Acute and Critical Care Flashcards
A pt with acute decompensated HF is receiving milrinone. Which of the following statements concerning milrinone are correct?
a. Milrinone is a positive inotrope and increases contractility in the heart.
b. Milrinone is an alpha-2 agonist.
c. Milrinone is a vasodilator.
d. Milrinone is administered IV only.
e. Monitor BP, HR, renal function, and ECG (for arrhythmias) when using this agent.
a, c, d, e
-Milrinone is often referred to as an “inodilator.”
-Milrinone requires dose adjustment in renal dysfunction.
A pt picks up an Rx for an EpiPen for her son. Which of the following ratio strengths is used for epinephrine given by IM administration?
a. 1:500
b. 1:1,000
c. 1:10,000
d. 1:100,000
e. 1:1,000,000
b
Epinephrine (1:1,000) is used in epinephrine products designed for IM or SC administration.
LS is an 84 y/o Hispanic female admitted directly to the medical ICU on 12/15 because of low BP during evaluation in the ER. She was transferred from her nursing home for confusion, disorientation, and decreased PO intake. Her PMH includes HTN, diabetes, and dementia.
Allergies: NKDA
Meds:
Norvasc 10 mg PO daily
Lasix 40 mg PO daily (started 12/1 for LE swelling)
Exelon patch 9.5 mg/24 hr
Namenda 5 mg BID
Lantus 10 units QHS
Novolin R sliding scale PRN (scale not documented on transfer records)
Calcium supplement (dose not documented on transfer records
Abnormal Labs on 10/2 from Nursing Home:
Glucose = 187 (100-125)
PO4 = 2.2 (2.3-4.7)
A1C = 8.9%
Abnormal Labs on 12/15 on Hospital Admission:
K = 3.1 (3.5-5)
BUN = 42 (7-20)
SCr = 1.4 (0.6-1.3)
Glucose = 169 (100-125)
Mg = 1.0 (1.3-2.1)
PO4 = 1.9 (2.3-4.7)
A1C = 8.8%
Albumin = 2.9 (3.5-5)
Tests:
EKG: Sinus tachycardia, non-specific T-wave changes, and prolonged QT interval
Urinalysis and blood cultures are ordered and results are pending.
LS requires fluid resuscitation. Which of the following is the best recommendation?
a. Hydroxyethyl starch
b. Dextrose 5%
c. NaCl 0.9%
d. Albumin 25%
e. Dextran
c
LS likely has sepsis, and the crystalloid 0.9% NaCl should be used for fluid resuscitation. Crystalloids are less expensive and associated with fewer AEs than colloids. Though the patient’s serum albumin is low, IV albumin isn’t effective at increasing serum albumin and shouldn’t be used for this purpose.
LS is an 84 y/o Hispanic female admitted directly to the medical ICU on 12/15 because of low BP during evaluation in the ER. She was transferred from her nursing home for confusion, disorientation, and decreased PO intake. Her PMH includes HTN, diabetes, and dementia.
Allergies: NKDA
Meds:
Norvasc 10 mg PO daily
Lasix 40 mg PO daily (started 12/1 for LE swelling)
Exelon patch 9.5 mg/24 hr
Namenda 5 mg BID
Lantus 10 units QHS
Novolin R sliding scale PRN (scale not documented on transfer records)
Calcium supplement (dose not documented on transfer records
Abnormal Labs on 10/2 from Nursing Home:
Glucose = 187 (100-125)
PO4 = 2.2 (2.3-4.7)
A1C = 8.9%
Abnormal Labs on 12/15 on Hospital Admission:
K = 3.1 (3.5-5)
BUN = 42 (7-20)
SCr = 1.4 (0.6-1.3)
Glucose = 169 (100-125)
Mg = 1.0 (1.3-2.1)
PO4 = 1.9 (2.3-4.7)
A1C = 8.8%
Albumin = 2.9 (3.5-5)
Tests:
EKG: Sinus tachycardia, non-specific T-wave changes, and prolonged QT interval
Urinalysis and blood cultures are ordered and results are pending.
A dopamine drip is ordered for LS. Which of the following represents the correct combo of dose-effect relationships for dopamine?
a. Low dose –> vasopressor effects, medium dose –> positive inotropic effect, and high dose –> renal vasodilation
b. Low dose –> positive inotropic effect, medium dose –> renal vasodilation, and high dose –> vasopressor effects
c. Low dose –> vasopressor effects, medium dose –> renal vasodilation, and high dose –> positive inotropic effect
d. Low dose –> positive inotropic effect, medium dose –> vasopressor effects, and high dose –> renal vasodilation
e. Low dose –> renal vasodilation, medium dose –> positive inotropic effect, and high dose –> vasopressor effects
e
LS is an 84 y/o Hispanic female admitted directly to the medical ICU on 12/15 because of low BP during evaluation in the ER. She was transferred from her nursing home for confusion, disorientation, and decreased PO intake. Her PMH includes HTN, diabetes, and dementia.
