Name that Drug
This drug has a trade name of Lopressor.
What is Metoprolol?
What is the mechanism of action for Adenosine?
Adenosine Receptor Agonist. Slows conduction through the AV node, and interrupts AV nodal reentry pathways, by inhibiting calcium entry into cardiac pacemaker cells
In laymans terms - temporarily slows the heart’s electrical signals through the AV node, which can stop certain fast heart rhythms.
You have a patient who is currently receiving atropine for symptomatic bradycardia, when suddenly they start complaining of hot, dry skin. Should or shouldn't you continue to repeat dose?
No you should not. Contraindications for atropine are allergy and signs of atropine toxicity.
For extra points, tell me how many times you can give atropine for bradycardia.
What is the dosage for Albuterol and Ipratropium Bromide?
For a bonus tell me why those two work so well together.
A- 2.5mg
I- 0.5mg
+100 Bonus - Albuterol is a beta 2 agonist that relaxes airway smooth muscle directly while Ipratropium is an anticholinergic that blocks acetylcholine from signaling that muscle to constrict. It's duration of effect is also prolonged.
You have a patient with A-fib on the monitor, this is the first time they have experienced this. What are the drugs you could adminster, the dosages, and what question is important to ask before you make your decision?
Your two options are metoprolol and Diltiazem. the doses respectively are 5mg and 10mg. The important question to ask is if this person is already on metoprolol or a betablocker as a prescription.
This drug is a calcium channel blocker that is used to treat narrow complex SVT. Bonus points for dose.
What is Diltizem (Cardizem) ?
+50 bonus - 10mgs, repeat until reached 30mg
What is the mechanism of action for Albuterol Sulfate
Selective β2 Agonist. Stimulates adrenergic receptors of the sympathetic nervous system resulting in smooth muscle relaxation in bronchial tree and peripheral vasculature.
In laymans terms - Stimulates β2 receptors, causing the muscles around the airways and blood vessels to relax.
You have a patient with a chief complaint of diff breathing. They report they have used their inhaler 4 times before arrival. Should or shouldn't you continue to administer more albuterol through your duo-neb?
You should, There is no limit. Medics can administer Albuterol and Ipatropium Bromide along with a plethora of other meds to get the patient breathing better.
What is the Amiodarone dose for Tachycardia?
Bonus points if you can tell me the specific type of tachycardia.
150mg over 10 minutes.
50+ Bonus - Wide Complex Tachycardia
You have a patient with moderate to severe hyperkalemia. What is a drug other then similar replenishing electrolytes you can give to counteract it?
Bonus - Tell me another drug and its dose you could give for hyper K
Albuterol. 2.5 continuously nebulized until a max of 20mg.
100+ bonus - Calcium gluconate 3g IV, Calcium chloride 1g IV.
This cardiac drug is an Anticholinergic with 3 different indications. Bonus points if you can name all 3.
What is Atropine?
+100 Bonus - Bradycardia, organophosphate poisoning, pediatric RSI premedication
(CT protocols also add cholinergic nerve agent exposure) If you mentioned this +200 instead
What is the mechanism of action for Metoprolol
Decreases heart rate, conduction velocity, myocardial contractility, and cardiac output through the inhibition of cardiac release in cardiac cells. Used to control ventricular response in SVT (PSVT, atrial fibrillation and flutter). Negative chronotropy, inotropy, and dromotropy
In Laymans terms - slows heart rate, slows electrical conduction, decreases pumping strength through the inhibition of cardiac release in cardiac cells
You have a patient who called for diff breathing. After administering albuterol and ipatropium via duo-neb, You noticed on the monitor their heart rate has increased, however no complaints from the patient. Should or shouldn't you continue to administer?
You should continue administration. A Contraindication for albuterol is symptomatic tachydysrhythmias.
What is the Eclampsia dose for Magnesium Sulfate, including the rate it should be given at?
4g Bolus over 10 minutes.
50+ bonus if mentioned the consideration of 1g/hr continuous infusion.
You have a pediatric patient who is suffering from what you think is croup. What two drugs could you give, and what are their doses?
Racemic epi which is 0.5ml of a solution with 2.25% concentration, coming out to 11.25mgs. Or regular epi, which is 5mg of 1:1000
This drug's only indication is for Asthma/Croup.
What is Dexamethasone?
What is the mechanism of action for Methylprednisone
Suppresses acute and chronic inflammation by regulating gene expression increasing synthesis of proteins and enzymes that inhibit inflammatory agents; potentiates vascular smooth muscle relaxation by β‐adrenergic agonists
In laymans terms - Reduces inflammation by changing which proteins the body makes and helps β-adrenergic drugs relax blood vessels and airways.
You have a patient that is in recognized cardiogenic shock. Upon looking at the monitor your patient is now in a wide complex tachycardia. A Medic student suggests you administer Amiodarone. Should you, or shouldn't you?
You should not. While Amio is indicated for Wide complex tachycardias, it is also contraindicated for cardiogenic shock.
What is the Atropine dose for organophosphate poisoning and nerve agent?
2mg IM/IV/IO, then double dose until out of atropine or the bronchorrhea ceases.
You have an unstable patient with a wide complex tach on the monitor. You are going to give amiodarone, What is the classification, and MOA of this drug?
Amiodarone is an Antidysrhythmic, by blocking the potassium channels in the heart it prolongs the action potential. As well as blocking sodium channels, Beta receptors, and calcium. Affecting the pacemaker cells.
This cardiac drug blocks most receptors, and is contraindicated in patients with iodine hypersensitivity.
What is Amiodarone.
What is the mechanism of action for Amiodarone
Predominant Class III effects of prolonging cardiac actional potential and blocking potassium channels leading to prolonged phase 3 repolarization and refractory period of non‐pacemaker AP; Class I effects of rapidly blocking sodium channels decreasing the amplitude of phase 0 depolarization of non‐pacemaker AP; Class II, non‐competitive β blocker, and Class IV weak Ca2+ channel blocker causing negative chronotropy, inotropy, and dromotropy in pacemaker cells
In laymans terms - Slows and stabilizes the heart’s electrical activity by blocking potassium and sodium channels, while also having β-blocker and calcium-channel-blocker effects.
You have a patient experiencing an MI. Upon further inspection of the 12 lead you printed, you can infer that this patient is suffering specifically from an Inferior MI. The medic student riding along suggests administering Nitroglycerin. Should you or shouldn't you? And why?
You should not. Inferior MI's frequently involve the right ventricle, which becomes dependent on preload to maintain cardiac output.
What is the Lidocaine dose for IO access?
1-2.5ml of 2% lidocaine.
You have a patient who is having trouble breathing, while having your partner set up the duo-neb, you continue your assessment on the patient. What allergy could they mention that would make you change your standard duo-neb set up?