Geriatrics

Question 1

What are the cardiovascular changes in the geriatric population?

Answer 1

• Decrease in elasticity of arteries
• Elevated afterload and SBP
• Left ventricular hypertrophy
• Adrenergic activity decreases
• Decreased HR, both rest and max
• Decreased baroreceptor response

Question 2

How much does the HR decline per year?

Answer 2

Decreases 1 beat/minute/year over the age of 50

Question 3

Is there an increase or decreased risk of arrhythmias?

Answer 3

Increased, conduction system fibroses and loss of SA node cells increases the risk

Question 4

What does atrial enlargement put geriatrics at risk for?

Answer 4

SVT and a-fib

Question 5

Which type of hypertrophy has increased volume?

Answer 5

Eccentric

Question 6

Which type of hypertrophy has increased wall thickness?

Answer 6

Concentric

Question 7

Is inhalation or IV induction faster in the elderly?

Answer 7

Inhalation because circulation time is slow

Question 8

What are the 2 cardiovascular responses that are altered to blunted B-receptor response?

Answer 8

Decreased maximal HR and decreased peak ejection fraction

Question 9

How do elderly patients increase their CO?

Answer 9

Increase in end-diastolic volume as opposed to HR

Question 10

What are the respiratory changes in the geriatric population?

Answer 10

Decrease in elasticity of lungs
Decrease in alveolar surface area
Increased residual volume
Vent/Perfusion mismatch
Increased chest wall rigidity
Decreased cough
Blunted response to hypercapnea and hypoxia
Decreased max breathing capacity
Increased closing capacity and closing volume

Question 11

T/F: There is a collapse of small airways

Answer 11

True

Question 12

Are elderly at an increased risk for aspiration?

Answer 12

Yes r/t decrease in airway reflexes

Question 13

What happens to the FRC?

Answer 13

Increases slightly

Question 14

What happens to the vital capacity?

Answer 14

Significantly decreases 25 ml/year starting at 20

Question 15

What happens to residual volume and dead space?

Answer 15

Increases

Question 16

What happens to total lung capacity?

Answer 16

Decreases with age

Question 17

Does Vd/Vt ratio increase or decrease with age? And which equation do you use to find out?

Answer 17

Increases because dead space increases
Bohr equation (Vd=dead space, Vt=tidal volume)

Question 18

What happens to the gastric pH and emptying?

Answer 18

pH rises and gastric emptying slows

Question 19

What happens to heat production?

Answer 19

Decreases

Question 20

T/F: heat loss decreases

Answer 20

False, increases

Question 21

What are the 3 things that put the elderly population at risk regarding normothermia?

Answer 21

Decreased metabolic rate, decreased heat production, deficient thermostat control

Question 22

What happens to blood flow and GFR?

Answer 22

Decreases

Question 23

What happens to the mass of the kidney?

Answer 23

Decreases

Question 24

What happens to the concentration and dilution?

Answer 24

Both decreased

When they need to concentrate they can’t, when their body needs to dilute, they can’t

Question 25

Is drug excretion increased or decreased?

Answer 25

Decreased

Question 26

What happens to the renin-aldosterone response?

Answer 26

Decreased

Question 27

What is the renal cortex replaced with?

Answer 27

Fat and fibrotic tissue

Question 28

Is serum creatinine increased or decreased?

Answer 28

The same r/t decrease in muscle mass and decreased production of creatinine

Question 29

Does BUN increase or decrease?

Answer 29

Increases 0.2% mg/dl/year

Question 30

Do the elderly have increased or decreased risk for renal failure?

Answer 30

Increased risk d/t decreased blood flow to the kidneys

Question 31

What is the most specific test of renal failure?

Answer 31

24 hour serum creatinine clearance to assess GFR

Question 32

What happens to the cerebral blood flow and brain mass?

Answer 32

Both decrease

Question 33

What shows to preserve cognitive function?

Answer 33

Physical activity

Question 34

What leads to muscle atrophy?

Answer 34

Degeneration of peripheral nerves slows conduction and reactions

Question 35

Which thresholds increase in regards to the nervous system?

Answer 35

``` Touch Temperature Pain Proprioception Hearing Vision ```

Question 36

Are the dosages for locals and GAs increased or decreased?

Answer 36

Reduced

Question 37

What happens when you give the elderly an epidural?

Answer 37

Anesthetic tends to have a more cephalad spread

Question 38

Which type of drugs are the elderly very sensitive to?

Answer 38

Anticholinergics like scopolamine and atropine

Question 39

Relationship between drug dose and plasma concentrations

Answer 39

Pharmacokinetics

Question 40

Relationship between plasma concentrations and clinical effect

Answer 40

Pharmacodynamics

Question 41

There is a decrease in muscle mass and increase in body fat (more in women on body fat) so this leads to what?

Answer 41

Decreases total body water (effects water soluble drugs) Reduced volume for water soluble drugs can lead to higher plasma concentrations Conversely fat soluble drugs-with increased volume of distribution, can lower the plasma concentrations

Question 42

What happens to the MAC for the elderly?

Answer 42

Decrease 4% per decade after age 40

Question 43

Why does it take longer for the elderly to wake up?

Answer 43

Increased body fat Decreased hepatic function Decreased pulmonary gas exchange

Question 44

Most plasma proteins are unchanged, albumin slightly decreases, but what happens to alpha-1 glycoprotein?

Answer 44

AAG increases, this one binds with local anesthetics and opioids

Question 45

What is Progeria?

Answer 45

Hutchinson-Gilford syndrome | Premature aging

Question 46

When is progeria apparent?

Answer 46

After 6 months

Question 47

What types of s/s do patients with progeria show?

Answer 47

``` Ischemic heart disease HTN Cerebrovascular disease OA DM ```

Question 48

What is the avg life expectancy of progeria?

Answer 48

13 years

Question 49

What are the airway difficulties with Progeria?

Answer 49

Mandibular hypoplasia (underdevelopment) Micrognathis (small mandible) Narrow glottis opening