IV drugs, Fluids And Antidotes Flashcards Preview

NAPLEX > IV drugs, Fluids And Antidotes > Flashcards

Flashcards in IV drugs, Fluids And Antidotes Deck (139):
0

Advantages of central IV line?

Can deliver fluids/meds that are overly irritating to peripheral veins (e.g. some chemo drugs, PN, higher conc of K, vasopressor drugs, hypertonic soln)

Can contain multiple parallel compartments

1

Disadvantages of central IV line?

Higher risks of bleeding, inf and thromboembolism and they are more difficult to insert correctly

2

What's the concern with the use of Polyvinyl Chloride (PVC) infusion bags?

Leaching (1 substance pulled from another)

Sorption (1 substance pulls in another)

3

Which drugs are known to have Leaching issues?

Tacrolimus

Temsirolimus

Teniposide

Carbazitaxel

Docetaxel

Ixabepilone

Paclitaxel

(Tic tac toe, craving delicious irrestible pho)

4

Which drugs are known to have Sorption issues?

Amiodarone (for infusions greater than 2 hrs)

Carmustine

Lorazepam

Sufentanil

Thiopental

Regular human insulin

NTG

(ACLS TIN)

5

What type of IV fluid is preferred? Why?

Crystalloids

Less costly and safer

6

List fluids under Colloids

Albumin 5%, 25% (Albuked, Flexbumin)

Dextran (Dextran 40, Dextran 70)

Hydroxyethyl starch (Hespan, Hextend, Voluven)

7

Which fluid is more expensive with no evidence of superiority?

Albumin 5%, 25% (Albuked, Flexbumin)

8

Is 5% albumin isotonic, hypertonic, hypotonic?

Isotonic

9

Is 25% albumin isotonic, hypertonic, hypotonic?

Hypertonic

10

What's used to dilute/ prepare 5% albumin.?

NS (not sterile water)

11

What's the issue with Dextran (Dextran 40; 70)?

High risk for ADRs (urticaria, acute renal failure, increased bleeding time)

12

List types of Crystalloids (Less costly and safer)?

Lactated Ringers (LR)

Dextrose 5% (D5W)

NaCl 0.9% (NS, normal saline)

13

Whats gen. recommended as 1st line therapy in pts with hypovolemic shock (e.g. Hemorrhagic)?

Fluid resuscitation with Crystalliids (LR, D5W, NS)

or

Colloids (Albumin 5%, Dextran, Hydroxyethyl starch)

14

Why is vasopressors offered as 2nd line in hypovolemic shock?

Vasopressors are NOT effective w/o adequate fluid admin - at least 30mL/kg

15

What's Sepsis?

Presence of an infection with Systemic Inflammatory Response Syndrome (SIRS)

16

What's septic shock?

Dev of hypotension in a pt with sepsis

17

Moa of Inotropes?

Work by increasing contractility

18

MOA of Dobutamine?

Beta-agonist

Increases HR => increase CO

19

MOA of vasopressors?

Work via Vasoconstriction (think pressing down) => increase systemic vascular resistance (SVR)

20

What happens at medium doses of Dopamine?

Beta-1 receptors are stimulated => increased stoke vol => increased CO

21

What happens at high doses of Dopamine?

Alpha-1 receptors are stimulated => vasoconstriction => increased SVR

22

Moa of epinephrine?

Both alpha and beta agonist

Increases co and SVR

23

Moa of norepinephrine?

Both alpha and beta agonist, with greater alpha effects

24

List Inotropes and Vasopressors used in shock syndrome

DOBUTAMINE

Milrinone

DOPAMINE

EPINEPHRINE (Adrenalin)

NOREPINEPHRINE (Levophed)

Phenyephrine (Neo-Synephrine)

Vasopressin (Pitressin)

25

SEs of Dobutamine?

Hypotension

Premature ventricular beats

26

SEs of Milrinone?

Ventricula arrhythmias

Supraventricular arrhythmias

27

Milrinone and renal dysfunction?

Milrinone must be reduced for renal dysfxn

28

SEs of (dopamine, epinephrine, norepinephrine, phenylephrine)?

Arrhythmias

Tachycardia (esp with dopamine and epinephrine)

Bradycardia

Peripheral ischemia

Necrosis (gangrene)

29

What's the strength of Epinephrine used for IV route?

0.1 mg/mL or 1:10,000

30

SEs of Vasopressin?

Arrhythmias

Necrosis (gangrene)

31

What's Extravasation?

