Exam 2 Clinical Flashcards
(78 cards)
1
Q
When do you use cardiac monitor with kidney problems?
A
pts with low K+
2
Q
Stage 1 HTN tx
A
thiazides
3
Q
Stage 2 HTN tx
A
thiazides + ACEI/ARB/CCB/BB
4
Q
1st line for all HTN
A
lifestyle modification
5
Q
HTN with hypothyroidism
A
diastolic HTN
6
Q
Renal artery stenosis dx test
A
renal angiography
7
Q
Labs seen with primary aldosteronism
A
increased aldosterone
low renin
8
Q
Labs seen with renal artery stenosis
A
increased aldosterone and renin
9
Q
Drug tx for high renin activity
A
ACEI
Beta blockers
10
Q
Drug tx for low renin activity
A
alpha blockers
CCB
diuretics
11
Q
Cause of renal artery stenosis in young adults
A
medial fibroplasia
12
Q
Sign of endocrine HTN
A
imbalance of electrolytes
low renin, high aldosterone
13
Q
Tx for endocrine HTN
A
surgery (if unilateral)
spironolactone/triamterene in bilateral
14
Q
Pheochromocytoma impact
A
catecholamine release
abnormal lipid levels
hyperglycemia
HTN
15
Q
Tx for pheochromocytoma
A
surgery
alpha blockers
volume expansion
16
Q
Cushing syndrome
A
increased ACTH production (microadenoma of pituitary)
part of MEA syndrome
increased cortisol in morning and evening
17
Q
Metabolic acidosis with anion gap causes
A
Methanol Uremia DKA Paraldehyde Iron/INH Lactic acid Ethylene glycol Salicyclates
18
Q
Renal tubule acidosis type II
A
loss of max resorption bicarb in prox tubule decreased bicarb (15-20mEq/L) hypokalemia assc with myeloma/Fanconi syndrome can be caused by CAI's (acetazolamide)
19
Q
Some causes of hypernatremia
A
water loss
diabetes insipidus
mannitol/hyperglycemia
20
Q
Correction of hypernatremia
A
infuse water
if over 48hrs, no more than 10mEq/L a day correction
21
Q
Drug causes of diabetes insipidus
A
lithium
demeclocycline
22
Q
Causes of inappropriate hyponatremia
A
SIADH
hypothyroid
adrenal insufficiency
23
Q
Causes of appropriate hyponatremia
A
CHF
cirrhosis
volume loss
all are euvolemic hyponatremia
24
Q
Hyponatremia correction risk
A
can cause central pontine myelinolysis
from rapid correction of hyponatremia
cracks myelin sheath
25
Tx for hypovolemic hyponatremia
0.9% saline
26
Tx for euvolemic hyponatremia
3% saline (acutely)
saline must be more conc than urine osmolarity
demeclocycline/salt for chronic tx
27
Tx for hypervolemic hyponatremia
underlying disorder tx
| diuretics/aquaretics
28
Tx for hypernatremia
D5W/hydration
29
Risks of hypokalemia
```
cardiac arrhythmia (excitability)
rhabdomyolysis (releases K+ into serum)
alkalosis
```
30
Insulin/K+ relationship
causes transport of K+ into cells
decreases serum K+
can tx hyperkalemia acutely
31
Causes of K+ loss
```
diarrhea
villous adenoma
DKA/RTA
increased aldosterone
Bartter's & Gitelman's
```
32
Hypokalemia and RMP
increased excitability
causes increased firing
hyperpolarizes cells
delays repolarization
33
Hyperkalemia and RMP
depolarization of membrane
increased inactivation time
decreased firing
34
Catecholamines/K+ relationship
increase Na+/K+ ATPase
| drives K+ into cell
35
Normal K+ range
3.6-5.1
36
Causes of hyperkalemia
metabolic acidosis
hyperglycemia (insulin)
digoxin
beta blockers (less Na+/K+ ATPase)
37
Signs of hyperkalemia
muscle weakness
peaked T waves/wide QRS
bradycardia
38
Alkalosis impact on O2 dissociation curve
shift to the L
| less H+ to compete with oxygen binding on Hb
39
Acidosis impact on O2 dissociation curve
shift to the R
| more H+ competes with oxygen and displaces it on Hb
40
Causes of metabolic alkalosis
antacid
vomiting
diuretics
41
Methanol absorption
all routes, even skin contact
| 4mL blindness/15mL death ingestion
42
Methanol metabolism
alcohol DH converts to formic acid
| regulated by folic acid system
43
Formic acid toxicity
```
metabolic acidosis/anion gap
ocular toxicity
seizures/coma/increased ICP
CSF with WBCs/xanthochromia (putamen damage)
increased amylase
```
44
Tx for methanol poisoning
bicarb therapy
folic acid
dialysis
EtOH
45
Ethylene gylcol characteristics
