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Pharm 2 Exam 2 > ED Meds > Flashcards

ED Meds Flashcards

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1
Q

K normal range

A

Normal range is 3.5-4.5

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2
Q

Hypokalemia EKG findings

A

T wave inversion and prominent U waves

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3
Q

Hypokalemia sxs

A

Muscle weakness
Muscle cramps
Rhabdomyolysis
Respiratory failure
GI ileus
Arrhythmia

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4
Q

What other electrolyte should be treated before attempting to tx hypokalemia?

A

Hypomagnesemia - MUST correct Mag level before OR during correcting K

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5
Q

Which drugs cause hypokalemia?

A

Diuretics (R)
Loop
Thiazide
Antimicrobials (R)
Amphotericin B
Aminoglycosides
Penicillin
Mineralocorticoids (R)
Insulin (S)
Beta agonists (S)
Laxatives and enemas (G)

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6
Q

Which drugs cause renal loss of K?

A

Diuretics, antimicrobial abx, mineralocorticoids

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7
Q

Which drugs cause GI K loss?

A

Laxatives and enemas

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8
Q

Which drugs cause K to shift out intracellularly?

A

Insulin
Beta agonists

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9
Q

What is the rule of thumb w/ K dosing?

A

10mEq will raise the serum potassium by 0.1 mmol/dL - have to correct low mag first/ simultaneously

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10
Q

Cut offs for oral K supplementation vs IV?

A

3-3.4 can receive oral
< 3 IV is preferred +/- oral

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11
Q

Which K is preferred to be dosed IV?

A

Potassium chloride is preferred

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12
Q

K max rates in peripheral and central lines?

A

Peripheral line
Max rate is 10mEq/hr

Central line
Max rate is 40mEq/hr

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13
Q

Can you push K?

A

NEVER! Can cause cardiac arrest!

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14
Q

K SE

A

Oral:
GI: Diarrhea, nausea, vomiting, flatulence

IV:
CV: Cardiac arrest (if pushed), phlebitis, infusion site pain**

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15
Q

Which meds interact w/ K?

A

Anticholinergics

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16
Q

Hyperkalemia EKG findings

A

Peaked T waves
Lengthening of the PR and QRS duration

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17
Q

Mag normal range

A

Normal range is 1.8-2.2 mg/dL

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18
Q

Hypomagnesemia sxs

A

Lethargy
Muscle cramps/pain
Headaches
Tremor
Muscle fasciculations

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19
Q

Which drugs cause hypomagnesemia?

A

Diuretics
Loop
Thiazide
Antimicrobials
Amphotericin B
Aminoglycosides
Antitumoral
Cisplatin
Tyrosine kinase inhibitors
Proton pump inhibitors (PPI)
Laxatives and enemas
Immunosuppressants

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20
Q

1 gram is how many milliequivalents?

A

1gm = 8 mEq

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21
Q

Which route of Mag is preferred?

A

Oral

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22
Q

Typical Mag infusion rate?

A

Typical infusion rate is 1 gram/hr

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23
Q

In which situation would Mag be infused quicker?

A

Asthma exacerbation, Eclampsia

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24
Q

When can Mag be pushed?

A

Can be pushed in life threatening situations (Torsades)

