david89 Posted June 7, 2015 Share Posted June 7, 2015 hello all, i'm studying for my pance and currently doing questions from the DAVIS' PA exam review: by morton diamond. i hope this book pays off...lol...as one of my study questions book this is one of the question i came across: a 47 year old asthmatic woman suddenly has palpitations. blood pressure is 110/70, pulse 190, respiration is 20. lung exam is normal. no murmur or gallop is heard. ekg shows psvt. which of the following is the preffered initial therapy? a. adenosine b. metoprolol c. digoxin d. verapamil e. ibutilide answer from the book is verapamil. but i've always learned that it's adenosine. can someone please clarify this for me? if this was on the real pance, my kneejerk reaction would have been adenosine thank you Link to comment Share on other sites More sharing options...
Timon Posted June 7, 2015 Share Posted June 7, 2015 From UpToDate: For a hemodynamically stable patient with symptomatic AT, we suggest acute treatment with an oral or intravenous beta blocker or non-dihydropyridine calcium channel blocker (ie, diltiazem or verapamil). Such treatment may slow the ventricular response and/or terminate the arrhythmia. Intravenous amiodarone is an acceptable alternative that may be preferred in a patient with borderline hypotension as amiodarone may slow the rate or convert the rhythm back to normal sinus. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted June 8, 2015 Administrator Share Posted June 8, 2015 In other words, adenosine would be the correct answer, per ACLS, if the patient were unstable. Which is the wrong answer to slow her heart rate and why? Link to comment Share on other sites More sharing options...
Will352ns Posted June 8, 2015 Share Posted June 8, 2015 Vagal maneuvers then Adenosine. At 190 you can't tell if it is AT, Flutter....ect. Link to comment Share on other sites More sharing options...
gbrothers98 Posted June 8, 2015 Share Posted June 8, 2015 Long time contraindication of adenosine in bronchospastic disease though likely overstated: http://emj.bmj.com/content/18/1/61.1.full So that is why verapamil, otherwise adenosine likely ok in this scenario minus the asthma. GB PA-C Link to comment Share on other sites More sharing options...
david89 Posted June 10, 2015 Author Share Posted June 10, 2015 okayy, so then i was answering more questions from the pance kaplin purple book (it's the book that comes with 2 of 300 questions practice test). they say the first line therapy is adenosine lol.....i really hope when i take the real pance, that it won't come down to this deciding question of pass or fail....but i think i'll go with adenosine on the real pance..... p.s: i was going to attach some pictures of the questions and explainations but i can't seem to find the option of attaching pictures on here Link to comment Share on other sites More sharing options...
hochimin Posted February 9, 2016 Share Posted February 9, 2016 Adenosine is contraindicated in asthmatics Link to comment Share on other sites More sharing options...
Torshi Posted February 26, 2016 Share Posted February 26, 2016 In other words, adenosine would be the correct answer, per ACLS, if the patient were unstable. Which is the wrong answer to slow her heart rate and why? it's actually preferred (after vagal maneuver) if stable - if unstable (ie: hypotension, ischemic chest pain, heart issues, etc) per ACLS it's synchronized cardioversion Link to comment Share on other sites More sharing options...
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