AHA Advanced ECG and Pharmacology Flashcards
1
Q
State the non-arrest dose for adenosine
A
6mg given rapidly over 1 - 3 seconds, followed by NS bolus of 20mL; then elevate the extremity
2
Q
______ is the first drug for most forms of stable, narrow-complex SVT. Effective in terminating those due to reentry involving AV node or sinus node.
A
Adenosine
3
Q
True/False: adenosine may be considered for unstable narrow-complex reentry tachycardia
A
True
May consider for unstable narrow-complex reentry tachycardia while preparations are made for cardioversion
4
Q
________ is indicated for regular, monomorphic wide-complex tachycardia, thought to be or previously defined to be reentry SVT
A
Adenosine
5
Q
True/False: adenosine is indicated for atrial fibrilation, atrial flutter, or VT
A
False
Adenosine does not convert atrial fibrilation, atrial flutter, or VT
6
Q
_______ is indicated as a diagnostic maneuver in stable, narrow-complex SVT
A
Adenosine
7
Q
True/False: adenosine is indicated in poision/drug-induced tachycardia
A
False
Adenosine is contraindicated in poision/drug-induced tachycardia
8
Q
True/False: Adenosine is contra-indicated in second- or third-degree heart block
A
True
9
Q
List the transient side effects of adenosine
A
Flushing
Chest pain/tightness
Brief periods of asystole/bradycardia
Ventricular ectopy
10
Q
Adenosine is less effective (and hence, larger doses may be required) in patients taking ______
A
Adenosine is less effective (and hence, larger doses may be required) in patients taking theophylline or caffeine
11
Q
The initial dose of adenosine should be reduced to 3mg in patient’s receiving ______ or _______, heart transplant patients or if given by _______ ______ ______
A
The initial dose of adenosine should be reduced to 3mg in patient’s receiving dipyridamole or carbamazepine, in heart transplant patients, or if given by central venous access
12
Q
Adenosine administered for irregular, polymorphic, wide-complex tachycardia/VT, may cause ________
A
Deterioration (including hypotension)
13
Q
True/False: adenosine is unsafe in pregnancy
A
False
Adenosine is safe in pregnancy
14
Q
State the subsequent, non-arrest dose of adenosine
A
A second dose of 12mg can be given in 1 - 2 minutes if needed
15
Q
Outline the injection technique of adenosine
A
Record rhythm strip during administration
Draw up adenosine dose and flush in 2 separate syringes
Attach both syringes to the IV injection port closest to patient
Push IV adenosine as quickly as possible (1 to 3 seconds)
While maintaining pressure on adenosine plunger, push NS flush as rapidly as possible after adenosine
Unclamp IV tubing
16
Q
State the initial arrest dose of amiodarone
A
300mg IV/IO, push
17
Q
State the initial non-arrest dose of amiodarone
A
150mg IV over first 10min (15mg/min), rapid infusion
18
Q
True/False: amiodarone acts only on sodium channels
A
False
Amiodarone is a complex drug
Acts on sodium, potassium, and calcium channels
As well as α- and β- adrenergic blocking properties
19
Q
Because the use of amiodarone is associated with toxicity, it is indicated for use in patients with ____-_______ arrhythmias only with appropriate monitoring
A
Life-threatening
20
Q
_______ is indicated for VF/pulseless VT unresponsive to shock delivery, CPR and a vasopressor
A
Amiodarone
21
Q
_______ is indicated for recurrent, haemodynamically unstable VT
A
Amiodarone
22
Q
Amiodarone is indicated in which two situations
A
1) VF/VT cardiac arrest unresponsive to CPR, shock, and vasopressor
2) Life-threatening arrhythmias
23
Q
State the maximum cumulative dose of amiodarone in life-trheatening arrhythmias
A
2.2g IV over 24 hours
24
Q
Compare the 3 rates of administration of amiodarone in life-threatening arrhythmias
A
1) Rapid Infusion (15mg/min)
150mg IV over first 10min
May repeat every 10min as needed
2) Slow Infusion (1mg/min)
360mg IV over 6 hours
3) Maintenance Infusion (0.5mg per minute)
540mg IV over 18 hours
25
Rapid infusion of amiodarone may lead to \_\_\_\_\_\_\_
