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IPT: CC > More Block 1 > Flashcards

More Block 1 Flashcards

1
Q

HIT Type I vs II

Occurs 4-10 days after heparin exposure

A

Type II

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2
Q

HIT Type I vs II

PLT count normalizes w/ continued heparin

A

Type I

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3
Q

HIT Type I vs II

Major concerns for thrombotic complications

A

Type II

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4
Q

HIT Type I vs II

Occurs within first 2 days of heparin exposure

A

Type I

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5
Q

HIT Type I vs II

Non immune

A

Type I

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6
Q

HIT Type I vs II

Has HIT antibodies

A

Type II

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7
Q

LMWH vs UFH

Which has a higher chance of HIT?

A

UFH

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8
Q

How is the Fc receptor complex with heparin made? Whats the issue?

A

Platelet with PF4 combines with heparin to form heparin with PF4 cytokines

IgG combines with that complex and attaches to the platelet

More PF4 = more platelets

More thrombin = thrombosis occurs

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9
Q

What is the 4 T’s score?

A

Initial screen for suspicion of HIT

Thrombocytopenia
Timing
Thrombosis
Other causes of thrombocytopenia

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10
Q

Timing info for 4 T score

A

Days 5 - 10 or under 1 day if heparin used in past 30 days

Days >10 or under 1 day if heparin used within 30-100 days

Day <4 with no recent heparin use

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11
Q

Thrombocytopenia info for 4 T score

A

> 50% fall or nadir ≥20

30-50% fall or nadir 10019

<30% fall or nadir <10

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12
Q

4Ts score interpretation?

A

0-3 = low

4-5 = intermediate

≥6 = high

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13
Q

HIT/PF4 vs SRA

Which one is the gold standard for HIT diagnosis?

A

SRA

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14
Q

HIT/PF4 vs SRA

Which one is quicker to use and therefore has just moderate specificity?

A

HIT/PF4

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15
Q

HIT/PF4 vs SRA

Which one is typically used first?

A

HIT/PF4

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16
Q

What do you do if 4T comes back at ≥4?

A

d/c heparin and start non-heparin anticoagulant

Obtain immunoassay

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17
Q

What are the direct thrombin inhibitors?

A

Argatroban and Bivalirudin

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18
Q

Argatroban vs Bivalirudin

Which one is an arginine derivative?

A

Argatroban

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19
Q

Argatroban vs Bivalirudin

Which one is reversible?

A

Both

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20
Q

Argatroban vs Bivalirudin

Which one has a greater effect on INR?

A

Argatroban

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21
Q

Argatroban vs Bivalirudin

Which one is a synthetic analog of hirudin?

A

Bivalirudin

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22
Q

Argatroban vs Bivalirudin

Which one is divalent? Monovalent?

A

Argatroban - mono

Bivalirudin - divalent

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23
Q

Argatroban vs Bivalirudin

Which one is cleared hepatically?

A

Argatroban

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24
Q

Argatroban vs Bivalirudin

Which one is dosed regardless if they have renal/liver issues?

A

Bivalirudin

It’s not CI to use argatroban in liver failure pt, just be careful with dosing (25% or OG dose)

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25
Q

Argatroban vs Bivalirudin

When should aPTT be checked?

A

Every 4-24 hrs

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26
Q

Argatroban vs Bivalirudin

Which one is dosed at 2mcg/kg/min? Whats the other one’s dose?

A

Argatroban

Bivalirudin - 0.2mcg/kg/min

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27
Q

Argatroban vs Bivalirudin

Which one will show falsely elevated INR when bridging to warfarin?

A

Argatroban

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28
Q

Argatroban vs Bivalirudin

Which one is metabolized in plasma?

A

Bivalirudin

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29
Q

When transitioning to oral therapy from argatroban/bivalirudin, what can be considered?

A

DOACs or warfarin (only if PLTs are >150k)

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30
Q

If transitioning to warfarin from argatroban/bivalirudin, what must they meet?

A

PLT >150k

Overlap with DTI or fondaparinux

Continue for 4wks (no thrombosis) or 3 months (with thrombosis)

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31
Q

Base excess interpretatio?

A

2 = base excess of 2 more than normal = alkalotic

-5 = base deficit of 5 = acidotic

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32
Q

Normal pCO2 level?

A

40

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33
Q

Normal pO2 level?

A

80-100

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34
Q

Normal base excess level?

A

-2 to +2

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35
Q

Values for respiratory alkalosis/acidosis?

