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137 Cards in this Set
- Front
- Back
Noncompliance ranges from __ to __%
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21, 55
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Most common adverse drug events due to?
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- NSAIDs
- Cardiovascular - Psychotropic |
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T/F - Drug absorption is decreased with age.
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False - little effect with age
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T/F - Most drug absorption is active.
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False - passive, dependent on drug conc
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T/F - Active drug absorption less absorbed in older adults.
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True
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What drugs/supplements are less actively absorbed?
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Calcium, organic calcium, certain vitamins (i.e. Vitamin D)
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Distribution of drugs in the body is dependent on...
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body composition, plasma protein binding, blood flow to organs
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T/F - Age leads to less water and fat.
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True
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(Fat/Water) soluble drugs have incr distribution, and (fat/water) soluble drugs are distributed less.
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Fat, water
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Barbituates (phenobarbital) and benzodiazapines (diazepam) are (fat/water) soluble drugs.
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Fat
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Ethanol, digoxin, and cimetidine are (fat/water) soluble drugs
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water
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T/F - Pharmaceutically active drugs are not bound to albumin
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True
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Age reduces albumin by __%. What is the significance of this?
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25%; more drug in system, thus intense clinical effect and greater risk of adverse effects
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The reduction of albumin with age is significant in which drugs mentioned?
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Warfarin, phenytoin
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T/F - Hepatic blood flow decreases w/ age.
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True
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T/F - Smoking does not affect the metabolism of drugs.
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False - affects metabolism
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T/F - Drugs do not break down as fast and stay in the body longer in the elderly.
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True
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How does drug elimination relate to the kidneys in the elderly?
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Decr renal blood flow and GFR so decr drug elimination
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What is the significance of creatinine? Does it decr, remain stable, or incr w/ age?
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Meas renal drug elimination. Decr.
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Monitor creatinine in pts taking these drugs...
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Digoxin, Chlorpropamide, Cimetidine, Lithium
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What effect does cigarette smoking have on metabolism?
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Induces hepatic microsomal enzyme activity but effect on drug metabolism is variable.
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The majority of hospital admissions in elderly is due to what type of disease?
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Cardiovascular
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T/F - HTN, especially diastolic pressure increases after age 50.
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False - systolic
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What impact does thiazide diuretics show on pts with renal impairment?
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Decreased natriuretic effect, esp when creatinine clearance below 20 ml/min - may lead to decr cardiac output and electrolyte imbalance
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What drug class incr risk of hypokalemia?
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Diuretics (thiazide diuretics?)
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Diuretic vision effects?
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Sudden onset myopia or changes in refraction
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Digoxin (cardiac glycoside) half life elimination is (incr/decr) in older adults?
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incr
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What cardiovascular drug class has a narrow dosage level difference between therapeutic and toxic levels?
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cardiac glycosides e.g. digoxin
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What drugs enhances digoxin effects?
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Diuretics and certain Ca-channel blockers e.g. verapamil
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Cardiac glycosides can cause what kinds of side effects?
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GI, cardiac, neuro, and visual disturbances (altered color vision - greens)
Toxicity = nausea, anorexia, fatigue, depression |
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T/F - Beta blockers are effective heart meds for the elderly.
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False - decreased clinical response due to reduced interaction w/ cell receptors; also higher side effects (depression, confusion, incr falls)
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Pts taking Ca-channel blockers and ACE inhibitors must be monitored for dosage and freq if they have what condition(s)?
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Renal, hepatic insufficiency
ACE inhibitors - acute renal failure, hypotension, hyperkalemia |
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With ACE inhibitors, you must monitor pts with (hypo/hyper)kalemia.
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hyper
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What significance do NSAIDs have with elderly?
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Interfere w/ prostaglandin synthesis, which also protects gastric mucosa and autoreg of renal blood flow. Signif incidence of GI dz and renal impairment in older pts.
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Tylenol is effective if the pt has no Hx of...
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hepatic dysfxn, alcohol abuse
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In what manner should NSAIDs be dosed?
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lowest dose, then incr slowly
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CNS drugs have a (enhanced/decreased) effect in older adults.
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enhanced
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Short half life in CNS drugs result in (more/less) falls.
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less
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Barbituates and benzodiazepines have (incr/decr) half life in elderly.
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incr
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What benzodiazepines are better alternatives for elderly? Why?
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Alprazolam, Lorazepam, and Tempazepam ("ALT") better since shorter half life.
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Desipramine and Trazodone are what kind of drug?
