Critical Care and Fluid Electrolytes Flashcards
What do alpha 1 and beta 1 do?
How do you dose dopamine depending on receptor?
What to know about epinephrine moa?
Alpha 1 increases vasoconstriction and BP, Beta 1 increases CO and HR. Alpha 1 is phenylephrine, Dobutamine is Beta 1.
Low (renal) 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.
Adrenalin, Epipen, Alpha-1, Beta-1, beta-2 agonist.
What to know about Norepinephrine (Levophed)?
How does phenylephrine work?
How does vasopressin work?
Alpha-1 agonist > beta 1 agonist.
Alpha-1 agonist.
arginine vasopressin and ADH.
What are the warnings about the vasopressors?
What drug can cause coronary steal?
How does Nesiritide work?
Vesicants, treat extravasation with phentolamine. Arrhythmias, tachycardia, bradycardia (phenylephrine), necrosis (gangrene), bradycardia (phenylephrine), hyperglycemia (epinephrine). Continuous BP monitoring, solutions should not be used if they are discolored or contain a precipitate. Central IV line, Iv push is 0.1 mg/ Ml (1:10,000). IM injection, 1 mg//mL (1:1000).
Nitroprusside.
Recombinant B-type natriuretic.
What is the MOA of nitroglycerin and what are its safety concerns?
What is the MOA of nitroprusside and what are its safety concerns?
What to know about the inotropes?
low is venous vasodilator, high doses is arterial vasodilator. SBP <90, use with pde-5 inhibitors or riociguat. Headache, tachycardia, tachyphylaxis, Requires non PVC container (glass, polyolefin).
Nitropress, Nipride, Mixed (equal) arterial and venous vasodilator, Metabolism produces cyanide, excessive hypotension, diluted D5W preferred. Increased ICP, headache, tachycardia, thiocyanate/cyanide toxicity (increase in renal and hepatic impairment). Requires light protection, use only clear solutions, a blue color indicates degradation to cyanide.
Increase contractility. Dobutamine is a beta 1 agonist, Milrinone is a PDE 3 inhibitor. Dobutamine may turn slightly pink due to oxidation.
Do colloids generally remain in intravascular space and increase oncotic pressure?
What are crystalloids?
How do you treat pain/analgesia?
YES, Colloids are albumin, dextran, hydroxyethyl starch.
D5W, NS, lactated ringers.
Hydromorphone (dilaudid), fentanyl, morphine.
What to know about dexmedetomidine?
What to know about propofol (diprivan)?
What to know about lorazepam (ativan)?
Dexmedetomidine (precedex), alpha-2 adrenergic agonist. Hypo/hypertension, bradycardia, should not exceed 24 hours duration for infusion, intubated and non intubated patients.
CI’d to egg, soy. Hypotension, apnea, hypertriglyceridemia, green urine/hair/nail beds, PRIS (rare but can be fatal), monitor triglycerides, watch for bacterial growth and discard vial and tubing within 12 hours. Oil-in-water emulsion provides 1.1 kcal/mL.
propylene glycol toxicity, acute renal failure and metabolic acidosis.
What to know about midazolam (versed)?
What to know about other sedation meds?
What to know about Haloperidol and Quetiapine?
Use with potent CYP3A4 inhibitors is CI’d, renal impairment due to active metabolite.
Adrenal insufficiency for etomidate, Ketamine has emergence reactions.
Haldol, Seroquel.
What are risk factors for stress ulcers?
What are your local anesthetics?
What to know about succinylcholine?
Mechanical ventilation, Coagulopathy.
Lidocaine is local, inhaled is desflurane (suprane), sevoflurane. Injectable is bupivacaine, ropivacaine.
Nimbex, depolarizing. Glycopyrrolate is an anticholinergic.
What to know about non depolarizing NMBA’s?
What to know about tranexamic acid?
What is recombinant factor VIIA?
Flushing, bradycardia, hypotension, tachyphylaxis. Cisatracurium (Nimbex) has hofmann elimination (independent of renal and hepatic function), Pancuronium is a long-acting agent.
Cyklokapron, Lysteda. Lysteda (oral) is approved for menorrhagia.
NovoSeven RT
What are the topical hemostatic agents?
What to know about IVIG?
What to know about safety of IVIG?
Recothrom, Thrombin-JMI.
Carimune, Gammagard, Flebogamma DIF, gamunex, octagam, privigen. Use IBW to calculate dose, use slower infusion rate in renal and CV disease.
Acute renal dysfunction, most likely with products stabilized with sucrose, thrombosis may occur, HA, nausea, diarrhea, injection site reaction, infusion reaction and slow the infusion. Impair response to vaccination, treats MS, myasthenia gravis, Guillaine-Barre.
How to treat SIADH?
What to know about Tolvaptan (Samsca)?
Conivaptan or Tolvaptan (SIADH and hypervolemic hyponatremia).
Limited to <30 days dosing due to hepatotoxicity. Should be initiated and reinitiated in a hospital, overly rapid correction of hyponatermia (>12 mEq/L/24 hours) is associated with ODS (life-threatening). Hepatotoxicity, thirst, nausea, dry mouth, polyuria, Rate of Na increase.
