Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EM 101 > First Line Treatments - Pharm > Flashcards

First Line Treatments - Pharm Flashcards

1
Q

Tx of Ischemic Priapism?

A

Terbutaline 5-10mg PO

or 0.25-0.5 SQ or pseudoephedrine 60mg PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Tx of Epididymitis w/ STD suspected (<35 yrs old)?

A

Doxycycline 100mg PO BID x10-14 days
AND
AZITHROMYCIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Tx of Epididymitis w/ STD suspected (but PCN allergy)?

A

Doxycycline 100mg PO BID x10-14 days
AND
Azithromycin 2gm x1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tx of Epididymitis without suspicion for STD (>35 yrs old)?

A

Ciprofloxacin 500mg BID x10-14 days

OR Levofloxacin 750mg PO QD x10-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tx of Appendage Torsion?

A

NSAIDs, will self resolve in 1-2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tx of Fournier’s Gangrene?

A

Ciprofloxacin 400mg IV
AND
Clindamycin 1.2gm IV
+/- Vancomycin 1gm IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tx of Orchitis?

A

NSAIDs, ice, scrotal support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tx of Uncomplicated UTI?

A

Nitrofurantoin 100mg BID x5 days
(aka Macrobid)

**unless creatinine clearance <30 mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tx of Complicated UTI?

A

Ciprofloxacin 500mg BID x5-14 days
OR
Ceftriaxone 1gm IV daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tx of Complicated UTI and critically ill or septic?

A

Imipenem 500mg IV q6h
AND
Vancomycin 15-20 mg/kg q8-12 hours with or without loading dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tx of Vaginal bleeding in pregnant woman?

A

If Rh(-), RhoGAM 300mcg IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the contraindications to administering Methotrexate in ectopic pregnancy?

A
  • unstable or ruptured
  • quant HCG >15,000 IU/L
  • fetal cardiac activity
  • free fluid on US
  • gestational sac >3.5 cm
  • liver or renal disease
  • patient is breastfeeding
  • patient with unreliable follow up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Seizure prevention in preeclampsia?

A

Mg 2-4g IV load over 30 minutes, then 1g/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Seizure abortive in eclampsia?

A

Mg 2-4g IV q5-10 min

Diazepam 5mg IV q 5 min OR Phenytoin 15-20mg/kg IV once

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What medication should be used for BP control in preeclampsia/eclampsia

A

Labetalol 10-20mg IV once, then double dose q10 min up to 80 mg to max 200 mg

And Hydralazine 5-10mg IV q20min as needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In preeclampsia/eclampsia, what is the goal BP?

A

Don’t drop BP more than 25% in first 30 min. Goal BP 140-155/90-105 within the first several hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When giving magnesium, what do you need to be sure to monitor?

A

Magnesium toxicity:

  • diminished deep tendon reflexes
  • somnolence
  • dilated pupils
  • decreased respiratory drive
  • hypotension
  • bradycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In addition to hydration and correcting metabolic derangements, what is the treatment for hyperemesis gravidarumcausing hypovolemia?

A

Ondansetron (or metoclopramide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the treatment for nausea and vomiting in pregnancy that is not causing hypovolemia?

A

Prophylaxis (at night):
Doxylamine Succinate 10mg
AND Pyridoxine(B6) 10mg
(separate or combo pill)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the tx for vaginitis caused by suspected herpes?

A

Acyclovir 400mg TID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the tx for suspected GCC or PID?

A

Ceftriaxone 250mg IM x1

AND Doxycycline 100mg BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the tx for vaginitis caused by Trichomoniasis?

A

Metronidazole 500mg BID x7days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the tx for bacterial vaginosis?

A

Metronidazole 500mg BID x7-14 days, and partner should seek treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the treatment for uncomplicated vaginal candidiasis?

A

Fluconazole 150mg PO x1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the treatment for complicated vaginal Candidiasis (DM or recurrent infections)?

A

Fluconazole 150mg PO x2 (days 0 and 3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the treatment for vaginal candidiasis in a pregnant patient?

A

topical cream i.e. miconazole x7days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the treatment for diverticulitis?

A

10-14 days PO abx:
- Cipro 500mg BID + Metro 500mg TID x 14 days
plus clear diet x2-3 days and slowly advance diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the treatment for mild c. diff?

A

Metronidazole 500mg PO q8h x10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the treatment for severe c. diff?

A

Vanc 125-500mg PO q6h x10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the treatment for severe c. diff with complications?

A

Vanc 125-500 PO q6h x10 days
AND Metro 500mg IV q8h
plus surgical consultation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the treatment for abdominal pain plus nausea/vomiting?

A

Ondansetron 4 mg IV q8h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the 2nd line treatment for abd pain plus n/v?

A

Metoclopramide 10 mg PO/IV q6h
Prochlorperazine 10 mg PO/IV 6h/25 mg PR x1
Diphenhydramine 25-50 mg PO/IV q6h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the treatment for Appendicitis pain?

A

Morphine 0.05-0.1 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the treatment for appendicitis nausea?

A

Ondansetron 4 mg IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the treatment for uncomplicated (non-perforated) appendicitis undergoing surgery?

A 
Start within ONE HOUR of surgery
- Cefoxitin 2g IV QID
or 
- Ciprofloxacin 400 mg IV Q12h 
PLUS Metro 500 mg IV q6h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the treatment for perforated appendicitis undergoing surgery?

A 
Immediately start:
- Cefoxitin 2g IV QID
or 
- Ciprofloxacin 400 mg IV Q12h 
PLUS Metro 500 mg IV q6h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the treatment for perforated appendicitis undergoing surgery that is high risk?

