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Primary Care 2 > Exam 2: Geriatric pharmacology, CV, palliative care > Flashcards

Exam 2: Geriatric pharmacology, CV, palliative care Flashcards

1
Q

Pharmacokinetics

A

How drug changes when in the body

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2
Q

Pharmacodynamics

A

How the body responds to drugs

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3
Q

Kinetics

A

Absorption, distribution, metabolism, elimination

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4
Q

Dynamics

A

Baroreceptors, sensitivity (BEERS criteria)

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5
Q

Metabolic syndrome

A

High FBS, high BP, high triglycerides, truncal obesity, low HDL

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6
Q

When should palliative care begin

A

At the time of any serious or life limiting illness

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7
Q

Advanced directives

A

The type of care the patient does or does not wish at the end of life; name a proxy decision maker

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8
Q

5 wishes

A

The person I want to make care decisions for me when I can’t. the kind of medical treatment I want or dont want, how comfortable I want to be, how i want people to treat me, what i want my loved ones to know

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9
Q

Cachexia

A

State of general malnutrition marked by weight loss, malnutrition, weakness and emaciation, equal loss of fat, muscle and bone mineral content

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10
Q

Anorexia/cachexia common in

A

HIV, CA, CKD, HF, COPD

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11
Q

Dx for anorexia/cachexia

A

serum albumin, prealbumin, transferrin, triglycerides, total lymphocytes, hemoglobin, electrolytes

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12
Q

Indicator of presence of cachectic state

A

CRP

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13
Q

Appetite stimulants

A

Progesterone steroids, cannabinoids, corticosteroids

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14
Q

Dx for anxiety

A

CBC, electrolytes, glucose level, TSH, folate level, ferritin level, vitamin B12, drug screening, O2 saturation

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15
Q

Drug of choice for patients who are delirious in last few days of life

A

Haldol

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16
Q

Long term use of ___ Can cause delirium

A

High dose opioids

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17
Q

What opioid should not be used in elderly or seriously ill

A

Meperidine

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18
Q

What opioids cause less delirium

A

Fentanyl, hydromorphone, oxycodone

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19
Q

SIGECAPS for depression

A

Sleep changes, interest changes, guilt, energy change, concentration change, appetite, psychomotor, suicidal thoughts

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20
Q

Drug of choice for depression if death is anticipated within 1 month

A

Psychostimulant or steroid

Methylphenidate

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21
Q

Medications for dyspnea

A

O2 via nasal cannula
Morphine most common
Lorazepam every hour prn if still having symptoms

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22
Q

Xerostomia

A

Dry mouth

Dry cracker test or tongue blade test

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23
Q

Treatment of xerostomia

A

Treat underlying conditions (thrush), stimulate salivary flow, replace lost secretions, rehydrate
Pilocarpine (cholinergic agent)
-DO NOT USE with COPD, asthma, bradycardia, renal or hepatic impairment, glaucoma, bowel obstruction
Cevimeline: acetylcholinesterase inhibitor (give with mouthwash)

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24
Q

Tx of N/V

A

Prochlorperazine, haldol, ondansetron, diphenhydramine, scopolamine, steroids, metoclopramide, lorazepam, cannabinoids

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25
Q

First line for constipation

A

Senna–stimulant

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26
Q

Tx of opioid induced constipation

A

methylnaltrexone

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27
Q

Palliative sedation

A

Pharmacological agents to reduce consciousness
Reserved for treatment of intolerable and retractable symptoms
Only for patients with advanced progressive illness
Intervention of last resort

