• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/222

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

222 Cards in this Set

  • Front
  • Back
Which of the following would decrease blood pressure

1. Nitric oxide
2. Serotonin
3. Histamine
4. Vasopressin

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
B = 1,3
Which of the following is/are correct about cardiovascular regulation?

a. The two most important factors regulating blood flow are the pressure gradient between left and right sides of the heart and radius of the blood vessels
b. Short term blood pressure regulation is done through volume changes
c. Changes in heart function due to Starling’s law of the heart mostly affect stroke volume
d. Cardiac output is always increased by an increase in stroke volume
e. All of the above are correct
f. A and C are correct
f. A and C are correct
What is a major difference between dihydropyridine (DHP) and non-dihydropyridine (non-DHP) calcium channel blockers?

a. DHPs primarily affect the preload, while non-DHPs affect the afterload.
b. DHPs do not decrease heart rate, while non-DHPs decrease heart rate.
c. DHPs decrease contractility of the heart, while non-DHPs do not affect contractility.
d. DHPs block L-type calcium channels, while non-DHPs block T-type calcium channels.
e. None of the above are correct
b. DHPs do not decrease heart rate, while non-DHPs decrease heart rate.
Which of the following statements about verapamil is false?

a. Verapamil is a potent CYP3A inhibitor
b. Verapamil is a potent p-glycoprotein inhibitor
c. Verapamil can shorten the PR interval
d. Verapamil is a substrate of CYP3A
e. None of the above are correct
c. Verapamil can shorten the PR interval
Which of the following dihydropyridine (DHP) calcium channel blockers has the longest half-life?

a. Amlodipine
b. Nifedipine
c. Isradipine
d. Clevidipine
e. None of the above are correct
a. Amlodipine
Which of the following is the primary target of Gemfibrozil?

a. NP1C1
b. PPAR-Gamma
c. HMG-CoA Reductase
d. PPAR-Alpha
e. None of the above are correct
d. PPAR-Alpha
Which of the following is particularly effective for treating elevated triglyceride levels?

a. Cholestyramine
b. Ezetimibe
c. Simvastatin
d. Gemfibrozil
e. None of the above are correct
d. Gemfibrozil
Erythromycin which is a substrate and inhibitor of CYP3A4 would be least likely to affect metabolism of which of the following agents?

a. Lovastatin
b. Atorvastatin
c. Pravastatin
d. Simvastatin
e. None of the above are correct
c. Pravastatin
Please select the best agent below to add to a patient with atherogenic dyslipidemia (Low HDL and High Triglycerides) currently taking Simvastatin.

a. Ezetimibe
b. Niacin
c. Atorvastatin
d. Cholestyramine
e. None of the above are correct
b. Niacin
Which of the following classes of drugs exhibit pharmacologic effects by inhibiting HMG-CoA reductase?

a. Statins
b. Fibric acid derivatives (Fibrates)
c. Bile acid sequestrants
d. Cholesterol absorption inhibitors
e. None of the above are correct
a. Statins
Which of the following is/are correct?

1. Renin cleaves 4 amino acids off of angiotensinogen to form Angiotensin I
2. Angiotensin II only activates AT1 and AT 2 receptors
3. Renin release from juxtaglomerular cells is controlled partially by distal tubule NaCl.
4. Angiotensin II increases renin release through a positive feedback loop.

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
B = 1,3
Which of the following is/are true?

a. Angiotensin II (1-8) can be converted to Angiotensin III (2-8) by ACE
b. Angiotensin (1-7) has a very high affinity for AT2 receptors
c. Angiotensin I (1-10) can be converted to Angiotensin (2-10) by ACE2
d. Angiotensin III and IV have affinity for the AT4 receptor
e. All of the above are correct
f. None of the above are correct
d. Angiotensin III and IV have affinity for the AT4 receptor
Which of the following is/are true about ACE inhibitors?

1. Fosinopril would be the inhibitor of choice for a patient with kidney disease
2. All contain sulfhydral groups that bind zinc at the active site
3. Lisinopril would be a good inhibitor choice for a patient with liver disease
4. All except Quinapril cause angioedema

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
B = 1,3
Which of the following is/are correct about ACE inhibitors?

a. They are equally effective as monotherapy in African Americans and Caucasians
b. They benefit left ventricular dysfunction by decreasing afterload with no change in preload
c. They are preferred over Angiotensin receptors blockers in patients with renal artery stenosis
d. All may cause taste disturbances but Captopril is most common
e. All of the above are correct
f. None of the above are correct
d. All may cause taste disturbances but Captopril is most common
Angiotensin receptor blockers (ARB’s)

a. Are readily reversible and easily displaced from AT1 receptors
b. Are selective for AT1 receptors
c. Only Candesartin, Olmesarten and Losartin do not undergo metabolic activation
d. All are FDA approved for the use in left ventricular dysfunction
e. All of the above are correct
f. None of the above are correct
b. Are selective for AT1 receptors
Which of the following is/are true about Angiotensin receptor blockers (ARB’s)

a. They frequently cause hyperkalemia in patients with normal renal function treated for hypertension
b. Are less effective than ACE inhibitors for renal protection in type II diabetics
c. Should not be used with diuretics because of the increased risk of renal failure due to decreased fluid volume
d. Produce angioedema more frequently than ACE inhibitors
e. All of the above are correct
f. None of the above are correct
f. None of the above are correct
Aliskiren

a. Directly inactivates renin
b. Significantly elevates bradykinin levels
c. Is contraindicated for use with Angiotensin receptor blockers
d. Inhibits renin synthesis and release
e. All of the above are correct
f. None of the above are correct
a. Directly inactivates renin
Which of the following is/are true about beta blockers?

