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NAPLEX Prep > Acute/Crit Care Medicine > Flashcards

Acute/Crit Care Medicine Flashcards

Fluids, electrolyte disorders, VTE ppx, sympathetic targeters, shock, other common ICU conditions, OR meds

1
Q

FAST HUGS BID
what does the pneumonic stand for and why is it important in CC medicine?

A

Feeding
Analgesia
Sedation
Thromboprophylaxis

Head of Bed (VAP ppx)
Ulcer ppx
Glycemic control
Spontaneous breathing trial

Bowel regimen
Indweling catheters
De-escalation of ABX

can and should be done/assessed twice a day in CC!

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2
Q

examples of crystalloid fluids

A

LR
NS
D5W
D50
D5NS
Plasma-Lyte-A

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3
Q

examples of colloid fluids

A

albumin 5%, 25%
dextran
hydroxyethyl starch

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4
Q

hyponatremia is broken down into which 3 categories

A

hypotonic hypovolemic shock (HHS)
hypotonic isovolemic shock
hypotonic hypervolemic shock

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5
Q

hypotonic hypovolemic shock (HHS)
causes
treatment

A

diuretics, salt-wasting, adrenal insuff, blood loss, V/D

treat with 3% saline IV

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6
Q

hypotonic isovolemic shock
causes
treatment

A

SIADH (too much vasopressin causing water retention and dilution of Na)

d/c offending drug + diuresis
+/- demeclocycline

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7
Q

hypotonic hypervolemic shock
causes
treatment

A

fluid overload, cirrhosis, HF, renal failure

diuresis with fluid restriction

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8
Q

tolvaptan
MOA
uses
BBW
ADE

A

vasopressin antagonist (inc fluid excretion)
can be used in isovolemic or hypovolemic hypotonic hyponatremia, but evidence unclear
BBW: do not correct Na faster than 12mEq/L/day 2/2 ODS
ADE: thirst, N, xerostomia, polyuria, inc BG

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9
Q

hypernatremia is classified as a sodium >________.
how do we treat hypernatremia?

A

> 145mEq/L
hypovolemic (dehydration, N/V) –> fluids
isovolemic (diabetes insipidus) –> desmopressin
hypervolemic (intake of hypertonic solutions) –> diuresis (excrete Na and water)

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10
Q

Na should be corrected at _________ to prevent __________________________________

A

12mEq/L/day
osmotic demyelination syndrome

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11
Q

___________ should be replaced before _____________

A. potassium/magnesium
B. sodium/magnesium
C. magnesium/sodium
D. magnesium/chloride
E. magnesium/potassium

A

E. magnesium/potassium

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12
Q

what is magnesium normal range?
what is considered hypomagnesemia and what are possible causes?
how do we determine which dosage form to use for mag repletion?

A

normal range 1.5-2.4
hypomag = <1.3
can be due to AUD, Amph B, V/D, diuretics
if Mg <1 replace with IV mag
if Mg >1 replace with po mag

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13
Q

hypokamemia
treatment? what if IV? what if oral?
how many mEq will it take to raise K by 0.1

A

oral or IV K
if IV, must be a central line and infused at </= 10mEg/hour and a concentration of </= 10mEq/100mL
oral doses not to exceed 40mEq
10mEq oral K will raise K by 0.1mEq/L

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14
Q

phosphate
normal range
treatment of hypophosphatemia

A

normal 2.6-4.5
infuse 0.08-0.16 mmol/kg in NS or D5W over 6 hours

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15
Q

what is inceptive spirometry

A

facilitates lung expansion in hospitalized patients or those with atelectasis (dec lung volume)

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16
Q

IVIG can be used in what three conditions
and should be infused fast/slow?

A

myasthenia gravis
multiple sclerosis
Guillain Barre

slow!

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17
Q

DA
MOA
dosing

A

DA is a sympathomimetic
dosing is dependent on renal function
low/renal dosing = 1-4mcg/kg/min, DA1 ag
medium dose = 5-10mcg/kg/min, B1 ag
high dose = 10-20mcg/kg/min, a1 ag

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18
Q

BBW for all pressors

A

extravasation

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19
Q

pressor extravasation treatment

A

stop pressor, do not remove needle/cannula, do not flush line
treat with phentolamine (a1 blocker that antagonizes pressor)
NTG ointment also an option

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20
Q

EN MOA

A

a1, B1, B2 agonist

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21
Q

NE MOA

A

a1 ag >B1 ag

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22
Q

what score estimates ICU mortality risk

A

APACHE II

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23
Q

phenylepherine MOA

A

pre a1 agonism

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24
Q

vasopressin
MOA

A

ADH, vasopressin R agonist
no inotropic or chronotropic effects

25
Q

warnings for all vasopressors

A

extravasation since all are vesicants
caution with MAO-i
all IV vai CENTRAL LINE
need continuous monitoring

