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NAPLEX > Acute & Critical Care Medicine > Flashcards

Acute & Critical Care Medicine Flashcards

1
Q

Define crystalloid

A

contains various concentrations of sodium and/or dextrose that pass freely between semipermeable membranes. most of the volume does not remain in the intravascular space (inside the blood vessels), but moves into the extravascular space or interstitial space

  • less costly
  • fewer adverse reactions
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2
Q

Define colloids

A

large molecules (typically protein or starch) dispersed in solutions that primarily remain in the intravascular space and increase oncotic pressure

  • more expensive
  • have not shown clear clinical benefit over crystalloids
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3
Q

What product is used when water is needed intracellularly

A

dextrose b/c it contains “free water”

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4
Q

What products are used for volume resuscitation in shock states

A

LR

normal saline

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5
Q

What products are used in patients with significant edema (e.g. cirrhosis)

A

albumin

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6
Q

list crystalloids

A

D5W
NS
LR
multiple electrolyte injection (plasma-Lyte a)

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7
Q

List colloids

A

albumin

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8
Q

define hyponatremia

A

Na < 135

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9
Q

hypotonic hypovolemia hyponatremia treatment

A

NaCl

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10
Q

hypotonic hypervolemic hyponatermia treatment

A

diuresis with fluid restriction

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11
Q

max rate of Na repletion

A

12 mEq/L over 24 hours

above this is associated with ODS (osmotic demyelination syndrome)

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12
Q

Define hypernatremia

A

Na > 145

associated with water deficit and hypertonicity

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13
Q

a drop of potassium of 1 mEq/L below 3.5 represents what

A

total body deficit of 100-400 mEq

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14
Q

how to administer potassium

  • route
  • rate
  • max concentration
A

peripheral line
max rate < 10 mEq/L
max concentration of 10 mEq/100mL

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15
Q

Define hypophosphatemia

A

serum phosphate < 1 mg/dL

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16
Q

What does an APACHE 2 score tell you

A

determine patient prognosis and estimate ICU mortality risk

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17
Q

Vasopressor MOA

A

stimulate alpha receptors which cause vasoconstriction and increases systemic vascular resistance (SVR) which increases BP

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18
Q

epinephrine MOA

A

alpha-1, beta-1, beta-2 agonists

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19
Q

norepinephrine MOA

A

alpha-1 agonist > beta-1 agonist

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20
Q

phenylephrine MOA

A

alpha-1 agonist

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21
Q

vasopressin MOA

A

vasopressin receptor agonist

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22
Q

list vasopressors

A 
dopamine
epinephrine
norepinephrine
phenylephrine
vasopressin
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23
Q

dopamine MOA

A 
low dose 1-4 mcg/kg/min
-dopamine-1 agonist
medium dose 5-10 mcg/kg/min
-beta-1 agonist
high dose 10-20 mcg/kg/min
-alpha-1 agonist
24
Q

Define vesicants

A

cause tissue damage/necrosis with extravasation (leakage of drug from blood vessel into surrounding tissue)

25
Q

how to administer vasopressors

A

via central line to avoid extravasation

26
Q

how to treat vasopressor extravasation

A

phentolamine

27
Q

phentolamine MOA

A

alpha-1 blocker that antagnoizes the effects of the vasopressor

28
Q

list vasodilators

A

nitroglycerin
nitroprusside
nesiritide

29
Q

nitroglycerin IV MOA

A

in low dose: venous vasodilator

in high dose: arterial vasodilator

30
Q

nitroprusside MOA

A

mixed (equal) arterial and venous vasodilator

31
Q

Boxed warning for nitroprusside

A

metabolism produces cyanide

32
Q

inotropes MOA

A

increase contractility of the heart

33
Q

list inotropes

A

dobutamine

milrinone

34
Q

Dobutamine MOA

A

beta-1 agonist
increases HR and force of contraction, which increases CO
weak beta-2 (vasodilation) and alpha-1 agonist activity

35
Q

Milrinone MOA

A

phosphodiesterase-3 inhibitor in cardiac and vascular tissue to produce inotropic effect with significant vasodilation

36
Q

Define shock

A

hypoperfusion usually in the setting of hypotension defines as SBP <90 or MAP < 70

37
Q

hypovolemic shock treatment

A

fluid resusciation: crystalloid

hemorrhage: PRBC, FFP

38
Q

General principles for treating shock

A

fill the tank
-optimize preload with IV crystalloids bolus PRN
squeeze the pipes
-peripheral vasoconstrictor (alpha-1 agonist) to inc. SVR
kick the pump
-beta-1 agonist to inc. myocardial contractility and CO

39
Q

Define distributive shock

A

low SVR

initially high CO followed by low or normal CO

40
Q

what is the vasopressor of choice in septic shock

A

norepinephrine

41
Q

Define acute decompensated heart failure

A

worsening symptoms of heart failure such as sudden weight gain, inability to lie flat without sob, decreasing functionality

42
Q

Define cardiogenic shock

A

ADHF + hypotension + hypoperfusion

43
Q

how to treat ADHF

A 
volume overload
-diuretics, IV vasodilators
hypoperfusion (dec. renal function, ams, cool extremity)
-inotropes (dobutamine, milrinone)
-hypotensive: vasopressors
44
Q

first-line opioids for analgesia in ICU

A

morphine
hydromorphone
fentanyl

45
Q

how is agitation managed in ICU

A

benzodiazepines

hypnotics ( propofol, dexmedetomidine)

46
Q

preferred sedation agent

A

non-benzodiazepines

  • propofol
  • dexmedetomidine
47
Q

Brand name for dexmedetomidine

A

precedex

48
Q

what is the only sedative approved for use in intubated and non-intuated patients

A

dexmedetomidine

49
Q

SE of dexmedetomidine

A

hypo/hypertension

bradycardia

50
Q

SE of propofol

A

hypotension
hypertriglyceridemia
propofol-related infusion syndrome (PRIS)

51
Q

propofol brand name

A

diprivan

52
Q

how many kcal does propofol provide

A

1.1 kcal/mL

53
Q

what are the depolarizing NMBA

A

succinylcholine

54
Q

what drug can be used in someone that is intubated to reduce secretions

A

glycopyrrolate

55
Q

what are the non-depolarizing NMBAs

A

atracurium
cistracurium
rocuronium
vecuronium

NAPLEX (65 decks)

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