SHARP EKG 2026 QUESTIONS AND ANSWERS SET
A+
✔✔Epinephrine - ✔✔1. Main Actions: An alpha-adrenergic drug producing potent
vasoconstriction. It can increase coronary and cerebral perfusion pressure during CPR,
but can also increase myocardial work and reduce subendocardial perfusion. 2.
Standing Order: Asystole Unstable Bradycardia PEA V Fib/Pulseless V Tach Severe
Anaphylaxis 3. Considerations: May induce or exacerbate ventricular ectopy especially
when patient has electrolyte imbalance. Coronary ischemia may occur and is not related
to dose, ischemic renal failure can occur with high doses. The drug of choice for severe
anaphylaxis reactions because it blocks inflammatory mediator release from sensitized
cells.
✔✔Hydrocortisone - ✔✔1. Main Actions: Mineral corticoid effect, used for persistent
hypotension 2. Standing Order: Severe Anaphylaxis 3. Considerations: Dose/duration-
dependent. May increase risk of GI distress Barbiturates, Dilantin, rifampin may
decrease effect of steroid
✔✔Lorazepam (Ativan) - ✔✔1. Main Actions: A benzodiazepine effective as an anti-
epileptic drug. Also works as an anti-anxiety, sedative and amnesic agent 2. Standing
Order: Status Epilepticus 3. Considerations: Onset of hypnosis is 20 to 30 minutes and
the duration is 8 hours; elimination half-life is 10 to 16 hours. Patient may experience
hypotension, over sedation, respiratory depression, dry mouth, and abdominal
discomfort, Ativan may potentiate other CNS depressants.
✔✔Mannitol - ✔✔1. Main Actions: An osmotic diuretic. 2. Standing Order: Increased
Intracranial Pressure 3. Considerations: Diuresis occurs in 15 to 30 minutes and
persists for 2 to 8 h; a reduction in intracranial pressure will occur within 15 min and will
persist for 3 to 8 h; the drug distributes well to the extracellular fluid; hepatic metabolism
is minimal and the drug is primarily excreted unchanged in the urine by glomerular
filtration; the elimination halflife is 100 minutes. Can cause fluid and electrolyte
imbalance, tachycardia, chest pain, pulmonary edema, fluid and electrolyte imbalance
and hypotension. Check serum osmolarity. May cause a rebound increase in ICP 8-12
, hrs after diuresis, along with headache and confusion. Inspect for crystals in the IVPB.
Administer thru 0.22 micron filter.
✔✔Midazolam (Versed) - ✔✔1. Main Actions: A benzodiazepine used for procedural
sedation. It also used for preoperative sedation and anxiolysis. 2. Standing Order:
Unstable V Tach 3. Considerations: Onset in 3 to 5 minutes after single IV
administration with duration <2 hours (dose-dependent). Midazolam has been
associated with respiratory depression and respiratory arrest most often when used
concomitantly with other CNS depressants (eg, opioids). It may also cause CNS
depression, hypotension and paradoxical reactions.
✔✔Morphine Sulfate - ✔✔1. Main Actions: Has both analgesic and hemodynamic
effects. Low doses increase venous capacity, reduces SVR, relieves pulmonary
congestion, decreases MV02. 2. Standing Order: Chest Pain 3. Considerations: Causes
respiratory depression and hypotension (especially in volume depleted patients).
✔✔Narcan - ✔✔1. Main Actions: Narcotic antagonist administered to reverse the side
effects of respiratory depression 2. Standing Order: Respiratory Depression 3.
Considerations: Does not reverse respiratory depression caused by non-narcotic agents
(i.e. Ativan, Versed). Adverse effects include arrhythmias (VF, wide complex
tachycardia), hypotension, and opiate withdrawal symptoms (vomiting, restlessness,
hypertension, cramps). Respiratory rate should increase within 1-2 minutes, effects will
last up to 4 hrs. It is important to continue monitoring respiratory status since opioid
effects may last longer.
✔✔Nitroglycerin (NTG) - ✔✔1. Main Actions: Indicated for the initial management of
pain and ischemia with AMI without hypotension. Relaxes vascular smooth muscle
(causes vasodilation), dilates coronary arteries, increases collateral blood flow to
ischemia areas of the heart, decreases venous return, reduces left ventricular filling
pressure (preload), decreases MV02, and decreases SVR. Dose 0.4mg SL, May repeat
x 2 if SBP > 90 mmHg 2. Standing Order: Chest Pain 3. Considerations: Should be
used cautiously in acute MI patients because it may induce hypotension and aggravate
ischemia (especially inferior wall MI). Hypotension is best treated by ensuring the
patient is not hypovolemic. NTG should be avoided in patients with acute bradycardia
(<50) or tachycardia. Caution should also be taken with patients with acute RV infarcts.
✔✔Romazicon (Fumazenil) - ✔✔1. Main Actions: Antagonist for suspected
benzodiazepine overdose 2. Standing Order: Unstable V tach, Respiratory Depression
3. Considerations: Cardiac arrhythmias and bradycardia are reported rarely. Dizziness,
increased sweating, headache, blurred vision, and injection site pain are the most
common adverse effects with FLUMAZENIL. Seizures may occur with FLUMAZENIL
use, especially in cases of cyclic antidepressant or other mixed drug overdose.
✔✔Ventolin (Albuterol) - ✔✔1. Main Actions: Albuterol is an effective bronchodilator for
the treatment of asthma and reversible bronchospasm. 2. Standing Order: Respiratory
Distress 3. Considerations: Contraindicated in patients taking MAO inhibitors or tricyclic
A+
✔✔Epinephrine - ✔✔1. Main Actions: An alpha-adrenergic drug producing potent
vasoconstriction. It can increase coronary and cerebral perfusion pressure during CPR,
but can also increase myocardial work and reduce subendocardial perfusion. 2.
Standing Order: Asystole Unstable Bradycardia PEA V Fib/Pulseless V Tach Severe
Anaphylaxis 3. Considerations: May induce or exacerbate ventricular ectopy especially
when patient has electrolyte imbalance. Coronary ischemia may occur and is not related
to dose, ischemic renal failure can occur with high doses. The drug of choice for severe
anaphylaxis reactions because it blocks inflammatory mediator release from sensitized
cells.
✔✔Hydrocortisone - ✔✔1. Main Actions: Mineral corticoid effect, used for persistent
hypotension 2. Standing Order: Severe Anaphylaxis 3. Considerations: Dose/duration-
dependent. May increase risk of GI distress Barbiturates, Dilantin, rifampin may
decrease effect of steroid
✔✔Lorazepam (Ativan) - ✔✔1. Main Actions: A benzodiazepine effective as an anti-
epileptic drug. Also works as an anti-anxiety, sedative and amnesic agent 2. Standing
Order: Status Epilepticus 3. Considerations: Onset of hypnosis is 20 to 30 minutes and
the duration is 8 hours; elimination half-life is 10 to 16 hours. Patient may experience
hypotension, over sedation, respiratory depression, dry mouth, and abdominal
discomfort, Ativan may potentiate other CNS depressants.
✔✔Mannitol - ✔✔1. Main Actions: An osmotic diuretic. 2. Standing Order: Increased
Intracranial Pressure 3. Considerations: Diuresis occurs in 15 to 30 minutes and
persists for 2 to 8 h; a reduction in intracranial pressure will occur within 15 min and will
persist for 3 to 8 h; the drug distributes well to the extracellular fluid; hepatic metabolism
is minimal and the drug is primarily excreted unchanged in the urine by glomerular
filtration; the elimination halflife is 100 minutes. Can cause fluid and electrolyte
imbalance, tachycardia, chest pain, pulmonary edema, fluid and electrolyte imbalance
and hypotension. Check serum osmolarity. May cause a rebound increase in ICP 8-12
, hrs after diuresis, along with headache and confusion. Inspect for crystals in the IVPB.
Administer thru 0.22 micron filter.
✔✔Midazolam (Versed) - ✔✔1. Main Actions: A benzodiazepine used for procedural
sedation. It also used for preoperative sedation and anxiolysis. 2. Standing Order:
Unstable V Tach 3. Considerations: Onset in 3 to 5 minutes after single IV
administration with duration <2 hours (dose-dependent). Midazolam has been
associated with respiratory depression and respiratory arrest most often when used
concomitantly with other CNS depressants (eg, opioids). It may also cause CNS
depression, hypotension and paradoxical reactions.
✔✔Morphine Sulfate - ✔✔1. Main Actions: Has both analgesic and hemodynamic
effects. Low doses increase venous capacity, reduces SVR, relieves pulmonary
congestion, decreases MV02. 2. Standing Order: Chest Pain 3. Considerations: Causes
respiratory depression and hypotension (especially in volume depleted patients).
✔✔Narcan - ✔✔1. Main Actions: Narcotic antagonist administered to reverse the side
effects of respiratory depression 2. Standing Order: Respiratory Depression 3.
Considerations: Does not reverse respiratory depression caused by non-narcotic agents
(i.e. Ativan, Versed). Adverse effects include arrhythmias (VF, wide complex
tachycardia), hypotension, and opiate withdrawal symptoms (vomiting, restlessness,
hypertension, cramps). Respiratory rate should increase within 1-2 minutes, effects will
last up to 4 hrs. It is important to continue monitoring respiratory status since opioid
effects may last longer.
✔✔Nitroglycerin (NTG) - ✔✔1. Main Actions: Indicated for the initial management of
pain and ischemia with AMI without hypotension. Relaxes vascular smooth muscle
(causes vasodilation), dilates coronary arteries, increases collateral blood flow to
ischemia areas of the heart, decreases venous return, reduces left ventricular filling
pressure (preload), decreases MV02, and decreases SVR. Dose 0.4mg SL, May repeat
x 2 if SBP > 90 mmHg 2. Standing Order: Chest Pain 3. Considerations: Should be
used cautiously in acute MI patients because it may induce hypotension and aggravate
ischemia (especially inferior wall MI). Hypotension is best treated by ensuring the
patient is not hypovolemic. NTG should be avoided in patients with acute bradycardia
(<50) or tachycardia. Caution should also be taken with patients with acute RV infarcts.
✔✔Romazicon (Fumazenil) - ✔✔1. Main Actions: Antagonist for suspected
benzodiazepine overdose 2. Standing Order: Unstable V tach, Respiratory Depression
3. Considerations: Cardiac arrhythmias and bradycardia are reported rarely. Dizziness,
increased sweating, headache, blurred vision, and injection site pain are the most
common adverse effects with FLUMAZENIL. Seizures may occur with FLUMAZENIL
use, especially in cases of cyclic antidepressant or other mixed drug overdose.
✔✔Ventolin (Albuterol) - ✔✔1. Main Actions: Albuterol is an effective bronchodilator for
the treatment of asthma and reversible bronchospasm. 2. Standing Order: Respiratory
Distress 3. Considerations: Contraindicated in patients taking MAO inhibitors or tricyclic
