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compounding/critical care 499 > Crit Care > Flashcards

Crit Care Flashcards

1
Q

How does dobutamine work?

A

B1 agonist

Increases HR and force of contraction

Which increases cardiac output

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2
Q

Administration note for IVIG?

A

Use slower infusions rate for renal and CV disease

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3
Q

Dopamine dosing? 3 bullets

A
  1. Dopamine stimulates different receptors depending on dose
  2. Low renal dosing: 1-4 mcg/kg/min: Dope 1 agonist
  3. Medium: 5-10 mcg/kg/min Beta 1 agonist
  4. High: 10-20 mch/kg/min: Alpha 1 agonist
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4
Q

How does the CNS control functions of the body? 2 main systems

A
  1. Through the peripheral nervous system
    1. SOmatic nervous system
    2. autonomic nervous system
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5
Q

Cyklokapron?

A

Tranexamic acid

Hemostatic

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6
Q

Nitroprusside: Thiocyanate/cyanide roxicity risk is increased when what?

A

PAtients have renal or hepatic impairment

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7
Q

One alpha 1 agonist?

A

Phenylephrine

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8
Q

What is first line for hypovolemic shock?

A

IV crystalloids

In pts with hypovolemic chock that is not caused by hemorrhage

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9
Q

Common causes of Hypokalemia?

A

Underlying causes usually, meds, amphotericin and insulin

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10
Q

What is the vasopressor of choice in septic shock?

A

NE

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11
Q

How is hypovolemic hyponatremia treated?

A

Sodium chloride containing products IV

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12
Q

When is albumin particularly useful?

A

WHen there is significant edema (cirrhosis)

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13
Q

How does precedex work?

A

A2 adrenergic agonist

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14
Q

What 3 things do vasopresssors cause

A
  1. Vasoconstriction
  2. Increased SVR
    1. which increases BP
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15
Q

Pancuronium?

A

Long acting agent

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16
Q

Nitroglycerin or NTG uses?

A

During MI or uncontrolled hypertension but efficacy is limited to 24-48 hours due to tachyphylaxis (tolerance)

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17
Q

Haldol

A

Haloperidol

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18
Q

What can be used to treat SIADH and hypervolemic hyponatremia?

A

arginine vasopressin receptor antagonists (AVP)

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19
Q

The somatic nervous system controls muscle moves by?

A
  1. By sending signals through neurons to release
    1. Acetylcholine Ach to act on nicotinic receptors
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20
Q

Injectable anesthetics? 2

A

Bupivacaine, ropivicaine

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21
Q

Albuminar, Albutein, Alburx

A

Albumin 5% and 25%

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22
Q

Benzos role in sedation two times?

A

Seizure patients

and

Alcohol withdrawal patients

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23
Q

Warning for Samsca?

A

Hepatotoxicity

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24
Q

Precedex?

A

Dexmedetomidine

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25
Q

Special note for dobutmaine?

A

Way turn pink due to oxidation but potency is not lost

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26
Q

Epinephrine concentration used for IV push

A

0.1 mg/ml 1:10,000 ration strength

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27
Q

When should vasopressor solutions not be used?

A

If they are discolored or contain a precipitate

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28
Q

Common ICU conditions

Pain?

A

IV pioids

morphine and fentanyl first line

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29
Q

How does phentolamine work?

A

Alpha 1 antagonist

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30
Q

What is the safe way to correct sodium?

A

12 meq/L over 24 hours

More rapidly can cause osmotic demethylation syndrome (ODS)

or central pontine myelonolysis

can cause paralysis, seizure and death

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31
Q

SEs of Samsca? 4

A

Thirst, nausea, dry mouth, polyuria

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32
Q

SEs of Diprivan

A

Hypotension, apnea, hypertg, green urine/hair/nail beds, propofol related infusion syndrome (PRIS) can be fatal

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33
Q

Increasd time with foley catheter does one?

