Pharm Test 3

Front 1

Fluids that are Isotonic

Back 1

ECF, ICF, LR, NS

Front 2

Fluids that are hypotonic

Back 2

D5W
1/2 NS
D51/2

Front 3

Hypertonic IV fluids

Back 3

Na Lactate
3%

Front 4

Causes of Isotonic dehydration

Back 4

vomiting, diarrhea, polyuria, gastric suction, hemmorrhage, fever
third-space shifting(burns, BO, peritonitis)

Front 5

A BUN >30 suggest?

Back 5

Isotonic Dehydration

Front 6

Normal BUN levels

Back 6

8-20

Front 7

Which IV fluid should not be used with patients that have electrolyte imbalance

Back 7

LR

Front 8

IV fluid most similar to ECF?

Back 8

LR

Front 9

safest IV fluid to give to a pt.

Back 9

1/2 NS

Front 10

BUN between 20-30 suggest?

Back 10

true renal complications

Front 11

In which types of patients would you see Isotonic overhydration

Back 11

Renal failure
CHF
Liver cirrhosis

Excess Na intake

Front 12

S/Sx of isotonic overhydration

Back 12

Peripheral edema
Wt gain
JVD
pleural effusion
>BP
ascites
<HCT

Front 13

Tx for Iso Overhydration

Back 13

restrict fluids
diuretics
Monitor: VS,CXR, BUN,HCT

Front 14

Normal K levels

Back 14

3.5-5 meq/L

Front 15

what shift takes place in Hypokalemia

Back 15

transcellular shift ECF to ICF

Front 16

S/Sx of Hypokalemia

Back 16

anorexia, Drowsiness, Coma, N/V, arrythmia, hypotension

Front 17

Tx of Hypokalemia

Back 17

Correct underlying cause
K-sparing diuretics
correct hypomagnesemia

Front 18

severe hyperkalemia level

Back 18

>7

Front 19

drug given to pt's experiencing stinging pain due to rapid K infusion

Back 19

Neut

Front 20

A BUN/Cr ratio >30 suggest

Back 20

dehydration

Front 21

Burn pts tend to be Hypo or Hyperkalemic?

Back 21

Hyper bcz the cells burst and the K goes into the extracellular fluid; so use NS bcz LR has K in it

Front 22

what do you monitor in isotonic overhydration

Back 22

I/O, VS,CXR,BUN,HCT

Front 23

Important lab to get with hypokalemic patients

Back 23

Magnesium level

Front 24

amphotericin B causes hypokalemia by what mechanism?

Back 24

It decreases magnesium levels therefore it indirectly decreases K

Front 25

explain how lithium can cause hypo or hyperkalemia

Back 25

lithium is a salt that competes with K; so >k=<Li or >Li=<K; therefore must monitor K, Li, and Na

Front 26

drug that reverses digoxin toxicity

Back 26

Digibind

Front 27

normal digoxin levels

Back 27

.8-1.2

Front 28

if your pt tells you he sees halos, what's happening

Back 28

He has digoxin toxicity; he may also have ALOC

Front 29

what method is used to give K

Back 29

Infused 10meg/L over 30 min; if given too fast it can cause an arrythmia

Front 30

what is Neut?

Back 30

Sodium Bicarb, used to decrease stinging effect of fast K infusion

Front 31

causes of Hyperkalemia

Back 31

Acute renal failure
chronic renal failure
Burns
metabolic acidosis
Tumor lysis syndrome
Drug induce:
K-sparing diuretics, ACE-I, NSAIDS(arthritis, Gout),Heparin,Bactrim

Front 32

what causes latic acidosis

Back 32

glucophage

Front 33

Pt presentation in pt with Hyperkalemia

Back 33

confusion, arrythmias, N/V/D

Front 34

Tx for Hyperkalemia

Back 34

Acute: cardiac monitor, Calcium gluconate 10%(cardioprotective)
HCO3(for acidosis)
Insulin/dextrose(brings K into cell)
Kayexelate-30 gm PO

Never give Calcium who is Dig Toxic

Front 35

what happens if you give calcium to pt who is Dig toxic?

Back 35

you get a stone heart

Front 36

In Hyperkalemia, if pt is acidotic, how do you treat?

Back 36

give HCO3

Front 37

Kayexelate(Sodium Polyestherine)

Back 37

sugar-bases product given orally or enema, binds to K;
usually given to moderate pts.

Front 38

Tx for severe hyperkalemia

Back 38

Dialysis

Front 39

What is Hyponatremia

Back 39

sodium levels less than 135 meq/l

Front 40

what shift takes place in Hyponatremia?

