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Does CO increase or decrease in geriatric patients?
Decrease
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Why do geriatric patients have an increased PVR?
- Increased wall thickness & diameter
- Stiffening of aorta & large arteries
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Does geriatric patients have an impaired pump?
Yes
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Why do you see left ventricle hypertrophy in geriatric patients?
Chronic increase in afterload d/t increased PVR
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Is CAD a normal part of the aging process?
Yes
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Does blood volume increase or decrease in geriatric patients?
Decrease
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What does prolonged circulation time and decreased perfusion of organs do to the onset of drugs?
Delays induction time & slows onset of drug action
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Does lung compliance increase or decrease with age?
Increase
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Does lung elasticity increase or decrease with age?
Decreases
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What causes a decrease in FEV1 & FVC in the elderly?
Decreased elasticity
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Does CC increase or decrease with age?
Increase
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Does the A-a difference increase or decrease with age?
Increase
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Does resting PaO2 increase or decrease with age?
Decrease
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Does FRC increase or decrease with age?
Increases d/t increased RV
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Does VC increase or decrease with age?
Decrease
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Why does VC decrease in the aging adult?
d/t the decreased elastic recoil
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Does the ventilator response to hypoxia/hypercarbia increase or decrease in the aging adult?
Decrease
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What kind of structural changes can cause a decrease in lung capacity of aging adults?
- Kyphosis
- Massive scoliosis
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Why can’t the elderly tolerate the supine position?
Increased closing capacity
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Is the CBF & CMRO2 increased or decreased in the elderly?
Decreased
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Do neurons decrease in size & complexity in the elderly?
Yes
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Does the elderly have decreased receptors and neurotransmitters?
Yes
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Does the elderly lose neurons?
Yes- 50,000 per day which decreases the makers neurotransmitters
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Which brain mass declines more? Gray or white
Gray
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Does the elderly have an increased or decreased deafferentation?
Decreased sensation
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Does the elderly have an increase or decrease in adrenal mass?
Decrease
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What does a decrease in adrenal mass for the elderly mean?
Decrease cortisol/sympathetic response
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As brain mass declines, what increases to compensate?
CSF
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Does the elderly increase or decrease their CSF?
Increase
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Does the elderly have an increased or decreased baroreceptor response?
Decreased – less tachycardia IRT hypotension
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Does the elderly have an increased or decreased end-organ responsiveness to neurotransmitters?
Decreased
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Does the elderly have an increased or decreased chrono/inotropic response to agonists such as Atropine & antagonists such as propranolol?
Decreased
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What does the “endogenous beta-blockage of aging” mean?
That the elderly have 2-4 times higher plasma epi/norepi levels that have a less effect
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Is the CBF autoregulation & cerebral vasoconstrictive response to hyperventilation intact in the elderly?
Yes
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Does the elderly have an increase or decrease rate of gastric emptying?
decreased
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What type of lung pathophysiology does the aging lungs reflect?
Emphysema-like decreases
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How do you determine the resting arterial oxygen tension PaO2?
PaO2= 100 – (0.4x age in years) mm Hg
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What happens to the SNS and PSNS in geriatrics?
Increased SNS activity & decreased PSNS
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Are plasma drug levels increased or decreased in the elderly?
Increased d/t contracted blood volume (decrease TBW d/t increase fat)
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How is IH affected by the aging adult?
Decreases 4% each decade of life after the age of 40
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How is IV anesthetic agents affected by the aging adult?
Decreased doses with slow titration
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Which IV induction agent might be the most appropriate for the elderly?
Etomidate d/t the cardio-protectant qualities
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How is the dosing of narcotics affected by the aging adult?
Doses decreased d/t the decreased Vd & protein binding
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Is the elimination half-life of narcotics increased or decreased in the aging adult?
increased
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How is muscle relaxants affected by the aging adult?
- Same dose d/t them being highly polarized, relatively fat insoluble
- Increased elimination half-life (pick a short to intermediate acting)
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How does aging affect the kidneys?
- Decreased RBF/GFR
- Decreased urine concentration
- Decreased drug excretion
- Decreased ability to reabsorb glucose
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How much RBF do you lose after the age of 30?
1% per year after the age of 30
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How much GFR do you lose per year?
1-1.5%
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Is creatinine clearance increased or decreased in the elderly?
Decreased
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If the CC is decreased in the elderly, what happens to the serum creatinine levels?
Stable d/t the amount of creatinine produced (less)
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Why is it important to maintain a UO of >0.5ml//kg/hr in the perioperative period?
D/T ARF being responsible for a high mortality rate
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Why does the elderly have a decreased hepatic blood flow?
Decreased CO
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Does the aging process decrease the actual size of the liver?
Yes – 40 to 50% by the age of 80
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How does again affect hepatic biotransformation of drugs?
Decreases which causes vulnerability to cumulative drug effects
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Is hypercoagulability & peripheral thrombosis part of the aging process itself?
No
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How does aging affect the body’s response to anemia?
d/t bone marrow mass & spleen size decreasing, the hematopoetic response is decreased
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Does aging have an effect on RBC, WBC, the # or FX of platelets or coagulation?
No
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Is there a decrease in the erythrocyte life expectancy in the elderly?
No – only increased fragility
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Is anemia or disorders of hemostasis in the elderly part of the physiologic process of again?
Nope – only d/t DZ
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Is the Vd for lipophilic drugs increased or decreased in the elderly?
Increased
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Is the Vd for hydrophilic drugs increased or decreased in the elderly?
Decreased d/t the decrease of TBW
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What is the beta elimination half-life of Valium in hours equal to?
Patient’s age in years
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What are 3 major risk factors for mortality in elderly patients?
- Need to perform emergency surgery
- Site of surgery
- Physical status of the Pt at the time of surgery
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What can anticholinergic drugs do to the elderly if there is no change to onset or peak?
Increased cardiac arrhythmias if CV dz
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What happens to the heart conducting system in the elderly?
Fibrosis/atrophy
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With a decrease in CO, does the elderly have an increased or decreased systolic BP?
Increased
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Is an elderly Pt’s able to reach a maximum Hr?
No
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Might the elderly have a normal CO at rest?
Yes
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Does a slower HR speed up or slow down an IH induction?
Speeds up
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Would a slow HR speed up or slow down an IV induction?
Slow down
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Does hypothermia slow down emergence?
Yes
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How much decline does organ dysfunction go through after the age of 30?
1% each year after the age of 30
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