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Therapeutics Fall Semester P3 > Cumulative Final - Acute Care (Foster) > Flashcards

Cumulative Final - Acute Care (Foster) Flashcards

1
Q

What is septic shock?

A

CV collapse + hypotension

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2
Q

How is septic shock treated?

A

Fluids (crystalloids or colloids)
Vasopressor (Norepinephrine) - goal MAP > 65

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3
Q

What do we give for refractory septic shock?

A

CCS

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4
Q

What drugs do we use for thromboprophylaxis?

A

LMWH (enoxaparin)
UFH

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5
Q

Dosing of enoxaparin for thromboprophylaxis

A

30 mg SQ Q12H or 40 mg SQ Q24H
If CrCl < 30: 30 mg SQ Q24H

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6
Q

Dosing of UFH for thromboprophylaxis

A

5000 U SQ Q8-12H
**No renal adjustment

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7
Q

What should we monitor if a patient is on UFH?

A

CBC + signs/symptoms of bleeding

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8
Q

If pt on prophylactic dose, do we adjust for aPTT?

A

NO!!!!!!!!!!!!!!!

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9
Q

Stress Ulcer prophylaxis tx

A

H2RA (famotidine/ranitidine) - adjust for renal dysfunction

PPI (-prazole)

EN (not used as monotherapy)

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10
Q

When do we stop stress ulcer prophylaxis

A

Once risk factors are no longer present

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11
Q

What routes can H2RAs be given?

A

EN or PN

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12
Q

PPI increases the risk for

A

C. Diff + nosocomial pneumonia

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13
Q

Goal blood glucose in ICU

A

144-180 mg/dL

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14
Q

When should insulin be initiated for ICU patients

A

When BG > 180 mg/dL

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15
Q

When should stool softeners and laxatives be D/C

A

Once the pt is having diarrhea/frequent stools

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16
Q

What is the result of using succinylcholine?

A

Paralysis

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17
Q

Succinylcholine resembles

A

ACh

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18
Q

Succinylcholine elimination

A

Via pseudocholinesterase (not renally or hepatically)

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19
Q

When is succinylcholine used?

A

For initial procedure to get ET tube placed; not used for sustained neuromuscular blockade

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20
Q

Succinylcholine SE

A

Apnea
Muscle fasciculations (deep aching muscle pain)
Hyperkalemia

**C/I in major burn, crush injury, and upper motor neuron disease

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21
Q

NDNMBA

A

Rocuronium

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22
Q

What is used for hypothermia

A

NDNMBA

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23
Q

What is the endpoint for NMBA?

A

Peripheral nerve stimulation

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24
Q

What type of endpoint is peripheral nerve stimulation? How many twitches is our goal?

A

Toxicity endpoint
1-2 twitches

25
Q

What is the gold standard to assess pain?

A

What the pt says

26
Q

If unable to self-report pain, what scales can be used?

A

Behavioral Pain Scale (BPS)
Critical Care Pain Observation Tool (CPOT)

27
Q

What is a SE of IV opioids?

A

Sedation

28
Q

Non-opioid analgesic options for pain

A

APAP
Neuropathic pain meds (gabapentin)
NSAIDs – bleed risk
Ketamine

29
Q

What frequency can IV opioid meds be given?

A

Bolus dosing
Continuous infusion
Mixed

30
Q

How do we tx agitation

A

With sedation

31
Q

What pts is oversedation problematic?

A

Pts not on a vent

32
Q

How can we assess sedation?

A

RASS and SAS scales

33
Q

What is BIS?

A

Bispectral index
*Digital scale from 100 (completely awake) to 0 (isoelectric EEG)
*Used only when other measures are not feasible

34
Q

Why have benzos fallen out of favor for agitation?

A

Potential association with delirium

35
Q

What can happen if benzos are not gradually tapered after a patient taking them for a long time?

A

Seizure

36
Q

Frequency of benzos

A

Bolus dosing
Continuous infusion

37
Q

Which IV medication contains a high dose of propylene glycol?

A

Lorazepam

38
Q

How do we measure propylene glycol toxicity?

A

Osmol gap
(>10 may indicate potential toxicity)

39
Q

What is the option for rapid sedation of acutely agitated patients?

A

Midazolam

40
Q

How many kcal in 1 ml of propafol?

A

1.1 kcal

41
Q

Propafol ADR

A

May cause global CNS issues; hypotension; bradycardia

42
Q

What are we concerned about with propofol at high doses?

A

Propofol infusion syndrome (acidosis, bradycardia, lipidemia)

43
Q

Recommendation for propofol preservative: EDTA

A

Drug holiday after 7d of tx

44
Q

What is the preferred sedative when rapid awakening is important?

A

Propofol

45
Q

Important points to know regarding propofol

A

-TG should be monitored after 48H
-Account for total caloric intake from propofol

46
Q

Clinical pearls for Dexmed

A

-Light degree of sedation
-NO respiratory depression
-Short half-life (easily titratable)
-AVOID loading dose

47
Q

What limits the use of Dexmed?

A

Bradycardia
Hypotension

48
Q

How is delirium diagnosed?

A

It is a clinical diagnosis – no test or lab value available to determine it

49
Q

Delirium is associated with ____

A

Mortality

50
Q

Assessments for delirium

A

ICDSC
CAM-ICU
**Assessment may be limited by level of arousal

51
Q

When is pharmacological tx initiated for delirium?

A

Not recommended for prevention or routine tx
-Initiated in pts with delirium with significant stress

52
Q

Which agents are used to tx delirium?

A

Haloperidol
Atypical antipsychotics (Risperidone, Olanzapine, Quetiapine)

53
Q

When would Dexmed be used for delirium?

A

Delirium where agitation is precluding weaning of vent/extubation

54
Q

Clinical pearl of haloperidol

A

DO NOT USE AS A CONTINUOUS INFUSION
DO NOT USE AS AN IV DRUG

55
Q

Adverse effect of haloperidol

A

Prolongation of QT interval on ECG – potential torsades de pointes
**Check pt EKG

Decreases seizure threshold

Possible EPS

56
Q

Atypical antipsychotic ADR

A

-Fewer EPS than haloperidol
-Risk of QT interval prolongation
Olanzapine associated with NMS in non-icu pts
-High olanzapine dose may cause hypotension

57
Q

Antipsychotic indication in delirium

A

Used short-term for tx of delirium with significant stress (anxiety, fear, hallucinations, agitation)

58
Q

Sedation algorithm

A

Protocol based “analgesia-first sedation”

59
Q

Sedation algorithm

A

-Propofol is preferred
-Dexmed for pt with delirium and agitation

Therapeutics Fall Semester P3 (7 decks)

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