CCRN Critical Care Pharmacology 2

Question 1

A patient on a continuous heparin infusion develops a platelet count drop from 240,000 to 90,000 on day 7. The 4T score is 6. What is the most appropriate next step?

Accepted Answer

Discontinue heparin and start an alternative anticoagulant

Answer

A 4T score ≥4 indicates intermediate-to-high probability of HIT; heparin must be discontinued immediately and a non-heparin anticoagulant (argatroban or fondaparinux) initiated.

Question 2

Which electrolyte abnormality is the most dangerous complication of aggressive insulin therapy in DKA management?

Accepted Answer

Hypokalemia

Answer

Insulin shifts potassium intracellularly, and patients with DKA are already total-body potassium depleted; hypokalemia can cause fatal cardiac arrhythmias.

Question 3

Which drug interaction poses a risk of serotonin syndrome in ICU patients receiving fentanyl alongside?

Accepted Answer

Linezolid (an MAO inhibitor)

Answer

Linezolid has MAO-inhibiting properties; combining it with serotonergic opioids like fentanyl can precipitate serotonin syndrome.

Question 4

A patient receiving IV amiodarone through a peripheral IV develops pain and erythema at the infusion site. What is the most likely complication?

Accepted Answer

Phlebitis due to amiodarone's low pH and high osmolarity

Answer

Amiodarone IV formulation contains polysorbate 80 and has a low pH and high osmolarity, frequently causing phlebitis; central venous access is preferred for prolonged infusions.

Question 5

Which medication is used to reverse the anticoagulant effect of dabigatran (a direct thrombin inhibitor) in life-threatening bleeding?

Accepted Answer

Idarucizumab (Praxbind)

Answer

Idarucizumab (Praxbind) is a monoclonal antibody fragment that specifically and rapidly reverses dabigatran's anticoagulant effect.

CCRN Review Practice Test

CCRN Review Practice Test

CCRN Critical Care Pharmacology 2