Crit Care Flashcards
1
Q
How does dobutamine work?
A
B1 agonist
Increases HR and force of contraction
Which increases cardiac output
2
Q
Administration note for IVIG?
A
Use slower infusions rate for renal and CV disease
3
Q
Dopamine dosing? 3 bullets
A
- Dopamine stimulates different receptors depending on dose
- Low renal dosing: 1-4 mcg/kg/min: Dope 1 agonist
- Medium: 5-10 mcg/kg/min Beta 1 agonist
- High: 10-20 mch/kg/min: Alpha 1 agonist
4
Q
How does the CNS control functions of the body? 2 main systems
A
- Through the peripheral nervous system
- SOmatic nervous system
- autonomic nervous system
5
Q
Cyklokapron?
A
Tranexamic acid
Hemostatic
6
Q
Nitroprusside: Thiocyanate/cyanide roxicity risk is increased when what?
A
PAtients have renal or hepatic impairment
7
Q
One alpha 1 agonist?
A
Phenylephrine
8
Q
What is first line for hypovolemic shock?
A
IV crystalloids
In pts with hypovolemic chock that is not caused by hemorrhage
9
Q
Common causes of Hypokalemia?
A
Underlying causes usually, meds, amphotericin and insulin
10
Q
What is the vasopressor of choice in septic shock?
A
NE
11
Q
How is hypovolemic hyponatremia treated?
A
Sodium chloride containing products IV
12
Q
When is albumin particularly useful?
A
WHen there is significant edema (cirrhosis)
13
Q
How does precedex work?
A
A2 adrenergic agonist
14
Q
What 3 things do vasopresssors cause
A
- Vasoconstriction
- Increased SVR
- which increases BP
15
Q
Pancuronium?
A
Long acting agent
16
Q
Nitroglycerin or NTG uses?
A
During MI or uncontrolled hypertension but efficacy is limited to 24-48 hours due to tachyphylaxis (tolerance)
17
Q
Haldol
A
Haloperidol
18
Q
What can be used to treat SIADH and hypervolemic hyponatremia?
A
arginine vasopressin receptor antagonists (AVP)
19
Q
The somatic nervous system controls muscle moves by?
A
- By sending signals through neurons to release
- Acetylcholine Ach to act on nicotinic receptors
20
Q
Injectable anesthetics? 2
A
Bupivacaine, ropivicaine
21
Q
Albuminar, Albutein, Alburx
A
Albumin 5% and 25%
22
Q
Benzos role in sedation two times?
A
Seizure patients
and
Alcohol withdrawal patients
23
Q
Warning for Samsca?
A
Hepatotoxicity
24
Q
Precedex?
A
Dexmedetomidine
25
Special note for dobutmaine?
Way turn pink due to oxidation but potency is not lost
26
Epinephrine concentration used for IV push
0.1 mg/ml 1:10,000 ration strength
27
When should vasopressor solutions not be used?
If they are discolored or contain a precipitate
28
Common ICU conditions
Pain?
IV pioids
morphine and fentanyl first line
29
How does phentolamine work?
Alpha 1 antagonist
30
What is the safe way to correct sodium?
12 meq/L over 24 hours
More rapidly can cause osmotic demethylation syndrome (ODS)
or central pontine myelonolysis
can cause paralysis, seizure and death
31
SEs of Samsca? 4
Thirst, nausea, dry mouth, polyuria
32
SEs of Diprivan
Hypotension, apnea, hypertg, green urine/hair/nail beds, propofol related infusion syndrome (PRIS) can be fatal
33
Increasd time with foley catheter does one?
Increase chance of bladder infection
34
General principles for treating shock 3
# 1. Fill the tank
1. Optimize preload with IV crystalloids bolus as needed
2. Squeeze the pipes
1. Peripheral vasocontrictors (a1agonists) to increase systemic vascular resistance
3. Kick the pump
1. B1 agonist to increase myocardial contractility and cardiac output
35
How is agitation managed in the ICU?
WIth BZDs: lorazepam or midazolam
36
What 3 things have PPIs been associated with?
Bone fracture, C Diff, Nosocomial Pneumonia
37
treatment for sepsis and septic shock?
Broad spectrum abx and IV fluid resucitation with IV crystalloids
38
Nitropress, Nipride MOA?
