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Undeleted > Exam 2 Clinical > Flashcards

Exam 2 Clinical Flashcards

1
Q

When do you use cardiac monitor with kidney problems?

A

pts with low K+

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2
Q

Stage 1 HTN tx

A

thiazides

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3
Q

Stage 2 HTN tx

A

thiazides + ACEI/ARB/CCB/BB

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4
Q

1st line for all HTN

A

lifestyle modification

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5
Q

HTN with hypothyroidism

A

diastolic HTN

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6
Q

Renal artery stenosis dx test

A

renal angiography

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7
Q

Labs seen with primary aldosteronism

A

increased aldosterone

low renin

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8
Q

Labs seen with renal artery stenosis

A

increased aldosterone and renin

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9
Q

Drug tx for high renin activity

A

ACEI

Beta blockers

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10
Q

Drug tx for low renin activity

A

alpha blockers
CCB
diuretics

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11
Q

Cause of renal artery stenosis in young adults

A

medial fibroplasia

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12
Q

Sign of endocrine HTN

A

imbalance of electrolytes

low renin, high aldosterone

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13
Q

Tx for endocrine HTN

A

surgery (if unilateral)

spironolactone/triamterene in bilateral

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14
Q

Pheochromocytoma impact

A

catecholamine release
abnormal lipid levels
hyperglycemia
HTN

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15
Q

Tx for pheochromocytoma

A

surgery
alpha blockers
volume expansion

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16
Q

Cushing syndrome

A

increased ACTH production (microadenoma of pituitary)
part of MEA syndrome
increased cortisol in morning and evening

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17
Q

Metabolic acidosis with anion gap causes

A 
Methanol
Uremia
DKA
Paraldehyde
Iron/INH
Lactic acid
Ethylene glycol
Salicyclates
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18
Q

Renal tubule acidosis type II

A 
loss of max resorption bicarb in prox tubule
decreased bicarb (15-20mEq/L)
hypokalemia
assc with myeloma/Fanconi syndrome
can be caused by CAI's (acetazolamide)
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19
Q

Some causes of hypernatremia

A

water loss
diabetes insipidus
mannitol/hyperglycemia

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20
Q

Correction of hypernatremia

A

infuse water

if over 48hrs, no more than 10mEq/L a day correction

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21
Q

Drug causes of diabetes insipidus

A

lithium

demeclocycline

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22
Q

Causes of inappropriate hyponatremia

A

SIADH
hypothyroid
adrenal insufficiency

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23
Q

Causes of appropriate hyponatremia

A

CHF
cirrhosis
volume loss
all are euvolemic hyponatremia

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24
Q

Hyponatremia correction risk

A

can cause central pontine myelinolysis
from rapid correction of hyponatremia
cracks myelin sheath

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25
Q

Tx for hypovolemic hyponatremia

A

0.9% saline

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26
Q

Tx for euvolemic hyponatremia

A

3% saline (acutely)
saline must be more conc than urine osmolarity
demeclocycline/salt for chronic tx

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27
Q

Tx for hypervolemic hyponatremia

A

underlying disorder tx

diuretics/aquaretics

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28
Q

Tx for hypernatremia

A

D5W/hydration

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29
Q

Risks of hypokalemia

A 
cardiac arrhythmia (excitability)
rhabdomyolysis (releases K+ into serum)
alkalosis
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30
Q

Insulin/K+ relationship

A

causes transport of K+ into cells
decreases serum K+
can tx hyperkalemia acutely

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31
Q

Causes of K+ loss

A 
diarrhea
villous adenoma
DKA/RTA
increased aldosterone
Bartter's & Gitelman's
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32
Q

Hypokalemia and RMP

A

increased excitability
causes increased firing
hyperpolarizes cells
delays repolarization

33
Q

Hyperkalemia and RMP

A

depolarization of membrane
increased inactivation time
decreased firing

34
Q

Catecholamines/K+ relationship

A

increase Na+/K+ ATPase

drives K+ into cell

35
Q

Normal K+ range

A

3.6-5.1

36
Q

Causes of hyperkalemia

A

metabolic acidosis
hyperglycemia (insulin)
digoxin
beta blockers (less Na+/K+ ATPase)

37
Q

Signs of hyperkalemia

A

muscle weakness
peaked T waves/wide QRS
bradycardia

38
Q

Alkalosis impact on O2 dissociation curve

A

shift to the L

less H+ to compete with oxygen binding on Hb

39
Q

Acidosis impact on O2 dissociation curve

A

shift to the R

more H+ competes with oxygen and displaces it on Hb

40
Q

Causes of metabolic alkalosis

A

antacid
vomiting
diuretics

41
Q

Methanol absorption

A

all routes, even skin contact

4mL blindness/15mL death ingestion

42
Q

Methanol metabolism

A

alcohol DH converts to formic acid

regulated by folic acid system

43
Q

Formic acid toxicity

A 
metabolic acidosis/anion gap
ocular toxicity
seizures/coma/increased ICP
CSF with WBCs/xanthochromia (putamen damage)
increased amylase
44
Q

