Cardiac Pharma 1

Question 1

Epi
cardiac arrest dose (alternate)

Answer 1

1 mg 1:10,000 q. 3-5 min
Instead of 1st or 2nd dose, could use 40 units IV Vesopressin

Question 2

Amiodarone
Indications and dosage

Answer 2

Pulseless Vtach/Vfib
1st dose 300 mg IVP
2nd dose 150 mg IVP after 3-5 min

Vtach w pulse
150 mg slow IVP over 10 min
Infusion: 1mg/min, 100 mg in 100 ml bag (COH 1mg/ml)

Question 3

Lidocaine
Vtach w pulse or PVCs dose

Answer 3

1st dose 1.0-1.5 mg/kg IV bolus
2nd dose (half) 0.5-0.75 mg/kg (a. 3-5 min)
Max 3.0 mg/kg
Maintenance drip 2-4 mg/min, mix 1G in 250 ml bag (COH 4mg/ml)

Question 4

Magnesium sulfate
Type of Vtach/Vfib + dose

Answer 4

Torsades de Pointes
1-4 g, must be diluted

Question 5

Ventricular drugs

Answer 5

Amiodarone
Lidocaine
Magnesium Sulfate

Question 6

Supraventricular Drugs

Answer 6

Adenosine
Diltiazem
Metoprolol

Question 7

Metoprolol
Cardiac indication

Answer 7

Rapid atrial fibrillation/flutter
SVT after adenosine, tachy w pulse

1st 5mg slow IVP over 2 min
2nd+3rd 5mg slow IVP after 5-10 min
Max 15 mg

Question 8

Adenosine
Cardiac indication and dosage

Answer 8

SVT

1st 6mg rapid IVP, follow w rapid saline flush (20 ml bolus)
2nd 12mg rapid IVP

Question 9

Diltiazam
Cardiac indication and dosage

Answer 9

Rapid atrial fibrillation/flutter
SVT after adenosine

1st 0.25 mg/kg slow IVP over 2 min
2nd 0.35 mg/kg after 15 min

Question 10

Dopamine ROSC infusion

Answer 10

400 mg in 250 ml bag
COH 1600 mcg/ml
2-20 mcg/kg/min (start @5 and titrate)

Question 11

Epi ROSC infusion

Answer 11

1mg 1:1,000 in 250 ml bag
COH 4 mcg/ml
0.1-0.5 mcg/kg/min

Question 12

Norepi ROSC infusion

Answer 12

Use infusion pump
4 mg in 250 ml bag
COH 16 mcg/ml
0.1-0.5 mcg/kg/min

Question 13

Atropine
indications/dose

Answer 13

Hemodynamically significant bradycardia
0.5 mg IVP q 3-5 min
Max 3 mg
If failed, TCP then Dopamine or Epi infusions

Question 14

Epi
Hemodynamically significant Brady dose

Answer 14

2-10 mcg/min
COH 4 mcg/ml (lower than ROSC dose)

Question 15

Epi
drug class and MOA

Answer 15

Sympathetic agonist
Alpha effects for ROSC (vesoconstrict and send more blood to heart)
Beta effects for bradycardia (raise HR)
Positive chronotrope, inotrope, dromotrope, vesoconstrict, higher automaticity

Question 16

Norepi

drug class and MOA

Answer 16

Mostly alpha, some beta
Some Inotropic (heart squeeze harder)
Dilate coronary vessels

Question 17

Dopamine
drug class and MOA

Answer 17

Raise BP via alpha and beta
Positive inotropic (for cardiac shock/pump failure)
Indications: brady, cardiogenic shock, hypotension

Question 18

Metoprolol

drug class and MOA

Answer 18

Beta blocker
More B1 and lower HR, lower systolic,
Lower cardiac output, inhibits tachy

Question 19

Lidocaine
drug class and MOA

Answer 19

For ventricular dysrhythmias
Vtach/vfib w pulse, AMI, runs of PVC

Question 20

Adenosine

drug class and MOA

Answer 20

Works on slowing AV node for SVT
CAUTION: up to 6 sec of asystole after push

Question 21

Diltiazem

drug class and MOA

Answer 21

Calcium channel blocker
Slows afib/flutter (won’t covert), SVT after adenosine
Slows HR, lower contractility, vasodilator
Antidote: Calcium chloride
Never give w beta blocker or WPW

Question 22

Amiodarone MOA

Answer 22

Blocks everything, bad/fast vent. rhythms (vtach/vfib), sometimes bad/fast atrial rhythms
Slows action potential, delays Repolarization

Question 23

Amiodarone contraindications

Answer 23

Pregnancy
Slow rhythms
Iodine/shellfish allergy
Heart failure

Question 24

Mag sulfate MOA/ind/antidote

Answer 24

Calcium channel blocker (can be antidote for calcium)
Torsades de point
Can cause respiratory depressions/arrest (calcium counteracts)

Question 25

Hemodynamically significant Brady Tx algorithm

Answer 25

Atropine - 1 mg IV 3-5 min Max 3 mg
TCP
Dopamine - start @ 5 mcg/kg/min & titrate Max 20
Epi - 1 mg 1:1000 in 250 ml 2-10 mcg/min

Question 26

Aspirin dose/MOA

Answer 26

Aspirin - 162-324 mg
Platelet inhibitor and coronary vesodialation

Question 27

ACS Tx algorithm

Answer 27

Aspirin - 324 mg
NTG - 0.4 mg SL e 3-5 min Max 3 doses
Morphine - 2-4 mg or 0.1 mg/kg Max 10 mg
Fentanyl - 0.1 mcg/kg Max 150 mcg

Question 28

Acute Pulmonary Edema
Aka ?
S/S
Goals/Tx

Answer 28

Wet lung sounds, hypertension, high RR
Goals decrease after load, preload, BP

NTG, CPAP, Lasix 20-80 mg IVP (double daily dose if prescribed)

Question 29

Atropine MOA/drug class

Answer 29

Parasympatholytic
Blocks acetylcholine, works on AV node to raise HR (sometimes SA node)

Question 30

Calcium Chloride

Answer 30

Tx hyperkalemia, hypocalcemia, calcium channel blocker toxicity
Increases myocardial contraction force/vent automaticity
Hyperkalemia - 1G slow IVP over 5 min
Calcium CB OD - 2-4 mg/kg Max 1g
Antidote - mag sulfate

Question 31

Diuretics

Answer 31

Lasix (Furosemide) - CHF, PE

Question 32

Analgesics - narcotics

Answer 32

Alleviate pain/reduce anxiety
Morphine - 2-4 mg IV or 0.1 mg/kg Max 10 mg (could cause hypotension)
Fentanyl - 1 mcg/kg slow IVP Max 150 mcg (works faster/wears off faster than Morphine)

Question 33

Sodium Bicarbonate MOA/drug class/dose

Answer 33

Alkalinizing agent - elevates blood pH
Hyperkalemia w/ acidosis (ie missed dialysis)
Never mix w calcium
1 mEq/kg IV, 2nd dose med control 1/2 OG dose

Question 34

Anticoagulants - definition/drugs

Answer 34

Reduces ability for clot to form/grow
Heparin - unstable angina/NSTEMI
Fibrinolytics - disolves clots
Aspirin - platelet inhibitor/coronary vasodilator