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NAPLEX Prep > Critical Care/Fluids > Flashcards

Critical Care/Fluids Flashcards

1
Q

Peripheral nervous system breaks down into what 2 systems?

A

somatic and autonomic

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2
Q

Somatic nervous system controls ________
vs
autonomic nervous system controls _______

A

somatic: muscle movement
autonomic: bodily functions (digestion, cardiac output, blood pressure)

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3
Q

Autonomic nervous system breaks down into what different systems?

A

sympathetic and parasympathetic

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4
Q

Sympathetic or Parasympathetic:

is the “rest and digest” system

A

parasympathetic

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5
Q

Sympathetic or Parasympathetic:

is known as the fight/flight system

A

sympathetic

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6
Q

Sympathetic or Parasympathetic:

will release NE and Epi to act on adrenergic receptors

A

sympathetic

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7
Q

Sympathetic or Parasympathetic:

causes SLUDD

A

parasympathetic

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8
Q

what does SLUDD stand for

A 
salivation
lacrimation
urination
diarrhea/defecation
digestion
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9
Q

Sympathetic or Parasympathetic:

releases Ach to act on muscarinic receptors

A

parasympathetic

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10
Q

Sympathetic or Parasympathetic:

  • will increase glucose production
  • will increase bronchodilation
A

sympathetic

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11
Q

Sympathetic or Parasympathetic:

will increase HR and BP

A

sympathetic

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12
Q

Muscarinic receptors:

what happens with AGONIST action

A 
increased SLUDD (salivation
lacrimation
urination
diarrhea/defecation
digestion)
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13
Q

examples of muscarinic agonists?

A

pilocarpine

bethanecol

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14
Q

examples of muscarinic antagonists?

A

atropine

oxybutynin

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15
Q

Alpha 1 receptors:

what happens with AGONIST action

A

increased vasoCONSTRICTION

increased blood pressure

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16
Q

examples of alpha 1 agonists?

A

phenylephrine

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17
Q

examples of alpha 1 antagonists?

A 
phentolamine
doxazosin ("alpha blockers")
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18
Q

Alpha 1 receptors:

what happens with ANTAGONIST action

A 
increased vasodilation (via smooth muscle relaxation)
decreased blood pressure
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19
Q

examples of beta 1 agonists?

A

dobutamine

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20
Q

examples of beta 1 antagonists?

A

selective beta blockers and non-selective

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21
Q

Beta 1 receptors:

what happens with ANTAGONIST action

A

decreased Cardiac output and HR

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22
Q

Beta 1 receptors:

what happens with AGONIST action

A

increased Cardiac output and HR

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23
Q

Beta 2 receptors:

what happens with AGONIST action

A

increased bronchodilation

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24
Q

Beta 2 receptors:

what happens with ANTAGONIST action

A

bronchoCONSTRICTION
increased vasodilation
decreased BP

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25
Q

Examples of beta 2 AGONIST?

A

albuterol

terbutaline

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26
Q

Examples of beta 2 antagonists?

A

non-selective beta blockers

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27
Q

Clonidine is a _________ agonist and leads to overall _______

A

CENTRALLY located alpha 2;

overall DECREASED sympathetic output

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28
Q

Vasopressors:
work by stimulating ______ receptors
cause vaso________
which increased ______ and ______

A

alpha
vasoconstriction…
increased SVR (systemic vascular resistance)
increased blood pressure

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29
Q

______ is a natural precursor to NE

A

dopamine

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30
Q

which vasopressor’s MOA (which receptors it hits) is dose dependent?

A

dopamine

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31
Q

Dopamine is a dopamine-1 agonist at a (low, medium, high) dose which is this dosing range ________

A

LOW;

1 - 4 mcg/kg/min

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32
Q

Dopamine is a beta-1 agonist at a (low, medium, high) dose which is this dosing range ________

A

medium;

5 - 10 mcg/kg/min

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33
Q

Dopamine is a alpha-1 agonist at a (low, medium, high) dose which is this dosing range ________

A

HIGH;

10 - 20 mcg/kg/min

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34
Q

Boxed warning:
All vasopressors are _______ when given ____;
treat with ________

A

vesicants (cause extravasation); given IV

treat w/ phentolamine

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35
Q

Vasopressors should be given via a ______ line

A

central line

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36
Q

Monitoring for vasopressors?

A

CONTINUOUS BP monitoring
HR
MAP
ECG

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37
Q

Epinephrine dosing for IV push?