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28
Q

Palliative care is

A

needs driven

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29
Q

Tx of nociceptive pain in palliative care

A

NSAIDs, acetaminophen, opioids if more severe

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30
Q

Tx of neuropathic pain in palliative care

A

Gabapentin, TCAs, lidocaine patch, capsaicin cream

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31
Q

Avoid what pain meds in renal failure patients

A

NSAIDs and morphine

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32
Q

Safest pain meds for renal failure patients

A

Fentanyl and methadone

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33
Q

Opioids for acute pain

A

Morphine IR, oxycodone

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34
Q

Opioids for chronic pain

A

Morphine ER, oxycontin, fentanyl

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35
Q

Nause med that is renally cleared

A

Metoclopramide

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36
Q

Tx of delirium

A

Haldol, risperdal, seroquel

AVOID BENZOS

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37
Q

Cardic pharm test with

A

Dipyridamole or adenosine

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38
Q

Most common and least invasive test for diagnosis of CAD

A

Stress test

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39
Q

Major process that mediates acceleration and progression of CAD

A

Inflammation

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40
Q

Tx of aneurysm indicated when

A

<5.5cm

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41
Q

Triad of ruptured AAA symptoms

A

Hypotension, pulsatile abdominal mass, abdominal/back pain

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42
Q

Dx for AAA

A

Men <60 with sibling or parents with AAA get ultrasound

Men 65-75 who have ever smoked should get one time US

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43
Q

Possible causes of bradyarrhythmias

A

Hypothyroidism, advanced liver disease, hypothermia, severe hypoxia, calcium channel blockers, beta blockers

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44
Q

Symptoms of tachyarrhythmias

A

Palpitations, lightheadedness, dizziness, syncope, fatigue, drop in BP

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45
Q

Causes of tachyarrhythmias

A

Thyrotoxicosis, hypovolemia, regurgitant valvular disease, anemia, hypoglycemia, pheochromocytoma, fever, anxiety, menopause, caffeine, drugs, medications

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46
Q

Relative bradycadia

A

Too slow to maintain normal BP even if HR >60

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47
Q

S3 indicates

A

Increased ventricular filling–can be caused by fluid overload, HF, or decreased myocardial contractility
-May be normal in child, young adult or pregnant female

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48
Q

S4 indicates

A

Resistance in ventricular filling; usually due to LVH due to hypertension

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49
Q

Class 1 antiarrhythmics

A

Sodium channel blockade

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50
Q

Class 2 antiarrhythmics

A

Beta blockers

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51
Q

Class 3 antiarrhythmics

A

Potassium channel blockers

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52
Q

Class 4 antiarrhythmics

A

Calcium channel blockers

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53
Q

Initial attempt to restore sinus rhythm in A Fib with

A

Amiodarone

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54
Q

Rate control alone in A fib with

A

Beta blockers and non-dihydropyridine calcium cannel blockers (dilitazem + verapamil)

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55
Q

Principal agents used in chronic tx of V Tach

A

Amiodarone and sotalol

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56
Q

Initial med for bradyarrhythmias

A

Atropine

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57
Q

Drugs that may cause bradyarrhythmias

A

Beta blockers, calcium channel blockers, digoxin, clonidine, opiates

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58
Q

Where does carotid artery disease originate

A

Near the bifurcation of the common carotid artery in the region of the bulb

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59
Q

Symptomatic carotid stenosis

A

Transient or permanent focal neurologic symptoms

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60
Q

Amaurosis fugax

A

Temporary loss of vision

61
Q

Benefit groups of statins

A

LDL >190
40-75 with DM and LDL 70-189
40-75 LDL 70-189 and ASCVD score >7.5%

62
Q

3 factors that determine myocardial oxygen demand

A

HR, systemic BP, LV wall tension

63
Q

Syndrome X

A 
Microvascular angina
Women are more prone 
Chest pain is unpredictable 
More intense; does not go away with rest 
Not responsive to nitroglycerine
64
Q

Acute STEMI usually occurs when

A

An atherosclerotic plaque ruptures

65
Q

Chronic stable angina

A

Sx occur with predictable frequency, severity, duration and provocation
Occur with exertion, relieved by rest or no more than 1 nitroglycerine tablet
Lasts 1-3 minutes

66
Q

Levine sign

A

Clenched fist over chest

67
Q

Unstable angina Sx

A

occur at rest or wake patient from sleep

Related to decreased myocardial supply

68
Q

Variant angina

A

Spontaneous or unprovoked

Beta blockers may exacerbate

69
Q

CK-MB marker

A

Rises in 3-12 hours
Peaks at 24 hours
Normalizes 48-72 hours

70
Q

Myoglobin

A

Rises in 1-3 hours
Peaks at 6 hours
Normalizes in 24 hours

71
Q

Troponins

A

Rises in 3-12 hours
Peaks in 3-4 hours
Normalizes in 14 days

72
Q

Medications for chronic stable angina

A

Aspirin, beta blockers, lipid lowering agents, nitrates PRN, ACEI if EF <40 of pt has DM, HTN, CKD

73
Q

Variant angina tx

A

Sublingual nitroglycerine acute tx

Calcium channel blockers and beta blockers long term treatments of choice

74
Q

Unstable angina tx

A 
Immediate aspirin
Beta blockers 
Sublingual nitroglycerine 
ACEI and ARB improved survival rates 
High intensity statin therapy
75
Q

