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4th Semester > Critical care medications/ SEPSIS > Flashcards

Critical care medications/ SEPSIS Flashcards

1
Q

What is the sympathetic nervous system?

A

The flight or fight response, it mobilizes the body, and allows the body to function under stress

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2
Q

What are alpha 1 receptors and where are they located

A

The stimulation of alpha 1 receptors results in vasoconstriction. It responds strongly to norepinephrine and weakly to epinephrine
Alpha 1 receptors are located in blood vessels.

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3
Q

Where are beta 1 receptors located

A

The heart and kidney

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4
Q

What does stimulation of beta 1 receptors result in

A

Increased HR, contractility, conduction velocity, renin release in the kidney

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5
Q

Where are beta 2 receptors located

A

In the lungs. They are located in the smooth muscle of the bronchi and skeletal blood vessels

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6
Q

What does stimulation of beta 2 receptors result in

A

Relaxation of the bronchi and vasodilation

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7
Q

What are beta 2 receptors more sensitive to

A

They are more sensitive to epinephrine than norepinephrine

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8
Q

What are dopaminergic receptors

A

Receptor that upon there activation result in dilation

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9
Q

Where are dopaminergic receptors located

A

In the coronary arteries, renal, mesenteric, and the CNS

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10
Q

What medication is a neurotransmitter

A

Epinephrine,norepinephrine ( Levophed)

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11
Q

What is inotrope

A

A substance which affects myocardial contractility

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12
Q

What is a positive inotrope

A

Increased force of contraction

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13
Q

What is a negative inotrope

A

Decreased force of contraction

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14
Q

What is a chronotrope

A

A substance which affects the HR

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15
Q

What is a positive chronotrope

A

It equals increased HR

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16
Q

What is a negative chronotrope

A

Decreased HR

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17
Q

Preload

A

The volume/ pressure left in ventricle at the end of diastole

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18
Q

Wha is after load

A

The pressure of resistance against which the heart must pump

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19
Q

What is a agonist

A

A drug or substance that produces a predictable response ( stimulates action)

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20
Q

What is a antagonist

A

An agent that exerts an opposite action to another ( blocks the action

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21
Q

What is the trade name of epinephrine

A

Adrenaline

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22
Q

What are the clinical effects of epinephrine

A

Increased SVR, BP, HR, coronary and cerebral blood flow, contractility, and oxygen demand.

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23
Q

What is the mechanism of action for epinephrine

A

Alpha, beta 1,2

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24
Q

What are the beneficial effect of epinephrine

A

It produces beneficial effects in patients during cardiac arrest by of its alpha- Adrenergic stimulating properties

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25
Q

What is the trade name of dobutamine

A

Dobutrex

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26
Q

What is the mechanism of action for dobutamine

A

Strong beta 1, mild beta 2, weak alpha

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27
Q

What are the clinical effects of dobutamine

A

Increased CO, decreased SVR, slight increase in HR

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28
Q

What is the trade name of norepinephrine

A

Levophed

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29
Q

What is the mechanism of action for norepinephrine

A

Intense alpha and beta 1

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30
Q

What are the clinical effects of norepinephrine

A

Increased SVR, BP, bradycardia, some decrease in CO

decreased perfusion of kidney, brain, gut, and skeletal muscle

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31
Q

What are the clinical effects of phenylephrine

A

Increased SVR, BP, oxygen demand, slight increase in CO

decreased renal perfusion

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32
Q

What is the trade name of phenylephrine

A

Neosynephrine

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33
Q

What is the mechanism of action for phenylephrine

A

Potent alpha
No beta
Potent vasoconstrictor

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34
Q

What is isoproterenol

A

It increases HR,CO, contractility, extreme increase in myocardial oxygen consumption= myocardial ischemia, vasodilation

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35
Q

What is the mechanism of actin for isoproterenol

A

Pure beta 1 and 2

No alpha

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36
Q

What effects does milrinone have

A

It is an inotropic and vasodilator,
It increases cardiac contractility and CO
It decreases PCWP, AMD SVR
it does not significantly increase HR or myocardial oxygen demand

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37
Q

What is the clinical use for milirinone

A

Increased CI/ post op cardiac surgery

Increased cardiac function prior to heart transplant

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38
Q

What are complications for milrinone

A

Increased ectopy
Hypotension
Dysrthymias

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39
Q

What is vasopressin

A

A anti diuretic hormone with pressure and antidiuretic properties

40
Q

What are the effects of vasopressin

A

Promotes reabsorption of water in renal tubules.

