NJ MICU Drug Master Quiz Set

1) Naturally occurring nucleotide

2) Narrow Complex Anti-arrhythmic

1) SVT

2) Other narrow complex tachycardia

6mg Initial, 12mg second, 12 mg third.

All dose is quick IV push followed by bolus

1) Symptomatic Hypotension

2) Any other indication where cardioversion is indicated

• Slows/ stops conduction through AV node
• - Interrupts AV node re-entry pathways

Adenosine

1) B2 selective sympathomimetic

2) Beta agonist

• -Asthma
• -COPD
• -Wheezing
• -Reactive airway disease
• - Hyperkalemia

2.5mg in 3ml solution nebulized

Acts primarily on bronchial smooth muscle via Beta 2 receptors

Tachycardia, Palpitations, Restlessness

Albuterol Sulfate

Class I Anti-arrhythmic for atrial and ventricular arrhythmias

• -Vfib/ Pulseless V-Tach
• -Wide complex tachycardia
• -Adjunct to electrical cardioversion of SVT
• -Alternative for rate control in treatment of A-fib/flutter
• -WPW

• 1) Dead
•  -300mg IVP
•  -repeat 150mg IVP 3-5 minutes later

• 2) Alive
•  -150mg IVB over 10 minutes in 100ml NSS
•  -Reapeat once in 10 minutes

• -Hypotension
• -Bradycardia
• -Severe SA node disease

• - Slows sinus rate and AV conduction
• - Increases refractory period of myocardium

• -Ventricular Arrhythmia
• -Prolonged QT
• -Severe bradycardia
• -AV blocks and abnormalities
• -Sinus Arrest
• -CHF
• -Cardiogenic Shock
• -Hypotension
• -Flushing

Amiodarone

Anti-platelet aggregation inhibitor

• -Cardiac chest pain
• -TIA/ CVA

81mg tab x4 = 324mg

Active bleeding

• -Inhibits prostaglandin synthesis
• -Irreversibly inhibits platelet aggregation

Anticholinergic

• -Hemodynamically compromised symptomatic bradycardia
• -Symptomatic Sinus Arrest or Block
• -Organophosphate poisoning

0.5mg - 1.0mg IVP Q 3-5 mins

MAX 3mg ot 0.04mg/kg

Heart transplant -  no parasympathetic connection to heart- vagus nerve being severed.

Parasympatholytic- Blocks effects of acetylcholine

• -Increases myocardial O2 demand
• -Increases rate of discharge at SA and AV nodes
• -Relaxes smooth muscle in GI tract and Bronchial tree

Given too slowly or low of dose will cause paradoxical bradycardia

Anticholinergic/ Bronchodilator

• -COPD
• -Asthma

0.5mg in 2.5ml solution only nebulized with Albuterol

• -Bronchiole smooth muscle relaxer
• -Inhibits vagal mediated antagonists by blocking acetlycholine.

Atrovent

Benzodiazepine

• -Controlling seizures
• -Relative anxiety

IV- 1-2mg

IM-2-4mg

• -Hypersensitivity to benzodiazpines
• -Caution in elderly, ill, hypoxic patients.

Binds to benzodiazepine receptor and resulting in muscle relaxation and sedation.

• -Respiratory depression
• -Amnesia
• -Sedation
• -Dizziness

Ativan

Antihistamine

-Relief of symptoms from allergic reactions. 

-Dystonic state/ Anti-psychotic 

25-50mg IVP

• - Blocks histamine effects from preventing histamines reaching H1 receptor sites 
• - Sedative effects to CNS depression
• - Inhibits motion sickness

• -Convulsions and death from massive OD
• -Drowsiness and confusion, blurred vision

Benadryl

• -B2 agonist
• -Bronchodilator

• -Asthma and bronchospasms
• -Premature labor 

0.25mg SQ

Caution with hypertension and Ventricular arrhythmias. 

Stimulates beta-2 adrenergic receptors

• -Arrhythmias
• -Hypotension
• -Angina
• -Nervousness, headache, tachycardia, palpitations

Brethine

Electrolyte

• -Acute Hyperkalemia
• -Calcium Channel Blocker Toxicity

500mg-1g IVP

2-4mg/kg IVP

*Slow Push*

-Possible sudden death or bradycardia if pushed too fast

-Precipitates as carbonate salt in bicarbonate solution. 

