Many of the changes that occur as part of aging affect pharmacokinetics.
Which one of the following is increased in geriatric patients?
Correct Answer E:
The physiologic changes that accompany aging result in altered pharmacokinetics. Drug distribution is one important factor. In older persons, there is a relative increase in body fat and a relative decrease in lean body mass, which causes increased distribution of fat-soluble drugs such as diazepam. This also increases the elimination half-life of such medications. The volume of distribution of water-soluble compounds such as digoxin is decreased in older patients, which means a smaller dose is required to reach a given target plasma concentration. There is a predictable reduction in glomerular filtration rate and tubular secretion with aging, which causes decreased clearance of medications in the geriatric population. The absorption of drugs changes little with advancing age. All of these changes are important factors in choosing dosages of medications in the elderly population.
A patient complains that her otherwise healthy 66-year-old husband takes longer to achieve an erection that he did at age 40.
You advise that:
Correct Answer A:
Part of the normal aging process changes in the human sexual response. Although it is natural for a 66—year-old man to take longer to achieve an erection, it is possible that other factors may be involved. This includes the use of other medications and chronic medical conditions. Should this be the case, then appropriate referral is indicated.
Which one of the following best defines the sensitivity of a diagnostic test for a particular disease?
Correct Answer B:
Sensitivity is the ability of a test to identify patients who actually have the disease, or the true-positive rate. Independent of the sensitivity is the test’s specificity, which is the ability to correctly identify patients who do not have the disease, or the true-negative rate. The greater the test’s specificity, the lower the false-positive rate; the greater the test’s sensitivity, the lower the false-negative rate.
Information derived from which one of the following provides the best evidence when selecting a specific treatment plan for a patient?
In general, the strongest evidence for treatment, screening, or prevention strategies is found in systematic reviews, meta-analyses, randomized controlled trials (RCTs) with consistent findings, or a single high-quality RCT. Second tier levels of evidence would be poorer quality RCTs with inconsistent findings, cohort studies, or case-control studies. The lowest quality of evidence would come from such sources as expert opinion, consensus guidelines, or usual practice recommendations.
→ Prospective cohort study (choice A) follows over time a group of similar individuals (cohorts) who differ with respect to certain factors under study, to determine how these factors affect rates of a certain outcome. In disease prevention and treatment, meta-analysis, systematic reviews, and randomized controlled trials have much stronger level of evidence.
→ Expert opinion (choice B) doesn't have as strong evidence as meta-analysis and systematic reviews.
→ Case control studies (choice C) similary to cohort study is considered as a second-tier level of evidence.
→ Non-randomized intervention studies (choice E) are not as reliable as randomized controlled trials, and therefore have a level of evidence inferior to randomized controlled studies, meta-analysis, and systematic reviews.
Which one of the following is true about end-of-life care?
End-of-life issues are a challenge to primary care physicians because of concerns about a lack of education in pain control and palliative care. Trying to determine the prognosis of patients is difficult, and even with established criteria, the estimated prognosis is right only 50% of the time. There is a tendency for most physicians to overestimate life expectancy in a terminal patient.
Most patients who are appropriate candidates for hospice care do not receive referrals until late in their illness, if at all. Patients at the end of life have five main areas of concern: control of pain and other symptoms; avoiding a prolongation of the dying process; having a sense of control; relieving burdens on family and loved ones; and strengthening relationships with family and friends.
Click to expand