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IP4 > Critical Care > Flashcards

Critical Care Flashcards

1
Q

CO2 acid or base controlled by what

A

Acid lungs

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2
Q

Integrillin dose for renal impairment

A

CrCl <50 1mg/kg/min

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3
Q

Milrinone MOA

A

inhibit PDE which normally degrades cAMP into inactive peptides

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4
Q

Propofol special consideration

A

10% lipid emulsion so has 1.1 kcal/mL

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5
Q

Cardiogenic shock tx

A

Cold/wet= inotrope + diuretic

Cold/dry= inotrope +/- fluid

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6
Q

Septic shock tx

A

Fluids -30mL/kg of crystalloid

pressors if hypotension

-NE

empiric antimicrobial

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7
Q

Which NMBA are non-depolarizing agents

A

Amine Structure

  • Atracurium
  • Cisatracurium

Steroidal Structure

  • Pancuronium
  • Rocuronium
  • Vecuronium
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8
Q

Cangrelor to Prasugrel

A

Cangrelor 30mcg/kg bolus then 4 mcg/kg/min infusion Prasugrel 60mg immediately

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9
Q

Dexmedetomidine special considerations

A

does not cause respiratory depression for <24 hours in ICU

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10
Q

PCI treatment

A

UFH, LMWH, or Bivalirudin ASA 325mg x1 LD os P2Y12 Stent placement +/- GP 2b/3a

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11
Q

sepsis Gram - bacteria

A

S. aureus S. pneumoniae

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12
Q

pH <7.35 is what type of hemodynamic problem

A

acidosis

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13
Q

SAH tx

A

BP control -SBP <140 Vasospasm control -Nimodipine

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14
Q

Preload in left side of heart is what

A

PCWP

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15
Q

Obstructive shock hemodynamic parameters

A

CO ↓

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16
Q

ADHF when to hold ivabradine

A

Cardiogenic shock symptomatic ↓HR, BP new AFib

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17
Q

H’s and t’s 5, 4

A

H

  • hypoxia
  • hypovolemia
  • H ion
  • hypo/hyperkalemia
  • hypotermia

T

  • toxin
  • tamponade
  • tension pneumothorax
  • thombosis
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18
Q

ADHF when to hold ACEi/ARB/ARNi

A

cardiogenic shock symptomatic ↓ BP AKI ↑K

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19
Q

ADHF Cold &wet tx

A

SBP <90 w/ symptoms

-Inotrope + diuretics

if no symptoms

-IV diuretics +/- vasodilators

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20
Q

Arterial Line measures what

A

blood gas BP continuously

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21
Q

AIS BP goals

A

received tPA <180/<105

no tPA or thrombectomy <220/<120

No tPA with thrombectomy SBP <160

Hemorrhagic converson SBP <160

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22
Q

Sepsis 3 definition

A

> 2 qSOFA –for ED/Floor pt SOFA –ICU patients >2 pts

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23
Q

Define metabolic alkalosis

A

pH >7.45 HCO3 >26

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24
Q

PRIS s/s 3

A

ARF cardiac arrest dyslipidemia

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25
Q

Anion gap formula

A

Na - (HCO3 + Cl) normal <12

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26
Q

Angiotensin 2 Action

A

Vasoconstriction ↑ SVR

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27
Q

ADHF “cold” symptoms 8

A

fatigue

early satiety, nausea, anorexia

altered mental status

cool extremeties

tachycardia

narrow pulse pressure

sympomatic hypotension

↓Na

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28
Q

Dexmedetomidine ADE 5

A

↓ BP ↓ HR HTN N/V heart Block

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29
Q

Pancuronium ADE 2

A

tachycardia HTN

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30
Q

Thromboembolic prophylaxis LMWH dose

A

40mg SQ q24h 30mg SQ q12h if high risk

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31
Q

ADHF warm & wet tx

A

IV loop diuretic

naive–furosemide 40

experienced–2-2.5x home dose

+ HCTZ, metolazone, chlorothiazide

+/- vasodilators

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32
Q

Metabolic acidosis etiology

A

Anion gap

-MUDPILES –methanol, uremia, Diabetic ketoacidosis, propylene glycol, isoniazid and iron, lactic acid, ehtylene glycol, salicylates

Non-anion gap

-ACCRUED –Aldosterone inhibitors, compensation, carbonic anhydrase inhibitors, renal tubular acidosis, ureteral diversion, extraailmentation, diarrhea

