NU340 Dose Calculations Quiz & Critical Care Infusions Quiz Review

NU340 Dose Calculations Quiz & Critical Care Infusions Quiz Review 1/ (x) kg if looking for mg/kg/hr (or something similar), write equation as _____ (x) kg / 1 if looking for mL/hr (or something similar), write equation as _____ mcg / (kg x min) if mcg/kg/min (or something similar), then write equation as mcg _____ Morphine Sulfate which medication? - opioid agonist, schedule II, high alert - Onset: route-dependent (SC = 20 min; IM = 10-30 min; IV = rapid) - Function/Mechanism of Action: analgesia (binds to opioid receptors in CNS; alters perception & response to painful stimuli while producing generalized CNS depression) - Administration: PO, SC, IM, IV, rectal // dilute IVP with 5 mL NS // administer over 5 min - Adverse Effects: respiratory depression, prolonged sedation, confusion, hypotension, n/v, constipation - Other Considerations/Monitoring: Naloxone (Narcan) = reversal agent; use cautiously with head trauma; monitor pain, LOC, RR, HR, BP Fentanyl (Sublimaze) which medication? - opioid agonist, schedule II, high alert - Onset: route-dependent (IM = 15 min; IV = 1-2 min) - Function/Mechanism of Action: analgesia, supplemententation of anesthesia/sedation (binds to opioid receptors in CNS; alters perception & response to painful stimuli while producing generalized CNS depression) - Administration: IM, IV, transdermal // administer over 1-3 min - Adverse Effects: respiratory depression, apnea, laryngospasm, sedation, confusion, hypotension, bradycardia, constipation, muscle rigidity - Other Considerations/Monitoring: Naloxone (Narcan) = reversal agent; avoid if had MAOIs in last 14 days; monitor pain, LOC, RR, HR, BP Oxycodone which medication? - opioid agonist, schedule II, high alert - Onset: route-dependent (PO = 10-15 min) - Function/Mechanism of Action: analgesia (binds to opioid receptors in CNS; alters perception & response to painful stimuli while producing generalized CNS depression) - Administration: PO, rectal - Adverse Effects: respiratory depression, sedation, confusion, constipation - Other Considerations/Monitoring: Naloxone (Narcan) = reversal agent; monitor pain, LOC, RR, HR, BP Hydromorphone (Dilaudid) which medication? - opioid agonist, schedule II, high alert - Onset: route-dependent (PO = 30 min; IM = 15 min; IV = 10-15 min) - Function/Mechanism of Action: analgesia (binds to opioid receptors in CNS; alters perception & response to painful stimuli while producing generalized CNS depression), antitussive (suppresses cough reflex via direct central action) - Administration: PO, IM, IV - Adverse Effects: respiratory depression, sedation, confusion, constipation, hypotension - Other Considerations/Monitoring: Naloxone (Narcan) = reversal agent; avoid if had MAOIs in last 14 days; monitor pain, LOC, RR, HR, BP Propofol (Diprivan) which medication? - NMDA receptor agonist, sedative - Onset: rapid (~40-60 secs) // very short half life - Function/Mechanism of Action: intubation, procedural sedation, continuous sedation, antiemetic effects // no analgesic properties (not effective in helping manage pain) - Administration: IV // titrated to patient response - Adverse Effects: allergic reactions (soybean & egg products), respiratory depression, apnea, hypotension; pain, burning, stinging of site - Other Considerations/Monitoring: propofol infusion syndrome (collection of metabolic abnormalities & organ system failures; tends to happen in patients on high doses for 48 hrs & on vasopressors; sends patient into sudden cardiac failure (cardiogenic shock, metabolic acidosis, hepatic failure, renal failure, rhabdomyolysis); supportive therapy is tx); change IV tubing q 12 hrs (contains lots of lipids & calories, which increase risk of infection); monitor RR, HR, BP, triglyceride levels; maintain patient airway & adequate ventilation; patient must be intubated if infusion is running (causes respiratory