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naplex > acute and critical care medicine > Flashcards

acute and critical care medicine Flashcards

1
Q

what fluids are crystalloids

A

D5W
NS
LR
plasmalyte

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2
Q

what fluids are colloids

A

albumin
dextran

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3
Q

pros of crystalloids

A

less costly
fewer AE
does not sit in intravascular space

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4
Q

when is albumin used

A

edema not for serum albumin

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5
Q

hyponatremia state

A

<135
symptomatic when <120
3 diff state

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6
Q

hypotonic hypovolemic

A

cause is diuretic and sodium wasting
tx is correct cause and add IV NS

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7
Q

hypotonic hypervolemic hyponatremia

A

caused by fluid overload, cirrhosis, HF etc
tx is diuresis with fluid restriction

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8
Q

hypotonic isovolemic hyponatremia

A

cause - SIADH syndrome of inappropriate antidiuretic hormone

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9
Q

what is ODS

A

when treating hyponatremia aggressively it causes paralysis
should not be more than >12meq opver 24 hours
tx with stopping SIADH drugs , diuresis ore restricting fluids

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10
Q

what are AVP

A

arginine vasopressin receptor antagonist
used for SIADH or hypervolemic hyponatremia

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11
Q

tolvaptan

A

samsca
llimited to 30 days due to hepatoxic

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12
Q

hypernatremia

A

Na> 145 meq
with water defecit and hypertonicity

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13
Q

hypovolemic hypernatremia

A

caused by dehydration
tx with fluids

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14
Q

hypervolemic hypernatremia

A

intake of hypertonic fluids
tx with diuresis

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15
Q

isovolemic hypernatremia

A

caused by diabetes can decrease antidiuretic hormone
tx with desmopressin

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16
Q

hypokalemia

A

K<3.5
manage underlying cause- metabolic alkalosis, diuresis, meds
tx with oral K

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17
Q

what dose 1 drop of K below 3.5 mean

A

body defecit of 100-400 meq

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18
Q

how to tx potassium

A

check phos first if more than 2.5 use oral supplements if less than 2.5 phos then add Kphos

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19
Q

serum potassium instruction tx

A

<3.5 to 3.3 40 meq
3.0-3.2 60meq
2.6-2.9 80 meq
<2.6meq 100meq

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20
Q

monitoring of K

A

if <3.2 recheck immediatley and am check
if more than 3.2 check am

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21
Q

IV K recommendations

A

peripheral line max infusion rate 10meq/hr
max 10meq/100ml
IV push and undiluted can be fatal

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22
Q

resistant K level through tx

A

check mg,
if both hypo tx mg first

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23
Q

magnesium

A

hypo< 1.3
hyper is during renal insufficiency

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24
Q

when is IV MG recommended

A

when MG <1 with symptoms
MGSO4
or without symptoms IV or IM

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25
Q

when is MG oral recommende

A

when MG is between 1-1.5
MGO for 5 days

26
Q

phosphorus

A

hyper due to CKD
Hypo is severe and symptomatic when <1
hypo can be caused by phospahte binding drugs alcohol intake and hyperparathyroidism

27
Q

when is IV phos recommended

A

<1

28
Q

VTE prophylaxis

A

for inpatient

29
Q

IVIG

A

warning for thrombosis
HA, N/V/D
for Myasthenia gravis, multiple sclerosis, GBS

30
Q

ICU meds that target SNS

A

vasopressors
vasodilators
ionotropes

31
Q

what are some vasopressors

A

dopamine
epinephrine
norep
vasopressin
** all should be through central line

32
Q

MOA of dopamine

A

low dose- D1 agonist 1-4
medium dose- Beta 1 agonist
high dose- alpha 1 agonist 10-20mcg/kg/min

can cause vesicant, arrythmia, tachycardia, necrosis,

33
Q

MOA of epinephrine

A

A1 B1 B2 agonist
arrythmia, tachy, hyperglycemia

34
Q

MOA Norep

A

A1>B1

35
Q

phenylephrine MOA

A

A1

36
Q

vasopressin

A

AVP vasopressin receptor agonist

37
Q

how to treat extravastion caused by Alpha agonists

A

phentolamine

38
Q

what are vasodilators used in ICU

A

nitroglycerin
nitroprusside (nitropress)

39
Q

ionotrpoes in icu

A

dobutamine B1
PDE3 inhibitor milrinone

40
Q

types of shocks

A

Hypovolemic
distributive
cardiofenic
obstructive

41
Q

how to tx hypovolemic shock

A

fluid resuscitation with crystalloids for hypo shock not with hemorrhage
vasopressors will not work without effective intravascular volume

42
Q

distributive

A

when there is low SVR
septic anaphylactic and neurologic are ex of distributive

43
Q

septic shock

A

SOFA >2
alterered mental status
SBP<100
RR>22

44
Q

what are some contra indications of nitro

A

PDe5 inhibitors
HA Tachycardia
SBP <90

45
Q

high dose nitro is for

A

arterial vasodilation

46
Q

target MAP for treating shock

A

> 65
MAP= (2XDBP)+ SBP /3

47
Q

most common causes of ICU infections

A

Mechanical ventilation- psudomonas
foley catheter

48
Q

how to maintain MAP

A

vasoconstrictors and crystalloid fluids

49
Q

cardiogeneic shock

A

HF with worsening symptoms

50
Q

how to tx

A

avoid NSAIDS
avoid BB if Hypotension

51
Q

cardiogenic shock with volume overload

A

IV diuretics
vasodilators

52
Q

cardiogenic shock with hypoperfusion

A

inotropes
vasopressors

53
Q

cardiogenic shock with volume overload and hypoperfusion

A

combination of
IV diuretics
vasodilators
inotropes
vasopressors

54
Q

tx hypoperfusion if Bp is adequate

A

ionotrope with vasodilator

if not add vaso constrictors

55
Q

what are some non benzo sedation

A

prpofol
dexmedetomidine (precedex) preferred

56
Q

RASS scale

A

richmond agitation and sedation scale

57
Q

stress ulcers

A

H2raas and PPIs

58
Q

when is a risk for stress ulcer

A

mechanical ventilation >48 hours
coagulopathy
sepsis
TIA
major burns
AKI
high dose steroids

59
Q

anesthtics

A

local- lidocaine
inhaled - desflurane
secoflurane
inj- bupivacaine
ropivacaine

60
Q

neuromuscular blocking agents

A

causes paralysis
succinylcholine- depolarizing
cistra”curium” - non depolarizing

61
Q

hat is a depolizing NMBA good for

A

short acting `

naplex (78 decks)

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