1
Q
Human Chorionic gonadotropin
A
- Produced by developing conceptus and placenta
- Basis of many pregnancy tests and lab tests
- Prevents involution of corpus luteum
- Causes corpus luteum to secrete larger quantities of
sex hormones
2
Q
Understand the formation, function, and flow of blood through the placenta
A
Formation: formed from trophoblastic cells around the blastocyst
Blood-flow: diffusion
Function:
3
Q
Describe the response of the body to pregnancy
A
Weight gain: Average 24 pounds total
- Fetus: 7 pounds
- Placenta, amniotic fluid: 4 lbs
- Uterus: 2lbs
- Breasts: 2 lbs
- Plasma volume: 6lbs
- Fat: 3lbs
Circulatory:
*Although overall amount of red blood cells increases, hematocrit decreases because plasma volume increases by so much more
Metabolism & Nutrition:
- Basic metabolic rate increases about 15% during
latter half of pregnancy
- Placenta stores of nutrients are needed to sustain
fetal grown during the last months of pregnancy
Respiratory: Increased RR
- 20% increase in oxygen used by mother at term
- Progesterone increases minute ventilation
- Uterus presses abdominal content up against the
diaphragm
Kidney function:
- Glomerular filtration rate increases a lot, more to
filter out because of the fetus
- Systemic vascular resistance decreases a lot
Breast development:
- Milk ducts develop
- Soreness often early sign of pregnancy
4
Q
Describe anatomical changes that contribute to common complaints during pregnancy
A
Breast enlargement: sore breasts, sometimes leakage
Lungs: pressure on diaphragm makes breathing harder
Bladder: pressure on bladder increases frequency and urgency of urination
Small intestine: pressure results in constipation
Lower back: Extra curvature and soreness
Stomach: pressure on stomach makes eating large amounts difficult, mostly see eating small frequent meals – N/V
5
Q
Describe US regulation that addresses safety of drugs in pregnancy.
A
Males/females reproductive potential
New labeling:
- Pregnancy (includes labor and delivery)
- Lactation (includes nursing mothers)
Females and males of reproductive potential
6
Q
Define FDA pregnancy categories
A
A: Controlled human studies fail to demonstrate risk in 1st trimester; no evidence of risk in later trimesters
B: Animal – failure to demonstrate risk (or do show risk, but controlled human studies do not) Human – no controlled studies
C: Animal – adverse effect on fetus or no studies done; Human – no controlled studies
D: Human – proof of human fetal damage; “WARNING” statement on drug label
X: Animal or human studies demonstrate definite risk of fetal abnormality; “CONTRAINDICATION” statement on drug label
7
Q
Identify nursing actions to support safe use of drugs in pregnancy.
A
- Educate women of child-bearing age
- Assume any drug will reach the embryo/fetus
- Weigh risk vs. benefit
- Is a drug needed?
o Eliminate unnecessary drugs
o Avoid certain drugs; if drug therapy is necessary
o If necessary, use drugs with better safety profile - Avoid substances of abuse (before & during)
- For known teratogens (e.g. isotretinoin, Retin-A)
o Written informed consent
o Multiple forms of contraception
o Pregnancy test just prior to initiation, etc.
