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Adv Rx Test 3/Final
WillWallace Adv RX T 3/final Ch 4 8 13 17
| Question | Answer |
|---|---|
| drugs that can be instilled down an ET tube LEAN | lidocaine, epi, atropine, na bicarb |
| Lidocaine | anti-arrhythmia, drug of choice for VF and VT, suppresses myocardial conduction |
| lidocaine dose | load dose 1-1.5 mg/kg, second dose .5-.75 mg/kg max 3mg/kg |
| lidocaine cautions | old farts, renal problems |
| Epinephrine | B-adrenergic, drug of choice for CA w/ pulseless VT, asystole, PEA, severe <BP when pacing and atropine fail, with phosphodiesterase inhibitor like Xanthines (enzyme that breaks up CAMP), anaphylaxis, (can be used as vasopressor) |
| epi dose | 1mg 3-5 mins during ACLS (20ml flush after each), 1mg/500ml NS for cont IV, 2-2.5 mg diluted in 10ml NS for ETT instillation |
| epinephrine precautions | >BP, >HR |
| Atropine | anti-cholinergic, first line for symptomatic brady, 2nd drug after epi or vasopressor in asystole or PEA, |
| Atropine dose | brady is .5 mg 3-5 mins max .04 mg/kg or 3mg total, PEA and asystole is 1mg IV/IO, repeat 3-5 mins if needed, max 3mg, ETT instilled 2-3 mg max 9mg |
| atropine hazards | >myocardial O2 demand (caution with MI), hypothermic brady |
| Na Bicarb | rare used in known preexisting hyperkalemia, known preexisting metabolic acidosis (ketoacidosis, aspirin OD, cocaine), no good for hypercarbic acidosis |
| NA bicarb dose | 1mEq/kg IV bolus |
| bicarb precautions | adequate ventilation and CPR are ACLS buffers not bicarb, so not recommended for routine use in cardiac arrest |
| most important thing RT needs to know about ACLS | circulation and perfusion |
| perfusion | CO + systemic vascular resistance |
| anti-arrhythmic drugs (according to Karyl) | LADMAA, lidocaine, amiodarone, dopamine, magnesium, adenosine, atropine |
| amiodarone | cardiac arrest unresponsive to CPR, shocking and vasopressors, management of life-threating, recurrent VF and unstable VT that are unresponsive to other TX's |
| amiodarone cautions | life-threating side effects and difficult mgmt, hospitalized for loading dose |
| amiodarone dose | ACLS 300mg IV/IO (in 20-30 mL D5W) with ONE 150 mg 3-5 mins if needed, for mgmt of VF and VT max dose per day 2.2 g, load with 150 mg, rest is complicated and doubtful on test) |
| adenosine | ????????vasodilator, depresses AV and sinus node activity, drug of choice for stable narrow PSVT (paroxysmal aka continuous) |
| adenosine cautions | not for OD or poison tachy or 2nd or 3rd heart block, less effective w/caffeine, PT IN MILD REVERSE TRENDELENBURG TO ADMIN DRUG!!!!! |
| adenosine dose | trendelenburg for 6mg rapid infusion, less than 5 second half life, then elevate for 2nd and 3rd dose at 12mg, 30mg max |
| dopamine | ???????, second line for symptomatic brady (after atropine) and hypotension <70-100 with shock |
| dopamine dose | 2-20 ug/kg per minute, titrate to pt response |
| dopamine precautions | correct hypovelemia with volume prior to dopamine, caution with CHF, may cause tachy or excess vasoconstriction, never mix with bicarb |
| magnesium sulfate | cardiac arrest with torsades dede pointes, life-threating V-arrhythmias due to digitalis toxicity |
| magnesium precautions | rapid < BP with rapid admin, caution with renal failure present. |
| Magnesium dose | cardiac arrest due to hypo-magnesium or torsades 1-2 g (2-4ml of 50%) in 10ml of D5W over 5-20 mins, torsades with pulse 1-2 g with 50-100 ml D5W over 5-60 mins, followed by .5 to 1 g/h to control torsades |
| drug types that control rhythm and rate are | anti-rhythmics, b-blockers and calcium channel blockers |
| drugs of choice for rhythm and rate are (according to book) | (DVM-DANCED Kay loves vets ) dopamine, vasopressin, milrinone, dobutamine, amrinone/inamrinon, nitroglycerin, calcium, epi, digitalis) |
