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PHRM 864 > E3 acute/critical care > Flashcards

E3 acute/critical care Flashcards

1
Q

hydrophilic drugs
(higher/lower) Vd in critically ill surgery/trauma pts than in medical pts

A

higher

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2
Q

T or F:
hepatic enzyme expression and activity may be decreased in some critically ill patients

A

true

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3
Q

what two common ICU states may be associated with increased renal elimination

A

burns and trauma

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4
Q

______ associated with cardiovascular collapse/hypotension

A

sepsis

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5
Q

3 treatment options for septic shock

A

fluids
vasopressors
corticosteroids

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6
Q

what two types of fluids are used for treatment of septic shock

A

crystalloids and colloids

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7
Q

vasopressors (increase/decrease) vascular tone

A

increase

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8
Q

Target MAP for vasopressors (tf is this?)

A

> 65 mmHg

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9
Q

what is the preferred vasopressor

A

norepi

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10
Q

what is the refractory option after norepi for septic shock

A

IV hydrocortisone

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11
Q

what treatment may decrease mortality in severe acute respiratory distress syndrome

A

corticosteroids

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12
Q
A
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13
Q

important things from FASTHUGSBID

A

Analgesia
sedation
thromboprophylaxis
ulcer prophylaxis
glycemic control
spontaneous awakening trial
delirium assessment

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14
Q

the majority of ICU patients should receive pharmacological VTE prophylaxis unless ?

A

sufficiently mobile and very low risk OR contraindications to pharmacological prophylaxis

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15
Q

Up to __% VTE incidence in medical ICU, up to __% in surgical settings

A

30, 70

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16
Q

is LMWH or UFH preferred for thromboprophylaxis

A

LMWH

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17
Q

general dose youd see of UFH

A

5000 U SC q8h or q12h

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18
Q

2 monitoring parameters for UFH

A

s/s bleeding, CBC

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19
Q

T or F:
UFH needs renally adjusted

A

false

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20
Q

T or F:
LMWH enoxaparin needs renally adjusted

A

true, reduce dose in CrCl <30

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21
Q

T or F:
LMWH dalteparin needs renally adjusted

A

false? it just says no adjustment needed

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22
Q

LMWH general doses

A

either 30 or 40 SC q12h

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22
Q

general dose of LMWH dalteparin

A

5000 USC q24h

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23
Q

stress ulcer prophylaxis:
stress related ______ damage

A

mucosal

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24
Q

few risk factors for stress ulcers

A

shock
coagulopathy
chronic liver disease
mechanical ventilation

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25
Q

most widely recognized risk factor for stress ulcers

A

mechanical ventilation

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26
Q

2 drug options for stress ulcer prophylaxis

A

H2Ras and PPIs

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27
Q

when to d/c SUP

A

when risk factors no longer present

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28
Q

1 listed rare adverse reaction of H2RAs

A

potential thrombocytopenia

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29
Q

T or F:
Famotidine is adjusted in renal dysfunction

A

true, lower dose if CrCl <30

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30
Q

highlighted thing that PPis have a potential to increase risk of

A

Cdiff

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31
Q

T or F:
PPis can be administered both enteral and parenteral

A

True

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32
Q

target BG in ICU

A

144-180

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33
Q

initiate insulin in ICU if BG >?

A

180

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34
Q

avoid what kind of insulin in unstable pts

A

long-acting

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35
Q

(hypo/hyper)motility is common in critical illness

A

hypomotility

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36
Q

gastroparesis (lower/upper) intestinal problem

A

upper

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37
Q

two promotility agents under gastroparesis

A

metoclopramide
erythromycin

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38
Q

when to d/c bowel regimen/ gastro drugs

A

if pt is having diarrhea/frequent stools

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39
Q

succinylcholine binds and activates what

A

Ach receptors

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40
Q

Succinylcholine:
sustained _________ of neuromuscular junction -> muscle contraction CANT occur

A

depolarization

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41
Q

Succinylcholine has ____ onset and _____ duration

A

fast and short

42
Q

what is succinylcholine eliminated by?

A

rapidly hydrolyzed by pseudocholinesterase

43
Q

T or F:
Succinylcholine is used for sustained neuromuscular blockade

A

false

44
Q

what is succinylcholine used for?

A

rapid sequence intubation
- placement of an endotracheal tube

45
Q

what might succinylcholine cause at first?

A

initial muscle contractions

46
Q

what electrolyte can succinylcholine make hyper (idk how tf to word this sorry)

A

potassium, can cause hyperkalemia

47
Q

when is succinylcholine CI’d?

A

major burns
crush injury
upper motor neuron disease

48
Q

T or F:
Succinylcholine can cause apnea

A

true, be ready to intubate

49
Q

if you have impaired pseudocholinesterase activity or decreased levels, what succinylcholine ADR can become worse?