8
Q
Estrogen
A
- Produced by corpus luteum and placenta
- Enlargement of uterus, breasts, and external
genitalia - Relax pelvic ligaments
9
Q
Progesterone
A
- Role in nutrition of early embryo
- Decreases uterine contractility
- Helps estrogen prepare breasts for lactation
- Increases minute ventilation
10
Q
PK changes in childhood
A
Distribution:
- Limited protein binding
- BBB not fully developed
Metabolism
- Capacity of newborns is low; approaches adult level by a few months of age and complete liver maturation occurs by year 1
- Children over 1 year metabolize faster than adults; peaks around 2 years of age
Renal excretion
- Significantly reduced at birth
- Adult level of renal function achieved by 1 year
IM Absorption: slow and erratic in neonates but becomes more rapid in early infancy vs neonates and adults
Transdermal absorption more rapid and complete in infants vs older children and adults
11
Q
Arterial values of pH, pCO2, HCO3, pO2
A
pH: 7.35-7.45
pCO2: 35-45 mmHg
HCO3: 22-26mmHg
pO2: 80-100
12
Q
3 chemical buffers
A
- Bicarbonate-Carbonic acid buffer (ECF)
CO2 + H2O –> H2CO3 –> H+ + HCO3 - Protein buffer (ICF) - hemoglobin
- Phosphate buffer (ICF) - Sodium phosphate
13
Q
2nd line buffers and their speed
A
Respiratory system (Hours)
Renal system (Days)
14
Q
Respiratory buffer system
A
- If basic: breathe slower and shallower to increase CO2 gas to the blood, increase H+ and decrease pH (makes acidic)
- If acidic: breathe faster and deeper to remove CO2 gas from the blood, lower H+, and increase pH (makes basic)
15
Q
Renal system buffer
A
Kidneys can do 2 things:
- Secrete more or less H+ into renal tubule (phosphate and ammonia assist the kidneys)
- Secrete more H+ = increase pH
- Secrete less H+ = decrease pH - Reabsorb more or less bicarbonate into the blood (kidney can decide)
- more base in the bloodstream increases pH
- less base back in the bloodstream decreases pH
16
Q
Na role and range
A
- Major ECF fluid cation
- Primary puller of water (regulates osmotic forces and water balance)
- Regulates acid-base balance
- Facilitates nerve conduction and neuro-muscular function
- Transport of substances across cellular membrane
135 - 145 mEq/L
17
Q
K role and range
A
- Major ICF fluid cation
- Maintains cell electrical neutrality
- Facilitates cardiac muscle contraction and electrical conductivity
- Facilitates neuromuscular transmission of nerve impulses
- Maintains acid-base balance
3. 5 - 5 mEq/L
18
Q
Ca role and range
A
- Vital for cell permeability
- Bone and teeth formation
- Blood coagulation
- Nerve impulse transmission
- Normal muscle contraction
- Plays important role in cardiac action potential
- Essential for cardiac pacemaker automaticity
9-11 mg/dL (or 4.5-5.5 mEq/L)
19
Q
Mg role and range
A
- Women’s health and pregnancy
- Smooth muscle contraction and relaxation
- Suppresses release of acetylcholine at neuromuscular junctions (Low mg; higher Acetylcholine; more muscle spasms)
(High mg; low acetylcholine; decreased movement including respirations)
1.5 - 2.5 mEq/L
20
Q
pH normal range
A
7.35 - 7.45
21
Q
Distribution of Fluid throughout the body
A
1/3 TBW in ECF (interstitial and plasma)
- Includes interstitial fluid and plasma
- Interstitial fluid is between the cell membrane and the capillary membrane
- movement between interstitial and plasma is by filtration and absorption (managed by hydrostatic and colloid forces)
2/3 TBW in ICF
- Movement between ICF and ECF is through osmosis
22
Q
Total Body Water as % in infants, adults, and older adults
A
Infant: 70-80%
Adult: 50-60%
Older adult: 55%
23
Q
Major solutes inside and outside cell
A
Inside: K+ and Protein
Outside: Na+ and Cl-
24
Q
Osmotic pressure
A
force that attempts to balance the concentration of solute and water between intracellular and extracellular fluids (by moving water)
- Water flows toward the higher concentration of solutes
25
Hypotonic ECF
Concentration of solutes outside is smaller than concentration of solutes inside
Cell Swells
26
Hypertonic ECF
Concentration of solutes outside is greater than concentration of solutes inside
Cell shrinks
27
Examples of isotonic fluids
Normal Saline (0.9% NaCl)
Lactated Ringers
28
Example of Hypertonic fluid
D5NS or D5 1/5 NS
29
Example of hypotonic fluid
D5W (isotonic outside, but becomes hypotonic when metabolizing glucose)
** don't give to infants or head injury patients
30
Force involved in filtration and absorption
Oncotic pressure: osmotic pressure exerted by proteins (albumin) and pulls fluid toward high conc of solutes
Hydrostatic pressure: force generated by pressure of fluids on capillary walls; pushes water
31
Explain pressure involved in blood flow through a capillary
1. High fluid pressure on artery side (capillary hydrostatic pressure) pushes fluid out of capillary/vascular space into interstitial space
2. Naturally flows to an area of less pressure (venous side)
3. Capillary oncotic pressure pulls excess fluid back into the capillary/vascular space from the interstitial space
32
What forces favor filtration?
