DRUGS

Question 1

Phenobarb MOA for alcohol withdrawal syndrome;

Answer 1

GABA agonist and glutamate antagonist effects

Hepatically metabolized; thus avoided in pts with liver failure

With liver failure, you have prolonged half-life and thus longer sedative effects

Question 2

MOA of dexemedotomidine?

Answer 2

Central a-2 acting agonist
Reduces anxiety, provides sedation without central respiratory depression

Question 3

SE of valproic acid?

Answer 3

Transaminitis and liver toxicity

Can be used to treat AWS

Question 4

MOA of alcohol?

Answer 4

Increase GABA release

Also acts as NMDA antagonist by decreasing glutamate levels

Question 5

What are the 3 indications for IV albumin administration in cirrhotic pts?

Answer 5

After large volume paracentesis
Hepatorenal syndrome
SBP

Question 6

SAFE trial?

Answer 6

Compared NS vs 4% albumin for resuscitation in ICU pts

No difference noted

Post-hoc analysis of SAFE trial showed pts with TBI receiving albumin for resuscitation had higher mortality

Question 7

Why is dapotmycin not a good abx for pneumonia?

Answer 7

Inactivated by surfactant

Question 8

Linezolid vs vanco for MRS pneumonia?

Answer 8

Linezolid better drug; excellent alveolar tissue penetration

Decreased nephrotoxicity compared to linezolid (ZEPHYR trial)

Question 9

MOA of methylene blue?

Answer 9

Helpful in pts with refractory shock on Levo/vaso with persistent vasoplegia

Decreases Nitric oxide by inhibiting nitric oxide synthetase

1-2 mg/kg bolus IV dose improves MAP and SVR and shown to decrease vasopressor requirements
To be effective, methylene blue has to be given within 8 hrs of septic shock

Question 10

MOA of midodrine?

Answer 10

Alpha-1 agonist

Used to treat symptomatic orthostatic hypotension

Question 11

MOA of isoproterenol?

Answer 11

Purely beta agonist

Beta 1/2

Increases cardiac contractility, heart rate and vasodilation

Used to provoke symptoms of hypertrophic cardiomyopathy

Question 12

MOA of TXA:

Answer 12

Synthetic derivative of amino acid lysine

Blocks the lysine binding site on plasminogen

Question 13

TEG parameter which reflects time of onset to clot formation:

Answer 13

R time

Normal is 5-10 minutes

When prolonged; need FFP

Question 14

Normal K time in TEG?

Answer 14

1-3 mins

Reflects beginning of clot formation

Tx; fibrinogen (cryoprecipitate)

Question 15

Normal alpha angle in TEG?

Answer 15

52-72%

Reflects speed of fibrin accumulation

If angle off; reflects fibrinogen deficit—> give cryo

Question 16

MOA of argatroban?

Answer 16

Direct thrombin inhibitor (Factor IIa)

Question 17

Monoclonal antibody fragment developed to rapidly reverse anticoagulant effects of dabigatran;

Answer 17

Idarucizumab

Question 18

Amiodarone?

Answer 18

Class III anti-arrhythmic
Used in monomorphic Vtach, not given in polymorphic V-tach

Slows conduction rate and prolongs the refractory period of the SA and AV nodes

Question 19

SE of amiodarone?

Answer 19

Interstitial lung disease
Liver dysfunction, elevated enzymes

Question 20

What does hydroxycobalamin do?

Answer 20

Used in suspected cyanide poisoning

Hydroxycobalamin is a precursor to Vit B 12; it binds cyanide in tissue and forms cyano-cobalamin

The molecule gets rapidly excreted in the urine’

Sxs; these pts are usually in house fires; w/sxs of cherry red skin colon, metabolic acidosis

Question 21

First line abx for ESBL?

Answer 21

Carbapenems

Question 22

Surviving sepsis guidelines for IV abx and IV fluid administration:

Answer 22

IV abx; within 1 hr

IVF: 30 ml/kg of crystalloids within 3 hrs

Question 23

Abx for Steph epi in an infected catheter?

Answer 23

Usually a contaminant

Remove the catheter because s. Epi causes biofilms to form

Question 24

Abx of choice for MRSA bacteremia:

Answer 24

Vanco
Dapto

Question 25

Linezolid for MRSA bacteremia?

Answer 25

Not FDA approved

SE of linezolid; pancytopenia/thrombocytopenia

Also interacts with. SSRIs

Question 26

Tx for Candida albicans?

Answer 26

Usually responsive to fluconazole

Question 27

What lab value do we monitor when concerned about daptomycin toxicity?

Answer 27

Creatinine kinase levels

Monitor CK levels once weekly while on adp to

Question 28

Tx for mucormycosis?

Answer 28

Liposomal amphoteracin B

Has less nephrotoxicity as amphoteracin B

Question 29

MC cause of bacterial meningitis in pts 15-50?

Answer 29

Strept pneumo and neisseria meningitidies

If pts pregnant consider adding penicillin for listeria monocytogenes coverage