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13
PHARMACY PREP

ARRHYTHMIAS


Supraventricular Tachycardia (SVT)

1-Which of the following goals of therapy for atrial fibrillation:
I-Control ventricular rate and convert sinus rhythm
II-Prevent reoccurrence
III-Prevent life threatening complications.
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-E
Comments
A-Effective control of heart rate at rest and during exercise----- blockers
B-Anticoagulants for paroxysmal and chronic atrial fibrillation---patient with no risk and
(under 65 years)ASA 325 mg /day
C- Anticoagulants for paroxysmal and chronic atrial fibrillation---patients over 75 yrs,
CHF, LVD, mitral valve disease, Hypertension, DM, previous stroke, embolism, LAE----
warfarin (INR 2-3), in over 75 years INR is 1.8 -2.5

2-All of the following drugs effectively control heart rate at rest and during exercise:
I-Metoprolol
II-verapamil
III-Nifedipine
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans--C
Comments: diltiazem, nifedipine has no effect AV node conduction. Digoxin is effective
some times at rest but not during exercise

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3-In Restoration and maintenance of sinus rhythm, the following drugs are effective:
I-amiodarone
II-Sotalol
III-Dofetilide
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans--E
Tips: Class III is effective.

4-All of the following drugs have torsades de pointes as side effects EXCEPT:
A-Quinidine
B-Procainamide
C-Diisopyramide
D-Sotalol
E-Propafenone
Ans--E
Comments: class IA and Class III drugs prolong the QT intervals. Torsades de pointes is
serious side effect.

5-Which of the following is the incorrect statement:
A- If AF has been present more than 48 hours initiate heparin followed by oral
anticoagulants
B- Beta blockers, digoxin, CCB and adenosine are contra indicated for AF treatment in
wolff Parkinson white syndrome. Iv procainamide and ibutilide are drug of choice
C- Consider long term thromboembolic therapy for all patient with paroxysmal atrial
fibrillation.
D- Rate control---b-blockers, CCB, digoxin
E- IV digoxin , and verapamil is monotherapy for wolff Parkinson white syndrome
Ans--E
Tips: digoxin and verapamil is contraindicated WPW syndrome
TC p 335 to 338

6-True statements about digoxin;
I-If patient hypokalemic decrease dose by 25-50%
II-With CCB, beta-blockers, amiodarone, propafenone, quinidine decrease dose by 25-
50%
III-Bradycardia, visual disturbances, proarrthymia, nausea and vomiting are side effects
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
AnsE
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7. Patient 75 years old with symptomatic AVRT (Atrioventricular Re-entry Tachycardia)
which happens to his occasionally. Best therapy his doctor should initiate is:
(A) Verapamil 120mg/day for 1 week
(B) Diltiazem 180mg/day
(C) Pill-in-the-pocket Propranolol
(D) Digoxin 0.25mg/day
(E) None of the above
Answer: (C)
TIPS: This is a case of Wolf Parkinson white syndrome where the rate control mediations
are contraindicated like Class IA, Class IC and Class III.

8. All are true about Amiodarone EXCEPT:
(A) Pulmonary toxicity
(B) Phototoxicity
(C) Hepatotoxicity
(D) Anemia
(E) Halo vision
Answer: D
Reference: Amiodarone monograph