Acute & Critical Care Medicine

arginine vasopressin (AVP) receptor antagonist

-For Hypervolemic or SIADH -Conivaptan (Vaprisol = dual AVP antagonist both V1A and V2) or Tolvaptan (Samsca =only V2)

SS presented to the ED with severe dehydration. He was out hiking in the Arizona sun and forgot to bring water. He got lost, and a 1-hour hike turned into a 6-hour hike. He is lethargic and nauseous. The Chem-7 returned, and his serum sodium level is 131 mEq/L (135 - 145 mEq/L). He has no evidence of seizure activity presently. Which of the following represents the best initial therapeutic option to correct his sodium?

0.9% NaCl Correct Normal saline (similar in tonicity to human blood) is the recommended first-line option to correct hypovolemic hyponatremia. Hypertonic saline (i.e., 3% NaCl) is a high-risk medication reserved for refractory cases in which the patient has significant complications such as seizures or coma. Refer to the section(s) beginning on pg. 715 of 2022 RxPrep Course Book.

An order is placed for LS to receive 40 mEq of KCl IV with continuous EKG monitoring. She only has a peripheral IV line at this point. The hospital stocks premixed bags of 10 mEq KCl/100 mL 0.9% NaCl. The pharmacist modifies the order to read "10 mEq KCl/100 mL 0.9% NaCl x 4 doses." What is the shortest recommended infusion time for each 10 mEq KCl bag?

1 hour correct Potassium replacement should occur via the oral route when possible. IV replacement may be warranted in cases like this, where ECG changes may be a result of the electrolyte abnormality. Safe recommendations for potassium administration via peripheral line include ≤ 10 mEq/hr and ≤ 10 mEq/100mL. Potassium can be infused faster and at higher concentrations if there is a central line and cardiac monitoring. Refer to the section(s) beginning on pg. 717 of 2022 RxPrep Course Book.

A patient picks up a prescription for an EpiPen for her son. Which of the following ratio strengths is used for epinephrine given by intramuscular administration?

1:1,000 Correct Epinephrine [1:1,000] 1 mg/mL is used in epinephrine products designed for intramuscular or subcutaneous administration. The Institute for Safe Medication Practices (ISMP) has advocated for changes to epinephrine labeling due to frequent errors associated with confusion between the available strengths (1:1,000 vs. 1:10,000). (1 mg/mL vs 0.1 mg/mL) Refer to the section(s) beginning on pg. 719 of 2022 RxPrep Course Book.

Select the correct concentration of epinephrine that should be used to mix solutions intended for intravenous administration:

1:1,000 correct Epinephrine [1:1,000] is used to compound products intended for intravenous administration. Epinephrine that is given IV push is 1:10,000. Refer to the section(s) beginning on pg. 719 of 2022 RxPrep Course Book.

Dopamine dosing

< 5 mcg/kg/min: renal- Dopamine-1 Agonist 5-10 mcg/kg/min: Beta-1 Agonist inc cardiac output (inotropic effect) > 10 mcg/kg/min: Alpha-1 agonist inc SVR

A patient in the ICU is receiving a dopamine drip at 44 mL/hr. The patient weighs 200 lbs and is receiving the hospital's standard dopamine drip (400 mg/250 mL). What receptor effect should be expected from this dose?

Alpha-1 receptor agonism correct The dose must be calculated first. (400 mg / 250 mL) x (44 mL / 1 hr) x (1 hr / 60 min) x (1000 mcg / 1 mg) = 1173.3333 mcg/min200 lb / 2.2 = 90.9 kg1173.3333 mcg/min / 90.9 kg = 12.9 mcg/kg/min Alpha-1 agonism is expected at this dopamine drip rate of approximately 13 mcg/kg/min. Dopamine doses > 10 mcg/kg/min are considered high dose. Refer to the section(s) beginning on pg. 719 of 2022 RxPrep Course Book.

Which of the following agents are used as ICU sedatives?

