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Symptoms > Weakness > Flashcards

Weakness Flashcards

1
Q

What are the 5 I’s of Geriatrics?

A
  • Impaired homeostasis
  • Incompetence
  • Incontinence
  • Impaired mobility, falls, weakness
  • Iatrogenesis
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2
Q

How common are iatrogenic illnesses in older patients?

What kind is the most common?

What is the result?

A
  • 1/3 acutely hospitallized older patients
  • Adverse drug reactions
  • Functional losses & increased costs
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3
Q

What are some factors that affect drug disposition & response in the elderly?

A
  • Body composition
  • Reduced TBW
  • Reduced lean body mass/weight
  • Increased body fat
  • Protein binding
  • Reduced serum albumin
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4
Q

Elderly Patients

Drugs that distribute to body fat will have a (higher/lower) volume of distribution.

Drugs that distribute to TBW will have a (higher/lower) volume of distribution.

A

Drugs that distribute to body fat will have a higher volume of distribution.

Drugs that distribute to TBW will have a lower volume of distribution.

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5
Q

What are the functions of the kidney?

A
  • Excretion of metabolic waste products & foreign chemicals
  • Regulation of water & electrolyte balances
  • Regulation of body fluid osmolality & electrolyte concentrations
  • Regulation of arterial pressure
  • Regulation of acid-base balance
  • Secretion, metabolism & excretion of hormones
  • Gluconeogenesis
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6
Q

Estimate the interstitial fluid volume of a healthy individual with a body mass of 60 kg.

  • 36 liters
  • 24 liters
  • 12 liters
  • 9 liters
  • 3 liters
A

9 liters

  • ICF = 40% body weight
  • ECF = 20% body weight
  • Interstitial fluid = 3/4 ECF
  • Plasma volume = 1/4 ECF
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7
Q

What is the equation for blood volume?

A

Plasma volume/(1-Hct)

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8
Q

An individual of normal body composition (plasma osmolarity = 280 mOsm/l) ingests 1 liter of a solution containing 200 mmole/L NaCl. After equilibrium of body fluids, & before any renal excretion has occurred, which statement will be true?

  • His TBW is reduced compared to initial conditions
  • His interstitial fluid osmolarity will be reduced compared to initial conditions
  • His plasma volume will be reduced compared to initial conditions
  • His intracellular fluid osmolarity will be increased compared to initial conditions
  • His intracellular fluid volume will be increased compared to initial conditions
A

His intracellular fluid osmolarity will be increased compared to initial conditions

  • The ingestion of a hypertonic NaCl solution will lead to an increase in TBW, an increase in ECFV & an increase in osmolarity is all fluid compartments, & a decrease in ICFV
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9
Q

What is the composition of the fluid in the different compartments?

A

water, electrolytes, non-electrolyte small molecules, protein

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10
Q

What is the difference btwn plasma & interstitial fluid?

A
  • Plasma ~ interstitial fluid, except for more proteins in plasma
  • Capillary wall is highly permeable to water, electrolytes, and other small molecules, but not proteins
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11
Q

What is the difference btwn ECF & ICF?

A
  • ECF & ICF have substantial differences
  • The cell membrane is highly permeable to water, but not to most electrolytes or proteins
  • ECF: high in Na+, Cl-, HCO3-
  • ICF: high in K+, PO43- & organic anions, protein
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12
Q

What is responsible for the distribution of Na+ & K+ btwn ECF & ICF?

What is the barrier?

A
  • Na+/K+ ATPase
    • 3 Na+ out, 2 K+ in
  • Barrier: cell membrane
  • Distribution governed by osmotic forces
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13
Q

What is the definition of osmolarity?

A
  • A function of the total number of particles in solution, independent of mass, charge or chemical composition
  • The concentration of osmotically active particles in total solution
  • Expressed in mOsm/L of water
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14
Q

Osmolarity

For substances that do not dissociate into smaller particles when dissolved….

For substances that dissolve into 2 particles or 3 particles…..

A
  • For substances that do not dissociate into smaller particles when dissolved
    • 1 mmole = 1 mOsm
  • For substances that dissolve into 2 or 3 particles, the osmolarity will be double or triple the molarity
    • 1 mmole NaCl = 2 mOsm
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15
Q

What is the definition of osmosis?

