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6901 > Geriatric Pt- Lecture 1 > Flashcards

Geriatric Pt- Lecture 1 Flashcards

1
Q

What produces higher than anticipated plasma concentration of IV agents?

A

decrease in blood volume

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2
Q

What happens to Vd of H20 soluble meds in geriatric patients?

A

Vd decreases so plasma concentrations are higher than normal

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3
Q

What happens to the Vd of fat sol meds in geriatric population?

A

longer 1/2 life because of increase in body fat and may cause extension of pharmacologic properties and slower excretion from the body

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4
Q

Three theories of aging process?

A

1- programmed aging (killer gene), 2- telomere shortening, 3- gradual, cumulative process of damage and deterioration

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5
Q

What is “safety margin for function above basal needs?”

A

functional reserve

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6
Q

When does functional reserve peak? Then what happens?

A

30 years. Gradually declines over next few decades and experiences steeper decline after age 80

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7
Q

What simple test can you measure functional reserve w?

A

4 METs

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8
Q

What causes the decline in basal metabolism in geriatric pts?

A

change in body composition- less skeletal muscle, more fat

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9
Q

What happens to the total body water and how much does blood volume decrease in elderly?

A

decreases; 20-30%

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10
Q

Why are elderly patients more susceptible to hypotension with shifts in position?

A

decreased blood volume and decreased total body water

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11
Q

What is one thing that stays intact in the elderly CNS system?

A

autoregulation

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12
Q

What 5 things decrease in the elderly CNS?

A

brain mass (primarily frontal lobe of cerebral cortex), # of neurons, synthesis of NTs, synthesis of functional receptors, CBF

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13
Q

What structure that affects thermoregulation in CNS does not function well in elderly?

A

hypothalamus

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14
Q

Why does hypothermia last longer in elderly? What does hypothermia d/t anesthetic elimination?

A

less effective peripheral vasoconstriction, decreased basal metabolic rate, high ratio of surface to body ratio mass; slows it, prolongs recovery, impairs coagulation, increases chance that pt will shiver (increases O2 consumption 400%)

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15
Q

How much should Propofol doses be lowered in elderly?

A

15%

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16
Q

MAC decreases how much per decade?

A

6%

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17
Q

Is the elderly heart more or less compliant?

A

less

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18
Q

Why is atrial contraction more important in maintaining adequate ventricular filling in the elderly patients?

A

because the combination of ventricular hypertrophy and lower myocardial relaxation result in late diastolic filling and diastolic dysfunction

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19
Q

Why is HTN common in elderly and what type of HTN is it (concentric or eccentric)?

A

common d/t loss of ventricular elasticity; concentric

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20
Q

Do elderly have a decreased, same, or increased amt of catecholamines?

A

increased

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21
Q

3 reasons why elderly have difficulty increasing CO

A

diminished baroreceptor responses, endogenous physiological beta blocked, reduced efficacy of beta agonists

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22
Q

What do the cardiovascular changes in the elderly do to drug circulating time?

A

prolong it

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23
Q

What type of onset do IA versus IV drugs have in elderly?

A

faster with IA, slow onset of IV drugs

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24
Q

What leads to loss of vascular elasticity in elderly?

A

decrease in elastin production and increase in collagen damage

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25
Q

What does decrease in elasticity and compliance do to PVR, afterload, and vascular system?

A

stiffens

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26
Q

What does the pulse pressure do in the elderly?

A

widen

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27
Q

What causes the overall stiffening of atria and ventricles?

A

loss of collagen

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28
Q

What is something that predisposes the elderly to arrhythmias?

A

calcification of conducting system, including loss of SA node

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29
Q

Patients with diastolic dysfunction, which is very common in the elderly, are dependent upon what for filling?

A

atrial kick

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30
Q

This corresponds to the amount of O2 consumed by a 70 kg male at rest (around 3 mL of O2/kg/min)?

A

MET

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31
Q

3 causes of higher BP in elderly?

A

increased PVR, decreased arterial elasticity, cardiac workload

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32
Q

What causes a decreased TV in elderly?

A

VC

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33
Q

Why is there an increased work of breathing?

A

inelastic chest and closure of small airways

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34
Q

At what age does the PaO2 decrease? And why?

A

75+ (PaO2 83); attributed to premature closing of small airways and decreased surface area for gas exchange so therefore, a VQ mismatch and less efficient gas exchange

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35
Q

What type of vent settings should you avoid in the elderly pt with increased wob?

A

avoid high pressure, high TV, consider PEEP, and lower FiO2

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36
Q

What causes the VQ mismatch?

A

increase in compliance

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37
Q

What type of response do the elderly have to hypercapnea and hypoxia?

A

diminished response

38
Q

What is necessary for maintaining small airway diameter?

A

elastic recoil

39
Q

Increased compliance does what to the airway diameter?

A

decreases/narrows and increases closing volume

40
Q

Closing volumes exceed FRC at what age in erect position and what age in supine position?

A

65; 45

41
Q

What can prevent small airway collapse?

A

greater lung inflation

42
Q

Why are elderly patients at an increased risk for aspiration?

A

diminished protective airway reflexes

43
Q

What type of change is seen in hepatic enzyme function in elderly?

A

little change

44
Q

What happens to the liver size and blood flow in elderly?

