Advanced Pharmacology Final UPDATED ACTUAL Questions and CORRECT
Answers
1. What is the most serious type of Fribrillaton
arrhythmia?
Ventricular fibrillation is fatal and atrial fibrillation (AF),
the most common cardiac arrhythmia, is usually symp-
tomatic.
2. How are arrhythmias classified? Location (ventricular or supraventricular)
Direction of rate change: bradycardia or tachycardia.
3. Arrhythmias occur in approxi- 25%
mately of all surgical patients
under anesthesia. Most do not require treatment.
4. When do we treat arrhythmia? ?
5. Causes of Arrhythmia can be: STRUCTURAL:
-CAD, Valvular dz
-Cardiomyopathies
-SSS or prolonged QT syndromes
-WPW
TRANSIENT IMBALANCES:
Stress
Electrolyte imbalance or metabolic imbalance
Hypoxia
Hypercarbia
ICD/Pacemaker
Surgical stimulation
Anesthetic agents (or lack of)
6. Why not give everyone at risk an- Prophylactic antiarrhythmic therapy is largely unwar-
tiarrhythmics? ranted in CAD and STEMI patients because of the risk of
being proarrhythmic
, ICDs and radio frequency ablation have superseded
pharmacologic therapy of sustained post-STEMI ar-
rhythmias
7. Routine use of class I antiarrhyth- True
mics is contraindicated post-MI.
True or False?
8. Radiofrequency (RF) catheter ab- WPW, AV nodal reentry, and Atrial ectopic tachycardia, AF
lation is the 1st-line therapy/high- and several types of monomorphic VT
ly effective for:
9. Vaughan-Williams Classification: the system most commonly used to classify antidys-
rhythmic drugs
Class I- interfere with Na+ channel. Subdivided into a, b
&c
Quinidine, Procainamide, Lidocaine, Phenytoin, Fle-
cainide
Class II- Anti-SNS agents.
Beta blockers
Class III- Affect K+ efflux.
Amiodarone
Class IV- Affect the av node.
Ca2+ channel blockers
Class V- Work by other or unknown mechanisms
Digoxin, Adenosine, and Magnesium
Limitations
, 10. Mnemonic for Class I-IV agents: SoBe PoCa (SOBE as in South Beach or the drink, POCA
as in Polka dance)
Sodium channel blockers, Beta blockers, Potassium
channel blockers, Calcium channel blockers
11. Ventricular Myocyte Action Poten- *Rapid Depolarization*
tial -Na+ inflow
*Plateau Phase*
-Ca+ inflow
*Repolarization*
-K+ outflow
-Ca+ outflow
*Absolute Refractory*
-Longer than skeletal
12. Procainamide (Pronestyl, Procan): Increases the effective refractory period and reduces im-
nTx of lido/amio resistant ventric- pulse conduction velocity in the atria, His-Purkinje fibers
ular arrhythmia, afib, or PSVT, ar- and ventricular muscle. Variable effect on AV conduction,
rhythmia control in MH after lido- slowing effect on AV node
caine, ACLS algorithms (Class Ia)
Direct myocardial depression level >8 mcg/ml
13. Procainamide is contraindicated -CHB
in: -SLE
-Torsades
(prolonged QT)
Answers
1. What is the most serious type of Fribrillaton
arrhythmia?
Ventricular fibrillation is fatal and atrial fibrillation (AF),
the most common cardiac arrhythmia, is usually symp-
tomatic.
2. How are arrhythmias classified? Location (ventricular or supraventricular)
Direction of rate change: bradycardia or tachycardia.
3. Arrhythmias occur in approxi- 25%
mately of all surgical patients
under anesthesia. Most do not require treatment.
4. When do we treat arrhythmia? ?
5. Causes of Arrhythmia can be: STRUCTURAL:
-CAD, Valvular dz
-Cardiomyopathies
-SSS or prolonged QT syndromes
-WPW
TRANSIENT IMBALANCES:
Stress
Electrolyte imbalance or metabolic imbalance
Hypoxia
Hypercarbia
ICD/Pacemaker
Surgical stimulation
Anesthetic agents (or lack of)
6. Why not give everyone at risk an- Prophylactic antiarrhythmic therapy is largely unwar-
tiarrhythmics? ranted in CAD and STEMI patients because of the risk of
being proarrhythmic
, ICDs and radio frequency ablation have superseded
pharmacologic therapy of sustained post-STEMI ar-
rhythmias
7. Routine use of class I antiarrhyth- True
mics is contraindicated post-MI.
True or False?
8. Radiofrequency (RF) catheter ab- WPW, AV nodal reentry, and Atrial ectopic tachycardia, AF
lation is the 1st-line therapy/high- and several types of monomorphic VT
ly effective for:
9. Vaughan-Williams Classification: the system most commonly used to classify antidys-
rhythmic drugs
Class I- interfere with Na+ channel. Subdivided into a, b
&c
Quinidine, Procainamide, Lidocaine, Phenytoin, Fle-
cainide
Class II- Anti-SNS agents.
Beta blockers
Class III- Affect K+ efflux.
Amiodarone
Class IV- Affect the av node.
Ca2+ channel blockers
Class V- Work by other or unknown mechanisms
Digoxin, Adenosine, and Magnesium
Limitations
, 10. Mnemonic for Class I-IV agents: SoBe PoCa (SOBE as in South Beach or the drink, POCA
as in Polka dance)
Sodium channel blockers, Beta blockers, Potassium
channel blockers, Calcium channel blockers
11. Ventricular Myocyte Action Poten- *Rapid Depolarization*
tial -Na+ inflow
*Plateau Phase*
-Ca+ inflow
*Repolarization*
-K+ outflow
-Ca+ outflow
*Absolute Refractory*
-Longer than skeletal
12. Procainamide (Pronestyl, Procan): Increases the effective refractory period and reduces im-
nTx of lido/amio resistant ventric- pulse conduction velocity in the atria, His-Purkinje fibers
ular arrhythmia, afib, or PSVT, ar- and ventricular muscle. Variable effect on AV conduction,
rhythmia control in MH after lido- slowing effect on AV node
caine, ACLS algorithms (Class Ia)
Direct myocardial depression level >8 mcg/ml
13. Procainamide is contraindicated -CHB
in: -SLE
-Torsades
(prolonged QT)
