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163 Cards in this Set
- Front
- Back
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What drug has a med guide?
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Zenpep (pancreatic enzyme)
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When do you use nonenteric coated pancreatic enzymes?
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CP for pain
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When do you use enteric coated pancreatic enzymes?
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AP for steatorrhea, just want to absorb it
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How is Primaxin (imipenem/cilastatin) dosed renaly?
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can't take if CrCl<70
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How is Merrem (meropenem) dosed renaly?
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can't take if CrCl<51
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Is pancreatitis due to gall stones more common in men or women?
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women
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Is pancreatitis due to alcohol more common in men or women?
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men
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What does the IM version of Primaxin have?
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lidocaine
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What does cilastatin inhibit?
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dehydropeptidase 1 (enzyme in kidney that inactivates imipenem)
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What are SE for demerol, morphine, opioids?
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respiratory reduction, increase intracranial pressure
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What is a SE morphine might cause?
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oddi muscle spasm
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In AP if you don't know bacterial infection is present, how long do you treat?
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10-14 days
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In AP if know bacterial infection is present, how long do you treat and when do you start?
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treat 2-3 weeks and start within 48 hours
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What is brand name for morphine ER capsules?
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Avinza and Kadian
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What is brand name for morphine injection?
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duramorph
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What is name of extended release liposome injection form of morphine?
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Depodur
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What is Valturna?
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valsartan/aliskiren
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What is phenergan BBW?
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don't give to kids younger than 2
necrosis on injection |
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What is disulfram BBW?
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don't give within 12 hours of alcohol
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What is BBW for naltrexone?
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hepatotoxic at high dose
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What is MOA for naltrexone?
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binds to mu opioid receptors
pure opioid antagonist |
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How long should pt be opioid free before giving naltrexone?
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7-10 days
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What is demerol metabolized to?
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normeperidine
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What alcohol abstinence drug do you not give if CrCl is <30?
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acamprosate (Campral)
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What is SE of octreotide (Sandostatin)?
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QT prolongation
way more potent than somatostatin |
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What do delta cells in pancreas secrete?
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somatostatin
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What do B cells in pancrease secrete?
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insulin
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What do alpha cells in pancrease secrete?
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glucagon
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What do gamma cells in pancrease secrete?
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pancreatic polypeptide
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What is morphine and demeral pregnancy category?
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B
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What happens if you give MAOI with phenergan?
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extrapyrimidal SE
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What is plus of naltrexone IM dosing?
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one dose lasts one month
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What is the only benzo given IM?
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lorazepam (Ativan) and it is refrigerated
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When taking pancreatic enzymes what kind of hypersensitivity do you have to watch out for?
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pork
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What pancreatic enzymes are pregnancy category B?
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pancrease, pancrease MT
others are C |
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Does pancreatic enzyme in capsule or tab have more?
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tablet
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What alcohol abstinance drug can cause impotence and decreased libido?
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acamprosate
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What CYP is involved with Octreotide?
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3A4
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What pts should not receive ODT?
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PKU
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What do you treat overdose of benzo with?
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flumazenil (Romazicon)
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What benzo comes as rectal gel?
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diazepam (Diastat)
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Does rifampin affect any cyps?
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inducer of 3A4
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Does CCB affect any cyps?
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substrate of 3A4
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Do BDZ affect any cyps?
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substrate of 3A4
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What BDZ are available as ODT?
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alprazolam (Xanax)
clonazepam (Klonopin) |
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What BDZ has very fast speed of onset and long acting?
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diazepam (Valium)
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What BDZ has slow onset of action?
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oxazepam (Serax)
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What BDZ has fast onset of action?
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clorazepate (Tranxene)
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What BDZ have an intermediate onset of action?
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alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), and lorazepam (Ativan)
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What is brand name and BBW for midazolam?
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Versed, syrup associated with respiratory depression and arrest
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When should alprazolam extended release (Xanax XR) be taken?
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in the morning once a day, cont crush or chew
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How many kcal/g for dextrose?
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3.4kcal/g
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How many kcal/g for AA?
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4kcal/g
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How many kcal/g for lipids?
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10kcal/g
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What is the lipid emulsifier?
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egg phosphotides
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What kind of immuno action does long chain fatty acids have?
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immuno suppressing
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What kind of immuno action does medium chain fatty acids have?
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immuno stimulating
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How do you calculate osmolarity?
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g of dex x 5
g of AA x 10 |
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Do more lipids make it more hypotonic, isotonic, hypertonic?
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hypotonic
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How many units of insuling to dextrose?
