Critical Care/Fluids Flashcards
1
Q
Peripheral nervous system breaks down into what 2 systems?
A
somatic and autonomic
2
Q
Somatic nervous system controls ________
vs
autonomic nervous system controls _______
A
somatic: muscle movement
autonomic: bodily functions (digestion, cardiac output, blood pressure)
3
Q
Autonomic nervous system breaks down into what different systems?
A
sympathetic and parasympathetic
4
Q
Sympathetic or Parasympathetic:
is the “rest and digest” system
A
parasympathetic
5
Q
Sympathetic or Parasympathetic:
is known as the fight/flight system
A
sympathetic
6
Q
Sympathetic or Parasympathetic:
will release NE and Epi to act on adrenergic receptors
A
sympathetic
7
Q
Sympathetic or Parasympathetic:
causes SLUDD
A
parasympathetic
8
Q
what does SLUDD stand for
A
salivation lacrimation urination diarrhea/defecation digestion
9
Q
Sympathetic or Parasympathetic:
releases Ach to act on muscarinic receptors
A
parasympathetic
10
Q
Sympathetic or Parasympathetic:
- will increase glucose production
- will increase bronchodilation
A
sympathetic
11
Q
Sympathetic or Parasympathetic:
will increase HR and BP
A
sympathetic
12
Q
Muscarinic receptors:
what happens with AGONIST action
A
increased SLUDD (salivation lacrimation urination diarrhea/defecation digestion)
13
Q
examples of muscarinic agonists?
A
pilocarpine
bethanecol
14
Q
examples of muscarinic antagonists?
A
atropine
oxybutynin
15
Q
Alpha 1 receptors:
what happens with AGONIST action
A
increased vasoCONSTRICTION
increased blood pressure
16
Q
examples of alpha 1 agonists?
A
phenylephrine
17
Q
examples of alpha 1 antagonists?
A
phentolamine
doxazosin ("alpha blockers")
18
Q
Alpha 1 receptors:
what happens with ANTAGONIST action
A
increased vasodilation (via smooth muscle relaxation) decreased blood pressure
19
Q
examples of beta 1 agonists?
A
dobutamine
20
Q
examples of beta 1 antagonists?
A
selective beta blockers and non-selective
21
Q
Beta 1 receptors:
what happens with ANTAGONIST action
A
decreased Cardiac output and HR
22
Q
Beta 1 receptors:
what happens with AGONIST action
A
increased Cardiac output and HR
23
Q
Beta 2 receptors:
what happens with AGONIST action
A
increased bronchodilation
24
Q
Beta 2 receptors:
what happens with ANTAGONIST action
A
bronchoCONSTRICTION
increased vasodilation
decreased BP
25
Examples of beta 2 AGONIST?
albuterol
| terbutaline
26
Examples of beta 2 antagonists?
non-selective beta blockers
27
Clonidine is a _________ agonist and leads to overall _______
CENTRALLY located alpha 2;
| overall DECREASED sympathetic output
28
Vasopressors:
work by stimulating ______ receptors
cause vaso________
which increased ______ and ______
alpha
vasoconstriction...
increased SVR (systemic vascular resistance)
increased blood pressure
29
______ is a natural precursor to NE
dopamine
30
which vasopressor's MOA (which receptors it hits) is dose dependent?
dopamine
31
Dopamine is a dopamine-1 agonist at a (low, medium, high) dose which is this dosing range ________
LOW;
| 1 - 4 mcg/kg/min
32
Dopamine is a beta-1 agonist at a (low, medium, high) dose which is this dosing range ________
medium;
| 5 - 10 mcg/kg/min
33
Dopamine is a alpha-1 agonist at a (low, medium, high) dose which is this dosing range ________
HIGH;
| 10 - 20 mcg/kg/min
34
Boxed warning:
All vasopressors are _______ when given ____;
treat with ________
vesicants (cause extravasation); given IV
treat w/ phentolamine
35
Vasopressors should be given via a ______ line
central line
36
Monitoring for vasopressors?