a. Lipid solubility is highest in agents which undergo renal elimination
b. Agents with highest the ISA activity also have the highest membrane stabilizing activity
c. 3rd generation agents all have Beta 2 agonist activity
d. Pindolol shows one of the highest ISA activities
e. All of the above are correct
f. None of the above are correct
d. Pindolol shows one of the highest ISA activities
Which of the following is/are correct?

a. Nadolol – high ISA activity
b. Timolol – moderate lipid solubility
c. Acebutolol – no membrane stabilizing activity
d. Bisoprolol - high lipid solubility, high ISA
e. Cartelol - Alpha blocking and antioxidant activity
f. Labetalol - NO stimulating and Beta 2 agonist activity
b. Timolol – moderate lipid solubility
Which of the following is/are true?

a. Beta blockers with high ISA acutely decrease blood pressure by decreasing TPR
b. Beta blockers with low ISA acutely increase cardiac output
c. Beta blockers with high ISA chronically decrease blood pressure by decreasing TPR
d. Beta one selective beta blockers acutely decrease CO which slowly returns to normal with continued use
e. All of the above are correct
f. None of the above are correct
c. Beta blockers with high ISA chronically decrease blood pressure by decreasing TPR
Which of the following actions of beta blockers contribute to their therapeutic usefulness as antihypertensives?

1. Competitive blockade of cardiac beta 1 receptors to decrease stroke volume
2. Competitive blockade of beta 1 receptors on juxtaglomerular cells to decrease renin secretion
3. Competitive blockade of beta presynaptic receptors to decrease NE release
4. Competitive blockade of vascular beta 2 receptors
A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
A = 1,2,3
Which of the following clinical indications and mechanisms is/are correct for beta blockers?

a. Hypertension – works best in young patients with elevated catecholamines
b. Glaucoma – decrease aqueous humor production
c. Hyperthyroidism – blocks tremor and tachycardia
d. Panic attacks – decreases anxiety mediated increases in HR and SV
e. Congestive heart failure - Increase CO, decrease TPR and HR
f. All of the above are correct
f. All of the above are correct
Which of the following is/are true?

a. In a patient with normal blood pressure Propranolol would cause no change in pressure but would decrease exercise tolerance.
b. In a patient with respiratory problems Atenolol would be preferred over Nadolol
c. In type II diabetic patients Labetalol would be preferred over Propranolol
d. In patients with Peripheral artery disease Acebutolol would be preferred over Propranolol because of less blockade of vasodilatation
e. All of the above are correct
f. None of the above are correct
e. All of the above are correct
Propranolol

a. Abrupt withdrawal of Clonidine when used in combination with may cause significant elevations in blood pressure
b. In combination with Verapamil may significantly decrease HR and CO
c. May elevate LDL and triglyceride levels
d. Is useful in arrhythmias like paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia
e. All of the above are correct
f. None of the above are correct
e. All of the above are correct
Which of the following is/are true about vascular smooth muscle?

a. Resting membrane potential of vascular smooth muscle is -90 mV
b. Calcium activates calmodulin to phosphorylate myosin
c. Myosin light chain kinase removes a phosphate from myosin to allow relaxation
d. Beta 2 agonists stimulate cAMP mediated calcium transport out of cells to relax muscle
e. The majority of calcium for contraction comes from the sacoplasmic reticulum
f. None of the above are correct
d. Beta 2 agonists stimulate cAMP mediated calcium transport out of cells to relax muscle
Prazosin

1. Decreases TPR and causes a significant reflex increase in HR
2. May cause a modest reduction in LDL and TG’s and increase HDL
3. Blood pressure lowering is enhanced in combination with NSAID’s
4. May increase sodium and water retention

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
C = 2,4
Which of the following is/are true?

a. Doxazosin is useful in hypertensive patients with left ventricular dysfunction
b. Prazosin may be an acceptable antihypertensive in males with benign prostatic hyperplasia
c. Tamsulosin is selective for alpha 1B receptors
d. Carvedilol has equal activity at beta and alpha receptors
e. All of the above are correct
f. None of the above are correct
b. Prazosin may be an acceptable antihypertensive in males with benign prostatic hyperplasia
Alpha methyldopa

a. Has partial agonist activity at alpha 2 receptors and full agonist activity at Imidazoline 1 receptors
b. Is metabolically converted to alpha-methyl-norepinephrine by DOPA decarboxylase and Dopamine-Beta-hydroxylase
c. Is contraindicated during pregnancy
d. Has minimal effects on sodium and water retention
e. All of the above are correct
f. None of the above are correct
b. Is metabolically converted to alpha-methyl-norepinephrine by DOPA decarboxylase and Dopamine-Beta-hydroxylase
Clonidine

a. Blood pressure lowering effects are decreased in patients taking diuretics
b. Decreases salivation by activation of presynaptic receptors in the salivary glands
c. Decreases Antidiuretic secretion
d. May cause hyperglycemia
e. All of the above are correct
f. None of the above are correct
c. Decreases Antidiuretic secretion
d. May cause hyperglycemia
Which of the following is/are true?

