115 Questions
What can be used to treat extravasation by reversing alpha 1 agonism?
Phentolamine
Where are the nicotinic receptors found?
Skeletal muscle fibers, ganglionic neurons, and hormone-producing cells of adrenal medulla
What type of response occurs when acetylcholine binds to nicotinic receptors?
Always excitatory
Which type of receptors are found on effector cells stimulated by postganglionic fibers?
Muscarinic receptors
What happens when beta adrenergic receptors are activated?
Vasodilation, increase in heart rate, and contractility
Which receptors predominantly respond to low concentrations of epinephrine by increasing heart rate and contractility?
Beta 1 receptors
What effect do alpha adrenergic receptors have when activated?
Vasoconstriction
Which medication activates alpha adrenergic receptors and leads to vasoconstriction?
Norepinephrine
Which of the following is true regarding enoxaparin?
It cannot be eliminated through dialysis
Which of the following is NOT a good candidate for non-drug options for thromboembolic prophylaxis?
Patients with normal platelet count and no bleeding risk
What is the primary reason for elevating the head of the bed by 30-45 degrees?
To prevent ventilator-associated pneumonia (VAP)
Which of the following medications is NOT listed as contributing to delirium?
Antidepressants
Which of the following is NOT a treatment or prevention strategy for delirium mentioned in the text?
Administration of antipsychotics other than haloperidol or quetiapine
What is the goal for QTc interval when administering haloperidol?
QTc < 450 ms
Which of the following is NOT a risk factor for stress ulcer prophylaxis mentioned in the text?
Chronic liver disease
What is the goal for glucose control in critically ill patients?
140-180 mg/dL
What is the primary advantage of using IV continuous infusion of regular insulin for glycemic control?
It provides the best control over blood glucose levels
Which statement about the use of sliding scale insulin is correct?
It is recommended for assessing insulin needs and avoiding long-acting agents
What is the recommended treatment for opioid-induced constipation?
Administration of stimulant laxatives
What does the 'I' in 'BID' stand for in the context of patient care?
Indwelling
What does the 'D' in 'BID' represent in the context of patient care?
De-escalation of therapies
What is the primary benefit of using etomidate for induction in rapid sequence intubation (RSI)?
It minimizes cardiovascular effects
Which statement about ketamine is correct when used for sedation in rapid sequence intubation (RSI)?
It has analgesic properties and causes catecholamine release
Which drug used for induction in rapid sequence intubation (RSI) has the longest duration of action?
Midazolam (Versed)
Which statement about Hydromorphone is correct?
It is more potent than Morphine and should be dosed very carefully.
Which route of administration is NOT mentioned for Oxycodone?
Intravenous injection
Which statement about Ketorolac is correct?
It has a risk of gastrointestinal bleed and a maximum therapy duration of 5 days.
Which of the following is NOT mentioned as an important reminder for analgesia?
Monitor liver function tests regularly.
Which statement about Propofol is correct?
It has a caloric value of 1.1 kcal/g and is administered as a continuous infusion.
Which statement about monitoring Propofol is correct?
Monitor for hypotension and hypertriglyceridemia, with baseline triglyceride levels and rechecks every 5-7 days.
Which statement about benzodiazepines is correct?
They are good for providing retrograde amnesia.
Which agent used for sedation is NOT mentioned in the text?
Fentanyl
Which of the following is NOT a type of intravenous access?
Nasogastric (NG) tube
Which of the following statements about Peripherally inserted Central Catheters (PICCs) is FALSE?
A dedicated line for TPN is not required when using a PICC.
Which of the following is a characteristic of tunneled central venous catheters (CVCs)?
They have a lower chance of infection compared to non-tunneled CVCs.
Which of the following statements about Nasogastric (NG) tubes and Dobhoff/Corpak tubes is TRUE?
Both NG tubes and Dobhoff/Corpak tubes can be used for enteral nutrition.
Which of the following statements about the Richmond Agitation Sedation Scale (RASS) is FALSE?
It is used to assess pain control.
Which of the following statements about the Confusion Assessment Method for ICU (CAM-ICU) is TRUE?
It is used to assess delirium and fluctuation of mental status.
