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Anti-arrhythmic drugs
Document created: 07.12.2021 21:02
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Intro Slide
Anti-arrhythmic drugs
by Shivankan Kakkar, MD (Gold Medal)
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Question Group 1 (20/20 questions)
Info Slide 1.
Anti-arrhythmic drugs
Recall MCQs (for practice and test)
from various
NEET PG,
INICET and
FMGE entrance exams.
Best of Luck!
Question 2. Multiple Choice, 10 points, 4 attempts
Which anti-arrhythmic drug should NOT be given in a patient with pulmonary fibrosis?

4. 4
Correct Choices Feedback
V
Amiodarone
RECALL AMIODARONE HAS THE SIDE EFFECT OF
Pulmonary fibrosis so is best avoided in this patient
RECALL AMIODARONE ALL SIDE EFFECTS
Pulmonary fibrosis, hepatotoxicity, hypothyroidism or hyperthyroidism
(amiodarone is 40% iodine by weight), acts as hapten (corneal deposits,
blue/gray skin deposits resulting in photodermatitis), neurologic effects,
constipation, cardiovascular effects (bradycardia, heart block, HF).
Remember to check PFTs, LFTs, and TFTs when using amiodarone.

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Correct Choices Feedback
Flecainide
It's side effects are:-
Proarrhythmic, especially post-MI (contraindicated).
Flecainide is Class IC
IC is Contraindicated in structural and ischemic heart disease.
lV ibutilide Ibutilide can have the side Effect: torsades de pointes.
Lidocaine It's side effects are: CNS stimulation/depression, cardiovascular depression.
Lidocaine is Class IB.
Question 3. Multiple Choice, 10 points, 4 attempts
Mechanism of action of Digitalis in atrial fibrillation is:
Correct Choices Feedback
By decreasing cardiac
contractility
It increases the cardiac contractility
Na+ K+ ATPase
inhibition
It helps in increasing cardiac contractility by inhibiting Na-K-ATPase.
Remember

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Correct Choices Feedback
Digoxin has two cardiac effects.
V
Increase in
refractoriness of AV
nodal tissue
Recall
Remember
Digoxin has two cardiac effects.
By causing
bradycardia
Try again!

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Question 4. Multiple Choice, 10 points, 4 attempts
Amiodarone side effect all EXCEPT:
Correct Choices Feedback
Hepatic
cirrhosis
Try again!
Corneal
micro-
deposits
Try again!
V
Dry
chronic
cough
Recall: Side effects of Amiodarone:-
—pulmonary fibrosis, hepatotoxicity, hypothyroidism or hyperthyroidism
(amiodarone is 40% iodine by weight), acts as hapten (corneal deposits,
blue/gray skin deposits resulting
in photodermatitis), neurologic effects, constipation, cardiovascular effects
(bradycardia, heart block, HF).
Remember to check PFTs, LFTs, and TFTs when using amiodarone.
Amiodarone is lipophilic and has class I, II, III, and IV effects.

8. 8
Correct Choices Feedback
Pulmonary
fibrosis
Try again!
Question 5. Multiple Choice, 10 points, 4 attempts
Drug of choice for termination of paroxysmal supraventricular ventricular tachycardia is:

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Correct Choices Feedback
Calcium
channel
blocker
These are for prevention of nodal arrhythmias (SVT), rate control in atrial
fibrillation.
Beta-
blocker
These are for SVT, ventricular rate control for atrial fibrillation and atrial flutter
Digoxin
Used in atrial fibrillation
V Adenosine
Drug of choice in diagnosing/terminating certain forms of SVT. Very short acting
(~ 15 sec). Effects blunted by theophylline and caffeine (both are adenosine
receptor antagonists). Adverse effects include flushing, hypotension, chest pain,
sense of impending doom, bronchospasm (do not use in asthmatics).

