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NAPLEx > Acute & Critical Care Medicine > Flashcards

Acute & Critical Care Medicine Flashcards

1
Q

crystalloids

A

5% dextrose (D5W)
0.9% NaCl (normal saline, NS)
Lactated Ringer’s (LR)- contains NaCl, KCl etc.
multiple electrolyte injecting (plasma-Lyte)

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2
Q

Colloids

A

albumin 5%, 25%
Dextran
Hydroxyethyl starch

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3
Q

hyponatremia

A

Na<135 meq/L
usually not symptomatic till <120 meq/L

symptoms: cerebral edema, increased intracranial pressure (severe: seizures, coma moderate: headache)

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4
Q

types of hyponatremia

A
  • hypotonic hypervolemic hyponatremia
    —> fluid overload- tx: diuresis w/ fluid restriction
  • hypotonic isovolumic hyponatremia
    —> Syndrome of inappropriate antidiuretic hormone (SIADH)
    —> tx: stop the drug that caused it and diuresis w/ fluid restriction
  • Hypotonic hypovolemic hyponatremia: can be caused by diuretics, salt-wasting syndrome, blood loss, and adrenal insufficiency.
    —> tx: the underlying conditions and manage symptoms
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5
Q

hyponatremia corretion

A
  • should not be too quickly
    –> 4-8 meq/L/ 24 hrs
  • rapid correction so >12meq/L/24hrs can cause demyelinating syndrome
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6
Q

arginine vasopressin

A

AVP receptor antagonstis (conivaptan and tolvaptan)
used to tx SIADH and hypervolemic hyponatremia.
increase excretion of free water

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7
Q

conivaptan

A

Vaprisol

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8
Q

tolvaptan

A

Samsca

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9
Q

hypokalemia

A

<3.5 meq/l
1meq/l drop is 100-400 meq of total body deficit

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10
Q

hypokalemia max infusion

A

<= 10 meq/hr
max concentration 100meq/100ml

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11
Q

hypokalemia fatal

A

admin undiluted or via IV push

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12
Q

hypokalemia and mg

A

if hypo mg, mg needs to be replaced first
mg is needed for K uptake

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13
Q

hypo mg

A

< 1.3 meq/L
<1 meq/L
causes are OH, diuretcis, vomting etc.
hypo can develop life-threatening symptoms: seizures, arrhythmias, etc.

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14
Q

hypophosphatemia

A

< 1mg/DL

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15
Q

IV immunoglobulin

A

Gammagard, Gamunex-C, Octagam, Privgent
Ms, Myasthenia gravis, Guilllain-Barre syndrome

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16
Q

dopamine dosing

A

low dose: renal- 1-4mcg/kg/min
- dopamine-1 agonist

medium dsoe: 5-10mcg/kg/min
- beta-1 agonist

high does: 10-20mcg/kg/min
- alpha-1 agonist

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17
Q

dopamine and norepi extravasation
all vasopressors

A

tx/phentolamine

all vasopressors are vesicants
keep in mind so they SE of arrhythmias, necrosis (gangrene), hyperglycemia, etc.

ALL VASOPRESSORS MUST BE ADMIN BY CENTRAL LINE

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18
Q

epinephrine

A

adrenalin
EpiPen for anaphylaxis

  • alpha-1, beta-1, beta-2 agonists
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19
Q

NorEpi

A

levophed

-alpha-1 agonist > beta-1 agonists

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20
Q

phenylephrine

A
  • alpha-1 agonsits
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21
Q

vasopressin

A

vasosstrcit
vasopressin receptor agonists

known as arginine vasopressin (AVP) and antidiuretic hormone (ADH)

  • vasoconstriction, no inotropic or chronotropic effects
22
Q

epi used for IV push, IM

A

IV push is 0.1 mg/ml (1:10,000)
IM injection or compounding is 1mg/ml (1:1,000)

23
Q

nitroglycerin

A

low dose: venous vasodilator
high dose: arterial vasodilator

contra SBP <90 , and w/ PDE-5 inhibitors
SE causes vasodilation: headache, flushing, tachyphylaxis, etc.

