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IPT: CC > More Block 1 > Flashcards

More Block 1 Flashcards

1
Q

HIT Type I vs II

Occurs 4-10 days after heparin exposure

A

Type II

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2
Q

HIT Type I vs II

PLT count normalizes w/ continued heparin

A

Type I

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3
Q

HIT Type I vs II

Major concerns for thrombotic complications

A

Type II

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4
Q

HIT Type I vs II

Occurs within first 2 days of heparin exposure

A

Type I

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5
Q

HIT Type I vs II

Non immune

A

Type I

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6
Q

HIT Type I vs II

Has HIT antibodies

A

Type II

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7
Q

LMWH vs UFH

Which has a higher chance of HIT?

A

UFH

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8
Q

How is the Fc receptor complex with heparin made? Whats the issue?

A

Platelet with PF4 combines with heparin to form heparin with PF4 cytokines

IgG combines with that complex and attaches to the platelet

More PF4 = more platelets

More thrombin = thrombosis occurs

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9
Q

What is the 4 T’s score?

A

Initial screen for suspicion of HIT

Thrombocytopenia
Timing
Thrombosis
Other causes of thrombocytopenia

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10
Q

Timing info for 4 T score

A

Days 5 - 10 or under 1 day if heparin used in past 30 days

Days >10 or under 1 day if heparin used within 30-100 days

Day <4 with no recent heparin use

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11
Q

Thrombocytopenia info for 4 T score

A

> 50% fall or nadir ≥20

30-50% fall or nadir 10019

<30% fall or nadir <10

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12
Q

4Ts score interpretation?

A

0-3 = low

4-5 = intermediate

≥6 = high

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13
Q

HIT/PF4 vs SRA

Which one is the gold standard for HIT diagnosis?

A

SRA

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14
Q

HIT/PF4 vs SRA

Which one is quicker to use and therefore has just moderate specificity?

A

HIT/PF4

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15
Q

HIT/PF4 vs SRA

Which one is typically used first?

A

HIT/PF4

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16
Q

What do you do if 4T comes back at ≥4?

A

d/c heparin and start non-heparin anticoagulant

Obtain immunoassay

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17
Q

What are the direct thrombin inhibitors?

A

Argatroban and Bivalirudin

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18
Q

Argatroban vs Bivalirudin

Which one is an arginine derivative?

A

Argatroban

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19
Q

Argatroban vs Bivalirudin

Which one is reversible?

A

Both

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20
Q

Argatroban vs Bivalirudin

Which one has a greater effect on INR?

A

Argatroban

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21
Q

Argatroban vs Bivalirudin

Which one is a synthetic analog of hirudin?

A

Bivalirudin

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22
Q

Argatroban vs Bivalirudin

Which one is divalent? Monovalent?

A

Argatroban - mono

Bivalirudin - divalent

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23
Q

Argatroban vs Bivalirudin

Which one is cleared hepatically?

A

Argatroban

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24
Q

Argatroban vs Bivalirudin

Which one is dosed regardless if they have renal/liver issues?

A

Bivalirudin

It’s not CI to use argatroban in liver failure pt, just be careful with dosing (25% or OG dose)

