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Cardiovascular MCQs for pharmacology


review. USMLE style questions on
PHAR MACOLOGY
antiarrhythmics
TOPICS
Author: Flavio Guzman, MD.
Pharmacokinetics
Here are a couple of questions related to the pharmacology cardiac Pharmacodynamics
rhythm. These questions from the UMKC School of Medicine have a Autonomic
different degree of difficulty, but are useful to review the topic. pharmacology
CNS drugs
Item Number: 11423 correct answer: 1 category: Antiarrhythmics Anticonvulsants
1. Properties of the class IA antiarrhythmics include Antidepressants
A. reduce automaticity of his-Purkinje fibers Antipsychotics
Benzodiazepines
B. decrease the rate of rise and amplitude of phase 0
and Z-drugs
depolarization Antiemetics
C. prolong P-R and Q-T intervals Cardiovascular
D. facilitate inward sodium conductance during rapid
Antihypertensives
depolarization Diuretics
1. A,B,C Lipid-
2. A,C lowering
agents
3. B,D
Antiplatelet
4. D only
agents
5. All are correct Antithrombotics
Thrombolytics
Item Number: 11432 correct answer: 4 category: Antiarrhythmics Antiarrhythmics
2. Which of the following antiarrhythmics may worsen angina
Endocrine
symptoms by
Diabetes
increasing myocardial oxygen requirements? drug therapy
A. lidocaine Pain drug
B. verapamil therapy

C. propranolol Anesthetics
Opioids
D. disopyramide
Antibiotics
1. A,B,C
Antivirals
2. A,C
Antiretrovirals
3. B,D
Cancer
4. D only .
chemotherapy
5. All are correct Vaccines

Item Number: 11433 correct answer: 4 category: Antiarrhythmics R ECOMMENDED


3. Cinchonism is a dose-related adverse reaction associated with SITES
which of the
following antiarrhythmics? Psychopharmacology
Institute
A. tocainide
B. procainamide
C. disopyramide
D. quinidine
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11447 correct answer: 4 category: Antiarrhythmics


4. Addition of propranolol to the drug regimen of a patient
receiving lidocaine
for premature ventricular contractions after a myocardial infarction
results
in:
A. increased likelihood of breakthrough PVCs
B. displacement of protein-bound lidocaine
C. reduced renal clearance of lidocaine
D. increased likelihood of lidocaine toxicity
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11448 correct answer: 1 category: Antiarrhythmics


5. Electrophysiologic properties possessed by lidocaine include:
A. reduction of effective refractory period in normal his-Purkinje
fibers
B. prolonged effective refractory period in ischemic his-Purkinje
fibers
C. shortened Q-T interval
D. prolonged P-R interval
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11464 correct answer: 5 category: Antiarrhythmics


6. Which of the following are classified as IB antiarrhythmics?
A. lidocaine
B. phenytoin
C. tocainide
D. mexiletine
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11466 correct answer: 1 category: Antiarrhythmics


7. In treating supraventricular arrhythmias, which of the following
reduces
ventricular response primarily by increasing the effective refractory
period
of the A-V node?
A. propranolol
B. digoxin
C. verapamil
D. tocainide
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11474 correct answer: 1 category: Antiarrhythmics


8. Potential side effects associated with amiodarone therapy
include:
A. pneumonitis
B. pseudocyanosis
C. photosensitivity
D. parotiditis
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11475 correct answer: 3 category: Antiarrhythmics


9. Class IC antiarrhythmics possess which of the following
electrophysiologic
properties?
A. markedly prolong repolarization
B. markedly depress phase 0 depolarization
C. inhibit calcium entry during plateau portion of action potential
D. inhibit sodium entry during phase 0 depolarization
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11476 correct answer: 1 category: Antiarrhythmics


10. Adverse effects associated with disopyramide therapy include:
A. urinary retention
B. constipation
C. blurred vision
D. lupus syndrome
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 289 correct answer: 5 category: Antiarrhythmics


11. Antiarrhythmic drugs can be separated into four groups, types
I to IV. All of
the following are type I antiarrhythmic drugs EXCEPT:
1. quinidine
2. lidocaine
3. procainamide
4. phenytoin
5. propranolol

Item Number: 291 correct answer: 5 category: Antiarrhythmics


12. Individual antiarrhythmic agents can alter the surface
electrocardiogram.
Characteristics of quinidine include:
1. decreased PR interval
2. increased QRS duration
3. increased QT interval
4. All of the above
5. 2,3

