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Courses > AHA Advanced ECG and Pharmacology > Flashcards

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

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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

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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

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4
Q

________ is indicated for regular, monomorphic wide-complex tachycardia, thought to be or previously defined to be reentry SVT

A

Adenosine

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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

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6
Q

_______ is indicated as a diagnostic maneuver in stable, narrow-complex SVT

A

Adenosine

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7
Q

True/False: adenosine is indicated in poision/drug-induced tachycardia

A

False

Adenosine is contraindicated in poision/drug-induced tachycardia

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8
Q

True/False: Adenosine is contra-indicated in second- or third-degree heart block

A

True

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9
Q

List the transient side effects of adenosine

A

Flushing

Chest pain/tightness

Brief periods of asystole/bradycardia

Ventricular ectopy

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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

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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

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12
Q

Adenosine administered for irregular, polymorphic, wide-complex tachycardia/VT, may cause ________

A

Deterioration (including hypotension)

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13
Q

True/False: adenosine is unsafe in pregnancy

A

False

Adenosine is safe in pregnancy

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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

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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

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16
Q

State the initial arrest dose of amiodarone

A

300mg IV/IO, push

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17
Q

State the initial non-arrest dose of amiodarone

A

150mg IV over first 10min (15mg/min), rapid infusion

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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

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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

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20
Q

_______ is indicated for VF/pulseless VT unresponsive to shock delivery, CPR and a vasopressor

A

Amiodarone

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21
Q

_______ is indicated for recurrent, haemodynamically unstable VT

A

Amiodarone

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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

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23
Q

State the maximum cumulative dose of amiodarone in life-trheatening arrhythmias

A

2.2g IV over 24 hours

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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

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25
Q

Rapid infusion of amiodarone may lead to _______

A

Hypotension

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26
Q

With multiple dosing of amiodarone, cumulative doses of >2.2g amiodarone over 24hrs are associated with significant _______ in clinical trials

A

Hypotension

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27
Q

Do not administer amiodarone with other drugs that _______

A

Prolong the QT interval

e.g. procainamide

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28
Q

Terminal elimination of amiodarone is extremely long (half-life lasts up to __ days)

A

40 days

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29
Q

State the non-arrest dose of aspirin

A

160 - 300mg

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30
Q

State the preferred formulation of aspirin in the emergency setting

A

Non-enteric-coated tablet

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31
Q

_____ should be administered to all patients with ACS, particularly reperfusion candidates

A

Aspirin

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32
Q

Aspirin should be administered to all patients with ACS, particularly reperfusion candidates, unless ______

A

Hypersensitive to aspirin

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33
Q

Aspirin blocks the formation of thromboxane __, which causes platelets to aggregate and arteries to constrict. This reduces overall ACS mortality, reinfarction, and nonfatal stroke

A

Thromboxane A2

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34
Q

_____ is indicated for any person with symptoms (“pressure,” “heavy weight”, “squeezing”, “crushing”) suggestive of ischaemic chest pain

A

Aspirin

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35
Q

Aspirin is relatively contraindicated in patients with _____ and _____

A

Active ulcer disease

Asthma

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36
Q

True/False: swallowing aspirin is preferable to chewing in the emergency environment

A

False

Chewing is preferred

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37
Q

State the alternate route of administration of aspirin in the emergency environment for patients that cannot take it in orally

A

300mg rectal suppository

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38
Q

State the non-arrest dose of atropine sulfate

A

0.5mg IV every 3 to 5 minutes as needed

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39
Q

_____ is the first drug for symptomatic sinus bradycardia

A

Atropine sulfate

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40
Q

_____ 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

A

Atropine sulfate

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41
Q

True/False: atropine sulfate is routinely indicated for use during PEA or asytole

A

False

Routine use is unlikely to have a therapeutic benefit

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42
Q

In organophosphate poisoning, extremely large doses of _____ are likely to be needed

A

Atropine sulfate (2 - 4mg)

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43
Q

True/False: atropine sulfate increases myocardial oxygen demand

A

True

Use with caution in presence of myocardial ischaemia and hypoxia

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44
Q

Atropine sulfate should be avoided in ______ bradycardia

A

Hypothermic

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45
Q

List the two types of conduction abnormalities atropine sulfate may not be effective for, and what preparations should be made in these situations

A

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
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46
Q

