Pharmacology Chapter 15 with Book

If drugs are administered via an endotracheal tube during a resuscitation, the dosage should be increased to ________________ times the IV dose.

2 to 2.5

The acceptable dosage for vasopressin during resuscitation is: a. 40 units IV or IO given once. b. 20 units IV given every 10 minutes. c. 40 units IV or IO given alternately with epinephrine. d. 20 units IV or IO given alternately with epinephrine.

A. 40 units IV or IO given once. Single-dose vasopressin is given one time only as 40 units IV or IO.

Which of the following calcium-channel blocking agents should not be used to treat atrial fibrillation? a. Adenosine b. Cardizem c. Isoptin d. Verapamil

A. Adenosine Adenosine will not terminate atrial fibrillation, atrial flutter, or ventricular tachycardia because they are caused by the rapid firing of atrial ectopic foci rather than a reentry mechanism.

In which of the following situations would digoxin be administered? a. Atrial fibrillation b. Symptomatic bradycardia c. Ventricular fibrillation d. Pulseless arrest

A. Atrial fibrillation Digoxin is indicated in advanced cardiac life support to slow ventricular response in atrial fibrillation or flutter. Symptomatic bradycardia is treated with atropine, while ventricular fibrillation and pulseless arrest are treated with epinephrine and vasopressin.

All except which of the following can be the cause of bradycardia? a. Decreased parasympathetic tone b. Profound hypoxia c. Heart block d. Damage to the conduction system

A. Decreased parasympathetic tone An increased parasympathetic tone causes the heart rate to slow, leading to bradycardia.

Which of the following is an indication for the administration of atropine? a. Symptomatic bradycardia b. Intranodal AV block c. Third-degree block with wide QRS complex d. Hypothermic bradycardia

A. Symptomatic bradycardia Atropine is indicated for the treatment of symptomatic bradycardia. It is contraindicated in hypothermic bradycardia and is ineffective for intranodal AV block and third-degree block with wide QRS complexes.

Of the following medications, which drug causes peripheral vasoconstriction? a. Vasopressin b. Inamrinone c. Nitroglycerin d. Sodium nitroprusside

A. Vasopressin Vasopressin is a nonadrenergic peripheral vasoconstrictor that increases peripheral vascular resistance.

All except which of the following are indications for beta blockers? a. Suspected myocardial infarction b. AV heart block c. Supraventricular tachyarrhythmia d. Unstable angina

B. AV heart block Beta blockers are contraindicated in patients with AV heart blocks.

A patient is brought to the emergency room in full cardiac arrest. The paramedics have not been able to establish intravenous access for administration of resuscitation drugs. Which of the following should be considered? I. Administering drugs via the endotracheal tube II. Having the nurse insert a gastric tube III. Using an intraosseous route a. I and II b. I and III c. II and III d. I, II, and III

B. I and III When IV access is not available, an intraosseous route or the endotracheal tube may be used for administration of resuscitation drugs.

All except which of the following are antiarrhythmic drugs? a. Lidocaine b. Inamrinone c. Amiodarone d. Procainamide

B. Inamrinone Inamrinone is a positive inotrope that is used to treat heart failure refractory to diuretics, vasodilators, and conventional inotropic agents.

Administration of positive inotropic drugs causes all of the following except: a. An increased force of contraction of the heart. b. Increased conduction through the AV node and increased heart rate. c. Increased cardiac output. d. Increased tissue perfusion.

B. Increased conduction through the AV node and increased heart rate. Positive inotropic drugs cause a decrease in the conduction through the AV node, which decreases heart rate. The slower conduction and heart rate allow for more ventricular filling time combined with increased force of ventricular contraction.

Epinephrine should be used with caution in which of the following situations? a. Profound symptomatic bradycardia b. Patients receiving digitalis c. Severe allergic reactions d. Pulseless ventricular tachycardiac

B. Patients receiving digitalis Epinephrine can cause ventricular ectopy in patients receiving digitalis.

Pulseless cardiac arrest is produced by all except which of the following arrhythmias? a. Asystole b. PEA c. Atrial fibrillation d. Ventricular fibrillation

C. Atrial fibrillation Atrial fibrillation causes rapid heart rates and is usually treated pharmacologically.

The administration of sodium bicarbonate is indicated in which of the following situations? a. Cardiac arrest due to respiratory failure b. During CPR, prior to intubation c. Cardiac arrest due to metabolic acidosis d. Hypokalemia

C. Cardiac arrest due to metabolic acidosis Sodium bicarbonate is primarily indicated when the patient is known to have had metabolic acidosis prior to cardiac arrest or when the patient has been in cardiac arrest for a prolonged period of time. It is also administered for hyperkalemia, preexisting bicarbonate-responsive acidosis, or tricyclic antidepressant overdose.

