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Pharmacology quiz 2 > ACLS > Flashcards

ACLS Flashcards

1
Q

which drugs used in cardiac arrest are prepared in a syringe for you?

A

epinephrine, atropine sulfate, adenosine, lidocaine, sodium bicarbonate

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2
Q

which drugs used in cardiac arrest require a vial and syringe?

A

vasopressin, amiodarone, diltiazem, verapamil, metoprolol, magnesium sulfate

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3
Q

effects of epinephrine

A

restore electrical activity in asystole, beta stimulation causes stronger and faster contraction, alpha stimulation causes vasoconstriction, bronchodilation due to beta2 activation

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4
Q

uses for epinephrine

A

cardiac arrest, anaphylaxis, acute asthmatic attacks

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5
Q

When should epinephrine not be used/watched carefully?

A

angina, HTN, hyperthryroid, >40 y/o with HR > 120

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6
Q

ADR of epinephrine

A

tachycardia, increased BP

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7
Q

how is epinephrine prepared?

A

1mg/10ml

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8
Q

how is a 1mg/1ml vial of epi diluted?

A

up to 1mg/10ml

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9
Q

effects of vasopressin

A

vasoconstriction, increases contractility of SM and coronary arteries

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10
Q

ADR of vasopressin

A

arrhythmias, myocardial ischemia, angioedema, bronchoconstriction, anaphylaxis

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11
Q

MOA of amiodarone?

A

affects Na, K and Ca channels to prolong refractoriness in the AV node, alpha and beta blocking capabilities

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12
Q

uses of amiodarone

A

atrial and ventricular tachyarrhythmias

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13
Q

ADR of amiodarone

A

vasodilation, HOTN, negtive inotropic effects

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14
Q

MOA of atropine sulfate?

A

parasympathetic blockade, anticholinergic - enhances condustion through Av node

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15
Q

uses for atropine sulfate

A

sinus bradycardia, systolic pressure <90 with PVCs or signs of decreased perfusion, asystole

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16
Q

when should atropine sulfate be avoided?

A

Aflutter, Afib with rapid ventricular response

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17
Q

things to watch for with atropine sulfate use

A

increased myocardial oxygen demand trigger of tachycardias

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18
Q

ADR of atropine sulfate

A

skin flushing, dry mouth, tachycardia, dilated pupils

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19
Q

what happens if atropine is given too slowly?

A

causes transient decrease in HR

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20
Q

MOA of adenosine

A

decreases conduction of electrical impulse through Av node

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21
Q

uses for adenosine

A

PSVT (narrow) refractory to normal vagal maneuvers, tachycardia (wide complex) of uncertain type post-lidocaine administration

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22
Q

what is important to watch for with adenosine administration?

A

2nd/3rd degree heart block, SSS, dysrhtymias

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23
Q

ADR of adenosine

A

facial flushing, HA, dizziness, nausea, CP/tightness, bradycardia, asystole

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24
Q

MOA of diltiazem

A

inhibits the influx of Ca ions during membrane depolarization of cardiac and SM, slows AV node conduction and prolong AV refractoriness

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25
Q

Uses for diltiazem in cardiac arrest

A

AF/flutter, PSVT

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26
Q

Things to watch for with diltiazem use

A

canr esult in 2nd or 3rd degree AV block, HF, symptomatic HF, ventricular premature beats on conversion of PSVT to sinus rhythm

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27
Q

Contraindications of diltiazem?

A

WPW

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28
Q

ADR of diltiazem

A

asymptomatic/symptomatic HOTN, site reactions, vasodilation, arrhythmia

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29
Q

MOA of metoprolol

A

beta adrenergic receptor blocking agent, Beta1

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30
Q

Uses of metoprolol in cardiac arrest

A

rate control in narrow-complex tachycardias originating from a reentrant mechanism (SVT) or an autonomic focus uncontrolled by vagal maneuvers and adenosine with preseved vantricular function, rate control in Afib/flutter

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31
Q

things to watch for with metoprolol use

A

decreased HR, AV blocks, HOTN, bronchospastic diseases

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32
Q

Moa of magnesium sulfate

A

may inhibit acetylcholine release

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33
Q

uses for magnesium sulfate

A

Tdp, VF/VT with known hypomagnesemia

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34
Q

things to watch for with magnesium sulfate

A

rapid administration may cause mild bradycardia, HOTN, flushing, sweating

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35
Q

ADR of magnesium sulfate

A

circulatory collapse, respiratory paralysis, decreased reflexes, flaccid paralysis

36
Q

lidocaine MOA

A

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

37
Q

Uses of lidocaine

A

PVCs with AMI, prevention of Vfib, to treat VT/VF

38
Q

things to watch for with lidocaine use

A

allergy to “caines”, 2nd or 3rd degree heart block, bradycardia, arrest

39
Q

ADR of lidocaine

A

low CO, low BP, drowsiness, slurred speech, altered consciousness, respiratory depression

40
Q

how does lidocaine come prepared?

