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Pharm Quiz #2 > ACLS > Flashcards

ACLS Flashcards

1
Q

If Adult Cardiac Arrest what do you do 1st?

A

Shout for help/activate emergency response

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2
Q

After you Shout for help/activate emergency response, what do you do next?

A

Start CPR

  • Give oxygen
  • Attach monitor/defibrillator
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3
Q

After you started CPR what do you do?

A
  • Check rhythm
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4
Q

What if the patient is in VF/VT?

A

Shock

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5
Q

After check rhythm…

A
  • Give continuous CPR, and monitor CPR quality for 2 minutes
  • Drug Therapy
    1. IV access
    2. Epinephrine every 3-5 minutes
    3. Amiodarone for refractory VF/VT
  • Consider Advanced Airway: quantitative waveform capnography
  • Treat reversible causes
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6
Q

After you shock 1st time, what do you do?

A

CPR 2 min with IV/IO acces

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7
Q

After shocked 1st time and 2nd round CPR, then what?

A

Is rhythm shockable?

  1. Yes: so shock, then CPR 2 min, Epinephrine every 3-5 minutes, Consider Advanced Airway
  2. NO: no signs of return to spontaneous circulation, either do
    a.) CPR 2 min with IV/IO acces, Epinephrine every 3-5 minutes, Consider Advanced Airway
    OR
    b.) CPR 2 min, Treat reversible causes
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8
Q

After shocked 2nd time and 3rd round CPR, then what?

A

Is rhythm shockable?

  1. Yes: so shock, then CPR 2 min, Amiodarone, Treat reversible causes
  2. NO: no signs of return to spontaneous circulation, either do
    a.) CPR 2 min with IV/IO acces, Epinephrine every 3-5 minutes, Consider Advanced Airway
    OR
    b.) CPR 2 min, Treat reversible causes
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9
Q

After initial start of CPR and Rhythm is not shockable (asytole/PEA) then what?

A

CPR 2 min with IV/IO access, Epinephrine every 3-5 minutes, Consider Advanced Airway

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10
Q

If Persistent Tachycardia IS causing Hypotension, acutely altered mental status, signs of shock, or ischemic chest discomfort, or acute heart failure?

A

Synchronized Cardioversion

  • consider sedation
  • if narrow complex, consider adenosine
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11
Q

If Persistent Tachycardia IS NOT causing Hypotension, acutely altered mental status, signs of shock, or ischemic chest discomfort, or acute heart failure?

A

Look at if there is a Wide QRS (greater than 0.12 seconds)

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12
Q

Yes Persistent Tachycardia has a Wide QRS (greater than 0.12 seconds)

A
  • IV access and 12-lead EKG
  • Consider adenosine only if regular and monomorphic
  • Consider antiarrhythmic infusion
  • Consider expert consultation
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13
Q

NO Persistent Tachycardia has a Wide QRS (greater than 0.12 seconds)

A
  • IV access and 12-lead EKG
  • Vagal Maneuvers
  • adenosine (if regular)
  • Beta blocker or calcium channel blocker
    • Consider expert consultation
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14
Q

If Persistent Bradycardia IS NOT causing Hypotension, acutely altered mental status, signs of shock, or ischemic chest discomfort, or acute heart failure?

A

Monitor and observe

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15
Q

If Persistent Tachycardia IS causing Hypotension, acutely altered mental status, signs of shock, or ischemic chest discomfort, or acute heart failure?

A
  • Atropine IV dose:
    1st dose: 0.5mg bolus
    repeat every 3-5 mins
    max = 3 mg

OR
- Dopamine IV infusion:
2-10 mcg/kg per min

OR
- Epinephrine IV infusion:
2-10 mcg/kg per min

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16
Q

Epinephrine Dose

A

o 1 mg every 3 5 minutes in adult cardiac arrest; follow each dose with 20 ml flush
o Intraosseous administration
o ET capable- 2 to 2.5 mg

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17
Q

Epinephrine MOA

A

o May restore electrical activity in asystole
o During resuscitation causes heart to contract faster and more forcefully due to beta stimulation
o Vasoconstriction due to alpha stimulation
o Bronchodilation due to beta2 effect

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18
Q

Epinephrine Indications

A

o All types of cardiac arrest, anaphylaxis, acute asthmatic attacks

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19
Q

Watch for with Epinephrine

A

o Use with caution in angina, hypertension, hyperthyroidism

o Patients over 40 years old with heart rate greater than 120/min.

