Drug Toxicities, HH vs DS, electrolytes Flashcards
Lithium
(Antimania)
Indications: Bipolar disorders - for Manic episodes not for depression
Therapeutic level
Toxic level
Other
Therapeutic level: 0.6 - 1.2
Toxic level: > 2
Other Gray area 1.3 - 2
Lithium
(Antimania)
Therapeutic level: 0.6 - 1.2
Toxic level: > 2
Other Gray area 1.3 - 2
What is it used for
Manic episodes for Bipolar disorder
Lanoxin/ Digoxin
Indications: A-fib, CHF
Therapeutic level:
Toxic level:
Others:
Therapeutic level:1 - 2
Toxic level: >2
Others:
Lanoxin / Digoxin
Therapeutic level:1 - 2
Toxic level: >2
Others:
Indications:
Indications: A-fib & CHF
Aminophylline
(Compound of bronchodilator theophylline)
Indications: Muscle Spasm relaxer for airway
Therapeutic:
Toxic level:
Other:
Therapeutic: 10 - 20
Toxic level: >20
Other: Non-therapeutic level <10 (in this case, increase dose and assess for compliance)
Aminophylline
(Compound of bronchodilator theophylline)
Therapeutic: 10 - 20
Toxic level: >20
Other: Non-therapeutic level <10 (in this case, increase dose and assess for compliance)
Indications;
Indicaciones: Muscle spams relaxer for airway
Dilantin (Phenytoin)
Indication Seizure Medicine
Therapeutic level:
Toxic level:
Therapeutic level: 10 - 20
Toxic level: >20
Dilantin (Phenytoin)
Therapeutic level: 10-20
Toxic level: >20
Indications:
Seizure Medication
Bilirubin
Indication: Breakdown produce of RBC’s
Therapeutic level:
Toxic:
Other:
Therapeutic level: 0.2 - 1.2 for adults, higher for newborns
Toxic: elevated newborn 10 - 20 & Toxic level for newborn is >20
Other: Hospitalize newborns if bili is > 14
Jaundice for excess bilirubin
Pathological: Jaundice within first 24 hrs of birth (concerning/ normal)
Physiological: Jaundice 2 to 3 days postpartum (concerning/ normal)
Pathological: Jaundice within first 24 hrs of birth concerning
Physiological: Jaundice 2 to 3 days postpartum normal
Kernicterus; Excess bilirubin in the brain (bili>20) may cause aseptic/sterile ____ or ______
Meningitis/ Encephalopathy
For Drug Toxicity
Pathological: Jaundice within first 24 hrs of birth (concerning/ normal)
Physiological: Jaundice 2 to 3 days postpartum (concerning/ normal)
Pathological: Jaundice within first 24 hrs of birth concerning
Physiological: Jaundice 2 to 3 days postpartum normal
Toxicity levels
Lithium (Antimania)
Lanoxin/ Digoxin
&
Aminophylline, Dilantin, Bilirubin
Lithium (Antimania)
Lanoxin/ Digoxin
>2
&
Aminophylline, Dilantin, Bilirubin
>20
Opisthotonos…
Hyperextended posistion that the new born assumes d/t irritation of the meninges from kernicterus
A newborn is in the Opisthotonos ( severe backward archingposition) from being kernicterus (bilirubin encephalopathy)
Which position would you put him in
On their side
Hiatal Hernia (does what)
Vs
Dumping Syndrome
regurgitation of acid into the esophagus, upper part of stomach herniates through diaphragm
Right rate but wrong direction
Follows gastric surgery
Gastric contents dump too quickly into duodenum.
Right direction wrong rate
Hatial Hernia S &S
GERD
It is a Haital Herina not just GERD if…
You eat & lay down then get GERD symptoms
Dumping Syndrome S&S
Drunk, Shock, Acute Abdominal Drestress
Drunk
Slurred, staggering, impaired, reaction time, liable
Shock
Hypotension, Tachycardia,
Skin: Pale, Cold, Clammy
Acute Abdominal Distress
Cramping, Pain, Guarding, Diarrhea, Boborigmi
Hiatal Hernia
Interventions
3 things (Elevate Everything)
Elevate HOB 1h post meals
Increase fluid with meals
Increase Carbs / Decrease Protein
(Protein stays in stomach longer)
Dumping Syndrome
Interventions
3 things (Lower Everything)
Lower HOB & turn pt on the side
Decrease fluid amount 1 to 2 hrs before and after meals
Decrease Carbs/ Increase Protein
(Protein prevents the stomach from emptying too quickly
Memorize
Kalemia (K+) do the same as the prefix except for HR & U/O
Hyperkalemia:
Seizures, Agitation, Irritability, Tented T Wave, ST elevation, Tachypnea, Diarrhea, borborygmi, spasticity, increased tone, hyperreflexia BRADYCARDIA / OLIGURIA
Hypokalemia:
Lethary, bradypnea, paralytic ileus, Constipation, muscle flaccid, hyporeflexia, 0,1, TACHYCARDIA, POLYURIA
How to memorize Hyper & Hypo Kalemia S & S
S & S go in same direction as Prefix
Except for HR and UO urine output
Obtunded
characterized by diminished responsiveness to stimuli, often due to a state of reduced consciousness:
Paralytic ileus(or adynamic ileus)
Motor Paralysis of the digestive tract secondary to neuromuscular failure
Clonus…
is involuntary and rhythmic muscle contractions caused by a permanent lesion in descending motor neurons.