Capillary hydrostatic pressure
| Interstitial oncotic pressure
33
What forces favor reabsorption?
Capillary oncotic pressure
| Interstitial hydrostatic pressure
34
Changes in capillary/interstitial pressures during inflammation?
- Increased venous permeability means that proteins can escape
- Results in a decrease in capillary oncotic pressure
- end result is Edema
35
Discuss causes of respiratory/metabolic acidosis/alkalosis
Increased pCO2 = decreased pH = Respiratory acidosis
Decreased pCO2 = increased pH = Respiratory alkalosis
Increased HCO3 = Increased pH = Metabolic alkalosis
Decreased HCO3 = decreased pH = metabolic acidosis
36
embryonic period
0-8 weeks
| major morphologic changes
37
Fetal period
9 weeks - birth
changes in function
- Fetal lung development
- Fetal circulatory development
38
Adaptations in a fetus circulatory system
Ductus venosus: bypasses the immature liver and goes straight to inferior vena cava
Ductus arteriosus: pathway from pulmonary artery to aorta to bypass the immature lungs
Foramen ovale: opening between atria that shunts blood away from right ventricle so it doesn't go into the pulmonary artery
Increased pulmonary vascular resistance: shunts blood away from lungs
39
Fetal benchmarks in months
By first month: gross characteristics; heart tube and cardiac veins by week 3; heartbeat by week 4
By 3rd month, bone marrow is producing most of RBC
By 4th month: organs grossly same as neonate
Last 2-3 months: produce small amounts of meconium
By birth: everything except nervous system, kidneys, and liver are fully developed
40
Oligohydramnios and polyhydramnios
Too little or too much amniotic fluid
--> kidney problems can lead to not enough fluid
41
Viability:
22-26 weeks viable outside the uterus
| Surfactant doesn't develop really until 26 -38 weeks
42
Growth vs development
Growth: an increase in physical size
Development:
- Continuous, orderly, series
- Increase in function, complexity, and capabilities
43
Factors influencing growth and development
- Critical/sensitive period
- Genetics
- Environment - physical and psychological
- Culture
- Health status
- Family
44
Patterns of growth and devlepment
Pace: fast between birth and 2, and between puberty and ~15 years (slower between 2 and puberty, and ~16-24)
- Cephalocaudal
- Proximodistal
- Simple to complex
45
Endoderm
Inside: "Chemist" (homeostasis and metabolism)
- Epithelium of GI tract
- Liver
- Pancreas
- Urinary bladder
- Epithelial portions
46
Mesoderm
Middle: "architect" (structure, muscles, skeleton)
- Skeleton (head and body)
- Muscle
- Connective tissue
- Circulatory system
- Urinary system
- Spleen
- Adrenal cortex
- Genital system
- Dermis
- Dentine of teeth
47
Ectoderm
Outside: "External affairs"
- Nervous tissue
- Epidermis/skin
- Interactions with environment
48
5 Cardinal signs of inflammation
```
Pain
Heat
Redness
Swelling
Loss of function (if severe)
```
49
Describe three lines of defense
1. Physical barriers (innate)
2. Inflammation (innate)
3. Adaptive (acquired) immunity
50
State the benefits of inflammation
- Prevents infection and further injury from microorganisms
- Self-limiting through plasma proteins (feedback loop)
- Interacts with components of adaptive immunity to elicit a more specific response
- Prepares the area for healing
51
End effects of compliment
1. Chemotaxis (call phagocytes to attention)
2. Opsonization (tagging something as foreign)
2. Direct destroy (lyse pathogens)
4. Degranulation of mast cells (vascular permeability of mast cell releases key players
52
End effects of kinin
1. Pain
2. Vascular permeability
3. Vasodilation
**All from bradykinin
53
End effects of coagulation
1. Blood clot
2. Emigration of leukocytes
3. Chemotaxis
4. Increased permeability
54
Responsible for Pain?
