1. Therapeutics 1 Tutoring
Sarah Darby
September 16, 2016

2. Lectures Covered
ACLS
Supraventricular arrhythmias

3. ACLS Which cardiac rhythm is shockable? Ventricular fibrillation
Pulseless ventricular tachycardia
Pulseless electrical activity
Asystole
A and B
C and D

4. ACLS Identify the rhythm Sinus bradycardia Sinus tachycardia
Ventricular tachycardia
Pulseless electrical activity

5. ACLS Identify the rhythm Asystole Ventricular fibrillation
Ventricular tachycardia
Pulseless electrical activity
Ekg.academy.com

6. ACLS Identify the rhythm Asystole Ventricular fibrillation
Ventricular tachycardia
Pulseless electrical activity
Medlibes.com

7. ACLS Identify the rhythm Sinus bradycardia Sinus tachycardia
Ventricular tachycardia
Pulseless electrical activity
Learningcentral.health.unm.edu

8. ACLS Identify the rhythm Asystole Ventricular fibrillation
Ventricular tachycardia
Pulseless electrical activity
Studentsofmedicineplus.weebly.com

9. ACLS Identify the rhythm Sinus bradycardia Sinus tachycardia
Ventricular tachycardia
Pulseless electrical activity
Lifeinthefastlane.com

10. ACLS Identify the rhythm First degree AV block
Second degree AV block type 1
Second degree AV block type 2
Third degree AV block
Ekgacademy.com

11. ACLS Identify the rhythm Pulseless electrical activity
Ventricular tachycardia
Ventricular fibrillation
Torsades de pointes
Ekgacademy.com

12. ACLS What is the preferred initial catecholamine in ACLS?
Norepinephrine
Epinephrine
Vasopressin
Phenylephrine

13. ACLS
JY is a 65 yo WM (80kg) who was found down at home by his wife. EMS arrived and began CPR. En route to the hospital, the first dose of Epinephrine is given. Which is appropriate?
1mg every 1 minute
1mg every 3 minutes
5mg every 1 minute
5mg every 3 minutes

14. ACLS
How many milliliters of Epinephrine should EMS administer if they have a 30mL vial (1:1000)?
1mL
2mL
5mL
10mL

15. ACLS
How many milliliters of Epinephrine should EMS administer if they are using a prefilled 10ml syringe (1:10,000)?
1mL
2mL
5mL
10mL

16. ACLS Which statement is true about Amiodarone?
It is only used in patients with preserved left ventricular function
The initial bolus dose is 150mg IV or IO
It is a class III antiarrhythmic drug
It has no effect on sodium or potassium channels

17. ACLS Which statement is true about Lidocaine?
It is first line therapy for pVT and VF
It causes less asystole than epinephrine
It is superior to Amiodarone according to the ALIVE trial
It should be dose adjusted in hepatic impairment

18. ACLS
The physician asks you to dose the initial IV lidocaine bolus for a 75kg patient. Which is appropriate?
50mg
100mg
150mg
200mg

19. ACLS
Which is the maximum cumulative dose of lidocaine that a 60kg patient can receive?
90mg
100mg
180mg
300mg

20. ACLS Lidocaine is part of the ACLS algorithm for pVT and VF.
True or False.

21. ACLS Which statement is true about magnesium?
It should be given rapid IV push.
It should only be given in Mg deficiency.
It is indicated for drug-induced Torsades.
Mg has no effect on cardiac cell depolarization.

