Acute/Critical Care Flashcards
1
Q
Hyponatremia Tx
A
- Na < 135 mEq/L
- Hypovolemic - administer NS
- Hypervolemic - diuresis with fluid restriction
- Don’t correct Na more than 12 mEq/d = risk for osmotic demyelination syndrome or central pontine myelinolysis
- If treating SIADH (isovolemic) or hypervolemic hypoNa - AVP antagonists, conivaptan and tolvaptan, can be used to increase free water excretion
2
Q
Samsca
A
- Tolvaptan, AVP (arginine vasopressin) receptor antagonists
- Box Warnings: initiate/reinitiate at hospital with close Na monitoring, don’t overcorrect Na (>12 mEq/d)
- Warning: hepatotoxicity
- SE: Thirst, nausea, dry mouth, polyuria
3
Q
Hypernatremia
A
- Na > 145 mEq/L
- Hypovolemic - fluids
- Hypervolemic - diuresis
- Isovolemic - often due to diabetes insipidus, treat with desmopressin (ADH analog)
4
Q
Hypokalemia
A
- K < 3.5
- Amphotericin and insulin can lower K
- 1 mEq below 3.5 ~ 100-400 mEq body deficit
- Max peripheral infusion = 10 mEq/hr and max [10mEq/100mL]
- If resistant to replenishment, check magnesium (Mg needed for K uptake)
- IV K+ can be fatal is given undiluted or by IV push
5
Q
Hypomagnesemia
A
- Mg < 1.3
- Mg < 1 usually related to life-threatening sxs like seizure and arrhythmias => IV replenish
- Magnesium sulfate used for IV, magnesium oxide for PO (Use when 1 < Mg < 1.5)
- Replenish for 5 days to replace body stores
6
Q
Hypophosphatemia
A
- Considered severe and is symptomatic when Phos <1
- When < 1 use IV phosphorous for replacement
- If less severe, PO formulations can be used
- Often will need Mg and K corrected as well
- Replenishment often takes a week or longer
7
Q
Privigen/Octagam/Gammagard/Carimune NF
A
- IVIG
- Extracted for the plasma of thousands of blood donors
- Originally only for immunodeficiency conditions, now many off-label conditions as well (MS, myasthenia gravis, Guillain-Barre syndrome)
- Can impair response to vaccination
- Slower infusion rates needed in CV and renal disease
8
Q
IVIG Information
A
- Box warning: acute renal dysfunction (especially in products with sucrose), thrombosis (w/o risk factors)
- SE: HA, N/D, injection site rxn, infusion rxn (flush/fever/hypotension - slow/stop infusion)
9
Q
Dopamine Dosing/MoA
A
- Low (renal) dose: 1-4 mcg/kg/min => dopamine agonist
- Medium dose: 5-10 mcg/kg/min => beta-1 agonist
- High doses: 10-20 mcg/kg/min => alpha-1 agonist (vasopressor)
10
Q
Epi MoA
A
- Vasopressor
- Alpha-1, beta-1, and beta-2 agonist
- Causes hyperglycemia
- IV push is 0.1 mg/mL (1:10,000) while IM injection is 1mg/mL (1:1000)
- Ratio strengths have been removed from labeling per FDA
11
Q
NE MoA
A
- Vasopressor
- Alpha-1 and beta-1 agonist (more alpha than beta)
12
Q
Phenylephrine MoA
A
- Vasopressor
- Alpha-1 agonist
- Causes bradycardia
13
Q
Vasopressin
A
- Vasopressor
- Arginine vasopressor (AVP) + ADH
14
Q
Vasopressor Information
A
- Box warning: all vesicants, treat extravasation with phentolamine (alpha-1 blocker)
- SE: Arrhythmia, tachycardia, necrosis
- Continuously monitor BP
- Don’t use if discolored or contain precipitate
- Administer via central line
15
Q
NTG
A
- Used when active MI or uncontrolled HTN
- Effectiveness usually limited to 24-48 hours due to tachyphylaxis (tolerance)
- Low doses => venous vasodilator; high doses => arterial vasodilator
16
Q
NTG Information
A
- CI: SBP < 90 or use with PDE5i
- SE: HA, tachycardia, tachyphylaxis
- Requires non-PVC container (glass, polyolefin)
17
Q
Nitropress/Nipride
A
- Nitroprusside
- Mixed arterial and venous vasodilator (equal)
- DON’T use in active MI, can cause “coronary steal”
- Metabolites are toxic, thiocyanate and cyanide
- Hydroxocobalamin = used to reduce thiocyanate toxicity
- Sodium thiosulfate = used for cyanide toxicity
18
Q
Nitroprusside Information
A
- Box warning: metabolism produces cyanide, excessive hypotension, diluted with D5W (preferably) for injection
- Warning: increases ICP
- SE: HA, tachycardia, thiocyanate/cyanide toxicity (increased risk in renal/hepatic impairment)
- Requires light protection
- If blue color, it has degraded to cyanide, do not use
