Exam 3 - Acute Care Foster

Question 1

thromboprophylaxis: which is generally preferred?

a. UFH
b. LMWH

Answer 1

b. LMWH

Question 2

which drug for thromboprophylaxis needs dose adjustment for renal dysfunction?

a. UFH
b. enoxaparin
c. dalteparin

Answer 2

b. enoxaparin

Question 3

drugs for stress ulcer prophylaxis (2 classes)

Answer 3

H2RAs
PPIs

Question 4

septic shock hypotension is related to decreased ______ ______

Answer 4

vascular tone

Question 5

septic shock tx: 2 fluids we can use

Answer 5

crystalloids, colloids

Question 6

septic shock: what drugs/class increases vascular tone and potentially cardiac output?

Answer 6

vasopressors

Question 7

septic shock tx if refractory

a. fluids
b. vasopressors
c. corticosteroids

Answer 7

c. corticosteroids (IV hydrocortisone)

Question 8

T or F: enteral feeding can be use as sole prophylaxis in high risk stress ulcer patients

Answer 8

F (add pharmacological SUP)

Question 9

H2RAs rare ADR

a. thrombocytopenia
b. itching
c. C diff

Answer 9

a. thrombocytopenia

Question 10

PPIs ADR

a. thrombocytopenia
b. itching
c. C diff

Answer 10

c. C diff

Question 11

glycemic control: initiate insulin if BG > ____ and target a BG of ____-____

Answer 11

> 180
144-180

Question 12

what procedure involves stopping sedatives and narcotics for a period of time to assess a pt’s ability to breathe on their own?

Answer 12

spontaneous awakening trial

Question 13

NMBA used for rapid sequence intubation

Answer 13

succinylcholine

Question 14

succinylcholine ADRs (4 that I wrote down)

Answer 14

apnea
muscle fasciculations (pain)
hyperkalemia
ICP elevation

Question 15

T or F: NDNMBAs can also be used for rapid sequence intubation if CI to succinylcholine

Answer 15

T

Question 16

which drug class has a clinical indication for therapeutic hypothermia (32-34 C post cardiac arrest)?

a. NMBAs
b. NDNMBAs

Answer 16

b. NDNMBAs

Question 17

T or F: NMBAs do NOT provide analgesic, sedative, or anxiolytic effect

Answer 17

T

Question 18

PADIS stands for

Answer 18

pain, agitation/sedation, delirium, immobility, sleep

Question 19

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

Answer 19

b. agitation

Question 20

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

Answer 20

c. delirium

Question 21

two scales for pain

Answer 21

BPS (behavioral pain scale)
CPOT (critical care pain observation tool)

Question 22

in general _______ preferred for non-neuropathic pain in critically ill pts

a. oral opioids
b. IV opioids
c. ibuprofen

Answer 22

b. IV opioids

Question 23

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

Answer 23

a. sedation

Question 24

state of minimal motor activity that is physically similar to sleep; altered consciousness, artificially induced

a. sedation
b. hypnosis
c. anxiolysis

Answer 24

b. hypnosis

Question 25

reduction of emotional and physical responses to real/perceived danger

a. sedation
b. hypnosis
c. anxiolysis

Answer 25

c. anxiolysis

Question 26

two scales for sedation/agitation

Answer 26

RASS (Richmon-agitation-sedation scale)
SAS (sedation-agitation scale)

Question 27

sedatives used in the ICU (4 of them; slide 78)

Answer 27

BZDs (lorazepam, midazolam)
propofol
dexmedethomidine

Question 28

IV lorazepam contains what solvent?

Answer 28

propylene glycol (antifreeze)

Question 29

what are two potential ADRs of IV lorazepam after high doses or prolonged infusions?

Answer 29

lactic acidosis, nephrotoxicity

Question 30

T or F: lorazepam is the best choice for sedation if rapid awakening is required

Answer 30

F (not the best choice due to intermed half-life)

Question 31

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

Answer 31

b. Recommended for long term sedation (> 48-72 hr)

(not recommended bc my be associated with unpredictable awakening time)

Question 32

propofol is ____ kcal/mL

Answer 32

1.1

Question 33

a rare complication can occur with propfol that leads to acidosis, bradycardia, and lipidemia? What is it called?

Answer 33

propofol infusion syndrome

Question 34

preservative in propofol

Answer 34

EDTA

Question 35

why does the manufacturer for propofol recommend a drug holiday after 7 days of tx

Answer 35

to avoid electrolyte abnormalities (especially Zn)

Question 36

what should be monitored after giving propofol for > 48 hours and at regular intervals thereafter?

Answer 36

TGs

Question 37

which sedation drug is a selective alpha-2 agonist?

a. propofol
b. lorazepam
c. midazolam
d. dexmed

Answer 37

d. dexmed

Question 38

dexmed has some impairment in _______ dysfunction

a. renal
b. hepatic
c. biliary

Answer 38

b. hepatic (dec dose 40-70%)

Question 39

T or F: avoid loading dose for dexmed

Answer 39

T (inc CV effects)

Question 40

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

Answer 40

d. they are all CV effects of dexmed