CONTINUOUS BP monitoring
HR
MAP
ECG
37
Epinephrine dosing for IV push?
0.1 mg/mL (1 : 10,000 ratio strength)
38
Epinephrine dosing for IM injection or compounding IV products?
1 mg/mL (1: 1000 ratio strength)
39
Examples of vasopressors?
```
Dopamine
Epinephrine
Norepinephrine
Phenylephrine
Vasopressin
```
40
Vasopressin --- known as ______ and ______
AVP (arginine vasopressin) and ADH (antidiuretic hormone)
41
Examples of Vasodilators?
Nitroprusside
Nitroglycerin
nesiritide
42
Which vasodilator is used for MIs/ uncontrolled HTN
nitroglycerin
43
How long can you use Nitroglycerin?
24 - 48 hours MAX because of tachyphylaxis
44
Metabolism of which vasodilator will lead to toxicity via thiocynate or cyanide?
nitroprusside
45
which vasodilator is a recombinant B type natriuretic peptide (will work by binding to vascular smooth muscle and increase cGMP)?
Nesiritide
46
Which vasodilator requires a non-PVC container
nitroglycerin
47
Contraindications for nitroglycerin?
SBP < 90 mmHg;
| concurrent use of PDE-5 inhibitors or riociguat
48
Warnings of nitroglycerin?
severe hypotension and increased intracranial pressure
49
which vasopressor requires light protection during administration?
nitroprusside
50
Nitroprusside: use only ______ solutions;
a ______ solution indicates degradation to cyanide and you must not use it!!
use CLEAR;
a blue colored solution = cyanide
51
which vasopressor is not used commonly? (because it has not been found to reduce mortality...)
nesiritide
52
Inotropes increase what?
contractility of the heart
53
what are some common inotropes?
DOBUTamine
| Milrinone
54
Which inotrope MUST be dose reduced in renal impairment?
Milrinone
55
which inotrope might turn pink due to oxidation (but is still ok to use if it does turn pink?)
DOBUTamine
56
what color may dobuatmine may turn due to oxidation
pink
57
Shock = hypoperfusion usually due to hypotension
defined as
SBP < _____ mmHg
or
MAP < _____mmHg
SBP < 90
MAP < 70
58
4 main types of shock?
hypovolemic
distributive
cardiogenic
obstructive
59
1st line treatment for hypovolemic shock that is not caused by hemorrhage?
crystalloids
60
Blood products for shock should be used when?
if Hgb < 7 (< 10 if CV pt)
| or if significant active bleed
61
Shock treatment principles (what 3 steps?)
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
what is the only sedative approved for intubated AND non intubated patients
dexmedetomidine
63
possible ways to decrease the incidence of delirium?
sedate with NON benzos
| and/or shorten the duration in patients who already have it
64
is it recommended to use haloperidol for delirium in ICU pts?
not recommended -- very little evidence
65
caution with injectable lorazepam??
formulated in propylene glycol --- therefor risk for propylene glycol toxicity
66
what is PRIS
propofol related infusion syndrome -- rare but fatal
67
propofol can cause which metabolic change?
high triglycerides....
monitor if used for more than 2 days
68
Administration notes for Propofol:
| Do not use filter < ______
5 micron
69
Administration notes for Propofol:
| Discard vial/tubing after _______
12 hours
70
Administration notes for Propofol:
| is a _____ in a _____ emulsion
oil in water
71
Which sedative provides 1.1 kcal/mL?
propofol
72
Dexmedetomidine:
| do not exceed infusion > ______
24 hours
73
MOA of dexmedetomidine?
alpha 2 adrenergic agonist
74
risk factors for stress ulcer?
