Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

IPT: CC > Block 1 > Flashcards

Block 1 Flashcards

1
Q

What is inpatient hyperglycemia?

A

≥140mg/dl

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

What are the major classes of drugs that cause hyperglycemia?

A

Corticosteroids

Atypical antipsychotics (Risperidone, Olanzapine, Quetiapine)

Immunosuppressants

Catecholamines

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

Insulin is given to those with a range of ______ to keep them off of >180mg/dl

A

140-180

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

What are the rapid acting insulins?

A

Aspart, Lispro, Glulisine

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

How do you determine the dose of insulin experienced and insulin naive patients?

A

Experienced = take 1/2 to 1/3 of their normal dose

Naive = 0.1u/kg/day (outpatient)

If well controlled or at higher risk of hypoglycemia = 0.2u/kg/day

If poorly controlled = 0.5-0.8u/kg

BUT naive pt use sliding scales but should remain the sole treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which insulin is typically used in ICU patients?

A

Insulin regular IV bags

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When a patient is stable, how do you transition from IV to SQ insulin?

A

Calculate TDD by taking average rate/hr in the past 6-8hrs

Multiply number by 24 (total IV insulin) then multiplying it by 0.8 (total SC insulin)

SC is given as 50/50 basal and bolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When should you monitor pt on basal only insulin?

A

Once daily with morning labs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should you monitor pt on basal + bolus regimen?

A

Before each meal and at bedtime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is hypoglycemia?

A

Warnings begin at <70 but officially ≤54mg/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you manage hypoglycemia?

A

BG checked q15min

D50W 25ml if <70
D50W 50ml if <54

Glucagon if <70 + no IV access

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Differentiating pieces of DKA and HHS?

A

DKA - metabolic acidosis + ketonemia; tachypnea, kussmaul breathing, acetone breath

HHS - high serum osmolality + dehydration; hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How often should you monitor a DKA pt?

A

Every 2-4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When treating DKA or HHS, what kind of insulin plan do we utilize?

A

Bolus 0.1u/kg

0.1u/kg/hr continuously IV infusion

DKA BG <200 or HHS BG<300; decrease dose to 0.02-0.05u/kg/hr and switch fluids to D51/2NS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the corrected sodium equation?

A

Measured Na + ((0.016*(glucose-100))

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When do we correct potassium during insulin therapy?

A

<3.3 = hold insulin, give 20-30mEq/hr until potassium is above 3.3

3.3-5.2 = give 20-30mEq/hr in 1L fluid

> 5.2 = dont give potassium and check q2hrs

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

How do you measure anion gap?

A

Na - (Cl+HCO3)

Normal <12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you manage fluids in DKA/HHS?

A

Regardless of condition, 1L bolus of NS

If <135 Na, Give NS 250-500ml/hr

If >135 Na, Give 1/2NS 250-500ml/hr

If glucose range is below their targets, just add D5W

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

DKA is resolved in what criteria?

A

Glucose <200 and two of the following:

Bicarb≥15
Venous pH>7.3
Anion gap≤12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

HHS is resolved in what criteria?

A

Normal osmolality and normal mental status

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

Post resolution care, when should you start SQ admin of insulin?

A

1-2 hrs before stopping IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some complications of DVT and PE?

A

DVT = swelling and pain, unilaterally

PE = Arrhythmias and death, SOB, chest pain

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

RF for VTE?

A

Stasis

ICU

Cancer

Rx (estrogen, vasopressor, ESAs)

Patient-related

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a good thing about using the PADUA prediction score for VTE?

