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Adv Rx Test 3/Final

WillWallace Adv RX T 3/final Ch 4 8 13 17

QuestionAnswer
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)
Created by: williamwallace