use24-48hrs cause tolerance

24
Q

nitroprusside

A

nipride

metabolism of nitroprusside results in thiocyanate and cyanide formulation
antidote: sodium thiosulfate + sodium nitrite (nithiodote)

25
Q

inotropes

A

dobutamine- beta-1 agonist w/ some beta-2 and alpha-1 agonism
milrinone - PDE-3 inhibitors

26
Q

hypovolemic shock

A

hemorrhagic

27
Q

distributive shock

A

septic, anaphylactic

28
Q

cardiogenic shock

A

post-myocardia infarction

29
Q

obstructive shock

A

ex. massive pulmonary embolism

30
Q

target mean arterial pressure

A

MAP >=65mmHg
MAP=
[(2xDBP) +SBP]/3

31
Q

General principles of tx shock

A

fill the tank
- optimize preload w/ IV crystalloids

Squeeze the pipe and kick the pump
- alpha-1 agonists activity to (peripheral vasoconstriction) to increase SVR
- beta-1 agonist activity to increase myocardial contractility and CO

32
Q

two causes of ICU infection

A
  • ↑ time on ventilator= ↑ risk of infection, including lung infection
  • ↑ time w/ foley catheter= ↑ risk of bladder infection
33
Q

treating ADHF (acute decompensated heart failure)
pt w/ edema

A
  • edema (pulmonary or lower extremity), jugular venous distent (JVD), and/or ascites are VOLUME OVERLOAD
    tx: loop diuretics, vasodialtors (NTG, nitroprusside)
34
Q

treating ADHF (acute decompensated heart failure)
pt w/ decreased renal function

A
  • decreased renal function, altered mental statues and/or cool extremities have hypoperfusion
    tx: inotropes (dobutamine, milrinone), if pt become hypotensive- consider adding vasopressor (dopamine, norepi, epi)
35
Q

treating ADHF (acute decompensated heart failure)
pt w/ VOLUME OVERLOAD and HYPOPERFUSION

A
  • combo of agents lol
36
Q

RASS

A

Richmond agitation and sedation scale

37
Q

fentanyl

A

sublimaze
- pain/analgesia

38
Q

hydromorphone

A

dilaudid
- pain/analgesia

39
Q

morphine

A

duramorph, infumorph
- pain/analgesia

40
Q

dexmedetomidine

A

precedex
- alpha-2 adrenergic agonist
- agitation/sedation
use for sedation in both intubated and non-intubated

41
Q

propofol

A

Diprivan
contra: soy or egg allergy
1.1kcal/ml
strict aseptic technique, discarded vail and tubing within 12 hrs
- agitation/sedation

42
Q

lorazepam

A

ativan
- agitation/sedation

43
Q

midazolam

A

versed
- agitation/sedation

44
Q

etomidate

A

amidate
- monitor for adrenal insufficiency
- agitation/sedation

45
Q

ketamine

A

ketalar
- agitation/sedation

46
Q

haloperidol

A

hadol
- delirium

47
Q

quetiapine

A

Seroquel
- delirium

48
Q

stress ulcer risk:

A
  • mechanical ventilation >48 hrs
  • coagulopathy
  • sepsis, burn, etc.

tx: PPI or proton pump inhibitors

PPI= increased risk of c. diff, fractures, and nosocomial pneumonia

49
Q

depolarizing NMBA
succinylcholine

A
  • paralysis of skeletal muscle including respiratory muscles need to put pt on a respirator

short-acting

resembling ACh, succinylcholine binds to and actives the ACh receptors and desensitizes them

50
Q

non-depolarizing NMBAs
cisatriacurium (nimbex)
rocuronium
vecuronium

A
  • pt are unable to breathe, move, blink or cough

long-acting

bing to ACh receptor and block the action of endogenous ACh.

51
Q

glycopyrrolate

A

anticholoringeric,
reduce secretions

52
Q

hemostatic agents stop bleed

A

tranexamic acid

NAPLEx (75 decks)

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