Allergies: NKDA
Meds:
Norvasc 10 mg PO daily
Lasix 40 mg PO daily (started 12/1 for LE swelling)
Exelon patch 9.5 mg/24 hr
Namenda 5 mg BID
Lantus 10 units QHS
Novolin R sliding scale PRN (scale not documented on transfer records)
Calcium supplement (dose not documented on transfer records
Abnormal Labs on 10/2 from Nursing Home:
Glucose = 187 (100-125)
PO4 = 2.2 (2.3-4.7)
A1C = 8.9%
Abnormal Labs on 12/15 on Hospital Admission:
K = 3.1 (3.5-5)
BUN = 42 (7-20)
SCr = 1.4 (0.6-1.3)
Glucose = 169 (100-125)
Mg = 1.0 (1.3-2.1)
PO4 = 1.9 (2.3-4.7)
A1C = 8.8%
Albumin = 2.9 (3.5-5)
Tests:
EKG: Sinus tachycardia, non-specific T-wave changes, and prolonged QT interval
Urinalysis and blood cultures are ordered and results are pending.
The ICU staff will monitor LS for delirium during her stay. Which statement is correct regarding ICU delirium?
a. Delirium is rare in ventilated ICU patients.
b. Haloperidol is recommended for prophylaxis and treatment of ICU delirium.
c. Providing sedation with Ativan as opposed to Precedex may reduce the incidence of delirium.
d. Seroquel may increase the duration of delirium.
e. Early mobilization and environmental control are recommended to prevent delirium.
e
-The incidence of delirium can be reduced by using non-BZD sedation, increasing mobilization, and controlling the environment (keeping the room dark at night, light during the day).
-Quetiapine (Seroquel) can be useful for treating delirium.
LS is an 84 y/o Hispanic female admitted directly to the medical ICU on 12/15 because of low BP during evaluation in the ER. She was transferred from her nursing home for confusion, disorientation, and decreased PO intake. Her PMH includes HTN, diabetes, and dementia.
Allergies: NKDA
Meds:
Norvasc 10 mg PO daily
Lasix 40 mg PO daily (started 12/1 for LE swelling)
Exelon patch 9.5 mg/24 hr
Namenda 5 mg BID
Lantus 10 units QHS
Novolin R sliding scale PRN (scale not documented on transfer records)
Calcium supplement (dose not documented on transfer records
Abnormal Labs on 10/2 from Nursing Home:
Glucose = 187 (100-125)
PO4 = 2.2 (2.3-4.7)
A1C = 8.9%
Abnormal Labs on 12/15 on Hospital Admission:
K = 3.1 (3.5-5)
BUN = 42 (7-20)
SCr = 1.4 (0.6-1.3)
Glucose = 169 (100-125)
Mg = 1.0 (1.3-2.1)
PO4 = 1.9 (2.3-4.7)
A1C = 8.8%
Albumin = 2.9 (3.5-5)
Tests:
EKG: Sinus tachycardia, non-specific T-wave changes, and prolonged QT interval
Urinalysis and blood cultures are ordered and results are pending.
Which statement is correct regarding LS’s electrolyte abnormalities on 12/15?
a. Lasix may have caused teh hypokalemia and hypomagnesemia.
b. Replacement of the pt’s body stores of magnesium will be complete after 1 dose of IV magnesium sulfate.
c. Hypophosphatemia is considered severe and usually symptomatic when the serum phosphorous level is < 2 mg/dL.
d. Hypomagnesemia should be treated IV when serum magnesium level is < 1 mEq/L with seizures or arrhythmias.
e. The pt’s serum potassium suggests a total body deficit of 400-1600 mEq.
a, d
Additional info is provided in the Lab Values and Drug Monitoring Chapter.
LS is an 84 y/o Hispanic female admitted directly to the medical ICU on 12/15 because of low BP during evaluation in the ER. She was transferred from her nursing home for confusion, disorientation, and decreased PO intake. Her PMH includes HTN, diabetes, and dementia.
Allergies: NKDA
Meds:
Norvasc 10 mg PO daily
Lasix 40 mg PO daily (started 12/1 for LE swelling)
Exelon patch 9.5 mg/24 hr
Namenda 5 mg BID
Lantus 10 units QHS
Novolin R sliding scale PRN (scale not documented on transfer records)
Calcium supplement (dose not documented on transfer records
Abnormal Labs on 10/2 from Nursing Home:
Glucose = 187 (100-125)
PO4 = 2.2 (2.3-4.7)
A1C = 8.9%
Abnormal Labs on 12/15 on Hospital Admission:
K = 3.1 (3.5-5)
BUN = 42 (7-20)
SCr = 1.4 (0.6-1.3)
Glucose = 169 (100-125)
Mg = 1.0 (1.3-2.1)
PO4 = 1.9 (2.3-4.7)
A1C = 8.8%
Albumin = 2.9 (3.5-5)
Tests:
EKG: Sinus tachycardia, non-specific T-wave changes, and prolonged QT interval
Urinalysis and blood cultures are ordered and results are pending.
