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40 Cards in this Set
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What is pharmacokinetics? |
“Pharmacokinetics is the study of what happens to a drug in the body. It takes into account all aspects of drug disposition in the body, including absorption from the administration site,distribution into various body compartments, and clearance from the body. Drug clearance is composed primarily of metabolism to active and inactive metabolites (by-products of drug metabolism)and renal excretion of parent drug and metabolites. In short, the practice of clinical pharmacokinetics strives to reduce drug toxicity without compromising efficacy and/or to increase efficacy while avoiding toxicity” (Robnett & Chop, 2015, p. 173). In summary it describes movement of drugs in the body. |
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What is gerotranscendence? |
“In an updated version of personality development, Erikson & Erikson include a 9th stage in their theory: gerotranscendence, which is associated with wisdom and a moving away from early and midlife materialism. Ardelt describes this “transcendence of the self” as a move toward selflessness, comparison,and reflection, all characteristics of a truly wise person” (Robnett & Chop, 2015, p. 130). |
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Give an example of a strategy to mitigate cognitive decline over the lifespan at a primary level of prevention. |
Primary prevention works with healthy populations to prevent disease or injury from occurring. Robnett& Chop (2015) suggest 5 strategies to mitigate cognitive decline: minimize disease risk and prevent disuse from occurring (p. 106 – 107), utilize compensatory techniques for memory (pp. 114-115), engage in novel & complex tasks on a regular basis (p. 118), participate in aerobic activity, “aerobic activity fosters the production of new neurons in the hippocampus, mental activity, especially learning new skills helps the newly formed neurons survive over the long term” (p. 156). |
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Identify one clinical implication of age-related changes in absorption for older adults. |
Absorption impacts how a drug gets into the body. Age related changes include:↑Gastric pH,↓Gastric emptying time,↓GI motility,↓GI blood flow,↓Cardiac output & blood flow (Robnett & Chop, 2015). Such changes can: “interfere with the dissolution or breakdown and subsequent pharmacologic response of some drugs” (Robnett &Chop, 2015, p. 174). More contact time with the stomach increase potential irritation/ ↑ drug-drug interactions possible (Robnett &Chop, 2015, p. 174); “despite preceding changes, the extent of absorption and resulting bioavailability of most drugs are not significantly affected in older adults. Because of the delay in gastric emptying and decreased motility, the rate of absorption may potentially be reduced, but any reduction is usually minor” (Robnett & Chop, 2015, p. 174). |
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Distribution refers to how a drug gets dispersed in the body. What are age-related changes that effect distribution of drugs in older adults? |
Age-related changes include:↓Lean muscle mass,↑Total body fat, ↓Total body water,↓Serum albumin, and ↓Cardiac Output (Robnett & Chop, 2015). |
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What is clearance metabolism and how may clearance metabolism differ in a 30-year-old as compared to a 75-year-old person? |
Clearance metabolism refers to the process of the liver & intestine eliminate drugs from the body by converting “drugs through various metabolic pathways to more hydrophilic metabolites” in preparation for excretion through the kidneys (Robnett & Chop, 2015, p. 175). Age-related changes that impact clearance include:↓ liver mass,↓hepatic blood flow, and↓enzyme activity. As a result it will take longer for the 75 year-old to metabolize drugs. |
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What is pharmacodynamics? How does it change with age? |
“Pharmacodynamics refers to the biological effects resulting from the interaction between a drug and its receptor site, and generally describes the relationship between plasma drug concentrations and an observed effect or response” (Robnett & Chop,2015, p. 177). “Equal concentrations of drug at the site of action produce different effects in the young and the old. Although relatively understudied, age-related pharmacodynamic changes in older adults can greatly influence drug response, usually leading to increased sensitivity or an exaggerated pharmacologic response to a given drug….altered responses may be the result of depletion of neurotransmitters and changes at the receptor site, including a decreased number of receptors and a decreased affinity or sensitivity of receptors overall” (Robnett & Chop, 2015, pp. 177-178). Note if drug dosage is changed in response to pharmacokinetics and desired plasma concentration is achieved, altered drug responses can still occur due to pharmacodynamic changes (Robnett & Chop, 2015, p. 177). |
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Whatis polypharmacy? What is one potential causeof polypharmacy. |
Polypharmacy“refers to the use of multiple medications in one individual” Potential causesinclude: ·Increased # of chronic illnesses or physicalailments ·Multiple healthcare providers/ uncoordinatedmedical care ·Multiple pharmacies ·Self-treatment (e.g., over-the-countermedications, herbal remedies, supplements) (Robnett & Chop, 2015, p. 178). |
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Describe a scenario of a medication-related problem. Provide a reason why the medication related problem occurred in this scenario. |
