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43 Cards in this Set
- Front
- Back
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Crystalloids vs colloids |
Crystalloids - most of admin vol do not remain in intravascular space but moves into extravascular space or interstitial space - less costly and fewer SE than colloids - 5% dextrose -0.9% NS - Lactated ringers Colloids - Albumin 5%, 25% - remain in intravascular space an inc oncotic press |
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Hyponatremia |
< 135 mEq/mL Hyponatremia should not be corrected quickly. Correcting rapidly than > 12 mEq/L over 24 hours can cause ODS ( osmotic demyelination syndrome) which can cause death, paralysis and seizure. |
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SIADH |
Condition in which body makes too much ADH. This hormone control amounts of water you body looses through urine. SIADH causes body to retain too much water. With SIADH urine is very concentrated. Not enough water is excreted and there is too much water in the blood. These dilutes many sub in blood such as sodium. Low blood sodium level is common sX of too much ADH
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Hypovolemic hyponatremia |
Low Na and low low vol - caused by diuretics, blood loss, vomiting/ diarrhea, salt wasting syndrome Treatment is administer: NaCl IV solution |
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Hypervolemic hyponatremia |
High vol and low Na - caused by fluid overload ( HF , Cirrhosis or renal failure) Treatment: Diuresis with fluid restrictions
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Isovolemic ( euvolemic) hyponatremia |
Normal vol and low Na - caused by SIADH Tx includes stopping drugs that induce SIADH , Diuresis or restricting fluids. Demeclocycline used off label for SIADH |
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What does Arginine Vasopressin Receptor Antagonist (AVP) do? Drugs |
Increase excretion of free water while maintaining sodium Drugs used to tx SIADH & Hypervolemic hyponatremia -Conivaptan -Tolvaptan |
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Conivaptan |
Vaprisol |
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Tolvaptan |
Samsca Formulation - Tablet Dose: < 30 days due to hepatotoxicity |
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Tolvaptan Box warning Warning SE Monitoring |
Box warning: initiated and re-initiated in hospital Rapid correction of hyponatremia is associated with ODS Warning: hepatotoxicity SE: thirst, dry mouth, nausea , polyuria |
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Hypernatremia |
Na > 145 mEq/ L is associated with water deficit and hypertonicity |
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Potassium range |
3.5-5.0 mEq/mL |
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Potassium |
-drop of 1mEq/L in K represent total body deficit of 100 -400 mEq - k sliding scale - IV replacement: KCL premixed IV K replacement thru Peripheral IV line include maximum conc of < 10 mEq/hr and maximum conc of 10mEq/ 100mL ***IV potassium is fetal if admin undiluted or IV push * when Hypokalemia is resistant to tx serum mag should be checked. Magnesium is necessary for K intake |
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Magnesium |
When serum Mg is < 1mEq/L with life threatening sx; IV replacement is recommended - Mag sulfate recommend for IV replacement. |
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Phosphorus |
Hypophosphatemia is severe and usually symptomatic when serum phosphate is < 1 mg/ dL - when serum PO4 is less than < 1mg/dL IV phosphorus is used for replacement |
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IVIG |
Immunoglobulin admin intravenously. IVIG off label use - multiple sclerosis, myasthenia gravies, Giulian Barre syndrome Tx with IVIG can impair response to vaccination |
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IVIG names |
Carimune, Octagam, Privigen Use slower infusion rate in renal and and CV disease Box Warning - acute renal dysfunction Side Effects - HA, nausea, diarrhea, injection site reaction, infusion reaction, chest tightness, fever, chills , hypotension |
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IVIG |
Need to space out from lots of vaccines *** Exam question!! |
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Vasopressor |
Stimulate alpha receptor which causes vasoconstriction and increase SVR, which the increase BP |
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Vasopressin drugs |
- dopamine - epinephrine ( Adrenalin) EpiPen - Norepinephrine (Levophed) -Vasopressin |
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Dopamine dosing |
Dopamine Stimulates diff receptor depending on dose Low (renal ) dose: 1-4mcg/kg/min - dopamine-1 agonist Medium dose: 5-10 mcg/kg/min- beta -1 agonist ( works on heart High dose alpha 1agonist - 10-20mcg/kg/min - alpha 1 agonist ( act on lungs) |
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Vasopressin Warning SE Notes |
Warning: extravasation SE: arrhythmia, tachycardia, necrosis, bradycardia, hyperglycemia Monitor: BP Notes: Epinephrine used for IV push is 0.1mg/mL Injection is - 1mg/mL (1:1000)
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Extravassation |
Treat vasopressin extravasation with Phentolamine an alpha-1- blocker antagonize effect of vasopressor |
