Antiarrhythmatic Drug Sample Qs Flashcards by Chelsea Luedtke

1.  Which of the following drugs will lengthen the Q-T interval of the ECG?
A.	Lidocaine
B.	Dofetilide
C.	Flecainide
D.	Verapamil

B. Dofetilide

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2.  Which of the following drugs will lengthen the P-R interval of the ECG?
A.	Lidocaine
B.	Dofetilide
C.	Flecainide
D.	Verapamil

D. Verapamil

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Which of the following drugs is most likely to have torsades de pointes as a side effect?
a. Quinidine
b. Digoxin
c. Propanolol
d. Lidocaine

a. Quinidine

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4.  Which of the following best describes the mechanism of action of procainamide?
A.	Selective block of Na+ channels
B.	Selective block of K+ channels
C.	Block of both Na+ and K+ channels
D.	Selective block of Ca2+ channels

C. Block of both Na+ and K+ channels

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5.  Which of the following drugs would be the best choice for treating a ventricular arrhythmia arising from digoxin treatment?
A.	Verapamil
B.	Flecainide
C.	Quinidine
D.	Lidocaine

D. Lidocaine

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6.  Which of the following drugs would be least effective in suppressing AV nodal transmission?
A.	Verapamil
B.	Adenosine
C.	Flecainide
D.	Propanolol

C. Flecainide

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7.  Which of the following drugs is least likely to have the side effect of gastrointestinal discomfort (nausea, vomiting, or diarrhea)?
A.	Quinidine
B.	Procainamide
C.	Lidocaine
D.	Digoxin

C. Lidocaine

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Which mechanism best describes the direct actions of digoxin on cardiac tissue?
A. Digoxin decreases intracellular Ca2+ levels.
B. Digoxin increases intracellular Ca2+ levels.
C. Digoxin blocks K+ channels.
D. Digoxin blocks Na+ channels.

B. Digoxin increases intracellular Ca2+ levels.

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Which of the following is an unusual pharmacokinetic property of verapamil?
A. It is extensively tissue bound with a half-life of 1-2 mos.
B. When introduced intravenously, it has a half-life of 4 min.
C. It is metabolized into a pro-arrhythmic breakdown product.
D. Activity is enhanced by low plasma K+ levels.

B. When introduced intravenously, it has a half-life of 4 min.

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10.  Which of the following is a common side effect of amiodarone?
A.	Corneal microdeposits 
B.	Gynecomastia
C.	Lupus erythematosus
D.	Bronchospasm

A. Corneal microdeposits

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11.  Which cardiovascular side effect is most likely to occur as a result of verapamil overdose?
A.	Wolff-Parkinson-White syndrome
B.	 Torsades de pointes
C.	AV block
E.	AV nodal reentry

C. AV block

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12. Which of the following drugs increases parasympathetic activity?
A.	Quinidine
B.	Magnesium
C.	Verapamil
D.	Digoxin

D. Digoxin

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13.  Following antibiotic treatment, your patient develops premature ventricular beats as a side-effect of the cardiac drug she is taking.  Which drug is most likely to cause the development of premature ventricular beats following antibiotic treatment?
A.	Verapamil
B.	Lidocaine
C.	Digoxin
D.	Quinidine

C. Digoxin

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Which of the following drugs produces a pro-arrhythmic metabolite?
A.	Quinidine
B.	Procainamide
C.	Lidocaine
D.	Verapamil

B. Procainamide

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Which most accurately describes the effects of flecainide on ventricular action potentials?
A. Slows the initial regenerative depolarization (phase 0)
B. Abolishes the transient repolarization (phase 1)
C. Extends the plateau phase of the action potential (phase 2)
D. Slows repolarization at the end of the action potential (phase 3)

