Special Populations

Question 1

Summary of Pharmacokinetic changes in the eldery

Answer 1

decrease in TBW, Lean body mass, serum albumin, kidney weight and hepatic blood flow
Increase: body fat
increase in alpha 1 glycoprotein

Question 2

Anesthesia in the Elderly require

Answer 2

meticulous preoperative assessment
detailed management of intraoperative variables and disease states
cautious titration of drug administration and dosages

Question 3

What complicates pain control in the elderly?

Answer 3

pre-existing cognitive impairment
fear of opioid related side effects (opioid requirements are inversely related to patients age and essentially independent of body size)

Question 4

Regional Anesthesia and the Elderly

Answer 4

anatomic changes in epidural and subarachnoid space
diameter and number of myelinated fibers is decreased
increased permeability of dura and decreased volume of CSF
occlusion of intervertebral formania with fibrous connective tissue
with fixed dose of volume of local anesthetic, spread of block is higher in elderly

Question 5

Muscle Relaxants and the Elderly

Answer 5

elderly have reduced muscle mass
onset of action is delayed
duration of action is extended
antagonism remains unchanged
reduced plasmacholinesterase

Question 6

General Geriatric Population Considerations

Answer 6

renal impairement
decreased plasma protein
reduced gastric motility and acidity
altered distribution increased total body fat
decreased plasma albumin concentration
decreased hepatic flow
decreased GFR

Question 7

Drug Classes that may induce POD

Answer 7

tricyclic antidepressants, antihistamines, antispasmodics, first generation anyti-psychotics, H2 receptor antagonist, skeletal muscle relaxants, anti-emetics
corticosteroids
meperidine
sedative hypnotics
polypharmacy

Question 8

Pharmacology and Obese Patients is significantly influenced by

Answer 8

difference in tissue distribution
hemodynamics
blood flow to tissue types (organs, adipose, splanchnic)
plasma composition
liver and kidney function

Question 9

Pharmacokinetic factors in Obese patients are influenced by

Answer 9

lipid solubility of drug

diffusion through body compartments

Question 10

Overall, dosing with obese patients should consider

Answer 10

volume of distribution for loading dose
IBW for drugs that prefer lean tissue 
TBW for drugs with equal distribution to lean and adipose tissue
Clearance for. maintenance dose
lean body weight

Question 11

Thiopental Dosing

Answer 11

TBW

Question 12

Propofol Dosing

Answer 12

LBW for induction

TBW for maintenance

Question 13

Midazolam Dosing

Answer 13

TBW loading dose

IBW mantainence

Question 14

Dex Dosing

Answer 14

0.2mcg/kg/min

Question 15

Succ Dosing

Answer 15

TBW

Question 16

Roc/ Vec/ CIs/Pan Dosing

Answer 16

IBW

Question 17

Fentanyl dosing

Answer 17

inconclusive

Question 18

Sufentanil Dosing

Answer 18

Loading Dose TBW

Mantainence LBW and response

Question 19

Remifentanil Dosing

Answer 19

IBW

Question 20

What PK properties changes from fetus to baby to adult

Answer 20

VD, elimination, receptor sensitivity, side effects, organ function

Question 21

IV drug distribution in children depends on

Answer 21

circulating blood elements
blood tissue partition coefficients
distribution of blood flow

Question 22

Alpha 1 acid glycoprotein and albumin levels in infants is

Answer 22

lower

Question 23

Blood flow and pediatric pharmacology

Answer 23

relatively smaller muscle mass and greater fat stores in neonates and infants
greater blood flow to central organs (brain liver heart kidneys
water soluble drugs may require higher doses
mismatch in tissue types effects durations of actions

Question 24

Other factors that affect pediatric drug distribution

Answer 24

integrity of BBB
-rapid uptake of anesthetics into CNS
-higher brain blood flow
receptor affinity nad sensitivity
developmental changes in hepatic metabolism
changes in renal function

Question 25

What are the two questions as a CRNA for the pharmacology of cancer patients?

Answer 25

how will the chemotherapy drugs affect your patients? | how will your anesthetic affect the patient's prognosis

Question 26

Cell cycle and checkpoints

Answer 26

cell growth checkpoints DNA synthesis checkpoint mitosis checkpoint

Question 27

cell growth checkpoint

Answer 27

occurs toward the end of growth phase 1 checks whether the cell is big enough and has made proper proteins for the synthesis phase if not, cell goes through resting period until it is ready to divide

Question 28

DNA synthesis checkpoint

Answer 28

occurs during synthesis (S) checks whether DNA has been replicated correctly if so, cell continues to mitosis

Question 29

Mitosis Checkpoint

Answer 29

occurs during mitosis phase checks whether mitosis is complete if so cell divides and cycle completes

Question 30

Clinical and Toxicity of Cisplatin

Answer 30

lung cancer, breast cancer, bile duct cancer, ovarian cancer | nephrotoxicity, peripheral neuropathy, nerve dysfunction

Question 31

Clinical and Toxicity of Methotrexate

Answer 31

breast cancer, lymphomas, bladder cancer | myelosuppression with neutropenia and thrombocytopenia

Question 32

Clinical and Toxicity of Bleomycin

Answer 32

hodgkin's and non-hodgkin's lymphoma | pulmonary fibrosis

Question 33

Clinical and Toxicity of Doxorubicin

Answer 33

Lung cancer, lymphomas, ovarian CA and thyroid cancer | cardiotoxicity, myelosuppression

Question 34

Clinical and Toxicity of Cetuximab

Answer 34

Colon CA GI cancer interstitial lung disease

Question 35

Volatiles, barbs and ketamine

Answer 35

suppress NK cell activity and can promote cancer cell mets

Question 36

Nitrous Oxide

Answer 36

reduces purine and thus DNA synthesis and also suppresses neutrophil chemotaxis, potentially facilitating the spread of cancer

Question 37

Propofol

Answer 37

seems to exhibit protective effects through various mechanisms, including anti-inflammatory effect inhibitiong of COX2 and reduction of PGE2, weak bet adrenereceptor binding, enhancement fo antitumor immunity and NK funciton preservation

Question 38

Perioperative opioids

Answer 38

may produce cellular and humoral immunosuppression | morphine example

Question 39

Local anesthetics have been shown to

Answer 39

reduce metastatic burden