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.

Presentation on theme: "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."— Presentation transcript:

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 A.利多卡因 B.肾上腺素 C.吗啡 D.阿托品 E.苯妥英钠 参与人数:80 反馈人数:0

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

4 4. Which of the following is an antiarrhythmic agent that has relatively few electrophysiologic effects on normal myocardial tissue but suppresses the arrhythmogenic tendencies of ischemic myocardial tissues? a. Propranolol b. Procainamide c. Quinidine d. Lidocaine e. Disopyramide 投票人数:38

5 a. The absorption of digoxin from the GI tract is decreased
2017/3/16 5. If quinidine and digoxin are administered concurrently, which of the following effects does quinidine have on digoxin? a. The absorption of digoxin from the GI tract is decreased b. The metabolism of digoxin is prevented c. The concentration of digoxin in the plasma is increased d. The effect of digoxin on the AV node is antagonized e. The ability of digoxin to inhibit the Na+K+-stimulated ATPase is reduced c e 投票人数:38

6 6. In a patient who has had attacks of paroxysmal atrial tachycardia, an ideal prophylactic drug is
a. Adenosine b. Procainamide c. Lidocaine d. Nifedipine e. Verapamil 投票人数:38

7 2017/3/16 7 The first-line drug for treating an acute attack of reentrant supraven-tricular tachycardia (SVT) is a. Adenosine b. Digoxin c. Propranolol d. Phenylephrine e. Edrophonium The answer is a. (Katzung, p 240.) Older therapies—all designed to favor parasympathetic control of rhythm—include digoxin, propra- nolol, edrophonium, and vasoconstrictors. The vasoconstrictor phenyl- ephrine (given by intravenous bolus) causes stimulation of the carotid sinus and reflex vagal stimulation of the atria. More recently, adenosine has been favored over verapamil, which is also very effective but slower acting. 投票人数:38

8 b. Hydrochlorothiazide c. Phenobarbital d. Nitroglycerin e. Captopril
2017/3/16 8 A 64-year-old male with arteriosclerotic heart disease (AHD) and CHF who has been treated with digoxin complains of nausea, vomiting, and diarrhea. His EKG reveals a bigeminal rhythm. The symptoms and EKG findings occurred shortly after another therapeutic agent was added to his regimen. A drug-drug interaction is suspected. Which agent was involved? a. Lovastatin b. Hydrochlorothiazide c. Phenobarbital d. Nitroglycerin e. Captopril The answer is b. (Hardman, pp 703–704.) Low K stores due to the effects of thiazide diuretics such as hydrochlorothiazide increase suscepti- bility to cardiac glycoside toxicity. 投票人数:38

9 9 A 66-year-old man had a myocardial infarct
9 A 66-year-old man had a myocardial infarct. Which one of the following would be appropriate prophylactic antiarrhythmic therapy? A. Lidocaine. B. Metoprolol. C. Procainamide. D. Quinidine. E. Verapamil. 投票人数:0

10 A. Has vagomimetic effects on the AV node. B. Is a β-blocker.
10. Suppression of arrhythmias resulting from a reentry focus is most likely to occur if the drug: A. Has vagomimetic effects on the AV node. B. Is a β-blocker. C. Converts a unidirectional block to a bidirectional block. D. Slows conduction through the atria. E. Has atropine-like effects on the AV node. 投票人数:0

11 A. Amiodarone. B. Procainamide. C. Propranolol. D. Quinidine.
11. A 57-year-old man is being treated for an atrial arrhythmia. He complains of headache, dizziness, and tinnitus. Which one of the following antiarrhythmic drugs is the most likely cause? A. Amiodarone B. Procainamide. C. Propranolol D. Quinidine. E. Verapamil. 投票人数:0

12 12. A 58-year-old woman is being treated for chronic suppression of a ventricular arrhythmia. After 2 months of therapy, she complains about feeling tired all the time. Examination reveals a resting heart rate of 10 beats per minute lower than her previous rate. Her skin is cool and clammy. Laboratory test results indicate low thyroxin and elevated thyroid-stimulating hormone levels. Which of the following antiarrhythmic drugs is the likely cause of these signs and symptoms? 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 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

14 14.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

15 b. Inhibition of Na+,K+, chloride (Cl−) co transporter
15. A 59-year-old female with mild CHF is treated with furosemide. What is its primary mechanism of action? a. Inhibition of sodium-potassium (Na+,K+) adenosine triphosphatase (ATPase) b. Inhibition of Na+,K+, chloride (Cl−) co transporter c. Inhibition of Na+,Cl− co-transporter d. Inhibition of Cl− transporter e. Inhibition of Ca2+ divalent cation (Ca2+) transporter 投票人数:0 2017/3/16

16 a. The length of the refractory period
16. A 59-year-old male with a history of rheumatic heart disease is found to have atrial fibrillation (AF), for which he is treated with digoxin. Treatment with digoxin converts his AF to a normal sinus rhythm and most likely results in a decrease in which of the following? a. The length of the refractory period b. The velocity of shortening of the cardiac muscle c. The conduction velocity in the atrioventricular (AV) node d. The atrial maximum diastolic resting potential 投票人数:0

17 17. The cardiovascular responses of a normal man were recorded and are shown in the accompanying figure following a 15-min infusion of drug X.Which of the following was most likely drug X? a. Methacholine b. Propranolol c. Atropine d. Isoproterenol e. Norepinephrine 投票人数:0 2017/3/16

18 a. Inhibition of cyclic adenosine 5′-monophosphate (cAMP) synthesis
18. A 75-year-old female in congestive heart failure (CHF) is nable to climb a flight of stairs without experiencing shortness of breath. Digoxin is administered to improve cardiac muscle contractility. Within two weeks, she has a marked improvement in her symptoms. What cellular action of digoxin accounts for this? a. Inhibition of cyclic adenosine 5′-monophosphate (cAMP) synthesis b. Inhibition of mitochondrial calcium (Ca2+) release c. Inhibition of the sodium (Na+) pump d. Inhibition of β-adrenergic stimulation e. Inhibition of adenosine triphosphate (ATP) degradation 投票人数:0 2017/3/16

19 a. Reduced production of catecholamines
19.The therapeutic action of β-adrenergic receptor blockers such as propranolol in angina pectoris is believed to be primarily the result of a. Reduced production of catecholamines b. Dilation of the coronary vasculature c. Decreased requirement for myocardial oxygen d. Increased peripheral resistance e. Increased sensitivity to catecholamines 投票人数:0 2017/3/16

20 20. 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 2017/3/16

21 21 In a hypertensive patient who is taking insulin to treat diabetes, which of the following drugs is to be used with extra caution and advice to the patient? a. Hydralazine b. Prazosin c. Guanethidine d. Propranolol e. Methyldopa

22 22 Angiotensin converting enzyme (ACE) inhibitors are associated with a high incidence of which of the following adverse reactions? a. Cough b. Hypokalemia c. Agranulocytosis d. Proteinuria e. Hirsutism

23 23 A 56-year-old female has recently developed essential hypertension, for which she is receiving chlorothiazide to lower her blood pressure. Which of these ions would not increase in concentration in her urine? a. K+ b. Cl− c. Ca2+ d. Na+ e. Mg2+

24 24 A 54-year-old female is treated for essential hypertension with an antihypertensive that controls her blood pressure. One day, she comes to the ED with chest pain, tachycardia, anxiety, and a blood pressure of 240/140 mmHg. She has not taken her medication for two days. Which antihypertensive can account for her findings? a. Clonidine b. Propranolol c. Doxazosin d. Minoxidil e. Prazosin 反馈人数:0 参与人数:0

25 25 能增加肝HMG-CoA还原酶活性的药物是
B．烟酸 C．氯贝特 D．洛伐他汀 E．普罗布考 反馈人数:0 参与人数:0

26 1. 人工合成抗心律失常肽药物研究进展 2. 探讨心律失常模型的优缺点
小专论题目 1. 人工合成抗心律失常肽药物研究进展 2. 探讨心律失常模型的优缺点

27 Thank you