A 
Cefepime 2 g IV q12h 
\+ Metro 500 mg IV q8h
OR
Pip/Tazo (Zosyn) 4.5 g IV QID
OR
Imipenem 500 mg q6h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the treatment for acute pancreatitis?

A

LR 250-500 mL/hr
or LR 5-10 mL/kg/hr
given over first 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the treatment for pancreatic necrosis?

A

Imipenem 500 mg IV q6h

b/c known to penetrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the treatment for status epilepticus?

A

Benzos: Midazolam, Lorazepam, Diazepam

If refractory –> Fosphenytoin IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the treatment for an agitated patient? (oral medication)

A

Haloperidol 5 mg PO, 0.5-1 mg PO if elderly

or Olanzanzapine 5-10 mg PO
or Lorazepam 1-2 mg PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the treatment for an agitated patient? (injectable)

A

Benzos:
Lorazepam 1-2 mg IV/IM
Haloperidol 0.5-10 mg IV/IM
Ziprasidone 10-25 mg IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the treatment for extrapyramidal symptoms?

A

Diphenhydramine 25-50 mg PO/IV/IM
or Benztropine 1 mg PO/IV/IM

Check EKG if on antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the treatment for EtOH withdrawal with seizures?

A

Benzos:
Lorazepam - start with 2mg IV/PO q2h
up to 6-8mg IV q15-60min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the treatment for EtOH withdrawal hallucinations?

A

Haloperidol
or Ziprasidone
or Dexmedetomidate

Load 1mcg/kg IV over 10 min
then infusion 0.2-0.7 mcg/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the treatment for Ibuprofen overdose (>/= 400 mg/kg)?

A

one dose activated charcoal

more doses would not help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the treatment for methanol & ethylene glycol overdose/poisoning?

A

Fomepizole 15 mg/kg IV load then 10 mg/kg q12h
plus thiamine 100 mg IV q6h x 2 days
plus pyridoxine 50 mg IV q6h x 2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the treatment for methanol & ethylene glycol overdose/poisoning is pH < 7.3?

A

sodium bicarb to promote urinary excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the treatment for isopropyl alcohol poisoning?

A

supportive

NO fomepizole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the treatment for peripheral vertigo?

A 
Meclizine 25 mg PO
or benadryl 25 mg PO or IV
or valium 5mg IV
or ondansetron 4 mg IV
PLUS IV fluids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the treatment for hepatic encephalopathy?

A

Lactulose 30-60 grams PO, NGT or 300 grams PR

second line: Rifamixin 400 mg TID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the treatment for hyperkalemia?

A

Calcium then Insulin 10 units + 1 amp D50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the treatment for Spontaneous Bacterial Peritonitis?

A

Third Gen Cephalosporin

  • Cefotaxime 2g IV q8h
  • Ceftriaxone 2g IV q24 h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the treatment for Spontaneous Bacterial Peritonitis if the patient has a penicillin allergy?

A

Levofloxacin 750 mg IV q24h
Ciprofloxacin 400mg IV BID
Pip/Tazo 4.5 g IV TID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the treatment for DKA and K+<3.3?

A

20-30 mEq/hr IV K+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the fluid treatment for DKA in adults?

A

1-2 L NS Bolus over 1-2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the fluid treatment for DKA in pediatric patients?

A

20 mL/kg NS over first hour, then 250-500 mL/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the treatment for ongoing seizure?

A

Lorazepam (Ativan) 2-4 mg IV/IM, repeat PRN

max of 0.1 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the treatment for ongoing seizure refractory to Lorazepam after 5 minutes?

A

Fosphenytoin 20-30 PE/kg at 150 PE/min IV
or
Levetiracetem 20 mg/kg IV to max 60 mg/kg
or
Valproic Acid 20-40 mg/kg @ 7.5 mg/min IV
or
Phenobarbital 20 mg/kg IV at 50-100 mg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the dosing of Lorazepam for acute seizure?

A

2-4 mg IV/IM, repeat PRN

max of 0.1 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the dosing of Fosphenytoin for acute seizure?

A

20-30 PE/kg at 150 PE/min IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the dosing of Leviteracetem for acute seizure?

A

20 mg/kg IV to max 60 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the dosing of Valproic Acid for acute seizure?

A

20-40 mg/kg @ 7.5 mg/min IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the dosing of Phenobarbital for acute seizure?

A

20 mg/kg IV at 50-100 mg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is medication and dose for Nephrolithiasis pain control?

A

Morphine 0.1mg/kg or 4 mg IV

and Ketorolac 30 mg IV if no CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is medication and dose for Nephrolithiasis nausea control?

A

Zofran 4 mg IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the treatment for nephrolithiasis plus UTI?

A

Ciprofloxacin or 3rd gen cephalosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the antibiotic for epidural abscess with possible MRSA?

A

Vanc 15-30 mg/kg IV

PLUS Metronidazole 500 mg IV
PLUS Cefotaxime 2 g IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is the antibiotic for epidural abscess without concerns for MRSA?

A

Nafcillin 2 g IV
or
Oxacillin 2 g IV

PLUS Metronidazole 500 mg IV
PLUS Cefotaxime 2 g IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is the treatment for epistaxis refractory to pressure?

A

topical vasoconstrictor – oxymetazolone or phenylephrine
intranasal spray or cotton pledgets soaked in vasoconstrictor and anesthetic – viscous lidocaine 2% or lidocaine 4% topical solution with 0.5% phenylephrine
leave in place for five minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the treatment for ITP?

