Elderly Pharm-PPt Josh

Question 1

Thankyou teresa and remember……

Answer 1

round eyes on the right

Question 2

Physiology:

Physiologic changes that occur during aging can effec pharmcological responses including what 3 main things

Answer 2

• Plasma protein binding
• Body content
• Drug metabolism

Question 3

Physiology:

what happens to the plasma protein albumin (acidic)

Answer 3

decreased

Question 4

Physiology:

what happens to the plasma protein Alpha1-acid glycoprotein (base)

Answer 4

Increased

Question 5

Physiology: Body content

what happens to lean body mass

Answer 5

Decreased

Question 6

Physiology: Body content

what happens to body fat

Answer 6

Increased

Question 7

Physiology: Body content

what happens to total body water

Answer 7

Decreased

Question 8

Physiology: Body content

recap what are the 3 maoin body content changes that affect how drugs work

Answer 8

• decreased muscle mass
• increased Body fat
• decreased total body water

Question 9

Physiology:Water soluble drugs

what happens to Vd

Answer 9

Smaller

Question 10

Physiology:Water soluble drugs

wha happes to plasma concentration of drugs

Answer 10

Higher

Question 11

Physiology:Water soluble drugs

what will happen to pharmacological effect

Answer 11

Increase

Question 12

Physiology: Lipid soluble drugs

what happens to Vd

Answer 12

Larger

Question 13

Physiology: Lipid soluble drugs

what happens to plasma concentration

Answer 13

Lower

Question 14

Physiology: Lipid soluble drugs

what happens to elimination

Answer 14

Prolonged

Question 15

Physiology: Drug Elimination

in the liver the liver volumes decreases 20-40%, hepatic blood flow decreases 10% per decade, and there is a decrease innate capacity to metabolize drugs. this all leads to what r/t drug metabolisim

Answer 15

it decreases

Question 16

Physiology: Drug Elimination

the renal changes are decreased plasma flow, GFR decreases 6-8% per decade, and renal fxn in reduced, this all leads to what r/t excretion ability of drugs

Answer 16

it decreases

Question 17

Physiology: Summary

name the effects

1. Decreased vascular volume
2. decreased protein binding
3. increased total body lipid stores
4. Decreased renal and hepatic blood flow

Answer 17

1. high inital plasma concentration
2. Increased availability of free drug
3. Prolomnged action of lipid soluble drugs
4. Prolomged action of drugs dependent on kidney and liver elimination

Question 18

Pharmacology: Benzodiazepines

what happens to Vd

Answer 18

Increased

Question 19

Pharmacology: Benzodiazepines

what happens to elimination 1/2 life

Answer 19

prolonged

Question 20

Pharmacology: Benzodiazepines

Versed- the reuirements are about ___% less

Answer 20

50%

Question 21

Pharmacology: Benzodiazepines

Versed- elimination 1/2 life is prolonged from 2.5 to__ hours

Answer 21

4

Question 22

Pharmacology: induction drugs

There is a delayed induction time and onset of IV drugs d/t what 3 things

Answer 22

• impaired Myocardial pump
• Reduced CO
• Decreased Perfusion of organs

Question 23

Pharmacology: induction drugs: Propofol

requires nearly ___% lower blood levels than a younger pt

Answer 23

50%

Question 24

Pharmacology: induction drugs: Propofol

there is a dramatic decrease in what

Answer 24

Systemic BP

Question 25

Pharmacology: induction drugs: Propofol is the a longer or quicker recovery of cognitive fxn

Answer 25

Quicker

Question 26

Pharmacology: Inhaled Anesthetics there is a _____ requirement

Answer 26

Reduced

Question 27

Pharmacology: Inhaled Anesthetics MAC is reduced \_\_-\_\_% perdecade of life after age 40

Answer 27

4-6%

Question 28

Pharmacology: Inhaled Anesthetics what happens to inhalation agent uptake if there is a decreased CO

Answer 28

More rapid

Question 29

Pharmacology: Inhaled Anesthetics the ______ depressamt effects of VAAs are exaggerated

Answer 29

Myocardial

Question 30

Pharmacology: Inhaled Anesthetics there is a prolonged recovery from anesthesia w/ VAAs b/c of what 3 things

Answer 30

* Increased Vd * Decreased Hepatic fxn * Decreased Pulmonary gas exchange

Question 31

Pharmacology: Opioids there is a decreased requirement for narcotics b/c of decreased what? (2)

Answer 31

* Vd * Protein binding

Question 32

## Footnote Pharmacology: Opioids there is a prolomnged elimination 1/2 time leading to what complicatins

Answer 32

decreased ventilation prolonged analgesia

Question 33

Pharmacology: Morphine what is the metabolite or morphine

Answer 33

Morphine-6-glucuronide

Question 34

Pharmacology: Morphine does the metabolite morphine-6-glucuronide have analgesic properties?

Answer 34

Yes

Question 35

Pharmacology: Morphine the metabolite morphine-6-glucuronide depends on what type of excretion

Answer 35

Renal

Question 36

Pharmacology: Sufenta, Alfentanil, Fentanyl 1. are ____ as potent in elderly pt's

Answer 36

twice

Question 37

Pharmacology: Remifentanyl is ___ as potent

Answer 37

twice

Question 38

Pharmacology: Remifentanyl there should be a \_\_\_% reduction in bolus dose

Answer 38

50%

Question 39

Pharmacology: Remifentanyl there should be a \_\_\_-\_\_\_% reduction in infusion rate

Answer 39

30-50%

Question 40

Pharmacology: Muscle Relaxants what happens to teh respons to both SCh and non-depol

Answer 40

nothing it's unchanged

Question 41

Pharmacology: Muscle Relaxants what happens to the onset time of NM blockade

Answer 41

prolonged

Question 42

Pharmacology: Muscle Relaxants there is a reduction in clearance and increased elimination 1/2 time. but wait there is one exception... what drug is it?

Answer 42

Cisatracurium

Question 43

Pharmacology: Muscle Relaxants elderly ***_M or F_*** display a prolonged effect from SCh

Answer 43

Men

Question 44

Pharmacology: Cardiovascular the is a ____ response to B-adrenergic agents

Answer 44

decreased

Question 45

Pharmacology: Cardiovascular the sysmpathetic response decreases why?

Answer 45

decreased number of sympathetic receptors

Question 46

Pharmacology: Cardiovascular you may have to _______ the dose for equal CV response

Answer 46

Increase

Question 47

Thats it mother......

Answer 47

fucker