Term
| What do the American Society of pharmacists say about drug interactions between NSAIDs and Coumadin in the elderly?? |
|
Definition
| It is a VERY bad combo! Oftentimes will cause GI bleeds in the elderly. |
|
|
Term
| What is the most common type of urinary incontience? |
|
Definition
|
|
Term
| When suspecting elderly abuse, how should the interview go? |
|
Definition
| Interview the caregiver and pt separately. |
|
|
Term
| What were the 4 main drugs Prof Yattaw said to avoid in the elderly?? |
|
Definition
1. Coumadin
2. Demerol (Pain)
3. Valium (long-acting)
4. Xanax |
|
|
Term
| What is one of the most common psych disorders in the elderly? |
|
Definition
| Depression-it is poorly recoginzed and undertreated. |
|
|
Term
| What is a good drug to give an elderly person with anxiety? |
|
Definition
| Atavan (Lorazepam)- avoid giving XANAX and Valium bc they are associated with falls. |
|
|
Term
| What is Sporonox (Itraconazol)? What is it used for? What does it do to elderly individuals? |
|
Definition
| Oral Antifungal. Used for toe nail fungus. It decreases liver metabolism of many drugs and increases GI pH(affecting absorption of meds). It is very hard on the liver. Can cause diarrhea and dizzy. |
|
|
Term
| If an elderly person has sx of being dizzy, can't sleep, chronic pain and can't cope...what do they probably have? |
|
Definition
|
|
Term
| Abrupt vertigo (weak and dizzy) is common in what types of pts? |
|
Definition
| Pts who have had a TIA with vertebrobasilar artery sx. |
|
|
Term
| What are some common causes of delirium? |
|
Definition
| Sundowning and polypharmacy |
|
|
Term
| When a pt falls and hits their head, what should be a concern and your next step of action? |
|
Definition
| You should be worried about an underlying neurologic problem. Do eval, get CT and MRI. Make sure to get Neuro involved...AKA...MAKE THE RIGHT CONSULT. |
|
|
Term
| What is geriatric syndrome? What do you need to do as a provider in regards to this syndrome? |
|
Definition
| Deliruim, incontience, fraility, falls, polypharmacy. You want to prevent this syndrome from getting out of hand. After taking 9 or more meds, they are "flagged" It consists of medication prescribing and avoiding risky diagnostic workups. |
|
|
Term
| What class of drugs are known to have SE of less falls in the elderly? Give 2 really good examples. |
|
Definition
| TCAs such as Norpremine and decipramin. DO NOT GIVE XANAX (TCAs are the best antidepressants for elderly) |
|
|
Term
| If there is a leakage of urine while laughing and coughing, this is called? |
|
Definition
|
|
Term
| What should be used to assess alzhiemer's? |
|
Definition
|
|
Term
| How does Meniere's dz present? |
|
Definition
| Vertigo, tinnitus, hearing loss |
|
|
Term
| What is a full thickness decubital ulcer? What stage is it? |
|
Definition
| It is an ulcer that extends down to the fascia but NOT into it. It is a stage 3 decubiti. |
|
|
Term
| If a pt complains of back pain, what are some other things you should consider? |
|
Definition
| AAA, spinal mets (tumor), urinary bladder syndrome, bowel issues. |
|
|
Term
| What is the life expectancy of an individual with alzheimer's? |
|
Definition
|
|
Term
| What are some DDX for sexual dysfunction? What work-ups should u do? |
|
Definition
| Hormonal, endocrine (thyroid), neuro |
|
|
Term
| What affects does aging have on the kidneys? |
|
Definition
| It causes a decrease in creatinine clearance, therefore causing decrease renal BF. |
|
|
Term
| What is the purpose of CYP450? |
|
Definition
| Competes for transformation through liver enzymes. |
|
|
Term
| What is significant about grapefruit juice? |