| vasopressin | can be alternative to epi in shock-refractory VF, asystole and PEA, also as hemodynamic support in septic shock |
| vasopressin cautions | potent vasoconstrictor can cause cardiac ischemia and angina, not recommended for pt w/coronary art disease |
| vasopressin dose | 40 U IV/IO ONE TIME ONLY, only one dose for cardiac arrest, can replace epi first or second dose (epi can be give 3x during CA) |
| Milrinone | (positive inatrope) myocardial dysfunction and increased systemic or pulmonary vascular resistance, CHF post surgery, shock w/high systemic vascular resistance |
| milrinone cautions | very short half life(shorter than inamrinone), nausea, vomit, hypotension, may accumulate in renal failure pts |
| milrinone dose | 50 ug/kg over 10 mins loading dose, .375-.75/min for 2-3 days |
| other drugs used during ACLS are (according to book) | morphine, bicarb and thrombolitics |
| morphine | narcotic analgesic/opioid (agonist), chest pain with ACS (acute coronary syndrome) unresponsive to nitrates and acute cardiogenic pulmonary edema (if blood pressure is adequate), fyi morphine is a phosphodiesterase inhibitor |
| Thrombolitics | streptokinase and urokinase, clot-busters (FYI, was on first test and Mark got it wrong, Heparin is listed in answers and is not a clot-buster, only strepto and uro |
| ACLS drugs are administered via | IV, IO (intraosseous-into the bone marrow of tibia, femur and iliac crest are bone of choice), instilled via ETT |
| Isoproterenol is sometimes used during ACLS for what | a pure B-adrenergic agonist (potent inotropic and chronotropic) as vasopressor, temp if external pacer not avail for TX of symptomatic brady or refractory torsades unresponsive to magnesium, poisoning from B-blockers |
| Isoproterenol cautions | NEVER AS A TX FOR CARDIAC ARREST, increased O2 need of myocardial may increase ischemia, never with epinephrine(causes VT/VF) |
| isoproterenol dosing | 2-10 ug/min, titrate to adequate HR, in torsades titrate until VT is suppressed |
| Big 4, main drugs in ACLS are (like going to drink beer at on oxygen bar) | O2+ALE. O2, atropine, lidocaine, and epi |
| dopamine and dobutamine are for what | >CO and >BP, vasopressors |
| bicarb in ACLS is useful when | pt has preexisting met acidosis |
| best drugs in ACLS for pt with frequent PVC's and runs of VT | lidocaine |
| ongoing CPR, pt is intubated and ventilated, pt is asystole on monitor, what is drug choice | 1mg epinephrine |
| following resuscitation, pt in CCU cont having freq multi-focal PVC's and runs of VT what do you recommend | lidocaine 2-4 mg/min to reduce cardiac irritability |
| diltiazem and verpimil are | calcium channel blockers for mgmt of atrial dysrrhythmias |
| when ACLS drugs are instilled in ETT, what is dose | 2-2.5 times standard IV dose |
| what is O2 FIO2 for ACLS | 100% |
| best IV solution when admin ACLS drugs via IV, in the absence of volume depletion | NS or lactated ringers (use whats available, don't let absence of volume keep you from choosing lactated ringers) |
| if using thrombolytic (clotbusters-urokinase and streptokinase) following MI, should be administered when? | within 6 hours |
| MONA | MI drugs, morphine, O2, Nitroglycerin, aspirin |
| which of the following is true about the use of magnesium in CA? | 1 mg is indicated for VF/pulseless VT associated with torsades de pointe |
| Pt is in CA, CPR in progress, pt is intubated and IV is started, rhythm is asystole, what is first drug to administer | epi 1mg or vasopressin 40 U IV |
| Pt is intubated, IV/IO is not available. What combo of drugs can be instilled in ETT? Hint V is Lean | vasopressin, lidocaine, epi, atropine, na bicarb |