Ativan Midazolam Diprivan Precedex correct Norepinephrine (Levophed) is used as a vasopressor in shock. Though midazolam is no longer branded, many in clinical practice still refer to it by the brand name Versed. Refer to the section(s) beginning on pg. 723 of 2022 RxPrep Course Book.

Which of the following methods reduce the risk of adverse renal events in a patient with kidney disease that requires intravenous immunoglobulin (IVIG)?

Avoid IVIG products with sucrose Avoid IV vancomycin therapy, if possible Avoid IV gentamicin therapy, if possible Use a slower infusion rate correct Refer to the section(s) beginning on pg. 718 of 2022 RxPrep Course Book.

Nimbex

Cisatracurium (non-depolarizing NMS blocker) Hofmann elimination- Independent of hepatic or renal function

Which of the following statements is true of colloids and crystalloids?

Colloids are more expensive than crystalloids. Correct Colloids are more expensive than crystalloids. Refer to the section(s) beginning on pg. 714 of 2022 RxPrep Course Book.

A pharmacist is checking several ICU drips that were made by a technician. The first is a dexmedetomidine drip labeled with a final concentration of 2 mcg/mL. In reviewing the technician's notes and IV room waste, the technician used 2 mL from a dexmedetomidine vial (100 mcg/mL) and added this to 48 mL of NS to prepare a final volume of 50 mL. What is the correct final concentration of this drip in mcg/mL?

Correct answer: 4 2 mL x 100 mcg/mL = 200 mcg. The prepared concentration is 200 mcg/50 mL or 4 mcg/mL. Refer to Calculations IV - Flow Rates for additional examples, though this is a simple concentration problem. Refer to the section(s) beginning on pg. 723 of 2022 RxPrep Course Book

A pharmacist is checking the ICU drips before her shift ends so she can let the midnight pharmacist know what drips will need to be made overnight. A 210 pound patient is receiving Precedex (200 mcg/50 mL NS) at 0.2 mcg/kg/hr. There is 25 mL remaining in the bag. Assuming a constant rate of infusion, how many more hours will the bag last?

Correct answer: 5 To provide the correct weight-based dose, the drip should be running at ~4.77 mL/hr. At this rate, the remaining 25 mL will last a little over 5 hours. In reality, a critical drip like this would be made well before it is allowed to run out (as stability allows). Refer to Flow Rates - Calculations IV for additional examples. Refer to the section(s) beginning on pg. 723 of 2022 RxPrep Course Book.

A patient in the OR received succinylcholine for intubation and is currently receiving inhaled isoflurane during surgery. Which rare, but serious, side effect is this patient potentially at risk for?

Crystalloids are large molecules that primarily remain in the intravascular space and increase oncotic pressure. Correct Colloids are more expensive than crystalloids. Refer to the section(s) beginning on pg. 714 of 2022 RxPrep Course Book.

Succinylcholine

Depolarizing neuromuscular blocker

The pharmacist receives an order for Precedex. Which of the following is an appropriate generic substitution for Precedex?

Dexmedetomidine correct The generic name of Precedex is dexmedetomidine. Refer to the section(s) beginning on pg. 723 of 2022 RxPrep Course Book.

A patient presents to the hospital with hypernatremia and a "free water" deficit. The physician determines that the patient needs more intracellular water. Which fluid replacement strategy would be preferred?

Dextrose 5% correct Dextrose-containing products contain "free water." They are used when intracellular water is needed. Refer to the section(s) beginning on pg. 714 of 2022 RxPrep Course Book.

JH is a 55-year-old male who will be receiving his third IVIG treatment for autoimmune encephalopathy. He reports that he had been receiving steroid therapy for many years, but was changed to IVIG the previous fall when his symptoms worsened. He has presented to the infusion room. The pharmacist cannot locate the referring physician's paperwork and will attempt to conduct a pre-screening before the treatment. Which of the following screening questions should the pharmacist ask?

