Special Populations Flashcards

1
Q

Which patient population has less organ reserve?

A

Geriatric population

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2
Q

What does having less organ reserve mean?

A

diminished function, may be smaller (liver, brain)

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3
Q

Patients over 70 take how many prescription medications daily?

A

two

19% taking more than 10!

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4
Q

Why are geriatrics more prone to adverse reactions to medications?

A

Polypharmacy

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5
Q

Physiologic considerations for geriatrics

A
Volume dependent
LV hypertrophy = increased LVEDP
Endogenously beta-blocked = decreased HR
Hypotensive
Lungs stiffer = gas exchange not as efficient
slower circulation time
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6
Q

Pharmacokinetic changes in geriatrics

A
decreased total body water
decreased lean body mass
more body fat
decreased serum albumin
decreased kidney weight/function
decreased hepatic blood flow
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7
Q

What is another protein that drugs bind to besides albumin?

A

alpha 1 glycoprotein

not usually a big impact however

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8
Q

Anesthetic considerations for the elderly

A

meticulous preoperative assessment (activity level)
cautious titration of drug administration and dosages
decreased MAC requirements

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9
Q

Sensitivity to opioids in the aging population may be a result from

A

declining neuronal function

may need additional monitoring such as BIS monitor

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10
Q

plasma drug concentrations immediately after inject are usually ____ in the elderly

A

higher

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11
Q

regional anesthesia geriatric considerations

A

anatomic changes in epidural and subarachnoid space
diameter and number of myelinated fibers is decreased
increased permeability of the dura and decreased volume of CSF
occlusion of intervertebral foramina with fibrous connective tissue

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12
Q

muscle relaxant considerations for the elderly

A

reduced skeletal muscle mass
delayed onset of action
extended duration of action
reduced plasmacholinesterase

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13
Q

What is a common postoperative complication in the elderly?

A

delirium

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14
Q

Commonly used medications used in the perioperative setting that may induce postoperative delirium

A

tricyclic antidepressants, antihistamines, antimuscarinics, antispasmodics (scopolamine), antipsychotics, H2 receptor antagonists, skeletal muscle relaxants, antiemetics, corticosteroids, meperidine, benzodiazepines, sedative-hypnotics

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15
Q

Dosing in the obese patients should consider

A

volume of distribution for loading dose
clearance for maintenance dose
lean body weight

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16
Q

Propofol dosing for obese

A

LBW for induction
TBW for maintenance
total clearance and Vd correlate well with TBW

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17
Q

Midazolam dosing for obese

A

TBW for loading dose
IBW for maintenance
sedative effects correlate better to larger Vd and less to elimination

18
Q

Dexmeditomidine dosing for obese

A

0.2 mcg/kg/min

lower than usual infusion rates to decrease cardiac S/Es

19
Q

Succinylcholine dosing for obese

A

TBW

pseudocholinesterase activity increases with weight

20
Q

Roc/Vec/Cis dosing for obese

A

IBW - ensures more predictable recovery

prolonged DOA with TBW administration

21
Q

Fentanyl dosing for obese

A

dosing based on TBW overestimates dose requirements

22
Q

Sufentanil dosing for obese

A

TBW loading dose
LBW maintenance
increased Vd and prolonged elimination 1/2 life correlates with degree of obesity

23
Q

Remifentanil dosing for obese

A

IBW

kinetics not effected by weight

24
Q

Rectal administration of drugs in pediatrics

A

slower absorption

used in children under 5 for sedation

25
Intranasal administration of drugs in pediatrics
faster onset less offensive can give Midazolam or Fentanyl
26
IM administration of drugs in pediatrics
not recommended d/t pain that can last days may be used in emergency and pain medications may not have as much muscle decreased blood flow so not sure what effect youll get
27
Smaller muscle mass and greater fat stores in neonates and infants =
greater blood flow to the central organs, water soluble drugs may require higher doses, and mismatch in tissue types effects durations of actions
28
GFR at birth
40mL/min
29
GFR at 1 year of age
100mL/min
30
Anesthetic considerations for cancer patients
NV, dehydrated, decreased total body water, pulmonary fibrosis/toxicity, heart damage
31
Cisplastin
use: lung CA, breast CA, bile duct CA, ovarian CA toxicity: nephrotoxicity, peripheral neuropathy, nerve dysfunction
32
Methotrexate
use: breast CA, lymphomas, bladder CA toxicity: myelosuppression w/ neutropenia and thrombocytopenia
33
Bleomycin
use: Hodkin's and nonHodkin's lymphoma toxicity: pulmonary fibrosis
34
Doxorubicin
use: lung CA, lymphomas, ovarian CA, thyroid CA toxicity: cardiotoxicity, myelosuppression
35
Cetuximab
use: colon CA, GI CA toxicity: interstitial lung disease
36
How volatiles, barbs, and ketamine influence cancer cell activity
suppress NK cell activity and promote cancer cell mets
37
How nitrous oxide influences cancer cell activity
reduces purine and DNA synthesis, suppresses neutrophil chemotaxis, facilitates spread of cancer
38
How propofol influences cancer cell activity
protective effects - anti-inflammatory effect, inhibition of COX2 and reduction of PGE-2, weak Beta adrenoreceptor binding, enhancement of antitumor immunity, NK function preservation
39
How opioids influences cancer cell activity
produce cellular and humoral immunosuppression (morphine)
40
How local anesthetics influences cancer cell activity
reduce metastatic burden