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0.1unit insulin/ 1g dextrose
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How many grams of AA is equal to 1g Nitrogen?
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6.3g
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How long does a fentanyl patch last?
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72 hours
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How long does 2:1, TNA, and Lipid only tube set last?
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2:1 - 72 hours
TNA - 48 hours Lipids - 24 hours |
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What are hang times for 2:1, TNA, and lipids?
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2:1 and TNA: 24 hours
lipids: 12 hours |
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What does the stability of PN depend on?
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temperature, pH, light, time, composition, order
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Cl or acetate for metabolic alkalosis?
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Cl
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Cl or acetate for metabolic acidosis?
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acetate
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What do you give if pt has thrombophelebitis?
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heparin
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If pt is on TPN and becomes hypoglycemic, what do you do?
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take down TPN and hang D10
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What does Zinc do?
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wound healing
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What does copper do?
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blood cells
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What does manganese do?
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homeostasis of carbs, lipids, and proteins
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What do you see in manganese deficiency?
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wt loss, growth retardation, dermatitis
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What is manganese madness?
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to much manganese, parkinsosns like symptoms
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What do you give selenium for?
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keishons disease
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What is max osmolarity for peripheral?
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900
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What is min osmolarity for central?
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1800
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Are 10% and 20% lipids isotonic or hypotonic?
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isotonic
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Are 30% lipids isotonic or hypotonic?
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hypotonic
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What does 12 multivitamin not have in it?
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vitamin K
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What should weekly dose of vitamin K be?
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2-4mg/week
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What is the thiamine dose/day?
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100mg
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How much calcium and phosphate can be added?
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40 meq
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Which calcium should be used?
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calcium gluconate, not calcium chloride
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Which is added first calcium or phosphate?
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phosphate
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What are calorie percentages for central line?
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60-70% dextrose
5-10% AA 30-40% lipids |
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What are calorie percentages for peripheral line?
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60-70% lipids
30-40% dextrose 3-5% AA |
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What can cause hyperaldosteronism?
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decreased K
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What can cause hypoaldosteronism?
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increased K
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What is max rate for K in peripheral?
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10meq/hr
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What is max rate for K in central?
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20meq/hr max
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What does K do in metabolic alkalosis?
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K going in, H going out, serum K goes down
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What drugs cause hyperkalemia?
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ACEI/ARBs, NSAIDs, heparin, trimethoprim, B2 antagonist, K sparing diuretic
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Why does hypomagnesemia cause hypokalemia?
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Mg is a cofactor for Na/K ATPase pump
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In hypomagnesemia dn hypokalemia, which is corrected first?
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Mg
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What does FENa (fractional excretion of Na)<1% mean?
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renal Na retention, 2% is excreting to much
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How do you treat hypovolemic hypernatremic?
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NS 1st then hypotonic fluid (D5W, 1/2NS, 1/4NS)
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How do you treat euvolemic hypernatremia?
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hypotonic fluids (D5W, 1/2NS, 1/4NS)
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What is max rate for Mg?
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8meq/hr or 1g/hr
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How much MG is needed to increase serum 0.1mg/dl?
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8.12 meq
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In hypophosphatemia, when do you Na phosphate vs K phosphate?
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Na if K greater than 4
K if K less than 4 |
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How long does Mg take to get where you need it?
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36-48 hours
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How is hypocalcemia dosed?
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add up to 11
1.0/1g, 0.9/2g, 0.8/3g |
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What does hyperparathyroidism do?
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increase Ca from bone and gut (vit D) and kidney (stops excretion)
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What are hazards of Ca infusion?
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necrosis and exravasation
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What AA have phosphorus containing AA?
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hepatamine, hepatasol, freeamine
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What is refeeding syndrome?
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decrease in phosphate, mg, K, and increase in ECF volume
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Where did we discover refeeding syndrome?
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WWII
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Who is at risk for refeeding syndrome?
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anyone malnourished, loss >10% body weight, anorexia, >7 days NPO
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What is hypercalcemia tx?
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biphosphonate, loop diuretic, and NS
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What are pediatric fluid requirements?
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up to 10kg: 100ml/kg
>10kg-20kg: L + 50ml/kg for every kg over 10 greater than 20kg: 1.5L + 20ml/kg over 20 |
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What is volume depletion?
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loss of Na from extracellular space
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What is dehydration?
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loss of intracellular water, results in elevated plasma Na
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How is extracellular divided?
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25% IV and 75% interstitial
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Where does D5W go?
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2/3 intracellular, 1/3 extracellular
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Where does D51/2NS go?