A

0.1 mg/mL (1 : 10,000 ratio strength)

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38
Q

Epinephrine dosing for IM injection or compounding IV products?

A

1 mg/mL (1: 1000 ratio strength)

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39
Q

Examples of vasopressors?

A 
Dopamine
Epinephrine
Norepinephrine
Phenylephrine
Vasopressin
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40
Q

Vasopressin — known as ______ and ______

A

AVP (arginine vasopressin) and ADH (antidiuretic hormone)

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41
Q

Examples of Vasodilators?

A

Nitroprusside
Nitroglycerin
nesiritide

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42
Q

Which vasodilator is used for MIs/ uncontrolled HTN

A

nitroglycerin

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43
Q

How long can you use Nitroglycerin?

A

24 - 48 hours MAX because of tachyphylaxis

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44
Q

Metabolism of which vasodilator will lead to toxicity via thiocynate or cyanide?

A

nitroprusside

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45
Q

which vasodilator is a recombinant B type natriuretic peptide (will work by binding to vascular smooth muscle and increase cGMP)?

A

Nesiritide

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46
Q

Which vasodilator requires a non-PVC container

A

nitroglycerin

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47
Q

Contraindications for nitroglycerin?

A

SBP < 90 mmHg;

concurrent use of PDE-5 inhibitors or riociguat

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48
Q

Warnings of nitroglycerin?

A

severe hypotension and increased intracranial pressure

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49
Q

which vasopressor requires light protection during administration?

A

nitroprusside

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50
Q

Nitroprusside: use only ______ solutions;

a ______ solution indicates degradation to cyanide and you must not use it!!

A

use CLEAR;

a blue colored solution = cyanide

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51
Q

which vasopressor is not used commonly? (because it has not been found to reduce mortality…)

A

nesiritide

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52
Q

Inotropes increase what?

A

contractility of the heart

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53
Q

what are some common inotropes?

A

DOBUTamine

Milrinone

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54
Q

Which inotrope MUST be dose reduced in renal impairment?

A

Milrinone

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55
Q

which inotrope might turn pink due to oxidation (but is still ok to use if it does turn pink?)

A

DOBUTamine

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56
Q

what color may dobuatmine may turn due to oxidation

A

pink

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57
Q

Shock = hypoperfusion usually due to hypotension

defined as
SBP < _____ mmHg
or
MAP < _____mmHg

A

SBP < 90

MAP < 70

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58
Q

4 main types of shock?

A

hypovolemic
distributive
cardiogenic
obstructive

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59
Q

1st line treatment for hypovolemic shock that is not caused by hemorrhage?

A

crystalloids

60
Q

Blood products for shock should be used when?

A

if Hgb < 7 (< 10 if CV pt)

or if significant active bleed

61
Q

Shock treatment principles (what 3 steps?)

A

Fill the tank: IV crystalloids
Squeeze the pipes: vasopressors - alpha agonist to cause vasoconstriction and thus increase SVR
Kick the pump: beta 1 agonist to increase myocardial contractility/cardiac output

62
Q

what is the only sedative approved for intubated AND non intubated patients

A

dexmedetomidine

63
Q

possible ways to decrease the incidence of delirium?

A

sedate with NON benzos

and/or shorten the duration in patients who already have it

64
Q

is it recommended to use haloperidol for delirium in ICU pts?

A

not recommended – very little evidence

65
Q

caution with injectable lorazepam??

A

formulated in propylene glycol — therefor risk for propylene glycol toxicity

66
Q

what is PRIS

A

propofol related infusion syndrome – rare but fatal

67
Q

propofol can cause which metabolic change?

A

high triglycerides….

monitor if used for more than 2 days

68
Q

Administration notes for Propofol:

Do not use filter < ______

A

5 micron

69
Q

Administration notes for Propofol:

Discard vial/tubing after _______

A

12 hours

70
Q

Administration notes for Propofol:

is a _____ in a _____ emulsion

A

oil in water

71
Q

Which sedative provides 1.1 kcal/mL?

A

propofol

72
Q

Dexmedetomidine:

do not exceed infusion > ______

A

24 hours

73
Q

MOA of dexmedetomidine?

A

alpha 2 adrenergic agonist

74
Q

risk factors for stress ulcer?

A 
**mechanical ventilation
coagulopathy**
sepsis
traumatic brain injury
burn patients
acute renal failure
high dose systemic steroids
75
Q

what are the different types of anesthetics?

