Acute Care Therapeutics Flashcards by Madelynn Packer

How is absorption of drugs altered in critical care

impaired/unpredictable due to:
-gastric emptying/motility
-interactions w/ tube feeds

How well did you know this?

Not at all

Perfectly

How is distribution of drugs altered in critical care?

Fluid and hydration status is altered
Alterations in plasma protein binding

How well did you know this?

Not at all

Perfectly

How is metabolism of drugs altered in critical care?

Hepatic enzyme expression may be decreased

How well did you know this?

Not at all

Perfectly

How is renal elimination altered in critical care patients

Kidney may not work so drugs will build up in system

How well did you know this?

Not at all

Perfectly

what is sepsis

life threatening organ dysfunction caused by dysregulated response to infection

How well did you know this?

Not at all

Perfectly

how to treat sepsis

no specific drug therapy
antibiotics and source control

How well did you know this?

Not at all

Perfectly

what is septic shock?

sepsis associated with CV collapse/hypotension

How well did you know this?

Not at all

Perfectly

how do you treat septic shock?

fluids (LR)
vasopressors (norepi)
steroids (hydrocortisone)

How well did you know this?

Not at all

Perfectly

What is Acute Respiratory Distress Syndrome (ARDS)

Life threatening respiratory failure that is acute with lung injury
often requires ventilation and sedation

How well did you know this?

Not at all

Perfectly

what is FASTHUGSBID

Feeding/fluids
Analgesia
Sedation
Thromboprophylaxis
HOB elevation
Ulcer prophylaxis
Glycemic control
Spontaneous waking
Bowel regimen
Indwelling catheters
Delirium assessment

How well did you know this?

Not at all

Perfectly

who in the ICU should receive thromboprophylaxis

majority of ICU patients should unless sufficiently mobile and very low risk or a contraindication

How well did you know this?

Not at all

Perfectly

what are the factors that ICU patients have that make them candidates for thromboprophylaxis

immobility
trauma, hypercoagulable states
cancer/obesity/prior VTE

How well did you know this?

Not at all

Perfectly

what are the preferred agents for thromboprophylaxis

LMWH (enoxaparin, dalteparin) over UFH

How well did you know this?

Not at all

Perfectly

what is the dosing of UFH for thromboprophylaxis

5000 U SC q8h or q12h

How well did you know this?

Not at all

Perfectly

what is the dose of enoxaparin for thromboprophylaxis

30mg SC q12h, 40mg SC q24h

How well did you know this?

Not at all

Perfectly

what is the dose of dalteparin for thromboprophylaxis

5000 U SC q24h

How well did you know this?

Not at all

Perfectly

what is the monitoring for all thromboprophylaxis agents

s/s bleeding, CBC for HIT

How well did you know this?

Not at all

Perfectly

what thromboprophylactic agents need renal adjustments

Enoxaparin

How well did you know this?

Not at all

Perfectly

what are risk factors for stress ulcers

shock, coagulopathy
mechanical ventilation
neurotrauma
burns
life support
drugs: antiplatelets, anticoag, NSAIDs

How well did you know this?

Not at all

Perfectly

what should you do for stress ulcer prophylaxis

H2RAs or PPIs and encourage enteral feeding

How well did you know this?

Not at all

Perfectly

which is better for stress ulcer prophylaxis

H2RA and PPI are same

How well did you know this?

Not at all

Perfectly

when to d/c SUP

when risk factors no longer present

How well did you know this?

Not at all

Perfectly

what are ADRs of H2RAs

potential thrombocytopenia
adjust for renal dysfunction

How well did you know this?

Not at all

Perfectly

what are the ADRs of PPIs

increased risk for C. diff and pneumonia

How well did you know this?