A

steroids, IVIG, or anti-D immunoglobulin

avoid NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is the treatment for TTP?

A

FFP and plasma exchange with stat hematology consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is the treatment for DIC?

A

if severe bleeding –> transfuse
if clotting –> heparin

FFP for prolonged coagulation and bleeding
Cryoprecipitate for fibrinogen <100 despite FFP
Platelets if <50k and bleeding
Platelets if <20k and no bleeding
pRBCs PRN for anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the treatment for HIT?

A

stop heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is the treatment for GI bleeding if the patient has known ascites/liver failure?

A

Rocephin (Ceftriaxone) or Azithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Activated charcoal does not absorb ..?

A
  1. acids or alkalis
  2. alcohols
  3. metals or ionic compounds (eg iron potassium lithium)
  4. hydrocarbons

*** must have normal GCS and maintaining own airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is the dose of activated charcoal?

A

1 g/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are really the only toxicities that whole bowel irrigation is used for?

A

iron (>60 mg/kg elemental iron)
slow release calcium channel blockers
slow-release potassium chloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is the substance/dose used for whole bowel irrigation?

A

polyethylene glycol - 30 mL/kg/h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

For which ingestions would you consider multi-dose activated charcoal administration and what is the dose?

A

carbamazepine
phenobaritone
quinine
theophylline

dose is 1 g/kg activated charcoal four hourly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

For alkalinization of the urine during treatment of salicylate toxicity, what is the dose of sodium bicarb?

A

1-2 mmol/kg NaHCO3 stat

then you can infuse further doses over the next 1-2 hours, aiming for a urinary pH >7.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What amount of iron would have to be ingested to be considered significant?

A

> 40 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is the treatment for iron overdose?

A

whole bowel irrigation if significant ingestion and confirmed with xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

When should deferoxamine be considered in iron overdose?

A

serum iron concentrations >90 micromol/L

or if 60-90, visible on xray, and patient is symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is the dose of deferoxamine for acute iron ingestion?

A

15 mg/kg/hr IV, then reduce rate after 4-6 hours so that the total IV dose dose not exceed 80 mg/kg/24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

When can you stop treatment for iron ingestion?

A

until the child is asymptomatic, the anion-gap acidosis is resolved, and the serum iron concentration is <60 micromol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the treatment for hypertension related to toxic injection?

A

calcium-channel blocking agents, phentolamine, labetalol, or nitroprusside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is the first line treatment for patient with ventricular tachycardia in the context of intoxication, specifically drugs with drug with sodium-channel blocking properties (eg, tricyclic antidepressants, carbamazepine, cocaine)?

A

Sodium bicarb

Types IA (eg, procainamide), IC, and III antiarrhythmic agents are not recommended and are potentially dangerous since they may further impair cardiac conduction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What anti-epileptic medication is contraindicated in treatment of seizures due to intoxication?

A

Phenytoin

also Keppra is unlikely to help –> use benzos instead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is the treatment for hyperthermia related to drug toxicity?

A

possibly ice water immersion

do not use antipyretics like acetaminophen or ibuprofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the antidote for Acetaminophen toxicity?

A

N-acetylcysteine (NAC) IV 150 mg/kg over 1 hr
then infuse 12.5 mg/kg/hr x 4 hrs
then 6.25 mg/kg/hr x 16 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is the antidote for anticholinergic toxicity?

A

Physostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What is the antidote for arsenic toxicity?

A

dimercaprol/BAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is the antidote for beta blocker toxicity?

A

glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is the antidote for copper toxicity?

A

penicillamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is the antidote for cyanide toxicity?

A

thiosulfate, hydrocobalamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is the antidote for digoxin toxicity?

A

digoxin specific immune Fab fragments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is the antidote for ethylene glycol toxicity?

A

Fomepizole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is the antidote for glypizide toxicity?

A

glucose, octrotide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is the antidote for heparin toxicity?

A

protamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is the antidote for hydrofluoric acid toxicity?

A

calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is the antidote for isoniazid toxicity?

A

pyridoxime

103
Q

What is the antidote for lead toxicity?

A

dimercaprol

104
Q

What is the antidote for lidocaine toxicity?

A

lipid emulsion (aka intralipid) and sodium bicarb)

105
Q

What is the antidote for magnesium toxicity?

A

calcium

106
Q

What is the antidote for MAOI or SSRI toxicity?

A

cyproheptadine or benzos for serotonin syndrome

107
Q

What is the antidote for methemoglobinemia?

A

methylene blue

108
Q

What is the antidote for methotrexate toxicity?

A

folic acid, leucovorin

109
Q

What is the antidote for mercury toxicity?

A

dimercaprol (BAL), EDTA or DMSA

110
Q

What is the antidote for opioid toxicity?

A

naloxone

111
Q

What is the treatment for warfarin overdose?

A

vitamin K

112
Q

What is the treatment for salicylate toxicity?

A

alkalinization of the blood to 7.5 or higher with:
1 AMPS/100 mEq NaHCO3

followed by D5W with 150 mEq NaHCO3/L at 200-250 mL/hr

+/- hemodialysis
+ IV potassium repletion

ADMIT

113
Q

What is the treatment for acute digoxin toxicity?

A

10 vials Digoxin immune Fab
(effects within 30-120 min)

Atropine for bradydysrhythmias
Magnesium for VT/VF

114
Q

What is the treatment for opioid overdose?

