Pharm Test III 2

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Which IV fluid is the most similar to ECF?: Lactated Ringer's
Which IV fluid is the safest to give to pts?: 1/2 Normal Saline
Two isotonic solutions: NS and LR
Name the three hypotonic solutions: D5W, 1/2 NS, D5 1/2
Name the two hypertonic solutions: Na Lactate, 3%
What does "isotonic" mean?: the same concentration inside and outside of the cell
Osmolarity/tonicity are measured in what?: mEq
ECF and ICF have what type of tonicity?: Isotonic - normal osmolarity ranges =
ECF=280-310, ICF=350-400
Major intracellular cation: Potassium (K+)
This is defined as fluid/Na lost ineven amounts in ECF with no ICF shift.: Isotonic dehydration
A BUN/Creatinine >30 suggests what?: Dehydration (isotonic dehydration)
A BUN/Creatinine of 20-30 suggests what?: a renal problem
Causes of isotonic dehydration: Anything that can cause you to lose fluid - third spacing, vomiting, diarrhea, polyuria, gastric suction, hemorrhage, fever
What is "third space shifting"?: fluid located within organ spaces where fluid is not normally located (ascites, peritonitis, burns)
Which fluid should a pt with an electrolyte imbalance NOT receive? Why?: LR. It contains many electrolytes that can further exacerbate a pt's imbalance.
S/Sx of isotonic dehydration: Altered mental status, weight loss, dry mucous membranes, increasd BUN/CR, decreased BP, decreased skin turgor
Treatment of isotonic dehydration: underlying cause, isotonic fluid replacement, monitor I/O, LOC, VS, BUN, CBC, electrolytes
Why monitor CBCs in pt w/isotonic dehydration?: To see if pt is bleeding and establish if that is the cause of dehydration
This is defined as fluid/Na+ gain in even amounts in ECF with no ICF shift (excessive fluid accumulation): Isotonic Overhydration
Causes of isotonic overhydration: -CHF, CRF, Liver Dz.
-Too much Na+
-Too much hypertonic soln.
-Too many saline enemas, corticosteroids (solumed, pred)
S/Sx Isotonic Overhydration: Peripheral edema, polyuria, acute weight gain, JVD, ascites, increased BP, decreased HCT
Why would a pt's HCT be decreased in isotonic overhydration: it becomes diluted with the excess fluid accumulation
Treatment of isotonic overhydration: -underlying cause
-less fluids
-diuretics
-I/O, VS, CXR, HEMATOCRIT!!!, BUN
Why do you want to do a CXR on a pt w/ isotonic overhydration?: assess for pleural effusion or pulmonary edema
What is the urine excretion goal in a pt w/isotonic overhydration?: 1 ml/kg/hr (max)
Serum levels of hypokalemia: mild = 3 - 3.5
Moderate = 2.5 - 3
Severe = < 2.5

meq/L
What is the transcellular shift seen in hypokalemia?: ECF ---> ICF
How is Lithium associated with hypokalemia?: Lithium is a salt. It competes with K+ for excretion.
Causes of hypokalemia: -Loop diuretics -Stress
-Laxative abuse -Amphotericin
-Lithium -hypothyroid
-Liquor (alcohol)
-Liver
What other electrolyte deficiency will hinder the increase of potassium?: Magnesium - if K+ will not increase, check Mg+ levels and fix those first
What is Amphotericin B and what is it's relationship to hypokalemia?: anti-fungal used to treat infections that works on Mg+. May inhibit a rise in K+ levels due to decrease in Mg+ levels.
The "biggest" cause of hypokalemia?: diuretics
S/Sx of hypokalemia: -anorexia -EKG change
-drowsiness -leg cramps
-paresthesia -lethargy
-digoxin toxicity
Why is insulin/glucose therapy a cause of hypokalemia?: insulin draws potassium into the cell
What drug reverses Digoxin toxicity?: Digibind
(0.8-1.2 = normal dig.)
Treatment of hypokalemia: -underlying cause =
-hypomagnesemia
-give K+ supplement
-K+ sparing diuretic
Potassium level is low and your digoxin level is high...what is this called?: Digoxin toxicity
Digoxin is an antiarrhythmic that works on the ATPase pump. T/F?: True
Serum levels for hyperkalemia: Mild = 5.5 - 6
Moderate = 6.1 - 6.9
Severe = >7