22. ACLS Which statement is true about adenosine?
It is used to treat bradycardia
It has a half life of 5 minutes
It accelerates SA and AV nodal conduction
It is contraindicated in pts with heart blocks

23. ACLS
WT arrives in the ED with an EKG showing SVT and HR of 180. Which dose of adenosine is appropriate for this patient?
6mg rapid bolus
6mg infusion over 10 minutes
12mg rapid bolus
12mg infusion over 10 minutes

24. ACLS
Which of the following side effects do you not expect to see with adenosine?
Chest pain
Flushing
Vomiting
Dyspnea

25. ACLS
What do you recommend for a patient who is taking both adenosine and carbamazepine?
Reduce the initial adenosine dose to 3mg
Increase the initial adenosine dose to 9mg
Reduce the carbamazepine dose
Avoid adenosine altogether

26. ACLS Which statement is not true about atropine?
It can cause tachycardia
It increases sinus node automaticity
It is first line for PEA
Slow infusions should be avoided

27. ACLS
During cardiac arrest, _______ tissue perfusion may lead to acidemia and the need for ____________ therapy.
Poor; sodium bicarbonate
High; sodium bicarbonate
Poor; adenosine
High; adenosine

28. ACLS Which statement is true about sodium bicarbonate?
It improves survival and ROSC
May induce hyponatremia
May potentiate simultaneously administered catecholamines
May help correct an existing metabolic acidosis

29. ACLS
JT is an IV drug user, and the nurse is having trouble getting an IV placed. The nurse convinces the physician to use IO for administration. Which of JT’s meds can NOT be given IO?
Epinephrine
Amiodarone
Adenosine
Magnesium

30. ACLS Remember! IO = MAVEL Magnesium Amiodarone + Atropine Vasopressin
Epinephrine
Lidocaine

31. ACLS Which agent should not be administered down an ET tube? Lidocaine
Amiodarone
Epinephrine
Atropine

32. ACLS Remember! Endotracheal tube = NAVEL Narcan Atropine
Valium/Vasopressin
Epinephrine
Lidocaine

33. ACLS
EB requires epinephrine but has an ET tube. What dose do you recommend?
1mg
2.5mg
5mg
10mg

34. ACLS
Which patient is most likely to be a candidate for therapeutic hypothermia?
Pt who is sitting up in bed talking one day after cardiac arrest
Pt who is unresponsive after achieving ROSC in the ER
Pt who is unresponsive and cannot maintain ROSC
Pt on ventilator but can squeeze your hand when directed

35. ACLS
EMS arrive on scene to find patient down. CPR is immediately started. The EKG shows VF. What is the first time point that epinephrine can be given?
Before the first shock
After the first shock
After the second shock
After the third shock

36. ACLS
EMS arrive on scene to find patient down. CPR is immediately started. The EKG shows VF. What is the first time point that amiodarone can be given?
Before the first shock
After the first shock
After the second shock
After the third shock

37. ACLS
EMS arrive on scene to find patient down. CPR is immediately started. The EKG shows PEA. What is the preferred course of action? (multiple answers)
Administer a shock
Give epinephrine every 3-5 minutes
Give amiodarone after the third shock
Continuous CPR
Assess for reversible causes

38. Supraventricular Arrhythmias
RT complains of sudden onset of palpitations and chest discomfort that spontaneously resolves. This most often occurs after exercising. What arrhythmia is described?
AFib
Paroxysmal SVT
Ventricular tachycardia

39. Supraventricular Arrhythmias
RT’s current BP is 85/45 and HR is Vagal maneuvers and adenosine were attempted without desired effect. What treatment do you recommend?
DCC
Metoprolol
Diltiazem
Verapamil

40. Supraventricular Arrhythmias
What if RT’s BP had been 135/90 and HR was 115? Vagal maneuvers and adenosine were attempted without desired effect. What treatment is not appropriate?
Metoprolol
Diltiazem
Verampamil
Amlodipine

41. Supraventricular Arrhythmias
Which of the following is not an example of a vagal maneuver?
Carotid massage
Valsalva
Coughing
Hot water immersion

42. Supraventricular Arrhythmias
MT is a 68 yom who has struggled with AFib for years. He and his physician decide that attempting to maintain NSR is no longer desired. Classify his AFib.
Paroxysmal
Persistent
Long-standing
Permanent/chronic

43. Supraventricular Arrhythmias
MT presents to the ED with dizziness and fatigue that started 12 hours ago. His BP is 80/45 and HR is 192. The EKG shows a regularly irregular heart rhythm. Which statement is false?
MT is hemodynamically unstable.
MT is at an increased risk of stroke.
DCC is an appropriate choice at this time.
Oral anticoagulation should occur before DCC