A. Slows the initial regenerative depolarization (phase 0)

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What is the effect on the ECG of therapeutic levels of diltiazem?
a. Lengthen the P-R interval
b. Lengthen the QRS complex
c. Lengthen the Q-T interval
d. Lengthen the T wave

a. Lengthen the P-R interval

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Torsades de pointes is typically caused by which of the following mechanisms?
a. Ectopic pacemaker in atrial muscle
b. Wolff-Parkinson-White syndrome
c. Early after-depolarization
d. Re-entry arrhythmia

c. Early after-depolarization

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Which of the following drugs would be the best choice for treating digoxin-induced ventricular tachyarrhythmias?
a. Lidocaine
b. Beta blocker
c. Verapamil
d. Quinidine

a. Lidocaine

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What is meant by the term “use-dependent blockade” as applied to lidocaine?
a. Lidocaine does not block channels in the closed state but blocks sodium channels that are open or have entered the inactivated state.
b. Lidocaine does not block channels in the closed state but blocks potassium channels that are open or have entered the inactivated state.
c. Lidocaine becomes increasingly effective with long-term use by the patient.
d. Lidocaine becomes increasingly less effective with long-term use by the patient.

a. Lidocaine does not block channels in the closed state but blocks sodium channels that are open or have entered the inactivated state.

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Non-cardiac side effects of procainamide include which ONE of the following?
a. Lupus erythematosus
b. Cutaneous photosensitivity
c. Yellow/green chromatopsia
d. Numbness in peripheral extremities

a. Lupus erythematosus

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Which of the following best describes the mechanism of action of adenosine?
a. Activation of adenosine receptors stimulates Na+ channels in the AV node.
b. Activation of adenosine receptors stimulates K+ channels in the AV node.
c. Blockade of K+ channels
d. Blockade of Na+ channels

b. Activation of adenosine receptors stimulates K+ channels in the AV node.

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What is the effect of K+ channel blockers on the ventricular action potential?
a. Slowing of phase 0 depolarization
b. Enhanced phase 1 repolarization
c. Increased plateau (phase 2) duration
d. More negative resting membrane potential (phase 4)

c. Increased plateau (phase 2) duration

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Which of the following best describes the “direct” mechanism of action of digoxin?

a. Beta receptor blockade
b. Ca2+ channel blockade
c. Stimulation of Na/K-ATPase
d. Inhibition of Na/K-ATPase

d. Inhibition of Na/K-ATPase

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Which of the following drugs increase plasma levels of digoxin?
a. Quinidine
b. Lidocaine
c. Verapamil
d. Propanolol

a. Quinidine

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25. Which of the following is NOT a side effect of amiodarone? a. Pulmonary toxicity b. Gynecomastia c. Thyroid dysfunction d. Corneal microdeposits

b. Gynecomastia

26. What is the most common cardiac symptom of overdosage with digoxin? a. Torsades de pointes b. Premature ventricular beat c. Wolff-Parkinson-White syndrome d. SA block

b. Premature ventricular beat

27. Which of the following conditions would be least effectively treated with beta blockers? a. Ventricular arrhythmias due to exercise or emotion. b. Supraventricular tachycardia. c. Reentry arrhythmias in the AV node d. Reentry arrhythmias involving only ventricular muscle

d. Reentry arrhythmias involving only ventricular muscle

``` 28. Which of the following drugs is most likely to lengthen the Q-T interval of the ECG? A. Lidocaine B. Quinidine C. Flecainide D. Verapamil ```

B. Quinidine

``` 29. Which of the following drugs is most likely to produce torsade de pointes? A. Lidocaine B. Quinidine C. Flecainide D. Verapamil ```

B. Quinidine

30. What is the mechanism of action of procainamide? A. Block of calcium channels. B. Block of sodium-potassium ATPase. C. Use-dependent block of sodium channels. D. Block of potassium and sodium channels.

D. Block of potassium and sodium channels.

``` 33. Which of the following is NOT a side effect of amiodarone? A. Yellow/green halos (chromatopsia) B. Pulmonary toxicity C. Corneal microdeposits D. Cutaneous photosensitivity ```

A. Yellow/green halos (chromatopsia)

``` 34. Following a heart attack, which of the following drugs would be MOST effective in preventing arrhythmias originating in the infarcted tissue? A. Adenosine B. Lidocaine C. Verapamil D. Procainamide ```

