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Therapeutics Fall Semester P3 > Cumulative Final - Acute Care (Foster) > Flashcards

Cumulative Final - Acute Care (Foster) Flashcards

(59 cards)

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1
Q

What is septic shock?

A

CV collapse + hypotension

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2
Q

How is septic shock treated?

A

Fluids (crystalloids or colloids)
Vasopressor (Norepinephrine) - goal MAP > 65

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3
Q

What do we give for refractory septic shock?

A

CCS

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4
Q

What drugs do we use for thromboprophylaxis?

A

LMWH (enoxaparin)
UFH

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5
Q

Dosing of enoxaparin for thromboprophylaxis

A

30 mg SQ Q12H or 40 mg SQ Q24H
If CrCl < 30: 30 mg SQ Q24H

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6
Q

Dosing of UFH for thromboprophylaxis

A

5000 U SQ Q8-12H
**No renal adjustment

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7
Q

What should we monitor if a patient is on UFH?

A

CBC + signs/symptoms of bleeding

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8
Q

If pt on prophylactic dose, do we adjust for aPTT?

A

NO!!!!!!!!!!!!!!!

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9
Q

Stress Ulcer prophylaxis tx

A

H2RA (famotidine/ranitidine) - adjust for renal dysfunction

PPI (-prazole)

EN (not used as monotherapy)

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10
Q

When do we stop stress ulcer prophylaxis

A

Once risk factors are no longer present

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11
Q

What routes can H2RAs be given?

A

EN or PN

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12
Q

PPI increases the risk for

A

C. Diff + nosocomial pneumonia

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13
Q

Goal blood glucose in ICU

A

144-180 mg/dL

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14
Q

When should insulin be initiated for ICU patients

A

When BG > 180 mg/dL

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15
Q

When should stool softeners and laxatives be D/C

A

Once the pt is having diarrhea/frequent stools

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16
Q

What is the result of using succinylcholine?

A

Paralysis

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17
Q

Succinylcholine resembles

A

ACh

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18
Q

Succinylcholine elimination

A

Via pseudocholinesterase (not renally or hepatically)

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19
Q

When is succinylcholine used?

A

For initial procedure to get ET tube placed; not used for sustained neuromuscular blockade

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20
Q

Succinylcholine SE

A

Apnea
Muscle fasciculations (deep aching muscle pain)
Hyperkalemia

**C/I in major burn, crush injury, and upper motor neuron disease

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21
Q

NDNMBA

A

Rocuronium

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22
Q

What is used for hypothermia

A

NDNMBA

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23
Q

What is the endpoint for NMBA?

A

Peripheral nerve stimulation

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24
Q

What type of endpoint is peripheral nerve stimulation? How many twitches is our goal?

Study These Flashcards
A

Toxicity endpoint
1-2 twitches

25
What is the gold standard to assess pain?
What the pt says
26
If unable to self-report pain, what scales can be used?
Behavioral Pain Scale (BPS) Critical Care Pain Observation Tool (CPOT)
27
What is a SE of IV opioids?
Sedation
28
Non-opioid analgesic options for pain
APAP Neuropathic pain meds (gabapentin) NSAIDs -- bleed risk Ketamine
29
What frequency can IV opioid meds be given?
Bolus dosing Continuous infusion Mixed
30
How do we tx agitation
With sedation
31
What pts is oversedation problematic?
Pts not on a vent
32
How can we assess sedation?
RASS and SAS scales
33
What is BIS?
Bispectral index *Digital scale from 100 (completely awake) to 0 (isoelectric EEG) *Used only when other measures are not feasible
34
Why have benzos fallen out of favor for agitation?
Potential association with delirium
35
What can happen if benzos are not gradually tapered after a patient taking them for a long time?
Seizure
36
Frequency of benzos
Bolus dosing Continuous infusion
37
Which IV medication contains a high dose of propylene glycol?
Lorazepam
38
How do we measure propylene glycol toxicity?
Osmol gap (>10 may indicate potential toxicity)
39
What is the option for rapid sedation of acutely agitated patients?
Midazolam
40
How many kcal in 1 ml of propafol?
1.1 kcal
41
Propafol ADR
May cause global CNS issues; hypotension; bradycardia
42
What are we concerned about with propofol at high doses?
Propofol infusion syndrome (acidosis, bradycardia, lipidemia)
43
Recommendation for propofol preservative: EDTA
Drug holiday after 7d of tx
44
What is the preferred sedative when rapid awakening is important?
Propofol
45
Important points to know regarding propofol
-TG should be monitored after 48H -Account for total caloric intake from propofol
46
Clinical pearls for Dexmed
-Light degree of sedation -NO respiratory depression -Short half-life (easily titratable) -AVOID loading dose
47
What limits the use of Dexmed?
Bradycardia Hypotension
48
How is delirium diagnosed?
It is a clinical diagnosis -- no test or lab value available to determine it
49
Delirium is associated with ____
Mortality
50
Assessments for delirium
ICDSC CAM-ICU **Assessment may be limited by level of arousal
51
When is pharmacological tx initiated for delirium?
Not recommended for prevention or routine tx -Initiated in pts with delirium with significant stress
52
Which agents are used to tx delirium?
Haloperidol Atypical antipsychotics (Risperidone, Olanzapine, Quetiapine)
53
When would Dexmed be used for delirium?
Delirium where agitation is precluding weaning of vent/extubation
54
Clinical pearl of haloperidol
DO NOT USE AS A CONTINUOUS INFUSION DO NOT USE AS AN IV DRUG
55
Adverse effect of haloperidol
Prolongation of QT interval on ECG -- potential torsades de pointes **Check pt EKG Decreases seizure threshold Possible EPS
56
Atypical antipsychotic ADR
-Fewer EPS than haloperidol -Risk of QT interval prolongation Olanzapine associated with NMS in non-icu pts -High olanzapine dose may cause hypotension
57
Antipsychotic indication in delirium
Used short-term for tx of delirium with significant stress (anxiety, fear, hallucinations, agitation)
58
Sedation algorithm
Protocol based "analgesia-first sedation"
59
Sedation algorithm
-Propofol is preferred -Dexmed for pt with delirium and agitation

Therapeutics Fall Semester P3 (7 decks)

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