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25
Rule of thumb for Mag raising?
1gm will raise the serum magnesium level by 0.1 mg/dL
26
Mag uses
Hypomagnesemia Asthma exacerbation Eclampsia Constipation Migraines* Torsades de pointes
27
Mag SE
CV: flushing, hypotension, vasodilation (with IV) GI: Diarrhea (with PO), vomiting (with IV push)
28
Which drugs interact w/ Mag?
Bisphosphonates Levothyroxine Tetracyclines Quinolones
29
Ca normal range
8.6 to 10.3 - Must be corrected for low albumin
30
Hypocalcemia sxs
Paresthesia Muscle spasms Cramps Seizures
31
Hypocalcemia causing drugs
Bisphosphonates Cinacalcet Calcium chelators Citrate, phosphate Phenytoin Chemotherapy Cisplatin
32
How much more elemental Ca is in calcium chloride than in calcium gluconate?
3x as much Calcium chloride, 1 gram = 270 mg of elemental calcium Calcium gluconate, 1 gram = 90 mg of elemental calcium
33
In hyperkalemia, how should Ca be given?
In emergent situations (hyperkalemia with EKG changes), calcium can be pushed
34
When is Ca gluconate preferred?
Calcium gluconate is preferred when a patient does not have a central line due to less phlebitis and pain
35
Uses of Ca
Hypocalcemia Beta-blocker overdose Calcium channel blocker overdose Hyperkalemia Hydrofluoric acid burns
36
Ca SE when given IV
CV: Hypotension (with IV push)
37
Which drugs should not be given w/ Ca?
Quinolones Tetracyclines Bisphosphonates
38
Na normal range
Normal range is 135-145 mEq/L
39
Hyponatremia sxs
Restlessness and irritability Headache Confusion Muscle weakness, cramps Seizure Coma
40
Which drugs can cause hyponatremia?
Diuretics Loop Thiazide Antidepressants SSRIs Antipsychotics 1st and 2nd Generation Anticonvulsants Carbamazepine, oxcarbazepine Antimicrobials Amphotericin B Aminoglycosides Chemotherapeutic Cisplatin, cyclophosphamide, vinblastine, carboplatin
41
Tx of severe hyponatremia
Immediate treatment with 100mL bolus of hypertonic (3%) saline IV Maintenance rate of 30mL/hr of hypertonic saline via peripheral line
42
Moderate hyponatremia tx
Depends on fluid status Hypervolemic - Fluid and sodium restriction +/- diuretic Euvolemic - 0.9% sodium chloride IV with or without diuretic Hypovolemic - 0.9% sodium chloride IV or NaCl tablets 1-2g TID
43
Max correction rate of Na
Max correction rate is 8 mEq/L per 24 hours
44
Na SE
Osmotic demyelination syndrome (ODS) – occurs when sodium is corrected too quickly Phlebitis, tissue necrosis (When IV hypertonic saline is administered to quickly)
45
What is used in benzo OD?
Flumazenil - kicks off benzo
46
In which pts can Flumazenil potentially cause a sz?
Never administer to chronic benzo users - if status unknown, avoid use
47
What is the tx for ethylene glycol/ methanol OD?
Fomepizole or Ethanol
48
Fomepizole or Ethanol MOA
Competitively inhibits alcohol dehydrogenase
49
What happens to the urine of a pt who recently ingested antifreeze?
Urine of a patient who recently ingested antifreeze will glow when held to black light
50
Digoxin OD tx
DigiFab
51
Anthrax OF tx
Cipro
52
Malignant hyperthermia tx
Dantrolene
53
Lithium OD tx
NS
54
Which rhythms can you shock?
V Tach and V Fib
55
What are the non-shockable rhythms?
Asystole and pulseless electrical activity
56
During cardiac arrest, what is the dosing for Epi when given to a pt w/ a shockable (pulseless V Tach, V Fib) rhythm?
1mg Q3-5 min (no max)
57
During cardiac arrest, what is the dosing of Amiodarone given to a pt w/ a shockable (pulseless V Tach, V Fib) rhythm?
First dose: 300 mg bolus (push) Second dose: 150 mg
58
During cardiac arrest, what is the dosing of Epi given in a non-shockable rhythm?
Epi IV 1 mg Q3-5 min
59
How often should rhythm be assessed during CPR?
Q2 mins
60
When do we treat bradyarrhythmias?
When the pt is symptomatic
61
What is the drug of choice for bradyarrhythmia?
Atropine IV dose: 1st dose: 1 mg IV bolus Repeat every 3-5 minutes Maximum: 3 mg
62
Max atropine dose?
3 mg
63
First step in tx tachyarrhythmia?
Assess if the pt is stable
64
What happens if the pt has tachyarrhythmia and is unstable?
Shock - hope to break arrhythmia
65
A pt w/ tachyarrhythmia is stable, what is next?
Check if QRS is wide (> 0.12s - SVT vs V Tach) to determine next steps
66
A pt w/ tachyarrhythmia is stable w/ a wide QRS complex, what is the tx regimen?
Consider adenosine only if regular and monomorphic Consider antiarrhythmic infusion
67
A pt w/ tachyarrhythmia is stable w/ a narrow QRS complex, what is the tx regimen?
Adenosine (if regular) BB or CCB
68
Adenosine dosing for narrow complex tachyarrhythmia?
Adenosine IV dose: 1st dose: 6 mg IV push 2nd dose: 12 mg
69
Amiodarone dosing for wide complex tachyarrhythmia?
Amiodarone IV: 1st dose: 150 mg/10min Repeat PRN if VT recurs. Maintenance infusion: 1 mg/min for 6 hours
70
Reversable causes of cardiac arrest?
Hypovolemia Hypoxia Hydrogen ion (acidosis) - MUDPILES Hypo-/hyperkalemia Hypothermia Tension pneumothorax Tamponade, cardiac Toxins Thombosis, pulmonary Thrombosis, coronary
71
Hyperkalemia findings on EKG
Peaked T waves Lengthening of the PR and QRS duration
72
Treatment goals for hyperkalemia
Stabilize the cardiac membrane Drive extracellular potassium into the cells Remove potassium from the body
73
What drugs are used to tx hyperkalemia?
IV Calcium gluconate or calcium chloride IV Insulin - given with dextrose to avoid hypoglycemia Albuterol nebulizer Loop diuretics Cation exchangers +/- dialysis
74
What is the purpose of IV Calcium gluconate or calcium chloride when tx hyperkalemia?
Stabilize the cardiac membrane
75
What is the purpose of IV insulin and albuterol in tx hyperkalemia?
Drive extracellular potassium into the cells
76
What is the purpose of loop diuretics, cation exchangers and dialysis when tx hyperkalemia?
Remove potassium from the body

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