NR 567 Midterm Study Material - Comprehensive Answer Key

NR 567 Midterm Study Material - Comprehensive Answer Key Phenylephrine receptor - answer - only alpha 1 Norepinephrine receptor - answer - alpha 1, alpha 2, beta 1 Epinephrine receptor - answer - alpha 1, alpha 2, beta 1, beta 2 Isoproterenol receptors - answer - beta 1, beta 2 Dobutamine receptors - answer - beta 1 Dopamine receptors - answer - alpha 1, beta 1, dopamine Alpha 1 effects - answer - Vasoconstriction of arteries and veins Elevation of BP Alpha 2 effects - answer - Oppose effects of sympathetic nervous system Inhibitory Decrease sympathetic outflow to heart and vessels Relief of pain Beta 1 effects - answer - Positive inotrope / chronotrope Increases HR, force of contraction, CO, tissue perfusion What is a negative side effect of Beta 1 activation? - answer - Tachydysrhythmias or angina due to increase myocardial demand What is a negative side effect of Beta 2 activation? - answer - Hyperglycemia and muscle tremors What is a negative side effect of Alpha 1 activation? - answer - Hypertension, necrosis, bradycardia What is the inpatient daily insulin requirements range in a pt with admission glucose 154? - answer - 0.4 units/kg/day What is the inpatient daily insulin requirements range in a patient who is 65 with admission glucose 215? - answer - 0.5 units/kg/day What is the inpatient daily insulin requirement range in a patient who is 72 with bgl 245? - answer - 0.3 units/kg/day What is the goal blood glucose reduction in an hour? - answer - 50 mg/dL/hr What is the continuous rate of IV regular insulin in a DKA patient? - answer - 0.1 units/kg/hr What is the initial bolus range in patients with IV regular insulin in DKA? - answer - 0.1-0.15 units/kg Why might you not give bicarbonate to patients in DKA? - answer - bicarbonate promotes hypokalemia What is a common cause of HHNS? - answer - gram negative pneumonia What puts older adults at higher risk for HHNS? - answer - diuretics that lead to dehydration Typically how much volume do DKA patients need in the first 12 hours of treatment? - answer - 8-10 L of fluid Why does contrast media and metformin damage kidneys - answer - Contrast can cause AKI, leading to reduction of clearance of metformin from body increased risk of lactic acid What is the recommendation for patient with normal kidney function and getting contrast - answer - metformin does not need to be discontinued before or following IV contrast. What is the recommendation for patients with CKD on metformin? - answer - Hold metformin at time of procedure and for 48 hours after What are clinical indications for dobutamine? - answer - Cardiogenic shock, heart failure How does isoproterenol treat AV block? - answer - enhances impulse conduction through AV node (B1, B2 receptors) A patient taking isoproterenol develops a muscle tremor - answer - common side effect due to activation of B2 in muscles. dose dependent, fades with time. What is a side effect of phenelzine and epinephrine? - answer - MAO is an enzyme that inactivates epinephrine. MAOI's will prolong and intensify epinephrine's effects What medications should post MI patients take? - answer - Beta blocker, ACEI or ARB, statin, antiplatelet (asa or plavix) OR anticoag (warfarin) What should you do if the patient cant get to emergent PCI? - answer - use thrombolytics/fibrinolytics (alteplase, tenecteplase) What are the benefits of reperfusion therapy? - answer - less residual stenosis, lower recurrence rates of ischemia, can be used when fibrinolytics are contraindicated What ACEI's decrease short term mortality in all patients and long term mortality in patients with reduced LV? - answer - captopril and lisinopril What is dosage of statin after STEMI? - answer - high intensity statin ASAP Atorvastatin 40-80mg Rosuvastatin 20mg What should all patients undergoing PCI recieve? - answer - anticoagulant (heparin, bivalirudin), combined with antiplatelet (asa plus either plavix, ticagrelor or prasurgel) and perhaps gly