26
Q

concentration of EN push is__________
concentration of EN inj is______________

A

push is 0.1mg/mL
inj is 1mg/mL

27
Q

NTG at low doses is a _________ dilator whereas it is a ________________ dilator at higher doses

A. venous/arterial
B. arterial/venous

A

A. venous/arterial

28
Q

NTP
risks compared to NTG
MOA
not for use in _________________

A

purely 1:1 arterial and venous vasodilator
lowers BP more than NTG and is

metabolized into cyanide and thiocyanate –> use lowest dose for lowest duration

not for use in myocardial ischemia 2/2 shunting from heart (coronary steal)

29
Q

NTG and NTP both increase __________

A

ICP

30
Q

what can be given to reduce the risk of thiocyanate toxicity with NTP administration

A

hydroxocobalamin

31
Q

what can be given for cyanide toxicity

A

sodium thiocyanate

32
Q

hypovolemic shock
treatment

how will PCWP, CO, SVR and pvO2 present

A

fluid challenges
(replace blood with FFP or PRBC if hemorrhagic hypovolemia)
if fluid chalenges do not work, vasopressors are second option

dec PCWP dec CO inc SVR dec svO2

33
Q

septic shock
septic shock is a type of ________ shock
treatment

how will PCWP, CO, SVR and pvO2 present

A

distributive

fluids, ABX, pressors (NE = #1), inotropes
(fill the tank, squeeze the pipe, kick the pump)

dec PCWP dec/inc CO dec SVR inc/dec svO2

34
Q

cardiogenic shock
treatment

how will PCWP, CO, SVR and pvO2 present

A

treat underlying (MI, HF exacerbation etc.)
includes diuretics, inotropes, pressors

inc PCWP dec CO inc SVR dec svO2

35
Q

what is the preferred treatment for hypoperfusion in cardiogenic shock in patients with hypotension? hypertension?

A

hypotension - may prefer pressors NW, EN, DA
hypertension may prefer inotrope (dobutamine)

36
Q

target RASS score for most patients

A

0 to -2
alert and calm to light sedation

37
Q

treatment options for ICU delirium

A

low dose quetiapine
orientation, music, noise reduction

38
Q

dexmedetomidine
brand
MOA
hemodynamic effects
use

A

Precedex
a2 agonist
dec HR dec BP
can use as sedation in intubated or non intubated patients

39
Q

what patients do we use precedex cautiously in

A

liver imp, DM, heart block, bradycardia, ventriculat dysfxn, hypovolemia, HTN

40
Q

propofol
brand
CI
SE

A

Diprivan
CI egg or soy allergy
SE: dec BP, apnea/resp dep, inc TG, PRIS

41
Q

does precedex cause respiratory depression

A

no

42
Q

what is PRIS

A

propofol-related infusion syndrome
rare, but fatal reaction in intubated patients on propofol (Diprivan) categorized by multi-organ failure, metabolic acidosis, lactc acidosis, rhabdo, hyperkalemia

43
Q

propofol is made up of _____ in _____ and provides what amount of nutritional component in TPN

A

oil in water

1.1 kcal/mL lipids/fat

44
Q

midazolam has a BBW for

A

resp depression

45
Q

etomodate
brand
uses

A

Amidate
ultra short-acting
used to induce sedation

46
Q

ketamine
brand
uses
SE

A

Ketalar
induction for intubation
SE: resp dep, inc CSF pressure, apnea, psych

47
Q

risk factors for stress ulcers while hospitalized

A

mechanical vent >48h
coagulopathy
sepsis
TBI
major burns
acute renal failure
high dose steroids

48
Q

concerns about H2RAs for ulcer ppx

A

thrombocytopenia
AMS in elderly
renal impairment concerns
tachyphylaxis has been reported

49
Q

concerns about PPIs for ulcer ppx

A

osteoporosis
c diff
fractures
nosocomial PNA

50
Q

local anesthetics

A

lidocaine
benzocaine
liposomal bupivicaine

51
Q

all inhaled anesthetics can cause

A

malignant hyperthermia

52
Q

bupivicaine cannot be administered

A. IV
B. epidural
C. intrathecal

A

A. IV

53
Q

anasthetic in most epidurals

A

bupivicaine

54
Q

_________ is the only depolarizing NMBA

A

succinylcholine

55
Q

what are intermediate-acting NMBAs

A

rocuronium
vecuronium
atracurium
cisatracurium

56
Q

what is the only long acting NMBA

A

pancuronium

57
Q

NMBAs must have a label that says

A

WARNING, PARALYZING AGENT

58
Q

tranexamic acid
uses
ADE

A

menorrhagia, to stop bleeding in hemorrhage

ADE: vascular occlusion, thrombosis

NAPLEX Prep (57 decks)

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