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WorksheetsCardio Exam 4 - Part 2
Total questions: 96
Worksheet time: 48mins
Name
Class
Date
1.
How do class 1b antiarrhythymics affect repol
a)
shorten by increasing rate of repolarization
b)
slow phase 0 depol and prolonged repol -> decrease reentry
c)
increase threshold potential and decrease phase 4 slope -> decreasing firing rate and automaticity
d)
decrease automaticity of SA nodal cells
e)
block open L-type Ca channels to slow conduction in SA and AV nodes
2.
What are class 1b antiarrhythmics effective in treating
a)
supraventricular arrhythmias
b)
ventricular arrhythmias
c)
supraventricular and ventricular arrhythmias
3.
What are examples of class 1b antiarrhythmics
a)
Lidocaine
b)
Mexiletine
c)
Phenytoin
d)
Dofetilide
e)
Propafenone
4.
Lidocaine has a smaller therapeutic window than many other antiarrhythmics
a)
true
b)
FALSE (larger)
5.
Due to its large therapeutic window, what is Lidocaine effective for
a)
ischemic myocardium
b)
prolonged QT situations
c)
decreasing maximum conduction rate
d)
slow rate of dissociation from Na channels
6.
Why is phenytoin not commonly used as an antiarrhythmic
a)
it is an antiepileptic drug with antiarrhythmic activity
b)
it is an antihistamine with antiarrhythmic properties
c)
it is an antidepressant with antiarrhythmic activity
7.
What indication is phenytoin effective for in children
a)
a-fib
b)
v-tach
c)
a-flutter
d)
TdP<br />
8.
Which subclass of class I antiarrhythmics has a significant effect in blocking fast Na channels
a)
1a
b)
1b
c)
1c
9.
How do class 1c antiarrhythmics affect repol
a)
increase
b)
decrease
c)
no effect
10.
What are class 1c antiarrhythmics typically used for
a)
life-threatening supraventricular tachycardia
b)
ventricular tachyarrhythmias
c)
supraventricular tachyarrhythmias
d)
atrial fibrillation
11.
What are examples of class 1c antiarrhythmics
a)
Lidocaine
b)
Mexiletine
c)
Phenytoin
d)
Flecainide
e)
Propafenone
12.
Which class 1c antiarrthyrmic is typically reserved fro unresponsible arrhthymia and is a flurinated benzamide derivative
a)
Lidocaine
b)
Mexiletine
c)
Phenytoin
d)
Flecainide
e)
Propafenone
13.
What is a BBW for Flecainide
a)
do not use for chronic A-fib/life-threatening VT
b)
do not use for VT
c)
do not use for supraventricular tachyarrhythmia
14.
Which enantiomer of Propafenone is more potent and has beta-blocker activity as well?
a)
R
b)
S
15.
Which class Ic antiarrhythmic may cause a metallic taste
a)
Lidocaine
b)
Mexiletine
c)
Phenytoin
d)
Flecainide
e)
Propafenone
16.
What are ADRs of class Ic antiarrhythmics
a)
cardiac (arrhythmias, HF)
b)
CNS (dizziness, tremor, blurred vision)
c)
GI (nausea, CYP inhibition)
d)
cinchonism
e)
DILE
17.
What are C/I of class Ic antiarrhythmics
a)
any structural heart disease (SHD)
b)
MI
c)
HF
d)
heart block
e)
QT syndromes
18.
Which class I drugs are known to have proarrhythmic activity?
a)
Lidocaine
b)
Mexiletine
c)
Phenytoin
d)
Flecainide
e)
Propafenone
19.
What is the MOA of class III antiarrhythmics?
a)
shorten by increasing rate of repolarization
b)
slow phase 0 depol and prolonged repol -> decrease reentry
c)
increase threshold potential and decrease phase 4 slope -> decreasing firing rate and automaticity
d)
blocks K channels (prolongs phase 3 in ventricular myocyte)
e)
block open L-type Ca channels to slow conduction in SA and AV nodes
20.
What are some benefits of class III antiarrhythmics
a)
slows repolarization
b)
prolongs refractory period
c)
suppresses reentry
d)
elongates QT time
21.
What are some risks of class III antiarrhythmics?
a)
prolonged AP may increase risk of early afterdepolarization
b)
reverse-use dependency
c)
QT syndromes
22.
What is early afterdepolarization
a)
abnormal electrical conduction in which a loop form outside the normal circuit
b)
cell spontaneously depolarizes during repolarization phase
c)
abnormal electrical conduction in which a loop forms inside the normal circuit
d)
cell spontaneously depolarizes at any point
23.
Early afterdepolarization, especially in phase 2 or 3, can lead to what?
a)
atrial fibrillation
b)
atrial flutter
c)
ventricular tachycardia
d)
TdP<br />
24.
What is reverse use dependency?
a)
the efficacy of the drug is reduced after repeated action on a tissue making it more refractory at lower HR (proarrhythmic)
b)
the efficiacy of the drug is increased after repeated action on a tissue making it more sensitive at lower HR
25.
What class III antiarrhythmic does not exhibit reverse use dependency?
a)
amiodarone
b)
sotalol
c)
dronedarone
d)
ibutilide
e)
dofetilide
26.
What are examples of class III antiarrhythmics?
a)
amiodarone
b)
sotalol
c)
dronedarone
d)
ibutilide
e)
dofetilide
27.
Which class III antiarrhythmics are indicated in VT and SVT?
a)
amiodarone
b)
sotalol
c)
dronedarone
d)
ibutilide
e)
dofetilide
28.
Which class III antiarrhythmics are indicated in SVT only?
a)
amiodarone
b)
sotalol
c)
dronedarone
d)
ibutilide
e)
dofetilide
29.
Amiodarone has multi-class actions (class I, II, III, IV)
a)
true
b)
FALSE (single class action)
30.
What effects does Amiodarone have?
a)
extends ERP in all cardiac tissue
b)
decrease pacemaker automaticity
c)
AV nodal block and bradycardia
d)
block open L-type Ca channels to slow conduction in SA and AV nodes
31.
What moiety found in Amiodarone causes an increase in thyroid disorder
a)
sulfide
b)
iodine
c)
amide
d)
heparin
32.
Torsades de pointes is a common ADR with Amiodarone
a)
true
b)
false
33.
When are ADRs of Amiodarone most prevalent?
a)
chronic use
b)
high doses
c)
low doses
d)
intermittent use
34.
What is the half-life of Amiodarone
a)
54 days (40-60 days)
b)
24 hours (5-7 days)
c)
< 10 secs
35.
When administering Amiodarone, when should infusion at a slow rate or D/C occur?
a)
hypotension
b)
bradycardia
c)
hypertension
d)
tachycardia
36.
Infusion of Amiodarone > 2 hrs must be administered in what manner?
a)
non-PVC container (glass or polyolefin)
b)
PVC container
37.
How does premixed Nexterone come and what are advantages of it?
a)
GALAXY container (non-PVC)
b)
PVC container
c)
longer stability
d)
less breakable
38.
What size needle is used when administering Amiodarone?
a)
0.22 needle
b)
0.22 micron filter
c)
0.25 needle
d)
0.25 micron filter
39.
Heparin may be used to flush out the system of a pt on Amiodarone
a)
true
b)
FALSE (LMWH may be used)
c)
FALSE (incompatible with heparin, use saline)
40.
What CV ADRs are seen with Amiodarone?
a)
negative inotrope (decreased contractility)
b)
bradycardia
c)
hypotension<br />
d)
positive inotrope
e)
dizziness
41.
What pulmonary ADRs are seen with Amiodarone
a)
pulmonary toxicity
b)
hyper/hypothyroidism
c)
hepatotoxicity
d)
optic neuropathy
e)
peripheral neuropathy
42.
What thyroid ADRs are seen with Amiodarone?
a)
pulmonary toxicity
b)
hyper/hypothyroidism
c)
hepatotoxicity
d)
optic neuropathy
e)
peripheral neuropathy
43.
What hepatic ADRs are seen with Amiodarone
a)
elevated LFTs
b)
inhibit CYP enzyme
c)
hepatotoxicity
d)
optic neuropathy
e)
peripheral neuropathy
44.
What neurological ADRs are seen with Amiodarone
a)
HA
b)
tremors
c)
ataxia
d)
optic neuropathy
e)
peripheral neuropathy
45.
What optic ADRs are seen with Amiodarone
a)
corneal microdeposits
b)
hyper/hypothyroidism
c)
hepatotoxicity
d)
optic neuropathy
e)
peripheral neuropathy
46.
What dermatological ADRs are seen with Amiodarone
a)
blue-gray skin discoloration
b)
green-yellow halo
c)
hepatotoxicity
d)
optic neuropathy
e)
peripheral neuropathy
47.
What are some other common ADRs seen with Amiodarone
a)
infertility
b)
testicular dysfunction
c)
hair loss
d)
excessive hair growth
48.
Amiodarone is a substrate of which enzymes
a)
CYP3A4
b)
CYP2C8
c)
P-GP
d)
CYP2C9
e)
CYP2D6
49.
Amiodarone is an inhibitor of which enzymes
a)
CYP3A4
b)
CYP2C8
c)
P-GP
d)
CYP2C9
e)
CYP2D6
50.
How must the dose be adjusted in a pt taking Amiodarone and Digoxin
a)
decrease Digoxin dose by 50% when starting Amiodarone
b)
inhibition of P-GP can double Digoxin levels
c)
increase Digoxin dose by 50% when starting Amiodarone
d)
inhibition of P-GP can reduce Digoxin levels
51.
How must the dose be adjusted in a pt taking Amiodarone and Warfarin
a)
reduce Warfarin dose by 30-50% when starting Amiodarone
b)
inhibition of CYP2C9 can increase Warfarin levels
c)
increase Warfarin 30-50% when starting Amiodarone
d)
inhibition of CYP2C9 can decrease Warfarin levels
52.
How must the dose be adjusted in a pt taking Amiodarone and Simvastatin/Lovastatin
a)
Max: Simvastatin 20 mg/day
b)
Max: Lovastatin 40 mg/day
c)
Max: Simvastatin 40 mg/day
d)
Max: Lovastatin 20 mg/day
53.
Amiodarone has an additive effect with which drug classes that can decrease HR
a)
nDHP CCBs
b)
Digoxin
c)
Beta blockers
d)
Clonidine
e)
Clopidogrel
54.
Which class III antiarrhythmic has decreased lipophilicity and half-life and removes the iodines as compared to Amiodarone
a)
sotalol
b)
dronedarone
c)
ibutilide
d)
dofetilide
55.
What significance does removing the iodine group from Dronedarone have
a)
little effect on liver function
b)
little effect on kidney function
c)
little effect on thyroid function
d)
little effect on cardiac function
56.
Although Dronedarone has less ADRs, what are some important BBW to be mindful of?
a)
systolic HF
b)
permanent A-fib
c)
bradycardia
57.
What are C/I of Dronedarone
a)
QTc > 500 mS (use w/ QT prolonging agents)
b)
bradycardia
c)
use w/ 3A4
58.
What are important counseling points to bring up regarding Dronedarone
a)
hepatic failure (esp within the first 6 mo)
b)
pulmonary disease
c)
ataxia
d)
optic neuropathy
e)
dizziness
59.
Other than being a K channel blocker, what other action does Sotalol have
a)
non-selective beta blocker
b)
nDHP CCB
c)
Na channel blocker
60.
Sotalol is administered as a racemic mixture because both enantiomers have class II activity
a)
true
b)
FALSE (only one enantiomer has BB activity)
c)
FALSE (both enantiomers have class III activity)
61.
A pt on Sotalol and with a CrCl < 60 should take what measures
a)
decrease frequency of sotalol
b)
increase frequency of sotalol
c)
d/c sotalol
62.
Which class III antiarrhythmic also enhances slow inward Na current and has a high risk of QT prolongation and TdP
a)
amiodarone
b)
sotalol
c)
dronedarone
d)
ibutilide
e)
dofetilide
63.
When taking Ibutilide, what parameters must be correct first and throughout tx
a)
hypokalemia
b)
hypomagnesemia
c)
hyponatremia<br />
d)
hypocalcemia
64.
How is Ibutilide administered
a)
PO
b)
SC
c)
IV
d)
Sublingual
65.
Which class III antiarrhythmic is known as Sotalol w/o beta-blocker activity
a)
amiodarone
b)
sotalol
c)
dronedarone
d)
ibutilide
e)
dofetilide
66.
What indication is Dofetilide reserved for
a)
highly symptomatic pts with a-fib or a-flutter
b)
highly symptomatic pts with v-fib
67.
What is a counseling point when initiating Dofetilide
a)
must be initiated or re-initiated in the hospital for at least 3 days
b)
must be initiated or re-initiated for 3 days at home
c)
must stick with home regimen to ensure adequate dosing
68.
What must be monitored w/ Dofetilide
a)
ECG monitoring
b)
CrCl
c)
hypokalemia
d)
hypomagnesemia
69.
Which class III antiarrhythmic is safe to use in pts w/ sulfa allergy
a)
amiodarone
b)
sotalol
c)
dronedarone
d)
ibutilide
e)
dofetilide
70.
Which class III antiarrhythmic is the DOC in HF
a)
amiodarone
b)
sotalol
c)
dronedarone
d)
ibutilide
e)
dofetilide
71.
When is Digoxin used in a pts w/ arrhythmias?
a)
if pt has HF
b)
if pt is at risk for HF
c)
rate control (used w/ BB or nDHP CCB)
d)
rhythm control
72.
What is the typical dose of Digoxin
a)
0.125-0.25 mg PO daily
b)
0.125-0.25 mg PO BID
c)
0.25-0.5 mg PO daily
d)
0.25-0.5 mg PO BID
73.
What is the therapeutic range of Digoxin when used for A-fib?
a)
0.8-2 ng/mL
b)
2-4 ng/mL
c)
0.1-0.8 ng/mL
74.
What course of action should be taken if a pt has a CrCl < 50 and is on Digoxin
a)
decrease Digoxin dose or frequency
b)
increase Digoxin dose frequency
c)
discontinue Digoxin
75.
What course of action should be taken if switching from PO to IV administration of Digoxin
a)
decrease dose by 20-25%
b)
increase dose by 20-25%
c)
decrease dose by 25-30%
d)
increase dose by 25-30%
76.
What antidote or reversal agent is used for Digoxin toxicity
a)
Digifab
b)
Vitamin K
77.
What are common ADRs seen with Digoxin
a)
N/V, anorexia
b)
blurred/double vision
c)
greenish-yellow halos
d)
bradycardia
e)
blue-grey skin discoloration
78.
Digoxin has an additive effect when combined with what agents that decrease HR
a)
amiodarone
b)
nDHP CCB
c)
Beta blockers
d)
Clonidine
e)
Clopidogrel
79.
What imbalances in electrolytes can increase toxicity risk of Digoxin
a)
hypokalemia
b)
hypomagnesemia
c)
hypercalcemia
d)
hypocalcemia
e)
hypermagnesemia
80.
What is Adensoine indicated for
a)
reentrant supraventricular tachycardia
b)
atrial flutter
c)
TdP<br />
d)
ventricular fibrillation
81.
What is the half-life of Adenosine
a)
54 days (40-60 days)
b)
24 hours (5-7 days)
c)
< 10 secs
82.
How does A-fib occur
a)
multiple atrial reentrant loops
b)
misfiring of AV node
c)
complete heart block
d)
electrolyte imbalance
83.
What is acute A-fib
a)
onset within 48 hrs
b)
self-terminating in <7 days, may recur w/ variable frequency
c)
>12 months
d)
does not terminate
84.
What is paroxysmal A-fib
a)
onset within 48 hrs
b)
self-terminating in <7 days, may recur w/ variable frequency
c)
>12 months
d)
does not terminate
85.
Two or more episodes of A-fib is considered what
a)
recurrent a-fib
b)
persistent a-fib
c)
long-standing a-fib
d)
acute a-fib
e)
permanent a-fib
86.
Continuous, sustained A-fib for >7 days w/o terminating spontaneously is considered what
a)
recurrent a-fib
b)
persistent a-fib
c)
long-standing a-fib
d)
acute a-fib
e)
permanent a-fib
87.
A-fib lasting >12 months is known as?
a)
recurrent a-fib
b)
persistent a-fib
c)
long-standing a-fib
d)
acute a-fib
e)
permanent a-fib
88.
What kind of A-fib does not terminate w/ any pharmacologic or electrical cardioversion?
a)
recurrent a-fib
b)
persistent a-fib
c)
long-standing a-fib
d)
acute a-fib
e)
permanent a-fib
89.
What is the difference b/w valvular and non-valvular A-fib
a)
valvular: mitral senosis or mechanical heart valve
b)
non-valvular: w/o mitral stenosis or mechanical heart valve
c)
valvular: w/o mitral stenosis or mechanical heart valve
d)
non-valvular: mitral stenosis or mechanical heart valve
90.
What initial drug therapy is given for rate control in A-fib
a)
Na channel blockers (class I)
b)
beta blockers (class II)
c)
K channel blockers (class III)
d)
nDHP CCBs (class IV)
e)
digoxin
91.
How are drugs selected for rate control in pts w/ A-fib
a)
based on LV function
b)
based on sinus rhythm
c)
based on HF status
d)
based on comorbidities
92.
What is the RoA for acute rate control mx of A-fib?
a)
PO
b)
SC
c)
IV
d)
Sublingual
93.
What is the RoA for chronic rate control mx of A-fib
a)
PO
b)
SC
c)
IV
d)
Sublingual
94.
A hemodynamically stable pt w/ A-fib wanting to control heart rate w/ LVEF <40% should take what course of action as first line?
a)
amiodarone
b)
sotalol
c)
digoxin
d)
dronedarone
95.
In what pts is rate control usually recommended as tx in A-fib?
a)
asymptomatic (long-standing or recurrent a-fib)
b)
age > 80 (permanent a-fib)
c)
symptomatic
d)
age < 80
96.
A hemodynamically stable pt w/ A-fib wanting to control heart rate should use class II or IV drugs in what scenario?
a)
no hx of HF
b)
no hx of CAD
c)
no HTN
d)
LVEF > 40%
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