WiseMD Modules

Question 1

Define oliguria

Answer 1

UOP under 30 ml/hr

Technically: under .5 ml/kg/hr
–So 70 kg pt under 35 ml/hr

Question 2

Name pre-renal causes of oliguria

Answer 2

Prerenal etiologies of oliguiria

• septic/hemorrhagic/hypovolemic shock
• MI
• CHF

Question 3

Intrinsic renal causes of oliguria

Answer 3

Renal causes of oliguria:

• iodinated contrast
• med induced nephropathy (diuretics, NSAIDs, ACEi, abx)

Question 4

Main culprits of med induced nephropathy

Answer 4

• Diuretics
• Abx
• ACEi (lisinopril)
• NSAIDs

Question 5

Post-renal causes of oliguria

Answer 5

Post-renal

• renal calculi
• BPH
• foley dysfunction (kinked)

Question 6

Name the major categories of dyspnea etiologies

Answer 6

Etiologies of dyspnea

• Pulmonary: upper or lower airway
• Cardiac: MI, CHF, arrhythmia
• Systemic: sepsis, metabolic acidosis, abdominal pressure
• Neurogenic: CNS depression, drugs
• Psychiatric: anxiety

Question 7

4 sepsis criteria

Answer 7

2+ of SIRS w/ known or suspected infection

SIRS criteria:

• T over 100.4 or under 96.8
• Tachy to HR > 90
• Tachypenic: RR > 20 or pCO2 under 32
• WBC >12k or under 4K

So temp, HR, RR, WBC
–what’s not here = BP!!!

Question 8

Mild pain

(a) First line
(b) Second line

Answer 8

Mild pain

a) First line = acetaminophen (tylenol
(b) Second line = NSAIDS (ibuprophen, naproxen, ketorolac)

Question 9

Moderate pain Rx safe in cirrhotics and ESRD

Answer 9

Online one is oxycodone
(+ acetaminophen = percocet)

While codeine, hydrocodone, morphine all contraindicated in liver and kidney failure

Question 10

2 meds for severe pain

Answer 10

Severe pain

• hydromorphone (dilaudid): 4-7x more potent than morphine
• fentanyl: 10x stronger than IV morphine

Question 11

Acetaminophen

(a) Starting dose
(b) Max daily dose

Answer 11

(a) 650mg regardless of mode (PO, PR, IV)

(b) Max daily dose: 3-4 g/day

Question 12

Name the 3 different NSAIDs

Answer 12

NSAIDS

1. Ibuprophen = advil, motrin
2. Naproxen = aleve, naprosen
3. Ketorolac = Toradol

Question 13

Pain meds for moderate pain

Answer 13

Moderate pain

• tramadol (synthetic codeine)
• codeine (really anti-tussive)
• hydrocodine (oral opioid)
• morphine
• oxycodone

Question 14

Narco vs. Vicodin

Answer 14

Narco = Hydrocodone (oral opioid) at diff doses (5, 7.5, 10mg) + acetaminophen 325

Vicodine = Same as above but + acetaminophen 300

Question 15

Narco vs. Percocet

Answer 15

Narco = Hydrocodone (oral opioid) at diff doses (5, 7.5, 10mg) + acetaminophen 325

Percocet = Oxycodine (1.5x strength of hydrocodone/morphine) + acetaminophen 325

Question 16

IV to PO conversion of morphine

Answer 16

Rule of thumb: 1mg IV morphine = 3mg PO morphine

Question 17

Pain med to use w/ specific caution in psych patient

Answer 17

Tramadol (synthetic codeine) also inhibits reuptake of NE and 5-HT => watch out for serotonin syndrome in pts also on SSRI, SNRI, MAOI, TCA