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  • Question 1 - You're called to a cardiac arrest in your Emergency Department resuscitation area. The...

    Correct

    • You're called to a cardiac arrest in your Emergency Department resuscitation area. The rhythm strip is shown in the diagram below. Defibrillation has already been attempted three times on the patient. You intended to administer amiodarone, but your department has informed you that it is not available. In these circumstances, if amiodarone is not available, which of the following drugs is recommended by the ALS guidelines? Ventricular fibrillation

      Your Answer: Lidocaine

      Explanation:

      If amiodarone is unavailable in VF/pVT arrests, lidocaine at a dose of 1 mg/kg can be used instead, according to the latest ALS guidelines. If amiodarone has already been given, no lidocaine should be given.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      14.6
      Seconds

  • Question 2 - For the treatment of his atrial fibrillation, a 59-year-old man is about to...

    Correct

    • For the treatment of his atrial fibrillation, a 59-year-old man is about to begin taking warfarin. He also takes a number of other medications.

      Which of the following medications will enhance warfarin's effects?

      Your Answer: Erythromycin

      Explanation:

      Many medications, including warfarin, require cytochrome P450 enzymes for their metabolism. When co-prescribing cytochrome p450 enzyme inducers and inhibitors with warfarin, it’s critical to be cautious.

      Inhibitors of the cytochrome p450 enzyme potentiate the effects of warfarin, resulting in a higher INR. To remember the most commonly encountered cytochrome p450 enzyme inhibitors, use the mnemonic O DEVICES:

      O– Omeprazole
      D– Disulfiram
      E– Erythromycin (And other macrolide antibiotics)
      V– Valproate (sodium valproate)
      I– Isoniazid
      C– Ciprofloxacin
      E– Ethanol (acute ingestion)
      S- Sulphonamides

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      42.9
      Seconds

  • Question 3 - A 67-year-old man complains of chest pain and goes to the emergency room....

    Correct

    • A 67-year-old man complains of chest pain and goes to the emergency room. He takes several medications, including amiodarone.

      Which of the following is amiodarone mechanism of action?

      Your Answer: Blocks Na + and K + channels and beta-adrenoreceptors in the heart

      Explanation:

      Amiodarone is an anti-arrhythmic medication that can be used to treat both ventricular and atrial arrhythmias. It’s a class III anti-arrhythmic that works by blocking a variety of channels, including Na+ and K+ channels, as well as beta-adrenoreceptors. As a result, it slows conduction through the SA and AV nodes and prolongs phase 3 of the cardiac action potential (slowing repolarisation).

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      48.7
      Seconds

  • Question 4 - An ambulance transports a 72-year-old woman to the Emergency Department. She is confused,...

    Correct

    • An ambulance transports a 72-year-old woman to the Emergency Department. She is confused, has been vomiting and having stomach pains. Digoxin is one of her medications.

      Which of the following claims about digoxin is correct?

      Your Answer: Therapeutic plasma levels are between 1.0-1.5 nmol/l

      Explanation:

      Digoxin is a cardiac glycoside that is used to treat atrial fibrillation and flutter, as well as congestive heart failure. In cardiac myocytes, it works by inhibiting the membrane Na/K ATPase. Through Na/Ca exchange, this raises intracellular sodium concentration and indirectly increases intracellular calcium availability. Increased intracellular calcium levels have both a positive inotropic and negative chronotropic effect.

      Digoxin therapeutic plasma levels are typically between 1.0 and 1.5 nmol/l, though higher concentrations may be required, and the value varies between laboratories. At concentrations greater than 2 nmol/l, the risk of toxicity increases dramatically.

      In patients with normal renal function, digoxin has a long plasma half-life of 36 to 48 hours. This can take up to 5 days in patients with impaired renal function.

      Hypokalaemia, rather than hyperkalaemia, has been shown to increase the risk of digoxin toxicity.

