Therapeutics Final Nutrition, Fluid Therapy

Front 1

How do you calculate the maximum glucose infusion rate?

Back 1

5mg/kg/minute

Front 2

How do you calculate energy expenditure?

Back 2

BMR X disease stress (1.2-2) X activity (1.0-1.3)

Front 3

What is a normal persons energy requirements in kcal?

Back 3

25-30 kcal/kg

Front 4

Peripheral PN must have an osmolarity of what?

Back 4

< 900 mOsm/L

(<10% dextrose, <5% a.a.)

Front 5

What must run concurrently with peripheral PN to prevent venous sclerosis/phlebitis?

Back 5

IV fat emulsion

Front 6

What is the normal requirement of daily protein?

Back 6

1.3g/kg

Front 7

What is the normal amount of fluid required?

Back 7

30-40 mL/kg

Front 8

How many kcals are provided with a gram of protein?

Back 8

4 kcal/gram

Front 9

What percentage of parenteral nutrition is usually fat?

Back 9

<30%

Front 10

What is the maximum amount of dextrose given during the first day of parenteral nutrition?

Back 10

< 200 g

(<150 g if diabetic)

Front 11

A DDI where the blood levels of the drugs are not changed is called what?

Back 11

pharmacodynamic interaction

Front 12

A DDI where the blood levels of the drugs DO change is called what?

Back 12

pharmacokinetic interaction

Front 13

What are examples of a pharmacodynamic DI?

Back 13

-CCB + BB
-amiodarone + erythromycin
(both increase Qt interval)
-Acetaminophen + Codein
(additive analgesia)
-ACEI + K-sparing diuretics
(hyperkalemia)

Front 14

What are the 3 types of pharmacokinetic DI?

Back 14

absorption

distribution

metabolism

Front 15

What are 4 examples of pro-drugs?

Back 15

enalapril to enalaprilat

clopidogrel to active derivative

codeine to morphine

hydrocodone to hydromorphone

Front 16

What is an example of a phase 1 CYP450 metabolism interaction?

Back 16

allopurinol inhibits xanthine oxidase leading to increased levels of 6MP or azathioprine

Front 17

What is an example of a phase 2 CYP450 metabolism interaction?

Back 17

entacapone or tolcapone
+ carbidopa/levodopa

Front 18

Drugs that interact with P-glycoprotein also tend to interact with what CYP enzyme?

Back 18

CYP3A4

Front 19

What is an example of a common P-gp substrate?

Back 19

digoxin

Front 20

What are 3 P-gp inhibitors?

Back 20

quinidine
itraconazole
atorvastatin

Front 21

What are 2 P-gp inducers?

Back 21

rifampin
st. johns wort

Front 22

Grapefruit juice inhibits what?

Back 22

CYP3A4
P-gp

(lasts up to 72 hrs)
(inhibits only in gut)

Front 23

Caffeine inhibits metabolism of what drug?

Back 23

theophylline

Front 24

Tyramine can cause a hypertensive crisis in patients on what drugs?

Back 24

MAOIs

Front 25

Dairy products decreases the absorption of what drugs?

Back 25

fluoroquinolones
tetracyclines
bisphosphonates
Methotrexate
phenytoin
thyroid hormones
cefuroxime

Front 26

Fiber decreases the absorption of what drugs?

Back 26

metformin
glyburide
thyroid hormones
digoxin
pinicillin
lithium

Front 27

What is the normal distribution of total body water?

Back 27

2/3 = intracellular fluid

1/3 extracellular fluid
(3/4 interstitial, 1/4 intravascualr)

Front 28

what is the normal ECF and ICF osmolality?

Back 28

275-295 mOsm/L

Front 29

What is the Minimum Na+ required to replace losses (without sweating)?

Back 29

8 mEq/day (0.18g/d)

Front 30

How much potassium does a person need?

Back 30

4.7g (120mEq/day)

Front 31

Metabolic alkalosis is associated with what K abnormality?

Back 31

hypokalemia

Front 32

What is the tx for hypotonic fluid loss (hypernatremic dehydration) occuring with: fistula drainage, cystic fibrosis, adrenal insufficiency, pure water replacement in the volume depleted patient?

