Acute & Critical Care Medicine Flashcards
(117 cards)
1
Q
cystalloids
A
less costly
fewer adverse reactions
compared to colloids
examples: D5W
NS
LR
Plasma-lyte A
2
Q
colloids
A
large molecules
primarily remain in intravascular space
inc oncotic pressure
more expensive, no clear clinical benefit compared to crystalloids
ex: albumin 5%, 25% (Albutein, AlbuRx
3
Q
dextrose-containing products
A
have “free water”
use when water is needed intracellularly
4
Q
most common fluids for volume resuscitation
A
LR and NS
5
Q
albumin
A
most commonly used colloid
useful when significant edema (cirrhosis)
6
Q
hydroxyethyl starch
A
only use if others unavailable
BBW: mortality
7
Q
hyponatremia
A
Na <135
not usu symptomatic until Na <120
severe: seizures, coma
8
Q
hypotonic hypervolemic hyponatremia
A
caused by fluid overload
9
Q
hypotonic hypervolemic hyponatremia treatment
A
diuresis with fluid restrictions
10
Q
hypotonic hypovolemic hyponatremia
A
caused by diurets
if severe symptoms and/or Na <120 = hypertonic 3% NaCl IV
11
Q
correcting sodium rapidly
A
correcting >12 mEq/L/24h
causes osmotic demyelination syndrome (ODS) or central pontine myelinolysis = causes paralysis, seizures, death
12
Q
arginine vasopressin (AVP) receptor antagonists
A
examples: conivaptan and tolvaptan
treat SIADH and hypervolemia hyponatremia
do not use oral (tolvaptan/Samsca) >30 days
13
Q
tolvaptan dosing
A
PO
use 30 days or less bc hepatotoxicity
14
Q
tolvaptan BBW
A
initiate and re-inititae in hospital - closely monitor Na to avoid rapid correction = ODS
15
Q
tolvaptan warnings
A
hepatotoxicity
16
Q
tolvaptan side effects
A
thirst, nausea, dry mouth, polyuria
17
Q
tolvaptan monitoirng
A
rate of Na increase
18
Q
hypernatremia
A
Na >145 mEq/L
water deficit and hypertonicity
19
Q
hypokalemia
A
K <3.5
common in hospitalized patients
20
Q
body deficit of K from K <3.5
A
100-400 mEq
21
Q
hypokalemia treatment
A
treat underlying cause (amphotericin, insulon)
22
Q
KCl treatment
A
IV through peripheral line
max infusion rate <=10 mEq/hr
max conc of 10 mEq/100 mL
can be fatal if undiluted or IV push
23
Q
what to check if resistant to hypokalemia treatment
A
magnesium bc necessary for K uptake
replace mag first if hypomagnesemia and hypokalemia found
24
Q
hypomagnesemia
A
caused by diuretics
25
when to give treatment for hypomagnesemia
serum Mg <1 mEq/L with life-threatening symptoms (seizures, arrhythmias)
26
how to treat hypomagnesemia
IV magnesium sulfat replacement
27
severe hypophosphatemia parameters
usu symptomatic
PO4 <1 mg/dL
28
when to treat hypophosphatemia
phosphorous is <1 mg/dL
29
what to use to treat hypophosphatemia
IV phosphorous
30
IV immunoglobulin (Gammagard, Gamunex-C, Octagam, Privigen) dosing
slower infusion rate in renal and CV disease
do not shake
31
IV immunoglobulin BBW
acute renal dysfunction
more likely with products stabilized with sucrose
thrombosis
32
IV immunoglobulin side effects
infusion reaction (facial flushing, chest tightness, fever, chills, hypotension - slow/stop infusion)
33
IV immunoglobulin notes
slower titration and premedication may be needed if past reaction
34
Acute Physiologic Assessment and Chronic Health Evaluation II
scoring tool to determine prognosis and estimate ICU mortality risk
35
vasopressors
peripheral vasoconstriction
inc SVR
inc BP
36
dopamine MOA low/renal dose
1-4 mcg/kg/min
DA-1 agonist
37
dopamine MOA medium dose
5-10 mcg/kg/min
Beta-1 agonist
38
dopamine MOA high dose
10-20 mcg/kg/min
alpha-1 agonist
39