A

local
regional
general

76
Q

what type of anesthetic will cause malignant hyperthermia

A

inhaled anesthetics

77
Q

examples of local anesthetics

A

lidocaine
benzocaine
LIPOSOMAL bupivacaine

78
Q

examples of inhaled anesthetics

A

desflurane
sevoflurane
nitrous oxide
isoflurane

79
Q

brand of desflurane?

A

Suprane

80
Q

brand of sevoflurane?

A

Ultane

81
Q

examples of injectable anesthetics?

A

bupivacaine
ropivacaine
lidocaine

82
Q

Bupivacaine (which is commonly found in ______) is FATAL if administered ______

A

found in epidurals;

fatal if administered IV

83
Q

Lidocaine (should or should not) be given dual routes (IV and topical)

A

should NOT

84
Q

Lidocaine and _______ are typically used together to keep lidocaine localized

A

epinephrine (causes vasoconstriction)

85
Q

what does NMBA stand for

A

neuromuscular blocking agent

86
Q

NMBAs cause _______ of _______

A

paralysis of skeletal muscle

87
Q

T or F: NMBAs help with pain AND sedation

A

false; it helps with NEITHER pain or sedation

patients must get adequate sedation/analgesia prior to NMBA

88
Q

NMBAs:

T or F: patients need mechanically ventilated

A

TRUE!

NMBAs cause diaphragm paralysis

89
Q

All NMBAs need a label that say ______ (per ISMP)

A

WARNING: PARALYZING AGENT

90
Q

types of NMBAs

A

depolarizing and polarizing

91
Q

Options for depolarizing NMBA?

A

only thing available = succinylcholine

92
Q

MOA of succinylcholine:
Resembles _______
binds to and activates _______ receptors which ________ them

A

resembles acetylcholine;
activates acetylcholine receptors;
desensitizes them

93
Q

Patients on NMBAs cannot move, blink, or breath…

can use _______ to reduce secretions

A

glycopyrrolate (anticholinergic

94
Q

what drugs can be used to reverse NMBAs?

A

neostigmine methylsulfate and sugammadex

95
Q

brand for neostigmine methylsulfate

A

Bloxiverz

96
Q

brand for sugammadex

A

Bridion

97
Q

neostigmine methylsulfate or sugammadex?

is an acetylcholinesterase inhibitor

A

neostigmine

98
Q

neostigmine methylsulfate and sugammadex?

reverses rocuronium or vercuronium (aka only reverses non-depolarizing agents)

A

sugammadex

99
Q

Examples of hemostatic drugs

A

Tranexamic Acid
Recombinant Factor VIIa
Aminocaproic Acid

100
Q

Topical hemostatic drugs are usually used in surgery:

It is usually _______ in a bunch of different dosage forms

A

thrombin

101
Q

Drug name examples for topical thrombin products

A

Recothrom

102
Q

IVIG stands for ?

A

intravenous immunoglobulin (IgG)

103
Q

Possible indications for IVIG?

A

immunodeficiency conditions, guillan barre, MS, myasthenia gravis

(look at products for specific indications)

104
Q

Some brand names for IVIG?

A 
Carimune NF
Flebogamma DIF
Gammagard
Gamunex-C
Octagam
Privigen
105
Q

How to dose IVIG?

A

use IBW!!

106
Q

Use a slower infusion rate for IVIG for what patients?

A

renal and cardiovascular disease patients

107
Q

Contraindication to using IVIG?

A

IgA deficiency

108
Q

Boxed Warnings for IVIG:

Acute _______; more common with products stabilized in _______

A

Acute renal dysfunction;

sucrose

109
Q

Boxed Warnings for IVIG:

Use with caution (because of acute renal issues) in what patients?

A

pts with…

  • renal disease
  • diabetes
  • volume depletion
  • sepsis
  • paraproteinemia
  • nephrotoxic medications
110
Q

Boxed Warnings for IVIG:

Can cause _______ even when no risk factors

A

thrombosis

111
Q

Monitoring for IVIG?

A

renal function
urine output
volume status

112
Q

Hyponatremia:
Considered < _____ mEq/L
but not symptomatic until ______ usually

A

< 135;

Symptomatic: < 120

113
Q

Hypotonic Hypovolemic Hyponatremia:

usually caused by?

