34 Questions
Which medication is recommended for patients with NYHA Class II-III symptomatic chronic heart failure with reduced LVEF in place of ACE inhibitors or ARBs to further improve morbidity and survival?
Sacubitril/valsartan (ARNi)
Which medication is indicated for patients who cannot tolerate ACE inhibitors or ARBs due to poor renal function, history of angioedema, or hyperkalemia?
Hydral-Nitrates
Which medication is recommended for patients with NYHA III or IV heart failure who are still symptomatic despite treatment with ACE inhibitors, ARBs, ARNi, and beta blockers?
Ivabradine
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 drug is the most frequent cause of drug-induced lupus?
Procainamide
Which drug is not recommended for use in patients with chronic atrial fibrillation?
Flecainide
Which class of medications is contraindicated in patients with vasospastic angina?
Beta Blockers
What is the first-line therapy for prophylaxis and daily maintenance monotherapy of chronic stable angina?
Beta Blockers
Which medication is the most commonly used agent for rhythm control in atrial fibrillation?
Amiodarone
What is the major effect of nitrates on venous smooth muscle and preload?
Decreased preload
Which type of angina is indicated for treatment with nitrates?
Variant Angina
What is the consequence of continuous nitrate use?
Development of tolerance
What are the side effects of sublingual NTG?
Dizziness and headache
Which factor is associated with the greatest benefits in patients receiving Digoxin?
NYHA class III-IV
Which of the following is a rationale for using aldosterone antagonists (AA) in severe HF?
Improvement of cardiac remodeling
Which of the following describes the properties of B-type natriuretic peptide (BNP)?
Reduces pulmonary capillary wedge pressure (PCWP)
Which inotropic agent is preferred for preload reduction in severe HF, and which vasodilator is the choice for severe HF and acute MI?
NTG; NTG
Which drug is contraindicated in patients with congenital or acquired long QT syndrome, QT interval > 440 msec, or severe renal impairment?
Dofetilide
Which drug is indicated for the conversion to and maintenance of normal sinus rhythm (NSR) in patients with atrial fibrillation (AF)?
Dofetilide
Which drug is contraindicated in patients with WPW syndrome accompanied by atrial fibrillation (AF) or atrial flutter (AFlutter)?
Verapamil
Which drug is indicated for the rapid conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm (NSR)?
Ibutilide
Which class of antiarrhythmic drugs includes lidocaine and mexiletine?
Class IB
Which class of antiarrhythmic drugs is most useful in tachycardias?
Class II
Which class of antiarrhythmic drugs prolongs action potential duration and delays repolarization?
Class III
Which class of antiarrhythmic drugs blocks calcium channels and slows conduction of SA and AV nodes?
Class IV
Which medication is indicated for patients with NYHA Class II-III symptomatic chronic heart failure with reduced LVEF in place of ACE inhibitors or ARBs to further improve morbidity and survival?
ARNi
Which medication is recommended for patients with NYHA III or IV heart failure who are still symptomatic despite treatment with ACE inhibitors, ARBs, ARNi, and beta blockers?
Digoxin
Which class of medications is contraindicated in patients with vasospastic angina?
Beta blockers
Which drug is indicated for the rapid conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm (NSR)?
Digoxin
Which neurohormonal factors are reduced by beta blockers in the treatment of 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 of angiotensin converting-enzyme inhibitors (ACEI) in interrupting the cycle of heart failure?
Inhibiting the synthesis of angiotensin II
What is the mechanism of action for sacubitril/valsartan (ARNi) in the treatment of heart failure?
Inhibition of neprilysin
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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