第二十二章-抗心律失常藥PPT課件

.,1,1.女性，44歲。八年來(lái)勞累后心慌氣短。既往曾患過(guò)“風(fēng)濕性關(guān)節(jié)炎”。近日因勞累病情加重，心慌，氣短，咯血，不能平臥急診入院。查體：半臥位，慢性重病容。脈搏80次/分，血壓13.3/9.33kPa(100/70mmHg)。心向左側(cè)擴(kuò)大，心律不齊，心率120次/分，心尖區(qū)舒張期雷鳴樣雜音，主動(dòng)脈瓣區(qū)收縮期和舒張期雜音。肝肋下3cm，下肢輕度浮腫。診斷：風(fēng)濕性心臟病，二尖瓣狹窄，主動(dòng)脈瓣狹窄及關(guān)閉不全，心房纖顫，心功能不全I(xiàn)I度。該病人在用強(qiáng)心藥治療的過(guò)程中，心率突然減為50次/分，此時(shí)應(yīng)選用,反饋人數(shù):0,參與人數(shù):80,A.利多卡因B.腎上腺素C.嗎啡D.阿托品E.苯妥英鈉,.,2,2.女性，74歲。自覺(jué)因擦背著涼后兩肩和后背陣陣酸痛，每陣10分鐘左右，不發(fā)燒，仍可下床走動(dòng)。于今晨1時(shí)許，突然出現(xiàn)心前區(qū)劇痛，并向雙肩、后背和左臂放射，伴大汗，休息后不見(jiàn)緩解，早8點(diǎn)急診住院。檢查：年邁，半臥位，無(wú)明顯青紫，頸靜脈不怒張，肺（），心略向左側(cè)擴(kuò)大，心律尚齊，未聞心臟雜音及摩擦音。心電圖：病理性Q波，ST段抬高，T波倒置。診斷：急性心肌梗塞。為防止室性心律失常的發(fā)生，病人應(yīng)立即給予的藥物是,A.利多卡因B.奎尼丁C.胺碘酮D.普萘洛爾E.苯妥英鈉,.,3,3.女性，34歲，因過(guò)度勞累及情緒激動(dòng)有心悸、胸前區(qū)不適、心暈及頸部脹滿感，并伴有焦慮或恐懼。心電圖：心室率常在160250次/分鐘；QRS波群形態(tài)和正常竇性的QRS波型一樣，間期小于0.10秒；有逆行P波。診斷為室上性心動(dòng)過(guò)速，應(yīng)首選的藥是維拉帕米普魯卡因胺胺碘酮利多卡因奎尼丁,投票人數(shù):38,.,4,4.Whichofthefollowingisanantiarrhythmicagentthathasrelativelyfewelectrophysiologiceffectsonnormalmyocardialtissuebutsuppressesthearrhythmogenictendenciesofischemicmyocardialtissues?a.Propranololb.Procainamidec.Quinidined.Lidocainee.Disopyramide,投票人數(shù):38,.,5,5.Ifquinidineanddigoxinareadministeredconcurrently,whichofthefollowingeffectsdoesquinidinehaveondigoxin?a.TheabsorptionofdigoxinfromtheGItractisdecreasedb.Themetabolismofdigoxinispreventedc.Theconcentrationofdigoxinintheplasmaisincreasedd.TheeffectofdigoxinontheAVnodeisantagonizede.TheabilityofdigoxintoinhibittheNa+K+-stimulatedATPaseisreduced,投票人數(shù):38,.,6,6.Inapatientwhohashadattacksofparoxysmalatrialtachycardia,anidealprophylacticdrugisa.Adenosineb.Procainamidec.Lidocained.Nifedipinee.Verapamil,投票人數(shù):38,.,7,7Thefirst-linedrugfortreatinganacuteattackofreentrantsupraven-triculartachycardia(SVT)isa.Adenosineb.Digoxinc.Propranolold.Phenylephrinee.Edrophonium,投票人數(shù):38,.,8,8A64-year-oldmalewitharterioscleroticheartdisease(AHD)andCHFwhohasbeentreatedwithdigoxincomplainsofnausea,vomiting,anddiarrhea.HisEKGrevealsabigeminalrhythm.ThesymptomsandEKGfindingsoccurredshortlyafteranothertherapeuticagentwasaddedtohisregimen.Adrug-druginteractionissuspected.Whichagentwasinvolved?a.Lovastatinb.Hydrochlorothiazidec.Phenobarbitald.Nitroglycerine.Captopril,投票人數(shù):38,.,9,9A66-year-oldmanhadamyocardialinfarct.Whichoneofthefollowingwouldbeappropriateprophylacticantiarrhythmictherapy?A.Lidocaine.B.Metoprolol.C.Procainamide.D.Quinidine.E.Verapamil.,投票人數(shù):0,.,10,10.Suppressionofarrhythmiasresultingfromareentryfocusismostlikelytooccurifthedrug:A.HasvagomimeticeffectsontheAVnode.B.Isa-blocker.C.Convertsaunidirectionalblocktoabidirectionalblock.D.Slowsconductionthroughtheatria.E.Hasatropine-likeeffectsontheAVnode.,投票人數(shù):0,.,11,11.A57-year-oldmanisbeingtreatedforanatrialarrhythmia.Hecomplainsofheadache,dizziness,andtinnitus.Whichoneofthefollowingantiarrhythmicdrugsisthemostlikelycause?A.Amiodarone.B.Procainamide.C.Propranolol.D.Quinidine.E.Verapamil.,投票人數(shù):0,.,12,12.A58-year-oldwomanisbeingtreatedforchronicsuppressionofaventriculararrhythmia.After2monthsoftherapy,shecomplainsaboutfeelingtiredallthetime.Examinationrevealsarestingheartrateof10beatsperminutelowerthanherpreviousrate.Herskiniscoolandclammy.Laboratorytestresultsindicatelowthyroxinandelevatedthyroid-stimulatinghormonelevels.Whichofthefollowingantiarrhythmicdrugsisthelikelycauseofthesesignsandsymptoms?A.Amiodarone.B.Procainamide.C.Propranolol.D.Quinidine.E.Verapamil.,投票人數(shù):0,.,13,13.維拉帕米抗心律失常的主要作用機(jī)制是阻滯Na+內(nèi)流促進(jìn)K+外流阻滯Ca2+內(nèi)流阻滯1受體延長(zhǎng)動(dòng)作電位時(shí)程,投票人數(shù):0,.,14,14.對(duì)室上性心動(dòng)過(guò)速無(wú)效的藥物是西地蘭維拉帕米普萘洛爾利多卡因胺碘酮,投票人數(shù):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,投票人數(shù):0,.,16,16.A59-year-oldmalewithahistoryofrheumaticheartdiseaseisfoundtohaveatrialfibrillation(AF),forwhichheistreatedwithdigoxin.TreatmentwithdigoxinconvertshisAFtoanormalsinusrhythmandmostlikelyresultsinadecreaseinwhichofthefollowing?a.Thelengthoftherefractoryperiodb.Thevelocityofshorteningofthecardiacmusclec.Theconductionvelocityintheatrioventricular(AV)noded.Theatrialmaximumdiastolicrestingpotential,投票人數(shù):0,.,17,2020/4/27,17.Thecardiovascularresponsesofanormalmanwererecordedandareshownintheaccompanyingfigurefollowinga15-mininfusionofdrugX.WhichofthefollowingwasmostlikelydrugX?a.Methacholineb.Propranololc.Atropined.Isoproterenole.Norepinephrine,投票人數(shù):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,投票人數(shù):0,.,19,2020/4/27,19.Thetherapeuticactionof-adrenergicreceptorblockerssuchaspropranololinanginapectorisisbelievedtobeprimarilytheresultofa.Reducedproductionofcatecholaminesb.Dilationofthecoronaryvasculaturec.Decreasedrequirementformyocardialoxygend.Increasedperipheralresistancee.Increasedsensitivitytocatecholamines,投票人數(shù):0,.,20,2020/4/27,20.普萘洛爾（心得安）對(duì)下列何種類型的心絞痛較好活動(dòng)時(shí)發(fā)生的心絞痛活動(dòng)、靜息均可發(fā)生的心絞痛靜息時(shí)發(fā)生的心絞痛支氣管哮喘者并發(fā)心絞痛以上均可,投票人數(shù):0,.,21,21Inahypertensivepatientwhoistakinginsulintotreatdiabetes,whichofthefollowingdrugsistobeusedwithextracautionandadvicetothepatient?a.Hydralazineb.Prazosinc.Guanethidined.Propranolole.Methyldopa,.,22,22Angiotensinconvertingenzyme(ACE)inhibitorsareassociatedwithahighincidenceofwhichofthefollowingadversereactions?a.Coughb.Hypokalemiac.Agranulocytosisd.Proteinuriae.Hirsutism,.,23,23A56-year-oldfemalehasrecentlydevelopedessentialhype