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Naplex 2023 > Acute & Critical Care Medicine > Flashcards

Acute & Critical Care Medicine Flashcards

1
Q

cystalloids

A

less costly
fewer adverse reactions
compared to colloids
examples: D5W
NS
LR
Plasma-lyte A

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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

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3
Q

dextrose-containing products

A

have “free water”
use when water is needed intracellularly

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4
Q

most common fluids for volume resuscitation

A

LR and NS

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5
Q

albumin

A

most commonly used colloid
useful when significant edema (cirrhosis)

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6
Q

hydroxyethyl starch

A

only use if others unavailable
BBW: mortality

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7
Q

hyponatremia

A

Na <135
not usu symptomatic until Na <120
severe: seizures, coma

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8
Q

hypotonic hypervolemic hyponatremia

A

caused by fluid overload

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9
Q

hypotonic hypervolemic hyponatremia treatment

A

diuresis with fluid restrictions

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10
Q

hypotonic hypovolemic hyponatremia

A

caused by diurets
if severe symptoms and/or Na <120 = hypertonic 3% NaCl IV

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11
Q

correcting sodium rapidly

A

correcting >12 mEq/L/24h
causes osmotic demyelination syndrome (ODS) or central pontine myelinolysis = causes paralysis, seizures, death

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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

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13
Q

tolvaptan dosing

A

PO
use 30 days or less bc hepatotoxicity

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14
Q

tolvaptan BBW

A

initiate and re-inititae in hospital - closely monitor Na to avoid rapid correction = ODS

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15
Q

tolvaptan warnings

A

hepatotoxicity

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16
Q

tolvaptan side effects

A

thirst, nausea, dry mouth, polyuria

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17
Q

tolvaptan monitoirng

A

rate of Na increase

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18
Q

hypernatremia

A

Na >145 mEq/L
water deficit and hypertonicity

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19
Q

hypokalemia

A

K <3.5
common in hospitalized patients

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20
Q

body deficit of K from K <3.5

A

100-400 mEq

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21
Q

hypokalemia treatment

A

treat underlying cause (amphotericin, insulon)

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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

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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

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24
Q

hypomagnesemia

A

caused by diuretics

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25
Q

when to give treatment for hypomagnesemia

A

serum Mg <1 mEq/L with life-threatening symptoms (seizures, arrhythmias)

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26
Q

how to treat hypomagnesemia

A

IV magnesium sulfat replacement

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27
Q

severe hypophosphatemia parameters

A

usu symptomatic
PO4 <1 mg/dL

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28
Q

when to treat hypophosphatemia

A

phosphorous is <1 mg/dL

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29
Q

what to use to treat hypophosphatemia

A

IV phosphorous

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30
Q

IV immunoglobulin (Gammagard, Gamunex-C, Octagam, Privigen) dosing

A

slower infusion rate in renal and CV disease

do not shake

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31
Q

IV immunoglobulin BBW

A

acute renal dysfunction
more likely with products stabilized with sucrose
thrombosis

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32
Q

IV immunoglobulin side effects

A

infusion reaction (facial flushing, chest tightness, fever, chills, hypotension - slow/stop infusion)

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33
Q

IV immunoglobulin notes

A

slower titration and premedication may be needed if past reaction

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34
Q

Acute Physiologic Assessment and Chronic Health Evaluation II

A

scoring tool to determine prognosis and estimate ICU mortality risk

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35
Q

vasopressors

A

peripheral vasoconstriction
inc SVR
inc BP

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36
Q

dopamine MOA low/renal dose

A

1-4 mcg/kg/min
DA-1 agonist

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37
Q

dopamine MOA medium dose

A

5-10 mcg/kg/min
Beta-1 agonist

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38
Q

dopamine MOA high dose

A

10-20 mcg/kg/min
alpha-1 agonist

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39
Q

epinephrine MOA

A

alpha-1, beta-1, beta-2 agonist

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40
Q

norepinephrine/Levophed MOA

A

alpha-1 agonist > beta-1 agonist

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41
Q

phenylephrine MOA

A

alpha-1 agonist

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42
Q

vasopressin (aka arginine vasopressin/AVP and ADH)

A

vasopressin receptor agonist

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43
Q

vasopressors BBW

A

vesicants

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44
Q

treatment for vasopressor extravasation

A

phentolamine

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45
Q

vasopressors side effects

A

arrhythmia
tachycardia
necross/gangrene
bradycardia (phenylephrine)
hyperglycemia (epinephrine)

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46
Q

vasopressors monitoring

A

continuous BP
MAP

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47
Q

vasopressors notes

A

should not use if discolored/have precipitate
use central IV line

48
Q

concentration if epinephrine for IV push vs IM/compounding IV products

A

IV push: 0.1 mg/dL (1:10,000)
IM/compounding: 1 mg/mL 1:1,000

49
Q

extravasation

A

from vesicants
medical emergency
treat with phentolamine

50
Q

phentolamine

A

treats extravasation
alpha-1 blocker = antagonize vasopressor effect

51
Q

vasidilators

A

monitor BP

52
Q

nitroglycerin/NTG MOA

A

used when active MI or uncontrolled hypertension
only effects 24-48 hrs because tachyphylaxis/tolerance
low doses: venous vasodilator
high doses: arterial vasodilator

53
Q

nitroprusside MOAs

A

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
Q

what should be given to prevent nitroprusside toxicity cyanide

A

sodium thiosulfate

55
Q

what should be given to prevent thiocyanate toxicity from nitroprusside

A

hydroxocobalamin

56
Q

nitroglycerin CI

A

SBP <90
use with PDE-5 inhibitors

57
Q

BBWnitroglycerin side effects

A

headache
tachycardia
tachyphylaxis

58
Q

nitroglycerin notes

A

requires non-PVC container (glass, polyolefin)

