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CDM1 > Exam 1: Geriatrics > Flashcards

Exam 1: Geriatrics Flashcards

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
Q

Genitourinary aging: What does the detrusor muscle do?

A

Pushes urine out

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26
Q

Genitourinary aging: 2 Conditions

A
  1. urinary frequency (overactive bladder)

2. urinary retention/obstruction (retention - can’t empty bladder completely, obstruction - doesn’t let urine leave)

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27
Q

Genitourinary aging: Women: Menopause: When and what happens

A

~52
decrease in estrogen
ovaries, uterus, vagina atrophy

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28
Q

Genitourinary aging: Women: Effects on the vagina

A

Vagina atrophy, decreased lubrication, painful intercourse (dyspareunia)

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29
Q

Genitourinary aging: Women: 2 conditions

A
  1. UTI

2. Dyspareunia

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30
Q

Genitourinary aging: Men: 2 conditions

A
  1. BPH (benign prostatic hyperplasia)

2. erectile dysfunction

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31
Q

Skeletal aging: Effects on bones

A

Decreased mass and density

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32
Q

Skeletal aging: Conditions

A
  1. Osteoporosis
  2. Arthritis
  3. Gait changes
  4. Loss of balance
  5. Falls
  6. Fractures
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33
Q

Skin aging: Loss of ____ between __ and __

A

Loss of INTERDIGITATIONS between EPIDERMIS + DERMIS

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34
Q

Skin aging: What causes tearing/breakdown of the skin?

A

Loss of interdigitations b/t epidermis + dermis

Drier and thinner > breakage

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35
Q

GI Aging: Effects on the esophagus

A

Decrease taste sensation

36
Q

GI aging: Effects on stomach

A

Decreased gastric acid secretion

37
Q

GI aging: effects on small intestine

A

Decrease absorption of calcium, folic acid, and vit b12

38
Q

GI Aging: effects on colon

A

Slow transit time

Increased water reabsorption

39
Q

GI Aging: Conditions relating to effects on esophagus and stomach

A

Dysphagia (difficult swallowing)
Aspiration (choking)
GERD (acid reflux)

40
Q

GI aging: Conditions relating effects on small intestine and colon

A

Nutrient depletion
Diverticulosis (small bulging pouches in colon)
Constipation
Incontinence (fecal/urine) – loss of bladder/colon control

41
Q

PK Changes with Aging: Effects on body water, body mass, and body fat

A

Decrease on body water, body mass

Increase body fat

42
Q

PK Changes with Aging: changes in absorption and exceptions

A

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
Q

PK Changes with Aging: Changes in distribution for hydrophilic drugs

A 
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
Q

PK Changes with Aging: Changes with distribution of lipophilic drugs

A

Increased Vd
Increased t1/2
Increased duration of therapeutic/toxic effects

Ex. diazepam, phenothiazine, phenyoin

45
Q

PK Changes with Aging: Changes with distribution and protein binding

A

Decreased albumin and increase % of unbound free drug

Interactions: highly protein-bound drugs (ex. warfarin, phenytoin, benzodiazepines)

46
Q

PK Changes with Aging: Changes in metabolism

A
  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
Q

PK Changes with Aging: Changes with excretion

A

CrCl (Cockcroft-Gault) may not be accurate

Decrease clearance and increase of t1/2 for drugs with renal elimination and active metabolites

48
Q

Which renal exam estimates CrCl?

A

Cockcroft-Gault

49
Q

Which renal exam estimates GFR?

50
Q

Cockcroft-Gault: Does it overestimate/underestimate CrCl

A

Overestimates especially for frail and reduced muscle mass

51
Q

Which renal exam is used for most drug dosing?

A

Cockcroft-Gault (CrCl)

52
Q

What is the use of MDRD renal exam?

A

Stages chronic kidney disease (CKD)

Drug dosing for new meds

53
Q

PD Changes with Aging: Increased sensitivity and side effects of which drugs?

