Editing Pharmacology – RN Flashcards (section)

== High-Alert and Critical Care ==

;Why is concentrated potassium chloride never given intravenous push, and what are the safe parameters?
:Rapid delivery causes fatal cardiac arrest. Always dilute and infuse by pump, generally no faster than 10 mEq per hour through a peripheral line, with higher rates only through central access with continuous cardiac monitoring per policy. Verify adequate urine output first.

;Which insulin can be given intravenously?
:Regular insulin is the only insulin routinely given intravenously.

;In diabetic ketoacidosis, what is done when the glucose falls to about 200 to 250 mg/dL?
:Add dextrose to the intravenous fluid and continue the insulin infusion, because the endpoint of therapy is closure of the anion gap and clearance of ketosis, not normalization of glucose. Monitor potassium closely, since insulin drives potassium intracellularly.

;What must always accompany a neuromuscular blocking agent?
:Adequate sedation and analgesia, plus a secured airway and mechanical ventilation. These agents paralyze without providing sedation or pain relief, and they are a high-alert class requiring independent double checks.

;Which medication classes require an independent double check?
:Insulin, anticoagulants such as heparin, opioid infusions and patient-controlled analgesia, chemotherapy, concentrated electrolytes, vasoactive infusions, and pediatric or neonatal high-alert doses. The second clinician verifies independently, without being told the expected values.

;Signs of magnesium sulfate toxicity and the antidote?
:Loss of deep tendon reflexes first, then respiratory depression, oliguria, hypotension, and cardiac arrest. Stop the infusion and administer calcium gluconate.