Exam 2: Geriatric pharmacology, CV, palliative care Flashcards
1
Q
Pharmacokinetics
A
How drug changes when in the body
2
Q
Pharmacodynamics
A
How the body responds to drugs
3
Q
Kinetics
A
Absorption, distribution, metabolism, elimination
4
Q
Dynamics
A
Baroreceptors, sensitivity (BEERS criteria)
5
Q
Metabolic syndrome
A
High FBS, high BP, high triglycerides, truncal obesity, low HDL
6
Q
When should palliative care begin
A
At the time of any serious or life limiting illness
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
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
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
10
Q
Anorexia/cachexia common in
A
HIV, CA, CKD, HF, COPD
11
Q
Dx for anorexia/cachexia
A
serum albumin, prealbumin, transferrin, triglycerides, total lymphocytes, hemoglobin, electrolytes
12
Q
Indicator of presence of cachectic state
A
CRP
13
Q
Appetite stimulants
A
Progesterone steroids, cannabinoids, corticosteroids
14
Q
Dx for anxiety
A
CBC, electrolytes, glucose level, TSH, folate level, ferritin level, vitamin B12, drug screening, O2 saturation
15
Q
Drug of choice for patients who are delirious in last few days of life
A
Haldol
16
Q
Long term use of ___ Can cause delirium
A
High dose opioids
17
Q
What opioid should not be used in elderly or seriously ill
A
Meperidine
18
Q
What opioids cause less delirium
A
Fentanyl, hydromorphone, oxycodone
19
Q
SIGECAPS for depression
A
Sleep changes, interest changes, guilt, energy change, concentration change, appetite, psychomotor, suicidal thoughts
20
Q
Drug of choice for depression if death is anticipated within 1 month
A
Psychostimulant or steroid
Methylphenidate
21
Q
Medications for dyspnea
A
O2 via nasal cannula
Morphine most common
Lorazepam every hour prn if still having symptoms
22
Q
Xerostomia
A
Dry mouth
Dry cracker test or tongue blade test
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)
24
Q
Tx of N/V
A
Prochlorperazine, haldol, ondansetron, diphenhydramine, scopolamine, steroids, metoclopramide, lorazepam, cannabinoids
25
First line for constipation
Senna--stimulant
26
Tx of opioid induced constipation
methylnaltrexone
27
Palliative sedation
Pharmacological agents to reduce consciousness
Reserved for treatment of intolerable and retractable symptoms
Only for patients with advanced progressive illness
Intervention of last resort
28
Palliative care is
needs driven
29
Tx of nociceptive pain in palliative care
NSAIDs, acetaminophen, opioids if more severe
30
Tx of neuropathic pain in palliative care
Gabapentin, TCAs, lidocaine patch, capsaicin cream
31
Avoid what pain meds in renal failure patients
NSAIDs and morphine
32
Safest pain meds for renal failure patients
Fentanyl and methadone
33
Opioids for acute pain
Morphine IR, oxycodone
34
Opioids for chronic pain
Morphine ER, oxycontin, fentanyl
35
Nause med that is renally cleared
Metoclopramide
36
Tx of delirium
Haldol, risperdal, seroquel
| AVOID BENZOS
37
Cardic pharm test with
Dipyridamole or adenosine
38
Most common and least invasive test for diagnosis of CAD
Stress test
39
Major process that mediates acceleration and progression of CAD
Inflammation
40
Tx of aneurysm indicated when
<5.5cm
41
Triad of ruptured AAA symptoms
Hypotension, pulsatile abdominal mass, abdominal/back pain
42
Dx for AAA
Men <60 with sibling or parents with AAA get ultrasound
| Men 65-75 who have ever smoked should get one time US
43
Possible causes of bradyarrhythmias
Hypothyroidism, advanced liver disease, hypothermia, severe hypoxia, calcium channel blockers, beta blockers
44
Symptoms of tachyarrhythmias
Palpitations, lightheadedness, dizziness, syncope, fatigue, drop in BP
45
Causes of tachyarrhythmias
Thyrotoxicosis, hypovolemia, regurgitant valvular disease, anemia, hypoglycemia, pheochromocytoma, fever, anxiety, menopause, caffeine, drugs, medications
46
Relative bradycadia
Too slow to maintain normal BP even if HR >60
47
S3 indicates
Increased ventricular filling--can be caused by fluid overload, HF, or decreased myocardial contractility
-May be normal in child, young adult or pregnant female
48
S4 indicates
Resistance in ventricular filling; usually due to LVH due to hypertension
49
Class 1 antiarrhythmics
Sodium channel blockade
50
Class 2 antiarrhythmics
Beta blockers
51
Class 3 antiarrhythmics
Potassium channel blockers
52
Class 4 antiarrhythmics
Calcium channel blockers
53
Initial attempt to restore sinus rhythm in A Fib with
