Senior Care

Question 1

What is the “age” sub-group for:
old-young
young-old
middle old
old-old
centenarians
super centenarians

Answer 1

50-64
65-74
75-84
85+
100+
110+

Question 2

Geriatric/elderly/older adults refers to?

Answer 2

age 65 and older

Question 3

frail elderly refers to?

Answer 3

over 85 with multiple comorbidities

Question 4

define long-term care

Answer 4

care provided for a long time. Not environment specific

Question 5

define nursing facility

Answer 5

aka nursing home, care based on a medical/nursing model—extended stay

Question 6

what’s the difference b/w nursing facility and skilled nursing facility?

Answer 6

a skilled nursing facility is medicare-certified

Question 7

what is subacute care?

Answer 7

intense post-hospital care

Question 8

define assisted living

Answer 8

community-based care

Question 9

a pharmacist that specializes in advocating for patients who solves drug therapy problems is called?

Answer 9

a consultant pharmacist

Question 10

what is the difference between life span and life expectancy?

Answer 10

life span is the longest period of time an organism can live, whereas live expectancy is the estimated time that an organism is likely to live

Question 11

who is the oldest recorded human and hw old are they?

Answer 11

Jeanne Calment, 122 y/o

Question 12

Who is the current oldest living man/woman?

Answer 12

Juan Perez -112
Maria Morera - 115

Question 13

what’s the name/age of the oldest dog?

Answer 13

Toby Keith 21 y/o

Question 14

T/F there is significant variation in life expectancy at birth between countries

Answer 14

true

Question 15

what’s the average life expectancy in the US?

Answer 15

around 77

Question 16

which country has the highest life expectancy? avg age?

Answer 16

Hong Kong, 84

Question 17

which country has the highest population over 65?

Answer 17

Japan

Question 18

what are the theories of aging?

Answer 18

-error theory
-wear and tear theory
-cross-linking theory
-biological clock
-free-radical theory
-telomere hypothesis

Question 19

what is the telomere hypothesis?

Answer 19

shortening of telomeres occurs until threshold length is achieved. replicative senescence “mitotic clock” blocks further cell division. essentially, telomeres have a major influence on the aging process

Question 20

what is progeria (Hutchinson-Gilford syndrome)?

Answer 20

a rare genetic disorder that causes children to age rapidly, starting in their first 2 years of life. children in the first year start to have slowed growth and hair loss

Question 21

what are the power 9 principles for living longer?

Answer 21

Down shift: relieve stress
Purpose: wake up with a purpose
Plant Slant: less meat and more plants
Wine @ five: enjoy a daily glass of wine with friends
Family first: invest time with family
80% rule: eat mindfully and stop when 80% full
Move naturally: move more!
Right tribe: surround yourself with people who support you
Belong: belong to a faith-based community

Question 22

what are the top 3 causes of death in adults over 65 (in order)?

Answer 22

1. Heart disease
2. Cancer
3. COPD

Question 23

what is the ranking of care in regards to highest -> lowest cost + highest-> lowest caregiver skills?
a. Subacute, Home Health Care, Assisted Living, Nursing Facility, Hospital
b. Hospital, Subacute, Home Health Care, Nursing Facility, Assisted Living
c. Hospital, Subacute, Nursing Facility, Assisted Living, Home Health Care
d. Home Health Care, Assisted Living, Hospital, Subacute
e. Home Health Care, Subacute, Nursing Facility, Assisted Living

Answer 23

c

Question 24

What are the opportunities for Pharmacists in regards to:
-Hospital and subacute
-Nursing Facility
-Assisted Living
-Home Health Care
-Independent Living

Answer 24

H/A: specialty pharmacy practice opportunities
NF: MMRs
AL: similar to NF
HHC: prevention of re-hospitalization
IL: tons of opportunities

Question 25

what is the federal requirement in regards to Pharmacy in Nursing Facilities?

Answer 25

pharmacists must perform a MRR (aka DRR) for each resident at least monthly

Question 26

how do nursing facilities and assisted living faculties differ?

Answer 26

-nursing facilities tend to have more skilled staff. -nursing facilities are federally regulated whereas assisted living is state regulated -nursing facilities have mandated MRR due to being federally regulated whereas assisted living MRR mandates vary based on state

Question 27

which state has the most expensive nursing home costs?

Answer 27

Alaska

Question 28

age-related pharmacokinetic changes in absorption: decreased production of ______ slower __________ actively absorbed compounds such as ____________ may have decreased absorption _________ drug delivery not well-studied

Answer 28

HCl (achlorhydria) gastric emptying calcium, iron, and B12 transdermal drug

Question 29

age-related pharmacokinetic changes in distribution: increased _______ and decreased _________ alterations in _____________ water-soluble drugs such as digoxin, morphine, and lithium may have a smaller ______________ fat soluble drugs may have a larger _____________ _____________ decrease common, many drugs are _______ bound

Answer 29

body fat, total body water volume of distribution volume of distribution volume of distribution -serum protein, protein

Question 30

age-related pharmacokinetic changes in metabolism: liver decreases in _____ and __________ may have altered _______ function ______ changes more neccesary

Answer 30

size, blood flow liver drug dose

Question 31

why is a dose reduction in geriatric pts req. for alprazolam?