Tx for methanol poisoning

A

bicarb therapy
folic acid
dialysis
EtOH

45
Q

Ethylene gylcol characteristics

A

sweet taste/aromatic odor
ingestion toxicity
metabolized by liver into acids

46
Q

Ethylene glycol poisoning

A

CNS stage-acidosis/intox/coma
Cardiopulmonary stage-HTN/cyanosis
Renal stage-crystalluria/ATN/renal failure

47
Q

Acids produced from ethylene glycol metabolism

A

glycoaldehyde
glycolic acid/glyoxylic acid
oxalic acid (precipitates in organs/kidneys)
formic acid

48
Q

Dx of ethylene glycol poisoning

A

wood lamp exam
increased osmolar gap (early)
decreased serum Ca2+
large anion gap

49
Q

Digoxin characteristics

A

excreted via kidneys

alters Na+ transport in cardiac m./increased IC Ca2+

50
Q

Sx of digoxin toxicity

A 
N/V
seizures
amnesia/confusion
yellow/green vision
dysrhythmia
51
Q

Causes of digoxin toxicity

A

erythromycin/tetracycline (decreased bacterial metabolism of digoxin)
electrolyte imbalances
hepatic/renal disease

52
Q

Tx for Dig toxicity

A

Digibind

FAB fragment

53
Q

Salicylate metabolism

A 
mostly liver (kidney if excess)
rapid absorption
54
Q

Aspirin overdose

A 
alkalosis (hyperventilation)
decreased factor VIII (increased PT time)
acute renal failure
metabolic acidosis from organic acids
ox-phos uncoupling (hyperthermia)
55
Q

Sx of aspirin OD

A

hyperpnea
coma/seizures/vomiting
tinnitus
hyperpyrexia

56
Q

Tx for salicylate OD

A 
salicylate nomogram (within 6hrs)
supportive care
57
Q

Acetaminophen toxicity

A

Phase 1: 30min-4hrs, N/V
Phase 2: 24-72hrs, liver abn, increased transaminase
Phase 3: 3-5 days, jaundice/encephalopathy/hepatic necrosis
Phase 4: 7-8 days, return to normal/continue decline

58
Q

Prognosis factor for acetaminophen OD

A

serum concentration

59
Q

Tx for acetaminophen OD

A

nomogram within 4 hrs
N-acetylcysteine within 24 hrs
donates sulfhydryl group for nontox elimination

60
Q

Acetylcholinesterase inhibitors

A

carbamates and organophosphates

organophosphates absorbed all routes

61
Q

Carbamates

A

acetylcholinesterase inhibitor
lower toxicity/shorter duration
does not cross BBB

62
Q

Organophosphates

A

acetylcholinesterase inhibitor
stimulates ANS/skeletal m./CNS
garlic odor of insecticides

63
Q

Muscarinic effects of organophosphates

A 
SLUG BAM
salivation
lacrimation
urination
GI upset/motility
Bradycardia
Abd pain
Miosis
64
Q

Nicotinic effects of organophosphates

A 
MTWtHF (days of week)
midriasis
tachycardia
weakness
HtN
fasciculations
65
Q

Cause of death with acetylcholinesterase inhibitors

A

respiratory failure (prolonged contraction)

66
Q

Intermediate syndrome

A

24-96hrs post poisoning of acetylcholinesterase inhibitors
paralytic sx for days
no atropine response

67
Q

Tx for acetylcholinesterase inhibitors

A

atropine for muscarinic effects

pralidoxime for nicotinic/CNS effects

68
Q

Cyanide characteristics

A

decreases ATP production
cell membranes are permeable to CN
bind iron on Hb tightly

69
Q

Cyanide metabolism

A

B12 incorporation
thiocyanate conversion
rhodanase

70
Q

Dx of cyanide toxicity

A

LOC/metabolic acidosis
almond odor
bright red venous blood
Lee-Jones test

71
Q

Tx for cyanide

A

amyl nitrate/sodium nitrate (converts to oxyhemoglobin)

Na+ thiosulfate (convertes to thiocyanate)

72
Q

Phases of iron intoxication

A

1: 30-120min, acidosis/N&V
2: 2-24hrs, apparent recovery
3: 12-48hrs, acidosis/coma/shock
4: 2-4 days, hepatic necrosis/bleeding diathesis
5: 2-4wks, GI scarring/cirrhosis/CNS sx

73
Q

Dx of iron intox

A

pills on x-ray
bloody stool/diarrhea
damage after iron saturates ferritin (300-450ug/dL)

74
Q

Tx for iron intox

A

deferoxamine (chelator)-complexes and kidney secretion

use if iron over 350ug/dL in serum

75
Q

Anticholinergic drug action

A

blocks muscarinic sites (parasympathetics)

76
Q

Anticholingergic syndrome

A

dilated pupils/blurred vision
flushing/dry skin
HTN/hyperthermia

77
Q

Tx for anticholinergic toxicity

A

lidocaine for VT
valium for psychotic sx
anticholinesterases (physostigmine)
cold packs for hyperthermia

78
Q

Physostigmine characteristics

A

for anticholinergic OD
can cross BBB
do not use with GI/GU obstructions
caution with DM/glaucoma/asthma/heartblock

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