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ED/Surgery > ED/Surgery Meds > Flashcards

ED/Surgery Meds Flashcards

1
Q

How to adjust blood pressure in ED?

A

BP too high = Hydralazine

BP too low = Norepinephrine

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2
Q

How to adjust HR in ED?

A

HR too high = Cardizem

HR too low = Dopamine

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3
Q

How to adjust glucose in ED?

A

BG too high = Regular Insulin IV

BG too Low = D50 or D5 ½ NS IV

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4
Q

How to medically sedate an agitated patient?

A

B52 (Benadryl 25mg, Haldol 5mg, Ativan 2mg) IV

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5
Q

How to treat opioid overdose?

A

Naloxone (Narcan)

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6
Q

IV anti-inflammatory of choice in ED

A

Decadron IM, Solu-Medrol IV

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7
Q

How to treat fever in ED - baby vs adult?

A 
Baby = Tylenol PR
Adult = Toradol IV
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8
Q

How to treat vomiting in ED - baby vs adult?

A 
Baby = Zofran liquid
Adult = Zofran ODT, Phenergan PR
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9
Q

Common sedation meds for babies and adults

A 
Baby = Versed nasally
Adult = Propofol  IV
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10
Q

How to treat emergency dyspnea?

A

DuoNeb SVN

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11
Q

Treatment for Croup

A

Racemic Epinephrine SVN

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12
Q

Antibiotic for common infections in children seen in ER

A

Bactroban Top, Amoxicillin PO, Omnicef PO

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13
Q

Go-to antibiotics for lungs

A

Azithromycin

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14
Q

Go-to antibiotics for GI infections

A

Cipro and Flagyl

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15
Q

Go-to antibiotic for most ENT infections

A

Amoxicillin, PCN for throat, Augmenting for sinuses

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16
Q

Antibiotics for mild, moderate, and severe UTI

A 
Mild = Macrobid
Moderate = Bactrim
Severe = Cipro
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17
Q

Go-to antibiotics for skin infections

A

Keflex (+ Bactrim for MRSA)

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18
Q

What is a broad spectrum antibiotic good for empirical treatment of most infections?

A

Doxycycline

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19
Q

A 48 yo woman has difficulty breathing and a pulse ox of 88%. She smokes tobacco and has a history of childhood asthma but hasn’t had any issues for several years. What treatment should be given right away before further evaluation?

A

Albuterol + ipratropium

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20
Q

When choosing treatment for hypertensive emergencies, what characteristics of drug are most optimal?

A

Rapid onset
Short duration
Parenteral formulation
Modest potency (more gradual BP reduction)

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21
Q

What anti-HTN meds are most appropriate in HTN emergency?

A

Enalaprilat (ACE), Hydralazine, Labetalol (BB), Nicardipine (CCB), Nitropusside (vasodilator)

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22
Q

A 55 year old man had a lymph node biopsy last week which became infected and now he is septic. He is hypotensive despite IV fluids and there is a concern that he is in shock. He has no arrhythmias on EKG. Which med is most appropriate in treating his hypotension?

A

Norepinephrine

  • Epi better for anaphylactic shock
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23
Q

Which type of insulin when given intravenously is most appropriate in bringing down the blood glucose in a patient with diabetic ketoacidosis?

A

IV short-acting like regular insulin

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24
Q

You are managing a patient’s glucose levels with insulin and now they have become hypoglycemic such that they have lost consciousness. You have IV access. What is most appropriate treatment?

A

hypertonic IV fluids - Dextrose (D50)

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25
Q

You are interviewing an intoxicated patient when they start speaking loudly and aggressively, pounding on walls, and throwing things. You decide to chemically restrain the patient. What med is both safe and effective?

A

Lorazepam

  • B52 best for patient with acute/severe psychosis
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26
Q

Patient has become somnolent from too much Lorazepam. What can you give to wake him up?

A

Flumazenil (benzo receptor antagonist)

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27
Q

A 55 year old woman has claustrophobia and needs an MRI scan. Which med should be used for sedation?

A

Midazolam

  • Ketamine also good but has more side effects
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28
Q

Best sedation to use for suturing 2 yo’s lip.

