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Pharmacology > Special Populations > Flashcards

Special Populations Flashcards

1
Q

Aging patients (3 facts)

A
  1. fastest growing population
  2. have less organ reserve
  3. more prone to adverse reactions
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2
Q

Aging patients hemodynamics (3 facts)

A
  1. volume dependent b/c LV hypertrophy (LVEDP increased)
  2. endogenously blocked (beta)
  3. stiff lungs
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3
Q

Pharmacokinetic Changes in Elderly

A
  1. Body water decreases (60 —-> 50%)
  2. Serum Albumin decreases (4.7 —-> 3.8)
  3. Kidney weight decreases (80%)
  4. Hepatic blood flow decreases (55%)
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4
Q

Elderly & opioids (2)

A

brains are very sensitive - watch out - use BIS

dosage is inversely r/t patient’s age and essentially independent of body size

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5
Q

Age-related dose reductions for IV medications (6)

A
  1. Longer 1/2 lifes
  2. 30% decrease dose/10 years
  3. increased brain sensitivity to narcotics
  4. Plasma drug concentrations immediately post injection are higher
  5. CYP450 enzymes are maintained
  6. Plasma cholinesterase decreases in elderly (male)
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6
Q

Regional anesthesia & elderly (5)

A
  1. Anatomic changes in epidural/subarachnoid space
  2. Diameter and number of myelinated fibers is decreased
  3. Increased permeability of dura & decreased volume of CSF
  4. Occlusion of foramina w/fibrous CT (patchy block)
  5. With a fixed dose & volume of LA, spread of block is higher in the elderly
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7
Q

Muscle relaxants & elderly (5)

A
  1. onset of action is delayed
  2. they have less muscle mass
  3. DOA extended
  4. antagonism is unchanged
  5. reduced plasma cholinesterase
    * increase dose of NMBD or keep the same*
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8
Q

Postop Delirium (cause; onset)

A

occurs 1-3 days postop; inflammatory process

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9
Q

What drugs to avoid in elderly?

A
  1. meperidine
  2. antihistamines/anticholinergics
  3. adjust renal meds
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10
Q

Drugs w/anticholinergic properties

A 
TCA
Antihistamine
Antimuscarinic
Antispasmodic
1st gen antipsychotics
H2 antagonists (cimetidine, ranitidine)
Skeletal muscle relaxants 
Antiemetics (promethazine)
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11
Q

Drugs that induce POD

A 
anticholinergics
steroids
meperidine
sedative hypnotics
polypharmacy
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12
Q

Some other stuff about oldies (3)

A
  1. Renal impairment
  2. Decreased plasma protein
  3. Reduced gastric motility and acidity
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13
Q

Obese pt - pharmacology significantly influenced by ??

A
  1. tissue
  2. hemodynamics
  3. blood flow
  4. plasma composition
  5. liver/kidney function
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14
Q

PK factors & obesity

A

lipid solubility

diffusion through compartments

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15
Q

Dosing for obese patients (3)

A
  1. Vd (IBW for drugs to lean tissue, TBW for drugs w/equal distribution to lean/adipose tissue)
  2. clearance
  3. LBW - extremely obese pt create more muscle weight….
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16
Q

Thiopental & obese

A

TBW

prolonged duration of action

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17
Q

Propofol & obese

A

LBW for induction
TBW for maintenance
highly lipophilic- total clearance and VD correlate well w/TBW

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18
Q

Midazolam & obese

A

Loading dose TBW
Maintenance IBW
higher dose to achieve initial therapeutic effects

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19
Q

Dexmedetomidine & obese

A
  1. 2 mcg/kg/m

* lower than usual infusion rates recommended to decrease cardiac S/E*

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20
Q

Succinylcholine & Obese

A

TBW

large ECF compartment in the obese; pseudocholinesterase activity increases w/weight

21
Q

Roc/Vec/Cis & obese

22
Q

Fentanyl & obese

A

??? IBW ???

23
Q

sufentanil & obese

A

loading dose: TBW

Maintenance: LBW (increased 1/2 life w/prolonged elimination)

24
Q

pediatric rectal

A

rectal: slower, used for < 5 y.o.

25
Q

pediatrac intranasal

A

faster; midaz & fent

26
Q

pediatric IM

A

not recommended d/t pain for days

27
Q

pediatric IV (3)

A

DEPENDENT ON

  1. circulating blood elements
  2. blood/tissue partition
  3. distribution of blood flow
28
Q

what are the two major proteins involved in binding drugs

A
  1. albumin
  2. alpha 1 acid glycoprotein

MUCH LOWER IN INFANTS

29
Q

muscle mass & fat in the infant

A

less muscle mass; greater fat stores

30
Q

blood flow to central organs in infant

31
Q

succinylcholine dose in peds

A

higher (all water soluble drugs may require higher doses)

32
Q

CO in the infant

A

HIGH (400 ml/kg/m)

33
Q

GFR at birth

34
Q

GFR at 1-2yr

35
Q

G1

A

cell growth checkpoint (at the end of growth phase G1)

checks if cell is big enough/right proteins
goes to G0 if not ready

36
Q

S phase

A

DNA synthesis checkpoint

37
Q

G2 –> M

A 
M phase (mitosis checkpoint)
makes sure mitosis is complete before dividing
38
Q

Cisplatin

A

nephrotoxicity, neuropathy, nerve dysfunction

39
Q

Methotrexate

A

myelosuppression, neutropenia & thrombocytopenia

40
Q

Bleomycin

A

hodgkins/non-hodgkins

-pulmonary fibrosis

41
Q

Doxorubicin

A

cardiotoxicity, myelosuppression

42
Q

Cetuximab

A

interstitial lung disease

43
Q

Volatiles, barbs, ketamine

A

SUPPRESS NK CELL ACTIVITY - promote cancer

44
Q

Nitrous oxide

A

SUPPRESS NEUTROPHIL - promote cancer

45
Q

Propofol

A

protective effects - activates helper T cells; antimetastatic

46
Q

Opioids

A

immunosuppression especially morphine

47
Q

LA

A

reduce metastatic burden

48
Q

GA on CA patients

A

immunosuppresion, decreasing HPA axis, hypothermia

49
Q

Drugs good for CA patients

A 
propofol
LA
BB
NSAIDS
Naltrexone

Pharmacology (2 decks)

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