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Flashcards in Critical Care & Fluids Deck (55):
1

Parasympathetic responses

Sleep
Lacrimation
Urination
DIgest
Diarrhea

2

Sympathetic responses

Controls Bladder
Saliva
Peristalsis

Bronchdilation
Glucose production
Pupil dilation

3

ACh acts on what receptors if the Parasymp?

Muscarinic in the stomach and bladder

4

ACh, NEPI and EPI act on which receptors of the Sympathetic system?

Alpha 1- blood vessesls
Beta 1- heart
Beta 2- lungs

5

Alpha 1 agonize what and by what drug example?

Increase vasoconstriction
Increase blood pressure

-Phenylephrine

6

Alpha 1 antagonize what and by what drug example?

Increase vasodilation via smooth muscle relaxation
Decrease BP

-Doxazosin, Phentolomine

7

Beta 1 agonize what and by what drug example?

Increase CO an HR

-Dobutamine and Isoproterenol

8

Beta 1 antagonize what and by what drug example?

Decrease CO and HR

-BETA BLOCKERS

9

Beta 2 agonize what and by what drug example?

Bronchdilation

-Albuterol, Terbutaline

10

Beta 2 antagonize what and by what drug example?

Bronchoconstriction

-Non selective beta blockers (Inderall)

11

Dopamine low dose 1-4mcg/kg/min acts as what?

Dopamine agonist

12

Dopamine medium 5-10 mcg/kg/min acts as what?

Beta 1 agonist

13

Dopamine high dose 10-20mcg/kg/min acts as what?

Alpha 1 agonist

14

Vasopressors examples?

Dopamine, Epinephrine, NEPI, Phenylephrine, Vasopressin

15

Vasopressin is also known as what?

AVP and ADH (anti-diuretic hormone)

16

Boxed warnings for Vasopressors?

NEPI and Dopamine cause extravasation
All vasopressors are vesicants and administered IV treat with Phentolomine

17

SE, Monitoring and notes for Vasopressors?

Tachycarida, Arrhythmias, Necosis (gangrene)
Phenyephrine (Bradycardia)
Epinephrine (Hyperglycemia)

18

When are vasodilators such as NTG normally indicated?

When there is an ischemia or uncontrolled hyper tension

19

Which NTG is a mixed venous/arterial vasodilator?

Nitroprusside

20

What drug is used to treat Thiocyanate a toxicity due to Nitroprusside?

Hydroxocobolamin

21

What drug is used to treat Cyanide a toxicity due to Nitroprusside?

Sodium thiosulfate

22

What is Nesiritide?

A recombinant BNP that binds to smooth muscle and increase cGMP

23

Nitroglycerin MOA at Low dose and High dose?

Low dose, venous dilator
High dose, Arterial dilator

24

Nitroglycerin CI, SE, Notes?

CI in SBP<90

SE: Tachycardia, Tachyphylaxis, HA

Notes: must be administered NON-PVC container (Glass or Polyolefin)

25

Nitropress notes?

Must be diluted with D5W

Must have light protection

Only use clear solutions

26

Dobutamine and Milrinone MOA?

Dobutamine: Beta 1 agonist
Milrinone: PD3 3 inhibitor

27

Dobutamine and Milirinone notes?

Milrinone- renal adjustments

Dobutamine might turn pink due to oxidation but still potent

Also known inodilators

28

Crystalloids examples and notes

D5W (free water)
0.9% NaCl
LR (Common Resuscitation)
Electrolytes

Less costly, Fewer adverse reactions

29

Colloids examples and notes

Large molecules, remain in intravascular space and

Increase oncotic pressure so they expand the vessels

Albumin (Most common for edema, mortality)
Dextran
Hydro starch

30

Hypotension is defined as what?

SBP<90
MAP<70

31

What are the 4 main types of shock?

Hypovolemic (Hemorrhagic)
Distributive (Sepsis)
Cardiogenic
Obstructive (Embolisim)

32

How to treat hypovolemic shock?

Restore volume and oxygen by Fluid resuscitation crystalloids... then Vasopressors (NEPI for sepsis) if not responding to fluids.

33

Principles of treating shock..

Fill the tank
Squeeze the pipe
Kick the pump

34

What is cardiogenic shock?

ADHF with hypotension/hypoperfusion

35

How to treat ADHF?

Volume overload- Loops/Vasodilator

Hypoperfusion- Inotropes, if hypotensive add vasopressor AVOID Vasodilator

36

Which drugs can worsen ADHF and which drug should be stopped if hypoperfusion/hypotension exist?

BB should be stopped

Drugs like, NSAID/COX2, negative inotropes

37

Which catheter is guided and used for monitoring in patients with ADHF?

Swanz (PA catheter)

38

What does a swanz do?

Measures:
hemodynamic monitoring (PCWP)
Hypoperfusion

39

Pain which opioids are given IV?

Morphine and Fentanyl
Dilaudid

40

Agitation which drugs are given?

maintain syncronized breathing

BZDs (Lorazepam/Midazolam)
Non-BZD (Propofol, dexmedetomidine) improved outcomes

41

Which non-bzd is approved for use of intubated and non intubated patients and what are the side effects and notes?

Precedex (Dexemedetiomidine)

SE: Hypo or Hypertension, bradycardia

Notes: ONLY 24 HOURS

42

Sedation is followed by what scale?

RASS
+ means agitation
- means sedation

43

Delirium which drugs are used?

Seroquel but non-bzds will likely provide delirium comfort

44

Propofol SE, Monitoring, Notes?

SE: Hypotension, HyperTGL, apnea, green, PRIS

Monitoring: TGL

Notes: Shake well, Strict aseptic technique, discard withtin 12 hours of use, Oil-in-Water emulsion 1.1kcal.ml

45

Ativan notes?

Can cause PEG toxicity leading to metabolic acidosis and acute renal failure

46

Versed (Midazolam) BW, CI, Notes

BW: No rapid effusion, respiratory depression

SE: Glaucoma, Intrathecal administration, CYP Inhibitor

Notes: Highly lipohillic can accumilate in obese patients and renal impaired patients

47

Etomidate (Amidate) notes?

Decrease coritisol production, SO must monitor for adrenal insufficiency

ULTRA SHORT ACTING

48

Ketamine (Ketalar) notes?

Emergence reactions (Weird dreams)

49

Give examples of inhaled anesthetics and its SE

Desflurane (Suprane)
Sevoflurane (Ultane)

Malignant hyperthermia

50

Give examples of injected anesthetics and SE

Bupivacaine (Marcaine, Sensorcaine)
Lidocaine (Xylocaine)
Ropivacaine (Naropin)

If IV can be fatal

51

What do NMBA do?

Facilitate mechanical ventilation
Manage increased ICP
Treat muscle spasms
Prevent shivering

Patients should receive sedation or analgesia agents prior

52

two types of NMBA?

Depolarizing (Succuinylcholine SHORT ACTING)
Non-Depolorizing

53

What should you monitor for while on NMBA?

NTG side effects, flushing hypotension tachys

PROTECT SKIN
EYES
SUCTION AIRWAY

54

What is the only NMBA used to reduce secretions?

Glycopyrronium (robinul)

55

How is Hypokalemia treated?

Treat underlying cause
Amphotericin
Insulin