NAPLEX Acute & Critical Care Medicine

IV fluid that is less expensive

crystalloids

IV fluid that is more expensive

colloids

IV fluid that has fewer ADRs

crystalloids

IV fluid that primarily remain in the intravascular space and increase oncotic pressure

colloids

IV fluid that has not shown a clear clinical benefit over crystalloids

colloids

What type of IV fluid is 5% Dextrose (D5W)?

crystalloid

What type of IV fluid is 0.9% NaCl (NS)?

crystalloid

What type of IV fluid is Lactated Ringer’s (LR)?

crystalloid

What type of IV fluid are multiple electrolyte inj. like Plasma-Lyte A?

crystalloid

What type of IV fluid is Albumin (5%, 25%)?

colloid

What type of IV fluid is Albutein?

colloid

What type of IV fluid is AlbuRx?

colloid

What type of IV fluid is Dextran?

colloid

What type of IV fluid is Hydroxyethyl starch (Hespan, Hextend)?

colloid

Which type of IV fluid contains various concentrations of sodium and/or dextrose that pass freely between semipermeable membranes?

crystalloid

What type of IV fluid are large molecules (typically protein or starch)

colloid

____-containing products contain “free water” and are used when water is needed intracellularly

dextrose

Which IV fluids are most commonly used for fluid resuscitation in shock states?

Lactated Ringer’s and NS

Which is the most commonly use colloid that is particularly useful when there is significant edema (e.g. cirrhosis)?

albumin

Which colloid should only be used if other treatments are unavailable due to its BOXED WARNING for MORTALITY, renal injury, and coagulopathy (bleeding)?

hydroxyethyl starch

Hyponatremia is when Na < ___ mEq/L

135

Hypernatremia is when Na > ___ mEq/L

145

Hypokalemia is when K < ____ mEq/L

3.5

Hyperkalemia is when K < ____ mEq/L

5.5

Hypomagnesemia is when Mg < ____ mEq/L

1.3

Hypomagnesemia is caused by ______

chronic alcohol use, diruetics, amphotericin B, vomiting, and diarrhea

IV magnesium sulfate replacement is recommended for hypomagnesemia when serum Mg is < ___ mEq/L with life-threatening sx (e.g. seizures, arrhythmias)?

1

IV phosphorus replacement is recommended for hypophosphatemia when serum PO4 is < ___ mEq/L

1

What treatment is recommended for hypomagnesemia when serum Mg is < 1 mEq/L with life-threatening sx (e.g. seizures, arrhythmias)?

IV magnesium sulfate replacement

What treatment is recommended for hypophosphatemia when serum PO4 is < 1 mEq/L?

IV phosphorus replacement

What treatment is recommended for hypomagnesemia when serum Mg is 1 - 1.5 mEq/L?

PO magnesium oxide

Hyponatremia is caused by ______

dehydration, vomiting or diarrhea

Hyponatremia is treated with _____

fluids

Hypernatremia is caused by _____

intake of hypertonic fluids

Hypernatremia is treated with ______

diuresis

Hypernatremia is associated with _____

water deficit and hypertonicity

Isovolemic (euvolemic) hypernatremia is frequently caused by ______

diabetes insipidius (DI), which is a lack of antidiuretic hormone (ADH)

Isovolemic (euvolemic) hypernatremia is treated with ______

desmopressin

Patients with hyponatremia are not usually symptomatic until Na is < ____ mEq/L

120

Severe symptoms of hyponatremia

seizures, coma, respiratory arrest

Hypotonic hypervolemic hyponatremia is caused by _____

fluid overload (e.g. cirrhosis, HF renal failure)

Preferred treatment for hypotonic hypervolemic hyponatremia

diuresis with fluid restriction

Hypotonic hypovolemic hyponatremia is caused by _____

diuretics, salt-wasting syndromes, adrenal insufficiency, blood loss, or vomiting/diarrhea

What is used to treat severe sx or Na < 120 meq/L in hypotonic hypovolemic hyponatremia?