Item Number: 292 correct answer: 5 category: Antiarrhythmics


13. Quinidine toxicity includes all of the following EXCEPT:
1. thrombocytopenia
2. diarrhea
3. cinchonism
4. ventricular fibrillation
5. hypertension

Item Number: 293 correct answer: 1 category: Antiarrhythmics


14. Of the following antiarrhythmic agents, the one which most
closely resembles
procainamide with respect to electrophysiologic effects and
mechanism of
action is:
1. quinidine
2. lidocaine
3. phenytoin
4. propranolol
5. bretylium

Item Number: 1360 correct answer: 5 category: Antiarrhythmics


15. Bronchiolar constriction is a rare but potentially dangerous
side effect of:
1. quinidine
2. lidocaine
3. procainamide
4. phenytoin
5. propranolol

Item Number: 1578 correct answer: 4 category: Antiarrhythmics


16. The effect of different antiarrhythmic agents is best
understood by knowing
their predominant actions on cardiac fibers. All of the following
general
statements are true EXCEPT:
1. quinidine slows the rate of depolarization of cardiac action
potentials
and increases the refractory period
2. lidocaine and phenytoin are class 1 B antiarrhythmic
3. beta-receptor blocking drugs act by reducing the slope of the
pacemaker
potential
4. procainamide acts as a specific calcium antagonist
5. bretylium prolongs the action potential and so prolongs the
absolute
refractory period

Item Number: 9518 correct answer: 4 category: Antiarrhythmics


17. In the pharmacologic treatment of cardiovascular disorders,
quinidine has all
of the following effects EXCEPT:
1. prolongation of the effective refractory period
2. slows conduction velocity
3. reduces spontaneous frequency of discharge of ectopic
pacemaker
4. has a positive chronotropic effect
5. produces peripheral vasodilation in large doses

Item Number: 9893 correct answer: 3 category: Antiarrhythmics


18. Which of the following medications is contraindicated in a
patient with
untreated complete heart block?
1. atropine
2. prednisone
3. quinidine
4. isoproterenol
5. hydrochlorothiazide

Item Number: 11386 correct answer: 1 category: Antiarrhythmics


19. The therapeutic rationale for the use of quinidine or
procainamide includes
their ability to:
1. depress ectopic myocardial automaticity
2. enhance myocardial membrane responsiveness
3. decrease the effective refractory period
4. 1,2
5. 2,3

Item Number: 12788 correct answer: 3 category: Antiarrhythmics


20. All of the following are common side effects of quinidine
administration
EXCEPT:
1. diarrhea
2. nausea and vomiting
3. dry mouth
4. tinnitus
5. headache

Item Number: 14457 correct answer: 4 category: Antiarrhythmics


21. 24 hours after an acute myocardial infarction, a 46-year-old
male is being
treated with a continuous intravenous drip of an antiarrhythmic
drug to
suppress frequent multifocal premature ventricular contractions. He
develops
generalized seizure activity. The seizure activity can be most
readily
explained by:
1. ventricular tachycardia
2. systemic embolization
3. systemic hypotension
4. lidocaine toxicity
5. ventricular asystole

Item Number: correct answer: 1 category: Antiarrhythmics


22. TRUE statements concerning Vaughan-Williams’s Class III
antiarrhythmic
drugs include all EXCEPT:
1. encainide, flecainide, and propafenone are in this class
2. bretylium, amiodarone, and sotalol are in this class
3. possess diverse pharmacologic effects but share the capacity
to prolong
action potential duration and refractoriness in Purkinje fibers
4. block outflow of potassium during cell repolarization
5. do not alter phase 0 depolarization or resting membrane
potential

Questions 23 – 29
Choose the correct answer for the following questions from the list
below.
Each answer can be used once, more than once, or not at all.

1. bretylium
2. amiodarone
3. adenosine
4. flecainide
5. lidocaine

Item Number: correct answer: 5 category: Antiarrhythmics


23. In ACLS algorithm, first antiarrhythmic to be administered in
the treatment of
ventricular fibrillation refractory to defibrillation and epinephrine.

Item Number: correct answer: 3 category: Antiarrhythmics


24. Drug of choice for paroxysmal supraventricular tachycardia
unresponsive to
vagal maneuvers.

Item Number: correct answer: 1 category: Antiarrhythmics


25. Produces transient increase in blood pressure followed by
hypotension due to
an initial release of norepinephrine from neurons followed by
blockade of
norepinephrine re-uptake.

Item Number: correct answer: 2 category: Antiarrhythmics


26. Contains iodine in molecular structure, is similar to thyroxine,
and use is
associated with hyper- or hypothyroidism in 2% – 5% of patients.

