Exam 1: Pharm (Electrolyte therapy/replacement)

Question 1

Sodium bicarbonate

Answer 1

Electrolyte replacement

Used for severe metabolic acidosis, hyperkalemia; **base: buffering system

AEs: Can be caustic to vasculature, can cause hypokalemia and metabolic alkalosis

Question 2

Potassium chloride

Answer 2

Electrolyte replacement (IV and PO)

Indicated for hypokalemia; long-acting formula: slowly releases over hours, less GI irritation

AEs: GI (N/V/D, abdominal discomfort), esophagitis, IV (can cause local irritation and pain)

C/Is: monitor closely in pts with renal dysfunction and in pts on medications that can increase serum potassium levels (Trimethorpri and ACE inhibitors)

NCs: should give with food and LOTS of water; IV (extravasation irritation); potasssium can be added to maintenance IV fluid, concentrated K vial should not be available on unit

Monitor serum potassium levels and for s/s of hyperkalemia, watch IV site carefully

Question 3

Magnesium sulfate

Answer 3

electrolyte replacement (IV)

Used for hypomagnesemia, preeclampsia, eclampsia, migraines, status asthmaticus, polymorphic tachycardia

use with caution in renal dysfunction

Monitor patients cardiac and neuromuscular status in renal dysfunction pts

Question 4

Calcium chloride

Answer 4

electrolyte replacement (IV; Centrally)

More elemental calcium than calcium gluconate

AEs: Caustic to vasculature (more than gluconate)

Rate of administration will depend on the indication for the drug (Hyperkalemia faster vs Replacement slower)

Question 5

Calcium gluconate

Answer 5

electrolyte replacement (IV Peripherally)

Less elemental calcium than calcium chloride

Rate of administration will depend on the indication (hyperkalemia faster vs replacement slower)

Question 6

Albuterol

Answer 6

Short acting beta2 agonist

Binds to beta2 receptors in lungs, causes bronchodilation & activates adenylate cyclase, which tehn stimulates production of cAMP (used by the Na-K ATPase pump to move K intracellularly)

AEs: Tachycardia/tremor

NCs: when you stop albuterol, the K+ will shift back out/normalize and if you supplement during the treatment you may get hyperkalemic (in asthmatics)

Total body K+ in asthmatics will be hiding in the cells

Question 7

Dextrose 50% injection

Answer 7

Hyperkalemia treatment

concentrated dextrose used for treatment of hypoglycemia and kyperkalemia (in conjunction with insulin)

Giving with insulin combats hypoglycemia side effect

Question 8

Insulin, regular

Answer 8

Hyperkalemia treatment (IV usually, or SC)

Used for treatment of diabetes and hyperkalemia; essential for cellular uptake of glucose;can accumulate in renal dysfunction

Monitor for toxicity in renal dysfunction

Question 9

Kayexalate

Answer 9

Hyperkalemia treatment, resin (PO or rectally)

Exchanges Na for K in the gut (poop it out!); takes a few hours to start working (not for emergencies)

AEs: Associated with intestinal necrosis and other serious GI AEs