IV hypertonic (3%) saline

Hypotonic isovolemic (euvolemic) hyponatremia can be caused by _____

SIADH (syndrome of inappropriate antidiuretic hormone

Hypotonic isovolemic (euvolemic) hyponatremia is treated with _____

demeclocycline

When treating hyponatremia, sodium should not be corrected more rapidly than _____ mEq/L per 24 hours

12

Correcting sodium too rapidly in hyponatremia can cause ______

osmotic demyelination syndrome (ODS) or central pontine myelinolysis

Sx of osmotic demyelination syndrome

paralysis, seizures, death

Conivaptan drug class

arginine vasopressin (AVP) receptor antagonist

Tolvaptan drug class

arginine vasopressin (AVP) receptor antagonist

Conivaptan use

SIADH and hypervolemic hyponatremia

Tolvaptan use

SIADH and hypervolemic hyponatremia

Conivaptan administration

PO

Tolvaptan administration

injection

Tolvaptan is not recommended to be used beyond ____ days

30

Tolvaptan has a warning for _____ if used longer than the recommended amount of days

hepatotoxicity

MOA of arginine vasopressin (AVP) receptor antagonists (Conivaptan, Tolvaptan)

increases excretion of free water while maintaining sodium

Samsca generic name

tolvaptan

Tolvaptan brand name

samsca

Samsca drug class

arginine vasopressin (AVP) receptor antagonist

Which med should be initiated and reinitiated in a hospital with close monitoring of serum Na?

tolvaptan

Side effects of tolvaptan

thirst, nausea, dry mouth, polyuria, weakness, hyperglycemia, hypernatremia

Which electrolyte imbalance is common in hospitalized patients?

hypokalemia

In general, a drop of 1 mEq/L in serum K < 3.5 mEq/L represents a total body deficit of ______ mEq

100-400

What is the management of hypokalemia?

treating the underlying cause and administering PO or IV potassium

Which drugs can cause hypokalemia?

amphotericin, insulin

The maximum infusion rate for administering IV potassium through a peripheral line is ≤ ___ mEq/hr

10

The maximum concentration for administering IV potassium through a peripheral line is ___ mEq/ ____mL

10 mEq/100 mL

IV potassium can be fatal is administered ______

undiluted or via IV push

Which electrolyte is necessary for potassium uptake?

magnesium

Which electrolyte should be replaced first if both hypokalemia and hypomagnesemia are present?

magnesium

Hypophosphatemia is considered severe and is usually symptomatic when serum PO4 is < ____ mg/dL

1

Incentive spirometry

a device used to facilitate lung expansion in patients with atelectasis (completely or partially collapsed lung with reduced lung volume)

What is used to help patients breathe with atelectasis?

incentive spirometry

IV immune globulin (IVIG or IGIV) contains pooled _______ from the plasma of a thousand or more blood donors

immunoglobulin (IgG)

Plasma protein replacement therapy used for immune-deficient patients who have decreased or abolished antibody production capabilities.

IVIG

IVIG was initially only used for _______

immunodeficiency conditions

Off-label indications for IVIG

MS, myasthenia gravis, Guillain-Barre syndrome

Treatment used off-label for multiple sclerosis

IVIG

Treatment used off-label for myasthenia gravis

IVIG

Treatment used off-label for Guillain-Barre syndrome

IVIG

IVIG treatment can impair the response to ______

vaccinations

Gammagard generic name

IVIG (IV immunoglobulin)

Gamunex-C generic name

IVIG (IV immunoglobulin)

Octagam generic name

IVIG (IV immunoglobulin)

Privigen generic name

IVIG (IV immunoglobulin)

Vasopressor or Vasodilator or Inotrope: Dopamine

vasopressor

Vasopressor or Vasodilator or Inotrope: Epinephrine

vasopressor

Vasopressor or Vasodilator or Inotrope: Adrenalin

vasopressor

Vasopressor or Vasodilator or Inotrope: Norepinephrine

vasopressor

Vasopressor or Vasodilator or Inotrope: Levophed

vasopressor

Vasopressor or Vasodilator or Inotrope: Phenylephrine

vasopressor

Vasopressor or Vasodilator or Inotrope: Vasopressin (Vasostrict)

vasopressor

Vasopressor or Vasodilator or Inotrope: Nitroglycerin

vasodilator

Vasopressor or Vasodilator or Inotrope: Nitroprusside

vasodilator

Vasopressor or Vasodilator or Inotrope: Nipride

vasodilator

Vasopressor or Vasodilator or Inotrope: Dobutamine

inotrope

Vasopressor or Vasodilator or Inotrope: Milrinone

inotrope

Epinephrine drug class

alpha-1, beta-1, beta-2 agonist