Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NAPLEX Special Populations > Acute & Critical Care Medicine > Flashcards

Acute & Critical Care Medicine Flashcards

1
Q

What is the cause of

hypervolemic hyponatremia

A

Fluid overload

e.g., cirrhosis, heart failure, renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the cause of

hypervolemic hypernatremia

A

Intake of hypertonic fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the cause of

isovolemic hypernatremia

A

Diabetes insipidus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the treatment for

isovolemic hypernatremia

A

Desmopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the treatment for

hypervolemic hypernatremia

A

Diuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the cause of

hypovolemic hypernatremia

A
  • Dehydration
  • Vomiting
  • Diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the treatment for

hypovolemic hypernatremia

A

Fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the treatment for

hypervolemic hyponatremia

A
  • Diuresis with fluid restriction
  • AVP receptor antagonists

AVP receptor antagonists: conivaptan, tolvaptan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the treatment for

isovolemic hyponatremia

A
  • Stopping drugs that can induce SIADH
  • Demeclocycline (SIADH)
  • Diuresis
  • Restricting fluids
  • AVP receptor antagonists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the treatment for

hypovolemic hyponatremia

A
  • Hypertonic (3%) sodium chloride IV for severe symptoms and/or Na < 120

Severe symptoms = seizures, coma, respiratory arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the cause of

isovolemic hyponatremia

A

SIADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the cause of

hypovolemic hyponatremia

A
  • Diuretics
  • Salt-wasting syndromes
  • Adrenal insufficiency
  • Blood loss
  • Vomiting
  • Diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can happen if sodium is being corrected faster than 12 mEq/L/24 hours?

A

Can cause osmotic demyelination syndrome (ODS) or central pontine myelinolysis, which can cause paralysis, seizures and death.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tolvaptan (Samsca)

A
  • PO
  • Arginine vasopressin receptor antagonist; selective AVP antagonist [vasopressin 2 (V2) only]
  • Should be initiate and re-initiated in a hospital with close monitoring of serum Na
  • Overly rapid correction of hyponatremia (> 12 mEq/L/24 hrs) is associated with ODS
  • Use is limited to ≤ 30 days due to hepatotoxicity
  • SEs: thirst, nausea, dry mouth, polyuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which electrolyte must be corrected before correcting potassium?

A

Magnesium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the maximum IV KCl infusion rate and concentration for treating hypokalemia through a peripheral line?

A
  • Max infusion rate: ≤ 10 mEq/hr
  • Max concentration: 10 mEq/100mL

Never administer undiluted IV potassium or via IV push

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which route of administration is preferred for KCl?

A

PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the preferred treatment when serum Mg is < 1 mEq/L w/ life-threatening symptoms (e.g., seizures, arrhythmias)?

A

IV magnesium sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Vasopressor MOA

A

Stimulating alpha receptors → peripheral vasoconstriction and ↑ systemic vascular resistance (SVR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Vasopressors

A
  • Dopamine: dose-dependent receptor effects (D1 → beta-1 → alpha-1)
  • Epinephrine: alpha-1, beta-1, beta-2
  • Norepinephrine: alpha-1 > beta-1
  • Phenylephrine: alpha-1
  • Vasopression: vasopression agonnist
  • Angiotensin II: vasoconstriction, aldosterone release
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the boxed warning for all IV vasopressors?

A

All vasopressors are vesicants when administered IV

Treat extravasation with phentolamine (an alpha-1 blocker)

22
Q

Vasopressor SEs

A
  • Arrythmias
  • Tachycardia (esp. dopamine, epinephrine)
  • Necrosis (gangrene)
  • Bradycardia (phenylephrine)
  • Hyperglycemia (epinephrine)
23
Q

What is the concentration of epinephrine used for IV push?

A

0.1 mg/mL

24
Q

What is the concentration of epinephrine used for IM injection or compounding IV products?

A

1 mg/mL

25
Q

What lab needs to be frequentlt/continuously monitored when giving continuous IV vasodilators?

