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NAPLEX Review > Acute and Critical Care Medicine > Flashcards

Acute and Critical Care Medicine Flashcards

1
Q

Which increases oncotic pressure crystalloids or colloids?

A

Colloids

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2
Q

Which are more expensive, crystalloids or colloids?

A

Colloids

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3
Q

Hydroxyethyl BBW

A

avoid in critical illness d/t mortality

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4
Q

What medications are crystalloids? Colloids?

A

Crystalloids: D5W, NS, LR, multiple electrolyte injection
Colloids: Albumin, dextran, hydroxyethyl starch

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5
Q

What is considered hyponatremia?

A

Na <135

Usually not symptomatic until <120

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6
Q

How to treat hypotonic hypovolemia hyponatremia

A

Administer NS

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7
Q

How to treat hypotonic hypervolemic hyponatremia?

A

Diuresis with fluid restriction

Caused by fluid overload

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8
Q

How to treat hypotonic isovolemic (euvolemic) hyponatremia)

A

Fluid restriction or diuresis

Commonly caused by SIADH

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9
Q

Which medications can be used to treat SIADH?

A

Conivaaptan or tolvaptan

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10
Q

How much can sodium be corrected in 24 hours?

A

No more than 12 mEq/L over 24 hours

Can cause osmotic demyelination syndrome or central pontine myelinolysis which can cause paralysis, seizures, and death

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11
Q

Tolvaptan (Samsca) BBW, warnings, SE, notes

A

BBW: initiate in hospital with close Na monitoring; do not correct really quick d/t demyelination syndrome
Warnings: hepatotoxicity (do not use >30 days)
SE: thirst, nausea, dry mouth, polyuria
Notes: do not use >30 days

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12
Q

What is considered hypernatremia?

A

Na >145

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13
Q

What is considered hypokalemia?

A

K < 3.5

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14
Q 
How much KCl to give if K 
<2.6
2.6-2.9
3-3.2
3.3-3.5
A

<2.6 - 100 mEq
2.6-2.9 - 80
3-3.2 - 60
3.3-3.5 - 40

If phos 2.5 or less give K-phos instead

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15
Q

What rate to infuse potassium?

A

10mEq or less/hr

20mEq/hr requires cardiac monitoring

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16
Q

What electrolyte is required for potassium uptake?

A

Mg

Can be cause of treatment refractory hypokalemia

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17
Q

What can happen if Mg < 1?

A

Seizures, arrhythmias

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18
Q

What is considered hypomagnesemia?

A

Mg < 1.3

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19
Q

What is considered severe hypophosphatemia?

A

PO4 < 1

Use IV replacement

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20
Q

Hypophosphatemia symptoms

A

muscle weakness nad respiratory failure

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21
Q

What is IVIG used for?

A

plasma protein replacement therapy for immune deficient patients who have decreased or abolished antibody production capabilities

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22
Q

What is IVIG used for?

A

Immunodeficiency conditions, multiple sclerosis, myasthenia gravis, guillain-barre

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23
Q

IVIG (Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen) BBW and SE

A

BBW: acute renal dysfunction can cause fatalities (decrease rate in renal and CV disease)
SE: HA, N/D, injection site reaction, infusion reaction (facial flushing, chest tightness, fever, chills, hypotension - slow/stop infusion)

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24
Q

What is the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II)?

