CFRN Critical Care Medications and Pharmacology 2 — Questions and Answers
Question 1: A patient receiving a heparin infusion develops acute HIT (Heparin-Induced Thrombocytopenia). Which action is the priority?
- Reduce the heparin dose by 50%
- Discontinue all heparin and switch to argatroban or bivalirudin (Correct answer)
- Add aspirin to the current regimen
- Administer platelets immediately
Correct answer: Discontinue all heparin and switch to argatroban or bivalirudin
All heparin products must be stopped immediately in confirmed or suspected HIT, and a direct thrombin inhibitor such as argatroban should be started.
Question 2: Which reversal agent is used for suspected opioid overdose during air medical transport?
- Flumazenil
- Naloxone (Correct answer)
- Physostigmine
- Protamine sulfate
Correct answer: Naloxone
Naloxone competitively antagonizes mu-opioid receptors to reverse respiratory depression, sedation, and analgesia caused by opioids.
Question 3: What is the correct IV loading dose of amiodarone for a hemodynamically stable patient with ventricular tachycardia?
- 75 mg over 10 minutes
- 150 mg over 10 minutes (Correct answer)
- 300 mg IV push
- 600 mg over 30 minutes
Correct answer: 150 mg over 10 minutes
The standard amiodarone loading dose for stable VT is 150 mg IV over 10 minutes, followed by a maintenance infusion.
Question 4: A diabetic patient transported by air has a blood glucose of 38 mg/dL and is unconscious. There is no IV access. What is the best immediate treatment?
- Oral glucose gel
- Glucagon 1 mg IM (Correct answer)
- D50W via IO access
- Insulin drip
Correct answer: Glucagon 1 mg IM
When IV access is unavailable and the patient is unconscious, glucagon 1 mg IM stimulates hepatic glycogenolysis to raise blood glucose.
Question 5: Which medication is the antidote for acetaminophen overdose and should be initiated during long-distance transport?
- Fomepizole
- N-acetylcysteine (NAC) (Correct answer)
- Deferoxamine
- Pyridoxine
Correct answer: N-acetylcysteine (NAC)
N-acetylcysteine replenishes glutathione stores, preventing hepatic damage from the toxic acetaminophen metabolite NAPQI.
Question 6: Rocuronium is selected instead of succinylcholine for RSI. What reversal agent is available for rocuronium?
- Neostigmine
- Sugammadex (Correct answer)
- Flumazenil
- Physostigmine
Correct answer: Sugammadex
Sugammadex encapsulates and inactivates rocuronium (and vecuronium), providing rapid reversal of neuromuscular blockade.
CFRN Critical Care Medications and Pharmacology 2
A patient receiving a heparin infusion develops acute HIT (Heparin-Induced Thrombocytopenia).
Which action is the priority?