epinephrine MOA
alpha-1, beta-1, beta-2 agonist
40
norepinephrine/Levophed MOA
alpha-1 agonist > beta-1 agonist
41
phenylephrine MOA
alpha-1 agonist
42
vasopressin (aka arginine vasopressin/AVP and ADH)
vasopressin receptor agonist
43
vasopressors BBW
vesicants
44
treatment for vasopressor extravasation
phentolamine
45
vasopressors side effects
arrhythmia
tachycardia
necross/gangrene
bradycardia (phenylephrine)
hyperglycemia (epinephrine)
46
vasopressors monitoring
continuous BP
MAP
47
vasopressors notes
should not use if discolored/have precipitate
use central IV line
48
concentration if epinephrine for IV push vs IM/compounding IV products
IV push: 0.1 mg/dL (1:10,000)
IM/compounding: 1 mg/mL 1:1,000
49
extravasation
from vesicants
medical emergency
treat with phentolamine
50
phentolamine
treats extravasation
alpha-1 blocker = antagonize vasopressor effect
51
vasidilators
monitor BP
52
nitroglycerin/NTG MOA
used when active MI or uncontrolled hypertension
only effects 24-48 hrs because tachyphylaxis/tolerance
low doses: venous vasodilator
high doses: arterial vasodilator
53
nitroprusside MOAs
mixed arterial/venous vasodilator
do not use in active MI ("coronary steal")
causes thiocyanate (in renal insufficiency) and cyanide (in hepatic insufficiency) formation = toxicity
54
what should be given to prevent nitroprusside toxicity cyanide
sodium thiosulfate
55
what should be given to prevent thiocyanate toxicity from nitroprusside
hydroxocobalamin
56
nitroglycerin CI
SBP <90
use with PDE-5 inhibitors
57
BBWnitroglycerin side effects
headache
tachycardia
tachyphylaxis
58
nitroglycerin notes
requires non-PVC container (glass, polyolefin)
59
nitroprusside BBW
produces cyanide
excessive hypotension
has to be diluted (D5W preferred)
60
what should be used to dilute nitroprusside
D5W
61
nitroprusside warnings
inc ICP
62
nitroprusside side effects
headache
tachycardia
thiocyantate/cyanide risk (inc with renal/hepatic impairment
63
nitroprusside notes
needs light protection
use only clear solution - if blue, degradation to cyanide has occured
64
inotropes
increase contracility of heart
65
dobutamine MOA
beta-1 agonist
66
milrinone MOA
PDE-3 inhibitor
significant vasodilation
67
dobutamine notes
may be slightly pink due to oxidation
68
types of shock
hypoperfusion usu from hypotension
69
hypovolemic shock first-line treatment
fluid resuscitation with crystalloids if not from hemorrhage
vasopressors not effective unless IV volume is adequate
70
distributive shock
septic shock
71
sepsis
life-thretening organ dysfunction from dysregulated host response to infection
72
common causes of ICU infection
mechanical ventilation: inc time = inc risk of infection
indwelling urinary catheter: inc time with foley = inc risk of bladder infection
73
principles for treating septic shock
MAP goal of >=65
MAP = [(2xDBP)+SBP]/3
optimize preload with crystalloids (balanced like LR preferred)
a-1 agonist for inc SVR
beta-1 agonist to inc myocardial contractility and CO
74
which crystalloid if preferred for septic shock
balanced fluids like LR
75
vasopressor of choice in septic shock
NE
76
ADHF
worsening HF symptoms
77
cardiogenic shock
ADHF + hypotension + hypoperfusion
78
Swan-Ganz
catheter for invasive monitoring in ADHF
goes through right side of heart into pulmonary artery
provides PCWP
79
treating ADHF
edema, JVD, ascites = volume overload = use loop diuretics, vasodilators
renal function impairment, altered mental status, cool extremities = hypoperfusion = inotropes (dobutamine, milrinone), add vasopressor if hypotensive
