Miscellaneous
The situation when you would use atropine.
Symptomatic bradycardia
The first line vasopressor for septic shock.
Levophed.
Dobutamine: primarily vasopressor or positive inotrope?
positive inotrope
Which drug has the longest duration of action? Fentany or hydromorphone?
Hydromorphone IV (2-3 hours)
Fentanyl IV (30-60 minutes)
The percentage to decrease insulin gtt when pt is NPO
50%
The reason a ketamine gtt is used (other than for sedation).
Status epilepticus
The amount of fluid resuscitation typically appropriate for a patient in septic shock.
30 mL/kg
The vasopressor that can be infused through a PIV.
Phenylephrine
The number a patient's QTc should not be above to receive Haldol.
550
*Use with caution for a QTc 500-549
The appropriate PPE for chemotherapy administration.
Yellow gown, double gloves, and mask with shield.
The two conditions that warrant caution in using beta blockers.
Acute asthma and cocaine usage
You have zosyn and vancomycin ordered at the same time for your patient in septic shock. Which one do you administer first?
Zosyn
DAILY DOUBLE!
Your patient is hypotensive and has tachycardia > 150. They are NOT suspected to be in septic shock. Which agent would you select and why?
Phenylephrine because it's primary effect is vasoconstriction. It has no effect on beta receptors and therefore heart rate.
Side effects of opioids. Name at least 3.
- hypotension
-respiratory depression
- over-sedation
- pruritus
- decreased GI motility
Drugs (that are not antipsychotics) that can prolong QTc. Name at least 3.
- Zofran
- Phenergan
- Azithro
- Amio
- Benadryl
- Methadone
Side effects of albuterol. Name at least 3.
Increased heart rate.
Pupil dilation.
Tremors
Lactic acidosis
Decreased lacrimation.
Adverse effects of Levophed. Name at least 3.
- Compromised organ perfusion and damage
- tissue necrosis
- metabolic acidosis
- tachycardia
IV gtts used for hypertensive emergency. Name at least 3.
- Nitroprusside (Nitropress)
- Labetalol
- Nicardipine (Cardene)
- Clevidipine
Antipsychotics cause this life-threatening emergency.
Neuroleptic Malignant Syndrome
The highest concentration of IV potassium that a patient on continuous ECG monitoring can receive in 1 hour via (1)a peripheral IV and (2)a central line.
1) 10 mEq/100 mL
2) 20 mEq/100 mL
*In an emergency can receive up to 40 mEq/100 mL via a central line
Per the UMMC guideline, how do you wean fentanyl gtt?
50 mcg/hr every 2 hours to maintain pain level < 4
Adverse effect of vasopressin. Name at least 3.
- MI
- Decrease in cardiac index
- Decrease in mesenteric mucosal perfusion (GI ischemia)
- ischemic skin changes
- hyponatremia
In hypertensive emergency: the maximum percentage to safely lower a patient's MAP during the first hour of treatment.
25% in the first hour
*additionally 15% over the next 23 hours
Symptoms of propofol infusion syndrome. Name at least 3.
- metabolic acidosis
-rhabdomyolysis
-arrhythmias (commonly bradycardia)
- hepatomegaly
- liver toxicity
- cardiomyopathy with acute cardiac failure
Onset of action of insulin aspart.
5-15 minutes.