Hf Htn Ihd Anti-Anginals

Front 1

drug(s) that selectively inhibit(s) PDE III in the SR of cardiac cells?

Back 1

amrinone and milrinone

Front 2

Which drug is thought to have antioxidant properties and is therefore useful to treat heart failure in some people?

Back 2

carvedilol (mixed alpha and beta antagonist)

Front 3

Which drug has oral bioavailability problems (tablets) and is eliminated from the body by renal excretion?
a. digoxin
b. digitoxin
c. amrinone
d. dobutamine
e. carvedilol

Back 3

a. digoxin

Front 4

This might be the first indication of toxicity to a cardiac glycoside:

a. Fatigue
b. Dizziness
c. Cardiac arrythmia
d. Diarrhea
e. Any one of the above

Back 4

e. any of the above

Front 5

Which drug inhibits the active Na/K pump in the cell membrane of cardiac cells?

a. Digoxin
b. Nitroglycerin
c. Amrinone
d. Dopamine
e. Carvedilol

Back 5

a. digoxin

Front 6

How does Aliskiren work?

Back 6

It is a direct renin inhibitor that decreases plasma renin activity (PRA) and inhibits the conversion of angiotensinogen I to angiotensin

Front 7

What is the approved use of and dose for Aliskiren?

Back 7

Approved for tx. of HTN
150-300 mg PO qday

Front 8

What kind of dose adjustments need to be made when prescribing aliskiren to patients with renal dz? hepatic failure? elderly?

Back 8

no dose adjustments needed, though elderly and women generally don't benefit from doses >150mg PO qday

Front 9

What is the major dietary consideration for patients taking aliskiren?

Back 9

high-fat meals decrease absorption substantially

Front 10

which drug is NOT known to have an interaction with aliskiren:
a. irbesartan
b. furosemide
c. ketoconazole
d. atenolol
e. atorvastatin

Back 10

d. atenolol (the other four have known interactions with aliskeren, but are not necessarily contraindicated)

Front 11

when are you most likely to see hypotension in a patient on aliskiren?

Back 11

when the patient is on other anti-HTN drugs (especially diuretics)

Front 12

by what point is the antihypertensive effect of aliskiren usually seen?

Back 12

by two weeks

Front 13

how long does it take for steady-state blood levels to be reached in aliskiren?

Back 13

7-8 days

Front 14

what is one potentially dangerous side effect that has been reported with aliskiren use (also known side effect of ACEIs)

Back 14

angioedema

Front 15

what should be monitored for, especially in diabetic patients on aliskiren plus an ACEI?

Back 15

hyperkalemia

Front 16

which drugs are bipyridines?

Back 16

amrinone
milrinone

Front 17

what are the 3 top side effects/toxicities of bipyridines?

Back 17

thrombocytopenia
GI effects
CV (proarrhthymic)

Front 18

what dose of dopamine stimulates just the D1 receptor?

Back 18

1-3 mcg/kg/min

Front 19

what dose of dopamine stimulates the B1 receptor (and the B2 receptor slightly) in addition to stimulating the D1 receptor?

Back 19

3-10 mcg/kg/min

Front 20

what dose of dopamine stimulates the alpha1 receptor (in addition to the D1 and beta receptors)?

Back 20

>10 mcg/kg/min

Front 21

why is knowing the underlying pathophysiology important in angina pectoris?

Back 21

determines the kind of ischemic event and the drug that should be used

Front 22

Three important points in stable angina?

Back 22

predictability
avoidance of activities
prophylaxis not very important

Front 23

two important points when increasing involvement of spasm?

Back 23

not very predictable
prophylaxis is very important

Front 24

two important points in unstable angina?

Back 24

unpredictable -- so prophylaxis very important
therapy also directed at thrombotic occlusions

Front 25

How is digoxin excreted from the body?

Back 25

by the kidneys

Front 26

how is digitoxin excreted from the body?

Back 26

by the liver

Front 27

Furosemide exhibits a fast onset and relative short duration of action because:
a. it is highly lipid soluble
b. it is not readily bound by plasma protein
c. it is cleared by renal tubular secretion
d. a and b
e. all of the above

Back 27

c. it is cleared by renal tubular secretion

Front 28

the juxtoglomerular apparatus is important in the autoregulation of renal function and systemic BP because it:
a. secretes renin
b. senses tubular Na+ concentration
c. secretes aldosterone
d. a and b
e. all of the above

Back 28

d. a and b

Front 29

establishment and maintenance of the CCMM is critically dependent upon:
a. action of aldosterone on the distal tubule and collecting duct
b. transport of Na/K/2Cl in the thick ascending limb of Henle
c. action of ADH on the distal tubule and collecting duct
d. a and b
e. all of the above

