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Geriatric Flashcards

1
Q

Heart rate declines ___ beat per minute every year over age _____.

A
  • 1

- 50

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2
Q

What causes the increase chance in arrhythmias?

A
  • Conduction system fibrosis

- SA node cell loss

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3
Q

Atrial enlargement puts old people at risk for what 2 things?

A
  • SVT

- AFib

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4
Q

Left ventricular wall thickens by _______ the _______

A
  • Decreasing

- Cavity

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5
Q

Wall thickness increases in proportion to increase in chamber radius, this type of hypertrophy is called what?

A

Eccentric hypertrophy

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6
Q

What type of hypertrophy when chamber radius does not change while wall thickness increases?

A

-Concentric hypertrophy

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7
Q

In concentric hypertrophy, how are new sarcomeres added?

A

-Parallel to existing sarcomeres

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8
Q

Chronic pressure overload can lead to what type of hypertrophy?

A

Concentric

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9
Q

How will slowed circulation effect IV and Inhaled agents?

A
  • Slow IV

- Speeds Inhaled agents

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10
Q

Autonomic responses that maintain homeostasis decline with age, this can lead to what and do what during induction?

A
  • Autonomic dysfunction

- Drop in BP

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11
Q

Blunted B-receptors alter what two responses?

A
  • Decreased HR

- Decreased ejection fraction

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12
Q

To increase CO, old people are more dependent on ______, rather than _______.

A
  • End diastolic volume

- HR

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13
Q

Due to old peoples reliance on end diastolic volume vs. HR, this place them at greater risk of what?

A

-CHF from large volumes of IV fluid, with anesthesia induced myocardial depression

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14
Q

Name 2 elevated CV changes among old people?

A
  • Elevated Afterload

- Elevated Systolic pressure

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15
Q

What 4 CV things decrease with oldies?

A
  • Decreased elasticity of arteries
  • Decreased adrenergic activity
  • Decreased HR
  • Decreased baroreceptor response
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16
Q

What 5 respiratory changes decrease with elderly?

A
  • Decreased elasticity of lungs
  • Decrease alveolar surface area
  • Decreased cough
  • Decrease Max breathing
  • Decreased vital capicity
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17
Q

What 6 respiratory changes increase with elderly?

A
  • Increased residual volume
  • Increased V/Q mismatch
  • Increase chest wall rigidity
  • Increased closing capicity/volume
  • Increased FRC
  • Increased Dead space
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18
Q

The elderly have _______ response to hypercapnia and hypoxia

A

-Blunted

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19
Q

Elderly have over ________ of alveoli and _______ of small airways

A
  • Distension

- Collapse

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20
Q

Elderly increased risk of aspiration is r/t what?

A

-loss of airway reflexes

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21
Q

Vital capacity decreases ____ mls per year starting at age ____.

A
  • 25

- 20

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22
Q

does Vd/Vt ratio increase or decrease with age?

A

Increase

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23
Q

Elderly GI consideration

A
  • pH rises
  • Gastric emptying slows
  • Smaller stomachs
24
Q

Elderly temp considerations

A
  • Heat production decreases

- Heat loss increases

25
What 3 things put elderly risk for temp loss?
- Decreased metabolic rate - Decreased heat production - Deficient thermostat control
26
What decreasing renal problems are seen w/ oldies?
- Blood flow - GFR - Renal Mass - Concentration - Dilution - Drug excretion - Renin-aldosterone response
27
What 3 renal functions are impaired with oldies?
- Sodium handling - Fluid handling - Potassium excretion
28
Renal cortex is replaced with what?
-Fat and fibrotic tissue
29
BUN gradually _______ 0.2 mg/dl per year
Increases
30
Why does serum creatinine remain the same as we age?
-decrease in muscle mass
31
Elderly are predisposed to what?
- Dehydration | - Fluid overload
32
Fluid overload in oldies is related to what?
- Sodium - diluting - concentrating management changes
33
What increases the elderly risk of acute renal failure?
-Decreased blood flow
34
Oldies are predisposed to hyper and hypokalemia due to what?
-Diuretics
35
What is the most specific test for renal failure?
-Serum creatinine clearance (24 hour urine)
36
What things decrease in the nervous system with the elderly?
- Cerebral blood flow - Brain Mass - Neurotransmitters (dopamine)
37
What helps preserve cognitive function?
-Physical activity
38
What leads to muscle atrophy?
-Degeneration of peripheral nerves which slows conduction and reactions
39
What nervous system threshold increase with oldies?
- Touch - Temp - Pain - Proprioception - Hearing - Vision
40
Dosages for local anesthetics and general anesthetics are ______.
Reduced
41
Epidural anesthesia has a more ________ spread.
Cephalad
42
Elderly are very sensitive to anticholinergics like _________ and _______.
Scopalmine and atropine
43
High incidence of confusion and delirium can be related to what?
- Drugs - Pain - Hypoxemia - Metabolic disturbances - Previous dementia
44
What is pharmacokinetics?
-Relationship between drug and plasma concentration
45
What is pharmacodynamics?
-Relationship between plasma concentration and clinical effect
46
A decrease in muscle mas and increase in fat does what?
-Decreases total body water and effects water soluble drugs
47
How are fat and water soluble drugs effected on oldies?
- Water = Increased plasma concentrations | - Fat = decreased plasma concentrations
48
MAC for inhalation agents declines ______ per decade after age _____.
- 4% | - Age 40
49
Inhalation agent onset is more rapid if cardiac output is ______.
Deceased
50
myocardial depressant effect is ________ and tachycardia response is _________.
- Exaggerated | - Decreased
51
Lower doses are needed for what 3 meds?
- Barbs - Opioid agonists - Benzos
52
_____ ______ in muscle relaxant effects, but do have _________ excretion.
- No change | - Prolonged
53
Most plasma proteins are unchanged with elderly except what 2?
- Albumin = slight decrease | - Alpha 1 glycoprotein = increase
54
What plasma protein binds to local anesthetic and opioids?
-Alpha 1 glycoprotein (AAG)
55
Hutchinson-Gilford syndrome causes what? When is it apparent? and how long do they live?
- Premature aging - after 6 months - 13 years
56
Progeria anesthesia considerations
- Mandibular hypoplasia - Micrognathis - Narrow glottic opening
57
Elderly anesthesia tidbits.
- Give beta blockers - give ABX - Avoid hypothermia - think regional - Longer emergence / extubation time

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