An order is placed for LS to receive 40 mEq of KCL IV with continuous EKD monitoring. The hospital stocks premixed bags of 10 mEq KCl/100 mL 0.9% NaCl. The pharmacist modifies the order to read “10 mEq KCl/100 mL 0.9% NaCl x 4 doses.” What is the shortest recommended infusion time for each 10 mEq KCl bag?
a. 1-2 min
b. 30 min
c. 1 hr
d. 4 hr
e. 12 hr
c
Safe recommendations for potassium administration via peripheral line include </= 10 mEq/hr and </= 10 mEq/100 mL. It can be infused faster and at higher concentrations if there’s a central line and cardiac monitoring.
NS is a 32 y/o female in the coronary care unit after a sudden drop in BP following her cardiac cath procedure earlier this morning. Her BP remained stable for the past 2 hours without the use of meds. She’s sitting up in bed and eating her lunch. The med team is anticipating sending her home by this evening or early tomorrow morning. Is NS a candidate for stress ulcer prophylaxis?
a. Yes, since she’s in the coronary care unit.
b. Yes, since she had a stressful medical procedure.
c. No, since she doesn’t have any risk factors.
d. No, since she’s under the age of 50.
e. There’s not enough info provided to make a recommendation.
c
Which of the following statements is true of colloids and crystalloids?
a. Crystalloids cause more AEs than colloids.
b. Colloids improve mortality in shock when compared to crystalloids.
c. Colloids are commonly used for maintenance hydration and to replace fluid losses.
d. Colloids are more expensive than crystalloids.
e. Crystalloids are large molecules that primarily remain in the intravascular space.
d
While reading an article about acute decompensated HF, a pharmacist notes that reduction in pulmonary capillary wedge pressure (PCWP) is often used in clinical trials as a measure of ADHF treatment success. How is PCWP monitored?
a. Available on the comprehensive metabolic profile (CMP)
b Calculated from an arterial blood gas
c. Determined from a chest radiograph
d. Available from a Quinton catheter
e. Available from a Swan-Ganz catheter
e
A Quinton catheter is a commonly used catheter for administering IVs and for dialysis access.
Which of the following agents is associated with a risk of cyanide toxicity?
a. Nitroglycerin
b. Nitroprusside
c. Dobutamine
d. Eplerenone
e. Enalaprilat
b
SS presented to the ED with severe dehydration. He was out hiking in the Arizona sun and forgot to bring water. He got lost, and a 1 hr hike turned into a 6 hr hike. He’s lethargic and nauseous. The Chem-7 returned, and his serum sodium level is 131 mEq/L (135 - 145 mEq/L). He has no evidence of seizure activity presently. Which of the following represents the best initial therapeutic option to correct his sodium?
a. Conivaptan
b. 3% NaCl
c. D5W
d. 0.9% NaCl
e. HES
d
-Normal saline is the recommended 1st line option to correct hypovolemic hyponatremia.
-Hypertonic saline is a high-risk med reserved for refractory cases in which the pt has significant complications, such as seizures or coma.
A pt presents to the hospital with increasing SOB, fatigue, and LE edema. The pt is diagnosed with acute decompensated HF. His BP is 109/60 mmHg, and his HR is 80 BPM. His SCr is 1.4 mg/dL. In addition to furosemide, the cardiologist recommends an IV vasodilator. Which of the following meds is appropriate for this pt?
a. Nitroglycerin
b. Tolvaptan
c. Vasopressin
d. Dopamine
e. Phenylephrine
a
Vasopressin, dopamine, and phenylephrine aren’t vasodilators. The pt’s BP would need to be monitored very carefully, as it’s quite low already.
A pt in septic shock is unresponsive to repeated doses of epinephrine, and his BP continues to decline. The decision is made to initiate an IV vasopressin drip. What is the correct receptor pharmacology that explains the utility of vasopressin in the maintenance of BP?
a. Alpha-1 agonist
b. Beta-1 agonist
c. Vasopressin agonist
d. Vasopressin antagonist
e. Dopamine-1 agonist
c
A pt presents to the hospital with hypernatremia and a “free water” deficit. The physician determines that the pt needs more intracellular water. Which fluid replacement strategy would be preferred?
a. Normal saline
b. Sodium chloride 0.45%
c. Lactated ringers
d. Dextrose 5%
e. Albumin
d
Dextrose-containing products contain “free water.” They are used when intracellular water is needed.