Prostaglandins
| Vasodilation
55
Responsible for heat and redness?
Vasodilation
56
Responsible for swelling?
Neutrophil emigration, increased permeability, greater blood volume, leukotrienes, prostoglandins, histamine
57
Role of histamine
vasodilation, itching
Treat with antihistamines
58
Role of prostoglandin
Pain, vasodilation, chemotaxis
Treat with NSAIDs
59
Role of Leukotrienes
vasodilation, chemotaxis
Treat with leukotriene receptor antagonists
60
Role of bradykinin
Pain, vasodilation, vascular permeability
61
Role of cytokines
Signaling molecules; cell communication
Involved in chemotaxis, simulation and differentiation of leukocytes
**Produced by macrophages and helper T cells
62
Role of leukocytes
WBCs:
- Neutrophils ("Police")
- Eosinophils ("Fumigators")
- Monocytes ("riot police")
- Basophils ("Fire fighters")
- Lymphocytes (B, T, and NK cells)
63
Describe systemic manifestations of inflammation
1. Fever
2. Leukocytosis: increase in circulating WBCs
3. Lab changes:
- Erythrocyte sedimentation rate (ESR); inflammation causes RBCs to aggregate
- C reactive protein (CRP) helps with opsonization to facilitate phagocytosis
64
3 steps of inflammation
1. Increased Vascular Permeability
2. Emigration of leukocytes
3. Phagocytosis
65
Step 1 of inflammation
Mast cells release key players (histamine, prostaglandin, and leukotrienes)
Results in increased blood volume/hydrostatic pressure pushes fluid into interstitial space; vasodilation
66
Step 2 of inflammation
Emigration of leukocytes
1. Margination (or pavementing) - WBCs stick to wall of capillary
2. Emigration/Diapedesis (movement through capillary wall)
3. Chemotaxis (migrates to site)
67
Step 3 of inflammation
Phagocytosis
1. Recognize the antigen (binding)
2. Engulf the antigen/form a phagosome
3. Fusion with a lysosome creating a phagolysosome
4. Destruction (killing)and digestion
5. By products are created (free oxygen radicals, pus; macrophages clean up)
68
Compliment system/cascade
Activated directly or indirectly by:
1. classical pathway (antibodies)
2. Alternate pathway: infectious organisms
3. Lectin: other plasma proteins
69
What activates the coagulation/clotting system?
