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Pharmacology 2 Antirrhytmics

Total questions: 97

Worksheet time: 49mins

Name
Class
Date
1.
Which is a Class Ia
a)
Procainamide
b)
Mexiletine
c)
Lidocaine
d)
Flecainide
2.
Patient comes into the hospital taking Procainamide for WPW what shift would you expect above
a)
Blue 
b)
Black
c)
Red 
d)
Green
3.

Which statement about class IC mediation is true

a)

It cause no change in phase 0 on the cardiac myocytes

b)

It is the most potent class I anti-arrhythmic

c)

It increases the (Effective Refractory Period) ERP interval

d)

First line therapy for atrial arrhythmias

4.

What class of antiarrhythmic would you utilize to treat atrial fibrillation that is NOT new

a)

Class IC

b)

Class II

c)

Class IV

d)

Adenosine

5.

Which Class of cardiac medications alters phase 3 of the cardiac cell? Which myocyte does it work on?

a)

Class Ia; Nodal Myocytes

b)

Class III; Nodal Myocyte

c)

Class IV; Cardiac Myocytes

d)

Class III; Cardiac Myocyte

6.
What is ERP 
a)
Effective Recyle period 
b)
End refractory period 
c)
Effective Refractory Period
d)
Effective recycle Phase 
7.

Amiodarone is what class of cardiac medication

a)

Class I

b)

Class II

c)

Class III

d)

All the listed classes plus IV

8.
What is the half-life of amiodarone?
a)
60 days 
b)
12 days 
c)
65 days
d)
12 hours
9.

You are in a lap-Chole case the patient is on amiodarone at home and took it the morning of the surgery, what FiO2 setting should you use. There are no prior oxygenation issues with the patient

a)

50%

b)

40%

c)

At least 30%

d)

45%

10.

Calcium channel blocker work on what phase of the nodal myocyte select all that apply

a)

4

b)

1

c)

0

d)

3

11.

Digoxin works on which site and when is it contraindicated

a)

Nodal myocyte; Class 3 heart block

b)

Cardiac Myocyte; Class 3 heart block

c)

Nodal myocyte; Tachycardia

d)

Cardiac Myocytes; Tachycardia

12.

Select all that are common risk factors that cause an arrhythmia

a)

Arteriosclerosis

b)

Coronary Artery Spasm

c)

Heart Block

d)

Hepatic insufficiently

e)

Daily Exercise

13.

Antiarrhythmic drugs are utilized for all of the following EXCEPT:

a)

Decrease conduction velocity

b)

Change the duration of the effective refractory period (ERP)

c)

Suppress abnormal automaticity

d)

Increase automaticity of damaged tissue to improve patient survival

14.

Which of these medications is NOT a class IB antiarrhythmic

a)

Lidocaine

b)

Tocainide

c)

Mexiletine

d)

Moricizine

15.

Which sub classification of class 1 antiarrhythmics decreases the absolute refractory period?

a)

1A

b)

1B

c)

1C

d)

Neither they only work on phase 4

16.

Mr. Smith is a 28 year old patient who has chronic renal failure from drug use; he was recently diagnosed with WPW Wolff-Parkinson-White Syndrome. Which medication should he take?

a)

Procainamide

b)

Quinidine

c)

Lidocaine

d)

Flecainide

17.

Select all of side effects from toxic levels of Quindine

a)

AV block

b)

Increases Digoxin concentration

c)

Ventricular Tachycardia

d)

Increased Renal clearance

e)

Systemic lupus erythromatosus like symptoms

18.

Which of the following statements is false regarding Class 1 antiarrhythmics

a)

Class 1B are used for ventricular tachycardias

b)

Class 1C are used for paroxysmal atrial fibrillation

c)

Class 1A are used for Wolff-Parkinson-White Syndrome

d)

Class 1C and 1B both block potassium channels to increase duration of action potential

19.

Class II antiarrhythmics prolong ____ conduction? Which phase? What is the primary site of action of Class II drugs: Myocyte or Nodal?

a)

SA/AV; Phase 4; Nodal

b)

SA/AV; Phase 1; Nodal

c)

SA/AV; Phase 0; Myocyte

d)

SA/AV; Phase 3; Myocyte

20.

Which one of the these Class III antiarrhythmics is a pure potassium blocker?

a)

Sotalol

b)

Amiodarone

c)

Bretylium

d)

Ibutilide

21.

Which of the following statements regarding Sotalol is true?

a)

It is a selective Beta Blocker that exhibits Class III antiarrhythmic properties

b)

Because it increases Effective Refractory Period it cannot cause polymorphic torsades de pointes

c)

It is metabolized by the liver and excreted through bile

d)

It should not be used in conjunction with diuretics to prevent hypokalemia

22.

Which Amiodarone side effect is linked with iodine properties of the medication

a)

Hyper/hypothyrodism

b)

Corneal micro-deposits

c)

Pulmonary pneumonitis

d)

Liver toxicity

23.

Select all that apply to Class IV antiarrhythmics

a)

First line choice for ventricular tachyarrhythmias

b)

Decrease AV node conduction

c)

Block L type channels

d)

Verapamil depresses ventricular response rate with patients of WPW syndrome.

e)

Can be utilized to treat supra-ventricular tachycardia preventing the occurrence of ventricular arrhythmias

24.

All of the following are adverse effects of Diltiazem except:

a)

Hypotension

b)

Bradycardia

c)

Dizziness

d)

Pulmonary edema

25.

Which of the following is not on the Vaughan William classification and causes hyper-polarization of the cardiac cell membrane

a)

Adenosine

b)

Mg Sulfate

c)

Digibind

d)

Verapamil

26.

Hemostatis occurs with all of the following factors Except

a)

Adherence with factor VIII:vWF

b)

Activation of plasma coagulation factors through thrombin

c)

Platelets aggregation requiring ADP and thrombaxane A2

d)

Formation of a fibrin clot through prothrombintase

27.

What is the normal platelet count? Where are they produced?

a)

250,000 cells; Produced in the spleen

b)

2,500,000 cells; Produced in the bone marrow

c)

250,000 cells; Produced in the bone marrow

d)

25,000 cells; Produced in the spleen

28.

Which of the following statements regarding the Platelet plug is false:

a)

Contact with collagen makes platelets sticky and adhere to the wall of the damaged vessels

b)

Circulating platelets get stuck to other immobilized platelets

c)

To form a platelet plug it requires factor VIII: vWF

d)

Collagen hardens through platelet inhibiting enzyme creating a hard clot

29.

Which of the nomenclature followed by site of production is INCORRECT?

a)

I Firbrinogen (Liver)

b)

Prothrombin (Liver)

c)

IV Calcium (Diet)

d)

VIII vWF vonWillibrands Factor (Vascular endothelial)

e)

V Proaccelerin (Vascular walls)

30.

Select all the factors that require Vitamin K

a)

II Prothrombin

b)

VII Proconvertin Factor

c)

IX Christmas Factor

d)

X Stuart Prower Factor

e)

VIII Antihemophilic

31.

Which statement regarding Extrinsic and Intrinsic Pathway is False

a)

Extrinsic pathway utilizes Thromboplastin and Proconvertin factor

b)

Intrinsic Pathway utilizes Hageman Factor, Plasma Thromboplastin antecedant, Christmas Factor, and Antihemophilic factor

c)

The onset of the intrinsic pathway is 2-6 minutes

d)

The extrinsic pathways is more insidious (slower) than the intrinsic factor

e)

The onset of the Extrinsic Pathway is 15 sec

32.

Which factor does not require calcium

a)

Prothrombin II

b)

Stuart Prower Factor X

c)

Thromboplastin III

d)

Fibrin Stabilizing Factor XIII

33.

Select two answer based on how the intrinsic pathway cascade starts

a)

Cut to the arm

b)

Utilizes factor XI, XII, IX, VIII

c)

Trauma to the blood itself or exposure of the blood to collagen

d)

Utilizes factor XII, X, VIII, IV, II

34.

Select all of the factors that antithrombin III binds to

a)

IXa

b)

Xa

c)

XIa

d)

IIa

35.

What is false about Heparin

a)

Dose not cross the placenta

b)

Heparin inhibits factor IIa and Xa

c)

Heparin acts as an anticoagulant by binding to ATIII enhancing the complex by 1000 to 10000 times

d)

Heparin has fibrinolysis factors

36.

Which of the following is not a clinical use for heparin

a)

Venous thrombosis

b)

Pulmonary embolism

c)

Unstable angina

d)

Coronary angioplasty

e)

Rhabdomyolysis

37.

What statement about heparin's pharmacokinetics is true

a)

IV onset is 3 to 6 minutes

b)

Sq onset is 2 to 4 hours

c)

It is metabolized by the liver and the reticuloendothelial system

d)

It is excreted exclusively by one system the saturable mechanism

38.

What is the half life of heparin? What is the aPTT goal needed to be achieved?

a)

23 mins to 2.48 hours; 1.5 to 2.5 times normal value

b)

25 mins to 2.7 hours; 1 to 2 times normal value

c)

15 mins to 1.5 hours; 4 to 6 times normal value

d)

24 mins to 2.5 hours; 2 to 4 times normal value

39.

What is utilized to monitor High Heparin dosing?

a)

aPTT

b)

Activated Clotting Time (ACT)

c)

[aPTT * INR]- PT

d)

TEG

40.

Mrs. Parker received heparin 14 years ago for a femur fracture, she developed Heparin induced thrombocytopenia; she is requiring anticoagulant therapy for her total hip replacement. What should you give her

a)

Heparin, older formulas were more likely to cause HIT

b)

Protamine Sulfate with heparin

c)

Argatroban; it is a synthetic alternative to heparin

d)

Mrs. Parker cannot receive any anticoagulant therapy

41.

Select two major difference from Low molecular weight heparin and UFN. LMWH:

a)

Blocks factor Xa only

b)

removed mostly by non-saturable renal excretion

c)

Utilized in neuraxial anesthesia

d)

Blocks factor IIa

42.

Mr. Hernandez received 5,000 units of heparin 1 hour ago, how much protamine sulfate would you give?

a)

50 mg

b)

25 mg

c)

35 mg

d)

5 mg

43.

Which statement about Warfarin is False

a)

It is the most frequently used anticoagulant because of its predictability of onset and duration of action

b)

It has excellent bioavailability after oral administration, and is 97% protein bound

c)

It crosses the placenta and causes exaggerated effects on the fetus

d)

The anticoagulant effect of oral warfarin is delayed for 4 to 6 hours

44.

What two lab examination evaluate oral anticoagulants

a)

PT; aPTT

b)

INR; PT

c)

INR; aPTT

d)

INR; aPTT

45.

Which of the following is not a direct Xa inhibitor

a)

Rivaroxaban

b)

Edoxaban

c)

Dabigatran

d)

Apixaban

46.

What is the minimum recommended time frame patients should stop taking there aspirin prior to a major surgery?

a)

5 days

b)

12 days

c)

7 days

d)

They do not need to stop their aspirin

47.

Select all that apply to Plavix

a)

Dose is 300 mg loading dose followed by 75mg/day

b)

Works at the G receptors binding irreversibly to stop ADP binding

c)

Neutropenia is the only side effect

d)

Plavix should be taken for at least 1 month with a bare metal stent prior to major surgery

48.

Which is not a contraindication to thrombolytic therapy

a)

Surgery within 10 days

b)

Serious GI bleeding within 3 months

c)

HTN DBP greater than 110 mmHg

d)

Aortic dissection

e)

Stage 2 Hypertension 150/90

49.

Which Plasminogen Activators is more likely to cause a reaction

a)

Tissue- type plasminogen activator (tPA)

b)

Urokinase-type plasminogen activator (uPA)

c)

Streptokinase

d)

None of the answer choice

50.

Select all that apply for the treatment of Heparin Induced Thrombocytopenia

a)

Suspend use of all heparin

b)

Investigate lower-limb DVT

c)

Give platelet transfusion

d)

Begin alternative Anticoagulant therapy

e)

Utilize vitamin K antagonist post HIT

51.

True or false: PONV is nausea and/or vomiting occurring within 24 hours of surgery. PONV cost the OR about 62 dollars per minute

a)

True

b)

False

52.

Select all of the strategies to Reduce PONV

a)

Use Nitrous Oxide

b)

Regional Anesthesia

c)

Maintain Hydration

d)

Minimize opioid use

e)

Propofol for induction and maintenance

53.

NOT19 Which statement regarding the pathophysiology of emesis is false

a)

Muscular contraction within the ileum and jejunum cause backward flow of intestinal content

b)

Closure of the glottis and contraction of the diaphragm

c)

Abdominal muscles contract decreasing intra-abdominal pressure

d)

Pharyngeal sphincters relax

54.

Regurgitation occurs as gastric material is _____ into the esophagus

a)

Passively reflexes

b)

Forcefully contracts

c)

Passively diffuses

d)

Actively reflexes

55.

Select all of the patient related factors related to PONV

a)

Young age

b)

Female Gender

c)

Pain

d)

Nonsmoker

e)

Male Gender

56.

Of the following which has the highest incident of PONV

a)

Opioids

b)

Volatile agents excluding Nitrous Oxide

c)

Etomidate

d)

Ketamine

57.

Which Surgery has the least probability of causing PONV

a)

Laparoscopy

b)

D&C Dilation and Curettage

c)

Head and Neck surgery

d)

Tibial repair

58.

Select all of the surgeries that place children at a higher risk of PONV

a)

Adentonsillectomy

b)

Mole Extraction

c)

Orchiopexy

d)

Heel cord lengthening with tibialis tendon transfer

59.

The Chemo-receptor Trigger Zone (CTZ) is in what area? Where is it located anatomically?

a)

Area Postrema; Bottom of the fourth ventricle

b)

Area Postrema; Anterior to the thalamus

c)

Raphlus Magnus; Within the lower medulla

d)

Nucleus of the Tractus Solitarius; Within the midbrain

60.

The vomiting center is in what portion of the brain? What receptors does it have

a)

Medulla Oblongata; 5HT3, M1, NK1, H1

b)

Medulla Oblongata; 5HT3, M1, NK1, H1, D2 and Opioid

c)

Pons; 5HT3, M1, NK1, H1

d)

Pons; 5HT3, M1, NK1, H1, D2 and Opioid

61.

Charlie is 12 year old boy who suffers from severe motion sickness which medication would provide the best coverage of PONV

a)

Scopalamine

b)

Zofran

c)

Dexamtheasone

d)

Cannabinoids

62.

Select all the receptors that fill the Chemoreceptor trigger zone, i.e area postrema

a)

5-HT3

b)

D2

c)

NK1

d)

M1

e)

H1

63.

Which dosing and timing of PONV medications is incorrect

a)

Dexamethasone 4-10mg IV at induction

b)

Zofran 4 to 8 mg IV at the end of surgery

c)

Scopolamine Patch prior to surgery at least 2 hours

d)

Ondansetron 8 to 12 mg IV at the beginning of surgery

64.

Droperidol is what classification of medication

a)

D2 Dopamine Antagonist

b)

D2 Dopamine Agonist

c)

5HT3 Serotonin agonist

d)

5HT3 Serotonin antagonist

65.

which is not a side effect of Metoclopramide (Reglan)

a)

Somnolence

b)

Tardive Dyskinesia

c)

Dystonic reactions

d)

Hypergylcemia

66.

True or false: Scopolamine is a competitive antagonist of AcH at the muscarinic receptors. It is the most effective single agent for prevention of motion sickness

a)

True

b)

False

67.

which of the following statements regarding scopolamine is false

a)

Crosses the blood brain barrier readily accessing emetic center

b)

Half-life 5 hours

c)

Dry mouth, blurred vision, dizziness, drowsiness, urinary retention are unwanted side effects

d)

Half the dose can be given to patients with closed angle glaucoma, and renal impairment

68.

What is the appropriate medications to counter act an over dose or Central Anticholinergic Syndrome of scopolamine

a)

Atropine 0.5 mg IV

b)

Physostigmine 0.4 mg/kg

c)

Neostigmine 0.03-0.07 mg/kg

d)

Endrophnium 1-1.5 mg/kg

69.

Which statement about zofran is incorrect

a)

Decreases PONV by 81% if surgery is less than 2 hours

b)

pediatric dose is 0.05 to 0.15 mg/kg for a max of 4 mg

c)

Onset time is 3 hours

d)

QT prolongation, with low probability of AV block

70.

Select all of the physical methods to prevent aspiration

a)

Cricoid Pressure

b)

Preoperative OGT or NGT

c)

Use of cuffed ETT

d)

Deep Extubation

e)

Use of General Anesthesia

71.

Which is the most potent H2 receptor blocker

a)

Ranitidine (Zantac)

b)

CImetidine (Tagamet)

c)

Famotidine (Pepcid)

d)

Nizatidine

72.

Of the following medications which is most likely to change gastric pH

a)

Famotidine (Pepcid)

b)

Sodium Citrate (Bicitra)

c)

Dimenhyrinate (Dramamine)

d)

Ondansetron (Zofran)

73.

Alyssa is a 20 year old female, non-smoker, who has motion sickness, she has had one previous surgery which she had bouts of emesis in the PACU. Today she is having a laparoscopic appendectomy, you plan on giving opioids. How many risk factors are present? What would you give as an antiemetic?

a)

3; Scopolamine

b)

4; Dexamethsone with Zofran

c)

5; Dexamethsone, Scopolamine, Zofran, possbile TIVA

d)

7; Dexamethsone, Pepcid, Zofran, extubation deep, Socpolamine

74.

Select all the side effects of Aprepitant (Emend)

a)

Steven-Johnson's Syndrome

b)

Nausea

c)

Headaches

d)

QT prolongation

e)

Febrile neutropenia

75.

Tom is a 68 year old male who has smoked fro 45 years, and smoked this morning prior to surgery. He has had previous surgeries without complication. He is having a IND procedure today, he is NPO since yesterday 2100. What antiemetic would you give him?

a)

None

b)

Pepcid in holding

c)

Reglan in holding

d)

Zofran at the end of the procedure

76.

What is the major difference between Essential and secondary Hypertension

a)

Essential hypertension is caused by another disease process

b)

Secondary hypertension is caused by smoking only

c)

Essential hypertension is a disorder of unknown origin affecting the Blood pressure regulating mechanism

d)

Secondary hypertension is caused by primary hypertension, it is the second stage

77.

Per AHA guidelines what is stage 2 hypertension

a)

120/80 mmHg

b)

130-139/80-89 mmHg

c)

140/90 mmHg

d)

180/120 mmHg

78.

What is the initial therapy for Essential Stage 1 Hypertension

a)

ACE inhibitors

b)

Smoking cessation

c)

Thiazide diuretics

d)

Beta Blockers

79.

What is the normal physiological compensatory mechanism to combat hypotension, select all that apply

a)

Increase cardiac output

b)

Increase in renin production

c)

Decrease in sodium and water retention

d)

Activation of Beta 1 adrenoceptors on the kidney

e)

Decrease in peripheral resistance

80.

Which of the following is not a drug administered safety pre-operatively for hypertension per AHA guideline lines

a)

Enalapril

b)

Metoprolol

c)

Amlodipine

d)

Hydralazine

81.

Select all of the remedial causes of hypertension in a patient undergoing surgery?

a)

Pain

b)

1.5 MAC of Anesthetic agent

c)

Hypoxia

d)

Hypervolemia

e)

Normal bladder

82.

Which medication below works on the L-type calcium channels with antirrhythmic properties and lowers peripheral vascular resistance

a)

Nicardipine

b)

Verapamil

c)

Diltiazem

d)

Enalapril

83.

Which medication would last longer in liver failure do to its prodrug properties

a)

Captopril

b)

Lisinopril

c)

Enalapril

d)

Ramipril

84.

Select all that apply with ACE inhibitors

a)

Reduce the circulating enzyme angiotensin II

b)

Decrease generation of angiotension II by blocking the converting enzyme

c)

Inhibition of angiotension II causes less aldosterone production limiting sodium and water retention

d)

Breaks down bradykinin causing vasodilation

e)

Reduces activation of LDL receptors in an unknown fashion decreasing plasma LDL concentration

85.

Select all the disorders that ACE inhibitors are considered first line therapy

a)

CHF

b)

Mitral Regurgitation

c)

Stage 1 Hypertension

d)

Chronic renal failure

86.

NOT19 Where do Thiazide diuretics

a)

Distal convoluted tubule

b)

Collecting tubule

c)

Thin descending limb

d)

Thick ascending limb of Henle

87.

NOT19 In general select all that apply to the mechanism of action of diuretics

a)

Increase urine flow and promote diuresis

b)

Block sodium re-absorption in different location of the nephron resulting in increased sodium ion delivery to the distal tubules

c)

Hypernatremia and hyperkalemia is a concern with all diuretics

d)

Metabolic alkalosis is common with loop diuretics

88.

NOT19 What is not one of the properties of carbonic anhydrase inibitors

a)

Excretion of sodium, potassium, bicarb, and water

b)

Loss of chloride due to exchange pump inhibition

c)

Treatment of altitude

d)

Decrease intra-ocular pressure in treatment of glaucoma

89.

NOT19 Osmotic diuretics work based on the following force EXCEPT

a)

Urea

b)

Isosorbide

c)

Glycerin

d)

Sodium

90.

NOT19 All are true about Mannitol Except

a)

Undergoes metabolism

b)

Does not enter cells

c)

Decreases cerebral edema

d)

Requires a filter

91.

NOT19 What does furosemide have in common with mannitol

a)

Potent diuretic

b)

Decrease ICP

c)

Works in the ascending loop of Henle

d)

Digitalis toxicity

92.

NOT19 Thiazide Diuretics excrete these ions except

a)

Sodium

b)

Chloride

c)

Potassium

d)

Calcium

93.

NOT19 Mr. Jones has chronic kidney disease with renal insufficiency, but still makes urine what diuretic should he take

a)

Hydrochlorathiazide

b)

Furosemide

c)

Mannitol

d)

Acetazolamide

94.

NOT19 Potassium Sparing Diuretics work on what portion of the renal tubules

a)

Collection Tubules

b)

Distal convoluting tubules

c)

Loop of Henle

d)

Ascending Loop of Henle

95.

NOT19 Which statement regarding furosemide is false

a)

Rapid onset 5 to 10 minutes

b)

90% of furosemide is bound to albumin

c)

In order to reach natriuresis furosemide needs to reach the site of action within the kidneys

d)

Exerts effect outside of the tubular cells form the plasma, does not need to reach the renal tubule

96.

NOT19 What is not side effect of long term use of Mannitol

a)

Hypolvolemia

b)

Electrolyte disturbances

c)

Hypochloremic alkalosis

d)

Plasma hypo-osmolarity

97.

NOT19 Which Diuretics has a higher potential for potentiating non depolarizing neuromuscular blocking agents

a)

Loop Diuretics

b)

Carbonic anhydrase inhibitors

c)

Potassium-sparing diuretics

d)

Osmotic diuretics

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