| Pt with acute MI with ongoing chest pain is unresponsive to 3 doses of nitroglycerin. Pt is given 4mg of morphine. Shortly after, BP is 88/60 and complains of chest pain, what do you do? | give NS 250-500 mL fluid bolus |
| Pt has sinus brady with rate of 36, atropine has been given totaling 3mg, pt is confused and BP is 100/66, what now? | start dopamine 2-20 ug/min (because BP is good) |
| Pt is in refractory VF and has received multiple shocks. 2Mg epi and an initial dose of lidocaine IV. A second dose of lidocaine is indicated, what is the recommended dose? | .5-.75 mg/kg IV push |
| which of the following is contra-indicated for the administration of nitrates | use of phosphdiesterase |
| what is the correct use of vasopressin in CA | dose of 40 U IV/IO 1 time only, never instead of epi during asystole, and not for VF prior to the first shock |
| pt has wide complex tachycardia, rate is 138, BP 110/70 and asymptomatic, what action is recommended | expert consult (pt is asymptomatic) |
| pt is in CA, VF and refractory to initial shock. What drug and dose should we give first | epi 1mg |
| pt in pulseless VT, two shock and epi has been given, what is next drug and dose | amiodarone 300 mg |
| your called to a code and CPR is ongoing, no shock is indicated and pt has asystole on monitor, what's next | establish IV or IO access, need to get drugs in |
| 35 year old woman with palpitations, she is lite headed like Kay, stable tachycardia at 180, irregular narrow QRS, vagal manover did not work, IV is in place, what drug do you recommend to convert? | adinosine (chemical cardiovert) |
| Pt with possible ACS, brady at 42 bpm, what is initial dose of atropine? | .5mg |
| 62 yr old male with left side weakness and difficulty speaking, what should we give him | Fibrinolytic agent (TPA) (streptokinase), but not the asprin (never give asprin with TPA or heprin) |
| Nicotinic-2 receptor | somatic (voluntary) receptor for skeletal muscle |
| ACH and skeletal muscle | ACH is neurotransmitter for somatic nervous system at muscle/nerve junction, N2 is receptor |
| NE | neurotransmitter of sympathetic division of nervous system, A, B1 and B2 are receptors |
| peripheral-acting muscle relaxants (2 classes) | drugs that interact w/N2 and cause paralysis, depolarizing and non-depolarizing |
| depolarizing neuromuscular blockers (muscle relaxant) | cause persistent depolarizing at motor so ACH cannot work, muscles twitch, but cannot respond |
| non-depolarizing neuromuscular (muscle relaxants) | competitive inhibition aka antagonism with ACH for N2 receptor |
| what class of drugs are used for pt on ventilator for paralytic | non depolarizing competitive antagonist |
| the non depolarizing muscle relaxant drugs are | d-tubocurarine/curare (prototype), atracurium/tracrium and vecuronium/norcurum |
| d-tubocurarine/curare | prototype non depolarizing, semi-synthetic muscle relax, side affects-releases histamine, bad cardio so not used anymore |
| atracurium/tracrium | non-depolarizing peripheral muscle relaxant for surgery strong cardio probs, no histamine |
| vecruronium/norcuron | none-polarizing peripheral muscle relaxant for surgery, metabolized in liver excreted by kidney |
| depolarizing muscle relaxants medication | succinylcholine, competitive antagonist w/ACH met in plasma and liver, fast acting-short duration, peripheral, used mostly in ER for ET intubation |
| Succinylcholine hazards/precautions | releases histamines, cardio probs <BP, can interact with Halothane to cause MALIGNANT HYPOTHERMIA |
| direct acting peripheral muscle relaxants | cantrolene/Dantrium, used for muscle spasms w/ MS, CP, malignant hypothermia and spinal cord injuries |
| what drug can cause malignant hypothermia | succs, when mixed with general anesthetics like Halothane during surgery, usually in teen males |