1. Extrinsic (tissue injury, VII)
2. Intrinsic - abnormal vessel wall and factor XII
3. Components of the kinin system
70
Activation of kinin system
Activation of factor XII to factor XIIa
71
Neutrophils
"Police"
- Fast response
- Non-specific
- Phagocytosis
- Release toxins
72
Eosinophils
"Fumigators"
- Get rid of "pests" or pathogen
- Allergic reactions and parasite infections
- Regulates inflammatory response
73
Monocytes
"Riot police"
- Immature macrophages
- Live longer (months)
- Primarily phagocytosis
- Secretes cytokines (signals)
- Presents antigens to activate T cells
- Cleans up
74
Basophils
"Fire fighters"
- immature mast cells
- Pro inflammatory chemicals
- Allergic reactions
- Acute and chronic inflammation
- Wound healing
- "Put out the flames"
75
Lymphocytes
B cells (humoral) - make antibodies; have antibody-like receptors on surfaces
T cells (cell-mediated) CD4 are helper cells, CD8 are killer cells
NK cells (innate immunity); nonspecific
76
Modes of cell signaling
1. Direct contact via receptors on the cell (immunity and inflammation)
2. Signal protein moves from one cell to another via interstitial fluid (paracrine and neurotransmitter)
3. Signal protein moves from one cell to another via the blood stream (hormonal and neurohormonal; slower process than direct contact)
4. Autocrine (cell talking to self; secreting cell targets self)
77
3 major types of cell surface receptor proteins
1. Ion-channel-linked receptors
2. Enzyme-linked receptors
3. G-Protein-linked receptors
78
Functions of proteins
1. Structure (provide support for cells through cell membrane/walls; eg elastin, collagen)
2. Immunity/antibody (bind to specific foreign particles like viruses and bacteria to help protect the body; eg immunoglobulin G or any group)
3. Enzyme (carry out almost all of the chemical reactions that take place in cells. Assist with replication, transcription, and translation; eg. polymerase, helicase, lactase)
4. Messengers/communication (transmit signals to coordinate body processes; eg. oxytocin, growth hormone, insulin)
5. Transport and storage (bind and carry atoms and small molecules within cells and throughout body; eg. hemoglobin)
79
Ligand-Gated Ion channel
- Ligand attaches to surface of protein (receptor)
- Gives message to open or close
- Lets ion go through
- Ligand, receptor both protein
- Similar to voltage-gradient process of ion channels
80
G-Protein-Coupled Receptor
Best example: opioid receptors
- Also called second messengers
- Ligand attaches to receptor protein
- Activates G-protein
1. Transforms from GDP to GTP
2. Detaches from larger protein
- Alpha acts as second messenger to tell another receptor to do something else
- Indirect impact; end result is due to second messenger
81
Enzyme-linked receptor
- Transmembrane
- Ligand binds to 2 sites and connects them by pulling together
- Results in series of reactions of cell that effects the cell
- Secondary impact
- Cascade of reactions
- Examples; insulin, growth hormone
82
Signal transduction
- Ligand-gated ion channel
- Activates a receptor on cell surface
- Activated cell surface receptor relays the signal intracellularly, amplifies signal
- Results in divergent intracellular responses
83
Intracellular receptors
- Ligand must be lipophilic to get through lipid bilayer through diffusion
- Once through membrane, can act in cytoplasm or move to nucleus through membrane
- Intracellular receptors are responsible for mRNA's ability to move out of nucleus into cytoplasm
- Inside cell doesn't need receptors because its lipophilic
84
Alpha blockers or agonists
Alpha blockers: increase GI motility, decrease bladder contraction, and decrease arterial constriction. (combats sympathetic)
Alpha agonists: Decreased GI motility, increased Bladder sphincter contraction, increased arterial constriction
85
Beta blockers or agonists
Beta blockers: Treat hypertension; expect lower heart rate, lower contractility (combats sympathetic)
Beta adrenergic agonists: Bronchodilation, increased HR, increased contractility, Increased pupil dilation
86
Muscarinic blockers or agonists
Muscarinic blockers: Combats parasympathetic, increases HR, increases contractility, pupil and bronchial dilation, decreased GI motility, bladder constriction, and arterial constriction
Muscarinic agonists: decreased HR, decreased contractility, constricted pupils, broncho-constriction, Increased GI motility, bladder sphincter relaxation, vasodilation
87
