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72 Cards in this Set
- Front
- Back
Blood urea Nitrogen (BUN) Normal values |
indicator of hydration, not renal function 8-23 mg/dL |
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_______ is the best indicator of kidney function. The more nephrons that have been destroyed, the higher the level. Normal levels are____. |
serum creatinine level. 0.6 to 1.2 mg/dL |
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the BUN-creatinine ratio is important because it helps determine whether a patient has any type of _____failure. Normal ratio is: |
renal failure 10:1 to 20:1 |
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patients with renal insufficiency or renal failure are prone to: (a) metabolic acidosis (b) metabolic alkalosis |
(a) metabolic acidosis
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AV shunts should be palpated for ____ and listened to for ______. These findings indicate the shunt is patent and functioning normally. Absence of these findings may indicate clotting of shunt. |
Thrill and bruit |
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Ideal weight calculation for pharm doses. Female (Kg) |
Male: 50 + (2.3 x patient's height over 5') Female: 45.5 + (2.3 x patient's height over 5') |
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During anaphylaxis, drugs typically given IM or SubCu may need to be administered ______. |
by IV |
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Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common genetic disorder that causes potentially life threatening hemolytic anemia when exposed to: |
oxiant medications (like antimalarials), sulfonamides, nitrofurantoin, phenazopyridine, exposure to napthalene (mothballs) |
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FDA pregnancy risk category: A |
no risk to fetus in first trimester, and no evidence of danger to later trimesters |
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FDA pregnancy risk category: B
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animal studies demonstrate NO risk, but no studies done in pregnant women.
Animal studies show adverse effect (other than decrease in fertility), but not confirmed in pregnant women. |
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FDA pregnancy risk category: C
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studies in animals revealed adverse effects on fetus and there are no studies on women. OR studies in women and animals not available. Give drug if benefits:risk is favorable |
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FDA pregnancy risk category: D |
positive evidence of human fetal risk, but benefits from use in pregnant women may be acceptable despite the risk. |
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FDA pregnancy risk category: X
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risk of use in pregnant women clearly outweighs any possible benefit. Contraindicated to pregnant women. |
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Iatrogenic response |
symptoms that mimic naturally occurring disease states |
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patients with egg or soy allergies should not be sedated with: |
propofol (Diprivan) |
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An allergy to bananas or avocados is highly suggestive of a _____ allergy |
latex |
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tachyphylaxis |
a condition in which the patient rapidly becomes tolerant to a medication |
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alcohol-acetaminophen symdrome |
high doses of acetaminophen damage the liver. alcohol potentiates this effect and causes more of the medication to be taken up into the liver, resulting in acute liver failure. |
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cardiazem (Diltiazem), and various neruomuscular blocking agents such as (succinylcholine and rocuronium), and lorazepam (Ativan) have this similar storage requirement: |
require refrigerator storage. They are stable at room temp for very short periods of time. |
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This group of medications, ______, are the gold standard for patients requiring ET intubation: And the drug of choice is _____. Alternatives are: |
Ultra-short-acting nonbarbituate hypnotic agents drug of choice: etomidate (Amidate) Alternative: Ketamine |
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Etomidate (Amidate) is a _______, and acts by: |
Ultra-short-acting nonbarbituate hypnotic agent
depresses the reticular activating system by stimulating the gamma-aminobutyric acid (GABA) receptors decreases O2 consumption and cerebralblood flow (ideal for increase ICP) |
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In RSI: Etomidate Dose ___, reaches peak effect in ____ minute, and provides anasthesia for ____ minutes. |
0.3 mg/kg peak effect: 1 minute anesthesia: 3 to 5 minutes |
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Are there absolute contraindications for use of etomidate (Amidate) in RSI protocol? |
No |
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Ketamine is a ______, and a ____ derivative. |
Ultra-short-acting nonbarbituate hypnotic agent.
phencyclidine (PCP) derivative |
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In RSI= Ketamine dose: onset time: duration of action: |
dose: 1 -4 mg/kg onset: less than 1 minute duration: 10 to 15 minutes. |
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This RSI drug causes anesthesia, analgesia and amnesia; causes increase in BP, pulse and cardiac output It may be preferred induction method in patients with respiratory failure |
Ketamine |
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Propofol (Diprovan) is a _______ agent used in ____ management. normal adult dose is _____ for induction. Both anesthetic and amnesic effects begin at around _______ seconds, and lasts _______. The maintenance dose is: |
sedative-hypnotic agent used in airway management.
initial adult dose: 1 to 2.5 mg/kg for induction effects begin around 20 seconds lasts 10 to 15 minutes maintenance dose: 5 - 50 mcg/kg/min |
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Patient with status epilepticus has resisted first line drugs phenytoin and benzodiazepines. You could consider using: |
propofol, for anticonvulsant properties.