depression) Dexmedetomidine (Precedex) which medication? - sedative, hypnotic, anxiolytic, anesthesia - Onset: rapid - Function/Mechanism of Action: selective alpha adrenergic agonist with sedative properties; sedates initially-intubated & mechanically ventilated - Administration: IV - Adverse Effects: hypotension, bradycardia, sinus arrest, AV blocks, ventricular dysfunction // doesn't cause respiratory depression (patients don't need to be on ventilator) - Other Considerations/Monitoring: contraindicated with chemotherapy; monitor HR, BP, ECG Midazolam (Versed) which medication? - antianxiety, anticonvulsant, sedative/hypnotic, high alert - Onset: route-dependent (IN = 5 min, IM = 15 min, IV = 1.5-5 min) - Function/Mechanism of Action: produces generalized CNS depression (such as short-term sedation, postoperative amnesia, termination of seizure activity); effects can be mediated by GABA (inhibitory neurotransmitter) - Administration: PO, IN, IM, IV // titrate carefully - Adverse Effects: respiratory depression, apnea, laryngospasm, cardiac arrest, suicidal thoughts, phelbitis - Other Considerations/Monitoring: monitor RR, HR, BP Lorazepam (Ativan) which medication? - antianxiety, sedative/hypnotic, anesthesia adjunct - Onset: route-dependent (PO = 15-60 min; IM = 30-60 min; IV = 15-30 min) - Function/Mechanism of Action: depresses CNS; treats n/v, seizure disorders - Administration: PO, IM, IV, IVP (dilute in at least same volume; don't exceed 2 mg/min) - Adverse Effects: respiratory depression, apnea, cardiac arrest (rapid IV infusion), dizziness, drowsiness, lethargy - Other Considerations/Monitoring: cautions driving/operating machinery; cautions in elderly (fall risk; delirium risk); Flumazenil (Romazicon) = reversal agent; monitor anxiety, RR, HR, BP Furosemide (Lasix) which medication? - loop diuretic - Onset: route-dependent (PO = 30-60 min; IV = 5 min) - Function/Mechanism of Action: inhibits reabsorption of sodium & chloride; increases renal excretion of water & electrolytes; treats fluid overload, heart failure - Administration: PO, IV // administer 20 mg/min - Adverse Effects: hypokalemia, hyponatremia, hypomagnesemia, hypochloremia, hypovolemia, hypotension, dehydration, metabolic acidosis, ototoxicity - Other Considerations/Monitoring: risk of ototoxicity if administered too fast; monitor K+ level, HR, BP, fluid status, & continence status Insulin Lispro (Humalog), Insulin Aspart (Novolog), Insulin Glulisine (Apidra) which medications? (3) - rapid-acting insulins, high alert - Onset: 15-30 min // Peak: 1 hr // Duration: 3-5 hrs - Function/Mechanism of Action: rapid-acting; lowers blood glucose - Administration: SC, IV (Humalog only) // administer 15 min before eating - Adverse Effects: hypoglycemia (blood glucose 70 mg/dL; anxiety, confusion, headache, hunger, pallor, shaking, sweating, tachycardia, weakness), hypokalemia - Other Considerations/Monitoring: rotate injection sites; monitor blood glucose levels Regular Insulin which medication? - Onset: 30 min - 1 hr // Peak: 3 hrs // Duration: 5-7 hrs - Function/Mechanism of Action: short-acting; lowers blood glucose (by promoting entry of glucose into cells) - Administration: SC, IV // administer 30 min before eating - Adverse Effects: hypoglycemia (blood glucose 70 mg/dL; anxiety, confusion, headache, hunger, pallor, shaking, sweating, tachycardia, weakness) - Other Considerations/Monitoring: rotate injection sites; monitor blood glucose levels NPH (Isophane) which medication? sophane): - Onset: 1-2 hrs // Peak: 8 hrs // Duration: 18 hrs - Function/Mechanism of Action: intermediate-acting; lowers blood glucose - Administration: SC - Adverse Effects: hypoglycemia (blood glucose 70 mg/dL; anxiety, confusion, headache, hunger, pallor, shaking, sweating, tachycardia, weakness) - Other Considerations/Monitoring: rotate injection sites; monitor blood glucose levels Insulin Glargine (Lantus), Insulin Detemir (Levemir) which medications? (2) - Onset: 