Leaking of IV meds into surrounding tissue, of vasopressors/Inotropes can cause tissue damage and necrosis

32

Howz Extravasation treated?

Phentolamine (an alpha-adrenergic blocker that antagonizes the effects of vassopressors)

Dilute 5-10 mg in NS and give SC to infiltrated area

33

List agents used for ICU sedation and analgesia

Opioids (Morphine, Hydomorphone, Fentanyl)

BZD (Midazolam, Lorazepam)

Antipsychotics (Haloperidol, Quetiapine, Risperidone)

Hypnotics (Propofol, Dexmedetomidine)

34

What's the preferred drug for achieving rapid analgesia?

Fentanyl

35

What's the preferred drug for rapid sedation?

BZD, Propofol and Dexmedetomidine

36

Care in Propofol admin?

Limit dose and duration or Propofol due to Propofol-related infusion syndrome, which can result in cardiac arrhythmias and death

37

Sedation for pts with delirium?

Dexmedetomidine (not BZD)

38

List agents used for ICU sedation and agitation

Lorazepam (Ativan; Lorazepam Intensol)

Midazolam

Propofol (Diprivan)

Dexmedetomidine (Precedex)

Morphine

Fentanyl

Hydromorphone (Dilaudid)

Remifentanil (Ultiva)

Haloperidol (Haldol)

39

SE of Lorazepam (Ativan, Lorazepam Intensol)?

Respiratory depression

Oversedation

Hypotension

Propylene glycol poisoning at high doses and prolonged infusions (look for metabolic acidosis and renal insufficiency)

40

CI to Midazolam?

Concurrent use of potent CYP3A4 inihibitors

41

SE of Midazolam?

Respiratory depression

Apnea

Oversedation

Hypotension

42

Duration of Midazolam use?

Short-term sedation (< 48 hrs)

43

Brand name of Propofol?

Diprivan

44

SEs of Propofol (Diprivan)?

Hypotension

Apnea

Hypertriglyceridemia

Green urine

Propofol-related infusion syndrome (PRIS -rare, but can be fatal)

45

What should be monitored if on Propofol (Diprivan) longer than 2 days?

TGs

46

Why's strict aseptic technique recommended when handling Propofol (Diprivan)?

Due to potential for bacterial growth

47

Size of filter required for Propofol (Diprivan) admin?

Don't use < 5 microns

48

How's Propofol (Diprivan) formulated?

In a lipid emulsion (provides 1.1 kcal/mL)

49

Brand name of Dexmedetomidine?

Precedex

(Alpha2-adrenergic agonist

50

SEs of Dexmedetomidine (Precedex)?

Transient HTN during loading dose (may need to reduce infusion rate)

Hypotension

Bradycardia

Dry mouth

Nause

51

Howz Dexmedetomidine (Precedex) mixed?

With NS ONLY

52

Max duration of infusion for Dexmedetomidine (Precedex)?

Should not exceed 24 hrs per manufacturers labeling

53

SEs of Morphine?

Respiratory depression

Hypotension

Over sedation

Bradycardia

Pruritus

Xerostomia

Constipation

54

T/F? Morphone has an active metabolite?

T

Morphine-6-glucuronide

55

SEs of Fentanyl?

Respiratory depression

Bradycardia

Oversedation

Comstipation

Rigidity with high doses

56

Advantage of Fentanyl over morphine?

Less hypotension than morphine due to NO histamine release

57

What's the brand name of Hydromophone?

Dilaudid

58

Brand name of Haloperidol?

Haldol

59

SEs of Haloperidol (Haldol)?

Hypotension

QT prolongation

Tachycardia

Extrapyrimidal sx (EPS)

60

Monitoring of Haloperidol (Haldol)?

QT interval and ECG

61

What's an acid?

Substance that DONATES protons or H+ ions

62

Whats a base?

Substance that ACCEPTS protons or H+ ions

63

What's normal pH of blood? Range?

7.4 (range 7.35-7.45h

64

What's an acidosis?

Acid-base disorder that leads to a pH < 7.35

65

What's alkalosis?

Acid-base disorder that leads to a pH > 7.45

66

What's a metabolic acidosis?

Xterized primarily by a DECREASE in plasma HCO3 conc

67

What's a metabolic alkalosis?

Xterized primarily by a INCREASE in plasma HCO3 conc

68

Howz anion gap (AG) calculated?

Na - (Cl + HCO3)

69

What's hypertonic?

State in which serum osmolality is increased and is caused by hyperglycemia

Or

Use of hypertonic solns that don't contain sodium

70

What's Isotonic?