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Be cautious using propofol in patients with _____ blood pressure. And be sure to use aseptic technique! |
low
because propofol will decrease blood pressure |
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Propofol infusions should not last longer than _____ hours because high doses of propofol will cause propofol infusion syndrome, which includes: |
48 hours
metabolic acidosis rhabdomyolysis cardiac and renal failure |
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3 common critical care benzodiazepines include ___, ____, and ___ and are all pregnancy class _____ |
diazepam (Valium)
lorazepam (Ativan) midazolam (Versed) Pregnancy class D, which indicates strong risk to fetus |
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Benzodiazepines have these 3 desired effects, and should be used with caution in people with ____ blood pressure. |
anxiolytic, sedative, and anticonvulsant
low, because it will lower the BP |
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_____ is the most common choice of benzodiazepines for RSI due to the relatively fast onset time (compared to other benzos) of ____ minutes when administered at a dose of _______ in adults. It also has the added benefit of _____. It's duration is about ___, and patients can take up to ___ hours to recover. |
midazolam (Versed) 1 to 5 minutes dose: 2.5 to 10 mg IV in adults causing anteretrograde amnesia duration: 60 minutes recovery: 2 hours |
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______ is a moderatley long-acting benzodiazepine with a duration of 30 to 90 minutes, but has a relatively slow onset of approximately ___ minutes. |
Diazepam (Valium) onset: 5 minutes dose: 2 to 10 mg IV |
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______is a commonly used benzodiazepine with rapid onset of 1 to 5 minutes, but a variable peak effect. |
lorazepam (Ativan)
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A patient may be premedicated with a narcotic such as _______ when using midazolam (Versed) to get a potentiating effect |
fentanyl
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Of the benzodiazepines, these two are first choice anticonvulsants: |
diazepam (Valium)
lorazepam (Ativan) |
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In a patient with excessive levels of benzodiazepines, the use of _________ may be necessitated, using an initial dose of _______ over _____ seconds. After 30 seconds observation, a second dose of _______. If still need more, continue with _____ every _____ until max dose of ______. |
flumazenil (Romazicon)
0.2 mg IV over 30 seconds. after by 30 seconds of observation, a second dose of 0.3 mg over 30 seconds. Continue with 0.5 mg every minute up to 3 mg total until desired effect. |
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The pediatric dose of flumazenil (Romazicon) to counteract overdose of benzodiazepines: |
.002 to 0.02 mg/kg IV every minute
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Be cautious about using flumazenil in patients with history or potential for: |
seizures, unknown drug overdoses, using diazepam long term
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This depolarizing agent is an ideal paralytic agent due to causing muscle relaxation in ___ seconds, total paralysis in ____ seconds, and a duration of action lasting ____ to ___ minutes.
