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NAPLEX Content > IV drugs, Fluids And Antidotes > Flashcards

IV drugs, Fluids And Antidotes Flashcards

1
Q

Disadvantages of central IV line?

A

Higher risks of bleeding, inf and thromboembolism and they are more difficult to insert correctly

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2
Q

What’s the concern with the use of Polyvinyl Chloride (PVC) infusion bags?

A

Leaching (1 substance pulled from another)

Sorption (1 substance pulls in another)

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3
Q

Which drugs are known to have Leaching issues?

A

Tacrolimus

Temsirolimus

Teniposide

Carbazitaxel

Docetaxel

Ixabepilone

Paclitaxel

(Tic tac toe, craving delicious irrestible pho)

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4
Q

Which drugs are known to have Sorption issues?

A

Amiodarone (for infusions greater than 2 hrs)

Carmustine

Lorazepam

Sufentanil

Thiopental

Regular human insulin

NTG

(ACLS TIN)

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5
Q

What type of IV fluid is preferred? Why?

A

Crystalloids

Less costly and safer

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6
Q

List fluids under Colloids

A

Albumin 5%, 25% (Albuked, Flexbumin)

Dextran (Dextran 40, Dextran 70)

Hydroxyethyl starch (Hespan, Hextend, Voluven)

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7
Q

Which fluid is more expensive with no evidence of superiority?

A

Albumin 5%, 25% (Albuked, Flexbumin)

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8
Q

Is 5% albumin isotonic, hypertonic, hypotonic?

A

Isotonic

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9
Q

Is 25% albumin isotonic, hypertonic, hypotonic?

A

Hypertonic

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10
Q

What’s used to dilute/ prepare 5% albumin.?

A

NS (not sterile water)

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11
Q

What’s the issue with Dextran (Dextran 40; 70)?

A

High risk for ADRs (urticaria, acute renal failure, increased bleeding time)

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12
Q

List types of Crystalloids (Less costly and safer)?

A

Lactated Ringers (LR)

Dextrose 5% (D5W)

NaCl 0.9% (NS, normal saline)

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13
Q

Whats gen. recommended as 1st line therapy in pts with hypovolemic shock (e.g. Hemorrhagic)?

A

Fluid resuscitation with Crystalliids (LR, D5W, NS)

or

Colloids (Albumin 5%, Dextran, Hydroxyethyl starch)

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14
Q

Why is vasopressors offered as 2nd line in hypovolemic shock?

A

Vasopressors are NOT effective w/o adequate fluid admin - at least 30mL/kg

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15
Q

What’s Sepsis?

A

Presence of an infection with Systemic Inflammatory Response Syndrome (SIRS)

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16
Q

What’s septic shock?

A

Dev of hypotension in a pt with sepsis

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17
Q

Moa of Inotropes?

A

Work by increasing contractility

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18
Q

MOA of Dobutamine?

A

Beta-agonist

Increases HR => increase CO

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19
Q

MOA of vasopressors?

A

Work via Vasoconstriction (think pressing down) => increase systemic vascular resistance (SVR)

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20
Q

What happens at medium doses of Dopamine?

A

Beta-1 receptors are stimulated => increased stoke vol => increased CO

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21
Q

What happens at high doses of Dopamine?

A

Alpha-1 receptors are stimulated => vasoconstriction => increased SVR

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22
Q

Moa of epinephrine?

A

Both alpha and beta agonist

Increases co and SVR

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23
Q

Moa of norepinephrine?

A

Both alpha and beta agonist, with greater alpha effects

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24
Q

List Inotropes and Vasopressors used in shock syndrome

A

DOBUTAMINE

Milrinone

DOPAMINE

EPINEPHRINE (Adrenalin)

NOREPINEPHRINE (Levophed)

Phenyephrine (Neo-Synephrine)

Vasopressin (Pitressin)

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25
Q

SEs of Dobutamine?

A

Hypotension

Premature ventricular beats

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26
Q

SEs of Milrinone?

A

Ventricula arrhythmias

Supraventricular arrhythmias

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27
Q

Milrinone and renal dysfunction?

A

Milrinone must be reduced for renal dysfxn

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28
Q

SEs of (dopamine, epinephrine, norepinephrine, phenylephrine)?

A

Arrhythmias

Tachycardia (esp with dopamine and epinephrine)

Bradycardia

Peripheral ischemia

Necrosis (gangrene)

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29
Q

What’s the strength of Epinephrine used for IV route?

A

0.1 mg/mL or 1:10,000

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30
Q

SEs of Vasopressin?

A

Arrhythmias

Necrosis (gangrene)

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31
Q

What’s Extravasation?

A

Leaking of IV meds into surrounding tissue, of vasopressors/Inotropes can cause tissue damage and necrosis

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32
Q

Howz Extravasation treated?

A

Phentolamine (an alpha-adrenergic blocker that antagonizes the effects of vassopressors)

Dilute 5-10 mg in NS and give SC to infiltrated area

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33
Q

List agents used for ICU sedation and analgesia

A

Opioids (Morphine, Hydomorphone, Fentanyl)

BZD (Midazolam, Lorazepam)

Antipsychotics (Haloperidol, Quetiapine, Risperidone)

Hypnotics (Propofol, Dexmedetomidine)

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34
Q

What’s the preferred drug for achieving rapid analgesia?

A

Fentanyl

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35
Q

What’s the preferred drug for rapid sedation?

A

BZD, Propofol and Dexmedetomidine

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36
Q

Care in Propofol admin?

A

Limit dose and duration or Propofol due to Propofol-related infusion syndrome, which can result in cardiac arrhythmias and death

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37
Q

Sedation for pts with delirium?

A

Dexmedetomidine (not BZD)

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38
Q

List agents used for ICU sedation and agitation

A

Lorazepam (Ativan; Lorazepam Intensol)

Midazolam

Propofol (Diprivan)

Dexmedetomidine (Precedex)

Morphine

Fentanyl

Hydromorphone (Dilaudid)

Remifentanil (Ultiva)

Haloperidol (Haldol)

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39
Q

SE of Lorazepam (Ativan, Lorazepam Intensol)?

A

Respiratory depression

Oversedation

Hypotension

Propylene glycol poisoning at high doses and prolonged infusions (look for metabolic acidosis and renal insufficiency)

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40
Q

CI to Midazolam?

A

Concurrent use of potent CYP3A4 inihibitors

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41
Q

SE of Midazolam?

A

Respiratory depression

Apnea

Oversedation

Hypotension

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42
Q

Duration of Midazolam use?

A

Short-term sedation (< 48 hrs)

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43
Q

Brand name of Propofol?

A

Diprivan

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44
Q

SEs of Propofol (Diprivan)?

A

Hypotension

Apnea

Hypertriglyceridemia

Green urine

Propofol-related infusion syndrome (PRIS -rare, but can be fatal)

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45
Q

What should be monitored if on Propofol (Diprivan) longer than 2 days?

A

TGs

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46
Q

Why’s strict aseptic technique recommended when handling Propofol (Diprivan)?

A

Due to potential for bacterial growth

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47
Q

Size of filter required for Propofol (Diprivan) admin?

A

Don’t use < 5 microns

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48
Q

How’s Propofol (Diprivan) formulated?

A

In a lipid emulsion (provides 1.1 kcal/mL)

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49
Q

Brand name of Dexmedetomidine?

A

Precedex

(Alpha2-adrenergic agonist

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50
Q

SEs of Dexmedetomidine (Precedex)?

A

Transient HTN during loading dose (may need to reduce infusion rate)

Hypotension

Bradycardia

Dry mouth

Nause

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51
Q

Howz Dexmedetomidine (Precedex) mixed?

A

With NS ONLY

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52
Q

Max duration of infusion for Dexmedetomidine (Precedex)?

A

Should not exceed 24 hrs per manufacturers labeling

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53
Q

SEs of Morphine?

A

Respiratory depression

Hypotension

Over sedation

Bradycardia

Pruritus

Xerostomia

Constipation

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54
Q

T/F? Morphone has an active metabolite?

A

T

Morphine-6-glucuronide

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55
Q

SEs of Fentanyl?

A

Respiratory depression

Bradycardia

Oversedation

Comstipation

Rigidity with high doses

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56
Q

Advantage of Fentanyl over morphine?

A

Less hypotension than morphine due to NO histamine release

57
Q

What’s the brand name of Hydromophone?

58
Q

Brand name of Haloperidol?

59
Q

SEs of Haloperidol (Haldol)?

A

Hypotension

QT prolongation

Tachycardia

Extrapyrimidal sx (EPS)

60
Q

Monitoring of Haloperidol (Haldol)?

A

QT interval and ECG

61
Q

What’s an acid?

A

Substance that DONATES protons or H+ ions

62
Q

Whats a base?

A

Substance that ACCEPTS protons or H+ ions

63
Q

What’s normal pH of blood? Range?

A

7.4 (range 7.35-7.45h

64
Q

What’s an acidosis?

A

Acid-base disorder that leads to a pH < 7.35

65
Q

What’s alkalosis?

A

Acid-base disorder that leads to a pH > 7.45

66
Q

What’s a metabolic acidosis?

A

Xterized primarily by a DECREASE in plasma HCO3 conc

67
Q

What’s a metabolic alkalosis?

A

Xterized primarily by a INCREASE in plasma HCO3 conc

68
Q

Howz anion gap (AG) calculated?

A

Na - (Cl + HCO3)

69
Q

What’s hypertonic?

A

State in which serum osmolality is increased and is caused by hyperglycemia

Or

Use of hypertonic solns that don’t contain sodium

70
Q

What’s Isotonic?

A

Normal osmolality and can be associated with hyperlipidemia

71
Q

What’s Hypotonic?

A

May occur with changes in volume status

  • Hypovolemic
  • Hypervolemic
  • Isovolemic (usually caused by Syndrome of Inappropriate Antidiuretic Hormone (SIADH))
72
Q

What may be used to treat Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

A

Conivaptan or Tolvaptan

73
Q

Moa of Conivaptan or Tolvaptan (used to treat SIADH)?

A

Vasopressin V2-receptor antagonist

74
Q

CI to Conivaptan (Vaprisol)?

75
Q

SE to Conivaptan (Vaprisol)?

A

Orthostatic hypotension

Fever

Hypokalemia

76
Q

Max duration of Tolvaptan (Samsca)? Why?

A

For up to 30 days dut to hepatoxicity

77
Q

CI to Tolvaptan (Samsca) use?

A

Pts who can’t sense or respond appropriately to thirst

Anura

78
Q

SE of Tolvaptan (Samsca)?

A

Thirst

Nausea

Dry mouth

Asthenia

Constipation

Polyuria

Hyperglycemia

79
Q

What’s Hypo- & Hyper-natremia?

A

Hypo - (Na < 135 mEq/L)

Hyper - (Na > 145 mEq/L)

80
Q

What’s hypovolemic?

A

Caused by dehydration, vomiting, diarrhea and is usually treated with Dextrose to replace free water deficits and hypotonic solution (0.46% NaCl)

81
Q

What’s hypervolemic?

A

Caused by admin of hypertonic solns.

Diuretics is tx of choice with 5% dextrose

82
Q

What’s Isovolemic (Euvolemic)?

A

Freq ass with diabetes insipidus (DI)

83
Q

What’s the caution in correcting Na disorder?

A

Don’t correct too quickly

84
Q

What’s the max pt to which u should correct Na anymore?

A

Corrections of Na > 12mEq/L over 24 hrs have been ass. with development of central pontine myelinosis, a devastating neurologic complication that can lead to quadriparesis, seizures and death

85
Q

What’s hypokalemia?

A

K < 3.5 mEq/L

86
Q

What’s the preferred route to correcting K?

A

Oral route, when available is preferred

87
Q

How should IV K be admin in correcting hypokalemia?

A

No faster than 10-20 mEq/hr with intermittent doses

88
Q

Critical illness and blood flow to gut?

A

Pts with critical illness have reduced blood flow to the gut (as blood,is diverted to major organs of the body) => breakdown of gastric mucosal defense mechanisms

89
Q

Risk factors for dev of stress ulcer?

A

MECHANICAL VENTILATION

COAGULOPATHY

Sepsis

Traumatic brain injury

Burn pts

Acute renal failure

High dose corticosteroids

90
Q

Should pts w/o stress ulcers risk factor receive stress ulcer prophylaxis?

91
Q

Risk factors for dev venous thromboembolism (VTE)?

A

Surgery

Major trauma

Immobility

Cancer

Previous VTE

Pregnancy

Estrogen-containing meds or Selecyive estrogen receptor modulators

92
Q

Dose of low dose UFH used in VTE?

A

5,000 units SC BID-TID

93
Q

Dose of LMWH used in VTE?

A

Enoxaparin 30mg SC BID or 40mg SC daily (give 30mg SC daily, if CrCl < 30ml/min)

Dalteparin 2,500 - 5,000 units SC daily

94
Q

What can inhaled anesthetics cause? How should it be treated?

A

Malignant hyperthermia (rare)

Should be treated with Dantrolene

95
Q

List topical anesthetics agents

A

Lidocaine (Xylocaine)

Benzocaine

96
Q

List inhaled anesthetics agents

A

Desflurane (Suprane)

Sevoflurane (Ultane)

Isoflurane (Forane)

Nitrous oxide

97
Q

List injectable anesthetics agents

A

Bupivacaine (Marcaine, Sensorcaine)

Lidocaine (Xylocaine)

Ropivacaine (Naropin)

98
Q

How epidural containing bupivacaine NOT be given?

A

IV infusion (don’t give via this route)

99
Q

What should be given prior to admin of Neuromuscular Blocking Agents (NMBAs)? Why?

A

Sedation and analgesia

Bcuz NMBAs don’t provide either

100
Q

What must be done to pts b4 admin of NMBAs?

A

Pt must be mechanically ventilated

101
Q

What must all NMBAs be labeled with?

A

Bright, red auxiliary labels stating “WARNING, PARALYSING AGENTS”

102
Q

Types of NMBAs?

A

Depolarizing (Succinylcholine is the only 1 in this Grp and used for intubation)

Non-depolarizing (works by binding to acetylcholine receptor and blocks actions of endogenous acetylcholine)

103
Q

SEs of non-depolarizing NMBAs?

A

Flushing

Bradycardia

Hypotension

Tachyphylaxis

104
Q

List non-depolarizing NMBAs

A

Atracurium

Cisatracurium (Nimbex)

Pancuronium

Rocuronium (Zemuron)

Vecuronium

105
Q

What’s the brand name of Cisatracurium? Non-depolarizing NMBAs

106
Q

Which NMBAs have short half-life (t1/2); intermediate acting; metabolized by Hofmann elimination?

A

Atracurium

Cisatracurium (Nimbex)

107
Q

Which NMBAs is long-acting, can accumulate in renal or hepatic dysfxn, increased HR?

A

Pancuronium

108
Q

Which NMBAs is intermediate-acting, )can accumulate in renal or hepatic dysfxn)?

A

Rocuronium (Zemuron)

Pancuronium

109
Q

What does hemostasis mean?

A

Causing bleeding to stop

110
Q

List systemic Hemostatic Agents

A

Aminocaproic acid (Amicar)

Tranexamic avid

Recombinant Factor VIIa (NovoSeven RT)

111
Q

Brand name of Recombinant Factor VIIa?

A

NovoSeven RT

112
Q

FDA approval for Tranexamic acid?

A

Menorrhagia (heavy menstrual bleeding)

113
Q

What’s intravenous Immunoglobulin (IVIG)?

A

Contains pooled Immunoglobulin (IgG)

114
Q

Whats use to dose IVIG?

115
Q

When should slower infusion rates be used in IVIG infusion?

A

In renal and cardiovascular dx

116
Q

BBW of IVIG?

A

Acute renal dysfxn (more likely with pdts stabilized with sucrose)

Caution in elderly, pts with renal dx, DM, vol depletion, sepsis, paraproteinemia and nephrotoxic meds

Thrombosis

117
Q

CI of IVIG?

A

IgA deficiency (can use product with lowest amt of IgA)

118
Q

SEs of IVIG?

A

Fever, nausea, chills, hypotension, flushing, HA, myalgias, chest pain, tachycardia

Renal failure, aseptic meningitis, hemolysis, neutropenia, thromboembolic disorders and anaphylaxis are rare but serious

119
Q

Monitoring of IVIG?

A

Renal fxn

Urine output

Vol status

120
Q

Name the most commonly used resources for IV drug compatibility?

A

Trissel’s Handbook on Injectable Drugs

King Guide to Parenteral Admixtures

121
Q

List photosensitive drugs (drugs that req protection from light)

A

Amiodarone, Amphotericin

Ceftriaxone, Cefepime, Cipro

Dopamine, Doxycycline

Epinephrine

Fentanyl, Furosemide

Hydrocortisone, Hydromorphone

Levofloxacin, Levothyroxine, Linezolid

Methylprednisolone, Metronidazole, Micafungin

Norepinephrine

Ondansetron

Pentamidine, Phytonadione

SMX/TMP, Sodium Nitroprusside

122
Q

List meds that shouldn’t be refrigerated

A

Metronidazole (Flagyl)

SMX/TMP (Bactrim)

Phenylephrine (Neosynephrine)

Hydralazine, Moxifloxacin (Avelox)

Acetaminophen (Ofirmev)

Esomeprazole (Nexium)

123
Q

What used to be done for poisoning that’s no longer recommended?

A

Syrup of ipecac (to induce vomiting)

Gastric decontamination, such as, Activated charcoal

Gastric lavage

124
Q

Sx of organophosphate poisoning?

A

Cholinergic (MUDDLES)

Miosis (pinpoint pupils)
Urination
Diarrhea
Diaphoresis
Lacrimation
Excitation (anxiety)
Salivation
125
Q

What’s the antidote for APAP?

A

N-acetylcysteine

126
Q

What’s the antidote for Anticolinesterase insecticide/ organophosphate ?

127
Q

What’s the antidote for Anticholinergic Compds?

A

Physostigmine (Antilirium)

128
Q

What’s the antidote for BZD?

A

Flumazenil (Romazicon)

129
Q

What’s the antidote for Beta blockers?

A

Glucagon (GlucaGen)

130
Q

What’s the antidote for Digoxin?

A

Digoxin Immune Fab (DigiFab)

131
Q

What’s the antidote for Ethylene glycol, methanol?

A

Ethanol or Fomepizole (Antizol)

132
Q

What’s the antidote for heavy metal?

A

Dimercaprol

133
Q

What’s the antidote for Heparin?

134
Q

What’s the antidote for iron?

A

Deferoxamine (Desferal)

135
Q

What’s the antidote for Isoniazid (INH)?

A

Pyridoxine (Vit. B6)

136
Q

What’s the antidote for opioids?

A

Naloxone (Narcan)

137
Q

What’s the antidote for snake bites?

A

Crotalidae polyvalent (Antivenin, Crofab)

138
Q

What’s the antidote for warfarin, rat poison?

A

Phytonadione (AquaMephyton, Mephyton) Vit. K

139
Q

Advantages of central IV line?

A

Can deliver fluids/meds that are overly irritating to peripheral veins (e.g. some chemo drugs, PN, higher conc of K, vasopressor drugs, hypertonic soln)

Can contain multiple parallel compartments

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