A
  • The movement of water across a semi-permeable membrane due to differences in osmolarity (osmotic pressure gradient)
  • A 1 mOsm/L difference in osmolarity can exert an osmotic pressure equivalent to 19.3 mmHg
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16
Q

What is the influence of adding isotonic, hypotonic and hypertonic NaCl solutions to the ECF on TBW, ECFV & ICFV?

A
17
Q

What is a common pneumonic used when determining a differential diagnosis?

A

IPINGII

  • Infection, infestation
  • Physical/traumatic
  • Immune
  • Neoplastic
  • Genetic/metabolic
  • Iatrogenic
  • Idiopathic
18
Q

What are some changes related to aging that affect pharmacokinetics of drugs?

A
  • Decreased body water
  • Decreased lean body mass
  • Increased body fat
  • Decreased serum albumin
  • Decreased kidney weight
  • Decreased hepatic blood flow
19
Q

Which of the following medications should be avoided as hyponotics in older patients?

  • Diazepam
  • Flurazepam
  • Oxazepam
  • Lorazepam
A

Diazepam, Flurazepam

  • Phase I hepatic metabolism affected by aging
  • Phase II hepatic metabolism NOT affected by aging (Oxazepam, Lorazepam)
20
Q

In which drugs is there an age-related decreased in hepatic clearance?

A
  • Alprazolam
  • Barbiturates
  • Carbenoxolone
  • Chlordiazepoxide
  • Chlormethiazole
  • Clobazam
  • Desmethyldiazepam
  • Diazepam
  • Flurazepam
  • Imipramine
  • Meperidine
  • Nortriptyline
  • Phenylbutazone
  • Propranolol
  • Quinidine, quinine
  • Theophylline
  • Tolbutamide
21
Q

In which drugs is there no age-related difference found in hepatic clearance?

A
  • Ethanol
  • Isoniazid
  • Lidocaine
  • Lorazepam
  • Nitrazepam
  • Oxazepam
  • Prazosin
  • Salicylate
  • Warfarin
22
Q

Describe Phase II hepatic metabolism

A
  • Mediated by cytoplasmic enzymes
  • Addition of water soluble moieties to drugs (acetylation, glucuronidation, sulfation, glycine conjugation)
  • Not commonly altered with age
23
Q

How does creatinine clearance change with age?

A
  • GFR decreases with age
  • Creatinine clearance decreases with age
  • Total body production decreases with age
  • However, serum concentration doesn’t change very much because you don’t make as much, it no longer reflects renal function
24
Q

How is creatinine clearance calculated?

A

Cockgroft Gault Equation for Creatine Clearance​

  • For women, multiply by 0.85
25
Q

What are the 4 kidney processes that determine the composition of urine?

A
  • Filtration
  • Reabsorption
  • Secretion
  • Excretion
26
Q

You obtain the following experimental data from a 70 kg male subject: UFR = 1.0 ml/min, PIN = 1.0 mg/ml, PPAH = 1.0 mg/ml, UIN = 60 mg/ml, UPAH = 650 mg/ml, Hct = 50%. What is this individual’s GFR?

  • 30 ml/min
  • 60 ml/min
  • 120 ml/min
  • 650 ml/min
  • 1300 ml/min
A

60 ml/min

  • GFR = [UFR*UIN]/PIN
  • GFR = [(1 ml/min)(60 mg/ml)]/(1.0 mg/ml)
  • GFR = 60 ml/min
27
Q

What is the definition of mass balance for the kidney?

For the nephron?

A

renal arterial input = urine output + renal venous & lymphatic output

filtered + secretion = reabsorption + excretion

28
Q

How is inulin filtered through the kidney?

How can this be used to estimate GFR?

A
  • Inulin is freely filtered at the glomerulus but is not reabsorbed or secreted
  • Filtration of inulin = excretion of inulin
  • GFR x PIN = UF x UIN
  • GFR = (UF x UIN)/PIN
29
Q

What is the definition of clearance?

How is it calculated?

A
  • The volume of plasma from which a substance has been removed & excreted into the urine per unit of time (volume/time)
  • CX = (UF*UX)/PX
  • Clearance of creatinine can be used to measure GFR with an endogenous compound
30
Q

A normal individual receives a drug that effectively halves his glomerular filtration rate. After a period of 2 wks on this drug, this patient will have ______ plasma creatinine concentration, _______ creatinine clearance rate, and _________ creatinine excretion rate compared

A

Symptoms (17 decks)

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