Normal osmolality and can be associated with hyperlipidemia

71

What's Hypotonic?

May occur with changes in volume status
- Hypovolemic
- Hypervolemic
- Isovolemic (usually caused by Syndrome of Inappropriate Antidiuretic Hormone (SIADH))

72

What may be used to treat Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

Conivaptan or Tolvaptan

73

Moa of Conivaptan or Tolvaptan (used to treat SIADH)?

Vasopressin V2-receptor antagonist

74

CI to Conivaptan (Vaprisol)?

Anura

75

SE to Conivaptan (Vaprisol)?

Orthostatic hypotension

Fever

Hypokalemia

76

Max duration of Tolvaptan (Samsca)? Why?

For up to 30 days dut to hepatoxicity

77

CI to Tolvaptan (Samsca) use?

Pts who can't sense or respond appropriately to thirst

Anura

78

SE of Tolvaptan (Samsca)?

Thirst

Nausea

Dry mouth

Asthenia

Constipation

Polyuria

Hyperglycemia

79

What's Hypo- & Hyper-natremia?

Hypo - (Na < 135 mEq/L)

Hyper - (Na > 145 mEq/L)

80

What's hypovolemic?

Caused by dehydration, vomiting, diarrhea and is usually treated with Dextrose to replace free water deficits and hypotonic solution (0.46% NaCl)

81

What's hypervolemic?

Caused by admin of hypertonic solns.

Diuretics is tx of choice with 5% dextrose

82

What's Isovolemic (Euvolemic)?

Freq ass with diabetes insipidus (DI)

83

What's the caution in correcting Na disorder?

Don't correct too quickly

84

What's the max pt to which u should correct Na anymore?

Corrections of Na > 12mEq/L over 24 hrs have been ass. with development of central pontine myelinosis, a devastating neurologic complication that can lead to quadriparesis, seizures and death

85

What's hypokalemia?

K < 3.5 mEq/L

86

What's the preferred route to correcting K?

Oral route, when available is preferred

87

How should IV K be admin in correcting hypokalemia?

No faster than 10-20 mEq/hr with intermittent doses

88

Critical illness and blood flow to gut?

Pts with critical illness have reduced blood flow to the gut (as blood,is diverted to major organs of the body) => breakdown of gastric mucosal defense mechanisms

89

Risk factors for dev of stress ulcer?

MECHANICAL VENTILATION

COAGULOPATHY

Sepsis

Traumatic brain injury

Burn pts

Acute renal failure

High dose corticosteroids

90

Should pts w/o stress ulcers risk factor receive stress ulcer prophylaxis?

No!

91

Risk factors for dev venous thromboembolism (VTE)?

Surgery

Major trauma

Immobility

Cancer

Previous VTE

Pregnancy

Estrogen-containing meds or Selecyive estrogen receptor modulators

92

Dose of low dose UFH used in VTE?

5,000 units SC BID-TID

93

Dose of LMWH used in VTE?

Enoxaparin 30mg SC BID or 40mg SC daily (give 30mg SC daily, if CrCl < 30ml/min)

Dalteparin 2,500 - 5,000 units SC daily

94

What can inhaled anesthetics cause? How should it be treated?

Malignant hyperthermia (rare)

Should be treated with Dantrolene

95

List topical anesthetics agents

Lidocaine (Xylocaine)

Benzocaine

96

List inhaled anesthetics agents

Desflurane (Suprane)

Sevoflurane (Ultane)

Isoflurane (Forane)

Nitrous oxide

97

List injectable anesthetics agents

Bupivacaine (Marcaine, Sensorcaine)

Lidocaine (Xylocaine)

Ropivacaine (Naropin)

98

How epidural containing bupivacaine NOT be given?

IV infusion (don't give via this route)

99

What should be given prior to admin of Neuromuscular Blocking Agents (NMBAs)? Why?

Sedation and analgesia

Bcuz NMBAs don't provide either

100

What must be done to pts b4 admin of NMBAs?

Pt must be mechanically ventilated

101

What must all NMBAs be labeled with?

Bright, red auxiliary labels stating "WARNING, PARALYSING AGENTS"

102

Types of NMBAs?

Depolarizing (Succinylcholine is the only 1 in this Grp and used for intubation)

Non-depolarizing (works by binding to acetylcholine receptor and blocks actions of endogenous acetylcholine)

103

SEs of non-depolarizing NMBAs?

