Before

Question 1

Adenosine

Answer 1

Any irregular tachycardia. Specifically never administer to an irregular wide-complex tachycardia, which may be lethal

Drug Intx
Methylxanthines (eg caffeine) antagonize adenosine, a higher dose may be required
Dipyridamole (persantine) potentiates the effect of adenosine; reduction of adenosine dose may be required
Carbamazepine may potentiate the AV-nodal blocking effect of adenosine

Question 2

Albuterol

Answer 2

Severe tachycardia is a relative contraindication

Drug Intx
Sympathomimetics may exacerbate adverse cardiovascular effects
B-Blockers may antagonize albuterol

Question 3

Amiodarone

Answer 3

Precautions
Wide complex irregular tachycardia
Sympathomimetic toxidromes, i.e. cocaine or amphetamine overdose
NOT to be used to treat ventricular escape beats or accelerated idioventricular rhythms
Contraindications
2nd or 3rd degree AV block
Cardiogenic shock

Question 4

Aspirin

Answer 4

Active GI bleed

Allergy

Question 5

Atropine

Answer 5

Precautions
Should not be used w/o medical control direction for stable bradycardias
Closed-angle glaucoma

Question 6

Calcium Gluconate

Answer 6

Known hypercalcemia

Suspected digoxin toxicity

Question 7

Dextrose 50%

Answer 7

None

Question 8

Diazepam (Valium)

Answer 8

Precaution

CNS or cardiovascular side effects are compounded with patients under the influence of drugs or alcohol.

Question 9

Diltiazem (Cardizem)

Answer 9

Precaution
Concurrent use with Midazolam may required decreased dose
Use with caution in patients on PO/IV beta-blockers

Question 10

Diphenhydramine (Benadryl)

Answer 10

Precautions
Asthma or COPD, thickens bronchial secretions
Narrow-angle glaucoma
Drug Intx
CNS depressants and alcohol may have additive effects
MAO inhibitors may prolong and intensify anticholinergic affects of antihistamines

Question 11

Dopamine

Answer 11

Hypovolemia

Hemorrhagic shock

Question 12

Epinephrine

Answer 12

Drug intx

Should not be added to sodium bicarbonate or other alkaloids as epinephrine will be inactivated at higher pH

Question 13

Fentanyl

Answer 13

Hypotension, hemodynamic instability or shock

Respiratory depression

Question 14

Furosemide

Answer 14

Pregnancy

Dehydration or shock

Question 15

Glucagon

Answer 15

None

Question 16

Haloperidol (Haldol)

Answer 16

Contraindications
Suspected myocardial infarction
Hypotension
Respiratory or CNS depression
Pregnancy
Children < 8 years old

Precautions
Haldol may cause hypotension, tachycardia, and prolongation of the QT interval. Use with caution in severe cardiovascular disease
Cardiac monitor and establish an IV as soon as possible with all administrations
Some patients may experience unpleasant sensations manifested as restlessness, hyperactivity, or anxiety following haloperidol administration
Rare instances of neuroleptic malignant syndrome (very high fever, muscular rigidity) have been known to occur after the use of haloperidol.

Question 17

Ipratropium Bromide (Atrovent)

Answer 17

Do not administer to children < 2 years
Soy or peanut allergy is a contraindication to use of Atrovent metered dose inhaler, not the nebulized solution, which does not have the allergen contained in propellant.

Question 18

Lidocaine 2% Solution

Answer 18

Precaution: Lidocaine is metabolized in the liver and therefore, elderly patients and those with liver disease or poor liver perfusion secondary to shock or congestive heart failure are more likely to experience side effects.

Question 19

Lorazepam (Ativan)

Answer 19

Hypersensitivity to benzodiazepines
Acute narrow-angle glaucoma
Intraarterial administration
Pregnancy class D (benefit may outweigh risk for life threatening situation)

Question 20

Magnesium Sulfate

Answer 20

Precautions
Bradycardia
Hypotension
Respiratory depression

Question 21

Metoclopramide (Reglan)

Answer 21

Children < 8 years

Question 22

Methylprednisolone (Solu-Medrol)

Answer 22

Evidence of active GI bleed

Question 23

Midazolam (Versed)

Answer 23

Hypotension

Question 24

Morphine Sulfate

Answer 24

Hypovolemia

Hypotension (relative)

Question 25

Naloxone

Answer 25

None

Question 26

Nitroglycerine

Answer 26

Suspected right ventricular ST-segment elevation MI (Inferior STEMI pattern plus ST elevation in right sided precordial leads)
Hypotension SBP < 100
Recent use of erectile dysfunction (ED) medication (eg Viagra, Cialis, Levitra)

Question 27

Ondansetron (Zofran)

Answer 27

None

Question 28

Oral Glucose

Answer 28

Inability to swallow or protect airway

Unable to take PO meds for another reason

Question 29

Phenylephrine (IN)

Answer 29

Precaution

Avoid administration into the eyes, which will dilate pupils

Question 30

Promethazine (Phenergan)

Answer 30

Precautions
Promethazine does not eliminate the need to monitor the airway
Respiratory depression may occur if the patient has used alcohol or drugs
Extrapyramidal effects are more likely to manifest in pediatric patients with acute illness or dehydration

Contraindications
Coma
CNS depression from alcohol or drug use
Pts < 2 years

Question 31

Racemic Epinephrine

Answer 31

None

Question 32

Sodium Bicarbonate

Answer 32

Metabolic and respiratory alkalosis
Hypocalcemia
Hypokalemia

Question 33

Topical Ophthalmic Anesthetics

Answer 33

Known allergy to local anesthetics

Globe lacerations or rupture