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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
Q

What dose stimulates what receptors for dopamine?

A

1-4 mcg/kg/min: dopamin-1
5-10 mcg/kg/min: Beta-1
10-20 mcg/kg/min: alpha-1 agonist

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26
Q

What receptors does epinephrine (Adrenalin) act on?

A

Alpha-1, Beta-1, beta-2 agonisst

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27
Q

What receptors does Norepinephrine (Levophed) act on?

A

Alpha-1 agonist > beta-1 agonist

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28
Q

What receptors Vasopressin act on?

A

Vasopressin receptor agonist

Only vasoconstricts, no inotropic or chronotropic effects

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29
Q

How to treat vasopressor extravasation

A

phentolamine

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30
Q

Why does nitroglycerine IV have limited efficacy after 24-48 hours?

A

tachyphylaxis (tolerance)

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31
Q

Why to not use nitroprusside in active myocardial ischemia (MI)

A

It is a vasodilator and can cause blood to be diverted away from the disease coronary vessels

32
Q

What are the nitroprusside metabolites?

A

Thiocyanate and cyanide

33
Q

What is administered to reduce the risk of thiocyanate toxicity when giving nitroprusside?

A

Hydroxocobalamin

34
Q

What is administered to reduce the risk of cyanide toxicity when giving nitroprusside?

A

sodium thiosulfate

35
Q

Nesiritide MOA

A

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
Q

Nitroglycerine action, CI, SE, and administration notes

A

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
Q

Nitroprusside action, BBW, warnings, SE, and notes

A

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
Q

What color should nitroprusside be?

A

Clear! If it is blue it has converted to cyanide!

39
Q

What medications are inotropes? What effect do they have on the heart?

A

Dobutamine
Milrinone
Increase contractility of the heart

40
Q

Dobutamine MOA and administration note

A

Beta-1 agonist with little beta-2 and alpha-1 agonism

May turn slightly pink d/t oxidation, but potency is not lost

41
Q

Milrinone MOA

A

PDE-3 inhibitor

Causes significant vasodilation

42
Q

What are the 3 general principles for treating shock?

A

Fill the tank - Make sure not dehydrated/low volume
Squeeze the pipes - increase SVR
Kick the pump - increase myocardial contractility and cardiac output

43
Q

What are the 4 types of shock?

A

Hypovolemic
Distributive
Cardiogenic
Obstructive

44
Q

What is the main characteristic of shock?

A

hypoperfusion

45
Q

How to treat hypovolemic shock

A

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
Q

Sepsis definition

A

Life-threatening organ dysfunction caused by dysregulated host response to infection

47
Q

What are the qSOFA requirements? What does it indicate?

A

2 or more = sepsis
Altered mental status
SBP 100 or less
RR 22 BPM or more

48
Q

What are 2 common causes of ICU infections

A

Mechanical ventilation
Foley catheters
Increased time of use = increased risk of infection

49
Q

How to treat sepsis?

A

Broad spectrum antibiotics

IV fluid resuscitation with IV crystalloids

50
Q

What is the vasopressor of choice in septic shock?

A

Norepinephrine

51
Q

What is cardiogenic shock?

A

Acute decompensated heart failure with hypotension and hypoperfusion

52
Q

How to tread acute decompensated HF (ADFH)

A

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
Q

What are first line analgesics in ICU

A

IV Opioids

54
Q

How to manage agitation in ICU

A

benzodiazepines (lorazepam, midazolam) and/or hypnotics (propofol, dexmedetomidine)
Non-benzos are associated with improved ICU outcomes

55
Q

What sedative is approved for intubated and non-intubated patients?

A

Dexmedetomidine (Precidex)

56
Q

What medication is used for ICU delerium?

A

Quetiapine (Seroquel) (DOC) haloperidol (Haldol)

57
Q

What RAAS score means combative, agitated, alert and calm, moderate sedation, unarousable?

A 
Combative: 4
Agitated: 2
Alert and calm: 0
Moderate sedation: -3
Unarousable: -5
58
Q

Dexmedetomidine (Precidex) MOA, SE, and notes

A

MOA: Alpha-2 adrenergic agonist
SE: hypy/hypertension, bradycardia
Notes: FDA says do not exceed 24 hours

59
Q

Propofol CI, SE, monitoring, notes

A

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
Q

Midazolam CI and notes

A

CI: use with potent CYP3A4 inhibitors
Notes: renal impairment can cause accumulation

61
Q

Ketamine warnings

A

Emergence reactions (vivis dreams, hallucinations, delirium)

62
Q

Risk factors for development of stress ulcers

A 
Mechanical ventilation > 48 hours
Coagulopathy
Sepsis
Traumatic brain injury
Major burns
Acute renal failure
High dose systemic steroids
63
Q

What drugs are recommended for prevention of stress ulcers

A

PPIs and H2RAs

64
Q

PPI risk

A

increased risk of GI infections, fractures, and nosocomial pneumonia

65
Q

What is a potential SE of inhaled anesthetics?

A

Malignant hyperthermia (MH)

66
Q

What anesthetic is fatal if administered IV?

A

Bupivicaine

67
Q

What are commonly used local, inhaled, and injectable anesthetics?

A

Local: lidocaine (Xylocaine), benzocaine, liposomal bupivacaine (Exparel)
Inhaled: desflurane (Suprane), sevoflurane (Ultane), nitrous oxide
Injectable: bupivacaine, lidocaine, ropivacaine

68
Q

Why are neuromuscular blocking agents used?

A

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
Q

What should be started before starting an neuromuscular blocking agent?

A

sedation and analgesia

patients MUST be ventilated

70
Q

Which neuromuscular blocking agent is non-depolarizing and what is it used for?

A

Succinylcholine
Reserved for intubation
Short acting with fast onset

71
Q

What is glycopyrrolate used or in intubated patients?

A

reduce secretions

72
Q

What are non-depolarizing NMBAs?

A

Cisatracurium (Nimbex) Rocuronium, Vecuronium

73
Q

Non-depolarizing NMBA SE

A

Flushing, bradycardia, hypotension, tachyphylaxis

74
Q

Which NMBAs are long, intermediate, short acting?

A

Long: pancuronium
Intermediate: Rocuronium, vecuronium
Short; Atracuronium, cistracurium

75
Q

How do systemic hemostatic drugs work?

A

Inhibiting fibrinolysis or enhancing coagulation

Used to treat hemorrhage in patients with hemophilia

76
Q

What is Lysteda approved for?

A

Heavy menstrual bleeding (menorrhagia)

77
Q

What medications are hemostatic drugs?

A 
Aminocaproic acid (Amicar)
Tranexamic acid (Cyklokapron, Lysteda)
Recombinant Factor VIIa (NovoSeven RT)

NAPLEX Review (79 decks)

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