A

Midazolam

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29
Q

Midazolam vs Ketamine

A

Midazolam provides sedation but NO analgesia; Ketamine provides both

Ketamine commonly causes N/V and usually given with odansetron

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30
Q

Treatments for 30 yo woman in ED with a fever. IV and oral?

A

IV Ketorolac

Oral Tylenol or ibuprofen

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31
Q

A 25 year old patient is vomiting and is not able to tolerate any liquids. Which med is most appropriate?

A

odansetron

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32
Q

A 15 month old patient is vomiting and is not able to tolerate any liquids. He has acute gastroenteritis. Which med is most appropriate?

A

odansetron

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33
Q

What characteristics of dexamethasone make it an appealing therapy for acute inflammation?

A
  • Long duration (36-48 hr)
  • Rapid onset (3 hr)
  • Fewer ADRs than other glucocorticoids
  • High potency compared to hydrocortisone
  • Oral similar onset and duration as parenteral
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34
Q

ABX for otitis media, uncomplicated UTIs in kids, CAP in kids, strep pharyngitis, sinusitis

A

oral amoxicillin

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35
Q

ABX for impetigo

A

Mupirocin

36
Q

What can oral azithromycin treat?

A

OM, CAP, strep throat

alternative to PCNs or cephalosporins

37
Q

What can oral Levofloxacin treat?

A

complicated and uncomplicated UTI
CAP
cellulitis or skin abscess
traveler’s diarrhea

38
Q

Physiologic consequences of improperly treated acute pain?

A

CV: increased cardiac work, increased PVR and BP, MI

Pulm: tachypnea, decreased vital capacity, hypoxia, increased pulm infection risk

GI: reduced motility, ileus, N/V

Renal: urinary retention, oliguria

Coag: DVT, platelet aggregation

Others: impaired immune system, muscle atrophy, fatigue, depression, anxiety

39
Q

Different opioid receptors and what effects they have?

A

Mu - “PEAR” = physical dependence, euphoria, analgesia, respiratory distress
Kappa - “SAM” = sedation, analgesia (spinal), miosis
Delta - “ARG” = analgesia, release of GH
Sigma - “Do HaRM” = dysphoria, hallucination, repiratory and vasomotor stimulation, mydriasis

40
Q

What med is a full opioid agonist opioid?

A

Methadone

41
Q

What med is full opioid antagonist?

A

Naloxone

42
Q

Risk factors for PONV

A 
female
non-smoker
dehydration
Inadequate pain control
h/o motion sickness
h/o PONV
GI or gyno surgery
43
Q

ADRs of opioids

A 
N/V
constipation
urinary retention
orthostatic hypotension and bradycardia
pruritus
truncal rigidity
44
Q

Principle agent used in PCA (patient controlled analgesia) devices

A

morphine

45
Q

Receptors associated with central vomiting reflex and what meds antagonize these receptors

A

5HT-3/serotonin = ondansetron

Muscarinic/MI = scopolamine (anticholinergics)

histamine = dimenhydrinate

dopamine = promethazine

46
Q

When should anticoagulants (like Warfarin) be stopped pre-op?

A

d/c 5 days prior to elective surgery (ie Tuesday before a Monday surgery)

Check PT/INR day before surgery; if INR >1.5 then consider administering a low dose of oral vitamin K (1-2 mg) and then recheck the following day

Restarting warfarin often needs a bridging approach - those with high risk of thromboembolism will need LMW heparin until warfarin “kicks in” again

47
Q

What meds can be continued perioperatively?

A

anti-HTN
insulin
thyroid meds
aspirin controversial

48
Q

Can ACE-inhibitors and diuretics be taken during surgery?

A

No, must be stopped day of surgery

49
Q

Postpone elective surgery in patients who have glucose levels greater than _______.

A

300 mg (goal is under 200)

50
Q

Indications of Midazolam (Versed)

A

Conscious sedation, anxiolysis, and amnesia during minor ED / surgical procedures, manipulations, or diagnostic procedures (including intubation)

51
Q

Advantages of parental drug administration

A

Drugs can be administered to unconscious, uncooperative, or nauseous
Vastly decreases first-pass effect (skip liver)
Can be used to delay or slow onset of drug action

52
Q

Disadvantages of parental drug administration

A

STRICT aseptic technique
Some degree of pain
Difficult to reverse drug effects
Inconvenient if freq dosing required

53
Q

How is tourniquet appropriately applied?