|
Definition
| Competes with P450 binding sites (BP MEDS). It is an inhibitor which causes increased levels of the drug that could be toxic. This is also seen with CCBs. |
|
|
Term
| Can elderly men have premature ejaculation without an erection? |
|
Definition
|
|
Term
| Can elderly men have premature ejaculation without an erection? |
|
Definition
|
|
Term
| Menopause is associated with (5)? |
|
Definition
1. Decrease sexual function
2. Decreased sexual interest
3. Decreased responsiveness
4. Decreased coital frequency
5. INCEASED urogenital sx- often not discussed with the MD** |
|
|
Term
|
Definition
| Certain foods or drugs that can cause drug interactions. They decrease metabolism of drugs causing either increase drug effect or toxic effects. |
|
|
Term
|
Definition
| They increase metabolism of a drug, which can lead to decreased drug effects and lower levels. |
|
|
Term
| Why should Soma be avoided? |
|
Definition
| It has active metabolites that can be very addicting. Benzos will give drug hangovers and can build up in the body. |
|
|
Term
| When giving meds to the elderly, what should be monitored? |
|
Definition
|
|
Term
| What are common SE of ACEi? |
|
Definition
|
|
Term
| Arthritis meds can be toxic to pts with what type conditions? |
|
Definition
|
|
Term
| What affect may aminoglycsodies have on the elderly? |
|
Definition
|
|
Term
| IV contrast can be ____________ to pts. What should be monitored when giving a pt IV contrast? |
|
Definition
| nephrotoxic. MONITOR creatinine. |
|
|
Term
| Demerol should not be used in elderly pts with delirium bc? |
|
Definition
| Can cause serotonin syndrome and renal insufficiency. (Automatic substitition). Also leads to respiratory depression |
|
|
Term
| When is IV demerol approved? |
|
Definition
|
|
Term
| ACEi can cause ______ in elderly men. |
|
Definition
|
|
Term
| When using the Vacumm tumescence device, how long should the ring be left on for? |
|
Definition
|
|
Term
| Do the elderly have more or less gastric acid? How does this affect drug absorption? |
|
Definition
| LESS. Drugs that require a low pH to be broken down are not absorbed as well. |
|
|
Term
| Are topical meds in the elderly absorbed slower or quicker? why? |
|
Definition
| Slower. B/C skin perfusion has declined. |
|
|
Term
| Do the elderly have more or less free water in the body? What does this lead to? |
|
Definition
| LESS. This leads to higher active drug concentrations. |
|
|
Term
| Malnutrition in the elderly affects proteins in which way? |
|
Definition
| Causes less serum protein for drugs to bind to causing higher serum levels. |
|
|
Term
| Oftentimes drug levels in the elderly are higher bc their bodies are not processing it as fast. What causes this? From a providers stand point, what should you do about this? |
|
Definition
| Liver mass + decreased hepatic BF + decreased renal clearance. Reduce dosages and monitor creatinine clearance. |
|
|
Term
| Which drugs are the elderly more sensitive to? |
|
Definition
| Warfarin and centrally acting drugs like NSAIDs |
|
|
Term
| Oftentimes drug levels in the elderly are higher bc their bodies are not processing it as fast. What causes this? From a providers stand point, what should you do about this? |
|
Definition
| Liver mass + decreased hepatic BF + decreased renal clearance. Reduce dosages and monitor creatinine clearance. |
|
|
Term
| As the provider, what are important things to counsel elderly pts on? |
|
Definition
| Drug interactions and lifestyle. (ie smoking and ETOH) |
|
|
Term
| What drugs cause confusion in the elderly? Examples of these drugs include: |
|
Definition
Anti-Ach.
