Critical Care Pharmacology Flashcards

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?

Answer: Discontinue heparin and start an alternative anticoagulant

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.

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

Answer: Hypokalemia

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

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

Answer: Linezolid (an MAO inhibitor)

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

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

Answer: Phlebitis due to amiodarone's low pH and high osmolarity

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.

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

Answer: Idarucizumab (Praxbind)

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

Which vasopressor has positive inotropic effects primarily via beta-1 receptors and is added to norepinephrine in septic shock with myocardial depression?

Answer: Dobutamine

Dobutamine is a beta-1 agonist that increases cardiac contractility and is used as an adjunct in septic shock complicated by myocardial depression or low cardiac output.