A

decrease

45
Q

Hepatic blood flow decreases what percentage per decade?

A

10%

46
Q

At what age does liver volume begin to increase?

A

50%

47
Q

What happens to the rate of hepatic plasma clearance?

A

reduced rate

48
Q

How does elderly hepatic function affect drug reactions?

A

there is an increase in drug reactions w hepatic problems

49
Q

What does the reduced rate of plasma clearance d/t hepatic ftn in elderly do to the clinical effects of most IV anesthetics?

A

prolongs the effects

50
Q

What do you have to be mindful about with elderly and their livers and narcotics?

A

risk of respiratory depression

51
Q

What are 4 exceptions to hepatic function in elderly prolonged effects of most IV anesthetics?

A

Cisatracurium, Atracurium, Suxxs, Esmolol

52
Q

Vd of hydrophillic versus lipophillic drugs in elderly patients because of liver function

A

decreased Vd in hydrophillic, which is caused by increase in plasma concentration; increased Vd of lipophillic drugs caused by decrease in plasma concentration

53
Q

What happens to the renal blood flow, renal mass, GFR, and labs in elderly?

A

decrease, decrease, decrease, remain unchanged

54
Q

Decreased renal drug clearance particularly of hydrophillic or lipophillic drugs?

A

hydrophillic

55
Q

Best indicator of renal drug clearance?

A

creatinine clearance

56
Q

What type of response to renal changes in the elderly cause to aldosterone and ADH?

A

decreased response

57
Q

Drugs with renal elimination have shorter or longer duration in elderly?

A

longer

58
Q

Older patients have tendency to lose what electrolyte?

A

Na

59
Q

What happens to PNS vs SNS tone/activity in elderly?

A

decreased PNS, increased SNS

60
Q

What happens to SVR, SBP, SV, CO in elderly?

A

increase, increase, decrease, decrease

61
Q

What happens to the size of central airway versus small airway in elderly?

A

increases, decreases

62
Q

Decrease/increase in lung compliance and decrease/increase in chest wall compliance?

A

increase, decrease

63
Q

Most everything in elderly decreases except for these 5 things:

A

storage size for lipid sol drugs, sympathetic neural activity, lung compliance, reserve vol and FRC, closing vol, and closing capacity

64
Q

Midazolam has what 1/2 life in elderly?

A

6 hours versus 2 in younger person

65
Q

Greater Vd does what to reservoir? Lesser Vd does what to plasma concentration?

A

increases; increases

66
Q

Increased body fat means what endocrine wise?

A

insulin resistance

67
Q

Elderly lose heat how much faster than younger adults?

A

twice

68
Q

Skeletal muscle mass decreases around what percentage?

A

10%

69
Q

What does decreased muscle mass do to resting O2 consumption and CO?

A

decrease, decrease

70
Q

Why must you be careful with titration of muscle relaxants, especially Vec and Roc in elderly?

A

decreased liver mass and decreased skeletal muscle mass

71
Q

Which compartment loses water more in the elderly-ICF or ECF?

A

ICF

72
Q

Up to a __% decrease in plasma volume in elderly?

A

30

73
Q

What does a decrease in plasma volume do to drug concentrations?

A

increases

74
Q

Decreased plasma protein binding means what for those drugs highly protein bound?

A

increase in free plasma concentration

75
Q

Risk to benefit ratio on those patients> 65 depend on what 4 factors?

A

age, physiological status and coexisting diseases according to ASA, whether surgery is elective or urgent, type of procedure and home care

76
Q

What do you need to do to the dose of General, MAC, and local anesthesia in elderly?

A

DECREASE

77
Q

Decrease dose of induction agents how much in older patient?

A

30-40%

78
Q

What happens to the levels and duration of action with SAB in elderly?

A

get higher faster and last longer

79
Q

Positives about regional anesthesia in elderly?

A

lower PDPH, lower incidence of hypoxemia if heavy sedation avoided, decreased DVT and blood loss

80
Q

Negative about regional anesthesia in elderly?

A

post op residual paresthesias are more common

81
Q

What is the most frequent type of anesthetic complication in elderly?

A

neurological

82
Q

How long is cognitive decline after surgery reversible?

A

3 months

83
Q

Post operative cognitive dysfunction is different from delirium how?

A

It’s a progressive development of symptoms and is subtle

84
Q

Predictors of post operative cognitive decline?

A

age, low education level, preop cognitive impairment, depression, surgical procedure, low albumin, prior stroke or TIA

85
Q

Most accurate indicator of kidney function in elderly?

A

GFR

86
Q

Ratio of GFR to creatinine clearance decreases/increases in elderly?

A

decreases

87
Q

4 preop lab tests reasonable for all geriatric pts?

A

BUN, Cr, Hg, albumin

88
Q

What is the MET score for walking around house, take care of yourself, walk a block on level ground?

A

MET 1

89
Q

MET score for doing light work around the house like dusting or walking dishes; climb a flight of stairs or walk up a hill?

A

MET 4

90
Q

participating in strenuous sports is how many METs?

A

> 10

91
Q

5 criteria for frailty scale?

A

weight loss, decreased grip strength, exhaustion, low physical activity, slowed walking speed

92
Q

patients with severe nutrition risk should have nutrition support how many days prior to surgery?

A

10-14

6901 (18 decks)

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