1. Flurosemide (all loop diuretics)
2. Clonidine
3. H2 blockers (Cimetidine, Ranitidine)
4. SSRIs and TCAs
5. Opiods
6. Benzos and some antipshych drugs
7. Digitalis
8. NSAIDs
9. BB (Propanolol)
10. Fluroquinolones |
|
|
Term
| What drugs are esp associated with falls? |
|
Definition
1. Anticonvulsants
2. HTN
3. TCAs, Benzo
4. Diruetics
5. Vasodilators
6. Opioids |
|
|
Term
| As a provider what it important to note about drug interactions and polypharmacy? |
|
Definition
| You need to be careful. SE can be visible (rash, vomiting) or subtle (personality changes, somnolence) |
|
|
Term
| What is signficant with alternative therapy? |
|
Definition
| These meds (herbals, supplements) can interact with their Rx meds....monitor these and be very careful! |
|
|
Term
| How should you manage Polypharmacy?? |
|
Definition
1. Minimize the # of drugs they are taking
2. Consider the alternatives
3. Start low, go slow
4. Titrate therapy to get the goal
5. Educate the pt, family
6. Review the drug list at each visit
7. Don't give one drug just to fix another drug's SE
8. Some drugs may worsen existing conditions--> arthritis meds and kidney dz
9. USE as FEW drugs as possible--> there may be competition for absorption and metabolism of each drug
10. Metabolism is changes by other drugs and diet- avoid grapefruit juice with meds! |
|
|
Term
| How can drugs affect social activities? |
|
Definition
| They can change them. Pts may quit drugs and not tell the MD. |
|
|
Term
|
Definition
| When a pt quits taking a drug for a period of time if they feel it is in their best interest. Some drugs may be discontinued with CLOSE follow up- be sure to monitor them! |
|
|
Term
| Conditions that contribute to gait disorders include? |
|
Definition
1. DJD
2. Acquired musculoskeletal deformities
3. Intermittent cladication
4. Impairments following orthopedic surgery
5. Impairments following stoke
6. Postural hypotension
7. Dementia
8. Fear of falling |
|
|
Term
| Parkinsonism is what type of gait disorder? What are the sx? |
|
Definition
| Middle sensorimotor level gait disorder. Sx: small shuffling steps, hesitation, propulsion, retropulsion, turning en bloc, absent arm swing |
|
|
Term
| Cerebellar ataxia is what type of gait disorder? What are common sx of this disorder? |
|
Definition
| Middle sensorimotor level. Sx: antalgic (wide-based) gait with increased trunk sway, irregular stepping. |
|
|
Term
| What does the neuroendocrine theory state about the hypothalamus? |
|
Definition
| As we age, the hypothalamus looses its precision of action. |
|
|
Term
| What are the 2 leading chronic conditions shared by both sexes? |
|
Definition
|
|
Term
| What are the top chronic conditions in elderly men? |
|
Definition
1. Hearing impairment
2. Heart Condition
3. Arthritis
4. HTN
5. Cararacts |
|
|
Term
| What are the top chronic condition in elderly women? |
|
Definition
1. Arthritis
2. HTN
3. Heart condition
4. Hearing impairment
5. Cataracts |
|
|
Term
| Memory impairment begins to rapidly deteriorate in men and women after ____ years. |
|
Definition
|
|
Term
| Depression is more common among with sex? |
|
Definition
| Women-- but as people age, the ratio evens. |
|
|
Term
| Which race reports better health across all decades among both sexes than other minority groups? |
|
Definition
|
|
Term
| What is the #1 cause of death among people 65+? |
|
Definition
|
|
Term
| What comprises the bulk of medicare expeditures? |
|
Definition
| Inpatient hospitaliztions and outpatient medical expenses. |
|
|
Term
| What is the Barthel Index? |
|
Definition
10 items that measure a person's daily functioning. These include:
1. Feeding
2. Moving
3. Personal toilet use
4. transfers (on/off toilet)
5. bathing self
6. walking
7. mobility ease (assistive devices used?)
8. Stairs
9. Dressing
10. Continence- BM and bladder control |
|
|
Term
| How is the score assessed for Barthel's Index? |
|
Definition
| Person receives a score based on whether they have received help while doing the task. The higher the score, the more independent the person. |
|
|
Term
| What is Fostein's Mini Mental State Exam (MMSE)? |
|
Definition
| (Recall 3 items) It is widely used. Tests orientation, registration, recall, attention, calculation, language, visual-spatial skills. A number score is given in 5-10 minutes. |
|
|
Term
| If a pt has difficulty with immediate recall of 3 words during the Mini Mental State Exam (MMSE), this generally indicates? |
|
Definition
|
|
Term
| If a pt has difficulty with predominant recall after 5 minutes of 3 words during the Mini Mental State Exam (MMSE), this generally indicates? |
|
Definition
|
|
Term
| If a pt deficits of attention recognized by inability to spell simple words backwards, repeat 5 digits or recite the months backwards during the MMSE, this suggests? |
|
Definition
|
|
Term
| Hbg, serum BUN, creatnine, glu can help exclude what in the elderly? |
|
Definition
| dehydration, anemia or hyperglycemia. |
|
|
Term
| Is the holter monitor good for routine eval? |
|
Definition
| NO. There is no proven value for it. |
|
|
Term
| What you do to uncover carotid sinus hypersensitivity? |
|
Definition
| Carotid sinus massage with continous HR and BP monitoring. |
|
|
Term