```
**mechanical ventilation
coagulopathy**
sepsis
traumatic brain injury
burn patients
acute renal failure
high dose systemic steroids
```
75
what are the different types of anesthetics?
local
regional
general
76
what type of anesthetic will cause malignant hyperthermia
inhaled anesthetics
77
examples of local anesthetics
lidocaine
benzocaine
LIPOSOMAL bupivacaine
78
examples of inhaled anesthetics
desflurane
sevoflurane
nitrous oxide
isoflurane
79
brand of desflurane?
Suprane
80
brand of sevoflurane?
Ultane
81
examples of injectable anesthetics?
bupivacaine
ropivacaine
lidocaine
82
Bupivacaine (which is commonly found in ______) is FATAL if administered ______
found in epidurals;
fatal if administered IV
83
Lidocaine (should or should not) be given dual routes (IV and topical)
should NOT
84
Lidocaine and _______ are typically used together to keep lidocaine localized
epinephrine (causes vasoconstriction)
85
what does NMBA stand for
neuromuscular blocking agent
86
NMBAs cause _______ of _______
paralysis of skeletal muscle
87
T or F: NMBAs help with pain AND sedation
false; it helps with NEITHER pain or sedation
| patients must get adequate sedation/analgesia prior to NMBA
88
NMBAs:
| T or F: patients need mechanically ventilated
TRUE!
| NMBAs cause diaphragm paralysis
89
All NMBAs need a label that say ______ (per ISMP)
WARNING: PARALYZING AGENT
90
types of NMBAs
depolarizing and polarizing
91
Options for depolarizing NMBA?
only thing available = succinylcholine
92
MOA of succinylcholine:
Resembles _______
binds to and activates _______ receptors which ________ them
resembles acetylcholine;
activates acetylcholine receptors;
desensitizes them
93
Patients on NMBAs cannot move, blink, or breath...
| can use _______ to reduce secretions
glycopyrrolate (anticholinergic
94
what drugs can be used to reverse NMBAs?
neostigmine methylsulfate and sugammadex
95
brand for neostigmine methylsulfate
Bloxiverz
96
brand for sugammadex
Bridion
97
neostigmine methylsulfate or sugammadex?
| is an acetylcholinesterase inhibitor
neostigmine
98
neostigmine methylsulfate and sugammadex?
| reverses rocuronium or vercuronium (aka only reverses non-depolarizing agents)
sugammadex
99
Examples of hemostatic drugs
Tranexamic Acid
Recombinant Factor VIIa
Aminocaproic Acid
100
Topical hemostatic drugs are usually used in surgery:
| It is usually _______ in a bunch of different dosage forms
thrombin
101
Drug name examples for topical thrombin products
Recothrom
102
IVIG stands for ?
intravenous immunoglobulin (IgG)
103
Possible indications for IVIG?
immunodeficiency conditions, guillan barre, MS, myasthenia gravis
(look at products for specific indications)
104
Some brand names for IVIG?
```
Carimune NF
Flebogamma DIF
Gammagard
Gamunex-C
Octagam
Privigen
```
105
How to dose IVIG?
use IBW!!
106
Use a slower infusion rate for IVIG for what patients?
renal and cardiovascular disease patients
107
Contraindication to using IVIG?
IgA deficiency
108
Boxed Warnings for IVIG:
| Acute _______; more common with products stabilized in _______
Acute renal dysfunction;
sucrose
109
Boxed Warnings for IVIG:
| Use with caution (because of acute renal issues) in what patients?
pts with...
- renal disease
- diabetes
- volume depletion
- sepsis
- paraproteinemia
- nephrotoxic medications
110
Boxed Warnings for IVIG:
| Can cause _______ even when no risk factors
thrombosis
111
Monitoring for IVIG?
renal function
urine output
volume status
112
Hyponatremia:
Considered < _____ mEq/L
but not symptomatic until ______ usually
< 135;
Symptomatic: < 120
113
Hypotonic Hypovolemic Hyponatremia:
| usually caused by?