Robnett & Chop (2015) share 7 common medication-relatedproblems seen in older adult populations: · Untreated indications “occur when the patientdoes not receive the therapy indicated for some medical condition orprophylactic need, such as immunizations” (p. 179) · Drug use without indications · Improper drug selection · Incorrect dose · Adverse drug reactions · Drug interactions · Non-adherence |
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Provide a specific example of a warning sign of nutrition risk in an older adult. |
Warning signs may include: disease, eating poorly, tooth loss or mouth pain, economic hardship, reduced social contact, multiple medications, involuntary weight gain, needs assistance in self-care, and elder years past 80. DETERMINE is the acronym to help remember these warning signs. (Robnett & Chop, 2015, p..195). |
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Why are older adults at risk for low vitamin D levels, and what may low vitamin D levels increase the risk of in older adults? |
“The ability to synthesize vitamin D in the skin by sunlight decreases with age. In addition, older adults, especially those who are homebound, are less likely to get outdoors so exposure to sunlight is limited. Low vitamin D levels may increase the risk of falls and fractures and contribute to the development of osteoporosis” (Robnett & Chop, 2015, p. 198). |
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Name 3 of the 9 common symptoms of dehydration. |
1. Dry lips 2. Sunken eyes 3. Swollen tongue 4. Increased body temperature 5. Decreased blood pressure 6. Constipation 7. Decreased urine output 8. Nausea (most symptoms of a hangover are due todehydration) 9. Confusion(Robnett & Chop, 2015, p. 199) |
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Provide one specific example of a drug and nutrient interaction. |
Robnett & Chop (2015) share ideas on p. 207· “antihyperlipidemic drugs such as statins caninteract with niacin, a nutritional supplement (vitamin B2) increasing the risk of myopathy and rhabdomyolysis”· “Garlic interacts with Coumadin (warfarin) ananticoagulant and increases the risk of bleeding”· “Vegetables high in vitamin K (e.g., dark greenleafy vegetables, broccoli, cauliflower, cabbage) may decreased the effectiveness of Coumadin and increase the risk of clotting”· “Grapefruit juice affects the metabolism of a large number of drugs including statins. It increases the bioavailability of these drugs and can result in higher serum levels.” |
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Your client reports mouth pain. She has experienced a recent weight loss of 20 pounds. She wears dentures during the day and leaves them soak overnight. What may be occurring? |
If a person experiences significant weight gain or loss dentures may no longer fit; it is possible her dentures just don't fit correctly right now. |
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Define cachexia. |
Cachexia “a complex metabolic syndrome associated with underlying illness and characterized by loss of muscle with or without loss of fat mass. This is associated with the production of inflammatory cytokines that stimulate fat and muscle breakdown as well as anorexia. This condition is often resistant to nutritional intervention and must be treated by addressing the illness leading to the production of the cytokines” (Robnett & Chop, 2015, pp. 197-198). |
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Define sarcopenia and provide on reason sarcopenia may occur. |
Sarcopenia refers to a loss of muscle mass; “may be due to changes in endocrine function such as low estrogen and testosterone levels, or chronic diseases associated with insulin resistance and inadequate dietary protein intake”…also decreased physical activity (Robnett & Chop,2015, p. 198). |
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What is edentualism? Is this part of normal aging? |
Edentulism refers to toothlessness; this is not a normal part of aging (Robnett &Chop, 2015, p. 217) |
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What theory of aging resonates with you? Briefly describe this theory and why it makes sense to you. |
Various theories include: Genetic Theories of Aging: · somatic mutation theory· endocrine· immunological Environmental Theories of Aging· wear and tear theory· rate of living theory (focus on caloric restrictionto prolong life)· free radical theory of aging (see Robnett & Chop, 2015, pp. 57-60 for details of a theory). |
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Describe three normal age-related changes in the integumentary system. |
Robnett& Chop (2015) discuss several:· Basement membrane flattens out making skin more susceptible to “shearing forces,abrasion & blister formation (p. 62)· Epidermis replacement turnover rate decreases 30-50% between ages 20-70 (p. 62)· Melanocytes & resulting melanin pigment decreases – skin is more susceptible to UV light(p. 62)· Collagen& elastin in the dermis decrease = thinning & wrinkling of skin; reduced collagen makes skin vulnerable to wear and tear and decreased elastin causes skin to lose its resilience (p. 63)· Density of dermal blood flow decreases, decreasing signs of inflammation, so it is hard to tell when older adults have tissue injury such as from sunburn, cancer or bacterial infection (p.63)· Diminished dermal blood flow, plus decrease in sweat glands make older adults more susceptible to heat stroke (p. 63)· Decreased lamellate (Pacinian and tactile (Meissner corpuscles = reduced sensitivity to vibration, pressure & light touch (p. 63)· Thinning of subcutaneous layer of skin, particularly in face, backs of hands, & soles of the feet (can exacerbate foot conditions) (p. 63) · Graying, thinning & loss of hair Benign dermatologic skin lesions such as skin tags, seborrheic keratosis & subcutaneous nevi or moles (p. 63) |
