Exam 3 - Acute Care Foster Flashcards
thromboprophylaxis: which is generally preferred?
a. UFH
b. LMWH
b. LMWH
which drug for thromboprophylaxis needs dose adjustment for renal dysfunction?
a. UFH
b. enoxaparin
c. dalteparin
b. enoxaparin
drugs for stress ulcer prophylaxis (2 classes)
H2RAs
PPIs
septic shock hypotension is related to decreased ______ ______
vascular tone
septic shock tx: 2 fluids we can use
crystalloids, colloids
septic shock: what drugs/class increases vascular tone and potentially cardiac output?
vasopressors
septic shock tx if refractory
a. fluids
b. vasopressors
c. corticosteroids
c. corticosteroids (IV hydrocortisone)
T or F: enteral feeding can be use as sole prophylaxis in high risk stress ulcer patients
F (add pharmacological SUP)
H2RAs rare ADR
a. thrombocytopenia
b. itching
c. C diff
a. thrombocytopenia
PPIs ADR
a. thrombocytopenia
b. itching
c. C diff
c. C diff
glycemic control: initiate insulin if BG > ____ and target a BG of ____-____
> 180
144-180
what procedure involves stopping sedatives and narcotics for a period of time to assess a pt’s ability to breathe on their own?
spontaneous awakening trial
NMBA used for rapid sequence intubation
succinylcholine
succinylcholine ADRs (4 that I wrote down)
apnea
muscle fasciculations (pain)
hyperkalemia
ICP elevation
T or F: NDNMBAs can also be used for rapid sequence intubation if CI to succinylcholine
T
which drug class has a clinical indication for therapeutic hypothermia (32-34 C post cardiac arrest)?
a. NMBAs
b. NDNMBAs
b. NDNMBAs
T or F: NMBAs do NOT provide analgesic, sedative, or anxiolytic effect
T
PADIS stands for
pain, agitation/sedation, delirium, immobility, sleep
condition characterized by apprehension, increased motor activity, and autonomic arousal; may also be manifested by fearful withdrawal; state of anxiety accompanied by motor restlessness
a. pain
b. agitation
c. delirium
d. immobility
e. sleep
b. agitation
cardinal features:
-disturbed level of consciousness (dec clarity of awareness of environment) with a reduced ability to focus, sustain, or shift attention
-either a change in cognition (memory/disorientation/language) or developmental of a perceptual disturbance (hallucination/delusions)
a. pain
b. agitation
c. delirium
d. immobility
e. sleep
c. delirium
two scales for pain
BPS (behavioral pain scale)
CPOT (critical care pain observation tool)
in general _______ preferred for non-neuropathic pain in critically ill pts
a. oral opioids
b. IV opioids
c. ibuprofen
b. IV opioids
the act of calming, especially by the administration of a sedative drug; mainstay of tx of agitation/anxiety in ICU
a. sedation
b. hypnosis
c. anxiolysis
a. sedation
state of minimal motor activity that is physically similar to sleep; altered consciousness, artificially induced
a. sedation
b. hypnosis
c. anxiolysis
b. hypnosis
reduction of emotional and physical responses to real/perceived danger
a. sedation
b. hypnosis
c. anxiolysis
c. anxiolysis
two scales for sedation/agitation
RASS (Richmon-agitation-sedation scale)
SAS (sedation-agitation scale)
sedatives used in the ICU (4 of them; slide 78)
BZDs (lorazepam, midazolam)
propofol
dexmedethomidine
IV lorazepam contains what solvent?
propylene glycol (antifreeze)
what are two potential ADRs of IV lorazepam after high doses or prolonged infusions?
lactic acidosis, nephrotoxicity
T or F: lorazepam is the best choice for sedation if rapid awakening is required
F (not the best choice due to intermed half-life)
which is FALSE about midazolam for sedation in the ICU?
a. Option for rapid sedation of acutely agitated patients (fast onset)
b. Recommended for long term sedation (> 48-72 hr)
c. may use for procedural sedation
d. declining use due to potential assoc with delirium and trend to lighter sedation goals
b. Recommended for long term sedation (> 48-72 hr)
(not recommended bc my be associated with unpredictable awakening time)
propofol is ____ kcal/mL
1.1
a rare complication can occur with propfol that leads to acidosis, bradycardia, and lipidemia? What is it called?
propofol infusion syndrome
preservative in propofol
EDTA
why does the manufacturer for propofol recommend a drug holiday after 7 days of tx
to avoid electrolyte abnormalities (especially Zn)
what should be monitored after giving propofol for > 48 hours and at regular intervals thereafter?
TGs
which sedation drug is a selective alpha-2 agonist?
a. propofol
b. lorazepam
c. midazolam
d. dexmed
d. dexmed
dexmed has some impairment in _______ dysfunction
a. renal
b. hepatic
c. biliary
b. hepatic (dec dose 40-70%)
T or F: avoid loading dose for dexmed
T (inc CV effects)
which is NOT a CV effect of dexmed?
a. inc in BP with rapid administration
b. bradycardia from loading dose
c. hypotension from loading dose
d. they are all CV effects of dexmed
d. they are all CV effects of dexmed