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33
Q

pH ___ as HCO3___ pH ___ as PaCO2___

A

increases, increases decreases, increases

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34
Q

ADHF when to hold BB

A

cardiogenic shock symptomatic ↓BP, HR

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35
Q

Andexanet alfa MOA

A

decoy protein that sequesters and prevents binding to endogenous factor 10a

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36
Q

Activated 4-factor product

A

Feiba

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37
Q

Kcentra MOA

A

PCC 4 factor, unactivated replaces factors 2,9,10, and unactivated 7

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38
Q

Vecuronium Contraindication 2

A

Renal failure Liver failure

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39
Q

Ketamine MOA

A

NMDA blocker ACh blocker L-type Ca block

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40
Q

Vasopressors ADE

A

HTN tissue necrosis ARF Ischemia

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41
Q

Dopamine 1 & 2 action

A

Vasodilation ↑ UOP ↓ SVR

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42
Q

What happens when you add acid to buffer system

A

combine with HCO3 generating CO2 that is dissolved in the blood and subsequently eliminated via the lungs

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43
Q

4-factor product

A

Kcentra

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44
Q

Sepsis Gram + bacteria

A

E. coli Klebsiella spp. Pseudomonas

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45
Q

Phenylephrine Selectivity and action

A

Alpha 1 & 2 vasoconstriction

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46
Q

Alpha 1 Action

A

Vasocontriction ↑SVR ↑MAP

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47
Q

Initial resuscitation of Shock

A

“VIP” Ventilate Infuse Pump 30mL/kg IV crystalloid in 1st 3hrs MAP >65 normalize lactate

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48
Q

Which drug is a venous vasodilator

A

Nitroglycerin

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49
Q

pH normal value

A

7.35-7.45

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50
Q

Compensation for respiratory alkalosis

A

Acute

-for each ↓10 of PaCO2 HCO3 ↓ 2mEq/L

Chronic

-for each ↓10 of PaCO2 HCO3 ↓5 mEq/L

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51
Q

Beta 2 action

A

Vasodilation Bronchodilation ↓SVR

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52
Q

Norepinephrine Selectivity and Action

A

Alpha 1 > beta 1 > Beta 2 ↑ Chronotropy/Inotropy Vasoconstriction

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53
Q

Respiratory Alkalosis etiology

A

Central stimulation hypoxia latrogenic

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54
Q

Vecuronium ADE 2

A

Bradycardia Prolonged blockade on D/C

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55
Q

Beta 1 action

A

Chronotropy Inotropy Vasodilation ↑CO ↑HR ↓SVR

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56
Q

Distributive shock hemodynamic parameters

A

SVT ↓

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57
Q

Milrinone Hemodynamic effect HR, MAP, CO, SVR

A

HR ↑ MAP ↓ CO ↑ SVR ↓

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58
Q

Hemorrhagic shock treatment

A

identify source of bleeding volume rsuscitate –crystalloids –Packe red blood cells Vasopressors to MAP >60

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59
Q

Cardiogenic Shock hemodynamic parameters

A

CO ↓

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60
Q

TX of hyperkalemia

A

Ca gluconate

regular insulin

albuterol

sodium bicarb

furosemide

Na polystyrene sulfonate

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61
Q

Suggammadex MOA

A

modified cyclodextrin that encapsulates rocuronium and vecuronium to inhibit their binding to ACh receptor

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62
Q

Propofol MOA

A

GABA receptor

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63
Q

AIS primary prevention

A

ASA 81 for women 55-79

64
Q

Epi, NE, DA ADE

A

Tachycardia Hyperglycemia

65
Q

Pancuronium Contraindication 3

A

CAD renal failure Liver failure

66
Q

Venous vasodilation MOA

A

↓ preload > ↓ pulmonary congestion ↓ CVP + PCWP = symptom relief

67
Q

Succinylcholine MOA

A

inactivates AChE so inactive metabolites are made results in prolonged depolarization followed by paralysis

