CEP Cardiac Care & Emergency Pharmacology 4 — Questions and Answers
Question 1: A patient is taking sildenafil and presents with chest pain. Which medication must be withheld?
- Aspirin
- Morphine
- Nitroglycerin (Correct answer)
- Heparin
Correct answer: Nitroglycerin
Nitroglycerin is absolutely contraindicated within 24-48 hours of phosphodiesterase-5 inhibitor (e.g., sildenafil) use due to the risk of severe, refractory hypotension.
Question 2: Which finding on a 12-lead ECG is pathognomonic of hyperkalemia in a critical patient?
- Prolonged PR interval
- Peaked T waves with widened QRS (Correct answer)
- ST depression in lateral leads
- Shortened QT interval
Correct answer: Peaked T waves with widened QRS
Severe hyperkalemia produces peaked (tent-shaped) T waves followed by widening of the QRS complex as potassium rises, reflecting slowed ventricular conduction.
Question 3: A patient in VF arrest has received epinephrine and two shocks. Amiodarone 300 mg is given. When is the next dose of amiodarone appropriate?
- Immediately if VF persists
- 150 mg after the next shock if VF persists
- 300 mg after 5 minutes
- 150 mg after 2-minute CPR cycle and reassessment (Correct answer)
Correct answer: 150 mg after 2-minute CPR cycle and reassessment
A second dose of amiodarone 150 mg IV may be given after completing a 2-minute CPR cycle and reassessing if VF/pVT persists.
Question 4: Which of the following is the most appropriate prehospital intervention for a patient with suspected cardiac tamponade?
- IV fluid bolus to maintain preload and rapid transport (Correct answer)
- Immediate needle decompression of the left chest
- Synchronized cardioversion at 200 J
- Nitroglycerin to reduce afterload
Correct answer: IV fluid bolus to maintain preload and rapid transport
Prehospital management of cardiac tamponade focuses on maintaining preload with IV fluids and rapid transport for pericardiocentesis in hospital.
Question 5: A patient has a BP of 60/40 and is unresponsive after a syncopal episode. The monitor shows sinus bradycardia at 28 bpm. Transcutaneous pacing is initiated. What confirms electrical capture?
- Pacer spikes visible on the ECG
- Patient reports feeling pacing impulses
- Wide QRS complexes after each pacer spike with a palpable pulse (Correct answer)
- Heart rate increases above 60 bpm on the monitor
Correct answer: Wide QRS complexes after each pacer spike with a palpable pulse
Electrical capture is confirmed by a wide QRS following each pacer spike, and mechanical capture requires a corresponding palpable pulse.
Question 6: Sodium bicarbonate is indicated in cardiac arrest caused by which of the following?
- Primary ventricular fibrillation
- Hyperkalemia-induced cardiac arrest (Correct answer)
- Hypoxia-induced PEA
- Pulmonary embolism arrest
Correct answer: Hyperkalemia-induced cardiac arrest
Sodium bicarbonate can help shift potassium intracellularly, making it useful in hyperkalemia-induced cardiac arrest or arrest associated with tricyclic antidepressant overdose.
Question 7: A patient with Wolff-Parkinson-White (WPW) syndrome develops atrial fibrillation. Which medication is dangerous?
- Magnesium sulfate
- Adenosine (Correct answer)
- Procainamide
- Amiodarone (IV)
Correct answer: Adenosine
Adenosine blocks the AV node but can accelerate conduction through the accessory pathway in WPW with AF, potentially precipitating ventricular fibrillation.
CEP Cardiac Care & Emergency Pharmacology 4
A patient is taking sildenafil and presents with chest pain.
Which medication must be withheld?