if volume overload and hypoperfusion: can use combo
*avoid vasocilators in hypoperfusion bc dec BP
80
pain
IV opioids first-line (morphine, hydromorphone, fentanyl
81
analgosedation
sedation strategy
uses analgesia first to relive pain and discomfort
82
agitation
sedation might be needed for synchronized breathing with vent (prevent bucking the vent)
use benzos or non-benzos
83
preferred drugs for sedation
non-benzos = propofol, dexmedetomidine)
improved ICU outcomes
may reduced delirium and/or shorten duration of delirium
84
drug approved for intubated and non-intubated patients
dexmedetomidine/Precedex
85
when benzos are imprortant in sedation
seizures
alcohol/benzo withdrawal
86
preferred level of sedation
light unless CI
87
how often should patients have sedation vacations
daily
88
useful drug for delirium
quetiapine, other atypicals
89
dexmedetomidine/Precedex MOA
alpha-2 agonist
90
dexmedetomidine side effects
hypo/hypertension
bradycardi
91
dexmedetomidine notes
does not require refrigeration
do not give >24 hrs
can use in intubated and non-intubated
92
propofol/Diprivan CI
HSN to egg or soy
93
propofol side effects
hypotension
apnea
hyptertriglyceridemia
green urine/hair/nail beds
propofol-related infusion syndrome (PRIS) - rare but fatal)
94
propfol monitoring
triglycerides
95
propofol notes
be careful to prevent bacterial growth
discard vial/tubing within 12 hrs
96
lorazepam/Ativan notes
propylene glycol toxicity (acute renal failure/metabolic acidosis acidosis) can occur bc formulated in propylene glycol
97
midazolam/Versed CI
do not use with potent CYP3A4 inhibitors
98
midazolam notes
can accumulate in renal impairment (active metabolite)
99
etomidate/Amidate monitoring
adrenal insufficiency
100
ketamine/Ketalar warinings
emergence reactions (vivid dreams, hallucinations, delirium)
101
stress ulcers prevention
in those with risk factors: mechanical ventilation >48 h,
coagulopathy
use H2RAs and PPIs
102
PPIs risks
GI infections (C. diff)
fractures
nosocomial pneumonia
103
anesthetics rare but serious
malignant hyperthermia
104
bupivocaine
used for epidurals
fatal if IV
105
lidocaine/epinephrine
good for local procedures that need anesthetic
epinephrine causes vasoconstriction to keep lidocaine in area
deaths have happened bc confused with single epinephrine products
106
neuromuscular blocking agents
used for general anesthesia, mechanical ventilation, and muscle spasms
cause paralysis of skeletal muscle
give after adequate sedation and analgesia before
patient must be mechanically ventilated
label "WARNING, PARALYZING AGENT
107
succinuylchole
NMBA
only avail. depolarizing agent
usu used in intubation, not continuous NMB
108
how to care for patient on NMBA
protect skin
lubricate eyes
suction airway
109
can reduce secretions for patients on NMBA
glycopyrrolate
anticholinergic
110
drugs that can inc activity of NMBA
aminoglycosides
polymyxin
111
all non-depolarizing NMBA side effects
flushing, bradycardia, hypotension, tachyphylaxis
112
cisatracurium/Nimbrex
NMBA
metabolized by Hofmann elimination (not renal or hepatic)
113
pancuronium
NMBA
long-acting
114
systemic hemostatic agents MOA
inhibit fibrinolysis/enhance coagulation
115
topical hemostatic agent
Recothrom, Throbin-JMI
116
Tranexamic acid (Cyklokapron injection; Lysteda, tablet)
hemostatic agent
Lysteda approved for menorrhagia
117
liRecombinant Factor VIIa (NovoSeven RT)
hemostatic agent