68
Q

Metabolic alkalosis treatment

A

cl responsive –replace Cl

cl unresponsive –correct hypokalemia

69
Q

Rocuronium Contraindication

A

Severe Liver failure

70
Q

Hypovolemic shock hemodynamic parameters

A

CVP ↓ PCWP ↓

71
Q

Epinephrine Selectivity and Action

A

Alpha 1 = beta 1 > beta 2 ↑ Chronotropy/Inotropy Vasoconstriction

72
Q

Angiotensin 2 ADE

A

Hypernatremia hypokalemia thrombosis lower dose if on ACEi

73
Q

Cangrelor to ticagrelor

A

Cangrelor 30mcg/kg bolus then 4 mcg/kg/min infusion Ticagrelor 180mg

74
Q

What 3 drugs also need added when on NMBA

A

Sedation–RAAS -4 to-5 prior –CIV benzo CIV opioid

75
Q

pH >7.45 is what type of hemodynamic problem

A

Alkalosis

76
Q

non-shockable rhythms

A

PEA asystole

77
Q

Septic shock definition

A

vasopressors to maintain MAP >65 Lactate >2 in absence of hypovolemia

78
Q

HCO3 acid or base controlled by what

A

base kidneys

79
Q

Propofol type of sedation

A

sedation w/out amensia or analgesia

80
Q

ADHF when to hold aldosterone antagonist

A

renal dysfunction ↑K

81
Q

When to add corticosteroids for shock

A

if not stable on fluids and pressors alone -hydrocortisone

82
Q

Which NMBA is a Depolarizing agent

A

Succinylcholine

83
Q

Dobutamine Hemodynamic effect HR, CO, SVR

A

HR ↑ CO ↑ SVR ↓

84
Q

Define respiratory alkalosis

A

pH >7.45 PaCO2 <35

85
Q

Cangrelor to Clopidogrel switch

A

Cangrelor 30 mcg/kg bolus then 4 mcg/kg/min infusion Clopidogrel 600mg immediately

86
Q

Crystalloids example

A

non-balanced-NS balanced-LR, plasmalyte

87
Q

Ciraparantag MOA

A

binds heparins, factor 10a inhibitors, DTI through hydrogen bonds

88
Q

PA catheter measures what

A

PCWP CO CI SVR CVP

89
Q

Which drug can cause cyanide/thiocynate toxicity

A

nitroprusside

90
Q

PRIS risk factors

A

Dose >83 mcg/kg/min > 48 h concomitant catecholamine or glucocorticoid ketogenic diet

91
Q

Heparin and LMWH Reversal agent

A

Protamine

92
Q

HCO3 inc/dec in metabolic acidosis and alkalosis

A

↑ metabolic alkalosis ↓ metabolic acidosis

93
Q

qSOFA levels

A

RR > 22 Altered mental status SBP >100

94
Q

HCO3 normal values

A

22-26 mEq/L

95
Q

Preload in right side of heart is what

A

CVP

96
Q

SAH S/S

A

Worst HA of life Loss of consciousness N/V Nuchal rigidity

97
Q

Dexmedetomidine MOA

A

Alpha2 agonist to block reuptake of NE to initially but long will ↓ NE concentration

98
Q

Propofol ADE 3

A

respiratory depression hypertriglyceridemia PRIS

99
Q

ICH S/S

A

Acute HA N/V pupillary changes HTN

100
Q

Aggrastat dose for renal impairment

A

CrCl <60 0.075 mcg/kg/min

101
Q

Lytic Tx

A

lytic therapy started ASA 325 x1 clopidogrel 75-300 –> 75 years = 75mg –<75 years = 300mg Anticoag–UFH, LMWH, Fondaparinux