Equal venous and arterial vasodilation
39
When is dextrose used pertaining to fluids
when water is needed intracellularly
These products contain free water
40
What do inotropes do?
Increase contractility of the heart
41
How long should a pt be treated with Samsca?
Talvaptan AVP
limited to less than \<=30 days due to hepatotoxicity
42
What type of sedation is preferred?
Light sedation
43
When is hypophosphetemia life threatening?
\<1mg/dL
44
What do Epi and NE do? Leads to what 3 things?
Stimulate multiple receptors including alpha 1 and beta 1, b2
WHich leads to increased vaso constriction HR and BP
45
What has to be present to characterize acute decompensated heart failure to cardiogenic shock?
Hypoperfusion and hypotension
46
How is hypervolemic hyponatremia treated?
Duiretics and fluid
47
Monitoring for Etomidate?
Adrenal insufficiency
48
Xylocaine?
Lidocaine
49
How are vasopressors given?
Through IV central line
50
Versed?
Midazolam
51
How is vesication with vasopressors treated?
Phentoloamine
52
Acute decompensated HF and cardiogenic shock
What is it?
Acute decompensated heart failure
rapid decline in health, wt gain, worseing of symptoms
53
Colloids 3
Albumin
Dextran
Hydoxyethyl startch
54
Boxed warnings for Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen
2
1. Acute renal dysfunction, usually within 7 days, more likley with products stabalized by sucrose
2. THrombosis
55
Warning for Nitroprusside?
Increase Inctracranial pressure
56
SEs of Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen
10
1. HA
2. Nausea
3. diarrhea
4. injection site rxn
5. infusion rxn, facial flushing, chest pain, tightness, fever, chills, hypotension- slow/stop infusion
57
Increased time on ventilator increases risk of infection what is a common pathogen?
Pseudomonas they like moist air
58
If nitroprusside is hat color?
Blue indicated cyanide formation dont use
59
Treating with IVIG can do what?
impair response to vaccines
60
How is isovolemic hyponatremia caused?
COmmonly caused by Syndrome of Inappropriate antidiuretic hormone
SIADH
61
How is hypoperfusion characterized? 3 things
1. Decreased renal function
2. ALtered mental status
3. or cold extremities
62
What is succinylcholine typically reserved for?
Intubation
63
What special care needs to be taken with NMBA?? 3
1. Ensure eye lubrication
2. Airway suction
3. Protect the skin
64
Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen
IVIG
65
What should pts be treated with if they have both volume overload and hypoperfusion
Both sets of agents
Loops, but avoid vasodilators
66
Risk factors to develop Stress ulcers? 2
Mechanical ventilation and coagulopathy
67
3 SEs of Nitroprusside?
1. HA
2. Tachycardia
3. Thiocyanate/cyanide toxicity (Increase risk in renal and hepatic impairment
68
What is needed for potassium?
Mg must be corrected
69
When should BBs be stopped in patients with ADHF?
If hypotension or hypoperfusion is present
70
Example of beta 1 agonist?
Dobutamine
71
Common oral mg agent?
Mg oxide
72
Adrenalin and Epipen?
MOA?
Epinephrine
A1,B1,B2 agonist
73
What is the only available depolarizing NMBA?
Succinylcholine
74
Beta 1 agonism causes what two things?
Increased CO and HR
75
Ration strenght for IM or compounded epinephrine?
1:1000
76
How is hypernatremia defined?
What is it associated with?
Na\>145 meq/L
Water deficiency and hypertonicity
77
Antagonism of the alpha 1 receptor causes what?
Vasodilation through smooth muscle relaxation and decrease BP
78
Contraindication to Versed?
Strong CYP3A4 inhibitors
79
What is lysteda used for?
Heavy menstrual bleeding: mennorhagic
80
Note about Ativan injection?
formulated in propylene glycol prop glycol toxicity: can ccause acute renal failure and metabolic acidosis
81
5 SEs of vasopressors
1. Arrythmias
2. Tachcardia
3. necrosis gangrene
4. Bradycardia with phenylephrine
5. Hyperglycemia with epinephrine
82
How can potassium chloride kill you?
IF it is not diluted or given via IV push
83
Seroquel?
Quetiapine
84
K deficiency related to total body
1. 1mEq drop in serum below 3.5
1. Indicated a total def of 100-400meq
85
What can be used to reduce airway secretions when using NMBA?
