7) intro to therapy

Question 1

CHART Narrative:

Answer 1

Chief Complaint, History(includes SAMPLE), Assessment (head-to-toe), Rx/Treatments, Transport

Question 2

(Adenosine) class:

Dynamics:

Answer 2

= Misc antiarrhythmic binds to adenosine A1 receptors causes efflux of K & inhibits Ca influx (in autoarhythmic cells)
= Causes hyperpolarization of autorhythmic cells (SA/AV node)
Slows AV conduction w/ very short half-life

Question 3

(Adenosine) indications:

contraindications

Answer 3

= 1st for stable narrow complex SVT, Regular & monomorphic wide-complex Tcardia thought from a reentry SVT (SVT w/ BBB)
= Torsades de pointes, Poison/drug-Tcardia, 2nd or 3rd AVB, WPW,DOESNT CONVERT A-FIB/FLUTTER

Question 4

(Adenosine) Effects:
Dose:

admin notes:

Answer 4

= periods of sinus Bcardia/asystole & ventricular ectopy after admin
= 1st dose 6mg rapid IV/IO push followed w/ rapid flush &2nd dose 12mg also rapid push & flush
= rapid push followed by rapid flush 20mL fluid best accomplished w/ 3-way stopcock & 1/2 initial dose in PTs receiving dipyridamole or carbamazepine, heart transplant, or if given by central venous access

Question 5

(Amiodarone) Class:
Dynamics:

Indi:

B/c its toxicity indi:
W/ expert consultation may be used for:
Terminal elimination:

Answer 5

= Class III antiarrhythmic
= Slows K+ efflux delaying repolarization on all of heart
= VF/Pulseless VT-no/response to shock CPR & Epi, Recurrent hemodynamically unstable VT w/ pulse
= PT w/ life-threatening arrhythmias w/ monitoring
= some atrial & ventricular rhythms w/ life-threatening hypoBP
= Extremely long (half-life lasts max 40 days)

Question 6

(Amiodarone) Contra:
Effects:
Caution b/c:

Answer 6

= Allergic, Bradycardias w/ AV blocks, Breastfeeding mothers
= Severe hypotension, Bradycardia, Prolong QT which can lead to TdP
= Toxicity, Causes severe BP drop, Prolong QT which can lead to TdP

Question 7

(Amiodarone) Max total dose per day:
Slow Infusion dose:
Maintenance Infusion dose:
VF/Pulseless & VT Cardiac Arrest Unresponsive 1st Dosage:
VF/Pulseless & VT Cardiac Arrest Unresponsive 2nd Dosage:
Life-Threatening Arrhythmia 1st Dosage:
Life-Threatening Arrhythmia 2nd Dosage:

Answer 7

= 2.2 grams
= 360 mg IV 6Hrs (1mg/min)
= 540 mg IV 18Hrs (0.5 mg/min)
= 300 mg IV/O push
= 150 mg IV/O push if needed
= 1st Dose: Rapid Infusion 150 mg/10 mins (15 mg/min)
= 2nd Dose: 150mg/10 mins (15 mg/min) if needed

Question 8

(Aspirin) Class:
Dynamics:

Answer 8

= NSAID & COX inhibiter
= Blocks cyclooxygenase (enzyme that’s basically alarm bell for body)
COX acts upon Arachidonic Acid which in turn gen/s Thromboxane A2, a compound that reg/s the activation of platelets to form a clot

Question 9

(Aspirin) indications:
Contraindications:

Answer 9

= Cardiac S/S w/ ischemia etiology
= common allergy, Bronchospasm, Angiodema

Question 10

(Aspirin) effects:
Avoid:
dose:

Answer 10

=Can cause bromchoconstriction in ~10% asthmatic PTs, N/V, upset GI
= enteric-coated Aspirin when admin/ing to PT w/ cardiac S/S
= 160-325mg PO of non-entric coated ASA

Question 11

(Atropine) class:
Dynamics:

Answer 11

= parasympatholytic
= selectively blocks muscarinic receptors inhibiting the parasympathetic NS “Vagus N. Blocker”- letting sympathetic take over

Question 12

(Atropine) indications:

Contraindications:
Avoid:

