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49 Cards in this Set
- Front
- Back
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what is a huge cause of status epilepticus that pharmacists can prevent
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sudden withdrawl of antiepileptics
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what agents are used to treat SE in Peds
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BZD
Phenytoin/Fosphenytoin Phenobarbital Propofol |
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what are the BZD used to treat SE
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Lorazepam
Midazolam Diazepam |
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what BZD has the fastest onset
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midazolam
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what BZD has the longest duration
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Diazepam
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what BZD is very lipid soluble and rapidly crosses the BBB
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Diazepam
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what is meant by "follow short acting meds with long acting meds" when using BZD. give an example
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if initially treated with midazolam (rapid onse BUT short duration) follow treatment with Diazepam or Lorazepam
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what is the main AE of BZD
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respiratory depression
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why can Fosphenytoin be administered more rapidly
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if Phenytoin was pushed rapidly due to it being soluble in PEG it would cause arrythmias and hypotension therefore has to be given slowly
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what are the therapeutic levels of Fosphenytoin/Phenytoin
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10-20 mcg/ml
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why do we check the free levels of Fosphenytoin/Phenytoin
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check free levels because it is highly protein bound to albumin
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what may occur with high doses or repeated doses of Fosphenytoin
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cardiac toxicity
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it is stated that Phenytoin/Fosphenytoin can be used in conjunction with BZD give an example
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give BZD to immediately end the SE and then load phenytoin/fosphenytoin afterwards
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why is Phenobarbital not good for acute treatment
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it lasts for a long time (half life 20-200 hours)
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when would you administer Propofol to a patient
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patient must be intubated/ventilated
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what is the onset and duration of Propofol
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onset 30 secs
duration 3 days |
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what are the AE of Propofol
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hypotension
careful in patients with EGG or SOY allergy |
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what is the black box warning for Propofol
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should not be infused > 48 hrs
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what is status asthmaticus
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asthma that is poorly responsive to bronchodilator therapy or Epi
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what is hyperinflation
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inability to get air out leading to an accumulation of CO2
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what are the pharmacotherapy of treating status asthmaticus
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oxygen
fluids beta 2 agonist corticosteroids Mg Sulfate Ketamine |
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what are the Beta 2 agonist used to treat status asthmaticus
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albuterol
terbutaline levalbuterol |
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what beta 2 agonist can be given as a continuous IV infusion
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terbutaline
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what are the SE of Beta 2 agonist
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tachycardia
hyperglycemia flushing hypokalemia |
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what are the corticosteroids used to treat status asthmaticus
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methylprednisolone
prednisone |
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what are the SE of corticosteroids
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psychosis
hyperglycemia hypertension GI upset |
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after how many days can you taper off Corticosteroids
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> 5 days use
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what agents can be used in conjunction with Beta agonist, corticosteroids, and oxygen
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Mg Sulfate
anticholinergics |
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what anticholinergic is used to treat status asthmaticus
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Ipatropium Bromide
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why does Ipatropium Bromide not cause a lot of SE
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bromide prevents it from crossing the BBB
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why is theophylline not used often to treat Status asthmaticus
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high incedence of AE
tachycardia, nausea and vomiting, agitation, increased diuresis |
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what agent seperates the limbic system
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ketamine
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what patients get ketamine
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must be intubated/ventilated
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what are SE of ketamine
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emergence phenomena
increased ICP secretions |
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Jane has just been given ketamine and says she feels like her body has been blocked off and is starting to have hallucinations what is going on and what can you give her to treat
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she is suffering from EMERGENCE PHENOMENA
treat with BZD |
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what is the pathophysiology of DKA
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omission of insulin
production of ketones acidosis hypovolemia hyperglycemia osmotic diuresis |
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in DKA what are we trying to correct
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ketones and acidosis are the main problem
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what are SSx of DKA
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polydipsia
polyuria weight loss fruity breath odor blood glucose 400-1000 blood pH < 7.3 urine ketones |
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what is the pharmacotherapy for treating DKA
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fluids (lactated ringers or NS)
regular insulin lyte management |
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when treating DKA fluids drop blood glucose by
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200-300 mg/dL
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what fluids are initially given when treating DKA
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lactated ringers
Normal Saline |
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regular insulin reverses ketosis and lowers blood glucose what is the starting dose
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0.1 units/kg/hr infusion
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how much dose regular insulin lower blood glucose
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75-100 mg/dL/hr
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when do you give a patient with DKA dextrose
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once the regular insulin lowers blood glucose to 300 mg/dL
dextrose added to prevent hypoglycemia |
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when are patients with DKA switched to SQ insulin
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@ 200 mg/dL
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what lyte deficiencies do pts with DKA have
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hyponatremia (FIX ASAP)
hypokalemia (FIX ASAP) hypophosphatemia (CORRECTS ON ITS OWN) |
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what agent is not recommended to treat acidosis unless the patient is critically ill
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sodium bicarbonate
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why must we infuse the insulin slow when treating DKA
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cerebral edema may occur with rapid reduction in blood glucose
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what can be used to treat cerebral edema
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mannitol
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