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Correct Choices Feedback
Question 6. Multiple Choice, 10 points, 4 attempts
The anti-arrhythmic drug is:
Correct Choices Feedback
Phentolamine alpha blocker
Phenobarbitone Sedative hypnotic drug

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Correct Choices Feedback
V Procainamide
Class IA anti-arrhythmic drug
Side effect: reversible SLE-like syndrome
Pentamidine Antimicrobial agent
Question 7. Multiple Choice, 10 points, 4 attempts
A 80-year-old woman has been newly diagnosed with atrial fibrillation. She is not currently having
symptoms of palpitations or fatigue. Which is appropriate to initiate for rate control as an outpatient?
Correct Choices Feedback
Amiodarone Rhythm control
Dronedarone Rhythm control
Esmolol Esmolol is IV only, cannot be used on OPD basis
Flecainide Rhythm control
V Metoprolol
Since Esmolol is IV only, the only option to start as an outpatient is
Metoprolol.
Question 8. Multiple Choice, 10 points, 4 attempts
A 62-year-old woman is being treated for chronic suppression of a ventricular arrhythmia. After 1 week
of therapy, she complains about feeling severe upset stomach and heartburn. Which antiarrhythmic
drug is the likely cause of these symptoms?

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Correct Choices Feedback
Amiodarone Does not cause dyspepsia
Digoxin Does not cause dyspepsia
V Mexiletine
The patient is exhibiting a classic adverse effect of mexiletine. None of the
other agents listed are likely to cause dyspepsia.
Mexiletine side effects include:
 nausea.
 vomiting.
 heartburn.
 changes in appetite.
 lightheadedness or dizziness.
 shaking of a part of your body that you cannot control.
 loss of coordination.
 numbness or tingling sensation.
Other side effects of class IB drugs
Propranolol Does not cause dyspepsia
Quinidine Does not cause dyspepsia

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Question 9. Multiple Choice, 10 points, 4 attempts
All of the following are used in atrial arrhythmias EXCEPT:
Correct Choices Feedback
Digoxin Try again!
Verapamil Try again!
Quinidine Try again!
V Lidocaine
Lidocaine is used for Acute ventricular arrhythmias (especially post- MI), digitalis-
induced arrhythmias.
Lidocaine is class IB
IB is Best post-MI.

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Correct Choices Feedback
Question 10. Multiple Choice, 10 points, 4 attempts
Iodine content in amiodarone is:
Correct Choices Feedback
10-20% Try again!
V 20-40%
amiodarone is 40% iodine by weight
40-60% Try again!
60-80% Try again!
Question 11. Multiple Choice, 10 points, 4 attempts
Drug of choice for ventricular premature beats (VPC) due to digitalis toxicity is:

15. 15
Correct Choices Feedback
V Phenytoin
Phenytoin is an alternative to lidocaine for digitalis induced ventricular
arrhythmia
Both are Class IB drugs
Uses of Class IB drugs: - Acute ventricular arrhythmias (especially post- MI),
digitalis-induced arrhythmias.
IB is Best post-MI
Quinidine Try again!
Amiodarone Try again!
Verapamil Try again!
Question 12. Multiple Choice, 10 points, 4 attempts
Arrhythmias refractory to the treatment of lidocaine can be treated by:

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Correct Choices Feedback
Quinidine Try again!
V Amiodarone
Amiodarone is used for refractory arrhythmias.
Diltiazem Try again!
Sotalol Try again!
Question 13. Multiple Choice, 10 points, 4 attempts
In a patient of congenital prolonged QT syndrome and intermittent Torsades de pointes,
which of the following should be prescribed:

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Correct Choices Feedback
V Magnesium sulphate
Metoprolol Try again!
Cardiac pacing Try again!
Isoprenaline Try again!
Question 14. Multiple Choice, 10 points, 4 attempts
Urgent treatment of procainamide toxicity is:

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Correct Choices Feedback
Calcium
chelation
Try again!
Potassium
chloride
Try again!
Nitroprusside Try again!
V
Sodium
lactate
Pressor agents (to reverse hypotension) and sodium lactate (to reverse
arrhythmias) are indicated for the treatment of procainamide toxicity.
Recall

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Question 15. Multiple Choice, 10 points, 4 attempts
Which of the following drugs can cause Torsades de pointes?
Correct Choices Feedback
V Quinidine
torsades de pointes due to QT interval prolongation

