Cardiac Drugs, Ambulance

Question 0

What is aspirin indicated for?

Answer 0

Chest pain or s/s suggestive of acute coronary syndrome. ECG changes that suggest acute myocardial infarction.

Question 1

What is the mechanism of action of aspirin?

Answer 1

It prevents the formation of thrombaxane a2, which causes platelets to clump together, and forms plugs that clog small coronary arteries.

Question 2

What is aspirin contraindicated for?

Answer 2

PEDS, vomiting, intact gag reflex, Inability to follow commands, hypersensitivity to salicylates or other NSAIDS, bleeding ulcer, hemorrhagic states, bleeding disorders hemophilia, children and adolescents, LAST THREE MONTHS OF PREGNANCY.

Question 3

What is the dose of aspirin?

Answer 3

Adult: 324mg 4x81 mg tablets
PEDS: contraindicated

Question 4

What is the action of morphine?

Answer 4

Binds to opioid receptors.

Question 5

What are the indications of morphine?

Answer 5

Moderate to severe acute and chronic pain, relief of pain in ACS.

Question 6

What are the contraindications of morphine?

Answer 6

Hypotension, head injured patients, PREGNANCY, impaired respiratory/pulmonary function, acute asthma

Question 7

Morphine route of administration?

Answer 7

IV, IM, IO

Question 8

Interactions of morphine?

Answer 8

Be careful with concurrent use of benzos, narcotics, or alcohol

Question 9

What is the dose of morphine?

Answer 9

Adult-chf 2 mg
CP-2mg
Burns-4 mg
Fractures- 4mg

PEDS- 0.1 mg/kg up to 8 mg

Question 10

What are some special considerations of morphine administration?

Answer 10

Have naloxone ready, not for reversal of withdrawl symptoms or sedation of obs pt.s. not to be used if c-spine of spinal fractures are a concern. If there is a doubt contact med control.

Question 11

What is the mechanism of action of nitroglycerin?

Answer 11

It relaxes smooth muscle, thereby dilating peripheral arteries and veins, this causes a pooling of venous blood and decreases venous return to the heart, which decreases preload. Also reduces left ventricular systolic wall tension which decreases afterload.

Question 12

What are the indications for nitroglycerin?

Answer 12

Angina and pulmonary congestion associated with CHF.

Question 13

What are the contraindications of nitroglycerin?

Answer 13

Hypersensitivity
Inferior wall MI (II,III,aVF) with suspicion of right ventricular involvement
Hypotension systolic<50bpm
In corrected hypocalcemia
Pt. on phosphodietrase PDE inhibitors in the last 24 hours for Viagra or levitra 48 hours for tafadil, cialis, adcirca

Question 14

What is the route of administration for nitroglycerin?

Answer 14

Sublingual

Question 15

When should you use caution with nitroglycerin use?

Answer 15

In alcohol or calcium channel blocker use, pregnancy category C

Question 16

What is the dose of nitroglycerin?

Answer 16

400mcg or .4 mg

Question 17

What is the pediatric dose of nitroglycerin?

Answer 17

It is not indicated.

Question 18

Can you give nitroglycerin before you have IV access?

Answer 18

Yes only if the bp is over 130 mmhg systolic.

Question 19

What is the mechanism of action of atropine?

Answer 19

In general, atropine counters the “rest and digest” activity of glands regulated by the parasympathetic nervous system. This occurs because atropine is a competitive antagonist of the muscarinic acetylcholine receptors (acetylcholine being the main neurotransmitter used by the parasympathetic nervous system). Atropine dilates the pupils, increases heart rate, and reduces salivation and other secretions.
Receptors affected most to least; salivary, bronchial sweat glands, eye, heart, and gi tract

Question 20

What is acetylcholine?

Answer 20

It is a neurotransmitter in the central nervous system and the peripheral nervous system. It’s effect on the heart is to slow heart rate. It acts in an excitability capacity for skeletal muscle.

Question 21

What is a muscarinic receptor?

Answer 21

It is the acetylcholine receptor.

Question 22

What are the indications of atropine?

Answer 22

Bradycardia, Acetylcholinesterase inhibitor poisoning (nerve agents, insecticides certain mushrooms)

Question 23

What are signs and symptoms of cholinergic poisoning?

Answer 23

SLUDGEM
Salivation
Lacrimation-secretion of tears
Urination
Defecation
Gastrointestinal distress
Emesis-vomiting
Miosis- constriction of people

Question 24

What are the contraindications of atropine?

Answer 24

Hypersensitivity, tachycardia, obstruction of GI tract, obstructive uropathy, mi, narrow angle glaucoma, myasthenia gravis

Question 25

What is myasthenia gravis?