A

0.4 mg Naloxone IV in adults

If no effect, increase dose q2-3 min
2mg –> 4 mg –> 10mg –>15mg

(0.1 mg/kg in kids – max2mg)

Monitor for 4-6 hrs back to baseline
If require 2 or more doses of Naloxone –> admit

115
Q

What is the treatment for opioid withdrawal?

A

Clonidine 0.1mg PO
- can repeat dose every 30-60 min
Monitor BP closely!

116
Q

What is the method for decontamination/elimination in TCA overdose?

A 
IV intralipid (central administration preferred)
1 ml/kg to 1.5 ml/kg bolus q3-5 min to a total of 3 ml/kg
IV drip started at 0.25 mL/kg/min-0.5ml/kg/min for 1 hr or until max dose of 8 ml/kg delivered
117
Q

What is the tx for arrhythmia due to TCA overdose?

A

Sodium Bicarb
Bolus 100mEq for QRS>100, repeat q5min until QRS narrows
QRS<100, start drip (150mEq/1L of D5W, infusing at 150/hr) until goal pH 7.45-7.55 on ABG

118
Q

What is the preferred method for BP support in TCA overdose?

A

Start with IV fluids – fill the tank
- consider hypertonic saline (3%) to saturate Na channels
May need to add pressors –> neosynephrine or norepi preferred to overcome alpha blockade

119
Q

What labs and imaging should be ordered for suspected hyperthermia/heat stroke?

A
  1. EKG
  2. CXR (pulm edema common in heat stroke)
  3. Labs: CBC and coags, BMP, Mg/Phos/Ca, and CPK (acute renal failure, rhabdomyolysis), liver enzymes (acute liver failure), +/- tox screen
120
Q

What empiric abx should be given to infants 0-28 days with fever?

A 
Ampicillin 100mg/kg/24 hrs divided q6h
PLUS either
Gentamicin 5 mg/kg/24hrs divided q8h
or
Cefotaxime 150 mg/kg/24 hrs divided q8h

(avoid ceftriaxone in infants <28 days due to possibly inducing acute bilirubin encephalopathy)

121
Q

If pressor is required during sepsis, what is first line and its dose?

A

Norepinephrine:

  • initial starting dose: 8-12mcg/min
  • Weight based dosing: 0.01-3mcg/kg/min

(Increases BP and HR)

122
Q

What are two second line pressors for sepsis and their associated dose?

A

Epinephrine & Vasopressin

Epinephrine:
- Initial starting dose: 5-35 mcg/min
- weight based dosing: 0.1-0.5 mcg/kg/min
(increases BP and HR)

Vasopressin:
- fixed dosing at 0.04 units/min

123
Q

If patient is septic and only have peripheral IV access, what pressor can be used (although not first line)?

A

Phenylephrine
- initial starting dose: 25-180 mcg/min
- weight based dosing: 0.5mcg/kg/min
(can cause reflex bradycardia)

124
Q

What abx are used for outpatient tx of community acquired pneumonia in previously healthy people?

A

Azithromycin 500 mg PO x1 and 250mg PO QD x4days
OR
Doxycycline 100 mg PO BID x7 days

125
Q

What abx are used for outpatient tx of community acquired pneumonia in patients with co-morbidities or recent abx?

A

Levofloxacin 750 mg PO QD x5days
OR
Cefpodoxine 200mg PO BID + Azithromycin 500 mg PO QD x7days

126
Q

For outpatient tx of CAP, if aspiration is suspected, which abx should be added?

A

Clindamycin or Metronidazole

127
Q

What is inpatient abx tx for CAP?

A

Levofloxacin 750mg PO/IV
OR
Ceftriaxone 1 g IV q12h PLUS Azithromycin 500 mg PO/IV

128
Q

What additional abx should be added for inpatient abx tx of CAP if patient requiring ICU?

A

Vancomycin

129
Q

What is inpatient abx tx for HCAP, HAP, or VAP?

A 
Cefepime 2g IV q12h
\+
Levofloxacin 750 mg IV qd
\+
Vancomycin 1g IV q12h
130
Q

What is abx tx for presumed PCP pneumonia?

A

Trimethoprim/Sulfamethoxazole 240/1200mg IV q6h

consider steroids

131
Q

In patients with pneumonia, what 2 risk stratification tools help determine need for admission?

A

CURB-65

Pneumonia Severity Index

132
Q

What absolute neutrophil count defines neutropenia?

A

ANC < 500 cells/microL

ANC = WBC x (%neutrophils+%bands)

133
Q

What are the empiric abx for suspected meningitis in pediatrics <1 month old?

A 
Ampicillin 50 mg/kg QID
\+
Gentamicin 2.5mg/kg IV TID
\+
Cefotaxime 50mg/kg IV QID
134
Q

What are the empiric abx for suspected meningitis in pediatrics >1 month old?

A

Ampicillin 50 mg/kg QID
+
Cefotaxime 100mg/kg IV TID

OR

Ceftriaxone 50mg/kg IV BID
+
Vancomycin 15 mg/kg IV QID

135
Q

What are the empiric abx for suspected meningitis in adults?

A 
Ceftriaxone 2g IV BID
OR
Cefotaxime 2g q4h
\+
Vancomycin 15-20 mg/kg IV BID
\+
If >50y/o: Ampicillin 2q q4h (covers Listeria)
136
Q

What are the empiric abx for suspected healthcare-associated meningitis?

A 
Vancomycin 15-20mg/kg IV BID
\+
Cefepime 2g IV TID
OR
Merepenem 2g IV TID
137
Q

What is the empiric tx for suspected HSV meningitis?