Answer 12

= 1st med/ for symptomatic sinus Bcardia, Maybe beneficial AV block, Organophosphate poisoning (large dose r/q) hypothermic Bcardia
= Allergic to drug, Use w/ extreme caution w/ myocardial ischemia
= causes increased myocardial O2 demand so caution w/ Hblock & Doses <0.5mg may result in paradoxical slowing of the heart
May not be effective for infranodal blocks- be prepared to pace

Question 13

(Atropine) Adverse effects:
Bradycardia (w/ or w/o ACS) Dosage:
severe clinical conditions dosage:
organophosphate poisoning dosage:

Answer 13

= Blurred vision, Dry mouth, Dilated pupils, Confusion
=1 mg IV push every 3-5mins as needed (0.04mg/Kg (total 3mg)
=1 mg IVP every 3 mins
= 2-4mg (or higher) IVP

Question 14

(Diltiazem/Cardizem)class:
pharmacodynamics:

Answer 14

= IV (4) antiarrhythmic Ca channel blocker
= slows auto arrhythmic cells AP in heart atriums by blocking Ca channels

Question 15

(Diltiazem/Cardizem)indi/s:

Contraindications:

Answer 15

= 1st med for AFib/Flutter w/ RVR (>150bpm), 2nd med for SVT refractory to Adenosine
= hypoBP, CHF/cardio/shock, Wide-complex Tcardia, WPW, Hypersensitivity

Question 16

(Diltiazem/Cardizem)effects:
1st dose:
2nd dose:

Answer 16

= HypoBP, Pos/ CHF if used w/ beta-blockers , N/V/D, Dizziness, H/A
= 0.25mg/kg w/ max dose of 20mg
= 0.35 mg/kg w/ max dose of 25mg

Question 17

(Epinephrine 1:10,000) Class:
Dynamics:

Answer 17

= SNS agonist, Sympathomimetic
= Powerful Alpha and Beta agonist

Question 18

(Epinephrine 1:10,000) Effects:

Admin via:
(Adult) Cardiac Arrest dose:
(Adult) Bradycardia dose:
(PEDI) Bradycardia/Cardiac Arrest dose:
(PEDI) Hypoperfusion & Severe anaphylaxis dose:

Answer 18

= Palpitations, Anxiety, Jitters, H/A, Dizziness, HyperBP, Tcardia, Can worsen cardiac ischemia
= IV infusion drip
= 1mg IVP/IOP every 3-5 mins
= 2-10 mcg/min IV/IO infusion
= 0.01 mg/kg or 0.1 mL/kg
= 0.1-1 mcg/kg/min infusion by Mixing 1mg of Epi 1:10 into 1L IV bag

Question 19

(Epinephrine 1:10,000) Indications:
Contraindications:

Answer 19

= Cardiac arrest, Bcardia, Normovolemic hypoBP, Anaphylaxis, Asthma
= rewards over risks so really none

Question 20

(Labetalol) class:
pharmacodynamics:

Answer 20

= beta-blocker
= Blocks adrenergic stim/ on B-receptors, causing a slowing of HR

Question 21

(Labetalol) Indications:

Contraindications:
Do not administer to PTs w/ STEMI if following present:

Answer 21

= 2nd med/ for SVT after admin/ Adenosine, A-Fib/Flutter w/ RVR Reduce myocardial ischemia in AMI PTs w/ +HRs, Antihypertensive
= Increased risk of cardiogenic shock Hypotension Bradycardia
= signs of heart failure Low cardiac output

Question 22

(Labetalol) Adverse Effects:

Max dose:
Adult Dose:

Answer 22

= admin/ after IV Ca-channel blockers can cause severe hypotension, Bcardia, heart blocks & CHF
= 150mg
= 10 mg IV/O push 1-2 mins & May repeat every 10 mins to max dose

Question 23

Lidocaine) Class:
Dynamics:

Answer 23

= Ib Antiarrhythmic
= Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity in ventricles

Question 24

(Lidocaine) Ind:

Contra:

Effects:

Answer 24

= Stable monomorphic VT w/ preserved LVF & Alternative to Amiodarone in cardiac arrest by VF/pVT
= Shouldn’t use if PT already received IV Ca channel blockers, Not given prophylactically in AMI setting
= Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension

Question 25

(Lidocaine) Max dose:
Cardiac Arrest from VF/pVT dose:
Refractory VF dose:
Perfusing Arrhythmia dose:
Maintenance Infusion dose:

Answer 25

= 3 mg/kg
= 1-1.5 mg/kg IV/IO
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= 1-4mg/min (30-50 mcg/kg/min)

Question 26

(Mag-Sulfate) Class:
Dynamics:

Answer 26

= Misc. Airway med, Mineral, powerful noradrenergic bronchodilator
= Organic Salt act as a physiologic Ca-channel blocker Bronchodilator

Question 27

(Mag-Sulfate) Indi:

Contra:
Effects:

Answer 27

= cardiac arrest only if Torsades de Pointes (Tdp) suspected, Tdp w/ pulse
= AMI not recommended, High degree AV block, HypoBP, VFib/Tach
= Bcardia, HypoBP, Diaphoresis, Resp/ depres/, Hypothermia

Question 28

(Mag-Sulfate) Effects:
Bronchodilation Adult Dose:
Bronchodilation Pedi Dose:

Answer 28

= Flushing, Sweating, B-cardia, Resp/ depres/, Hypothermia
= 1-2G IV/IO over 10-20 mins (Infusion)
= 25-50 mg/kg IV/IO (max 2G) over 15-30 mins (Infusion)

Question 29

(Nitroglycerin) indications:
Contraindications

Answer 29

= Symptoms suggestive of Myocardial ischemia CHF
= HypoBP (SBP<90 or >30 below baseline BP) Severe Bcardia<50bpm, Tcardia>100bpm, Use of phosphodiesterase inhibitors (Boner pills) in last 48 hours, Increased ICP

Question 30

(Nitroglycerin) effects:

dose:

Answer 30

=H/A, Dizziness, Weakness, Tcardia, HypoBP (tablets lose effectiveness after exposed to sun/air)
= 0.4mg SL (pill or spray) → repeat 3x (Q5 mins) for total dose of 1.2mg
DONT SHAKE SPRAY B/C AFFECTS DOSE

Question 31

(Procainamide)class:
Dynamics:

Answer 31

= 1a antiarrhythmic
= Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity

Question 32

(Procainamide) indications:

Contra:

Answer 32

=V-Tach w/ pulse, Pre-excitation rhythms (WPW)
=Shouldn’t admin to PTs received IV Ca channel blocker

Question 33

Procainamide)effect:

4 ending points:

Answer 33

= Drowsy, Slurred speech, Confusion, Seizures, HypoBP
= 1. Termination of rhythm, 2. HypoBP, 3. Widening QRS>50%, 4. Meet the max total dose

Question 34

(Verapamil) class:
pharmacodynamics:

Answer 34

= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels

Question 35

(Verapamil) indications:

Contraindications:

Answer 35

= 2nd med for A-Fib/Flutter w/ RVR, May use as alterative med (after adenosine), narrow QRS complex Tcardia w/ preserved LV function
= HypoBP (SBP<90), CHF/cardio/ shock, Wide-complex Tcardia, WPW
Hypersensitivity to med

Question 36

(Verapamil)1.May cause:
2. Effects:
3. Max total dose:
4. 1st dose:
5. 2nd dose:

Answer 36

1.= more profound hypotension response than that of Diltiazem
2.= Severe CHF may result if used w/ beta-blocker, N/V/D, Dizziness, H/A
3.= 20mg
4.=2.5-5mg IV/O bolus 2-3min
5.= 5-10mg over 2-3 mins

Question 37

Medical PT) Unstable:

Stable:

Answer 37

= AMS, Rapid assess, Basline V/S, Hx of present illness & SAMPLE
= SBP >90, Hx of present illness (HPI), Perform Focused, Assessment, Hx of present illness & SAMPLE

Question 38

What is considered the first line medication for the treatment of symptomatic and stable bradycardia? Atropine

A premature ventricular contraction (PVC) that occurs between two regular beats and doesn’t cause a drop in a QRS complex is known as a(n): Interpolated pause

An ECG strip that has 30 small boxes in between each R wave would represent a heart rate of: 50BPM
A ventricular rhythm that had a rate greater than 100 beats per minute is known as ___Ventricular Tachycardia___

A normal QRS complex represents what in the ventricles?
Answer: ventricles in synchioum
Four small vertical boxes on an ECG represents 0.4 mV’s.