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Is osteoarthritis a normal age-related change? |
No, osteoarthritis is common, but not a normal part of aging (Robnett & Chop, 2015, p. 71) |
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Describe two normal age-related changes in the musculoskeletal system. |
Robnett& Chop (2015) discuss several:· Osteoporosis(p. 71)· “loss of bone mass in the vertebrae cause …kyphosis, an exaggerated convex curvature of the upper spine…concomitant deformity of the rib cage can alter the normal mechanics of breathing. At about age 40,the rate of bone resorption surpasses the rate of new bone formation, with a subsequent loss of about 40% of total bone mass in women and 30% in men over the course of the life span. Bone resorption is most extreme in the inner spongy bone at the enlarged ends (epiphyses) and along the inside rim of long bones, making older bones more vulnerable to fractures from both compression and lateral impact” (p. 71)“the number of skeletal muscle fibers (cells)decrease with age…greater in muscles used less frequently” (p. 72)“variable decrease in muscle fiber size (atrophy) and capillary supply, an increase in deposition of lipofuscin and adipose (fat) cells, and a spotty loss of the motor neuron innervation → gradual decline in muscle strength and efficiency….regular physical training can improve muscles strength and endurance?(p. 72). |
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Describe one normal age-related change in the cardiovascular system. |
Robnett& Chop (2015) discuss several:· Heart “lipofuscin is deposited at a regular rate and mitochondrial DNA is damaged in cardiac muscle cells. Adipose tissue accumulates in and around the heart. The inner lining, or endocardium undergoes fibrosis (i.e., scarring), and there is a gradual loss of specialized conduction cells (auto rhythmic cells) that coordinate events of the cardiac conduction system” (p. 72-71)· Cardiac output decrease 1% a year after age 30 – “caused by a decrease in stroke volume caused in part by a decreased efficiency of cardiac muscles as well as a decreased responsiveness of the heart to the sympathetic nervous system, the branch of the nervous system whose effect is normally to increase the strength of the heart’s contraction, or contractility”, also decreased elasticity of smooth muscle of venous walls allow the veins to hold blood and decrease venous return rate → decreased preload and cardiac output (Starling’s law of the heart) (p. 73)· Ability to redirect blood flow to working organs during exercise decreases with age“largely because of decreased sympathetic nervous system activity; maximum heart rate decreases…a related problem also caused in part by insufficient sympathetic nervous system activity, is postural, or orthostatic hypotension,which is a fall in systemic blood pressure upon rising from a supine to a standing position (p. 74).Atherosclerosis “earliest evidence of fatty accumulation is detectable in the first decade of life…lesions progress throughout life” (p. 75) |
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Describe one normal age-related change in the respiratory system. |
Robnett& Chop (2015) discuss several:· “FVC(forced vital capacity), defined as the maximal volume of air breathed outduring on forced exhalation after maximal inhalation …declines at a steady rateof about 21 mL/year, primarily because of changes in soft tissue of thelings…elastin fibers in the lungs are altered, probably by both excessivecross-linking between fibers and breakage of individual fibers…lose some oftheir elastic recoil, and the small bronchioles tend to partially or completelycollapse during exhalation, causing obstruction of airflow and trapping of airin the alveoli. Air trapping decreasesthe rate of oxygen delivery to and carbon dioxide delivery from thebloodstream. In addition, air trappingin alveoli increases residual volume, which is the volume of air remaining inthe lungs after a forced exhalation. Because total lung capacity changes littlein a healthy aging person, any increase in residual volume comes at the expenseof decreasing FVAS. Further hampering of gas exchange occurs with age as aresult of a gradual loss of alveolar wall surface area, estimate to be a 4%decline per decade after age 30” (p. 78)Mechanical properties of the thorax wall – ribcage stiffens due to calcification of cartilage between ribs & vertebrae& due to kyphosis → limits mobility of the rib cage & makes itdifficult for external intercostal muscles, accessory muscles of inhalation(sternocleidomastoid & pectoralis major & minor) to expand the rib cage(p. 79). |
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Name two pathological changes that may occur in the digestive system. |
Robnett & Chop (2015) discuss several:Common, but not necessarily normal aging – teeth wear,osteoporotic changes in the jaw → loose teeth, recession of gums due toperiodontal disease, tooth loss, dental carries (cavities) usually secondary todifficulties with teeth brushing; xerostomia (dry mouth), dysphagia (difficultyswallowing), increased incidence of peptic ulcers & gastritis, storage ofbile in the gall bladder → gallstones, diverticulosis, fecal incontinence dueto weakening of the external anal sphincter muscle (pp. 85-88). |
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Describe one normal age-related change in the genitourinary system. |