A 
diuretics
salt wasting syndromes
adrenal insufficiency
blood loss
vomiting/diarrhea
114
Q

Hypotonic Hypovolemic Hyponatremia:

usually treated with

A

treat underlying cause… and sodium chloride solutions

115
Q

Hypotonic Hypervolemic Hyponatremia:

usually caused by?

A

fluid overload (because of cirrhosis, heart failure, or renal failure usually)

116
Q

Hypotonic Hypervolemic Hyponatremia:

usually treated with?

A

diuretics and fluid restriction

117
Q

Hypotonic Isovolemic Hyponatremia:

usually caused by?

A

SIADH (syndrome of inappropriate antidiuretic hormone)

118
Q

Arginine vasopression (AVP) receptor antagonists examples?

A

conivaptan or tolvaptan

119
Q

Arginine vasopression (AVP) receptor antagonists are usually used to treat what?

A

SIADH and hypervolemic hyponatremia

120
Q

Arginine vasopression (AVP) receptor antagonists are useful because they cause ______ excretion but while maintaining _______

A

water excretion;

maintain sodium

121
Q

Arginine vasopression (AVP) receptor antagonists aren’t used that much because they are a lot more expensive than ________

A

3% saline

122
Q

Correcting sodium more than _____mEq/L over ____ hours can cause issues

A

12 mEq/L over 24 hours

123
Q

what issues can happen if sodium is corrected too quickly

A

ODS (osmotic demyelination syndrome) or CPM (Central pontine myelination) or paralysis/seizures/death

124
Q

Contraindication to Conivaptan?

A

hypovolemic hyponatremia

anuria

125
Q

ADEs of Conivaptan?

A

orthostatic hypotension
fever
hypokalemia
infusion site reaction (very common)

126
Q

How is Conivaptan and Tolvaptan given?

A

Coni: IV
Tolva: PO - tablet

127
Q

Conivaptan or Tolvaptan?

which one is limited to less than 30 days for use due to hepatoxicity

A

Tolvaptan

128
Q

Contraindication to Tolvaptan?

A
  • people who cannot respond/sense response to thirst
  • if Na needs to increase quickly
  • anuria
129
Q

Warnings for Tolvaptan?

A

hepatoxicity

130
Q

ADEs for Tolvaptan?

A 
thirst 
nausea
dry mouth
polyuria
weakness
131
Q

Hypernatremia is > _____mEq/L

A

145

132
Q

Cause of hypovolemic hypernatremia - and how to treat???

A

dehydration
vomiting/diarrhea

tx w/ fluids

133
Q

Cause of hypervolemic hypernatremia - and how to treat???

A

caused by intake of hypertonic fluids

treated with diuresis

134
Q

Cause of Isovolemic (euvolemic) hypernatremia - and how to treat???

A

caused: by diabetes insipidus - which decreases ADH

tx with desmopressin

135
Q

Hypokalemia is < ____mEq/L

A

3.5

136
Q

Potassium:

A drop of 1 mEq/L in serum K+ = about a total body deficit of ____ - ____ mEq

A

100 - 400

137
Q

Potassium Replacement: (for safest replacement)

  • give thru a _____ line
  • infusion rate should be < _____ mEq/HOUR
A

peripheral

be < 10 mEq/hour

138
Q

Potassium Replacement:

if want to infuse K+ faster than 10 mEq/hour — what 2 things must you do

A

use CENTRAL line and have cardiac monitoring

139
Q

Maximum concentration of Potassium??

A

Max is 10 mEq/100 mL

140
Q

IV potassium can be fatal if given _______ or _______

A

given UNDILUTED or IV Push

141
Q

If hypokalemia is being resistant to treatment;

check serum ________ (it is needed for K+ uptake)

A

magnesium

142
Q

Hypomagnesium is < ___mEq/L

A

1.3

143
Q

When serum magnesium is less than _____ mEq/L there are life threatening symptoms that include what???

treat this how??

A

< 1 mEq/L
seizures and arrhythmias

IV magnesium SULFATE recommended here

144
Q

Magnesium replacement should continue for how long to fully replace body stores???

A

5 days

145
Q

Hypophosphotemia:
usually < ____ mg/dL

is it (usually asymptomatic/not life threatening) or is it (severe and symptomatic)

treat how??

A

1 mg/dL

severe and symptomatic

IV phosphorous

146
Q

Less severe hypophosphotemia can be treated orally — full replacement takes how long?

A

1 week or longer

NAPLEX Prep (19 decks)

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