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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
Metoprolol dosing?
Metoprolol: 5 mg slow IVP at 5-minute interval (to a total of 15 mg)
26
Atenolol dosing?
Atenolol: 5 mg slow IVP (over 5 minutes) may repeat x 1
27
Propranolol dosing?
Propranolol: 0.1 mg/kg slow IVP divided into 3 equal doses at 2- to 3-minute intervals (rate ≤ 1 mg/kg)
28
Esmolol dosing?
Esmolol: 500 mcg/kg bolus IVP (over 1 min), followed by a 4-minute infusion of 50 mcg/kg/min (total 200 mcg/kg)
29
Avoid adenosine, digoxin, diltiazem, verapamil in which conditions
AF + WPW syndrome
30
When should the dose of adenosine be reduced to 3mg instead of 6?
Reduce dose to 3 mg in recent heart transplant patients, in pts taking carbamazepine, dipyridamole
31
Differences in dosing of magnesium for tachycardia
1 – 2 gram (diluted in 50 – 100 mL D5W) over 5 – 60 min IV
32
Procainamide class?
Class IA antiarrhythmic agent
33
Procainamide dosing?
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
DOC for the following conditions: Torsades de pointes Symptomatic bradycardia Supraventricular tachycardia
Torsades - magnesium Symptomatic bradycardia - atropine Supraventricular tachycardia - adenosine
35
How is pulmonary HTN classified?
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
How does endothelin, NO, and prostacyclin cause/treat PAH?
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
PAH class types?
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
How is PAH diagnosed?
Invasive tests Requires echocardiography (transthoracic) and pulmonary artery catheterization (also known as right-heart catheterization)
39
What criteria must be met to be diagnosed with PAH?
mPAP≥25 + PCWP/LVEDP ≤15 + PVR>3
40
Whats given to assess mPAP?
Adenosine, NO, or epoprostenol If reduced by 10-39, its considered postive
41
CCB indication for PAH?
Positive test required!
42
CCB AE?
Hypotension Peripheral edema Bradycardia (diltiazem only)
43
How is epoprostenol initiated?
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
How is epoprostenol given?
IV infusion only, has a very short half life
45
What should be avoided with epoprostenol?
Nitrates; severe refractory hypotension
46
Brand differences of epoprostenol?
Flolan® - original formulation, requires ice packs, low stability Veletri® - more basic, greater room temperature stability
47
How is Treprostinil given?
IV, SQ, oral, inhaled
48
Because Treprostinil has a longer half life than epoprostenol, what other advantage does it have on AE?
Decreasing the risk of rebound pulmonary vasoconstriction
49
What are some other issues (AE) of treprostinil vs epoprostenol?
More bloodstream infections via IV Infusion site pain via SQ Throat burn via inhalation
50
How is Iloprost given?
Inhalation only
51
What is an administration issue of Iloprost has that doesnt occur with treprostinil?
It takes 10-15 min to inhale Treprostinil just takes longer to prepare
52
What are the endothelin receptor antagonists?
Bosentan (A + B) Ambrisentan (A only) Macitentan (A + B; but higher selectivity with A)
53
Bosentan Ambrisentan Macitentan Letairis Opsumit Tracleer Which programs need to be associated w/ each drug?
Bosentan - Tracleer Ambrisentan - Letairis Macitentan - Opsumit
54
Bosentan AE?
Preg cat: X Anemia + Edema If AST/ALT 3x upper limit, reduce dose or hold
55
Ambrisentan AE?
2 forms of birth control Anemia + Edema Transaminitis, Nasal congestion, flushing, and palpitations
56
Macitentan AE?
Females register only Anemia + Edema Transaminitis, Nasal congestion, flushing, and palpitations
57
PDE5 inhibitor MOA?
Increased intracellular cGMP concentration
58
PDE5i AE?
Vision change and loss can occur – therapy should be discontinued if this happens ``` Dyspepsia Diarrhea Systemic hypotension Headaches Flushing Epistaxis ```
59
PDE5i Interactions?
Nitrates – precipitous drop in blood pressure, avoid combination Bosentan - 50% decrease of PDE5i concentration
60
What are the Soluble cGMP Stimulator Rx? MOA?
Riociguat Works synergistically with nitric oxide and directly stimulates soluble guanylate cyclase Increases intracellular cGMP concentration
61
Riociguat AE?
``` Headaches Peripheral edema Major bleeding GERD Systemic hypotension ``` Preg Cat: X
62
Riociguat interactions?
Nitrates, PDE5 inhibitors
63
What are the Prostacyclin Receptor Agonist Rx?
Selexipag
64
Selexipag AE?
``` Headaches Jaw pain Myalgia Flushing Anemia Rash ```
65
Selexipag interactions?
Gemfibrozil (will increase selexipag conc.)
66
What vaccines are recommended for PAH?
Maintain current influenza and pneumococcal vaccination
67
PAH I Tx plan?
Monitor patient
68
PAH II or III w/ NO rapid disease progression Tx plan?
Ask if pt can tolerate combo therapy If yes, ambrisentan and tadalafil If no, endothelin receptor antagonists, riociguat, sildenafil, or tadalafil
69
PAH III Tx plan w/ rapid disease progression
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
PAH treatment if inadequate treatment from previous tx plan?
Add second line or third line (if REALLY bad)
71
PAH treatment if nothing works at all?
Lung transplant (if applicable) or palliative care

IPT: CC (7 decks)

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