study guide Washburn Flashcards
what is the dosage of dextrose?
25g of 10-50% IV
50 ml of 50% dextrose
100 ml of 25% dextrose
150 ml of 10% dextrose
what is the Peds dose of dextrose?
0.5- 1 g/kg of 10-25% dextrose IV
what is the dose of thiamine
Dose of Thiamine: 100 mg IV IO IM
what is the indication of thiamine?
coma of unknown origin
if alcohol may be involved
give thiamine prior to glucose.
Delirium tremors with thiamine prior to glucose
what does thiamine do?
Thiamin is necessary for carbohydrate metabolism. Alcoholics and malnourished patient may affect intake, absorption and utilization of glucose so thiamine is administered prior to glucose
describe type I diabetes
typically described as juvenile diabetes
body does not make insulin
what is type II diabetes
make their own insulin but it’s not used properly by the body.
Where is insulin produced?-
Pancreas
How is insulin produced?
The islets of Langerhans are made up of different types of cells that make hormones, the commonest ones are the beta cells, which produce insulin.
what is hypoglycemic unawareness?
Diabetics who have been struggling with diabetes for years. They can lose the ability to recognize symptoms of hypoglycemia such as tachycardia, pallor sweating and anxiety.
where does glucagon come from?
the pancreas.
its a response to low blood sugar.
Glucagon mobilizes glucose stored in the liver and muscle in the form of glycogen
what is the dose of glucagon?
1mg IM IN
What is Wernicke’s korsakoff syndrome?
If given dextrose before thiamine these pts can develop this brain condition
S/S: amnesia, confabulation, attention deficit, disorientation and vision impairment.
Administer thiamine to malnourished, or alcoholic patients
alcoholics or malnourished patients with depressed mental status may have deficiency of thiamine.
What is the most common med prescribed to type II diabetic?
metformin glipizide
What classification is thiamine?
Water soluble vitamin
it aids in carbohydrate metabolism for ETOH and malnourished patients.
What is DKA-
occurs mostly in pts with type I diabetes, the problem is a lack of insulin. The body is unable to use the glucose or sugar in their bloodstream but not enough insulin to use it. So now the cells still need the blood sugar but start to break down fat producing acid and chemicals (ketone bodies).
What is keto acidosis?
The patients in dka have metabolic acidosis, dehydration, and electrolyte abnormalities,the type of acidosis that this patients have is ketoacidosis
What is lactic acidosis?-
when the body is in shock- perfusion is lacking (no o2)
so the body is using anaerobic metabolism
therefore the body is in a state of lactic acidosis.
LACTATE IS THE BYPRODUCT OF ANAEROBIC METABOLISM
What is the tx for hyperglycemia (over 300mg/dL) and showing signs of hyperkalemia (12-Lead EKG shows peaked T waves)?
Administer fluids
Sodium bicarbonate: 1 mEq/kg (max of 50 mEq) bolus over 5 min - this is alkalinic *
Albuterol: 2.5 mg in 3 mL nebulized - this shifts potassium p. 74 prot
If glucose is over 300, with s/s dehydration, vomiting, abdominal pain, altered level of consciousness give: Crystalloid resuscitation: A: 20 cc/kg IV IO repeat prn P: 20 cc/kg IV IO prn
What is the ped dose of glucagon?
over 5 yo 1mg IM IN
younger than 5 yo 0.5 mg IM IN
What is hypertensive urgency?-
severe elevation of blood pressure without evidence of organ failure. P 232 guy
What is hypertensive emergency?-
high blood pressure with:
evidence of end organ damage
kidneys heart and brain.
S/S headache visual changes, altered LOC , heart failure.
What is the dose for ASA in MI attack?
162-324 mg
What is eclampsia?
very high blood pressure, visual disturbance, kidney failure liver damage SEIZURES.
What is the action of magnesium?
calcium channel blocker that blocks neuromuscular transmission.
Class: electrolyte, Antiinflammatory
What is the action of magnesium?
calcium channel blocker that blocks neuromuscular transmission.
Class: electrolyte, Antiinflammatory
What is the action of magnesium?
calcium channel blocker and blocks neuromuscular transmission.
Class: electrolyte, Antiinflammatory
What is the dose of magnesium in torsades?
2 g in 100mL NS or D5W over 10 min
What is the dose of magnesium in eclampsia?
4 g in 100ml NS or D5W wide open till seizure stops then slow to finish.
What is hydralazine used for? P. 212 Class:
Class: vasodilator
Action: direct vasodilator at level of arterioles. Indicated for severe HTN with preeclampsia symptoms dose: 5 mg
What is the dose of amiodarone for tachycardia?
150 mg IV over 10 min then maintenance 1 mg/min for first 6 hrs
What is the fentanyl dose for a patient over 55?
0.5 mcg/kg max of 100 mcg
What is the dose for epi for peds anaphylaxis and allergic reaction?
P: 0.15 - 0.3 mg SQ IM max dose: 0.3 mg SQ IM
What is the dose for benadryl for nausea and vomiting?
50 mg IV IM, peds same dose for benadryl 1 mg/kg IV IM
What is the IV dose for ondansetron?
4mg IV repeated once in 10 min
What is the dose for Versed for an adult seizure
2.5- 5 mg IM IV IO 5 mg IN
What med binds to GABA A receptors
Benzodiazepines
What is the peds (<12 yo) dose of diazepam for seizures?
1mg
What is the dose for levophed in sepsis?