A

Increase chance of bladder infection

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34
Q

General principles for treating shock 3

A

1. Fill the tank

1. Optimize preload with IV crystalloids bolus as needed 2. Squeeze the pipes
1. Peripheral vasocontrictors (a1agonists) to increase systemic vascular resistance 3. Kick the pump
1. B1 agonist to increase myocardial contractility and cardiac output
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35
Q

How is agitation managed in the ICU?

A

WIth BZDs: lorazepam or midazolam

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36
Q

What 3 things have PPIs been associated with?

A

Bone fracture, C Diff, Nosocomial Pneumonia

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37
Q

treatment for sepsis and septic shock?

A

Broad spectrum abx and IV fluid resucitation with IV crystalloids

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38
Q

Nitropress, Nipride MOA?

A

Equal venous and arterial vasodilation

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39
Q

When is dextrose used pertaining to fluids

A

when water is needed intracellularly

These products contain free water

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40
Q

What do inotropes do?

A

Increase contractility of the heart

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41
Q

How long should a pt be treated with Samsca?

A

Talvaptan AVP

limited to less than <=30 days due to hepatotoxicity

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42
Q

What type of sedation is preferred?

A

Light sedation

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43
Q

When is hypophosphetemia life threatening?

A

<1mg/dL

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44
Q

What do Epi and NE do? Leads to what 3 things?

A

Stimulate multiple receptors including alpha 1 and beta 1, b2

WHich leads to increased vaso constriction HR and BP

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45
Q

What has to be present to characterize acute decompensated heart failure to cardiogenic shock?

A

Hypoperfusion and hypotension

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46
Q

How is hypervolemic hyponatremia treated?

A

Duiretics and fluid

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47
Q

Monitoring for Etomidate?

A

Adrenal insufficiency

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48
Q

Xylocaine?

A

Lidocaine

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49
Q

How are vasopressors given?

A

Through IV central line

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50
Q

Versed?

A

Midazolam

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51
Q

How is vesication with vasopressors treated?

A

Phentoloamine

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52
Q

Acute decompensated HF and cardiogenic shock

What is it?

A

Acute decompensated heart failure

rapid decline in health, wt gain, worseing of symptoms

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53
Q

Colloids 3

A

Albumin

Dextran

Hydoxyethyl startch

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54
Q

Boxed warnings for Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen

2

A
  1. Acute renal dysfunction, usually within 7 days, more likley with products stabalized by sucrose
  2. THrombosis
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55
Q

Warning for Nitroprusside?

A

Increase Inctracranial pressure

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56
Q

SEs of Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen

10

A
  1. HA
  2. Nausea
  3. diarrhea
  4. injection site rxn
  5. infusion rxn, facial flushing, chest pain, tightness, fever, chills, hypotension- slow/stop infusion
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57
Q

Increased time on ventilator increases risk of infection what is a common pathogen?

A

Pseudomonas they like moist air

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58
Q

If nitroprusside is hat color?

A

Blue indicated cyanide formation dont use

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59
Q

Treating with IVIG can do what?

A

impair response to vaccines

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60
Q

How is isovolemic hyponatremia caused?

A

COmmonly caused by Syndrome of Inappropriate antidiuretic hormone

SIADH

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61
Q

How is hypoperfusion characterized? 3 things

A
  1. Decreased renal function
  2. ALtered mental status
  3. or cold extremities
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62
Q

What is succinylcholine typically reserved for?

A

Intubation

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63
Q

What special care needs to be taken with NMBA?? 3

A
  1. Ensure eye lubrication
  2. Airway suction
  3. Protect the skin
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64
Q

Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen

A

IVIG

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65
Q

What should pts be treated with if they have both volume overload and hypoperfusion

A

Both sets of agents

Loops, but avoid vasodilators

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66
Q

Risk factors to develop Stress ulcers? 2

A

Mechanical ventilation and coagulopathy

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67
Q

3 SEs of Nitroprusside?

A
  1. HA
  2. Tachycardia
  3. Thiocyanate/cyanide toxicity (Increase risk in renal and hepatic impairment
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68
Q

What is needed for potassium?

