Pharmacology Antidysrhythmics and Bronchodilators

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Questions and Answers

What is the primary mechanism of action of adenosine?

Stimulating the parasympathetic nervous system

Slowing conduction through the AV node (correct)

Dilating peripheral vessels and constricting coronary arteries

Blocking alpha and beta adrenergic receptors

Which of the following is a contraindication when using adenosine?

Acute bronchospasms

Hypersensitivity to soy

Narrow complex tachycardia

Second degree AV block (correct)

What is the typical adult dosage for Atrovent administered via nebulizer?

5mg IV push

0.5mg one dose, over 5-15 minutes (correct)

1mg every 10 minutes, max of 3 doses

6mg rapid IV push

Which of these best describes the mechanism of action for epinephrine?

It increases heart rate and contractility (D) Signup and view all the answers

Which medication has a classification of 'Parasympatholytic Bronchodilator'?

Atrovent (B) Signup and view all the answers

Which of the following best describes the action of Atrovent on the respiratory system?

It acts to bronchodilate and dry respiratory secretions (D) Signup and view all the answers

In which situation is epinephrine indicated?

Anaphylaxis (B) Signup and view all the answers

What is the half-life of adenosine?

Approximately 10-12 seconds (B) Signup and view all the answers

What is the primary mechanism of action for Albuterol?

A beta II adrenergic stimulant that causes bronchial smooth muscle relaxation. (D) Signup and view all the answers

For a patient experiencing severe allergic reaction, what is the initial dose of Epinephrine (1:10,000 solution) that should be administered intravenously or intraosseously?

0.1 mg (D) Signup and view all the answers

Which of the following is a contraindication for the use of calcium chloride?

Digitalis toxicity (A) Signup and view all the answers

What is the correct initial intravenous dose of adenosine for an adult in cardiac arrest, with asystole, or pulseless electrical activity (PEA)?

1mg IV/IO (1:10,000 Solution). (D) Signup and view all the answers

A 7-year-old child in cardiac arrest requires Epinephrine. What is the correct initial dose?

0.01 mg/kg IV/IO (1:10,000) (C) Signup and view all the answers

What is a common side effect of Albuterol?

Tachycardia (C) Signup and view all the answers

When administering Adenosine, what is the correct procedure for an adult patient and the dose following a failed dose of 6mg?

12mg IV push followed by 20ml of normal saline after 2 minutes (A) Signup and view all the answers

Which of the following is an indication for the use of Albuterol?

Bronchospasm (A) Signup and view all the answers

Study Notes

Adenosine (Adenocard)

Class: Antidysrhythmic
Mechanism of Action (MOA): Slows AV node conduction, dilates coronary and peripheral vessels. Short half-life (10-12 seconds)
Indications: Narrow complex tachycardias, supraventricular tachycardia (SVT)
Contraindications: Second and third-degree AV blocks, caution with asthma history.
Side Effects: Transient asystole, chest pain, shortness of breath (SOB), flushing
Dosage (Adult): 6mg rapid IV push, followed by 20ml NS. If no response, 12mg rapid IV push, followed by 20 ml NS. May repeat a third time at 12mg rapid IV push.
Pediatric: Base contact only

Albuterol (Proventil)

Class: Sympathomimetic Bronchodilator
MOA: Beta-2 adrenergic stimulant, relaxes bronchial smooth muscle
Indications: Bronchospasm, asthma, emphysema, bronchitis
Contraindications: Hypersensitivity, caution with heart failure (CHF) patients
Side Effects: Anxiety, dizziness, tachycardia, palpitations, nausea
Dosage (Adult): 2.5mg nebulized over 5-15 minutes at 6-8 LPM. May repeat twice.
Pediatric: Same as adult dose

Aspirin (Bayer, ASA)

Class: Anti-platelet
MOA: Inhibits platelet aggregation by blocking thromboxane formation
Indications: Chest pain of unknown cause, myocardial infarction (MI), transient ischemic attack (TIA)
Contraindications: History of GI bleeding, intracranial hemorrhage, hypersensitivity, recent major surgery, prior thrombosis, AAA
Side Effects: Nausea, vomiting, hemorrhage
Dosage (Adult): 325mg PO (4 x 81mg tablets)
Pediatric: Not indicated