Did the patient develop any reactions to the medication, either during the infusion, or afterward? What is the name of the IVIG medication received previously, and is the patient aware of the dose? Did the patient use any medications prior to the treatment to help lessen the side effects? correct Refer to the section(s) beginning on pg. 718 of 2022 RxPrep Course Book.

Which of the following drugs is formulated in a lipid emulsion?

Diprivan correct Monitor triglycerides if Diprivan is used long-term. Usually, triglyceride monitoring begins on day 3 of therapy. Refer to the section(s) beginning on pg. 723 of 2022 RxPrep Course Book.

Propofol

Diprivan General Anesthetic 1.1 kcal/mL lipid (oil-in-water) emulsion aseptic techniques due to bacterial growth discard vial and tubing 12 hours after use

A patient with end-stage alcoholic cirrhosis is admitted to the medical floor. His serum sodium level is 122 mEq/L. On physical exam, he has ascites and peripheral edema, but only mild shortness of breath. What is the preferred treatment for this patient's hyponatremia?

Diuresis and fluid restriction - start now. correct Hypervolemic hyponatremia is common in patients with cirrhosis, heart failure and renal failure. The total body sodium is diluted in an increased volume. Administering fluids to these patients will often worsen the hyponatremia. Refer to the section(s) beginning on pg. 715 of 2022 RxPrep Course Book.

The ICU staff will monitor LS for delirium during her stay. Which statement is correct regarding ICU delirium?

Early mobilization and environmental control are recommended to prevent delirium. correct The incidence of delirium can be reduced by using non-benzodiazepine sedation, increasing mobilization and controlling the environment (keeping the room dark at night, light during the day). Though haloperidol is often used for this purpose, data does not support this practice. Quetiapine (Seroquel) can be useful for treating delirium. Refer to the section(s) beginning on pg. 723 of 2022 RxPrep Course Book.

Which of the following represent risks associated with IVIG therapy?

Fever Infusion reactions Acute renal damage correct Acute renal damage, infusion reactions and fever are among the potential risks associated with IVIG therapy. Refer to the section(s) beginning on pg. 718 of 2022 RxPrep Course Book.

A patient in the ICU has been receiving a continuous infusion of vecuronium for 3 days. On rounds, the nurse comments that the patient requires constant suctioning of his mouth secretions. Which medication can be recommended to reduce secretions?

Glycopyrrolate correct Glycopyrrolate is often used specifically for this purpose in critical care patients. Sugammadex and neostigmine are both used to reverse NMBAs. Refer to the section(s) beginning on pg. 727 of 2022 RxPrep Course Book.

Which of the following fluids would be expected to remain in the intravascular space and increase oncotic pressure?

Hydroxyethyl starch Albumin Dextran correct Fluid replacement therapy generally consists of crystalloids and/or colloids. Albumin, Hespan and dextran (is not dextrose) are colloids. Refer to the section(s) beginning on pg. 714 of 2022 RxPrep Course Book.

What are the risks associated with providing proton pump inhibitors to patients who do not require stress ulcer prophylaxis?

Increased risk of developing Clostridioides difficile diarrhea. Increased infection risk by increasing gastric pH and allowing bacteria overgrowth in the GI tract and airways. Increased risk of contracting hospital-acquired pneumonia. correct Appropriate use of stress ulcer prophylaxis prevents GI bleeding in high-risk patients (e.g., someone mechanically ventilated > 48 hours). H2RAs and PPIs should not be over-used in hospitalized patients. Most PPI orders should be discontinued when patients leave the ICU to prevent inadvertent continuation. Refer to the section(s) beginning on pg. 726 of 2022 RxPrep Course Book.

