第二十二章-抗心律失常药PPT课件

.,1,1.女性，44岁。八年来劳累后心慌气短。既往曾患过“风湿性关节炎”。近日因劳累病情加重，心慌，气短，咯血，不能平卧急诊入院。查体：半卧位，慢性重病容。脉搏80次/分，血压13.3/9.33kPa(100/70mmHg)。心向左侧扩大，心律不齐，心率120次/分，心尖区舒张期雷鸣样杂音，主动脉瓣区收缩期和舒张期杂音。肝肋下3cm，下肢轻度浮肿。诊断：风湿性心脏病，二尖瓣狭窄，主动脉瓣狭窄及关闭不全，心房纤颤，心功能不全II度。该病人在用强心药治疗的过程中，心率突然减为50次/分，此时应选用,反馈人数:0,参与人数:80,A.利多卡因B.肾上腺素C.吗啡D.阿托品E.苯妥英钠,.,2,2.女性，74岁。自觉因擦背着凉后两肩和后背阵阵酸痛，每阵10分钟左右，不发烧，仍可下床走动。于今晨1时许，突然出现心前区剧痛，并向双肩、后背和左臂放射，伴大汗，休息后不见缓解，早8点急诊住院。检查：年迈，半卧位，无明显青紫，颈静脉不怒张，肺（），心略向左侧扩大，心律尚齐，未闻心脏杂音及摩擦音。心电图：病理性Q波，ST段抬高，T波倒置。诊断：急性心肌梗塞。为防止室性心律失常的发生，病人应立即给予的药物是,A.利多卡因B.奎尼丁C.胺碘酮D.普萘洛尔E.苯妥英钠,.,3,3.女性，34岁，因过度劳累及情绪激动有心悸、胸前区不适、心晕及颈部胀满感，并伴有焦虑或恐惧。心电图：心室率常在160250次/分钟；QRS波群形态和正常窦性的QRS波型一样，间期小于0.10秒；有逆行P波。诊断为室上性心动过速，应首选的药是维拉帕米普鲁卡因胺胺碘酮利多卡因奎尼丁,投票人数:38,.,4,4.Whichofthefollowingisanantiarrhythmicagentthathasrelativelyfewelectrophysiologiceffectsonnormalmyocardialtissuebutsuppressesthearrhythmogenictendenciesofischemicmyocardialtissues?a.Propranololb.Procainamidec.Quinidined.Lidocainee.Disopyramide,投票人数:38,.,5,5.Ifquinidineanddigoxinareadministeredconcurrently,whichofthefollowingeffectsdoesquinidinehaveondigoxin?a.TheabsorptionofdigoxinfromtheGItractisdecreasedb.Themetabolismofdigoxinispreventedc.Theconcentrationofdigoxinintheplasmaisincreasedd.TheeffectofdigoxinontheAVnodeisantagonizede.TheabilityofdigoxintoinhibittheNa+K+-stimulatedATPaseisreduced,投票人数:38,.,6,6.Inapatientwhohashadattacksofparoxysmalatrialtachycardia,anidealprophylacticdrugisa.Adenosineb.Procainamidec.Lidocained.Nifedipinee.Verapamil,投票人数:38,.,7,7Thefirst-linedrugfortreatinganacuteattackofreentrantsupraven-triculartachycardia(SVT)isa.Adenosineb.Digoxinc.Propranolold.Phenylephrinee.Edrophonium,投票人数:38,.,8,8A64-year-oldmalewitharterioscleroticheartdisease(AHD)andCHFwhohasbeentreatedwithdigoxincomplainsofnausea,vomiting,anddiarrhea.HisEKGrevealsabigeminalrhythm.ThesymptomsandEKGfindingsoccurredshortlyafteranothertherapeuticagentwasaddedtohisregimen.Adrug-druginteractionissuspected.Whichagentwasinvolved?a.Lovastatinb.Hydrochlorothiazidec.Phenobarbitald.Nitroglycerine.Captopril,投票人数:38,.,9,9A66-year-oldmanhadamyocardialinfarct.Whichoneofthefollowingwouldbeappropriateprophylacticantiarrhythmictherapy?A.Lidocaine.B.Metoprolol.C.Procainamide.D.Quinidine.E.Verapamil.,投票人数:0,.,10,10.Suppressionofarrhythmiasresultingfromareentryfocusismostlikelytooccurifthedrug:A.HasvagomimeticeffectsontheAVnode.B.Isa-blocker.C.Convertsaunidirectionalblocktoabidirectionalblock.D.Slowsconductionthroughtheatria.E.Hasatropine-likeeffectsontheAVnode.,投票人数:0,.,11,11.A57-year-oldmanisbeingtreatedforanatrialarrhythmia.Hecomplainsofheadache,dizziness,andtinnitus.Whichoneofthefollowingantiarrhythmicdrugsisthemostlikelycause?A.Amiodarone.B.Procainamide.C.Propranolol.D.Quinidine.E.Verapamil.,投票人数:0,.,12,12.A58-year-oldwomanisbeingtreatedforchronicsuppressionofaventriculararrhythmia.After2monthsoftherapy,shecomplainsaboutfeelingtiredallthetime.Examinationrevealsarestingheartrateof10beatsperminutelowerthanherpreviousrate.Herskiniscoolandclammy.Laboratorytestresultsindicatelowthyroxinandelevatedthyroid-stimulatinghormonelevels.Whichofthefollowingantiarrhythmicdrugsisthelikelycauseofthesesignsandsymptoms?A.Amiodarone.B.Procainamide.C.Propranolol.D.Quinidine.E.Verapamil.,投票人数:0,.,13,13.维拉帕米抗心律失常的主要作用机制是阻滞Na+内流促进K+外流阻滞Ca2+内流阻滞1受体延长动作电位时程,投票人数:0,.,14,14.对室上性心动过速无效的药物是西地兰维拉帕米普萘洛尔利多卡因胺碘酮,投票人数:0,.,15,2020/4/27,15.A59-year-oldfemalewithmildCHFistreatedwithfurosemide.Whatisitsprimarymechanismofaction?a.Inhibitionofsodium-potassium(Na+,K+)adenosinetriphosphatase(ATPase)b.InhibitionofNa+,K+,chloride(Cl)cotransporterc.InhibitionofNa+,Clco-transporterd.InhibitionofCltransportere.InhibitionofCa2+divalentcation(Ca2+)transporter,投票人数:0,.,16,16.A59-year-oldmalewithahistoryofrheumaticheartdiseaseisfoundtohaveatrialfibrillation(AF),forwhichheistreatedwithdigoxin.TreatmentwithdigoxinconvertshisAFtoanormalsinusrhythmandmostlikelyresultsinadecreaseinwhichofthefollowing?a.Thelengthoftherefractoryperiodb.Thevelocityofshorteningofthecardiacmusclec.Theconductionvelocityintheatrioventricular(AV)noded.Theatrialmaximumdiastolicrestingpotential,投票人数:0,.,17,2020/4/27,17.Thecardiovascularresponsesofanormalmanwererecordedandareshownintheaccompanyingfigurefollowinga15-mininfusionofdrugX.WhichofthefollowingwasmostlikelydrugX?a.Methacholineb.Propranololc.Atropined.Isoproterenole.Norepinephrine,投票人数:0,.,18,2020/4/27,18.A75-year-oldfemaleincongestiveheartfailure(CHF)isnabletoclimbaflightofstairswithoutexperiencingshortnessofbreath.Digoxinisadministeredtoimprovecardiacmusclecontractility.Withintwoweeks,shehasamarkedimprovementinhersymptoms.Whatcellularactionofdigoxinaccountsforthis?a.Inhibitionofcyclicadenosine5-monophosphate(cAMP)synthesisb.Inhibitionofmitochondrialcalcium(Ca2+)releasec.Inhibitionofthesodium(Na+)pumpd.Inhibitionof-adrenergicstimulatione.Inhibitionofadenosinetriphosphate(ATP)degradation,投票人数:0,.,19,2020/4/27,19.Thetherapeuticactionof-adrenergicreceptorblockerssuchaspropranololinanginapectorisisbelievedtobeprimarilytheresultofa.Reducedproductionofcatecholaminesb.Dilationofthecoronaryvasculaturec.Decreasedrequirementformyocardialoxygend.Increasedperipheralresistancee.Increasedsensitivitytocatecholamines,投票人数:0,.,20,2020/4/27,20.普萘洛尔（心得安）对下列何种类型的心绞痛较好活动时发生的心绞痛活动、静息均可发生的心绞痛静息时发生的心绞痛支气管哮喘者并发心绞痛以上均可,投票人数:0,.,21,21Inahypertensivepatientwhoistakinginsulintotreatdiabetes,whichofthefollowingdrugsistobeusedwithextracautionandadvicetothepatient?a.Hydralazineb.Prazosinc.Guanethidined.Propranolole.Methyldopa,.,22,22Angiotensinconvertingenzyme(ACE)inhibitorsareassociatedwithahighincidenceofwhichofthefollowingadversereactions?a.Coughb.Hypokalemiac.Agranulocytosisd.Proteinuriae.Hirsutism,.,23,23A56-year-oldfemalehasrecentlydevelopedessentialhype