Special Populations

Question 1

Which patient population has less organ reserve?

Answer 1

Geriatric population

Question 2

What does having less organ reserve mean?

Answer 2

diminished function, may be smaller (liver, brain)

Question 3

Patients over 70 take how many prescription medications daily?

Answer 3

two

19% taking more than 10!

Question 4

Why are geriatrics more prone to adverse reactions to medications?

Answer 4

Polypharmacy

Question 5

Physiologic considerations for geriatrics

Answer 5

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

Question 6

Pharmacokinetic changes in geriatrics

Answer 6

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

Question 7

What is another protein that drugs bind to besides albumin?

Answer 7

alpha 1 glycoprotein

not usually a big impact however

Question 8

Anesthetic considerations for the elderly

Answer 8

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

Question 9

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

Answer 9

declining neuronal function

may need additional monitoring such as BIS monitor

Question 10

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

Answer 10

higher

Question 11

regional anesthesia geriatric considerations

Answer 11

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

Question 12

muscle relaxant considerations for the elderly

Answer 12

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

Question 13

What is a common postoperative complication in the elderly?

Answer 13

delirium

Question 14

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

Answer 14

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

Question 15

Dosing in the obese patients should consider

Answer 15

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

Question 16

Propofol dosing for obese

Answer 16

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

Question 17

Midazolam dosing for obese

Answer 17

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

Question 18

Dexmeditomidine dosing for obese

Answer 18

0.2 mcg/kg/min

lower than usual infusion rates to decrease cardiac S/Es

Question 19

Succinylcholine dosing for obese

Answer 19

TBW

pseudocholinesterase activity increases with weight

Question 20

Roc/Vec/Cis dosing for obese

Answer 20

IBW - ensures more predictable recovery

prolonged DOA with TBW administration

Question 21

Fentanyl dosing for obese

Answer 21

dosing based on TBW overestimates dose requirements

Question 22

Sufentanil dosing for obese

Answer 22

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

Question 23

Remifentanil dosing for obese

Answer 23

IBW

kinetics not effected by weight

Question 24

Rectal administration of drugs in pediatrics

Answer 24

slower absorption

used in children under 5 for sedation

Question 25

Intranasal administration of drugs in pediatrics

Answer 25

faster onset
less offensive
can give Midazolam or Fentanyl

Question 26

IM administration of drugs in pediatrics

Answer 26

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

Question 27

Smaller muscle mass and greater fat stores in neonates and infants =

Answer 27

greater blood flow to the central organs, water soluble drugs may require higher doses, and mismatch in tissue types effects durations of actions

Question 28

GFR at birth

Answer 28

40mL/min

Question 29

GFR at 1 year of age

Answer 29

100mL/min

Question 30

Anesthetic considerations for cancer patients

Answer 30

NV, dehydrated, decreased total body water, pulmonary fibrosis/toxicity, heart damage

Question 31

Cisplastin

Answer 31

use: lung CA, breast CA, bile duct CA, ovarian CA
toxicity: nephrotoxicity, peripheral neuropathy, nerve dysfunction

Question 32

Methotrexate

Answer 32

use: breast CA, lymphomas, bladder CA
toxicity: myelosuppression w/ neutropenia and thrombocytopenia

Question 33

Bleomycin

Answer 33

use: Hodkin’s and nonHodkin’s lymphoma
toxicity: pulmonary fibrosis

Question 34

Doxorubicin

Answer 34

use: lung CA, lymphomas, ovarian CA, thyroid CA
toxicity: cardiotoxicity, myelosuppression

Question 35

Cetuximab

Answer 35

use: colon CA, GI CA
toxicity: interstitial lung disease

Question 36

How volatiles, barbs, and ketamine influence cancer cell activity

Answer 36

suppress NK cell activity and promote cancer cell mets

Question 37

How nitrous oxide influences cancer cell activity

Answer 37

reduces purine and DNA synthesis, suppresses neutrophil chemotaxis, facilitates spread of cancer

Question 38

How propofol influences cancer cell activity

Answer 38

protective effects - anti-inflammatory effect, inhibition of COX2 and reduction of PGE-2, weak Beta adrenoreceptor binding, enhancement of antitumor immunity, NK function preservation

Question 39

How opioids influences cancer cell activity

Answer 39

produce cellular and humoral immunosuppression (morphine)

Question 40

How local anesthetics influences cancer cell activity

Answer 40

reduce metastatic burden