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Antidepressants
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When drugs are bound to albumin, they (can/cannot) pass the blood-brain barrier.
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cannot
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T/F - H1-blocking agents can cross the blood brain barrier (why/why not?).
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True - since highly lipophilic
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T/F - H1-blocking agents can have both depressive or stimulating effects.
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True - but mostly depressive in older pts
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Most common side effect of H1-blocking agents?
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sedation
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Older adults are (less/more) sensitive to the cognitive effects of H1-blocking agents?
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more
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H1-blocking agents are best dosed when?
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QHS
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Name two H1-blocking agents.
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Diphenhydramine (benadryl) and chlorpheniramine OTC.
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What is the advantage of 2nd generation H1-blocking agents?
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Do not cross blood-brain barrier thus less side effect of CNS depression
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H1-blocking agents can be Rxed with Pseudophedrine, but what ADEs should you watch for?
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Palpitations, HAs, insomnia in older adults
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H2-blocking agents are used for...
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peptic and duodenal disorders
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H2-blocking agents ADEs?
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Safe but HAs and mental confusion possible
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H2-blocking agents have contraindication with what drugs?
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Cimetidine (inhibitor of P450), drugs metabolized by P450 e.g. benzodiazepines, phenytoin, theophylline, warfarin
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Name the anticholinergic drug classes mentioned
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Hypnotics and Anti...psychotics, depressants, epileptics, spasmodics, histamines
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Anticholinergic drugs and elderly don't mix well because...
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Elderly more susceptible to impaired autonomic effects on GI, bladder, CNS; loss of memory and delirium w/ atropine; sudden loss of memory w/ scopolamine
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(Incr/Decr) mortality rates w/ antimicrobials in the elderly due to...
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Incr due to reduced host-defense mech and rxn to antimicrobials
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(Narrow/Broad) antibiotics are preferred in elderly.
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Broad
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Watch for decr renal fxn in these antibiotics...
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Fluoroquinolones, amantadine, tetracyclines (except doxy and minocycline)
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What consideration should you take in elderly pts w/ CHF or renal failure taking antacids?
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Sodium content in antacids - watch for pts w/ CHF and renal failure
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In elderly, antacids alters pH, (incr/decr) acidic drug absorption, and (incr/decr) basic drug absorption.
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incr, decr
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Alcohol (in consideration of cold/cough meds) can...
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potentiate effects of antipsychotics, sedatives, and H1 antihistamines
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Older pts w/ what kinds of problems are advised against the used of antihistamines or anticholinergic agents?
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Asthma, glaucoma, urinary tract probs
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Long term use of laxatives can cause...
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disturbances in electrolyte and water balance
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What types of laxatives are safest for chronic constipation?
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Bulk formers, stool softeners
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Megadose vitamin intake is assoc w/...
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renal and CNS effects
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Niacin side effects...
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Alter liver fxn and raise uric acid and glucose in blood
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What vitamins affect lab tests?
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Vit A and D
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Alcohol + CNS depressants = what ADE(s)?
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Enhanced depression
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Alcohol + Phenothiazines = what ADE(s)?
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Inhibition of phenothiazine absorption
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Alcohol + Aspirin = what ADE(s)?
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GI bleeding
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Alcohol + Tetracycline = what ADE(s)?
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Divalent cations prevent absorption of drug
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Topical Alpha-2 adrenergic ADEs?
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oral dryness, fatigue, ocular allergic rxn
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Topical nonselective adrenergic blockers (i.e. timolol) ADEs?
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bronchial, cardio, CNS effects e.g. fatigue, depression, confusion
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Adrenergic agonists ADEs?
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Dry upper respiratory passage, HAs, anxiety, tachycardia, hypertensive crisis
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T/F - Phenyl only causes tachycardia.
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False - can also cause reflex bradycardia
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What adrenergic agonist causes subarachnoid hemorrhages and occipital HAs?
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Phenyl
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T/F - Adrenergic-blocking agents causes constipation.
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False - diarrhea
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Name two cholinergic agonists.
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Pilo, echothiophate
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T/F - Pilo can cause GI disturbances.
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True
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T/F - Echothiophate can cause dryness of the mouth.
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False - salivation
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T/F - Atropine causes excessive urination.
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False - urinary retention (cholinergic antagonist!)
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T/F - Atropine decreases the heart rate.
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False - tachycardia
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T/F - Cyclopentolate causes drowsiness.
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True - also restlessness!