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Vasodilatior drugs |
Nitroglycerin Nitroprusside ( nitro press, Nipride) |
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NTG MOA |
Low doses venous vasodilator High dose arterial vasodilator |
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Nitropurrisude MOA |
Mixed arterial and venous vasodilator |
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Vasodilator NTG CI SE Notes |
CI: -SBP< 90MmHg , -use with PDE-5 inhibitors SE- HA, tachycardia, tachyphylaxis Notes: req non pvc container |
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Nitropurisside Box Warning Warning SE Notes |
Box warning: cyanide, excessive hypotension Warning: inc ICP SE: HA, tachycardia, cyanide toxicity Notes : req light protection - blue color indicates degradation of cyanide |
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Ionotrope Drugs cause |
Inc contractility of heart Drugs - Dobutamine ( beta 1 agonist) - Milrinone ( PDE-3 Inhibitor) and vasodilator |
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What is shock and what are different type of shock? |
Shock is tissue hypo perfusion leading to cellular hypoxia and dysfunction It is characterized by hypo perfusion in setting of hypotension - Hypovolemic ( hemorrhagic vs non hemorrhagic) -distributive ( septic, anaphylactic) - cardiogenic ( post MI) - obstructive ( Massive pulmonary embolism) |
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Hypovolemic shock |
Result from intravascular vol by extracellular fluid loss or blood loss Tx: fluid resuscitation with crystalloids is a 1st line therapy Blood products should be admin in hypovolemic shock with intravascular depletion due to bleeding. If pt. Don’t respond to fluid or blood products therapy then vasopressor may be indicated |
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Vasopressor vs inotrope |
Vasopressor
Vasopressors constrict or tighten your blood vessels, making your heart have more forceful contractions. All of these help your body distribute blood to your vital organs. - makes your blood vessels narrower to increase BP Inotropes: help your heart pump more blood. *** together they can help you send more blood to body. |
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What’s the difference between septic shock and sepsis? |
Septic shock is the last and most dangerous stage of sepsis. Sepsis can be divided into three stages: sepsis, severe sepsis and septic shock.
Sepsis: Sepsis is life-threatening. It happens when your immune system overreacts to an infection. Severe sepsis: This is when sepsis causes your organs to malfunction. This is usually because of low blood pressure, a result of inflammation throughout your body. Septic shock: Septic shock is the last stage of sepsis and is defined by extremely low blood pressure, despite lots of IV (intravenous) fluids. |
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What vasopressor is used sepsis shock? |
Norepinephrine |
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Cardiogenic shock |
Cardiogenic shock takes place when the heart has been damaged so much that it is unable to supply enough blood and oxygen to the organs of the body.
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*****Treatment of ADHF***** |
Pt. With edema, JVD , ascites are volume overload so tx includes -loop diuretic - vasodilator can be added ( NTG, nitropurisside) Pt. With dec renal function, altered mental status, cool extremities have hypo perfusion. Tx includes - ionotrope (dobutamine, milrinone) - If pt becomes hypotension add vasopressor ( dopamine, NE, phenylephrine) If pt. Exp both volume overload and hypo perfusion tx includes combinations of agents above |
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***General principle for treating shock **** |
1. Fill the tank - optimize preload with crystalloid fluid 2. Speed the pipe and kick the pump - alpha 1 agonist activity to increase systemic vascular resistance *** - beta 1agonist to inc myocardial contraindications and cardiac output **heart |
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MAP ( mean arterial pressure) of > 65 mmHg |
[(2 x DBP) + SBP] / 3 |
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In critical care what meds are used for agitation/ sedation? |
Dexmedetomidine ( precedex), propofol, BZD SE: hypo/hypertension, bradycardia -Used for sedation in intubated and non- intubated - duration: infusion should not exceed 24 hrs MOA: alpha-2 adrenergic agonist |
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Agitation/ sedation Propofol |
Diprivan - CI: hypersensitivity to eggs, soy products SE: hypotension, hypertriglyceridemia, green urine/ hair/nails Monitor: TG Oil in water emulsion provide 1.1kcal/mL |
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Stress ulcers Tx |
Stress ulceration is defined as ulceration of the upper gastrointestinal (GI) tract (esophagus, stomach, duodenum) that occurs due to hospitalization Tx includes- H2RA PPI risk- GI infection, C.diff, fracture, nonsocomial pneumonia |
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Commonly used Anesthetic |
Local: lidocaine (Xylocaine) Inhale: Desflurane ( Suprane) , sevoflurane Injectable: bupivicaine, ropivicaine |
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Neuromuscular agent |
Succinylcholine Cisatracurium ( nimbex) Rocuronium Vecuronium |
