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IPT: CC > Block 3 > Flashcards

Block 3 Flashcards

1
Q

Chest compressions

Rate of _______ compressions per minute

A

100-120

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2
Q

30/2 – 30 compressions, 2 breaths

If an advanced airway is in place, __ breath every __ seconds

A

1 breath every 6 seconds

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3
Q

Which rhythms should you shock/not shock?

A

Pulseless vTac, VFib

Do not do on pulseless electrical activity (PEA) or asystole

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4
Q

Establish IV access (after/before) attempt of CPR and defibrillation

A

AFTER

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5
Q

Which drugs are absorbed in the trachea

A

NAVEL

Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine
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6
Q

Amiodarone class? MOA?

A

Class III antiarrhythmic agent

Inhibit ion flux through Na+, K+, Ca2+ channels
Has α- and β- blocking activities

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7
Q

Amiodarone dose in ACLS?

A

300 mg IVP/IO; may repeat 150 mg IVP/IO once; may start continuous infusion

Continuous infusion: 1 mg/min x 6 hrs followed by 0.5 mg/min x 18 hours

Max 2.2 grams in 24 hours

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8
Q

Lidocaine class? MOA?

A

Class IB antiarrhythmic agent

Inhibit ion flux through Na+ channels

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9
Q

Lidocaine dose in ACLS?

A

1 – 1.5 mg/kg IVP; may repeat if pVT/VF persists with 0.5 – 0.75 mg/kg IVP at 5- to 10-minute intervals

Can be given via ET tube at a dose of 2 – 4 mg/kg

Max dose: 3 mg/kg

Continuous infusion (after ROSC): 1 – 4 mg/min

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10
Q

Magnesium MOA in ACLS?

A

Facilitate prolongation of ventricular repolarization by enhancing intracellular myocardial K+ flux (a process that requires Mg2+)

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11
Q

Magnesium dose in ACLS?

A

1 – 2 gram (diluted in 10 mL D5W) IVP/IO

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12
Q

What are the H’s and T’s?

A

Hypothermia

Hypoxia

Hypovolemia

Hyper/hypokalemia

Hydrogen ions

Tablets (overdose, toxins)

Thrombosis, ACS

Thrombosis, PE

Tamponade, cardiac

Tension pneumothorax

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13
Q

In what situations should you give meds if a person is bradycardic? What meds can you give then?

A

Hypotension

Acutely altered mental status

Signs of shock

Ischemic chest discomfort

Acute heart failure

Atropine, dopamine, epi

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14
Q

Atropine MOA?

A

Blocks acetylcholine receptors; inhibit the action of the vagus nerve on the heart

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15
Q

Atropine dosing?

A

1 mg IV, may repeat

Max dose: 3 mg

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16
Q

Dopamine dosing?

A

Infusion (begin at 5 – 10 mcg/kg/min, titrate to response)

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17
Q

As you increase dose of dopamine, what receptors are affected?

A

It goes from mostly dopamine and beta to just alpha and beta

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18
Q

Epi dosing for bradycardia?

A

Infusion (begin at 2 – 10 mcg/min, titrate to response)

No maximum doses

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19
Q

If tachycardic and have these symptoms, what do you do?

A

Hypotension

Acutely altered mental status

Signs of shock

Ischemic chest discomfort

Acute heart failure

Move on to synchronized cardioversion

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20
Q

What conditions are considered wide QRS? How is it treated

A

Anything ≥0.12 sec

Ventricular tachycardia
SVT with aberrancy
Pre-excited tachycardias (via accessory pathways)

Adenosine only if regular and monomorphic, Amiodarone Magnesium, and Procainamide

Anything else is narrow complex

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21
Q

How is narrow QRS treated?

A

Treated with vagal maneuvers, adenosine, BB, CCB

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22
Q

Adenosine dosing?

A

6 mg rapid IVP & 20-mL saline flush at the same time with elevation of the arm infused into

May repeat with 12 mg bolus x 2 if no conversion occurs within 1 – 2 min

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23
Q

Verapamil dosing?

