ACLS Emergency Pharmacology 2 — Questions and Answers
Question 1: Which vasopressor can replace the second dose of epinephrine in a cardiac arrest algorithm?
- Vasopressin 40 units IV (Correct answer)
- Dopamine 10 mcg/kg/min IV
- Norepinephrine 8 mg IV
- Phenylephrine 200 mcg IV
Correct answer: Vasopressin 40 units IV
Vasopressin 40 units IV/IO can replace the first or second dose of epinephrine in cardiac arrest.
Question 2: A patient in refractory VF has received two defibrillation attempts and epinephrine. What antiarrhythmic should be given next?
- Amiodarone 300 mg IV push (Correct answer)
- Lidocaine 1.5 mg/kg IV push
- Magnesium 2 g IV push
- Procainamide 100 mg IV push
Correct answer: Amiodarone 300 mg IV push
Amiodarone 300 mg IV push is the first-line antiarrhythmic for shock-refractory VF/pulseless VT.
Question 3: What is the maximum cumulative dose of adenosine for treating SVT in an adult?
- 30 mg
- 18 mg (Correct answer)
- 12 mg
- 6 mg
Correct answer: 18 mg
The maximum cumulative adenosine dose is 18 mg (6 mg first dose, then 12 mg second dose if needed).
Question 4: Which medication is contraindicated in a patient with WPW syndrome presenting with rapid atrial fibrillation?
- Amiodarone
- Adenosine
- Diltiazem (Correct answer)
- Verapamil
Correct answer: Diltiazem
Diltiazem (and other AV-nodal blockers like verapamil and beta-blockers) are contraindicated in WPW with AF because they can enhance accessory pathway conduction.
Question 5: Sodium bicarbonate is most clearly indicated during cardiac arrest in which clinical scenario?
- Prolonged arrest >10 minutes
- Pre-existing hyperkalemia (Correct answer)
- Hypoxic lactic acidosis
- Respiratory acidosis from hypoventilation
Correct answer: Pre-existing hyperkalemia
Sodium bicarbonate has a clear indication in cardiac arrest caused by pre-existing hyperkalemia or tricyclic antidepressant overdose.
Question 6: A patient develops Torsades de Pointes with a pulse. Which drug is the treatment of choice?
- Amiodarone 150 mg IV over 10 min
- Magnesium sulfate 1–2 g IV over 15 min (Correct answer)
- Lidocaine 1 mg/kg IV push
- Procainamide 20 mg/min IV
Correct answer: Magnesium sulfate 1–2 g IV over 15 min
Magnesium sulfate 1–2 g IV over 15 minutes is the first-line treatment for Torsades de Pointes.
Question 7: When using atropine for symptomatic bradycardia, what is the maximum total IV dose?
- 1 mg
- 2 mg
- 3 mg (Correct answer)
- 0.5 mg
Correct answer: 3 mg
The maximum total dose of atropine for symptomatic bradycardia is 3 mg IV.
ACLS Emergency Pharmacology 2
Which vasopressor can replace the second dose of epinephrine in a cardiac arrest algorithm?