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Emergency Med/Surgery > Pharm > Flashcards

Pharm Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

A patient comes in with HR of 35, BP 85/50, and AMS. How do you treat?

A

Atropine.
First dose: 0.5 mg
Repeat q 3-5 min.
Maximum: 3mg

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2
Q

HR of 35, BP 85/50, and AMS. No improvement with first line treatment. What’s your next best step?

A
  • Transcutaneous pacing
  • Epinephrine
  • Dopamine
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3
Q

You decide to use an antimuscarinic to treat a patient with __. What is this drug, its AE, MOA, and its indication?

A

Bradycardia

Drug: Atropine

MOA: Antagonizes parasympathetic vagal tone

AE:

  • Mouth dryness, - Blurred vision
  • Photophobia
  • Tachycardia
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4
Q

Dopamine:

  • Indication
  • MOA
  • AE
A

Indication: Bradycardia

MOA: Beta-1 & alpha-1 agonist

AE: cardiac arrhythmias

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5
Q

Epinephrine

  • Indication
  • MOA
  • AE
A

Indication: bradycardia

MOA: beta-1 & alpha-1 agonist

AE:
- cardiac arrhythmias, - excessive rise in BP

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6
Q

A patient comes in with HR of 165, BP 85/50, and AMS. How do you treat?

A

Synchronized cardioversion

Consider adenosine if regular narrow complex

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7
Q

A patient comes in with HR of 165 and a wide QRS greater than/equal to 0.12 seconds. How do you treat?

A
  • IV
  • 12 lead ECG
  • If regular and monomorphic: adenosine
  • antiarrhythmic infusion
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8
Q

A patient comes in with HR 0f 165. No hypotension, AMS, or wide QRS. How do you treat?

A
  • IV access
  • 12 lead ECG
  • Adenosine (if regular)
  • Beta-blocker or CCB
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9
Q

A patient comes in with regular narrow complex tachycardia. He is symptomatic but stable. What do you do prior to meds?

A

Valsalva maneuver.

MOA: increases vagal response by slowing AV node conduction

Converts SVTs to sinus rhythm

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10
Q

A patient comes in with regular narrow complex tachycardia. He is symptomatic but stable. You give adenosine. MOA? CI? AE?

A

MOA: endogenous purine nucleoside

  • activates Ach-sensitive K+ current in SA and AV nodes
  • hyperpolarization and suppression of Ca2+ dependent AP
  • Transiently blocks conduction through AV node

CI: asthma

AE:

  • transient flushing
  • dyspnea
  • bronchospasm
  • chest pressure
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11
Q

If adenosine fails to convert a regular narrow complex tachycardia, what should you consider?

A

Other etiologies for this rhythm, including A-flutter or a non-reentrant SVT

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12
Q

A patient comes in with irregular narrow complex tachycardia. They are symptomatic but stable. What is your first step?

A

Rate control

Goal: HR <100 beats/min via BB or non-DNP CCB OR digoxin

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13
Q

MOA of Beta blockers?

A

Reduce effects of circulating catecholamines

Reduce HR

Reduce AV node conduction and BP

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14
Q

MOA of non-DNP CCB?

A

Slow AV node conduction

Increase AV node refractoriness

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15
Q

MOA of digoxin?

A

Enhances parasympathetic tone in tachycardia.

Since it’s a positive inotrope, it is useful in those with decompensated HF with reduced EF

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16
Q

A patient presents with A-fib and is hemodynamically unstable. What do you do?

A

Synchronized cardioversion

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17
Q

A patient presents with hemodynamically stable A-Fib. What do you do?

A

Nothing - most AF spontaneously convert to sinus in 24-48 hours

18
Q

A patient presents with ventricular tachycardia and has a pulse. After checking ABC and monitoring via ECG, BP, and oximetry, you determine the patient is stable and has a monomorphic VT. What do you do next?

A

Administer amiodarone IV 150 mg over 10 min

Max dose of 2.2 g/24 hours

19
Q

A patient presents with ventricular tachycardia and has a pulse. After checking ABC and monitoring via ECG, BP, and oximetry, you determine the patient is stable and has a polymorphic VT/ torsades de pointes. What do you do next?

A

Defib

Correct electrolyte imbalances

Mg load

Overdrive pacing or isoproterenol

20
Q

A patient presents with ventricular tachycardia and has a pulse. After checking ABC and monitoring via ECG, BP, and oximetry, you determine the patient is unstable. What do you do next?

A

Immediate direct-current cardioversion x 3 attempts

Then amiodarone IV 300 mg over 2 min –> repeat shock

21
Q

What are some AEs of amiodarone?