a. Guanabenz causes more water and sodium retention than Clonidine
b. Guanfacine is less selective for alpha 2 receptors than Clonidine
c. Rilmenidine shows similar antihypertensive efficacy but less sedation sodium retention and dry mouth than Clonidine
d. Clonidine has FDA approval for use in ADHD, Tourrette’s syndrome and menopausal flushing
e. All of the above are correct
f. None of the above are correct
c. Rilmenidine shows similar antihypertensive efficacy but less sedation sodium retention and dry mouth than Clonidine
Reserpine

a. Depletes both central and peripheral neuronal stores of Norepinephrine
b. May lead to thoughts of suicide with chronic use
c. May lead to bradycardia
d. Effective in elderly in combination with diuretics
e. All of the above are correct
f. None of the above are correct
e. All of the above are correct
Which of the following is/are true about direct acting vasodilators?

a. They are equally effective on arteries and veins
b. They all require use of beta blockers and diuretics to be effective
c. Diazoxide by an action on the potassium channel decreases insulin releases and is sometimes used to treat hypoglycemia
d. Fenoldopam may cause sodium and water retention
e. All of the above are correct
f. None of the above are correct
c. Diazoxide by an action on the potassium channel decreases insulin releases and is sometimes used to treat hypoglycemia
Which of the following is/are true?

a. Hydralazine relaxes vascular smooth muscle by decreasing the open time of ATP dependent potassium channels
b. Minoxidil relaxes vascular smooth muscle by increasing the movement of calcium out of the cell through the calcium transporter
c. Minoxidil may turn stools black
d. Hydralazine causes vasorelaxation by stimulating activation of cGMP mediated activation of phosphatases to dephosphorylate myosin
e. All of the above are correct
f. None of the above are correct
d. Hydralazine causes vasorelaxation by stimulating activation of cGMP mediated activation of phosphatases to dephosphorylate myosin
Nitroprusside

a. Releases nitric oxide which prevents calmodulin from interacting with myosin light chain kinase
b. May cause vomiting and convulsions due to cyanide toxicity
c. Requires the use of diuretics and beta blocker to be effective
d. May cause a lupus like syndrome
e. All of the above are correct
f. None of the above are correct
b. May cause vomiting and convulsions due to cyanide toxicity
Nitrates

1. Preferentially dilates veins
2. Require sulfhydral groups for activation
3. Activate protein kinase G to decrease activity of myosin light chain kinase and activate phosphatases
4. Shows cross tolerance with Nitroprusside

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
A = 1,2,3
Nitroglycerin

a. May decrease platelet adhesion
b. May cause reflex tachycardia
c. May cause elevated methemoglobin
d. May cause nausea
e. All of the above are correct
f. None of the above are correct
e. All of the above are correct
Which of the following is/are true?

a. Sildenafil – inhibits the breakdown of cAMP
b. Tadalafil – Is selective of PDE5
c. Vardenafil – by itself will directly cause an erection
d. Tadalafil - and Sildenafil produce significantly more visual problems than Vardenafil
e. All of the above are correct
f. None of the above are correct
b. Tadalafil – Is selective of PDE5
Which of the following is/are correct about cardiovascular regulation?

a) The most important factor governing blood flow is the pressure change between the right and left side of the heart
b) BP = (SV X HR) X TPR
c) TPR is determined mainly by left ventricular ejection fraction
d) Cardiac output is always increased by an increase in heart rate
e) Changes in blood volume are involved in acute regulation of blood pressure
f) None of the above are correct
b) BP = (SV X HR) X TPR
Non-dihydropyridine calcium channel blockers:
a. Decrease conduction through the AV node
b. Affect preload of the heart at therapeutic doses
c. Increase the rate of recovery of the L-type calcium channel
d. Cause reflex tachycardia due to vasodilation
e. All of the above
f. None of the above
a. Decrease conduction through the AV node
Diltiazem:

a. Binds to T-type calcium channels
b. Binds to troponin in cardiac muscle cell
c. Binds to calmodulin in vascular smooth muscle cells
d. Binds to L-type calcium channels
e. All of the above
f. None of the above
d. Binds to L-type calcium channels
Nifedipine:

a. Suppresses cardiac contractility at therapeutic doses
b. Is useful for vasospasm-related ischemia associated with subarachnoid hemorrhage
c. Has a short half-life which may lead to severe reflex tachycardia
d. Is primarily excreted unchanged by the kidneys
e. All of the above
f. None of the above
c. Has a short half-life which may lead to severe reflex tachycardia
Verapamil may worsen the following co-morbid condition (s):

