Ccp-C Exam

Front 1

Blood urea Nitrogen (BUN)

Normal values

Back 1

indicator of hydration, not renal function

8-23 mg/dL

Front 2

_______ is the best indicator of kidney function. The more nephrons that have been destroyed, the higher the level.

Normal levels are____.

Back 2

serum creatinine level.

0.6 to 1.2 mg/dL

Front 3

the BUN-creatinine ratio is important because it helps determine whether a patient has any type of _____failure.

Normal ratio is:

Back 3

renal failure

10:1 to 20:1

Front 4

patients with renal insufficiency or renal failure are prone to:

(a) metabolic acidosis

(b) metabolic alkalosis

Back 4

(a) metabolic acidosis

Front 5

AV shunts should be palpated for ____ and listened to for ______. These findings indicate the shunt is patent and functioning normally. Absence of these findings may indicate clotting of shunt.

Back 5

Thrill and bruit

Front 6

Ideal weight calculation for pharm doses.
Male (kg)

Female (Kg)

Back 6

Male: 50 + (2.3 x patient's height over 5')

Female: 45.5 + (2.3 x patient's height over 5')

Front 7

During anaphylaxis, drugs typically given IM or SubCu may need to be administered ______.

Back 7

by IV

Front 8

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common genetic disorder that causes potentially life threatening hemolytic anemia when exposed to:

Back 8

oxiant medications (like antimalarials), sulfonamides, nitrofurantoin, phenazopyridine,

exposure to napthalene (mothballs)

Front 9

FDA pregnancy risk category: A

Back 9

no risk to fetus in first trimester, and no evidence of danger to later trimesters

Front 10

FDA pregnancy risk category: B

Back 10

animal studies demonstrate NO risk, but no studies done in pregnant women.

OR

Animal studies show adverse effect (other than decrease in fertility), but not confirmed in pregnant women.

Front 11

FDA pregnancy risk category: C

Back 11

studies in animals revealed adverse effects on fetus and there are no studies on women.

OR

studies in women and animals not available.

Give drug if benefits:risk is favorable

Front 12

FDA pregnancy risk category: D

Back 12

positive evidence of human fetal risk, but benefits from use in pregnant women may be acceptable despite the risk.

Front 13

FDA pregnancy risk category: X

Back 13

risk of use in pregnant women clearly outweighs any possible benefit.

Contraindicated to pregnant women.

Front 14

Iatrogenic response

Back 14

symptoms that mimic naturally occurring disease states

Front 15

patients with egg or soy allergies should not be sedated with:

Back 15

propofol (Diprivan)

Front 16

An allergy to bananas or avocados is highly suggestive of a _____ allergy

Back 16

latex

Front 17

tachyphylaxis

Back 17

a condition in which the patient rapidly becomes tolerant to a medication

Front 18

alcohol-acetaminophen symdrome

Back 18

high doses of acetaminophen damage the liver. alcohol potentiates this effect and causes more of the medication to be taken up into the liver, resulting in acute liver failure.

Front 19

cardiazem (Diltiazem), and various neruomuscular blocking agents such as (succinylcholine and rocuronium), and lorazepam (Ativan) have this similar storage requirement:

Back 19

require refrigerator storage. They are stable at room temp for very short periods of time.

Front 20

This group of medications, ______, are the gold standard for patients requiring ET intubation:

And the drug of choice is _____.

Alternatives are:

Back 20

Ultra-short-acting nonbarbituate hypnotic agents

drug of choice: etomidate (Amidate)

Alternative: Ketamine

Front 21

Etomidate (Amidate) is a _______, and acts by:

Back 21

Ultra-short-acting nonbarbituate hypnotic agent

depresses the reticular activating system by stimulating the gamma-aminobutyric acid (GABA) receptors

decreases O2 consumption and cerebralblood flow (ideal for increase ICP)

Front 22

In RSI:

Etomidate Dose ___, reaches peak effect in ____ minute, and provides anasthesia for ____ minutes.

Back 22

0.3 mg/kg

peak effect: 1 minute

anesthesia: 3 to 5 minutes

Front 23

Are there absolute contraindications for use of etomidate (Amidate) in RSI protocol?

Back 23

No

Front 24

Ketamine is a ______, and a ____ derivative.

Back 24

Ultra-short-acting nonbarbituate hypnotic agent.

phencyclidine (PCP) derivative

Front 25

In RSI=

Ketamine dose:

onset time:

duration of action:

Back 25

dose: 1 -4 mg/kg

onset: less than 1 minute

duration: 10 to 15 minutes.

Front 26

This RSI drug causes anesthesia, analgesia and amnesia;

causes increase in BP, pulse and cardiac output

It may be preferred induction method in patients with respiratory failure

Back 26

Ketamine

Front 27

Propofol (Diprovan) is a _______ agent used in ____ management.

normal adult dose is _____ for induction.

Both anesthetic and amnesic effects begin at around _______ seconds, and lasts _______.