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succinylcholine (Anectine)
muscle relaxtion in 30 seconds paralysis in 45 seconds duration 7 to 10 minutes |
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dso of succinylcholine (Anectine) to intubate
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1 to 2 mg/kg
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succinylcholine (Anectine) will _____ heart rate in children and _____ serum potassium levels
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reduce heart rate
increase serum potassium levels |
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To intubate patients with malignant hyperthermia, acute injuries such as burns, crush injuries, and spinal cord injuries, or conditions affecting potassium such as renal failure, OR has been exposed to acetylcholinesterase inhibitors (chemical nerve agents) consider using something ELSE besides ______ for paralysis. |
succinylcholine (Anectine)
Because: causes malignant hyperthermia can increase ICP increases serum K+ the chemical will cause longer duration of action |
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Muscle fasciculations (twitching) are a common side effect of what paralyzing drug? |
succinylcholine (Anectine) |
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major drawback of non depolarizing agents in comparison with succinylcholine is:
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slower onset time and longer duration of action
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______ has the fastest onset time of non depolarizing agents taking _____ to ____ seconds at a dose of ______. At that dose the medication will last ____ minutes. Maintenance dose: |
Rocuronium (Zemuron) onset 60 to 90 seconds dose: 0.5 to 1 mg/kg duration: 45 minutes maintenace dose: 0.5 mg/kg |
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typical dose of albuterol via nebulizer |
2.5 to 5 mg
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albuterol, while selective beta-2 agonist, will cause beta-1 agonism seen as ___ and ___ effects
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cardiac chronotropic and inotropic
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This non depolarizing muscle relaxant has onset of 30 seconds, peak effects in 2.5 - 3 minutes and duration of 25 to 30 minutes |
Vecuronium (Norcuron) |
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Pancuronium (Pavulon) is a ______ agent. Onset is _____ seconds, with paralysis in ___ to __ minutes |
non depolarizing muscle relaxant
onset: 30 seconds peak effect, paralysis: 2 to 5 minutes |
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Cisatracurium (Nimbex) and Atracurium (Tracium) are ___ agents that have onset times of _____ minutes. |
non depolarizing muscle relaxant
onset: 2 to 3 minutes |
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Cisatracurium (Nimbex) peak effects in ____ minutes and duration ____ minutes |
peak: 3 to 5 minutes
duration 25 to 90 minutes |
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Atracurium (Tracium) peak effects in ___ minutes and duration ____ minutes. Dose dependent onset. |
peak: 5-7 minutes
duration 60 - 70 minutes |
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long term albuterol use can cause these 3 main problems, and ______ is a new drug that may replace albuterol for people with sensitivities due to having much fewer AEs
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severe hypokalemia
metabolic acidosis many cardiac issues levalbuterol |
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Terbutaline is a _____ agonist that is commonly used off-label as a ________. Dose: |
beta-2 agonist (bronchodilator) tocolytic: prevents premature laborDose: 0.25 mg SC every 20 min. improves resp status in 5-6m. peak : 20 to 30 min |
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common beta-2 agonist side effects
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tachycardia
high bp trembling and anxiety |
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the anticholinergic medication ________ is often used concurrently with albuterol.
It has a long onset time of ____ m. dose: should be avoided in patients with ____ |
onset: 20 minute
dose 0.5 mg every 20 m for 3 doses. contraindication: narrow-angle glaucoma |
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corticosteroid with least chance of placental crossing
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prednisolone
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If accidental extravasation occurs while infusing alpha-adrenergic medication (epi/norepi/dopamine), diluted _______ is injected into affected tissues near the site of extravasation to prevent local vasospasm and cell/tissue death. effective therapy is shown by |
phentolamine
return of normal skin color within 1 hour |
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contradictions of beta blockers (ex. labetolol)
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hhigh degree (greater than first-degree) HB
sick sinus syndrome heart failure cardiogenic shock |
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Class 1A anti arrhythmic medications. Most common in CCP |
increase effective refractory period (ERP). That is:
lengthens the time that cells cannot be depolarized most common is Procainamide. stop when QRS is 50% wider, arrhythmia is suppressed or pt is hypotensive |
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Class 1B anti arrhythmic medications |
decrease the effective refractory period and the action potential duration = cumulatively reduce automaticity, which reduces chances of disorganized depolarization
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The prototypical Class 1B medication is: |
lidocaine
dose 1 to 1.5 mg/kg repeat dose: -.5 to 0.75 mg/kg max dose: 3 mg/kg AHA favors amiodarone over lidocaine for certain arrhythmias. |
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Class 1 C antiarrhythmics: |
spress the phase 0 repolarization.
has virtually no effect on action potential. |
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Class II anti arrhythmic medications are |
beta-adrenergic blocking agents.
sympatholytics propranolol, metoprolol |
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Class III anti arrhythmic medications are: |
the potassium channel blockers.
they delay phase 3 repolarization of cells. tend to see prolonged QT intervals on ECG |
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mmost common class III antiarrhthmic
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amiodarone (Cordarone)
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Class IV antiarryhtmics are ______ and are useful for arrhythmias originating in the _____ |
calcium channel blockers
atria (because it decreases conduction velocity through the AV node) |
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The two common Class IV antiarrythmics are: |
verapamil (Calan)
diltiazem ( Cardizem) |
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What class antiarrythmic is adenosine? how does it work |
It is classified as an endogenous nucleoside, not a typical classification. slows AV conduction and entry through AV node. so helps with SVT, but not a-fib |
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what should you expect after an initial 6 mg dose of adenosine?
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a brief period of profound bradycardia or even systole. this is usually well tolerated and converts to sinus rhythm. if not, follow with 12mg then 12mg again
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