FPGEE Review Exam Questions with Correct Answers

FPGEE Review Exam Questions with Correct Answers In FAST response fibers - Electrolyte involved in phase 0 - Answer-Na+ influx In FAST response fibers - Electrolyte involved in phase 2 - Answer-Ca+ influx, K+ outflux plateau In FAST response fibers - Electrolyte involved in phase 3 - Answer-K+ outflux (Ca+ drops off) rapid repolarization In SLOW response fibers - Electrolyte involved in phase 0 - Answer-Ca+(few Na+ channels in Nodal fibers) In SLOW response fibers - Electrolyte involved in phase 3 - Answer-K+ outflux repolarization In SLOW response fibers - Electrolyte involved in phase 4 - Answer-"Mainly Na+ (This is the pacemaker current) aarapim. " Ectopic rhythm can result from - Answer-ischemia, electrolyte abnormalities, or heightened sympathetic tone If an early afterdepolarization is sustained - Answer-torades de pointes (QRS complexes of varying amplitudes) ECG of a patient with an accessory pathway (bundle of Kent) - Answer-"Wide QRS complexes, early ventricular upstroke (also predisposed to re-entry loops) (Wolff Parkinson White (WPW) syndrome) wolff-parkinson-white-accessory-bundle-bundle-ofKent " MOA of quinidine - Answer-Blocks (open-activated) Na+ channels: In SA Nodal tissue - Shift to a more positive threshold and decrease the pacemaker slope (phase 4), In Ventricular tissue - Decreases the phase 0 slope (depolarization) and block K+ channels prolongs repolarization (longer refractory period protected from reentry currents): Anticholanergic (vagolytic effect faster conduction through AV node) Indications of quinidine - Answer-"atrial flutter or fibrillation maintain normal sinus rhythm,Paroxysmal supraventricular tachycardia, Premature atrial or ventricular contractions, paroxysmal AV junctional rhythm 9" When taking this drug patients must be monitored for lupus (with ANA) - AnswerProcainamide Take with quinidine to prevent rapid ventricular response in patient with atrial flutter - Answer-β-blocker or Ca2+ channel blocker Which 1A antiarrhythmic for a patient on digoxin - Answer-Procainamide (doesn't alter digoxin levels) MOA of Lidocaine and Phenytoin - Answer-( 1B) block of voltage-gated Na+ in ventricular myocytes (decrease phase 0 upstroke) MOA of Encainide, Flecainide, Moricizine, Propafenone - Answer-( 1C) block of voltagegated Na+ channelsin ventricular myocytes MOA of Propranolol, Atenolol, Metoprolol... - Answer-( ) block β1-adrenergic receptors SLOW SA and AV nodal activity,(decreases phase 4 slope) MOA of Ibutilide, Dofetilide, Sotalol, Amiodarone - Answer-( I) Block K+ channels longer action potential plateau and prolonged repolarization MOA of Verapamil, Diltiazem - Answer-( IV) Ca2+ channel blocker slows action potential upstroke in SA and AV nodes This 1A drug is associated with the development of Lupus, hematotoxicity, but less likely to cause torsades - Answer-procainamide Antiarrhythmics of choice for post ischemic insults - Answer-1B Drug used for Supraventricular tachycardias, and post-MI prophylaxis - Answerantiarrhythmics (β-blockers) What does Quinidine do to AV node - Answer-increases conduction velocity (via anticholinergic effects) This 1A drug is meolized to a meolite with a pure I effect (prolonging refractory, lengthening QT interval) - Answer-Procainamide DOC or ventricular arrhythmias in ER situations (like in MI) - Answer-Lidocaine LidocaineMexiletine should be (increased or decreased) in patients with drug inducible P0 - Answer-increased Moderate Na+ channel block decrease phase 0, and prolonged repolarization ( 1A, 1B or 1C) - Answer-1A Mild Na+ channel block slight pahse 0 slope decrease, shortened repolarization( 1A, 1B or 1C) - Answer-1B Marked Na+ channel block severe decreased in phase 0 slope, No change in repolarization ( 1A, 1B or 1C) - Answer-1C This drug can worsen the arrhythmia in patients with pre-existing ventricular tachyarrythmias and those with a history of MI - Answer-Flecainide (a 1C) Drug used when other measure fail to help life threatening paroxysmal supraventricular or vventricular arrhythmias - Answer-Flecainide (a 1C) MOA of β1-blockers - Answer-block sympathetic input to AV (and SA nodes) decrease the rate of phase 4 depolarization (pacemaker current), prolong repolarization Non-selective β1 and β2 blockers that DO NOT prolong repolarization - Answer-First generation β-blockers (Propranolol, Nadolol, Timolol) and carvedilol and labetalol Β-blocker also used for glaucoma - Answer-Timolol This β-blocker can cause liver damage - Answer-labetalol These β-blockers cause vasodilationvia α1-blockage - Answer-Carvedilol and labetalol Selective β1-blocker with a very short half-life - Answer-Esmolol Used in ER treatment to block β in thyroid storm - Answer-esmolol A selective β1-blocker and selective β2-agonist - Answer-celiprolol MOA of K+ channel blockers - Answer-I antiarrhythmics lengthen the plateau (phase 2) and prolong repolarization Lengthening the plateau phase does what (in I) - Answer-increases the refractory period (prevents re-entry), On the bad side: increases likely-hood of afterdepolarizations and torsades de pointes Drug for conversion of atrial flutter - Answer-quinidine, ibutilide, dofetilide of amiodarone - Answer-Mainly I, but has effects in all es Unique MOA of amiodarone - Answer-alters lipid membrane where ion channela and receptors are located The most dreaded complication of Amiodarone - Answer-Pneumonitis leading to pulmonary fibrosis