Item Number: correct answer: 2 category: Antiarrhythmics


27. Pharmacokinetic properties characterized by very high protein-
binding (99.9%),
very large volume of distribution (66 L/kg), and average elimination
half-life
of 25 days.
Item Number: correct answer: 4 category: Antiarrhythmics
28. A class IC antiarrhythmic, characterized by high affinity for and
slow
dissociation from fast sodium channels

Item Number: correct answer: 5 category: Antiarrhythmics


29. A class IB antiarrhythmic, characterized by rapid association –
dissociation
from sodium channels

Item Number: correct answer: 4 category: Antiarrhythmics


30. Correct statements concerning propafenone include all
EXCEPT:
1. class IC antiarrhythmic
2. slows actions potential conduction by blocking sodium channels
3. possesses weak beta blocking activity
4. class III antiarrhythmic
5. increases duration of QRS complex

Item Number: correct answer: 1 category: Antiarrhythmics

Are you 31. Correct


a visual statements
learner concerning
interested sotalol include
in learning all EXCEPT:
psychopharmacology?
1. prolongs action potential duration and effective refractory PSY CHOPHAR MACOLOGY
period by Click here to get our videos
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blocking sodium channels.
2. prolongs cell repolarization by blocking potassium channels. Get our free
3. produces bradycardia psychopharmacology lectures
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4. prolongs Q-T interval
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5. increases effective refractory period
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Questions 32 – 35
Choose the correct answer for the following questions from the list
below. Profession
Select your profession
Each answer can be used once, more than once, or not at all.
Country
1. propranolol
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2. acebutolol
3. sotalol
4. esmolol Click here to subscribe
5. butorphanol
Item Number: correct answer: 4 category: Antiarrhythmics
32. Cardioselective beta blocker with a short elimination half-life
administered
intravenously only.

Item Number: correct answer: 3 category: Antiarrhythmics


33. Nonselective beta blocker which slows heart rate and also
prolongs action
potential duration by blocking transmembrane potassium currents.

Item Number: correct answer: 2 category: Antiarrhythmics


34. Cardioselective beta blocker possessing intrinsic sympathetic
activity and
given by oral administration only.

Item Number: correct answer: 1 category: Antiarrhythmics


35. Nonselective beta blocker possessing quinidine-like membrane
stabilizing
effects.

Item Number: correct answer: 5 category: Antiarrhythmics


36. FALSE statement concerning use of calcium channel blockers
as antiarrhythmics:
1. slows inward calcium current thereby decreasing the rate of
spontaneous
phase 4 depolarization in Purkinje fibers
2. slows conduction velocity through the atrio-ventricular node
and
increases functional refractory period
3. useful for slowing ventricular rate in atrial fibrillation
4. hypotension may be a limiting side effect
5. verapamil, diltiazem, and nifedipine all exert equally effective
antiarrhythmic actions

Item Number: correct answer: 3 category: Antiarrhythmics


37. CORRECT statement concerning the antiarrhythmic drug
adenosine:
1. undergoes extensive hepatic metabolism
2. produces coronary vasoconstriction
3. causes frequent but transient post-conversion arrhythmias
4. increases sinus node rate
5. increases atrio-ventricular conduction

Item Number: correct answer: 1 category: Antiarrhythmics


38. True statement concerning adenosine include all EXCEPT:
1. administered sublingually
2. negative chronotrope
3. negative dromotrope
4. negative inotrope
5. may precipitate bronchospasm

Item Number: correct answer: 5 category: Antiarrhythmics


39. FALSE statement concerning adenosine:
1. half-life of 1 – 10 seconds
2. higher doses necessary in patients taking theophylline
3. chest pain and shortness of breath are common but short-lived
side
effects
4. indicated for treating paroxysmal supraventricular tachycardia
5. less effective than verapamil for treating paroxysmal
supraventricular
tachycardia

Item Number: correct answer: 2 category: Antiarrhythmics


40. Correct statements about epinephrine administration for
ventricular
fibrillation include all EXCEPT:
1. 1 mg IV push every 3 – 5 minutes
2. 0.1 mg IV push every 3 – 5 minutes
3. 0.1 mg/kg IV push every 3 – 5 minutes
4. 1 mg IV push followed by 3 mg IV push followed by 5 mg IV
push 3 minutes
apart
5. 2.5 mg diluted to a total volume of 10 ml in saline solution via
an
endotracheal tube when no IV access is available

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