A

If you score low, it has a 99% value stating that you have a low risk for VTE, it is not specific nor sensitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Which diagnostic tests are used in DVT vs PE?
DVT = compression ultrasound PE = CT and ventilation/perfusion scans
26
Prophylactic dosing of: Enoxaparin Dalteparin Unfractionated heparin Fondaparinux (Xa inhibitor)
Enoxaparin 40mg daily Dalteparin 5000u daily Heparin 5000u q8-12hrs Fondaparinux 2.5mg daily DOACs not recommended
27
MOA of: Enoxaparin Dalteparin Unfractionated heparin Fondaparinux (Xa inhibitor)
Enoxaparin + Dalteparin + Fondaparinux = Indirect Xa inhibitors Heparin = indirect IIa and Xa inhibitor
28
Dose of heparin and lovenox in BMI>40?
Heparin 7500 TID Lovenox 40mg BID or 0.5mg/kg/day
29
Dose of heparin and lovenox in low body weight <50kg
Heparin 5000 BID or TID Lovenox 30mg QD
30
Dose of heparin and lovenox in renal dysfunction?
Heparin = no change Lovenox; if CrCl<30 its 30mg QD or switch to heparin
31
Dose of heparin and lovenox in surgery?
Major orthopedic surgery, then Lovenox 30mg BID
32
What RF are there for hemorrhages?
Increasing doses of anticoagulation, concomitant antiplatelet therapy Low body weight (<50kg) Malignancy, HF, renal failure h/o bleed
33
What is a major bleed?
Fatal bleed Symptomatic bleed in critical organ Bleeding causing Hgb >=2g/dl Transfusion w/ 2+ units of blood
34
What is a life-threatening bleed?
Symptomatic intracranial bleed Bleeding causing Hgb >=5g/dl Transfusion w/ 4+ units of blood Bleed associated w/ hypotension
35
What do they inactive: Protamine
Protamine - UFH + LMWH
36
1mg Protamine neutralizes ____ units of UFH
100
37
Utilize the last _____ hours of heparin administered when using protamine
2-3
38
Max dose of protamine = ___ mg
50
39
Max infusion rate of protamine = ____mg/min
5
40
IV vs SQ heparin reversal, how do you administer protamine?
IV = just give protamine infusion rate of 5mg/ml SQ = bolus dose protamine of 25mg, then remaining dose of IV over 8hours
41
When administering protamine for heparin, how much does it reverse LMWH?
Only 60%
42
Protamine dosing for LMWH?
Time since last dose: <8hrs = 1mg (100u) / 1mgLMWH 8-12hrs = 0.5 (50u) / 1mg LMWH >12hrs = n/a Max dose of protamine = 50mg
43
How is protamine administered for LMWH?
SQ only
44
What intervention is needed with warfarin if INR is supratherapeutic but <4.5 and NO bleed?
Hold 1-2 doses OR reduce warfarin dose
45
What intervention is needed with warfarin if INR is 4.5-9.9 and NO bleed?
Hold doses
46
What intervention is needed with warfarin if INR is >10 and NO bleed?
Hold dose AND give Vit. K PO 1-2.5mg
47
What intervention is needed with warfarin at any INR with major/life-threatening/emergency bleed?
Hold dose AND give 4-factor PCC and Vit. K IV 5-10mg Recheck INR 30-60 min after 4-factor PCC, then every 6 hours
48
What is fresh frozen plasma used to reverse? Dose and considerations?
Warfarin reversal 15ml/kg Time consuming (90min from order to admin), must find ABO blood type match and thawing process, volume overload
49
Kcentra is dosed based on ______
Factor IX/kg (actual body weight)
50
What is recombinant factor VIIa used for?
Warfarin reversal BBW of serious thrombotic events
51
What is andexant alfa used for?
Rivaroxaban and apixaban reversal
52
Andexant alfa dose?
400-800mg IV bolus then 4-8mg/min infusion for 2 hours
53
What is idarucizumab used for?
Dabigatran reversal
54
Idarucizumab dose?
50mg/kg IV *max dose of 5000u. Typically uses 2 separate 2.5g vials 15 min apart
55
What is the metabolism of critical ill patients? Carbs Lipids Protein
Carbs = increased glucose production + insulin resistance = hyperglycemia Lipids = increased lipolysis Protein catabolism > protein synthesis Net effect = decreased lean body mass
56
Which lab values should not be included for nutrition screening?
Albumin, transferrin, prealbumin
57
What NRS-2002 score indicates nutritionally at-risk?
Anything greater than 2
58
What mNUTRIC score indicates worse clinical outcome AND likely to benefit from aggressive nutrition therapy?
Anything greater than 4
59
What are the weights to measure calories needed for patients? Some cons?
Indirect Calorimetry**gold standard Predictive equations **not super accurate, less accurate in pt w/ obesity or are underweight Simplistic weight-based estimation
60
Indirect calorimetry info?
Gold standard Estimates energy expenditure from measures of CO2 production and O2 consumption Uses respiratory quotient (normal = 0.8-0.85) Can provide resting energy expenditure
61
What is the most "important" macronutrient? Who needs more of them?
Protein, generally higher amount in ICU patients Dont reduce protein need in acute kidney or hepatic failure
62
What is used to measure adequacy or protein administration?
Weekly urine urea nitrogen
63
High dose protein should be given to which specific patients?