Amiodarone
54
Rate control alone in A fib with
Beta blockers and non-dihydropyridine calcium cannel blockers (dilitazem + verapamil)
55
Principal agents used in chronic tx of V Tach
Amiodarone and sotalol
56
Initial med for bradyarrhythmias
Atropine
57
Drugs that may cause bradyarrhythmias
Beta blockers, calcium channel blockers, digoxin, clonidine, opiates
58
Where does carotid artery disease originate
Near the bifurcation of the common carotid artery in the region of the bulb
59
Symptomatic carotid stenosis
Transient or permanent focal neurologic symptoms
60
Amaurosis fugax
Temporary loss of vision
61
Benefit groups of statins
LDL >190
40-75 with DM and LDL 70-189
40-75 LDL 70-189 and ASCVD score >7.5%
62
3 factors that determine myocardial oxygen demand
HR, systemic BP, LV wall tension
63
Syndrome X
```
Microvascular angina
Women are more prone
Chest pain is unpredictable
More intense; does not go away with rest
Not responsive to nitroglycerine
```
64
Acute STEMI usually occurs when
An atherosclerotic plaque ruptures
65
Chronic stable angina
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
Levine sign
Clenched fist over chest
67
Unstable angina Sx
occur at rest or wake patient from sleep
| Related to decreased myocardial supply
68
Variant angina
Spontaneous or unprovoked
| Beta blockers may exacerbate
69
CK-MB marker
Rises in 3-12 hours
Peaks at 24 hours
Normalizes 48-72 hours
70
Myoglobin
Rises in 1-3 hours
Peaks at 6 hours
Normalizes in 24 hours
71
Troponins
Rises in 3-12 hours
Peaks in 3-4 hours
Normalizes in 14 days
72
Medications for chronic stable angina
Aspirin, beta blockers, lipid lowering agents, nitrates PRN, ACEI if EF <40 of pt has DM, HTN, CKD
73
Variant angina tx
Sublingual nitroglycerine acute tx
| Calcium channel blockers and beta blockers long term treatments of choice
74
Unstable angina tx
```
Immediate aspirin
Beta blockers
Sublingual nitroglycerine
ACEI and ARB improved survival rates
High intensity statin therapy
```
75
Beta 1 selective blockers
A-M
76
SE of beta blockers
Fatigue, impotence, cold extremities, bronchospasm, worsening claudication, bradycardia
77
In smaller doses of nitrates
Dilates venous system, causing a decreased preload
78
In larger doses of nitrates
Dilates arterial vasculature, lowering the afterload and decreasing resistance to ventricular ejection
79
Dihydropyridines are more
Vascular selective--minimal or no effect on SA/AV node; dominant effect on vasodilation
80
Pheochromoctyoma
Catecholamine producing tumor of adrenal glands
| 5 H's: hypertension, headache, hyperhidrosis, hypermetabolic state, hyperglycemia
81
Monitor ___ after initiation of diuretics, ACEI or ARBs
Potassium and renal function
82
Secondary hypertension should be considered when hypertension develops
<30 or >65
83
Hypertensive emergency
Hypertensive encephalopathy, intracranial hemorrhage, unstable angina, acute MI, pulmonary edema, eclampsia
84
Hypertensive urgency
Optic disc edema, progressive target organ complications, severe perioperative hypertension
85
Medications for hypertensive emergency
Nitroprusside, nitroglycerine, labetalol, esmolol, nicardipine, furosemide, hydralazine, fenoldopam, clevidipine
86
Sx of myocarditis
Fever, atypical chest pain, fatigue, palpitations
Resting tachycardia with exaggerated chronotropic response to any exertion
May have JVD, hepatic enlargement and pedal edema
87
Biomarkers in myocarditis
CRP, ESR, troponins
88
Tx of myocarditis
Hospital and bed rest
ACEI/ARB, loop diuretics and beta blockers
Antiviral therapy
89
Sx of PAD
Exertional leg sx, poor wound healing in leg/feet, pain at rest in lower leg/feet, abdominal pain that occurs after eating
90
PE in PAD
Limbs may have muscle wasting and loss of hair
Ulceration
Reduced temperature in limb
Dependent rubor
91
ABI score in PAD
<0.9
92
Tx PAD
Daily aspirin, statins
93
Acute arterial insufficiency
May result from embolus
Recent hx of MI or A fib
Limb usually pale and pulseless with absent or diminished cap refill
94
Tx of superficial vein phlebitis
NSAIDs, leg elevation, compression stockings, LMWH or factor Xa inhibitor for 6 weeks at least
95
Chronic venous stasis sx
Chronic edema and skin discoloration on the legs and ankles; varicose veins; ulceration; cellulitis
96
Purpose of HDL
Lowers LDL by preventing oxidation of LDL within the arterial wall
97
After initiation of lipid lowering drugs...
