E3 acute/critical care Flashcards
hydrophilic drugs
(higher/lower) Vd in critically ill surgery/trauma pts than in medical pts
higher
T or F:
hepatic enzyme expression and activity may be decreased in some critically ill patients
true
what two common ICU states may be associated with increased renal elimination
burns and trauma
______ associated with cardiovascular collapse/hypotension
sepsis
3 treatment options for septic shock
fluids
vasopressors
corticosteroids
what two types of fluids are used for treatment of septic shock
crystalloids and colloids
vasopressors (increase/decrease) vascular tone
increase
Target MAP for vasopressors (tf is this?)
> 65 mmHg
what is the preferred vasopressor
norepi
what is the refractory option after norepi for septic shock
IV hydrocortisone
what treatment may decrease mortality in severe acute respiratory distress syndrome
corticosteroids
important things from FASTHUGSBID
Analgesia
sedation
thromboprophylaxis
ulcer prophylaxis
glycemic control
spontaneous awakening trial
delirium assessment
the majority of ICU patients should receive pharmacological VTE prophylaxis unless ?
sufficiently mobile and very low risk OR contraindications to pharmacological prophylaxis
Up to __% VTE incidence in medical ICU, up to __% in surgical settings
30, 70
is LMWH or UFH preferred for thromboprophylaxis
LMWH
general dose youd see of UFH
5000 U SC q8h or q12h
2 monitoring parameters for UFH
s/s bleeding, CBC
T or F:
UFH needs renally adjusted
false
T or F:
LMWH enoxaparin needs renally adjusted
true, reduce dose in CrCl <30
T or F:
LMWH dalteparin needs renally adjusted
false? it just says no adjustment needed
LMWH general doses
either 30 or 40 SC q12h
general dose of LMWH dalteparin
5000 USC q24h
stress ulcer prophylaxis:
stress related ______ damage
mucosal
few risk factors for stress ulcers
shock
coagulopathy
chronic liver disease
mechanical ventilation
most widely recognized risk factor for stress ulcers
mechanical ventilation
2 drug options for stress ulcer prophylaxis
H2Ras and PPIs
when to d/c SUP
when risk factors no longer present
1 listed rare adverse reaction of H2RAs
potential thrombocytopenia
T or F:
Famotidine is adjusted in renal dysfunction
true, lower dose if CrCl <30
highlighted thing that PPis have a potential to increase risk of
Cdiff
T or F:
PPis can be administered both enteral and parenteral
True
target BG in ICU
144-180
initiate insulin in ICU if BG >?
180
avoid what kind of insulin in unstable pts
long-acting
(hypo/hyper)motility is common in critical illness
hypomotility
gastroparesis (lower/upper) intestinal problem
upper
two promotility agents under gastroparesis
metoclopramide
erythromycin
when to d/c bowel regimen/ gastro drugs
if pt is having diarrhea/frequent stools
succinylcholine binds and activates what
Ach receptors
Succinylcholine:
sustained _________ of neuromuscular junction -> muscle contraction CANT occur
depolarization
Succinylcholine has ____ onset and _____ duration
fast and short
what is succinylcholine eliminated by?
rapidly hydrolyzed by pseudocholinesterase
T or F:
Succinylcholine is used for sustained neuromuscular blockade
false
what is succinylcholine used for?
rapid sequence intubation
- placement of an endotracheal tube
what might succinylcholine cause at first?
initial muscle contractions
what electrolyte can succinylcholine make hyper (idk how tf to word this sorry)
potassium, can cause hyperkalemia
when is succinylcholine CI’d?
major burns
crush injury
upper motor neuron disease
T or F:
Succinylcholine can cause apnea
true, be ready to intubate
if you have impaired pseudocholinesterase activity or decreased levels, what succinylcholine ADR can become worse?
can cause prolonged apnea because succinylcholine isnt getting eliminated
T or F:
Succinylcholine can cause an elevation in intracranial pressure
true
T or F:
Nondepolarizing NMBAs competitively block the action of Ach and activate the Ach receptor
false, they do not activate the receptor
aminosteroidal and benzylisoquinolinium
2 general classes of nondepolarizing NMBAs
what class are pyridostigmine and neostigmine
acetylcholinesterase inhibitors
modified A-cyclodextrin for reversal of rocuonium/vecuronium
sugammadex
-curonium
aminosteroidal NMBAs
-curium
benzylisoquinolinium NMBAs
NDNMBAs are generally indicated in what kind of pts?
pts with acute lung injury or acute respiratory distress syndrome
NMBAs purely _______ and nothing else
paralyze
main 2 adrs of NDNMBAs
paralysis of muscles and apnea
when you see drug holidays what do you think about
decreasing incidencee of AQMS which is thee muscle weakness thing from nmbas and shit
toxicity endpoint of sustained NMB
peripheral nerve stimulation
for peripheral nerve stimulation you stimulate the nerve how many times?
4
pain related stress response:
increases _________ nervous system activation, raises _________ levels
sympathetic
catecholamine
behavioral pain scale and critical care observation tool
two options for ICU pts unable to self report pain
2 scales for assessment of sedation
richmond-agitation-sedation scale
sedation-agitation scale
bispectral index
assessment of sedation for pts that we cant use other scales on like pts with neuromuscular blockade or something like that
benzos used in ICU
lorazepam and midazolam
benzos bind and activate a specific site on the ____ receptor
GABA
how is lorazepam metabolized
into inactive metabolite by glucoronidation
what do IV formulations of lorazepam contain
propylene glycol solvent
lorazepam has potential ______ ________ after high doses or prolonged infusions
lactic acidosis (because of propylene glycol)
midazolam dosage form for this unit
IV only
midazolam metabolized by what and where
CYP450 and liver
T or F:
Midazolam is an option for controlled sedation
false, rapid
alkylphenol sedative and hypnotic agent
propofol
propofol
(slow/rapid) onset
(slow/rapid) offset
rapid both
T or F:
propofol has analgesic properties
false
why does propofol have a rapid onset?
easily penetrates BBB
Propofol is ______ protein bound
highly
T or F:
no PK changes reported with renal or hepatic dysfunction for propofol
true
T or F:
propofol may reduce elevated intracranial pressure
true
1.1 kcal/ml
propofol
long term infusions of propofol may result in ?
hypertriglyceridemia
4 highlighted adverse effects of propofol
apnea
hypotension
bradycardia
“propofol infusion syndrome”
propofol preservative that can cause adverse effects
EDTA
selective a-2 agonist
dexmet
analgesic-sparing effects
dexmet
T or F:
dexmet has no respiratory depression
true
T or F:
dexmet may be associated with less delirium than BZDs
no fucking shit
dexmet metabolized where, eliminated where and as what
liver, urine, glucuronide
T or F:
you should always use a loading dose for dexmet
NEVER USE ONE
3 adverse effects dexmet
transient inc in BP with rapid admin
bradycardia
hypotension
dexmet recommended over bzds for what types of pts
critically ill and mechanically ventilated
T or F:
Benzos are a non-modifiable risk for delirium
false, modifiable
ICDSC and CAM-ICU
assessments of delirium
T or F:
early mobilization may decrease delirium
true
____________ may be used short term for treatment of delirium associated with significant stress (anxiety, fearfulness, hallucinations, agitation)
antipsychotics
recommended for delirium where agitation is precluding weaning of vent/extubation
dexmet
T or F:
there is evidence that haloperidol reduces duration of delirium
falsee
main adverse effect of haloperidol
prolong QT -> torsades
preferred sedative for rapid awakening
propofol
what is the pharmacologic choice for prevention of delirium
none you idiot