B. Lidocaine

35. What is the direct mechanism of action of digoxin? a. Block of the sodium-potassium ATPase b. Block of calcium channels c. Block of potassium and sodium channels d. Block of sodium channels in the inactivated state

a. Block of the sodium-potassium ATPase

36. Which of the following drugs would NOT be used to treat congestive heart failure? a. Digoxin b. ACE inhibitors c. Losartan d. Verapamil

d. Verapamil

37. Which of the following drugs is degraded by intestinal bacteria in a small number of patients? a. Procainamide b. Flecainide c. Digoxin d. Amiodarone

c. Digoxin

39. What is the primary mechanism of action by which beta-adrenergic antagonists exert their cardiac anti-arrhythmic actions? a. Blocks potassium channels b. Use-dependent blockade of sodium channels c. Blocks beta-adrenergic stimulation of calcium channels d. Stimulates calcium channels

c. Blocks beta-adrenergic stimulation of calcium channels

40. Which of the following is MOST likely to be a side effect of lidocaine? a. Tinnitus b. Lupus erythematosus c. Corneal microdeposits d. Diarrhea

a. Tinnitus

41. Which one of the following describes a pharmacokinetic property of amiodarone? a. Activity is enhanced by low serum potassium b. When introduced intravenously, a half life of 4 minutes c. It is metabolized into a cardioactive metabolite d. It has a half-life of 1-2 months.

d. It has a half-life of 1-2 months.

42. Which condition would be MOST effectively treated with verapamil? a. Partial AV block b. Ventricular tachycardia c. Torsade de pointes d. Supraventricular tachycardia due to AV nodal reentry

d. Supraventricular tachycardia due to AV nodal reentry

``` 44. Which of the following drugs is LEAST likely to lead to torsades de pointes? A. Quinidine B. Sotalol C. Procainamide D. Dofetilide E. Lidocaine ```

E. Lidocaine

``` 45. Which of the following drugs is MOST likely to broaden the QRS complex of the ERG? A. Sotalol B. Flecainide C. Verapamil D. Propanolol E. Adenosine ```

B. Flecainide

``` 46. Which of the following is a common side effect of amiodarone? A. Yellow/brown corneal microdeposits B. Yellow/green chromatopsia C. Gynecomastia D. Thrombocytopenia E. Cinchonism ```

A. Yellow/brown corneal microdeposits

``` 47. Which of the following drugs has the LONGEST half life? A. Procainamide B. Digoxin C. Amiodarone D. Lidocaine E. Adenosine ```

C. Amiodarone

``` 48. Upon taking antibiotics to treat a sinus infection, your patient develops heart arrhythmias (premature ventricular beats) that are side effects of his cardiac medication. Which of the following cardiac drugs was the patient most likely taking? A. Sotalol B. Digoxin C. Quinidine D. Propafenone E. Amiodarone ```

B. Digoxin

``` 49. Which of the following drugs is LEAST likely to reduce transmission through the atrioventricular node? A. Digoxin B. Sotalol C. Diltiazem D. Propanolol E. Propafenone ```