Second panel should be obtained in 4-12 weeks
98
Initial dx before statins
Liver function test
99
Most common endocrine disorders associated with lipid abnormalities
Hypothyroidism and diabetes
100
SE of Niacin
Flushing, itching, rash, GI upset
101
Acanthosis nigricans
Diffuse, hyperpigmented, velvety thickening of the skin that is found in the neck and axillae
Due to metabolic syndrome
102
Most common cause of HF
CAD
| Other common: Htn, A Fib, diabetes
103
Preload
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
Afterload
Amount of LV wall tension that develops during systole
| Arterial BP
105
Cardinal sx of HF
Dyspnea and fatigue
106
Specifix sx of HF
JVD, cardiac enlargement, S3
107
Most effective dx tool for HF
Echo
108
Stage 1 HF Tx
Control BP, treat lipid disorders
| ACEI/ARB in patients with DM
109
Stage 2 HF Tx
ACEI/ARB
| Beta blockers
110
Stage 3 HF Tx
Daily weights
Sodium restriction
Reduce exercise
Avoid NSAIDs and calcium channel blockers
ACEI/ARB, Beta blocker, diuretic, aldosterone antagonist
111
Stage 4 HF Tx
Same as stage 3
| + control of fluid balance
112
Beta blockers for HF
Carvedilol, metoprolol, bisoprolol
| Do not give until patient is decongested and stabilized
113
MRASS
Mitral regurgitation
Aortic stenosis
SYSTOLIC
114
MSARD
Mitral stenosis
Aortic regurgitation
DIASTOLIC
115
MVP
Midsystolic click
116
Aortic stenosis
Advancing age
| 3/6 crescendo/decrescendo systolic murmur; thrill present usually
117
Tizandine
Muscle relaxant
| Do not give to elderly
118
Function of LDL
Transport cholesterol to liver cells
119
Medications that can cause dyslipidemia
Steroids, amiodraone, cyclosporine, estrogen, glucocoricoids, bile acid sequestrants, beta blockers
120
Screening guidelines for lipids
At age 20 every 5 years
Older than 40 every 2-3 years
With pre-existing hyperlipidemia screen annually
121
Borderline high total cholesterol
200-239
122
Borderline high LDL
130-159
123
Risk of what with triglycerides >1000
Acute pancreatitis
124
When to take cholesterol medications
At night
125
BNP value indicative of HF
>500
126
Labs with HF
```
CBC shows anemia
Serum albumin elevated
ESR decreased
Electrolytes low except potassium is high
BUN/Cr: elevated
```
127
First degree block
Prolonged PR with normal rhythm
Seen with drugs such as dig toxicity, beta blockers, calcium channel blockers
Tx: Stop the med
128
Aortic stenosis S/S
SOB
| Tx if symptomatic: valve replacement
129
Second degree type 1 heart block
Progressive PR interval until QRS complex dropped
130
Second degree type 2 heart block
Normal or lengthened PR interval with a periodic drop of QRS complex
131
Third degree heart block
No impulse to ventricles
132
Bacterial endocarditis
Caused by S. Aureus or strep viridans
133
Cause of rheumatic fever
GAS
134
CHA-2 score for
A fib risk factor tool for stroke
135
ASCVD risk assessment tool for
Hyperlipidemia
136
Metoclopramide for elderly
Renally cleared
| Dose adjust
137
Xanthomas
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
xanthelasma
a sharply demarcated yellowish deposit of cholesterol underneath the skin. It usually occurs on or around the eyelids
Due to high cholesterol
139
Transaminitis
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
Rhabdo
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
Myositis
inflammation of the muscles
| Can be SE of statin
142
Myalgia
muscle aches and pain
| Can be SE of statin
143
TAVR
minimally invasive procedure to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis).
144
Angiogram
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
ACC stage A HF
High risk of HF but without structural disease or symptoms
| Tx: Treat BP and lipid disorders and other co-morbidities
146
ACC stage B HF
Structural heart disease without sx of HF
| Tx: all patients should take ACEI, take beta blocker after MI
147
ACC stage C HF
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
ACC stage D HF
Refractory HF requiring specialized interventions
| Tx: determine if need transplant or other surgery or palliative/hospice care
