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27 Cards in this Set
- Front
- Back
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Goal blood glucose target in ICU
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< 180mg/dl
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T/F. Regularly scheduled administration of insulin is preferable to bolus insulin in ICU
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True, proactive approach is preferable to reactive approach
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When should glucose be monitored in ICU
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every 1 - 2 hours until stable, then every 4 hours
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Drug therapy for stress ulcer is indicated for patients with what risk factors
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1) respiratory failure requiring mechanical ventilation
2) coagulopathy - platelet < 50,000, inr > 1.5, apt > 2 times control (patients on anticoagulants is not a coagulopathy) |
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Which class of meds has been shown clearly in clinical trials for stress ulcer prophylaxis
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H2 antagonists
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What is recommended method of administration of H2 blockers in stress ulcer prophylaxis
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Evidence of effect is IV however they are administered enterally when possible due to excellent bioavailability
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Despite limited evidence this class is used for stress ulcer prophylaxis
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PPI (enterally administered - limited evidence, IV has no evidence)
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Complications of acid suppression therapy in stress ulcer prophylaxis
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pneumonia
C. Diff |
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Which agents are NOT recommended for stress ulcer prophylaxis
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Antacids, sucralfate
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Adverse effects of H2 blockers in stress ulcer prophylaxis
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mental status changes
Thrombocytopenia (cimetidine) |
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Doses of h2 blockers in SUP
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drug po iv
ranitidine 150mg q12 50mg q8 famotidine 20mg 20mg q12 cimetidine 300mg q6 300mg q6 or 37.5-50mg ci nizatidine 150mg q12 |
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Only H2 blocker FDA approved for SUP
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cimetidine
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PPI pharmacology and mechanism of action
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prodrugs that are activated in the acidic environment of the parietal cell that then bind to active proton pumps. Oral formulations are designed to dissolve at pH > 5.6 to protect from degradation and premature activation in the stomach
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Which PPI formulation should not be administered via NG/OGT
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lansoprazole delayed release suspension which has xanthan gum in formulation
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What is the only PPI formulation FDA approved for SUP
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Zegerid powder for oral suspension 20mg
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Adverse Effects of PPI's in SUP
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Headache, diarrhea, constipation, abdominal pain, nausea
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Disadvantages of PPI in SUP
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Risk for Clostridium Difficile, and pneumonia, cost, Drug interaction (inhibit conversion of clopidogrel to active form)
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Why is antithrombotic drug contraindicated in neuraxial anesthesia/analgesia?
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Increased risk of spinal/epidural hematoma leading to spinal cord ischemia and paraplegia
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Dose of enoxaparin in VTE
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40mg daily, reduced to 30mg if CrCl 20 -30 ml/min
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Risk factors for ICU VTE
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surgery, major trauma, epo tx, malignancy, sepsis, HF, resp failure, incr. age, immobility, pregnancy, obesity, central line
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T/F, due to long duration, fondaparinux should be avoided in patients with continuous epidural analgesia
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True
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How long should anticoagulant use be delayed after spinal needle/catheter removed
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2 hours
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Dose of Enoxaparin in patients at risk for VTE post major trauma or acute spinal cord injury
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30mg every 12 hours
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Benefits of enteral nutrition in ICU patients
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reduced risk of infection, improved wound healing, maintained integrity of gut mucosa and reduction in bacterial translocation
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What two meds can promote GI motility and reduce gastric residuals, improving tolerance to EN
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Metoclopramide and erythromycin
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Preventing Aspiration from EN is accomplished by
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interrupt if gastric volume is 250 - 5000 ml, head of bed is at 30 - 45 deg, feeding tube placed past pylorus, prokinetic agent
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T/F Late initiation of PN is associated with reduced icu stay, infection, cholestasis, and total health care cost.
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True. Initiate PN after a one week delay either as a supplement to EN or as sole nutrition
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