Hypotension
26
With multiple dosing of amiodarone, cumulative doses of \>2.2g amiodarone over 24hrs are associated with significant _______ in clinical trials
Hypotension
27
Do not administer amiodarone with other drugs that \_\_\_\_\_\_\_
Prolong the QT interval
e.g. procainamide
28
Terminal elimination of amiodarone is extremely long (half-life lasts up to __ days)
40 days
29
State the non-arrest dose of aspirin
160 - 300mg
30
State the preferred formulation of aspirin in the emergency setting
Non-enteric-coated tablet
31
\_\_\_\_\_ should be administered to all patients with ACS, particularly reperfusion candidates
Aspirin
32
Aspirin should be administered to all patients with ACS, particularly reperfusion candidates, unless \_\_\_\_\_\_
Hypersensitive to aspirin
33
Aspirin blocks the formation of thromboxane \_\_, which causes platelets to aggregate and arteries to constrict. This reduces overall ACS mortality, reinfarction, and nonfatal stroke
Thromboxane A2
34
\_\_\_\_\_ is indicated for any person with symptoms ("pressure," "heavy weight", "squeezing", "crushing") suggestive of ischaemic chest pain
Aspirin
35
Aspirin is *relatively* contraindicated in patients with _____ and \_\_\_\_\_
Active ulcer disease
Asthma
36
True/False: *swallowing* aspirin is preferable to *chewing* in the emergency environment
False
**Chewing** is preferred
37
State the alternate route of administration of aspirin in the emergency environment for patients that cannot take it in orally
300mg rectal suppository
38
State the non-arrest dose of atropine sulfate
0.5mg IV every 3 to 5 minutes as needed
39
\_\_\_\_\_ is the first drug for symptomatic sinus bradycardia
Atropine sulfate
40
\_\_\_\_\_ may be beneficial in presence of AV nodal block.
Unlikely to be effective for Type II second-degree and third-degree AV block, or block in non-nodal tissue
Atropine sulfate
41
True/False: atropine sulfate is routinely indicated for use during PEA or asytole
False
Routine use is unlikely to have a therapeutic benefit
42
In organophosphate poisoning, extremely large doses of _____ are likely to be needed
Atropine sulfate (2 - 4mg)
43
True/False: atropine sulfate increases myocardial oxygen demand
True
Use with caution in presence of myocardial ischaemia and hypoxia
44
Atropine sulfate should be avoided in ______ bradycardia
Hypothermic
45
List the two types of conduction abnormalities atropine sulfate may not be effective for, and what preparations should be made in these situations
_May not be effective in:_
i) Infranodal (Type II) AV block
ii) New third-degree block with wide QRS complexes
_In these patients, may cause **paradoxical slowing**:_
- Be prepared to pace *OR* give catecholamines
46
Doses of atropine ____ may result in paradoxical slowing of heart rate
\<0.5mg
47
State the maximum dose of atropine
0.04mg/kg (total 3mg)
48
\_\_\_\_\_\_\_ are indicated for all patients with suspected myocardial infarction and unstable angina (these are effective antianginal agents and can reduce the incidence of VF)
β-Blockers
49
\_\_\_\_\_\_ are second-line agents after adenosine in supraventricular tachyarrhythmias (reentry SVT, atrial fibrillation, or atrial flutter) to convert to normal sinus rhythm or to slow ventricular response (or both)
β-Blockers
50
\_\_\_\_\_\_\_ are indicated to reduce myocardial ischaemia and damage in AMI patients with elevated heart rzte, blood pressure or both
β-Blockers
51
\_\_\_\_\_\_\_ recommended for emergency antihypertensive therapy for haemorrhagic and acute ischaemic stroke
Labetolol
52
True/False: β-Blockers are all dosed equivalently
False
53
Early, aggressive β-blocker therapy may be hazardous in haemodynamically _______ patients
Unstable
54
β-Blockers should not be given to patients with STEMI if any of the following are present
1) SIgns of CCF
2) Low cardiac output
3) Increased risk for cardiogenic shock
55
A relative contraindication for β-blockers is a PR interval \_\_\_\_\_
\> 0.24 seconds
56