Doses of atropine ____ may result in paradoxical slowing of heart rate

A

<0.5mg

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47
Q

State the maximum dose of atropine

A

0.04mg/kg (total 3mg)

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48
Q

_______ are indicated for all patients with suspected myocardial infarction and unstable angina (these are effective antianginal agents and can reduce the incidence of VF)

A

β-Blockers

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49
Q

______ 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)

A

β-Blockers

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50
Q

_______ are indicated to reduce myocardial ischaemia and damage in AMI patients with elevated heart rzte, blood pressure or both

A

β-Blockers

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51
Q

_______ recommended for emergency antihypertensive therapy for haemorrhagic and acute ischaemic stroke

A

Labetolol

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52
Q

True/False: β-Blockers are all dosed equivalently

A

False

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53
Q

Early, aggressive β-blocker therapy may be hazardous in haemodynamically _______ patients

A

Unstable

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54
Q

β-Blockers should not be given to patients with STEMI if any of the following are present

A

1) SIgns of CCF
2) Low cardiac output
3) Increased risk for cardiogenic shock

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55
Q

A relative contraindication for β-blockers is a PR interval _____

A

> 0.24 seconds

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56
Q

A relative contraindication for β-blockers is a SBP ______

A

SBP < 100 mmHg

57
Q

A relative contraindication for β-blockers is a ____ or _____ heart block

A

Second- or third-degree

58
Q

A relative contraindication for β-blockers is a severe bradycardia/tachycardia

A

Bradycardia

59
Q

IV administration of β-blockers with _____ channel blocking agents can cause severe hypotension and bradycardia/heartblock

A

Calcium channel blocking agents

Like verapamil or diltiazem

60
Q

______ is contraindicated in cocaine-induced ACS

A

Propanalol

Other β-blockers relatively contraindicated

61
Q

State the initial non-arrest dose of diltiazem

A

Acute Rate Control:

15 to 20mg (0.25mg/kg) IV over 2 minutes

62
Q

_______ 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

A

Diltiazem

63
Q

_______ is indicated for use after adenosine to treat refractory rentry SVT in patients with narrow QRS complex and adequete blood pressure

A

Diltiazem

64
Q

Diltiazem is indicated for use after adenosine to treat refractory rentry SVT in patients with _____ QRS complex and ______ blood pressure

A

Diltiazem is indicated for use after adenosine to treat refractory rentry SVT in patients with narrow QRS complex and adequete blood pressure

65
Q

____-blockers are contraindicated for wide-QRS tachycardias of uncertain origin or poison/drug-induced tachycardia

A

Calcium channel-blockers are contraindicated for wide-QRS tachycardias of uncertain origin or poison/drug-induced tachycardia

66
Q

Avoid calcium-channel blockers in patients with ___ syndrome plus rapid atrial fibrillation or flutter

A

WPW syndrome

67
Q

True/False: calcium channel blockers should be avoided in patients with sick sinus syndrome

A

True

68
Q

True/False: avoid calcium channel blockers in patients with AV block without a pacemaker

A

True

69
Q

Calcium channel blockers should be avoided in patients taking oral _______ and concurrent IV administration with IV ________ can cause severe hypotension and AV block

A

β-blockers

70
Q

State the subsequent non-arrest dose of diltiazem

A

Acute Rate Control:

  • May give another IV dose in 15 minutes at 20 to 25mg (0.35mg/kg) over 2min
71
Q

State the non-arrest dose for dopamine

A

2 - 20mcg/kg per minute; titrate to patient response

72
Q

______ is the second-line drug for symptomatic bradycardia after atropine

A

Dopamine

73
Q

_______ is indicated for hypotension (SBP < 70 to 100 mmHg) with signs/symptoms of shock

A

Dopamine

74
Q

Correct _______ before initiating dopamine

A

Hypovolaemia

75
Q

Dopamine may cause __________, excessive vasoconstriction

A

Tachyarrhythmias

76
Q

Do not mix dopamine with ______ ________

A

Sodium bicarbonate

77
Q

Epinephrine (adrenaline) is available in 1 : _____ and 1 : _____

A

1 : 10 000

1 : 1 000

78
Q

Compare the arrest and non-arrest dose of epinephrine (adrenaline)

A

Arrest Dose

1mg IV/IO push every 3 to 5 minutes

Non-Arrest Dose

2 - 10mcg/min infusion; titrate to patient response

79
Q

______ is indicated in cardiac arrest (VF, pulseless VT, asystole, PEA)

A

Epinephrine (adrenaline)

