Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

N929 Pharmacology II > Anesthesia Pharmacology and Special Populations > Flashcards

Anesthesia Pharmacology and Special Populations Flashcards

1
Q

Aging patients have less

A

organ reserve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The fastest growing population is the

A

aging patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Elderly patients and medications:

A

account for 30% of prescriptions
more prone to adverse reactions to medications
consume 40% of all over the counter meds
patients over 70 are on two prescription meds daily on average with 19%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PK changes in the elderly as compared to young adults include:

A

less % of body water, less % lean body mass, more body fat, less serum albumin, less kidney function and hepatic function/blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Anesthesia plans as it relates to the elderly population include:

A

do not require a “special” anesthetic but rather require- meticulous preoperative assessment, detailed management of intraop variables and disease states, cautious titration of drug administration and dosages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the mechanism for producing age-related increases in pharmacodynamic sensitivity to anesthesia agents?

A

it is unknown but could be a result of declining neuronal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Significant age-related dose reductions for IV medications include:

A

longer half-lives
30% decrease dose
increased brain sensitivity to narcotics
plasma drug concentrations immediately after injection are usually higher in elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Elderly patients and anesthetic requirements might include indication for

A

additional monitoring of anesthetic depth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When giving muscle relaxants to the elderly it is important to take into account the following:

A

elderly have reduced skeletal muscle mass
onset of action is delayed
duration of action is extended (metabolism/elimination)
antagonism remains unchanged
Reduced plasmacholinesterase- more reduction in males than females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Optimizing postoperative pain management in the elderly may be complicated by:

A

pre-existing cognitive impairment
Fear of opioid related side effects (opioid requirements are inversely related to patients ae and essentially independent of body size)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

For elderly patients receiving regional anesthesia:

A

anatomic changes in epidural and subarachnoid space
diameter and number of myelinated fibers is decreased
increased permeability of the dura and decreased volume of CSF
occlusion of intervertebral foramina with fibrous connective tissue
with a fixed dose and volume of local anesthetic spread of a block is higher in the elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The most common post-operative complication for older adults undergoing surgery includes

A

delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Post-op delirium is upsetting for patients and families and can be

A

harmful if not recognized and treated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Studies have shown that delirium can be

A

prevented in up to 40% of cases in some hospitalized older adult populations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When conducting an anesthesia pre-op review of medications, it is important for us to be aware of

A

discontinue or substitute meds with potential drug interactions with anesthesia
discontinue meds that increase surgical risk
identify meds to be discontinued based on Beer’s criteria
continue meds with withdrawal potential
avoid starting new benzos
avoid meperidine
caution with antihistamines and meds with anticholinergic effects
adjust dosing of meds that undergo renal excretion
consider starting meds that decrease perioperative CV adverse events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Important considerations for elderly patients include:

A

renal impairment
decreased plasma protein
reduced gastric motility and acidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Additional considerations for the elderly patient includes:

A

altered distribution of increased total body fat
decreased plasma albumin concentration
decreased hepatic blood flow
decreased GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Common medications used in the periop setting that may induce postoperative delirium includes:

A 
drugs with anticholinergic properties- TCAs, antihistamines, antimuscarinics, antispasmodics, antipsychotics (first generation), H2 receptor antagonists, skeletal muscle relaxants, antiemetics
corticosteroids
meperidine 
sedative hypnotics
polypharmacy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pharmacology in the obese patient is significantly influenced by:

A 
differences in tissue distribution
hemodynamics
blood flow to tissue types (organs, adipose, splanchnic)
plasma composition
liver and kidney function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Pharmacokinetic factors are influenced by _____ in the obese patient

A

lipid solubility of the drug

diffusion through body compartments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In general, dosing for the obese patient should consider:

A

volume of distribution for loading dose- IBW for drugs that are preferential to lean tissue, TBW for drugs with equal distribution to lean and adipose tissue
clearance for maintenance dose
lean body weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When thinking about giving thiopental to obese patients, (dosing & pearls)

A

dosing: TBW

prolonged duration of action and half life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When thinking about giving propofol to the obese patient, (dosing and pearls)

A

dosing- LBW for induction and TBW for maintenance

highly liphophilic-total clearance and VD correlate well with TBW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When thinking about giving midazolam to the obese patient (dosing and pearls)

A 
loading dose (TBW), maintenance (IBW)
sedative effects correlate better to large VD and less to elimination (higher dose to achieve initial therapeutic effects)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When thinking about giving dexmedetomidine to the obese patients (dosing and pearls)

A

dosing: 0.2 mcg/kg/min

lower than usual infusion rates recommended to decrease cardiac side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When giving succinylcholine to the obese patient (dosing and pearls):

A

dosing: TBW
large extracellular fluid compartment in the obese
psuedocholinesterase activity increases with weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When giving roc/vec/cis to the obese patient the dosing is based on

