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NAPLEX review 2024 RXPrep Book > Special Populations: Acute & Critical Care Medicine > Flashcards

Special Populations: Acute & Critical Care Medicine Flashcards

1
Q

Crystallids vs Colloids

A

Crystallaoids: cheaper, less adverse reactions, most volume doesnt remain in intraveascalr space

Colloids: More $$$, remain primarily in intravascular space, inc oncotic pressure

not shown to have clear benefit

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2
Q

Common Colloids

A

Albumin
Dextran
Hydrocyethyl starch

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3
Q

Common Crystalloids

A

D5W
NS
Lactated Ringers
Multiple electrolyte injections

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4
Q

When is Hyponatremia usually symptomatic?

A

< 120 mEq/L

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5
Q

Osmotic demyelination syndrome can occur when.

A

sodium is corrected too rapidly, more than 12 mEq/L/24hrs

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6
Q

Who is candidate for hypertonic 3% sodium chloride IV

A

severe symptoms and NA 120 mEq/L

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7
Q

Drugs that can be used to treat SIADH? and Hypervolemic hyponatremia?

A

Arginine vasopressin receptor antagonist

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8
Q

AVP receptor antagonists

A

Conivaptan
Tolvaptan

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9
Q

Tolvaptan dosing limited to how many days

A

< 30 days due to hepatoxicity

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10
Q

Tolvaptan Boxed warning

A

only to be started in hospital with close monitoring
rapid correction of hyponatrema associated with ODS (life threatening)

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11
Q

Tolvaptan Warnings

A

Hepatotoxicity
dry mouth
excessive urination

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12
Q

Tolvaptan monitoring requirements

A

Rat of Na Increase
BP

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13
Q

Max infusion rate and concentration of IV Potassium

A

rate = < 10 mEq/hr
conc = 10 Meq/100ml

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14
Q

If both low potassium and magnesium, which should be replaced first?

A

magnesium, its necessary for potassium uptake

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15
Q

Hypophosphatemia considered severe and symptomatic when

A

< 1 mg/dL

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16
Q

IVIG Boxed warnings

A

acute renal dysfunction = rare, usually within 7 days
thrombosis

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17
Q

IVIG side effects

A

infusion reactions = facial fusing, chest tightness, fever, chills, hypotension = stop/slow infusion

slow infusion rate w/ renal and CV disease patients

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18
Q

Vasopressors

A

Dopamine = MOA is dose dependent
Epinephrine = MOA is Alpha 1, Beta 1/2 agonist
Norepinephrine = MOA is Alpha 1 agonist > Beta 1 agonist
Phenylephrine = MOA is Alpha 1 agonist
Vasopressin = MOA is Vasopressin receptor agonist

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19
Q

Vasopressor boxed warnings

A

Dopamine & Norepi = extravasation

All vasopressors are vesicant tho

treat extravasation with phentolamine

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20
Q

Vasopressor warnings

A

use caution on patients taking an MAOI

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21
Q

Vasopressor Side effects

A

Arrhythmias + tachycardia (dop + Epi)
necrosis (gangrene)
bradycardia (phenylephrine)
hyperglycemia (Epi)

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22
Q

Vasopressor monitoring

A

constant BP monitoring

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23
Q

Vasopressor notes

A

should be admin via Central IV line
dont used if discolored or precipitate

24
Q

Nitroprusside should not be used in…

A

active myocardial ischemia

25
Q

Nitroglycerin MOA

A

Low doses: venous vasodilator
High doses: arterial vasodilator

26
Q

Nitroglycerin Contraindications

A

SBP < 90
using with PDE-5i or riociguat

27
Q

Nitroglycerin warnings

A

severe hypotension and inc intracranial pressure

28
Q

Nitroglycerin Side effects

A

HA
Tachycardia
Tachyphylaxis

29
Q

Nitroprusside MOA

A

mixed equally arterial and venous vasodilator

30
Q

Nitroprusside Boxed warnings

A

metabolism produces cyanide
excessive Hypotension

31
Q

Nitroprusside warnings

A

Inc ICP

32
Q

Nitroprusside Side effects

A

Headache
Tachycardia
Thiocyanate/cyanide toxicity (risk inc w/ renal and hepatic impairment)

33
Q

Nitroprusside notes

A

use only clear solutions, if blue means degradation to cyanide
requires light protection

34
Q

How to reduce risk of thiocyanate toxicity with Nitroprusside

A

can give Hydroxocobalamin

35
Q

Inotrope meds for Vasodilation

A

Dobutamine
Milrinone

36
Q

Dobutamien MOA

A

Beta-1 agonist, some beta 2/alpha 1 agonism

inc HR and force of myocardial contraction = inc CO

37
Q

Milrinone MOA

A

PDE-3i

produces sig vasodilator

38
Q

If dobuatmine is slightly pink?

A

its okay, just oxidation but didnt lose potency

39
Q

Types of Shock

A

Hypovolemic = hemorrhagic
Distributive = sepsis, anaphylactic
Cardiogenic = post MI
Obstructive = massive PE

40
Q

Hypovolemic shock treatment

A

fluid resuscitation with crystalloids generally 1st line

blood products if due to bleeding

can do vasopressors if doesnt respond to initial crystalloid/blood products

41
Q

Septic shock is sepsis with…..

A

persistent hypotension requiring vasopressor to maintain MAP > 65 mmHG and serum lactate lvl > 2 mEq

42
Q

Vasopressor of choice for septic shock?

A

Vasopressin

43
Q

Volume overload patient treatment options

A

loop diuretic
vasodilators can be added

44
Q

Dexmedetomidine (Precedex) side effects

A

Hypotension
HTN
bradycardia
dry mouth
nausea
constipation

45
Q

Dexmedetomidine (Precedex) notes

A

doesnt req refrigeration
duration of infusion < 24hrs
used for sedation in intubated and on-intubated patients

46
Q

Propofol (Diprivan) CI

A

Hypersensitivity to egg, egg product, soy or soy product

47
Q

Propofol (Diprivan) Side effects

A

Hypotension
apnea
hypertriglyceridemia
green urinehair/nail beds
Propofol-related infusion syndrome = rare but can be fatal)

48
Q

Midazolam CI

A

dont use with patient CYP 3A4 inhibitors

49
Q

Midazolam boxed warnings

A

respiratory depression, start low

50
Q

Midazolam in renal impairment & obese patients

A

metabolic can accumulate, caution continuous infusion

51
Q

Ketamine warnings

A

Vivid dreams
hallucinations
delirium

52
Q

Risk factors for developing stress ulcers

A

Mech ventilation > 48hrs
coagulopathy
sepsis
TBI
major burns
acute renal failure
high dose systemic steroids

53
Q

Medicatons for Stress ulcers prevention

A

H2RAs or PPIs

54
Q

the only depolarizing NMBA

A

Succinylcholine

55
Q

Non depolarizing NMBAs side effects

A

flushing
bradycardia
hypotension
tachyphylaxis

56
Q

Hemostatic agents

A

Tranexamic acid
Recombinant Factor VIIa
Aminocaproic acid

57
Q
A

NAPLEX review 2024 RXPrep Book (78 decks)

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