Robnett & Chop (2015) discuss:· “because of loss pf nephrons (30 -40% loss by age 85) and the less efficient functioning of them that remain, the kidneys of older adults have a more difficult time responding to any added metabolic stressor on the body” (p. 88) – “decreased functional reserve capacity …makes it more difficult for the kidneys to efficiently excrete drugs” (p. 89)· Ability of kidneys to maintain appropriate water balance in the body decreases (p. 89). |
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Describe one normal age-related change in the central nervous system. |
Robnett & Chop (2015) discuss several:· Decrease numbers of neurons in the hippocampus, cerebellum, raphe nucleus, locus ceruleus,& nucleus basalis (p. 65)· “Important structural & functional alterations …axons…lose moderate amounts of myelin (a lipid wrapping around the axon that increases the speed of the nerve impulse) or become swollen with age. These changes may contribute to the 10% decrease in nerve impulse conduction velocity noted with aging, a phenomenon that is partly responsible for the slowed reaction time and speed of mental processing in older adults”(p. 66).· Degree of branching of dendrites decreases (p.66)· “Decline in neurotransmitter signaling mechanisms”– this is more a result of a loss of balance in neurotransmitters not an “absolute loss of any one particular neurotransmitter” (p.66)· Atherosclerosis– fatty plaques clog the cerebral arteries and decrease blood flow (p.66)“slowing of fine motor tasks, diminished postural reflexes, and alteration of gait…a more hesitant, broad-based gait…such deficiencies in motors skills have been attributed primarily to an overall decrease in function of motor control centers in the brain, such as the basal nuclei, cerebellum, and cerebral cortex” (p.67)Table on pp.108-109 summarizes corresponding changes in cognition:· Alternating between tasks is more difficult· Decreased memory acuity, especially with STM & source related information· Fluid intelligence declines; more difficulty with complex, multi-step tasks. |
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Identify if the following is a normal age-related change orpathological change: Increased difficulty hearing high frequencysounds |
Normal |
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Identify if the following is a normal age-related change or pathologicalchange: Increased difficult tuning out background noise |
Normal |
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Identify if the following is a normal age-related change or pathological change: Decreased taste and smell |
Normal |
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Identify if the following is a normal age-related change orpathological change: Loss of spatial awareness |
Pathological |
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Identify if the following is a normal age-related change or pathological change: Decreased hearing requiring hearing aids |
Pathological |
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Identify if the following is a normal age-related change or pathological change: Insomnia |
Pathological |
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Identify if the following is a normal age-related change or pathological change: Restless leg syndrome |
Pathological |
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Identify if the following is a normal age-related change orpathological change: Obstructive sleep apnea |
Pathological |
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When might an OT work on prospective memory tasks with anolder adult? |
An older adult experiencing pathological aging may have difficulty with prospective memory which relates to remembering to do something in the future (Robnett & Chop, 2015, p. 111). An example of a common task OT is involved in is managing routines, such as remembering when to bathe, went to take medications, when to call a family member, etc. |
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Identify if the following is a normal age-related change or pathological change: Decreased semantic memory |
PathologicalSemantic memory – “a cumulative knowledge base about theworld in general (e.g., language…mathematical facts…vocationalinformation…current events..)” this is part of crystallized intelligence. “Semantic memory changes portray a complexpicture in that elders have more word-finding problems (such as tip-of-the-tonguephenomenon), but vocabulary may even improve into old age”(Robnett & Chop, 2015, p. 112) |
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Identify if the following is a normal age-related change orpathological change: Decreased episodic memory |
NormalEpisodic memory – “oriented toward the past and is what most people think of when they think of the global term memory… declarative or conscious memory particularly involves remembering episodes or experiences in our lives…can be either short turn or long term… is particularly vulnerable to the effects of aging. When tested simultaneously, younger people tend to outperform older people on tests of episodic memory” (Robnett & Chop, 2015, p. 112) |
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Identify and describe three factors that may lead tocognitive impairment in older adults. |
1. Disease (Alzheimer’s & other dementias, Parkinson’sdisease, diabetes, cardiac disease, acquired brain injuries such asstroke) 2. Disuse 3. Aging (Robnett & Chop, 2015, p. 106) |
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Is hypertension a normal part of aging? |
Hypertension is common, but not anormal part of aging (Robnett & Chop, 2015, p. 74) |
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Is a change in IQ a normal part of aging? |
No. Overall IQ remains stable: crystalized intelligenceincreases and fluid intelligence decreases (Robnett & Chop, 2015, p .67). |