sweet taste/aromatic odor
ingestion toxicity
metabolized by liver into acids
46
Ethylene glycol poisoning
CNS stage-acidosis/intox/coma
Cardiopulmonary stage-HTN/cyanosis
Renal stage-crystalluria/ATN/renal failure
47
Acids produced from ethylene glycol metabolism
glycoaldehyde
glycolic acid/glyoxylic acid
oxalic acid (precipitates in organs/kidneys)
formic acid
48
Dx of ethylene glycol poisoning
wood lamp exam
increased osmolar gap (early)
decreased serum Ca2+
large anion gap
49
Digoxin characteristics
excreted via kidneys
| alters Na+ transport in cardiac m./increased IC Ca2+
50
Sx of digoxin toxicity
```
N/V
seizures
amnesia/confusion
yellow/green vision
dysrhythmia
```
51
Causes of digoxin toxicity
erythromycin/tetracycline (decreased bacterial metabolism of digoxin)
electrolyte imbalances
hepatic/renal disease
52
Tx for Dig toxicity
Digibind
| FAB fragment
53
Salicylate metabolism
```
mostly liver (kidney if excess)
rapid absorption
```
54
Aspirin overdose
```
alkalosis (hyperventilation)
decreased factor VIII (increased PT time)
acute renal failure
metabolic acidosis from organic acids
ox-phos uncoupling (hyperthermia)
```
55
Sx of aspirin OD
hyperpnea
coma/seizures/vomiting
tinnitus
hyperpyrexia
56
Tx for salicylate OD
```
salicylate nomogram (within 6hrs)
supportive care
```
57
Acetaminophen toxicity
Phase 1: 30min-4hrs, N/V
Phase 2: 24-72hrs, liver abn, increased transaminase
Phase 3: 3-5 days, jaundice/encephalopathy/hepatic necrosis
Phase 4: 7-8 days, return to normal/continue decline
58
Prognosis factor for acetaminophen OD
serum concentration
59
Tx for acetaminophen OD
nomogram within 4 hrs
N-acetylcysteine within 24 hrs
donates sulfhydryl group for nontox elimination
60
Acetylcholinesterase inhibitors
carbamates and organophosphates
| organophosphates absorbed all routes
61
Carbamates
acetylcholinesterase inhibitor
lower toxicity/shorter duration
does not cross BBB
62
Organophosphates
acetylcholinesterase inhibitor
stimulates ANS/skeletal m./CNS
garlic odor of insecticides
63
Muscarinic effects of organophosphates
```
SLUG BAM
salivation
lacrimation
urination
GI upset/motility
Bradycardia
Abd pain
Miosis
```
64
Nicotinic effects of organophosphates
```
MTWtHF (days of week)
midriasis
tachycardia
weakness
HtN
fasciculations
```
65
Cause of death with acetylcholinesterase inhibitors
respiratory failure (prolonged contraction)
66
Intermediate syndrome
24-96hrs post poisoning of acetylcholinesterase inhibitors
paralytic sx for days
no atropine response
67
Tx for acetylcholinesterase inhibitors
atropine for muscarinic effects
| pralidoxime for nicotinic/CNS effects
68
Cyanide characteristics
decreases ATP production
cell membranes are permeable to CN
bind iron on Hb tightly
69
Cyanide metabolism
B12 incorporation
thiocyanate conversion
rhodanase
70
Dx of cyanide toxicity
LOC/metabolic acidosis
almond odor
bright red venous blood
Lee-Jones test
71
Tx for cyanide
amyl nitrate/sodium nitrate (converts to oxyhemoglobin)
| Na+ thiosulfate (convertes to thiocyanate)
72
Phases of iron intoxication
1: 30-120min, acidosis/N&V
2: 2-24hrs, apparent recovery
3: 12-48hrs, acidosis/coma/shock
4: 2-4 days, hepatic necrosis/bleeding diathesis
5: 2-4wks, GI scarring/cirrhosis/CNS sx
73
Dx of iron intox
pills on x-ray
bloody stool/diarrhea
damage after iron saturates ferritin (300-450ug/dL)
74
Tx for iron intox
deferoxamine (chelator)-complexes and kidney secretion
| use if iron over 350ug/dL in serum
75
Anticholinergic drug action
blocks muscarinic sites (parasympathetics)
76
Anticholingergic syndrome
dilated pupils/blurred vision
flushing/dry skin
HTN/hyperthermia
77
Tx for anticholinergic toxicity
lidocaine for VT
valium for psychotic sx
anticholinesterases (physostigmine)
cold packs for hyperthermia
78
Physostigmine characteristics
for anticholinergic OD
can cross BBB
do not use with GI/GU obstructions
caution with DM/glaucoma/asthma/heartblock
