CARDIOVASCULAR – HEART FAILURE

1. Digoxin
a. Causes a decrease in intracellular sodium
b. Causes hypokalaemia in overdose
c. Has a half life of 40 hours in a normal patient
d. Decreases cardiac output
e. Has no role in the treatment of heart failure
2. Digoxin
a. Does not cross the blood brain barrier
b. Hypokalaemia decreases efficacy of digoxin
c. Hypomagnesaemia decreases efficacy of digoxin
d. Antibiotics have effects on digoxin
e. ?
3. Digoxin
a. Is not very lipid soluble and has a low volume of distribution
b. Is extensively metabolized prior to its excretion
c. Is highly protein bound
d. Has a half-life of 100 hours, thus allowing for once daily dosing
e. None of the above are correct
4. The electrical effects of digoxin in therapeutic concentrations include:
a. The ability to revert atrial fibrillation to normal sinus rhythm in >60% of patients <12 hours
b. No indirect effect (ie. Vagal) upon the Purkinje fibres in the ventricles
c. Increased refractory period at the atrioventricular node
d. Increased rate of firing of the sinoatrial node
e. ST segment elevation in the inferolateral segments of the ECG
5. Which of the following drugs has no significant interaction with digoxin?
a. Quinidine
b. Amlodipine
c. Verapamil
d. Warfarin
e. Thiazide diuretics
6. Digoxin exerts its effects upon myocardial muscle at a cellular level by
a. Increasing intracellular calcium
b. Inducing Na+/K+/ATPase at the cell membrane
c. Acting as a second messenger for G proteins
d. Acting directly upon actin and myosin filaments to promote contractility
e. Sub-contracting non-union labour and threatening legal action via the high court if the cell
doesn’t give into its demands!
7. Digoxin Fab antibodies
a. Are used routinely in the management of digoxin toxicity
b. Decreases the serum digoxin level in the circulation
c. Are commonly associated with tachyarrythmias after administration
d. Take approximately 12 hours to have an effect
e. Are metabolized in the liver
8. digitalis
a. is a positive inotrope
b. ?
c. ?
d. ?
e. ?
9. The primary mechanism of action of digoxin involves:
a. An increase in action potential amplitude
b. An increase in ATP synthesis
c. Modification of the actin molecule
d. An increase in intracellular Ca2+ levels
e. Block of the Na+/Ca2+ exchange
10. Regarding pharmacokinetics of digoxin
a. It is poorly absorbed with oral administration
b. Its renal clearance is increased with renal disesase
c. 40% of individuals have enteric bacteria inactivating it
d. two thirds of digoxin is excreted by the kidneys
e. the enterohepatic circulation contributes to the short half-life
11. All of the following may increase the effect of digoxin EXCEPT:
a. Amiodarone
b. Frusemide
c. Carbamazepine
d. verapamil
e. quinidine