Flushing

Bradycardia

Hypotension

Tachyphylaxis

104

List non-depolarizing NMBAs

Atracurium

Cisatracurium (Nimbex)

Pancuronium

Rocuronium (Zemuron)

Vecuronium

105

What's the brand name of Cisatracurium? Non-depolarizing NMBAs

Nimbex

106

Which NMBAs have short half-life (t1/2); intermediate acting; metabolized by Hofmann elimination?

Atracurium

Cisatracurium (Nimbex)

107

Which NMBAs is long-acting, can accumulate in renal or hepatic dysfxn, increased HR?

Pancuronium

108

Which NMBAs is intermediate-acting, )can accumulate in renal or hepatic dysfxn)?

Rocuronium (Zemuron)

Pancuronium

109

What does hemostasis mean?

Causing bleeding to stop

110

List systemic Hemostatic Agents

Aminocaproic acid (Amicar)

Tranexamic avid

Recombinant Factor VIIa (NovoSeven RT)

111

Brand name of Recombinant Factor VIIa?

NovoSeven RT

112

FDA approval for Tranexamic acid?

Menorrhagia (heavy menstrual bleeding)

113

What's intravenous Immunoglobulin (IVIG)?

Contains pooled Immunoglobulin (IgG)

114

Whats use to dose IVIG?

IBW

115

When should slower infusion rates be used in IVIG infusion?

In renal and cardiovascular dx

116

BBW of IVIG?

Acute renal dysfxn (more likely with pdts stabilized with sucrose)

Caution in elderly, pts with renal dx, DM, vol depletion, sepsis, paraproteinemia and nephrotoxic meds

Thrombosis

117

CI of IVIG?

IgA deficiency (can use product with lowest amt of IgA)

118

SEs of IVIG?

Fever, nausea, chills, hypotension, flushing, HA, myalgias, chest pain, tachycardia

Renal failure, aseptic meningitis, hemolysis, neutropenia, thromboembolic disorders and anaphylaxis are rare but serious

119

Monitoring of IVIG?

Renal fxn

Urine output

Vol status

120

Name the most commonly used resources for IV drug compatibility?

Trissel's Handbook on Injectable Drugs

King Guide to Parenteral Admixtures

121

List photosensitive drugs (drugs that req protection from light)

Amiodarone, Amphotericin

Ceftriaxone, Cefepime, Cipro

Dopamine, Doxycycline

Epinephrine

Fentanyl, Furosemide

Hydrocortisone, Hydromorphone

Levofloxacin, Levothyroxine, Linezolid

Methylprednisolone, Metronidazole, Micafungin

Norepinephrine

Ondansetron

Pentamidine, Phytonadione

SMX/TMP, Sodium Nitroprusside

122

List meds that shouldn't be refrigerated

Metronidazole (Flagyl)

SMX/TMP (Bactrim)

Phenylephrine (Neosynephrine)

Hydralazine, Moxifloxacin (Avelox)

Acetaminophen (Ofirmev)

Esomeprazole (Nexium)

123

What used to be done for poisoning that's no longer recommended?

Syrup of ipecac (to induce vomiting)

Gastric decontamination, such as, Activated charcoal

Gastric lavage

124

Sx of organophosphate poisoning?

Cholinergic (MUDDLES)

Miosis (pinpoint pupils)
Urination
Diarrhea
Diaphoresis
Lacrimation
Excitation (anxiety)
Salivation

125

What's the antidote for APAP?

N-acetylcysteine

126

What's the antidote for Anticolinesterase insecticide/ organophosphate ?

Atropine

127

What's the antidote for Anticholinergic Compds?

Physostigmine (Antilirium)

128

What's the antidote for BZD?

Flumazenil (Romazicon)

129

What's the antidote for Beta blockers?

Glucagon (GlucaGen)

130

What's the antidote for Digoxin?

Digoxin Immune Fab (DigiFab)

131

What's the antidote for Ethylene glycol, methanol?

Ethanol or Fomepizole (Antizol)

132

What's the antidote for heavy metal?

Dimercaprol

133

What's the antidote for Heparin?

Protamine

134

What's the antidote for iron?

Deferoxamine (Desferal)

135

What's the antidote for Isoniazid (INH)?

Pyridoxine (Vit. B6)

136

What's the antidote for opioids?

Naloxone (Narcan)

137

What's the antidote for snake bites?

Crotalidae polyvalent (Antivenin, Crofab)

138

What's the antidote for warfarin, rat poison?

Phytonadione (AquaMephyton, Mephyton) Vit. K

Decks in NAPLEX Class (73):