Which of the following statements about sedation and neuromuscular blocking agents (NMBs) is TRUE?
Sedation and NMBs should be used in combination with pain control measures.
Never ______ before sedation
paralyze
Supportive care for continuous NMB include eye care, DVT prophy, physical therapy, and ______ assessment
TOF
Agents used for paralysis in RSI include depolarizing and ______ agents
non-depolarizing
______ is depolarizing and has fast on/off
Succinylcholine
MAP is a surrogate indicator of ______
blood flow
Hypertensive ______ is asymptomatic or has mild symptoms and is often a result of non-adherence to medications
urgency
Ischemic stroke is a result of emboli blocking blood flow whereas ______ stroke is defined by bleeding in the brain that leads to swelling
hemorrhagic
Fibrinolytics are used in ischemic stroke with goal BP being ______
<185/110
Enoxaparin cannot be eliminated in ______.
dialysis
Good candidates for non-drug options are patients with low platelet count (<______),traumatic bleed, or high risk of bleeding.
50K
Elevate head of bed by 30-45 degrees to prevent ______ by making aspiration gravitationally unlikely.
VAP
Medications that contribute to delirium are benzos, opioids, sedatives, and ______.
steroids
Adverse effects of haloperidol include prolonged QTc, torsade de pointes, ______.
EPS
Stress ulcer prophylaxis is indicated for patients mechanically ventilated for >______ hours and coagulopathy.
48
Goal for glucose control is ______ mg/dL.
140-180
PPIs increase gastric pH more than ______.
H2Ras
IV continuous infusion of regular insulin provides the best ______ control.
glycemic
Use ______ scale to assess insulin needs and avoid long-acting agents.
sliding
Use ______ for opioid induced constipation.
stimulants
RSI includes induction (sedation), ______ with neuromuscular blockade, and analgesics.
paralysis
Etomidate has ______ onset of unconsciousness and apnea.
rapid
Benefits of Etomidate include excellent sedation, fast on/off, and minimal ______ effects.
cardiovascular
Ketamine benefits include catecholamine release, ______, and analgesic properties.
bronchodilation
Midazolam (Versed) has potent dose-related ______.
amnesia
_______ that activate B1 receptors include norepinephrine, epinephrine, dopamine, and dobutamine.
Drugs
Beta 2 receptors are predominant in arterioles and bronchi and cause _______ (because we want blood flow to areas where we want blood during fight/flight).
vasodilation
Low concentrations of epinephrine activate beta2 receptors which cause _______.
vasodilation
High concentrations of epinephrine saturates B2 receptors and also alpha 1 receptors which cause _______.
vasoconstriction
Sepsis is a life-threatening organ dysfunction caused by dysregulated host response due to _______.
infection
Septic shock is sepsis related hypotension that is refractory to recommended/adequate _______.
fluids
Sepsis is diagnosed by SIRS criteria (any 2) + infection Heart rate greater than 90 beats per minute Temperature greater than 38 degressC or less than 36degreesC Respiratory Rate greater than 20 breaths per minute ______ less than 4,000 or greater than 12,000 or greater than 10% bands Systolic BP less than 90 or diastolic BP less than 60 SOFA and 1SOFA are used to monitor patients in the ICU who have sepsis.Criteria include: Respiratory Rate of greater than 22 breaths per minute Altered mentation Systolic Blood pressure less than 100.
WBC
_______ is used to monitor patients in the ICU who have sepsis.
SOFA
Extravasation can be treated with ______, which reverses alpha 1 agonism and causes vasodilation.
phentolamine
______ Receptors are found on skeletal muscle fibers, ganglionic neurons, and hormone-producing cells of adrenal medulla.
