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NAPLEX 21 > Acute & critical care medicine > Flashcards

Acute & critical care medicine Flashcards

1
Q

Which fluid is less costly and has fewer adverse reactions?

A

crystalloids

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2
Q

this liquid contains large molecules (proteins) that disperse in solutions that primarily remain in the intravascular space and INCREASE oncotic pressure

A

colloids

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3
Q

these products are used when water is needed intracellularly as these products contain free water

A

dextrose

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4
Q

the most common drugs/fluid used for volume resuscitation in shock states

A

LR and NS

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5
Q

the most commonly used colloid

A

albumin

specifically useful when there is SIGNIFICANT EDEMA (cirrhosis)

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6
Q

D5W
NS
LR
Plasma-Lyte A

examples of

A

crystalloids

seep out

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7
Q

Albumin %5, 25%
dextran 40, 70
hydroxyethyl starch (Hespan, Hextend)

examples of

A

colloids ($$)

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8
Q

this type of hyponatremia is caused by diuretics, salt-washing syndromes, adrenal insufficiency, blood loss or vomiting/diarrhea

A

hypotonic hypovolemic hyponatremia

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9
Q

How do you treat hypotonic hypovolemic hyponatremia

A

sodium chloride IV solutions

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10
Q

this type of hyponatremia is caused by fluid overload (cirrhosis, HF, renal failure)

A

hypotonic hypervolumic hyponatremia

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11
Q

How do you treat hypotonic hypervolumic hyponatremia

A

diuresis with fluid restriction

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12
Q

this type of hyponatremia is caused by SIADH

A

hypotonic euvolemic hyponatremia

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13
Q

what is used to treat SIADH and hypervolemic hyponatremia

A

arginine vasopressin (AVP) receptor antagonists (conivaptan or tolvaptan)

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14
Q

How should you correct sodium?

A

conservatively!

> 12mEq/L over 24 hours can cause osmotic demyelination syndrome (ODS) or central pontine myelinolysis which can cause paralysis, seizures, and death

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15
Q

Brand: Samsca

A

Generic: tolvaptan (PO)

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16
Q

Tolvaptan is limited to <30 days due to …

A

hepatotoxicity

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17
Q

Side effects of Tolvaptan

A

thirst, nausea, dry mouth, polyuria

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18
Q

Hypernatremia is associated with a:

A

water deficit and hypertonicity

caused by: diarrhea, dehydration, vomitting

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19
Q

What drugs commonly decrease potassium?

A

amphotericin, insulin

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20
Q

Hyperkalemia is often due to what disease state?

A

CKD

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21
Q

1mEq/L in serum K below 3.5 represents a total body deficit of:

A

100-400mEq

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22
Q

Safe recommendations for IV K replacement through a peripheral line include a max infusion rate

A

<10mEq/hr

10mEq/100mL

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23
Q

what electrolyte is necessary for potassium uptake?

A

Mg

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24
Q

Hyperphosphatemia (<1mEq SEVERE) is often due to what disease?

A

CKD

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25
Q

IVIG off-label uses include

A

MS, myasthenia gravis, guilliain-Barre

*treatment with IVIG can impair response to vaccination

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26
Q

Brand: Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen

A

generic: IVIG

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27
Q

Boxed warning for IVIG

A

acute renal dysfunction can occur (usually with products stabilized with sucrose)

thrombosis

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28
Q

Side effects of IVIG

A

HA, nausea, diarrhea, inj sit reaction, flushing, chest tightness, fever, chills, hypotension, — SLOW/STOP infusion

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29
Q

What scoring tool is APACHE II used for?

A

mortality risk in the ICU

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30
Q

Most vasopressors work by stimulating alpha receptors which causes: ______________

& increases ____________, which increases BP

A

vasoconstriction

inc systemic vascular resistance (SVR)

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31
Q

Low dose of dopamine (1-4mcg/kg/min) results in

A

dopamine-1 agonist (renal vasopressor)

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32
Q

medium dose of dopamine (5-10mcg/kg/min) results in

A

beta-1 agonist (+ ionottropic HF)

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33
Q

high dose of dopamine (10-20mcg/kg/min) results in

A

alpha-1 agonist (vasopressor)

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34
Q

Boxed warnings for vasopressors

A

VESICANTS!! treated with phentolamine, an alpha-1 blocker

use central line

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35
Q

Side effects of vasopressors

A

arrhythmias, tachy, necrosis, bradycardia (phenylephrine), inc BG (epinephrine)

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36
Q

Brand: Adrenalin

A

generic: epinephrine

37
Q

Brand: Levophed

A

generic: norepinephrine

38
Q

This vasopressor is an alpha-1, beta-1 and beta-2 agonist

A

epinephrine

39
Q

this vasopressor is an alpha-1 agonist >beta-1 agonist

A

norepinephrine

40
Q

this vasopressor is an alpha-1 agonist

A

phenylephrine

41
Q

What kind of drugs are NTG, nitroprusside, and nesiritdie

A

vasodilators (DEC bp)

42
Q

what vasodilator is limited after 24-48 hours due to tachyphylaxis (tolerance)

43
Q

this is a mixed (equal) arterial and venous vasodilator at all doses. not to be used during an MI due to coronary steal

A

nitroprusside

44
Q

what is administered with nitroprusside to reduce the risk of thiocyanate toxicity?