A

IBW

prolonged DOA with TBW administration; hydrophilic drugs given on IBW ensures more predictable recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

The dosing when giving fentanyl to the obese patient is

A

inconclusive
dosing based on TBW overestimates dose requirements. Measure clearance has non linear relationship to TBW (implications to IBW)

29
Q

The dosing when giving sufentanil to the obese patient is

A

loading dose: TBW
maintenance: LBW and response
increased VD and prolonged elimination 1/2 life correlates with degree of obesity

30
Q

The dosing when giving remifentanil to the obese patient is

A

IBW

kinetics not affected by weight

31
Q

Children are NOT

A

small adults

32
Q

Converting adult doses to children’s doses on a per kilogram basis

A

does not always yield equivalent drug concentrations or effects

33
Q

The following change from fetus to baby to child to adult:

A

VD, drug elimination, receptor sensitivity, side effects, and organ function

34
Q

Drugs administered rectally in the pediatric population:

A

generally a slower absorption; commonly used in children under 5 for sedation

35
Q

Drugs administered intranasally in the pediatric population:

A

faster onset, less offensive to children; midazolam and fentanyl

36
Q

Drugs administered IM in the pediatric patient:

A

not recommended due to pain that last days; emergency drugs and pain medications

37
Q

Drugs administered IV in the pediatric patient:

A

distribution dependent on circulating blood elements, blood-tissue partition coefficients, distribution of blood flow

38
Q

Major proteins involved in binding drugs include:

A

albumin and alpha 1 acid glycoprotein

39
Q

Albumin and alpha 1 acid glycoprotein are

A

much lower concentration in infants

40
Q

Agents that are highly protein bound have

A

a large volume of distribution as seen in neonates

41
Q

The presence of substances that can displace drugs from proteins will

A

alter pharmacology

42
Q

Albumin and alpha 1 acid glycoprotein have implications to

A

blood-gas and blood-tissue coefficients and volatile anesthetics

43
Q

Determination of drug dosages for children

A

can be based off of surface area

44
Q

In neonates and infants, there is relatively smaller

A

muscle mass and greater fat stores

45
Q

Neonates and infants have greater

A

blood flow to the central organs (brain, liver, blood, heart, and kidneys)

46
Q

Neonates and infants may require higher doses of

A

water soluble drugs such as succinylcholine

47
Q

______ effects durations of action in neonates and infants

A

mismatch in tissue types

48
Q

Factors that affect pediatric drug distribution include:

A

integrity of the blood-brain barrier
receptor affinity and sensitivity
developmental changes in hepatic metabolism
changes in renal function

49
Q

The changes in renal function at birth & 1 year of age

A

birth GFR is 40 mL/min

at 1 year of age it is 100 mL/min.

50
Q

The integrity of the blood-brain barrier in the pediatric population allows for

A

rapid uptake of anesthetics into the CNS and higher brain blood flow

51
Q

When thinking about anesthesia and patients with cancer, we must consider:

A

how will the chemo drugs affect your patients & how will the anesthetic effect the patient’s prognosis

52
Q

For patients on chemotherapy, we assume that

A

ALL patients have nausea and vomiting

53
Q

Cisplatin (clinical use)

A

lung cancer, breast cancer, bile duct cancer, ovarian cancer

54
Q

Cisplatin toxicity includes

A

nephrotoxicity, peripheral neuropathy, and nerve dysfunction

55
Q

Methotrexate treats

A

breast cancer, lymphomas, and bladder cancer

56
Q

Methotrexate toxicity includes

A

myelosuppression with neutropenia and thrombocytopenia

57
Q

Bleomycin treats

A

Hodgkin’s and non-Hodgkin’s lymphoma

58
Q

Bleomycin toxicity includes

A

pulmonary fibrosis

59
Q

Doxorubicin treats

A

Lung cancer, lymphomas, ovarian cancer, & thyroid cancer

60
Q

Doxorubicin toxicity includes

A

cardiotoxicity and myelosuppression

61
Q

Cetuximab uses include

A

colon CA, GI cancer

62
Q

Cetuximab can cause

A

interstitial lung disease

63
Q

The best anesthesia plan for cancer patients includes:

A

regional anesthesia, local anesthetics, naltrexone, beta blockers and cox-inhibitors

64
Q

Volatiles, barbs, and ketamine will

A

suppress NK cell activity and can promote cancer cell mets

65
Q

Nitrous oxide will

A

reduce purine ad thus DNA synthesis and also suppress neutrophil chemotaxis, potentially facilitating the spread of cancer

66
Q

Propofol seems to exhibit

A

protective effects through various mechanisms including an anti-inflammatory effect, enhancement of antitumor immunity, and NK function preservation

67
Q

Perioperative opioids may produce

A

cellular and humoral immunosuppression in particular morphine

68
Q

Local anesthetics have been shown to reduce

A

metastatic burden

N929 Pharmacology II (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions