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
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)
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)
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)
5
Q
What type of IV fluid is preferred? Why?
A
Crystalloids
Less costly and safer
6
Q
List fluids under Colloids
A
Albumin 5%, 25% (Albuked, Flexbumin)
Dextran (Dextran 40, Dextran 70)
Hydroxyethyl starch (Hespan, Hextend, Voluven)
7
Q
Which fluid is more expensive with no evidence of superiority?
A
Albumin 5%, 25% (Albuked, Flexbumin)
8
Q
Is 5% albumin isotonic, hypertonic, hypotonic?
A
Isotonic
9
Q
Is 25% albumin isotonic, hypertonic, hypotonic?
A
Hypertonic
10
Q
What’s used to dilute/ prepare 5% albumin.?
A
NS (not sterile water)
11
Q
What’s the issue with Dextran (Dextran 40; 70)?
A
High risk for ADRs (urticaria, acute renal failure, increased bleeding time)
12
Q
List types of Crystalloids (Less costly and safer)?
A
Lactated Ringers (LR)
Dextrose 5% (D5W)
NaCl 0.9% (NS, normal saline)
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)
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
15
Q
What’s Sepsis?
A
Presence of an infection with Systemic Inflammatory Response Syndrome (SIRS)
16
Q
What’s septic shock?
A
Dev of hypotension in a pt with sepsis
17
Q
Moa of Inotropes?
A
Work by increasing contractility
18
Q
MOA of Dobutamine?
A
Beta-agonist
Increases HR => increase CO
19
Q
MOA of vasopressors?
A
Work via Vasoconstriction (think pressing down) => increase systemic vascular resistance (SVR)
20
Q
What happens at medium doses of Dopamine?
A
Beta-1 receptors are stimulated => increased stoke vol => increased CO
21
Q
What happens at high doses of Dopamine?
A
Alpha-1 receptors are stimulated => vasoconstriction => increased SVR
22
Q
Moa of epinephrine?
A
Both alpha and beta agonist
Increases co and SVR
23
Q
Moa of norepinephrine?
A
Both alpha and beta agonist, with greater alpha effects
24
Q
List Inotropes and Vasopressors used in shock syndrome
A
DOBUTAMINE
Milrinone
DOPAMINE
EPINEPHRINE (Adrenalin)
NOREPINEPHRINE (Levophed)
Phenyephrine (Neo-Synephrine)
Vasopressin (Pitressin)
25
SEs of Dobutamine?
Hypotension
Premature ventricular beats
26
SEs of Milrinone?
Ventricula arrhythmias
Supraventricular arrhythmias
27
Milrinone and renal dysfunction?
Milrinone must be reduced for renal dysfxn
28
SEs of (dopamine, epinephrine, norepinephrine, phenylephrine)?
Arrhythmias
Tachycardia (esp with dopamine and epinephrine)
Bradycardia
Peripheral ischemia
Necrosis (gangrene)
29
What's the strength of Epinephrine used for IV route?
0.1 mg/mL or 1:10,000
30
SEs of Vasopressin?
Arrhythmias
Necrosis (gangrene)
31
What's Extravasation?
Leaking of IV meds into surrounding tissue, of vasopressors/Inotropes can cause tissue damage and necrosis
32
Howz Extravasation treated?
Phentolamine (an alpha-adrenergic blocker that antagonizes the effects of vassopressors)
Dilute 5-10 mg in NS and give SC to infiltrated area
33
List agents used for ICU sedation and analgesia
Opioids (Morphine, Hydomorphone, Fentanyl)
BZD (Midazolam, Lorazepam)
Antipsychotics (Haloperidol, Quetiapine, Risperidone)
Hypnotics (Propofol, Dexmedetomidine)
34
What's the preferred drug for achieving rapid analgesia?
Fentanyl
35
What's the preferred drug for rapid sedation?
BZD, Propofol and Dexmedetomidine
36
Care in Propofol admin?
Limit dose and duration or Propofol due to Propofol-related infusion syndrome, which can result in cardiac arrhythmias and death
37
Sedation for pts with delirium?
Dexmedetomidine (not BZD)
38
List agents used for ICU sedation and agitation
Lorazepam (Ativan; Lorazepam Intensol)
Midazolam
Propofol (Diprivan)
Dexmedetomidine (Precedex)
Morphine
Fentanyl
Hydromorphone (Dilaudid)
Remifentanil (Ultiva)
Haloperidol (Haldol)
39
SE of Lorazepam (Ativan, Lorazepam Intensol)?
Respiratory depression
Oversedation
Hypotension
Propylene glycol poisoning at high doses and prolonged infusions (look for metabolic acidosis and renal insufficiency)
40
CI to Midazolam?
Concurrent use of potent CYP3A4 inihibitors
41
SE of Midazolam?
Respiratory depression
Apnea
Oversedation
Hypotension
42
Duration of Midazolam use?
Short-term sedation (< 48 hrs)
43
Brand name of Propofol?
Diprivan
44
SEs of Propofol (Diprivan)?