Back 29

b. transport of Na/K/2Cl in the thick ascending limb of Henle

Front 30

furosemide is a "high ceiling" diuretic because it:
a. blocks at a site that is responsible for 20-30% of Na/H2O reabsorption
b. disrupts the CCMM causing isosmotic medullary interstitium
c. exhibits significant carbonic anhydrase inhibition since it was derived from the CAIs
d. a and b
e. all of the above

Back 30

d. a and b

Front 31

The mechanism of action of K-sparing diuretics is:
a. blockade of aldosterone
b. blockade of sodium channels
c. blockade of potassium channels
d. a and b
e. all of the above

Back 31

d. a and b

Front 32

the stimulus for the release of ANF is:
a. increased BP
b. increased blood volume
c. increased interstitial fluid pressure
d. increased distal tubular Na+ concentration
e. all of the above

Back 32

b. increased blood volume

Front 33

the receptor for ANF is:
a. G-protein coupled receptor
b. tyrosine kinase
c. guanylyl cyclase
d. PDE III
e. Phospholipase C

Back 33

c. guanylyl cyclase

Front 34

Tolerance to ACEIs may result from:
a. upregulation of ACE
b. increased release of renin
c. inability of the ACEI to act on local ACE
d. a and b
e. all of the above

Back 34

e. all of the above

Front 35

the efficacy of ACEI may be due in part to preservation of:
a. endothelin-1
b. bradykinin
c. atrial natriuretic peptides
d. a and b
e. all of the above

Back 35

b. bradykinin

Front 36

CCBs “block”:
a.Ligand gated calcium channels
b.Voltage gated calcium channels
c.G-protein subunit () operated calcium channels
d.a and b
e.All of the above

Back 36

b.Voltage gated calcium channels

Front 37

CCBs exhibit no effect on skeletal muscle because skeletal muscle:
a.Lacks calcium channels
b.Does not require extracellular calcium for contraction
c.Actin and myosin complex is so sensitive to Ca that CCBs are ineffective
d.Skeletal actin and myosin interdigitation is not dependent on Ca
e.None of the above

Back 37

b.Does not require extracellular calcium for contraction

Front 38

While mean arterial pressure decreases with alpha1 and beta1 receptor blockers, cardiac output:
a.Increases with alpha1 blockers and decreases with beta1 blockers
b.Decreases with alpha1 and beta1 blockers
c.Increases with alpha1 and beta1 blockers
d.Decreases with alpha1 blockers and increases with beta1 blockers.

Back 38

a.Increases with alpha1 blockers and decreases with beta1 blockers

Front 39

Administration of a non-selective alpha receptor antagonist would prevent the therapeutic effect of this drug.
a.Reserpine
b.Guanabenz
c.Guanethidine
d.a and b
e.All of the above

Back 39

b.Guanabenz

Front 40

Administration of a tricyclic antidepressant (e.g., Imipramine) would prevent the therapeutic effect of this drug:
a.Guanfacine
b.Clonidine
c.Alpha-methyldopa
d.a and b
e.All of the above

Back 40

e.All of the above

Front 41

This medication is available as a patch and requires special instruction regarding its application and disposal.
a.Clonidine
b.Nitroglycerine
c.Scopolamine
d.a and b
e.All of the above

Back 41

e.All of the above

Front 42

Each of these antihypertensive drugs causes depletion of transmitter NE EXCEPT for:
a.Guanadrel
b.Reserpine
c.Guanethidine
d.Vesamicol
e.Dopa-decarboxylase inhbitor

Back 42

d.Vesamicol

Front 43

This drug is least likely to cause receptor up-regulation and supersensitivity:
a.Propranolol
b.Pindolol
c.Timolol
d.a and b
e.All of the above

Back 43

b.Pindolol

Front 44

Reserpine:
a. Depletes the monoamines NE, DA and 5HT
b. Prevents synthesis of NE
c. Blocks Uptake2 for NE and DA
d. a and b
e. All of the above

Back 44

d. a and b

Front 45

Higher doses of this drug may be required in “Fast Acetylators”:
a.Minoxidil
b.Hydralazine
c.Propranolol
d.Esmolol
e.Losartan

Back 45

b. Hydralazine

Front 46

Match each of the following drugs with a side effect/ADR/toxicity (each may be used only once):

drugs: lisinopril, prazosin, spironolactone, nitroglycerin, verapamil

SE/ADR/toxicity: Hirsutism, Ankle swelling, Syncope, Angioedema, Headache

Back 46

lisinopril: angioedema
prazosin: syncope
spironolactone: hirsutism
nitroglycerin: headache
verapamil: ankle swelling

Front 47

48. Indication of clinical efficacy of beta blockers is:
a. Headache
b. Facial flushing
c. Bradycardia at rest
d. Ankle edema
e. Urinary retention

