Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Naplex 2025 > Acute & Critical Care Medicine > Flashcards

Acute & Critical Care Medicine Flashcards

(72 cards)

Start Studying
1
Q

What is the difference between crystalloids & colloids

A
  • Cystalloids: less costly & have fewer ADRs
  • Colliods: larger molecules in solution that remain in the intravascular space and increase oncotic pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the common cyrstalliods that are used?

A
  • 5% Dextrose (D5W)
  • 0.9% NaCl (Normal Saline)
  • Lactated Ringers (LR)
  • Mulitple Electrolyte Injections (Plasma-Lyte A, others)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are common colliods that are used?

A
  • Albumin 5%, 25% (Albutein, AlbuRx, others)
  • Dextran
  • Hydroxyethyl Starch (Hespan, Hextend)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is hyponatremia?

A
  • When the Na < 135 - not symptomatic until Na < 120
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some of the symptoms of hyponatremia?

A
  • Most commonly Cerebral Edema, Increased Intracranial Pressure
  • Mild to Mod: Headaches, confusion, lethargy, giat
  • Severe: Seizures, Coma, Respiratory Arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the different classifications of Hyponatremia?

A
  • Hypotonic hypervolemic: fluid overload (Diuresis is treatment)
  • Hypotonic Isovolemic: caused by SIADH or inappropriate antidiuretic use (Diuresis, stopping fluids, stopping drugs that cause it is treatment)
  • Hypotonic hypovolemic: too much diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How quickly should hyponatremia be treated?

A
  • ~ 4 - 8 mEq/L/24 hours
  • Correcting more rapidly (> 12) can causes osmotic demylination syndrome or central pontine myelinolysis (i.e.; Paralysis, Seizures, Death)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some of the treatment options for someone that may have SIADH and/or Hypervolemic Hyponatremia? How do they work?

A
  • Arginine Vasopressin (AVP) Receptors Antagonists
  • MOA: Incresing the excretion of water but keeping Na
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the Arginine Vasipressin Receptor Antagonists that are used for hyponatremia?

A
  • Conivaptan (Vaprisol) [Dual AVP - 1A & 2]
  • Tolvaptan (Samsca) [Selective 2 only]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some boxed warnings for Tolvaptan used for Hyponatremia?

A
  • Used ONLY in hospital setting
  • Rapid correction (> 12) = life threating DOS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some warnings for Tolvaptan used for Hyponatremia?

A
  • Hepatotoxicity (avoid use > 30 days in liver disease/cirrhosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some side effects for Tolvaptan used for Hyponatremia?

A
  • Thirst, Nausea, Dry Mouth, Polyuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some things to monitor for when using tolvaptan used for Hyponatremia?

A
  • Rate of Na increase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Hypokalemia?

A
  • When K < 3.5 - common in hospitals
  • The Drop of 1 in serum K below 3.5 = deficit of 100 - 400
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the recommended dosing for potassium replacement protocols?

A
  • < 2.6…………100 mEq IV; contact MD
  • 2.6 - 2.9….. 80 mEq IV; contact MD
  • 3.0 - 3.2….. 60 mEq PO/IV
  • 3.3 - 3.5….. 40 mEq PO/IV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the safe recommendations for administration when giving potassium via IV peripheral line?

A
  • MAX rate of < 10 mEq/hr with a MAX conc. of 10 mEq/100 mL

IV potassium can be fatal if givin undiluted or via IV push

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is one thing that you should also check for when you have hypokalemia/

A
  • Magnesium - Mg is necessary for K reuptake (Mg should be replace 1st)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is hypomagnesemia

A
  • When Mg < 1.3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some of the common causes of hypomagnesemia?

A
  • Chronic Alcohol Use
  • Diuretics
  • Amphotericin B
  • Vomiting & Diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When the serum Mg falls below 1 what are some things that coudl occur?

Life threating symptoms

A
  • Seizures
  • Arrhythmias

IV Mg is recommended to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is incentive spirometry and when is it used?

A
  • Helps with lung expansion with a device that facilatates deep breathes
  • Used in those with a collapsed lungs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is intravenous immunoglobulin?

i.e.; Gammagard, Gamunex-C, Octagam, Pribigen

A
  • IgG excrated from +1000 blood donors given as a replacement for immunodeficiency conditions

Also used for multiple sclerosis, myasthenia gravis, Guillain-Barre Syndrome as off label indications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are some Boxed warnings for Intravneous Immunoglobulin?

A
  • Acute renal dysfunction (rare - more likely to occur in those products with sucrose)
  • Thrombosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some Side effects for Intravneous Immunoglobulin?

