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NAPLEX Prep > Acute and Critical Care Medicine > Flashcards

Acute and Critical Care Medicine Flashcards

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1
Q

What is the difference between crystalloids and colloids

A

Crystalloids: less costly and fewer ADRs

Colloids: large molecules that remain in intravascular space to ↑ oncotic pressure

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2
Q

Types of crystalloids

A

D5W
NS
LR

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3
Q

Types of colloids

A

Albumin 5% or 25%

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4
Q

Hyponatremia

A

<135

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5
Q

Sx of hyponatremia

A

Sezures, coma

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6
Q

Level of hyponatremia for the use hypertonic saline

A

<120

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7
Q

How do you correct hyponatremia

A

Goal: 4-8 mEq/L/day

Correcting >12 mEq/day → osmotic demyelination syndrome or central pontine myelinolysis → paralysis, seizures, and death

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8
Q

Agents used to treat SIADH and hypervolemic hyponatremia

A

AVP receptor antagonist (tolvaptan and conivaptan)

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9
Q

Warning of tolvaptan

A

Limited <30 days due to hepatotoxicity

BBW: must be initiated at the hospital, rapid overcorrection → ODS

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10
Q

ADR of tolvaptan

A

Thirst, nausea, dry mouth, polyuria

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11
Q

Tolvaptan

A

Samsca

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12
Q

What is hypernatremia

A

> 145

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13
Q

Hypernatremia treatment

A

Hypovolemic: fluids
Hypervolemic: diuresis
Isovolemic: desmopressin

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14
Q

What is hypokalemia?

A

<3.5

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15
Q

Potassium replacement dosing

A

IV potassium: peripheral line with max rate ≤10 mEq/hr and max concentration of 10 mEq/100mL

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16
Q

What is hypomagnesemia?

A

<1.3

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17
Q

Sx of hypomagnesemia

A

Sz, arrhythmi

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18
Q

Tx of hypomagnesemia

A

Mg <1: IV mag sulfate

If Mg is between 1-1.5 → PO mag oxide

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19
Q

What is hypophosphatemia

A

<1

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20
Q

Treatment of hypophosphatemia

A

IV phosphorus

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21
Q

Dosing of IVIG

A

Slower infusion rate in real and CV diseases

Don’t freeze or shake

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22
Q

BBW of IVIG

A

Acute renal dysfunction (stabilized with sucrose)

Increased risk for thrombosis

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23
Q

ADR of IVIG

A

Infusion-related reactions (facial flushing, chest tightness, fever, chills. hypotension) → slow or stop infusion

