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Pharmocology HSC 116 > Fluid/electrolyte and common amenias > Flashcards

Fluid/electrolyte and common amenias Flashcards

1
Q

What is the ratio of water in our body weight?

A

2/3

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2
Q

What is the average fluid intake/day?

A

2500 mL

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3
Q

What ratio of body fluids are intracellular fluids (ICF)?

A

2/3

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4
Q

What are some intracellular fluid (ICF) electrolytes?

A

K+ Mg2+ Ca2+

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5
Q

What are two locations that extracellular fluids (ECF) can be found?

A

plasma and interstitial fluid

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6
Q

What are some extracellular fluid (ECF) electrolytes

A

Na+ Cl-

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7
Q

What are the four main things that electrolytes do in the body?

A

conduct energy

regulate fluid balance

transport nutrients

regulate pH

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8
Q

What are some things that can cause electrolyte/water imbalances?

A
  • dehydration
  • diarrhea
  • vomiting
  • sweating
  • fluid retention
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9
Q

What are the 3 organs that regulate water/electrolyte balance?

A

kidneys, skin, and respiratory system

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10
Q

What are the two types of IV fluids?

A

Crystalloids

Colloids

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11
Q

What are crystalloids? When is this most commonly used?

A

type of IV fluid that maintain a balance between the extravascular and intravascular compartments.

COMMONLY USED TO:
replace fluids when there are fluid defecits

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12
Q

What are the 4 types of crystalloid fluids? Which is the most common?

A

Normal saline 0.9% NaCl

Hypertonic Saline 3% NaCl

D5W (dextrose 5% in water)

Lactated Ringers solution

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13
Q

What are colloids?

A

a type of IV fluid that contains substances that move fluid from the interstitial plasma by “pulling” the fluid into the vessels

Large molecules that attract water

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14
Q

What are the 3 types of colloids?

A

Dextran

Hetastarch

Albumin

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15
Q

What is as common use for colloid IVs?

A

burn cases

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16
Q

What are some common causes of dehydration?

A
  • diuretic therapy
  • vomiting/diarrhea
  • hemorrhage
  • decreased fluid intake
  • excess urination
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17
Q

What can diabetes insipidus (DI) cause? what characteristic of the urine makes dehydration by this unique?

A

dehydration because of excess urination

doesn’t cause highly concentrated urination

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18
Q

What are the signs and symptoms of dehydration? (4)

A
  • Hypotension (dizziness)
  • weak and rapid pulse
  • decreased skin turgor and dry mucous membranes
  • low urine output (and very concentrated if present)
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19
Q

What are the 3 methods for management of dehydration?

A
  • replace fluids
  • replace electrolytes
  • treat/reverse underlying causes if possible
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20
Q

What are the 2 methods for prevention of dehydration?

A
  • patient education

- prevent recurrences

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21
Q

What is the normal blood concentration for Na+?

A

135-145 mmol/L

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22
Q

What is the normal blood concentration for K+?

A

3.5-5.0 mmol/L

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23
Q

What does K+ affect?

A

Heart rhythm

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24
Q

What is hypo/hyper natremia?

A

hypo/hyper Na+ levels

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25
Q

What are the signs and symptoms of hyponatremia? (8)

A

SODIUM < 120 mmol/L

Cerebral edema (especially if it happens rapidly and body not able to compensate. Osmotic gradient causes water to rush into brain)

anorexia
lethargy
disorientation
agitation
depressed reflexes
seizures
coma
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26
Q

What are the mortality rates for hyponatremia? what does severity of hyponatremia depend on?

A

5-20%

depends on how rapidly Na+ decreases and the signs and symptoms that present

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27
Q

What are the management methods for hyponatremia? (3)

A
  • replace water and sodium
  • reverse underlying causes or remove precipitating agent if possible
  • rate at which to replace sodium depends on the duration and symptoms
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28
Q

What can happen if you increase the sodium levels too fast?

A

can develop CENTRAL PONTINE MYELINOLYSIS:

severe damage of the myelin sheath which can cause

  • sudden paralysis
  • dysphagia (can’t swallow)
  • dysarthia (can’t speak)
  • double vision
  • loss of consciousness
  • may experience locked-in syndrome where cognition is intact, but muscles (except blinking) are paralyzed
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29
Q

What are the drugs that can be used to treat hyponatremia?

A

Oral electrolyte solutions:

  • pedialyte or Gatorade
  • sodium chloride

IV fluids:

  • normal saline
  • hypertonic saline (for severe symptoms)
30
Q

What is the normal rate for IV fluids to treat hyponatremia?

A

1 mL/kg/hour

31
Q

What are the signs and symptoms of Hypernatremia? (5)

A
  • lethargy
  • weakness
  • hyperreflexia
  • seizures
  • coma
32
Q

What are the 3 ways to manage hypernatremia?

A
  • lower the serum sodium concentration by 0.5 mmol/L/hr
  • rapid correction should be avoided b/c of brains adaptive response to hypernatremia can lead to cerebral edema
  • remove source of excess salt, use diuretics to inc sodium excretion and inc water intake
33
Q

What is hyper/hyp kalemia?

A

hyper/hypo K+ levels

34
Q

What are the signs and symptoms of hypokalemia? (6)

A
  • heart arrhythmias
  • muscle weakness
  • confusion
  • thirst
  • hypotension
  • vomiting
35
Q

How do you manage hypokalemia?