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25
Argatroban vs Bivalirudin When should aPTT be checked?
Every 4-24 hrs
26
Argatroban vs Bivalirudin Which one is dosed at 2mcg/kg/min? Whats the other one's dose?
Argatroban Bivalirudin - 0.2mcg/kg/min
27
Argatroban vs Bivalirudin Which one will show falsely elevated INR when bridging to warfarin?
Argatroban
28
Argatroban vs Bivalirudin Which one is metabolized in plasma?
Bivalirudin
29
When transitioning to oral therapy from argatroban/bivalirudin, what can be considered?
DOACs or warfarin (only if PLTs are >150k)
30
If transitioning to warfarin from argatroban/bivalirudin, what must they meet?
PLT >150k Overlap with DTI or fondaparinux Continue for 4wks (no thrombosis) or 3 months (with thrombosis)
31
Base excess interpretatio?
2 = base excess of 2 more than normal = alkalotic -5 = base deficit of 5 = acidotic
32
Normal pCO2 level?
40
33
Normal pO2 level?
80-100
34
Normal base excess level?
-2 to +2
35
Values for respiratory alkalosis/acidosis?
<40 pCO2 = respiratory acidosis >40 pCO2 = respiratory acidosis
36
Values for metabolic alkalosis/acidosis?
>28 HCO3 = metabolic alkalosis <22 HCO3 = metabolic acidosis
37
Which condition should you check AG?
Metabolic acidosis Na - Cl - HCO3 Take that and subtract 12 and add to HCO3 to reveal new HCO3
38
What is FAST HUG?
Feeding Analgesics Sedation Thromboembolic prophylaxis Head of bed elevation Ulcers Glucose control
39
Are antiplatelet agents VTE prophylaxis?
Nope
40
RF for GI bleed?
Mech. ventilation >48hrs INR >1.5 or PLT <50k h/o GI bleed Hypotension Liver failure Head or spinal cord injury
41
How does enteral feeding affect GI bleed?
No difference in overt GI bleed and not beneficial
42
What are some limitations of sucralfate for GI bleed?
DDI Clogs feeding tube Aluminum accumulation and low phosphorus Constipation
43
How does antacids affect GI bleed?
No mortality benefit; equivalent to sucralfate
44
RF of upper GI bleed via PUD?
NSAIDs Concomitant OAC or antiplatelet use H. pylori >65yrs old Alcohol use
45
GI bleed symptoms?
Melena and hematemesis = upper GI bleed Hematochezia = lower GI bleed
46
What separates upper from lower GI?
Ligament of Treitz, duodenum is upper and jejunum starts the lower
47
Upper GI bleed Treatment for high risk patient?
PPI IV bolus before endoscopy Then Post endoscopy PPI x72hrs High risk = ≥60yrs old, unstable, active bleed
48
Upper GI bleed treatment for low risk patient?
PPI IV bolus Post endoscopy PPI (PO if clean)
49
When should you reintroduce these meds when on PPI? NSAIDs ASA DAPT Anticoagulation
First check to see if its actually necessary in the first place NSAIDs, switch to COX2 inhibitor ASA, start ASAP post-endoscopy DAPT, start 3-7 days post-endoscopy Anticoagulation, case-by-case, 7-30 days post-endoscopy
50
Treatment of lower GI bleed?
None, PPI unlikely will have a difference
51
ADME of a critically ill person?
Poor oral absorption Large Vd (due to fluid intake) Hypercatabolic Excretion could be faster or slower than normal
52
What drugs are affected from critically ill patients with large Vd?
Concentration dependent (EX: Amino, fluro, metro) Hydrophilic drugs
53
What something known in critically ill patients with their kidneys? RF?
Augmented Renal Clearance (CrCl >120 or >130) ``` Younger pt (<50) Male TRAUMA TBI Mech. ventilation ```
54
When calculating Ke, what assumptions do you make?
Assume blood flow rate to kidneys is stable Stable clearance
55
What is the main drug parameter that determines steady state?
t1/2
56
How do you calculate AUC? Cl?
Dose / Clearance = AUC Ke*Vd = Cl Cl and Vd are independent factors
57
LD (increase/decrease) time to therapeutic levels and (do/do not) affect the time to steady state
Decrease time Do not affect
58
If a patient is on HD, what should you monitor instead of CrCl?
UOP for any dramatic changes
59
Vd of HD patients?
0.4L/kg
60
When do you get levels with HD patients?
Practical = morning at random time before HD Vanco = wait at least 6 hrs after HD is done
61