Vasoconstrictor effect on GI TRACT

41
Q

What is the clinical use of vasopressin

A

It decreased urinary output in diuresis in diabetes insipidus
It controls GI hemmorhage from gastric and esophageal varies as an adjunct drug

42
Q

What are complications to monitor for with vasopressin

A

Anaphylaxis
Cardiac arrest
MI
POUNDING SENSATION IN HEAD

43
Q

What is nesiritide

A

A human BNP that inhibits ADH by increasing Na loss by kidney
Decreased fluid overload
Decreased PCWP, preload, AMD dyspnea

44
Q

What are complications to monitor for the nesiritide

A

Hypotension
Dysrthymias
Renal failure
Cough

45
Q

What drug is used for shock

A

Dopamine

46
Q

What drug is used to treat HF

A

Dobutamine

47
Q

What drug is used to treat ischemic LVF

A

Dobutamine

48
Q

What drug is used to treat renal failure

A

Dopamine

49
Q

What are complications to monitor for with dopamine

A

Tachyarrthymias

Immunosuppression

50
Q

What’s the clinical use of dopamine

A

Shock

Renal failure

51
Q

What’s the clinical use of dobutamine

A

Heart failure

Ischemic LVF

52
Q

What is the action of nitroglycerin

A

It is a vasodilator. It increases the coronary blood flow by dilating the coronary arteries. ( it is also shown to potentiate hypotensive effects of those who take erectile dysfunction medications.)

53
Q

What are the desired effects of nitroglycerin

A

It reduces systolic, diastolic and MAP,
It produces antianginal, anti ischemic, and anti hypertensive effects. when effective nitroglycerin prevents angina pectoris, controls CHF related to MI and controls HTN in the cardiac patient.

54
Q

What are the most common adverse effects of nitroglycerin

A

Headaches

Hypotension

55
Q

ADENOSINE is used for what

A

It is an anti arrthymic
It causes a block at the AV node
It is used for stable and unstable narrow complex tachycardia

56
Q

What are considerations of ADENOSINE

A

HR ,BP, AND CARDIAC PATTERN SHOULD BE MONITORED

PREPARE FOR A CODE SITUATION BY HAVING A CRASH CART, O2,SUCTION AND DEFIBRILLATOR ON HAND

57
Q

What are side effects of ADENOSINE

A

Facial flushing, Diaphoresis, light headedness,chest pain,and a sense of doom, the symptoms usually last less than one minute

58
Q

If the Dysrthymia returns, or does not convert with ADENOSINE, what should be used

A

A longer acting AV node blocking agent such as calcupium channel blockers or BETA BLOCKERS is the second line DRUG of choice

59
Q

What is dexamethosone used for

A

It produces a reduction in cerebral edema and an improvement in neurological symptoms within 8-48 hrs after dosing.

60
Q

What are side effects of dexamethosone

A

Euphoria, insomnia,increased appetite, wt gain,HTN,muscle weaknesss in the legs HTPERGLYCEMIA

61
Q

What is Phenytoin

A

It is an anti convulsant that works by blocking the repetitive action of the sodium channel

62
Q

Side effects of phenytoin

A

Hirutism,acne, gingival hyperplasia

63
Q

What are nursing considerations of phenytoin

A

Monitor ECG, and BP during administration and st least a half hour afterwards

64
Q

What is epinephrine administered for

A

Epinephrine infusion may be used to treat symptomatic bradycardia that is UNRESPONSIVE to atropine

65
Q

What are side effects of dopamine

A

Tachycardia
Arrthymias
Hypotension

66
Q

What is dilitiazem

A

A CCB that treats narrow complex tachycardia of rhythm remains uncontrolled or or unconverted by adenosine. It also controls ventricular rate in pull with a fib, or a flutter.

67
Q

What are side effects of dilitiazem

A

Hypotension
Bradycardia
AV heart block
Flushing, burning or itching at the injection site and CHF.

