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What would be the effect of IV atropine (muscarinic antagonist) on resistance vessel tone?

A. Moderate increase in constrictor tone
B. Slight increase in constrictor tone
C. No effect on tone
D. Slight vasodilatory action
E. Moderate vasodilatory action



Which set of direct action / reflex compensatory response would you see following IV administration of phenylephrine?
Direct Effect Baroreceptor Reflex Action

A. Vasodilation Reflex bradycardia
B. Vasodilation Reflex tachycardia
C. Vasoconstriction Reflex bradycardia
D. Vasoconstriction Reflex tachycardia



In response to an acute decrease in blood pressure, what is the initial compensatory response?

A. Increased parasympathetic input to the SA node
B. Increased sympathetic input to the SA node
C. Increased release of aldosterone from the adrenal cortex
D. Increased angiotensin II in the bloodstream



Activation of the sympathetic nervous system in response (flight-or-fight response) to an environmental stressor causes epinephrine release from the adrenal gland, resulting in which of the following actions?

A. Decreased blood glucose levels
B. Bronchoconstriction
C. Pupil constriction (miosis)
D. Increase in AV node conduction velocity
E. Increased GI motility
F. Relaxation of peripheral resistance vessels



Which of the following autonomic nervous system drugs would be MOST likely to predispose a patient to cardiac arrhythmias due to an increase in cardiac conduction rate?

A. Albuterol
B. Atenolol
C. Isoproterenol
D. Pilocarpine
E. Propranolol



A concern when examining patients is the possibility that they may be taking medications that interfere with the function of the baroreceptor reflex and can increase the potential for orthostatic hypotension. This would be most likely to occur with which class of autonomic nervous system drugs?

A. Atropine
B. Pilocarpine
C. Neostigmine
D. Doxazosin
E. Albuterol



Which of the following statements concerning the ions and ion channels involved in the cardiac ion potential is FALSE?

A. “Trigger” Ca++ for cardiac muscle contraction moves into ventricular cells during phase 2 of the action potential.
B. Phase 0 current in ventricular muscle cells is carried by Na+ ions.
C. Phase 4 current in the SA node pacemaker cells is an important determinant of automaticity.
D. Repolarization (phase 3) in ventricular cells occurs when potassium channels close



As a calcium channel blocker, diltiazem (Cardizem®) would be categorized in which class of antiarrhythmic agents?

A. Class I
B. Class II
C. Class III
D. Class IV
E. Miscellaneous



A 58-year-old man had a myocardial infarction. Which of the following should be used to prevent life-threatening arrhythmias that can occur post-MI in this patient?

A. Flecainide
B. Digoxin
C. Metoprolol
D. Lidocaine
E. Amiodarone



The most common mechanism of arrhythmias, accounting for as many as 85% of all arrhythmias, is:

A. Failure of impulse initiation at SA node
B. Failure of impulse conduction thru AV node
C. Enhanced automaticity at SA node
D. Triggered automaticity in ventricular tissue
E. Abnormal impulse conduction due to reentry phenomenon



Suppression of arrhythmias resulting from a reentry focus is most likely to occur if the drug:

A. Has vagomimetic properties on the AV node
B. Is a beta-blocker
C. Converts a unidirectional block to a bidirectional block
D. Slows conduction through the atria
E. Has atropine-like effects at the AV node



A 78-year-old woman has been newly diagnosed with atrial fibrillation. She is currently not having symptoms of fatigue or palpitations. Which drug is appropriate to initiate for rate control?

A. Amiodarone
B. Metoprolol
C. Sotalol
D. Lidocaine
E. Flecainide



Which of the following is correct regarding digoxin when used for atrial fibrillation?

A. Digoxin works by blocking voltage-sensitive calcium channels
B. Digoxin produces vagomimetic effects at the AV node
C. Digoxin is used for rhythm control in patients with atrial fibrillation
D. Digoxin increases conduction velocity through the AV node



The drugs most commonly used for rate control in patients with atrial fibrillation include:

A. Beta-blockers
B. Verapamil
C. Diltiazem
D. Amlodipine
E. All of the above

A, B and C


Which of the following beta-blockers is not available in an oral formulation?