Back 47

c. Bradycardia at rest

Front 48

49. Patients should be counseled not to discontinue beta blockers because it may precipitate:
a. Cerebral hemorrhage
b. Myocardial infarct
c. Bilateral renal ischemia
d. Vasospastic episode (Raynaud’s episode)
e. Glaucoma attack

Back 48

b. Myocardial infarct

Front 49

match each drug with one action (use each only once).

drugs: fenoldopam, diazoxide, amilioride, nitroprusside, eprosartan

action: K+ channel opener; releases NO directly; dopamine receptor agonist; AT1 receptor antagonist; blocks Na+ channels

Back 49

fenoldopam: dopamine receptor agonist
diazoxide: K+ channel opener
amilioride: blocks Na+ channels
nitroprusside: releases NO directly
eprosartan: AT1 receptor antagonist

Front 50

55. The antihypertensive effects of beta blockers can be attributed to all of the following EXCEPT:

a. Block of cardiac B1 receptors
b. Block of renal B1 receptors
c. Block of presynaptic B1 receptors
d. Blockade of central B1 receptors

Back 50

d. Blockade of central B1 receptors

Front 51

All of the following would be expected to directly unload (decreased preload or afterload) a heart with left ventricular dysfunction EXCEPT:

a. amrinone
b. intravenous nitroglycerin
c. hydralazine
d. digoxin
e. dobutamine

Back 51

a. amrinone

Front 52

Which of the following is the most important reason why the heart rate would decrease during the efficacious use of a cardiac glycoside to treat heart failure?

a. Increased Vagus nerve activity to the heart.
b. Decreased atrioventricular (AV) node conduction.
c. Decreased sympathetic nerve (reflex) activity which affects the heart
d. Sensitization of the sinoatrial (SA) node to the effect of acetylcholine.
e. Increased sympathetic nerve (reflex) activity which affects the heart.

Back 52

c. Decreased sympathetic nerve (reflex) activity which affects the heart

Front 53

Which of the following is the most important reason why kidney function might improve during the efficacious use of a cardiac glycoside to treat heart failure?

a. Increased sympathetic nerve activity (a reflex increase)
b. Stimulation (agonism) of receptors in the vasculature of the kidneys
c. Increased stroke volume
d. Redistribution of systemic blood flow to favor the kidneys
e. The appearance of pulmonary hypotension

Back 53

c. Increased stroke volume

Front 54

refers to digoxin or digitoxin?
A decrease in renal excretion would increase its elimination half-life.

Back 54

digoxin

Front 55

refers to digoxin or digitoxin?

Longest half-life of elimination in a person with “normal” renal and hepatic function.

Back 55

digitoxin

Front 56

refers to digoxin or digitoxin?

A decrease in skeletal muscle mass would decrease its volume of distribution.

Back 56

digoxin

Front 57

refers to digoxin or digitoxin?

A higher serum therapeutic serum level because of higher plasma protein binding.

Back 57

digitoxin

Front 58

refers to digoxin or digitoxin?

severe, chronic alcoholic might have a problem eliminating this drug.

Back 58

digitoxin

Front 59

refers to digoxin or digitoxin?

An adverse effect would take the longest time to subside following discontinuation of the drug.

Back 59

digitoxin

Front 60

Match each mechanism of action with a drug (drugs may be used more than once)

drugs: minoxidil, digoxin, milrinone, intravenous dopamine, sublingual nitroglycerin

a. A relatively selective inhibition of the activity of sarcoplasmic reticulum phosphodiesterase III
b. A relatively selective relaxation of arteriolar smooth muscle
c. Increase in the amount of NO in venous smooth muscle
d. Inhibition of membrane Na+/K+ ATPase activity
e. Agonism of receptors in the renal circulation to improve kidney function
f. Indirectly slows the Ca++/Na+ exchanger in the cardiac cell membrane

Back 60

a: milrinone
b: minoxidil
c: sublingual nitroglycerin
d: digoxin
e: intravenous dopamine
f: digoxin

Front 61

The most important reason which underlies the effect of sublingual nitroglycerin to rapidly and efficaciously terminate an episode of exercise-induced stable angina is:

a. Redistribution of coronary blood flow to favor ischemic cardiac tissue
b. Pooling of blood in the venous circulation which decreases venous return of blood to the heart
c. Improved myocardial perfusion
d. Increased preload on the heart
e. An increase in total coronary blood flow

Back 61

b. Pooling of blood in the venous circulation which decreases venous return of blood to the heart

Front 62

The most important reason why propranolol (or any beta receptor antagonist) may be effective in protecting the heart from episodes of angina (a prophylactic effect) is:

a. an increase in the preload on the heart
b. increased release of sarcoplasmic reticulum (SR) Ca++
c. a normalization of the heart rate, especially during activities which may increase the heart rate
d. increased contractile force of the myocardium
e. an increase in the end-diastolic volume of the heart

Back 62

c. a normalization of the heart rate, especially during activities which may increase the heart rate

Front 63

Which portion of the systemic circulation is the most sensitive to the effects of a sublingual dose of nitroglycerin?

a. Arteriolar smooth muscle
b. Venous smooth muscle
c. Large coronary artery smooth muscle
d. Systemic capillary smooth muscle
e. Aortic smooth muscle

Back 63

b. Venous smooth muscle

Front 64

Digoxin (or any cardiac glycoside):

a. May cause a delayed afterdepolarization-induced cardiac dysrhythmia because of Ca++ overload of cardiac cells.
b. Will have a positive inotropic effect on myocardial cells.
c. May interact with many OTC and prescription-only drugs or products.
d. Only b and c are correct
e. All choices (a-c) are correct

Back 64

e. All choices (a-c) are correct

Front 65

Correctly select the drug which causes faster uptake of Ca++ into the sarcoplasmic reticulum (SR) of cardiac cells
leading to better relaxation and filling of the ventricles (a negative lusitropic effect).

a. Digoxin
b. Minoxidil
c. Milrinone
d. Intravenous nitroglycerin
e. Atenolol (Tenormin)

Back 65

c. Milrinone

Front 66

This compound would cause the slow depletion (loss) of intracellular K+ from a cardiac cell which might lead
to cardiotoxicity.

a. Digitoxin
b. Hydralazine
c. Amrinone
d. Intravenous nitroglycerin
e. Propranolol

Back 66

a. Digitoxin

Front 67

The drug of choice for treatment of organophosphate poisoning is:

a. Atropine
b. Pralidoxime
c. Physostigmine
d. Isoflurophate
e. a plus b

Back 67

e. a plus b

Front 68

In the list below the drug of choice for decreasing secretions and relaxing bronchial smooth muscle of an asthmatic patient is:

a. Metaproterenol
b. Ipratropium
c. Isoproterenol
d. Phentolamine
e. Scopolamine

Back 68

b. Ipratropium

Front 69

If the potency of Drug X, an alpha receptor antagonist, is similar at the alpha1and alpha2 receptor, then:

a. Drug X can be used to treat hypertension with low risk of increased norepinephrine release
b. Drug X should not be used to treat hypertension because it would likely cause alpha2-mediated sympathetic hyperstimulation
c. Drug X would have a high liability for producing postural hypotension as a result of alpha1 receptor blockade
d. Both statements A and C are correct of Drug X
e. None of the above statements can correctly predict the pharmacology of Drug X

Back 69

b. Drug X should not be used to treat hypertension because it would likely cause alpha2-mediated sympathetic hyperstimulation
or
c. Drug X would have a high liability for producing postural hypotension as a result of alpha1 receptor blockade

Front 70

Either prazosin or pindolol may be used to treat hypertension. What is true about these drugs?

a. They are both adrenoceptor antagonists
b. Prazosin decreases peripheral resistance while pindolol decreases cardiac output
c. Prazosin can cause orthostatic hypotension while pindolol may not cause resting bradycardia
d. Both A and B are correct
e. All of the above are correct

Back 70

e. All of the above are correct

Front 71

All of the following are prodrugs EXCEPT:
a. losartan
b. enalapril
c. alpha-methyldopa
d. lisinopril
e. nitroglycerin

Back 71

d. lisinopril

Front 72

The action of this drug can be blocked by administration of a DOPA decarboxylase inhibitor, a dopamine beta hydroxylase inhibitor, or a tricyclic antidepressant.
a. clonidine
b. guanabenz
c. methyldopa
d. a and b
e. all of the above

Back 72

e. all of the above

Front 73

Beneficial therapeutic effects of this drug result from combined actions on vascular smooth muscle and heart for all of the following EXCEPT:
a. verapamil
b. terazosin
c. labetalol
d. carvedilol
e. a and b

Back 73

b. terazosin

Front 74

Reflex tachycardia is most likely to occur with:
a. verapamil
b. phenoxybenzamine
c. clonidine
d. carvedilol
e. pindolol

Back 74

b. phenoxybenzamine

Front 75

This antihypertensive drug may cause clinical depression in predisposed patients.
a. clonidine
b. reserpine
c. guanabenz
d. a and b
e. all of the above

Back 75

e. all of the above

Front 76

Beta blockers may worsen the condition of patients who have:
a. asthma b. vasospastic disease c. pheochromocytoma
d. a and b
e. all of the above

Back 76

e. all of the above

Front 77

A patient suffering from unacceptable tachycardia while taking hydralazine for his hypertension may benefit if changed to one of the following drugs:
a. verapamil
b. nifedipine SR
c. phentolamine
d. a and b
e. any of the above

Back 77

a. verapamil

Front 78

This drug releases NO directly not requiring enzymes or substrates:
a. nitroglycerin
b. nitroprusside
c. hydralazine
d. a and b
e. b and c

Back 78

b. nitroprusside

Front 79

All of the following increase production of cGMP EXCEPT:
a. diazoxide
b. ANP
c. nitroprusside
d. hydralazine
e. nitroglycerin

Back 79

a. diazoxide

Front 80

Mechanism of action of this drug is via blockade of Na/K/2Cl transporter:
a. acetazolamide
b. furosemide
c. hydrochlorothiazide
d. spironolactone
e. b and c

Back 80

b. furosemide

Front 81

Hypokalemia is a common feature for all of the following diuretics EXCEPT:
a. acetazolamide
b. hydrochlorothiazide
c. furosemide
d. eplerenone
e. chlorothiazide

Back 81

d. eplerenone

Front 82

The diuretic action of carbonic anhydrase inhibitors produces:
a. metabolic acidosis
b. urinary alkalosis
c. metabolic alkalosis
d. a and b
e. b and c

Back 82

d. a and b

Front 83

Despite the fact that they are highly protein bound, loop diuretics have a relatively short duration of action because they are:

a. secreted into the tubular lumen
b. secreted into the bile
c. redistributed and sequestered in fat
d. rapidly metabolized in the liver
e. a and b

Back 83

a. secreted into the tubular lumen

Front 84

Tolerance develops to the diuretic effects of loop diuretics because of:

a. induction of CYP450
b. induction of tubular lumen organic acid/base secretory mechanisms
c. distal tubular lumen transporter upregulation
d. increased production of circulating globulins
e. all of the above

Back 84

c. distal tubular lumen transporter upregulation

Front 85

Select the following rational drug combinations and correct reasons for the combination:

a. lisinopril & spironolactone because the combination decreases risk of K+ imbalance
b. ethacrynic acid & hydrochlorothiazide in order to maximize efficacy while avoiding adverse reaction to sulfa drugs
c. chlorthalidone & eplerenone to prevent metabolic alkalosis
d. furosemide & hydrochlorothiazide to overcome diuretic tolerance
e. all of the above

Back 85

d. furosemide & hydrochlorothiazide to overcome diuretic tolerance

Front 86

Antagonists of these peptides would be beneficial in the treatment of hypertension:
a. bradykinin
b. endothelin-1
c. atrial natriuretic peptide
d. a and b
e. b and c

Back 86

b. endothelin-1

Front 87

This is a membrane bound enzyme:
a. PLC
b. NEP
c. ACE
d. a and b
e. all of the above

Back 87

e. all of the above

Front 88

Inhibition of this enzyme would be beneficial in the treatment of hypertension:
a. guanylyl cyclase
b. NO synthase
c. NEP
d. glutathione reductase
e. c and d

Back 88

c. NEP

Front 89

Blockade of this enzyme would directly increase circulating concentrations of both ANP and bradykinin:
a. NEP
b. ACE
c. Renin
d. either a or b e. any one of the above

Back 89

a. NEP

Front 90

Blockade of this enzyme would decrease the circulating concentration of endothelin-1:
a. ACE
b. Renin
c. NEP
d. a or b
e. any one of the above

Back 90

e. any one of the above

Front 91

Patients with essential hypertension may have high plasma concentration of this peptide.
a. angiotensin II
b. endothelin-1
c. ANP
d. a or b
e. any one or all of the above

Back 91

e. any one or all of the above

Front 92

The mechanism of action of the cardiac glycosides at the cellular level is best described as:

a. direct inhibition of membrane Na+/K+ ATPase leading to an increase in intracellular Na+ ions
b. direct inhibition of membrane Na+/K+ ATPase leading to an increase in intracellular K+ ions
c. direct inhibition of the Na+/Ca++ exchanger in cardiac cell membranes
d. inhibition of phosphodiesterase III in the sarcoplasmic reticulum (SR) of cardiac cells
e. direct stimulation of SR Na+/Ca++ active exchange leading to more Ca++ available for contraction

Back 92

a. direct inhibition of membrane Na+/K+ ATPase leading to an increase in intracellular Na+ ions

Front 93

The first indication of cardiac glycoside toxicity is:

a. loss of appetite and fatigue
b. some kind of visual disturbance
c. a psychological change
d. a cardiac arrhythmia
e. Any choice (a – d) could be the first indication

Back 93

e. Any choice (a – d) could be the first indication

Front 94

When digoxin is efficacious to treat heart failure, systemic vascular resistance decreases because:
a. digoxin directly causes arteriolar dilation
b. sympathetic reflexes decrease because of better tissue perfusion
c. digoxin decreases ankle edema
d. digoxin has a long half-life of elimination
e. digoxin directly decreases heart rate

Back 94

b. sympathetic reflexes decrease because of better tissue perfusion

Front 95

match each of the following drugs to a possible mechanism by which tolerance may develop to its therapeutic action.

drugs: nitroglycerin, phenoxybenzamine, acetazolamide, propranolol, losartan

mechanisms:
a. receptor upregulation
b. inhibition of CYP450
c. depleted cysteine
d. blockade of presynaptic alpha-2 receptors
e. depleted bicarbonate

Back 95

nitroglycerin: c. depleted cysteine
phenoxybenzamine: d. blockade of presynaptic alpha-2 receptors
acetazolamide: e. depleted bicarbonate
propranolol: a. receptor upregulation
losartan: b. inhibition of CYP450

Front 96

Correctly match each drug with a mechanism of action (each drug may be used only once)

drugs: Dopamine, Isosorbide dinitrate, Digoxin, Amrinone, Hydralazine

a. At the appropriate dose, selectively inhibits phosphodiesterase III
b. At the appropriate dose, activates peripheral D1 and ß1 receptors
c. At the appropriate dose, decreases the preload on the heart by selectively dilating veins
d. At the appropriate dose, decreases the afterload on the heart by selectively dilating arterioles
e. At the appropriate dose, increases cardiac intracellular Na+ and Ca++ ions

Back 96

Dopamine: b. At the appropriate dose, activates peripheral D1 and ß1 receptors
Isosorbide dinitrate: c. At the appropriate dose, decreases the preload on the heart by selectively dilating veins
Digoxin: e. At the appropriate dose, increases cardiac intracellular Na+ and Ca++ ions
Amrinone: a. At the appropriate dose, selectively inhibits phosphodiesterase III
Hydralazine: d. At the appropriate dose, decreases the afterload on the heart by selectively dilating arterioles

Front 97

digoxin or digitoxin?

a. Hepatic metabolism is the principle route of elimination; Elimination half-life measured in days (i.e., half-life of elimination is about seven (7) days

Back 97

digitoxin

Front 98

digoxin or digitoxin?

Highly bound to lean body tissue (i.e., skeletal muscle); Volume of distribution is high

Back 98

digoxin

Front 99

digoxin or digitoxin?

Therapeutic blood level (total) is between 0.5 and 2.0 ng/ml

Back 99

digoxin

Front 100

digoxin or digitoxin?

Problems with bioavailability, especially with tablets; Little binding to plasma protein (i.e., fraction unbound in high)

Back 100

digoxin

Front 101

digoxin or digitoxin?

Renal excretion is the principle route of elimination

Back 101

digoxin

Front 102

Used for hypercalcemia:
a. acetazolamide
b. HCTZ
c. furosemide
d. triamterene

Back 102

c. furosemide

Front 103

used for hypercalciuria:
a. acetazolamide
b. HCTZ
c. furosemide
d. triamterene

Back 103

b. HCTZ

Front 104

used for hypokalemia:
a. acetazolamide
b. HCTZ
c. furosemide
d. triamterene

Back 104

d. triamterene

Front 105

used for glaucoma:
a. acetazolamide
b. HCTZ
c. furosemide
d. triamterene

Back 105

a. acetazolamide

Front 106

used for epilepsy:
a. acetazolamide
b. HCTZ
c. furosemide
d. triamterene

Back 106

a. acetazolamide

Front 107

diuretics such as furosemide, ethacrynic acid and HCTZ may precipitate an attack of gout because they:
a. decrease the metabolism of uric acid
b. block the secretion of uric acid
c. increase reabsorption of uric acid by the CCMM
d. increase production of uric acid
e. decrease glomerular filtration of uric acid

Back 107

b. block the secretion of uric acid

Front 108

furosemide exhibits a fast onset and relative short duration of action because:
a. it experiences a large "first pass" effect
b. it is sequestered by bile acids
c. it is secreted into the renal tubular lumen
d. a and b
e. all of the above

Back 108

c. it is secreted into the renal tubular lumen
(need to double-check?)

Front 109

Which drug has metabolic alkalosis as a consequence of its administration:
a. chlorothiazide
b. acetazolamide
c. amiloride
d. urea

Back 109

a. chlorothiazide

Front 110

which drug has metabolic acidosis as a consequence of its administration:
a. chlorothiazide
b. acetazolamide
c. amiloride
d. urea

Back 110

b. acetazolamide

Front 111

which drug has urinary alkalosis as a consequence of its administration:
a. chlorothiazide
b. acetazolamide
c. amiloride
d. urea

Back 111

b. acetazolamide

Front 112

which drug has hyperkalemia as a consequence of its administration:
a. chlorothiazide
b. acetazolamide
c. amiloride
d. urea

Back 112

c. amiloride

Front 113

which drug can elevate plasma lipids, glucose and uric acid:
a. chlorothiazide
b. acetazolamide
c. amiloride
d. urea

Back 113

a. chlorothiazide

Front 114

each of these antihypertensive drugs must be converted to an active metabolite except for:
a. methyldopa
b. losartan
c. minoxidil
d. verapamil
e. lisinopril

Back 114

e. lisinopril

Front 115

match each drug to its mechanism of action

drugs: methyldopa, losartan, minoxidil, verapamil, lisinopril

MOA: CCB, ACEI, alpha2 agonist, K+ channel opener, AT1 receptor antagonist

Back 115

methyldopa: alpha2 agonist
losartan: AT1 receptor antagonist
Minoxidil: K+ channel opener
verapamil: CCB
lisinopril: ACEI

Front 116

match each drug with its characteristic side effect (each should be used once)

drugs: fosinopril, nifedipine, verapamil, propranolol, captopril

side effects: cough; constipation; elevated lipids; sulfa-drug induced allergy; negative chronotropy

Back 116

fosinopril: cough
nifedipine: constipation
verapamil: negative chronotropy
propranolol: elevated lipids
captopril: sulfa-drug induced allergy

Front 117

this medication is available as a patch and requires special instruction regarding its application and disposal
a. clonidine
b. nitroglycerin
c. benazepril
d. a and b
e. all of the above

Back 117

d. a and b

Front 118

this drug causes receptor upregulation and agonist supersensitivity:
a. propranolol
b. reserpine
c. pindolol
d. a and b
e. all of the above

Back 118

e. all of the above

Front 119

match each drug with a possible side effect or serious adverse effect (each should be used once)

drugs: prazosin, captopril, nitroglycerin, diltiazem, minoxidil

side effect/adverse effect: hypertrichosis; ankle swelling; headache; angioedema; syncope

Back 119

prazosin: syncope
captopril: angioedema
nitroglycerin: headache
diltiazem: ankle swelling
minoxidil: hypertrichosis

Front 120

bradykinin relaxes smooth muscle via stimulation of:
a. NO formation
b. prostacyclin formation
c. cAMP
d. a and b
e. all of the above

Back 120

d. a and b (needs to be double-checked)

Front 121

bradykinin:
a. decreases renal blood flow
b. exhibits mitogenic activity in the heart
c. increases renal sodium reabsorption
d. a and b
e. none of the above

Back 121

c. increases renal sodium reabsorption (needs to be double-checked)

Front 122

this drug is the only endothelin receptor antagonist on the US market:
a. eprosartan
b. bosentan
c. fenoldopam
d. moexipril
e. diazoxide

Back 122

b. bosentan

Front 123

match the drugs and characteristic side effect or potential serious adverse effect (drugs may be used only once)

drugs: hydralazine; lisinopril; nisoldipine; nitroglycerin; propranolol

side effects: SLE-like syndrome; gingival hyperplasia; tolerance due to superoxide formation; acute renal failure

Back 123

SLE-like syndrome: hydralazine
gingival hyperplasia: nisoldipine
tolerance due to superoxide formation: nitroglycerin
acute renal failure: lisinopril

Front 124

how do CCBs work?

Back 124

they bind to sites on the voltage-gated Ca2+ channel in a stereoselective manner; they bind more effectively to channels in the depolarized state ("use-dependent blockade")

Front 125

name 3 drugs (or class of drugs) known to cause gingival hyperplasia

Back 125

phenytoin
cyclosporine
CCBs

Front 126

what is the prevaling theory of the cause of tolerance with continuous NTG use?

Back 126

formation of superoxide

Front 127

how does minoxidil work for HTN?

Back 127

K+ channel opener (causes relaxation of smooth muscle)

Front 128

how is diazoxide thought to work in treatment of HTN?

Back 128

blocks ATP from binding to K+ channel, causing channel to stay open, which results in smooth muscle relaxation

Front 129

what's another term for ACE?

Back 129

kinase II

Front 130

what is aliskiren?

Back 130

a non-peptide inhibitor of renin, so it inhibits the conversion of angiotensinogen to angiotensin I

Front 131

name 3 actions of angiotensin II

Back 131

vasoconstriction, increased arterial and cardiac wall muscle (remodeling), and aldosterone secretion

Front 132

how do ACEIs work?

Back 132

by inhibiting ACE, they (1) block conversion of Ang. I to Angiotensin II, and (2) they prevent metabolism of bradykinin, a vasodilator

Front 133

what is AT1?

Back 133

Angiotensin II receptor subtype 1; found on VSM and adrenal gland; leads to vascular and cardiac hypertrophy/remodeling, vasoconstriction, and Na+ retention via aldosterone secretion

Front 134

how do ARBs work?

Back 134

they block the AT1 receptor

Front 135

which class of drugs used in the treatment of HTN can cause hyperkalemia? why?

Back 135

ACEIs, because blocking RAAS allows loss of Na+ and K+ is retained

Front 136

what are enoximone and piroximone?

Back 136

two examples of experimental drugs that may be useful in tx of HF; better inhibitors of PDE III

Front 137

The primary reason sublingual NTG is efficacious to rapidly terminate an episode of stable angina is:
a. reduction of preload on the heart
b. reduction of afterload on the heart
c. reduction of systemic blood pressure
d. redistribution of coronary blood flow to ischemic tissue
e. improved myocardial perfusion


(2003exam3)

Back 137

a. reduction of preload on the heart

Front 138

The rationale for the use of high doses of nitrates (so called 'long-acting' nitrates) is to:
a. avoid the rapid development of tolerance to nitrates
b. improve the GI absorption of nitrates
c. overcome first-pass metabolism of nitrates
d. avoid side effects of nitrates


(2003exam3)

Back 138

c. overcome first-pass metabolism of nitrates

Front 139

Propranolol decreases the incidence and severity of episodes of stable angina by:
a. pooling blood in the peripheral venous circulation
b. increasing the preload on the heart
c. decreasing the heart rate, especially during exercise
d. causing the left and right ventricles to empty more completely
e. all of the above


(2003exam3)

Back 139

c. decreasing the heart rate, especially during exercise

Front 140

A primary side effect of an ordinary sublingual dose of NTG is:
a. a transient headache
b. a severe reduction in systemic blood pressure
c. cinchonism
d. the very dangerous arrhythmia Torsades de Pointes (TdP)
e. cardiac arrest due to a reduction in venous return to the heart


(2003exam3)

Back 140

a. a transient headache

Front 141

T/F: dipyridamole is not used to treat angina because it causes coronary steal.


(2003exam3)

Back 141

true

Front 142

Match each drug with a short description (use each choice only once)

drugs:
oral propranolol
oral nifedipine
sublingual nitroglycerin
oral isosorbide dinitrate
oral diltiazem

descriptions:
a. May increase end-diastolic left ventricular volume in some patients; Decreases the heart rate, especially
during exercise.
b. Strong effect to directly depress atrioventricular (AV) node and sinoatrial (SA) node conduction velocity; Alters the kinetics of the entry of a divalent cation into cardiac cells; Little or no vascular selectivity.
c. Used in doses high enough to overcome first pass hepatic metabolism; Prophylactic use; Improves exercise tolerance.
d. Probably causes coronary artery dilation in therapeutic doses; Usually decreases systemic diastolic blood
pressure; Sympathetic reflex activity may oppose any decrease in heart rate.
e. Unstable; Relative dose-dependent selectivity for veins compared to arterioles; Used to terminate episodes of myocardial ischemia



2004exam3

Back 142

a. May increase end-diastolic left ventricular volume in some patients; Decreases the heart rate, especially
during exercise: oral propranolol

b. Strong effect to directly depress atrioventricular (AV) node and sinoatrial (SA) node conduction velocity; Alters the kinetics of the entry of a divalent cation into cardiac cells; Little or no vascular selectivity: oral diltiazem

c. Used in doses high enough to overcome first pass hepatic metabolism; Prophylactic use; Improves exercise tolerance: isosorbide dinitrate

d. Probably causes coronary artery dilation in therapeutic doses; Usually decreases systemic diastolic blood
pressure; Sympathetic reflex activity may oppose any decrease in heart rate: oral nifedipine

e. Unstable; Relative dose-dependent selectivity for veins compared to arterioles; Used to terminate episodes of myocardial ischemia: sublingual nitroglycerin

Front 143

Beta blockers may worsen the condition of patients who have:
a. asthma
b. vasospastic disease
c. glaucoma
d. a and b
e. all of the above


(2002 exam 3 q57)

Back 143

d. a and b

Front 144

Inhibitors of these enzymes would be beneficial in the treatment of hypertension except for:
a. carbonic anhydrase
b. endothelin converting enzyme
c. renin
d. guanylyl cyclase
e. c and d


(2002 exam 3 q58)

Back 144

d. guanylyl cyclase

Front 145

Of the following calcium channel blockers, which is the least likely to cause tachycardia?
a. verapamil
b. nifedipine
c. diltiazem
d. nisoldipine


(2002 exam 3 q59)

Back 145

a. verapamil

Front 146

Because of the mode of action of CCBs to lower blood pressure, patients may commonly complain of:
a. constipation
b. headache
c. swelling of the feet
d. a and b
e. all of the above


(2002 exam 3 q60)

Back 146

e. all of the above