| What is important to order for ALL geriatric services? |
|
Definition
| PT and OT. Many MDs do not know how to order this. |
|
|
Term
| Black stool can indicate what? |
|
Definition
|
|
Term
| Small amounts of diarrhea can indicate what? |
|
Definition
|
|
Term
| Prune juice is excellent for what? |
|
Definition
| Stimulates peristalsis, accelerating transit. (stimulants and softeners) |
|
|
Term
| Polyethyleneglycol is good for what? |
|
Definition
| Consitiation or impaction. This is Miralaz....lots of MDs use this. |
|
|
Term
| Many drugs have SE of dizzy. Dizzy with postural changes is MC in those with? |
|
Definition
|
|
Term
| What is the preferred class of drugs for most anxiety disorders? |
|
Definition
|
|
Term
| Depression in the elderly causes: |
|
Definition
| Marked disability, hastened functional decline, increased hospitalization, diminshed QOF, increased medical services, increased mortality (4x) |
|
|
Term
| What makes dx of depression in older people more difficult? |
|
Definition
| They more often report somatic sx, less often report depressed mood to to guilt, may present with masked depression (more concerned about physical condition) |
|
|
Term
| What are the risk factors of depression? |
|
Definition
| Medical illness, fxnal disability, social isolation, total life stressors and losses, genetic vulnerabilites. |
|
|
Term
| Do not give Nortriptyline or Desipramine in the presence of: |
|
Definition
| Conduction disturbance, heart dz, intolerance to anticholinergic SE |
|
|
Term
| SSRIs are used when...to tx depression? SE include? |
|
Definition
| Mild to mod severe depression, use if TCAs are contraindicated or not tolerated. SE: anxiety, agitation, N, D, sex effects, psuendoparkinsonism, increase warfarin effect, hyponatremia/SIADH, falls and fxs |
|
|
Term
| When are MAOIs indicated for depression? SE? MOA? |
|
Definition
| If TCAs and SSRIs don't work. SE: Orthostatic hypotension, falls, life-threatening HTN crisis if taken with tyramine rich foods, SS if taken with SSRIs (Meperidine). MOA: Blocks monoamine oxidase enzyme in CNS which precvents the breakdown of NT |
|
|
Term
| ECT (Electoconvulsive therapy) is the 1st line tx for pts with? What improves with ECT? |
|
Definition
Serious risk of suicide (70% success rate for MDD)
Anterograde amnesia improves rapidly after tx, retrograde more persistent (events prior to tx may be forgotten) |
|
|
Term
| What is geriatric psychosis? |
|
Definition
| The 1st sign of medical, neurologic or substance-induced condition. It is a LOSS OF CONTACT WITH REALITY. Need eval--> send to psych. |
|
|
Term
| Risk factors for psychosis include: |
|
Definition
1. deterioration of cortical areas
2. neuro and chemical changes
3. hearing and visual impairments
4. social isolaton
5. congitive deficits |
|
|
Term
| What are the risk factors for sucicide in older adults? |
|
Definition
| depression, physical illness, living alone, male, alcoholism- VIOLENT sucicdes are MC |
|
|
Term
| what are the risk factors for ETOCH dependence? |
|
Definition
| social isolation, depression, financial stress, housing needs, spousal loss/death |
|
|
Term
| What should be considered as a factor for people who fall, have appetite/memory problems, trouble sleeping and depression? |
|
Definition
|
|
Term
| What drug might help relapse to ETOH abuse in 50-70 yo? |
|
Definition
| Naltroxone (elderly pts are most likely to comply to absintence programs) |
|
|
Term
| What are some factors assoc with nursing home placement? |
|
Definition
1. Increasing age
2. Low income
3 .Poor family supports (esp lack of spouse/children)
4. Accepting attitude toward nursing home
5. Cognitive and functional impairment |
|
|
Term
| What do you use to test the PROGRESSION of dementia in old ppl? |
|
Definition
|
|
Term
| What is one of the most correctable reasons for dementia? |
|
Definition
|
|
Term
|
Definition
1. Degenerative Disorders- MS, Alzeimers, huntings, creurtfeldt-jacob (mad cow)
2. CV- Stoke/TIZ, infarct, Endocarditis
3. Trauma- brain injury, subdural, concussion, punch drunk
4. Infections-meningitis, enceph, spesis, syphilis |
|
|
Term
| Meds that require Caution include: (4) and SE of them: |
|
Definition
1. Anti-Ach- Dryness, sedation, urinary retention, blurred vision
2. Long Acting/Active Metabolites- have hangover effect (Benzos)
3. NSAIDs- GI Bleeds, Renal failure
4. Drugs with narrow theraprutic index- dig, coumadin, dilantin, quinidine |
|
|
Term
| What % of pts cannot get up without help after a fall? What predicts function decline? |
|
Definition
| 50%; if they are stuck lying on the ground for a long time ("long lie") |
|
|
Term
| What 3 conditions contribute to hip fx? |
|
Definition
| Osteopenia, osteoporosis, vit D def. |
|
|
Term
| If the pt has a single fall, what should you check for? |
|
Definition
| Balance or gait disturbance |
|
|
Term
| If a pt has recurrent falls, what should u check? |
|
Definition
| hx, meds, joints, CV, neuro reasons. |
|
|
Term
| What is the "get up and go test"? What are the time frames and what do they indicate? |
|
Definition
Test to see hoe long it takes to get out of chair, walk 10 feet, turn, return to chair and sit. Should be 10 secs for a healthy adult. Elderly may be btw 11-20.
