Exam 3 2010

Front 1

PL has atrial flutter and the physician wants to treat this condition by prescribing a calcium channel blocker that will slow conduction through the AV node. Which CCB would be the best choice?

Back 1

Verapamil

Front 2

A physician wishes to prescribe a CCB that will reduce heart rate and decrease the force of cardiac contraction for a patient with stable angina. Which CCB would be the best choice?

Back 2

Verapamil

Front 3

JT is currently taking atenolol for hy[ertension. His doctor has prescribed Diltiazem to help further reduce his blood pressure. You notice that there is a potential drug interaction with this combination and alert the doctor of which of the following?

Back 3

The combination of Diltiazem and atenolol may put a patient at risk for heart block.

Front 4

TR has heart failure. The physician wishes to add a CCB for hypertension but does not wish to increase the patient's risk of negative inotropic effects. Which CCB would be the best option?

Back 4

Nifedipine

Front 5

True/False: Niacin mediated flushing may be reduced by pretreatment with aspirin thirty minutes prior to ingestion of niacin.

Back 5

True

Front 6

True/False: Niacin mediated flushing is believed to be caused by prostaglandin D2 binding to the DP1 receptor which leads to vasoconstriction.

Back 6

False

Front 7

True/False: Most patients develop tolerance to niacin mediated flushing in one to two weeks.

Back 7

True

Front 8

Niacin mediated flushing may be reduced by using a sustained release formulation rather than an immediate release formulation.

Back 8

True

Front 9

True/False: Fenofibrate may cause the production of gallstones.

Back 9

True

Front 10

True/False: Gemfibrozil may decrease the effects of warfarin.

Back 10

False

Front 11

True/False: Fenofibrate is not recommended in patients with triglycerides above 1000mg/dl.

Back 11

False

Front 12

True/False: Gemfibrozil is a weak CYP2C9 inhibitor.

Back 12

False

Front 13

Which statin (Atorvastatin, Lovastatin, Pravastatin, or Simvastatin) would be expected to interact less with ketoconazole, a potent CYP3A4 inhibitor?

Back 13

Pravastatin

Front 14

True/False: Statins prevent the absorption of cholesterol form the intestine.

Back 14

False

Front 15

True/False: Statins increase the uptake of LDL from the blood.

Back 15

True

Front 16

True/False: Statins are classified as pregnancy category C medications.

Back 16

False

Front 17

True/False: One of the possible pleiotropic effects of statins is increased platelet activation.

Back 17

False

Front 18

True/False: Ezetimibe inhibits cholesterol absorption.

Back 18

True

Front 19

True/False: Ezetimibe is dosed once daily due to its 22 hour half-life.

Back 19

True

Front 20

True/False: Ezetimibe's molecular target is the Niemann-Pick C1-like transporter.

Back 20

True

Front 21

True/False: Fatty meals may increase Ezetimibe's clinical effect.

Back 21

False

Front 22

True/False: In rare cases the statin side effect myopathy may lead to rhabdomyolysis.

Back 22

True

Front 23

True/False: An increase in AST and ALT when using statins is usually temporary.

Back 23

True

Front 24

True/False: Hypertension from statin use is a condition which could predispose patients to rhabdomyolysis.

Back 24

False

Front 25

True/False: Myopathy, due to statin use, is defined as muscle aches or weakness with an associated increases in creatinine phosphokinase (CPK) greater than 10 times the upper limit of normal.

Back 25

True

Front 26

Bob is taking 10 mg of Lovastatin. His LDL level is currently 117. His doctor wants to see this level below 100. How would his Lovastatin have to be changed to reach this level?

Back 26

Increase the dose of Lovastatin by 8 times to 80 mg

Front 27

True/False: BB contribute to blood pressure lowering effects by Blockade of Beta1 receptors in the SA node.

Back 27

True

Front 28

True/False: BB contribute to blood pressure lowering effects by competitive blockade of Beta2 receptors.

Back 28

False

Front 29

True/False: BB contribute to blood pressure lowering effects by competitive blockade of Beta1 receptors that mediate renin release

Back 29

True

Front 30

True/False: BB contribute to blood pressure lowering effects by membrane stabilizing activity.

Back 30

False

Front 31

True/False: Pindolol - High ISA activity

Back 31

True

Front 32

Name four things that are true about BB in hypertension.

Back 32

1. They are considered first line agents in young hypertensives with elevated heart rates.
2. Agents with ISA lower blood pressure by a sustained decrease in TPR.
3. Non-selective agents lower blood pressure by a substantial decrease in CO.
4. Beta1 selective agents initially increase TPR which chronically returns towards normal.

Front 33

True/False: Timolol is useful in glaucoma because it increases uveoscleral outflow out of the eye.

Back 33

False

Front 34

True/False: Agents with increased lipid solubility are required for migraine prophylaxis.

Back 34

True

Front 35

True/False: Propranolol's actions in thyrotoxicosis are related to membrane stabilizing activity that decrease thyroid hormone release.

Back 35

False

Front 36

True/False: BB usefulness in angina and MI are due to their ability to decrease oxygen demand of the heart.

Back 36

True

Front 37

Name four types of patients that propranolol use should be avoided.

Back 37

1. Resting heart rate <60bpm
2. Reynaud's Disease
3. Intermittent Claudication
4. Depression

Front 38

True/False: Metoprolol would be preferred over Propranolol to treat an asthmatic patient with premature ventricular contractions.

Back 38

True

Front 39

True/False: All BB may cause vivid dreams and nightmares

Back 39

False

Front 40

True/False: Labetalol has low lipid solubility and some membrane stabilizing activity

Back 40

True

Front 41

True/False: The nonselective BB would be preferred in patients with elevated LDL and triglycerides.

Back 41

False

Front 42

Central sympatholytics...

Back 42

All cause sedation

Front 43

True/False: Alpha methyldopa has agonist activity at Imidazoline 1 receptors.

Back 43

False

Front 44

True/False: Alpha methyldopa is taken up into synapse by the reuptake pump and converted to alpha methylnorepinephrine by DOPA decarboxylase and dopamine beta hydroxylase.

Back 44

True

Front 45

True/False: Alpha methyldopa is contraindicated during pregnancy.

Back 45

False

Front 46

True/False: Alpha methyldopa may cause sodium and water retention.

Back 46

True

Front 47

Name four things Clonidine can do:

Back 47

1. Inhibits brainstem sympathetic outflow and increases vagal nerve activity
2. May cause bradycardia
3. May cause dry mouth
4. May cause hyperglycemia

Front 48

True/False: Apraclonidine increases alpha2 mediated contraction of the trabecular meshwork to increase aqueous fluid outflow of the eye.

Back 48

False

Front 49

True/False: Guanabenz produces less dry mouth and sedation than Clonidine.

Back 49

False

Front 50

True/False: Rilmenidine activates Imidazoline 1 receptors in the rostral ventral lateral medulla to decrease sympathetic outflow.

Back 50

True

Front 51

True/False: Reserpine should not be used in combination with diuretics because of excessive sodium loss

Back 51

False

Front 52

Prazosin...

Back 52

May have central sympatholytic activity that limits reflex tachycardia

Front 53

True/False: The Doxazosin arm of the ALLHAT trial was stopped because Doxazosin produced excessive orthostatic hypotension in patients

Back 53

False

Front 54

True/False: Tamsulosin is selective for alpha 1c receptors

Back 54

False

Front 55

True/False: Prazosin may be an acceptable antihypertensive in male patients with benign prostatic hyperplasia

Back 55

True

Front 56

True/False: Labetalol has equal beta and alpha blocking activity.

Back 56

False

Front 57

Vascular smooth muscle...

Back 57

has L-type voltage sensitive calcium channels that open at a membrane potential around -20mv

Front 58

True/False: Direct acting vasodilators directly decrease TPR.

Back 58

True

Front 59

True/False: Direct acting vasodilators all affect both arteries and veins

Back 59

False

Front 60

True/False: Direct acting vasodilators reflexively increase sodium and water retention.

Back 60

True

Front 61

True/False: Direct acting vasodilators are effective as long term mono-therapy

Back 61

False

Front 62

Hydralazine...

Back 62

increases cGMP which activates phosphatases that dephosphorylate myosin

Front 63

True/False: Minoxidil requires liver sulfotransferase for activation.

Back 63

True

Front 64

True/False: Nitroprusside releases NO which activates cGMP to decrease intracellular calcium.

Back 64

True

Front 65

True/False: Minoxidil activates ATP modulated potassium channels to increase outflow of potassium to cause hyperpolarization.

Back 65

True

Front 66

True/False: Nitroprusside induced myocardial ischemia can be reversed by sodium thiosulfate.

Back 66

False

Front 67

True/False: Nitrates preferentially reduce preload.

Back 67

True

Front 68

True/False: Nitrates show cross tolerance with NO donors.

Back 68

False

Front 69

True/False: Nitrates require sulhydryl groups for activation

Back 69

True

Front 70

True/False: Nitrates preferentially dilate coronary vessels so TPR and CO do not change.

Back 70

False

Front 71

True/False: Amyl nitrate is available for sublingual administration.

Back 71

False

Front 72

True/False: Nitroglycerin tolerance can be reversed with N-acetylcysteine.

Back 72

True

Front 73

True/False: Nitrates may turn stools black.

Back 73

False

Front 74

True/False: Isosorbide dinitrate may cause orthostatic hypotension

Back 74

True

Front 75

True/False: Sildenafil shows higher selectivity for PDE5 than Tadalafil

Back 75

False

Front 76

True/False: Tadalafil has a slower onset of action and a longer duration of action compared to Vardenafil

Back 76

True

Front 77

True/False: Vardenafil has a higher incidence of priapism than either Tadalafil or Sildenafil

Back 77

False

Front 78

True/False: Erectile dysfunction drugs all work by inhibiting the interaction of calcium-calmodulin with myosin light chain kinase

Back 78

False

Front 79

True/False: Triggers for migraine include the following: stress, anxiety, chocolate, red wine, and MSG.

Back 79

True

Front 80

True/False: Premonitory phase pf migraine occurs much more frequently in women than men

Back 80

False

Front 81

True/False: The neurogenic model of migraine combines neuronal dysfunction with vascular changes.

Back 81

True

Front 82

True/False: The postdrome consists of depression and irritability for up to 24 hours after the headache

Back 82

False

Front 83

True/False: Ergotamine tartrate is an agonist at 5HT2 receptors

Back 83

False

Front 84

True/False: Dihydroergotamine is only available as a nasal spray.

Back 84

True

Front 85

True/False: Ketorolac is an opiate with mixed mu agonist activity

Back 85

False

Front 86

True/False: Ergot alkaloids cause vasoconstriction by activating alpha1 receptors

Back 86

False

Front 87

Name four things true about triptans.

Back 87

1. Naratriptan has a long duration of action.
2. Sumatriptan activates presynaptic 5HT1D/B receptors which decrease peptide release
3. They are contraindicated in coronary artery disease and within 24 hours of receiving ergots
4. Side effects include tightness and pressure in the chest

Front 88

True/False: In migraine prophylaxis, BB with ISA are very useful

Back 88

False

Front 89

True/False: In migraine prophylaxis, Topiramate blocks the spreading depression and trigeminal activation

Back 89

True

Front 90

True/False: Lithium is very useful in preventing the release of the peptides that lead to vasoconstriction and inflammation

Back 90

False

Front 91

True/False: SSRI type antidepressants work better than tricyclic antidepressants

Back 91

False