Deck 22: Antiarrhythmic Drugs

Question 1

Which of the following diuretic agents has the longest duration of action?

A) Spironolactone (Aldactone)
B) Furosemide (Lasix)
C) Hydrochlorothiazide (HydroDIURIL)
D) Amiloride (Midamor)

Answer 1

Spironolactone (Aldactone)

Question 2

Which of the following statements is true of the physiologic actions resulting from the use of angiotensin-converting enzyme (ACE)inhibitors in the treatment of chronic heart failure?

A) ACE inhibitors reduce the formation of angiotensin II.
B) ACE inhibitors promote excretion of sodium and water from the kidneys.
C) ACE inhibitors decrease the inactivation of bradykinin.
D) All of these are correct.

Answer 2

All of these are correct.

Question 3

Identify the main causes of heart failure.

A) Untreated hypertension, myocardial infarction, and valvular defects
B) Untreated hyperglycemia, myocardial infarction, and valvular defects
C) Untreated hyperthyroidism, myocardial infarction, and valvular defects
D) None of the above

Answer 3

Untreated hypertension, myocardial infarction, and valvular defects

Question 4

Which of the following statements is true of the administration of digoxin?

A) The patient should maintain adequate potassium intake.
B) The patient should avoid taking antacids and laxatives.
C) The patient's pulse rate should be between 60 and 100 beats per minute.
D) All of the above are correct.

Question 5

Which of the following measures should be taken when implementing a treatment plan with digoxin for a patient who already takes quinidine for arrhythmias?

A) An increased dosage of digoxin due to antagonism with quinidine
B) A decreased dosage of digoxin due to the potentiation of digoxin levels in the plasma
C) An increased dosage of quinidine due to antagonism with digoxin
D) None of the above

Question 6

What are the physiological changes that occur in the heart as a result of chronic heart failure?

A) Chronic heart failure causes the cardiac muscle to undergo hypertrophy, where the walls of the heart chambers increase in size and undergo structural remodeling in an attempt to generate more forceful contractions.
B) Chronic heart failure causes the weakness of the mitral valves, which increases the movement of blood from the atria to the ventricles.
C) Chronic heart failure causes the weakness of the aorta, which slows the movement of blood from the left ventricle to the body.
D) Chronic heart failure causes the blockage of norepinephrine and epinephrine receptors, which increases the heart rate and the force of myocardial contraction.

Question 7

While treating chronic heart failure,which of the following signs should one look out for after the administration of a vasodilator such as hydralazine?

A) Postural hypotension
B) Reflex tachycardia
C) Nausea and headache
D) All of the above

Question 8

Which of the following accurately describes the renin-angiotensin-aldosterone (RAA)mechanism?

A) A drop in systemic blood pressure or a decrease in renal blood flow stimulates the release of renin from the kidneys. Renin initiates reactions that lead to the formation of angiotensin II. Angiotensin II causes vasoconstriction and the release of aldosterone (sodium retention) and ADH (water retention). These actions normally function to maintain normal blood pressure and blood volume.
B) An increase in systemic blood pressure or an increase in renal blood flow stimulates the release of renin from the kidneys. Renin initiates reactions that lead to the formation of angiotensin II. Angiotensin II causes vasoconstriction and the release of aldosterone (sodium retention) and ADH (water retention). These actions normally function to maintain normal blood pressure and blood volume.
C) A drop in systemic blood pressure or a decrease in renal blood flow stimulates the release of renin from the kidneys. Renin initiates reactions that lead to the formation of angiotensin II. Angiotensin II causes vasodilation and the release of aldosterone (sodium retention) and ADH (water retention). These actions normally function to maintain normal blood pressure and blood volume.
D) None of the above are correct.

Question 9

What is the physiological effect of restricting sodium intake during diuretic therapy for mild chronic heart failure (CHF)?

A) Restriction of sodium intake during diuretic therapy may decrease the edema and congestion that occur with CHF, but it has no effect on the cardiac output.
B) Restriction of sodium intake during diuretic therapy may control the edema, congestion, and reduced cardiac output that occur with CHF.
C) Restriction of sodium intake along with diuretic therapy may improve the cardiac output, but it has no effect on the edema and congestion that occur with CHF.
D) None of the above are correct.

Question 10

In the context of drug administration,select the correct statement related to digitalization and maintenance.