Atropine Sulfate

Class: Parasympatholytic Agent
MOA: Blocks acetylcholine receptors, increasing heart rate
Indications: Bradycardia, organophosphate poisoning
Contraindications: Myocardial infarction (MI), 2nd & 3rd degree AV blocks, children (8 & under in cardiac emergencies)
Side Effects: Increased heart rate, blood pressure
Dosage (Adult): Bradycardia: 0.5mg IV, may repeat every 5 minutes up to 3mg (or 0.04mg/kg). Organophosphate poisoning 2mg IV, repeat in 2mg increments if needed.
Pediatric: Not indicated

Atropine (Atrovent)

Class: Parasympatholytic Bronchodilator
MOA: Blocks acetylcholine receptors, bronchodilating and drying respiratory secretions.
Indications: Acute bronchospasms
Contraindications: Hypersensitivity, peanut/soy allergies
Side Effects: Nausea, vomiting, nosebleeds (epistaxis), nervousness, headache
Dosage (Adult): 0.5mg nebulized over 5-15 minutes at 6-8 LPM. One dose only.
Pediatric: One dose only (0.25mg 1-12 months; 0.5mg 1-14 years).

Calcium Chloride

Class: Electrolyte
MOA: Increases myocardial contractile force and enhances ventricular excitability.
Indications: Calcium channel blocker overdose/poisoning
Contraindications: Ventricular fibrillation (V-fib), hypercalcemia, digitalis toxicity
Side Effects: Bradycardia, arrhythmias, cardiac arrest, syncope
Dosage (Adult): Base hospital order only. Calcium channel blocker overdose: 1 gm IV

Dextrose (D10W)

Class: Carbohydrate
MOA: Rapid source of glucose for cellular metabolism.
Indications: Hypoglycemia
Contraindications: Hyperglycemia
Side Effects: Hyperglycemia, tissue necrosis
Dosage (Adult): Dextrose 10%/250ml (25gm) IV/IO bolus
Pediatric: Dextrose 10%/250ml (25gm) 0.5gm/kg (5ml/kg) IV/IO for neonates (<4 weeks) or pediatric patients (>4 weeks) with blood glucose <60mg/dL.

Diphenhydramine (Benadryl)

Class: Antihistamine
MOA: Blocks H1 receptors, preventing histamine release
Indications: Allergic reactions, anaphylaxis
Contraindications: Hypersensitivity
Side Effects: Fatigue, headache, sedation, sleepiness, dizziness
Dosage (Adult): 50mg IM or 25mg IV/IO slowly
Pediatric: 2mg/kg IM or 1mg/kg IV/IO slowly, not exceeding adult dose.

Epinephrine (Epi, Adrenaline)

Class: Sympathomimetic, endogenous catecholamine
MOA: Alpha and beta adrenergic receptor agonist; vasoconstricts, increases heart rate, contractility, potentially initiates electrical activity in asystole and converts fine V-fib to coarse V-fib. Bronchodilator in anaphylaxis
Indications: Pulseless electrical activity (PEA), asystole, anaphylaxis, bronchospasm
Contraindications: (Generally none for cardiac arrest; caution with patients over 40 with CAD or HTN)
Side Effects: Increased heart rate, hypertension, weakness, dizziness, syncope
Dosage (Adult): Cardiac arrest/Asystole/PEA: 1mg IV/IO (1:10,000). Repeat after 2 minute cycle of CPR. Severe allergic reaction: 0.1 mg IVP/IO (1:10,000), repeat every 5 minutes up to 0.5mg. Bronchospasm/Anaphylaxis: 0.3mg IM (1:1000). May repeat after 15 minutes.
Pediatric: Dosage scaled by weight

Fentanyl (Duragesic, Sublimaze)

Class: Opioid analgesic, synthetic narcotic
MOA: Binds to opioid receptors, blocking pain signals
Indications: Isolated extremity trauma, burns, chest pain, cardioversion, pacing
Contraindications: Allergy to fentanyl or other opioids, caution with pregnancy.
Side Effects: Respiratory depression, bradycardia, dizziness, nausea, vomiting
Dosage (Adult): For isolated extremity trauma, burns: 50mcg IV/IO over 1 minute, 100mcg IN/IM. May repeat at reduced doses. For pacing, cardioversion: 50mcg IV/IO. May repeat at reduced doses.

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Description

This quiz covers essential pharmacological information about Adenosine and Albuterol, including their mechanisms of action, indications, contraindications, and side effects. Test your knowledge on these critical medications used in emergency settings and respiratory care.