What does it do?
Glycopyrolate
Anticholinergic
86
Label for NMBA?
Warning paralyzing agent
87
2 topical hemostatic agents?
Recothrom, Thrombin JMI
88
When are neuromuscular blockers used? 4
1. During surgery
2. To help with mechanical ventilation
3. TO manage increase ICP
4. Treat muscle spasms
89
How is sepsis defined?
Life-threatening organ dysfunction due to dysregulated host response to infection
90
What is used to prevent cyanide toxicity with nitroprusside?
Hydroxocobalamin
Sodium thiosulfate is used for cyanide toxicity
91
Used of precedex?
Sedation in intubated and not intubated patients
92
Local anesthetic?
Lidocaine
93
Ativan
Lorazepam
94
Diprivan?
Propofol
95
How is Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen, dosed?
Using IBW
96
Doses of nitroglycerin pertaining to its effects 2
1. Low: venous vsaodilation
2. High: arterial vasodilation
97
Vasodilators 2
Nitroglycerin
Nitroprusside
98
Nimbex?
Cisatracurium
99
SEs of precedex 3?
1. Hypotension
2. HYpertension
3. bradycardia
100
Treating volume overload?
Loops and IV vasodilators
101
What do you need to make sure before giving someone NMBA? 2
1. Ensure adequate sedation and analgesia
2. Must be mechanically ventilated
102
Common ICU infections
2 ones
Mechanical ventilations
foley catheter
103
When is IV phos used?
PO4 is \< 1mg/dL
104
Inhaled anesthetics? 2
Desflurane, sevoflurane
105
The sympathetic nervous system works by?
releasing epinephrine and nerepinephrine
to act on the adrenergic receptors (aplha 1, beta 1 and beta 2)
106
How is hypokalemia defined?
K\<3.5 mEq/L
107
Suprane
Defsflurane
108
What is used to assess someones readiness to get off of sedatives?
Sedation vacaiton baby!`
`
109
Note about midazolam?
Can accumulate in obese patients and renal impariment (active metabolite)
110
What should be monitored for propofol?
Triglycerides with given for more than 2 days
111
Hydroxyethyl startch boxed watning?
Limited by box warning for use in critically ill including sepsis due to increase mortalitiy
112
Lysteda?
Tanexamic acid: tablet
113
What is the only sedative approved for intubated and nonintubated patients?
Dexmetomadine
114
2 boxed warnings for Samsca?
Talvaptan
1. Intiated and re-initiated in hospital
2. Overly rapid correction of hyponatremia \>12 meq/L/24 is associated with ODS
115
What is used for IV mg replacement?
Mg sulfate
116
Crystalloids 3
Dextrose
NS
LActate ringers
117
What does propofol give you?
Oil in water emulsion give 1.1 kcal/mL
118
Quelicin?
Depolarizing NMBA
Succinylcholine
119
What does epinenephrine do in the lidocaine/Epi combo?
Vasoconstriction and keeps the lido locals
pretty neat!
120
What does the somatic nervous system do?
COntrols muscle movements
121
What does nesiritide do?
Recombinant B-type natriuttic peptide
Binds to vasuclar smooth muscle and increases cGMP
122
Samsca?
Talvaptan
Arginine vasopressin receptor antagonist
123
When is IV mg recommended?
When Mg \<1mEq/L with life threatening symptoms (seizure or arrythmias)
124
Ketamine Warnings?
Emergence reactions vivid dreams hallucinations delerium
125
3 SEs of nitroglycerin?
1. HA
2. tachycardia
3. tachyphylaxis
126
How does milrinone work?
PDE-3 inhibitor
Produces inotropic effects with significant vasodilation
127
How is hypervolemic hyponatremia caused?
fluid overload, cirhosis, HF, renal failure
128
The sympathetic nervous system is also known as?
What three things does it result in?
Also known as fight or flight
1. Increase in
1. Blood pressure
2. HR
3. and glucose production
129
How long should the infusion for precedex be?
Duration should not be longer than 24 hours
130
Examples of two vasopressors?
Epinephrine and NE
131
Dilaudid?
Hydromorphone
132
Notes for propofol?
bacterial growth discard vial and tubing within 12 hours
133
How do systemic hemostatic agents work?