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20
Q

ADR of Epinephrine

A

o Tachycardia

o Increased blood pressure

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21
Q

Vasopressin Dose

A

o 40 Units IV push one time (vial)

o Intraosseous administration

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22
Q

Vasopressin MOA

A

o Potent vasoconstrictor effect

o Increases contractility of smooth musculature especially of coronary arteries

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23
Q

Vasopressin indications

A

o Alternative vasoconstrictor to epinephrine

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24
Q

Vasopressin ADR

A 
o	Arrhythmias
o	Myocardial ischemia
o	Angioedema
o	Bronchoconstriction
o	Anaphylaxis
•
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25
Q

Amiodarone Dosing

A

o Cardiac arrest- 300 mg IV push, consider repeat doses of 150 mg in 3-5 minutes
o Wide-Complex Tachycardia- 150 mg IV over first 10 minutes (repeat every 10 minutes PRN); slow infusion 360 mg IV over 6 hours
o Intraosseous administration

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26
Q

Amiodarone MOA

A

o Affects sodium, potassium and calcium channels which contributes to slowing of conduction and prolongs refractoriness in the AV node
o Alpha and beta blocking properties
o Lengthens cardiac action potential

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27
Q

Amiodarone Indications

A

o Wide variety of atrial and ventricular tachyarrhythmias

28
Q

Amiodarone ADR

A

o Vasodilation
o Hypotension
o Negative inotropic effects

29
Q

Atropine Sulfate Dosing

A

o 500 mcg to 1 mg IV push in bradycardia
o 1 mg IV push in asystole or PEA
o Dose may be repeated at 3 5 minute intervals
o Give dose rapidly (slow administration causes transient decrease in heart rate)
o Intraosseous administration

30
Q

Atropine Sulfate MOA

A

o Enhancement of conduction through AV junction by parasympathetic blockade

31
Q

Atropine Sulfate Indications

A

o Sinus bradycardia with a pulse less than 60/min
o When accompanied by PVCs, systolic pressure less than 90 mm Hg or other signs of decreased perfusion
o Asystole
o Bradycardic PEA

32
Q

Avoid Atropine Sulfate if

A

o Atrial flutter/fibrillation with rapid ventricular response

33
Q

Watch for these if on Atropine Sulfate

A

o Increased myocardial oxygen demand trigger of tachycardias

34
Q

Atropine Sulfate ADR

A

o Flushing of skin
o Dryness of mouth
o Tachycardia
o Pupillary dilation

35
Q

Adenosine dose

A

o 6 mg rapid IV push (over 1 3 seconds)

o Follow each bolus immediately with 20 ml flush of 0.9% sodium chloride

36
Q

Adenosine MOA

A

o Decreases conduction of electrical impulse through AV node

37
Q

Adenosine Indications

A 
o	PSVT (narrow complex) refractory to normal vagal maneuvers
o	Tachycardia (wide complex) of uncertain type post  lidocaine administration
38
Q

Watch for with Adenosine

A

o in 2nd/3rd degree heart block
o Sick sinus syndrome
o Dysrhythmias other than PSVT

39
Q

Adenosine ADR

A

o Facial flushing, headache, dizziness, nausea, chest pain or tightness, brief episodes of bradycardia, asystole

40
Q

Diltiazem dose

A

o 0.25 mg/kg actual body weight as a bolus administered over 2 minutes
 20 mg is a reasonable dose for the average patient
o Second bolus dose should be 0.35 mg/kg actual body weight administered over 2 minutes
 25 mg is a reasonable dose for the average patient).

41
Q

Diltiazem MOA

A

o Inhibits the influx of calcium ions during membrane depolarization of cardiac and vascular smooth muscle
o Ability to slow AV nodal conduction time and prolong AV nodal refractoriness

42
Q

Diltiazem Indications

A

o Atrial fibrillation or atrial flutter

o Paroxysmal supraventricular tachycardia

43
Q

Watch for with Diltiazem

A

o Refractoriness that may rarely result in second- or third-degree AV block in sinus rhythm
o Caution should be exercised when using the drug in severe heart failure
o Occasionally result in symptomatic hypotension
o VPBs may be present on conversion of PSVT to sinus rhythm

