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Based on my research across cardiology and pharmacology textbooks, here are the answers to all five clinical questions:

Question 1 — Side Effects of Otzidan (Oxidized Glutathione / likely Obsidan = Propranolol 160 mg/day) + Sustak Forte (Isosorbide Dinitrate) + Panangin

Patient post-MI with ventricular extrasystoles on these medications.

Correct Answer: 3. Hypotension, dizziness, nausea, vomiting, abdominal pain

Propranolol (Obsidan/Otzidan): can cause bradycardia, hypotension, bronchospasm, fatigue
Sustak Forte (isosorbide dinitrate): headache, hypotension, dizziness, nausea
Panangin (K+/Mg²+): nausea, abdominal discomfort
Together, hypotension is the most clinically significant combined side effect
Options 1 (arrhythmia) and 2 (tachycardia) are opposite effects — propranolol treats these; option 4 (edema) is not characteristic

Question 2 — Patient R., 56 y/o: Post-MI, sinus tachycardia HR 102, isolated ventricular extrasystoles. Choose antiarrhythmic drug.

Correct Answer: 1. Bisoprolol (Bisoprolol)

Ventricular extrasystoles after MI in the context of sinus tachycardia and cicatricial (scar) changes → beta-blockers are first-line
Beta-blockers (bisoprolol) reduce sympathetic drive, suppress ventricular ectopy post-MI, reduce mortality
Lidocaine (option 4) is for acute ventricular tachycardia/fibrillation, not isolated extrasystoles
Amlodipine (option 2) is a calcium channel blocker with no antiarrhythmic class for VEBs
Atropine (option 3) increases heart rate — contraindicated here
Ethacizine (option 5) is a Class IC drug; Class IC agents are contraindicated post-MI (CAST trial showed increased mortality)

Question 3 — Patient K., 26 y/o: Paroxysmal sinus tachycardia HR 170 bpm, hemodynamically stable (BP 130/80), onset 20 min ago. What is your tactic?

Correct Answer: 4. Isoptin (Verapamil) 2.5% — 4 ml in saline, IV slow push

Paroxysmal sinus tachycardia at 170 bpm: first try vagal maneuvers (Valsalva); if ineffective, verapamil IV is appropriate for narrow-complex supraventricular tachycardia
Verapamil slows AV nodal conduction and is a standard agent for narrow-complex tachycardias
Lidocaine (option 1) is for ventricular tachycardia — wrong drug class
Atropine (option 2) increases heart rate — completely contraindicated
Amiodarone (Kordaron) (option 3) is reserved for refractory cases or ventricular arrhythmias
Novocainamide (option 5) — may be used for SVT but verapamil is more appropriate first-line for narrow-complex tachycardia

Question 4 — Patient S., 39 y/o: Sinus rhythm HR 49 bpm, weakness, dyspnea, chest heaviness. What is your tactic?

Correct Answer: 2. Atropine 0.1% — 0.5 ml IM

HR 49 = symptomatic sinus bradycardia
Atropine is the first-line treatment for symptomatic bradycardia — it blocks muscarinic receptors, increases SA node firing rate
Isoptin/Verapamil (option 1) would worsen bradycardia — absolutely contraindicated
Amiodarone (option 3) slows heart rate — contraindicated in bradycardia
Lidocaine (option 4) is for ventricular tachycardia — irrelevant here
Novocainamide (option 5) is a sodium channel blocker that can also slow conduction — not indicated

Question 5 — Patient S., 72 y/o: Acute MI (ST elevation anterior-lateral wall, positive troponin, leukocytosis, fever), frequent ventricular extrasystoles in bigeminy, HR 100, BP 100/70.

Correct Answer: 1. Promedol (morphine analog) 1% 1 ml IM + Heparin 5000 U IV + Aspirin 1 tablet (chew) + Lidocaine 2% 5 ml IV + Isosorbide dinitrate 10.0 in saline

Rationale:

Active STEMI → urgent reperfusion + anti-ischemic + anticoagulation
Promedol/morphine: pain relief, reduces sympathetic activation
Heparin + Aspirin: anticoagulation + antiplatelet for acute STEMI (standard MONA+ protocol)
Lidocaine IV: first-line for frequent ventricular extrasystoles in bigeminy in the setting of acute MI — suppresses ventricular ectopy acutely
Isosorbide dinitrate: reduces preload, anti-ischemic
Option 2 (bisoprolol) — while beta-blockers are used in MI, in this patient with BP 100/70 and HR 100, oral bisoprolol is not the immediate priority; lidocaine for bigeminy in acute MI takes precedence over bisoprolol

Summary Table

Q	Correct Answer
1	3. Hypotension, dizziness, nausea/vomiting, abdominal pain
2	1. Bisoprolol
3	4. Isoptin (Verapamil) IV
4	2. Atropine 0.1% IM
5	1. Promedol + Heparin + Aspirin + Lidocaine IV + Isosorbide dinitrate

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