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ED/Surgery > ED/Surgery Meds > Flashcards

ED/Surgery Meds Flashcards

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1
Q

How to adjust blood pressure in ED?

A

BP too high = Hydralazine

BP too low = Norepinephrine

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2
Q

How to adjust HR in ED?

A

HR too high = Cardizem

HR too low = Dopamine

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3
Q

How to adjust glucose in ED?

A

BG too high = Regular Insulin IV

BG too Low = D50 or D5 ½ NS IV

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4
Q

How to medically sedate an agitated patient?

A

B52 (Benadryl 25mg, Haldol 5mg, Ativan 2mg) IV

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5
Q

How to treat opioid overdose?

A

Naloxone (Narcan)

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6
Q

IV anti-inflammatory of choice in ED

A

Decadron IM, Solu-Medrol IV

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7
Q

How to treat fever in ED - baby vs adult?

A 
Baby = Tylenol PR
Adult = Toradol IV
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8
Q

How to treat vomiting in ED - baby vs adult?

A 
Baby = Zofran liquid
Adult = Zofran ODT, Phenergan PR
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9
Q

Common sedation meds for babies and adults

A 
Baby = Versed nasally
Adult = Propofol  IV
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10
Q

How to treat emergency dyspnea?

A

DuoNeb SVN

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11
Q

Treatment for Croup

A

Racemic Epinephrine SVN

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12
Q

Antibiotic for common infections in children seen in ER

A

Bactroban Top, Amoxicillin PO, Omnicef PO

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13
Q

Go-to antibiotics for lungs

A

Azithromycin

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14
Q

Go-to antibiotics for GI infections

A

Cipro and Flagyl

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15
Q

Go-to antibiotic for most ENT infections

A

Amoxicillin, PCN for throat, Augmenting for sinuses

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16
Q

Antibiotics for mild, moderate, and severe UTI

A 
Mild = Macrobid
Moderate = Bactrim
Severe = Cipro
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17
Q

Go-to antibiotics for skin infections

A

Keflex (+ Bactrim for MRSA)

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18
Q

What is a broad spectrum antibiotic good for empirical treatment of most infections?

A

Doxycycline

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19
Q

A 48 yo woman has difficulty breathing and a pulse ox of 88%. She smokes tobacco and has a history of childhood asthma but hasn’t had any issues for several years. What treatment should be given right away before further evaluation?

A

Albuterol + ipratropium

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20
Q

When choosing treatment for hypertensive emergencies, what characteristics of drug are most optimal?

A

Rapid onset
Short duration
Parenteral formulation
Modest potency (more gradual BP reduction)

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21
Q

What anti-HTN meds are most appropriate in HTN emergency?

A

Enalaprilat (ACE), Hydralazine, Labetalol (BB), Nicardipine (CCB), Nitropusside (vasodilator)

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22
Q

A 55 year old man had a lymph node biopsy last week which became infected and now he is septic. He is hypotensive despite IV fluids and there is a concern that he is in shock. He has no arrhythmias on EKG. Which med is most appropriate in treating his hypotension?

A

Norepinephrine

  • Epi better for anaphylactic shock
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23
Q

Which type of insulin when given intravenously is most appropriate in bringing down the blood glucose in a patient with diabetic ketoacidosis?

A

IV short-acting like regular insulin

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24
Q

You are managing a patient’s glucose levels with insulin and now they have become hypoglycemic such that they have lost consciousness. You have IV access. What is most appropriate treatment?

A

hypertonic IV fluids - Dextrose (D50)

