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My own Naplex > Acute Care and Critical Care Medicine > Flashcards

Acute Care and Critical Care Medicine Flashcards

1
Q

Crystaloids vs colloids

A

Crystalloids:

  • less costly
  • fewer adverse reactions

Colloids:

  • large molecules
  • remain in the intervascular space and increase oncotic pressure
  • more expensive and do not show clear clinical benefit
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2
Q

Crystalloids examples

A

5% dextrose (D5W)
0.9% NaCl (normal saline, NS)
Lactated Ringers (LR)
Plasma Lyte

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3
Q

Colloid examples

A

Albumin 5, 25%

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4
Q

When are dextrose crystalloids used?

A

When water is needed intracellularly since they contain free water

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5
Q

When are Lactated Ringers and normal saline used?

A

For volume resuscitation in shock states

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6
Q

when is the colloid albumin used

A

when there is significant edema (cirrhosis)

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7
Q

Why is the hydroxyethyl startch use limited

A

boxed warning in critical illness due to mortality

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8
Q

what is the cutoff for hyponaturemia

A

Na <135

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9
Q

what is the tx for hypovolemic hyponatremia

A

administer sodium chloride IV

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10
Q

What is the tx for hypervolemic hyponatremia

A

diuresis with fluid restriction

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11
Q

What is arginine vasopressin receptor (AVP) antagonists (conivaptan or tolvaptan) used to treat

A

SIADH and hypervolemic hyponaturemia

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12
Q

What is too rapid for sodium correction and what can happen?

A

12 meq/L over 24 hours to cause osmotic demyelination syndrome (ODS) or central pontine myelinolysis which can cause seizures and death

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13
Q

Samsca

A

Tolvaptan

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14
Q

What are the arginine vasopressin receptor antagonists

A

Conivaptan (Vapristol) and Tolvaptan (Samsca)

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15
Q

Why is Tolvaptan limited to greater than 30 days

A

hepatotoxicity

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16
Q

How should tolvaptan be administered

A

in a hospital

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17
Q

Side effects of tolvaptan

A

thirst, nausea, dry mouth, polyuria

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18
Q

monitoring for tolvaptan

A

rate of na increase

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19
Q

what is the cutoff for hypernaturemia

A

Na > 145 mEq/L

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20
Q

what are medications that cancause hypokalemia

A

amphotercin, insulin

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21
Q

What does a drop of 1meq/L represent in body defecit

A

100-300meQ

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22
Q

What can you NEVER administer potassium via

A

undiluted of via IV push

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23
Q

What needs to be given to incrtease potassium uptake

A

magensium

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24
Q

what is the max infusion rate and concentration of potassium

A

<10meq/100mL infusion rate and concentration of 10meq/100ml

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25
Q

what form of magnesium is orally replaced

A

magnesium oxide

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26
Q

what form of magnesium is replaced via IV

A

magnesium sulfate

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27
Q

when is IV magnesium recommended

A

When serum MG is <1 with life threatening symotins (seizures or arrhytmias)

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28
Q

When is hypophosphatemia considered severe? How to tx?

A

Less than 1mg/dL - tx by giving IV phos

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29
Q

carimune nf, flebogamma DIF, gammagard, gamumex c, octogam, privigen

A

intravenous immunoglobulin

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30
Q

when do you give slower infusion of iv immunoglobulin

A

in renal and CV disease

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31
Q

boxed warning of IV immunuglob

A

acute renal dysfunction (more likely in products stabilized with sucrose) and thrombosis

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32
Q

what are the side effects of iv immunoglobulin

A

headache, nausea, diarrhea, injection site reacion, infusion reacition (facial flushing, chest tightness, fever, chils, hypotension - slow, stop infusion)

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33
Q

what tool is used to estimate ICU mortality risk

A

APACHE II

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34
Q

Dosing for dopamine and receptors

A

Low (renal) dose 1-4 mcg/kg/min - Dopamine 1 agonist

Medium dose 5-10 mcg/kg/min beta 1 agonist

High dose 10-20 mcg/kg/min alpha 1 agonist

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35
Q

what does stimulating alpha receptors do

A

vasoconstriciton and increasing svr which increases BP

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36
Q

what is dopamine a precursor of

A

norephinephrine

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37
Q

epinephrine hits what receptors

A

alpha 1, beta 1, beta 2

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38
Q

levophed

A

norepinephrine

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39
Q

norepinephrine

A

alpha 1 > beta 1 agonist

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40
Q

phenylephrine moa

A

alpha 1 agonist

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41
Q

vasopressin known as

A

arginine vasopressin and antidiuretic hormone

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42
Q

boxed warning for vasopressor

A

vesicants when administered IV; treat extravasation with phentolamine

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43
Q

Side effects of vasopressors

A

arrhythmias, tachycardia, necrosis (gangrene), bradycardia (for phenylephrine), hyperglycemia (epinephrine)

44
Q

monitoring for vasopressor

A

continuous BP

45
Q

dosing for epinephrine push

A

0.1 mg/mL for IV and 1 mg/mL for IM

46
Q

how to treat vasopressor extravasation

A

phentolamine which is an alpha 1 blocker that antagonizes the effects of the vasopressor

47
Q

nitropres

A

nitroprusside

48
Q

Nipride

A

Nitroprusside

49
Q

contraindication to nitroglycerin

A

SBP < 90 mm hg or use with a PDE-5 inhibitor

50
Q

What is nitroglycerin at low vs high dose vs nitroprosside

A

Nitroglycerin:

