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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 (58 cards)

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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

Study These Flashcards
A

ADH, vasopressin R agonist
no inotropic or chronotropic effects

25
warnings for all vasopressors
extravasation since all are vesicants caution with MAO-i all IV vai CENTRAL LINE need continuous monitoring
26
concentration of EN push is__________ concentration of EN inj is______________
push is 0.1mg/mL inj is 1mg/mL
27
NTG at low doses is a _________ dilator whereas it is a ________________ dilator at higher doses A. venous/arterial B. arterial/venous
A. venous/arterial
28
NTP risks compared to NTG MOA not for use in _________________
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
NTG and NTP both increase __________
ICP
30
what can be given to reduce the risk of thiocyanate toxicity with NTP administration
hydroxocobalamin
31
what can be given for cyanide toxicity
sodium thiocyanate
32
hypovolemic shock treatment how will PCWP, CO, SVR and pvO2 present
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
septic shock septic shock is a type of ________ shock treatment how will PCWP, CO, SVR and pvO2 present
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
cardiogenic shock treatment how will PCWP, CO, SVR and pvO2 present
treat underlying (MI, HF exacerbation etc.) includes diuretics, inotropes, pressors inc PCWP dec CO inc SVR dec svO2
35
what is the preferred treatment for hypoperfusion in cardiogenic shock in patients with hypotension? hypertension?
hypotension - may prefer pressors NW, EN, DA hypertension may prefer inotrope (dobutamine)
36
target RASS score for most patients
0 to -2 alert and calm to light sedation
37
treatment options for ICU delirium
low dose quetiapine orientation, music, noise reduction
38
dexmedetomidine brand MOA hemodynamic effects use
Precedex a2 agonist dec HR dec BP can use as sedation in intubated or non intubated patients
39
what patients do we use precedex cautiously in
liver imp, DM, heart block, bradycardia, ventriculat dysfxn, hypovolemia, HTN
40
propofol brand CI SE
Diprivan CI egg or soy allergy SE: dec BP, apnea/resp dep, inc TG, PRIS
41
does precedex cause respiratory depression
no
42
what is PRIS
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
propofol is made up of _____ in _____ and provides what amount of nutritional component in TPN
oil in water 1.1 kcal/mL lipids/fat
44
midazolam has a BBW for
resp depression
45
etomodate brand uses
Amidate ultra short-acting used to induce sedation
46
ketamine brand uses SE
Ketalar induction for intubation SE: resp dep, inc CSF pressure, apnea, psych
47
risk factors for stress ulcers while hospitalized
mechanical vent >48h coagulopathy sepsis TBI major burns acute renal failure high dose steroids
48
concerns about H2RAs for ulcer ppx
thrombocytopenia AMS in elderly renal impairment concerns tachyphylaxis has been reported
49
concerns about PPIs for ulcer ppx
osteoporosis c diff fractures nosocomial PNA
50
local anesthetics
lidocaine benzocaine liposomal bupivicaine
51
all inhaled anesthetics can cause
malignant hyperthermia
52
bupivicaine cannot be administered A. IV B. epidural C. intrathecal
A. IV
53
anasthetic in most epidurals
bupivicaine
54
_________ is the only depolarizing NMBA
succinylcholine
55
what are intermediate-acting NMBAs
rocuronium vecuronium atracurium cisatracurium
56
what is the only long acting NMBA
pancuronium
57
NMBAs must have a label that says
WARNING, PARALYZING AGENT
58
tranexamic acid uses ADE
menorrhagia, to stop bleeding in hemorrhage ADE: vascular occlusion, thrombosis

NAPLEX Prep (57 decks)

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