Drug Toxicities, HH vs DS, electrolytes

Question 1

Lithium
(Antimania)

Indications: Bipolar disorders - for Manic episodes not for depression

Therapeutic level
Toxic level
Other

Answer 1

Therapeutic level: 0.6 - 1.2
Toxic level: > 2
Other Gray area 1.3 - 2

Question 2

Lithium
(Antimania)

Therapeutic level: 0.6 - 1.2
Toxic level: > 2
Other Gray area 1.3 - 2

What is it used for

Answer 2

Manic episodes for Bipolar disorder

Question 3

Lanoxin/ Digoxin

Indications: A-fib, CHF

Therapeutic level:
Toxic level:
Others:

Answer 3

Therapeutic level:1 - 2
Toxic level: >2
Others:

Question 4

Lanoxin / Digoxin

Therapeutic level:1 - 2
Toxic level: >2
Others:

Indications:

Answer 4

Indications: A-fib & CHF

Question 5

Aminophylline
(Compound of bronchodilator theophylline)

Indications: Muscle Spasm relaxer for airway

Therapeutic:
Toxic level:
Other:

Answer 5

Therapeutic: 10 - 20
Toxic level: >20
Other: Non-therapeutic level <10 (in this case, increase dose and assess for compliance)

Question 6

Aminophylline
(Compound of bronchodilator theophylline)

Therapeutic: 10 - 20
Toxic level: >20
Other: Non-therapeutic level <10 (in this case, increase dose and assess for compliance)

Indications;

Answer 6

Indicaciones: Muscle spams relaxer for airway

Question 7

Dilantin (Phenytoin)

Indication Seizure Medicine

Therapeutic level:
Toxic level:

Answer 7

Therapeutic level: 10 - 20
Toxic level: >20

Question 8

Dilantin (Phenytoin)

Therapeutic level: 10-20
Toxic level: >20

Indications:

Answer 8

Seizure Medication

Question 9

Bilirubin

Indication: Breakdown produce of RBC’s

Therapeutic level:
Toxic:
Other:

Answer 9

Therapeutic level: 0.2 - 1.2 for adults, higher for newborns
Toxic: elevated newborn 10 - 20 & Toxic level for newborn is >20

Other: Hospitalize newborns if bili is > 14

Question 10

Jaundice for excess bilirubin

Pathological: Jaundice within first 24 hrs of birth (concerning/ normal)

Physiological: Jaundice 2 to 3 days postpartum (concerning/ normal)

Answer 10

Pathological: Jaundice within first 24 hrs of birth concerning

Physiological: Jaundice 2 to 3 days postpartum normal

Question 11

Kernicterus; Excess bilirubin in the brain (bili>20) may cause aseptic/sterile ____ or ______

Answer 11

Meningitis/ Encephalopathy

Question 12

For Drug Toxicity

Pathological: Jaundice within first 24 hrs of birth (concerning/ normal)

Physiological: Jaundice 2 to 3 days postpartum (concerning/ normal)

Answer 12

Pathological: Jaundice within first 24 hrs of birth concerning

Physiological: Jaundice 2 to 3 days postpartum normal

Question 13

Toxicity levels

Lithium (Antimania)
Lanoxin/ Digoxin

&

Aminophylline, Dilantin, Bilirubin

Answer 13

Lithium (Antimania)
Lanoxin/ Digoxin
>2

&

Aminophylline, Dilantin, Bilirubin
>20

Question 14

Opisthotonos…

Answer 14

Hyperextended posistion that the new born assumes d/t irritation of the meninges from kernicterus

Question 15

A newborn is in the Opisthotonos ( severe backward archingposition) from being kernicterus (bilirubin encephalopathy)

Which position would you put him in

Answer 15

On their side

Question 16

Hiatal Hernia (does what)

Vs

Dumping Syndrome

Answer 16

regurgitation of acid into the esophagus, upper part of stomach herniates through diaphragm
Right rate but wrong direction

Follows gastric surgery
Gastric contents dump too quickly into duodenum.
Right direction wrong rate

Question 17

Hatial Hernia S &S

Answer 17

GERD

Question 18

It is a Haital Herina not just GERD if…

Answer 18

You eat & lay down then get GERD symptoms

Question 19

Dumping Syndrome S&S

Answer 19

Drunk, Shock, Acute Abdominal Drestress

Drunk

Slurred, staggering, impaired, reaction time, liable

Shock

Hypotension, Tachycardia,
Skin: Pale, Cold, Clammy

Acute Abdominal Distress

Cramping, Pain, Guarding, Diarrhea, Boborigmi

Question 20

Hiatal Hernia

Interventions

Answer 20

3 things (Elevate Everything)

Elevate HOB 1h post meals
Increase fluid with meals
Increase Carbs / Decrease Protein
(Protein stays in stomach longer)

Question 21

Dumping Syndrome

Interventions

Answer 21

3 things (Lower Everything)

Lower HOB & turn pt on the side
Decrease fluid amount 1 to 2 hrs before and after meals
Decrease Carbs/ Increase Protein
(Protein prevents the stomach from emptying too quickly

Question 22

Memorize

Kalemia (K+) do the same as the prefix except for HR & U/O

Answer 22

Hyperkalemia:
Seizures, Agitation, Irritability, Tented T Wave, ST elevation, Tachypnea, Diarrhea, borborygmi, spasticity, increased tone, hyperreflexia BRADYCARDIA / OLIGURIA

Hypokalemia:
Lethary, bradypnea, paralytic ileus, Constipation, muscle flaccid, hyporeflexia, 0,1, TACHYCARDIA, POLYURIA

Question 23

How to memorize Hyper & Hypo Kalemia S & S

Answer 23

S & S go in same direction as Prefix

Except for HR and UO urine output

Question 24

Obtunded

Answer 24

characterized by diminished responsiveness to stimuli, often due to a state of reduced consciousness:

Question 25

Paralytic ileus (or adynamic ileus)

Answer 25

Motor Paralysis of the digestive tract secondary to neuromuscular failure

Question 26

Clonus...

