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60 Cards in this Set
- Front
- Back
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The pancrease has both an exocrine and endocrine function, the EXOCRINE IS the digestive portion andn what are the main enzyme
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protease, Amalyase, and lipases
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In acute pancreatitis you have an initial insulin what results in
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release of active enzymes in the pancrease, causing inflamation and tissue damage
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What are the MAIN signs/symptoms of acute pancreatitis
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abdominal--epigastric--SEVERE==SHARP
Abd distioant N/V, fever |
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What are the LAB abnormalites assoicated with acute pancreatitis
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Alterations in glucose
Na/K--if N/V Elevations in Amylase/Lipase |
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What are the 2 MAIN causes of acute pancreatitis
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1. Chronic Alcohol
2. Gall stone |
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What are other risk facotrs for development of acute pancreatitis
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DRGS, HIGH TG's infection, tramay or cystic fibrosis
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What are the 7 main drugs that cuase Acute Pancreatitis
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VETTSSS MCVF
Vaproci acid Estrogens Thiazide/TCN Steriods/Sulfa Metronidazole/Frusoemid |
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How does valproci acid cuase acute pancreatitis
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hypersenstivity reaction
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How does ACE-I cause acute pancreatitis
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build of autoantibiotic against the pancrease
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Do any of the drug have a time assoication to cause acute prancreatitis
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NO==could start weeks after thearpy to a year afther then
TIME DOES NOT MATTER |
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How do you rule out that cause is NOT from Gallstone
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U/S
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What is the ALL the treatment necessary for acute pancreastits
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NPO
N/V Nutrtional Support Electrolyte replacement Etoh cessation DVT prophylaxis Hydration therapy Oxygen Pain |
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What are signs/symptoms of dehydration
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Dry MM, hypotension, increased BUN, as hemocrit/hemoglobin
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What do you monitor in treatment patient with hydration
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Urine output, and BP
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What are the 3 best options for treatment of N/V
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Promethazine, Ondansetron, prochlorperazine---IV
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What is the first thing you do in treatment of acute pancreat is NPO
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want to prevent increase stimulation of the pancrease
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What patient do you give O2
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want to treat until O2 stats above 95%
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When should electroylte replacement occur
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could wiat 4 hrs and see if electroyl normalize
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What is corrected calcium equation
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(4-albumin)*0.8 + serum calcium
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The types of nutrition are enteral and parenteral nutrition, which is preffered in acute pancreatitis
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enteral nutrtion, b/c TPN has increase risk of infection b/c you are giving it IV
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What is the preferred enterla nturtion
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Nasojujual---as has much less pancreatic simulation then the nasogastric
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How long should you wait to start enternal nutrtion
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Wait 3-5 days prior to starting to talk about enternal nutrtion, then start about 7 days after
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What do you give patient prior to enternal nurtion
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hydration therpay is usualy enough--i
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When would you give TPN instead of enternal nutrtion
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it patient ahs intestinal blockage or ilulus or if patient is NOT tolerating or absorbing
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How do you tell if patient is NOT absorbing enternal nutrtion
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pull back on the syringe and still residual volume in the stomach--swich to IV formation
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What is the thing you give patient when starting to switch back to oral feeding
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Start with ice chipd
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Once patient is tolerating ice chipd, then what
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START CLEAR liquid (both, apple jucie, water
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Once patient is tolerating clear liquids, then what
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switch to SOFT food (Jeel, apple suce
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Once patient tolerates SOFT FOODS then what
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discharge on soft food
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Can you feed the pateient while the NJ tube is still in
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YES
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What are the pain mangement option in acute pancreatitis, and MOA
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Morphine
Hydromorphone Fentanyl Meperidine and narcotic agoisnts |
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What are the ONLY options for a TRUE morphine allergy
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Fentanyl or Meperidine
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What are the PROS of morphine
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Drug of choice for treatment of acute pancreatits, available in many formations
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What are the CONS of morphine
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May cause a spasms in the spincter of oddi and worsen pain, morhpine commonly cuases a HISTAMINE reacyion
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Is pruitis a TRUE allery
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NO---and adminstition of bendaryl DOES NOT help
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What are the CONS of Meperdiein
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Contraindicated in renal failure as it has an active metabolite, and caus seziures and has a ceiling of 600mg, and also very addivtive
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What is dosing of Hydromorphone
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1-2mg every 3-4
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What is dosing of Fentranyl
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50-100mcg every 1-2 hours
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In an opioid naïve patient, how do we start narcotics
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we would start with round the clock (nurse administered) or demand dose only (PCA with no basal) first
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What is pain relief goal
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reductio in pain by 4-5 points
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What are the 2 components of PCA
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Basal Rate
Demand Dose |
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What is the basal rate
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contious rate over 24 hours
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What is the demand dose
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where the patient presses the button, and gets a certain amount of medication
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Can you set up a PCA with just BOTH or just a DEMAND
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YES
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What are common lockout times in PCA
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6,8,12,15 minutes
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After 48 hours the patient is using a large amount of narcotics, then what do we do (either on round-the-clock dosing or demand dosing)
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START PCA
or add basal rate |
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What should you NEVER do in a opioid naive pt
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START with basal rate
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How do you calculate the basal rate
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calculate the total dose given and divide by how many hours, and --the basal rate is 50% of that /hr
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How do you calculate the demand rate
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50% of basal rate
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PROBLEM: the patient has had 40 mg of MSO4 in the past 8 hours, calculate basal and demand rate
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40/8=5mg/hr--the basal is 50% of hourlrl rate -----2.5mg/hr
the demand rate is 50%---1.25mg every |
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What is the preferred lock out for an opiod naive pt
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every 10 or 20 minutes
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Do OPIOD conersion
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YES
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When are antibitoics indicated in acute pancreatitis
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is necrotizing pancreatitis
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How do you determine necorotizing pancreatitis
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>30% of necrosis of CT scan
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When else would you consider patient ahve necrotizing pancreatitis besides a CT scan
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patient is NOT improving ----
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What treat necortizing pancreatitis with antibiotics?
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patients with necrotizing pancreatitis have a a much HIGH risk for mortaility--and prevent further progession
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What drugs are choose and WHY (antibitoics)
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Imipenen
Meropenem Metronizole+ 3rd geneartion cephaolospoin, they have great penetration into pancreas |
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How long are patient treated with antibotic prophyalxis for necrotizing pancreatitis
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10-14 days
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WHat is the MOA of Octreotide
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decreasing pancreatic secretion
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What is the role of octreotide
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selection in patients WHO are NOT responding and STILL NOT improving--but there is NOT evidence of benfit
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