      In the treatment of persistent and permanent atrial fibrillation, digoxin is no longer widely used. Beta-blockers, also known as rate-limiting calcium channel blockers, are now the first-line treatment for this condition.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      18.6
      Seconds

  • Question 5 - A 55-year-old female is urgently rushed into the Emergency Department as she complains...

    Incorrect

    • A 55-year-old female is urgently rushed into the Emergency Department as she complains of chest pain that is worse on breathing, shortness of breath, palpitations, and haemoptysis.

      She undergoes a CT pulmonary angiogram, which reveals a large pulmonary embolus. She is immediately started on heparin and shifted to the acute medical ward.

      Which of the following does heparin activate?

      Your Answer: Factor IX

      Correct Answer: Antithrombin III

      Explanation:

      Heparin works by binding to and activating the enzyme inhibitor antithrombin III.

      Antithrombin III inactivates thrombin (factor IIa) by forming a 1:1 complex with thrombin. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. The heparin-ATIII complex can also inactivate IX, XI, XII, and plasmin.

      Heparin is a polymer of glycosaminoglycan. It occurs naturally and is found in mast cells. Clinically, it is used in two forms:
      1. Unfractionated: widely varying polymer chain lengths
      2. Low molecular weight: Smaller polymers only

      Heparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics.

      Heparin is used for:
      1. Prevention and treatment of venous thromboembolism
      2. Treatment of disseminated intravascular coagulation
      3. Treatment of fat embolism
      4. Priming of haemodialysis and cardiopulmonary bypass machines

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      85.2
      Seconds

  • Question 6 - A 72-year-old man presents with chest pain that is characteristic of angina. You...

    Correct

    • A 72-year-old man presents with chest pain that is characteristic of angina. You administer a dose of glyceryl trinitrate (GTN), which rapidly resolved his symptoms. Unfortunately, he also develops an unpleasant side effect.
      Which of the following side effects is he most likely to have developed? Select ONE answer only.

      Your Answer: Headache

      Explanation:

      Nitrates are used in the treatment of angina pectoris and the prevention of myocardial ischaemia. Commonly used examples of nitrates are glyceryl trinitrate and isosorbide dinitrate. Unwanted effects, however, are common and can limit therapy, particularly when angina is severe or when patients are unusually sensitive to the effects of nitrates.
      The following are common or very common side effects of nitrates
      Arrhythmias
      Asthenia
      Cerebral ischaemia
      Dizziness
      Drowsiness
      Flushing
      Headache
      Hypotension
      Nausea and vomiting
      Diarrhoea, syncope and cyanosis can occur, but these are rare side effects. Dry eyes, bradycardia and metabolic acidosis have not been reported.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      14.6
      Seconds

  • Question 7 - You're a member of the cardiac arrest team, and you're helping to resuscitate...

    Incorrect

    • You're a member of the cardiac arrest team, and you're helping to resuscitate an elderly gentleman who had collapsed at home. The team leader requests that you administer an adrenaline shot.

      Which of the following statements about adrenaline is FALSE?

      Your Answer: It may be administered via an endotracheal tube

      Correct Answer: The IM dose in anaphylaxis is 1 ml of 1:1000

      Explanation:

      Adrenaline (epinephrine) is a sympathomimetic amine that binds to alpha- and beta-adrenergic receptors and acts as an agonist. It is active at both alpha and beta receptors in roughly equal amounts.

      When taken orally, it becomes inactive. Subcutaneous absorption is slower than intramuscular absorption. In cardiac arrest, it is well absorbed from the tracheal mucosa and can be given through an endotracheal tube.

      At the adrenergic synapse, catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) metabolise it primarily. The inactive products are then passed through the kidneys and excreted in the urine.

      In adult cardiac arrest, the IV dose is 1 mg, which is equal to 10 ml of 1:10000 or 1 ml of 1:1000. In anaphylaxis, the IM dose is 0.5 ml of 1:1000. (500 mcg).

      In open-angle glaucoma, adrenaline causes mydriasis and lowers pressure.

      Adrenaline is used in cardiopulmonary resuscitation, the treatment of severe croup, and the emergency management of acute allergic and anaphylactic reactions (as a nebuliser solution).

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      19
      Seconds

  • Question 8 - You examine a 79-year-old woman who has had hypertension and atrial fibrillation in...

    Incorrect

    • You examine a 79-year-old woman who has had hypertension and atrial fibrillation in the past. Her most recent blood tests show that she has severe renal impairment.

      Which medication adjustments should you make in this patient's case?

      Your Answer: Increase dose of digoxin

      Correct Answer: Reduce dose of digoxin

      Explanation:

      Digoxin is excreted through the kidneys, and impaired renal function can lead to elevated digoxin levels and toxicity.
      The patient’s digoxin dose should be reduced in this case, and their digoxin level and electrolytes should be closely monitored.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      57.1
      Seconds

  • Question 9 - An 82-year-old woman was brought in an ambulance to the Emergency Department with...

    Correct

    • An 82-year-old woman was brought in an ambulance to the Emergency Department with a 1-hour history of left-sided weakness and dysphasia.

      A CT scan is performed, and primary intracerebral haemorrhage is excluded as a possible cause. She is prepared for thrombolysis when her blood pressure is recorded at 200/115 mmHg.

      Out of the following, which step would be the most appropriate as the next step in her management?

      Your Answer: Labetalol 10 mg IV

      Explanation:

      A patient suffering from acute ischemic stroke can commonly present with hypertensive emergencies. Thrombolytic therapy is contraindicated in a patient with:
      1. Systolic blood pressure greater than 185 mmHg
      2. Diastolic blood pressure greater than 110 mmHg

      But delaying thrombolytic therapy is associated with increased morbidity in patients with acute ischemic stroke.

      Managing high blood pressure in acute ischemic stroke requires a slower and more controlled reduction in BP. In the presence of an ischaemic stroke, rapid reduction of MAP can compromise blood flow, causing further ischemia and worsening of the neurological deficit.

      Intravenous labetalol is the agent of choice. The dose is 10 mg IV over 1-2 minutes. This dose can be repeated, or an infusion can be set up that runs at 2-8 mg/minute. Thrombolysis can be performed once the blood pressure is brought down to less than 180/105 mmHg.

      A nitrate infusion (for example, Isoket) can be used as an alternative in patients with contraindications to the use of beta-blockers (e.g., asthma, heart block, cardiac failure).

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      15.7
      Seconds

  • Question 10 - An 85-year-old woman is brought in from her nursing home. She arrives in...

    Correct

    • An 85-year-old woman is brought in from her nursing home. She arrives in the Emergency Department and appears confused. The staff member from the nursing home accompanying her informs you that she takes a water tablet.

      From her past medical history and records, you deduce that the water tablet is a loop diuretic.

      Which of the following parts of a nephron does a loop diuretic act on?

      Your Answer: Ascending loop of Henlé

      Explanation:

      Loop diuretics are drugs used to manage and treat fluid overload associated with CHF, liver cirrhosis, and renal disease. The drugs commonly used are:
      Furosemide
      Bumetanide
      Torsemide
      Ethacrynic Acid

      Loop diuretics act on the apical membrane of the thick ascending loop of Henle and inhibit the Na-K-Cl cotransporter. This blocks the reabsorption of sodium and chloride and results in salt-water excretion. This relieves congestion and reduces oedema.

      Other diuretics act on the following part of the nephron:
      1. Thiazide diuretics – Na/Cl co-transporter in the distal convoluted tubule
      2. Osmotic diuretics – PCT and the loop of Henle
      3. Aldosterone antagonists – distal convoluted tubule
      4. Carbonic anhydrase inhibitors – inhibit the carbonic anhydrase and act on proximal tubular cells

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      16.5
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular Pharmacology (7/10) 70%
Pharmacology (7/10) 70%
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