5 - 30mcg/kg infusion in 500mg bag NS until systolic is ≥100.
levophed for sepsis
cinco mcg/kg cinco to 30
What is the dose for epi in cardiogenic shock
Epinephrine 0.1 – 0.5 mcg/kg/minute
What is the dose for acetaminophen for shock?
15 mg/kg to a max dose of 1000 mg
Tylenol 15mg/kg
What is the dose for ibuprofen for shock?
10 mg/kg to a max dose of 800 mg
I be 10 mg/kg
ib 10-8
800 mg max
What is DUMBELS?
Diarrhea Urination miosis/muscle weakness Bronchospasm, bronchorrhea, bradycardia Emesis Lacrimation Salivation sweating
What is the peds dose for Narcan? IV, IM, IN, ETT?
The pediatric dose of naloxone is 0.1 mg/kg IV, IM, IN, or ETT
- Maximum dose of 2 mg IV, IM, or ETT
- Maximum dose of 4 mg IN
What is the adult dose for Lorazepam <60 for seizure?
<60 for seizure
2 mg SIVP
lorazepam Ativan adult 2 mg SIVP seizure
What is a muscarinic antagonist?
atropine
How would you ID an ACE inhibitor?
How would you ID a Beta Blocker?
Prils lisinopril for HTN
olols- metoprolol afib a flutter
What is a Sodium channel blocker?
What is a potassium channel blocker?
Procainamide ides
Cardizem
What is a class III drug? What is a class IV drug?
Amiodarone
Cardizem
What is the Racemic epi dose for Croup (peds)?
2.5 mg in 3 mL with solumedrol 2 mg/kg IVIO push
How much solumedrol do you give peds with croup?
2 mg/kg IVIO solumedrol
What is the dose for pain meds for 65yo M with back pain?
Fentanyl 0.5 mcg/kg up to 100 mcg
Morphine 1mg SIVP up to 10 mg
How much Haldol do you give a psych patient?
5 mg IV/IO push with Ativan 2mg
How much ativan would you give a pt who is 64 yo?
0.1 mg/kg up to 4.0 mg per dose IV / IO
What med gives you a dissociative effect? dissociative Agents (provide sedation and analgesia):
Ketamine violence Adult: 250 – 500 mg IM (if no IV obtained) 2 mg/kg IV (max dose 2 mg/kg).
What is the dose of albuterol for bronchospasm?
2.5 - 5 mg in 3 mL
What is the action of albuterol ?
Class bronchodilator, Action:
selective beta 2 adrenergic receptor agonist, decreasing bronchospasm
What is the decadron dose for bronchospasm?
16 mg IV IM IO one time only
What is the medication administered to a respiratory distress patient not responding to albuterol, duoneb, solumedrol or decadron or mag sulfate?
Epi adult 0.5 mg IM
Peds 0.01- mg/kg IM max dose 0.3 mg IM
What is duoneb made of?
albuterol 2.5 mg and Ipratropium 0.5 mg in 3 mL
What is a hypoxic respiratory drive?
]. The pt requires a mild degree of hypoxia to continue breathing. If the pt has too much oxygen their hypoxic respiratory drive is removed. As well as pts stimulus for spontaneous respirations.
What is the rectal dose for diazepam?
0.2 mg/kg PR MAX 10 mg
What is the pediatric febrile seizure dose for acetaminophen rectally?
15 mg/kg PR/IV/IO max 650 mg
P. 82 prot
What drug treats seizures as well as mood disorders?
Benzodiazepines Ie ativan, valium
What is distributive shock?
sepsis, burns anaphylaxis, spinal cord injury neurogenic shock, endocrine emergencies, poisoning or overdose impaired blood circulation and systemic tissue perfusion
What is obstructive shock?
an obstruction outside of the heart causes reduced cardiac output. Pulmonary embolism, tension pneumo where vascular flow is compromised, pericardial tamponade where pressure within pericardial sac is causing decreased cardiac output.
What is a Burette used for?
dispense small volumes of liquid called aliquots, or sometimes gas, with high accuracy. It consists of a long glass tube with a valve at one end to control the flow of liquid. Burettes serve essentially the same purpose as a pipette.
What is the calibrated drip rate per min of an IV 2500 ml with a drop set of 20 in 24 hrs?
20gtt (2500ml)/
24 hr
volume x drop set over time
What is the calibrated drip rate per min of an IV 2500 ml with a drop set of 15 in 24 hrs?
vol x gtt set over time
15gtt (2500ml)
24 hr
How to calculate infusion of dopamine
Prepare a dopamine infusion at 2 mcg/kg /min . prepare infusion by adding 800 mg of dopamine to 500 ml bag of normal saline. Pt weighs 110lbs
110lbs/2.2 = 50 kg
2mcg (50 kg) = 100mcg/min
Convert 800 mg to mcg
800mg = 800,000 mcg
800,000 mcg = 1600 mcg/ml
500 ml
Use 60 gtt/ml
100 mcg/min X 60gtt/ml = 3.75 gtt/min or 4gtt/min
1600 mcg/ml
How to calculate infusion of epinephrine
Administer an epi infusion at 2 mcg/min. Prepare the infusion by adding 1 mg epi to a bag of 500 ml normal saline. What is the drug concentration (DH)? What is the drip rate if a microdrip infusion set that delivers 60 gtt/ml is used?
1 mg= 1000 mcg
DH is 1000 mcg /500 ml = 2 mcg/ml
DD: 2mcg/min (60 gtt/ml) = 120/2 = 60 gtt/min
DH: 2 mcg/ml