A
  • Benzodiazepines
  • Opioids
  • Alcohol
  • Neuroleptics
  • Anticholinergics
  • H1 antihistamines (1st gen)
54
Q

PD Changes with Aging: Beta-blockers

A

Decreased response

55
Q

PD Changes with Aging: Warfarin

A

Increased risk of bleeding

56
Q

PD Changes with Aging: Cardiac drugs

A

Increased risk of orthostatic hypotension

57
Q

PD Changes with Aging: Diuretics

A

Decreased effectiveness

58
Q

Aging: Functional loss: Common reasons for institutionalization

A
  • 80% problems with mobility

- 65% difficulty with bowel control

59
Q

Aging: Functional loss: Causes

A
  • Heart disease
  • Stroke
  • Diabetes
  • Other chronic diseases
60
Q

What are examples of activities of daily living (ADL)?

A
  • bathing
  • ambulation
  • toileting
  • transfers
  • eating
  • dressing
  • taking meds
61
Q

What are examples of instrumental ADLs (IADLs)?

A
  • shopping
  • cooking/cleaning
  • using telephone or transportation
  • managing money and medications
62
Q

What is polypharmacy?

A

Use of any unnecessary medication

63
Q

T/F: research shows that any symptom in an elderly person should be considered an ADVERSE EFFECT unless proven otherwise

64
Q

What is START/STOPP for inappropriate prescribing?

A

Mostly used in Europe

START – omissions of therapy
STOPP – potentially inappropriate/duplication of therapy

65
Q

AGS Beers Criteria: Sedating antihistamines potential harm

A

Highly anticholinergic

Clearance reduced in older patients

66
Q

AGS Beers Criteria: Sedating antihistamines examples

A 
Brompheniramine
Chlorpheniramine
Dimenhydrinate
Diphenhydramine
Doxylamine
67
Q

AGS Beers Criteria: Sedating antihistamines: Exceptions and notes

A

Diphenhydramine may be used for acute allergic reactions

Tolerance develops when used as a hypnotic

68
Q

AGS Beers Criteria: PPI examples

A

omeprazole
esomeprazole
lansoprazole

69
Q

AGS Beers Criteria: PPI potential harm

A

C difficile infection

Bone loss and fractures

70
Q

AGS Beers Criteria: PPI: Exceptions and notes

A

Chronic NSAID or corticosteroid use
Erosive esophagitis
Failure of drug discontinuation or H2 blocker trial

Conditions: avoid use >8 weeks

71
Q

AGS Beers Criteria: CV: Digoxin: Potential harm

A

Higher doses have no added benefit > toxicity
Other agents have evidence of mortality and hospitalization
Benefits in HFrEF

72
Q

AGS Beers Criteria: CV: Digoxin: Conditions

A

Conditions:
When used first line for rate control for Afib
When used first line for HF doses
> 125mcg/day

73
Q

AGS Beers Criteria: CV: Alpha blockers: Examples

A

Doxazosin
Prazosin
Terazosin

74
Q

AGS Beers Criteria: CV: Alpha blockers: Potential harm

A

orthostatic hypotension (high risk)

75
Q

AGS Beers Criteria: CV: Alpha blockers: Conditions

A

When used for treatment of HTN

76
Q

AGS Beers Criteria: CNS: Benzodiazepines: potential harm

A

cognitive impairment
delirium
fall/fractures

77
Q

AGS Beers Criteria: CNS: Benzodiazepines: Exceptions

A

Seizure disorders, REM sleep behavior disorder, alcohol withdrawal, severe anxiety

78
Q

AGS Beers Criteria: CNS: Benzodiazepines: Rationale

A

Increased sensitivity and decreased metabolism

79
Q

AGS Beers Criteria: CNS: Tricyclic antidepressant: Examples

A

Amitriptyline
Nortriptyline
Protriptyline

80
Q

AGS Beers Criteria: CNS: Tricyclic antidepressants

A

Highly anticholinergic
Sedating
Orthostatic hypotension

81
Q

AGS Beers Criteria: Disease specific: HF: Medications and potential harm

A

NSAIDs (all)

Fluid retention may exacerbate HF

82
Q

AGS Beers Criteria: Disease specific: CKD: Medications and potential harm

A

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
Q

AGS Beers Criteria: Disease specific: Delirium: Medication and potential harm

A

H2 receptor blockers

May cause/increase confusion

84
Q

AGS Beers Criteria: Disease-specific: Dementia: Medication and potential harm

A

Anticholinergics

Adverse CNS effects

85
Q

What does MAI stand for

A

Medication appropriateness index

86
Q

What is the saying for dosing in geriatrics?

A

Start low, go slow, but go

CDM1 (19 decks)

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