44
Q

Diltiazem ADR

A 
o	Asymptomatic hypotension 
o	Symptomatic hypotension 
o	Site reactions
o	Vasodilation
o	Arrhythmia
45
Q

Verapamil dose

A

o 2.5 to 5 mg IV Push over 2 minutes
o Repeat doses of 5 to 10 mg every 15 minutes to a total maximum of 20 mg
 Alternative- 5 mg bolus every 15 minutes for a total of 30 mg

46
Q

Metoprolol dose

A

o 5 mg by slow intravenous or intraosseous push at 5 minute intervals to a total of 15 mg

47
Q

Metoprolol MOA

A

o Beta-adrenergic receptor blocking agent

o Preferential effect on beta1 adrenoreceptors, chiefly located in cardiac muscle

48
Q

Metoprolol indications

A

o Rate control in narrow-complex tachycardias that originate either from a reentry mechanism (reentry SVT) or an automatic focus uncontrolled by vagal maneuvers and adenosine in the patient with preserved ventricular function
o Rate control in atrial fibrillation and atrial flutter in the patient with preserved ventricular function

49
Q

Metoprolol ADR/watch for

A

o Decrease in sinus heart rate in most patients
o May produce significant first- (P-R interval greater than or equal to 0.26 sec), second-, or third-degree heart block
o Hypotension
o Patients with bronchospastic diseases should, in general, not receive beta blockers

50
Q

Magnesium Sulfate Dose

A

o 1 to 2 g IV push (diluent of 10 ml 5% dextrose injection) over 5 to 20 minutes
o Doses may go as high as 6 g in torsades with pulses
 1 -2 g mixed in 50-100 ml 5% dextrose as loading dose

o Infusion:
 500 mg to 1 g per hour infusion in torsades

51
Q

Magnesium Sulfate MOA

A

o Unknown mechanism although may involve inhibition of acetylcholine release

52
Q

Magnesium Sulfate Indications

A

o Torsades, VF/VT associated with known or suspected hypomagnesemia and severe refractory VF

53
Q

watch for with Magnesium Sulfate

A

o Rapid administration may cause mild bradycardia, hypotension, flushing, sweating

54
Q

Magnesium Sulfate ADR

A

o Circulatory collapse, respiratory paralysis, decreased reflexes, flaccid paralysis

55
Q

Lidocaine (syringe) Dose

A 
o	Cardiac Arrest:
	1 1.5 mg/kg IV push 
o	Refractory VF:
	See above starting dose the subsequent doses of 0.5 0.75 mg/kg every 5 10 minutes to 3 mg/kg maximum
o	ET Tube Capable:
	2-4 mg/kg
56
Q

Lidocaine MOA

A

o Decrease automaticity, depolarization and excitability in ventricles during diastolic phase by direct action on nerve tissue

57
Q

Lidocaine Indications

A

o PVCs associated with acute myocardial infarction

o Prevention of recurrence of ventricular fibrillation and to treat ventricular tachycardia and ventricular fibrillation

58
Q

Watch for with Lidocaine

A

o Known allergy to lidocaine/”caines”
o 2nd or 3rd degree heart block
o Sinus bradycardia/ sinus arrest

59
Q

Lidocaine ADR

A

o Decrease in cardiac output and blood pressure
o Drowsiness, slurred speech, altered consciousness
o Rare seizures
o Respiratory depression

60
Q

Sodium Bicarbonate (syringe) dose

A

o 1 mEq/kg IV push followed by 0.5 mEq/kg every 10 minutes depending on results of arterial blood gas values

61
Q

Sodium Bicarbonate MOA

A

o Restores the body’s buffering capacity and neutralizes excess acid

62
Q

Sodium Bicarbonate Indications

A

o Metabolic acidosis, hyperkalemia, drug overdose

63
Q

Sodium Bicarbonate Watch for’s

A

o Inactivation of dopamine (acidic) infusion

o Induction of intracellular acidosis with resulting negative inotropic effect

64
Q

Sodium Bicarbonate ADR

A

o Local pain and irritation at injection site
o Hyperosmolarity
o Hypernatremia

65
Q

POISONING basic steps

A
  • Establishment of an airway
  • Ventilation
  • Maintenance of adequate vital signs
  • Measure often and accurately
  • Accurate temperatures
  • Respiratory rate carefully counted
  • Unconscious: Naloxone, Oxygen,
    Dextrose?

Pharm Quiz #2 (6 decks)

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