a. Gastroesophageal Reflux Disease
b. Asthma
c. Diarrhea
d. Hypertension
e. All of the above
f. None of the above
a. Gastroesophageal Reflux Disease
The non-dihydropyridine calcium channel blockers may interact pharmacodynamically with:

a. Cyclosporine
b. Atorvastatin
c. Atazanavir
d. Carbamazepine
e. All of the above
f. None of the above
c. Atazanavir
A mechanism of the following medication(s) is to reduce LDL levels by increasing LDL receptor expression or activity:

a. Colestipol tablets
b. Atorvastatin
c. Ezetimibe
d. Cholestyramine powder
e. All of the above
f. None of the above
e. All of the above
hich of the following medications is particularly effective for treating elevated triglyceride levels?

a. Pravastatin
b. Fenofibrate
c. Ezetimibe
d. Cholestyramine
e. Niacin
f. None of the above
b. Fenofibrate
Which of the following medications may increase the likelihood of myopathy with HMG-CoA Inhibitors?

a. Verapamil
b. Niacin
c. Gemfibrozil.
d. Erythromycin
e. All of the above
f. None of the above
e. All of the above
Which of the following medications are enterohepatically circulated, limiting systemic exposure?

a. Colestipol
b. Lovastatin
c. Fenofibrate
d. Ezetimibe
e. Niacin
f. None of the above
d. Ezetimibe
Which of the following adverse effects are associated with niacin therapy?

a. Peripheral neuropathy
b. Hypoglycemia
c. Cutaneous Flushing
d. Hypertension
e. All of the above are correct
f. None of the above are correct
c. Cutaneous Flushing
Which of the following is/are true?

a. Aminopeptidase converts Angiotensin I (1-10) to Angiotensin (1-9)
b. Angiotensin (2-10) is converted to Angiotensin III (2-8) by ACE 2
c. Angiotensin 4 (3-8) is equipotent to Angiotensin II (1-8) on Aldosterone secretion
d. Angiotensin (1-7) mimics the action of Angiotensin II (1-8)
e. All of the above are correct
f. None of the above are correct
f. None of the above are correct
ACE inhibitors

a. All have sulfhydral groups that bind to the zinc at the active site of the enzyme
b. Prevent or delay progression of renal disease in diabetics
c. Are all prodrugs that must be metabolically activated
d. Are useful in lowering blood pressure in late pregnancy in women having problems with other antihypertensive medications
e. All of the above are correct
f. None of the above are correct
b. Prevent or delay progression of renal disease in diabetics
Which of the following is /are true about the side effects of ACE inhibitors?

a. Angioedema – is much more common in women
b. Taste disturbances – are due to the drug binding of zinc
c. Hyperkalemia– only occurs in patients taking potassium supplements
d. Skin rash – most commonly seen with Enalapril
e. All of the above are correct
f. None of the above are correct
b. Taste disturbances – are due to the drug binding of zinc
Which of the following is/are true?

1. Captopril – Long half-life
2. Benzapril – active form eliminated through kidneys
3. Lisniopril – Available as IV formulation
4. Trandolapril – must be metabolically activated

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of above are correct
F = None of the above are correct
C = 2,4
Angiotensin receptor blockers:

a. Valsartan requires metabolic activation
b. Show a step linear dose response curve
c. Are readily reversible because of a rapid dissociation from the receptor
d. May be used in combination with diuretics in salt-sensitive hypertension
e. All of the above are correct
f. None of the above are correct
d. May be used in combination with diuretics in salt-sensitive hypertension
Angiotensin receptor blockers:

a. Are preferred over ACE inhibitors for Renal protection in type I diabetics
b. May be used in place of ACE inhibitors in patients with renal artery stenosis
c. Produce dry cough due to the buildup of Bradykinin
d. May increase the activity of Angiotensin II on AT2 receptors
e. All of the above are correct
f. None of the above are correct
d. May increase the activity of Angiotensin II on AT2 receptors
Aliskiren

a. Inhibits the conversion of Angiotensinogen to Angiotensin I
b. Is mainly excreted unchanged in the feces
c. May cause a reflex increase in renin secretion
d. May cause diarrhea and dyspepsia
e. All of the above are correct
f. None of the above are correct
e. All of the above are correct
Which of the following contribute to the therapeutic usefulness of beta blockers?

a) Decrease in cardiac output
b) Competitive blockade of beta one receptors in juxtaglomerular cells
c) Altered baro-reflex sensitivity
d) Competitive blockade of presynaptic receptors
e) All of the above are correct
f) None of the above are correct
e) All of the above are correct
Which of the following is/are true?

a. Beta blockers that undergo hepatic metabolism all show significant membrane stabilizing activity
b. Lipid solubility predicts ISA activity
c. Third generation agents all show significant membrane stabilizing activity
d. Second generation agents show low to no ISA activity
e. All of the above are correct
f. None of the above are correct
d. Second generation agents show low to no ISA activity
Which of the following is/are correct?