Answer 25

Myasthenia gravis (from Greek "muscle", "weakness", and Latin: gravis "serious"; abbreviated MG) It is an autoimmune disorder, in which weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction, inhibiting the excitatory effects of the neurotransmitter acetylcholine on nicotinic receptors throughout neuromuscular junctions.

Question 26

What is the route of atropine?

Answer 26

IV, IO

Question 27

What happens if you overdose atropine?

Answer 27

Anticholinergic affects: Mad as a hatter, blind as a bat, dry as a bone, red as a beet. Delirium, blurred vision, photophobia, difficulty swallowing, decrease salivation, hot flush skin plus acute urinary retention and nausea vomiting.

Question 28

Adult dose of atropine?

Answer 28

Bradycardia: 0.5mg iv/io every 3-5 minutes up to 3 mg. | Nerve agent or insecticide poisoning: 1-2 mg iv/io every 5 minutes until secretions dry up.

Question 29

Pediatric dose of atropine?

Answer 29

.02 mg/kg min dose of 0.1 mg max of 0.5 max total of 3 mg. IV/IO

Question 30

What is the pregnancy precautions for atropine?

Answer 30

It is a class c drug, meaning it has adverse effects on animal fetus studies but use in an emergency.

Question 31

What are the pregnancy precautions and what do they mean?

Answer 31

The pregnancy category of a pharmaceutical agent is an assessment of the risk of fetal injury due to the pharmaceutical. It does not include any risks conferred by pharmaceutical agents or their metabolites that are present in breast milk. Pregnancy Category A- Adequate and well-controlled human studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). Pregnancy Category B-Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester. Pregnancy Category C- Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Pregnancy Category D- There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Pregnancy Category X- Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits. Pregnancy Category N", which is a transitional identification indicating that the FDA has not yet classified the drug into a specified pregnancy category.

Question 32

What is the mechanism of action for Epinephrine?

Answer 32

Epinephrine binds strongly with alpha and beta receptors producing increased blood pressure, increased heart rate, and bronchodilation.

Question 33

What are the indications of Epinephrine?

Answer 33

Cardiac arrest, profound bradycardia, severe bronchospasm, anaphlaxis.

Question 34

What are the contraindications of Epinephrine?

Answer 34

None in cardiac arrest. Hypovolemic shock, coronary insufficiency, closed-angle glaucoma, pregnant woman in active labor, hypersensitivity, arrhythmias other then pulseless VT, VF, PEA or asystole

Question 35

What are the routes of administration of Epinephrine?

Answer 35

IV, IO, ETT, IM

Question 36

What is Epinephrine's interaction with other drugs?

Answer 36

Line must be flushed i sodium bicarb is to be administered.

Question 37

What is the Adult dose of Epinephrine?

Answer 37

Anaphylaxis: 0.3 mg deep IM of 1:1,000 Cardiac arrest: 1 mg IV/IO of 1:10,000 every 3-5 minutes.

Question 38

What is the Pediatric dose of Epinephrine?

Answer 38

Anaphlaxis: 0.01 mg/kg o 1:1,000 (.01 ml/kg max max dose of 0.5 mg.) Cardiac Arrest: 0.01 mg/kg (0.1ml/kg of 1:10,000) IV/IO

Question 39

What is epinephrine's consideration with pregnant pt.s?

Answer 39

It is a pregnancy category C drug and is not to be used in patients in active labor.

Question 40

What is the mechanism of action of Adenosine?

Answer 40

Slows the conduction of electrical impulses at the AV node.

Question 41

What are the indications of Adenosine?

Answer 41

Narrow QRS supraventricular tachycardia, wide QRS complex regular tachycardia.

Question 42

What are the routes of administration of Adenosine?

Answer 42

IV

Question 43

What are interactions to keep in mind for Adenosine?

Answer 43

Larger doses may be required for patients with significant levels of theophylline, caffeine, or theobromine. The Initial dose should be reduced to 3 mg in patients taking dipyridamole or carbamazepine or hose with hert transplants. Use with caution in patients with emphysema, asthma or acute bronchitis. It is a pregnancy category C drug.

Question 44

What is the Adult dose of Adenosine?

Answer 44

6mg rapid IV push followed by 20mL normal saline flush. a repeat dose o 12 mg may be administered two additional times. I think it got changed to one additional time.

Question 45

What is the Pediatric dose of Adenosine?

Answer 45

0.1 mg/kg max of 6mg rapid IV push followed by a 20 mL normal saline flush. A repeat dose of 0.2 mg/kg max of 12 mg may be administered two additional times. I have to check on that one.