Burn or multitrauma
64
Obese + critical patient, what kind of feeding should they get?
Early EN within 24-48hrs High protein + hypocaloric
65
Those w/ HD or CRRT, how is protein intake adjusted?
Increases protein to 2.5g/kg/day
66
Nutritionally needs for those w/ respiratory failure?
If they have the condition for >72hrs, low/moderate risk get trophic fee for 6 days and high risk gets for 2-3 days Low/moderate risk get PN on top of EN after a week of EN High risk gets PN ASAP on top of EN
67
EN complications?
Aspiration pneumonia Diarrhea
68
How many kcal/gram does dextrose contain and what should the rate be?
3.4kcal/gram Limit to <4mg/kg/min to prevent hyperglycemia
69
What is SMOF?
Lipid emulsion (non-soybean oil) even though it has some soybean :/ 30% soybean oil 30% median chain TG 25% Olive oil 15% fish oil
70
What factors affect the activity of the Na-K ATPase pump, the rate-limiting step in for potassium entry into cells?
Several factors affect the activity of this pump, including insulin, glucagon, catecholamines, aldosterone, acid-base status, plasma osmolality, and intracellular potassium levels.
71
What are some examples of symptoms of hypokalemia
Signs and symptoms of hypokalemia include nausea, vomiting, weakness, constipation, paralysis, respiratory compromise, and rhabdomyolysis Severe - ECG changes
72
What ECG changes might you see due to hypokalemia?
ST-segment depression T-wave flattening T-wave inversion U waves
73
What drugs cause an intracellular shift of potassium?
Beta agonists Insulin Theophylline Caffeine
74
What drugs/conditions cause potassium loss?
Loop and thiazide diuretics SPS Corticosteroids (especially mineralocorticoids such as fludrocortisone) Aminoglycosides Amphotericin B Magnesium depletion HD, CRRT, etc GI losses (e.g., diarrhea, nasogastric suctioning)
75
Which IV fluid will worsen hypokalemia?
Dextrose, it will stimulate insulin release
76
What will happen if you inject potassium peripherally?
Potassium infusion via a peripheral vein may cause burning pain and phlebitis at the infusion site.
77
What can you do to minimize pain associated with injecting potassium peripherally? Any issues?
Adding 1 mL of 1% lidocaine to a potassium solution of 10–20 meq/100 mL may minimize the pain at the infusion site. However, this could mask a sign of underlying venous damage.
78
How do you treat hyperkalemia? AE of drugs?
Calcium gluconate (antagonizes cardiac complications) Bicarb (be careful in HF or liver issue, it has sodium in it) Insulin Dextrose Furosemide SPS (be careful in HF or liver issue, it has sodium in it, GI tract necrosis) Albuterol Hemodialysis (removes potassium from plasma)
79
Issues with hypophosphatemia?
Respiratory, cardiac, neurologic issues
80
What conditions predispose pt to hypophosphatemia?
Malnutrition Inadequate body phosphorus stores or inadequate phosphate administration Alkalosis [respiratory and metabolic] DKA Alcoholism Vomiting
81
Which medications can cause hypophosphatemia?
CRRT Insulin Diuretics Antacids Sucralfate, Administration of carbohydrate loads
82
What can cause hyperphosphatemia? Treatment?
Hypocalcemia Correct calcium levels (calcium x phosphorus must be <60) Drugs: ``` Calcium acetate Calcium carbonate Aluminum hydroxide Magnesium hydroxide Sevelamer ```
83
Why do we calculate a corrected calcium level? Formula?
Calcium is bound to albumin, therefore patients with hypoalbuminemia will have a "low" level Calcium + ((0.8(4-albumin))
84
What causes hypocalcemia?
Hypoalbuminemia. Hypomagnesemia Hyperphosphatemia, Sepsis, pancreatitis, renal insufficiency, hypoparathyroidism, and administration of blood preserved with citrate The hallmark sign of severe acute hypocalcemia is tetany
85
S/Sx of hypocalcemia?
Brittle and grooved nails, hair loss, dermatitis, | and eczema
86
Differences between calcium gluconate and calcium chloride?
Calcium chloride provides three times more elemental calcium than an equivalent amount of calcium gluconate
87
When is calcium gluconate preferred over calcium chloride?
Calcium gluconate should be used as the preferred salt for routine calcium maintenance and supplementation Calcium chloride for emergency use
88
What causes hypercalcemia?
The primary causes of hypercalcemia are malignancy and | primary hyperparathyroidism
89
How do you treat hypercalcemia?
NS Lasix HD if severe or renally impaired Bisphosphonates Etidronate disodium
90
Hypomagnesemia can impact which other electrolytes?
Hypokalemia and hypocalcemia
91
What drugs can cause hypomagnesemia?
Loop and thiazide diuretics Aminoglycosides Amphotericin B Cisplatin Cyclosporine Digoxin
92
Why must IV admin of magnesium go slowly?
It distributes into tissues slowly, but is renally excreted quickly
93
How do you treat hypermagnesemia?
IV calcium

IPT: CC (7 decks)

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