Answer 26

is involuntary and rhythmic muscle contractions caused by a permanent lesion in descending motor neurons.

Question 27

Calcemia does the (opposite / same) of the Prefix

Answer 27

Oppsite

Question 28

Select All that Apply S & S of Hyperkalemia Adynamic Illeus Obtunded +1 reflex Colonus (involuntary, rhythmic muscle contractions) U wave Depressed ST wave Polyuria Bradycardia

Answer 28

Adynamic Illeus: NO Obtunded: NO +1 reflex: NO Colonus: YES U wave: NO Depressed ST wave: NO Polyuria: NO Bradycardia: YES

Question 29

Calcium goes low, everything goes (high/ low) Calcium goes high, everything goes (high / low)

Answer 29

Calcium goes low, everything goes high Calcium goes high, everything goes low

Question 30

(Hypercalcemia/ Hypocalcemia) Bradycardia Bradypenea Flaccid muscles Constipation Hyporeflexia (Hypercalcemia/ Hypocalcemia) Tachypnea Tachypnea Colonus Diarrhea Hyperreflexia

Answer 30

Hypercalcemia Bradycardia Bradypenea Flaccid muscles Constipation Hyporeflexia Hypocalcemia Chvostek's sign (twitching of facial muscles in response to tapping over the facial nerve) Trousseau's sign Carpopedal spasm induced inflated sphygmomanometer cuff. Tachypnea Tachypnea Colonus Diarrhea Hyperreflexia

Question 31

Which 2 signs / test indicate Hypocalcemia when positive

Answer 31

Chvostek's sign (twitching of facial muscles in response to tapping over the facial nerve. Trousseau's sign (carpopedal spasm induced by inflated sphygmomanometer cuff.)

Question 32

Magnesium does the (oppsite / same) as the prefix? Low magnesium = (High/ Low) S&S High magnesium = (High/ Low) S&S

Answer 32

Magnesium the oppsite as the prefix Low magnesium = High S&S High magnesium = Low S&S

Question 33

Incase of a Tie in Electrolytes (Pick / Don't Pick ) Mg If Skeletal Muscle or Nerve Blame it on (Ca, K, Na) For every thing else select

Answer 33

Don't Pick Mg; Why, not a major player If Skeletal Muscle or Nerve Blame it on: Ca For every thing else select: K

Question 34

Patient has diarrhea, which causes it A. Hyperkalemia B. Hypokalemia C. Hypomagnesemia D. Hypocalcemia

Answer 34

A. Hyperkalemia Because it isn't Skeletal/ nerve muscle

Question 35

Patient has tetany, which is the cause A. Hyperkalemia B. Hypokalemia C. Hypocalcemia D. Hypomagnesemia

Answer 35

C. Because it is skeletal/ nerve muslce

Question 36

Hyponatremia (Dehydration/ Fluid Overload) Hypernatremia (Dehydration/ Fluid Overload)

Answer 36

Hyponatremia Fluid Overload Hypernatremia Dehydration

Question 37

LPN says " I just ran a whole L in 10 min of D5W " RESULT: Hypo / Hypernatremia

Answer 37

Hyponatremia

Question 38

Which patient's get Fluid Restrictions & Laskis Hyponatremia/ Hypernatremia

Answer 38

Hyponatremia

Question 39

Which patient's are given lots of fluids Hyponatremia/ Hypernatremia

Answer 39

Hypernatremia

Question 40

Hot Flushed dry skin S & S Hyponatremia/ Hypernatremia

Answer 40

Hypernatremia

Question 41

DKA These two electrolyte problem

Answer 41

Hyperkalemia & Hypernatremia

Question 42

1. Fluid volume excess 2. SIADH 3. DI 4. HHNK Hyponatremia / Hypernatremia

Answer 42

1. Hyponatremia 2. Hyponatremia 3. Hypernatremia 4. Hypernatremia (HHNK = Dehydration)

Question 43

Earliest sign of any electrolyte imbalance is

Answer 43

(Paresthesia) Numbness & Tingling

Question 44

Universal Sign of Electrolytes Imbalance

Answer 44

Paresis Muscle Weakness All electrolyte imbalance cause this

Question 45

Paresis Paresthesia Numbness & Tingling Muscle Weakness

Answer 45

Paresis: Muscle Weakness Paresthesia: Numbness & Tingling

Question 46

At which level of potassium does you push an IV

Answer 46

Never push a potassium IV

Question 47

What is the maximum mL of K per liter you can give without calling the Dr. To verify order

Answer 47

40mL

Question 48

Fastest way to lower K

Answer 48

D5W with Regular insulin Drives Potassium back into cells from the bloodstream

Question 49

Kayexalate (Full of sodium) goes into the gut and exchanges itself for (this electrolyte) which will then be pooped out

Answer 49

K potassium

Question 50

What is the upside / downside to treating hypekalemia with... D5W & Insulin Kayexalate

Answer 50

D5W & Insulin Upside: Immediate Actinf Downside: Temporarily Fix, K is still inside body (in the Cells) Kayexalate Upside: Permanent Fix (K left the body) Downside: Takes longer to work

Question 51

Kernicterus

Answer 51

also known as bilirubin encephalopathy, is a rare but serious complication of untreated jaundice in babies.