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PHRM 864 > E3 acute/critical care > Flashcards

E3 acute/critical care Flashcards

(103 cards)

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1
Q

hydrophilic drugs
(higher/lower) Vd in critically ill surgery/trauma pts than in medical pts

A

higher

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2
Q

T or F:
hepatic enzyme expression and activity may be decreased in some critically ill patients

A

true

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3
Q

what two common ICU states may be associated with increased renal elimination

A

burns and trauma

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4
Q

______ associated with cardiovascular collapse/hypotension

A

sepsis

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5
Q

3 treatment options for septic shock

A

fluids
vasopressors
corticosteroids

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6
Q

what two types of fluids are used for treatment of septic shock

A

crystalloids and colloids

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7
Q

vasopressors (increase/decrease) vascular tone

A

increase

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8
Q

Target MAP for vasopressors (tf is this?)

A

> 65 mmHg

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9
Q

what is the preferred vasopressor

A

norepi

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10
Q

what is the refractory option after norepi for septic shock

A

IV hydrocortisone

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11
Q

what treatment may decrease mortality in severe acute respiratory distress syndrome

A

corticosteroids

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12
Q
A
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13
Q

important things from FASTHUGSBID

A

Analgesia
sedation
thromboprophylaxis
ulcer prophylaxis
glycemic control
spontaneous awakening trial
delirium assessment

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14
Q

the majority of ICU patients should receive pharmacological VTE prophylaxis unless ?

A

sufficiently mobile and very low risk OR contraindications to pharmacological prophylaxis