A

Pulmonary fibrosis

Cornea & skin discoloration

Hypo/hyperT

Peripheral neuropathy

Photosensitivity

Vasodilation

Arrhythmias (rare)

22
Q

A patient presents with ventricular tachycardia. Amiodarone does not work. What is the second line treatment for VT?

A

Procainamide - 20-50 mg/min until arrhythmia is suppressed.

Max dose: 17

23
Q

What are the AEs of procainamide and what is its indication?

A

AE:

  • N/V
  • Anorexia
  • Rash
  • Granulocytosis
  • Torsades de Pointes
  • Lupus like reaction

Indication: SVT and VT

24
Q

A patient comes in for VT. Both amiodarone and procainamide don’t work. What’s your next line treatment?

A

IV lidocaine 100-200 mg

25
Q

What are some AEs of lidocaine and what is its indication?

A

AEs:

  • visual disturbances
  • tremor
  • seizure
  • drowsiness
  • hallucination
  • coma
  • asystole & hypotension
  • N/V

Indication: VT and VFib

26
Q

A patient comes in with palpitations and HR 255. Synchronized cardioversion was attempted but unsuccessful. Amiodarone and a repeat cardioversion was attempted, which was followed by a recurrence of a tachycardia determined to be pre-excited AFib. How is a hemodynamically stable patient with pre-excited Afib treated?

A

Use an AV nodal blocking agent to enhance conduction over the accessory pathway exacerbating tachycardia, collapsing ventricular fibrillation.

Tx with Ibutilide or IV procainamide

27
Q

MOA and indication for ibutilide.

A

Indication: AFib with accessory pathway - hemodynamically stable

MOA:

  • class III antiarrhythmic drug
  • prolongs AV node refractoriness
  • prolongs His-Purkinje system refractoriness
28
Q

MOA and indication for procainamide.

A

Indication:
- AFib with accessory pathway

MOA:

  • class 1A antiarrhythmic
  • decreases excitability & conduction velocity of atrial and ventricular myocardium without any AV nodal blocking effect
29
Q

A patient presents with cardiac arrest. You start CPR. The AED determines that the rhythm is not shockable. What is the patient in and how do you proceed?

A

Asystole/PEA

CPR 2 minutes & Epinephrine q 3-5 minutes

30
Q

A patient presents with cardiac arrest. The AED determines that the rhythm is shockable. What is the patient in and how do you proceed?

A

VP/pVT

  1. CPR 2 min
  2. Shock if rhythm is shockable
  3. Epinephrine q 3-5 min
  4. Shock if rhythm is shockable
  5. CPR 2 min + amiodarone or lidocaine
31
Q

What receptors does epinephrine stimulate and how does this affect BP?

A

Increases systolic BP:
- Beta-1 mediated: increases HR and ventricular contractility

Increases diastolic BP:
- alpha-1 and 2 receptor mediated: vasoconstriction

Dilates skeletal muscle blood vessels by stimulating Beta-2 receptors.

32
Q

If a patient is in hypovolemic shock, what would we expect to see in terms of preload, CO, and SVR? Treatment?

A

Preload: down
CO: up
SVR: up

Tx: IVF

33
Q

If a patient is in cardiogenic shock, what would we expect to see in terms of preload, CO, and SVR? Treatment?

A

Preload: up
CO: down
SVR: up

Tx: Inotropes & revascularization

34
Q

If a patient is in distributive shock (septic, neurogenic), what would we expect to see in terms of preload, CO, and SVR? Treatment?

A

Preload: down
CO: up
SVR: down

Tx: vasopressors & IVF

35
Q

When is a swan-ganz catheter used?

A

When congestion and perfusion can’t be determined from a clinical assessment or when symptoms persist despite empiric adjustment of standard therapies.

It’s used for direct pressure measurments but is not a first line tool.

36
Q

What are examples of inotropes and when are they used?

A

Ex:

  • dopamine
  • dobutamine
  • milrinone

Used:

  • severe systolic dysfunction
  • symptomatic hypotension
  • worsening renal function
37
Q

What is the MOA of dopamine and what is its indication?

A

Indication: hypotension

MOA: Beta adrenergic agonist

  • increases adenylate cyclase
  • increases cAMP

Vasodilation, increases contratility

38
Q

What is the MOA of dobutamine and its indication?

A

Indication: hypotension

MOA:
- increases Ca2+ = increases contractility

Decreases SVR

39
Q

If a patient is cold and wet, what do we give them?

A

Inotropes

Decreases SVR and PVR –> hypotension (rare)

40
Q

What is the MOA of milrinone and what is its indication?

A

MOA: decreases PDE, which increases cAMP

41
Q

If a patient presents as cardiogenic + significant hypotension, how do you treat?

A

High dose dopamine and NE

These preserve end-organ perfusion but increase afterload

Emergency Med/Surgery (8 decks)

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