A

Mg must be corrected

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69
Q

When should BBs be stopped in patients with ADHF?

A

If hypotension or hypoperfusion is present

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70
Q

Example of beta 1 agonist?

A

Dobutamine

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71
Q

Common oral mg agent?

A

Mg oxide

72
Q

Adrenalin and Epipen?

MOA?

A

Epinephrine

A1,B1,B2 agonist

73
Q

What is the only available depolarizing NMBA?

A

Succinylcholine

74
Q

Beta 1 agonism causes what two things?

A

Increased CO and HR

75
Q

Ration strenght for IM or compounded epinephrine?

A

1:1000

76
Q

How is hypernatremia defined?

What is it associated with?

A

Na>145 meq/L

Water deficiency and hypertonicity

77
Q

Antagonism of the alpha 1 receptor causes what?

A

Vasodilation through smooth muscle relaxation and decrease BP

78
Q

Contraindication to Versed?

A

Strong CYP3A4 inhibitors

79
Q

What is lysteda used for?

A

Heavy menstrual bleeding: mennorhagic

80
Q

Note about Ativan injection?

A

formulated in propylene glycol prop glycol toxicity: can ccause acute renal failure and metabolic acidosis

81
Q

5 SEs of vasopressors

A
  1. Arrythmias
  2. Tachcardia
  3. necrosis gangrene
  4. Bradycardia with phenylephrine
  5. Hyperglycemia with epinephrine
82
Q

How can potassium chloride kill you?

A

IF it is not diluted or given via IV push

83
Q

Seroquel?

A

Quetiapine

84
Q

K deficiency related to total body

A
  1. 1mEq drop in serum below 3.5
    1. Indicated a total def of 100-400meq
85
Q

What can be used to reduce airway secretions when using NMBA?

What does it do?

A

Glycopyrolate

Anticholinergic

86
Q

Label for NMBA?

A

Warning paralyzing agent

87
Q

2 topical hemostatic agents?

A

Recothrom, Thrombin JMI

88
Q

When are neuromuscular blockers used? 4

A
  1. During surgery
  2. To help with mechanical ventilation
  3. TO manage increase ICP
  4. Treat muscle spasms
89
Q

How is sepsis defined?

A

Life-threatening organ dysfunction due to dysregulated host response to infection

90
Q

What is used to prevent cyanide toxicity with nitroprusside?

A

Hydroxocobalamin

Sodium thiosulfate is used for cyanide toxicity

91
Q

Used of precedex?

A

Sedation in intubated and not intubated patients

92
Q

Local anesthetic?

A

Lidocaine

93
Q

Ativan

A

Lorazepam

94
Q

Diprivan?

A

Propofol

95
Q

How is Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen, dosed?

A

Using IBW

96
Q

Doses of nitroglycerin pertaining to its effects 2

A
  1. Low: venous vsaodilation
  2. High: arterial vasodilation
97
Q

Vasodilators 2

A

Nitroglycerin

Nitroprusside

98
Q

Nimbex?

A

Cisatracurium

99
Q

SEs of precedex 3?

A
  1. Hypotension
  2. HYpertension
  3. bradycardia
100
Q

Treating volume overload?

A

Loops and IV vasodilators

101
Q

What do you need to make sure before giving someone NMBA? 2

A
  1. Ensure adequate sedation and analgesia
  2. Must be mechanically ventilated
102
Q

Common ICU infections

2 ones

A

Mechanical ventilations

foley catheter

103
Q

When is IV phos used?

A

PO4 is < 1mg/dL

104
Q

Inhaled anesthetics? 2

A

Desflurane, sevoflurane

105
Q

The sympathetic nervous system works by?

A

releasing epinephrine and nerepinephrine

to act on the adrenergic receptors (aplha 1, beta 1 and beta 2)

106
Q

How is hypokalemia defined?