If over 14s- increased risk of fall
If over 20s-need to do comp eval.
*This test shows a strong correlation btw functional independence and ability to do ADL's. |
|
|
Term
| What is the "get up and go test"? What are the time frames and what do they indicate? |
|
Definition
Test to see hoe long it takes to get out of chair, walk 10 feet, turn, return to chair and sit. Should be 10 secs for a healthy adult. Elderly may be btw 11-20.
If over 14s- increased risk of fall
If over 20s-need to do comp eval.
*This test shows a strong correlation btw functional independence and ability to do ADL's. |
|
|
Term
| Is incontience a sx or dz? |
|
Definition
|
|
Term
| What are reversible causes of incontience? |
|
Definition
"DRIP"
1. Delirium, drugs
2. Restricted mobility, retention of urine
3. Infection, inflammation, injury, impaction, illness
4. Polyuria, pharmaceuticals |
|
|
Term
| What are the persistent causes of incontinence? |
|
Definition
1. Stress- leakage increased with intrabd. pressure- MC in WOMEN
2. Urge- inability to delay bladder emptying (deturssor hyperactivity) MC in ELDERLY
3. Overflow-pressure of full bladder exceeds that of outlet of outlet which is partially obstructed; enlarged prostate
4. Functional- US is nrl (impaired mobility, unaware of need to urinate). MC in DEMETIA, NEURO, IMPAIRED MOBILITY |
|
|
Term
| Small gut has propagated motor activity every: |
|
Definition
|
|
Term
Food stay in s. intestine for?
Lg. intestine? |
|
Definition
| Small- 1-2h; lg-1-3 days. GI transit is prolonged in the elderly |
|
|
Term
| What body parts are affected in regards to the colon and consitipation? |
|
Definition
| external anal sphincter and pelvic floor strength decrease; decreased rectal sensation in elderly with hx of impactation. |
|
|
Term
| Meds known to cause constipation include: |
|
Definition
1. CCBs
2. Narcotics
3. antidepre
4. anti-Ach
5. Ca
6. NSAIDS
7. Fe |
|
|
Term
| Disorders assoc with constipation: |
|
Definition
| 1. hypo K/mg, DM, parkinson's, dementia, strokes |
|
|
Term
| Structural disorders assoc with constipation: |
|
Definition
| anal fissures, mucosal prolapse, rectocele, divertic, pelvic floor dysfn, strictures |
|
|
Term
|
Definition
| spinning or motion. due to imbalance in vestib system from middle ear, brainstem, cerebellum. MCC: BPPV, cerebrovascular dz, larrinthitis, vestibular neuronitis |
|
|
Term
|
Definition
| Recurrent verigo and tinnitus. ear stuffiness may precede attack. Rx= diurtics, endolyphatic shunt for severe. |
|
|
Term
| Discribe REM sleep with aging. |
|
Definition
| REM sleep decreases with aging. Stages 1 and 2 increase, 3 and 4 decrease. |
|
|
Term
| What is organic brain syndrome? |
|
Definition
| dz that are not psych disorders, but cause decreased mental fxn. (NOT A DZ) Loss of fxn is not normal for a pts age. |
|
|
Term
| What are the sx of organiz brain syndrome?? |
|
Definition
| agitation, confusion, loss of brain fxn short term (delirium) and long term (dementia) |
|
|
