抗心律失常药课件

抗心律失常药课件第1页/共28页21.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:80A.利多卡因B.肾上腺素C.吗啡D.阿托品E.苯妥英钠第2页/共28页32.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.苯妥英钠第3页/共28页43.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160～250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Ａ．维拉帕米Ｂ．普鲁卡因胺Ｃ．胺碘酮Ｄ．利多卡因Ｅ．奎尼丁投票人数:38第4页/共28页54.Whichofthefollowingisanantiarrhythmicagentthathasrelativelyfewelectrophysiologiceffectsonnormalmyocardialtissuebutsuppressesthearrhythmogenictendenciesofischemicmyocardialtissues?a.Propranololb.Procainamidec.Quinidined.Lidocainee.Disopyramide投票人数:38第5页/共28页65.Ifquinidineanddigoxinareadministeredconcurrently,whichofthefollowingeffectsdoesquinidinehaveondigoxin?a.TheabsorptionofdigoxinfromtheGItractisdecreasedb.Themetabolismofdigoxinispreventedc.Theconcentrationofdigoxinintheplasmaisincreasedd.TheeffectofdigoxinontheAVnodeisantagonizede.TheabilityofdigoxintoinhibittheNa+K+-stimulatedATPaseisreduced投票人数:38第6页/共28页76.Inapatientwhohashadattacksofparoxysmalatrialtachycardia,anidealprophylacticdrugisa.Adenosineb.Procainamidec.Lidocained.Nifedipinee.Verapamil投票人数:38第7页/共28页87Thefirst-linedrugfortreatinganacuteattackofreentrantsupraven-triculartachycardia(SVT)isa.Adenosineb.Digoxinc.Propranolold.Phenylephrinee.Edrophonium投票人数:38第8页/共28页98A64-year-oldmalewitharterioscleroticheartdisease(AHD)andCHFwhohasbeentreatedwithdigoxincomplainsofnausea,vomiting,anddiarrhea.HisEKGrevealsabigeminalrhythm.ThesymptomsandEKGfindingsoccurredshortlyafteranothertherapeuticagentwasaddedtohisregimen.Adrug-druginteractionissuspected.Whichagentwasinvolved?a.Lovastatinb.Hydrochlorothiazidec.Phenobarbitald.Nitroglycerine.Captopril投票人数:38第9页/共28页109A66-year-oldmanhadamyocardialinfarct.Whichoneofthefollowingwouldbeappropriateprophylacticantiarrhythmictherapy?A.Lidocaine.B.Metoprolol.C.Procainamide.D.Quinidine.E.Verapamil.投票人数:0第10页/共28页1110.Suppressionofarrhythmiasresultingfromareentryfocusismostlikelytooccurifthedrug:A.HasvagomimeticeffectsontheAVnode.B.Isaβ-blocker.C.Convertsaunidirectionalblocktoabidirectionalblock.D.Slowsconductionthroughtheatria.E.Hasatropine-likeeffectsontheAVnode.投票人数:0第11页/共28页1211.A57-year-oldmanisbeingtreatedforanatrialarrhythmia.Hecomplainsofheadache,dizziness,andtinnitus.Whichoneofthefollowingantiarrhythmicdrugsisthemostlikelycause?A.Amiodarone.B.Procainamide.C.Propranolol.D.Quinidine.E.Verapamil.投票人数:0第12页/共28页1312.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第13页/共28页1413.维拉帕米抗心律失常的主要作用机制是Ａ．阻滞Na+内流Ｂ．促进K+外流Ｃ．阻滞Ca2+内流Ｄ．阻滞β1受体Ｅ．延长动作电位时程投票人数:0第14页/共28页1514.对室上性心动过速无效的药物是Ａ．西地兰Ｂ．维拉帕米Ｃ．普萘洛尔Ｄ．利多卡因Ｅ．胺碘酮投票人数:0第15页/共28页2023/4/91615.A59-year-oldfemalewithmildCHFistreatedwithfurosemide.Whatisitsprimarymechanismofaction?a.Inhibitionofsodium-potassium(Na+,K+)adenosinetriphosphatase(ATPase)b.InhibitionofNa+,K+,chloride(Cl−)cotransporterc.InhibitionofNa+,Cl−co-transporterd.InhibitionofCl−transportere.InhibitionofCa2+divalentcation(Ca2+)transporter投票人数:0第16页/共28页1716.A59-year-oldmalewithahistoryofrheumaticheartdiseaseisfoundtohaveatrialfibrillation(AF),forwhichheistreatedwithdigoxin.TreatmentwithdigoxinconvertshisAFtoanormalsinusrhythmandmostlikelyresultsinadecreaseinwhichofthefollowing?a.Thelengthoftherefractoryperiodb.Thevelocityofshorteningofthecardiacmusclec.Theconductionvelocityintheatrioventricular(AV)noded.Theatrialmaximumdiastolicrestingpotential投票人数:0第17页/共28页2023/4/91817.Thecardiovascularresponsesofanormalmanwererecordedandareshownintheaccompanyingfigurefollowinga15-mininfusionofdrugX.WhichofthefollowingwasmostlikelydrugX?a.Methacholineb.Propranololc.Atropined.Isoproterenole.Norepinephrine投票人数:0第18页/共28页2023/4/91918.A75-year-oldfemaleincongestiveheartfailure(CHF)isnabletoclimbaflightofstairswithoutexperiencingshortnessofbreath.Digoxinisadministeredtoimprovecardiacmusclecontractility.Withintwoweeks,shehasamarkedimprovementinhersymptoms.Whatcellularactionofdigoxinaccountsforthis?a.Inhibitionofcyclicadenosine5′-monophosphate(cAMP)synthesisb.Inhibitionofmitochondrialcalcium(Ca2+)releasec.Inhibitionofthesodium(Na+)pumpd.Inhibitionofβ-adrenergicstimulatione.Inhibitionofadenosinetriphosphate(ATP)degradation投票人数:0第19页/共28页2023/4/92019.Thetherapeuticactionofβ-adrenergicreceptorblockerssuchaspropranololinanginapectorisisbelievedtobeprimarilytheresultofa.Reducedproductionofcatecholaminesb.Dilationofthecoronaryvasculaturec.Decreasedrequirementformyocardialoxygend.Increasedperipheralresistancee.Increasedsensitivitytocatecholamines投票人数:0第20页/共28页2023/4/92120.普萘洛尔（心得安）对下列何种类型的心绞痛较好Ａ．活动时发生的心绞痛Ｂ．活动、静息均可发生的心绞痛Ｃ．静息时发生的心绞痛Ｄ．支气管哮喘者并发心绞痛Ｅ．以上均可投票人数:0第21页/共28页21Inahypertensivepatientwhoistakinginsulintotreatdiabetes,whichofthefollowingdrugsistobeusedwithextracautionandadvicetothepatient?a.Hydralazineb.Prazosinc.Guanethidined.Propranolole.Methyldopa第22页/共28页22Angiotensinconvertingenzyme(ACE)inhibitorsareassociatedwithahighincidenceofwhichofthefollowingadversereactions?a.Coughb.Hypokalemiac.Agranulocytosisd.Proteinuriae.Hirsutism第23页/共28页23A56-year-oldfemalehasrecentlydevelopedessentialhype