Drug Quiz 4

Question 1

Adenosine

Answer 1

Adenocard

Question 2

Adenosine Drug Classification

Answer 2

Antidysrhythmic (Class V) / Nucleoside

Question 3

Adenosine Mechanism of Action

Answer 3

Adenosine (A1) R-agonist -> Slows AV conduction by activation of G-protein second messengers, decreasing cAMP and inhibiting calcium entry into the pacemaker cells

Question 4

Adenosine Pharmacokinetics

Answer 4

Onset of Action= Immediate
Peak Effects= Immediate
Duration of Effect= 30-45 seconds
Half-Life= 6 seconds

Question 5

Adenosine Indications/ Field Use

Answer 5

1) SVT (PSVT)/Narrow Complex Tachycardia
2) R/O SVT when diagnosing or assessing a rapid rhythm
3) Wide complex tachycardia

Question 6

Adenosine Contraindications

Answer 6

2degree/3degree heart block, Sick Sinus Syndrome
Poison/chemical induced SVT
Caution with asthma, bronchospasm, and unstable angina
Torsades de Pointes

Question 7

Adenosine Side Effects/ Adverse Reactions

Answer 7

Facial flushing
Headache
Chest Pain
Dizziness

Question 8

Adenosine Dose

Answer 8

Adult 1st dose: 6mg rapid IVP followed by 20cc NS flush
Adult 2nd dose: 12mg rapid IVP followed by 20cc NS flush
Adult 3rd dose: 12mg rapid IVP followed by 20cc NS flush
Pedi 1st dose: 0.1mg/kg IV/IO rapid push, max dose 6mg
Pedi 2nd dose: 0.2mg/kg IV/IO rapid push, max dose 12mg

Question 9

Adenosine Precautions

Answer 9

Begin printing rhythm strip before administering adenosine

Give in A/C or higher (more proximal)

Question 10

Adenosine Drug-Drug Interactions

Answer 10

Methylxanthines (caffeine) are nonspecific competitive antagonists for adenosine receptors-double the dose for Pt.’s taking large amounts
Carbamazepines potentiate effects of adenosine-have the dose

Question 11

Amiodarone HCL

Answer 11

Cordarone

Question 12

Amiodarone HCL Drug Classification

Answer 12

Antidysrhythmic agent

Question 13

Amiodarone HCL Mechanism of Action

Answer 13

Class III Antiarrhythmic/K+ channel blocker->Prolongs cardiac action potential duration and refractory period
Demonstrates properties of Na+/Ca2+ channel blockers
Noncompetitive inhibitor of alpha and beta adrenergic receptors

Question 14

Amiodarone HCL Pharmacokinetics

Answer 14

Onset of Action: Immediate
Peak Effects: 30-45 min
Duration of Effect: Varies
Half-Life: 40-55 days

Question 15

Amiodarone HCL Indications/Field Use

Answer 15

Cardiac Arrest

Wide Complex Tachycardia

Question 16

Amiodarone HCL Contraindications

Answer 16

Cardiogenic shock
Severe sinus node dysfunction
Marked or symptomatic bradycardia
2degree/3degree heart block
Hypersensitivity

Question 17

Amiodarone HCL Side Effects/Adverse Reactions

Answer 17

Hypotension
Bradycardia
Dyspnea
Cough
Dizziness
Prolonged PR, QRS, QT intervals
Increased ventricular beats

Question 18

Amiodarone HCL Dose

Answer 18

VF/Pulseless VT (Adult): 300mg IV, IO, repeat dose 150mg IV, IO in 3-5 min PRN
VT + Pulse (Adult): 150mg IV, IO over 10 min
Maintenance (Adult): 1mg/min first six hours, then 0.5mg/min
VF/ Pulseless VT (Pedi): 5mg/kg IV, IO; max dose 300mg, max total dose 15mg/kg
VT+Pulse (Pedi): 5mg/kg IV, IO over 20-60 min, max dose 300mg

Question 19

Amiodarone HCL Precautions

Answer 19

Caution patients with heart failure

Question 20

Amiodarone HCL Drug-Drug Interactions

Answer 20

Warfarin, digoxin, procainamide, quinidine, phenytoin

Question 21

Atropine Sulfate Drug Classification

Answer 21

Anticholinergic/Parasymatholytic

Question 22

Atropine Sulfate Mechanism of Action

Answer 22

Acetycholine receptor antagonist->parasympathetic inhibition, positive chronotropy, no inotropic effect

Question 23

Atropine Sulfate Pharmacokinetics

Answer 23

Onset of Action: Immediate
Peak Effects: 2-4 minutes
Duration of Effect: 4 hours
Half-Life: 2-3 hours

Question 24

Atropine Sulfate Indications/Field Use

Answer 24

Symptomatic (AMS, pulmonary edema, hypotension, chest pain) bradycardia
Premedication for RSI with bradycardia <50bpm
Organophosphate poisoning

Question 25

Atropine Sulfate Contraindications

Answer 25

No longer recommended for PEA and asystole

Question 26

Atropine Sulfate Side Effects/Adverse Reactions

Answer 26

``` Blurred Vision Dilated pupils Dry mouth Tachycardia Drowsiness Confusion ```

Question 27

Atropine Sulfate Dose

Answer 27

Bradycardia (Adult): 0.5mg q3-5 min IV, IO up to 3 mg RSI (Adult): 0.5-1mg IV, IO Organophosphate (Adult): 2-5mg Bradycardia (Pedi): 0.02mg/kg IV, IO; minimum single dose 0.1mg; max single dose 0.5mg RSI (Pedi): 0.02mg/kg IV, IO Organophosphate (Pedi): 0.02-0.05mg/kg IV, IO, q 20-30min until S/S resolve

Question 28

Atropine Sulfate Precautions

Answer 28

Do not give less than 0.5mg (Adult) or 0.1mg (Pedi)-causes paradoxical effect May cause paradoxical slowing or may be ineffective if used for 2degree type II/3degree Heart block Increases myocardial oxygen demand

Question 29

Atropine Sulfate Drug-Drug Interactions

Answer 29

Few EMS