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15
Q

Up to __% VTE incidence in medical ICU, up to __% in surgical settings

A

30, 70

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16
Q

is LMWH or UFH preferred for thromboprophylaxis

A

LMWH

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17
Q

general dose youd see of UFH

A

5000 U SC q8h or q12h

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18
Q

2 monitoring parameters for UFH

A

s/s bleeding, CBC

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19
Q

T or F:
UFH needs renally adjusted

A

false

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20
Q

T or F:
LMWH enoxaparin needs renally adjusted

A

true, reduce dose in CrCl <30

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21
Q

T or F:
LMWH dalteparin needs renally adjusted

A

false? it just says no adjustment needed

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22
Q

LMWH general doses

A

either 30 or 40 SC q12h

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22
Q

general dose of LMWH dalteparin

A

5000 USC q24h

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23
Q

stress ulcer prophylaxis:
stress related ______ damage

A

mucosal

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24
few risk factors for stress ulcers
shock coagulopathy chronic liver disease mechanical ventilation
25
most widely recognized risk factor for stress ulcers
mechanical ventilation
26
2 drug options for stress ulcer prophylaxis
H2Ras and PPIs
27
when to d/c SUP
when risk factors no longer present
28
1 listed rare adverse reaction of H2RAs
potential thrombocytopenia
29
T or F: Famotidine is adjusted in renal dysfunction
true, lower dose if CrCl <30
30
highlighted thing that PPis have a potential to increase risk of
Cdiff
31
T or F: PPis can be administered both enteral and parenteral
True
32
target BG in ICU
144-180
33
initiate insulin in ICU if BG >?
180
34
avoid what kind of insulin in unstable pts
long-acting
35
(hypo/hyper)motility is common in critical illness
hypomotility
36
gastroparesis (lower/upper) intestinal problem
upper
37
two promotility agents under gastroparesis
metoclopramide erythromycin
38
when to d/c bowel regimen/ gastro drugs
if pt is having diarrhea/frequent stools
39
succinylcholine binds and activates what
Ach receptors
40
Succinylcholine: sustained _________ of neuromuscular junction -> muscle contraction CANT occur
depolarization
41
Succinylcholine has ____ onset and _____ duration
fast and short
42
what is succinylcholine eliminated by?
rapidly hydrolyzed by pseudocholinesterase
43
T or F: Succinylcholine is used for sustained neuromuscular blockade
false
44
what is succinylcholine used for?
rapid sequence intubation - placement of an endotracheal tube
45
what might succinylcholine cause at first?
initial muscle contractions
46
what electrolyte can succinylcholine make hyper (idk how tf to word this sorry)
potassium, can cause hyperkalemia
47
when is succinylcholine CI'd?
major burns crush injury upper motor neuron disease
48
T or F: Succinylcholine can cause apnea
true, be ready to intubate
49
if you have impaired pseudocholinesterase activity or decreased levels, what succinylcholine ADR can become worse?
can cause prolonged apnea because succinylcholine isnt getting eliminated
50
T or F: Succinylcholine can cause an elevation in intracranial pressure
true
51
T or F: Nondepolarizing NMBAs competitively block the action of Ach and activate the Ach receptor
false, they do not activate the receptor
52
aminosteroidal and benzylisoquinolinium
2 general classes of nondepolarizing NMBAs
53
what class are pyridostigmine and neostigmine
acetylcholinesterase inhibitors
54
modified A-cyclodextrin for reversal of rocuonium/vecuronium
sugammadex
55
-curonium
aminosteroidal NMBAs
56
-curium
benzylisoquinolinium NMBAs
57
NDNMBAs are generally indicated in what kind of pts?
pts with acute lung injury or acute respiratory distress syndrome
58
NMBAs purely _______ and nothing else
paralyze
59
main 2 adrs of NDNMBAs
paralysis of muscles and apnea
60
when you see drug holidays what do you think about
decreasing incidencee of AQMS which is thee muscle weakness thing from nmbas and shit
61
toxicity endpoint of sustained NMB
peripheral nerve stimulation
62
for peripheral nerve stimulation you stimulate the nerve how many times?
4
63
pain related stress response: increases _________ nervous system activation, raises _________ levels
sympathetic catecholamine
64
behavioral pain scale and critical care observation tool
two options for ICU pts unable to self report pain
65
2 scales for assessment of sedation
richmond-agitation-sedation scale sedation-agitation scale
66
bispectral index
assessment of sedation for pts that we cant use other scales on like pts with neuromuscular blockade or something like that
67
benzos used in ICU
lorazepam and midazolam
68
benzos bind and activate a specific site on the ____ receptor
GABA
69
how is lorazepam metabolized
into inactive metabolite by glucoronidation
70
what do IV formulations of lorazepam contain
propylene glycol solvent
71
lorazepam has potential ______ ________ after high doses or prolonged infusions
lactic acidosis (because of propylene glycol)
71
midazolam dosage form for this unit
IV only
72
midazolam metabolized by what and where
CYP450 and liver
73
T or F: Midazolam is an option for controlled sedation
false, rapid
74
alkylphenol sedative and hypnotic agent
propofol
75
propofol (slow/rapid) onset (slow/rapid) offset
rapid both
76
T or F: propofol has analgesic properties
false
77
why does propofol have a rapid onset?
easily penetrates BBB
78
Propofol is ______ protein bound
highly
79
T or F: no PK changes reported with renal or hepatic dysfunction for propofol
true
80
T or F: propofol may reduce elevated intracranial pressure
true
81
1.1 kcal/ml
propofol
82
long term infusions of propofol may result in ?
hypertriglyceridemia
83
4 highlighted adverse effects of propofol
apnea hypotension bradycardia "propofol infusion syndrome"
84
propofol preservative that can cause adverse effects
EDTA
85
selective a-2 agonist
dexmet
86
analgesic-sparing effects
dexmet
87
T or F: dexmet has no respiratory depression
true
88
T or F: dexmet may be associated with less delirium than BZDs
no fucking shit
89
dexmet metabolized where, eliminated where and as what
liver, urine, glucuronide
90
T or F: you should always use a loading dose for dexmet
NEVER USE ONE
91
3 adverse effects dexmet
transient inc in BP with rapid admin bradycardia hypotension
92
dexmet recommended over bzds for what types of pts
critically ill and mechanically ventilated
93
T or F: Benzos are a non-modifiable risk for delirium
false, modifiable
94
ICDSC and CAM-ICU
assessments of delirium
95
T or F: early mobilization may decrease delirium
true
96
____________ may be used short term for treatment of delirium associated with significant stress (anxiety, fearfulness, hallucinations, agitation)
antipsychotics
97
recommended for delirium where agitation is precluding weaning of vent/extubation
dexmet
98
T or F: there is evidence that haloperidol reduces duration of delirium
falsee
99
main adverse effect of haloperidol
prolong QT -> torsades
100
preferred sedative for rapid awakening
propofol
101
what is the pharmacologic choice for prevention of delirium
none you idiot

PHRM 864 (29 decks)

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