a. Penbutolol – High ISA
b. Timolol – High membrane stabilizing activity
c. Acebutolol – High lipid solubility
d. Carvedilol – Alpha one blocking activity
e. Betaxolol – Stimulates nitric oxide
f. Bisoprolol – highest membrane stabilizing activity of second generation agents
d. Carvedilol – Alpha one blocking activity
Which of the following is/are true?

a. Beta blockers with high ISA initially decrease blood pressure by significantly decreasing cardiac output
b. Beta blockers with low ISA initially increase TPR
c. Beta blockers with high ISA chronically decrease blood pressure by decreasing cardiac output
d. Beta one selective blockers initially increase TPR which is maintained chronically
e. All of the above are correct
f. None of the above are correct
b. Beta blockers with low ISA initially increase TPR
Which of the following is/are true?

a. Timolol is useful in glaucoma because it increases aqueous humor outflow through the trabecular meshwork
b. Lipid solubility predicts effectiveness in migraine prophylaxis
c. Agents with high ISA should be avoided in hypertension
d. The major therapeutic action of beta blockers in angina is to increase CO
e. All of the above are correct
f. None of the above are correct
b. Lipid solubility predicts effectiveness in migraine prophylaxis
Which of the following is/are correct?
a. In patients with impaired ventricular function beta blockers ↑ CO, ↓ TPR and ↓ HR
b. Beta one selective agents are preferred to treat tremor
c. In patients talking Propranolol for CHF that develop nightmares and vivid dreams the drug should be stopped immediately
d. Beta blockers are the preferred therapy for hypertension in patients with impaired circulatory diseases like Renaud’s syndrome and intermittent claudication
e. All of the above are correct
f. None of the above are correct
a. In patients with impaired ventricular function beta blockers ↑ CO, ↓ TPR and ↓ HR
Which of the following is/are true about vascular smooth muscle?

a. L-type voltage sensitive calcium channels are found mainly in the membrane of the sarcoplasmic reticulum
b. Activation of alpha 1 and AT1 receptors directly cause the release of calcium from the sarcoplasmic reticulum
c. Calcium directly activates myosin light chain kinase
d. Beta two agonists activate adenylate cyclase to increase cAMP levels to increase calcium sequestration and outflow causing relaxation
e. Myosin light chain kinase removes a phosphate from myosin to allow actin and myosin to interact
f. All of the above are correct
d. Beta two agonists activate adenylate cyclase to increase cAMP levels to increase calcium sequestration and outflow causing relaxation
Prazosin

a. May reduce LDL and TG’s and increase HDL
b. Should not be used in patients receiving thiazide diuretics
c. Decreases blood pressure mainly by actions on cardiac output
d. Is indicated for hypertensive patients with moderate to severe congestive heart failure
e. All of the above are correct
f. None of the above are correct
a. May reduce LDL and TG’s and increase HDL
Central Sympatholytics

a. Decrease blood pressure mainly by actions on cardiac output
b. Elevate TG and LDL levels and decrease HDL levels
c. Generally produce dry mouth
d. Are contraindicated in males because they cause sexual dysfunction
e. All of the above are correct
f. None of the above are correct
c. Generally produce dry mouth
Alpha methyldopa

a. Is converted to alpha methylnorepinephrine inside the cell
b. May cause sodium and water retention
c. May safely be used during pregnancy
d. May produce a positive comb’s test
e. All of the above are correct
f. None of the above are correct
e. All of the above are correct
Clonidine

a. Inhibits insulin secretion
b. Increases sodium excretion
c. Decreases activity of analgesics
d. Produces significant reflex tachycardia
e. All of the above are correct
f. None of the above are correct
a. Inhibits insulin secretion
Rilmenidine

a. Selective imidazoline 1 receptor agonist
b. Causes more sedation than Clonidine
c. Should not be withdrawn suddenly because it can cause rebound hypertension
d. Should not be combined with diuretic
e. All of the above are correct
f. None of the above are correct
a. Selective imidazoline 1 receptor agonist
Reserpine

1) Commonly used with thiazide diuretics
2) Depletes only peripheral norepinephrine stores
3) May Induce arrhythmias
4) Drug of choice for depressed patients with hypertension

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
B = 1,3
Which of the following is/are true about direct vasodilators?

a. Minoxidil activates ATP – modulated potassium channels
b. Hydralazine is contraindicated in the elderly
c. Diazoxide has been used to decrease insulin during hypoglycemia
d. Fenoldopam has both natriuretic and diuretic activity
e. All of the above are correct
f. None of the above are correct
e. All of the above are correct
Which of the following is/are true?

a. Nitroprusside should always be used in combination with beta blockers and diuretics
b. Minoxidil toxicity may be limited by administration of thiosulfate
c. Hydralazine directly interacts with myosin light chain kinase activity to decrease activity
d. Diazoxide directly decreased TPR and reflexively increases CO and HR
e. All of the above are correct
f. None of the above are correct
d. Diazoxide directly decreased TPR and reflexively increases CO and HR
Nitroprusside

a. Releases nitric oxide which prevents calmodulin from activating myosin light chain kinase
b. Effects both arteries and veins
c. Causes significant sodium retention
d. May induce a Lupus like syndrome
e. All of the above are correct
f. None of the above are correct
b. Effects both arteries and veins
Nitrates

a. Preferentially reduce preload
b. Show cross tolerance with nitroprusside
c. May turn stools black
d. Activate cytosolic adenylate cyclase to increase cAMP
e. All of the above are correct
f. None of the above are correct
a. Preferentially reduce preload
Which of the following is/ are true?

