PSA Emergency Prescribing 3 — Questions and Answers
Question 1: A hemodynamically stable patient has atrial fibrillation with rapid ventricular response (HR 148 bpm) and preserved ejection fraction. Which drug is preferred for acute rate control?
- Metoprolol 5mg IV over 2 minutes (may repeat x2) (Correct answer)
- Digoxin 0.5mg IV
- Amiodarone 300mg IV bolus
- Adenosine 6mg rapid IV push
Correct answer: Metoprolol 5mg IV over 2 minutes (may repeat x2)
IV beta-blockers such as metoprolol are first-line for rate control in AF with RVR in hemodynamically stable patients with preserved EF.
Question 2: A patient presents 2.5 hours after ischemic stroke onset with NIHSS 12 and BP 160/88 mmHg. There are no contraindications. What is the correct treatment and dose?
- Alteplase (tPA) 0.9mg/kg IV (max 90mg), 10% as bolus then remainder over 60 min (Correct answer)
- Aspirin 325mg PO immediately
- Heparin 80 units/kg IV bolus
- Tenecteplase 0.25mg/kg IV bolus
Correct answer: Alteplase (tPA) 0.9mg/kg IV (max 90mg), 10% as bolus then remainder over 60 min
Alteplase 0.9mg/kg IV (max 90mg) is the standard thrombolytic for eligible ischemic stroke within 4.5 hours of onset.
Question 3: A patient with Type 1 diabetes presents in DKA (glucose 520 mg/dL, pH 7.08, bicarbonate 8 mEq/L). What is the initial fluid resuscitation of choice?
- 0.9% Normal saline 1L IV over 1 hour (Correct answer)
- Lactated Ringer's 1L IV bolus
- D5W 500mL IV bolus
- Hypertonic saline (3%) 250mL IV over 30 min
Correct answer: 0.9% Normal saline 1L IV over 1 hour
Isotonic normal saline is the initial fluid for DKA to correct volume deficit and hemodynamic instability before transitioning to 0.45% NaCl.
Question 4: An unconscious patient is found with pinpoint pupils and a respiratory rate of 4 breaths/min. What is the immediate treatment?
- Naloxone 0.4–2mg IV/IM/intranasal (Correct answer)
- Flumazenil 0.2mg IV over 30 seconds
- Physostigmine 2mg IV slowly
- Dextrose 50% 25g IV push
Correct answer: Naloxone 0.4–2mg IV/IM/intranasal
Naloxone is the specific opioid antagonist that rapidly reverses opioid-induced respiratory depression, miosis, and coma.
Question 5: A patient in cardiac arrest with ventricular fibrillation has received CPR and two defibrillation shocks without return of spontaneous circulation. What drug is indicated next?
- Epinephrine 1mg IV every 3–5 minutes (Correct answer)
- Lidocaine 1.5mg/kg IV bolus
- Magnesium sulfate 2g IV push
- Atropine 1mg IV
Correct answer: Epinephrine 1mg IV every 3–5 minutes
Epinephrine 1mg IV every 3–5 minutes is the vasopressor of choice in cardiac arrest per current ACLS guidelines.
Question 6: A diabetic patient is found unconscious with a blood glucose of 28 mg/dL. IV access is established. What is the appropriate treatment?
- Dextrose 50% (D50W) 25g IV push (Correct answer)
- Glucagon 1mg IV push
- D5W 500mL infusion over 1 hour
- Orange juice 240mL via nasogastric tube
Correct answer: Dextrose 50% (D50W) 25g IV push
IV dextrose 50% (D50W) 25–50g provides the fastest correction of severe hypoglycemia when IV access is available.
Question 7: A patient has a massive pulmonary embolism confirmed by CT-PA with BP 78/48 mmHg and HR 128 bpm. What is the definitive treatment?
- Systemic thrombolysis with alteplase 100mg IV over 2 hours (Correct answer)
- Unfractionated heparin 80 units/kg IV bolus alone
- Rivaroxaban 15mg PO twice daily with food
- Fondaparinux 7.5mg SC daily
Correct answer: Systemic thrombolysis with alteplase 100mg IV over 2 hours
Systemic thrombolysis with alteplase 100mg over 2 hours is the treatment for massive PE with hemodynamic compromise.
PSA Emergency Prescribing 3
A hemodynamically stable patient has atrial fibrillation with rapid ventricular response (HR 148 bpm) and preserved ejection fraction.
Which drug is preferred for acute rate control?