80
Q

________ is indicated for symptomatic bradycardia after atropine as an alternative infusion to dopamine

A

Epinephrine (adrenaline)

81
Q

______ is indicated in severe hypotension; can be used when pacing and atropine fail, when hypotension accompanies bradycardia, or with phosphodiesterase inhibitor

A

Epinephrine (adrenaline)

82
Q

______ is indicated for anaphylaxis and severe allergic reactions

A

Epinephrine (adrenaline)

83
Q

True/False: epinephrine (adrenaline) may cause myocardial ischaemia

A

True

Rasing BP and increasing HR may cause myocardial ischaemia, angina and increase myocardial oxygen demand

84
Q

True/False: high doses of epinephrine (adrenaline) improve survival and neurological outcome

A

False

High doses do not improve survival or neurological outcome and may contribute to postresuscitation myocardial dysfunction

85
Q

Higher/lower doses of epinephrine (adrenaline) may be required to treat poison/drug-induced shock

A

Higher doses (up to 0.2 mg/kg) may be used for specific indications

e.g. B-blocker or CCB overdose

86
Q

Outline the injection technique of epinephrine (adrenaline)

A

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
Q

True/False: finbrinolytic agents are recommended for routine use in cardiac arrest

A

False

Insufficient evidence to recommend routine use in cardiac arrest

88
Q

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

A

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
Q

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

A

V3*: 2.5 mm in men <40 years; 1.5 mm in all women

90
Q

Fibronolytic agents are indicated for AMI in adulys with time from onset of symptoms < __ hours

A

Fibronolytic agents are indicated for AMI in adulys with time from onset of symptoms < 12 hours

91
Q

_______ is the only fibrinolytic agent approved for acute ischaemic stroke

A

Alteplase

92
Q

Outline the technique to administer fibrinolytic agents

A

Insert 2 peripheral IV lines

Use 1 line exclusively for fibrinolytic administration

93
Q

Compare the initial cardiac arrest dose of lidocaine with the non-arrest dose

A

Arrest Dose:

1 - 1.5 mg/kg IV/IO push

Non-Arrest Dose:

0.5 - 1.5 mg/kg

94
Q

_______ is an alternative to amiodarone in cardiac arrest from VF/VT

A

Lidocaine

95
Q

_________ is indicated for stable monomorphic VT with preserved ventricular function

A

Lidocaine

96
Q

__________ is indicated for stable polymorphic VT with normal baseline QT interval and preserved LV function when ischaemia is treated and electrolyte balance is corrected

A

Lidocaine

97
Q

________ can be used for stable polymorphic VT with baseline QT-interval prolongation if torsades suspected

A

Lidocaine

98
Q

Reduce the maintenance dose (not the loading dose) of lidocaine in the presence of impaired _____ function or __ dysfunction

A

Reduce the maintenance dose (not the loading dose) of lidocaine in the presence of impaired liver function or LV dysfunction

99
Q

State the subsequent dosing of lidocaine (in cardiac arrest from cardiac arrest from VF/VT OR for perfusing arrhythmias of uncertain type, significant ectopy)

A

May give additional 0.5 - 0.75mg/kg IV push

Repeat in 5 - 10min intervals

Maximum 3 doses OR total 3mg/kg

100
Q

State the maintenance infusion of lidocaine

A

1 - 4mg/min (30 - 50mcg/kg/min)

101
Q

Compare the initial arrest dose with the initial non-arrest dose of magnesium sulfate

A

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
Q

_______ is recommended for use in cardiac arrest if torsades de pointe is suspected

A

Magnesium Sulfate

103
Q

_______ ________ is recommended for use in cardiac arrest if hypomagnesemia is present

A

Magnesium Sulfate

104
Q

________ ______ is indicated in life-threatening ventricular arrhythmias due to digitalis toxicity

A

Magnesium Sulfate

105
Q

State the maintenance dose of magnesium sulfate in Torsades de Pointes with a pulse OR AMI with hypomagnesemia

A

0.5 - 1g/hour IV (titrate to control torsades)

