Flashcards in IV drugs, Fluids And Antidotes Deck (139):
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
Disadvantages of central IV line?
Higher risks of bleeding, inf and thromboembolism and they are more difficult to insert correctly
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)
Which drugs are known to have Leaching issues?
(Tic tac toe, craving delicious irrestible pho)
Which drugs are known to have Sorption issues?
Amiodarone (for infusions greater than 2 hrs)
Regular human insulin
What type of IV fluid is preferred? Why?
Less costly and safer
List fluids under Colloids
Albumin 5%, 25% (Albuked, Flexbumin)
Dextran (Dextran 40, Dextran 70)
Hydroxyethyl starch (Hespan, Hextend, Voluven)
Which fluid is more expensive with no evidence of superiority?
Albumin 5%, 25% (Albuked, Flexbumin)
Is 5% albumin isotonic, hypertonic, hypotonic?
Is 25% albumin isotonic, hypertonic, hypotonic?
What's used to dilute/ prepare 5% albumin.?
NS (not sterile water)
What's the issue with Dextran (Dextran 40; 70)?
High risk for ADRs (urticaria, acute renal failure, increased bleeding time)
List types of Crystalloids (Less costly and safer)?
Lactated Ringers (LR)
Dextrose 5% (D5W)
NaCl 0.9% (NS, normal saline)
Whats gen. recommended as 1st line therapy in pts with hypovolemic shock (e.g. Hemorrhagic)?
Fluid resuscitation with Crystalliids (LR, D5W, NS)
Colloids (Albumin 5%, Dextran, Hydroxyethyl starch)
Why is vasopressors offered as 2nd line in hypovolemic shock?
Vasopressors are NOT effective w/o adequate fluid admin - at least 30mL/kg
Presence of an infection with Systemic Inflammatory Response Syndrome (SIRS)
What's septic shock?
Dev of hypotension in a pt with sepsis
Moa of Inotropes?
Work by increasing contractility
MOA of Dobutamine?
Increases HR => increase CO
MOA of vasopressors?
Work via Vasoconstriction (think pressing down) => increase systemic vascular resistance (SVR)
What happens at medium doses of Dopamine?
Beta-1 receptors are stimulated => increased stoke vol => increased CO
What happens at high doses of Dopamine?
Alpha-1 receptors are stimulated => vasoconstriction => increased SVR
Moa of epinephrine?
Both alpha and beta agonist
Increases co and SVR
Moa of norepinephrine?
Both alpha and beta agonist, with greater alpha effects
List Inotropes and Vasopressors used in shock syndrome
SEs of Dobutamine?
Premature ventricular beats
SEs of Milrinone?
Milrinone and renal dysfunction?
Milrinone must be reduced for renal dysfxn
SEs of (dopamine, epinephrine, norepinephrine, phenylephrine)?
Tachycardia (esp with dopamine and epinephrine)
What's the strength of Epinephrine used for IV route?
0.1 mg/mL or 1:10,000
SEs of Vasopressin?
Leaking of IV meds into surrounding tissue, of vasopressors/Inotropes can cause tissue damage and necrosis
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
List agents used for ICU sedation and analgesia
Opioids (Morphine, Hydomorphone, Fentanyl)
BZD (Midazolam, Lorazepam)
Antipsychotics (Haloperidol, Quetiapine, Risperidone)
Hypnotics (Propofol, Dexmedetomidine)
What's the preferred drug for achieving rapid analgesia?
What's the preferred drug for rapid sedation?
BZD, Propofol and Dexmedetomidine
Care in Propofol admin?
Limit dose and duration or Propofol due to Propofol-related infusion syndrome, which can result in cardiac arrhythmias and death
Sedation for pts with delirium?
Dexmedetomidine (not BZD)
List agents used for ICU sedation and agitation
Lorazepam (Ativan; Lorazepam Intensol)
SE of Lorazepam (Ativan, Lorazepam Intensol)?
Propylene glycol poisoning at high doses and prolonged infusions (look for metabolic acidosis and renal insufficiency)
CI to Midazolam?
Concurrent use of potent CYP3A4 inihibitors
SE of Midazolam?
Duration of Midazolam use?
Short-term sedation (< 48 hrs)
Brand name of Propofol?
SEs of Propofol (Diprivan)?
Propofol-related infusion syndrome (PRIS -rare, but can be fatal)
What should be monitored if on Propofol (Diprivan) longer than 2 days?
Why's strict aseptic technique recommended when handling Propofol (Diprivan)?
Due to potential for bacterial growth
Size of filter required for Propofol (Diprivan) admin?
Don't use < 5 microns
How's Propofol (Diprivan) formulated?
In a lipid emulsion (provides 1.1 kcal/mL)
Brand name of Dexmedetomidine?
SEs of Dexmedetomidine (Precedex)?
Transient HTN during loading dose (may need to reduce infusion rate)
Howz Dexmedetomidine (Precedex) mixed?
With NS ONLY
Max duration of infusion for Dexmedetomidine (Precedex)?
Should not exceed 24 hrs per manufacturers labeling
SEs of Morphine?
T/F? Morphone has an active metabolite?
SEs of Fentanyl?
Rigidity with high doses
Advantage of Fentanyl over morphine?
Less hypotension than morphine due to NO histamine release
What's the brand name of Hydromophone?
Brand name of Haloperidol?
SEs of Haloperidol (Haldol)?
Extrapyrimidal sx (EPS)
Monitoring of Haloperidol (Haldol)?
QT interval and ECG
What's an acid?
Substance that DONATES protons or H+ ions
Whats a base?
Substance that ACCEPTS protons or H+ ions
What's normal pH of blood? Range?