True contraindications of vaccine administration
- Anaphylactic reactions to specific vaccine: should not get further doses of THAT vaccine
- Anaphylactic reaction to a vaccine component: should not get further vaccines with THAT component
- Moderate or severe illnesses with or without a fever
88
Not contraindications (May get a vaccine)
- Mild to moderate local reaction following a dose of an injectable vaccine
- Mild acute illness with or without low grade fever
- Diarrhea
- Current antimicrobial therapy
- Convalescent phase of illness
- Prematurity (same dose and indication as for normal, full-term infants)
- Recent exposure to an infectious disease
- Personal or family history of either penicillin allergy or nonspecific allergies
89
Difference between active and passive immunity
Active
- Via natural vaccine or disease
- biological response (Antibodies and memory B cells; Cytotoxic and memory T cells)
- Several weeks to full response
- Booster after titer testing
Passive
- Administer antibody for immediate protection
- Duration is a few weeks or months
- Eg. Breastfeeding, Ig admin,, Hep B Ig, Tetanus Ig, Rabies Ig
90
Herd immunity
- Vaccination of group protects unvaccinated
| - If only some get vaccinated, virus spreads
91
Where resources are for vaccine information
CDC has immunization standards
92
Purpose of VIS (Vaccine info statement) and when given
Given before every dose
| Available in over 30 languages
93
Iron
- Essential for making red blood cells
- Use in pregnancy: expansion of maternal RBC mass, blood volume and RBC production in fetus
- Dose: general pregnancy i 27mg/day (increased from 15-18)
- AEs: can cause constipation, nausea, bloating, diarrhea, dark stools
* *Overdose can be fatal
- May attention to dosage strength/form -- looking at elemental form
- Vitamin C increases absorption
- Food decreases absorption but may help with GI probs
- Ferrous is more easily absorbed than ferric form
94
Calcium during pregnancy
Functions:
- Bone, neuronal excitability/NT release, muscle contraction, cardiac action potential, blood coagulation
Pregnancy:
- Fetal skeletal development in 3rd Tri
- Maternal skeleton
- Possible prevention of preeclampsia but more prevention needed
- RDA: 1000mg elemental Ca per day (19-50 years old) including food intake
95
Folic acid
Function
- Cell division, DNA synthesis
(amino acids, purines, and thymidine)
Pregnancy:
- Neurodevelopment; neural tube closure at 18-26 days post conception
- Populations at risk: epilepsy, family hx
AEs:
- water soluble so not many
- May mask deficiency of vitamin B12
Dose:
- 400-800mg/day for women of childbearing age
96
Caffeine clinical effects:
- CNS nervousness, insomnia, tremors
- CV; dysrthymia
- Blood vessles; CNS vasoconstriction, peripheral vasodilation
- Bronchi: relaxation of bronchial smooth muscle
- Kidney: diuretic
- Reproduction: risk for birth defects, low birth weight risk
97
Caffeine therapeutic uses
- Neonate apnea
- promoting wakefulness
- Headaches
98
Caffeine PK
- Readily absorbed from GI tract
- Peak plasma levels within 1 hour
- Half-life 3-7 hours
- Hepatic elimination
99
Alcohol
- Toxic: methanol, isopropyl, ethylene glycol
- Drinking: ethanol
- Acuse CNS effects: Targets GABA and Glutamate receptors (enhances GABA, bocks glutamate), targets serotonin to promote release of DA and reward circuit
Readily absorbed in stomach and intestines; food slows absorption
Distribution: nonionic and water soluble; goes everywhere including passing BBB
Metabolized in liver and stomach
Elimation: Zero order, constant amount is eliminated per unit of time (15ml per hour)
100
Marijuana
We are looking at effects from CBD
Highly lipid soluble
Three principle effects are euphoria, sedation, hallucinations
May cause tachycardia, acute bronchodilation, long term use causes decrease in hippocampus and amygdala
101
What is aging?
- Normal physiological process; universal and inevitable
- Time dependent loss of structure and function
- Cellular and molecular level
- NOT a disease
102
What happens in cell senescence
- There are limits to the number of times a cell can divide
- Genetically programmed: with each cell division, small amount of DNA is lost at the end of each chomosome (telomeres)
- Cell damage: reactive oxygen species
103
Reactive Oxygen Species (ROS)
= DNA Damage
- Formation of free radicals
- UV light, ionizing radiation, smoking, air pollution
- Metabolism and inflammation
104
How is the HPA implicated in aging theories?
