NUR 209 MIDTERM EXAM 2024 NEWEST EXAM WITH ACTUAL
EXAM QUESTIONS AND 100% CORRECT ANSWERS EXCELSIOR
COLLEGE (BRAND NEW!!) / ALREADY GRADED A+
leading cause of injury in older adults? - ANSWER: Falls!
- pts who fall are more likely to be admitted to long term care
- a hx of falls is a big predictor for future falls!!
Cataract Surgery: indications - ANSWER: - must be 20/40 or worse,
- and sx like glare, halo, and photosensitivity
Cataract Surgery: complications - ANSWER: infection, retinal detachment, corneal
edema
Cataract Treatment - ANSWER: - prevent with multivitamins, antioxidant foods,
supplements
- Surgery (vision must be 20/40 or worse, and sx like glare, halo, and
photosensitivity)
- Complication: infection, retinal detachment, corneal edema
Presbyopia - ANSWER: Farsightedness as a result of aging
- poor accommodation
- hardening of the crystalline lens (nuclear sclerosis)
- atrophy
- decreased photoreceptors in the retna
Pharmacokinetics - ANSWER: the body's effect on the drug
absorption, distribution, metabolism, and excretion
how is absorption different in geriatric patients - ANSWER: -certain diseases and
medications can cause increased GI motility (absorbs less drug) or increase motility
(sits there and is over-absorbed)
- decreased perfusion of blood to GI system, decr peristalsis
- antacid and PPI drugs = increased gastric pH (more basic( which affects absorption
of other drugs
- atrophy of GI tract = decr surface area &villi for absorption
- less active transporters, altering absorption
,- *absorption SPEED is SLOWED, but the total amount absorbed is unchanged from
young*
How is distribution different in geriatric pts - ANSWER: - older pts have more fat and
less lean mass = fat soluble drugs have more volume to distribute over = decr serum
levels
- old ppl have less total body water = hydrophilic drugs have less volume to
distribute over, causing incr serum level
- old pts have decreased serum albumin levels = drugs that bind to proteins will have
less to bind to = increased free floating active drugs in blood
How is metabolism different in geriatric pts - ANSWER: - Phase 1 metabolism
(cytochrome P450) system is used to metabolize drugs, and decreases with age.
The P450 system can be inhibited or activated by other drugs/food
- individuals can have genetic polymorphisms = fast ultra-metabolizers
- First pass/Phase 1 metabolism (activates the drug): decr by 1% per year
- Phase 2 (hepatic/conjunction) metabolism = for inactivating drugs mostly
How is excretion different in geriatric pts - ANSWER: - aging = decreased RENAL
FUNCTION (decr is mass and perfusion of kidney)
- low creatinine is a less reliable indicator of poor renal function in adults bc they
have decr muscle mass
- increased half life for water soluble drugs
Creatinine Clearance Formula - ANSWER: 1.2 (140-age) (weight in kg)
______________________________________
Serum creatinine (umol/L)
(for women, replace 1.2 with 0.85)
Pharmacodynamics - ANSWER: How the drug affects the body
How is the CARDIOVASCULAR system different in geriatric pts - ANSWER: - decr
baroreceptors sensitivity (therefore = postural hypotension caused by
antihypertensives)
- decr sensitivity and number of beta-adrenoreceptors (therefore decr
vasodilation/constriction when in need)
,- more likely to have prolonged QT interval (risk of arrhythmia and even vfib/MI)
How is the RENAL system different in geriatric pts - ANSWER: - incr risk of
dehydration, hypovolemia, and electrolyte imbalances (esp if given diuretics)
- worse kidney function/perfusion = diuretics don't reach the site of action on kidney
very well = may need a BIGGER diuretic dose
Geriatric pts have ___creased sensetivity to CNS drugs - ANSWER: increased
7 Categories of Medication Problems - ANSWER: - Medical condition that requires
new
or additional drug therapy.
•
Patient taking unnecessary drug
given present condition.
•
Incorrect drug for patient's medical
condition.
•
Correct drug, dose too low.
•
Correct drug, dose too high.
•
Adverse drug reaction.
•
Patient not taking drug correctly.
MRPs - ANSWER: medication related problems
3D CARE - ANSWER: Medication review acronym!
• Is the DRUG indicated and best choice (Beers list)?
• Is the DOSAGE and DURATION correct?
• Are there COMPLIANCE issues?
• Are there ADVERSE REACTIONS as result of: drug-drug interactions? or drug-
disease/condition interactions?
• Is this drug the least EXPENSIVE alternative compared to others of equal utility?
