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Pharm 2 Exam 2 > ED Meds > Flashcards

ED Meds Flashcards

1
Q

K normal range

A

Normal range is 3.5-4.5

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2
Q

Hypokalemia EKG findings

A

T wave inversion and prominent U waves

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3
Q

Hypokalemia sxs

A

Muscle weakness
Muscle cramps
Rhabdomyolysis
Respiratory failure
GI ileus
Arrhythmia

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4
Q

What other electrolyte should be treated before attempting to tx hypokalemia?

A

Hypomagnesemia - MUST correct Mag level before OR during correcting K

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5
Q

Which drugs cause hypokalemia?

A

Diuretics (R)
Loop
Thiazide
Antimicrobials (R)
Amphotericin B
Aminoglycosides
Penicillin
Mineralocorticoids (R)
Insulin (S)
Beta agonists (S)
Laxatives and enemas (G)

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6
Q

Which drugs cause renal loss of K?

A

Diuretics, antimicrobial abx, mineralocorticoids

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7
Q

Which drugs cause GI K loss?

A

Laxatives and enemas

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8
Q

Which drugs cause K to shift out intracellularly?

A

Insulin
Beta agonists

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9
Q

What is the rule of thumb w/ K dosing?

A

10mEq will raise the serum potassium by 0.1 mmol/dL - have to correct low mag first/ simultaneously

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10
Q

Cut offs for oral K supplementation vs IV?

A

3-3.4 can receive oral
< 3 IV is preferred +/- oral

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11
Q

Which K is preferred to be dosed IV?

A

Potassium chloride is preferred

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12
Q

K max rates in peripheral and central lines?

A

Peripheral line
Max rate is 10mEq/hr

Central line
Max rate is 40mEq/hr

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13
Q

Can you push K?

A

NEVER! Can cause cardiac arrest!

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14
Q

K SE

A

Oral:
GI: Diarrhea, nausea, vomiting, flatulence

IV:
CV: Cardiac arrest (if pushed), phlebitis, infusion site pain**

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15
Q

Which meds interact w/ K?

A

Anticholinergics

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16
Q

Hyperkalemia EKG findings

A

Peaked T waves
Lengthening of the PR and QRS duration

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17
Q

Mag normal range

A

Normal range is 1.8-2.2 mg/dL

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18
Q

Hypomagnesemia sxs

A

Lethargy
Muscle cramps/pain
Headaches
Tremor
Muscle fasciculations

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19
Q

Which drugs cause hypomagnesemia?

A

Diuretics
Loop
Thiazide
Antimicrobials
Amphotericin B
Aminoglycosides
Antitumoral
Cisplatin
Tyrosine kinase inhibitors
Proton pump inhibitors (PPI)
Laxatives and enemas
Immunosuppressants

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20
Q

1 gram is how many milliequivalents?

A

1gm = 8 mEq

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21
Q

Which route of Mag is preferred?

A

Oral

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22
Q

Typical Mag infusion rate?

A

Typical infusion rate is 1 gram/hr

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23
Q

In which situation would Mag be infused quicker?

A

Asthma exacerbation, Eclampsia

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24
Q

When can Mag be pushed?

A

Can be pushed in life threatening situations (Torsades)

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25
Q

Rule of thumb for Mag raising?

A

1gm will raise the serum magnesium level by 0.1 mg/dL

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26
Q

Mag uses

A

Hypomagnesemia
Asthma exacerbation
Eclampsia
Constipation
Migraines*
Torsades de pointes

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27
Q

Mag SE

A

CV: flushing, hypotension, vasodilation (with IV)
GI: Diarrhea (with PO), vomiting (with IV push)

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28
Q

Which drugs interact w/ Mag?

A

Bisphosphonates
Levothyroxine
Tetracyclines
Quinolones

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29
Q

Ca normal range

A

8.6 to 10.3 - Must be corrected for low albumin

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30
Q

Hypocalcemia sxs

A

Paresthesia
Muscle spasms
Cramps
Seizures

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31
Q

Hypocalcemia causing drugs

A

Bisphosphonates
Cinacalcet
Calcium chelators
Citrate, phosphate
Phenytoin
Chemotherapy
Cisplatin

32
Q

How much more elemental Ca is in calcium chloride than in calcium gluconate?

A

3x as much
Calcium chloride, 1 gram = 270 mg of elemental calcium
Calcium gluconate, 1 gram = 90 mg of elemental calcium

33
Q

In hyperkalemia, how should Ca be given?

A

In emergent situations (hyperkalemia with EKG changes), calcium can be pushed

34
Q

When is Ca gluconate preferred?

A

Calcium gluconate is preferred when a patient does not have a central line due to less phlebitis and pain

35
Q

Uses of Ca

A

Hypocalcemia
Beta-blocker overdose
Calcium channel blocker overdose
Hyperkalemia
Hydrofluoric acid burns

36
Q

Ca SE when given IV

A

CV: Hypotension (with IV push)

37
Q

Which drugs should not be given w/ Ca?

A

Quinolones
Tetracyclines
Bisphosphonates

38
Q

Na normal range

A

Normal range is 135-145 mEq/L

39
Q

Hyponatremia sxs

A

Restlessness and irritability
Headache
Confusion
Muscle weakness, cramps
Seizure
Coma

40
Q

Which drugs can cause hyponatremia?