A

Verapamil: 2.5 – 5 mg IV over 2 min, may repeat 5 – 10 mg Q 15 – 30 min (to a total dose of 20 mg)

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24
Q

Diltiazem dosing?

A

Diltiazem: 0.25 mg/kg (15 – 20 mg) IV over 2 min bolus; 0.35 mg/kg (20 – 25 mg) IV over 2 minutes (2nd bolus in 15 min); maintenance infusion 5 – 15 mg/hr (titrate to HR)

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25
Q

Metoprolol dosing?

A

Metoprolol: 5 mg slow IVP at 5-minute interval (to a total of 15 mg)

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26
Q

Atenolol dosing?

A

Atenolol: 5 mg slow IVP (over 5 minutes) may repeat x 1

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27
Q

Propranolol dosing?

A

Propranolol: 0.1 mg/kg slow IVP divided into 3 equal doses at 2- to 3-minute intervals (rate ≤ 1 mg/kg)

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28
Q

Esmolol dosing?

A

Esmolol: 500 mcg/kg bolus IVP (over 1 min), followed by a 4-minute infusion of 50 mcg/kg/min (total 200 mcg/kg)

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29
Q

Avoid adenosine, digoxin, diltiazem, verapamil in which conditions

A

AF + WPW syndrome

30
Q

When should the dose of adenosine be reduced to 3mg instead of 6?

A

Reduce dose to 3 mg in recent heart transplant patients, in pts taking carbamazepine, dipyridamole

31
Q

Differences in dosing of magnesium for tachycardia

A

1 – 2 gram (diluted in 50 – 100 mL D5W) over 5 – 60 min IV

32
Q

Procainamide class?

A

Class IA antiarrhythmic agent

33
Q

Procainamide dosing?

A

LD 20mg/min continuous infusion; until arrhythmia is suppressed

Maintenance infusion: 1 – 4 mg/min dilute in D5W or NS

Reduced in presence of renal failure

Max loading dose 17 mg/kg

34
Q

DOC for the following conditions:

Torsades de pointes
Symptomatic bradycardia
Supraventricular tachycardia

A

Torsades - magnesium

Symptomatic bradycardia - atropine

Supraventricular tachycardia - adenosine

35
Q

How is pulmonary HTN classified?

A

Group 1 - Pulmonary artery HTN

2 - Left heart disease

3 - Lung disease and/or hypoxia

4 - Chronic TE pulmonary HTN

5 - Unknown or multifactorial

36
Q

How does endothelin, NO, and prostacyclin cause/treat PAH?

A

Endothelin -> leads to vasoconstriction and proliferation

Nitric oxide -> leads to production of cGMP which causes vasodilatation and antiproliferation

Prostacyclin -> also leads to production of cAMP which causes vasodilatation and antiproliferation

37
Q

PAH class types?

A

I = no limitation of usual physical activity

II = Mild limitation of physical activity

III = Marked limitation of physical activity. There is no discomfort at rest,

IV = Unable to perform any physical activity at rest and who may have signs of right ventricular failure

38
Q

How is PAH diagnosed?

A

Invasive tests

Requires echocardiography (transthoracic) and pulmonary artery catheterization (also known as right-heart catheterization)

39
Q

What criteria must be met to be diagnosed with PAH?

A

mPAP≥25 + PCWP/LVEDP ≤15 + PVR>3

40
Q

Whats given to assess mPAP?

A

Adenosine, NO, or epoprostenol

If reduced by 10-39, its considered postive

41
Q

CCB indication for PAH?

A

Positive test required!

42
Q

CCB AE?

A

Hypotension

Peripheral edema

Bradycardia (diltiazem only)

43
Q

How is epoprostenol initiated?

A

Started at a low dose (2-4 ng/kg/min) and increased until rate-limiting side effects

Goal dose is 10-15 ng/kg/min

44
Q

How is epoprostenol given?