A

Acyclovir 10mg/kg IV TID

138
Q

What is the empiric tx for suspected cryptococcal meningitis?

A

Amphotericin B 0.7-1mg/kg IV QD
AND
Flucytosine 25 mg/kg PO QID

139
Q

What is the empiric tx for suspected TB meningitis?

A

Isoniazid 300 mg PO QD,
Rifampin 600mg QD,
Pyrazinamide 2g PO QD,
Ethambutol 1.6g PO QD

140
Q

What is the acronym for the quick differential for headaches?

A

BITE ME

Bleed, Infection, Thrombosis, Eye, Mass, Environmental

141
Q

What is normal opening pressure during LP?

A

9-18 cm H2O

142
Q

What is the first line treatment for a low-risk, mild headache?

A

Ibuprofen 800mg
Acetaminophen 1000mg
and/or
Caffeine 200mg

(all PO)

143
Q

What is first line for a low-risk, moderate-severe headache?

A

Ketorolac 30 mg IV (unless Ibuprofen already given)
+
Prochlorperazine 10mg IV (or Metoclopramide 10mg IV)
+
IV fluids

144
Q

What is the treatment for a cluster headache?
(unilateral, assoc with scleral injection, lacrimation, congestion, rhinorrhea, facial sweating, miosis, ptosis, or eyelid edema)

A

Oxygen 6-10L and sumatriptan 6mg SQ

145
Q

What are contraindications to triptan administration?

A

HTN, CAD, peripheral vascular disease, arrhythmias, recent MAOi, SSRI, or triptan use (serotonin syndrome)

146
Q

What are potential side effects of prochlorperazine?

A 
dystonic reaction (treat with benadryl)
QTc prolongation
147
Q

How is warfarin reversed?

A

Vitamin K 5-10mg IV over 10 minutes (INR corrected in 6-24 hrs)
PLUS either:
FFP or PCC

FFP (3-6 hrs to infuse, INR corrected in ~12 hrs)
PCC (INR corrected 15 min after 1 hr infusion, dosing is weight-based)

148
Q

How is aspirin reversed?

A

Platelet transfusion

149
Q

How is Heparin reversed?

A

Protamine Sulfate – call pharmacy for dosing, bc dependent on dose of heparin, route given, and time of last dose

150
Q

How is Dabigatran reversed?

A

No antidote. Half-life is 12 hours in patients with normal renal function.
One third is protein bound with 60% removed after 2-3 hrs of hemodialysis.

151
Q

What is the BP goal in patients with hemorrhagic stroke?

A

If presents with SBP 150-200, goal is <140

Otherwise aim for 25% reduction

152
Q

For BP control in intracranial hemorrhage patients, what is the first line medication and dose?

A

Nicardipine
- initial rate of 5 mg/hr IV
(can increase by 2.5 mg q15min until desired BP or max rate of 15 mg/hr.)
Once goal BP achieved titrate down to 3 mg/hr

  • use cautiously in patients with heart failure who are already taking beta blockers
153
Q

For BP control in ICH, what is the dose of labetalol?

A

10-20mgIV q10min (max dose 80mg/dose)

154
Q

When is labetalol contraindicated?

A

Bradycardia, heart failure, severe COPD

155
Q

For BP control in ICH, what is the dosing for Hydralazine?

A

10-20 mg IV q4-6h
(max dose 40mg/dose)

BP response may be delayed and unpredictable. Typically only for patients with contraindication to labetalol

156
Q

If patient begins to show signs of herniation in ICH, what is the treatment? (discuss with neurosurg)

A

Mannitol 1g/kg IV infusion with goal of serum osmolality of 300-310
- side effects include hypovolemia from diuresis

Hypertonic Saline dose is typically 30 mL of 23.4% saline over 20 mins
- requires infusion through a central line (3% saline does not)

157
Q

What is the goal cerebral perfusion pressure (CPP) in ICH?

A

Goal CPP is 50-70 mm Hg

CPP = MAP-ICP

158
Q

What is the goal BP in SAH?

A

<140 mmHg
(use nicardipine, labetalol, or hydralazine)

  • prevents delayed vasospasm that leads to secondary ischemia
159
Q

What labs are diagnostic of temporal arteritis?

A

ESR>50, elevated CRP, and CBC, which may show normochromic anemia

160
Q

What medication should be given as soon as temporal arteritis is suspected?

A

60mg of Prednisone PO daily for 2 weeks

start immediately; will not affect biopsy results in the first 48 hrs

161
Q

If temporal arteritis patient has vision loss, what is the medication that should be given & dose?

A

1000mg methylprednisone IV daily for 3 days, then maintenance dose
+
ASA 81 mg/daily – reduce risk of visual loss, TIA, or stroke

Add PPI while on steroids to reduce risk of peptic ulcer

162
Q

What labs and imaging should be ordered if venous sinus thrombosis is suspected?

A

Labs: CBC, BMP, Coags, HCG

Imaging: CT-venography or MRI/MR venography

163
Q

What is the treatment of venous sinus thrombosis?

A

Anticoagulation with heparin or LMWH, even in the presence of hemorrhagic infarction

164
Q

How is hypertensive emergency defined?

A

Hypertension that causes acute end organ damage (ie, CHF or increased Creatinine)

generally BP >180/120 (though rate is more important)

165
Q

How is hypertensive urgency defined?

A

Hypertension without the associated end organ damage

166
Q

What labs are important to obtain when evaluating hypertensive urgency/emergency?