A

K<3.5 mEq/L

107
Q

Suprane

A

Defsflurane

108
Q

What is used to assess someones readiness to get off of sedatives?

A

Sedation vacaiton baby!`

`

109
Q

Note about midazolam?

A

Can accumulate in obese patients and renal impariment (active metabolite)

110
Q

What should be monitored for propofol?

A

Triglycerides with given for more than 2 days

111
Q

Hydroxyethyl startch boxed watning?

A

Limited by box warning for use in critically ill including sepsis due to increase mortalitiy

112
Q

Lysteda?

A

Tanexamic acid: tablet

113
Q

What is the only sedative approved for intubated and nonintubated patients?

A

Dexmetomadine

114
Q

2 boxed warnings for Samsca?

A

Talvaptan

  1. Intiated and re-initiated in hospital
  2. Overly rapid correction of hyponatremia >12 meq/L/24 is associated with ODS
115
Q

What is used for IV mg replacement?

A

Mg sulfate

116
Q

Crystalloids 3

A

Dextrose

NS

LActate ringers

117
Q

What does propofol give you?

A

Oil in water emulsion give 1.1 kcal/mL

118
Q

Quelicin?

A

Depolarizing NMBA

Succinylcholine

119
Q

What does epinenephrine do in the lidocaine/Epi combo?

A

Vasoconstriction and keeps the lido locals

pretty neat!

120
Q

What does the somatic nervous system do?

A

COntrols muscle movements

121
Q

What does nesiritide do?

A

Recombinant B-type natriuttic peptide

Binds to vasuclar smooth muscle and increases cGMP

122
Q

Samsca?

A

Talvaptan

Arginine vasopressin receptor antagonist

123
Q

When is IV mg recommended?

A

When Mg <1mEq/L with life threatening symptoms (seizure or arrythmias)

124
Q

Ketamine Warnings?

A

Emergence reactions vivid dreams hallucinations delerium

125
Q

3 SEs of nitroglycerin?

A
  1. HA
  2. tachycardia
  3. tachyphylaxis
126
Q

How does milrinone work?

A

PDE-3 inhibitor

Produces inotropic effects with significant vasodilation

127
Q

How is hypervolemic hyponatremia caused?

A

fluid overload, cirhosis, HF, renal failure

128
Q

The sympathetic nervous system is also known as?

What three things does it result in?

A

Also known as fight or flight

  1. Increase in
    1. Blood pressure
    2. HR
    3. and glucose production
129
Q

How long should the infusion for precedex be?

A

Duration should not be longer than 24 hours

130
Q

Examples of two vasopressors?

A

Epinephrine and NE

131
Q

Dilaudid?

A

Hydromorphone

132
Q

Notes for propofol?

A

bacterial growth discard vial and tubing within 12 hours

133
Q

How do systemic hemostatic agents work?

A

By inhibiting fibrinolysis and enhancing coagulation

134
Q

Treatment options for volume overloaded ADHF patients? 2

A

Loop diuretics

vasodilators can be added

135
Q

IVIG uses? 4

A
  1. Used to only be indicated for immunodef conditions
  2. Now has many uses, MS, myathenia gravis, guilliane barr
136
Q

What to monitor for samca?

A

Rate of Na increase

137
Q

When are vasopressors not effective?

A

If intravascular volume is not adequate

138
Q

What happens when alpha 2 receptors in the brain on stimulated?

A

Decrease in overall sympathetic output

139
Q

Two inotropes to know?

A

Dobutamine

Milrinone

140
Q

Strategy when pain in ICU?

A

Analgesosedation: sedation strat that used analgesics first

141
Q

How is hyponatremia defined?

A

Na <135 meq/L

142
Q

Nitroglycerin notes?

A

Need non PVC container glass, polyolefin

143
Q

What is clonidine?

A

Central acting alpha 2 adrenergic agonist

144
Q

Max infusion rate and max concentration of IV potassium chloride?