A. Metoprolol
B. Propranolol
C. Esmolol
D. Carvedilol



Adverse effects of amiodarone include:

A. Bluish-gray skin discoloration
B. Pulmonary fibrosis
C. Hyperthyroidism
D. Hyperthyroidism
E. All of the above



The most effective drug available for maintenance of sinus rhythm in atrial fibrillation is:

A. Sotalol
B. Amiodarone
C. Diltiazem
D. Dronedarone



The treatment of choice for urgent conversion of atrial fibrillation to normal sinus rhythm is:

A. Anticoagulation
B. Catheter ablation
C. DC cardioversion
D. Digoxin



Lidocaine’s efficacy in the treatment of ventricular is related to which electrophysiologic action?

A. Block of L-type Ca++ channels at the AV node
B. Block of phase 3 K+ channels that mediate repolarization
C. Block of phase 0 Na+ channels that conduct impulses throughout the heart
D. Block of β1 receptors on cardiac muscle
E. Activation of purinergic receptors at the AV node



Lidocaine has the greatest efficacy in the treatment of which arrhythmia?

A. Torsades de pointes
B. Ventricular fibrillation
C. Atrial fibrillation
D. Atrial flutter
E. Ventricular tachycardia
F Supraventricular tachycardia



Which drug is most likely to exacerbate heart failure?

A. Acetaminophen
B. Naproxen
C. Oxycodone
D. Ibuprofen
E. Amoxicillin
F. Triazolam
G. Nitrous oxide

B and D


A 68-year-old white man with heart failure with reduced ejection fraction being treated with enalapril and carvedilol comes to your office complaining of shortness of breath. On physical exam, he has bilateral rales and edema in both lower extremities. Which of the following would you recommend for acute relief of symptoms in this patient?

A. Combination of hydralazine and isosorbide dinitrate
B. Valsartan
C. Loop diuretic
D. Thiazide diuretic
E. Digoxin



Jake is a 75-year-old male who has heart failure. He is seen in your clinic today reporting shortness of breath, increased pitting edema, and a 5 pound weight gain. His current medication regimen includes lisinopril and metoprolol. He has no chest pain and is deemed stable for outpatient treatment. Which of the following is the best recommendation?

A. Increase the dose of lisinopril
B. Add digoxin
C. Start HCTZ
D. Start furosemide
E. Discontinue the metoprolol



A 59-year-old white man presents post-MI with heart failure symptoms and a LVEF of 29%. He is currently being treated with an ACE inhibitor and metoprolol succinate ER. Which of the following drugs has been shown to prolong survival in such a patient?

A. Digoxin
B. Eplerenone
C. Hydrochlorothiazide
D. Hydralazine and isosorbide dinitrate



Describe the beneficial effect of spironolactone in HF:

A. Promotes potassium excretion
B. Promotes sodium retention
C. Activates aldosterone receptors
D. Blocks cardiac hypertrophy
E. Decreases renin release



A male patient is placed on a new medication for heart failure and notes that his breasts have become tender to the touch. Which medication is he most likely taking?

A. Carvedilol
B. Eplerenone
C. Furosemide
D. Hydrochlorothiazide
E. Spironolactone
F. Lisinopril



Beneficial actions of ACE inhibitors on the failing heart include:

A. Decreased adrenal release of aldosterone
B. Increased vascular resistance
C. Decreased cardiac output
D. Reduced preload
E. Reduced heart rate
F. Decreased cardiac remodeling action of angiotensin II

A, D and F


In patients with heart failure with reduced ejection fraction, ACE inhibitors have been shown to:

A. Improve symptoms
B. Decrease hospitalizations
C. Prolong survival
E. All of the above



The most common adverse effect of ACE inhibitors is:

A. Cough
B. Angioedema
C. Hypokalemia
D. Dizziness



Angiotensin receptor blockers (ARBs):

A. Are less effective than ACE inhibitors for treatment of chronic heart failure
B. Are more likely than ACE inhibitors to cause angioedema
C. Do not cause cough
D. All of the above