Acute Care & Critical Medicine Flashcards
1
Q
Samsca
A
- tolvaptan (tab)
- indicated for hypervolemic hyponatremia
- 15 mg PO qday; max 60 mg qday
- Limited to 30 days d/t hepatotox
- Avoid in CrCl <10
- avoid fluid restriction in first 24 hrs
BW: initiated in hospital under close monitoring
Do not correct >12 meq/L in 24 hrs due to ODS
CI: pts who are unable to respond to thirst, urgent need to raise Na, hypovolemic hyponatremia, use with strong CYP3A4i, anuria
ADE: thirst, nausea, dry mouth, polyuria, weakness, hyperglycemia, hypernatremia
2
Q
Potassium chloride (KCL) replacement notes
A
- <3.5 mEq/L
- 1 mEq/L drop in serum K <3.5 = 100-400 mEq in body
- Peripheral line OK: max infusion rate 10 mEq/hr, max conc 10mEq/100 mL
- IV potassium FATAL if administered undiluted or IV push
3
Q
Magnesium replenishment
A
- check Mg - needs to be sufficient for K reuptake
- <1.3 mEq/L (low)
- causes: chronic Etoh use, diuretics, vomiting/diarrhea
- when low can cause seizures/arrhythmias - use IV replacement if sx and low Mg
- Mag sulfate used for IV replacement
- Between 1 and 1.5 mEq/L - use PO mag oxide - continue 5 days for full body stores
4
Q
Phosphorus replenishment
A
- SEVERE, sx when serum phosphate <1 mg/dL
- Sx: muscle weakness, respiratory failure
- Causes: phosphate-binding drugs (ca, sevelamer, antacids, chronic Etoh, hyperparathyroidism
- Use iV phos if <1 mg/dL
- Often takes a week or longer to replenish for PO
5
Q
Dopamine (Intropin)
A
- Vasopressor –> increase BP
- rec for sx brady
- Low (renal) dose: 1-4 mg/Kg/min –> dopamine agonist
- Medium dose: 5-10 mcg/kig/min –> beta 1 agonist
- High dose: 10-20 mcg/kg/min –> alpha 1 agonist
6
Q
Vasopressor class notes
A
- All vasopressors are vesicants. Should be administered via central line but if extravasation occurs, tx with PHENTOLAMINE (NTG ointment off-label)
- Use caution in patients taking MAOI, prolonged HTN may result
- ADE: arrhythmias, tachy (dopamine, epi), necrosis, brady (phenylephrine), hyperglycemia (epi)
- do not use if solutions discolored or contain precipitate
- All are Y-SITE COMPATIBLE with each other (except angiotension II)