  • low dose: venous vasodilator
  • High dose: arterial

Nitroprusside: mixed arterial and venous

51
Q

metabolism warning for nitroprusside

A

produces cyanide, excessive hypotension, not for direct injection (diluted D5w preferred)

52
Q

warning for nitroprosside

A

increased ICP

53
Q

pneumonic for light protection

A

protect every necessary med from daylight

nitroprusside - protect from light, if blue a no go

54
Q

What are the pros and cons of using PPIS in the ICU

A

pros: stress ulcer prophylaxis
xons: risk of GI, fractures, nosocomial pneumonia

55
Q

what are the risk factors for stress ulcers

A

mechanical ventilation > 48h and coagulapathy

56
Q

What characterizes shock

A

hypoperfusion in the setting of hypotension

57
Q

tx for shock

A

1) fill the tank - IV crystaloid bous as needed to optomize preload
2) squeeze the pipes - peripheral vasoconstrictor (alpa 1 agonist) to increase SVR
3) kick the pump - beta 1 agonist to increase myocardial contractility and cardiac output

58
Q

What are two common cause of ICU infections

A

1) mechanical ventillator

2) foley catheters

59
Q

vasopressor of choice in septic shock

A

norpinephrine

60
Q

cardiogenic shock and acute decompensated heart failure meaning

A

ADHF is the worsening symptoms of HF and cardiogenic shock is when hypotension and hypoperfusion is present

61
Q

when should be stopped in heart failures

A

beta-blockers only if hypotension or hypoperfusion is present

62
Q

how is ADHF monitored

A

via a catheter called a swan ganz that provides pulmonary capillary wedge pressure

63
Q

volume overload treatment

A

loop diuretics +/- vasodilators (NTG, nitroprusside, nesiritide)

64
Q

hypoperfusion tx (cool extremities, altered mental status, decreased renal function)

A

ionotropes (dobutamine, milrinone) and maybe a vasopressor if hypotensive (dopamine, norepipenphrine, phenylephrine)

65
Q

What are sedatives used

A

to prevent bucking the vasodilator

66
Q

what is preferred in sedation and what are the risks with it

A

propofol and dexpedetodomine (precedex) due to improved outcomes and decreased chance of delerium

67
Q

Sublimaze

A

fentanyl

68
Q

Dilaudid

A

Hydromorphone

69
Q

Duramorph

A

Morphine

70
Q

Infumorph

A

Morphine

71
Q

Precedex

A

Dexmedetomidine

72
Q

MOA of precedex (dexmedetomine)

A

alpha 2 adrenergic agonist

73
Q

Warnings with dexamethadone (precedex)

A

hypotension, bradycardia

74
Q

max duration of precedex infusion and max use of vial

A

24 hours

12 hours for vial

75
Q

only sedative also approved for non intubated patients

A

precedex (dexmedetomadine)

76
Q

Diprivan

A

Propofol

77
Q

What are contraindications to propofol (Diprivan), what do you monitor, how much energy does it provide

A

egg, soy

monitor triglycerides, equivimlent to 10% sln

78
Q

What color can propofol turn urine

A

Green

79
Q

Side effects of propofol

A

Hypotension, apnea

80
Q

Ativan

A

Lorazepam

81
Q

What is Ativan/Propofol formulated in and what can it cause

A

propylene glycol which can cause acute renal failure and metabolic acidosis

82
Q

Versed

A

Midazolam

83
Q

Versed/Midazolam contraindications and warnings

A

Contraindicated with use in CYP3A4 inhibitors (PACMANG) and canaccumulate in renal impairment due to active metabolite

84
Q

What do you monitor for in Etomidate (Amidate)

A

adrenal insufficiency

85
Q

Ketamine warnings

A

Emergence reactons

86
Q

Haldol

A

Haloperidol

87
Q

Seroquel

A

Quetiapine

88
Q

Xylocaine

A

Lidocaine

89
Q

Suprane

A

Desflurane (inhaled)

90
Q

buvicane and ropicivane are what

A

injectible anesthetics

91
Q

Overdose of inhaled anastetics can cause what

A

malignant hyperthermia

92
Q

Bupivacaine for epidurals are fatal if administered

A

intravaneously

93
Q

purpose of giving epinephrine with lidocaine

A

epinephrine vasoconstricts

94
Q

Nimbex

A

Cisatracurium

95
Q

How is Nimbex (Cisatracurium) metabolized

A

by Hoffman elimination independant of hepatic and renal function

96
Q

Succinylcholine is what

A

A depolarizing NMBA (neuromuscular blocking agent) typically used for intubationj

97
Q

Non depolarizing NMBAs can cause what side effects

A

eg atracurium, cistracurium (nimbex) and can cause flushing, bradycardia, hypotension, tachyphylaxis

98
Q

labeling and use of NMBDA

A

must be labled with warning paralyzing agents, must be used with ventilator since paranyzes diapragm, usually used to faciltate mechanical ventilation, manage inctreased increased intractranial pressure, and treat muscle spasms

99
Q

What special care must be taken while giving NMBAs

A

protect the skin, lubricate the eyes and suction the airway. Glycopyrrolate is an anticholinergic drug that can be used to reduce secretions

100
Q

how do systemic hemostatic drugs work

A

inhibit fibrinolysis or enhance coagulation to stop bleeding

101
Q

recothrom and thrombin JMI are what

A

topical hemostatic agents

102
Q

Cyklokapron

A

Tranexamic acid

103
Q

Lysteda

A

Tranexamic acid

104
Q

What is Lysteda Tranexamic acid approved for

A

heavy menstrual bleeding (menorrhagia)

105
Q

NovosevenRT

A

Recombinant Factor VIIa

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