CEP Cardiac Care & Emergency Pharmacology 5 — Questions and Answers
Question 1: A patient presents with chest pain, diaphoresis, and the following ECG: ST elevation in II, III, aVF with reciprocal changes in I and aVL. Which artery is most likely occluded?
- Left anterior descending artery
- Left circumflex artery
- Right coronary artery (Correct answer)
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in the inferior leads (II, III, aVF) with reciprocal lateral depression indicates right coronary artery occlusion causing an inferior STEMI.
Question 2: Which of the following correctly describes the pharmacologic action of epinephrine in cardiac arrest?
- Beta-1 stimulation only, increasing heart rate and contractility
- Alpha-1 stimulation increasing coronary and cerebral perfusion pressure during CPR (Correct answer)
- Beta-2 stimulation causing bronchodilation and vasodilation
- Inhibition of phosphodiesterase, raising intracellular cAMP
Correct answer: Alpha-1 stimulation increasing coronary and cerebral perfusion pressure during CPR
In cardiac arrest, epinephrine's primary benefit is alpha-1 mediated vasoconstriction, which raises aortic diastolic pressure and improves coronary and cerebral perfusion during CPR.
Question 3: A patient develops third-degree (complete) AV block with a ventricular rate of 30 bpm. Atropine has been given twice with no improvement. What is the next step?
- Adenosine 6 mg rapid IV push
- Transcutaneous pacing (Correct answer)
- Amiodarone 300 mg IV over 10 minutes
- Lidocaine 1 mg/kg IV push
Correct answer: Transcutaneous pacing
Complete heart block with a slow escape rhythm that does not respond to atropine requires transcutaneous pacing as a bridge to transvenous pacing.
Question 4: A patient is in stable narrow-complex tachycardia at 170 bpm. Vagal maneuvers fail. Adenosine 6 mg and then 12 mg are both ineffective. What is the next intervention?
- Synchronized cardioversion at 50 J
- Verapamil 2.5-5 mg IV over 2 minutes (Correct answer)
- Amiodarone 300 mg IV push
- Lidocaine 100 mg IV push
Correct answer: Verapamil 2.5-5 mg IV over 2 minutes
If adenosine fails in stable SVT, calcium channel blockers such as verapamil (2.5-5 mg IV) or diltiazem are the next pharmacologic option per AHA guidelines.
Question 5: Which route of epinephrine administration is preferred in anaphylaxis?
- Intravenous push 1:10,000
- Sublingual injection
- Intramuscular injection into the anterolateral thigh using 1:1,000 (Correct answer)
- Subcutaneous injection 1:1,000
Correct answer: Intramuscular injection into the anterolateral thigh using 1:1,000
Epinephrine 1:1,000 at 0.3-0.5 mg IM into the anterolateral thigh provides faster, more reliable absorption than subcutaneous injection in anaphylaxis.
Question 6: A post-ROSC patient has a GCS of 6, BP 100/70, and a temperature of 37.2°C. Which intervention is now the standard of care for neuroprotection?
- Targeted temperature management (TTM) at 32-36°C for 24 hours (Correct answer)
- Active cooling to 28°C for 48 hours
- Sodium bicarbonate infusion to correct acidosis
- Hyperventilation to reduce ICP
Correct answer: Targeted temperature management (TTM) at 32-36°C for 24 hours
Targeted temperature management (TTM) maintaining core temp at 32-36°C for at least 24 hours is recommended post-cardiac arrest in comatose survivors to improve neurologic outcomes.
Question 7: A patient in cardiogenic shock has a BP of 70/50 and is in sinus rhythm at 100 bpm. Which vasopressor is most appropriate as initial therapy?
- Vasopressin 40 units IV bolus
- Norepinephrine infusion starting at 0.1 mcg/kg/min (Correct answer)
- Phenylephrine infusion at 100 mcg/min
- Dopamine infusion at 2 mcg/kg/min
Correct answer: Norepinephrine infusion starting at 0.1 mcg/kg/min
Norepinephrine is the preferred vasopressor for cardiogenic shock due to its combined alpha-1 vasoconstriction and mild beta-1 inotropic support with less tachycardia than dopamine.
CEP Cardiac Care & Emergency Pharmacology 5
A patient presents with chest pain, diaphoresis, and the following ECG: ST elevation in II, III, aVF with reciprocal changes in I and aVL.
Which artery is most likely occluded?