CCRN Critical Care Pharmacology

Question 1

Which vasopressor is considered first-line for septic shock according to Surviving Sepsis Campaign guidelines?

Accepted Answer

Norepinephrine

Answer

Norepinephrine is the first-line vasopressor for septic shock due to its predominant alpha-1 agonist activity with minimal beta effects, increasing MAP effectively.

Question 2

A patient receiving amiodarone develops blue-gray skin discoloration and thyroid dysfunction. These are examples of which type of adverse effects?

Accepted Answer

Long-term toxicity effects

Answer

Blue-gray skin discoloration and thyroid dysfunction (hypo- or hyperthyroidism) are well-known long-term toxicities of amiodarone due to its iodine content and tissue accumulation.

Question 3

Which anticoagulant requires monitoring with anti-Xa levels rather than aPTT for accurate dosing assessment?

Accepted Answer

Low-molecular-weight heparin (LMWH)

Answer

LMWH (e.g., enoxaparin) does not reliably prolong aPTT and requires anti-Xa level monitoring, especially in patients with renal impairment, obesity, or pregnancy.

Question 4

A patient in the ICU is receiving IV vancomycin. The AUC/MIC ratio target for optimal vancomycin efficacy against MRSA is:

Accepted Answer

400–600

Answer

Current ASHP/IDSA/SIDP guidelines recommend an AUC/MIC target of 400–600 mg·h/L for vancomycin to optimize efficacy and minimize nephrotoxicity.

Question 5

Which medication used in ICU patients is a direct thrombin inhibitor and is the anticoagulant of choice in heparin-induced thrombocytopenia (HIT)?

Accepted Answer

Argatroban

Answer

Argatroban is a direct thrombin inhibitor approved for anticoagulation in HIT; it is monitored by aPTT and does not require anti-Xa levels.

CCRN Review Practice Test

CCRN Review Practice Test

CCRN Critical Care Pharmacology