A

Labs: CBC, BMP, UA, troponin, BNP;

and EKG – assess for LV hypertrophy or acute ST or T wave changes

167
Q

What is the goal BP reduction timeline in hypertensive emergencies?

A

1-2 hrs: max reduction in MAP 20-25%

2-6 hrs: Goal BP 160/100

168
Q

What are potential antihypertensive medications to be used in hypertensive emergencies?

A
  1. Nitroglycerin 5-100 ug/min
  2. Labetalol 20-80mg IV bolus then 0.5-2 mg/min (Caution in bradycardia)
  3. Nicardipine 5-15mg/hr
  4. Hydralazine 5-20 mg q20-30min

In a true hypertensive emergency, use short-acting, titratable medications and place an A line to monitor BP closely

169
Q

For hypertensive urgency, rapid administration of antihypertensive therapy is unwarranted, what is the tx instead?

A

If patient has missed home med, start there.

Otherwise, initiate a maintenance dose of an oral medication before discharge in patients with SBP ?/= 200mg, or DBP >/=120 mm Hg;
this is optional in patients with lower BP

Asymptomatic patients may be discharged home.

170
Q

What is the treatment for carotid/vertebral dissection – extracranial dissection WITH ischemic neurologic symptoms?

A

Anticoagulation w/ unfractionated heparin (goal of PTT 45-60 sec) or LMWH (enoxaparin 1mg/kg BID or Dalteparin 100 U/kg BID)

  • this will usually either be followed by either warfarin or antiplatelet therapy (consult or inpatient team will decide this) bridge to outpatient therapy.
171
Q

What is the treatment for carotid/vertebral dissection – extracranial dissection WITHOUT ischemic neurologic symptoms?

A

antiplatelet therapy, NO anticoagulation

172
Q

What labs should be ordered if carbon monoxide poisoning is suspected?

A
  1. Carboxyhemoglobin level
    - baseline COHb in nonsmokers 3%, smokers 10-15%
  2. ABG (to evaluate acid-base status)
  3. Cardiac biomarkers if cardiac sx or risk factors
  4. CN (cyanide) level in patients with smoke inhalation injury

and EKG!

173
Q

What is the tx for CO poisioning?

A

100% O2 on nonrebreather for 90 min?

174
Q

If CN toxicity suspected/smoke inhalation injury, what is the tx?

A 
Sodium thiosulfate (25%) 1.65 mL/kg IV (max dose 12.5 g)
or 
Hydroxycobalamin 70mg/kg IV (5g is the standard adult dose)
175
Q

What labs should EVERY joint pain patient get?

A

UA
ESR/CRP
CBC
BMP

176
Q

What antibiotics should be ordered for open fractures?

A

Cephalexin +/- Gentamicin if contaminated

177
Q

What is a normal compartment pressure? What is abnormal and what indicates need for emergent fasciotomy?

A

Normal <12 mmHg
Elevated >20 mmHg
Need for Fasciotomy >30 mmHg

Can also use PULSE pressure (= diastolic pressure - compartment pressure) where <30mmHg indicates inadequate perfusion

178
Q

What labs should be sent on arthrocentesis fluid?

A 
Gram stain and culture
fluid cell count
crystals
synovial lactate
(glucose and protein are rarely helpful but can be sent)

Serum:
Consider serum lyme titer if suspicious
ESR and CRP will often be requested by consult services. CBC, BMP

179
Q

What should be on the differential for a painful joint?

A 
Septic arthritis
Gout
Pseudogout
Lyme Disease
Rheumatoid Arthritis
Cellulitis
Septic bursitis
osteoarthritis
180
Q

What is the treatment for septic joint with Gonococcus/Gram negative bacteria on gram stain?

A

Ceftriaxone 1g IV daily
+
OR washout

181
Q

What is the treatment for septic joint with Gam positives on gram stain, and not immunocompromised?

A

Vancomycin by total body weight
+
OR washout

182
Q

What is the treatment for septic joint with Gam positives on gram stain, and immunocompromised or IV drug user?

A

Vancomycin + Cefepime 2g QD
+
OR washout

183
Q

What is the treatment for septic joint with human or animal bite inoculation of wound?

A

Ampicillin + Sulbactam
+
OR washout

184
Q

How do you diagnose acute limb ischemia?

A

Doppler pulses –
normal if 1-1.4
borderline if 0.91-0.99
abnormal if <0.9

then arteriography, CT angiography, or MR angiography per hospital protocol or consultant preference.

185
Q

How do you manage acute limb ischemia?

A

Immediate IV heparin and aspirin followed by continuous heparin infusion
Vasc surg consult for revascularization +/-embolectomy, bypass graft

186
Q

How do you treat gout?

A

NSAIDs (Naproxen 500mg BID, Indomethacin 50mg TID, ibuprofen 800mg QID) –> high initial dose, then taper

  • If contraindication to NSAIDs (bleed, renal failure), then consider steroids

Colchicine: low dose course of 1.2 mg followed 1 hr later by 0.6 mg for 1.8mg total dose.
- warn pts of GI upset side effects

DONT use allopurinol or probenacid during acute exacerbations.

187
Q

What type of splint should be applied for a scaphoid/lunate fracture?

A

thumb spica

188
Q

What type of splint should be applied for a First Metacarpal fx?

A

thumb spica

189
Q

What type of splint should be applied for De Quervain’s tenosynovitis?

A

thumb spica

190
Q

What type of splint should be applied for a ulnar styloid fracture?

A

ulnar gutter

191
Q

What type of splint should be applied for a 4th and 5th metacarpal fx?

