Elderly Pharm-PPt Josh Flashcards
Thankyou teresa and remember……
round eyes on the right
Physiology:
Physiologic changes that occur during aging can effec pharmcological responses including what 3 main things
- Plasma protein binding
- Body content
- Drug metabolism
Physiology:
what happens to the plasma protein albumin (acidic)
decreased
Physiology:
what happens to the plasma protein Alpha1-acid glycoprotein (base)
Increased
Physiology: Body content
what happens to lean body mass
Decreased
Physiology: Body content
what happens to body fat
Increased
Physiology: Body content
what happens to total body water
Decreased
Physiology: Body content
recap what are the 3 maoin body content changes that affect how drugs work
- decreased muscle mass
- increased Body fat
- decreased total body water
Physiology:Water soluble drugs
what happens to Vd
Smaller
Physiology:Water soluble drugs
wha happes to plasma concentration of drugs
Higher
Physiology:Water soluble drugs
what will happen to pharmacological effect
Increase
Physiology: Lipid soluble drugs
what happens to Vd
Larger
Physiology: Lipid soluble drugs
what happens to plasma concentration
Lower
Physiology: Lipid soluble drugs
what happens to elimination
Prolonged
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
it decreases
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
it decreases
Physiology: Summary
name the effects
- Decreased vascular volume
- decreased protein binding
- increased total body lipid stores
- Decreased renal and hepatic blood flow
- high inital plasma concentration
- Increased availability of free drug
- Prolomnged action of lipid soluble drugs
- Prolomged action of drugs dependent on kidney and liver elimination
Pharmacology: Benzodiazepines
what happens to Vd
Increased
Pharmacology: Benzodiazepines
what happens to elimination 1/2 life
prolonged
Pharmacology: Benzodiazepines
Versed- the reuirements are about ___% less
50%
Pharmacology: Benzodiazepines
Versed- elimination 1/2 life is prolonged from 2.5 to__ hours
4
Pharmacology: induction drugs
There is a delayed induction time and onset of IV drugs d/t what 3 things
- impaired Myocardial pump
- Reduced CO
- Decreased Perfusion of organs
Pharmacology: induction drugs: Propofol
requires nearly ___% lower blood levels than a younger pt
50%
Pharmacology: induction drugs: Propofol
there is a dramatic decrease in what
Systemic BP
Pharmacology: induction drugs: Propofol
is the a longer or quicker recovery of cognitive fxn
Quicker
Pharmacology: Inhaled Anesthetics
there is a _____ requirement
Reduced
Pharmacology: Inhaled Anesthetics
MAC is reduced __-__% perdecade of life after age 40
4-6%
Pharmacology: Inhaled Anesthetics
what happens to inhalation agent uptake if there is a decreased CO
More rapid
Pharmacology: Inhaled Anesthetics
the ______ depressamt effects of VAAs are exaggerated
Myocardial
Pharmacology: Inhaled Anesthetics
there is a prolonged recovery from anesthesia w/ VAAs b/c of what 3 things
- Increased Vd
- Decreased Hepatic fxn
- Decreased Pulmonary gas exchange
Pharmacology: Opioids
there is a decreased requirement for narcotics b/c of decreased what? (2)
- Vd
- Protein binding
Pharmacology: Opioids
there is a prolomnged elimination 1/2 time leading to what complicatins
decreased ventilation
prolonged analgesia
Pharmacology: Morphine
what is the metabolite or morphine
Morphine-6-glucuronide
Pharmacology: Morphine
does the metabolite morphine-6-glucuronide have analgesic properties?
Yes
Pharmacology: Morphine
the metabolite morphine-6-glucuronide depends on what type of excretion
Renal
Pharmacology: Sufenta, Alfentanil, Fentanyl
- are ____ as potent in elderly pt’s
twice
Pharmacology: Remifentanyl
is ___ as potent
twice
Pharmacology: Remifentanyl
there should be a ___% reduction in bolus dose
50%
Pharmacology: Remifentanyl
there should be a ___-___% reduction in infusion rate
30-50%
Pharmacology: Muscle Relaxants
what happens to teh respons to both SCh and non-depol
nothing it’s unchanged
Pharmacology: Muscle Relaxants
what happens to the onset time of NM blockade
prolonged
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?
Cisatracurium
Pharmacology: Muscle Relaxants
elderly M or F display a prolonged effect from SCh
Men
Pharmacology: Cardiovascular
the is a ____ response to B-adrenergic agents
decreased
Pharmacology: Cardiovascular
the sysmpathetic response decreases why?
decreased number of sympathetic receptors
Pharmacology: Cardiovascular
you may have to _______ the dose for equal CV response
Increase
Thats it mother……
fucker