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Pharm 2 > Fluids and shock > Flashcards

Fluids and shock Flashcards

1
Q

Major physiologic determinants of tissue perfusion are:

A

BP, Cardiac output

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2
Q

main sign of pre-shock/ compensated shock

A

tachycardia

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3
Q

symptoms of shock

A

Signs and symptoms of end-organ dysfunction
Symptomatic tachycardia, dyspnea, hypotension, cool clammy skin
Metabolic acidosis, oliguria, renal dysfunction

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4
Q

what type of shock?
Intravascular fluid loss due to:
Hemorrhagic cause
Nonhemorrhagic cause
Third spacing

A

hypovolemic

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5
Q

hypovolemic shock effect on cardiac output

A

decrease in preload (volume in LV at end of diastole)

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6
Q

fluid options for Nonhemorrhagic hypovolemic shock

A

1st line is crystalloids (NS, LR), 2nd line is colloids

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7
Q

class: recombinant factor 7a (novoseven), tranexamic acid

A

hemostatic agents

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8
Q

managment for internal bleeding

A

hemostatic agents, blood

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9
Q

how to reverse warfarin

A

4Factor PCC (prothrombin complex concentrate)/KCentra + vitamin K

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10
Q

how to reverse dabigatran

A

Idarucizumab/Praxbind or activated PCC

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11
Q

how to reverse Xarelto, Eliquis

A

Andexanet alfa or 4F PCC/KCentra

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12
Q

criteria for septic shock dx

A

Infection: Invasion of normally sterile tissue by organisms OR Bacteremia.
Organ dysfunction
SOFA (Sequential (sepsis-related) Organ Failure Assessment score
Score ≥ 2
qSOFA can identify patients at risk for sepsis
Score ≥ 2

Patients who require vasopressors despite adequate fluid resuscitation maintain MAP ≥ 65 mmHg
+
Lactate ≥ 2 mmol/L

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13
Q

septic shock is a type of ____ shock

A

distributive

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14
Q

major factor of distributive shock

A

massive vasodilation

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15
Q

3 keys points for mgmt of sepsis

A

Management requires these 3-things:
Early recognition and intervention (including administration of IV fluids (NS or LR) and vasopressors as needed)
Early administration of broad spectrum antibiotics (w/in 1 hr of arrival)
Source control

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16
Q

rate/amount of fluid restoration for sepsis

A

30mL/kg total bolus
Given in 500-1000mL bolus
Reassessment performed following each bolus

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17
Q

indication for vasopressors in sepsis

A

Recommended in patient with MAP < 60 – 65 mmHg after failed fluid resuscitation. Used when fluid resuscitation is inadequate to maintain blood pressure and prevent organ dysfunction in shock

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18
Q

central or peripheral line for vasopressors?

A

central

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19
Q

1st line vasopressor in septic shock

A

norepinephrine

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20
Q

add ___ to NE if persistent hypotension in septic shock

A

epi

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21
Q

1st line for shock caused by HF or resulted in HF

A

dobutamine (but Rarely used in septic shock – only when combined with multiple other vasopressors)

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22
Q

indication for corticosteroids in shock

A

Hemodynamic instability despite fluid and vasopressor therapy
IV hydrocortisone: 200 mg/day (50 mg q6h)
Wean from steroids when vasopressor therapy no longer required

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23
Q

stress ulcer prophylaxis in shock

A

Drugs that increase gastric pH
Famotidine (Pepcid®) or ranitidine (Zantac®): histamine receptor antagonist
Lansoprazole (Prevacid®) or pantoprazole (Protonix®): proton pump inhibitors

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24
Q

pts at risk for stress ulcers

A

Mechanical ventilation (> 48 hours)
Coagulopathic
Hypotensive

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25
Q

predominant ion in intracellular fluid

A

K

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26
Q

plasma w/o clotting factors

A

serum

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27
Q

predominant ion in interstitial fluid

A

Na

28
Q

75% of oncotic pressure is from ____

A

albumin

29
Q

brain structure regulating thirst

A

hypothalamus

30
Q

should intake ___L of water, pee out ___L

A

2, 1.5

31
Q

BUN/Cr ratio in prerenal azotemia / dehydration

A

> 20:1
20:1

32
Q

HR and BP in dehydration

A

rapid HR, low BP

33
Q

Aqueous solutions of mineral salts or other water soluble molecules
* Increases intravascular volume and intracellular volume
* Low tendency to stay in intravascular space