A

ulnar gutter

192
Q

What type of splint should be applied for a 4th and 5th phalanges fx?

A

ulnar gutter

193
Q

What type of splint should be applied for a Distal Radius fx?

A

Sugar tong

194
Q

What type of splint should be applied for a Distal Ulnar fx?

A

Sugar tong

195
Q

What type of splint should be applied for wrist sprains?

A

Volar splint

196
Q

What type of splint should be applied for a metacarpal fx?

A

Volar splint

197
Q

What type of splint should be applied for distal humerus fx?

A

Posterior long arm

198
Q

What type of splint should be applied for a proximal humerus fx?

A

posterior long arm

199
Q

What type of splint should be applied for a radial head or neck fx?

A

posterior long arm

200
Q

What type of splint should be applied for olecranon fx?

A

posterior long arm

201
Q

What type of splint should be applied for severe ligamentous injuries of the elbow?

A

posterior long arm

202
Q

What type of splint should be applied for unstable ankle fractures?

A

Posterior leg/ Posterior Sugar tong

203
Q

What type of splint should be applied for a distal tib/fib fx?

A

Posterior leg/ Posterior Sugar tong

204
Q

What type of splint should be applied for midfoot fx (metatarsal/tarsal)?

A

Posterior leg/ Posterior Sugar tong

205
Q

What type of splint should be applied for proximal tib/fib fx?

A

long leg posterior

206
Q

What type of splint should be applied for unstable knee fx?

A

long leg posterior

207
Q

What type of splint should be applied for femur fx?

A

long leg posterior

208
Q

What is the treatment for status asthmaticus?

A

albuterol and ipratropium nebs and steroids

If in extremis, consider magnesium and IV epinephrine

209
Q

What size ET tube will work for most adults?

A

7.5

210
Q

What agents and doses should be used for the average expected uncomplicated intubation? (according to EMRA book)

A

20mg etomidate

120mg succinylcholine

211
Q

What are two pre-treatment agents that can be used in intubation and their doses?

A

Lidocaine 1.5 mg/kg (100mg)

Fentanyl 3mcg/kg (200mcg)

212
Q

Which two induction agents have little to no effect on BP?

A

Etomidate

Ketamine

213
Q

What is the dose for Etomidate when used as an induction agent?

A

0.3 mg/kg (20mg)

214
Q

What is the dose for Versed (Midazolam) + Fentanyl when used as an induction agent?

A

0.3 mg/kg (20mg)

3mcg/k (200mg)

215
Q

What is the dose for Propofol when used as an induction agent?

A

1.5 mg/kg (100 mg)

216
Q

What is the dose for Ketamine when used as an induction agent?

A

1.5 mg/kg (120mg adult)

217
Q

What is the dose for Succinylcholine when used as a paralytic agent? Onset/Duration?

A

1.5 mg/kg (120 mg)

Onset <1 min, Short duration (4-6 min)

218
Q

What is the dose for Rocuronium when used as a paralytic agent? Onset/Duration?

A

1 mg/kg (80 mg) of IDEAL BODY WEIGHT

Onset <2 min, Medium duration (30-60 min)

219
Q

What is the dose for Vecuronium when used as a paralytic agent? Onset/Duration?

A

0.08-0.1 mg/kg (10 mg)

Onset 2-3 min, Medium duration (25-40 min)

220
Q

What is the dose for Pancuronium when used as a paralytic agent? Onset/Duration?

A

0.1 mg/kg

Onset 2-3 min, Long duration (60-100 min)

221
Q

What are absolute contraindications to the use of succinylcholine?

A
  1. History of malignant hyperthermia
  2. Burns >5 days old until they are healed
  3. Spinal cord injury
  4. Stroke that occurred between 5 days and 6 months
  5. Neuromuscular disease
222
Q

What is the albuterol/ipatropium dose for acute asthma exacerbation?

A

Albuterol 4-8 puffs or 2.5-5mg q15-30min x1hr then q30min

Ipatroprium Bromide MDI 2 puffs or Neb: 0.5 mL of 0.02% onset 30+min, lasts up to 6 hrs

223
Q

In a patient with severe acute asthma exacerbation, what steroid/dose should be administered? what other med can be given?

A

PO: Prednisone 40-60mg
IV: Methylprednisolone 125mg IV

Magnesium 2-4g IV over 10-15 min

224
Q

What peak flow (FEV1) may be indicative of exacerbation?

A

FEV1 >70% : mild exacerbation
FEV1 >/=40%: mild-mod severity
FEV1 <40% or unable to obtain d/t clinical status: severe

225
Q

If patient with acute asthma exacerbation cannot tolerate inhaled therapy, what medication can be given?

A 
Terbutaline 0.25-0.5mg SQ q30min to max dose of 5mg over 4 hrs 
or
Epinephrine (1:1000) 0.2-0.5 mL SC Q20-30 min x3 doses
226
Q

If patients receive steroids in ED for acute asthma exacerbation, discharge on burst PO regiment, which is what?

A

Prednisone 40-60mg PO daily x3-7 days

If concern for poor compliance, alternative: Solumedrol 160mg IM x1 dose

227
Q

What antibiotic should be prescribed in UNCOMPLICATED moderate to severe COPD exacerbations?

Uncomplicated:

  • Age <65
  • no comorbidities
  • FEV1>50
  • <3exacerbations per year
A 
Azithromycin (Z pack)
or
Cefpodoxime 
or
Doxy
or
Bactrim 
for 5 days
228
Q

What is the dose of epinephrine in anaphylaxis?

