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Board Prep > Module 21 Geriatrics > Flashcards

Module 21 Geriatrics Flashcards

1
Q

How much does organ function decline as you age

A

1% for every year after 30yo

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2
Q

Unchanged hemodynamics in elderly

A 
Diastolic BP
Resting systolic function
Excitation-contraction coupling
Contractile proteins
ical levels
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3
Q

Respiratory changes that increase in elderly

A

Deadspace
Inspiratory capacity
Vital capacity

Aspiration risk
Potential for hypoxia 2/2 decreased elasticity

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4
Q

Respiratory changes that increase in elderly

A 
FRC
Closing volume
Closing capacity
Chest wall compliance
Protective reflexes
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5
Q

Post op delerium more common in

A

Old
Male
Longer anesthetic
Parkinson’s

More common in ortho procedure

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6
Q

Subtle delayed onset of cognitive symptoms that may not present for weeks to months after surgery

A

Postoperative Cognitive Dysfunction

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7
Q

What is the most sensitive indication of renal function in elderly. Acceptable level

A

Creatinine clearance

Goal >30

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8
Q

MAC decreases in what fashion as you age

A

Decreases 4-6% for each decade over 40yo

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9
Q

What pharmacological principles do not change in elderly

A

EC fluid volume
Plasma volume
Red cell mass
Response to muscle relaxants

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10
Q

Propofol dose in elderly

A

1-1.5mg/kg

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11
Q

Etomidate dose in elderly

A

0.2mg/kg

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12
Q

What drugs do elderly require increase dosing

A

Atropine

Isoproterenol

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13
Q

What percent of CO goes to liver? Through what vessels

A

25% of CO

75% portal vein
25% hepatic artery

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14
Q

What two vessels form portal vein

A

Splenic and superior mesenteric veins

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15
Q

Most common hematologic disorder in alcoholic

A

Megaloblastic anemia 2/2 folate and thiamine deficiency

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16
Q

Best inhalation agent for liver failure patient

A

Isoflurane

17
Q

What agents should you avoid in patient with porphyria

A 
Barbiturates
benzodiazepines
ketamine
Etomidate
Lidocaine
Ketorolac
Dilantin
Hydralazine
Sulfonamides
18
Q

What is the basic defect of porphyria

A

Metabolic disorder affecting biosynthesis of heme

19
Q

Drugs that increase LES tone

A 
Reglan
Edrophonium
Neostigmine
Succinylcholine 
Metoprolol
Alpha adrenergic agonists
Antacids
20
Q

What stimulates gallbladder contraction and release of pancreatic enzymes while inhibiting gastric motility

A

Cholecystokinin (CCK)

21
Q

What causes acid secretion in stomach and histamine release in stomach

A

Gastrin

22
Q

What causes serum alkaline phosphatase to increase

A

Biliary tract obstruction

23
Q

Biochemical hallmark of carcinoid syndrome

A

Overproduction of serotonin

24
Q

Electrolyte disturbance seen with anorexia

A

Hypokalemia
Hyponatremia
Hypochloremia
Metabolic alkalosis

25
Q

What hormonal mediators are involved in carcinoid syndrome

A 
Serotonin
Bradykinin
Histamine
Prostaglandins
Kallikrein
26
Q

What are the stimuli for release of mediators from carcinoid tumor

A

Catecholamines
Histamine
Hypotension
Tumor manipulation

27
Q

What drugs increase gastric pH and decrease gastric volume

A

H2 antagonists

Cimetidine
Famotidine
Ranitidine

28
Q

H2 antagonists have what effect on liver enzymes

A

Bind cytochrome P450 systems

Cimetidine most inhibits them

29
Q

How do antacids work

A

Raise gastric pH by neutralizing HCl

However they increase gastric volume

30
Q

Best way of increasing gastric pH quickly

A

Non-particulate antacids (sodium citrate)

31
Q

Non-particulate antacids lose effectiveness in how long

A

30-60 minutes

32
Q

Only drug approved for diabetic gastroparesis

Receptor

A

Metoclopramide

Dopamine antagonist

33
Q

Plasma protein changes in elderly

A

Most unchanged or slightly decreased (albumin)

Alpha 1 glycoprotein is increased

34
Q

How does ANS change with aging

A

Decrease in response to beta receptor stimulation

Increase in SNS activity

35
Q

Why is elimination of IV anesthetics half life increased in elderly

A

Decreased hepatic metabolism

Decreased plasma protein binding

Increase in fat increase Vd and prolongs lipid soluble drug half life

Board Prep (19 decks)

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