Not at all

Perfectly

why do we care about glycemic control in the ICU?

hyperglycemia is associated with increased ICU mortality

what is the BG target in the ICU

144-180

when to initiate insulin in ICU and with what formulations

initiate insulin if BG > 180 avoid long acting insulin in unstable patients

MOA of succinylcholine

binds and activates Ach receptors to induce sustained depolarization of neuromuscular junctions (muscle cant contract)

what are ADRs of succinylcholine

may cause initial muscle contractions APNEA Hyperkalemia increased intracranial pressure (ICP)

when to use succinylcholine

Rapid sequence intubation NOT for sustained NMB

when is succinylcholine contraindicated

major burns crash injury upper motor neuron disease

what is the MOA of nondepolarizing NMBAs

competitively block the action of Ach

what are the 2 general classes of nondepolarizing NMBAs

aminosteroidal benzylisoquinolinium

when are NDNMBAs indicated

immediate and sustained paralysis mechanical ventilation (ARDS) manage increased ICP

what are ADRs of NDNMBAa

paralysis of respiratory muscles/apnea Inadequate pain and sedation (must be optimized prior to sedation) prolonged paralysis/muscle weakness

how to monitor sustained NMB

can't really monitor goal is lowest dose possible and minimize ADRs

what is a toxicity endpoint for NMB

peripheral nerve stimulation

what is peripheral nerve stimulation

test 4 muscles to determine how deeply someone is suppressed. adjust to 1-2 twitches

what is PADIS

Pain Agitation Delirium Immobility Sleep

how is agitation characterized

increased motor activity and autonomic arousal agitation!!!

How is delirium characterized

fluctuation or change in baseline mental status disturbed consciousness

what are the two major pain scales

BPS or CPOT

what pain meds are preferred in the ICU

IV opioids

what IV opioids are most common

fentanyl morphine

when should sedatives be introduced

when adequate analgesia is not enough to keep patient calm and resting

why is oversedation bad

increased time on ventilator increased ICU stay obscure neuro testing

what is the goal of sedatives

LESS IS BEST! keep sedation light for spontaneous awakening to improve outcomes

what are the 2 sedation assessments called

RASS and SAS

is the bispectral index indicated?

not recommended in sedated ICU patients

what are the common sedative drugs used in the ICU

benzos (lorazepam, midazolam) propofol dexmedetomidine

what are ADRs of benzos

respiratory depression CV effects withdrawal could lead to seizures delayed emergence from sedation delirium

what are the cons of using lorazepam

delayed onset, prolonged duration of effect less titratable

what is an advantage of lorazepam

metabolite does not linger in elderly less prone to DDIs

what do some IV lorazepam agents contain that is toxic

propylene glycol solvent

how to track propylene glycol toxicity

calculate osmol gap

what is the onset of midazolam

rapid onset and short half life titratable

what is the onset of propofol

rapid onset rapid offset

what should be checked before starting propofol

egg or soybean allergy

how long can you hand propofol

no more than 12hrs risk of infection

what are the ADRs of propofol

apnea Hypotension, bradycardia pain inc TGs seizures neuroexcitory system

what limits high doses of propofol

CV effect/propofol infusion system

how to dc propofol

gradual tapering of dose especially if greater than 7 days of therapy

what is the MOA of dexmedetomidine

selective alpha-2 agonist

how is dexmed different than other sedatives

patients readily arousable with gentle stimulation no respiratory depression no anticonvulsant activity less delirium than BZDs

PK of dexmed

short half life hepatically metabolized

what is the dose of dexmed

maintenance infusion: 0.2-0.7 ug/kg/h AVOID LOADING DOSE

what are LDs of dexmed associated with

increased CV effects

how long can dexmed be used

only approved for short term, but can go longer if other options too risky

what are the ADRs of dexmed

increased CV effects such as bradycardia, hypotension

when should dexmed be used over benzos

for critically ill mechanically ventilated adults

what are non pharm treatments/prevention of delirium

early mobilization improving cognition optimizing sleep, hearing, and vision

what are pharm treatments/prevention of delirium

NO DRUGS antipsychotics may be used for short term but associated w/ significant stress dexmed may be option

when can haloperidol be used

in acute delirium situations

what are ADRs of haloperidol

prolongation of QT interval on ECG decreases seizure threshold

when to dc haloperidol

if QTc exceeds 450msec or increases >25 % from baseline?

what are the PAD guidelines

best way to avoid over sedation encourage regular assessment of ICU patient

Acute Care Therapeutics Flashcards

(76 cards)