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24
Q

IVIG with vaccines

A
  1. Administer together
  2. Live vaccine then IVIG → 2 wks months
  3. IVIG the live → ≥3 months
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25
IVIG
Gammagard, Gamunex-C, Octagon, PRivigen
26
Scoring tool used to determine prognosis and estimate ICU mortality risk
27
Low dose dopamine
D1 agonist: 1-4 mcg/kg/min
28
Mediam dose dopamine
5-10 mcg/kg/min B-1 agonist
29
High dose dopamine
10-20 mcg/kg/min A-1 agonist
30
Epinephrine selectivity
Nonselective a1 and b1 and b2 agonist
31
Norepinephrine selectivity
A1 > b1
32
Phenylephrine selectivity
A1
33
Vasopressin selectivity
Vasopressin receptor agonist
34
BBW of vasopressors
Vesciants → treat extravasation with phentolamine
35
ADR of vasopressors
Arrthymias, tachycardia, necrosis, hyperglycemia,
36
Administration site of vasopressors
Central line
37
Epinerphrine strength based on route of adminsitration
IV push 0.1 mg/mL (1:10000) IM injection 1 mg/mL (1:1000)
38
How to prevent extravasation from pressors
Infuse vasopressors via central line Phentolamine as a reversal agent (a1-blocker)
39
Indications for vasodilators
Myocardial infarction and uncontrolled HTNq
40
Selectivity of NG
Low: venous vasodilation High: arterial vasodilation
41
Sevectivity of nitroprusside
Mixed (equal) arterial and venous vasodilator
42
CI of NG
SBP <90 and on PDE5I
43
ADR of NG
HA, tachycardia, tachyphylaxis
44
BBW of nitroprusside
Nitroprusside → cynanide Excessive hypotension Must be diluted in D5W ↑ ICP
45
ADR of Nitroprusside?
HA, tachycardia, toxicity with renal and hepatic impairment)
46
Storage of NG and nitroprusside
NG: non-PVC container NP: light protection → blue (degradation to cyanide)
47
MOA of inotropes
Increase the contractility of the heart
48
Indications of inotropes
Used when BP is adequate due to vasodialtion
49
Selectivity of dobutamine
B1 > b2 and a1
50
Selectivity of milrinone
PDE3I
51
Storage of dobutamine
Slightly pink (oxidation) but potency is not lost
52
What is shock
Hypoperfusion in the setting of hypotension (SBP<90)
53
Tx of hypovolemic shock
Fluid (crystalloids) for non-hemorrhage Blood products Vasopressors not effective until volume is restored
54
Types of distributive shock
Low SVR and initially high CO then low or normal CO Septic Anaphylactic Neurogenic
55
What is septic shock
Life-threatening organ disfunction → dysregulated host response to infection
56
Criteria of septic shock
Tachypnea, tachcarida, hypotension, fever, decreased mental status NEW, qSOFA, SIRS
57
Tx of septic shock
MAP ≥65 (MAP = (2 x DBP + SBP)/3 A1 → ↑ SVR B1 → ↑ contractility and CO Broad-spectrum ABX and fluid crystalloids NE is VP of choice (A1 >B1 activity)
58
How do you assess ADHF
Cardiac catheter (Swan-Ganz) → PCWPn
59
When should BB by DC for ADHF
If hypotension and hypo perfusion is present
60
How to treat volume overload
Patients that present with edema, JVD, ascites: Loop diuretic Vasodilators
61
Tx of hypo perfusion
Patients presenting with decreased renal, altered mental status, cool extremities: Inotropes (dobutamine or milrinone) Hypotensive (vasopressors not Epi)
62
IV pain med first line
Morphine, hydromorphone, fentanyl
63
What is analgesia based sedation
Uses analgesia first to relieve pain and discomfort → primary cause of agitation
64
Why is sedation necessary?
Maintain synchornized breathing and prevent bucking the ventilator
65
First line for ICU sedation
BZD (lorazepam, midazolam) Non-PVD (propofol, dexmedatomidine)
66
Indication of BZD vs Precedex
BZD: sz or alcohol/BZD withdrawal Dexmedatomidine: approved for both intubated and noninyubated patients
67
What is a sedation vacation?
daily interruption go continuous sedative infusion to assess readiness to wean/off the sedative ASAP
68
First line for ICU delirium
Sedation with non-BZD → reduce incidence of delirium and shorten the duration in pts who already have it Quetiapine (Atypical antipsychotics) Haloperidol
69
Tool to evaluate agitation
RASS
70
Selectivity of Decmedetomidine
A-2 agonist
71
ADR of Precedex
Hypo/hypertension, bradycardia
72
Storage of Precedex
No fridge Infusion should not exceed 24 hrs
73
CI for propofol
Hypersensitivity to egg or soyD
74
ADR of propofol
Hypotension, apnea, HyperTG, green urine/hair/nail beds, PRIS
75
Administration of propofol
Use strict aseptic → ↑ risk of bacterial growth → discard vial and tubing within 12 hrs of use
76
Calories in propofol
1.1 kcal/mL
77
DDI of midazolam
Avoid potent CYP3A4 inhibitors
78
ADR of ketamine
Emergence reactions (vivid dreams)
79
RF of GI prophylaxis
Mechanically ventilated >48 hrs Coagulopathy Sepsis TBI Major burns AKI High dose systemic steroid
80
1st line for GI prophylaxis
H2RA and PPI
81
Risks of H2RAs and PPI
H2RA: mental status change in elderly and renal impairment PPI: Gi infection, fractures, nosocomial pneumonia
82
Local anesthetics
Lidocaine, benzocaine
83
Inhaled anestheitcs
Desflurane, sevoflurane, isoflurane, nitrous oxide
84
Deflurane
Suprane
85
Injectable anesthetics
Bupivicane, lidocaine, ropivacaine
86
Depolarizing NMBA
Succynily-coA
87
ADR of Suc
Malignant hyperthermia
88
Non-depolarizing NMBA
Rocuronium Cisatracurium Vecuroniam Pancuronium
89
ADR of non-depolarizing NMBA
Flushing, bradycardia, hypotenion, tachyphylaxis
90
How is cisatracurium metabolize
Hofmann elimination (independent of renal and hepatic)
91
MOA of hemostatic drugs
Inhibiting fibrinolysis enhancing coagulation
92
Topical hemostatic agent
Recothrom Thrombin-JMI
93
Hemostatic agents
Tranexamic acid Recombinant Factor VIIa (NovoSeven RT)

NAPLEX Prep (71 decks)

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