Criteria to decide which Drugs to Avoid - ANSWER: - STOPP (screening tool of older
persons prescriptions)
- BEERS criteria
- therapeutic competition (which drugs are most important/prioritized?)
- therapeutic burdern (cost/benefit)
Criteria of drugs to keep - ANSWER: - START (Screening Tool to Alert to Right
Treatment) criteria
, - Bisphosphonates, vitamin D, and calcium in patients on chronic
corticosteroid therapy (to promote bone health)
- Antiplatelet therapy, for pts with coronary, cerebral,
or peripheral vascular disease (but avoid combining with antiplatelets = bleed risk)
- Proton pump inhibitor with severe GERD (but: PPI can affect absorption of other
drugs & nutrients)
Hypoglycemic Drugs - ANSWER: - use long acting insulin, avoid sliding scale
(consistency is key)
- sulfonylureas: can cause weight gain, so pts try to lose weight and eat less, but still
take insulin = hypoglycemic episode
- metformin is preferred ? sulfonylureas
Risks of being on PPIs - ANSWER: RISKS: altered pH = worse absorption = Vit B12 and
magnesium deficiency, bone fractures, pneumonia, C. Diff infection in GI
Pts who SHOULD be on PPIS: - ANSWER: - Barrett's Esophagus pts: incr risk of
esophageal cancer!
- Severe GERD & esophageal inflammation
- Hx of bleeding gastric ulcers
- Pts taking chronic/long term NSAIDS
NSAIDS Risks - ANSWER: - incr GI bleed risk
- worsen CHF (decr renal perfusion & causes incr water and Na+ retention)
- can exascerbate respiratory issues! ("AIA & NERD")
Aspirin Risks - ANSWER: - antiplatelet= bleed rsk
- nephrotoxic!
- Renal failure: NSAIDS block prostaglandins = excess vasoconstriction = overwhelms
kidneys
- elevates liver enzymes
Benzodiazepine risks - ANSWER: - BZs can cause dependence, memory problems and
daytime
fatigue.
•associated with dementia and falls
Use Benzos only in:
Unmanaged anxiety, depression, physical or mental condition that
may be causing insomnia
Alcohol withdrawal
Antipsychotic Drugs Risk - ANSWER: - higher dose = higher sfx
- incr risk for falls, strokes, MI, diabetes, weight gain, high cholesterol
- rare: neuroleptic malignant sx (fever, hypertensive)
EXAM QUESTIONS AND 100% CORRECT ANSWERS EXCELSIOR
COLLEGE (BRAND NEW!!) / ALREADY GRADED A+
leading cause of injury in older adults? - ANSWER: Falls!
- pts who fall are more likely to be admitted to long term care
- a hx of falls is a big predictor for future falls!!
Cataract Surgery: indications - ANSWER: - must be 20/40 or worse,
- and sx like glare, halo, and photosensitivity
Cataract Surgery: complications - ANSWER: infection, retinal detachment, corneal
edema
Cataract Treatment - ANSWER: - prevent with multivitamins, antioxidant foods,
supplements
- Surgery (vision must be 20/40 or worse, and sx like glare, halo, and
photosensitivity)
- Complication: infection, retinal detachment, corneal edema
Presbyopia - ANSWER: Farsightedness as a result of aging
- poor accommodation
- hardening of the crystalline lens (nuclear sclerosis)
- atrophy
- decreased photoreceptors in the retna
Pharmacokinetics - ANSWER: the body's effect on the drug
absorption, distribution, metabolism, and excretion
how is absorption different in geriatric patients - ANSWER: -certain diseases and
medications can cause increased GI motility (absorbs less drug) or increase motility
(sits there and is over-absorbed)
- decreased perfusion of blood to GI system, decr peristalsis
- antacid and PPI drugs = increased gastric pH (more basic( which affects absorption
of other drugs
- atrophy of GI tract = decr surface area &villi for absorption
- less active transporters, altering absorption
,- *absorption SPEED is SLOWED, but the total amount absorbed is unchanged from
young*
How is distribution different in geriatric pts - ANSWER: - older pts have more fat and
less lean mass = fat soluble drugs have more volume to distribute over = decr serum
levels
- old ppl have less total body water = hydrophilic drugs have less volume to
distribute over, causing incr serum level
- old pts have decreased serum albumin levels = drugs that bind to proteins will have
less to bind to = increased free floating active drugs in blood
How is metabolism different in geriatric pts - ANSWER: - Phase 1 metabolism
(cytochrome P450) system is used to metabolize drugs, and decreases with age.