59
Q

nitroprusside BBW

A

produces cyanide
excessive hypotension
has to be diluted (D5W preferred)

60
Q

what should be used to dilute nitroprusside

A

D5W

61
Q

nitroprusside warnings

A

inc ICP

62
Q

nitroprusside side effects

A

headache
tachycardia
thiocyantate/cyanide risk (inc with renal/hepatic impairment

63
Q

nitroprusside notes

A

needs light protection
use only clear solution - if blue, degradation to cyanide has occured

64
Q

inotropes

A

increase contracility of heart

65
Q

dobutamine MOA

A

beta-1 agonist

66
Q

milrinone MOA

A

PDE-3 inhibitor
significant vasodilation

67
Q

dobutamine notes

A

may be slightly pink due to oxidation

68
Q

types of shock

A

hypoperfusion usu from hypotension

69
Q

hypovolemic shock first-line treatment

A

fluid resuscitation with crystalloids if not from hemorrhage
vasopressors not effective unless IV volume is adequate

70
Q

distributive shock

A

septic shock

71
Q

sepsis

A

life-thretening organ dysfunction from dysregulated host response to infection

72
Q

common causes of ICU infection

A

mechanical ventilation: inc time = inc risk of infection
indwelling urinary catheter: inc time with foley = inc risk of bladder infection

73
Q

principles for treating septic shock

A

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
Q

which crystalloid if preferred for septic shock

A

balanced fluids like LR

75
Q

vasopressor of choice in septic shock

A

NE

76
Q

ADHF

A

worsening HF symptoms

77
Q

cardiogenic shock

A

ADHF + hypotension + hypoperfusion

78
Q

Swan-Ganz

A

catheter for invasive monitoring in ADHF
goes through right side of heart into pulmonary artery
provides PCWP

79
Q

treating ADHF

A

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
Q

pain

A

IV opioids first-line (morphine, hydromorphone, fentanyl

81
Q

analgosedation

A

sedation strategy
uses analgesia first to relive pain and discomfort

82
Q

agitation

A

sedation might be needed for synchronized breathing with vent (prevent bucking the vent)

use benzos or non-benzos

83
Q

preferred drugs for sedation

A

non-benzos = propofol, dexmedetomidine)
improved ICU outcomes

may reduced delirium and/or shorten duration of delirium

84
Q

drug approved for intubated and non-intubated patients

A

dexmedetomidine/Precedex

85
Q

when benzos are imprortant in sedation

A

seizures
alcohol/benzo withdrawal

86
Q

preferred level of sedation

A

light unless CI

87
Q

how often should patients have sedation vacations

A

daily

88
Q

useful drug for delirium

A

quetiapine, other atypicals

89
Q

dexmedetomidine/Precedex MOA

A

alpha-2 agonist

90
Q

dexmedetomidine side effects

A

hypo/hypertension
bradycardi

91
Q

dexmedetomidine notes

A

does not require refrigeration
do not give >24 hrs
can use in intubated and non-intubated

92
Q

propofol/Diprivan CI

A

HSN to egg or soy

93
Q

propofol side effects

A

hypotension
apnea
hyptertriglyceridemia
green urine/hair/nail beds
propofol-related infusion syndrome (PRIS) - rare but fatal)

94
Q

propfol monitoring

A

triglycerides

95
Q

propofol notes

A

be careful to prevent bacterial growth
discard vial/tubing within 12 hrs

96
Q

lorazepam/Ativan notes

A

propylene glycol toxicity (acute renal failure/metabolic acidosis acidosis) can occur bc formulated in propylene glycol

97
Q

midazolam/Versed CI

A

do not use with potent CYP3A4 inhibitors

98
Q

midazolam notes

A

can accumulate in renal impairment (active metabolite)

99
Q

etomidate/Amidate monitoring

A

adrenal insufficiency

100
Q

ketamine/Ketalar warinings

A

emergence reactions (vivid dreams, hallucinations, delirium)

101
Q

stress ulcers prevention

A

in those with risk factors: mechanical ventilation >48 h,
coagulopathy
use H2RAs and PPIs

102
Q

PPIs risks

A

GI infections (C. diff)
fractures
nosocomial pneumonia

103
Q

anesthetics rare but serious

A

malignant hyperthermia

104
Q

bupivocaine

A

used for epidurals
fatal if IV

105
Q

lidocaine/epinephrine

A

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
Q

neuromuscular blocking agents

A

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
Q

succinuylchole

A

NMBA
only avail. depolarizing agent
usu used in intubation, not continuous NMB

108
Q

how to care for patient on NMBA

A

protect skin
lubricate eyes
suction airway

109
Q

can reduce secretions for patients on NMBA

A

glycopyrrolate
anticholinergic

110
Q

drugs that can inc activity of NMBA

A

aminoglycosides
polymyxin

111
Q

all non-depolarizing NMBA side effects

A

flushing, bradycardia, hypotension, tachyphylaxis

112
Q

cisatracurium/Nimbrex

A

NMBA
metabolized by Hofmann elimination (not renal or hepatic)

113
Q

pancuronium

A

NMBA
long-acting

114
Q

systemic hemostatic agents MOA

A

inhibit fibrinolysis/enhance coagulation

115
Q

topical hemostatic agent

A

Recothrom, Throbin-JMI

116
Q

Tranexamic acid (Cyklokapron injection; Lysteda, tablet)

A

hemostatic agent
Lysteda approved for menorrhagia

117
Q

liRecombinant Factor VIIa (NovoSeven RT)

A

hemostatic agent

Naplex 2023 (21 decks)

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