Pharm II final- misc memorization things

rapid acting insulin (lispro/humalog) onset

15-30 min

rapid acting insulin (lispro/humalog) peak

0.5-2.5 hr

rapid acting insulin (lispro/humalog) duration

3-6 hr

short acting insulin (regular) onset

30-60 min

short acting insulin (regular) peak

1-5 hr

short acting insulin (regular) duration

6-10 hr

intermediate (NPH) insulin onset

60-120 min

intermediate (NPH) insulin

6-14 hr

intermediate (NPH) insulin duration

16-24 hr

long acting insulin (glargine/lantus) onset

70 min

long acting insulin (glargine/lantus) peak

none

long acting insulin (glargine/lantus) duration

18-24 hr

key labs for DKA

Glucose >200 mg/dL, pH <7.3, bicarb <18 mEq/dL

DKA treatment

Insulin replacement, bicarbonate for acidosis, water/sodium replacement, potassium replacement, normalization of glucose level

HHS treatment

Correct hyperglycemia and dehydration with IV insulin, fluids, and electrolytes

hypoglycemia signs/symptoms

shakiness, sweating, chills, clamminess, tachycardia, palpitations, nervousness, anxiety, irritability, sudden hunger or upset stomach, pale skin, tingling or numbness in the lips/tongue/cheeks

moderate- dizziness, headache, confusion, blurred vision, fatigue, unusual behavior; severe- fainting, seizures, confusion or combativeness

treatment for hypoglycemia

orange juice, glucose tablets, sugar cubes/packets, IV glucose, glucagon

heparin mechanism

activates antithrombin III → inactivates thrombin and factor Xa

heparin lab to monitor

aPTT (1.5-2.5x control)

heparin reversal

protamine sulfate (1-1.5 mg inj per 100u of heparin)

LMWH (enoxaporin/lovenox)

Activates antithrombin III → preferentially inactivates factor Xa

LMWH (enoxaporin/lovenox) reversal

protamine sulfate

warfarin (coumadin) mechanism

vit K antagonist, blocks factors II, IIV, IX, X

warfarin (coumadin) labs to monitor

INR (2-3), and PT

warfarin (coumadin) reversal

vit K and fresh frozen plasma (FFP)

dabigatran (pradaxa) mecnanism

direct thrombin inhibitor (DTI)

dabigatran (pradaxa) reversal

idarucizumab (praxbind)

rivaroxaban (xarelto) and apixaban (eliquis) mechanism

direct factor Xa inhibitor

rivaroxaban (xarelto) and apixaban (eliquis) reversal

andexanet alpha (andexxa), activated charcoal (if recent)

aspirin (ASA) mechanism

irreversibly inhibits COX-1 and COX-2, preventing thromboxane A2 formation

aspirin (ASA) reversal

platelet transfusion

alteplase (TPA) mechanism

converts plasminogen to plasmin, breaking down fibrin in existing clots

alteplase (TPA) reversal

aminocapropic acid (amicar), trarnexamic acid

heparin induced thrombocytopenia (HIT)

Severe, immune-mediated adverse reaction to heparin. Causes both low platelet counts (thrombocytopenia) and an extremely high risk of life- threatening blood clots (thrombosis)

heparin induced thrombocytopenia (HIT) treatment

STOP all heparin immediately, switch to argatroban or bivalirudin (DTIs), do NOT give warfarin until platelet count recovers

food/herb interaction with warfarin (coumadin)

Consistent vit K intake

Herbs/food increasing bleeding risk: ginkgo, garlic, fish oil, vit E

St. John's wort decreases warfarin's effect and lowers INR

STEMI

complete occlusion of the artery that has ST elevation, extensive tissue damage affecting the full thickness of the heart muscle, requiring immediate surgery/procedures to open the artery

non-STEMI

partial or temporary occlusion usually only affecting the inner layer of the heart, treated with medication to prevent further clotting and evaluate whether a stent is needed

most preferred treatment for STEMI

primary percutaneous coronary intervention 

STEMI medications

Morphine, Oxygen (if hypoxic), Nitrates, Aspirin (chew immediately), Beta- blocker — plus emergent reperfusion (PCI or tPA), heparin, P2Y12 antiplatelet, statin

TPA indications

acute ischemic stroke (within window), STEMI without timely PCI access, massive PE

post-MI / post-cath lab medications

Beta-blocker, ACE inhibitor/ARB, high-intensity statin, aspirin

SIRS criteria

temp <36or >38 C, HR >90, RR >20, WBC <4k or >12K

severe sepsis

simple sepsis and signs of organ dysfunction (lactate >2, altered mental status, creatinine >2, hypotension, hypoxia <94%, acute total bili >2, acute platelet <100, INR >1.5 or aPTT >60)

septic shock

Lactate >4 or hypotension despite IV fluid resuscitation (30 mL/kg)

sepsis priority interventions (do first)

Obtain blood cultures (without significantly delaying antibiotics) → broad-spectrum IV antibiotics within 1 hr → lactate lvl → 30 mL/kg crystalloid fluid bolus → vasopressor (norepinephrine first-line) if still hypotensive, goal MAP ≥65

most common UTI organism

E coli

septic shock key signs

Warm/flushed early → cold/clammy late; fever; hypotension; high CO early

cardiogenic shock signs and treatment

signs: Cold, clammy, ↓ BP, ↑ HR, crackles, JVD, ↓ UO

treatment: Inotropes (dobutamine), diuretics if fluid-overloaded, possible IABP

obstructive shock signs and treatment

signs: ↓ CO, ↑ JVD, hypotension; Beck's triad for tamponade (↓ BP, muffled heart sounds, JVD)

treatment: Remove obstruction: needle Shock, decompression (tension PTX), pericardiocentesis (tamponade), thrombolytics/embolectomy (PE)

metformin class and mechanism

Biguanide— decreases hepatic glucose production and increases insulin sensitivity

hyperthyroidism/grave’s disease