morning. T/F?

A

False, can make tired during the day. Take at night.

57
Q

Define sarcopenia

A

muscle wasting

58
Q

Iatrogenic disease: define and 3 most common in elderly.

A

illness caused by medical interventions

ADE, AKI, adverse surgical outcomes

59
Q

HTN initial diagnostic workup

A 
UA
electrolytes
FBG
A1C
Lipid profile
ECG
60
Q

What 5 symptoms constitute frailty? “FRAIL”

A 
Fatigue
Resistance - weak grip
Ambulation (slow walking speed, low physical acitivity)
Illnesses
Loss weight
61
Q

Hearing screening frequency in older adults

A

Q2 years > 60 years

62
Q

Eye screening frequency for DM

A

1-2 years

63
Q

Screening for falls risk, frequency

A

Annual

NUNP 547 - Older Adult (19 decks)

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