A

IV infusion only, has a very short half life

45
Q

What should be avoided with epoprostenol?

A

Nitrates; severe refractory hypotension

46
Q

Brand differences of epoprostenol?

A

Flolan® - original formulation, requires ice packs, low stability

Veletri® - more basic, greater room temperature stability

47
Q

How is Treprostinil given?

A

IV, SQ, oral, inhaled

48
Q

Because Treprostinil has a longer half life than epoprostenol, what other advantage does it have on AE?

A

Decreasing the risk of rebound pulmonary vasoconstriction

49
Q

What are some other issues (AE) of treprostinil vs epoprostenol?

A

More bloodstream infections via IV

Infusion site pain via SQ

Throat burn via inhalation

50
Q

How is Iloprost given?

A

Inhalation only

51
Q

What is an administration issue of Iloprost has that doesnt occur with treprostinil?

A

It takes 10-15 min to inhale

Treprostinil just takes longer to prepare

52
Q

What are the endothelin receptor antagonists?

A

Bosentan (A + B)

Ambrisentan (A only)

Macitentan (A + B; but higher selectivity with A)

53
Q

Bosentan
Ambrisentan
Macitentan

Letairis
Opsumit
Tracleer

Which programs need to be associated w/ each drug?

A

Bosentan - Tracleer

Ambrisentan - Letairis

Macitentan - Opsumit

54
Q

Bosentan AE?

A

Preg cat: X

Anemia + Edema

If AST/ALT 3x upper limit, reduce dose or hold

55
Q

Ambrisentan AE?

A

2 forms of birth control

Anemia + Edema

Transaminitis, Nasal congestion, flushing, and palpitations

56
Q

Macitentan AE?

A

Females register only

Anemia + Edema

Transaminitis, Nasal congestion, flushing, and palpitations

57
Q

PDE5 inhibitor MOA?

A

Increased intracellular cGMP concentration

58
Q

PDE5i AE?

A

Vision change and loss can occur – therapy should be discontinued if this happens

Dyspepsia
Diarrhea
Systemic hypotension
Headaches
Flushing
Epistaxis
59
Q

PDE5i Interactions?

A

Nitrates – precipitous drop in blood pressure, avoid combination

Bosentan - 50% decrease of PDE5i concentration

60
Q

What are the Soluble cGMP Stimulator Rx? MOA?

A

Riociguat

Works synergistically with nitric oxide and directly stimulates soluble guanylate cyclase

Increases intracellular cGMP concentration

61
Q

Riociguat AE?

A 
Headaches
Peripheral edema
Major bleeding
GERD
Systemic hypotension

Preg Cat: X

62
Q

Riociguat interactions?

A

Nitrates, PDE5 inhibitors

63
Q

What are the Prostacyclin Receptor Agonist Rx?

A

Selexipag

64
Q

Selexipag AE?

A 
Headaches
Jaw pain
Myalgia
Flushing
Anemia
Rash
65
Q

Selexipag interactions?

A

Gemfibrozil (will increase selexipag conc.)

66
Q

What vaccines are recommended for PAH?

A

Maintain current influenza and pneumococcal vaccination

67
Q

PAH I Tx plan?

A

Monitor patient

68
Q

PAH II or III w/ NO rapid disease progression Tx plan?

A

Ask if pt can tolerate combo therapy

If yes, ambrisentan and tadalafil

If no, endothelin receptor antagonists, riociguat, sildenafil, or tadalafil

69
Q

PAH III Tx plan w/ rapid disease progression

A

Ask if pt can tolerate parenteral prostanoids

If yes, continuous IV epoprostenol, IV treprostinil, or SC treprostinil

If no, addition of inhaled or oral prostanoid

70
Q

PAH treatment if inadequate treatment from previous tx plan?

A

Add second line or third line (if REALLY bad)

71
Q

PAH treatment if nothing works at all?

A

Lung transplant (if applicable) or palliative care

IPT: CC (7 decks)

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