A

crystalloids

34
Q

isotonic crystalloid; contains Na, Cl, K, Ca, lactate; prevents hyperchloremia acidosis

A

lactated ringers

35
Q

NS overload can cause

A

overload can cause high Na, low K, metabolic acidosis, high Cl

36
Q

3 contraindications for half normal saline

A

burns, trauma, cirrhosis

37
Q

indications for half normal saline

A

hypernatremia, DKA

38
Q

indications for Electrolyte-Free Water
o D5w: dextrose 5% In water, D10w: dextrose 10% in water

A

hypoglycemia, critically elevated serum osmolarity

39
Q

contras for Electrolyte-Free Water
o D5w: dextrose 5% In water, D10w: dextrose 10% in water

A

edema, blood loss, hypovolemia

40
Q

3% saline (or higher): causes volume expansion where?

A

larger volume expansion in intravascular space

41
Q

severe hypovolemia / large quantity of fluid needed. use NS or LR?

A

LR (to prevent hypercholremic acidosis, AKI)

42
Q

High concentration solutes and protein designed to keep fluids in intravascular space à “plasma expander”
* Large molecules/proteins suspended in solution
* Don’t diffuse out of blood stream into interstitial or intracellular space
* Draws fluid into bloodstream by oncotic pressure à increases oncotic pressure

A

colloids

43
Q

class: Fresh frozen plasma or albumin (natural)
o Hespan or Dextran (synthetic)

A

colloids

44
Q

pt w/ blood loss–what to give them?

A

blood

45
Q

what fluid can reverese a coagulopathy (pre-procedural)?

A

fresh frozen plasma

46
Q

quantity of fluid replacement for 68kg adult

A

For adults: Your patient weighs 68 kg
–First take 40 ml/hr
–Now add 68 ml/hr (this is the 1 ml/hr per kg of the patient’s weight )
Maintenance IV fluid rate is 40+68=108 ml/hr

47
Q

quantity of fluid replacement for 25kg kid

A

Your patient weighs 25 kg (55 lbs):
-First 10 kg allow 4ml/kg/hr= 40 ml/hour
-Second 10 kg allow 2/mg/kg/hr=20 ml/hr
-Everything over gets 1 ml/kg/hr (in this case 5 more kg to make a total of 25 kg) SO…5 ml/hr
40 +20+5= 65ml/hr of chosen IV fluid for maintenance rate.

48
Q

bolus rate for adults

A

1-2L at a time

49
Q

bolus rate for CHF, ESRD

A

250-500cc, reassess every 2-5min

50
Q

bolus rate for elderly, kids

A

also elderly, kids (bolus slowly over 30min-1hr, 10-20cc/kg). don’t give too much too fast to kids

51
Q

what fluid to give burn pts

A

LR

52
Q

when to refer burn pt

A

> 10% of BSA burned

53
Q

when to give sodium bicarb in CKD metabolic acidosis

A

KDIGO suggests oral replacement when HCO3 concentrations are <22mEq

54
Q

caution for sodium bicarb

A

Caution in patients who should maintain a low sodium diet

55
Q

when to give bolus K+

A

never

56
Q

antidote for KCl

A

hyaluronidase antidote

57
Q

if giving pt PO KCl, also give ___

A

meal + full glass of water

58
Q

caution for KCl

A

renal failure/insufficiency d/t risk of hyperkalemia

59
Q

10 mEq of Kcl will increase serum K by ___

A

0.1

60
Q

acute hyperkalemia management:

A

insulin, dextrose, albuterol. if also have EKG changes, give Ca gluconate

61
Q

Gastrointestinal Cation Exchangers for Hyperkalemia – ok for renal impairment?

A

yes

62
Q

preferred Gastrointestinal Cation Exchangers for Hyperkalemia

A

Lokelma (zirconium cyclosilicate)
§ Newer, preferred, works quickly (~1 hr)
§ May be used for chronic hyperkalemia of CKD/ESRD

63
Q

contra for Gastrointestinal Cation Exchangers for Hyperkalemia

A

AVOID use in anyone w/ ileus, severe constipation, bowel obstruction or gastric motility disorders à risk of
intestinal necrosis!

64
Q

indicatin for Potassium Bicarbonate

A

hypokalemia in pt w/ metabolic acidosis (Ex: diarrhea)

65
Q

loop vs thiazide diuretic for CKD?

A

loop, esp if GFR<60

Pharm 2 (29 decks)

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