68
Q

What is Amiodarone

A

It is a anti arrhythmic agent that has similar actions to CCB on slowing conduction. It treats a fib, ventricular tachycardia and
V fib.

69
Q

What are are side effects of amiodarone

A

Hypotension
Bradycardia
QT interval prolongation
Torsades de pointes ( a type of ventricular tachycardia)

70
Q

Silver sulfadiazene is used for what

A

Both partial and full thickness burns, it has a broad spectrum bactericidal action against many gram neg and positive bacteria. Applications is painless
IT DOES NOT PENETRATE ESCHAR

71
Q

Side effect of silver sulfadiazene

A

Leukopenia

72
Q

What is propofol

A

Is has a very short duration of action
It is indicated when sedation is required but rapid awakening to perform neurological assessment or extubation is necessary

73
Q

What are nursing considerations of propofol

A

A large vein is recommended
Monitor for the development of hypotension
It has no analgesic properties
Monitor lipid levels, triglycerides

74
Q

What is Lidocaine

A

An anti arrhythmic drug that blocks the sodium channels decreasing cardiac automaticity and depolarization. Used as a second line drug in treating VT

75
Q

What process is impaired in ARDS

A

Alveolar perfusion and ventilation

76
Q

Who should be monitored closely for ARDS

A

A pt with acute pancreatitis

77
Q

What complications of propofol should be closely monitored

A

Hypotension and apnea

78
Q

Why does hyperglycemia worsen the clients neurological outcome

A

Hyperglycemia increases ischemic acidosis

79
Q

Most common complication of EVD

A

Meningitis

80
Q

What is a fluid/med that should be given for shock

A

Crystalloids 0.9% NaCl

81
Q

What should be given for hemmorhage

A

PRBC over whole blood bc it is less likely to cause coagulopathy or overload.

82
Q

What shouldn’t you give for a ICP patient

A

Don’t give isotonic fluids

83
Q

5 tubes for trauma patients

A 
O2
IV
SUCTION
FOLEY CATHETER
NG TUBE
84
Q

RTS

A

Revised trauma scale

Helps assign a score to help determine the severity of the trauma

85
Q

What is the lethal triad

A

Acute coagulopathy
Acidosis
Hypothermia

86
Q

What are causes of SEPSIS

A 
Pneumonia 
Peritonitis 
UTI
skin 
Hospital acquired VAP, MRSA
87
Q

What are signs and symptoms of SEPSIS

A 
Chills
Hypotension 
Decreased perfusion 
Decreased urinary output 
Significant edema or increased fluid balance  hyperglycemia above 120
Fever
88
Q

What is SIRS criteria

A 
Temp greater than 100.4
HR greater than 90
RR greater than 20
PACO2 less than 32
WBC greater than 12,000 or less than 4,000
89
Q

What is severe SEPSIS classified as

A

Dysfunction of 2 or more organ systems in response to hypoperfusion. It can develop suddenly or slowly

90
Q

How is SEPSIS treated

A

To be completed within 6 hrs of dx!
1. Measure serum lactate ( if increased indicates decreased perfusion)
2. Obtain blood culture b4 abx tx
3. NOW administer broad spectrum abx within 3 HR of ER visit and within 2 HR of non ER admission
4. Give initial fluid challenge of 500-100 ml over 30-60 min/ evaluate response monitor for overload
5 insert CVP line for repeat fluid challenges until CVP is greater than 8 or, 12-15 on a ventilator
5.

91
Q

If HCT is less than 30 what should you give

A

PRBC

92
Q

What drug increases O2 delivery

A

Dobutamine

93
Q

If the SEPSIS pt is experiencing refractory hypotension, what should the nurse do

A

Give vasopressors to maintain MAP above 80
The pt should have a arterial line
Give vasopressin if shock is refractory
Give norepinephrine or dopamine

94
Q

How is a fever treated in a septic patient

A

Alternate between ibuprofen and acetaminophen for fever greater than 102
Watch LFTs
Use hypothermic blanket if temp greater than 103
Prevent shivering by sedation/ paralytics

95
Q

What can be expected to be ordered in the septic patient

A

Give low dose steroids as ordered

Maintain tight glucose control of 80-150

96
Q

What is a complication of SEPSIS

A

SIRS

4th Semester (18 decks)

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