A

Diuretics
Loop
Thiazide
Antidepressants
SSRIs
Antipsychotics
1st and 2nd Generation
Anticonvulsants
Carbamazepine, oxcarbazepine
Antimicrobials
Amphotericin B
Aminoglycosides
Chemotherapeutic
Cisplatin, cyclophosphamide, vinblastine, carboplatin

41
Q

Tx of severe hyponatremia

A

Immediate treatment with 100mL bolus of hypertonic (3%) saline IV
Maintenance rate of 30mL/hr of hypertonic saline via peripheral line

42
Q

Moderate hyponatremia tx

A

Depends on fluid status
Hypervolemic - Fluid and sodium restriction +/- diuretic
Euvolemic - 0.9% sodium chloride IV with or without diuretic
Hypovolemic - 0.9% sodium chloride IV or NaCl tablets 1-2g TID

43
Q

Max correction rate of Na

A

Max correction rate is 8 mEq/L per 24 hours

44
Q

Na SE

A

Osmotic demyelination syndrome (ODS) – occurs when sodium is corrected too quickly
Phlebitis, tissue necrosis (When IV hypertonic saline is administered to quickly)

45
Q

What is used in benzo OD?

A

Flumazenil - kicks off benzo

46
Q

In which pts can Flumazenil potentially cause a sz?

A

Never administer to chronic benzo users - if status unknown, avoid use

47
Q

What is the tx for ethylene glycol/ methanol OD?

A

Fomepizole or Ethanol

48
Q

Fomepizole or Ethanol MOA

A

Competitively inhibits alcohol dehydrogenase

49
Q

What happens to the urine of a pt who recently ingested antifreeze?

A

Urine of a patient who recently ingested antifreeze will glow when held to black light

50
Q

Digoxin OD tx

A

DigiFab

51
Q

Anthrax OF tx

A

Cipro

52
Q

Malignant hyperthermia tx

A

Dantrolene

53
Q

Lithium OD tx

A

NS

54
Q

Which rhythms can you shock?

A

V Tach and V Fib

55
Q

What are the non-shockable rhythms?

A

Asystole and pulseless electrical activity

56
Q

During cardiac arrest, what is the dosing for Epi when given to a pt w/ a shockable (pulseless V Tach, V Fib) rhythm?

A

1mg Q3-5 min (no max)

57
Q

During cardiac arrest, what is the dosing of Amiodarone given to a pt w/ a shockable (pulseless V Tach, V Fib) rhythm?

A

First dose: 300 mg bolus (push)
Second dose: 150 mg

58
Q

During cardiac arrest, what is the dosing of Epi given in a non-shockable rhythm?

A

Epi IV 1 mg Q3-5 min

59
Q

How often should rhythm be assessed during CPR?

A

Q2 mins

60
Q

When do we treat bradyarrhythmias?

A

When the pt is symptomatic

61
Q

What is the drug of choice for bradyarrhythmia?

A

Atropine IV dose:
1st dose: 1 mg IV bolus
Repeat every 3-5 minutes
Maximum: 3 mg

62
Q

Max atropine dose?

A

3 mg

63
Q

First step in tx tachyarrhythmia?

A

Assess if the pt is stable

64
Q

What happens if the pt has tachyarrhythmia and is unstable?

A

Shock - hope to break arrhythmia

65
Q

A pt w/ tachyarrhythmia is stable, what is next?

A

Check if QRS is wide (> 0.12s - SVT vs V Tach) to determine next steps

66
Q

A pt w/ tachyarrhythmia is stable w/ a wide QRS complex, what is the tx regimen?

A

Consider adenosine only if regular and monomorphic
Consider antiarrhythmic infusion

67
Q

A pt w/ tachyarrhythmia is stable w/ a narrow QRS complex, what is the tx regimen?

A

Adenosine (if regular)
BB or CCB

68
Q

Adenosine dosing for narrow complex tachyarrhythmia?

A

Adenosine IV dose:
1st dose: 6 mg IV push
2nd dose: 12 mg

69
Q

Amiodarone dosing for wide complex tachyarrhythmia?

A

Amiodarone IV:
1st dose: 150 mg/10min
Repeat PRN if VT recurs. Maintenance infusion: 1 mg/min for 6 hours

70
Q

Reversable causes of cardiac arrest?

A

Hypovolemia
Hypoxia
Hydrogen ion (acidosis) - MUDPILES
Hypo-/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thombosis, pulmonary
Thrombosis, coronary

71
Q

Hyperkalemia findings on EKG

A

Peaked T waves
Lengthening of the PR and QRS duration

72
Q

Treatment goals for hyperkalemia

A

Stabilize the cardiac membrane
Drive extracellular potassium into the cells
Remove potassium from the body

73
Q

What drugs are used to tx hyperkalemia?

A

IV Calcium gluconate or calcium chloride
IV Insulin - given with dextrose to avoid hypoglycemia
Albuterol nebulizer
Loop diuretics
Cation exchangers
+/- dialysis

74
Q

What is the purpose of IV Calcium gluconate or calcium chloride when tx hyperkalemia?

A

Stabilize the cardiac membrane

75
Q

What is the purpose of IV insulin and albuterol in tx hyperkalemia?

A

Drive extracellular potassium into the cells

76
Q

What is the purpose of loop diuretics, cation exchangers and dialysis when tx hyperkalemia?

A

Remove potassium from the body

Pharm 2 Exam 2 (8 decks)

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