44. Supraventricular Arrhythmias
Which agent is not appropriate for acute rate control?
Metoprolol tartrate
Atenolol
Esmolol
Propranolol

45. Supraventricular Arrhythmias
KT is a 63 yo WM who presents to the ED with SOB and dizziness. EKG confirms that he is in AFib. PMH: HTN, asthma, DM. Which agent for acute rate control is most appropriate?
Esmolol
Diltiazem
Dronedarone
Digoxin

46. Supraventricular Arrhythmias
Which agent exerts its effects through vagal stimulation?
Atenolol
Verapamil
Digoxin
Amiodarone

47. Supraventricular Arrhythmias
FK is a 58 yo AAM who was admitted after experiencing ongoing breathing trouble for 1.5 weeks. In the ER his EKG showed AFib. The team decides to utilize pharmacological cardioversion on hospital day 2. Which agent is not appropriate?
Amiodarone
Flecainide
Ibutilide
Dofetilide

48. Supraventricular Arrhythmias
Which patient is not eligible for “pill in the pocket” pharmacological conversion?
68 yo w/ NYHA class 3 HF
34 yo w/ QT prolongation
38 yo w/ no hx of heart disease
55 yo w/ AV block

49. Supraventricular Arrhythmias
Which agent for maintenance of NSR is appropriate for patients with HF?
Amiodarone
Sotalol
Dofetilide
Flecainide
A and C
B and D

50. Supraventricular Arrhythmias
BD (80kg, CrCl=50ml/min) has been successfully converted out of AFib using DCC. The team wants to initiate Sotalol to maintain NSR. What dose do you recommend?
80mg BID
80mg daily
80mg QOD
Do not use Sotalol in this patient

51. Supraventricular Arrhythmias
Which agent requires admission into the hospital for initiation of therapy?
Sotalol
Dronedarone
Dofetilide
Ibutilide
A and C
B and D

52. Supraventricular Arrhythmias
DR is a 59 yo male requiring pharmacologic conversion. The team plans to continue him on this agent for maintenance therapy. PMH: HF, CKD.
Dronedarone
Flecainide/Propafenone
Amiodarone
Ibutilide

53. Supraventricular Arrhythmias
TH requires DCC for SOB and dizziness that has been coming and going for the past 2 weeks. EKG shows Afib. Choose the best sequence of events for cardioversion.
DCC immediately. No therapy needed after successful cardioversion.
Perform TEE. If no clot formation, DCC. No therapy needed afterward.
Perform TEE. If no clot formation, DCC. Use anticoagulant for 4 weeks after.
Use anticoagulant for 3 weeks before cardioversion. Discontinue after.
Use anticoagulant for 1 week before cardioversion. Continue for 4 weeks after.

54. Supraventricular Arrhythmias
MH is a 66 yo female. She is currently being treated for HTN, DM, COPD, and glaucoma. What is her CHA2DS2-VASc score? 1 2 3 4 5

55. Supraventricular Arrhythmias
CP is a 79 yo male. He has a history of CHF (LVEF=35%), PVD, HTN, and DM. What is his CHA2DS2-VASc score? 3 4 5 6 7

56. Supraventricular Arrhythmias
CP is a 79 yo male. He has a history of CHF (LVEF=35%), PVD, HTN, Afib and DM. According to his CHA2DS2-VASc, he is considered high risk. What do you recommend to prevent stroke?
No treatment recommendation
Warfarin
Aspirin
Enoxaparin

57. Supraventricular Arrhythmias
CP is a 79 yo male. According to his CHA2DS2-VASc, he is considered high risk. He desires to use a NOAC to avoid INR monitoring with Warfarin. His CrCl=25ml/min. Which agent is appropriate for him?
Dabigatran 150mg BID
Rivaroxaban 15mg daily
Apixaban 5mg BID
Edoxaban 30mg daily

58. Therapeutics 1 Tutoring Questions?
Sarah Darby
September 16, 2016