Flashcards in Critical Care & Fluids Deck (55):
ACh acts on what receptors if the Parasymp?
Muscarinic in the stomach and bladder
ACh, NEPI and EPI act on which receptors of the Sympathetic system?
Alpha 1- blood vessesls
Beta 1- heart
Beta 2- lungs
Alpha 1 agonize what and by what drug example?
Increase blood pressure
Alpha 1 antagonize what and by what drug example?
Increase vasodilation via smooth muscle relaxation
Beta 1 agonize what and by what drug example?
Increase CO an HR
-Dobutamine and Isoproterenol
Beta 1 antagonize what and by what drug example?
Decrease CO and HR
Beta 2 agonize what and by what drug example?
Beta 2 antagonize what and by what drug example?
-Non selective beta blockers (Inderall)
Dopamine low dose 1-4mcg/kg/min acts as what?
Dopamine medium 5-10 mcg/kg/min acts as what?
Beta 1 agonist
Dopamine high dose 10-20mcg/kg/min acts as what?
Alpha 1 agonist
Dopamine, Epinephrine, NEPI, Phenylephrine, Vasopressin
Vasopressin is also known as what?
AVP and ADH (anti-diuretic hormone)
Boxed warnings for Vasopressors?
NEPI and Dopamine cause extravasation
All vasopressors are vesicants and administered IV treat with Phentolomine
SE, Monitoring and notes for Vasopressors?
Tachycarida, Arrhythmias, Necosis (gangrene)
When are vasodilators such as NTG normally indicated?
When there is an ischemia or uncontrolled hyper tension
Which NTG is a mixed venous/arterial vasodilator?
What drug is used to treat Thiocyanate a toxicity due to Nitroprusside?
What drug is used to treat Cyanide a toxicity due to Nitroprusside?
What is Nesiritide?
A recombinant BNP that binds to smooth muscle and increase cGMP
Nitroglycerin MOA at Low dose and High dose?
Low dose, venous dilator
High dose, Arterial dilator
Nitroglycerin CI, SE, Notes?
CI in SBP<90
SE: Tachycardia, Tachyphylaxis, HA
Notes: must be administered NON-PVC container (Glass or Polyolefin)
Must be diluted with D5W
Must have light protection
Only use clear solutions
Dobutamine and Milrinone MOA?
Dobutamine: Beta 1 agonist
Milrinone: PD3 3 inhibitor
Dobutamine and Milirinone notes?
Milrinone- renal adjustments
Dobutamine might turn pink due to oxidation but still potent
Also known inodilators
Crystalloids examples and notes
D5W (free water)
LR (Common Resuscitation)
Less costly, Fewer adverse reactions
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)
Hypotension is defined as what?
What are the 4 main types of shock?
How to treat hypovolemic shock?
Restore volume and oxygen by Fluid resuscitation crystalloids... then Vasopressors (NEPI for sepsis) if not responding to fluids.
Principles of treating shock..
Fill the tank
Squeeze the pipe
Kick the pump
What is cardiogenic shock?
ADHF with hypotension/hypoperfusion
How to treat ADHF?
Volume overload- Loops/Vasodilator
Hypoperfusion- Inotropes, if hypotensive add vasopressor AVOID Vasodilator
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
Which catheter is guided and used for monitoring in patients with ADHF?
Swanz (PA catheter)
What does a swanz do?
hemodynamic monitoring (PCWP)
Pain which opioids are given IV?
Morphine and Fentanyl
Agitation which drugs are given?
maintain syncronized breathing
Non-BZD (Propofol, dexmedetomidine) improved outcomes
Which non-bzd is approved for use of intubated and non intubated patients and what are the side effects and notes?
SE: Hypo or Hypertension, bradycardia
Notes: ONLY 24 HOURS
Sedation is followed by what scale?
+ means agitation
- means sedation
Delirium which drugs are used?
Seroquel but non-bzds will likely provide delirium comfort
Propofol SE, Monitoring, Notes?
SE: Hypotension, HyperTGL, apnea, green, PRIS
Notes: Shake well, Strict aseptic technique, discard withtin 12 hours of use, Oil-in-Water emulsion 1.1kcal.ml
Can cause PEG toxicity leading to metabolic acidosis and acute renal failure
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
Etomidate (Amidate) notes?
Decrease coritisol production, SO must monitor for adrenal insufficiency
ULTRA SHORT ACTING
Ketamine (Ketalar) notes?
Emergence reactions (Weird dreams)
Give examples of inhaled anesthetics and its SE
Give examples of injected anesthetics and SE
Bupivacaine (Marcaine, Sensorcaine)
If IV can be fatal
What do NMBA do?
Facilitate mechanical ventilation
Manage increased ICP
Treat muscle spasms
Patients should receive sedation or analgesia agents prior
two types of NMBA?
Depolarizing (Succuinylcholine SHORT ACTING)
What should you monitor for while on NMBA?
NTG side effects, flushing hypotension tachys
What is the only NMBA used to reduce secretions?