A) Digitalization is similar to the process of administering a loading dose because both rapidly produce a therapeutic blood level of drug.
B) After the initial administration of digoxin, subsequent daily maintenance doses are lower and adjusted to maintain a therapeutic level of glycoside in the blood.
C) During digitalization, digoxin is administered by either the PO or IV route of administration.
D) All of the above are correct.

Question 11

Which of the following accurately describes the mechanism of action of digoxin?

A) Digoxin stimulates Na/K ATPase. Stimulation of Na/K ATPase increases intracellular concentration of Na+ ions. Increased intracellular Na+ decreases the activity of the Na/Ca exchanger and allows intracellular Ca++ concentrations to increase. Increased intracellular Ca++ increases the formation of actinomyosin and increases the force of myocardial contractions.
B) Digoxin binds to and inhibits Na/K ATPase. Inhibition of Na/K ATPase decreases intracellular concentration of Na+ ions. Decreased intracellular Na+ increases the activity of the Na/Ca exchanger and allows intracellular Ca++ concentrations to decrease. Decreased intracellular Ca++ increases the formation of actinomyosin and increases the force of myocardial contractions.
C) Digoxin binds to and inhibits Na/K ATPase. Inhibition of Na/K ATPase increases intracellular concentration of Na+ ions. Increased intracellular Na+ decreases the activity of the Na/Ca exchanger and allows intracellular Ca++ concentrations to increase. Increased intracellular Ca++ increases the formation of actinomyosin and increases the force of myocardial contractions.
D) None of the above are correct.

Question 12

Identify the main therapeutic effect of diuretic agents.

A) The elimination of excess potassium and calcium by the kidneys
B) The elimination of excess sodium and water by the kidneys
C) The elimination of excess renin and glucose by the kidneys
D) The elimination of excess aldosterone and serotonin by the kidneys

Question 13

Which of the following accurately describes the therapeutic action of the beta-blockers in the treatment of chronic heart failure?

A) Beta-blockers inhibit the release of renin, which in turn prevents the formation of angiotensin II, which causes vasoconstriction.
B) Beta-blockers decrease the rate at which the heart beats and reduce the force of the contractions of the heart.
C) Beta-blockers reduce the conduction of electrical impulses from the atria, which increases the blood pressure.
D) None of the above are correct.

Question 14

Select the preferred beta-blockers used for the treatment of chronic heart failure.

A) Ramipril (Altace) and Lisinopril (Zestril)
B) Metoprolol (Lopressor) and carvedilol (Coreg)
C) Atenolol (Tenormin) and metoprolol (Lopressor)
D) None of the above

Question 15

Explain the difference between hyperkalemia and hypercalcemia.

A) Hyperkalemia refers to low serum potassium, and hypercalcemia refers to high serum calcium.
B) Hypercalcemia refers to high serum potassium, and hyperkalemia refers to high serum calcium.
C) Hyperkalemia refers to high serum potassium, and hypercalcemia refers to high serum calcium.
D) Hyperkalemia refers to high serum potassium, and hypercalcemia refers to low serum calcium.

Question 16

Identify the difference between preload and afterload.

A) Preload is the force (force of ventricular contraction) that the heart must generate in order to overcome vascular resistance (open the aortic valve) and eject blood out of the left ventricle. Afterload is the amount of blood returning to the heart (venous return).
B) Preload is the force (force of atrial contraction) that the heart must generate in order to eject blood out of the right ventricle. Afterload is the amount of blood ejected by the left ventricle.
C) Preload is the amount of blood returning to the heart (venous return). Afterload is the force (force of ventricular contraction) that the heart must generate in order to overcome vascular resistance (open the aortic valve) and eject blood out of the left ventricle.
D) None of the above are correct.

Question 17

Which of the following statements is true of angiotensin receptor blockers (ARBs)?

A) The effect of using ARBs is similar to the effect of using the ACE inhibitors except that ARBs do not increase bradykinin.
B) The effect of using ARBs is similar to the effect of using the ACE inhibitors except that ARBs do not decrease pre- and afterload.
C) The effect of using ARBs is similar to the effect of using the ACE inhibitors except that ARBs do not increase cardiac output.
D) The effect of using ARBs is similar to the effect of using the ACE inhibitors except that ARBs only decrease preload and not afterload.

Question 18

Which of the following loop diuretics has the shortest duration of action?

A) Torsemide (Demadex)
B) Furosemide (Lasix)
C) Bumetanide (Bumex)
D) Eplerenone (Inspra)

Question 19

Identify the physiologic action that results from the administration of venodilators such as nitroglycerin and isosorbide dinitrate.