Hypotension
Apnea
Hypertriglyceridemia
Green urine
Propofol-related infusion syndrome (PRIS -rare, but can be fatal)
45
What should be monitored if on Propofol (Diprivan) longer than 2 days?
TGs
46
Why's strict aseptic technique recommended when handling Propofol (Diprivan)?
Due to potential for bacterial growth
47
Size of filter required for Propofol (Diprivan) admin?
Don't use < 5 microns
48
How's Propofol (Diprivan) formulated?
In a lipid emulsion (provides 1.1 kcal/mL)
49
Brand name of Dexmedetomidine?
Precedex
(Alpha2-adrenergic agonist
50
SEs of Dexmedetomidine (Precedex)?
Transient HTN during loading dose (may need to reduce infusion rate)
Hypotension
Bradycardia
Dry mouth
Nause
51
Howz Dexmedetomidine (Precedex) mixed?
With NS ONLY
52
Max duration of infusion for Dexmedetomidine (Precedex)?
Should not exceed 24 hrs per manufacturers labeling
53
SEs of Morphine?
Respiratory depression
Hypotension
Over sedation
Bradycardia
Pruritus
Xerostomia
Constipation
54
T/F? Morphone has an active metabolite?
T
Morphine-6-glucuronide
55
SEs of Fentanyl?
Respiratory depression
Bradycardia
Oversedation
Comstipation
Rigidity with high doses
56
Advantage of Fentanyl over morphine?
Less hypotension than morphine due to NO histamine release
57
What's the brand name of Hydromophone?
Dilaudid
58
Brand name of Haloperidol?
Haldol
59
SEs of Haloperidol (Haldol)?
Hypotension
QT prolongation
Tachycardia
Extrapyrimidal sx (EPS)
60
Monitoring of Haloperidol (Haldol)?
QT interval and ECG
61
What's an acid?
Substance that DONATES protons or H+ ions
62
Whats a base?
Substance that ACCEPTS protons or H+ ions
63
What's normal pH of blood? Range?
7.4 (range 7.35-7.45h
64
What's an acidosis?
Acid-base disorder that leads to a pH < 7.35
65
What's alkalosis?
Acid-base disorder that leads to a pH > 7.45
66
What's a metabolic acidosis?
Xterized primarily by a DECREASE in plasma HCO3 conc
67
What's a metabolic alkalosis?
Xterized primarily by a INCREASE in plasma HCO3 conc
68
Howz anion gap (AG) calculated?
Na - (Cl + HCO3)
69
What's hypertonic?
State in which serum osmolality is increased and is caused by hyperglycemia
Or
Use of hypertonic solns that don't contain sodium
70
What's Isotonic?
Normal osmolality and can be associated with hyperlipidemia
71
What's Hypotonic?
May occur with changes in volume status
- Hypovolemic
- Hypervolemic
- Isovolemic (usually caused by Syndrome of Inappropriate Antidiuretic Hormone (SIADH))
72
What may be used to treat Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?
Conivaptan or Tolvaptan
73
Moa of Conivaptan or Tolvaptan (used to treat SIADH)?
Vasopressin V2-receptor antagonist
74
CI to Conivaptan (Vaprisol)?
Anura
75
SE to Conivaptan (Vaprisol)?
Orthostatic hypotension
Fever
Hypokalemia
76
Max duration of Tolvaptan (Samsca)? Why?
For up to 30 days dut to hepatoxicity
77
CI to Tolvaptan (Samsca) use?
Pts who can't sense or respond appropriately to thirst
Anura
78
SE of Tolvaptan (Samsca)?
Thirst
Nausea
Dry mouth
Asthenia
Constipation
Polyuria
Hyperglycemia
79
What's Hypo- & Hyper-natremia?
Hypo - (Na < 135 mEq/L)
Hyper - (Na > 145 mEq/L)
80
What's hypovolemic?
Caused by dehydration, vomiting, diarrhea and is usually treated with Dextrose to replace free water deficits and hypotonic solution (0.46% NaCl)
81
What's hypervolemic?
Caused by admin of hypertonic solns.
Diuretics is tx of choice with 5% dextrose
82
What's Isovolemic (Euvolemic)?
Freq ass with diabetes insipidus (DI)
83
What's the caution in correcting Na disorder?
Don't correct too quickly
84
What's the max pt to which u should correct Na anymore?
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
What's hypokalemia?
K < 3.5 mEq/L
86
What's the preferred route to correcting K?
Oral route, when available is preferred
87
How should IV K be admin in correcting hypokalemia?
No faster than 10-20 mEq/hr with intermittent doses
88
Critical illness and blood flow to gut?
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
Risk factors for dev of stress ulcer?
MECHANICAL VENTILATION
COAGULOPATHY
Sepsis
Traumatic brain injury
Burn pts
Acute renal failure
High dose corticosteroids
90
Should pts w/o stress ulcers risk factor receive stress ulcer prophylaxis?
No!
91
Risk factors for dev venous thromboembolism (VTE)?