a. Sildenafil releases nitric oxide
b. Tadalafil is selective for PDE 5
c. Vardenafil has a much lower incidence of priapism than Sildenafil or Tadalifil
d. Sildenafil has the longest duration of action
e. All of the above are correct
f. None of the above are correct
b. Tadalafil is selective for PDE 5
Which of the following therapeutic actions-mechanisms of beta blockers is/are correct?

a) Anti-angina effects – due to decreased CO
b) Anti-hypertensive effects – due to acute decrease in TPR
c) Anti-glaucoma effect – increased aqueous humor outflow
d) Anti-tremor effects – due to central actions on motor pathways
e) All of the above are correct
f) None of the above are correct
a) Anti-angina effects – due to decreased CO
The major side-effects of Propranolol would include which of the following?

1) Decreased exercise tolerance
2) Increased LDL and VLDL and decreased HDL
3) Weird dreams and hallucinations
4) Impotence

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
E = All of the above are correct
Metoprolol would have fewer effects than Pindolol on which of the following

1) Glucose production
2) Norepinephrine release
3) Glaucoma
4) Renin release

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
A = 1,2,3
Short term regulation of cardiac output includes which of the following?

1) Increases in aldosterone
2) Changes in stroke volume
3) Changes in blood viscosity
4) Changes in vessel diameter

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
C = 2,4
Which of the following would increase renin release?

1) A blockage of the renal artery
2) Eating a whole bag of potato chips
3) Chronic sympathetic stimulation of the juxtaglomerular cells
4) Excessive water intake

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
B = 1,3
Which of the following is true about the angiotensins?

a) Angiotensin II (1-8) may inhibit renin release
b) Angiotensin III (2-8) more effective on Aldosterone release than vascular contraction
c) Angiotensin IV (3-8) is produced by aminopeptidase’s removal of 1 amino acid
d) Angiotensin (1-7) may decrease cardiac remodeling
e) All of the above are correct
f) None of the above are correct
e) All of the above are correct
ACE Inhibitors

a) All have carboxy groups which bind zinc at the active site of the enzyme
b) All increase metabolism of bradykinin
c) All except Captopril must be metabolically activated in the liver
d) All except Fosinopril require dosage adjustment in renal disease
e) All of the above are correct
f) None of the above are correct
d) All except Fosinopril require dosage adjustment in renal disease
ACE inhibitors

1) Decrease TPR
2) Drugs of choice for hypertension in type 1 diabetics
3) Decrease afterload and preload but increase CO
4) Decrease mortality and morbidity of congestive heart failure

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
E = All of the above are correct
Which of the following is/are true about ACE inhibitors?

a) May produce a dry cough which is seen more frequently in women than men
b) May cause angioedema due to increased breakdown of bradykinin
c) May cause hypotension with initiation of treatment or upward titration of dose
d) Effects are potentiated by daily NSAID therapy
e) A and C are correct
f) All of the above are correct
e) A and C are correct
Angiotensin receptor blockers (ARB’s)

a. Are readily reversible and easily displaced from the AT1 receptor
b. All undergo metabolic activation
c. Are selective for the AT1 receptor
d. Should not be used in combination with Thiazide diuretics because the combination may induce renal failure
e. All of the above choices are correct
f. None of the above choices are correct
c. Are selective for the AT1 receptor
Angiotensin receptor blockers (ARB’s)

1) Are more effective than ACE inhibitors for hypertension
2) Can be used instead of ACE inhibitors for patients with bilateral renal stenosis
3) Are contraindicated after a myocardial infarction
4) Are preferred over ACE inhibitors for renal protective effects in type II diabetics with hypertension

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above choices are correct
F = None of the above choices are correct
D = 4 only
Angiotensin receptor blockers (ARB’s)

1) Would cause decreased aldosterone secretion
2) May cause angioedema
3) Are better than ACE inhibitors at reducing the effects of ANG II at AT1 receptors
4) May cause dry cough

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above choices are correct
F = None of the above choices are correct
A = 1,2,3
Which of the following actions of beta blockers contribute to their blood pressure lowering effects?

1) Decrease in CO
2) Decreased renin release
3) Blockade of presynaptic receptors
4) Membrane stabilizing effects

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above choices are correct
F = None of the above choices are correct
A = 1,2,3
Which of the following is/are correct?