Nicotinic
Alpha adrenergic receptors are ______ and respond to norepinephrine and high concentrations of epinephrine.
peripheral
Activation on alpha receptors lead to ______, which increases blood pressure.
vasoconstriction
Beta adrenergic receptors are found on the heart, liver, and ______ muscles.
skeletal
Beta 1 receptors are predominant in the ______ and respond to low concentrations of epinephrine by increasing heart rate and contractility.
heart
Extravasation can be treated with ______, which is given as an infiltrate 5-10mg diluted in 10mL NS.
phentolamine
Other treatments for extravasation include ______ and topical nitroglycerin.
terbutaline
Match the drug with its mechanism of action:
Labetalol = Works on alpha1, beta1, and beta2 receptors Esmolol = Works on beta1 receptors only Clevidipine = Dihydropyridine calcium channel blocker Nicardipine = Dihydropyridine calcium channel blocker
Match the drug with its onset of effect:
Clevidipine = Lasts for only 5-15 minutes Nicardipine = Lasts for less than 8 hours
Match the type of shock with its description:
Cardiogenic shock = Shock related to heart failure Distributive shock = Shock related to vasodilation and decreased vascular resistance Obstructive shock = Shock related to physical obstruction of blood flow Hypovolemic shock = Shock related to low blood volume
Match the drug with its receptor specificity:
Labetalol = Alpha1, beta1, and beta2 receptors Metoprolol = Beta1 receptors only Esmolol = Shortest half-life (0.15)
Match the vasodilator with its duration of action:
Clevidipine = Onset of effect within 2-4 minutes Nicardipine = Onset of effect 30 minutes
Match the goal MAP during shock with the corresponding value:
65 mmHg = Goal MAP during shock 220 mmHg systolic and >120 mmHg diastolic = Threshold for treating BP during hemorrhagic stroke 140 mmHg systolic = Desired systolic BP during ischemic stroke for the first 48 hours <120 mmHg and HR <60 bpm = Rapid reduction in BP during aortic dissections
Match the drug with its availability form:
Esmolol = Only available as an IV infusion Metoprolol = Equivalence of 1mg IV to 2.5mg PO Labetalol = Clevidipine =
Match the following drug with its characteristics in Rapid Sequence Intubation (RSI):
Etomidate = One time dose with rapid onset and minimal CV effects Ketamine = Catecholamine release, bronchodilation, and analgesic properties Midazolam (Versed) = Potent dose-related amnesia and dose related CV effects Propofol = Bronchodilation and fast on/off properties
Match the following benefits with the corresponding sedative used in Rapid Sequence Intubation (RSI):
Etomidate = Excellent sedation, fast on/off, minimal CV effects Ketamine = Catecholamine release, bronchodilation, analgesic properties Midazolam (Versed) = Dose-related amnesia Propofol = Bronchodilation, fast on/off
Match the following drug considerations with the corresponding agent in Rapid Sequence Intubation (RSI):
Etomidate = Adrenal cortisol suppression Ketamine = Increases ICP and BP Midazolam (Versed) = Often underdosed in RSI Propofol = CV related side effects
Match the following onset characteristics with the appropriate drug used in Rapid Sequence Intubation (RSI):
Etomidate = ~0.3mg/kg dose, onset 15-50 seconds, duration 5-10 minutes Ketamine = Increases ICP and BP Midazolam (Versed) = Longest duration of 15-30 minutes Propofol = Fast on/off properties
Match the following side effects with the correct sedative used in Rapid Sequence Intubation (RSI):
Etomidate = Adrenal cortisol suppression Ketamine = ICP and BP elevation Midazolam (Versed) = Dose-related CV effects Propofol = CV related side effects
Match the following benefits of agents with their corresponding sedative used in Rapid Sequence Intubation (RSI):
Etomidate = Excellent sedation, fast on/off, minimal CV effects Ketamine = Catecholamine release, bronchodilation, analgesic properties Midazolam (Versed) = Potent dose-related amnesia Propofol = Bronchodilation, fast on/off
Match the following dose characteristics with the appropriate drug used in Rapid Sequence Intubation (RSI):
Etomidate = ~0.3mg/kg (~20mg) dose Ketamine = - Midazolam (Versed) = - Propofol = -
Match the following duration attributes with the correct sedative used in Rapid Sequence Intubation (RSI):
Etomidate = ~0.3mg/kg (~20mg) dose Ketamine = - Midazolam (Versed) = - Propofol = -
Match the following receptors with their response to epinephrine activation:
Beta 1 receptors = Increase heart rate and contractility Beta 2 receptors = Vasodilation at low concentrations, vasoconstriction at high concentrations Alpha 1 receptors = Vasoconstriction at high concentrations Alpha adrenergic receptors = Respond to norepinephrine and high concentrations of epinephrine
Match the following terms with their definitions:
Sepsis = Life-threatening organ dysfunction due to dysregulated host response to infection Septic shock = Sepsis-related hypotension refractory to fluids SOFA score = Used to monitor ICU patients with sepsis, includes respiratory rate, altered mentation, systolic blood pressure criteria SIRS criteria = Heart rate >90bpm, Temp >38 or <36 degC, Respiratory rate >20, WBC <4,000 or >12,000 or >10% bands, BP <90/60
Match the following drugs with their use in rapid sequence intubation (RSI):
Ketamine = Catecholamine release, bronchodilation, analgesia Etomidate = Excellent sedation, fast on/off, minimal side effects Midazolam (Versed) = Potent dose-related effects Haloperidol = Goal for QTc interval control
Match the following terms with their characteristics:
Tunneled central venous catheters (CVCs) = Not mentioned in text as important for analgesia Intravenous access types = Not including a specific type mentioned in text Sliding scale insulin use = Described incorrectly in a statement Delirium-contributing medications = Missing one medication from the list provided
Match the following receptors with their location:
Nicotinic Receptors = Skeletal muscle fibers Muscarinic Receptors = Effector cells stimulated by postganglionic fibers Alpha Adrenergic Receptors = Peripheral Beta Adrenergic Receptors = Heart, liver, and skeletal muscles
Match the following medications with their effects on extravasation:
Phentolamine = Reverses alpha 1 agonism and causes vasodilation Terbutaline = Treatment for extravasation Topical Nitroglycerin = Treatment for extravasation Epinephrine = Activates alpha receptors leading to vasoconstriction
Match the following drugs with their uses in sedation:
Ketamine = Catecholamine release and analgesic properties Propofol = Used for induction in rapid sequence intubation (RSI) Etomidate = Used for induction in rapid sequence intubation (RSI) Phentolamine = Not mentioned in the text for sedation
Match the following terms with their correct descriptions:
Vasoconstriction = Leads to tissue ischemia Vasodilation = Causes an increase in heart rate and contractility Ischemia = Can be treated with phentolamine to reverse alpha 1 agonism Tissue Ischemia = Significant vasoconstriction due to extravasation
Match the following treatments with their purposes:
Stress Ulcer Prophylaxis = Indicated for patients mechanically ventilated for > hours and coagulopathy IV Continuous Infusion of Regular Insulin = Provides the best glucose control Haloperidol = Used to monitor patients in the ICU who have sepsis PPIs = Increase gastric pH more than others
Match the following drugs with their side effects:
Haloperidol = Causes prolonged QTc and torsade de pointes Benzos = Contribute to delirium Opioids = Contribute to delirium Sedatives = Contribute to delirium
Match the following actions with their outcomes when beta adrenergic receptors are activated:
Increase in heart rate and contractility = Beta 1 receptors predominant in the heart respond to low concentrations of epinephrine Vasodilation = Caused by activation of beta adrenergic receptors on heart, liver, and skeletal muscles Vasoconstriction = Occurs when alpha adrenergic receptors are activated by agents like phenylephrine Catecholamine release and analgesic properties = Benefits include when using ketamine for sedation
Match the following terms with their correct effects on blood pressure:
Vasoconstriction = Leads to an increase in blood pressure by narrowing blood vessels Vasodilation = May cause a decrease in blood pressure by widening blood vessels Hypotension = (Not included in choices) Hypertension = (Not included in choices)
Match the following vasopressors with their primary mechanisms of action:
Phenylephrine = Pure alpha 1 agonist resulting in vasoconstriction with no effect on heart rate Norepinephrine = Alpha 1 and beta 1 agonist; alpha1 increases BP, beta1 increases contractility, cardiac output, and heart rate Epinephrine = Low dose activates beta 1 receptors (increased heart rate and contractility); high dose activates alpha 1 receptors (increased BP through vasoconstriction) Dopamine = Vasopressor with activity on alpha, beta, and dopamine receptors
Match the following inotropes with their primary characteristics:
Dobutamine = Acts primarily as a beta agonist, increasing contractility and heart rate; often used in patients unable to maintain stroke volume Milrinone = Works on PDE3 receptors inside the cell to increase cardiac contraction; used in cardiogenic shock when patients are taking beta blockers at home Vasopressin = Works on Vasopressin receptors and is used in synergy with other agents for better BP increases or lower doses of other agents Vasopressor Phenylephrine = Is pH dependent, pure alpha 1 agonist resulting in vasoconstriction with no effect on heart rate
Match the following statements with the correct drug: 'Phenylephrine and Norepinephrine are pH dependent.'