mEq/L
What is the trancellular shift seen in hyperkalemia?: ICF ---> ECF
Causes of hyperkalemia: -CRF or ARF
-tumor lysis syndrome
-burns/tissue trauma
-metabolic/lactic acidosis
How do burns/tissue trauma cause hyperkalemia?: the cellular breakdown involved releases excess K+
What SE does dig. toxicity cause visually?: halos around objects (think Van Gogh)
What drugs cause the lactic acidosis involved in hyperkalemia?: Metformin (glucophage)
What is the fastest way to give a pt K+ supplements if IV is not available?: Liquid form
T/F = It is OK to give a pt IV form of K+ IVP.: False. NEVER give K+ IVP. Always infuse = 10/mEq/30min (fastest) or 20mEq/hr
What is added to IV K+ to reduce the "sting" involved in it's administration?: "Nute" (added sodium bicarb)
What is the best way to give K+ supplement?: Always try to give it orally ("if your gut works, use it") - if any other funky changes (EKG, ALOC, etc.), then give IV INF
What can happen if you give K+ INF too fast?: it can cause an arrhythmia
What are the weakest diuretics?: Potassium Sparing (least amount of water loss)
What is an example of a potassium-sparing diuretic?: Spironalactone (Aldactone)
Triemetrine (Dyazide)
Why do you never give calcium to a pt that is Dig. Toxic?: It can cause "Stone Heart" - a condition where the heart becomes calcified and does not pump. If dig level is too high, DO NOT give Calcium
What are some drug-induced causes of hyperkalemia?: -K+-sparing diuretics
-NSAIDS
-dig. toxicity
-ACEI/ARB
Which is more critical - hyper or hypokalemia.: Hyperkalemia
S/Sx of hyperkalemia: -N/V/D
-paresthesias
-EKG
-confusion
What is Addison's Dz.?: A syndrome involving aldosterone secretion that causes an increase in potasiium levels.
What is the "biggest" cause of hyperkalemia?: Acute renal failure/chronic renal failure
How does Tumor Lysis Syndrome (TLS) cause hyperkalemia?: Pt with tumor that is undergoing chemo - cells are rapidly broken down causing excess K+ to be released
Acute hyperkalemia that is considered moderate or above (over 6)= what medication do you give the pt?: Calcium gluconate 10%
Why do you give calcium to a pt with acute hyperkalemia that is considered moderate or above?: It is cardio-protective (assists is contractions/reduces arrhythmias)
If your pt is hyperkalemic and is presenting with metabolic acidosis, what drug do you give?: Sodium Bicarb (HCO3)
- 50mL IVP over 10 minutes
- or add to bag and infuse over 1 hr.
If the potassium does not drop within an hour after your initial interventions for hyperkalemia, what do you do next?: Start an insulin drip
-100 units/100mL (1U/mL) or D10W
T/F - Both insulin and dextrose draw potassium into the cell.: True.
**What is another name for Kayexelate and what is it?: Sodium Polyesterene. A sorbitol or sugar-based product
How is Kayexelate given?: 30 gm Orally or 50 gm by enema
When is Kayexelate given?: Given to moderate hyperkalemic pts. that do not have the severe symptoms (EKG changes, etc.) b/c it takes 1-2 hrs to work.
How does Kayexelate work?: The sorbitol binds to the K= and excretes it in the feces
If the hyperkalemia does not go down despite all pharmacological efforts, what should you do for the pt?: Dialysis - will probably give Kayexelate in conjunction with the dialysis.
Serum level that marks hyponatremia.: <135 mEq/L
What is the fluid shift involved in hyponatremia?: ECF ---> ICF (causes cellular swelling)
S/Sx of hyponatremia: -CEREBRAL EDEMA -resp. arrest
-orthostasis
-confusion (key)
-seizures at 118
-pitting edema
Three types of hyponatremia: -Hypovolemic (low Na, low TBW)
-Euvolemic (normal Na, high TBW)
-Hypervolemic (high Na, high TBW
What is SIADH: Syndrome of inappropriate anti-diuretic hormone
What drug is used to help pt's with SIADH?: Desmopressin
Drugs that can cause hyponatremia: Vasopressin, NSAIDS, SSRIs, Clonidine (Alpha II agonist), TCAs
Treatment for hypovolemic and euvolemic hyponatremia: isotonic saline (NS) 1.5-2 mEq/L/hr until resolved

Goal = Na+ of 120 or better
If the Na+ level is below 118 (and you fear seizures), what soln. may you give?: 3% hypertonic soln
What happens if you give 3% hypertonic saline too fast?: may cause Central Potine Myelating Disorder - hurts cerebellum which impairs mov't and can cause paralysis
Treatment of Hypervolemic Hyponatremia: -3% hypertonic soln
-diuretics
-fluid restriction
Serum level that distinguishes hypernatremia: >145 mEq/L
What is the fluid shift in hypernatremia?: ICF ---> ECF (cell shrinks)
S/Sx of hypernatremia: -restlessness, weakness, tachycardia, flushed skin, delirium, decreased salivation & tears
Three types of Hypernatremia: -Hypovolemia (low Na, low TBW)
-Euvolemic (normal Na+, low TBW)
-Hypervolemia (high Na, norm TBW
What types of pt's are on osmotic diuretics?: Pt's with increased ICP or pts with increased cerebral edema (hyponatremia)
What is the only extrarenal cause of hypernatremia?: Skin. (sweating)
T/F - NSAIDS decrease Na+ (so you can use them to treat hypernatremia) but you avoid them in pt's that are hyperkalemia: True.
What are some causes of hypervolemic hypernatremia?: -improper formulas (feeding tubes)
-hyperaldosteronism
Treatment for hypernatremia?: Loops, D5W, poss. dialysis
Where is 60-70% of body fluid (water) exchanged in the kidney?: Loop of Henle
What are the strongest diuretics?: loops

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