Neuroendocrine theory:
- Aging is the decreased ability to survive stress
- Coordinating communication
- Programming physiological responses
- Maintaining optimal functional state
105
Aging and absorption
```
* Mostly only affects rate not so much extent - can lead to delayed response
Decrease GI motility
Decreased Gastric emptying
Decreased intestinal CYP450
Decreased intestinal P-gp activity
```
106
Aging and Distribution
- Decreased albumin
- Decreased lean body mass and total body water
- Decreased p-gp expression and activity
- Increased relative body fat
107
Metabolism in aging
Difficult to predict how it is effected patient to patient
- Decreased albumin
- Decreased hepatic blood flow and metabolism
108
Excretion
Drug accumulation secondary to reduced renal excretion; most important cause of adverse drug reactions in the elderly
- Decreased biliary excretion
- Decreased renal function
109
Respiratory changes in aging
- Decreased chest wall compliance (calcification of costal cartilage)
- Decreased alveolar ventilation
- Decreased respiratory muscle strength
- decreased elasticity = decreased ventilation
Therefore: less effective mucous clearance
- Reduced capacity for exercise
- Higher respiratory rate
110
Neurological changes with aging
Nerve cells degenerate and atrophy
- Decrease in neurons (in CNS)
- Decrease in neurotransmitters
- Decrease rate of conduction of nerve impulses
Loss of taste buds
Loss of auditory hair cells and sclerosis of eardrum
Therefore:
- slower processes
- Vision changes (near vision decreases)
- Hearing loss (especially high frequency)
- Decreased sensation to touch
- Decreased sense of taste
- Decreased sense of smell
- Decrease in appetite
Also short term memory, speed of motor responses, cognitive function, reflex strength and speed, decreased thirst sensation
111
Immune system changes with aging
Complex alterations in non-specific and adaptive immune function
- Increased risk for infection (decreased ability to make antibodies)
- Increased incidence of certain autoimmune diseases like thyroiditis (hyper) and gastritis
- Increased risk for malignancie
112
Endocrine/metabolic changes in aging
- Decreased basal metabolic rate
- decreased thermoregulation
- Decreased febrile response
Therefore:
- Less appetite
- Less tolerance to cold
- No fever with infection
113
Cardiovascular changes with aging
- Decreased number of heart muscle fibers, and increased thickness of individual fibers (hypertrophy)
- Decreased myocardial perfusion
- Decreased cardiac output
- Decreased cardiac contraction
- Decreased responsiveness to sympathetic stimulation
- Increased collagen and calcification of arteries (increased resistance0
- Decreased filling capacity and stroke volume
- Decreased left ventricle compliance
- 90% of sinus node cells lost by age 75
Therefore:
- Slower resting and maximum heart rate
- Higher blood pressure
- Less ability of heart and vessels to respond to changes/stress
114
Musculoskeletal changes in aging
- Decreased muscle mass
- Increased total body fat
- Decreased body water
- Decreased water in muscles, tendons, and joints
- Increased bone demineralization
- Increased joint degeneration, erosion, calcification
- Loss in bone calcium
Therefore:
overall stiffness of muscles and joints
115
Changes in integumentary system with aging
- Decreased elastin
- Decreased subcutaneous fat
- Decreased vascularity
Therefore:
- Smaller fat cushion
- Less blood flow
- Skin is less resilient, more fragile
116
hepatic changes with aging
Reduced liver size
reduced blood flow
Therefore:
reduced metabolic function
117
Renal changes with aging
- Decreased number of functional nephrons
- Declining GFR by 1%/year after age 40
- Decreased ability to regulate H+ concentration
- Decreased renal blood flow
- Decreased kidney size
- decreased bladder capacity
- Decreased ability to excrete drug metabolites and other toxins
118
GI changes in aging
- Decreased castrointestinal motility
- Decreased saliva production
- Smaller gastric capacity
Therefore:
Dry mouth, early satiety
119
Genitourinary changes in aging
- Vaginal dryness
- Longer time to erection
- Less forceful ejaculation/less firm
- Decreased sperm motility, though fertile into old age
- Prostate hyperplasia
- Decreased bladder size
- Pelvic muscle atrophy
Therefore:
- Changes in sexuality
- Urinary retention (males)
- Urinary incontinence (females)
Pathophysiology & Pharmacology
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