A

<40 pCO2 = respiratory acidosis

> 40 pCO2 = respiratory acidosis

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36
Q

Values for metabolic alkalosis/acidosis?

A

> 28 HCO3 = metabolic alkalosis

<22 HCO3 = metabolic acidosis

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37
Q

Which condition should you check AG?

A

Metabolic acidosis

Na - Cl - HCO3

Take that and subtract 12 and add to HCO3 to reveal new HCO3

38
Q

What is FAST HUG?

A

Feeding
Analgesics
Sedation
Thromboembolic prophylaxis

Head of bed elevation
Ulcers
Glucose control

39
Q

Are antiplatelet agents VTE prophylaxis?

A

Nope

40
Q

RF for GI bleed?

A

Mech. ventilation >48hrs
INR >1.5 or PLT <50k

h/o GI bleed
Hypotension
Liver failure
Head or spinal cord injury

41
Q

How does enteral feeding affect GI bleed?

A

No difference in overt GI bleed and not beneficial

42
Q

What are some limitations of sucralfate for GI bleed?

A

DDI

Clogs feeding tube

Aluminum accumulation and low phosphorus

Constipation

43
Q

How does antacids affect GI bleed?

A

No mortality benefit; equivalent to sucralfate

44
Q

RF of upper GI bleed via PUD?

A

NSAIDs

Concomitant OAC or antiplatelet use

H. pylori

> 65yrs old

Alcohol use

45
Q

GI bleed symptoms?

A

Melena and hematemesis = upper GI bleed

Hematochezia = lower GI bleed

46
Q

What separates upper from lower GI?

A

Ligament of Treitz, duodenum is upper and jejunum starts the lower

47
Q

Upper GI bleed Treatment for high risk patient?

A

PPI IV bolus before endoscopy

Then Post endoscopy PPI x72hrs

High risk = ≥60yrs old, unstable, active bleed

48
Q

Upper GI bleed treatment for low risk patient?

A

PPI IV bolus

Post endoscopy PPI (PO if clean)

49
Q

When should you reintroduce these meds when on PPI?

NSAIDs
ASA
DAPT
Anticoagulation

A

First check to see if its actually necessary in the first place

NSAIDs, switch to COX2 inhibitor

ASA, start ASAP post-endoscopy

DAPT, start 3-7 days post-endoscopy

Anticoagulation, case-by-case, 7-30 days post-endoscopy

50
Q

Treatment of lower GI bleed?

A

None, PPI unlikely will have a difference

51
Q

ADME of a critically ill person?

A

Poor oral absorption

Large Vd (due to fluid intake)

Hypercatabolic

Excretion could be faster or slower than normal

52
Q

What drugs are affected from critically ill patients with large Vd?

A

Concentration dependent (EX: Amino, fluro, metro)

Hydrophilic drugs

53
Q

What something known in critically ill patients with their kidneys? RF?

A

Augmented Renal Clearance (CrCl >120 or >130)

Younger pt (<50)
Male
TRAUMA
TBI
Mech. ventilation
54
Q

When calculating Ke, what assumptions do you make?

A

Assume blood flow rate to kidneys is stable

Stable clearance

55
Q

What is the main drug parameter that determines steady state?

A

t1/2

56
Q

How do you calculate AUC? Cl?

A

Dose / Clearance = AUC

Ke*Vd = Cl

Cl and Vd are independent factors

57
Q

LD (increase/decrease) time to therapeutic levels and (do/do not) affect the time to steady state

A

Decrease time

Do not affect

58
Q

If a patient is on HD, what should you monitor instead of CrCl?

A

UOP for any dramatic changes

59
Q

Vd of HD patients?

A

0.4L/kg

60
Q

When do you get levels with HD patients?

A

Practical = morning at random time before HD

Vanco = wait at least 6 hrs after HD is done

61
Q

LD/MD of vanco?

A

LD = 25-30mg/kg

MD = 15-20mg/kg

62
Q

What is the bayesian and 2 level PK method to measuring Vanco?

A

Bayesian = 2 levels are 1st or 2nd dose

2 level PK = peak and trough after 4th dose

63
Q

What is a Grade I, II, III trauma injury?

A

I = <1cm

II = >1cm

III = Extensive soft tissue injury

64
Q

What kind of wound cultures are ideal for trauma patients?

A

Surgical culture > wound swab

65
Q

Suspected pathogens in grade I-III trauma injuries?

A

All = S. aureus or strep

III = GNR organisms

66
Q

Treatment of grade I-III trauma injuries?

A

I or II = Cefazolin

III = ceftriaxone

Both for 2-3 days or 1 day after wound closure

67
Q

Penetrating wound severity list?