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1/3 intracellular, 2/3 extracellular
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Where does NS or LR go?
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100% extracellular
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What percentage of people in US have HTN?
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31%
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What is change in bp for every 10kg weight loss?
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SBP 5-20 decrease
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What is tx for BP with left ventricular dysfunction?
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ACE and diuretic, then add BB
can add ARB or aldosterone antagonist |
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What is tx for BP with post MI?
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BB, then add ACE or ARB
optional aldosterone antagonist |
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What is tx for BP with CAD?
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BB, then ACE or ARB
optional CCB with diuretic |
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What is tx for BP with diabetes?
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ACE or ARB
then diuretic, or BB and CCB |
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What is tx for BP with chronic kidney disease?
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ACE or ARB
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What is tx for BP with recurrent stroke prevention?
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ACE with diuretic
or ARB |
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How much Na do you want in DASH diet?
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1.5g/day, can start at 2.3g/day
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How much exercise for BP?
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30min/day most days of the week
60min/day if trying to lose weight |
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Which ARB retains the most Na?
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Losartan (Cozaar)
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What pregnancy category is Diovan (valsartan)?
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always D
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What pregnancy category are other ARBs?
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C during 1st trimester, D during 2nd and 3rd trimester
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What population has the highest risk for cough and angioedema from ARBs?
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blacks
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What ARB provides most benefit in blacks?
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irbesartan (Avapro)
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What htn meds for blacks?
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CCB and thiazide
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What is a longterm effect of thiazide?
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decrease PVR
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List the ARBs from highest to lowest affinity for AT1 receptor
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valsartan (Diovan), olmesartan (Benicar), candesartan (Atacand), irbesartan (Avapro), telmisartan (Micardis), losartan (Cozaar), eprosartan (Teveten)
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How long do you withhold nicotine and caffeine before taking BP?
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30 minutes
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When does the arm not have to be at heart level when taking BP?
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orthostatic hypotension
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What is metabolic syndrome?
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3/5
TG greater than 500, hdl less than 40 for men and 50 for women, waist greater than 40 in men and 35 in women, fasting glucose greater than or equal to 100, bp greater than 130/85 |
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What are SE of thiazide?
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hyperglycemia, hypomagnesimia, dyslipidemia, hypokalemia, hyperuricemia (gout), sexual dysfunction, hypercalcemia
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What are SE of loop diuretic?
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hyperglycemia, hypomagnesimia, dyslipidemia, hypakalemia, hyperuricemia, sexual dysfunction, hypocalcemia
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What do you give if pt has gout with thiazide?
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allopurinol (Zyloprim)
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What is BBW for Zaroxolyn (metolazone)?
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don't use other formulations of metolazone
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What is adverse effect of Spironolactone?
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man boobs
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What is BBW for spironolactone?
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shown to be a tumorigen in chronic toxicity
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What is amiloride (Midamor) BBW?
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hyperkalemia
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What is SE of eplerenone (Inspra)
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hyperkalemia
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What is the only ACEI that can't be taken once a day?
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captopril (Capoten)
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What ACEI must be taken 1 hour before food?
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captopril and moexipril
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Which ACEI has sulfhydral ligand?
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captopril
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Which ACEI has phoshydryl ligand?
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fosinopril (Monopril)
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Which ACEI are not prodrugs?
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lisinopril and captopril
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What are SE of ACEI?
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cough, angioedema, hyperkalemia, decrease GFR, photosensitivity
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What is fatal SE of ACEI?
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acute kidney failure
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Which ACEI causes the most cough?
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trandolapril (Mavik)
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Which ACEI comes IV?
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Enalprilat
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What is a SE of captopril?
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neutropenia
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What are the long acting ACEI?
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fosinopril (Monopril), ramipril, trandolapril (Mavik)
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What is short acting ACEI?
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captopril
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Does ACEI cough have higher incidence in men or women?
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women
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How do CCB affect CYPs?
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dihydropiridine goes through 3A4 and nondihydropyridine inhibits 3A4
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What are the BB with ISA?
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carteolol (Cartrol), pindolol (Visken), acebutolol (Sectral), penbutolol (Levatol)
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List rifamycin in order from most poten.
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rifampin, rifapentine, rifabutin
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What are the B1 selective (cardioselective) BB?
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betaxolol (Kerlone), bisoprolol (Zebeta)
esmolol (Brevibloc) acebutolol (Sectral), atenolol (Tenormin) Metoprolol (Lopressor) nebivolol (Bystolic) |
