30 Questions
Which of the following is the preferred agent for preload reduction in severe heart failure?
Milrinone
What is the endogenous source of B-type natriuretic peptide (BNP)?
Ventricular Muscles
Which of the following drugs used in the management of heart failure is not associated with improved survival?
Digoxin
Which class of antiarrhythmic agents is contraindicated in patients with structural heart disease?
Class IC agents
Which medication is the drug of choice for pharmacologic cardioversion (conversion to normal sinus rhythm)?
Ibutilide
Which antianginal drug is indicated for stable and Prinzmetal's angina, but contraindicated in vasospastic angina?
Non-DHP CCB
Which medication is recommended for patients with NYHA Class II-IV heart failure to reduce hospitalizations and cardiovascular death?
Sacubitril/valsartan (ARNi)
Which medication is indicated for patients who cannot tolerate ACE inhibitors/ARBs due to poor renal function/history of angioedema, or hyperkalemia?
Hydral-Nitrates
Which medication is recommended as adjunct therapy for patients with NYHA II-III heart failure, LVEF <35%, sinus rhythm with resting HR 70 BPM, and either on maximally tolerated beta blockers or have contraindications to beta blockers?
Ivabradine
Which neurohormonal factors are reduced by beta blockers in left ventricular systolic dysfunction?
Norepinephrine and angiotensin II
Which types of heart failure patients should not receive beta blockers?
Patients with reactive airways disease
What is the mechanism of action for sacubitril/valsartan in heart failure?
Inhibition of neprilysin
Which drug is contraindicated in patients with G6PD deficiency?
Quinidine
What is the major metabolite of procainamide and how is it formed?
N-acetylprocainamide (NAPA), formed by acetylation in the liver
Which antiarrhythmic drug is not recommended for use in patients with chronic atrial fibrillation?
Flecainide
Which drug is contraindicated in patients with congenital or acquired long QT syndrome, severe renal impairment, and a QT interval greater than 440 msec?
Dofetilide
Which drug is indicated for the rapid conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm (NSR)?
Adenosine
Which drug is used for ventricular rate control in supraventricular arrhythmias, such as atrial fibrillation (AF)?
Digoxin
Which class of antiarrhythmic drugs blocks sodium channels and has varying effects on action potential duration (APD) and effective refractory period (ERP)?
Class I
Which class of antiarrhythmic drugs is most useful in tachycardias?
Class II
Which class of antiarrhythmic drugs blocks calcium channels and slows conduction of SA and AV nodes?
Class IV
Which route of administration is not mentioned in the text for nitroglycerin?
Intramuscular
What effect does nitroglycerin have on coronary vascular resistance?
Decreases Coronary Vascular Resistance
How does nitroglycerin redistribute coronary blood flow?
To the subendocardial regions of the heart
Which type(s) of angina are nitrates indicated for?
All types of angina
What is the indication for using sublingual nitroglycerin?
Rapid relief of anginal pain
What are the side effects of nitroglycerin due to vasodilation?
Dizziness, headache, flushing, faintness, postural hypotension
What is the recommended storage condition for sublingual nitroglycerin tablets?
Dry place at room temperature
What is the consequence of continuous nitrate use?
Development of tolerance to the antianginal effect
What is the recommended method for preventing tolerance to nitroglycerin?
Interrupt nitrate therapy for a interval every day
Study Notes
Overview of Vaughan Williams Classification and Medications for Antiarrhythmics
- Vaughan Williams Classification is a system used to categorize antiarrhythmic drugs based on their dominant electrophysiological effect.
- The classification is controversial because it does not include all antiarrhythmic drugs and some agents have mechanisms that overlap between classes.
- Class I drugs include Class IA (disopyramide, quinidine, procainamide), Class IB (lidocaine, mexiletine), and Class IC (flecainide, propafenone).
- Class II drugs are beta blockers, including acebutolol, propranolol, and esmolol.
- Class III drugs include amiodarone, sotalol, and dofetilide.
- Class IV drugs are calcium channel blockers, including verapamil and diltiazem.
- Class I drugs block sodium channels and have varying effects on action potential duration (APD) and effective refractory period (ERP).
- Beta blockers decrease myocardial activity and are most useful in tachycardias.
- Class III drugs prolong action potential duration and delay repolarization.
- Class IV drugs block calcium channels and slow conduction of SA and AV nodes.
- Indications for the medications vary, but include treatment of ventricular arrhythmias, conversion to normal sinus rhythm, and prevention of atrial fibrillation/flutter.
- Contraindications for quinidine include cinchonism, which can cause symptoms such as tinnitus, headache, and visual disturbances.
Test your knowledge on Vaughan Williams Classification and the medications used for antiarrhythmics. Learn about the different drug classes, their mechanisms of action, and their indications. Discover the controversies surrounding the classification system and understand the contraindications for specific medications.
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