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T/F - Cyclopentolate causes restlessness
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True - also drowsiness!
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T/F - Cyclopentolate causes incoherent speech.
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True
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T/F - Local anesthetics cause bradycardia.
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False - tachycardia
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T/F - Local anesthetics cause nervousness.
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True
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T/F - Local anesthetics cause hypotension.
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True - and hypertension too!!!
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T/F - Topical adrenergic-blocking agents can cause asthma.
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True
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T/F - Sulfonamides causes contact dermatitis.
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False - Exfoliate dermatitis
Neomycin = contact dermatitis |
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T/F - Chloramphenicol causes erythema multiforme.
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False
Sulfonamides = erythema multiforme |
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What is a cheap alternative to tobradex?
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Maxitrol
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What is a cheap alternative to Vigamox/Zymar?
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Oculflox/Ciloxin
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What is a cheap alternative to Pataday?
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Zatidor
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RDA for elderly in older...
male (177lbs, 77kg) = ? kcal female (143lbs, 65kg) = ? kcal |
2300 kcal
1900 kcal |
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High protein diets are (more/same/less) digested and absorbed in elderly.
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less
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__g/kg of protein meets the need for elderly.
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1
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Carb absorption in elderly (incr/same/decr)?
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decr (slightly impaired)
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How does fat absorption compare in elderly vs younger?
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Equivalent up to 100g, but >120g/day less fat abs; institutionalized even less b/c body doesn't need to store it - don't move that much
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T/F - Elderly typically have good vitamin status.
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False - inadequate vitamin status common; poor food choices, inadequate dietary intake
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Vit A adequacy in elderly? Physiological change?
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may be too high; increased absorption
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Vit D adequacy in elderly? Physiological change?
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too low; decr skin synthesis, decr absorption
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Thiamine adequacy in elderly?
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adequate
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Riboflavin adequacy in elderly?
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adequate
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Vit B6 adequacy in elderly? Physiological change?
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too low; serum homocysteine levels rise when too low
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Folate adequacy in elderly?
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may be too low
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Vit B12 adequacy in elderly?
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may be too low
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Ascorbate adequacy in elderly?
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adequate
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Calcium adequacy in elderly?
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too low
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Iron adequacy in elderly?
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adequate
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Zinc adequacy in elderly?
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adequate
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Copper adequacy in elderly?
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adequate
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Selenium adequacy in elderly?
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adequate
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Magnesium adequacy in elderly?
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too high
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Chromium adequacy in elderly?
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too high
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What supplement type is the standard of care for ARMD?
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antioxidants
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*Undernutrition is defined as...
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- Lose >10lbs in 6 mo
- Lose 4-5% body wt in 1 yr - Lose 7.5% body wt in 6 mos |
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AREDS supplement regimen?
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Vit C 500mg
Vit E 400IU Beta carotene 15mg Zinc 80mg Copper 2mg |
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AREDS supplements decreased ARMD by __%
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25
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Free radical effect on carbohydrates?
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breaks chains of hyaluronic acid
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Free radical effect on nucleic acids?
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genetic defects
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Free radical effect on proteins?
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fragments plasma proteins, decr body fxns
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Free radical effect on lipids?
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cellular membrane function destruction (remember elderly tend to have leaner bodies)
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How does Vit E in the skin protect vs free radicals?
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prevents cell wall damage by reacting w/ free radicals
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What role does bilirubin and uric acid play in protecting the body?
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scavenge oxyradicals
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What role do plasma proteins play in protecting the body?
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reduce formation of atheromas on BV walls
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Free radicals result in lens (hydration/dehydration)?
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dehydration
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This harmful behavior diminishes levels of antioxidants, ascorbate, and carotenoids.
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Smoking
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Hyperbaric chambers cause...
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Reduced glutathione, incr glutathione sulfide
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T/F - There is a reduced size and frequency of B cell mediated response in the elderly.
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False - true for T-cells! No change for B-cells.
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How are phagocytosis and the ability to fight cancer in the elderly related?
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Antigen processing delayed
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What mineral is essential for cell mediated immunity?
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Zinc
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What mineral is essential for lymphocytic and granulocyte fxn?
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Iron
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Supplements of Vit C and Zinc in elderly increase ___ and ___ (immune responders).
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T-cells and IgG
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T/F - Obesity is a risk factor for diabetic retinopathy.
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True
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What antioxidant is excluded from the nutritional intervention of cataracts?
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Vitamin A
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T/F - HTN is a risk factor for ARMD.
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True
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