A run of more than three PVC’s in a row is known as a: Run of VTach
Atropine is administered at a dose of 1 mg IVP every 3-5 minutes for the treatment of bradycardia in an adult?

Question 39

RP of a cardiac contractile cell is
AP of a cardiac contractile cell is
Rapid influx of ion causes depolarization contractile cells:
Efflux of what ion causes repolarization:

Answer 39

= -90 mV’s
= -85 mV’s.
= Sodium
= Potassium

Question 40

RP of a cardiac autorhythmic cell is:
AP of a cardiac autorhythmic cell is:
Influx of what causes depolarization of autorhythmic cells:
Efflux of what ion causes repolarization:

Answer 40

= -60mVs
= -40mVs
= Calcium
= Potassium

Question 40

What is considered the first line medication for the treatment of symptomatic and stable SVT? Adenosine
The second dose of Adenosine is: 12 mg RIVP
The initial dose of Adenosine is: 6 mg

Question 41

A normal QRS complex width should be between ___1 small box / 0.04Secs___ and ___3 Small boxes/ 0.12___ seconds.
A normal PR Interval is between ___3 small boxs/ 0.12 Secs___ and ___5 small boxes/ 0.20seconds___ seconds.
Four small horizontal boxes on an ECG represents _ 0.16___ seconds

Question 41

In cardiac arrest, Epinephrine (1:10,000) is administered to a patient at a dose of: 1 mg IVP

Question 42

Lidocaine can be administered to a patient that presents with a V-Tach rhythm that is symptomatic and stable at a dose of: 1 mg/kg IV over 2 minutes

Question 43

A premature beat that results in a narrow QRS complex and has a P wave in front of it is known as a: Premature Atrial Contraction
A premature beat that has no P wave and results in a wide QRS complex is known as a: Premature Ventricular Contraction (PVC).
A wide QRS complex represents what is occuring in the ventricles? delayed or abnormal ventricular depolarization.
A premature beat that has no P wave and has a narrow QRS complex is known as a: (PJC) Premature Junctional Contraction

Question 44

A heart block that has normal and constant PR Interval for P waves that are in front of a QRS complex, but also has P waves that don’t have QRS complexes is known as a: Mobitz 2
A heart block that has an increasingly longer PRI until a QRS complex is dropped is known as a: Weckebach
A heart block in which there is no relationship between the atriums and the ventricles is known as a: 3rd/complete degree
A heart block that produces prolonged but constant PR Intervals is known as a: 1st degree

Question 44

An agonal idioventricular rhythm would have a rate less than ___15___ beats per minute.
An accelerated idioventricular rhythm would have a rate between ___41___ and ___100___ beats per minute.
An idioventricular rhythm would have a rate between ___15___ and ___40___ beats per minute.

Question 44

The residual pressure in the aorta that the left ventricle must overcome to eject blood out of the heart is known as: Afterload Pressure

Question 45

The purkinje fibers have an inherent firing rate of ___15___ to ___40___ beats per minute.
The atrioventricular (AV) node has an inherent firing rate of ___40___ to ___60___ beats per minute.
The sinoatrial (SA)node has an inherent firing rate of ___60___ to ___100___ beats per minute.

Question 45

A junctional tachycardia rhythm would have a rate greater than ___100___ beats per minute.
An accelerated junctional rhythm would have a rate between__61___ and ___100___ beats per minute.
A junctional bradycardia rhythm would have a rate less than ___40___ beats per minute.

Question 46

What is considered the first line medication for the treatment of symptomatic and stable A-Fib with RVR at a rate of 190 beats per minute? Diltiazem

Question 47

Amiodarone can be administered to a patient that presents with pulseless V-Tach at a dose of: 300 mg IVP
Amiodarone can be administered to a patient that presents with a V-Tach rhythm that is symptomatic and stable at a dose of: 150 mg over 10 minutes

Question 47

What accessory pathway is associated with Wolff-Parkinson White Syndrome? Bundle of Kent