Beta 1 selective blockers

A

A-M

76
Q

SE of beta blockers

A

Fatigue, impotence, cold extremities, bronchospasm, worsening claudication, bradycardia

77
Q

In smaller doses of nitrates

A

Dilates venous system, causing a decreased preload

78
Q

In larger doses of nitrates

A

Dilates arterial vasculature, lowering the afterload and decreasing resistance to ventricular ejection

79
Q

Dihydropyridines are more

A

Vascular selective–minimal or no effect on SA/AV node; dominant effect on vasodilation

80
Q

Pheochromoctyoma

A

Catecholamine producing tumor of adrenal glands

5 H’s: hypertension, headache, hyperhidrosis, hypermetabolic state, hyperglycemia

81
Q

Monitor ___ after initiation of diuretics, ACEI or ARBs

A

Potassium and renal function

82
Q

Secondary hypertension should be considered when hypertension develops

A

<30 or >65

83
Q

Hypertensive emergency

A

Hypertensive encephalopathy, intracranial hemorrhage, unstable angina, acute MI, pulmonary edema, eclampsia

84
Q

Hypertensive urgency

A

Optic disc edema, progressive target organ complications, severe perioperative hypertension

85
Q

Medications for hypertensive emergency

A

Nitroprusside, nitroglycerine, labetalol, esmolol, nicardipine, furosemide, hydralazine, fenoldopam, clevidipine

86
Q

Sx of myocarditis

A

Fever, atypical chest pain, fatigue, palpitations
Resting tachycardia with exaggerated chronotropic response to any exertion
May have JVD, hepatic enlargement and pedal edema

87
Q

Biomarkers in myocarditis

A

CRP, ESR, troponins

88
Q

Tx of myocarditis

A

Hospital and bed rest
ACEI/ARB, loop diuretics and beta blockers
Antiviral therapy

89
Q

Sx of PAD

A

Exertional leg sx, poor wound healing in leg/feet, pain at rest in lower leg/feet, abdominal pain that occurs after eating

90
Q

PE in PAD

A

Limbs may have muscle wasting and loss of hair
Ulceration
Reduced temperature in limb
Dependent rubor

91
Q

ABI score in PAD

A

<0.9

92
Q

Tx PAD

A

Daily aspirin, statins

93
Q

Acute arterial insufficiency

A

May result from embolus
Recent hx of MI or A fib
Limb usually pale and pulseless with absent or diminished cap refill

94
Q

Tx of superficial vein phlebitis

A

NSAIDs, leg elevation, compression stockings, LMWH or factor Xa inhibitor for 6 weeks at least

95
Q

Chronic venous stasis sx

A

Chronic edema and skin discoloration on the legs and ankles; varicose veins; ulceration; cellulitis

96
Q

Purpose of HDL

A

Lowers LDL by preventing oxidation of LDL within the arterial wall

97
Q

After initiation of lipid lowering drugs…

A

Second panel should be obtained in 4-12 weeks

98
Q

Initial dx before statins

A

Liver function test

99
Q

Most common endocrine disorders associated with lipid abnormalities

A

Hypothyroidism and diabetes

100
Q

SE of Niacin

A

Flushing, itching, rash, GI upset

101
Q

Acanthosis nigricans

A

Diffuse, hyperpigmented, velvety thickening of the skin that is found in the neck and axillae
Due to metabolic syndrome

102
Q

Most common cause of HF

A

CAD

Other common: Htn, A Fib, diabetes

103
Q

Preload

A

The degree of myocardial fiber stretch at the end of ventricular filling
Results in LV remodeling, with dilation and impaired contractility and activation of SANS and RAAS

104
Q

Afterload

A

Amount of LV wall tension that develops during systole

Arterial BP

105
Q

Cardinal sx of HF

A

Dyspnea and fatigue

106
Q

Specifix sx of HF

A

JVD, cardiac enlargement, S3

107
Q

Most effective dx tool for HF

A

Echo

108
Q

Stage 1 HF Tx

A

Control BP, treat lipid disorders

ACEI/ARB in patients with DM

109
Q

Stage 2 HF Tx

A

ACEI/ARB

Beta blockers

110
Q

Stage 3 HF Tx

A

Daily weights
Sodium restriction
Reduce exercise
Avoid NSAIDs and calcium channel blockers
ACEI/ARB, Beta blocker, diuretic, aldosterone antagonist

