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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
What are the signs and symptoms of hyponatremia? (8)
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 ```
26
What are the mortality rates for hyponatremia? what does severity of hyponatremia depend on?
5-20% depends on how rapidly Na+ decreases and the signs and symptoms that present
27
What are the management methods for hyponatremia? (3)
- 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
28
What can happen if you increase the sodium levels too fast?
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
29
What are the drugs that can be used to treat hyponatremia?
Oral electrolyte solutions: - pedialyte or Gatorade - sodium chloride IV fluids: - normal saline - hypertonic saline (for severe symptoms)
30
What is the normal rate for IV fluids to treat hyponatremia?
1 mL/kg/hour
31
What are the signs and symptoms of Hypernatremia? (5)
- lethargy - weakness - hyperreflexia - seizures - coma
32
What are the 3 ways to manage hypernatremia?
- 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
What is hyper/hyp kalemia?
hyper/hypo K+ levels
34
What are the signs and symptoms of hypokalemia? (6)
- heart arrhythmias - muscle weakness - confusion - thirst - hypotension - vomiting
35
How do you manage hypokalemia?
potassium supplementation and remove underlying cause if possible
36
What indicates what type of drug to use for hypokalemia?
if no cardiac symptoms and K+ >2.5 but < 2.5, IV
37
What are the two drugs for hypokalemia?
Potassium chloride (oral or IV) K-Dur tablets (slow release)
38
What is required if rate of potassium IV is <2.0 mEq/L? why?
cardiac monitoring, because too much K+ affects the heart rhythm
39
What is the maximum rate of IV administration of potassium chloride?
40 mEq/hr any more requires close monitoring
40
What are the maximum concentrations for IV administration for potassium chloride?
40 mEq/L in peripheral line (hands, arms, feet) 80 mEq/L in central line (larger vein; near neck)
41
What are the two sizes of IV bags for potassium chloride?
20 or 40 mEq bags
42
What are the signs and symptoms of hyperkalemia?
often asymptomatic - nausea - irregular heart beat - slow/weak pulse
43
What are three things that cause K+ to leave the intracellular fluid (ICF)
exercise cell lysis hyperosmolarity
44
What are the indicators to start treatment of hyperkalemia?
K+ >6 or any ECG changes
45
What are the 4 drugs used to treat hyperkalemia? explain their mechanism of action.
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
What is anemia?
defined as a hemoglobin value that is two standard deviations below the mean
47
What are the two types of anemias?
Microcytic: small RBC volume (commonly caused by iron-deficiency) Macrocytic: big RBC volume (commonly megaloblastic causes)
48
Goals of therapy for anemia?
- alleviate signs and symptoms - determine and address underlying cause - restore normal or adequate Hgb level - avoid transfusions
49
What does MCV mean?
mean cell volume
50
What is ferritin? What do its levels indicate?
an intracellular protein that stores iron and releases it in a controlled fashion amount of ferritin stored reflects amount of iron stored
51
What are the three ways that iron deficiency anemia can be treated?
Dietary iron Oral iron Parenteral iron
52
What foods contain iron? what are the disadvantages of using dietary iron to treat iron-deficient anemia?
apples, tomatoes, bananas, spinach, nuts, fish works more slowly and may not be sufficient for severe/persistent causes
53
What are the 3 types of oral iron? | What does each word indicate?
ferrous gluconate ferrous sulfate ferrous fumarate first word is just iron, second is the type of salt it is combined with to stabilize
54
When looking at oral iron supplements, you will see formula weight, tablet size, and iron dose. Which is important?
Iron dose
55
What is the target dose for oral iron supplementation?
100-200 mg/day of Elemental iron **note** don't count the pill weight, just iron content
56
What are the AE of oral iron supplements?
constipation black, tary, sticky stool (similar to GI bleeding symptom)
57
What are the three drugs used for parenteral iron supplementation?
Iron dextran sodium ferric gluconate Iron sucrose
58
When is parenteral iron supplementation used?
when patients have: 1) malabsorption 2) true intolerance to oral iron 3) ongoing losses exceeds gut's ability to absorb iron
59
What can be an AE of parenteral iron? What is the implication of this?
anaphylaxis (allergic reaction) therefore, taken in hospital setting
60
Does taking parenteral iron resolve the anemia faster than taking oral iron in patients that can tolerate it?
no
61
What are the causes of macrocytic anemia?
- impaired DNA synthesis from deficiencies in cobalamin (for B12 production) or folic acid - impaired DNA metabolism by drugs produce similar findings
62
What is cobalamin?
a protein needed to produce vit B12
63
What else besides anemia can cobalamin deficiency cause?
degeneration of the spinal cord ex. spina bifida
64
What are the only two sources of cobalamin in our diet?
meat and dairy therefore, vegans at greater risk
65
How long do the stores of cobalamin in the body last for?
several years
66
What are the most common causes of B12 deficiency?
- pernicious anemia (defect in production of intrinsic factor) - Gastrectemy - Inflammatory Bowel Disease (IBD)
67
What are the three routes for B12 supplements? which is most common?
Oral supplementation IM or subcutaneous IM most common
68
What is the cause of folic acid deficiency?
- dietary deficiency | - alcoholism (alcohol inhibits absorption)
69
What happens to the folic acid (folate) in food when it is cooked?
it is usually destroyed
70
When is there an inc need for folic acid (folate)?
in pregnancy to prevent neural tube defects in the fetus
71
What are the two drugs that require an increase in folic acid requirements?
methotrexate phenytoin
72
How is folic acid supplemented?
1mg PO daily

Pharmocology HSC 116 (5 decks)

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