Vassoactives
First-line shock pressor?
What is Norepinephrine
ICU sedative causing bradycardia?
What is Dexmedetomidine (Precedex)
When would Dobutamine be used
What is cardiogenic shock, hypotensive acute decompensated heart failure (increases renal perfusion)
This thrombolytic agent is administered as a single IV bolus based on patient weight, typically within 30 minutes of symptom onset in STEMI patients.
What is TNKase
A 58-year-old on norepinephrine 4mcg/min and vasopressin 0.03 U/min for septic shock now has MAP 75 mmHg, HR 110, lactate 1.8. You plan to start tapering vasopressors. Which agent do you reduce first, and why
What is Norepinephrine
Once stable, wean norepinephrine before vasopressin to prevent hemodynamic instability
Pressor acting primarily on α₁?
What is Phenylephrine
Prolonged infusion of this sedative—particularly >48 hours or >80 µg/kg/min—can lead to rhabdo, metabolic acidosis, hypertriglyceridemia, hyperkalemia, and liver dysfunction.
What is Propofol
Propofol Infusion Syndrome
Monitor triglycerides and lactate; if rising, consider switching sedation
This class reduces mortality in HF and also provides rate control in AF by reducing HR & contractility.
What is Beta Blockers
This is the antidote used to reverse the effects of heparin in cases of overdose or major bleeding
What is Protamine Sulfate
In a patient with cardiogenic shock and low blood pressure, this inotrope increases contractility via β₁-stimulation without causing vasoconstriction—potentially lowering SVR
What is milrinone
Ideal for post-cardiac surgery or cardiogenic shock, but use cautiously due to hypotension risk.
Drug working via β₁ then α₁?
What is Epinephrine
How frequently should Propofol tubing be changed?
What is every 12 hours
One key sign of toxicity from this drug is seeing halos or blurred vision.
What is Digoxin
This adverse effect is characterized by a decrease in platelet count and an increased risk of thrombosis, occurring in some patients receiving heparin therapy.
What is heparin-induced thrombocytopenia (HIT)
A 50‑y/o septic patient on norepinephrine shows: pH 7.14, PaCO₂ 34 mmHg, HCO₃⁻ 12 mEq/L, lactate 9 mmol/L, rising vasopressor needs. Ventilation is optimized. Which medication should be started for this patient?
What is Sodium Bicarb gtt
When would Dopamine be used?
What is Second-line for symptomatic bradycardia after atropine, or hypotension with signs of shock
Extra point if you can tell me a side effect to watch for with Dopamine...
Arrhythmias
What is the antidote for benzodiazepines?
What is Flumazenil
Extra credit point if you can tell me the dose:
0.2 mg IV over 15-30 sec
0.2 mg may be given every minute until the desired level of consciousness is achieved
Maximum total dose 1 mg
During refractory ventricular fibrillation (VF) after epinephrine, which first-line antiarrhythmic is administered at 300 mg IV bolus, with an optional 150 mg second dose?
What is Amiodarone
This is the typical duration for monitoring aPTT levels after initiating or adjusting heparin therapy
What is every 6 hours
In cardiogenic shock with low cardiac output and elevated SVR, you're considering between dobutamine or norepinephrine. Which is preferred and why?
What is dobutamine? As a β₁+β₂ agonist, it enhances contractility and reduces SVR—ideal when SVR is already high
Which vasopressor(s) do you add, and why?
What is vasopressin (0.03 U/min) to reduce Norepinephrine dose and arrhythmias
What depolarizing agent can cause malignant hyperthermia?
What is Succinylcholine
For stable SVT not responding to vagal maneuvers, what is the recommended dosing strategy for adenosine administration?
What is 6 mg rapid IV push immediately followed by a 20 mL saline flush, with a possible 12 mg dose after 1–2 minutes
This is the normal range for aPTT in seconds for a patient not receiving heparin therapy
What is 30–40 seconds
A 59‑year‑old ICU patient on propofol infusion (~1.3 mg/kg/hr ×20 days) develops metabolic acidosis (lactate 9.4 → 13.2 mmol/L), triglycerides 964 mg/dL, CK normal, hemodynamically stable. What’s the likely diagnosis and next step?
What is propofol infusion syndrome