Back 40

ECF to ICF-results in cell swelling

Front 41

Pt presentation with hyponatremia

Back 41

<skin turgor
malaise/headache/confusion
cerebral edema
seizures (below 118)
resp arrest

Front 42

Types of Hyponatremia

Back 42

Hypovolimic (<Na, <TBW)
Euvolemic (Normal Na, >TBW)
Hypervolemic (>Na, >TBW)

Front 43

Drugs that can cause Hyponatremia

Back 43

NSAIDS, SSRIs, Clonidine, Tricyclic antidepressants, vasopressin

Front 44

Tx of hypovolemic and Euvolemic hyponatremia

Back 44

iso saline 1.5-2 mEq/L/hr until symptoms resolve

Goal is 120

Front 45

when can you give 3% hypertonic solution

Back 45

if pt <118 Na; infuse slowly bcz can induce paralysis

Front 46

what is Hpernatremia

Back 46

Serum >145 mEq/L
fluid shift from ICF to ECF
Cell shrinks

Front 47

Tx for hypernatremia

Back 47

Extrerenal: NS, once stable switch to 1/2 NS
Renal: hypotonic saline, monitor until Na<148

Front 48

NSAIDS decrease Na (true or false)

Back 48

True

Front 49

what is the strongest diuretic

Back 49

loop diuretics

Front 50

serum level of Hypocalcemia

Back 50

<8 mEq/L

Front 51

Diuretics, insulin/glucose therapy, alcohol, <magnesium can all cause this condition

Back 51

hypokalemia

Front 52

which pts would use osmotic diuretics

Back 52

pt's with renal losses- ICP, hyponatremia(cell swelling,cerebral edema) because they reduce

Front 53

if you have renal losses with a hypertopnic pt, which fluid do you give

Back 53

hypotonic saline

Front 54

Tx for extrarenal hypernatremia

Back 54

start with NS then switch to 1/2 NS

Front 55

serun level of hypomagnesemia

Back 55

< 1.5

Front 56

causes of Hypomagnesemia

Back 56

excessive GI loss, laxative use, hypercacemia, pancreatitis

Front 57

serum level of hypermagnesemia

Back 57

> 3 mEq/L

Front 58

S/Sx of hypermagnesemia

Back 58

lethargy, depressed respirations, wide QRS, prolonged PR, elevated T waves

Front 59

S/Sx of hypophosphatemia; serum level <3

Back 59

anorexia, bone pain, arrhythmias, seizures,

Front 60

which cells secrete HCL

Back 60

parietal cells of the stomach

Front 61

what do prostaglandin do to protect the stomach lining?

Back 61

Mucus secretions
bicarbonate secretion

Front 62

name 3 things that cause GI mucosal injury

Back 62

aspirin
alcohol
K supplements

Front 63

drugs to use for mild to moderate GERD

Back 63

H2 antagonist:
Cimetidine (tagamet) Famotidine (Pepcid) Nizatidine (Axid)
Ranitidine (Zantac)

Front 64

drugs to use for moderate to severe GERD

Back 64

PPIs
Lansoprazole (Prevacid)
Pantoprazole (Protonix)

Front 65

How do you Dx H.Pylori

Back 65

Biopsy
breath ureases test
Culture

Front 66

Tx for H. Pylori

Back 66

Omoxicilin, H2 Blockers, Tetracyclin

Front 67

some risk factors for stress ulcers

Back 67

Hepatic Failure
Mechanical Ventilation
Major surgery
Severe Burns
Organ failures

Place these pts on prophylaxis

Front 68

Best treatment regimen for H.Pylori

Back 68

Contains 2 antibiotics and PPI:
1 g Amoxicilin
500 mg clarithromycin
PPI

x 7 days

Front 69

prolonged use of PPI causes?

Back 69

Gastric CA

Front 70

Tx for NSAID ulcers

Back 70

DC NSAIDs except with post MI pts

Front 71

Prophylaxis dose stress ulcers

Back 71

IV:
Pepsid 20 mg q12
Zantac 50 mg

or PO:

20 mg Pepsid BID
150 mg Zantac BID

Front 72

Normal Chem levels

Back 72

BUN 8-20 mg/dL
Creatinine .6-1.2 mg/dL
Sodium 135-145 mEq/L
Chloride 98-106 mEq/L
Potassium 3.5-5 mEq/L
CO2 24-29 mEq/L
Calcium 8.8-10.5 mg/dL
Phosphate 2.5-4.5 mg/dL