Answer 31

it has higher plasma concentrations in geriatric pts due to reduced clearance

Question 32

age-related pharmacokinetic changes in excretion: _______ function decreases with age (25-50%). measured using _________ or ____ to estimate drug elimination __________ adjustments often made

Answer 32

kidney, creatinine clearance, GFR renal dose

Question 33

age-related pharmacodynamic changes: may enhance and/or impede _________ changes in _________ affinity altered ________ control increased sensitivity to _____ effects increased ___________ toxicity change in _____________ response

Answer 33

drug action receptor homeostatic CNS anticholinergic baroreceptor

Question 34

how does the pharmacokinetics of glimepiride change as renal function declines?

Answer 34

serum levels decrease and its metabolites (M1 and M2) increase. pts with CrCl <20 had a much larger amount of M1 metabolite compared to pts with CrCl >50

Question 35

what would be an example of when a patient has a medical condition (a drug indication) that requires drug therapy but is not receiving a drug for that indication?

Answer 35

pt med compliance or rather non-compliance/adherence

Question 36

what are examples of non-compliance/adherence?

Answer 36

-under use -over use -intelligent non-compliance (self-adjusting meds) -premature discontinuation -not filling rx

Question 37

what would be an example of when a patient has a medical condition for which the wrong drug is being taken?

Answer 37

error in dispensing the wrong prescription based on a look-alike sound-alike error

Question 38

how can we prevent look-alike/sound-alike drug errors?

Answer 38

TALL man lettering

Question 39

what would be some examples of when a patient has a medical condition for which too little of the correct drug is being given?

Answer 39

-pt is taking pain meds but pain is not controlled -pt dose of antidepressant isn't high enough... titration=longer time of therapy before pt experiences beneficial effects from the drug

Question 40

what would be some examples of when a patient has a medical condition for which too much of the correct drug is being given?

Answer 40

-methotrexate: it can ben prescribed daily for RA sx, but it is indicated for once weekly for RA. it has immunosuppressive properties, and if dosed too high makes pt at an extremely higher risk of infection -sedatives: give pt a sedative for a psychotic episode, pt continues to take daily despite no longer experiencing psychotic episodes

Question 41

what would be some examples of when a patient has a medical condition that is the result of not receiving the prescribed drug?

Answer 41

-can't affort rx -can't access drug -can't arrange refills -can't use med correctly

Question 42

why should bisphosphonates be taken with a full glass of water? why should pt practice good oral hygiene? how much does OJ and coffee reduce the bioavailability? what about with food?

Answer 42

can cause esophagitis if it gets stuck in the throat so that med doesn't absorb in mouth: prevents osteonecrosis around 60%. bioavailability becomes negligible

Question 43

what would be an example of when a patient has a medical condition that is the result of taking a drug for which there is no valid medical indication?

Answer 43

for example: a pt had acute delirium and was given haloperidol which was continued when pt went back to her NF. she is now taking an antipsych drug daily for an acute episode

Question 44

why are PPIs commonly prescribed in the hospital to older pts? there is increasing evidence that PPIs may increase the risk of?

Answer 44

to prevent stress ulcers fractures and c. diff infections

Question 45

what is an example of when a patient has a medical condition resulting from an adverse drug reaction?

Answer 45

older pts could be taking a seemingly harmless OTC med such as Tylenol PM. Tylenol PM contains Benadryl which has cholinergic effects causing confusion and cardiac rhythm disturbances

Question 46

why are stereotypes of the elderly unfair, such as confusion, weakness, constipation, dry mouth, tremor, urinary issues, etc...?

Answer 46

these stereotypes are also the same as SEs from a lot of medications seniors take

Question 47

what are the concerns when a patient has a medical condition resulting from a drug-drug, drug-food, drug-laboratory interaction?

Answer 47

can potentially cause serious harm to the pt and it may be difficult to pinpoint the cause of the adverse reaction

Question 48

A 75 yo pt with history of respiratory disease developed a skin infection for which a quinolone antibiotic was prescribed. med history includes use of a corticosteroid inhaler. within 2 weeks he developed bilateral Achilles tendon ruptures with unsuccessful surgery. Pt became disabled, deconditioned, depressed and died. what went wrong?

Answer 48

quinolones have been associated with tendinopathy. pts over 60 have an increased risk, and pts over 60 using corticosteroids are at a significantly increased risk