Administration of sodium bicarbonate causes all of the following effects except: a. Metabolic alkalosis. b. Increased serum sodium. c. Enhanced oxygen release at the tissues. d. Hyperosmolality.

C. Enhanced oxygen release at the tissues Sodium bicarbonate comprises release of oxygen at the tissue level, causing a worsening hypoxemia.

Which of the following cardiac agents is also administered for allergic anaphylactic reactions? a. Atropine b. Dopamine c. Epinephrine d. Metoprolol

C. Epinephrine Epinephrine is used in the treatment of severe allergic anaphylactic reactions.

A heart rate greater than 130 is usually due to which of the following conditions? a. Stress b. Fever c. Pathologic arrhythmia d. Hypoxemia

C. Pathologic arrhythmia Heart rates greater than 130 are usually due to a pathologic arrhythmia, such as another pacemaker overriding the SA node, or increased irritability in the myocardial cells.

Which of the following arrhythmias should not be treated with amiodarone? a. Supraventricular tachycardia b. Ventricular fibrillation c. Torsade de pointes d. Pulseless ventricular tachycardia

C. Torsade de pointes Torsade de pointes should not be treated with amiodarone. This arrhythmia is a specific subtype of ventricular tachycardia that is treated with magnesium sulfate.

Which of the following is the drug of choice for treating narrow-complex paroxysmal supraventricular tachycardia? a. Dopamine b. Diltiazem c. Amiodarone d. Adenosine

D. Adenosine Adenosine slows conduction through the AV node and interrupts reentry pathways at the AV node. It can convert PSVT to a normal sinus rhythm.

Treatment for ventricular fibrillation includes all except which of the following? a. Defibrillation b. Compressions c. Ventilations d. Cardioversion

D. Cardioversion Cardioversion is used to treat unstable tachycardia that produces supraventricular or ventricular tachycardia.

Which of the following is an indication for the administration of dobutamine? a. Clinical signs of shock b. A known drug-induced shock c. Increased renal vasoconstriction d. Heart failure without signs of shock

D. Heart failure without signs of shock Dobutamine is used for HF as long as systolic blood pressure is 70 to 100 mmHg and there are no signs of shock.

Vasopressin can be administered for which of the following reasons during resuscitation? I. For hemodynamic support in vasodilatory shock II. As an alternative to the second dose of epinephrine in pulseless arrest III. To treat prolonged cardiac arrest after administration of epinephrine a. I and II b. II and III c. I and III d. I, II, and III

D. I, II, and III All of these situations are indications for administering vasopressin during resuscitation.

Benefits of epinephrine include all except which of the following? a. It increases the rate and force of myocardial contraction. b. It improves cerebral blood flow. c. It makes the heart more susceptible to direct countershock. d. It increases the oxygen consumption of the heart.

D. It increases the oxygen consumption of the heart. While epinephrine tends to increase oxygen consumption of the heart, this is not considered a benefit because it could increase ischemia of the myocardial tissue.

Which of the following drugs would not be used in the treatment of asystole? a. Epinephrine b. Vasopressin c. Atropine d. Lidocaine

D. Lidocaine Lidocaine is an antiarrhythmic agent that is said to make the heart more resistant to fibrillation and more responsive to defibrillation. It does not affect myocardial contractility, blood pressure, or atrial arrhythmias. It has no proven efficacy in cardiac arrest.

Which of the following drugs would not be considered for an asthmatic patient who requires treatment for atrial fibrillation? a. Atenolol b. Esmolol c. Metoprolol d. Propranolol

D. Propranolol Because propranolol is a nonspecific beta blocker, it can block both beta1 and beta2 receptors and cause bronchoconstriction.

All except which of the following drugs can be safely administered via the endotracheal tube during a resuscitation? a. Atropine b. Epinephrine c. Oxygen d. Sodium bicarbonate

D. Sodium bicarbonate Atropine, epinephrine, lidocaine, and oxygen can be administered via the endotracheal tube.

________________ is the first drug administered for all causes of cardiac arrest.

Epinephrine

True/ False Epinephrine increases the rate and force of myocardial contraction through alpha-adrenergic effects.

False Although epinephrine has both alpha and beta effects, it increases the rate and force of myocardial contraction through beta-adrenergic effects

True/ False Patients should be placed in the Trendelenburg position prior to administration of adenosine.

False It is common for a long pause to occur in the heart rhythm after administration of adenosine. Sinus bradycardia is also common. A mild reverse Trendelenburg position helps lessen any discomfort or hypotension associated with the drug.

True/ False Patients with severe left ventricular dysfunction receiving verapamil may experience an increase in blood pressure.

False Patients with severe left ventricular dysfunction may experience a decrease in blood pressure when receiving verapamil. Pretreatment with calcium can help prevent this problem.

True/ False A patient with a ventricular or supraventricular rhythm that is stable must be treated with cardioversion.

