Module 21 Geriatrics Flashcards
How much does organ function decline as you age
1% for every year after 30yo
Unchanged hemodynamics in elderly
Diastolic BP Resting systolic function Excitation-contraction coupling Contractile proteins ical levels
Respiratory changes that increase in elderly
Deadspace
Inspiratory capacity
Vital capacity
Aspiration risk
Potential for hypoxia 2/2 decreased elasticity
Respiratory changes that increase in elderly
FRC Closing volume Closing capacity Chest wall compliance Protective reflexes
Post op delerium more common in
Old
Male
Longer anesthetic
Parkinson’s
More common in ortho procedure
Subtle delayed onset of cognitive symptoms that may not present for weeks to months after surgery
Postoperative Cognitive Dysfunction
What is the most sensitive indication of renal function in elderly. Acceptable level
Creatinine clearance
Goal >30
MAC decreases in what fashion as you age
Decreases 4-6% for each decade over 40yo
What pharmacological principles do not change in elderly
EC fluid volume
Plasma volume
Red cell mass
Response to muscle relaxants
Propofol dose in elderly
1-1.5mg/kg
Etomidate dose in elderly
0.2mg/kg
What drugs do elderly require increase dosing
Atropine
Isoproterenol
What percent of CO goes to liver? Through what vessels
25% of CO
75% portal vein
25% hepatic artery
What two vessels form portal vein
Splenic and superior mesenteric veins
Most common hematologic disorder in alcoholic
Megaloblastic anemia 2/2 folate and thiamine deficiency
Best inhalation agent for liver failure patient
Isoflurane
What agents should you avoid in patient with porphyria
Barbiturates benzodiazepines ketamine Etomidate Lidocaine Ketorolac Dilantin Hydralazine Sulfonamides
What is the basic defect of porphyria
Metabolic disorder affecting biosynthesis of heme
Drugs that increase LES tone
Reglan Edrophonium Neostigmine Succinylcholine Metoprolol Alpha adrenergic agonists Antacids
What stimulates gallbladder contraction and release of pancreatic enzymes while inhibiting gastric motility
Cholecystokinin (CCK)
What causes acid secretion in stomach and histamine release in stomach
Gastrin
What causes serum alkaline phosphatase to increase
Biliary tract obstruction
Biochemical hallmark of carcinoid syndrome
Overproduction of serotonin
Electrolyte disturbance seen with anorexia
Hypokalemia
Hyponatremia
Hypochloremia
Metabolic alkalosis