The P450 system can be inhibited or activated by other drugs/food
- individuals can have genetic polymorphisms = fast ultra-metabolizers
- First pass/Phase 1 metabolism (activates the drug): decr by 1% per year
- Phase 2 (hepatic/conjunction) metabolism = for inactivating drugs mostly
How is excretion different in geriatric pts - ANSWER: - aging = decreased RENAL
FUNCTION (decr is mass and perfusion of kidney)
- low creatinine is a less reliable indicator of poor renal function in adults bc they
have decr muscle mass
- increased half life for water soluble drugs
Creatinine Clearance Formula - ANSWER: 1.2 (140-age) (weight in kg)
______________________________________
Serum creatinine (umol/L)
(for women, replace 1.2 with 0.85)
Pharmacodynamics - ANSWER: How the drug affects the body
How is the CARDIOVASCULAR system different in geriatric pts - ANSWER: - decr
baroreceptors sensitivity (therefore = postural hypotension caused by
antihypertensives)
- decr sensitivity and number of beta-adrenoreceptors (therefore decr
vasodilation/constriction when in need)
,- more likely to have prolonged QT interval (risk of arrhythmia and even vfib/MI)
How is the RENAL system different in geriatric pts - ANSWER: - incr risk of
dehydration, hypovolemia, and electrolyte imbalances (esp if given diuretics)
- worse kidney function/perfusion = diuretics don't reach the site of action on kidney
very well = may need a BIGGER diuretic dose
Geriatric pts have ___creased sensetivity to CNS drugs - ANSWER: increased
7 Categories of Medication Problems - ANSWER: - Medical condition that requires
new
or additional drug therapy.
•
Patient taking unnecessary drug
given present condition.
•
Incorrect drug for patient's medical
condition.
•
Correct drug, dose too low.
•
Correct drug, dose too high.
•
Adverse drug reaction.
•
Patient not taking drug correctly.
MRPs - ANSWER: medication related problems
3D CARE - ANSWER: Medication review acronym!
• Is the DRUG indicated and best choice (Beers list)?
• Is the DOSAGE and DURATION correct?
• Are there COMPLIANCE issues?
• Are there ADVERSE REACTIONS as result of: drug-drug interactions? or drug-
disease/condition interactions?
• Is this drug the least EXPENSIVE alternative compared to others of equal utility?
Criteria to decide which Drugs to Avoid - ANSWER: - STOPP (screening tool of older
persons prescriptions)
- BEERS criteria
- therapeutic competition (which drugs are most important/prioritized?)
- therapeutic burdern (cost/benefit)
Criteria of drugs to keep - ANSWER: - START (Screening Tool to Alert to Right
Treatment) criteria
, - Bisphosphonates, vitamin D, and calcium in patients on chronic
corticosteroid therapy (to promote bone health)
- Antiplatelet therapy, for pts with coronary, cerebral,
or peripheral vascular disease (but avoid combining with antiplatelets = bleed risk)
- Proton pump inhibitor with severe GERD (but: PPI can affect absorption of other
drugs & nutrients)
Hypoglycemic Drugs - ANSWER: - use long acting insulin, avoid sliding scale
(consistency is key)
- sulfonylureas: can cause weight gain, so pts try to lose weight and eat less, but still
take insulin = hypoglycemic episode
- metformin is preferred ? sulfonylureas
Risks of being on PPIs - ANSWER: RISKS: altered pH = worse absorption = Vit B12 and
magnesium deficiency, bone fractures, pneumonia, C. Diff infection in GI
Pts who SHOULD be on PPIS: - ANSWER: - Barrett's Esophagus pts: incr risk of
esophageal cancer!
- Severe GERD & esophageal inflammation
- Hx of bleeding gastric ulcers
- Pts taking chronic/long term NSAIDS
NSAIDS Risks - ANSWER: - incr GI bleed risk
- worsen CHF (decr renal perfusion & causes incr water and Na+ retention)
- can exascerbate respiratory issues! ("AIA & NERD")
Aspirin Risks - ANSWER: - antiplatelet= bleed rsk
- nephrotoxic!
- Renal failure: NSAIDS block prostaglandins = excess vasoconstriction = overwhelms
kidneys
- elevates liver enzymes
Benzodiazepine risks - ANSWER: - BZs can cause dependence, memory problems and
daytime
fatigue.
•associated with dementia and falls
Use Benzos only in:
Unmanaged anxiety, depression, physical or mental condition that
may be causing insomnia
Alcohol withdrawal
Antipsychotic Drugs Risk - ANSWER: - higher dose = higher sfx
- incr risk for falls, strokes, MI, diabetes, weight gain, high cholesterol
- rare: neuroleptic malignant sx (fever, hypertensive)