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25
You are interviewing an intoxicated patient when they start speaking loudly and aggressively, pounding on walls, and throwing things. You decide to chemically restrain the patient. What med is both safe and effective?
Lorazepam * B52 best for patient with acute/severe psychosis
26
Patient has become somnolent from too much Lorazepam. What can you give to wake him up?
Flumazenil (benzo receptor antagonist)
27
A 55 year old woman has claustrophobia and needs an MRI scan. Which med should be used for sedation?
Midazolam * Ketamine also good but has more side effects
28
Best sedation to use for suturing 2 yo's lip.
Midazolam
29
Midazolam vs Ketamine
Midazolam provides sedation but NO analgesia; Ketamine provides both Ketamine commonly causes N/V and usually given with odansetron
30
Treatments for 30 yo woman in ED with a fever. IV and oral?
IV Ketorolac | Oral Tylenol or ibuprofen
31
A 25 year old patient is vomiting and is not able to tolerate any liquids. Which med is most appropriate?
odansetron
32
A 15 month old patient is vomiting and is not able to tolerate any liquids. He has acute gastroenteritis. Which med is most appropriate?
odansetron
33
What characteristics of dexamethasone make it an appealing therapy for acute inflammation?
- Long duration (36-48 hr) - Rapid onset (3 hr) - Fewer ADRs than other glucocorticoids - High potency compared to hydrocortisone - Oral similar onset and duration as parenteral
34
ABX for otitis media, uncomplicated UTIs in kids, CAP in kids, strep pharyngitis, sinusitis
oral amoxicillin
35
ABX for impetigo
Mupirocin
36
What can oral azithromycin treat?
OM, CAP, strep throat alternative to PCNs or cephalosporins
37
What can oral Levofloxacin treat?
complicated and uncomplicated UTI CAP cellulitis or skin abscess traveler's diarrhea
38
Physiologic consequences of improperly treated acute pain?
CV: increased cardiac work, increased PVR and BP, MI Pulm: tachypnea, decreased vital capacity, hypoxia, increased pulm infection risk GI: reduced motility, ileus, N/V Renal: urinary retention, oliguria Coag: DVT, platelet aggregation Others: impaired immune system, muscle atrophy, fatigue, depression, anxiety
39
Different opioid receptors and what effects they have?
Mu - "PEAR" = physical dependence, euphoria, analgesia, respiratory distress Kappa - "SAM" = sedation, analgesia (spinal), miosis Delta - "ARG" = analgesia, release of GH Sigma - "Do HaRM" = dysphoria, hallucination, repiratory and vasomotor stimulation, mydriasis
40
What med is a full opioid agonist opioid?
Methadone
41
What med is full opioid antagonist?
Naloxone
42
Risk factors for PONV
``` female non-smoker dehydration Inadequate pain control h/o motion sickness h/o PONV GI or gyno surgery ```
43
ADRs of opioids
``` N/V constipation urinary retention orthostatic hypotension and bradycardia pruritus truncal rigidity ```
44
Principle agent used in PCA (patient controlled analgesia) devices
morphine
45
Receptors associated with central vomiting reflex and what meds antagonize these receptors
5HT-3/serotonin = ondansetron Muscarinic/MI = scopolamine (anticholinergics) histamine = dimenhydrinate dopamine = promethazine
46
When should anticoagulants (like Warfarin) be stopped pre-op?
d/c 5 days prior to elective surgery (ie Tuesday before a Monday surgery) Check PT/INR day before surgery; if INR >1.5 then consider administering a low dose of oral vitamin K (1-2 mg) and then recheck the following day Restarting warfarin often needs a bridging approach - those with high risk of thromboembolism will need LMW heparin until warfarin “kicks in” again
47
What meds can be continued perioperatively?
anti-HTN insulin thyroid meds aspirin controversial
48
Can ACE-inhibitors and diuretics be taken during surgery?
No, must be stopped day of surgery
49
Postpone elective surgery in patients who have glucose levels greater than _______.
300 mg (goal is under 200)
50
Indications of Midazolam (Versed)
Conscious sedation, anxiolysis, and amnesia during minor ED / surgical procedures, manipulations, or diagnostic procedures (including intubation)
51
Advantages of parental drug administration
Drugs can be administered to unconscious, uncooperative, or nauseous Vastly decreases first-pass effect (skip liver) Can be used to delay or slow onset of drug action
52
Disadvantages of parental drug administration
STRICT aseptic technique Some degree of pain Difficult to reverse drug effects Inconvenient if freq dosing required
53
How is tourniquet appropriately applied?
Applied to upper arm | Pressure enough to block vein but not artery
54
What makes a good vein to put IV in?
bouncy - refills when depressed easily palpable and visible soft above previous sites
55
Why do "bevel up" technique when doing IV?
insert bevel up at 10-30 deg angle provides cutting action reduces tissue damage more
56
Complications of IV placement
Site infection: cellulitis, systemic bloodstream infection (emergency) Infiltration/extravasation: isotonic fluids, alpha and beta adrenergic meds (emergency) Phlebitis Hematoma Air embolism (emergency)
57
What injections use Z-technique?
IM injections; pull down skin to inject straight down, then let go of skin
58
What common meds are given SQ?
heparin, insulin
59
How to do SQ injections?
pinch large skin fold and "dart" needle into skin
60
3rd generation cephalosporin administered IV or IM
Cefriaxone
61
Indications for Lidocaine
V tach | Local anesthesia
62
Drug interactions of Lidocaine
CYP450 | beta blockers
63
MOA of Lidocaine
Class IB anti-arrhythmic and cardiac depressant; weak Na channel blocker in Purkinje and ventricular cells and reduces AP
64
ADRs of opioids
GI upset, drowsiness, itching, constipation, respiratory depression, hyperalgesia, accident-proneness, tolerance, dependence, addiction/abuse
65
DIs of opioids
drugs that sedate | drugs that increase serotonin levels
66
hydrocodone + APAP =
Vicodin
67
Over medication of Midazolam can be reversed with _________.
flumazenil
68
MOA of Midazolam
Enhances GABA-dependent chloride conduction which hyperpolarizes the cell, inhibiting excitability (short acting 2-5 h)
69
ADRs of Midazolam
CNS depression (sedation, drowsiness, and much more), tolerance, dependence, respiratory/cardiovascular depression in patients cardiopulmonary disease
70
Drug class of Midazolam
Benzodiazepine
71
What should you monitor in long term Clindamycin therapy?
CBC, BUN/Cr, LFT
72
ADRs of Clindamycin
rash, GI upset, candida, CDAD, hypersensitivity, agranulocytosis
73
DIs of Clindamycin
erythromycin (antagonistic effects), neuromuscular blockers (prolongation of effects)
74
Opioids used for severe pain from least to most potent
Morphine Hydromorphone (Dilaudid) x5 Fentanyl x100
75
Potent opioid that is safe in renally impaired patient?
Fentanyl Maybe Hydromorphone, but NO morphine
76
Opioid that has longest duration
Fentanyl patch (48-72 hr)
77
Kappa opioid receptor agonist and Mu receptor antagonist
Nalbuphine
78
Nalbuphine has much less risk of _________ and _________ than morphine.
``` abuse potential (use to get off opioids) respiratory depression ```
79
MOA of Ketorolac/Toradol
NSAID, nonselective COX inhibitor | analgesic and anti-inflammatory
80
Indications of Scopolamine
motion sickness | PONV
81
Antiemetic that inhibits H1 muscarinic receptor
Promethazine
82
Important ADR of Promethazine
Neuroleptic malignant syndrome | Bone marrow suppression
83
Anticholinergic muscarinic antagonist that is used to treat nausea and vomiting
Scopolamine
84
What is the maximum dose of lidocaine?
5mg/kg
85
Indications of IV Dantrium
Muscle spasms | Malignant hyperthermia
86
Antidote of amphetamines
None available

ED/Surgery (16 decks)

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