E. Propafenone

``` 50. Which of the following drugs can lead to lupus in 1/3 of patients following sustained use? A. Procainamide B. Amiodarone C. Quinidine D. Verapamil E. Propanolol ```

A. Procainamide

51. What is the most common concern about combining loop diuretics with digoxin in the treatment of congestive heart failure? A) Loop diuretics lower serum magnesium levels which in turn reduces digoxin’s efficacy. B) Diminished water retention increases the cardiac afterload. C) Reduced serum potassium levels enhance efficacy of digoxin leading to greater side effects. D) Loop diuretics interfere with ventricular remodeling E) Loop diuretics lower serum calcium levels which significantly diminishes the strength of cardiac muscle contraction.

C) Reduced serum potassium levels enhance efficacy of digoxin leading to greater side effects.

52. Which of the following cardiac conditions would you be LEAST likely to treat with the beta blocker, metoprolol? A) After myocardial infarction to prevent recurrent infarction B) Ventricular arrhythmias due to exercise C) Mild congestive heart failure D) Serious congestive heart failure E) Supraventricular tachycardia

D) Serious congestive heart failure

53. What is the most likely effect of therapeutic levels of dofetilide on the ECG? A) Lengthen P-R interval B) Broaden QRS complex C) Lengthen Q-T interval D) Block the P wave E) Dofetilide exerts therapeutic effects on heart tissue without altering the ECG.

C) Lengthen Q-T interval

54. What are the main reasons that ACE inhibitors beneficial in treating congestive heart failure? A. ACE inhibitors reduce afterload and ventricular remodeling. B. ACE inhibitors act directly on cardiac myocytes to enhance the strength of contraction. C. ACE inhibitors increase serum magnesium levels. D. ACE inhibitors exert potent parasympathomimetic effects. E. ACE inhibitors block calcium channels.

A. ACE inhibitors reduce afterload and ventricular remodeling.

55. What are the mechanisms by which sotalol exerts its anti-arrhythmic effects? A) Sotalol inhibits K+ channels and acts as a beta blocker. B) Sotalol inhibits Na/K-ATPase activity and is a parasympathetic agonist. C) Sotalol directly inhibits Ca2+ channels D) Sotalol inhibits Na+ channel activity. E) Sotalol inhibits both Ca2+ and Na+ channels.

A) Sotalol inhibits K+ channels and acts as a beta blocker.

56. Which of the following best describes the mechanism by which adenosine alters heart function? A) Adenosine blocks Na+ channels B) Activation of adenosine receptors stimulates Ca++ channels in the AV node. C) Activation of adenosine receptors stimulates K+ channels in the AV node. D) Adenosine prevents the conversion of angiotensin I to angiotensin II. E) Adenosine blocks Na/K-ATPase activity

C) Activation of adenosine receptors stimulates K+ channels in the AV node.

57. The most common cardiovascular side effect of quinidine is a. congestive heart failure b. torsade de pointes c. atrioventricular block d. hypertension e. Wolff-Parkinson-White syndrome

b. torsade de pointes

58. Which of the following drugs blocks ONLY voltage-gated Na+ channels? a. digoxin b. verapamil c. flecainide d. propranolol e. adenosine

c. flecainide

59. Which of the following is a relatively common and dangerous side effect of amiodarone? a. Pulmonary toxicity b. Lupus erythematosus c. Thrombocytopenia d. Angioneurotic edema e. Tissue necrosis

a. Pulmonary toxicity

60. Which of the following drugs is most likely to produce a pro-arrhythmic metabolite? a. Procainamide b. Amiodarone c. Diltiazem d. Sotalol e. Quinidine

a. Procainamide

61. What is the major effect of K+ channel blockers on the electrocardiogram? a. Lengthen the QRS duration b. Shorten the QRS duration c. Lengthen the Q-T interval d. Shorten the Q-T interval e. Little or no effect

c. Lengthen the Q-T interval

62. Which one of the following is the most likely to be a side effect of lidocaine? a. Torsade de pointes b. Lupus erythematosus c. Tinnitus d. Diarrhea e. Thyroid dysfunction

c. Tinnitus

63. Which of the following drugs would be the best choice for treating a ventricular arrhythmia arising from digoxin treatment? a. Flecainide b. Verapamil c. Quinidine d. Lidocaine e. Dofetilide

