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Flashcards in Intravenous Fluids Deck (14)
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Issues with intravenous bags

1. Leaching: tacrolimus, temsirolimus, teniposide, cabazitaxel, docetaxel, ixabepilone, paclitaxel ( tic tac toe craving delicious irresistible pho)
2. Sorption: amiodarone for infusions greater than two hours, carmustine, lorazepam, sufentanil, REGULAR HUMAN INSULIN AND NITROGLYCERIN (ACLS TIN)

1

Types of shock

1. Hypovolemic
2. Cardiogenic
3. Distributive (septic)
4. Obstructive (massive pulmonary embolism)

2

Hypovolemic

Typically treated with fluids

3

Cardiogenic shock

Often requires the use of a vasopressor and/or Inotropic agent

4

Septic shock

Administer crystalloids or Holroyd fluids, vasopressors, and/or inotropic drugs

HIS PATIENTS OBVIOUSLY ALSO NEED ANTIBIOTICS AND SOMETIMES ARE GIVEN CORTICOSTEROIDS

5

Inotropes and vasopressors

Inotropes:
1. Dobutamine: beta agonist and increases heart rate which increases cardiac output
2. Milrinone is a selective phosphodiesterase inhibitor and cardiac and vascular tissue which causes vasodilation and inotropic effects (must be does reduced for renal dysfunction)

Vasopressors: cause vasoconstriction which increases systemic vascular resistance
1. Dopamine
2. Epinephrine (adrenalin)
3. Norepinephrine (levophed)
4. Phenylephrine (neo-synephrine)
5. Vasopressin (pitressin)

Note: extravastation can cause tissue damage and necrosis (phentolamine is used if this occurs as it antagonizes vasopressors)

6

Neuromuscular blockers

These agents do not provide sedation or analgesia. Therefore, patient should receive adequate sedation and in eulogies of prior to starting an NMBA

Two types:
1. Depolarizing: succinylcholine the only available agent is reserved for intubation
2. Nondepolarizing agents: vecuronium, atrcurium, cisatracurium (Nimbex), pancuronium, rocuronium (Zemuron)

Side effects of nondepolarizing NMBAs: Flushing, bradycardia, hypertension, tachyphylaxis

Monitoring: peripheral nerve stimulator to assess his depth of paralysis, vital signs

7

Injectable anesthetics

1. Bupivacaine ( Marcaine, Sensorcaine)
2. Lidocaine (Xylocaine)
3. Ropivacaine (Norapin)

EPIDURALS CONTAINING BUPIVACAINE CAN QUICKLY BE FATAL IF GIVEN VIA THE INTRAVENOUS ROUTE. DO NOT GET BUPIVACAINE EPIDURAL THE IV INFUSION

8

Photosensitive drugs

Amiodarone, amphotericin, ceftriaxone, cefepime, ciprofloxacin, dopamine, Dr. C cycling, epinephrine, Fentonville, Verizon line, hydrocortisone, hydromorphone, levofloxacin, levothyroxin, Linezolid, methylprednisolone, metronidazole, micafungin, norepinephrine, ondansetron, phytonadione, Bactrim, sodium nitroprusside

9

IV medications that require filtration

About a set, abciximab, albumin, amiodarone, amphotericin, diazepam, digoxin immune fab, infliximab, lipids, Lorazepam, mannitol, phenytoin, parenteral nutrition

10

IV agents that should not be refrigerated

Metronidazole (Flagyl), Bactrim, phenylephrine (Neo-Synephrine), hydralazine, moxifloxacin (Avelox), acetaminophen (ofirmev), esomeprazole (Nexium)

11

Poisoning

Gastric decontamination is no longer recommended: such as activated charcoal or syrup of ipecac

Insecticide poisoning: most occur from organophosphates which inhibit acetylcholinesterase leading to a buildup of acetylcholine and presenting with cholinergic side effects

Cholinergic side effects (MUDDLES): miosis, urination, diarrhea, diaphoresis, lacrimation, excitation and salivation

12

Antidotes for select toxicities

1. Acetaminophen: N acetylcysteine
2. Anti-cholinesterase insecticides organophosphates: atropine
3. Anticholinergic compounds: physostigmine (antilirium)
4. Arsenic, Lead: succimer
5. Benzodiazepines: flumazenil (romazicon)
6. Beta blockers: glucagon (GlucaGen)
7. Botulism: botulism antitoxin
8. Black widow spider bites: anti-venin (Latrodectus mactans)
9. Calcium channel blockers: calcium chloride 10%, glucagon
10. Carbon monoxide: oxygen
11. Cyanide: sodium nitrate, sodium thiosulfate, hydroxyocobalamin (cyano kit)
12. Digoxin: digoxin immune fab (digifab)
13. Ethylene guaiacol, methanol: ethanol or fomepizole (Antizol)
14. Heavy metals: dimercaprol
15. Heparin: protamine
16. Iron: deferoxamine (Desferal)
17. Isoniazid: pyridoxine or vitamin B6
18. Methemoglobinemia: methylene blue
19. Opioids: naloxone (Narcan)
20. Salicylate: sodium bicarbonate
21. Methotrexate: leucovorin
22. Snakebites: crotalidae polyvalent
23. Scorpion stings: anascorp
24. TCAs: sodium bicarbonate
25. Warfarin, rat poison: phytonadione (AquaMEPHYTON, mephyton)
26. Vasopressors: phentolamine

13

Acid-base: metabolic acidosis

PH less than 7.35 and bicarb less than 22

Anion gap= sodium- (Cl+HCO3)

Mud piles: methanol, uremia, diabetic ketoacidosis, purpling glycol, isoniazid, lactic acidosis, ethylene glycol, salicylates. (others: alcoholic ketoacidosis, ethanol, cyanide, toluene)