A

can cause prolonged apnea because succinylcholine isnt getting eliminated

50
Q

T or F:
Succinylcholine can cause an elevation in intracranial pressure

A

true

51
Q

T or F:
Nondepolarizing NMBAs competitively block the action of Ach and activate the Ach receptor

A

false, they do not activate the receptor

52
Q

aminosteroidal and benzylisoquinolinium

A

2 general classes of nondepolarizing NMBAs

53
Q

what class are pyridostigmine and neostigmine

A

acetylcholinesterase inhibitors

54
Q

modified A-cyclodextrin for reversal of rocuonium/vecuronium

A

sugammadex

55
Q

-curonium

A

aminosteroidal NMBAs

56
Q

-curium

A

benzylisoquinolinium NMBAs

57
Q

NDNMBAs are generally indicated in what kind of pts?

A

pts with acute lung injury or acute respiratory distress syndrome

58
Q

NMBAs purely _______ and nothing else

A

paralyze

59
Q

main 2 adrs of NDNMBAs

A

paralysis of muscles and apnea

60
Q

when you see drug holidays what do you think about

A

decreasing incidencee of AQMS which is thee muscle weakness thing from nmbas and shit

61
Q

toxicity endpoint of sustained NMB

A

peripheral nerve stimulation

62
Q

for peripheral nerve stimulation you stimulate the nerve how many times?

A

4

63
Q

pain related stress response:
increases _________ nervous system activation, raises _________ levels

A

sympathetic
catecholamine

64
Q

behavioral pain scale and critical care observation tool

A

two options for ICU pts unable to self report pain

65
Q

2 scales for assessment of sedation

A

richmond-agitation-sedation scale

sedation-agitation scale

66
Q

bispectral index

A

assessment of sedation for pts that we cant use other scales on like pts with neuromuscular blockade or something like that

67
Q

benzos used in ICU

A

lorazepam and midazolam

68
Q

benzos bind and activate a specific site on the ____ receptor

A

GABA

69
Q

how is lorazepam metabolized

A

into inactive metabolite by glucoronidation

70
Q

what do IV formulations of lorazepam contain

A

propylene glycol solvent

71
Q

lorazepam has potential ______ ________ after high doses or prolonged infusions

A

lactic acidosis (because of propylene glycol)

71
Q

midazolam dosage form for this unit

A

IV only

72
Q

midazolam metabolized by what and where

A

CYP450 and liver

73
Q

T or F:
Midazolam is an option for controlled sedation

A

false, rapid

74
Q

alkylphenol sedative and hypnotic agent

A

propofol

75
Q

propofol
(slow/rapid) onset
(slow/rapid) offset

A

rapid both

76
Q

T or F:
propofol has analgesic properties

A

false

77
Q

why does propofol have a rapid onset?

A

easily penetrates BBB

78
Q

Propofol is ______ protein bound

A

highly

79
Q

T or F:
no PK changes reported with renal or hepatic dysfunction for propofol

A

true

80
Q

T or F:
propofol may reduce elevated intracranial pressure

A

true

81
Q

1.1 kcal/ml

A

propofol

82
Q

long term infusions of propofol may result in ?

A

hypertriglyceridemia

83
Q

4 highlighted adverse effects of propofol

A

apnea
hypotension
bradycardia
“propofol infusion syndrome”

84
Q

propofol preservative that can cause adverse effects

A

EDTA

85
Q

selective a-2 agonist

A

dexmet

86
Q

analgesic-sparing effects

A

dexmet

87
Q

T or F:
dexmet has no respiratory depression

A

true

88
Q

T or F:
dexmet may be associated with less delirium than BZDs

A

no fucking shit

89
Q

dexmet metabolized where, eliminated where and as what

A

liver, urine, glucuronide

90
Q

T or F:
you should always use a loading dose for dexmet

A

NEVER USE ONE

91
Q

3 adverse effects dexmet

A

transient inc in BP with rapid admin
bradycardia
hypotension

92
Q

dexmet recommended over bzds for what types of pts

A

critically ill and mechanically ventilated

93
Q

T or F:
Benzos are a non-modifiable risk for delirium

A

false, modifiable

94
Q

ICDSC and CAM-ICU

A

assessments of delirium

95
Q

T or F:
early mobilization may decrease delirium

A

true

96
Q

____________ may be used short term for treatment of delirium associated with significant stress (anxiety, fearfulness, hallucinations, agitation)

A

antipsychotics

97
Q

recommended for delirium where agitation is precluding weaning of vent/extubation

A

dexmet

98
Q

T or F:
there is evidence that haloperidol reduces duration of delirium

A

falsee

99
Q

main adverse effect of haloperidol

A

prolong QT -> torsades

100
Q

preferred sedative for rapid awakening

A

propofol

101
Q

what is the pharmacologic choice for prevention of delirium

A

none you idiot

PHRM 864 (28 decks)

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