d. Lidocaine

64. Which of the following drugs are used in the treatment of congestive heart failure? a. ACE inhibitors b. Diuretics c. Digoxin d. Beta blockers e. All of the above

e. All of the above

65. Which of the following best describes a pharmacokinetic property of amiodarone? a. Its rapid clearance from the body necessitates IV administration b. Acetylation produces a cardioactive degradation product c. Intestinal bacteria can degrade this drug so one must be particularly cautious when using antibiotics d. Very short half life (4 min.) e. Very long half-life (13-103 days)

e. Very long half-life (13-103 days)

66. Which one of the following drugs would be most likely to inhibit transmission through AV nodal cells? a. Dofetilide b. Verapamil c. Quinidine d. Lidocaine e. Flecainide

b. Verapamil

67. What would be the most likely effect of flecainide on the ECG? a. Lengthen P-R interval b. Broaden QRS complex c. Lengthen Q-T interval d. Shorten Q-T interval e. No effect on the ECG in healthy individuals

b. Broaden QRS complex

68. What would be the most likely effect of ibutilide on the ECG? a. Lengthen P-R interval b. Broaden QRS complex c. Lengthen Q-T interval d. Shorten Q-T interval e. No effect on the ECG in healthy

c. Lengthen Q-T interval

69. Which of the following drugs is most likely to produce a pro-arrhythmic metabolite? a. Procainamide b. Amiodarone c. Lidocaine d. Dofetilide e. Flecainide

a. Procainamide

70. Which of the following drugs has life-threatening pulmonary toxicity as a potential side effect? a. ACE inhibitors b. Amiodarone c. Quinidine d. Lidocaine e. Sotalol

b. Amiodarone

71. Which of the following drugs would be MOST effective in preventing arrhythmias originating in ischemic tissue? a. Adenosine b. Lidocaine c. Verapamil d. Procainamide e. Digoxin

b. Lidocaine

. How does digoxin enhance the force of cardiac contraction? A. Block of the sodium-potassium ATPase indirectly causes an increase in intracellular calcium B. Block of the sodium-potassium ATPase indirectly causes a decrease in intracellular calcium C. Activation of voltage-gated calcium channels D. Block of potassium channels depolarizes heart cells E. Block of sodium channels depolarizes heart cells

B. Block of the sodium-potassium ATPase indirectly causes a decrease in intracellular calcium

. What is the primary mechanism of action by which beta-adrenergic antagonists exert their cardiac anti-arrhythmic actions? a. Blockade of potassium channels b. Use-dependent blockade of sodium channels c. Blockade of muscarinic receptors enhances A-V transmission d. Blockade of beta-adrenergic stimulation of calcium channels e. Stimulation of calcium channels

d. Blockade of beta-adrenergic stimulation of calcium channels

. What are the main reasons that ACE inhibitors are beneficial in treating congestive heart failure? A. ACE inhibitors act directly on cardiac myocytes to enhance the strength of contraction. B. ACE inhibitors increase serum magnesium levels. C. ACE inhibitors exert potent parasympathomimetic effects. D. ACE inhibitors increase preload. E. ACE inhibitors reduce afterload and ventricular remodeling.

E. ACE inhibitors reduce afterload and ventricular remodeling.

75. Which of the following is the most common cardiac symptom of digoxin overdosage in adults? a. Wolff-Parkinson-White syndrome b. Premature ventricular beat c. Torsade de pointes d. Atrial flutter e. Long Q-T syndrome

b. Premature ventricular beat

76. Which of the following drugs is NOT used in the treatment of congestive heart failure? a. Digoxin b. ACE inhibitors c. The angiotensin I antagonist, losartan d. The vasodilator, diltiazem e. The vasodilator, hydralazine

d. The vasodilator, diltiazem

77. Which serious side-effect limits the use of procainamide in long-term therapy? a. Lupus erythmatosus b. Corneal microdeposits c. Gynecomastia d. Blue-green visual halos e. Dyspnea

a. Lupus erythmatosus

. What is the primary mechanism of action of quinidine? a. Blockade of Ca2+ channels b. Blockade of both Na+ and K+ channels c. Selective blockade of only Na+ channels d. Blockade of beta adrenergic receptors e Blockade of Na/K-ATPase

b. Blockade of both Na+ and K+ channels