Calcemia does the (opposite / same) of the Prefix
Oppsite
Select All that Apply
S & S of Hyperkalemia
Adynamic Illeus
Obtunded
+1 reflex
Colonus (involuntary, rhythmic muscle contractions)
U wave
Depressed ST wave
Polyuria
Bradycardia
Adynamic Illeus: NO
Obtunded: NO
+1 reflex: NO
Colonus: YES
U wave: NO
Depressed ST wave: NO
Polyuria: NO
Bradycardia: YES
Calcium goes low, everything goes (high/ low)
Calcium goes high, everything goes (high / low)
Calcium goes low, everything goes high
Calcium goes high, everything goes low
(Hypercalcemia/ Hypocalcemia)
Bradycardia
Bradypenea
Flaccid muscles
Constipation
Hyporeflexia
(Hypercalcemia/ Hypocalcemia)
Tachypnea
Tachypnea
Colonus
Diarrhea
Hyperreflexia
Hypercalcemia
Bradycardia
Bradypenea
Flaccid muscles
Constipation
Hyporeflexia
Hypocalcemia
Chvostek’s sign (twitching of facial muscles in response to tapping over the facial nerve)
Trousseau’s sign Carpopedal spasm induced inflated sphygmomanometer cuff.
Tachypnea
Tachypnea
Colonus
Diarrhea
Hyperreflexia
Which 2 signs / test indicate Hypocalcemia when positive
Chvostek’s sign (twitching of facial muscles in response to tapping over the facial nerve.
Trousseau’s sign (carpopedal spasm induced by inflated sphygmomanometer cuff.)
Magnesium does the (oppsite / same) as the prefix?
Low magnesium = (High/ Low) S&S
High magnesium = (High/ Low) S&S
Magnesium the oppsite as the prefix
Low magnesium = High S&S
High magnesium = Low S&S
Incase of a Tie in Electrolytes
(Pick / Don’t Pick ) Mg
If Skeletal Muscle or Nerve Blame it on (Ca, K, Na)
For every thing else select
Don’t Pick Mg; Why, not a major player
If Skeletal Muscle or Nerve Blame it on: Ca
For every thing else select: K
Patient has diarrhea, which causes it
A. Hyperkalemia
B. Hypokalemia
C. Hypomagnesemia
D. Hypocalcemia
A. Hyperkalemia
Because it isn’t Skeletal/ nerve muscle
Patient has tetany, which is the cause
A. Hyperkalemia
B. Hypokalemia
C. Hypocalcemia
D. Hypomagnesemia
C.
Because it is skeletal/ nerve muslce
Hyponatremia (Dehydration/ Fluid Overload)
Hypernatremia (Dehydration/ Fluid Overload)
Hyponatremia Fluid Overload
Hypernatremia Dehydration
LPN says “ I just ran a whole L in 10 min of D5W “
RESULT: Hypo / Hypernatremia
Hyponatremia
Which patient’s get Fluid Restrictions & Laskis
Hyponatremia/ Hypernatremia
Hyponatremia
Which patient’s are given lots of fluids
Hyponatremia/ Hypernatremia
Hypernatremia
Hot Flushed dry skin S & S
Hyponatremia/ Hypernatremia
Hypernatremia
DKA
These two electrolyte problem
Hyperkalemia & Hypernatremia
- Fluid volume excess
- SIADH
- DI
- HHNK
Hyponatremia / Hypernatremia
- Hyponatremia
- Hyponatremia
- Hypernatremia
- Hypernatremia (HHNK = Dehydration)
Earliest sign of any electrolyte imbalance is
(Paresthesia)
Numbness & Tingling
Universal Sign of Electrolytes Imbalance
Paresis Muscle Weakness
All electrolyte imbalance cause this
Paresis
Paresthesia
Numbness & Tingling
Muscle Weakness
Paresis: Muscle Weakness
Paresthesia: Numbness & Tingling
At which level of potassium does you push an IV
Never push a potassium IV
What is the maximum mL of K per liter you can give without calling the Dr. To verify order
40mL
Fastest way to lower K
D5W with Regular insulin
Drives Potassium back into cells from the bloodstream
Kayexalate (Full of sodium) goes into the gut and exchanges itself for (this electrolyte) which will then be pooped out
K potassium
What is the upside / downside to treating hypekalemia with…
D5W & Insulin
Kayexalate
D5W & Insulin
Upside: Immediate Actinf
Downside: Temporarily Fix, K is still inside body (in the Cells)
Kayexalate
Upside: Permanent Fix (K left the body)
Downside: Takes longer to work
Kernicterus
also known as bilirubin encephalopathy, is a rare but serious complication of untreated jaundice
in babies.