A
  • Infusion site reactions (facial flushing, chest tightness, fever, chills, hypotension)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are some **additional notes** for **Intravneous Immunoglobulin**?
- Slower titrations and Premedications could be used to reduce SEs
26
What is the **name** of the **screening tools** for **estimating ICU mortality risk**?
- Acute Physiologic Assessment and Chronic Health Evaluation II (**APACHE II**)
27
What is the way that **Vasopressors** work in the body?
- Most stimulate Alpha receptors (**casues vasoconstriction**) and increses systemic vasular resistance (**which increases BP**) - Others stimualte Beta receptors (**increasing HR & CO**)
28
What are the **vasopressors** that are used within ICU?
- Dopamine - Epinephrine (Adrenalin) [EpiPen for Anaphylaixs] - Norepinephrine (Levophed) - Vasopressin (AVP or ADH)
29
What is the **MOA** (or what receptors) does **dopamine** act on?
- Low doses: 1 - 4 mcg/kg/min = **Dopamine-1** - Medium doses: 5 - 10 mcg/kg/min = **Beta-1** - High doses: 10 - 20 mcg/kg/min = **Alpha-1**
30
What is the **MOA** (or what receptors) does **Epinephrine** act on?
- Alpha-1, Beta-1, Beta-2 Agonist
31
What is the **MOA** (or what receptors) do **norepinephine** act on?
- Alpha-1 > Beta-1
32
What are some **boxed warnings** for **Vasopressors** what targets the sympatheitic nervous system?
- ALL vasopressors are **vesicants** when given **IV**; treat with **phentolamine** ## Footnote Vesicant: cause blistering
33
What are some **side effects** for **Vasopressors** what targets the sympatheitic nervous system?
- Arrhythmias - Tachycardia (especially with Dopamine, Epinephrine) - Nercorsis (gangrene) - Bradycardia (phenylephrine)
34
What are some **additional notes** for **Vasopressors** what targets the sympatheitic nervous system?
- Should **NOT BE USED** if **discolored** or contains **precipitate** - ALL should be given via **central IV line** - Epi use for **IV push is 0.1mg/ml** (1:10,000) while for **IM or compounds is 1mg/ml** (1:1,000)
35
What is **extravastion** and what is important to know about it?
- Vasopressors are **Vesicants** which can cause **severe tissue damage/necrosis** - **MEDICAL EMERGENCY** - Why we give them via central line - Treated with **Phentolamine** (alpha-1 blocker) or NTG if no Phentolamine
36
What are the **vasodilators** that are used within ICU?
- Nitoglycerin - Nitroprusside (Nipride)
37
When is **Nitroglycerin** more often used and for how long?
- When active **myocardial ischemia** or **uncontrolled HTN** - Limited to **24 - 48 hours** of use due to **tachyphylaxis**
38
When is **Nitroprusside** more often used?
- **SHOULD NOT** be used in active **myocardial ischemia** - moves blood away from the diseased coronary arteries ("conronary steal")
39
What are some **contraindications** for **Nitroglycerin** what targets the sympatheitic nervous system?
- SBP < 90 - Using PDE-5 Inhibitors
40
What are some **side effects** for **Nitroglycerin** what targets the sympatheitic nervous system?
- Headache - Tachycardia - Tachyphylaxis (if used longer than 24 - 48 hours)
41
What are some **additional notes** for **Nitroglycerin** what targets the sympatheitic nervous system?
- Need to use **non-PVC containers** (glass, polyolefin)
42
What are some **boxed warnings** for **Nitroprusside** what targets the sympatheitic nervous system?
- Metabolism makes **Cyanide** (must use lowest dose) - Excessive hypotension
43
What are some **warnings** for **Nitroprusside** what targets the sympatheitic nervous system?
- Increased Intracranial Pressure
44
What are some **side effects** for **Nitroprusside** what targets the sympatheitic nervous system?
- Headache - Tachycardia - Thiocynate/Cyanide toxicity (risk increases with renal & hepatic impairments) - treat with Hydroxocobalamin or Sodium Thiosulfate
45
What are some **additional notes** for **Nitroprusside** what targets the sympatheitic nervous system?
- Requires light protection during administrations - Use only **clear solutions** a blue color = cyanide - **Hydroxocobalamin** - reduce risk of cyanide toxicitiy & **Sodium Thiosulfate** - used for cyanide toxicity
46
What are the **inotropes** that are used within ICU?
- Dobutamine: Beta-1 Agonist (increases HR and Contractility) - Milrinone: PDE-3 Inhibitor
47
What are some **Additional notes** for **Inotropes** what targets the sympatheitic nervous system?
- Mil: dose reduction in renal impairment - Dobut: may turn **slightly pink** due to oxidation (this is ok)
48
What is **shock**?
- **MEDICAL EMERGNECY** characterized by **hypoperfusion** (hypotension - SBP < 90 or MAP < 70)
49
What are the **four** main types of **shock**
- Hypovolemic (i.e.; Hemorrhagic) - Distributive (i.e.; Septic, Anaphylactic) - Cardiogenic (i.e.; Post-MI) - Obstructive (i.e.; Massive Pulonary Embolism)
50
What is the **treatment** for someone that has **hypovoloemic shock**?
- **Cystalloids** are 1st line (**NOT** caused by hemorrhage) - **Blood products** for those that are bleeding - **Vasopressors** for those that didn't respond to Cystalloids or Blood (MUST have effective **intravascular volume** to work)