```
diuretics
salt wasting syndromes
adrenal insufficiency
blood loss
vomiting/diarrhea
```
114
Hypotonic Hypovolemic Hyponatremia:
| usually treated with
treat underlying cause... and sodium chloride solutions
115
Hypotonic Hypervolemic Hyponatremia:
| usually caused by?
fluid overload (because of cirrhosis, heart failure, or renal failure usually)
116
Hypotonic Hypervolemic Hyponatremia:
| usually treated with?
diuretics and fluid restriction
117
Hypotonic Isovolemic Hyponatremia:
| usually caused by?
SIADH (syndrome of inappropriate antidiuretic hormone)
118
Arginine vasopression (AVP) receptor antagonists examples?
conivaptan or tolvaptan
119
Arginine vasopression (AVP) receptor antagonists are usually used to treat what?
SIADH and hypervolemic hyponatremia
120
Arginine vasopression (AVP) receptor antagonists are useful because they cause ______ excretion but while maintaining _______
water excretion;
| maintain sodium
121
Arginine vasopression (AVP) receptor antagonists aren't used that much because they are a lot more expensive than ________
3% saline
122
Correcting sodium more than _____mEq/L over ____ hours can cause issues
12 mEq/L over 24 hours
123
what issues can happen if sodium is corrected too quickly
ODS (osmotic demyelination syndrome) or CPM (Central pontine myelination) or paralysis/seizures/death
124
Contraindication to Conivaptan?
hypovolemic hyponatremia
| anuria
125
ADEs of Conivaptan?
orthostatic hypotension
fever
hypokalemia
infusion site reaction (very common)
126
How is Conivaptan and Tolvaptan given?
Coni: IV
Tolva: PO - tablet
127
Conivaptan or Tolvaptan?
| which one is limited to less than 30 days for use due to hepatoxicity
Tolvaptan
128
Contraindication to Tolvaptan?
- people who cannot respond/sense response to thirst
- if Na needs to increase quickly
- anuria
129
Warnings for Tolvaptan?
hepatoxicity
130
ADEs for Tolvaptan?
```
thirst
nausea
dry mouth
polyuria
weakness
```
131
Hypernatremia is > _____mEq/L
145
132
Cause of hypovolemic hypernatremia - and how to treat???
dehydration
vomiting/diarrhea
tx w/ fluids
133
Cause of hypervolemic hypernatremia - and how to treat???
caused by intake of hypertonic fluids
treated with diuresis
134
Cause of Isovolemic (euvolemic) hypernatremia - and how to treat???
caused: by diabetes insipidus - which decreases ADH
tx with desmopressin
135
Hypokalemia is < ____mEq/L
3.5
136
Potassium:
| A drop of 1 mEq/L in serum K+ = about a total body deficit of ____ - ____ mEq
100 - 400
137
Potassium Replacement: (for safest replacement)
- give thru a _____ line
- infusion rate should be < _____ mEq/HOUR
peripheral
| be < 10 mEq/hour
138
Potassium Replacement:
| if want to infuse K+ faster than 10 mEq/hour --- what 2 things must you do
use CENTRAL line and have cardiac monitoring
139
Maximum concentration of Potassium??
Max is 10 mEq/100 mL
140
IV potassium can be fatal if given _______ or _______
given UNDILUTED or IV Push
141
If hypokalemia is being resistant to treatment;
| check serum ________ (it is needed for K+ uptake)
magnesium
142
Hypomagnesium is < ___mEq/L
1.3
143
When serum magnesium is less than _____ mEq/L there are life threatening symptoms that include what???
treat this how??
< 1 mEq/L
seizures and arrhythmias
IV magnesium SULFATE recommended here
144
Magnesium replacement should continue for how long to fully replace body stores???
5 days
145
Hypophosphotemia:
usually < ____ mg/dL
is it (usually asymptomatic/not life threatening) or is it (severe and symptomatic)
treat how??
1 mg/dL
severe and symptomatic
IV phosphorous
146
Less severe hypophosphotemia can be treated orally --- full replacement takes how long?
1 week or longer
