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N929 Pharmacology > Special Populations > Flashcards

Special Populations Flashcards

1
Q

Summary of Pharmacokinetic changes in the eldery

A

decrease in TBW, Lean body mass, serum albumin, kidney weight and hepatic blood flow
Increase: body fat
increase in alpha 1 glycoprotein

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2
Q

Anesthesia in the Elderly require

A

meticulous preoperative assessment
detailed management of intraoperative variables and disease states
cautious titration of drug administration and dosages

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3
Q

What complicates pain control in the elderly?

A

pre-existing cognitive impairment
fear of opioid related side effects (opioid requirements are inversely related to patients age and essentially independent of body size)

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4
Q

Regional Anesthesia and the Elderly

A

anatomic changes in epidural and subarachnoid space
diameter and number of myelinated fibers is decreased
increased permeability of dura and decreased volume of CSF
occlusion of intervertebral formania with fibrous connective tissue
with fixed dose of volume of local anesthetic, spread of block is higher in elderly

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5
Q

Muscle Relaxants and the Elderly

A 
elderly have reduced muscle mass
onset of action is delayed
duration of action is extended
antagonism remains unchanged
reduced plasmacholinesterase
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6
Q

General Geriatric Population Considerations

A 
renal impairement
decreased plasma protein
reduced gastric motility and acidity
altered distribution increased total body fat
decreased plasma albumin concentration
decreased hepatic flow
decreased GFR
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7
Q

Drug Classes that may induce POD

A 
tricyclic antidepressants, antihistamines, antispasmodics, first generation anyti-psychotics, H2 receptor antagonist, skeletal muscle relaxants, anti-emetics
corticosteroids
meperidine
sedative hypnotics
polypharmacy
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8
Q

Pharmacology and Obese Patients is significantly influenced by

A 
difference in tissue distribution
hemodynamics
blood flow to tissue types (organs, adipose, splanchnic)
plasma composition
liver and kidney function
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9
Q

Pharmacokinetic factors in Obese patients are influenced by

A

lipid solubility of drug

diffusion through body compartments

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10
Q

Overall, dosing with obese patients should consider

A 
volume of distribution for loading dose
IBW for drugs that prefer lean tissue 
TBW for drugs with equal distribution to lean and adipose tissue
Clearance for. maintenance dose
lean body weight
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11
Q

Thiopental Dosing

A

TBW

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12
Q

Propofol Dosing

A

LBW for induction

TBW for maintenance

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13
Q

Midazolam Dosing

A

TBW loading dose

IBW mantainence

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14
Q

Dex Dosing

A

0.2mcg/kg/min

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15
Q

Succ Dosing

A

TBW

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16
Q

Roc/ Vec/ CIs/Pan Dosing

A

IBW

17
Q

Fentanyl dosing

A

inconclusive

18
Q

Sufentanil Dosing

A

Loading Dose TBW

Mantainence LBW and response

19
Q

Remifentanil Dosing

A

IBW

20
Q

What PK properties changes from fetus to baby to adult

A

VD, elimination, receptor sensitivity, side effects, organ function

21
Q

IV drug distribution in children depends on

A

circulating blood elements
blood tissue partition coefficients
distribution of blood flow

22
Q

Alpha 1 acid glycoprotein and albumin levels in infants is

A

lower

23
Q

Blood flow and pediatric pharmacology

A

relatively smaller muscle mass and greater fat stores in neonates and infants
greater blood flow to central organs (brain liver heart kidneys
water soluble drugs may require higher doses
mismatch in tissue types effects durations of actions

24
Q

Other factors that affect pediatric drug distribution

A 
integrity of BBB
-rapid uptake of anesthetics into CNS
-higher brain blood flow
receptor affinity nad sensitivity
developmental changes in hepatic metabolism
changes in renal function
25
Q

What are the two questions as a CRNA for the pharmacology of cancer patients?

A

how will the chemotherapy drugs affect your patients?

how will your anesthetic affect the patient’s prognosis

26
Q

Cell cycle and checkpoints

A

cell growth checkpoints
DNA synthesis checkpoint
mitosis checkpoint

27
Q

cell growth checkpoint

A

occurs toward the end of growth phase 1
checks whether the cell is big enough and has made proper proteins for the synthesis phase
if not, cell goes through resting period until it is ready to divide

28
Q

DNA synthesis checkpoint

A

occurs during synthesis (S)
checks whether DNA has been replicated correctly
if so, cell continues to mitosis

29
Q

Mitosis Checkpoint

A

occurs during mitosis phase
checks whether mitosis is complete
if so cell divides and cycle completes

30
Q

Clinical and Toxicity of Cisplatin

A

lung cancer, breast cancer, bile duct cancer, ovarian cancer

nephrotoxicity, peripheral neuropathy, nerve dysfunction

31
Q

Clinical and Toxicity of Methotrexate

A

breast cancer, lymphomas, bladder cancer

myelosuppression with neutropenia and thrombocytopenia

32
Q

Clinical and Toxicity of Bleomycin

A

hodgkin’s and non-hodgkin’s lymphoma

pulmonary fibrosis

33
Q

Clinical and Toxicity of Doxorubicin

A

Lung cancer, lymphomas, ovarian CA and thyroid cancer

cardiotoxicity, myelosuppression

34
Q

Clinical and Toxicity of Cetuximab

A

Colon CA
GI cancer
interstitial lung disease

35
Q

Volatiles, barbs and ketamine

A

suppress NK cell activity and can promote cancer cell mets

36
Q

Nitrous Oxide

A

reduces purine and thus DNA synthesis and also suppresses neutrophil chemotaxis, potentially facilitating the spread of cancer

37
Q

Propofol

A

seems to exhibit protective effects through various mechanisms, including anti-inflammatory effect inhibitiong of COX2 and reduction of PGE2, weak bet adrenereceptor binding, enhancement fo antitumor immunity and NK funciton preservation

38
Q

Perioperative opioids

A

may produce cellular and humoral immunosuppression

morphine example

39
Q

Local anesthetics have been shown to

A

reduce metastatic burden

N929 Pharmacology (16 decks)

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