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Pharm II Final > Pharmacology in Special Populations > Flashcards

Pharmacology in Special Populations Flashcards

1
Q

What percentage of the elderly account for prescription medication use?

A

30%

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2
Q

What population consumes roughly 40% of all over the counter medications?

A

Elderly

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3
Q

On average, what percentage of the elderly take more than 10 medications?

A

19%

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4
Q

What two factors make the elderly more prone to adverse reactions to medications?

A

Less organ reserve and polypharmacy

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5
Q

What factor changes the volume of distribution in the elderly?

A

More fat and less body water content

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6
Q

What is the approximate rate at which the kidneys are functioning in patients older than 60?

A

Functioning at about 80%

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7
Q

What is the approximate rate at which the liver is functioning in patients older than 60?

A

55-60% hindering the ability to metabolize drugs

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8
Q

What considerations should be made when formulating an anesthetic plan for an elderly patient?

A

Meticulous preoperative assessment
Detailed management of intraoperative variables and disease states
Cautious titration of drug administration and dosages

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9
Q

What organ function and considerations should be inferred with the elderly?

A

HTN = cardiac issues
Hx smoking = lung issues
decreased mobility = decrease muscle mass
age = renal insufficiency
May have decrease circ time and decrease responsiveness to the BBB = be PATIENT

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10
Q

What is thought to be the reason for age related increases in pharmacodynamic sensitivity to anesthesia agents?

A

Declining neuronal function (oxidative stress or mitochondrial mutation)

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11
Q

What are some correlations with the elderly and use of of IV agents?

A

Longer half lives
30% decrease dose
Increased brain sensitivity to narcotics
Plasma drug concentration are higher after IV dose given

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12
Q

What is the rule of thumb with opioid in the elderly patient?

A

Opioid requirements are inversely related to patients age and essentially independent of body size

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13
Q

What type of local anesthetic block is higher in the elderly if a fixed dose and volume is used?

A

The sensory level of the block is higher in the elderly

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14
Q

What type of epidural dosing is reduced in the elderly?

A

Segmented dosing are reduced with aging

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15
Q

What can occur with neurogenic atrophy of the neuromuscular junction in the elderly?

A

Proliferation of extra-junctional cholinorecptors (be mindful of Succs use)

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16
Q

How is the effect and the duration of NMBA affected in the elderly patient?

A

Maximal effect is delayed and the duration of action is extended (metabolism/elimination)

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17
Q

How is reversal affected in the elderly patient?

A

Antagonism remains unchanged

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18
Q

What is one of the most common post op complications in the elderly patient?

A

Post op delirium

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19
Q

Why might the BIS monitor be a useful tool to used in the elderly?

A

Helps to gauge anesthetic level, giving fewer or lower doses will reduce postoperative delirium compared with deeper sedation

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20
Q

What drugs are known to induce post operative delirium in the elderly?

A 
Anticholinergics
Corticosteroids
Meperidine
Hypnotics
The use of five or more medications increases the risk for delirium
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21
Q

What method of anesthesia can be delivered to patient to elderly patients in pain in order to avoid delirium?

A

Regional anesthesia

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22
Q

What is the rule of thumb for providers treating post op delirium?

A

Use the lowest effective dose of benzos and antipsychotics doe the shortest duration and only after behavioral interventions have failed

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23
Q

What factors influence drugs in an obese patient?

A 
Difference in tissue distribution
Hemodynamics
Blood flow to tissue types (a lot of fat blood flow can shift from organs to adipose tissue)
Plasma composition
Liver and kidney function
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24
Q

How do we determine if a drug should be dosed on ideal body weight or total body weight?

A

IBW for drugs that are preferential to lean tissue

TBW for drugs with equal distribution to lean and adipose tissue

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25
Q

What weight should thiopental be dosed on?

A

IBW, prolongs the duration of action and half life

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26
Q

What weight should Propofol be dosed on?

A

TBW

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27
Q

What weight should Versed be dosed on?

A 
Loading dose (TBW)
Maintenance (IBW)
Sedative effects correlate better to larger VD and less to elimination
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28
Q

What weight should dexmedetomidine be dosed on?

A

TBW, does not effect respirations (preferred for analgesic qualities)

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29
Q

What weight should Succinylcholine be dosed on?

A

TBW, pseudocholinesterase activity increases with weight

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30
Q

What weight should Roc/Vec be dosed on?

A

IBW, prolonged DOA with TBW

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31
Q

What weight should Atracurium be dosed on

A

TBW, organic independent elimination

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32
Q

What weight should Cisatracurium be dosed on?

A

IBW, increase DOA seen with TBW dosing

33
Q

What weight should Fentanyl dosed on?

A

Inconclusive, TBW overestimates the dose

34
Q

What weight should Sufententanil be dosed on?

A

Loading dose TBW

Maintenance IBW

35
Q

What weight should Remifentanil be dosed on?

A

IBW, kinetics not effected by weight

36
Q

How do you calculate ideal body weight?

A

Male: 105 + 6lbs for every inch > 5ft
Female: 100 + 5lbs for every inch >5ft

37
Q

What is a disadvantage to administering children drugs via the rectal route?