106
Q

________ ______ is indicated for Torsades de Pointes with a pulse or AMI with hypomagnesamia

A

Magnesium Sulfate

107
Q

State the non-arrest dose of morphine sulfate

A

Non-Arrest Dose

2 - 4mg IV

108
Q

______ ______ is indicated for chest pain with ACS unresponsive to nitrates

A

Morphine Sulfate

109
Q

______ _______ is indicated for acute cardiogenic pulmonary oedema (if blood pressure is adequate)

A

Morphine Sulfate

110
Q

True/False: Morphine sulfate should be given rapidly

A

False

Administer slowly and titrate to effect

111
Q

Morphine Sulfate may cause _________ depression

A

Respiratory

112
Q

Morphine Sulfate causes hypotension in ______-depleted patients

A

Volume-depleted

113
Q

Morphine Sulfate must be used in caution in _____ ventricular infarction

A

Right

114
Q

Morphine sulfate may be reversed with ________

A

Naloxone

115
Q

State the dose of naloxone

A

0.04 - 2mg IV

116
Q

State the 3 available forms of nitroglycerin

A

IV

Sublingual

Aerosol

117
Q

True/False: IV bolus of nitroglycerin is only given if no other forms (SL or spray) is given

A

True

118
Q

Compare the dose of IV, SL and aerosol nitroglycerin

A

IV bolus:

12.5 to 25mcg

SL:

1 tablet (0.3 - 0.4mg)

Aerosol Spray:

1 - 2 sprays

119
Q

Sublingual nitroglycerin can be repeated for a total of __ doses at __-minute intervals

A

3 doses

5-minute intervals

120
Q

The dosing of aerosol nitroglycerin spray consists of 1 - 2 sprays, for 0.5 to 1 second at a time, at __-minute intervals

A

5-minute

121
Q

______ is the initial antianginal for suspected ischaemic pain

A

Nitroglycerin

122
Q

_______ is indicated for initial 24 - 48hrs in patients with AMI and CHF, large anterior wall infarction, persistent or recurrent ischaemia, or hypertension

A

Nitroglycerin

123
Q

______ is indicated in hypertensive urgency with ACS

A

Nitroglycerin

124
Q

Continued use of Nitroglycerin (beyond 48 hours) is indicated for patients with recurrent angina or ______

A

Persistent pulmonary congestion

125
Q

Nitroglycerin is contraindicated in hypotension (SBP <__mmHg or >__ mmHg below baseline)

A

SBP < 90mmHg OR > 30 mmHg below baseline

126
Q

Nitroglycerin is contraindicated in severe bradycardia (HR < __ bpm) OR tachycardia (HR > __ bpm)

A

Nitroglycerin is contraindicated in severe bradycardia (HR < 50 bpm) OR tachycardia (HR > 100 bpm)

127
Q

Nitroglycerin is contraindicated in ___ ventricular infarction

A

Right

128
Q

Nitroglycerin is contraindicated with the use of phosphodiesterase inhibitors for erectile dysfunction (e.g. sildenafil and vardenafil within __ hours; tadalafil within __ hours)

A

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
Q

The use of nitroglycerin with evidence of AMI and normotension, do not reduce SBP to <__mmHg

A

The use of nitroglycerin with evidence of AMI and normotension, do not reduce SBP to < 110mmHg

130
Q

Generally, the use of nitroglycerin with evidence of AMI and hypertension, do not decrease MAP by >__% (from initial MAP)

A

Generally, the use of nitroglycerin with evidence of AMI and hypertension, do not decrease MAP by >25% (from initial MAP)

131
Q

True/False: Nitroglycerin aerosal spray should be shaken before use

A

False

Do not shake aerosol spray because this affects metered dose

132
Q

The preferred route for nitroglycerin in the emergency situation is IV _____

A

IV infusion

133
Q

State the intial and subsequent dosing of IV infusion of nitroglycerin

A

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
Q

Compare the arrest and non-arrest dose of vasopressin

A

Arrest Dose

40U IV/IO push

Non-Arrest Dose

Infusion 0.02 - 0.04U/min

135
Q

_____ may be used as an alternative pressor to epinephrine in treatment of adult shock-refractory VF

A

Vasopressin

136
Q

_______ may be a useful alternative to epinephrine in asystole, PEA

A

Vasopressin

137
Q

_______ may be useful for haemodynamic support in vasodilatory shock (e.g. septic shock)

A

Vasopressin

138
Q

True/False: Vasopressin is a potent peripheral vasoconstrictor, which may provoke cardiac ischaemia and angina by increasing PVR

A

True

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