A

hydroxocobalamin

45
Q

this is a recombinant B type natriuretic peptide that binds to vascular smooth muscle and increases cGMP

A

nesteridie

46
Q

NTG low dose = _______ vasodilator

A

venous (preload)

47
Q

NTG high dose = _______ vasodilator

A

arterial (after load)

48
Q

Examples of inotropes

A

dobutamine

milrinone

49
Q

inrotropes increase/dec contractility of the heart

50
Q

beta-1 agonist inotrope

A

dobutamine

51
Q

PDE-3 inhibitor inotrope

52
Q

What are the general principles for treating shock?

A

1) fluids (IV crystalloid bolus)
2) vasopressor to inc SVR
3) + inotrope to inc myocardial contractility and CO

53
Q

hypovolemic shock not caused by hemmorhage: first line treatment

A

fluid resuscitation with crystalloids when

hgb<7 give blood products

54
Q

hypovolemic shock: second line

A

vasopressors

HOWEVER, vasopressors will not be effective unless intravascular volume is adequate

55
Q

examples of distributive shock

A

anaphylaxis, sepsis

low SVR, initially high CO followed by low or normal CO

56
Q

What are the two common causes of ICU infections?

A

mechanical ventilation - pseudomonas

Foley catheters

57
Q

what is the vasopressor of choice in septic shock?

A

norepinephrine

58
Q

patients with HF may experience episodes of worsening symptoms: weight gain, inability to lie flat, decreasing functionality .. this is called:

A

acute decompensated HF (ADHF)

59
Q

ADHF + hypotension + hypo perfusion =

A

cardiogenic shock

STOP BETA BLOCKERS

60
Q

Treatment of ADHF

A

VOLUME OVERLOAD: diuretics (loop +/- vasodilators NTG, nitroprusside)

HYPOPERFUSION: inotropes (dobutamine, milrinone
+/- vasopressor: dopamine, NE, PE)

BOTH? combo above, look at SCr tho

61
Q

first line agents for analgesia in the ICU

A

opioids given IV (morphine, hydromorphone, fentanyl)

62
Q

Agitation is managed with

(RASS) higher the score, more combative

A

benzos (Ativan, midazolam) but non-benzos are preferred (propofol, dexmedtomidine)

63
Q

What is the only sedative approved for use in intubated and non-intubated patients?

A

dexmedetomidine (Precedex)

64
Q

How to treat delirium?

A

no meds are recommended for prevention but sedation with non-benzos may decrease incidence or shorten duration

quetiapine or haloperidol commonly used

65
Q

Brand: Sublimaze

A

generic: fentanyl

66
Q

Brand: diluadid

A

generic: hydromorphone

67
Q

brand: duramorph, infumorph

A

generic: morphine

68
Q

brand: Precedex

A

generic: dexmedetomidine

alpha-2 adrenergic agonist

69
Q

brand: diprivan

A

generic: propofol

70
Q

This drug has a contraindication with egg or soy allergy

71
Q

Brand: versed

A

generic: midazolam

72
Q

Caution with those that have renal impairment

contraindicated with potent cyp3A4 inhibitors

73
Q

Risk factors for development of stress ulcers?

A

mechanical ventilation >48H

coagulapathy

74
Q

Prevention for stress-related mucosal damage

A

PPI - c diff, fractures, nosocomial pneumonia

or

H2RAs - thrombocytopenia, AMS in elderly/renal/hepatic imapriment

75
Q

What anesthetic can be fatal if administered IV?

A

bupivacaine (for epidurals)

76
Q

injectable anesthetic

A

bupivacaine, ropivacaine

77
Q

inhaled anesthetic

A

desflurane (Suprane), sevoflurane

78
Q

local anesthetic

A

lidocaine (Xylocaine)

79
Q

what is administered with lidocaine to keep the lidocaine localized?

A

epinephrine

80
Q

these agents cause paralysis of the skeletal muscle

A

neuromuscular blocking agents

81
Q

Examples NMBAs

A

succinylcholine, cisatracurium

82
Q

when are NMBAs used?

A

to facilitate mechanical ventilation** (MUST BE VENTILATED WHEN USING THESE!!), to manage ICP, to treat muscle spasms

83
Q

NMBA have NO effect on pain or sedation, thus..

A

adequate sedation and analgesia prior to starting an NMBA is needed

84
Q

which NMBA is reserved for intubation?

A

succinylcholine (depolarizing)

SHORT ACTING – onset 30-60 seconds

85
Q

What drug is used to reduce secretions during intubation?

A

glycopyrrolate (robinul) – an anticholinergic

86
Q

what is a long-acting agent for NMBA?

A

pancuronium

87
Q

What agents are used to stop bleeding? (hemostatic agents)

A

tranexamic acid (Cyklokapron-INJ; Lysteda-PO, menstrual/menorrhagia)

“TXA”

Recominant Factor VIIa (NovoSeven RT)

LOOK FOR CLOTS!!!!

88
Q

How do systemic hemostatic drugs work?

A

inhibiting fibrinolysis or enhancing coagulation

NAPLEX 21 (60 decks)

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