A

Very low = knife

Low = handgun

High = military rifle

Highest = fragmenting device

68
Q

Prophylactic Abx and penetrating wounds?

A

Only if there is a hollow viscous injury or CNS involvement, it is given 24hrs prior

If not, no Abx

69
Q

Who is indicated for pre-emptive Tx of bites? How long?

A

Immunocompromised

Edema of affected area

Moderate/severe injuries

x3-5 days

70
Q

Bugs of bites?

A

Polymicrobial w/ purulence

Staph + strep

Pasteurella (anaerobe)

71
Q

Bite Tx?

A

Animal = Augmentin + Flagyl + Ceftriaxone

Human = Augmentin

72
Q

Burn victim bugs?

A

Sterile at time of burn

48 hrs later, colonized with skin pathogens

5-7 days, G+ and G- and yeast are in

G- = PAK

Fungi (aspergillus)

CMV, HSV, VZV

73
Q

S/Sx of infection in CC?

A

Temp ≥~38 (can be hypothermia

WBC normal range 4.5-11

Shaking/chills

Changes in hemodynamics

74
Q

RF for hospital-acquired MRSA, pseudomonas, and ESBL/Amp-C/Carbapenemase?

A

All of them are previous infection and Abx use within 90 days

Hospital-acquired has addition of positive nasal carriage

ICU admission is NOT a RF

75
Q

ESBL clues and Tx?

A

3rd gen ceph - R (ceftriaxone)

Cephamycin - S

Low inoculum = zosyn
High inoculum = carbapenem

76
Q

Amp-C clues and Tx?

A

3rd gen ceph - S
(ceftriaxone)

Cephamycin - R

Low inoculum = cefepime
High inoculum = carbapenem

77
Q

General treatment for sepsis?

A

Broad-spec Abx within 1 hr

Vasopressors, volume status, and lactate

78
Q

Bugs found in CLABSI?

A

S. aurues
CoNS

Entero + Candida

79
Q

Treatment of CLABSI?

A

Remove catheter

Treat for ~7-14 days except in CoNS case, then its 5-7 days

80
Q

Treatment of Candidemia?

A

Empiric = Micafungin

Definitive = Fluconazole

x2 weeks from first negative culture

81
Q

Bugs found in CAUTI (urinary catheter)?

A

PEK

P. mirabilis
E. coli
K. pneumoniae

CAUTI is defined as catheter + >10^3 cfu + S/SX!

82
Q

Tx of CAUTI?

A

d/c or change catheter

Abx typically not used

83
Q

C. diff treatment?

A

Initial, non severe (WBC≤15000 + SCr<1.5) = vanco 125 or fidax 200 both for 10 days (same for initial, severe)

Initial, fulminant (hypotension, shock, ileus, megacolon) = vanco 500 + IV flagyl

first recurrence = vanco 125 or fidax if vanco was given initially

second+ recurrence = vanco, then rifaximin or just fidax or fecal transplant

84
Q

CAP bugs?

A

SMH

S. pneumoniae
M. catarrhalis
H. influenzae

85
Q

CAP general treatment?

A

Ceftriaxone + Azithromycin

86
Q

How can you tell if its a severe case of CAP?

A

1 of these:

Mech ventilation
Septic shock w/ vasopressor use

or 3 of these:

RR≥30
Multilobar infiltrates
Confusion
BUN≥20
WBC≤4000
PLT<100k
<36C
Hypotension needing fluid resuscitation
87
Q

Influenza Tx?

A

Oseltamivir (PO)
Zanamivir (inhalation)
Peramivir (IV)

88
Q

HAP admission?

A

Occurs 48hrs+ after admission

Early onset: within 4 days
Late: 5+ days

89
Q

HAP treatment?

A

If they have ventilation or septic shock or Abx use within 90 days, Anti-MRSA + 2 rx that cover pseudomonas

But if their RF for MRSA only, just Anti-MRSA and 1 rx for pseudo

90
Q

VAP admission? Bugs?

A

48-72 hrs after endotracheal intubation

PAK

Pseudo
Acinetobacter
K. pneumoniae ESBL

91
Q

Indication of double coverage similar for both HAP and VAP?

A

Abx use within 90 days + septic shock

Ventilation is just HAP

92
Q

Indication for double coverage of just VAP? Tx duration?

A

Abx use within 90 days + septic shock

Pt in ICU where susceptibility rates aren’t available

ARDS

RRT prior to VAP

x 7 days

IPT: CC (7 decks)

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