Case LS is an 84-year-old Hispanic female admitted directly to the medical ICU on 12/15 because of low blood pressure during evaluation in the ER. She was transferred from her nursing home for confusion, disorientation and decreased oral intake. Her past medical history includes hypertension, diabetes and dementia. Allergies: NKDA Medications: Norvasc 10 mg PO daily Lasix 40 mg PO daily (started 12/1 for lower extremity swelling) Exelon patch 9.5 mg/24 hr Namenda 5 mg BID Lantus 10 units at HS Novolin R sliding scale PRN (scale not documented on transfer records) Calcium supplement (dose not documented on transfer records) Vitals: Height: 5'2" Weight: 136 pounds BP: 85/62 mmHg HR: 101 BPM RR: 14 BPM Temp: 101.8°F Pain: 3/10 Labs from Nursing Home on 10/2: Na (mEq/L) = 138 (135 - 145) K (mEq/L) = 3.6 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 27 (24 - 30) BUN (mg/dL) = 20 (7 - 20) SCr (mg/dL) = 1.1 (0.6 - 1.3) Glucose (mg/dL) = 187 (100 - 125) Ca (mg/dL) = 8.7 (8.5 - 10.5) Mg (mEq/L) = 1.3 (1.3 - 2.1) PO4 (mg/dL) = 2.2 (2.3 - 4.7) A1C (%) = 8.9 Albumin (g/dL) = 3.6 (3.5 - 5) Labs on Hospital Admission 12/15: Na (mEq/L) = 135 (135 - 145) K (mEq/L) = 3.1 (3.5 - 5) Cl (mEq/L) = 99 (95 - 103) HCO3 (mEq/L) = 27 (24 - 30) BUN (mg/dL) = 42 (7 - 20) SCr (mg/dL) = 1.4 (0.6 - 1.3) Glucose (mg/dL) = 169 (100 - 125) Ca (mg/dL) = 8.8 (8.5 - 10.5) Mg (mEq/L) = 1.0 (1.3 - 2.1) PO4 (mg/dL) = 1.9 (2.3 - 4.7) A1C (%) = 8.8 Albumin (g/dL) = 2.9 (3.5 - 5) Tests: EKG: sinus tachycardia, non-specific T wave changes, and prolonged QT interval Urinalysis and blood cultures are ordered and results are pending. Question Add to Flashcards Which statement is correct regarding LS's electrolyte abnormalities on 12/15?

Lasix may have caused the hypokalemia and hypomagnesemia. Hypomagnesemia should be treated IV when serum magnesium level is < 1 mEq/L with seizures or arrhythmias. correct Strong knowledge of how medications impact lab values is required for NAPLEX. Additional information is provided in the Lab Values & Drug Monitoring Chapter. Refer to the section(s) beginning on pg. 717 of 2022 RxPrep Course Book.

A dopamine drip is ordered for LS. Which of the following represents the correct combination of dose-effect relationships for dopamine?

Low dose → renal vasodilation, medium dose → positive inotropic effect, and high dose → vasopressor effects correct Dopamine is unique in that the predominant receptor affected is dose-dependent. Refer to the section(s) beginning on pg. 719 of 2022 RxPrep Course Book.

KC is a 56-year-old male (85 kg) with a past medical history of COPD, hyperlipidemia and hypertension. He presented to the emergency room with shortness of breath, increased purulent sputum and fever of 102.1°F. His blood pressure did not respond to an initial fluid bolus and is now 78/50 mmHg. Broad-spectrum antibiotics are started. The physician decides to start a norepinephrine 4 mg/250 mL infusion to maintain a mean arterial pressure (MAP) above 65 mmHg. The nurse starts the infusion at a rate of 0.1 mcg/kg/minute. After 20 minutes, the patient's blood pressure is 88/56 mmHg. How should the infusion be adjusted based on the patient's target MAP?

Maintain the current infusion rate Correct MAP = [(2 x DBP) + SBP]/3MAP = [(2 x 56) + 88]/3 = 66.667 mmHgKC's MAP is at his goal of greater than 65 mmHg; the nurse should maintain the current infusion rate and there is no indication at this time to increase or decrease the rate. Vasopressin would be added if the patient worsens and is unable to achieve MAP goals on norepinephrine alone. We would not stop the infusion since this would cause the patient's pressure to drop. As the patient improves and the cause of hypotension resolves (in this case, a likely bacterial infection), norepinephrine can be slowly weaned off. Refer to the section(s) beginning on pg. 721 of 2022 RxPrep Course Book.

AB has recently been admitted to the intensive care unit after an acute asthma exacerbation. She has been intubated and requires adequate sedation. She has normal renal and liver function. The medical team wants to use the shortest acting benzodiazepine available intravenously for sedation. Which of the following medications would be the best recommendation?

Midazolam correct Midazolam is a short-acting benzodiazepine that is available intravenously. Temazepam and clonazepam do not come in an intravenous formulation. Midazolam does not accumulate when used for a short period of time in patients with normal renal and liver function. Refer to the section(s) beginning on pg. 723 of 2022 RxPrep Course Book.

Which of the following positive inotropes acts via phosphodiesterase-3 inhibition?

Milrinone Correct Milrinone is a PDE-3 inhibitor. Refer to the section(s) beginning on pg. 721 of 2022 RxPrep Course Book.

A patient with acute decompensated heart failure is receiving milrinone. Which of the statements concerning milrinone are correct?

Milrinone is administered IV only. Milrinone is a vasodilator. Milrinone is a positive inotrope and increases contractility in the heart. Monitor BP, HR, renal function and ECG (for arrhythmias) when using this agent. correct Milrinone is often referred to as an "inodilator". Milrinone is a PDE-3 inhibitor that requires dose adjustment in renal dysfunction. Refer to the section(s) beginning on pg. 721 of 2022 RxPrep Course Book.

LS requires fluid resuscitation. Which of the following is the best recommendation?

NaCl 0.9% correct LS likely has sepsis, and the crystalloid 0.9% sodium chloride should be used for fluid resuscitation. Crystalloids are less expensive and associated with fewer adverse reactions than colloids. Though the patient's serum albumin is low, IV albumin is not effective at increasing serum albumin and should not be used for this purpose. Refer to the section(s) beginning on pg. 714 of 2022 RxPrep Course Book.

A patient presents to the hospital with increasing shortness of breath, fatigue and lower extremity edema. The patient is diagnosed with acute decompensated heart failure. His blood pressure is 109/60 mmHg, and his heart rate is 80 BPM. His serum creatinine is 1.4 mg/dL. In addition to furosemide, the cardiologist recommends an IV vasodilator. Which of the following medications is appropriate for this patient?

Nitrogylcerin correct Vasopressin, dopamine and phenylephrine are not vasodilators. The patient's BP would need to be monitored very carefully, as it is quite low already. Refer to the section(s) beginning on pg. 720 of 2022 RxPrep Course Book.

Which of the following agents is associated with a risk of cyanide toxicity?

Nitroprusside Correct Nitroprusside has a risk of cyanide and thiocyanate toxicity. Requires light protection D E N M W P

NS is a 32-year-old female in the coronary care unit after a sudden drop in blood pressure following her cardiac catheterization procedure earlier this morning. Her blood pressure remained stable for the past two hours without the use of medications. She is sitting up in bed and eating her lunch. The medical team is anticipating sending her home by this evening or early tomorrow morning. Is NS a candidate for stress ulcer prophylaxis?

No, since she does not have any risk factors. correct She does not have any risk factors warranting stress ulcer prophylaxis, and overuse of acid-suppressive therapies is associated with known risks. Refer to the section(s) beginning on pg. 726 of 2022 RxPrep Course Book.

Select the correct generic name for Levophed:

Norepinephrine Correct The generic name for Levophed is norepinephrine. Refer to the section(s) beginning on pg. 719 of 2022 RxPrep Course Book.

Which of the following are IV hemostatic agents?

NovoSeven Praxbind Kcentra Aminocaproic acid correct anticoagulation antidotes = hemostatic Refer to the section(s) beginning on pg. 728 of 2022 RxPrep Course Book.

MS is an elderly patient admitted for altered mental status. His admission serum sodium is 115 mEq/L. MS is started on Vaprisol (loading dose and continuous infusion). The next day his serum sodium is 129 mEq/L. MS is at risk for which of the following adverse effects?

Osmotic demyelination syndrome (ODS) correct Osmotic demyelination syndrome (ODS) or central pontine myelinolysis (CPM) can be caused by overly rapid correction of hyponatremia ( > 12 mEq/L/24 hours). ODS can cause paralysis, seizures and death. Monitor serum sodium frequently during correction of hyponatremia. Refer to the section(s) beginning on pg. 715 of 2022 RxPrep Course Book.

While reading an article about acute decompensated heart failure, a pharmacist notes that reduction in pulmonary capillary wedge pressure (PCWP) is often used in clinical trials as a measure of ADHF treatment success. How is PCWP monitored?

PCWP is available from a Swan-Ganz catheter. correct A Swan-Ganz catheter, or PA catheter, provides hemodynamic measurements like PCWP, SVR, CVP and others that can be useful in ADHF. A Quinton catheter is a commonly used catheter for administering IVs and for dialysis access. Refer to the section(s) beginning on pg. 722 of 2022 RxPrep Course Book.

An ICU patient is receiving dexmedetomidine for sedation. Which of the following statements regarding dexmedetomidine is correct?

Patients are arousable and alert upon stimulation when using this agent. correct The duration of infusion should not exceed 24 hours. There is a lower risk of respiratory depression with dexmedetomidine than other sedatives, but the incidence (approximately 37%) is not low. Importantly, dexmedetomidine is an alpha-2 adrenergic agonist (same MOA as clonidine). Refer to the section(s) beginning on pg. 723 of 2022 RxPrep Course Book.

Which of the following medications is a vasopressor?

Phenylephrine Correct Vasopressors cause vasoconstriction, which increases blood pressure. Phenylephrine is a pure alpha agonist, causing vasoconstriction. Refer to the section(s) beginning on pg. 719 of 2022 RxPrep Course Book.

dexmedetomidine

Precedex (Alpha2-adrenergic agonist, sedative)

A pharmacist receives an order for Diprivan. Which of the following is an appropriate generic substitution for Diprivan?

Propofol Correct The generic name of Diprivan is propofol. Refer to the section(s) beginning on pg. 723 of 2022 RxPrep Course Book.

Hemostatic agents prevent blood loss. Which of the following statements concerning hemostatic agents are correct?

Recombinant thrombin (Recothrom) is a topical hemostatic agent. Tranexamic acid is a hemostatic agent that can be used for heavy menstrual bleeding. Hemostatic agents can increase risk of thrombosis. correct The most common adverse events from the use of hemostatic agents are hypersensitivity and thrombosis. Patients receiving systemic thrombin products are at risk of thrombosis (clotting). Topical hemostatic agents include Recothrom. Refer to the section(s) beginning on pg. 728 of 2022 RxPrep Course Book.

Which of the following are crystalloids?

Sodium chloride Lactated Ringers Dextrose Correct Sodium chloride, dextrose and lactated ringers are crystalloids. Refer to the section(s) beginning on pg. 714 of 2022 RxPrep Course Book.

Which of the following agents is a depolarizing neuromuscular blocking agent?

Succinylcholine Correct Succinylcholine is the only available depolarizing neuromuscular blocking agent. It is not used long-term in the ICU but is generally reserved for intubations. Refer to the section(s) beginning on pg. 727 of 2022 RxPrep Course Book.

A patient in the ICU has an order for a continuous infusion of Nimbex. Which of the following statements is correct regarding this medication?

The medical staff must ensure that the patient is receiving appropriate analgesia prior to the use of the Nimbex. A continuous infusion of Nimbex requires mechanical ventilation. The medical staff must ensure that the patient is adequately sedated prior to the use of the Nimbex. A peripheral nerve stimulator can be used to monitor Nimbex. correct NMBAs bind to the acetylcholine receptor. Refer to the section(s) beginning on pg. 727 of 2022 RxPrep Course Book.

Which of the following statements concerning rocuronium, vecuronium and cisatracurium is correct?

These drugs should have a warning applied to the bag, such as: "WARNING: PARALYZING AGENT." These drugs are paralytics or neuromuscular blocking agents (NMBAs). They are non-depolarizing neuromuscular blockers that bind to the acetylcholine receptor and block the action of acetylcholine. According to ISMP, these are all classified as "HIGH-RISK" medications. Correct NMBAs are paralytics. They do not provide sedation or analgesia. Refer to the section(s) beginning on pg. 727 of 2022 RxPrep Course Book.

A patient has been receiving 4 days worth of propofol for sedation post-traumatic brain injury. Which of the following statements regarding propofol is/are correct?

This patient may be at risk for developing infections. Hypotension, apnea and elevated triglycerides are likely side effects. This agent is generally shorter-acting than lorazepam. Propofol contains calories that must be accounted for in the daily nutrition plan for the patient. correct Propofol comes as an oil-in-water emulsion that is administered as a continuous infusion for ICU sedation. This formulation can lead to an increased risk of infections and elevated triglycerides that are dose and duration-dependent. Use strict aseptic technique when administering. Green urine/hair/nails have been seen in some patients on propofol. Propofol has a shorter half-life and less drug accumulation than benzodiazepines (e.g., lorazepam), which leads to improved ICU outcomes such as a shorter duration of mechanical ventilation. Refer to the section(s) beginning on pg. 723 of 2022 RxPrep Course Book.

Which of the following statements concerning IVIG is correct?

Thrombosis may occur without other risk factors. correct IVIG is nearly all IgG; small amounts of other antibodies may be present. IVIG is obtained from human donors only. The patient is receiving passive immunity (the transfer of human antibodies from another person, or persons, to the patient). IVIG is expensive. Acute renal dysfunction and thrombosis are Boxed Warnings. Refer to the section(s) beginning on pg. 718 of 2022 RxPrep Course Book.

What is the correct rationale for using an inotropic agent in a patient with shock syndrome?

To increase cardiac contraction in order to increase cardiac output. correct Agents that increase cardiac contractility, and therefore cardiac output, are considered inotropes. Refer to the section(s) beginning on pg. 721 of 2022 RxPrep Course Book.

A patient in the ICU with shock is receiving a norepinephrine infusion. What is the purpose of using norepinephrine in this setting?

To increase cardiac output, increase blood flow to vital organs and increase blood pressure. correct Vasopressors work via vasoconstriction to increase SVR and blood pressure. Refer to the section(s) beginning on pg. 719 of 2022 RxPrep Course Book.

A patient is admitted with significant hyponatremia (Na = 125). The provider would like to use tolvaptan. Which of the following statements is correct?

Tolvaptan use should be limited to 30 days due to the potential for hepatotoxicity. correct Tolvaptan (Samsca) is an oral vasopressin antagonist. It should only be used in refractory cases, and close monitoring is required, particularly to avoid raising the sodium by more than 12 mEq/L/24h. Refer to the section(s) beginning on pg. 715 of 2022 RxPrep Course Book.

A patient in septic shock is unresponsive to repeated doses of epinephrine, and his blood pressure continues to decline. The decision is made to initiate an intravenous vasopressin drip. What is the correct receptor pharmacology that explains the utility of vasopressin in the maintenance of blood pressure?

Vasopressin agonist correct Vasopressin acts on V1a receptors to exert its vasopressor effect. It is also an agonist at V2 receptors which results in water retention. Refer to the section(s) beginning on pg. 719 of 2022 RxPrep Course Book.

midazolam

Versed CI with Cyp3A4 inhibitors

Stress ulcer prophylaxis indications

mechanical ventilation > 48 hours and critically ill patients with coagulopathy Sepsis major burns acute renal failure

Chronotropic

rate of contraction

Inotropic

strength of contraction