A) Venodilators reduce venous return to the heart.
B) Venodilators increase cardiac output.
C) Venodilators decrease the rate of contraction of the heart.
D) All of the above are correct.

Question 20

What does the presence of excessive ST segment and T wave depression on an ECG indicate?

A) Excess of aldosterone in the body
B) Excess of antidiuretic hormone in the body
C) Digoxin toxicity
D) Bilirubin toxicity

Question 21

_____ enhances the action of digoxin and can lead to arrhythmias.

A) Hyperkalemia
B) Hyperglycemia
C) Hypercalcemia
D) Hypocholesterolemia

Question 22

Which of the following is true of digoxin?

A) Digoxin is bound significantly to plasma proteins.
B) Food delays the absorption of digoxin.
C) Food interferes with the extent of absorption of digoxin.
D) Digoxin should only be administered intravenously.

Question 23

Which of the following adverse effects is generally associated with venodilators but not with arterial dilators?

A) Nausea
B) Postural hypotension
C) Headache
D) Vasomotor flushing

Question 24

Terrence,a 42-year-old patient,presents with symptoms of chronic heart failure.His medical history reveals that he is allergic to ACEIs and administration of any ACEI to Terrence usually brings about a severe bout of angioedema.Which of the following drugs should be avoided?

A) Hydralazine
B) Captopril
C) Nitroglycerine
D) Isosorbide dinitrate

Question 25

Which of the following classes of drugs was originally obtained from the plant leaves of Digitalis purpurea and Digitalis lanata?

A) Angiotensin-converting enzyme inhibitors
B) Cardiac glycosides
C) Angiotensin receptor blockers
D) Diuretics

Question 26

Identify the primary mechanism of action of digoxin.

A) Release of nitric oxide
B) Blockade of angiotensin receptors
C) Blockade or norepinephrine receptors
D) Increase of myocardial contraction

Question 27

A patient is administered 1250 mcg of digoxin.When is the concentration of digoxin in the patient's body likely to reduce to 625 mcg?

A) Within an hour
B) Within 1 to 2 hours
C) Within a day
D) Within 1.5 to 2 days

Question 28

Raven is undergoing vasodilator therapy to treat chronic heart failure.She often feels nauseous and experiences headache.Her doctor switches her to a different drug hoping that the adverse effects would disappear.However,immediately after the initial administration of the drug,Raven presents with allergic reaction symptoms that resemble angioedema.Which of the following drugs was Raven most likely switched to?

A) Benazepril
B) Candesartan
C) Isosorbide dinitrate
D) Nitroglycerine

Question 29

A patient who is under digoxin therapy to treat chronic heart failure presents with symptoms such as nausea,vomiting,headache,and visual disturbances.Which of the following treatment options should be pursued?

A) The dose of digoxin should be increased.
B) The patient should be administered a calcium blocker instead of digoxin.
C) The patient should be taken off digoxin immediately.
D) The dose of digoxin should be reduced.

Question 30

How do thiazides and loop diuretics differ in their mechanisms of action?

A) They have different outcomes in the context of sodium retention.
B) They act at different sites in the kidney.
C) Thiazides are more potent than loop diuretics.
D) Thiazides cause hypokalemia, while loop diuretics cause hyperkalemia.

Question 31

Which of the following is the site at which aldosterone antagonists act?

A) The loop of Henle
B) The distal tubules of the kidney nephrons
C) The walls of the heart chambers
D) The collecting ducts of the nephrons

Question 32

Which of the following compensatory mechanisms is activated in the body in untreated chronic heart failure?

A) Blockade of epinephrine and norepinephrine receptors
B) Decrease in size of the walls of the heart chambers
C) Structural remodeling
D) Vasodilation

Question 33

Identify a true statement about digoxin.

A) Digoxin is bound significantly to plasma proteins.
B) Food does not delay the absorption of digoxin.
C) Digoxin is excreted mostly unmetabolized by the urinary tract.
D) Food interferes with the extent of absorption of digoxin.

Question 34

When is the use of Digoxin Immune Fab indicated?

A) Hyperkalemia
B) Hypercalcemia
C) Life-threatening digoxin intoxication
D) Nausea and headache

Question 35

The primary mechanism of action of arterial dilators such as hydralazine involves:

A) the inhibition of angiotensin II.
B) the formation of nitric oxide.
C) an increase in systemic blood pressure.
D) an increase in afterload.