Exam 3 2009

Front 1

When counseling a patient on when during the day is the best time of day to take their statin it is important to keep in mind the pharmacology of the drug and the normal physiology of the body. What is a true statement about the more potent statins?

Back 1

The more potent statins tend to not need to be dosed at night as opposed to the lower potency statins.

Front 2

A patient currently taking pravastatin for their hyperlipidemia has their LDL at goal, however their triglycerides are still elevated (above 200mg/dl) and their HDL is low (less than 30mg/dl). What is the best option to improve these secondary cholesterol targets (triglycerides and HDL):

Back 2

Add gemfibrozil to the current cholesterol regimen

Front 3

A patient returns to your pharmacy 1 week after starting niacin for their low HDL complaining of a warm, flushing sensation. Knowing the pharmacology of these agents you correctly inform them that:

Back 3

This is a common side effect that most people generate tolerance to in 1-2 weeks but will likely come back after missing a few doses. The symptoms can be at least partially alleviated by pre-treating with aspirin.

Front 4

A patient currently taking simvastatin for their cholesterol gets started on atazanavir (a very potent CYP3A4 inhibitor) and will likely stay on atazanavir chronically. You run an interaction report and decide to:

Back 4

Switch the simvastatin to an equipotent dose of fluvastatin to prevent increased statin toxicity due to the potential of decreased metabolism of simvastatin.

Front 5

True/False: Colesevelam binds bile acid and prevents the bile from undergoing enterohepatic recirculation.

Back 5

True

Front 6

True/False: Rosuvastatin inhibits the HMG-CoA reductase enzyme decreasing intracellular cholesterol production which causes increases in LDL receptor synthesis and subsequent internalization of LDL cholesterol from the systemic circulation.

Back 6

True

Front 7

True/False: Gemfibrozil's action is believed to be mediated through the PPAR-gamma receptor.

Back 7

False

Front 8

True/False: Nicotinic acid's exact mechanism is unknown, however is believed to be in part due to free fatty acid mobilization.

Back 8

True

Front 9

True/False: CCBs prevent calcium-induced calcium release from the sarcoplasmic reticulum.

Back 9

True

Front 10

True/False: CCBs prevent the downstream coordination of calcium and calmodulin in cardiac myocytes.

Back 10

False

Front 11

True/False: CCBs inhibit the downstream action of calcium binding to Troponin-C.

Back 11

True

Front 12

True/False: CCBs reduce the slow inward current of the L-tyoe calcium channel.

Back 12

True

Front 13

A patient is admitted to the hospital with a confirmed bleed in the subarachnoid space. Which CCB crosses the blood-brain barrier and is indicated to treat this condition?

Back 13

Nimodipine is the only CCB that crosses the blood-brain barrier that is indicated for this condition.

Front 14

A lab report indicates that a patient taking diltiazem has a slight elevation in liver function tests (LFTs). What is the best course of action?

Back 14

Do not change the course of therapy, because slight elevation in LFTs are a known effect of this drug.

Front 15

What is the most important factor for controlling blood flow?

Back 15

Blood vessel radius

Front 16

What factor is most affected by Starling's Law of the Heart?

Back 16

Stroke volume

Front 17

True/False: Renin is synthesized as a pre-hormone which is processed in the Juxtaglomerular cells.

Back 17

True

Front 18

True/False: Macula densa cells respond to stretch of the renal artery.

Back 18

False

Front 19

True/False: Increases in renal perfusion pressure activate renal baroreceptors to increase renin release.

Back 19

False

Front 20

True/False: Aminopeptidase converts Angiotensin I (1-10) into Angiotensin III (2-8)

Back 20

False

Front 21

True/False: Angiotensin I (1-10) can be converted to Angiotensin (1-9) by ACE2.

Back 21

True

Front 22

True/False: Angiotensin 4 (3-8) has activity on AT4 receptors.

Back 22

True

Front 23

True/False: Angiotensin (1-7) has actions opposite to those of Angiotensin II.

Back 23

True

Front 24

True/False: Angiotensin III (2-8) is as effective as Angiotensin II (1-8) at stimulating Aldosterone secretion, but less effective on the vasculature.

Back 24

True

Front 25

Angiotensin II...

Back 25

Is the primary agent maintaining renal blood flow in patients with renal stenosis

Front 26

True/False: ACE inhibitors all have carboxyl groups that bind the Zn2+ at the active site.

Back 26

False

Front 27

True/False: Lisinopril is a prodrug that requires metabolic activation.

Back 27

False

Front 28

True/False: Fosinopril undergoes both renal elimination and liver metabolism.

Back 28

True

Front 29

True/False: Ramipril is available as an injectable IV formulation

Back 29

False

Front 30

What is a main side effect of ACE inhibitors?

Back 30

Dry cough is thought to be due to Bradykinin and Substance P accumulation in the lungs.

Front 31

Angiotensin receptor blockers...

Back 31

Have nonlinear dose response curves because of saturation of the AT1 receptors at starting doses.

Front 32

What are four actions of BB that contribute to their therapeutic actions in congestive heart failure?

Back 32

1. Decrease in heart rate and contractility
2. Competitive blockade of beat 1 receptors
3. Altered baroreceptor sensitivity
4. Competitive blockade of presynaptic receptors

Front 33

True/False: Membrane stabilizing activity is directly related to lipid solubility.

Back 33

False

Front 34

True/False: Propranolol and Carvedilol show the most membrane stabilizing activity

Back 34

True

Front 35

True/False: Nadolol, Artenolol, Betaxolol all show significant hepatic metabolism.

Back 35

False

Front 36

True/False: Bisoprolol has the highest ISA activity of second generation agents.

Back 36

False

Front 37

True/False: BB work best in patients with low renin hypertension.

Back 37

False

Front 38

True/False: BB are first line antihypertensive agents in young hypertensive's with atrial fibrillation.

Back 38

True

Front 39

True/False: BB with ISA initially decrease CO which then returns to normal.

Back 39

False

Front 40

True/False: BB may cause fatigue and limit exercise content.

Back 40

True

Front 41

True/False: Propanolol is effective in the treatment of migraines because of its lipid solubility

Back 41

False

Propanolol prevents it doesn't treat migraines

Front 42

True/False: Timolol is effective in glaucoma because it contracts the trabecular meshwork.

Back 42

False

Front 43

True/False: Acebutolol is useful in thyrotoxicosis because of its membrane stabilizing action which prevents the release of thyroid hormone.

Back 43

False

Front 44

True/False: Metoprolol is useful in paroxysmal supraventricular tachycardia (PSVT) because it slows down conduction through the AV node.

Back 44

True

Front 45

True/False: Metoprolol would be more likely to adversely affect an asthmatic than Penbutolol.

Back 45

False

Front 46

True/False: BB can prolong hypoglycemia produced by oral anti-diabetic medications in type 2 patients.

Back 46

True

BB prevent breakdown of glycogen to glucose so they will prolong hypoglycemia.

Front 47

True/False: Nonselective BB would be more useful than the third generation agents in a hypertensive patient with elevated LDL and TG's.

Back 47

False

Front 48

True/False: BB would be useful to decrease anxiety in an athlete running in a marathon

Back 48

False

Front 49

Vascular smooth muscle...

Back 49

is calcium bound to calmodulin activates myosin light kinase which phosphorylates myosin.

Front 50

Prazosin...

Back 50

Increases sodium and water retention

Front 51

True/False: Tamsulosin would be the drug of choice to treat hypertension in a male with benign prostatic hyperplasia.

Back 51

False

Front 52

True/False: Doxazosin is preferred over Prazosin because of once daily dosing.

Back 52

True

Front 53

True/False: Labetalol has equivalent alpha and beta receptor clocking activity

Back 53

False

Front 54

True/False: In the ALLHAT study Doxazosin was shown to increase the incidence of CHF.

Back 54

True

Front 55

True/False: Guanabenz has Imidazoline receptor activity

Back 55

False

Front 56

True/False: Central sympatholytics work in the nucleus of the solitary tract (NTS) and the ventral lateral medulla (VLM) by inhibiting postsynaptic alpha two receptors.

Back 56

False

Front 57

True/False: Clonidine decreases TPR with a modest decrease in CO but causes significant reflex tachycardia.

Back 57

False

Front 58

True/False: Reserpine does not work well in the elderly and African Americans.

Back 58

False

Front 59

True/False: Alpha Methyl dopa is converted to alpha methylnorepinephrine in the vesicle by Dopamine-Beta-Hydroxylase.

Back 59

True

Front 60

True/False: Alpha Methyl dopa works by displacing norepinephrine from the vesicle so there is less to be released by nerve stimulation.

Back 60

False

Front 61

True/False: Alpha Methyl dopa may cause a positive Coombs test.

Back 61

True

Front 62

True/False: Alpha Methyl dopa should be avoided in the elderly

Back 62

False

Front 63

True/False: Clonidine is useful in opiate withdrawal because it blunts the craving for opiates.

Back 63

False

Front 64

True/False: Rilmenadine may not require use with a diuretic because it causes less sodium and water retention than Clonidine.

Back 64

True

Front 65

True/False: Guanfacine is less selective for alpha two receptors than Clonidine.

Back 65

False

Front 66

True/False: Rilmenadine blocks Imidazoline 1 receptors.

Back 66

False

Front 67

Direct acting vasodilators...

Back 67

are most effective in patients also taking BB and diuretics

Front 68

True/False: Hydralazine is the drug of choice to rapidly lower blood pressure in a patient with angina.

Back 68

False

Front 69

True/False: Minoxidil may turn stool black.

Back 69

False

Front 70

True/False: Hydralazine increases activation of ATP-modulated potassium channels

Back 70

False

Front 71

True/False: Diazoxide increases insulin release by opening the ATP dependent potassium channel

Back 71

False

Front 72

Nitroprusside...

Back 72

Overdose may include cyanide toxicity

Front 73

The physiological response to nitrates includes which three things?

Back 73

1. Decreased platelet adhesion
2. Reflex tachycardia
3. Reduced preload

Front 74

What are two side effects of nitrates?

Back 74

1. Methemoglobin
2. Headache

Front 75

True/False: Both Amyl Nitrite and Nitroglycerin require bioactivation with sulfhydral groups.

Back 75

True

Front 76

True/False: N-acetylcysteine can partially reverse Isosorbide Dinitrate tolerance

Back 76

True

Front 77

True/False: Fenoldopam is only available for short term use in hypertensive crisis

Back 77

True

Front 78

True/False: Isosorbide Dinitrate combined with Hydralazine was shown to be particularly useful in African Americans with CHF

Back 78

True

Front 79

True/False: Sildenafil is selective for PDE5.

Back 79

False

Front 80

True/False: Tadalifil activates guanylate cyclase to increase cGMP to decrease myosin light chain kinase activity and stimulate phosphatases

Back 80

False

Front 81

True/False: Vardenafil has a longer onset and shorter duration than Sildenafil.

Back 81

False

Front 82

True/False: All erectile dysfunction drugs are contraindicated within 24 hours of using Nitrate.

Back 82

True