Synthetic Steroid (Long acting glucocorticoid)

-Anti Inflammatory

• -Asthma/ Croup
• -Anaphylaxis
• -Alternative to Solu-Medrol

4-24mg IVP

Systemic fungal infections

-Stabilizes the cell wall of MAST cells, prevents further release of histamines

Decadron

Carbohydrate

0.5-1g/kg IVP slow

Raises blood sugar levels for hypoglycemia

Hypoglycemia

25-50g of D50: 50% solution 

Sympathomimetic

• -Cardiogenic shock
• -Symptomatic bradycardia

400mg in 250ml NSS bag at 2-20mcg/kg/min

• -Tachycardia
• -Hypovolemic Shock
• -Caution with MAO inhibitors

• -Exacerbation of asthma
• -Tachycardia
• -Headache, nausea, vomiting, vasoconstriction

Dopamine

Sympathomimetic

• -Bradycardia
• -Cardiac Arrest
• -Anaphylaxis
• -Asthma

0.3-0.5mg SQ/IM

1mg IVP Q 3-5mins

-Caution with patients with hypertension, angina, CAD

-May cause severe hypertension with those taking beta blockers

• -Stimulate Alpha and Beta-1,2 adrenergic receptors.
• Constricts blood vessels, raise systolic blood pressure, dilate pupils, lowers threshold for defib, dilate bronchial smooth muscle, increases myocardial O2 demand.

• - V-Fib/Tach
• - Tachycardia, Palpitations, Hypertension

Non-Barbituate, Non-Benzodiazepine Hypnotic

Induction agent for RSI

0.3mg/kg IVP MAX-0.6mg/kg

-Hypersensitivity

-Short acting drug that acts at the level of the reticular activating system to produce anesthesia

-Onset is 30 seconds, Duration is 3-5 minutes 

Dysrhythmias, Hypotension

*Rare*

Etomidate

Opiate/ Narcotic

Pain

50-100mcg IVP

• -Respiratory depression
• -CNS depression 

Binds to various opiate receptors producing analgesia

• -Respiratory Depression
• -Hypotension
• -Decreased LOC
• -Euphoria

Fentanyl

Endocrine Agonist/ Hormone

Hypoglycemia/ Beta Blocker OD

Hypoglycemia - 1mg IM

Beta Blocker OD - 2-4mg IVP

• Hypersensitivity
• Neonates

-Converts hepatic glycogen to glucose increasing glucose levels

-Onset 15-20 minutes

Disassociative anesthetic  

• Sedation
• RSI Induction

1-2mg/kg IVP

• -Uncontrolled HTN
• -Head Injury
• -Possible ICP

• -Reduces short acting amnesia w/o muscle relaxation
• -Derivative of PCP
• -Bronchodilation effects

-Hallucinations, explicit dreams, Diplopia 

Ketamine

Loop Diuretic

• -Pulmonary Edema
• -Hyperkalemia
• -Acute Renal Failure

20mg IVP -Standing orders

1mg/kg IVP slow

• -Relative to sulfa drug allergy
• -Hypotension
• -Caution with severe renal disease
• -Acute MI

• -Blocks sodium at the proximal loop of Henle
• -Onset about 5 minutes max of 30 mins
• -Some vasodilatory effects 

• -Hypotension
• -Urination
• -Dizziness
• -Hypokalemia

Lasix

Class I antiarrhythmic and local anesthetic 

• -Pulseless V-tach & V-fib
• -Hemodynamically compromising PVCs
• -Prevent reoccurrence of vfib/ vtach after electrical conversion.
• -Pretreatment for increased ICP

Alive- 0.5-0.75 mg/kg IVP Q 5-10 mins

Dead- 1mg-1.5mg/kg IVP

Bradycardia with escape PVCs

• -Acts through sodium channels
• -Potent cardiac suppressor in diseased tissue
• -Increases electrical stimulation threshold
• -Little effect on healthy myocardial cells
• -Onset within 1 minute-duration 20 minutes

• -Seizures
• -Confusion, Hypotension, Blurred vision

Lidocaine

Beta Blocker

• -Angina
• -Acute MI (Not inferior *brady)
• -AFib/Flutter with RVR

5mg IVP Q 5mins MAX 15mg

• -CHF patients
• -Inferior MI

• -Reduce heart rate and cardiac output
• -Reduced systolic blood pressure
• -Reduced reflex orthostatic tachycardia

• -Severe bradycardia
• -CHF
• -Bronchospasm
• -Dizziness
• -Fatigue
• -Wheezing

Lopressor

Antiarrhythmic 

• -Torsades 
• -Pulseless VT/VF
• -Preeclamptic Seizures
• -Status Asthmaticus

Torsades- 1-2g over 5-15 mins

Dead- 1-2g IVP

Asthma- 2g over 10-15 mins

Eclampsia- 2-4g over 30mins

• -Effects energy transfer and electric stability of myocardium
• -Stabilizes cardiac cells
• -Regulates potassium
• -Blocks calcium channels

• -Respiratory depression
• -Bradycardia
• -Hypotension
• -Depressed reflexes

Opiate/ Narcotic

Pain/ Cardiac chest pain

2-10mg Q 5 minutes until desired effects

• -Respiratory depression
• -COPD
• -CNS depression
• -Hypotension

• -Binds to opiate receptors for analgesia
• -Minimal cardiovascular effects at recommended doses
• -mild vasodilator