7.4 (range 7.35-7.45h
What's an acidosis?
Acid-base disorder that leads to a pH < 7.35
Acid-base disorder that leads to a pH > 7.45
What's a metabolic acidosis?
Xterized primarily by a DECREASE in plasma HCO3 conc
What's a metabolic alkalosis?
Xterized primarily by a INCREASE in plasma HCO3 conc
Howz anion gap (AG) calculated?
Na - (Cl + HCO3)
State in which serum osmolality is increased and is caused by hyperglycemia
Use of hypertonic solns that don't contain sodium
Normal osmolality and can be associated with hyperlipidemia
May occur with changes in volume status
- Isovolemic (usually caused by Syndrome of Inappropriate Antidiuretic Hormone (SIADH))
What may be used to treat Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?
Conivaptan or Tolvaptan
Moa of Conivaptan or Tolvaptan (used to treat SIADH)?
Vasopressin V2-receptor antagonist
CI to Conivaptan (Vaprisol)?
SE to Conivaptan (Vaprisol)?
Max duration of Tolvaptan (Samsca)? Why?
For up to 30 days dut to hepatoxicity
CI to Tolvaptan (Samsca) use?
Pts who can't sense or respond appropriately to thirst
SE of Tolvaptan (Samsca)?
What's Hypo- & Hyper-natremia?
Hypo - (Na < 135 mEq/L)
Hyper - (Na > 145 mEq/L)
Caused by dehydration, vomiting, diarrhea and is usually treated with Dextrose to replace free water deficits and hypotonic solution (0.46% NaCl)
Caused by admin of hypertonic solns.
Diuretics is tx of choice with 5% dextrose
What's Isovolemic (Euvolemic)?
Freq ass with diabetes insipidus (DI)
What's the caution in correcting Na disorder?
Don't correct too quickly
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
K < 3.5 mEq/L
What's the preferred route to correcting K?
Oral route, when available is preferred
How should IV K be admin in correcting hypokalemia?
No faster than 10-20 mEq/hr with intermittent doses
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
Risk factors for dev of stress ulcer?
Traumatic brain injury
Acute renal failure
High dose corticosteroids
Should pts w/o stress ulcers risk factor receive stress ulcer prophylaxis?
Risk factors for dev venous thromboembolism (VTE)?
Estrogen-containing meds or Selecyive estrogen receptor modulators
Dose of low dose UFH used in VTE?
5,000 units SC BID-TID
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
What can inhaled anesthetics cause? How should it be treated?
Malignant hyperthermia (rare)
Should be treated with Dantrolene
List topical anesthetics agents
List inhaled anesthetics agents
List injectable anesthetics agents
Bupivacaine (Marcaine, Sensorcaine)
How epidural containing bupivacaine NOT be given?
IV infusion (don't give via this route)
What should be given prior to admin of Neuromuscular Blocking Agents (NMBAs)? Why?
Sedation and analgesia
Bcuz NMBAs don't provide either
What must be done to pts b4 admin of NMBAs?
Pt must be mechanically ventilated
What must all NMBAs be labeled with?
Bright, red auxiliary labels stating "WARNING, PARALYSING AGENTS"
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)
SEs of non-depolarizing NMBAs?
List non-depolarizing NMBAs
What's the brand name of Cisatracurium? Non-depolarizing NMBAs
Which NMBAs have short half-life (t1/2); intermediate acting; metabolized by Hofmann elimination?
Which NMBAs is long-acting, can accumulate in renal or hepatic dysfxn, increased HR?
Which NMBAs is intermediate-acting, )can accumulate in renal or hepatic dysfxn)?
What does hemostasis mean?
Causing bleeding to stop
List systemic Hemostatic Agents
Aminocaproic acid (Amicar)
Recombinant Factor VIIa (NovoSeven RT)
Brand name of Recombinant Factor VIIa?
FDA approval for Tranexamic acid?
Menorrhagia (heavy menstrual bleeding)
What's intravenous Immunoglobulin (IVIG)?
Contains pooled Immunoglobulin (IgG)
Whats use to dose IVIG?
When should slower infusion rates be used in IVIG infusion?
In renal and cardiovascular dx
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
CI of IVIG?
IgA deficiency (can use product with lowest amt of IgA)
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
Monitoring of IVIG?
Name the most commonly used resources for IV drug compatibility?
Trissel's Handbook on Injectable Drugs
King Guide to Parenteral Admixtures
List photosensitive drugs (drugs that req protection from light)
Ceftriaxone, Cefepime, Cipro
Levofloxacin, Levothyroxine, Linezolid
Methylprednisolone, Metronidazole, Micafungin
SMX/TMP, Sodium Nitroprusside
List meds that shouldn't be refrigerated
Hydralazine, Moxifloxacin (Avelox)
What used to be done for poisoning that's no longer recommended?
Syrup of ipecac (to induce vomiting)
Gastric decontamination, such as, Activated charcoal
Sx of organophosphate poisoning?
Miosis (pinpoint pupils)
What's the antidote for APAP?
What's the antidote for Anticolinesterase insecticide/ organophosphate ?
What's the antidote for Anticholinergic Compds?
What's the antidote for BZD?
What's the antidote for Beta blockers?
What's the antidote for Digoxin?
Digoxin Immune Fab (DigiFab)
What's the antidote for Ethylene glycol, methanol?
Ethanol or Fomepizole (Antizol)
What's the antidote for heavy metal?
What's the antidote for Heparin?
What's the antidote for iron?
What's the antidote for Isoniazid (INH)?
Pyridoxine (Vit. B6)
What's the antidote for opioids?
What's the antidote for snake bites?
Crotalidae polyvalent (Antivenin, Crofab)