Phenylephrine = Pure alpha 1 agonist resulting in vasoconstriction with no effect on heart rate Norepinephrine = Alpha 1 and beta 1 agonist; alpha1 increases BP, beta1 increases contractility, cardiac output, and heart rate Epinephrine = Low dose activates beta 1 receptors (increased heart rate and contractility); high dose activates alpha 1 receptors (increased BP through vasoconstriction) Dopamine = Vasopressor with activity on alpha, beta, and dopamine receptors
Match the following drugs with their effects: 'Low dose epinephrine activates beta 1 receptors (increased heart rate and contractility).'
Phenylephrine = Pure alpha 1 agonist resulting in vasoconstriction with no effect on heart rate Norepinephrine = Alpha 1 and beta 1 agonist; alpha1 increases BP, beta1 increases contractility, cardiac output, and heart rate Epinephrine = High dose activates alpha 1 receptors (increased BP through vasoconstriction) Dopamine = Vasopressor with activity on alpha, beta, and dopamine receptors
Match the following drugs with their effects: 'High epinephrine activates alpha 1 receptors (increased BP through vasoconstriction).'
Phenylephrine = Pure alpha 1 agonist resulting in vasoconstriction with no effect on heart rate Norepinephrine = Alpha 1 and beta 1 agonist; alpha1 increases BP, beta1 increases contractility, cardiac output, and heart rate Epinephrine = Low dose activates beta 1 receptors (increased heart rate and contractility) Dopamine = Vasopressor with activity on alpha, beta, and dopamine receptors
Match the following drugs with their effects: 'Norepinephrine beta agonism is less than Epinephrine.'
Phenylephrine = Pure alpha 1 agonist resulting in vasoconstriction with no effect on heart rate Norepinephrine = Alpha 1 and beta 1 agonist; alpha1 increases BP, beta1 increases contractility, cardiac output, and heart rate Epinephrine = Low dose activates beta 1 receptors (increased heart rate and contractility); high dose activates alpha 1 receptors (increased BP through vasoconstriction) Dopamine = Vasopressor with activity on alpha, beta, and dopamine receptors
Match the following drugs with their effects: 'Dobutamine should be avoided in patients who are taking beta blockers at home.'
Dobutamine = Acts primarily as a beta agonist, increasing contractility and heart rate; often used in patients unable to maintain stroke volume Milrinone = Works on PDE3 receptors inside the cell to increase cardiac contraction; used in cardiogenic shock when patients are taking beta blockers at home
Match the following drugs with their effects: 'Milrinone is used in cardiogenic shock when patients are taking beta blockers at home.'
Dobutamine = Acts primarily as a beta agonist, increasing contractility and heart rate; often used in patients unable to maintain stroke volume Milrinone = - Works on PDE3 receptors inside the cell to increase cardiac contraction; used in cardiogenic shock when patients are taking beta blockers at home
Match the following statements about vasopressin:
Vasopressin is pH dependent. = It should never be used by itself. = 1 Avoid use of vasopressin in cardiogenic shock. = 1 It works on Vasopressin receptors. = 1
Test your knowledge on the different types of intravenous access, including Peripheral IV (INT), Peripherally inserted Central Catheter (PICC), and non-tunneled and tunneled central venous catheter (CVC). Learn about the importance of confirming PICC with an x-ray, dedicating a line for TPN if using PICC, and restrictions on using dextrose >12%, pressors, TPNs, or chemo in peripheral IV (INT).
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