111
Q

Stage 4 HF Tx

A

Same as stage 3

+ control of fluid balance

112
Q

Beta blockers for HF

A

Carvedilol, metoprolol, bisoprolol

Do not give until patient is decongested and stabilized

113
Q

MRASS

A

Mitral regurgitation
Aortic stenosis
SYSTOLIC

114
Q

MSARD

A

Mitral stenosis
Aortic regurgitation
DIASTOLIC

115
Q

MVP

A

Midsystolic click

116
Q

Aortic stenosis

A

Advancing age

3/6 crescendo/decrescendo systolic murmur; thrill present usually

117
Q

Tizandine

A

Muscle relaxant

Do not give to elderly

118
Q

Function of LDL

A

Transport cholesterol to liver cells

119
Q

Medications that can cause dyslipidemia

A

Steroids, amiodraone, cyclosporine, estrogen, glucocoricoids, bile acid sequestrants, beta blockers

120
Q

Screening guidelines for lipids

A

At age 20 every 5 years
Older than 40 every 2-3 years
With pre-existing hyperlipidemia screen annually

121
Q

Borderline high total cholesterol

A

200-239

122
Q

Borderline high LDL

A

130-159

123
Q

Risk of what with triglycerides >1000

A

Acute pancreatitis

124
Q

When to take cholesterol medications

A

At night

125
Q

BNP value indicative of HF

A

> 500

126
Q

Labs with HF

A 
CBC shows anemia
Serum albumin elevated
ESR decreased
Electrolytes low except potassium is high
BUN/Cr: elevated
127
Q

First degree block

A

Prolonged PR with normal rhythm
Seen with drugs such as dig toxicity, beta blockers, calcium channel blockers
Tx: Stop the med

128
Q

Aortic stenosis S/S

A

SOB

Tx if symptomatic: valve replacement

129
Q

Second degree type 1 heart block

A

Progressive PR interval until QRS complex dropped

130
Q

Second degree type 2 heart block

A

Normal or lengthened PR interval with a periodic drop of QRS complex

131
Q

Third degree heart block

A

No impulse to ventricles

132
Q

Bacterial endocarditis

A

Caused by S. Aureus or strep viridans

133
Q

Cause of rheumatic fever

A

GAS

134
Q

CHA-2 score for

A

A fib risk factor tool for stroke

135
Q

ASCVD risk assessment tool for

A

Hyperlipidemia

136
Q

Metoclopramide for elderly

A

Renally cleared

Dose adjust

137
Q

Xanthomas

A

a condition in which fatty growths develop underneath the skin. These growths can appear anywhere on the body, but they typically form on the: joints, especially the knees and elbows
Due to high cholesterol

138
Q

xanthelasma

A

a sharply demarcated yellowish deposit of cholesterol underneath the skin. It usually occurs on or around the eyelids
Due to high cholesterol

139
Q

Transaminitis

A

refers to unusually high levels of a family of enzymes called transaminases. Transaminitis is not a disease, but it can point to other issues that require treatment. High levels of fat or similar problems may be causing inflammation in the liver
Could be SE of statin

140
Q

Rhabdo

A

results from the death of muscle fibers and release of their contents into the bloodstream. This can lead to serious complications such as renal (kidney) failure
Can be SE of statin

141
Q

Myositis

A

inflammation of the muscles

Can be SE of statin

142
Q

Myalgia

A

muscle aches and pain

Can be SE of statin

143
Q

TAVR

A

minimally invasive procedure to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis).

144
Q

Angiogram

A

diagnostic test that uses x-rays to take pictures of your blood vessels. A long flexible catheter is inserted through the blood stream to deliver dye (contrast agent) into the arteries making them visible on the x-ray.

145
Q

ACC stage A HF

A

High risk of HF but without structural disease or symptoms

Tx: Treat BP and lipid disorders and other co-morbidities

146
Q

ACC stage B HF

A

Structural heart disease without sx of HF

Tx: all patients should take ACEI, take beta blocker after MI

147
Q

ACC stage C HF

A

Structural heart disease with prior or current sx of HF

Tx: diuretics and digoxin, aldosterone inhibitor if severe sx, monitor weight and restrict fluids

148
Q

ACC stage D HF

A

Refractory HF requiring specialized interventions

Tx: determine if need transplant or other surgery or palliative/hospice care

Primary Care 2 (5 decks)

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