102
Q

Succinylcholine Contraindication 5

A

Burn Trauma ↑K crush injury denervating injury

103
Q

Etomidate MOA

A

mediated through GABA to inhibit 11beta-hydroxylase

104
Q

pCO2 normal values

A

35-45 mmHg

105
Q

alteplase Dose

A

0.9mg/kg -actual body weight -max dose 90mg

106
Q

When to start Insulin infusion in ICU

A

glucose >200

107
Q

Dopamine Selectivity and Action

A

D > Beta 1 > alpha > beta 2 ↑UOP ↑ Chronotropy/inotropy Vasoconstriction ↑ Na ↓K

108
Q

Furosemide PO 40mg = to __ IV Furosemide __PO Torsemide __Bumetanide

A

20mg 20mg 1mg

109
Q

Direct Factor Xa inhibitor reversal agents

A

Andexanet alfa Kcentra FEIBA

110
Q

Anaphylactic shock tx

A

epi fluids supportive care -Histamine blockers -steroids -albuterol

111
Q

Warfarin Reversal agents

A

Vitamin K Kcentra

112
Q

Alpha 2 Action

A

Constriction 2a ↓ SVR 2b ↑ SVR

113
Q

Risk of arrhythmias if on vasopressors

A

DA>>Epi/NE>Phenylephrine/vasopressin

114
Q

Idarucizumab MOA

A

binds to bound and free dabigatran

115
Q

Alteplase Contraindication

A

ICH

in last 3 months

–Ischemic stroke

–severe head trauma

–intracranial/intraspinal surgery

SAH

GI malignancy

Coagulopathy

–Plt <10000

–INR >1.7

–aPTT >40 sec

–PT >15 sec

LMWH in 24 hours

NOAC in 48 hrs

GP2b/3a inhibitors

116
Q

Alteplase inclusion criteria

A

>18

Symptoms <3 hours

Extended window=3-4.5 hr

  • if on warfarin and INR <1.7
  • previous stroke and DM
117
Q

Compensation for respiratory acidosis

A

Acute

-for each ↑10 of PaCO2 HCO3 will ↑ 1mEq/L

Chronic

-for each ↑ 10 of PaCO2 HCO3 will ↑ 4mEq/L

118
Q

Define metabolic acidosis

A

pH <7.35 HCO3 <22

119
Q

Vasoactive meds for shock

A

NE 1st line -add vasopressin or epi to raise MAP or add vasopressin to ↓ NE dose

120
Q

Tx if PCI is unavailable and within what time frame

A

tPA Reteplase Tenecteplase 120 mins

121
Q

metabolic alkalosis etiology

A

Cl responsive

-vomiting, previous diuretic use

Cl unresponsive

-current use of diuretic, refeeding syndrome, excess mineralcorticoid

122
Q

ADHF cold & dry tx

A

If SBP <90 w/ symptoms

-IV inotrope

if no symptoms

-IV vasodilator

123
Q

Arterial Vasodilation MOA

A

↓ arterial vasoconstriction ↓ afterload > ↑ CO ↑ SV and ↓ SVR

124
Q

ADHF “wet” symptoms

A

SOB, dyspnea on exertion edema, weight gain ↑ JVP ↑ BNP

125
Q

Dexmedetomidine type of sedation

A

cooperative sedation analgesia

126
Q

HFrEF systolic or diastolic

A

systolic

127
Q

3 Stress ulcer prophylaxis indications

A

INR >1.5 PTT >2x ULN Plt <50000

128
Q

Define respiratory acidosis

A

pH <7.35 PaCO2 >45

129
Q

What happens when a base is added to buffer system

A

combines with H2CO3 to generate HCO3 which is eliminated via the kidneys

130
Q

PCC definition

A

prothrombin complex concentrate factor 10 complex prepared from human plasma with blood factors 2,7,9,10

131
Q

Neurogenic shock tx

A

Fluids Pressors atropine for bradycardia

132
Q

JFpF systolic or diastolic

A

diastolic

133
Q

ADHF warm & dry tx

A

optimize goal directed medical therapy

134
Q

Vasopressin Selectivity and action

A

V1 & V2 agonism Vasoconstriction

135
Q

Succinylcholine ADE

A

↑K = arrythmia Tachycardia Malignant Hyperthermia

136
Q

Ketamine type of sedation

A

dissociative anesthetic, analgesic, hypnosis

137
Q

Glucose control in ICU

A

100-180

138
Q

metabolic acidosis compensation

A

winter’s formula PaCO2=1.5(HCO3) +8+/-2

139
Q

Tx for ↓Na

A

Tolvaptan

140
Q

Exacerbating factor for ADHF

A

“Failured”

F-failure to comply to meds

A-Afib

I-Ischemia

L-Levothyroxine

U-Uncontrolled HTN

R-Renal failure

E-Embolus

D-drugs-steroids,NDHP, NSAID, TZD

141
Q

FASTHUG meaning

A

Feeding Analgesia Sedation Thromboembolic prevention Head of bed elevation stress ulcer prevention Glucose control

142
Q

Atracurium and Cisatracurium MOA

A

copmetitive antagonist for ACh which blocks depolarization

143
Q

ICH tx

A

BP control <160

Nicardipine DOC

Anticoag reversal

144
Q

Which drug is a mixed arterial/vasodilator

A

Nitroprusside

145
Q

Dabigatran reversal agent

A

Idarucizumab

146
Q

shockable rhythms

A

v fib pulseless v. tach

147
Q

Respiratory acidosis etiology

A

COPD central respiratory depression –sedation airway obstruction decline in gas exchange

148
Q

Vasopressin Action

A

Vasoconstriction ↑ SVR

149
Q

Dobutamine MOA

A

bind to beta receptor to ↑ cAMP to ↑ Ca release from SR

150
Q

Etomidate type of Sedation

A

Anesthetic, hypnosis, no analgesia

151
Q

Colloid example

A

Albumin, blood

152
Q

2 3-factor products

A

Profilnine SD Bebulin VH

153
Q

Absolute contraindication to tPA

A

previous hemorrhagic stroke

other stroke within 1 year

intracranial neoplasm

active internal bleeding

suspected aortic dissection

154
Q

CVC measures what

A

CVP TPN administration

155
Q

Atracurium and Cisatracurium elimination?

A

Hofmann elimination/Ester hydrolysis

156
Q

AIS tx

A

alteplase Treat BP

IP4 (4 decks)

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