Chronic Disease Management

Question 1

Hypertension Complications are directly correlated with ______________.

Accepted Answer

Blood pressure - The risk of CV disease doubles with every 20/10mmHg increase

Question 2

Hypertension Which blood pressure is a stronger predictor of complications in those over 50?

Accepted Answer

SBP >>>>>> DBP

Question 3

Hypertension What are the classifications of HTN?

Accepted Answer

Based on two different readings from 2 seperate visits

Question 4

Hypertension Goal BP for most patients including ASCVD, DM and CKD?

Accepted Answer

< 130/80

Question 5

Hypertension What patients is the goal of SBP < 130 (no regard to DBP)?

Accepted Answer

Older ambulatory, community dwelling patients

Question 6

Hypertension What patients is the goal of SBP <140 or <150 (no regard to DBP)?

Accepted Answer

- Institutionalized older patients - High disease burden - Limited life-expectancy

Question 7

Hypertension Tx Preferred first-line agents for most patients? (4)

Accepted Answer

- ACEi - ARBs - CCBs - Thiazides

Question 8

Hypertension Tx T/F: Using low-dose combinations provides greater BP control compared to higher doses of single agents.

Accepted Answer

TRUE!

Question 9

Hypertension Tx Benefits of low-dose combinations?

Accepted Answer

- Better BP control - Fewer drug related AEs - Better adherence is they come in one pill

Question 10

Hypertension Tx What is critical to improve outcomes in geriatric patients?

Accepted Answer

Patient-centered considerations - Not treating every person to the < 130/80 goal

Question 11

Stroke PPx in A. Fib What is the main thing we are trying to balance?

Accepted Answer

Risk of clot vs. Risk of bleed

Question 12

Stroke PPx in A. Fib What score is used to determine stroke risk in A. fib? What is the interpretation?

Accepted Answer

CHA2DS2-VASc - 2+ needs anticoagulation - Anyone over 75 automatically needs anticoagulation

Question 13

Stroke PPx in A. Fib What score is used to determine the risk of bleeding on anticoagulation?

Accepted Answer

HAS-BLED

Question 14

Stroke PPx in A. Fib T/F: Anticoagulants are often times over prescribed in patients over 75.

Accepted Answer

FALSE -- Under Prescribed

Question 15

Stroke PPx in A. Fib What is frequently listed as a barrier to anticoagulation? Is it actually as big as a barrier as it seems?

Accepted Answer

Falling - A patient would have to fall 295 times in one year for the risk of anticoagulation to outweigh its benefits

Question 16

Stroke PPx in A. Fib What are the considerations to using warfarin in the elderly?

Accepted Answer

- Drug and disease interactions - Monitoring

Question 17

Stroke PPx in A. Fib What are the considerations to using DOACs in the elderly?

Accepted Answer

- Limited indications (cannot be used in valves) - Dose adjustments (renal) - QD and BID dosing

Question 18

Stroke PPx in A. Fib Which DOACs are on the Beers list?

Accepted Answer

Dabigatran and Rivaroxaban

Question 19

Hyperlipidemia What is first-line to lower LDL?

Accepted Answer

Statins

Question 20

Hyperlipidemia Moderate-intensity statin use is supported in patients > 75 who have what 3 diseases?

Accepted Answer

- Clinical ASCVD - DM - Tolerated statins and wish to continue

Question 21

Hyperlipidemia What is the difference between using statins in patients > 75 for primary vs. secondary prevention?

Accepted Answer

- Primary: Unclear on the age cut off for benefit - Secondary: Continued to see benefit in patients > 75

Question 22

Hyperlipidemia Decision to initiate statin therapy in patients > 75 for primary prevention should consider what 3 things?

Accepted Answer

- Comorbidities - Safety - Priorities of care

Question 23

Hyperlipidemia What are the concerns with using statins in the elderly? (5)

Accepted Answer

- Myopathy - Hepatic injury - Cognitive dysfunction - Diabetes - DDIs

Question 24

Diabetes ADA recommends screening all adults over age ___ every ___ years.

Accepted Answer

Over 45 Every 3 years

Question 25

Diabetes What are the presentations of glocuria, increased osmolality, and insulin deficiency in older adults?

Accepted Answer

- Glucosuria: Incontinence - Inc. osmolality: Dehydration, confusion, delirium - Insulin def: Anorexia, weight loss

Question 26

Diabetes What is the relationship between glucose control and cognitive decline?

Accepted Answer

Diabetics have higher incidences of all-cause:
- Dementia
- Alzheimer disease
- Vascular dementia

Poor glycemic control is associated with a decline in cognitive function

Cognitive dysfunction can impact all areas of diabetes care:
- Glucose monitoring
- Insulin adjustments
- Timing/content of diet

Question 27

Diabetes Goal of treatment?

Accepted Answer

- ADA A1c goal for most adults is < 7% - Individualized A1c goals are key in older adults - AVOID hypoglycemia

Question 28

Diabetes Tx What is the main complication of treatment in elderly patients? S/S of this complication?

Accepted Answer

Hypoglycemia - Hunger - Sweating - Mental status - Changes - Poor coordination - Seizures - Stroke

Question 29

Depression Increase incidence of what type of depression with age?

Accepted Answer

Subsyndromal depression

Question 30

Depression What are the treatment options?

Accepted Answer

- Psychotherapy - SSRI (1st line): Hyponatremia, EPS, bleeding - SNRI:↑ BP, GI upset, sexual dysfunction, sleep changes, hyponatremia - Bupropion - Mirtazapine - TCAs

Question 31

What are the considerations of inhaler use in older adults?

Accepted Answer

- Decreased physical strength
- Poor manual dexterity
- Lung function considerations
- Impaired cognitive function
- Inhaler education/instruction challenges: Written handout, patient/provider demonstration, video, checklist
- Fixed income and Part D coverage gap

Question 32

What vaccines should older adults get?

Accepted Answer

- Influenza - Pneumococcal - Herpes zoster - Tetanus-diphtheria

Chronic Disease Management

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