A

>=10mEq/hr

max concentration of 10 mEq/100 mL

145
Q

Alpha 1 agonism causes what two things?

A

increased Vasoconstriction and BP

146
Q

What anesthetic can be fatal IV?

A

Bupivicaine

Commonly used in epiderals

147
Q

Contraindications to propofol?

A

hypersesitivity to eggs or soy

148
Q

Administrations notes for Nitroprusside?

A
  1. Protect from light during admin
  2. Use clear solutions only a blue color indicated cyanide formation
149
Q

Novoseven RT?

A

Recombinant factor VIIa

Hemostatic

150
Q

What is preferred for sedation in ICU patients?

A

Non-BZDs are preferred propofol and dexmedomadine

151
Q

Levophed?

MOA?

A

NE

Alpha 1> B1 agonist

152
Q

Nitroglycerin contraindications? 3

A
  1. SBP<90
  2. Use with PDe-5
  3. Ricoguat
153
Q

Nitroprusside, Nipride

A

Nitroprusside

154
Q

When is a ADHF patient considered volume overloaded?

A

Edema, ascites, jugular venous distention

155
Q

What drug can be useful for delirium in ICU patients?

A

Quitiapine

156
Q

What should be monitored all the time with vasopressos?

A

Continuos BP monitoring

157
Q

What can be used for invasive monioring?

What does it do?

A

Catheter called Swan Ganz

  1. Measures congeestion pulmonary cap wedge pressure
158
Q

Boxed warning for vasopressors?

A

Dopamine and NE have Black boxes for extravacation

But all are vesicants

It should be treated with phentolamine

159
Q

What 2 drugs are uniquely suited for hypoperfusion?

A

Dobutamine and milrinone

160
Q

How is hypovolemic hyponatremia caused? 5

A
  1. Diuresis
  2. salt wasting syndromes
  3. blood loss
  4. vomitting and diarrhea
161
Q

What are colloids?

A

large molecule typically proteins or startch

Remain in the intravascular space and increase oncotic pressue

162
Q

What is the most common colloid?

A

Albumin

163
Q

Crystalloids versus Colloids

Which one is less costly and generally has fewer adverse effects?

A

Crystalloids

164
Q

What is the parasympathetic nervous system known as?

A

The rest and digest system

165
Q

4 vasopressors

A
  1. Dopamine
  2. Epinephrine
  3. NE
  4. Vasopressin
166
Q

How is shock usually caused and defined?

A

Hypoperfusion

Hypotension: SBP <90

MAP <70

167
Q

2 treatment options for ADHF patient experiencing hypopurfusion?

A
  1. Intoropes : dobutamine, milrinone
  2. If pt become hypotensiove consider adding vasopressor, NE, dopamine, or phenylephrine
  3. Avoid vasodilators become they can decrease BP and worsen
168
Q

4 SEs for all non-depolarizing NMBA?

A

Bradycardia, flushing, hypotension, tachyphylaxis

169
Q

Boxed warning for Nitropress, Nipride? 3

A
  1. Metabolism leads to cyanide
  2. Excessive hypotension
  3. Not for direct injection must be further diluted with D5W
170
Q

Most common fluids used when volume rescusitation is needed in shock state?

A

Lactate ringers and NS

171
Q

What is recommended for stress ulcers in ICU patients?

A

H2RAs and PPIs

172
Q

What can decrease the risk of delerium in ICU patients?

A

Using non BZDs and or shorten the suration

173
Q

Nimbex Notes

A

Hofmann elimination: independent of renal and hepatic impairment

174
Q

What combo is sometimes used for local procedures, anesthetic

A

Lidocaine/Epi

175
Q

What are the 4 types of shocK?

A
  1. Hypovolemic (hemorrhage)
  2. Distributive (eptic, anaphylactic)
  3. Cardiogenic (post MI)
  4. Obstructive

compounding/critical care 499 (12 decks)

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