A relative contraindication for β-blockers is a SBP \_\_\_\_\_\_
SBP \< 100 mmHg
57
A relative contraindication for β-blockers is a ____ or _____ heart block
Second- or third-degree
58
A relative contraindication for β-blockers is a severe bradycardia/tachycardia
Bradycardia
59
IV administration of β-blockers with _____ channel blocking agents can cause severe hypotension and bradycardia/heartblock
Calcium channel blocking agents
Like verapamil or diltiazem
60
\_\_\_\_\_\_ is contraindicated in cocaine-induced ACS
Propanalol
Other β-blockers *relatively* contraindicated
61
State the initial non-arrest dose of diltiazem
_Acute Rate Control:_
15 to 20mg (0.25mg/kg) IV over 2 minutes
62
\_\_\_\_\_\_\_ is indicated to control ventricular rate in atrial fibrillation and atrial flutter, and may terminate reentrant arrhythmias that require AV nodal conduction for their continuation
Diltiazem
63
\_\_\_\_\_\_\_ is indicated for use after adenosine to treat refractory rentry SVT in patients with narrow QRS complex and adequete blood pressure
Diltiazem
64
Diltiazem is indicated for use after adenosine to treat refractory rentry SVT in patients with _____ QRS complex and ______ blood pressure
Diltiazem is indicated for use after adenosine to treat refractory rentry SVT in patients with **narrow** QRS complex and **adequete** blood pressure
65
\_\_\_\_-blockers are contraindicated for wide-QRS tachycardias of uncertain origin or poison/drug-induced tachycardia
**Calcium channe**l-blockers are contraindicated for wide-QRS tachycardias of uncertain origin or poison/drug-induced tachycardia
66
Avoid calcium-channel blockers in patients with ___ syndrome plus rapid atrial fibrillation or flutter
WPW syndrome
67
True/False: calcium channel blockers should be avoided in patients with sick sinus syndrome
True
68
True/False: avoid calcium channel blockers in patients with AV block without a pacemaker
True
69
Calcium channel blockers should be avoided in patients taking oral _______ and concurrent IV administration with IV ________ can cause severe hypotension and AV block
β-blockers
70
State the subsequent non-arrest dose of diltiazem
_Acute Rate Control:_
- May give another IV dose in 15 minutes at 20 to 25mg (0.35mg/kg) over 2min
71
State the non-arrest dose for dopamine
2 - 20mcg/kg per minute; titrate to patient response
72
\_\_\_\_\_\_ is the second-line drug for symptomatic bradycardia after atropine
Dopamine
73
\_\_\_\_\_\_\_ is indicated for hypotension (SBP _\<_ 70 to 100 mmHg) *with* signs/symptoms of shock
Dopamine
74
Correct _______ before initiating dopamine
Hypovolaemia
75
Dopamine may cause \_\_\_\_\_\_\_\_\_\_, excessive vasoconstriction
Tachyarrhythmias
76
Do not mix dopamine with ______ \_\_\_\_\_\_\_\_
Sodium bicarbonate
77
Epinephrine (adrenaline) is available in 1 : _____ and 1 : \_\_\_\_\_
1 : 10 000
1 : 1 000
78
Compare the arrest and non-arrest dose of epinephrine (adrenaline)
_Arrest Dose_
1mg IV/IO push every 3 to 5 minutes
_Non-Arrest Dose_
2 - 10mcg/min infusion; titrate to patient response
79
\_\_\_\_\_\_ is indicated in cardiac arrest (VF, pulseless VT, asystole, PEA)
Epinephrine (adrenaline)
80
\_\_\_\_\_\_\_\_ is indicated for symptomatic bradycardia after atropine as an alternative infusion to dopamine
Epinephrine (adrenaline)
81
\_\_\_\_\_\_ is indicated in severe hypotension; can be used when pacing and atropine fail, when hypotension accompanies bradycardia, or with phosphodiesterase inhibitor
Epinephrine (adrenaline)
82
\_\_\_\_\_\_ is indicated for anaphylaxis and severe allergic reactions
Epinephrine (adrenaline)
83
True/False: epinephrine (adrenaline) may cause myocardial ischaemia
True
Rasing BP and increasing HR may cause myocardial ischaemia, angina and increase myocardial oxygen demand
84
True/False: high doses of epinephrine (adrenaline) improve survival and neurological outcome
False
High doses do not improve survival or neurological outcome and may contribute to postresuscitation myocardial dysfunction
85