By inhibiting fibrinolysis and enhancing coagulation
134
Treatment options for volume overloaded ADHF patients? 2
Loop diuretics
vasodilators can be added
135
IVIG uses? 4
1. Used to only be indicated for immunodef conditions
2. Now has many uses, MS, myathenia gravis, guilliane barr
136
What to monitor for samca?
Rate of Na increase
137
When are vasopressors not effective?
If intravascular volume is not adequate
138
What happens when alpha 2 receptors in the brain on stimulated?
Decrease in overall sympathetic output
139
Two inotropes to know?
Dobutamine
Milrinone
140
Strategy when pain in ICU?
Analgesosedation: sedation strat that used analgesics first
141
How is hyponatremia defined?
Na \<135 meq/L
142
Nitroglycerin notes?
Need non PVC container glass, polyolefin
143
What is clonidine?
Central acting alpha 2 adrenergic agonist
144
Max infusion rate and max concentration of IV potassium chloride?
\>=10mEq/hr
max concentration of 10 mEq/100 mL
145
Alpha 1 agonism causes what two things?
increased Vasoconstriction and BP
146
What anesthetic can be fatal IV?
Bupivicaine
Commonly used in epiderals
147
Contraindications to propofol?
hypersesitivity to eggs or soy
148
Administrations notes for Nitroprusside?
1. Protect from light during admin
2. Use clear solutions only a blue color indicated cyanide formation
149
Novoseven RT?
Recombinant factor VIIa
Hemostatic
150
What is preferred for sedation in ICU patients?
Non-BZDs are preferred propofol and dexmedomadine
151
Levophed?
MOA?
NE
Alpha 1\> B1 agonist
152
Nitroglycerin contraindications? 3
1. SBP\<90
2. Use with PDe-5
3. Ricoguat
153
Nitroprusside, Nipride
Nitroprusside
154
When is a ADHF patient considered volume overloaded?
Edema, ascites, jugular venous distention
155
What drug can be useful for delirium in ICU patients?
Quitiapine
156
What should be monitored all the time with vasopressos?
Continuos BP monitoring
157
What can be used for invasive monioring?
What does it do?
Catheter called Swan Ganz
1. Measures congeestion pulmonary cap wedge pressure
158
Boxed warning for vasopressors?
Dopamine and NE have Black boxes for extravacation
But all are vesicants
It should be treated with phentolamine
159
What 2 drugs are uniquely suited for hypoperfusion?
Dobutamine and milrinone
160
How is hypovolemic hyponatremia caused? 5
1. Diuresis
2. salt wasting syndromes
3. blood loss
4. vomitting and diarrhea
161
What are colloids?
large molecule typically proteins or startch
Remain in the intravascular space and increase oncotic pressue
162
What is the most common colloid?
Albumin
163
Crystalloids versus Colloids
Which one is less costly and generally has fewer adverse effects?
Crystalloids
164
What is the parasympathetic nervous system known as?
The rest and digest system
165
4 vasopressors
1. Dopamine
2. Epinephrine
3. NE
4. Vasopressin
166
How is shock usually caused and defined?
Hypoperfusion
Hypotension: SBP \<90
MAP \<70
167
2 treatment options for ADHF patient experiencing hypopurfusion?
1. Intoropes : dobutamine, milrinone
2. If pt become hypotensiove consider adding vasopressor, NE, dopamine, or phenylephrine
3. Avoid vasodilators become they can decrease BP and worsen
168
4 SEs for all non-depolarizing NMBA?
Bradycardia, flushing, hypotension, tachyphylaxis
169
Boxed warning for Nitropress, Nipride? 3
1. Metabolism leads to cyanide
2. Excessive hypotension
3. Not for direct injection must be further diluted with D5W
170
Most common fluids used when volume rescusitation is needed in shock state?
Lactate ringers and NS
171
What is recommended for stress ulcers in ICU patients?
H2RAs and PPIs
172
What can decrease the risk of delerium in ICU patients?
Using non BZDs and or shorten the suration
173
Nimbex Notes
Hofmann elimination: independent of renal and hepatic impairment
174
What combo is sometimes used for local procedures, anesthetic
Lidocaine/Epi
175
What are the 4 types of shocK?
1. Hypovolemic (hemorrhage)
2. Distributive (eptic, anaphylactic)
3. Cardiogenic (post MI)
4. Obstructive
