Arrhythmias

Arrhythmias

Senior Summit 2021

John Dougherty MBA,PharmD, BCPS

Multiple Choice

What is the pacemaker of the heart?

• AV node

• SA node

• Bundle of His

• Purkinje system

Multiple Choice

When reviewing the movement of electrolytes during an action potential in the heart, all of the following electrolytes are involved EXCEPT_________

• Sodium

• Potassium

• Calcium

• Iron

Multiple Choice

The most common type of arrhythmia is_____________

• ventricular fibrillation

• atrial fibrillation

• ventricular tachycardia

• AV nodal reentrant tachycardia

Multiple Choice

A patient is newly diagnosed with atrial fibrillation (feeling short of breath and feels heart "pounding" in his chest). How would you generally categorize the ventricular rate (beats/min) in patients with atrial fibrillation who are symptomatic?

• <50 beats/min

• >50-<75 beats/min

• >75-<100 beats/min

• >100 beats/min

Multiple Choice

For a patient with atrial fibrillation, the number one goal is_____________

• Convert the patient back to a normal sinus rhythm

• Give the patient anticoagulation

• Control heart rate

• Control the blood pressure

Multiple Choice

What resting heart rate goal is recommended for a patient with atrial fibrillation and is symptomatic?

• <60 beats/min

• <80 beats/min

• <100 beats/min

• <150 beats/min

Multiple Choice

For a patient with an ejection fraction of 55%, what is the recommended drug to be used as 1st line therapy to the control heart rate?

• Amlodipine

• Diltiazem

• Digoxin

• Nicardipine

Multiple Choice

For a patient in atrial fibrillation, which drug would be preferred to control heart rate if the patient had a high sympathetic tone (ie thyrotoxicosis, post-surgery)?

• Diltiazem

• Metoprolol

• Verapamil

• Nifedipine

Multiple Choice

An example of a beta-1 selective blocker that is ONLY available to be given intravenously is____________

• Atenolol

• Esmolol

• Metoprolol

• Propranolol

Multiple Choice

A patient is started on diltiazem IV for symptomatic atrial fibrillation. The patient weighs 80 kg. The bolus dose is generally 0.25 mg/kg. What is the dose to give the patient and what adverse effect should be monitored for once the drug is given?

• 15 mg-hives

• 20 mg-hives

• 15 mg-hypotension

• 20 mg-hypotension

Multiple Choice

For a patient with atrial fibrillation and an ejection fraction of 25% (and the patient is in a state of heart decompensation), what drug is recommended as 1st line therapy to control heart rate?

• Verapamil

• Amiodarone

• Diltiazem

• Metoprolol

Multiple Choice

A patient with atrial fibrillation who has an increased heart rate has been ordered digoxin. The patient was started on metoprolol but it has not decreased the patient's heart rate significantly. What is important to remember when dosing digoxin?

• Dose needs to be decreased for patients on cholestyramine

• Dose needs to increased for patient's on amiodarone

• Dose needs to be adjusted for patient's with a previous stroke

• Dose needs to be adjusted in patient's with renal dysfunction

Multiple Choice

Amiodarone has anti-arrythmic properties (activity) in which Vaugh Williams class(es)?

• I

• I, II

• I, II, III

• I, II, III, IV

Multiple Choice

Adverse effects from amiodarone occur in all of the following organ systems EXCEPT__________

• Skin

• Liver

• Heart

• Thyroid

• None of the above are correct

Multiple Choice

Thyroid conditions are common when patients take amiodarone because of the iodine in its structure. Is hypothyroidism or hyperthyroidism more common?

• Hypothyroidism

• Hyperthyroidism

Multiple Choice

The following drugs can be used to convert a patient to NSR. Which of the following drugs is classified as an "IC" agent in the Vaugh Williams classification?

• Amiodarone

• Dofetilide

• Ibutilide

• Propafenone

Multiple Choice

Which drug would be recommended to maintain a patient in normal sinus rhythm if the patient has structural heart disease and renal dysfunction?

• Quinidine

• Sotalol

• Amiodarone

• Flecanide

Multiple Choice

The risk of QT prolongation increases for all of the following scenarios EXCEPT_______

• Patient that has hypokalemia

• Patient has hypomagnesemia

• Patient is receiving amiodarone

• Patient is receiving risperidone

• None of the above

Multiple Choice

Which patient would have the highest risk of QT prolongation?

• Female patient receiving azithromycin

• Male patient receiving azithromycin

• Female patient, receiving sotalolol and is hypokalemic

• Male patient receiving sotalol and is hypokaelemc

Multiple Choice

Pick the pair (drug-mechanism for increasing its risk of QT prolongation) that is correct_______

• Dofetilide-renal dysfunction

• Ciprofloxacin-hepatic dysfunction

• Sotalol--hepatic dysfunction

• Azithromycin-renal dysfunction

Multiple Choice

The drug of choice for a patient with torsades de pointes is________

• Calcium

• Magnesium

• Potassium

• Isoproterenol

Multiple Choice

An adverse of cinchonism occurs with this anti-arrhythmic agent. Which medication is it?

• Procainamide

• Quinidine

• Flecanide

• Propafenone

Multiple Choice

The IA anti-arrhythmic that causes anti-cholinergic adverse effects is______

• Quinidine

• Disopyramide

• Procainamide

• Flecainide