A

potassium supplementation and remove underlying cause if possible

36
Q

What indicates what type of drug to use for hypokalemia?

A

if no cardiac symptoms and K+ >2.5 but < 2.5, IV

37
Q

What are the two drugs for hypokalemia?

A

Potassium chloride (oral or IV)

K-Dur tablets (slow release)

38
Q

What is required if rate of potassium IV is <2.0 mEq/L? why?

A

cardiac monitoring, because too much K+ affects the heart rhythm

39
Q

What is the maximum rate of IV administration of potassium chloride?

A

40 mEq/hr

any more requires close monitoring

40
Q

What are the maximum concentrations for IV administration for potassium chloride?

A

40 mEq/L in peripheral line
(hands, arms, feet)

80 mEq/L in central line
(larger vein; near neck)

41
Q

What are the two sizes of IV bags for potassium chloride?

A

20 or 40 mEq bags

42
Q

What are the signs and symptoms of hyperkalemia?

A

often asymptomatic

  • nausea
  • irregular heart beat
  • slow/weak pulse
43
Q

What are three things that cause K+ to leave the intracellular fluid (ICF)

A

exercise
cell lysis
hyperosmolarity

44
Q

What are the indicators to start treatment of hyperkalemia?

A

K+ >6 or any ECG changes

45
Q

What are the 4 drugs used to treat hyperkalemia? explain their mechanism of action.

A

INSULIN and D5W: insulin will push potassium back into the cell, blood glucose must be monitored

SALBUTAMOL (B2 agonist): pushes potassium into cells

DIURETICS: pee potassium out

SODIUM POLYSTYRENE: binds to potassium to inc excretion via GI tract

46
Q

What is anemia?

A

defined as a hemoglobin value that is two standard deviations below the mean

47
Q

What are the two types of anemias?

A

Microcytic: small RBC volume
(commonly caused by iron-deficiency)

Macrocytic: big RBC volume
(commonly megaloblastic causes)

48
Q

Goals of therapy for anemia?

A
  • alleviate signs and symptoms
  • determine and address underlying cause
  • restore normal or adequate Hgb level
  • avoid transfusions
49
Q

What does MCV mean?

A

mean cell volume

50
Q

What is ferritin? What do its levels indicate?

A

an intracellular protein that stores iron and releases it in a controlled fashion

amount of ferritin stored reflects amount of iron stored

51
Q

What are the three ways that iron deficiency anemia can be treated?

A

Dietary iron

Oral iron

Parenteral iron

52
Q

What foods contain iron? what are the disadvantages of using dietary iron to treat iron-deficient anemia?

A

apples, tomatoes, bananas, spinach, nuts, fish

works more slowly and may not be sufficient for severe/persistent causes

53
Q

What are the 3 types of oral iron?

What does each word indicate?

A

ferrous gluconate
ferrous sulfate
ferrous fumarate

first word is just iron, second is the type of salt it is combined with to stabilize

54
Q

When looking at oral iron supplements, you will see formula weight, tablet size, and iron dose. Which is important?

55
Q

What is the target dose for oral iron supplementation?

A

100-200 mg/day of Elemental iron

note don’t count the pill weight, just iron content

56
Q

What are the AE of oral iron supplements?

A

constipation

black, tary, sticky stool (similar to GI bleeding symptom)

57
Q

What are the three drugs used for parenteral iron supplementation?

A

Iron dextran

sodium ferric gluconate

Iron sucrose

58
Q

When is parenteral iron supplementation used?

A

when patients have:

1) malabsorption
2) true intolerance to oral iron
3) ongoing losses exceeds gut’s ability to absorb iron

59
Q

What can be an AE of parenteral iron? What is the implication of this?

A

anaphylaxis (allergic reaction)

therefore, taken in hospital setting

60
Q

Does taking parenteral iron resolve the anemia faster than taking oral iron in patients that can tolerate it?

61
Q

What are the causes of macrocytic anemia?

A
  • impaired DNA synthesis from deficiencies in cobalamin (for B12 production) or folic acid
  • impaired DNA metabolism by drugs produce similar findings
62
Q

What is cobalamin?

A

a protein needed to produce vit B12

63
Q

What else besides anemia can cobalamin deficiency cause?

A

degeneration of the spinal cord

ex. spina bifida

64
Q

What are the only two sources of cobalamin in our diet?

A

meat and dairy

therefore, vegans at greater risk

65
Q

How long do the stores of cobalamin in the body last for?

A

several years

66
Q

What are the most common causes of B12 deficiency?

A
  • pernicious anemia (defect in production of intrinsic factor)
  • Gastrectemy
  • Inflammatory Bowel Disease (IBD)
67
Q

What are the three routes for B12 supplements? which is most common?

A

Oral supplementation
IM or subcutaneous

IM most common

68
Q

What is the cause of folic acid deficiency?

A
  • dietary deficiency

- alcoholism (alcohol inhibits absorption)

69
Q

What happens to the folic acid (folate) in food when it is cooked?

A

it is usually destroyed

70
Q

When is there an inc need for folic acid (folate)?

A

in pregnancy to prevent neural tube defects in the fetus

71
Q

What are the two drugs that require an increase in folic acid requirements?

A

methotrexate

phenytoin

72
Q

How is folic acid supplemented?

A

1mg PO daily

Pharmocology HSC 116 (5 decks)

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