False Rationale: Patients with tachycardia who are stable, whether the tachycardia originated in the ventricles or is a supraventricular rhythm, are treated pharmacologically.

_______________ is administered for heart failure that is refractory to diuretics, vasodilators, and conventional inotropic agents.

Inamrinone

Should procainamide be administered instead of lidocaine for ventricular fibrillation?

It is acceptable to use procainamide in this situation if lidocaine has failed. However, procainamide must be administered slowly, or it will cause hypotension; therefore, it is rarely considered as the first choice in VF.

What are the benefits of administering lidocaine during ventricular fibrillation?

Lidocaine decreases automaticity, increases the fibrillation threshold, and decreases the defibrillation threshold. This makes the heart more resistant to fibrillation and more responsive to defibrillation so that a lower shock joule or fewer shocks are required.

________________ is administered for refractory VF after lidocaine is given.

Magnesium

True/ False The treatment for ventricular tachycardia and ventricular fibrillation is the same.

True ACLS recommends following the pulseless arrest algorithm for treating both ventricular tachycardia and ventricular fibrillation.

True/ False Lidocaine is no longer the first-line antiarrhythmic drug used to treat ventricular tachycardia and ventricular fibrillation.

True Although still considered clinically useful, lidocaine is no longer the first-line antiarrhythmic drug to treat ventricular tachycardia and ventricular fibrillation. Lidocaine is considered an alternative treatment to amiodarone.

True/ False When a patient experiences a myocardial infarction, irreversible death of myocardial cells has occurred.

True Myocardial infarction refers to the death of myocardial cells, which is irreversible.

True/ False Norepinephrine is used for severe hypotension and low total peripheral vascular resistance refractory to other sympathomimetics.

True Norepinephrine is a potent alpha vasoconstrictor and beta1 inotrope. It should be considered if severe hemodynamic hypotension and low total peripheral vascular resistance are refractory to other sympathomimetics.

True/False The pause in the electrical impulse at the AV node allows time for the atria to contract and blood from the atria to flow into the ventricles.

True The pause in the electrical impulse at the AV node allows time for the ventricles to be fully loaded with blood. Once they are full, the impulse travels from the AV node to the bundle of His, and the bundle branches until transmission is complete, causing the ventricles to contract.

True/ False Dopamine can be used with hypovolemia after volume replacement.

True The primary effect of dopamine is to increase cardiac output. It causes marked vasoconstriction, which increases preload, afterload, and blood pressure. This is useful for patients in hypovolemic shock after volume has been replaced.

________________ may be considered as an alternative to the first or second dose of epinephrine in the treatment of pulseless arrest.

Vasopressin

Why is ventricular fibrillation life threatening, and how is it treated?

Ventricular fibrillation causes the ventricles to quiver rather than contract. Without contraction, there is not any cardiac output, and therefore there is no palpable pulse. CPR must be initiated to circulate blood throughout the heart and body, and defibrillation is necessary to stop the quivering of the heart muscle and reset the electrical impulses. Appropriate drug therapy needs to be provided during the resuscitation, following the recommended algorithm for pulseless arrest.

What advantage does diltiazem have compared to verapamil?

Verapamil is a negative chronotropic and negative inotropic drug, which results in a decreased heart rate and force of contraction as well as a reduction in systemic vascular resistance. This, however, can cause hypotension. Diltiazem has negative chronotropic effects with only mild negative inotropic action, which results in a slower rate and force of contraction without the hypotension, as seen with verapamil.

Why is it important for a respiratory therapist to know whether sodium bicarbonate is being administered during resuscitation?

When sodium bicarbonate is administered, it combines with acid to neutralize it and in the process produces carbon dioxide and water. This increases the amount of carbon dioxide in the blood. In order to remove this additional carbon dioxide from the body, ventilation must be adequate because carbon dioxide is excreted through the lungs during exhalation.

A/an _______________ is a systematic approach to help practitioners treat cardiac emergencies.

algorithm

Pulseless electrical activity is treated pharmacologically with _______________ or _______________.

epinephrine/vasopressin

The most common problem with procainamide, if it is given too rapidly, is ________________.

hypotension

When calcium-channel blockers or beta blockers are ineffective in controlling heart rate in atrial fibrillation, ________________ should be administered.

ibutilide

Premature ventricular contractions and wide complex PSVT can be treated with ________________.

lidocaine

Irritability of myocardial cells can occur due to a lack of ________________ to the myocardium.

oxygen

Medications that are used in advanced cardiac life support are referred to as _______________drugs.

pharmacology category I

To treat a patient who is in ventricular fibrillation, a health care team should follow the ________________ algorithm.

pulseless arrest

The term that describes a heart rate in the normal range when tachycardia would be expected is _______________.

relative bradycardia

Tachycardia that originates in the atria or AV node is called a/an ________________.

supraventricular tachycardia