``` 79. In some patients, antibiotic use can cause a sudden increase in drug toxicity with which of the following drugs? A) Digoxin B) Quinidine C) Amiodarone D) Procainamide E) Mexiletine ```

A) Digoxin

``` 80. Which of the following drugs has gastrointestinal disturbances as a side effect? A) Quinidine B) Procainamide C) Amiodarone D) Digoxin E) All of the above ```

E) All of the above

81. Which mechanism best describes the direct actions of digoxin on cardiac tissue? a . Digoxin binds to and inhibits Ca2+-ATPase. b. Digoxin binds to and inhibits Na+/K+-ATPase. c. Digoxin blocks K+ channels. d. Digoxin blocks Na+ channels.

b. Digoxin binds to and inhibits Na+/K+-ATPase.

82. What is the effect of K+ channel blockers on a ventricular action potential? a. Increase action potential duration b. Decrease action potential duration c. Accelerate upstroke of action potential d. Slow upstroke of action potential

a. Increase action potential duration

83. What is the primary mechanism of action of procainamide in treating cardiac arrhythmias? a. Block Ca2+ channels b. Block Na+ and K+ channels c. Use-dependent block of Na+ channels d. Block beta-adrenergic receptors.

b. Block Na+ and K+ channels

84. Which of the following are among the most common side effects of lidocaine? a. Premature ventricular beats b. Brown corneal deposits c. Prickling and tingling d. Anorexia

c. Prickling and tingling

85. Which of the following is an unusual pharmacokinetic property with amiodarone? a. It is extensively tissue bound with a half-life of 1-2 mos. b. When introduced intravenously, it has a half-life of 4 min. c. It is metabolized into a pro-arrhythmic breakdown product. d. Activity is enhanced by low plasma K+ levels.

a. It is extensively tissue bound with a half-life of 1-2 mos.

86. What is the primary mechanism by which beta-adrenergic antagonists exert their cardiac anti-arrhythmic actions? a. Blocks beta-adrenergic stimulation of Ca++ channels b. Blocks beta-adrenergic stimulation of Na+ channels c. Blocks beta-adrenergic stimulation of K+ channels d. Blocks beta-adrenergic stimulation of Na/K-ATPase

a. Blocks beta-adrenergic stimulation of Ca++ channels

87. What is the primary mechanism of lidocaine’s therapeutic actions in treating cardiac arrhythmias? a. Slows conduction in normally polarized fast tissue b. Slows conduction in depolarized fast tissue c. Slows conduction in normally polarized slow tissue d. Slows conduction in depolarized slow tissue

b. Slows conduction in depolarized fast tissue

88. Which one of the following is a side effect of beta-adrenergic blockers? a. Thyroid dysfunction b. Gynecomastia c. Increases digoxin plasma levels d. Bronchospasm

d. Bronchospasm

89. Ectopic pacemaker activity producing rotation of the QRS vectors would produce which of the following arrhythmias? a. Atrial flutter b. AV nodal reentry c. Torsades de pointes d. Wolff-Parkinson-White syndrome

c. Torsades de pointes

90. Which of the following interactions is a particular concern with digoxin? a. Low serum K+ levels depress binding of digoxin to Na/K-ATPase b. Low serum K+ levels enhance binding of digoxin to Na/K-ATPase c. Inhibition of K+ channels by adenosine synergistically enhances actions of digoxin d. Inhibition of Na+ channels by adenosine synergistically enhances actions of digoxin

b. Low serum K+ levels enhance binding of digoxin to Na/K-ATPase

91. Amiodarone is one of the most effective treatments for which of the following cardiovascular diseases? a. Congestive heart failure b. Ventricular tachycardia c. Angina d. AV block

b. Ventricular tachycardia

92. Which of the following is the most frequent cardiac symptom of digoxin overdosage in adults? a. Torsades de pointes b. Wolff-Parkinson-White syndrome c. Atrial fibrillation d. Premature ventricular beat

Premature ventricular beat

93. Which of the following drugs is the most dangerous with prolonged use? a. Flecainide b. Lidocaine c. Propanolol d. Amiodarone

a. Flecainide

94. Which of the following drugs is most likely to lengthen the PR interval of the ECG? a. Lidocaine b. Quinidine c. Verapamil d. Procainamide e. Dofetilide

c. Verapamil

95. What is the most common therapeutic use for dofetilide? a. Reduce the rate of ventricular contractions during atrial flutter b. Treat digitalis-induced arrhythmias c. Inhibit re-entry arrhythmias involving ventricular tissue d. Inhibit torsades de pointe e. Lower blood pressure

c. Inhibit re-entry arrhythmias involving ventricular tissue

96. What is the mechanism of action of mexiletine? a. Use-dependent blockade of sodium channels b. Highly selective block of sodium channels c. Block of potassium channels d. Block of both potassium and sodium channels e. Inhibition of beta adrenergic receptors

a. Use-dependent blockade of sodium channels

97. Which of the following drugs should NOT be used to treat mild to moderate congestive heart failure? a. Digoxin b. Losartan c. Hydralazine d. Diltiazem e. Propranolol

d. Diltiazem

98. If a patient did not tolerate ACE inhibitors well, what would be the most logical alternative drug for treatment of congestive heart failure? a. Mexiletine b. Lidocaine c. Losartan d. Diltiazem e. Amiodarone

c. Losartan

99. Which of the following is a side effect of digoxin? a. Brown flecks in the cornea b. Lupus erythmatosus c. Hepatitis d. Chromatopsia e. Thrombocytopenia

d. Chromatopsia

100. What is the primary mechanism of action of dronedarone and amiodarone in treating cardiac arrhythmias? a. Selective block of Na+ channels b. Selective block of K+ channels c. Selective block of Ca2+ channels d. Block beta-adrenergic receptors. e. Block of Na+ channels, K+ channels, and beta-adrenergic receptors

e. Block of Na+ channels, K+ channels, and beta-adrenergic receptors