Cardiovascular drugs: atrial fibrillation with accessory pathway: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Cardiovascular drugs: atrial fibrillation with accessory pathway

Sample item

A young man with pre-excited atrial fibrillation in Wolff-Parkinson-White syndrome is haemodynamically stable. Which intravenous drug is contraindicated?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Verapamil

AV nodal blockers such as verapamil, diltiazem, adenosine, digoxin and beta blockers slow the node and may shift conduction to the accessory pathway, causing very rapid ventricular rates and fibrillation. Drugs that slow the accessory pathway, such as procainamide, are preferred.

Option by option

  • A. Ibutilide

    Ibutilide prolongs refractoriness in the accessory pathway and may be used.

  • B. Verapamil (correct)

    Correct. Blocking the AV node favours conduction down the accessory pathway.

  • C. Disopyramide

    Disopyramide, a class IA drug, prolongs refractoriness of the accessory pathway.

  • D. Procainamide

    Procainamide slows conduction in the accessory pathway and is a recommended option.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Verapamil. AV nodal blockers such as verapamil, diltiazem, adenosine, digoxin and beta blockers slow the node and may shift conduction to the accessory pathway, causing very rapid ventricular rates and fibrillation.

Why is "Ibutilide" not the answer?

Ibutilide prolongs refractoriness in the accessory pathway and may be used.

Why is "Disopyramide" not the answer?

Disopyramide, a class IA drug, prolongs refractoriness of the accessory pathway.

Why is "Procainamide" not the answer?

Procainamide slows conduction in the accessory pathway and is a recommended option.

What concept does this question test?

It tests Cardiovascular drugs: atrial fibrillation with accessory pathway in Pharmacology. Drugs that slow the accessory pathway, such as procainamide, are preferred.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiovascular drugs: atrial fibrillation with accessory pathway?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.