A

Applied to upper arm

Pressure enough to block vein but not artery

54
Q

What makes a good vein to put IV in?

A

bouncy - refills when depressed
easily palpable and visible
soft
above previous sites

55
Q

Why do “bevel up” technique when doing IV?

A

insert bevel up at 10-30 deg angle
provides cutting action
reduces tissue damage
more

56
Q

Complications of IV placement

A

Site infection: cellulitis, systemic bloodstream infection (emergency)
Infiltration/extravasation: isotonic fluids, alpha and beta adrenergic meds (emergency)
Phlebitis
Hematoma
Air embolism (emergency)

57
Q

What injections use Z-technique?

A

IM injections; pull down skin to inject straight down, then let go of skin

58
Q

What common meds are given SQ?

A

heparin, insulin

59
Q

How to do SQ injections?

A

pinch large skin fold and “dart” needle into skin

60
Q

3rd generation cephalosporin administered IV or IM

A

Cefriaxone

61
Q

Indications for Lidocaine

A

V tach

Local anesthesia

62
Q

Drug interactions of Lidocaine

A

CYP450

beta blockers

63
Q

MOA of Lidocaine

A

Class IB anti-arrhythmic and cardiac depressant; weak Na channel blocker in Purkinje and ventricular cells and reduces AP

64
Q

ADRs of opioids

A

GI upset, drowsiness, itching, constipation, respiratory depression, hyperalgesia, accident-proneness, tolerance, dependence, addiction/abuse

65
Q

DIs of opioids

A

drugs that sedate

drugs that increase serotonin levels

66
Q

hydrocodone + APAP =

A

Vicodin

67
Q

Over medication of Midazolam can be reversed with _________.

A

flumazenil

68
Q

MOA of Midazolam

A

Enhances GABA-dependent chloride conduction which hyperpolarizes the cell, inhibiting excitability (short acting 2-5 h)

69
Q

ADRs of Midazolam

A

CNS depression (sedation, drowsiness, and much more), tolerance, dependence, respiratory/cardiovascular depression in patients cardiopulmonary disease

70
Q

Drug class of Midazolam

A

Benzodiazepine

71
Q

What should you monitor in long term Clindamycin therapy?

A

CBC, BUN/Cr, LFT

72
Q

ADRs of Clindamycin

A

rash, GI upset, candida, CDAD, hypersensitivity, agranulocytosis

73
Q

DIs of Clindamycin

A

erythromycin (antagonistic effects), neuromuscular blockers (prolongation of effects)

74
Q

Opioids used for severe pain from least to most potent

A

Morphine
Hydromorphone (Dilaudid) x5
Fentanyl x100

75
Q

Potent opioid that is safe in renally impaired patient?

A

Fentanyl

Maybe Hydromorphone, but NO morphine

76
Q

Opioid that has longest duration

A

Fentanyl patch (48-72 hr)

77
Q

Kappa opioid receptor agonist and Mu receptor antagonist

A

Nalbuphine

78
Q

Nalbuphine has much less risk of _________ and _________ than morphine.

A 
abuse potential (use to get off opioids)
respiratory depression
79
Q

MOA of Ketorolac/Toradol

A

NSAID, nonselective COX inhibitor

analgesic and anti-inflammatory

80
Q

Indications of Scopolamine

A

motion sickness

PONV

81
Q

Antiemetic that inhibits H1 muscarinic receptor

A

Promethazine

82
Q

Important ADR of Promethazine

A

Neuroleptic malignant syndrome

Bone marrow suppression

83
Q

Anticholinergic muscarinic antagonist that is used to treat nausea and vomiting

A

Scopolamine

84
Q

What is the maximum dose of lidocaine?

A

5mg/kg

85
Q

Indications of IV Dantrium

A

Muscle spasms

Malignant hyperthermia

86
Q

Antidote of amphetamines

A

None available

ED/Surgery (16 decks)

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