1-2 hrs // Peak: none // Duration: 24 hrs - Function/Mechanism of Action: long-acting; lowers blood glucose - Administration: SC - Adverse Effects: hypoglycemia (blood glucose 70 mg/dL; anxiety, confusion, headache, hunger, pallor, shaking, sweating, tachycardia, weakness) - Other Considerations/Monitoring: rotate injection sites; monitor blood glucose levels Nitroglycerin which medication? - vasodilator, anti-anginal - Onset: route-dependent (SL = 1-3 min; IV = rapid; transdermal: 40-60 min) - Function/Mechanism of Action: increases coronary blood flow by dilating coronary arteries & improving collateral flow to ischemic regions; treats angina pectoris (chest pain), heart failure - Administration: SL, IV, transdermal - Adverse Effects: hypotension, tachycardia, headache, dizziness - Other Considerations/Monitoring: don't administer w/ Sildenafil (Viagra); monitor pain, HR, BP Lisinopril (Prinivil, Zestril) which medication? - ACE-inhibitor - Onset: 1 hr // Peak: 6 hrs // Duration: 24 hrs - Function/Mechanism of Action: antihypertensive (blocks conversion of angiotensin I to angiotensin II) - Administration: PO - Adverse Effects: cough, orthostatic hypotension, hyperkalemia, angioedema - Other Considerations/Monitoring: monitor for renal impairment & BP Metoprolol (Lopressor) which medication? - beta 1 adrenergic antagonist (beta blocker) - Onset: route-dependent (PO = 15 min; IV = rapid) - Function/Mechanism of Action: antianginal, antihypertensive - Administration: PO, IV - Adverse Effects: bradycardia, heart failure, pulmonary edema, fatigue, weakness, erectile dysfunction - Other Considerations/Monitoring: before administration, take apical pulse ( 50 bpm to safely administer); monitor HR, BP, ECG Carvedilol (Coreg) which medication? - alpha & beta adrenergic antagonist (beta blocker) - Onset: within 1 hr // Peak: 1-2 hrs // Duration: 12 hrs - Function/Mechanism of Action: antihypertensive - Administration: PO - Adverse Effects: bradycardia, heart failure, pulmonary edema, fatigue, dizziness, weakness, hyperglycemia, diarrhea, erectile dysfunction - Other Considerations/Monitoring: before administration, take apical pulse ( 50 bpm to safely administer); monitor HR, BP, ECG, I&Os Diltiazem (Cardizem) which medication? - calcium channel blocker - Onset: route-dependent (PO = 30 min; IV = 2-5 min) - Function/Mechanism of Action: antianginal, antiarrhythmic, antihypertensive; inhibits transport of calcium into myocardium & smooth muscle cells, which inhibits excitation-contraction coupling & subsequent contractions - Administration: PO (ER, SR, CD), IV - Adverse Effects: peripheral edema, arrhythmias, heart failure, hypotension, headaches, dizziness - Other Considerations/Monitoring: don't stop abruptly (can precipitate anginal episode); monitor HR, BP, ECG, I&Os Heparin which medication? - anticoagulant, high alert - Onset: route-dependent (SC: 20-60 mins // IV: rapid); faster than Warfarin, but shorter duration - Function/Mechanism of Action: anticoagulant, antithrombotic (prevents clot formation; potentiates inhibitor effect of antithrombin on factor Xa & thrombin) - Administration: SC, IV - Adverse Effects: bleeding, heparin-induced thrombocytopenia (HIT; predisposes blood to clotting; Argatroban is tx), anemia - Other Considerations/Monitoring: Protamine Sulfate = reversal agent; safe for pregnancy; monitor aPTT/PTT, CBC, platelets, bleeding Enoxaparin (Lovenox) which medication? - low molecular weight heparin - Onset: unknown // Peak: 3-5 hrs // Duration: 12 hrs - Function/Mechanism of Action: anticoagulant, antithrombotic (prevents clot formation; potentiates inhibitor effect of antithrombin on factor Xa & thrombin) - Administration: SC // don't administer with heparin - Adverse Effects: bleeding, anemia - Other Considerations/Monitoring: lasts 2-4 times longer than heparin & requires fewer labs (ideal for home use); less likely to cause HIT; monitor for bleeding Warfarin (Coumadin)