LD/MD of vanco?
LD = 25-30mg/kg MD = 15-20mg/kg
62
What is the bayesian and 2 level PK method to measuring Vanco?
Bayesian = 2 levels are 1st or 2nd dose 2 level PK = peak and trough after 4th dose
63
What is a Grade I, II, III trauma injury?
I = <1cm II = >1cm III = Extensive soft tissue injury
64
What kind of wound cultures are ideal for trauma patients?
Surgical culture > wound swab
65
Suspected pathogens in grade I-III trauma injuries?
All = S. aureus or strep III = GNR organisms
66
Treatment of grade I-III trauma injuries?
I or II = Cefazolin III = ceftriaxone Both for 2-3 days or 1 day after wound closure
67
Penetrating wound severity list?
Very low = knife Low = handgun High = military rifle Highest = fragmenting device
68
Prophylactic Abx and penetrating wounds?
Only if there is a hollow viscous injury or CNS involvement, it is given 24hrs prior If not, no Abx
69
Who is indicated for pre-emptive Tx of bites? How long?
Immunocompromised Edema of affected area Moderate/severe injuries x3-5 days
70
Bugs of bites?
Polymicrobial w/ purulence Staph + strep Pasteurella (anaerobe)
71
Bite Tx?
Animal = Augmentin + Flagyl + Ceftriaxone Human = Augmentin
72
Burn victim bugs?
Sterile at time of burn 48 hrs later, colonized with skin pathogens 5-7 days, G+ and G- and yeast are in G- = PAK Fungi (aspergillus) CMV, HSV, VZV
73
S/Sx of infection in CC?
Temp ≥~38 (can be hypothermia WBC normal range 4.5-11 Shaking/chills Changes in hemodynamics
74
RF for hospital-acquired MRSA, pseudomonas, and ESBL/Amp-C/Carbapenemase?
All of them are previous infection and Abx use within 90 days Hospital-acquired has addition of positive nasal carriage ICU admission is NOT a RF
75
ESBL clues and Tx?
3rd gen ceph - R (ceftriaxone) Cephamycin - S Low inoculum = zosyn High inoculum = carbapenem
76
Amp-C clues and Tx?
3rd gen ceph - S (ceftriaxone) Cephamycin - R Low inoculum = cefepime High inoculum = carbapenem
77
General treatment for sepsis?
Broad-spec Abx within 1 hr Vasopressors, volume status, and lactate
78
Bugs found in CLABSI?
S. aurues CoNS Entero + Candida
79
Treatment of CLABSI?
Remove catheter Treat for ~7-14 days except in CoNS case, then its 5-7 days
80
Treatment of Candidemia?
Empiric = Micafungin Definitive = Fluconazole x2 weeks from first negative culture
81
Bugs found in CAUTI (urinary catheter)?
PEK P. mirabilis E. coli K. pneumoniae CAUTI is defined as catheter + >10^3 cfu + S/SX!
82
Tx of CAUTI?
d/c or change catheter Abx typically not used
83
C. diff treatment?
Initial, non severe (WBC≤15000 + SCr<1.5) = vanco 125 or fidax 200 both for 10 days (same for initial, severe) Initial, fulminant (hypotension, shock, ileus, megacolon) = vanco 500 + IV flagyl first recurrence = vanco 125 or fidax if vanco was given initially second+ recurrence = vanco, then rifaximin or just fidax or fecal transplant
84
CAP bugs?
SMH S. pneumoniae M. catarrhalis H. influenzae
85
CAP general treatment?
Ceftriaxone + Azithromycin
86
How can you tell if its a severe case of CAP?
1 of these: Mech ventilation Septic shock w/ vasopressor use or 3 of these: ``` RR≥30 Multilobar infiltrates Confusion BUN≥20 WBC≤4000 PLT<100k <36C Hypotension needing fluid resuscitation ```
87
Influenza Tx?
Oseltamivir (PO) Zanamivir (inhalation) Peramivir (IV)
88
HAP admission?
Occurs 48hrs+ after admission Early onset: within 4 days Late: 5+ days
89
HAP treatment?
If they have ventilation or septic shock or Abx use within 90 days, Anti-MRSA + 2 rx that cover pseudomonas But if their RF for MRSA only, just Anti-MRSA and 1 rx for pseudo
90
VAP admission? Bugs?
48-72 hrs after endotracheal intubation PAK Pseudo Acinetobacter K. pneumoniae ESBL
91
Indication of double coverage similar for both HAP and VAP?
Abx use within 90 days + septic shock Ventilation is just HAP
92
Indication for double coverage of just VAP? Tx duration?
Abx use within 90 days + septic shock Pt in ICU where susceptibility rates aren't available ARDS RRT prior to VAP x 7 days

IPT: CC (7 decks)

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