Back 32

dextrose containing solutions
(isotonic)

Front 33

When is D5 1/2 NS used?

Back 33

replacement fluid for GI drainage or as maintenance fluid when oral intake is inadequate

(The d5 component distributes equally into both the ECF and ICF whereas the NS part expands or maintains the ECF)

Front 34

When is 1/2 NS used?

Back 34

treating hypernatremia or DKA

Front 35

When is normal saline used?

Back 35

-used to expand the ECF
-hemorrhage in conjunction with blood replacement
-burns
-fluid loss during surgery
-with drug administration

Front 36

Lactated ringers solution should not be used in which patients?

Back 36

severe acidosis or liver dz

Front 37

What fluid replacement should be given in a patient with hypernatremia?

Back 37

D5W
1/2 NS (only short term)

Front 38

What fluids are given to treat DKA?

Back 38

-NS until BP good, the switch to 1/2 NS to replete intracellular dehydration, then switch to D5 1/2 NS when glucose drops < 250

Front 39

When is hypertonic saline used (3-5% NaCl)?

Back 39

severe hyponatremia, brain injury, volume resuscitation (sepsis)

(works by drawing fluid out of the ICF)

Front 40

What fluids should a Pt get who is going to surgery who is well nourished and NPO overnight?

Back 40

D5 1/2 NS or lactated ringers

Front 41

What fluids should an elite athlete with Na+ 154 mEq/L and free water deficit receive?

Back 41

D5W or hypotonic

Front 42

Marathon runner who presents with dropping blood pressure and hyponatremic should receive what fluids?

Back 42

isotonic saline boluses
(to boost ECF)

Front 43

What is the correct way to treat hyponatremia?

Back 43

5-10meq/kg/day increase in plasma Na+ per day

1-2 meq/hr

Front 44

What condition could cause hypertonic hyponatremia?

Back 44

poorly controlled diabetes

hypertonic infusions (glucose, mannitol)

Front 45

What conditions could cause hypotonic, hypovolemic, hyponatremia?

Back 45

Sequestration: burns, effusions, peritonitis, ascites, pancreatitis, intestinal obstruction

Rena: diuretics, Na wasting nepropathy

Front 46

What are causes of Hypotonic Euvolemic Hyponatremia?

Back 46

SIADH
Hypothyroidism
Drug induced
Reset osmostat
Hypopituitarism

Front 47

What are some causes of hypotonic hypervolemic hyponatremia?

Back 47

1.Nephrotic syndrome
2. CHF
3.Hepatic cirrhosis
4. acute and chronic renal failure

Front 48

What plasma osmolarity is seen in a hypertonic condition?

Back 48

>295 mOsm/kg

Front 49

What is the formula used to estimate the change in serum sodium caused by 1L of any infusate?

Back 49

Change in serum Na =
(infusate Na - Serum Na)/ (TBW +1)

Front 50

What is a symptom of hypotonic hypervolemic hyponatremia?

Back 50

edema

Front 51

What causes hypernatremic dehydration?

Back 51

loss of pure water from both ICF and ECF

Increased insensible water loss (fever, ventilation, burns)

Diabetes insipidus

Front 52

How should you lower Na in hypernatremia?

Back 52

no more than 0.5 mEq/L/hr

no more than 10 mEq/L/day

Front 53

What fluids should be used to treat hypernatremic dehydration?

Back 53

D5W or 1/2NS

Front 54

What can cause hypovolemic hypernatremia?

Back 54

Extrarenal losses: profuse sweating, severe diarrhea, respiratory losses

Renal losses: Diuretics, glycosuria, obstructive uropathy, acute/chronic renal failure

Front 55

What are causes of euvolemic hypernatremia?

Back 55

Insensible losses
diabetes insipidus
reset osmostat

Front 56

What are causes of hypervolemic hypernatremia?

Back 56

High NaCl or NaHCO3 administration

Mineralcorticoid excess (cushings, hyperaldosteronism)

Tx with diuretics and H20 replacement