CCRN Critical Care Pharmacology 1 — Questions and Answers
Question 1: Which vasopressor is considered first-line for septic shock according to Surviving Sepsis Campaign guidelines?
- Epinephrine
- Dopamine
- Norepinephrine (Correct answer)
- Vasopressin
Correct answer: Norepinephrine
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?
- Acute infusion reactions
- Long-term toxicity effects (Correct answer)
- Anaphylactic reactions
- First-dose effects
Correct answer: Long-term toxicity effects
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?
- Unfractionated heparin (continuous infusion)
- Warfarin
- Low-molecular-weight heparin (LMWH) (Correct answer)
- Argatroban
Correct answer: Low-molecular-weight heparin (LMWH)
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:
- 100–200
- 400–600 (Correct answer)
- 800–1200
- 1500–2000
Correct answer: 400–600
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)?
- Warfarin
- Fondaparinux
- Argatroban (Correct answer)
- Rivaroxaban
Correct answer: Argatroban
Argatroban is a direct thrombin inhibitor approved for anticoagulation in HIT; it is monitored by aPTT and does not require anti-Xa levels.
Question 6: Sodium bicarbonate infusion should NOT be used to treat metabolic acidosis caused by which condition?
- Bicarbonate-wasting renal tubular acidosis
- Diabetic ketoacidosis (DKA) (Correct answer)
- Severe hyperchloremic acidosis from normal saline
- Ingestion of methanol or ethylene glycol
Correct answer: Diabetic ketoacidosis (DKA)
In DKA, sodium bicarbonate is generally not recommended because it does not improve outcomes and may worsen hypokalemia, paradoxical CSF acidosis, and delay ketone clearance.
CCRN Critical Care Pharmacology 1
Which vasopressor is considered first-line for septic shock according to Surviving Sepsis Campaign guidelines?