1) Nadolol – moderate membrane stabilizing; low lipid solubility; High ISA
2) Metoprolol – moderate membrane stabilizing; moderate lipid solubility; No ISA
3) Acebutolol – low membrane stabilizing; low lipid solubility; low ISA
4) Carvedilol – high membrane stabilizing; moderate lipid solubility; No ISA

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above choices are correct
F = None of the above choices are correct
C = 2,4
Which of the following is/are true?

a. Propranolol decreases blood pressure mainly by a decrease in TPR
b. Pindolol decreases blood pressure mainly by a decrease in CO
c. Carvedilol decreases blood pressure by beta blockade plus NO activity and beta 2 agonist activity
d. Labetalol decreases blood pressure by actions on beta receptors plus beta 2 agonist and alpha1 antagonistic activity
e. All of the above choices are correct
d. None of the above choices are correct
d. Labetalol decreases blood pressure by actions on beta receptors plus beta 2 agonist and alpha1 antagonistic activity
Which of the following is/are true about beta blockers?

a. Timolol would decrease production of aqueous humor
b. Propranolol is useful in hyperthyroidism because it interferes with the effects of thyroid hormone on its receptor
c. Their major therapeutic action in angina is to decrease CO
d. Pindolol would be the drug of choice for migraine prophylaxis
e. All of the above choices are correct
f. None of the above choices are correct
a. Timolol would decrease production of aqueous humor
Which of the following is are true?

a. Metoprolol will return left ventricular function back to normal in CHF
b. Beta blockers rapidly increase exercise tolerance in CHF
c. Atenolol may cause hyperglycemia in type I diabetics because it blocks insulin secretion
d. Propranolol may be useful in peripheral artery disease (Intermittent claudication) because it can prevent vasospasm of leg arteries
e. All of the above choices are correct
f. None of the above choices are correct
f. None of the above choices are correct
Which of the following choices is/are correct about Propranolol?

a. It is the beta blocker of choice for depressed patients
b. It may cause sleep disturbances
c. Is not useful for arrhythmias because it lacks membrane stabilizing activity
d. May be combined with verapamil in patients with bradycardia if there blood pressure is not controlled adequately
e. All of the above choices are correct
f. None of the above choices are correct
b. It may cause sleep disturbances
Which of the following is/are true?

a. Voltage sensitive L-type calcium channels open at a membrane potential of - 50 mV
b. Calcium binds directly to myosin light chain kinase to activate phosphorylation of myosin
c. Beta 2 agonists cause relaxation by stimulating adenylate cyclase to form cAMP which increases calcium removal.
d. Activation of alpha 1 or AT1 receptors directly activates myosin light chain kinase
e. All of the above choices are correct
f. None of the above choices are correct
c. Beta 2 agonists cause relaxation by stimulating adenylate cyclase to form cAMP which increases calcium removal.
Prazosin

a. May increase sodium and water retention
b. Blood pressure lowering effects are enhanced in patients on aspirin therapy
c. Should be avoided in patients with elevated LDL cholesterol and triglycerides
d. May cause significant reflex tachycardia
e. All of the above choices are correct
f. None of the above choices are correct
a. May increase sodium and water retention
Central sympatholytics

a. Decrease TPR but cause reflex increases in HR and CO
b. Should be avoided in the elderly
c. Cause rebound hypertension with acute withdrawal
d. Must be taken together with a diuretic
e. All of the above choices are correct
f. None of the above choices are correct
c. Cause rebound hypertension with acute withdrawal
Alpha-methyldopa

a. Inhibits dopa decarboxylase
b. Has activity at both alpha 2 and I1 imidazoline receptors
c. May induce a lupus like syndrome
d. Is recommended in patients with liver disease
e. All of the above choices are correct
f. None of the above choices are correct
c. May induce a lupus like syndrome
or
f. None of the above choices are correct
Clonidine

a. May activate the motor nucleus of the vagus to decrease HR
b. Blood pressure lowering effects are enhanced when given with a diuretic
c. May cause hyperglycemia
d. Produces dry mouth
e. All of the above choices are correct
f. None of the above are correct
e. All of the above choices are correct
Rilmenidine

a. Acts on both alpha 2 and imidazoline receptors
b. May cause sedation
c. Should not be used with beta blockers because of enhanced effects
d. Minor orthostatic hypotension
e. All of the above choices are correct
f. None of the above choices are correct
d. Minor orthostatic hypotension
or
b. May cause sedation
Reserpine side effects could include

a. Sodium and water retention
b. Sedation
c. Thoughts of suicide
d. Arrhythmias
e. All of the above choices are correct
f. None of the above choices are correct
e. All of the above choices are correct
Direct acting vasodilators

a. Directly increase heart rate
b. Directly decrease renin release
c. All have significant actions of veins
d. Show tachyphylaxis
e. All of the above are correct
f. None of the above choices are correct
d. Show tachyphylaxis
Hydralazine

1) N-acetylated in the liver
2) Useful in patients with uncontrolled angina and hypertension
3) May enhance the activity of renal prostaglandins
4) Directly effects phosphorylation of myosin

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above choices are correct
F = None of the above choices are correct
B = 1,3
Minoxidil

a. Requires metabolic activation in the liver
b. Inhibits the activity of ATP-modulated K channels
c. May be useful in uncontrolled hypertension with angina
d. Minimal reflex tachycardia
e. All of the above choices are correct
f. None of the above choices are correct
a. Requires metabolic activation in the liver
Which of the following is/are true?

