Critical Care Medications Flashcards
What is a Central Venous Access Device (CVAD)?
An IV catheter that administers meds / fluids directly to the Superior Vena Cava
A CVAD can address blood and fluid volume needs, deliver meds, and improve or maintain-
Organ Perfusion
Movement of oxygenated blood through the body to the tissues =
Perfusion
Large volume IV bolus infusions are usually given as-
A one time prescription
Large volume IV infusions on a continuous basis are administered for-
Fluid & Electrolyte Replacement + Administering Meds
Volume of IV medication / fluid administered over a set period of time =
Intermittent IV Bolus Infusion
An Intermittent IV Bolus Infusion can also be called-
IV Piggyback
An Intermittent IV Bolus Infusion usually contains how much of a med?
50 - 250 mL of solution
Involve a small amount of med, either concentrated or diluted, and are administered over a short time =
Small-Volume IV Bolus Infusion
How long does it take to administer a Small-Volume IV Bolus Infusion?
About 1-5 min
A Small-Volume IV Bolus Infusion can also be called an-
IV Push
A condition of severe hypotension and decreased tissue perfusion =
Shock
What’s a Hemorrhage?
A loss of blood, externally or internally
During a fluid Bolus, what symptoms should be monitored for?
Wheezing, Dyspnea, or other indications of Fluid Overload
When administering a Large Volume Bolus, what should be used to allow for rapid infusion of the fluid?
A Central Line or Large Gauge Angiocatheter
What is an Angiocatheter?
A flexible tube inserted to a blood vessel to administer IV meds or fluids
What are Continuous IV Med Infusions prescribed in?
Units/hr
Mg/hr
Mg/min
Mcg/kg/min
What is Heparin?
A med that prevents the formation of blood clots
How is Heparin administered?
Only available for SUBQ or IV injection
What can be administered after the pt has an Acute Myocardial Infarction to prevent the formation of blood clots?
IV Heparin
What can IV Heparin do for pt’s with Venous Thrombosis or a Pulmonary Embolism?
Helps prevent additional clot formation or the further development of existing clots
What should always be available to prevent potential Heparin overdose?
Protamine Sulfate
What does Magnesium Sulfate do?
Activates many intracellular enzymes + Helps regulate skeletal muscle contractility + Helps blood coagulation
Magnesium Sulfate is important for the treatment of-
Seizures caused by Eclampsia, Acute Myocardial Infarction, Cardiac Arrest, Preterm Labor, Magnesium Deficiency
What is Eclampsia?
A Hypertensive Disorder after the 20th week of Gestation that results in Seizures
What should be monitored after administering Magnesium Sulfate?
Cardiac Status, Neuromuscular Status, Serum Magnesium Levels, Signs of Magnesium Toxicity
What are the signs of Magnesium Toxicity?
Hypotension, Depressed Cardiac Function, Depressed / Absent Deep Tendon Reflexes, Respiratory Depression
What should always be made available in case of a potential overdose of Magnesium Sulfate?
Calcium Gluconate
What is Labetalol?
A 3rd Generation Beta Blocker (Has Alpha and Beta activity)
What does a Alpha Blockade result in?
Vasodilation (Which Decreases Peripheral Resistance and Lowers BP)
What does a Beta Blockade do?
Decreases HR, Myocardial Contractility, and the AV Node’s Conduction Rate
Labetalol’s Vasodilation effect makes this med effective for-
Severe Hypertension
What should be monitored when taking Labetalol (Non-Intravenously)?
Vital Signs and Cardiac Status
What should be monitored when taking IV Labetalol?
Monitor for Hypotension, Bradycardia, Nausea, Dizziness, Pulmonary Edema, Sweating
What is Dopamine?
An Alpha and Beta Adrenergic Agonist
What do meds with an Adrenergic Affect mimic?
The Sympathetic Nervous System
What receptors in the heart are affected by Dopamine?
Beta 1 Receptors
What does Dopamine do to Cardiac Output?
Increases it
How can Dopamine increase Tissue Perfusion?
Increased Cardiac Output = Increased Tissue Perfusion
How does Dopamine affect the kidneys?
It activates Dopamine Receptors in the kidneys
When the kidney’s Dopamine Receptors are activated, what occurs?
The Renal Vessels will Dilate, causing an Increased Glomerular Filtration Rate (GFR) and Urinary Output
Dopamine’s effects on the kidneys (Increased GFR + Urinary Output) are good for treating-
Heart Failure, Cardiogenic Shock, and Septic Shock, where there’s a need for cardiac stimulation and Vasopressor action
What’s a Vasopressor?
A med that stimulates contraction of blood vessels + Increased BP
What should be frequently checked when administering Dopamine?
Vital Signs
Continuously Monitor Cardiac Status (Observe for Tachycardia, Dysrhythmias, Angina Pectoris, and Myocardial Infarction)
Monitor IV site closely for Extravasation
What is Angina Pectoris?
A type of chest pain that occurs when the heart doesn’t get enough blood and oxygen
What can high doses of Dopamine cause?
Alpha 1 Activation, leading to Local Vasoconstriction
What is it called when you modify the volume of a fluid / med in order to maintain physiological parameters?
You are Titrating the substance
What are some examples of Physiological Parameters?
BP + HR + Cardiac Output + Sedation Level
You can Titrate an IV infusion of Dopamine to maintain a Systolic BP between-
110 - 130 mmHg
Some of the meds that require Titrating include-
Heparin, Nitroprusside, Norepinephrine, Dobutamine, Nitroglycerin
Meds should be Titrated in very small increments to avoid-
Extreme Fluctuations in Vital Signs
What is Nitroprusside?
A non-nitrate Vasodilator that causes direct Vasodilation of both arteries and veins
What does taking Nitroprusside do to you?
Causes rapid reduction of BP
What is a Vasodilator?
A type of med that results in the Dilation (Widening) of blood vessels
What things is Nitroprusside used to treat?
Hypertensive Crisis + Acute Heart Failure
When do the effects of Nitroprusside take effect after administration?
Immediately
What cardiac changes can Nitroprusside cause?
Bradycardia + Tachycardia + ECG Changes
What things should be monitored when a pt takes Nitroprusside?
Vitals (Cardiac Status + BP)
Signs of Thiocyanate Toxicity
What are the signs of Thiocyanate Toxicity?
Blurred Vision, Tinnitus, Fatigue, Absent Reflexes, Changes in Mental Status
What is important to keep in mind about Nitroprusside before administering?
It’s light sensitive, so the solution container has to be placed in an opaque wrapper and used within 24 hr
What is Nitroglycerin?
An organic nitrate that causes direct Vasodilation of both arteries and veins
What does taking Nitroglycerin result in?
Decreased BP + Decreased Veinous Return + Decreased Cardiac Oxygen Demand
Nitroglycerin can be used to treat-
Acute Coronary Syndrome
Angina
Myocardial Infarction
Hypertensive Crisis
How can Nitroglycerin be administered?
Sublingually + as a Spray + Transmucosal Tablet + Tropical Ointment + Continuous IV Infusion
What do Preloaded Mini-Injection Systems provide?
Easy access + quick delivery of a med during an emergency
What are some meds that are available as a Mini-Injection System?
Atropine, Lidocaine, Sodium Bicarbonate, Epinephrine
How much med does one Mini Injection System hold?
1 Adult Dose
When using a Mini Injection System, what should be used if available?
A Central Line