A

The onset is slow and the drug effects can be unpredictable

38
Q

What route of administration is not recommended in pediatrics?

A

IM due to pain that can last for days (low muscle mass)

39
Q

What major factor may allow older children a higher dose of medications than adults?

A

They have a greater concentration of albumin and AAG than adults

40
Q

In infants, what substance can displace drugs from proteins altering drug concentration?

A

Bilirubin

41
Q

What type of drugs may require higher doses in neonates and infants?

A

Water soluble drugs

42
Q

What factor in neonates and infants allows rapid uptake of anesthetics into the CNS?

A

They have immature BBB making it more permeable

43
Q

What is an infants GFR at birth?

A

40mL/min

44
Q

What will an infants GFR increase to at 1yr old?

A

100mL/min (most profound change over a short period of time)

45
Q

What are the three checkpoints in the cell cycle?

A

Cell growth checkpoint
DNA synthesis checkpoint
Mitosis checkpoint

46
Q

When does the cell growth checkpoint occur?

A

Toward the end of growth phase 1 (G1)

47
Q

When does DNA synthesis checkpoint occur?

A

Occurs during the synthesis phase (S)

48
Q

When does the mitosis checkpoint occur?

A

Occurs during the mitosis phase (M)

49
Q

What is being checked in the cell growth checkpoint?

A

Whether the cell is big enough and has made the proper proteins for the synthesis phase

50
Q

What occurs if a cell does not pass the cell growth checkpoint?

A

The cell goes through a resting period (G0) until it is ready to divide

51
Q

What is being checked in the DNA synthesis checkpoint?

A

Whether the DNA has been replicated correctly, if so it continues to the mitosis phase

52
Q

What being checked at the mitosis checkpoint?

A

Checks if mitosis is complete, if so the cell divides and the cycle repeats

53
Q

What should be assumed about all patients receiving chemotherapy?

A

All patients will have nausea and vomiting, hair loss and altered blood counts

54
Q

If a patient has a history of using chemotherapy, what should be the anesthetists main concern?

A

The patient’s organ functions (CV, pulmonary and hepatic)

55
Q

What major toxicities are seen with cisplatin use?

A

Nephrotoxicities
Peripheral neuropathy
Nerve dysfunction

56
Q

What major toxicities are seen with methotrexate use?

A

Myelosuppression with neutropenia and thrombocytopenia

57
Q

What major toxicities are seen with bleomycin use?

A

Pulmonary fibrosis

58
Q

What major toxicities are seen with doxorubicin use?

A

Cardiotoxicity and myelosuppression

59
Q

What major toxicities are seen with cetuximab use?

A

Interstitial lung disease

60
Q

How do volatiles, barbiturates and ketamine affect cancer cell activity?

A

They suppress NK cell activity and can promote cancer cell mets

61
Q

How can nitrous oxide affect cancer cell activity?

A

It reduces purine and thus reducing DNA synthesis
Suppresses neutrophil chemotaxis
Potentially facilitates the spread of cancer

62
Q

How can propofol affect cancer cell activity?

A

It seems to exhibit protective effects through various mechanisms, including an anti-inflammatory effect, inhibition of COX-2 and reduction of PGE-2, weak beta-adrenoreceptor binding, enhancement of anti tumor immunity and NK function preservation

63
Q

How can opioids affect cancer cell activity?

A

May produce cellular and humoral immunosuppression, specifically morphine

64
Q

How can local anesthetics affect cancer cell activity?

A

They have been shown to reduce metastatic burden

65
Q

How is the ED50 of NMBA affected in the elderly?

A

They have a higher ED50 from increased density of receptors at the muscle endplate

66
Q

What three factors determine the passage of the drug across the placenta?

A

Lipid solubility, molecular weight of the drug and the degree of drug ionization

67
Q

At what molecular weight can a drug easily cross the placenta?

A

250-500

68
Q

At what molecular weight can a drug cross the placenta with a little more difficulty?

A

500-1000

69
Q

At what molecular weight does a drug very poorly cross the placenta?

A

> 1000

70
Q

How do drugs that cross the placenta enter fetal circulation?

A

Through the umbilical vein

71
Q

What is perinatal pharmacology?

A

Drug administration to the pregnant woman with the fetus as the intended target of the drug

72
Q

Why must drug administration must be done cautiously in a neonate that is jaundiced?

A

Drugs can displace bilirubin from albumin causing Kernicterus (brain damage)

73
Q

What is the difference between an elixir and a suspension?

A

An elixir solution has particles that are dissolved throughout where a suspension contains undissolved particles which could cause different dosing if not shaken properly

74
Q

What is the most common reason for medication errors in the pediatric population?

A

Incorrect calculations and incorrect placement the decimal point

75
Q

What factors cause a decrease in use of volatiles in elderly patients?

A

Reduced respiratory capacity and active pulmonary disease

76
Q

Why is it important to assess the elderly taking antihypertensives frequently for orthostatic hypotension?

A

Danger of cerebral ischemia and falls

77
Q

What is the most common cause of blindness in the elderly?

A

Age related macular degeneration

78
Q

What is drug non adherence usually due to in the elderly?

A

Forgetfulness, especially if the patient has several drugs and different dosing intervals

Pharm II Final (12 decks)

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