• -Respiratory Depression
• -Apnea
• -Hypotension
• -Euphoria
• -Decreased LOC

Opiate Antagonist

0.4-2mg IVP

• -Known or suspected opiate OD
• -Unconscious pt with respiratory depression 

-Antagonizes various opiate receptors

• -Tachycardia, Hypertension, Tremors
• -Withdrawal symptoms

Narcan

Nitrate

• -MI
• -Angina Pain
• -Pulmonary Edema

• -Spray
• -Tab
• -Paste
• -Drip (Tridil)

-1 spray= 0.4mg SL

-1 tab= 0.4mg SL

-0.5-2" of paste on skin (Chest)

• -Hypotension
• -Bradycardia

• -Vascular smooth muscle relaxation
• -Decrease preload (vasodilation) reducing myocardial O2 demand

• -Hypotension
• -Bradycardia
• -Headache
• -Lightheadedness

Class I Antiarrhythmic

• -Suppresses ventricular ectopy
• -Afib/Flutter
• -Wide QRS tachycardia
• -WPW

1g in 50ml NSS = 20mg/ml

 -2015mg/min (17mg/kg drip)

• 1) Arrhythmia terminates
• 2) QRS widens by 50%
• 3) Hypotensive
• 4)Lengthening of PRI or QTI

• -2nd or 3rd degree AV block
• -Torsades

Hypotension, Nausea, Vomiting

Procainamide 

Non-Depolarizing Neuromuscular Blocker

RSI Induction

Hypersensitivity

0.6-1.2mg/kg

Binds to acetylcholine receptors at the neuromuscular junction causing paralysis

• -Respiratory Depression
• -Hypertension
• -Hypotension

Rocuronium

Benzodiazepine Antagonist

Benzodiazepine OD

0.2mg over 30 seconds. Repeat up to 2mg for desired effect.

-Tricyclic OD

-Binding CNS benzodiazepine receptors and blocking benzodiazepine activation GABAergic synapses

Fatal seizure *Caution*

Flumazenil

Electrolyte

• -Suspected hyperkalemia
• -Tricyclic antidepressant OD/ ASA OD

1mEq/kg

• -Hypocalcemia
• -Caution with CHF

Inhibits release of oxygen to the tissues due to extracellular alkalosis

• -Sodium and Fluid Retention
• -Metabolic alkalosis

Glucocorticoid Steroid (Anti-Inflammatory)

• -Bronchoconstriction 
• -Respiratory Distress

125mg IVP

• -Suppresses acute and chronic inflammation.
• -Potentiate smooth muscle relaxation by beta adrenergic agonists

Solu-Medrol

Depolarizing Neuromuscular Blocker

1-1.5mg/kg IVP

RSI Induction

• -Burns older than 8 hours old
• -Heat stroke
• -Crush injuries

• -Binds to anectine receptor
• -Depolarizes muscle membranes and leads to fasiculations
• -No effect on consciousness or pain

• -Hyperthermia
• -Fasiculations 
• -Paralysis 

Succinylcholine 

Vitamin

• -Mainly malnourished or alcoholic individuals
• -Given before or after D50 to metabolize glucose

100mg IVP

Combines with ATP to form thiamine co-enzyme to metabolize carbohydrates

Vitamin B1

Non-depolarizing neuromuscular blocker

RSI Induction

0.1mg/kg IVP

Use caution/ Continuous monitoring

Prolonged respiratory paralysis (45mins-1hour)

• -Hypotension
• -Bradycardia
• -Dysrhythmias
• -Respiratory arrest

Vecuronium

Benzodiazepine

• -Anxiety
• -Sedation
• -Cardioversion
• -RSI Induction

Seizures- 2-5mg IVP

Induction- 0.1-0.2mg/kg IVP

• -Caution with decreased respiratory drive
• -AMS
• -Liver disease

• -Binds to benzodiazepine receptor
• -Muscle relaxation/ sedation
• -Amnesia

• -Respiratory depression
• -Amnesia
• -Euphoria
• -Hallucinations
• -Confusion
• -Dizziness

Versed

Anti-Emetic/ Serotonin antagonist

-Nausea/ Vomiting

2-4mg IVP

• -Selective serotonin receptor antagonist
• -Prevents the brain from receiving feeling of nausea

Headache/ Constipation

Zofran

Calcium Channel Blocker

• -AFib/Flutter
• -Second line for SVT

0.25mg/kg first, 0.35mg/kg second

• -WPW
• -CHF
• -MI
• -Hypotension

• -Inhibits influx of calcium ions during membrane depolarization of cardiac smooth muscle
• -Disruption of AV node re-entry circuit

• -Bradycardia
• -Hypotension
• -Headache, Nausea, Vomiting, Dizziness, Chest pain

Cardizem