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DR. AUSTIN CARDIO EXAM 4

Total questions: 65

Worksheet time: 3hrs 0mins

Name
Class
Date
1.

Which of the following electrolytes polarizes?

a)

Potassium (K+)

b)

Sodium (Na+)

c)

Calcium (Ca2+)

2.

Which of the following electrolytes depolarizes? Select all that apply

a)

Potassium (K+)

b)

Sodium (Na+)

c)

Calcium (Ca2+)

3.

SA node is the most important for normal heart rate control which is what of the following?

a)

60-110 bpm (avg. 85 bpm)

b)

90-110 bpm (avg. 95 bpm)

c)

60-100 bpm (avg. 75 bpm)

d)

90-120 bpm (avg. 100 bpm)

4.

The Sympathetic activation: increases heart rate, which means? Select all that apply

a)

lower threshold potential

b)

shorter duration action potentials

c)

more rapid depolarization

d)

slower depolarization

5.

Which of the following are causes for Arrhythmias to happen? Select all that apply

a)

anatomical defects

b)

electrolyte imbalances

c)

ischemia

d)

stress

e)

non-RX substances

6.

Which of the following are non RX substances that can cause Arrhythmias? Select all that apply

a)

Caffeine

b)

Decongestant

c)

Smoking/Nicotine

d)

Alcohol

e)

Ginseng

7.

Which of the following are considered Symptoms for Arrhythmias? Select all that apply

a)

Palpitations (skipped a beat)

b)

Fatigue

c)

Syncope

d)

Angina

e)

Dizziness, Dyspnea

8.

Which of the following is TRUE about Tachyarrhythmias?

a)

increased firing rate >100bpm

b)

decreased firing rate <60bpm

9.

Which of the following is TRUE about Bradyarrhythmias?

a)

Increased firing rate > 100bpm

b)

Decreased firing rate < 60bpm

10.

Know this

a)

Yes

b)

No

11.

Which of the following has a correlation with onset of Torsades de pointes (TdP) and cardiac arrest?

a)

QTc < 430 mS

b)

QTc > 510 mS

c)

QTc < 450 mS

d)

QTc 431-450

e)

QTc 440-460

12.

Which of the following are TRUE about Prolonged QT Interval? Select all that apply

a)

Congenital

b)

QTc > 510 mS correlation with onset of Torsades de pointes (TdP) and cardiac arrest

c)

Acquired

d)

Drug induced

e)

430

13.

Which of the following drugs/drug class prolongs QT interval? Select all that apply

a)

antiarrhythmics

b)

antipsychotics

c)

antidepressants

d)

antibacterials

e)

Acetaminophen

14.

Which of the following can be implanted in patients at high risk for death AND monitors for v-fib and v-tach?

a)

Implantable cardioverter defibrillators (ICD)

b)

Catheter ablation

15.

Which of the following is used for certain recurrent arrhythmias AND catheter heats and destroys abnormal tissue

a)

Catheter ablation

b)

Implantable cardioverter defibrillators (ICD)

16.

Which of the following are TRUE about Class I Antiarrhythmics? Select all that apply

a)

Block sodium channels (–membrane stabilizing activity)

b)

Effects both myocytes and pacemaker cells

c)

slows phase 0 depolarization

d)

Risk of pro-arrhythmic effects particularly in patients with ischemic heart disease

e)

Block potassium channels

17.

Which of the following are TRUE about Class I: Pacemaker Cells? Select all that apply

a)

Decrease automaticity of SA nodal cells

b)

Subclasses have similar effects on nodal cells

c)

shift threshold to more positive potential

d)

decrease slope of phase 4

18.

Which of the following are TRUE about Class I: Ventricular Myocytes? Select all that apply

a)

slows phase 0 depolarization

b)

Pronounced (and variable) effects on ventricular muscle

c)

may affect rate of repolarization

d)

decrease slope of phase 4

19.

Which of the following drugs class Moderate block of fast Na+ channels?

a)

Class IA

b)

Class IB

c)

Class IC

d)

Class II (Beta Blockers)

20.

Which of the following drug class would have a minimal change of resting membrane potential and decrease maximum conduction rate?

a)

Class IA

b)

Class IB

c)

Class IC

d)

Class II (Beta Blockers)

21.

Which of the following are the ADRs for Class IA? Select all that apply

a)

anticholinergic effects

b)

arrhythmias

c)

GI (nausea, diarrhea)

d)

dizziness

e)

rash

22.

Class IA drugs are contraindicated in which of the following? Select all that apply

a)

heart block

b)

QT syndromes

c)

hypersensitivity

23.

Which of the following drugs are Class IA agents? Select all that apply

a)

Quinidine

b)

Procainamide

c)

Disopyramide

d)

Lidocaine

e)

Mexiletine

24.

Which of the following drugs is an alkaloid obtained from Cinchona bark and has an ADR of Cinchonism?

a)

Quinidine

b)

Procainamide

c)

Disopyramide

d)

Lidocaine

25.

Which of the following drugs may cause CNS ADRs like depression, hallucinations and its chronic use may cause lupus-like syndrome?

a)

Quinidine

b)

Procainamide

c)

Disopyramide

d)

Lidocaine

26.

Which of the following drugs has an ADR of strong anticholinergic effects?

a)

Disopyramide

b)

Procainamide

c)

Quinidine

d)

Lidocaine

27.

A patient presenting symptoms like tinnitus, flush, excessive sweating, N/V/D and confusion maybe experiencing which of the following?

a)

Lupus like syndrome

b)

Cinchonism

c)

Gushing syndrome

d)

Yellow Halos

28.

Which of the following are TRUE about Class IB? Select all that apply

a)

Relatively rapid rate of dissociation from Na+ channels

b)

Increase rate of repolarization (shorter action potential duration)

c)

Typically used for ventricular arrhythmias

d)

Moderate block of fast Na+ channels

29.

Which of the following agents has a rapid association/dissociation and short t1/2 AND effective for ischemic myocardium?

a)

Mexiletine

b)

Lidocaine

c)

Quinidine

d)

Disopyramide

30.

Which of the following agents has a distinct antiarrhythmic activity from IA agents (despite chemical similarity) AND may be safer in prolonged QT situations

a)

Lidocaine

b)

Quinidine

c)

Disopyramide

d)

Mexiletine

31.

Which of the following statements is TRUE about Mexiletine and Phenytoin (Class IB agents?

a)

may be safer in prolonged QT situations

b)

larger therapeutic window than many other antiarrhythmics

c)

both have > t1/2 (relative to lidocaine)

d)

rapid association/dissociation and short t1/2

32.

Which of the following Class IB agents is used for V-tach in young children AND useful for patients with arrhythmia and epilepsy?

a)

Lidocaine

b)

Mexiletine

c)

Phenytoin

33.

Which of the following drug class markedly slows phase 0 depolarization

AND has NO effect on repolarization?

a)

Class IA

b)

Class IB

c)

Class IC

34.

Which of the following drug class is use typically for life threatening supraventricular tachyarrhythmias (SVT) and ventricular tachyarrhythmia?

a)

Class IA

b)

Class IB

c)

Class IC

35.

Which of the following drug class may increase risk of death in patients with history of MI or sustained ventricular arrhythmias?

a)

Class IA

b)

Class IB

c)

Class IC

36.

Which of the following agents is Fluorinated benzamide derivative AND typically reserved for unresponsive arrhythmias?

a)

Lidocaine

b)

Flecainide

c)

Propafenone

d)

Quinidine

37.

Which of the following drugs is optically active AND its S enantiomer is more potent and is also a β blocker?

a)

Lidocaine

b)

Propafenone

c)

Flecainide

d)

Quinidine

38.

Which of the following are the ADRs for Class IC agents? Select all that apply

a)

cardiac (arrhythmias, heat failure)

b)

CNS (dizziness, tremor, blurred vision)

c)

GI (nausea, CYP450 inhibition)

d)

Cinchonism

39.

Visual Summary (Photomemory)

a)

Yes

b)

No

40.

Which of the following drug class its agents have mixed (multi-class) activity AND block potassium channels.

a)

Class IA

b)

Class IB

c)

Class IC

d)

Class III

41.

Which of the following are the benefits for Class III Antiarrhythmics? Select all that apply

a)

slows repolarization

b)

prolongs effective refractory period

c)

suppresses re-entry arrhythmias

d)

prolonged APs may increase risk of early afterdepolarizations

42.

Which of the following are the risks for Class III Antiarrhythmics? Select all that apply

a)

prolonged APs may increase risk of early afterdepolarizations

b)

if depolarizations occur in phase 2 or 3, may cause torsades de pointes

c)

“reverse-use dependency” - more refractory at lower HRs (proarrhythmic)

exception: amiodarone

43.

Abnormal electrical conduction in which a loop forms outside of the normal circuit (early afterdepolarizations) is a risk in which of the following drug class?

a)

Class IA

b)

Class III

c)

Class IB

d)

Class IC

44.

Which of the following is the promiscuous antiarrhythmic, also has class I, and IV effects AND noncompetitive antagonist of α and β receptors

a)

Amiodarone

b)

Propafenone

c)

Lidocaine

d)

Quinidine

e)

Flecainide

45.

Which of the following are TRUE about the effects of Amiodarone? Select all that apply

a)

decreases pacemaker automaticity

b)

extends effective refractory period in all cardiac tissue

c)

increases pacemaker automaticity

d)

AV nodal block and bradycardia

46.

Which of the following drugs is Highly effective for treatment/prevention of multiple arrhythmias?

a)

Digoxin

b)

Amiodarone

c)

Propafenone

d)

Phenytoin

e)

Mexiletine

47.

Which of the following drugs has significant ADR profile particularly for chronic use and/or high doses AND half-life ~54 days

a)

Digoxin

b)

Propafenone

c)

Quinidine

d)

Amiodarone

48.

Which of the following are considered the ADRs for Amiodarone? Select all that apply

a)

negative inotrope

b)

bradycardia

c)

hypotension

d)

pulmonary, endocrine (thyroid), hepatic, neurological

e)

Cinchonism

49.

Amiodarone cause 99 problems but TdP [usually] won’t be one.

a)

True

b)

False

50.

Which of the following are the ADRS for Amiodarone? Select all that apply

a)

Blue Grey skin discoloration

b)

Pneumonitis leading to pulmonary fibrosis

c)

Elevated liver enzymes

d)

Corneal microdeposits

e)

Peripheral neuropathy, Ataxia, Tremors

51.

Photomemory

a)

Yes

b)

No

52.

Which of the following drugs was designed with similar efficacy to amiodarone but with fewer ADRs (decrease lipophilicity and t1/2; remove iodines)?

a)

Sotalol

b)

Dronedarone

c)

Ibutilide

d)

Dofetilide

e)

Dexamethasone

53.

Which of the following are the boxed warnings for Dronedarone? Select all that apply

a)

Permanent atrial fibrillation

b)

Systolic heart failure

c)

Cushing syndrome

d)

Lupus Like syndrome

e)

Increase the risk of bleeding

54.

Dronedarone is contraindicated in which of the following? Select all that apply

a)

QTc ≥ 500 mS

b)

bradycardia (>50 bpm)

c)

use with 3A4 inhibitors

d)

use with 2C9 inhibitors

55.

K+ channel blocker that is also a (non-selective) β blocker

a)

Sotalol

b)

Amiodarone

c)

Dofetilide

d)

Isubitilide

56.

Which of the following drugs is useful for patients who cannot tolerate amiodarone AND administered as racemic mixture, only one enantiomer has class II activity?

a)

Dofetilide

b)

Sotalol

c)

Adenosine

d)

Digoxin

e)

Ibutilide

57.

Which of the following drugs has a high risk of QT prolongation and TdP?

a)

Amiodarone

b)

Digoxin

c)

Quinidine

d)

Ibutilide

58.

Which of the following drugs is reserved for patients with highly symptomatic atrial fibrillation/flutter AND it is like Sotalol without the β activity?

a)

Dofetilide

b)

Ibutilide

c)

Digoxin

d)

Sotalol

59.

Which of the following class III antiarrhythmics is safe to use for a patient with a sulfa allergy?

a)

Amiodarone

b)

Dronedarone

c)

Ibutilide

d)

Dofetilide

e)

Sotalol

60.

Which of the following drugs is an endogenous molecule that inhibits nodal conduction?

a)

Adenosine

b)

Amiodarone

c)

Digoxin (Digitalis)

d)

Dofetilide

61.

Which of the following drugs decrease AV node conduction?

a)

Digitalis (Digoxin)

b)

Adenosine

c)

Amiodarone

d)

Ibutilide

62.

Inhibit sympathetic input to pacing regions of the heart (inhibits phase 4 depolarization)

a)

Class II Antiarrhythmics: β Blockers

b)

Class III

c)

Class IA

d)

Class IB

e)

Class IC

63.

Which of the following decrease automaticity and oxygen demand AND its common use for arrhythmias triggered by factors such as exercise or stress, arrhythmias post-MI?

a)

Class II Antiarrhythmics: β Blockers

b)

Class III

c)

Class IA

d)

Class IB

64.

Block open (or inactivated) calcium channels to slow conduction in tissues dependent on Ca2+ current → SA and AV nodes

a)

Class II Antiarrhythmics: β Blockers

b)

Class IV Antiarrythmics: CCBs

c)

Class III

d)

Class IA

65.

Combining which classes increases risk of heart failure? Select all that apply

a)

Class II

b)

Class III

c)

Class IV

d)

Class IA

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