Acute ICU

Question 1

Which drug may reduce the duration of delirium in adult ICU patients?

Answer 1

Atypical antipsychotics

Question 2

Risk factors for delirium

Answer 2

Preexisting dementia
	History of HTN
	History of alcoholism
	High severity of illness at admission
	Coma

Question 3

Prevention of delirium

Answer 3

Early mobilization (no pharm prevention)

Question 4

Non-pharm treatment for delirium

Answer 4

glasses, low stimulation environment, get rid of unneeded drugs, frequent reorientation (this is where you are, why you’re here etc), make sure they know when it is daytime vs. nighttime.

Question 5

Important AE for atypical antipsychotics?

Answer 5

QTc prolongation

Question 6

Which sedative has some analgesic properties?

Answer 6

Dexmedetomidine (Precedex)

Question 7

What is the MOA of dexmedetomidine (Precedex)

Answer 7

Alpha 2 agonist

Question 8

What are the 2 most common side effects of dexmedetomidine?

Answer 8

Bradycardia and hypotension

Question 9

Brand name of propofol?

Answer 9

Diprivan

Question 10

Levophed generic name is:

Answer 10

Norepenephrin

Question 11

What are some underlying causes of agitation and sedation?

Answer 11

Pain, delirium, hypoxemia, hypoglycemia, withdrawal

Question 12

what does RASS stand for?

Answer 12

Richmond agitation-sedation scale

Question 13

Midazolam brand name:

Answer 13

Versed

Question 14

Midaxolam MOA

Answer 14

GABA-A agoinst

Question 15

Where is midazolam metabolized?

Answer 15

liver (clearance decreases with age or renal/hepatic impairment)

Question 16

MOA of propofol

Answer 16

Binds to multiple receptors in the CNS including GABA-A, gycine, nicotinic and M1 receptors

Question 17

Which drugs have anticonvulsant effects?

Answer 17

Propofol, Midazolam.

Question 18

Which allergens are included in Propofol that you need to be aware of?

Answer 18

Egg and soy

Question 19

Clinical presentation of propofol infusion syndrome

Answer 19

Metabolic acidosis, hyperlipidemia, cardiac dysfunction, rhabdomyolysis, acute renal failure

Question 20

MOA of dexmedetomidine

Answer 20

selective Alpha2 receptor agonist

Question 21

What are some pros of precedex?

Answer 21

Sedative (but more easily arousable and interactive), minimal respiratory depresion, analgesic/opioid sparing and sympatholytic properties

Question 22

If a patient is on precedex do they need to be on a ventilator?

Answer 22

No, because respiratory depression is minimal, but you do need to have an Ambu bag in the room.

Question 23

Which agent has the shortest elimination half life?

Answer 23

Dexmedetomidine

Question 24

Lorzapam is formulated with propylene glycol, what is the problem with this?

Answer 24

Acidosis with longer durations

Question 25

What are some advantages of analgesic optimization before sedation?

Answer 25

decreases mechanical ventilation time and ICU length of stay

Question 26

Generic for Neosynephrine

Answer 26

Phenylephrine

Question 27

Phenylephrine works on which receptors?

Answer 27

primarily alpha 1

Question 28

First line vasopressor for the treatment of septic shock

Answer 28

Norepinephrine ("You absolutely need to know this" - Laswell)

Question 29

What is septic shock?

Answer 29

SIRS + infection + refractory to fluids

Question 30

Which vasopressor is most likely to cause arrhythmias? (tachyarrhythmias and tachydisrhythmias)

Answer 30

Dopamine (comes in a premixed bag)

Question 31

What does B1 receptor stimulation do?

Answer 31

increase myocardial contractility and chronicity

Question 32

What are some dose dependent effects of dopamine?

Answer 32

low: vasodilation (renal), medium: increased cardiac contractility and chronotropy, Mild SVR incrase, High: vasoconstrictiond due to alpha 1 mediated vasoconstriciton

Question 33

MOA of norepinemprine?

Answer 33

potent alpha 1 agonist and modest b agonist activity

Question 34

WHAT IS THE DRUG OF CHOICE FOR SEPTIC SHOCK!!??

Answer 34

Norepinephrine

Question 35

What is another name for vasopressin?

Answer 35

Antidiuretic hormone

Question 36

What dose should you not exceed with vasopressin and why

Answer 36

.04 units/min (larger doses lead to ischemia)

Question 37

Which vasopressor can cause malignant ventricular arrhythmias?

Answer 37

Dobutamine

Question 38

MOA of dobutamine

Answer 38

Selective B1-agonist with mild B2 and vascular a1-activity