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AP 1 > Test 2: Geriatrics (pt 3/3) > Flashcards

Test 2: Geriatrics (pt 3/3) Flashcards

1
Q

Generally, all medications given to an older adult are administered in a ______dose. (!!!)

A

Lower

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2
Q

What are the pharmacokinetic changes that lead to exaggerated responses and a prolonged duration of action in the elderly?

A

Changes in volume of distribution, renal/hepatic clearance rates, compartmental redistribution, and elimination 1/2 lives

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3
Q

What are the pharmacodynamic changes that lead to exaggerated responses and a prolonged duration of action in the elderly?

A

Altered receptor density and binding, changes in signal transduction, and impaired cellular responses

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4
Q

The minimal alveolar concentration (MAC) of inhalational agents decreases roughly ____% per decade from the MAC value of 40-year-old adults

A

6.7%

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5
Q

What is the NM blocking agent of choice for the older adult and why?

A

Cisatracurium, because it undergoes Hoffman elimination and ester hydrolysis and is not organ dependent.

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6
Q

What are the anesthetic considerations associated with administering propofol to an older adult?

A

Hypotension, prolonged recovery, increased brain sensitivity

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7
Q

What are the dose adjustments needed when giving propofol to an older adult?

A

-Decrease bolus and infusion by 50%
-Manufacturer recommends 1-1.5 mg/kg bolus for induction

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8
Q

What are the anesthetic considerations associated with administering etomidate to an older adult?

A

Increased brain sensitivity, greater hemodynamic stability

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9
Q

What are the dose adjustments needed when giving etomidate to an older adult?

A

Decrease bolus by 50%

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10
Q

What are the anesthetic considerations associated with administering opioids to an older adult?

A

-Increased brain sensitivity
-profound physiologic effects
-slower onset and delayed recovery
-consider route of metabolism and metabolites
-avoid meperidine

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11
Q

What are the dose adjustments needed when giving opioids to an older adult?

A

Decrease bolus by 50%

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12
Q

What are the anesthetic considerations associated with administering Midazolam to an older adult?

A

Increased brain sensitivity, avoid per Beers Criteria

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13
Q

What are the dose adjustments needed when giving Midazolam to an older adult?

A

AVOID
Decrease dose by 75%

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14
Q

What are the anesthetic considerations associated with administering Nondepolarizing MRs to an older adult?

A

-Slower onset and delayed recovery
-consider route of metabolism and metabolites
-Avoid long-acting NDMRs

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15
Q

What are the dose adjustments needed when giving Non-depolarizing MRs to an older adult?

A

No significant changes with intubating dose
Maintenance dose per PNS twitch response

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16
Q

What are the anesthetic considerations associated with administering Depolarizing MRs to an older adult?

A

Slower onset and delayed recovery

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17
Q

What are the dose adjustments needed when giving Depolarizing MRs to an older adult?

A

No dose adjustment

18
Q

What are the 4 basic principles in ethical decision making that apply to the older adult? (Same as for all patients)

A

1) Autonomy
2) Beneficence
3) Nonmaleficence
4) Justice

19
Q

What is autonomy?

A

The patient’s right to self-determination
-Informed consent, advanced directives (DNR)

20
Q

What is beneficence?

A

An obligation or responsibility to help the patient. To do good

21
Q

What is nonmaleficence?

A

To not intentionally harm the patient. Do no harm

22
Q

What is justice?

A

To treat the patient fairly (regardless of age, race, cultural beliefs, religion, disease process, resuscitation status, etc)

23
Q

A major neurocognitive disorder characterized by memory change or decline in memory, language, problem-solving, and other cognitive skills that affect a person’s ability to perform everyday activities.

A

Dementia

24
Q

What are common causes of dementia?

A

-Alzheimer’s Dz
-Vascular Dementia
-Parkinson’s Dz

25
Q

All types of dementia are associated with:

A

Behavioral, cognitive, and/or functional decline

26
Q

A comprehensive assessment of cognition includes:

A

-Assessment of decision-making capacity
-Assess cognition using Mini-Cog test as per recent ACS/AGS guidelines or the MoCA
-Identify risk factors for developing postoperative delirium
-Identify reversible causes of dementia
-Communication and coordination of care with geriatrician when appropriate

27
Q

A slowly progressive brain disease characterized by beta-amyloid protein deposits, intracellular neurofibrillary tangles, and loss of neurons.
-Most common cause of dementia (60-80%)

A

Alzheimer’s Dz

28
Q

-Risk factors: HTN and DM
-10% of dementia cases
-Location, number, and size of infarcts is directly r/t the degree of decline

A

Vascular Dementia

29
Q

What is mixed dementia?

A

Vascular infarcts found with Alzheimer’s Dz

30
Q

A progressive degenerative disorder of the basal ganglia associated with a deficiency in dopamine
-Behavioral, cognitive, and functional decline

A

Parkinson’s Dz

31
Q

What are causes of reversible dementia?

A

-medications
-alcohol
-metabolic disorders
-depression
-CNS neoplasms
-normal-pressure hydrocephalus

32
Q

The anesthetic plan should be based on what?

A

-patient condition
-surgery
-baseline neurologic impairment

33
Q

The use of benzodiazepines and antihistamines are associated with the development of _____, and should be avoided during the perioperative period.

A

Delirium

34
Q

Which patients may benefit from the use of Regional Anesthesia?

A

-Poorly controlled preop pain
-Chronic opioid users
-Anticipated high postop opioid requirements

35
Q

What are the most frequently occurring neurologic phenomena in older adults?

A

Postoperative Delirium and Postoperative Cognitive Dysfunction (POCD)

36
Q

Characterized by disruption of perception, thinking, memory, psychomotor behavior, sleep-wake cycle, consciousness, and attention.

A

Postoperative Delirium

37
Q

Postoperative Delirium is associated with an increased risk of:

A

-Periop mortality
-Institutionalization
-Dementia

38
Q

What are risk factors for postop delirium?

A

-Renal insufficiency
-Metabolic derangements
-Poorly controlled pain
-Polypharmacy (psychoactive drugs)
-Functional impairment
-Urinary retention
-Foley catheter
-Use of benzos and antihistamines and anticholinergics

39
Q

A predictor for postoperative delirium. Associated with an increased risk for cardiac events and death.
-Continue antidepressants perioperatively

A

Depression

40
Q

An array of cognitive impairments such as memory deficits, difficulty with concentration, impaired comprehension, and delayed psychomotor speed.
-Subtle onset, deficits may not present for weeks to months after surgery
-Inability to work, decline in ADLs, need for assisted care

A

Postoperative Cognitive Dysfunction

41
Q

How do you prevent postoperative cognitive dysfunction?

A

-Maintain oxygenation & cerebral perfusion
-Surgeries should be as short or as minimally invasive as possible
-Multimodal pain mgmt plan

AP 1 (32 decks)

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