Higher/lower doses of epinephrine (adrenaline) *may* be required to treat poison/drug-induced shock
**Higher** doses (up to 0.2 mg/kg) may be used for specific indications
e.g. B-blocker or CCB overdose
86
Outline the injection technique of epinephrine (adrenaline)
1mg (10mL of 1:10 000 solution) administered every 3 to 5 minutes during resuscitation
Follow each dose with 20mL flush
ELevate arm for 10 to 20 seconds after dose
87
True/False: finbrinolytic agents are recommended for routine use in cardiac arrest
False
Insufficient evidence to recommend routine use in cardiac arrest
88
Fibronolytic agents are recommended for ST elevation (threshold values: J-point elevation of __ mm in leads V2 and V3\*, and __ mm in all other leads) or new/presumed new LBBB
Fibronolytic agents are recommended for ST elevation (threshold values: J-point elevation of **2 mm** in leads V2 and V3\*, and **1 mm** in all other leads) or new/presumed new LBBB
89
Fibronolytic agents are recommended for ST elevation (threshold values: J-point elevation of 2 mm in leads V2 and V3\*, and 1 mm in all other leads) or new/presumed new LBBB
V3\*: __ mm in men \<40 years; __ mm in all women
V3\*: **2.5 mm** in men \<40 years; **1.5 mm** in all women
90
Fibronolytic agents are indicated for AMI in adulys with time from onset of symptoms _\<_ __ hours
Fibronolytic agents are indicated for AMI in adulys with time from onset of symptoms **_\<_ 12 hours**
91
\_\_\_\_\_\_\_ is the only fibrinolytic agent approved for acute ischaemic stroke
Alteplase
92
Outline the technique to administer fibrinolytic agents
Insert 2 peripheral IV lines
Use 1 line *exclusively* for fibrinolytic administration
93
Compare the initial cardiac arrest dose of lidocaine with the non-arrest dose
_Arrest Dose:_
1 - 1.5 mg/kg IV/IO push
_Non-Arrest Dose:_
0.5 - 1.5 mg/kg
94
\_\_\_\_\_\_\_ is an alternative to amiodarone in cardiac arrest from VF/VT
Lidocaine
95
\_\_\_\_\_\_\_\_\_ is indicated for stable monomorphic VT with preserved ventricular function
Lidocaine
96
\_\_\_\_\_\_\_\_\_\_ is indicated for stable polymorphic VT with normal baseline QT interval and preserved LV function when ischaemia is treated and electrolyte balance is corrected
Lidocaine
97
\_\_\_\_\_\_\_\_ can be used for stable polymorphic VT with baseline QT-interval prolongation if torsades suspected
Lidocaine
98
Reduce the *maintenance* dose (not the *loading* dose) of lidocaine in the presence of impaired _____ function or __ dysfunction
Reduce the maintenance dose (not the loading dose) of lidocaine in the presence of impaired **liver** function or **LV** dysfunction
99
State the subsequent dosing of lidocaine (in cardiac arrest from cardiac arrest from VF/VT *OR* for perfusing arrhythmias of uncertain type, significant ectopy)
May give additional 0.5 - 0.75mg/kg IV push
Repeat in 5 - 10min intervals
Maximum 3 doses *OR* total 3mg/kg
100
State the maintenance infusion of lidocaine
1 - 4mg/min (30 - 50mcg/kg/min)
101
Compare the *initial* arrest dose with the *initial* non-arrest dose of magnesium sulfate
_Arrest Dose:_
1 - 2g (2 - 4mL of a 50% solution diluted in 10mL D5W or NS) IV/IO
_Non-Arrest Dose_
Loading dose of 1 - 2g mixed in 50 - 100mL in diluent over 5 - 60min IV
102
\_\_\_\_\_\_\_ is recommended for use in cardiac arrest if torsades de pointe is suspected
Magnesium Sulfate
103
\_\_\_\_\_\_\_ ________ is recommended for use in cardiac arrest if hypomagnesemia is present
Magnesium Sulfate
104
\_\_\_\_\_\_\_\_ ______ is indicated in life-threatening ventricular arrhythmias due to digitalis toxicity
Magnesium Sulfate
105
State the *maintenance* dose of magnesium sulfate in Torsades de Pointes with a pulse *OR* AMI with hypomagnesemia
0.5 - 1g/hour IV (titrate to control torsades)
106
\_\_\_\_\_\_\_\_ ______ is indicated for Torsades de Pointes with a pulse or AMI with hypomagnesamia
Magnesium Sulfate
107
State the non-arrest dose of morphine sulfate
_Non-Arrest Dose_
2 - 4mg IV
108
\_\_\_\_\_\_ ______ is indicated for chest pain with ACS unresponsive to nitrates