The maintenance dose is:

Back 27

sedative-hypnotic agent used in airway management.

initial adult dose: 1 to 2.5 mg/kg for induction

effects begin around 20 seconds

lasts 10 to 15 minutes

maintenance dose: 5 - 50 mcg/kg/min

Front 28

Patient with status epilepticus has resisted first line drugs phenytoin and benzodiazepines. You could consider using:

Back 28

propofol, for anticonvulsant properties.

Front 29

Be cautious using propofol in patients with _____ blood pressure. And be sure to use aseptic technique!

Back 29

low

because propofol will decrease blood pressure

Front 30

Propofol infusions should not last longer than _____ hours because high doses of propofol will cause propofol infusion syndrome, which includes:

Back 30

48 hours

metabolic acidosis

rhabdomyolysis

cardiac and renal failure

Front 31

3 common critical care benzodiazepines include ___, ____, and ___ and are all pregnancy class _____

Back 31

diazepam (Valium)

lorazepam (Ativan)

midazolam (Versed)

Pregnancy class D, which indicates strong risk to fetus

Front 32

Benzodiazepines have these 3 desired effects, and should be used with caution in people with ____ blood pressure.

Back 32

anxiolytic, sedative, and anticonvulsant

low, because it will lower the BP

Front 33

_____ is the most common choice of benzodiazepines for RSI due to the relatively fast onset time (compared to other benzos) of ____ minutes when administered at a dose of _______ in adults.

It also has the added benefit of _____.

It's duration is about ___, and patients can take up to ___ hours to recover.

Back 33

midazolam (Versed)

1 to 5 minutes

dose: 2.5 to 10 mg IV in adults

causing anteretrograde amnesia

duration: 60 minutes

recovery: 2 hours

Front 34

______ is a moderatley long-acting benzodiazepine with a duration of 30 to 90 minutes, but has a relatively slow onset of approximately ___ minutes.

Back 34

Diazepam (Valium)

onset: 5 minutes

dose: 2 to 10 mg IV

Front 35

______is a commonly used benzodiazepine with rapid onset of 1 to 5 minutes, but a variable peak effect.

Back 35

lorazepam (Ativan)

Front 36

A patient may be premedicated with a narcotic such as _______ when using midazolam (Versed) to get a potentiating effect

Back 36

fentanyl

Front 37

Of the benzodiazepines, these two are first choice anticonvulsants:

Back 37

diazepam (Valium)

lorazepam (Ativan)

Front 38

In a patient with excessive levels of benzodiazepines, the use of _________ may be necessitated, using an initial dose of _______ over _____ seconds.

After 30 seconds observation, a second dose of _______.

If still need more, continue with _____ every _____ until max dose of ______.

Back 38

flumazenil (Romazicon)

0.2 mg IV over 30 seconds.

after by 30 seconds of observation, a second dose of 0.3 mg over 30 seconds.

Continue with 0.5 mg every minute up to 3 mg total until desired effect.

Front 39

The pediatric dose of flumazenil (Romazicon) to counteract overdose of benzodiazepines:

Back 39

.002 to 0.02 mg/kg IV every minute

Front 40

Be cautious about using flumazenil in patients with history or potential for:

Back 40

seizures, unknown drug overdoses, using diazepam long term

Front 41

This depolarizing agent is an ideal paralytic agent due to causing muscle relaxation in ___ seconds, total paralysis in ____ seconds, and a duration of action lasting ____ to ___ minutes.

Back 41

succinylcholine (Anectine)

muscle relaxtion in 30 seconds

paralysis in 45 seconds

duration 7 to 10 minutes

Front 42

dso of succinylcholine (Anectine) to intubate

Back 42

1 to 2 mg/kg

Front 43

succinylcholine (Anectine) will _____ heart rate in children and _____ serum potassium levels

Back 43

reduce heart rate

increase serum potassium levels

Front 44

To intubate patients with malignant hyperthermia, acute injuries such as burns, crush injuries, and spinal cord injuries, or conditions affecting potassium such as renal failure, OR has been exposed to acetylcholinesterase inhibitors (chemical nerve agents) consider using something ELSE besides ______ for paralysis.

Back 44

succinylcholine (Anectine)

Because:

causes malignant hyperthermia

can increase ICP

increases serum K+

the chemical will cause longer duration of action

Front 45

Muscle fasciculations (twitching) are a common side effect of what paralyzing drug?

Back 45

succinylcholine (Anectine)

Front 46

major drawback of non depolarizing agents in comparison with succinylcholine is:

Back 46

slower onset time and longer duration of action

Front 47

______ has the fastest onset time of non depolarizing agents taking _____ to ____ seconds at a dose of ______. At that dose the medication will last ____ minutes.

