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Personal APA > Geriatric > Flashcards

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
Q

What 3 things put elderly risk for temp loss?

A
  • Decreased metabolic rate
  • Decreased heat production
  • Deficient thermostat control
26
Q

What decreasing renal problems are seen w/ oldies?

A
  • Blood flow
  • GFR
  • Renal Mass
  • Concentration
  • Dilution
  • Drug excretion
  • Renin-aldosterone response
27
Q

What 3 renal functions are impaired with oldies?

A
  • Sodium handling
  • Fluid handling
  • Potassium excretion
28
Q

Renal cortex is replaced with what?

A

-Fat and fibrotic tissue

29
Q

BUN gradually _______ 0.2 mg/dl per year

A

Increases

30
Q

Why does serum creatinine remain the same as we age?

A

-decrease in muscle mass

31
Q

Elderly are predisposed to what?

A
  • Dehydration

- Fluid overload

32
Q

Fluid overload in oldies is related to what?

A
  • Sodium
  • diluting
  • concentrating management changes
33
Q

What increases the elderly risk of acute renal failure?

A

-Decreased blood flow

34
Q

Oldies are predisposed to hyper and hypokalemia due to what?

A

-Diuretics

35
Q

What is the most specific test for renal failure?

A

-Serum creatinine clearance (24 hour urine)

36
Q

What things decrease in the nervous system with the elderly?

A
  • Cerebral blood flow
  • Brain Mass
  • Neurotransmitters (dopamine)
37
Q

What helps preserve cognitive function?

A

-Physical activity

38
Q

What leads to muscle atrophy?

A

-Degeneration of peripheral nerves which slows conduction and reactions

39
Q

What nervous system threshold increase with oldies?

A
  • Touch
  • Temp
  • Pain
  • Proprioception
  • Hearing
  • Vision
40
Q

Dosages for local anesthetics and general anesthetics are ______.

A

Reduced

41
Q

Epidural anesthesia has a more ________ spread.

A

Cephalad

42
Q

Elderly are very sensitive to anticholinergics like _________ and _______.

A

Scopalmine and atropine

43
Q

High incidence of confusion and delirium can be related to what?

A
  • Drugs
  • Pain
  • Hypoxemia
  • Metabolic disturbances
  • Previous dementia
44
Q

What is pharmacokinetics?

A

-Relationship between drug and plasma concentration

45
Q

What is pharmacodynamics?

A

-Relationship between plasma concentration and clinical effect

46
Q

A decrease in muscle mas and increase in fat does what?

A

-Decreases total body water and effects water soluble drugs

47
Q

How are fat and water soluble drugs effected on oldies?

A
  • Water = Increased plasma concentrations

- Fat = decreased plasma concentrations

48
Q

MAC for inhalation agents declines ______ per decade after age _____.

A
  • 4%

- Age 40

49
Q

Inhalation agent onset is more rapid if cardiac output is ______.

A

Deceased

50
Q

myocardial depressant effect is ________ and tachycardia response is _________.

A
  • Exaggerated

- Decreased

51
Q

Lower doses are needed for what 3 meds?

A
  • Barbs
  • Opioid agonists
  • Benzos
52
Q

_____ ______ in muscle relaxant effects, but do have _________ excretion.

A
  • No change

- Prolonged

53
Q

Most plasma proteins are unchanged with elderly except what 2?

A
  • Albumin = slight decrease

- Alpha 1 glycoprotein = increase

54
Q

What plasma protein binds to local anesthetic and opioids?

A

-Alpha 1 glycoprotein (AAG)

55
Q

Hutchinson-Gilford syndrome causes what? When is it apparent? and how long do they live?

A
  • Premature aging
  • after 6 months
  • 13 years
56
Q

Progeria anesthesia considerations

A
  • Mandibular hypoplasia
  • Micrognathis
  • Narrow glottic opening
57
Q

Elderly anesthesia tidbits.

A
  • Give beta blockers
  • give ABX
  • Avoid hypothermia
  • think regional
  • Longer emergence / extubation time

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