Morphine Sulfate
109
\_\_\_\_\_\_ _______ is indicated for acute cardiogenic pulmonary oedema (if blood pressure is adequate)
Morphine Sulfate
110
True/False: Morphine sulfate should be given rapidly
False
Administer slowly and titrate to effect
111
Morphine Sulfate may cause _________ depression
Respiratory
112
Morphine Sulfate causes hypotension in \_\_\_\_\_\_-depleted patients
Volume-depleted
113
Morphine Sulfate must be used in caution in _____ ventricular infarction
Right
114
Morphine sulfate may be reversed with \_\_\_\_\_\_\_\_
Naloxone
115
State the dose of naloxone
0.04 - 2mg IV
116
State the 3 available forms of nitroglycerin
IV
Sublingual
Aerosol
117
True/False: IV bolus of nitroglycerin is only given if no other forms (SL or spray) is given
True
118
Compare the dose of IV, SL and aerosol nitroglycerin
_IV bolus:_
12.5 to 25mcg
_SL:_
1 tablet (0.3 - 0.4mg)
_Aerosol Spray:_
1 - 2 sprays
119
Sublingual nitroglycerin can be repeated for a total of __ doses at \_\_-minute intervals
**3** doses
**5-**minute intervals
120
The dosing of aerosol nitroglycerin spray consists of 1 - 2 sprays, for 0.5 to 1 second at a time, at \_\_-minute intervals
5-minute
121
\_\_\_\_\_\_ is the initial antianginal for suspected ischaemic pain
Nitroglycerin
122
\_\_\_\_\_\_\_ is indicated for initial 24 - 48hrs in patients with AMI and CHF, large anterior wall infarction, persistent or recurrent ischaemia, or hypertension
Nitroglycerin
123
\_\_\_\_\_\_ is indicated in hypertensive urgency with ACS
Nitroglycerin
124
Continued use of Nitroglycerin (beyond 48 hours) is indicated for patients with recurrent angina or \_\_\_\_\_\_
Persistent pulmonary congestion
125
Nitroglycerin is contraindicated in hypotension (SBP \<\_\_mmHg or \>\_\_ mmHg below baseline)
SBP **_\<_ 90mmHg** *OR* **_\>_ 30 mmHg** below baseline
126
Nitroglycerin is contraindicated in severe bradycardia (HR \< __ bpm) *OR* tachycardia (HR \> __ bpm)
Nitroglycerin is contraindicated in severe bradycardia (HR \< **50** bpm) *OR* tachycardia (HR \> **100** bpm)
127
Nitroglycerin is contraindicated in ___ ventricular infarction
Right
128
Nitroglycerin is contraindicated with the use of phosphodiesterase inhibitors for erectile dysfunction (e.g. sildenafil and vardenafil within __ hours; tadalafil within __ hours)
Nitroglycerin is contraindicated with the use of phosphodiesterase inhibitors for erectile dysfunction (e.g. sildenafil and vardenafil within **24** hours; tadalafil within **48** hours)
129
The use of nitroglycerin with evidence of AMI and normotension, do not reduce SBP to \<\_\_mmHg
The use of nitroglycerin with evidence of AMI and normotension, do not reduce SBP to \< **110mmHg**
130
Generally, the use of nitroglycerin with evidence of AMI and hypertension, do not decrease MAP by \>\_\_% (from initial MAP)
Generally, the use of nitroglycerin with evidence of AMI and hypertension, do not decrease MAP by **\>25%** (from initial MAP)
131
True/False: Nitroglycerin aerosal spray should be shaken before use
False
Do not shake aerosol spray because this affects metered dose
132
The preferred route for nitroglycerin in the emergency situation is IV \_\_\_\_\_
IV infusion
133
State the intial and subsequent dosing of IV infusion of nitroglycerin
Start at 10mcg/min
Titrate to effect
Increase by 10mcg/min every 3 - 5min until desired effect
Ceiling dose of 200mcg/min commonly used
134
Compare the arrest and non-arrest dose of vasopressin
_Arrest Dose_
40U IV/IO push
_Non-Arrest Dose_
Infusion 0.02 - 0.04U/min
135
\_\_\_\_\_ may be used as an alternative pressor to epinephrine in treatment of adult shock-refractory VF
Vasopressin
136
\_\_\_\_\_\_\_ may be a useful alternative to epinephrine in asystole, PEA
Vasopressin
137
\_\_\_\_\_\_\_ may be useful for haemodynamic support in vasodilatory shock (e.g. septic shock)
Vasopressin
138
True/False: Vasopressin is a potent peripheral vasoconstrictor, which may provoke cardiac ischaemia and angina by increasing PVR
True