| CNS muscle relaxants aka CNS sedatives drug | carisoprodol/Soma, central acting muscle relaxant, used in TX of spastic from over exertion, trauma and nervous tension |
| somatic nerve fiber neurotransmitter and receptor are | ACH and N2 |
| Peripheral acting muscle relaxant d-tubocurarine/Curare uses what method of action | non-depolarizing |
| peripheral acting muscle relaxant succinylcholine uses what method of action | depolarizing |
| peripheral acting muscle relaxant dantrolene/Dantrium uses what method of action | direct-acting |
| CNS muscle relaxants | work at the level of the spinal cord, do not affect normal function of neuromuscular junction, all of the drugs cause varying degrees of sedation, IV or ET |
| do antibiotics cross the blood brain barrier | no |
| antimicrobial agents | selectively toxic, kill or inhibit microorganisms |
| antibiotic | compounds produced by living organisms that kill bacteria |
| antibacterial | inhibit or destroy bacteria |
| bacteriostatic | antibiotic that inhibit bacteria |
| bacteriocidal | antibiotic that kill bacteria |
| antibacterial therapy fails because of | insensitive to DX, mixed infection, wrong drug, developed resistance, super infection, inadequate regimin, unable to penetrate infec site, no supportive measures, toxicity or hypersensity |
| categories of antibiotics | beta-lactams, neg-pos organisms, broad spectrum and sulfonamides |
| beta-lactam antibiotics drugs are | penicillins, cephalosporins, carbapenams and monobactams |
| autolytic | mechanism of action of beta-lactams, inhibit cell wall synthesis in bacteria, causing lysis of cell |
| natural penicillins are | penicillin G and V, G is not stable in acid so IV, V is acid stable so can be PO, includes streptococci, gentococci and meningcocci |
| beta-lactamase inhibitors | clavulanic and sulbactam, NOT AN ANTIBIOTIC, but combines to broaden antibacterial spectrum |
| beta-lactamase inhibitors drug | Augmentin, amoxicillin combined with betalactamase inhibitor |
| best drug for staph and nosocomial infections | aminoglycosides/gentamicin, very toxic antibiotic, tough on body, TX of pseudomonas, staph and nosocomials |
| adverse effects of aminoglycosides/Gentamicin | ototoxicity(hearing loss), nephrotoxicity and renal dysfunction, neuromuscular blockade can result in resp paralysis |
| first line TB drugs are (RISE) | rifampin/Rifadin, isoniazid/Nydrazid, streptomycin, ethambutol/Myambutol |
| best drug for TB prevention if pt has been exposed | Isoniazid (Inti) |
| TX for TB drug combos | all 4 drugs for 2-3 months, then combo of 2 for additional 9 months |
| anti-fungal for Candida is | nystatin |
| amphotericin B/fungizone | valley fever |
| ketoconazole/nizoral | most common anti-fungal, TX for chronic candidiasis, bad side effects, man boobs like mark |
| acyclovir/zovirax | antiviral, TX for cold sores, CMV, mono (Epstein-Barr) |
| ribavirin | antiviral for RSV (need spag unit) |
| aerosolized antimicrobials are | pentamadine (for PCPneumonia), Riboviron(RSV), Thrombomycine/TOBI (CF) |
| best antibiotics for for CF | TOBI, 28 days on 28 off, for TX and prophylactic of P-aerafinosa, also can us gentamiocen (chronic colonization) |
| influenza drugs | relenza, antiviral that only works if taken at first onset |
| bonus question, who discovered penicillin, meds biggest discovery ever? | Flemming |
| pulm infections effectively treated with aerosol antibiotics are | TB, spergilloma and coccidiomycosis |
| antiprotozoal method of action | inhibit RNA, DNA and protein synthesis |
| antiprotozoal antibiotic | pentamidine, used in TX of P-pneumonia (aids) |
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williamwallace
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