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Correct Choices Feedback
Drugs having cardiac K+ channel blocking activities can cause this arrhythmia.
These include:
– Class Ia antiarrhythmics -Quinidine, Procainamide (Na+ and K+ channel
blockers)
– Class III antiarrhythmics -Bretylium, sotalol, dofetilide, ibutilide and
amiodarone (K+ channel blockers)
– Other drugs like Terfenadine, Cisapride, Astemizole, Sparfloxacin, Gatifloxacin,
Grepafloxacin, Mefloquine, Pentamidine, Thioridazine, Ziprasidone etc.
Lidocaine Try again!
Esmolol Try again!
Flecainide Try again!
Question 16. Multiple Choice, 10 points, 4 attempts
Which of the following anti-arrhythmic agents does NOT belong to class IC?
Correct Choices Feedback
Encainide Class IC
Flecainide Class IC

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Correct Choices Feedback
V Tocainide
Althrough the name is similiar to class IC agents (like flecainide, encanide),
tocainide comes under class IB.
Class IB drugs include:
Lidocaine
Mexiletine
Phenytoin
Tocainide
Propafenone Class IC
Question 17. Multiple Choice, 10 points, 4 attempts
The drug of choice for rapid correction of PSVT in known asthmatic is:
Correct Choices Feedback
Adenosine
Adenosine may precipitate bronchospasm in asthmatics, so not preferred in
asthmatics.
Recall
Adenosine is the DOC for acute termination of PSVT. Esmolol and verapamil
are alternative 2nd choice drugs.
Neostigmine
Hint:
Adenosine is the DOC for acute termination of PSVT. Esmolol and verapamil
are alternative 2nd choice drugs.
Although, Adenosine may precipitate bronchospasm in asthmatics,
V Verapamil
In asthmatic patients, verapamil (as well as nifedipine) given by inhalation
significantly inhibits the bronchoconstriction induced by variety of stimuli.
Recall

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Correct Choices Feedback
Adenosine is the DOC for acute termination of PSVT. Esmolol and verapamil
are alternative 2nd choice drugs.
Esmolol
Beta-blockers should be avoided in asthmatics, if absolutely necessary,
cardioselective β blockers (e.g. esmolol) should be used.
However, in asthmatic patients, verapamil (as well as nifedipine) given by
inhalation significantly inhibits the bronchoconstriction induced by variety of
stimuli.
Recall
Adenosine is the DOC for acute termination of PSVT. Esmolol and verapamil
are alternative 2nd choice drugs.
Question 18. Multiple Choice, 10 points, 4 attempts
Which of the following drugs is used for termination as well as prophylaxis of paroxysmal
supraventricular tachycardia?
Correct Choices Feedback
Digoxin Try again!
V Verapamil It is used for the treatment as well as prophylaxis of PSVT .
Propanolol Try again!
Adenosine Adenosine is used only for the treatment of acute attack of PSVT

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Question 19. Multiple Choice, 10 points, 4 attempts
Characteristic adverse effect of quinidine includes:
Correct Choices Feedback
Lupus
erythematosis
Adverse effect of procainamide not quinidine
V Cinchonism

24. 24
Correct Choices Feedback
Increase in
digoxin
clearance
reduces the clearance
Precipitation of
hyperthyroidism
Side effect of Amiodarone
RECALL all side effects of amiodarone
pulmonary fibrosis, hepatotoxicity, hypothyroidism or hyperthyroidism
(amiodarone is 40% iodine by weight), acts as hapten (corneal deposits,
blue/gray skin deposits resulting
in photodermatitis), neurologic effects, constipation, cardiovascular effects
(bradycardia, heart block, HF).
Question 20. Multiple Choice, 10 points, 4 attempts
Class III anti arrythmic drug is:
Correct Choices Feedback
V Amiodarone
Phenytoin Class IB
Propafenone Class IC

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Correct Choices Feedback
Verapamil Class IV
Question 21. Multiple Choice, 10 points, 4 attempts
Which of the following drug has the longest half-life:
Correct Choices Feedback
V Amiodarone
Quinidine Try again!
Diltiazem Try again!
Procainamide Try again!

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