Surgery
Major trauma
Immobility
Cancer
Previous VTE
Pregnancy
Estrogen-containing meds or Selecyive estrogen receptor modulators
92
Dose of low dose UFH used in VTE?
5,000 units SC BID-TID
93
Dose of LMWH used in VTE?
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
What can inhaled anesthetics cause? How should it be treated?
Malignant hyperthermia (rare)
Should be treated with Dantrolene
95
List topical anesthetics agents
Lidocaine (Xylocaine)
Benzocaine
96
List inhaled anesthetics agents
Desflurane (Suprane)
Sevoflurane (Ultane)
Isoflurane (Forane)
Nitrous oxide
97
List injectable anesthetics agents
Bupivacaine (Marcaine, Sensorcaine)
Lidocaine (Xylocaine)
Ropivacaine (Naropin)
98
How epidural containing bupivacaine NOT be given?
IV infusion (don't give via this route)
99
What should be given prior to admin of Neuromuscular Blocking Agents (NMBAs)? Why?
Sedation and analgesia
Bcuz NMBAs don't provide either
100
What must be done to pts b4 admin of NMBAs?
Pt must be mechanically ventilated
101
What must all NMBAs be labeled with?
Bright, red auxiliary labels stating "WARNING, PARALYSING AGENTS"
102
Types of NMBAs?
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
SEs of non-depolarizing NMBAs?
Flushing
Bradycardia
Hypotension
Tachyphylaxis
104
List non-depolarizing NMBAs
Atracurium
Cisatracurium (Nimbex)
Pancuronium
Rocuronium (Zemuron)
Vecuronium
105
What's the brand name of Cisatracurium? Non-depolarizing NMBAs
Nimbex
106
Which NMBAs have short half-life (t1/2); intermediate acting; metabolized by Hofmann elimination?
Atracurium
Cisatracurium (Nimbex)
107
Which NMBAs is long-acting, can accumulate in renal or hepatic dysfxn, increased HR?
Pancuronium
108
Which NMBAs is intermediate-acting, )can accumulate in renal or hepatic dysfxn)?
Rocuronium (Zemuron)
Pancuronium
109
What does hemostasis mean?
Causing bleeding to stop
110
List systemic Hemostatic Agents
Aminocaproic acid (Amicar)
Tranexamic avid
Recombinant Factor VIIa (NovoSeven RT)
111
Brand name of Recombinant Factor VIIa?
NovoSeven RT
112
FDA approval for Tranexamic acid?
Menorrhagia (heavy menstrual bleeding)
113
What's intravenous Immunoglobulin (IVIG)?
Contains pooled Immunoglobulin (IgG)
114
Whats use to dose IVIG?
IBW
115
When should slower infusion rates be used in IVIG infusion?
In renal and cardiovascular dx
116
BBW of IVIG?
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
CI of IVIG?
IgA deficiency (can use product with lowest amt of IgA)
118
SEs of IVIG?
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
Monitoring of IVIG?
Renal fxn
Urine output
Vol status
120
Name the most commonly used resources for IV drug compatibility?
Trissel's Handbook on Injectable Drugs
King Guide to Parenteral Admixtures
121
List photosensitive drugs (drugs that req protection from light)
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
List meds that shouldn't be refrigerated
Metronidazole (Flagyl)
SMX/TMP (Bactrim)
Phenylephrine (Neosynephrine)
Hydralazine, Moxifloxacin (Avelox)
Acetaminophen (Ofirmev)
Esomeprazole (Nexium)
123
What used to be done for poisoning that's no longer recommended?
Syrup of ipecac (to induce vomiting)
Gastric decontamination, such as, Activated charcoal
Gastric lavage
124
Sx of organophosphate poisoning?
Cholinergic (MUDDLES)
```
Miosis (pinpoint pupils)
Urination
Diarrhea
Diaphoresis
Lacrimation
Excitation (anxiety)
Salivation
```
125
What's the antidote for APAP?
N-acetylcysteine
126
What's the antidote for Anticolinesterase insecticide/ organophosphate ?
Atropine
127
What's the antidote for Anticholinergic Compds?
Physostigmine (Antilirium)
128
What's the antidote for BZD?
Flumazenil (Romazicon)
129
What's the antidote for Beta blockers?
Glucagon (GlucaGen)
130
What's the antidote for Digoxin?
Digoxin Immune Fab (DigiFab)
131
What's the antidote for Ethylene glycol, methanol?
Ethanol or Fomepizole (Antizol)
132
What's the antidote for heavy metal?
Dimercaprol
133
What's the antidote for Heparin?
Protamine
134
What's the antidote for iron?
Deferoxamine (Desferal)
135
What's the antidote for Isoniazid (INH)?
Pyridoxine (Vit. B6)
136
What's the antidote for opioids?
Naloxone (Narcan)
137
What's the antidote for snake bites?
Crotalidae polyvalent (Antivenin, Crofab)
138
What's the antidote for warfarin, rat poison?
Phytonadione (AquaMephyton, Mephyton) Vit. K
139
Advantages of central IV line?
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