51
What is **Sepsis**? ## Footnote -
- **Life threatening organ dysfunction** caused by **dysregulation** of **host response to infection**
52
What is **septic shock**?
- Sepsis with **persistant hypotension** NEEDING a **vasopressor** to maintain **MAP > 65**
53
What are the **"bundles"** of the **surviving sepsis campaign** to reduce the mortality? ## Footnote Basically treatment options...
- **Broad-Spec Antibiotics** + **IV Crystalloids** (lowers overall mortaility) - **Vasopressors** if Crystalloids aren't working well (Norepi is DOC for Septic Shock)
54
What is **Acute Decompensated Heart Failure**? How does it related to **cardiogenic shock**?
- HF episodes of worsening symptoms (**sudden weight gain, cant lay flat without SOB, cant do daily tasks, increased SOB...**) - When **Hypotension & Hypoperfusion** are present = **cardiogenic shock**
55
What is the way that we can **monitor ADHF**? What are some of the things that it **measures**?
- ***Swan-Ganz*** - measures **congestion, hypoperfusion...** ## Footnote **Beta-Blockers** should be stopped if **Hypotenion or Hypoperfusion** are present
56
what are some of the **treatment options** for someone that is **Volume Overloaded**? ## Footnote i.e.; **edema (pulmonary or lower extremity), JVD and/or ascites**
- **Loop Diuretics** (IV 1st; fi resistance then increase dose or thiazides) - **+/- Vasodilators** (NTG, Nitroprusside)
57
What are some **treatment options** for someone that has **Hypoperfusion**? ## Footnote i.e.; **decreased renal function, Altered mental status and/or cool extremities**
- **Inotropes** (Dobutamine, Milrinone) - Hypotensive? **+ Vasopressor** (Dopamine, Norepi, Phenylephrine)
58
What are some of the **treatment options** for someone that has both **Volume Overload & Hypoperfusion**?
- Combo of the agents from each - **V.O**: Loops or Vasodilators - **Hypoper**: Inotropes or Vasopressors
59
When a patient has **pain** within the **ICU** what is the **1st line** option?
- **IV Opioids** (Morphine, Hydromorphone, Fentanyl) ## Footnote For alalgesia-based sedation **treat** the pain 1st then treat agitation
60
What is the way that we **treat or manage agitation** within the **ICU**?
- Benzos (Lorazepam, Midazolam) OR - Non-Benzo (Propofol, Dexmedetomidine) ## Footnote Non-Benzos are preferred in **sedation** and improving ICU outcomes **Dexmedetomidine** is the ONLY one approved for **intubation** & **non-intubation**
61
What are some of the ways that we can **decrease** the incidence of **delirium**?
- Getting the patient up and moving - Controling their enviroment (light, noise, stimuli...) - **NO** medications can help with prevent ## Footnote **Non-benzos** can reduce delirum duration **Quetiapine** & **Haloperidol** are common agents that are used for their sediation
62
What are that **medications** that are used for **pain/analgesia** in the **ICU**?
- Fentanyl (Sublimaze) - Hydromorphone (Dilaudid) - Morphine (Duramorph, Infumorph)
63
What are the **medications** that are used for **Agitation/sediation** within the **ICU**?
- **Dexmedetomidine (Precedex)** - **Propofol (Diprivan)** - **Lorazepam (Ativan)** - **Midazolam (Versed)** - Etomidate (Amidate) - Ketamine (Ketalar)
64
What are some **side effects** for **dexmedetomidine** used for **agitation/sediation** within the **ICU**?
- Hypo/Hypertension - Bradycardia
65
What are some **additional notes** for **dexmedetomidine** used for **agitation/sediation** within the **ICU**?
- **DOES NOT** require refrigeration - Duration of Infusion **SHOULD NOT** exceed **24 hours** - Used for Sediation in **Intubated** & **Non-Intubated** patients
66
What are some **contraindications** for **Propofol** used for **agitation/sediation** within the **ICU**?
- Hypersensitivity to **eggs** or **soy**
67
What are some **side effects** for **propofol** used for **agitation/sediation** within the **ICU**?
- Hypotension - Apena - Hypertrigylceridemia - Green Urine/hair/nail beds - **Propofol related infusion syndrome** (PRIS - Rare but fatal)
68
What are some **addtional notes** for **lorazepam** used for **agitation/sediation** within the **ICU**?
- Injection is formulated in proplyene glycol - total dose as low as 1 mg/kg/day can cause **propylene glycol toxicity**
69
What are some **contraindications** for **midazolam** used for **agitation/sediation** within the **ICU**?
- **DO NOT** use with **potent 3A4 Inhibitors**
70
What are some of the **medications** that are used for **delirium**?
- Haloperidol - Quetiapine (Seroquel)
71
What are some of the **treatment options** for someone that may have a **stress ulcer**?
- **H2RAs** (watch for **thrombocytopenia, mental status changes in eldery & renal imparient**) - **PPIs** (watch for **increase C. Diff risk, fractures, nosocomial pneumonia**)
72
What are some of the **commonly used local, inhaled & injectable anesthetics**?
- Local: Lidocaine (Xylocaine) - Inhaled: Desflurane (Suprane), Sevoflurane - Injectable: Bupivacine, Ropivacine

Naplex 2025 (72 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions