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Afib & coagulation

Total questions: 74

Worksheet time: 43mins

Name
Class
Date
1.

a patient has premature atrial contractions( PAC,), which of the following could be causing it?

a)

diuretics

allergies

b)

Increased SNS, decreased PNS

c)

stimulants, smoking

d)

alcohol

2.

a patient has premature atrial contractions( PAC,), which of the following is a good nonpharm?

a)

less stress

b)

more stress

c)

reduce alcohol, smoking, caffeine

3.

a patient has premature atrial contractions( PAC,), they are experiencing palpitations, SOB, dizziness , and fatigue. which of the following is a good treatment?

a)

Digibind

b)

metoprolol tartrate/succinate

c)

Digoxin

d)

diltiazem or verapamil

4.

SVT( atrial tachycardia) a patient comes in with fluttering and palpitation, what could be the cause?

a)

increased SNS activation

b)

anorexia

c)

digoxin toxicity

d)

CVD

5.

SVT( atrial tachycardia) a patient comes in with fluttering and palpitation, what is a non-pharm?

a)

go running

b)

reduce smoking, alcohol, caffeen

c)

eat and rest

6.

SVT( atrial tachycardia) a patient comes in with fluttering and palpitation, what is not recommended?

a)

stopping alcohol

b)

chronic oral anticoagulation due to low risk of stroke

c)

IV adenosinem, betablocker, diltiazem, amiadarone

d)

vagal maneuvers

7.

SVT( atrial tachycardia) a patient comes in with fluttering and palpitation, what is a first line treatment

a)

diltazem

b)

adenosine

c)

all IV adenosine betablocker, diltiazem, amiadarone

d)

amiadarone

8.

we cannot use adenosine for SVT(atrial vib) in which of the following patients?( Hint: Adenosine normally blocks SA or AV nodes for 10 seconds), so it may not block in people with accessory pathways)

a)

old

b)

wolff parkinson white syndrome( already tried vagal maneuver)

c)

heart transplant

d)

anorexic

9.

Adenosine has to be given with

a)

dextrose

b)

NS saline

10.

what is the purpose of a catheter ablation?

a)

to destroy tissue causing arrythmias

b)

to expand tissue

c)

to treat GI upset

11.

catheter ablations are preffered in which of the following conditions?

a)

Wolff parkingnson white syndrome

b)

MI

c)

PAC

12.

Wolff parkingnson white syndrome 1st line treatments ?

a)

amiodarone, adenosine , digoxin, diltiazem,verapamil( if accessory path way is still present)

b)

IV procainamide

c)

IV ibutilide to restore NSR

d)

Direct current cardioversion if hemodynamically compromised

13.

Wolff parkingnson white syndrome 1st line treatments ?

a)

amiodarone, adenosine , digoxin, diltiazem,verapamil( if accessory path way is still present)

b)

IV procainamide

c)

IV ibutilide to restore NSR

d)

Direct current cardioversion if hemodynamically compromised

14.

IV procainamide should be stopped if QRS widens ......orignial width and hypotension occurs or max of 17mg/kg

a)

>50%

b)

>70

15.

IV procainamide is being used in a patient with WPWS but hey have renal /hepatic issues, what should we do?

a)

cut their dose by 50%

b)

increase dose by 50%

16.

IV procainamide is being used in a patient with WPWS but they recently had a Myocardial infarction 6 months ago. what should we do?

a)

cut their dose by 50%

b)

increase dose by 50%

c)

stop the dose, because this is contraindicated due to the cast trial

17.

IV procainamide is being used in a patient with WPWS, they may experience

a)

lupus like symptoms and agranulocytosi

b)

N/V

c)

hyperglyemia

18.

a patient has WPWS, we don't have procainamide available, what can we give them instead?

a)

metoprolol

b)

Ibutilide

19.

a patient has Afib chronically with ejection fraction <40%, and hypokalemia/hypomagnesmia which of the following is contractraindicated ?

a)

Ibutilide

b)

procainamide

20.

an elderly patient with COPD and DM comes in with Afib, wha tis the best 1st line treatment?

a)

procainamide

b)

metoprol, esmolol

21.

match the type of AFib to duration: Terminates spontaneously or with intervention <7 days , can reocur

a)

longstanding persistent

b)

Poroxysmal

c)

permanent

d)

persistent

22.

match the type of AFib to duration: >7days

a)

longstanding persistent

b)

Poroxysmal

c)

permanent

d)

persistent

23.

match the type of AFib to duration: >12days

a)

longstanding persistent

b)

Poroxysmal

c)

permanent

d)

persistent

24.

match the type of AFib to duration: >patient or provider abanded further efforts to maintaain NSR

a)

longstanding persistent

b)

Poroxysmal

c)

permanent

d)

persistent

25.

a patient has Afib with LV dysfunction or HFrEF, which of the following is a good first line treatment?

a)

Metoprol + digoxin

b)

metoprolol or Diltiazem

c)

Amiodarone

26.

a patient has Afib with LV dysfunction or HFrEF, which of the following is contraindicated

a)

Metoprol + digoxin

b)

metoprolol or Diltiazem

c)

Amiodarone

27.

if a patient has AFIb with acutely decompensated heart failure, we should not use

a)

metoprolol and other betablockers

b)

amiodarone

28.

digoxin will increase vagal activity and reduce AV conduction: we must dose reduce the bolus by 50% in which of the following patients?

a)

elderly

b)

renal dysfunctions

c)

those taking amiodarone, dronedarone, verapamil

d)

all the above

29.

what are signs of digoxin toxicity? ( ADRS are anorexiam, nausea, vomiting, bradycardia)

a)

bidirectional VT

b)

amyloidosis

c)

hypokalemia, heart block

d)

all the above

30.

digoxin is good 1st line treatment for

a)

afib

b)

HF

c)

both

31.

amiodarone is good 2nd line treatment for

a)

afib

b)

HF

c)

both

32.

we check levels for digoxin 12-24 hrs after loading dose. what is the ideal AFib digoxin trough level?

a)

<1.2 ng/ml

b)

<3ng/ml

33.

no loading dose for digoxin, when should we check trough levels?

a)

12-24hrs

b)

3-5 days

c)

12-20 days

d)

5-7

34.

when we give digifab, what should we monitor for

a)

K+

b)

Ca++

c)

Mg++

35.

after we give digifab, what should we check for

a)

no digoxin levels!!

b)

digoxin levels

36.

When we treat acute Afib, we are controlling for

a)

rate

b)

rythmm

37.

which of the following is true about amiodaron DDIs?

a)

increases levels of warfarin( so we have to reduce dose for warfarin)

b)

increases levels of statins

c)

both

38.

in acute AFIb: if a patient is relatively stable, but not stable ( Normal HR) we will conduct .............to prevent going into VFIB

a)

maneuver

b)

defibrillation

c)

cardioversion

39.

if a patient has rythm control issues in an acute AFIb , but they have HF with LVEF <40%, which of the following drugs should they use?

a)

flecainide

b)

dofetilde

c)

amiodarone

d)

ibutilide

e)

propefenone

procainamide

40.

if a patient has rythm control issues in an acute AFIb , but they DOn't have HF , which of the following drugs should they use?

a)

flecainide

b)

dofetilde

c)

amiodarone

d)

ibutilide

e)

propefenone

procainamide

41.

if a patient has rythm control issues in an acute AFIb , but they DOn't have HF but have SHD( MI or structured heart disease), which of the following drugs should we avoid giving them??

a)

flecainide

b)

dofetilde

c)

amiodarone

d)

ibutilide

e)

propefenone

42.

during cardioversion, when should we always provide anticoagulation regardless of CHAD2VASC ?

a)

Electrical cardioverting

b)

medically cardioverting

c)

always provide during cardioversion

43.

what is the bigest risk of Afib( why we must do ECg before cardiovert)

a)

there is no risk

b)

STasis could cause blodvclot

44.

IN AFab , how do we determine anticoagulation?

a)

Cardioversion( at least 4 weeks post )

b)

CHAD2VASC

c)

valvular Afib

d)

all the above

45.

which of the following is true about the transition to oral amiodarone?

a)

do not need loading dose

b)

need loading dose due to duration of halflife

46.

Dofetilide must be dose based on ( during Renal adjustment)?

a)

Ideal body weight

b)

Actual body weight

47.

QTC prolongation, Torsades, Headaches, Chest pain are all side effects for which of the following drugs?

a)

propefenone

b)

flecainide

c)

dofetilide

48.

what is unique about dofetilide Per FDA?

a)

check QTC every 2-3 hrs post each dose

b)

have to be in hospital for 3 days and EKG monitoring

c)

QTC has to be less than 440s, has to be monitored every 3 months after

d)

monitor Scr,K/Mg

e)

all the above

49.

which of the following is contraindicated with dofetilide?

a)

Chlorothalidone

b)

ezetimibe

c)

Hydrochlorothiazide

50.

which of the following is contraindicated with dofetilide?

a)

prochlorperazine

b)

ezetimibe

c)

Hydrochlorothiazide

d)

ondensentron

51.

which of the following is contraindicated with dofetilide?

a)

dolutegravir,bictarvi

b)

verapamil

c)

ondensentron

d)

ezetimibe

e)

trimethoprim

52.

which of the following is contraindicated with dofetilide?

a)

ezetimibe

b)

megestrol( for apetite)

53.

Clas 1 drugs are usally are CONTRAINDICATED in MI( 6days-2 yrs) and other SHD like HF. both FLECAINIDE AND PROPEFENONE MUST be admin in hospital for initial loading dose for monitoring ( arrythmias). However, which of the following drugs also has betablocking activity?

a)

flecainide

b)

propafenone

54.

ADRs for flecainide

a)

blurred vision

b)

QRS complex prolongation, HF worsening , ventricular arrythmias

c)

dizziness

d)

gynocomastia

e)

AV block

55.

ADRs for propefenone

a)

blurred vision

b)

QRS complex prolongation, HF worsening , ventricular arrythmias

c)

dizziness

d)

gynocomastia

e)

AV block, bradycardia

56.

to reduce risk of 1: 2 AV. node condution, propefenone and flecainide should be given with which of the following drugs

a)

metoprolol

b)

simvastatin

c)

diltiazem

d)

AV block, bradycardia

57.

a patient with Afib - rythm issues needs to be transferred home and needs oral meds. which of the following 2 meds only come in oral form( cannot be used acutely for AFib)?

a)

dofetilide

b)

dronedarone

c)

flecainide

d)

sotalol

e)

propefenone, amiadarone

58.

a patient with Afib - rythm issues but has HEART FAILURE AND needs to be transferred home. which of the following will be first line meds to send them home with?

a)

dofetilide

b)

dronedarone

c)

flecainide

d)

sotalol

e)

amiadarone

59.

a patient with Afib - rythm issues but has CAD & needs to be transferred home. which of the following will be first line meds to send them home with?

a)

dofetilide

b)

dronedarone

c)

flecainide

d)

sotalol

e)

amiadarone

60.

a patient with Afib - rythm issues but has CAD or HF needs to be transferred home. which of the following is CONTRAINDICATED ?

a)

dofetilide

b)

dronedarone

c)

flecainide,PROPEFENONE

d)

sotalol

e)

amiadarone

61.

MATCH description to drug: must monitor LFTs at baseline every 6months, ECG/SCR due to ADRs of bradycardia, diarrhea, hepatotoxicity, pulmonary fibrosis, HF worsening, QTC prolongation and sister to amiodarone

a)

dofetilide

b)

dronedarone

c)

flecainide,PROPEFENONE

d)

sotalol

e)

amiadarone

62.

MATCH description to drug: has Class 2 & 3 action, must monitor ECG continuously due to ADRs AV block, bradycardia, worsening of HF, QTC prolongation, Torsades

a)

dofetilide

b)

dronedarone

c)

flecainide,PROPEFENONE

d)

sotalol

e)

amiadarone

63.

MATCH description to drug: contraindicated if Crcl is less than 40 and QTC is greater than 450ms

a)

dofetilide

b)

dronedarone

c)

flecainide,PROPEFENONE

d)

sotalol

e)

amiadarone

64.

what is unique about Sotalol compared to dofetilde dosing?

a)

it can be used inc Crcl < 40

b)

we can increase dose if patient is not bradycardic

65.

if a patient can take flecainide, we must check their

a)

Crcl

b)

LFts

66.

if a patient can take propefenone, we must check their

a)

Crcl

b)

Hepatic dosing

67.

how do we treat a flutter( sawtooth Ecg)

a)

Afib rythm control meds

b)

Afib rate control meds

68.

this favors rhythm control for Afib

a)

older

b)

younger

c)

long history of Afib

d)

short history of Afib

e)

patient does not want it

69.

this favors Rate control for Afib

a)

older

b)

younger

c)

long history of Afib

d)

short history of Afib

e)

patient wants it

70.

this favors Rhythm control for Afib

a)

fewer symptoms

b)

more symptoms

71.

which of the following should we NOT give a patient who has mitral stenosis or mechanical heart valve(Afib)?

a)

DOAC

b)

Heparin

72.

which of the following should we give to a patient who has NON-VALVULAR (Afib)?

a)

WARFARIN

b)

APIXABAN

73.

on the HAS-BLED score: which scanario gives 1-2 points

a)

Abnormal liver& renal

b)

Older, history of strok, bleeding

c)

labile INRs, HTN

d)

drugs or alcohol

74.

on the HAS-BLED score: which scanario gives 1 point

a)

Abnormal liver& renal

b)

Older, history of strok, bleeding

c)

labile INRs, HTN

d)

drugs or alcohol