A 
IM epi (1:1000): 0.3-0.5mL q5min PRN, titrate to effect
(EpiPen=0.3mL)
Inject into anterolateral thigh
229
Q

What 3 medications can/should be given for patients with angioedema?

A
  1. Steroid: methylprednisolone 125mg IV or dexamethasone 10mg IV
  2. H1 blocker: Diphenhydramine 50mg IV
  3. H2 blocker: Famotidine 40mg IV or Ranitidine 50 mg IV
230
Q

What NT-proBNP and BNP levels are indicative of ADHF?

A

NT-proBNP >1000
BNP>400

(but these vary with age)
if age>75, cutoff of BNP>800pg/mL

231
Q

What are the signs/sx of flash pulmonary edema?

A

Rales, crackles
SBP >180 mmHg
Tachycardia

Usually history of poorly controlled hypertension

232
Q

What are the two initial mainstays of treatment for flash pulmonary edema?

A

BiPAP with a PEEP of 5-8 and titrate up

Nitroglycerin drip– start BIG >25mcg/min and titrate up

233
Q

If patient is in ADHF and bradycardic, what med?

A

Atropine or external pacing

234
Q

If patient is in ADHF and is hypotensive, what med should be administered?

A

Norepinephrine

If norepi unavailable, can give dopamine

235
Q

What 2 medications can be given in ADHF to increase inotropy?

A

Milrinone, Dobutamine

236
Q

If ADHF is refractory to medical treatment, consult cardiology for what intervention?

A

Placement of an intraaortic balloon pump (IABP)

237
Q

If patient is in ADHF and is fluid overloaded, what medication should be ordered?

A

Furosemide for diuresis

Give total daily home PO dose as IV dose
Ex: 40 mg PO –> 40 mg IV

Furosemide IV to PO conversion is 1:2
20mg IV = 40mg PO

238
Q

What is the dose of nitroglycerin in flash pulmonary edema/acute heart failure?

A

0.4mg of sublingual spray or tab for immediate relief
Start 0.3-0.5 mcg/kg/min (typical starting dose is 25 mcg/min) Titrate up q3min

If no IV access, can place 0.5 to 1 inch of nitro paste

239
Q

What is a side effect of Nitroglycerin administration?

A

decrease in BP, so very efficacious in HTN

However, do not use if BP <95-100

240
Q

What 3 patient populations should not receive nitroglycerin?

A
  1. taking phosphodiesterase inhibitors
  2. with severe aortic stenosis
  3. with right sided MI
241
Q

What are side effects of Lasix/Furosemide?

A

Can cause electrolyte abnormalities (hypokalemia, hypocalcemia, hypochloremia)
Peak diuresis 30 min

242
Q

What is the Furosemide (Lasix), Torsemide, Bumex conversion?

A

furosemide 40 mg = Torsemide 20mg = Bumex 1mg

243
Q

What is the dose for milrinone?

A

Bolus 50mcg/kg IV over 10 min then start 0.375 mcg/kg/min IV and titrate up

244
Q

What are possible side effects of milrinone?

A

can cause hypotension and cardiac arrhythmias.

Obtain cardiology consult

245
Q

What DDimer is generally considered abnormal?

A

> 500 ng/mL

246
Q

What things can artificially elevate ddimer?

A 
advanced age (beginning age 40)
active malignancy
pregnancy
recent operation
rheumatologic disease
sickle cell disease
247
Q

In the case of pulmonary embolism, what is the dosing of unfractionated heparin?

A

80 units/kg IV bolus
followed by
18 units/kg/hr IV infusion (goal PTT 60-85 sec)

If no weight available, 5000u bolus, 1000u/hr drip in average sized patient.

248
Q

In the case of pulmonary embolism, what is the dosing of fractionated heparin (LMWH)?

A

Enoxaparin: 1mg/kg SC q12h
Dalteparin: 100 units/kg SC q12h or 150 units/kg SC q24 hrs

249
Q

What are contraindications to fractionated heparin (LMWH)

A

renal insufficiency (CrCl <30), HIT, weight <50 kg or >100kg, recent or planned procedure

250
Q

In the case of pulmonary embolism, what is the dosing of Fondaparinux (Factor Xa inhibitor)?

A

5-10 mg SQ injection (dose depends on body mass), safe in patients with HIT

251
Q

In the case of pulmonary embolism, what is the dosing of Rivaroxaban Factor Xa inhibitor?

A

15 mg PO BID

252
Q

In the case of pulmonary embolism, what is the dosing of Argatroban (Direct thombin inhibitor)?

A

2mcg/kg/min IV –> If hepatic dysfunction 0.5 mcg/kg/min

CALL HEMATOLOGY before administering given dosing variability. Effects are NONREVERSIBLE.

253
Q

In the case of pulmonary embolism, what is the dosing of Warfarin (Vit K antagonist)?

A

Do not start warfarin prior to starting short-term anticoagulation given increased risk of recurrent DVT/PE

Should be overlapped with short-term anticoagulation for a minimum of 5 days AND until INR is therapeutic (INR 2-3) for 24 hrs

Typical initial dose is 5mg PO for the first 2 days then adjusted according to INR.

MANY meds interact with warfarin. be sure to review med list.

254
Q

In massive PE, what is thrombolytic dosing?

A

Alteplase (tPA): 15 mg IV bolus followed by 2 hr infusion of 100 mg.
Discontinue heparin during infusion.

If pulseless 50 mg IV bolus over 2-3 min, additional 50 mg IV bolus can be given 30 min later.

EM 101 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions