Fluids and Electrolytes

An ICU patient is receiving dexmedetomidine for sedation. Which of the following statements regarding dexmedetomidine is incorrect: Answer A) The duration of the infusion should not exceed 72 hours. B) This agent has a very low risk of causing respiratory depression. C) Patients are arousable and alert upon stimulation when using this agent. D) The BP and HR must be monitored. E) Dexmedetomidine can cause significant blood pressure changes upon initiation of the infusion.

A) The duration of infusion should not exceed 24 hours. Dexmedetomidine causes transient hypertension when the infusion is started, and this may require an initial dose reduction. With continued use, monitor for hypotension, bradycardia, and dry mouth (in addition to BP, HR and sedation). There is a lower risk of respiratory depression with dexmedetomidine than other sedatives, but the incidence (approximately 37%) is not low.

A patient's norepinephrine intravenous line extravasated into the surrounding tissue. The nurse quickly starts to give phentolamine to reverse any skin necrosis. What is the mechanism of action of phentolamine? Answer A) Alpha-adrenergic antagonist B) Alpha-adrenergic agonist C) Beta-adrenergic antagonist D) Beta-adrenergic agonist E) Calcium channel antagonist

A) Alpha-adrenergic antagonist antagonizes the effects of vesicants such as vasopressors.

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, which of the following intravenous vasodilators is/are appropriate for this patient? (Select ALL that apply.) Answer A) Nitrogylcerin B) Nesiritide C) Vasopressin D) Dopamine E) Phenylephrine

A) Nitrogylcerin B) Nesiritide Vasopressin, dopamine and phenylephrine are not vasodilators. The patient's BP would need to be monitored very carefully, as it is quite low already.

Which of the following represent risks associated with IVIG therapy? (Select ALL that apply.) Answer A) Acute renal damage B) Infusion reactions C) Acute liver damage D) Fever E) Pulmonary fibrosis

A, B D. Acute renal damage, infusion reactions, and fever are among the potential risks associated with IVIG therapy.

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? (Select ALL that apply.) Answer A) Hypotension, apnea and elevated triglycerides are likely side effects. B) This patient may be at risk for developing infections. C) This medication can cause orange/red urine in rare cases. D) This agent is generally shorter-acting than lorazepam. E) Propofol contains calories that must be accounted for in the daily nutrition plan for the patient.

A, B, D, E.

Which of the following are crystalloids? (Select ALL that apply.) Answer A) Sodium chloride B) 5% Albumin C) Lactated Ringer's D) Dextrose E) Dextran

A, C, D

A patient with acute decompensated heart failure is receiving milrinone. Which of the statements concerning milrinone are correct? (Select ALL that apply.) Answer A) Milrinone is a positive inotrope and increases contractility in the heart. B) Milrinone is an alpha-2 agonist. C) Milrinone is a vasodilator. D) Milrinone is administered IV only. E) Monitor BP, HR, renal function and ECG (for arrhythmias) when using this agent.

A, C, D, E Milrinone is often referred to as an "inodilator". Milrinone requires dose adjustment in renal dysfunction. PDE3 Inhibitor

Hemostatic agents prevent blood loss. Which of the following statements concerning hemostatic agents are correct? (Select ALL that apply.) Answer A) Newer hemostatic agents are reducing the need for transfusions. B) The most common adverse events from the use of hemostatic agents are a drop in hemoglobin and anemia. C) Patients receiving hemostatic agents are at low risk of clotting. D) Recombinant thrombin (Recothrom) is not associated with the risk of disease transmission (such as Creutzfeld-Jakob disease) and is less immunogenic than previous thrombin formulations. E) Tranexamic acid is a hemostatic agent used for both heavy menstrual bleeding and hemophilia-associated bleeding; it comes as both an oral and injectable.

A, D, E. The most common adverse events from the use of hemostatic agents are hypersensitivity and thrombosis. Patients receiving thrombin products are at risk of thrombosis (clotting). Topical hemostatic agents (like Recothrom) would not be associated with disease transmission.

A patient arrives at the emergency department after a severe MVA. The patient's blood pressure is low and he is in shock. The physician wants to start fluid resuscitation with a colloid on this patient immediately. Which of the following agents are colloids? (Select ALL that apply.) Answer A) Normal saline B) Hydroxyethyl starch C) Lactated Ringer's D) Dextran E) Albumin

B, D, E hydroxyethyl starch (Hespan)

Which of the following statements concerning IVIG is correct? Answer A) IVIG is now available as inexpensive generic formulations. B) IVIG is a form of active immunity. C) Antibodies recognize antigens on foreign targets, such as bacteria. D) It takes 10 human donors to make one dose of IVIG. E) Intravenous immunoglobulins contain a mixture of approximately 50% IgG and 50% IgM.

C) 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 or human antibodies from another person, or persons, to the patient). IVIG is expensive.

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? Answer A) Alpha-1 agonist B) Beta-1 agonist C) Vasopressin agonist D) Vasopressin antagonist E) Dopamine-1 agonist

C) Vasopressin acts on V1a receptors to exert its vasopressor effect. It is also an agonist at V2 receptors which mediates its aquaresis effect.

A patient is receiving vecuronium for paralysis. Which of the following medications can potentiate the actions of vecuronium? Answer A) Tricyclic antidepressants B) Angiotensin converting enzyme inhibitors C) Proton pump inhibitors D) Aminoglycosides E) Azole antifungals

D) Aminoglycosides can potentiate the effect of NMBAs. If used together, close monitoring for respiratory depression is necessary (though the patient should be mechanically ventilated).

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? Answer A) Neuroleptic malignant syndrome B) Central pontine myelinolysis C) Serotonin syndrome D) Malignant hyperthermia E) Acute quadriplegic myopathy syndrome

D) Malignant hyperthermia can be seen with the use of inhaled anesthetics (like isoflurane and others), particularly when combined with succinylcholine.

Ana Bezahler 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 for Ms. Bezahler? Answer A) Temazepam B) Lorazepam C) Diazepam D) Clonazepam E) Midazolam

E) Midazolam is a short acting benzodiazepine that is available intravenously. Triazolam 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.

A patient is admitted with significant hyponatremia (Na = 125). The provider would like to use tolvaptan. Which of the following statements is correct? Answer A) Tolvaptan is available IV only. B) Tolvaptan is a first-line agent for treatment of hyponatremia. C) Sodium should be corrected at a rate of 12 mEq/hr while on tolvaptan. D) The brand name for tolvaptan is Vaprisol. E) Tolvaptan use should be limited to 30 days due to potential for hepatotoxicity.

E) Tolvaptan use should be limited to 30 days due to potential for hepatotoxicity. 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 Na by more than 12 mEq/L/24h.

Which of the following positive inotropes acts via phosphodiesterase-3 inhibition? Answer A) Digoxin B) Dobutamine C) Dopamine D) Epinephrine E) Milrinone

E) milrinone

Which of the following is not an IV hemostatic agent? Answer A) Amicar B) Kcentra C) Praxbind D) NovoSeven E) Amidate

Etomidate (Amidate) is used for agitation or sedation in the ICU.

The pharmacist receives an order for Precedex. Which of the following is an appropriate generic substitution for Precedex? Answer A) Cisatracurium B) Ketamine C) Dexmedetomidine D) Propofol E) Dexamethasone

The generic name of Precedex is dexmedetomidine.

Which of the following drugs is formulated in a lipid emulsion? Answer A) Precedex B) Valium C) Fentanyl D) Diprivan E) Ativan

propofol (Diprivan) Monitor triglycerides if Diprivan is used long-term. Usually, triglyceride monitoring begins on day 3 of therapy.