CCRN Critical Care Pharmacology 3

Question 1

Which medication used for stress ulcer prophylaxis in ICU patients is associated with the highest risk of Clostridioides difficile infection?

Accepted Answer

Proton pump inhibitors (PPIs)

Answer

PPIs carry the highest risk of C. difficile-associated diarrhea among stress ulcer prophylaxis agents due to their profound suppression of gastric acid, which normally inhibits spore germination.

Question 2

A patient receiving phenytoin IV for seizure management develops bradycardia and hypotension during infusion. What is the most appropriate intervention?

Accepted Answer

Slow the infusion rate to no faster than 50 mg/min

Answer

Phenytoin IV must not be infused faster than 50 mg/min due to its propylene glycol vehicle, which causes cardiac depression and hypotension with rapid administration.

Question 3

Which drug is used as a continuous infusion for refractory status epilepticus and requires monitoring for propylene glycol toxicity with prolonged use?

Accepted Answer

Midazolam

Answer

Continuous midazolam infusion is used for refractory status epilepticus; prolonged use can cause propylene glycol accumulation, leading to metabolic acidosis and renal failure.

Question 4

A critically ill patient requires vasopressin. What is the primary mechanism of action of vasopressin in septic shock?

Accepted Answer

V1 receptor-mediated vasoconstriction of vascular smooth muscle

Answer

Vasopressin acts on V1 receptors on vascular smooth muscle to cause vasoconstriction and restore vascular tone in septic shock, independent of adrenergic pathways.

Question 5

Which corticosteroid is recommended by current Surviving Sepsis guidelines for refractory septic shock (vasopressor-dependent)?

Accepted Answer

Hydrocortisone 200 mg/day (continuous or divided doses)

Answer

IV hydrocortisone 200 mg/day is recommended for adult septic shock patients who remain hemodynamically unstable despite adequate fluid resuscitation and vasopressor therapy.

CCRN Review Practice Test

CCRN Review Practice Test

CCRN Critical Care Pharmacology 3