A

Blood pressure

26
Q

Low dose nitroglycerin MOA

A

Venous vasodilator

Preload

27
Q

High dose nitroglycerin MOA

A

Arterial vasodilator

Afterload

28
Q

Nitroprusside MOA

A

Mixed (equal) arterial and venous vasodilator

29
Q

What are the metabolites of nitroprusside?

A
  • Thiocyanate
  • Cyanide

Hydroxocobalamin → reduce the risk of thiocyanate toxicity or to treat cyanide toxicity
Sodium thiosulfate + sodium nitrite → cyanide toxicity

30
Q

Which vasodilator requires a non-PVC container?

Non-PVC container: glass, polyolefin

A

Nitroglycerin

31
Q

Which vasodilator requires light protection during administration?

A

Nitroprusside

32
Q

What color of nitroprusside solution would indicate that it has been degradated to cyanide?

A

Blue

33
Q

Inotrope MOA

A

Increase the contractility of the heart
* Dobutamine – beta-1 agonist
* Milrinone – phosphodiesterase-3 inhibitor; also a vasodilator

34
Q

What is the characteristic of a shock?

A
  • Hypoperfusion
  • Hypotension (SBP < 90 or MAP < 70)
35
Q

What are the general principles for treating septic shock?

A
  • MAP goal: ≥ 65
  • Fill the tank: optimize preload with IV crystalloids (balanced fluids such as Lactated Ringer’s preferred)
  • Squeeze the pipe: alpha-1 agonist activity (peripheral vasoconstriction) to ↑ SVR
  • Kick the pump: beta-1 agnost activity to ↑ myocardial contractility and CO
36
Q

What is the vasopressor of choice in septic shock?

A

Norepinephrine

37
Q

What are the first-line analgesia in ICU?

A

IV opioids

38
Q

What treatments are used to manage agitation in ICU?

A
  • Benzodiazepines (lorazepma, midazolam)
  • Non-benzo hypnotics (propofol, dexmedetomidine)
39
Q

Which sedative can be used in both intubated and non-intubaed patients?

A

Dexmedetomideine (Precedex)

40
Q

What can be used for delirium in ICU?

A
  • Quetiapine
  • Haloperidol
41
Q

Propofol is contraindicated in patients with

A

egg or soy allergies

42
Q

Dexmedetomideine MOA

A

Alpha-2 adrenergic agonist

43
Q

List the risk factor for developing stress ulcers in ICU

A
  • Mechanical ventilation > 48 hrs
  • Coagulopathy
  • Sepsis
  • Traumatic brain injury
  • Major burns
  • Acute renal failure
  • High dose systemic steroids
44
Q

What prophylaxis are recommended to prevent stress-related mucosal damage in pts with risk factors for stress ulcer?

A
  • H2RAs (can cause thrombocytopenia and mental status changes in the elderly or those with renal impairement)
  • PPIs (associated with an increased risk of GI infections, fractures and nosocominal penumonia)
45
Q

1.

Bupivacaine can be fatal if administered

A

intravenously

46
Q

What is the purpose of epinepherine in the lidocaine/epinephrine combination product?

A

Epinephrine is added for vasoconstration, which keeps the lidocaine localized to the area where the numbing is needed.

47
Q

List the commonly used anesthetics

A
  • Lidocaine
  • Desflurane, sevoflurane
  • Bupivacaine, ropivacaine
48
Q

Cisatracurium (Nimbex) MOA

A

Non-depolarizing NMBA: block acetylcholine from binding to the receptor

49
Q

Succinylcholine

A

Depolarizing NMBA: activate the acetylcholine receptors and desensitizes them

50
Q

Neuromuscular blocking agents

A
  • Not routinely used
  • Cause skeletal muscle paralysis
  • Patients must be mechanically ventilated
  • NMBAs do not provide sedation or analgesia, patients should receive adequate sedation and analgesia prior to starting an NMBA
  • All agents should be labeled with a colored auxiliary label stating “Warning: Paralyzing Agent causes respiratory arrest”
51
Q

What are hemostatic agents used for?

A

Stop the bleeding

52
Q

Systemic hemostatic agents MOA

A

Inhibiting fibrinolysis or enhancing coagulation
* Tranexamic acid
* Recombinant Factor VIIa (NovoSeven RT)

NAPLEX Special Populations (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions