ED Meds Flashcards
K normal range
Normal range is 3.5-4.5
Hypokalemia EKG findings
T wave inversion and prominent U waves
Hypokalemia sxs
Muscle weakness
Muscle cramps
Rhabdomyolysis
Respiratory failure
GI ileus
Arrhythmia
What other electrolyte should be treated before attempting to tx hypokalemia?
Hypomagnesemia - MUST correct Mag level before OR during correcting K
Which drugs cause hypokalemia?
Diuretics (R)
Loop
Thiazide
Antimicrobials (R)
Amphotericin B
Aminoglycosides
Penicillin
Mineralocorticoids (R)
Insulin (S)
Beta agonists (S)
Laxatives and enemas (G)
Which drugs cause renal loss of K?
Diuretics, antimicrobial abx, mineralocorticoids
Which drugs cause GI K loss?
Laxatives and enemas
Which drugs cause K to shift out intracellularly?
Insulin
Beta agonists
What is the rule of thumb w/ K dosing?
10mEq will raise the serum potassium by 0.1 mmol/dL - have to correct low mag first/ simultaneously
Cut offs for oral K supplementation vs IV?
3-3.4 can receive oral
< 3 IV is preferred +/- oral
Which K is preferred to be dosed IV?
Potassium chloride is preferred
K max rates in peripheral and central lines?
Peripheral line
Max rate is 10mEq/hr
Central line
Max rate is 40mEq/hr
Can you push K?
NEVER! Can cause cardiac arrest!
K SE
Oral:
GI: Diarrhea, nausea, vomiting, flatulence
IV:
CV: Cardiac arrest (if pushed), phlebitis, infusion site pain**
Which meds interact w/ K?
Anticholinergics
Hyperkalemia EKG findings
Peaked T waves
Lengthening of the PR and QRS duration
Mag normal range
Normal range is 1.8-2.2 mg/dL
Hypomagnesemia sxs
Lethargy
Muscle cramps/pain
Headaches
Tremor
Muscle fasciculations
Which drugs cause hypomagnesemia?
Diuretics
Loop
Thiazide
Antimicrobials
Amphotericin B
Aminoglycosides
Antitumoral
Cisplatin
Tyrosine kinase inhibitors
Proton pump inhibitors (PPI)
Laxatives and enemas
Immunosuppressants
1 gram is how many milliequivalents?
1gm = 8 mEq
Which route of Mag is preferred?
Oral
Typical Mag infusion rate?
Typical infusion rate is 1 gram/hr
In which situation would Mag be infused quicker?
Asthma exacerbation, Eclampsia
When can Mag be pushed?
Can be pushed in life threatening situations (Torsades)
Rule of thumb for Mag raising?
1gm will raise the serum magnesium level by 0.1 mg/dL
Mag uses
Hypomagnesemia
Asthma exacerbation
Eclampsia
Constipation
Migraines*
Torsades de pointes
Mag SE
CV: flushing, hypotension, vasodilation (with IV)
GI: Diarrhea (with PO), vomiting (with IV push)
Which drugs interact w/ Mag?
Bisphosphonates
Levothyroxine
Tetracyclines
Quinolones
Ca normal range
8.6 to 10.3 - Must be corrected for low albumin
Hypocalcemia sxs
Paresthesia
Muscle spasms
Cramps
Seizures
Hypocalcemia causing drugs
Bisphosphonates
Cinacalcet
Calcium chelators
Citrate, phosphate
Phenytoin
Chemotherapy
Cisplatin
How much more elemental Ca is in calcium chloride than in calcium gluconate?
3x as much
Calcium chloride, 1 gram = 270 mg of elemental calcium
Calcium gluconate, 1 gram = 90 mg of elemental calcium
In hyperkalemia, how should Ca be given?
In emergent situations (hyperkalemia with EKG changes), calcium can be pushed
When is Ca gluconate preferred?
Calcium gluconate is preferred when a patient does not have a central line due to less phlebitis and pain
Uses of Ca
Hypocalcemia
Beta-blocker overdose
Calcium channel blocker overdose
Hyperkalemia
Hydrofluoric acid burns
Ca SE when given IV
CV: Hypotension (with IV push)
Which drugs should not be given w/ Ca?
Quinolones
Tetracyclines
Bisphosphonates
Na normal range
Normal range is 135-145 mEq/L
Hyponatremia sxs
Restlessness and irritability
Headache
Confusion
Muscle weakness, cramps
Seizure
Coma
Which drugs can cause hyponatremia?
Diuretics
Loop
Thiazide
Antidepressants
SSRIs
Antipsychotics
1st and 2nd Generation
Anticonvulsants
Carbamazepine, oxcarbazepine
Antimicrobials
Amphotericin B
Aminoglycosides
Chemotherapeutic
Cisplatin, cyclophosphamide, vinblastine, carboplatin
Tx of severe hyponatremia
Immediate treatment with 100mL bolus of hypertonic (3%) saline IV
Maintenance rate of 30mL/hr of hypertonic saline via peripheral line
Moderate hyponatremia tx
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
Max correction rate of Na
Max correction rate is 8 mEq/L per 24 hours
Na SE
Osmotic demyelination syndrome (ODS) – occurs when sodium is corrected too quickly
Phlebitis, tissue necrosis (When IV hypertonic saline is administered to quickly)
What is used in benzo OD?
Flumazenil - kicks off benzo
In which pts can Flumazenil potentially cause a sz?
Never administer to chronic benzo users - if status unknown, avoid use
What is the tx for ethylene glycol/ methanol OD?
Fomepizole or Ethanol
Fomepizole or Ethanol MOA
Competitively inhibits alcohol dehydrogenase
What happens to the urine of a pt who recently ingested antifreeze?
Urine of a patient who recently ingested antifreeze will glow when held to black light
Digoxin OD tx
DigiFab
Anthrax OF tx
Cipro
Malignant hyperthermia tx
Dantrolene
Lithium OD tx
NS
Which rhythms can you shock?
V Tach and V Fib
What are the non-shockable rhythms?
Asystole and pulseless electrical activity
During cardiac arrest, what is the dosing for Epi when given to a pt w/ a shockable (pulseless V Tach, V Fib) rhythm?
1mg Q3-5 min (no max)
During cardiac arrest, what is the dosing of Amiodarone given to a pt w/ a shockable (pulseless V Tach, V Fib) rhythm?
First dose: 300 mg bolus (push)
Second dose: 150 mg
During cardiac arrest, what is the dosing of Epi given in a non-shockable rhythm?
Epi IV 1 mg Q3-5 min
How often should rhythm be assessed during CPR?
Q2 mins
When do we treat bradyarrhythmias?
When the pt is symptomatic
What is the drug of choice for bradyarrhythmia?
Atropine IV dose:
1st dose: 1 mg IV bolus
Repeat every 3-5 minutes
Maximum: 3 mg
Max atropine dose?
3 mg
First step in tx tachyarrhythmia?
Assess if the pt is stable
What happens if the pt has tachyarrhythmia and is unstable?
Shock - hope to break arrhythmia
A pt w/ tachyarrhythmia is stable, what is next?
Check if QRS is wide (> 0.12s - SVT vs V Tach) to determine next steps
A pt w/ tachyarrhythmia is stable w/ a wide QRS complex, what is the tx regimen?
Consider adenosine only if regular and monomorphic
Consider antiarrhythmic infusion
A pt w/ tachyarrhythmia is stable w/ a narrow QRS complex, what is the tx regimen?
Adenosine (if regular)
BB or CCB
Adenosine dosing for narrow complex tachyarrhythmia?
Adenosine IV dose:
1st dose: 6 mg IV push
2nd dose: 12 mg
Amiodarone dosing for wide complex tachyarrhythmia?
Amiodarone IV:
1st dose: 150 mg/10min
Repeat PRN if VT recurs. Maintenance infusion: 1 mg/min for 6 hours
Reversable causes of cardiac arrest?
Hypovolemia
Hypoxia
Hydrogen ion (acidosis) - MUDPILES
Hypo-/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thombosis, pulmonary
Thrombosis, coronary
Hyperkalemia findings on EKG
Peaked T waves
Lengthening of the PR and QRS duration
Treatment goals for hyperkalemia
Stabilize the cardiac membrane
Drive extracellular potassium into the cells
Remove potassium from the body
What drugs are used to tx hyperkalemia?
IV Calcium gluconate or calcium chloride
IV Insulin - given with dextrose to avoid hypoglycemia
Albuterol nebulizer
Loop diuretics
Cation exchangers
+/- dialysis
What is the purpose of IV Calcium gluconate or calcium chloride when tx hyperkalemia?
Stabilize the cardiac membrane
What is the purpose of IV insulin and albuterol in tx hyperkalemia?
Drive extracellular potassium into the cells
What is the purpose of loop diuretics, cation exchangers and dialysis when tx hyperkalemia?
Remove potassium from the body