A

scoring tool used to determine prognosis and estimate ICU mortality risk

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25
What dose stimulates what receptors for dopamine?
1-4 mcg/kg/min: dopamin-1 5-10 mcg/kg/min: Beta-1 10-20 mcg/kg/min: alpha-1 agonist
26
What receptors does epinephrine (Adrenalin) act on?
Alpha-1, Beta-1, beta-2 agonisst
27
What receptors does Norepinephrine (Levophed) act on?
Alpha-1 agonist > beta-1 agonist
28
What receptors Vasopressin act on?
Vasopressin receptor agonist | Only vasoconstricts, no inotropic or chronotropic effects
29
How to treat vasopressor extravasation
phentolamine
30
Why does nitroglycerine IV have limited efficacy after 24-48 hours?
tachyphylaxis (tolerance)
31
Why to not use nitroprusside in active myocardial ischemia (MI)
It is a vasodilator and can cause blood to be diverted away from the disease coronary vessels
32
What are the nitroprusside metabolites?
Thiocyanate and cyanide
33
What is administered to reduce the risk of thiocyanate toxicity when giving nitroprusside?
Hydroxocobalamin
34
What is administered to reduce the risk of cyanide toxicity when giving nitroprusside?
sodium thiosulfate
35
Nesiritide MOA
it is a recombinant B-type natriuretic peptide that binds to vascular smooth muscle and increases cGMP, causing smooth muscle relaxation which causes vasodilation ***Not commonly used
36
Nitroglycerine action, CI, SE, and administration notes
Action: low doses venous dilator; high doses arterial dilator CI: SBP < 90, use with PDE-5 inhibitors SE: HA, tachycardia, tachyphylaxis Note: requires non-PVC container (glass, polyolefin)
37
Nitroprusside action, BBW, warnings, SE, and notes
Action: arterial and venous vasodilator BBW: cyanide, excessive hypotension, must be diluted Warnings: Increased ICP SE: HA, tachycardia, thiocyanate/cyanide toxicity (risk higher in renal impairment) Notes: Protect from light!
38
What color should nitroprusside be?
Clear! If it is blue it has converted to cyanide!
39
What medications are inotropes? What effect do they have on the heart?
Dobutamine Milrinone Increase contractility of the heart
40
Dobutamine MOA and administration note
Beta-1 agonist with little beta-2 and alpha-1 agonism | May turn slightly pink d/t oxidation, but potency is not lost
41
Milrinone MOA
PDE-3 inhibitor | Causes significant vasodilation
42
What are the 3 general principles for treating shock?
Fill the tank - Make sure not dehydrated/low volume Squeeze the pipes - increase SVR Kick the pump - increase myocardial contractility and cardiac output
43
What are the 4 types of shock?
Hypovolemic Distributive Cardiogenic Obstructive
44
What is the main characteristic of shock?
hypoperfusion
45
How to treat hypovolemic shock
Fluid resuscitation with crystalloids (if not caused by hemorrhage) If Hgb < 7 give blood (<10 in pts with CV disease) or if significant bleeding If not responsive to fluid resuscitation - give vasopressors
46
Sepsis definition
Life-threatening organ dysfunction caused by dysregulated host response to infection
47
What are the qSOFA requirements? What does it indicate?
2 or more = sepsis Altered mental status SBP 100 or less RR 22 BPM or more
48
What are 2 common causes of ICU infections
Mechanical ventilation Foley catheters Increased time of use = increased risk of infection
49
How to treat sepsis?
Broad spectrum antibiotics | IV fluid resuscitation with IV crystalloids
50
What is the vasopressor of choice in septic shock?
Norepinephrine
51
What is cardiogenic shock?
Acute decompensated heart failure with hypotension and hypoperfusion
52
How to tread acute decompensated HF (ADFH)
If edema or jugular venous distention (volume overloaded) give loop diuretics and vasodilators If decreased renal function, AMS, and/or cool extremities (hypoperfusion) give dobutamine or milrinone and vasopressor if hypotension
53
What are first line analgesics in ICU
IV Opioids
54
How to manage agitation in ICU
benzodiazepines (lorazepam, midazolam) and/or hypnotics (propofol, dexmedetomidine) Non-benzos are associated with improved ICU outcomes
55
What sedative is approved for intubated and non-intubated patients?
Dexmedetomidine (Precidex)
56
What medication is used for ICU delerium?
Quetiapine (Seroquel) (DOC) haloperidol (Haldol)
57
What RAAS score means combative, agitated, alert and calm, moderate sedation, unarousable?
``` Combative: 4 Agitated: 2 Alert and calm: 0 Moderate sedation: -3 Unarousable: -5 ```
58
Dexmedetomidine (Precidex) MOA, SE, and notes
MOA: Alpha-2 adrenergic agonist SE: hypy/hypertension, bradycardia Notes: FDA says do not exceed 24 hours
59
Propofol CI, SE, monitoring, notes
CI: sensitivity to egg or soy SE: hypotension, apnea, hypertriglyceridemia, green urine/hair/nail beds, propofol-related infusion syndrome (rare but fatal) Monitor: TG Notes: bacterial growth - do not use more than 12 hours; provides 1.1 kcal/mL
60
Midazolam CI and notes
CI: use with potent CYP3A4 inhibitors Notes: renal impairment can cause accumulation
61
Ketamine warnings
Emergence reactions (vivis dreams, hallucinations, delirium)
62
Risk factors for development of stress ulcers
``` Mechanical ventilation > 48 hours Coagulopathy Sepsis Traumatic brain injury Major burns Acute renal failure High dose systemic steroids ```
63
What drugs are recommended for prevention of stress ulcers
PPIs and H2RAs
64
PPI risk
increased risk of GI infections, fractures, and nosocomial pneumonia
65
What is a potential SE of inhaled anesthetics?
Malignant hyperthermia (MH)
66
What anesthetic is fatal if administered IV?
Bupivicaine
67
What are commonly used local, inhaled, and injectable anesthetics?
Local: lidocaine (Xylocaine), benzocaine, liposomal bupivacaine (Exparel) Inhaled: desflurane (Suprane), sevoflurane (Ultane), nitrous oxide Injectable: bupivacaine, lidocaine, ropivacaine
68
Why are neuromuscular blocking agents used?
To facilitate mechanical ventilation, manage increased intracranial pressure, treat muscle spasms (tetany), or to prevent shivering in patients undergoing therapeutic hypothermia after cardiac arrest
69
What should be started before starting an neuromuscular blocking agent?
sedation and analgesia | patients MUST be ventilated
70
Which neuromuscular blocking agent is non-depolarizing and what is it used for?
Succinylcholine Reserved for intubation Short acting with fast onset
71
What is glycopyrrolate used or in intubated patients?
reduce secretions
72
What are non-depolarizing NMBAs?
Cisatracurium (Nimbex) Rocuronium, Vecuronium
73
Non-depolarizing NMBA SE
Flushing, bradycardia, hypotension, tachyphylaxis
74
Which NMBAs are long, intermediate, short acting?
Long: pancuronium Intermediate: Rocuronium, vecuronium Short; Atracuronium, cistracurium
75
How do systemic hemostatic drugs work?
Inhibiting fibrinolysis or enhancing coagulation | Used to treat hemorrhage in patients with hemophilia
76
What is Lysteda approved for?
Heavy menstrual bleeding (menorrhagia)
77
What medications are hemostatic drugs?
``` Aminocaproic acid (Amicar) Tranexamic acid (Cyklokapron, Lysteda) Recombinant Factor VIIa (NovoSeven RT) ```

NAPLEX Review (79 decks)

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