A

100mg vials

41
Q

Moa for sodium bicarbonate

A

restores body’s buffering capacity

42
Q

uses for sodium bicarbonate

A

pre-exsting metbaolic acidoses, hyperkalemia, drug overdose

43
Q

things to watch for with sodium bicarbonate

A

inactivation of dopamine infusion (an acid), induction of intracellular acidosis leading to a negative inotropic effect

44
Q

ADR for sodium bicarbonate

A

local pain and irritation, hyperosmolarity, hypernatremia

45
Q

early treatment for poisoning

A

airway, maintain vitals, accurate temps, respiratory rate counted, if unconscious: naloxone, oxygen, dextrose if hypoglycemic

46
Q

Anticholinergic effects

A

delirium, tachycardia, dilated pupils, dry/flushed skin

47
Q

What can cause anticholinergic effects?

A

anithistamines, antiparkinsonism drugs, antipsychotics, muscle relaxants

48
Q

How to treat anticholinergic effects

A

muscle relaxants, activated charcoal, benzodiazepines, sodium bicarbonate, fluid, dopamine or vasopressors if needed

49
Q

effects of sodium bicarb

A

corrects acidosis, QRS prolongation

50
Q

effects of sympathomimetic agents

A

delusions, paranoia, tachycardia, HTN, hyperpyrexia, diaphoresis, mydriasis, hyper-reflexia

51
Q

What can cause sympathomimetic effects?

A

cocaine, amphetamines, decongestants, diet aids

52
Q

how can you treat sympathomimetic effects?

A

benzodiazepines, nitroglycerin, lidocaine, sodium bicarbonate

53
Q

active ingredient in bath salts

A

4-methylene-dioxypyrovalerone (MDPV)

54
Q

How are pts who take bath salts treated?

A

same as for amphetamines, airway, get glucose to r/o hypoglycemia, chemical restraint (ativan, valium, diazepam), treat HTN, seizure control with benzodiazepines, gastric decontamination, core temp monitoring

55
Q

is there an antidote for bath salts?

A

nope

56
Q

effects of depressant toxicity

A

coma, respiratory depression, miosis, HOTN, bradycardia, diminished bowel sounds, hyporeflexia

57
Q

what can cause toxic depressant effects?

A

opiates (codeine, morphine, heroin), barbituates, benzodiazepines, ethanol

58
Q

how to treat opiate toxicity

A

naloxone

59
Q

how to treat benzodiazepine toxicity

A

flumazenil - be cautious, could become more aggressive

60
Q

if a pt has opiate toxicity, what else do they likely have?

A

benzodiazepine toxicity

61
Q

true or false: drug overdose death rates in the US have more than tripled since 1990

A

TRUE

62
Q

effects of opiate toxicity

A

sedation, respiratory depression

63
Q

how long do opiates usually take to peak effect?

A

2-3 hours but long-acting dosage forms since opiates slow GI transit so there might be delayed peak effects

64
Q

true or false: fentanyl patch effects can last after the patch has been removed

A

TRUE

65
Q

clinical presentation of a mild to moderate opiate overdose

A

lethargy, pinpoint pupils, HOTN, low pulse, diminished bowel sounds, flaccid muscles

66
Q

clincial presentation of a severe opiate overdose

A

coma, respiratory depression

67
Q

Opiate overdose treatment

A

airway, ventilation, oxygen, treat the coma, HOTN and seizures, naloxone

68
Q

how are seizures treated?

A

methadone, codeine, tramadol

69
Q

What is important to consider when prescribing naloxone for opiate overdose

A

opiates stick around longer than naloxone because of its short half life so you might need to give more than 1 dose

70
Q

cholinergic-like effects

A

confusion, CNS depression, weakness, salivation, lacrimation, urinary/fecal incontinance, PE, seizures

71
Q

What drugs can cause cholinergic-like effects

A

organophosphates (nuclear chemical drugs), exposure to acetylcholinesterase inhibitor

72
Q

treatment for cholinergic toxicity

A

atropine, pralidoxime

73
Q

MOA for pralidoxime

A

reactivates cholinestease outside the CNS which had been phosphorylated by an organophosphate

74
Q

why is atropine always used concommitantly with pralidoxime

A

blocks the effect of accumulated acetylcholine at the site of action of pralidoxime

75
Q

MOA fo syrup of ipecac

A

local irritation of gastric mucosa and stimulation of chemoreceptor trigger zone

76
Q

ADR of syrup of ipecac

A

arrhythmias, myocarditis after excessive doses

77
Q

what counteracts syrup of ipecec?

A

activated charcoal

78
Q

Moa of activated charcoal

A

adsorbs various toxins in the GI tract, greatest benefit only up to 60 minutes post infection

79
Q

ADR of activated charcoal

A

vomiting from rapid ingestion, constipation, diarrhea

80
Q

How can the risk of vomiting with activated charcoal be reduced?

A

sorbitol along with first dose

81
Q

antidote for antifreeze

A

fomepizole

82
Q

antidote for benzodiazepines

A

flumazenil

83
Q

antidote for iron toxicity

A

deferoxamine mesylate

84
Q

antidote for digoxin

A

digoxin immune fab

85
Q

antidote for glucagon

A

insulin induced hypoglycemia

86
Q

antidote for acetaminophen

A

acetylcysteine

Pharmacology quiz 2 (6 decks)

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