Maintenance dose:

Back 47

Rocuronium (Zemuron)

onset 60 to 90 seconds

dose: 0.5 to 1 mg/kg

duration: 45 minutes

maintenace dose: 0.5 mg/kg

Front 48

typical dose of albuterol via nebulizer

Back 48

2.5 to 5 mg

Front 49

albuterol, while selective beta-2 agonist, will cause beta-1 agonism seen as ___ and ___ effects

Back 49

cardiac chronotropic and inotropic

Front 50

This non depolarizing muscle relaxant has onset of 30 seconds, peak effects in 2.5 - 3 minutes and duration of 25 to 30 minutes

Back 50

Vecuronium (Norcuron)

Front 51

Pancuronium (Pavulon) is a ______ agent. Onset is _____ seconds, with paralysis in ___ to __ minutes

Back 51

non depolarizing muscle relaxant

onset: 30 seconds

peak effect, paralysis: 2 to 5 minutes

Front 52

Cisatracurium (Nimbex) and Atracurium (Tracium) are ___ agents that have onset times of _____ minutes.

Back 52

non depolarizing muscle relaxant

onset: 2 to 3 minutes

Front 53

Cisatracurium (Nimbex) peak effects in ____ minutes and duration ____ minutes

Back 53

peak: 3 to 5 minutes

duration 25 to 90 minutes

Front 54

Atracurium (Tracium) peak effects in ___ minutes and duration ____ minutes. Dose dependent onset.

Back 54

peak: 5-7 minutes

duration 60 - 70 minutes

Front 55

long term albuterol use can cause these 3 main problems, and ______ is a new drug that may replace albuterol for people with sensitivities due to having much fewer AEs

Back 55

severe hypokalemia

metabolic acidosis

many cardiac issues

levalbuterol

Front 56

Terbutaline is a _____ agonist that is commonly used off-label as a ________.

Dose:

Back 56

beta-2 agonist (bronchodilator)

tocolytic: prevents premature labor

Dose: 0.25 mg SC every 20 min.

improves resp status in 5-6m.

peak : 20 to 30 min

Front 57

common beta-2 agonist side effects

Back 57

tachycardia

high bp

trembling and anxiety

Front 58

the anticholinergic medication ________ is often used concurrently with albuterol.

It has a long onset time of ____ m.

dose:

should be avoided in patients with ____

Back 58

onset: 20 minute

dose 0.5 mg every 20 m for 3 doses.

contraindication: narrow-angle glaucoma

Front 59

corticosteroid with least chance of placental crossing

Back 59

prednisolone

Front 60

If accidental extravasation occurs while infusing alpha-adrenergic medication (epi/norepi/dopamine), diluted _______ is injected into affected tissues near the site of extravasation to prevent local vasospasm and cell/tissue death.

effective therapy is shown by

Back 60

phentolamine

return of normal skin color within 1 hour

Front 61

contradictions of beta blockers (ex. labetolol)

Back 61

hhigh degree (greater than first-degree) HB

sick sinus syndrome

heart failure

cardiogenic shock

Front 62

Class 1A anti arrhythmic medications.

Most common in CCP

Back 62

increase effective refractory period (ERP). That is:

lengthens the time that cells cannot be depolarized

most common is Procainamide. stop when QRS is 50% wider, arrhythmia is suppressed or pt is hypotensive

Front 63

Class 1B anti arrhythmic medications

Back 63

decrease the effective refractory period and the action potential duration = cumulatively reduce automaticity, which reduces chances of disorganized depolarization

Front 64

The prototypical Class 1B medication is:

Back 64

lidocaine

dose 1 to 1.5 mg/kg

repeat dose: -.5 to 0.75 mg/kg

max dose: 3 mg/kg

AHA favors amiodarone over lidocaine for certain arrhythmias.

Front 65

Class 1 C antiarrhythmics:

Back 65

spress the phase 0 repolarization.

has virtually no effect on action potential.

Front 66

Class II anti arrhythmic medications are

Back 66

beta-adrenergic blocking agents.

sympatholytics

propranolol, metoprolol

Front 67

Class III anti arrhythmic medications are:

Back 67

the potassium channel blockers.

they delay phase 3 repolarization of cells.

tend to see prolonged QT intervals on ECG

Front 68

mmost common class III antiarrhthmic

Back 68

amiodarone (Cordarone)

Front 69

Class IV antiarryhtmics are ______ and are useful for arrhythmias originating in the _____

Back 69

calcium channel blockers

atria (because it decreases conduction velocity through the AV node)

Front 70

The two common Class IV antiarrythmics are:

Back 70

verapamil (Calan)

diltiazem ( Cardizem)

Front 71

What class antiarrythmic is adenosine?

how does it work

Back 71

It is classified as an endogenous nucleoside, not a typical classification.

slows AV conduction and entry through AV node. so helps with SVT, but not a-fib

Front 72

what should you expect after an initial 6 mg dose of adenosine?

Back 72

a brief period of profound bradycardia or even systole. this is usually well tolerated and converts to sinus rhythm. if not, follow with 12mg then 12mg again