1) Nitroprusside effects only arterioles
2) Diazoxide produces significant sodium retention
3) Nitroprusside may turn stools black
4) Fenoldopam has direct natriuretic and diuretic activity

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above choices are correct
F = None of the above choices are correct
C = 2,4
Nitrates

1) Reduce preload
2) Directly activate guanylate cyclase to increase intracellular cGMP levels
3) Decrease platelet adhesion
4) Decrease HR

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above choices are correct
F = None of the above choices are correct
B = 1,3
Which of the following is/are true?

1) Nitrate tolerance is solely due to deletion of sulfhydral groups
2) Nitrates directly inhibit myosin light chain kinase activity
3) Nitrates show cross tolerance with nitroprusside
4) Nitrate toxicity may cause elevated methemoglobin

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above choices are correct
F = None of the above choices are correct
D = 4 only
Which of the following is/are true about erectile dysfunction?

a. Sildenafil inhibits the breakdown of cGMP
b. Tadalifil may directly cause an erection by inhibiting PDE5
c. Vardenafil is selective for PDE5
d. Sildenafil potentiates the actions of nitrates by enhancing their binding to myosin light kinase.
e. All of the above choices are correct
f. None of the above choices are correct
a. Sildenafil inhibits the breakdown of cGMP
AB is a 24-yo male who is found to have very high LDL cholesterol level (1130 mg/dL) in blood. Genetic tests revealed that he is the first case in history, who has a new mutation in LDL receptor gene. The mutation was discovered to cause premature termination of transcription of LDL receptor gene. Therefore, he has no LDL receptors expressed. His physician is considering putting him on an antihypercholesterolemic agent. Which agent would be the least effective in lowering LDL-cholesterol level in this patient?

a. Atorvastatin
b. Colestipol
c. Niacin
d. Gemfibrozil
b. Colestipol
CD is a 58-yo female who received a new kidney for her end stage renal disease 3 months ago. She has taken cyclosporine, ramipril, and mycophenolate (an immunosuppressant) since then. Recently, her LDL-cholesterol level was checked and it was 155 mg/dL. It was decided to put her on a statin. Which statin has the least potential to have a drug interaction with the current medications she is taking?

a. Atorvastatin
b. Lovastatin
c. Pravastatin
d. Simvastatin
c. Pravastatin
EF is a 46-yo nurse who started niacin for her dyslipidemia 2 months ago. She is interested in how the drug works for her. Your response is

a. It inhibits absorption of cholesterol from the intestine.
b. It inhibits cholesterol biosynthesis by blocking the rate limiting step.
c. It inhibits VLDL synthesis by increasing oxidation of fatty acids in liver.
d. It inhibits hepatic uptake of apolipoprotein A1.
d. It inhibits hepatic uptake of apolipoprotein A1.
Which one(s) is/are true regarding fenofibrate?

1) Fenofibrate can cause myopathy
2) Fenofibrate binds to warfarin in the intestinal lumen
3) Fenofibrate can cause an increased INR by decreasing concentrations of vitamin K dependent coagulation factors
4) Fenofibrate can cause severe flushing and requires aspirin to prevent this adverse event

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above choices are correct
F = None of the above choices are correct
B = 1,3
Which statement is correct regarding Antihyperlipidemics agents?

a. 40 mg of rosuvastatin is required to decrease LDL-cholesterol by 30-40%.
b. Cholestyramine inhibits absorption of bile acid and, as compensation, liver decreases production of VLDL. Therefore, cholestyramine is used to treat hypertriglyceridemia.
c. Extended release niacin is more potent in reducing LDL-cholesterol level than immediate release niacin. However, immediate release niacin causes less cutaneous flushing.
d. An existing gall bladder disease is a contraindication to gemfibrozil.
d. An existing gall bladder disease is a contraindication to gemfibrozil.
Why are arteries more sensitive to calcium channel blockade than myocardial cells in terms of muscle contraction?

a. Arteries are more dependent on exogenous calcium, while myocardial cells depend on both exogenous and sarcoplasmic calcium.
b. Arteries are more dependent on exogenous calcium, while myocardial cells depend only on sarcoplasmic calcium.
c. Arteries are more dependent on sarcoplasmic calcium, while myocardial cells depend on both exogenous and sarcoplasmic calcium.
d. Arteries are more dependent on sarcoplasmic calcium, while myocardial cells depend only on exogenous calcium.
a. Arteries are more dependent on exogenous calcium, while myocardial cells depend on both exogenous and sarcoplasmic calcium.
What is a major difference between dihydropyridine (DHP) and non-dihydropyridine (non-DHP) calcium channel blockers?

a. DHPs act primarily on venules, while non-DHPs work at arterioles.
b. DHPs decrease contractility of heart, while non-DHPs do not affect contractility.
c. DHPs do not decrease heart rate, while non-DHP decrease heart rate
d. DHPs block L-type calcium channels, while non-DHP block T-type calcium channels.
c. DHPs do not decrease heart rate, while non-DHP decrease heart rate
IJ is a hypertensive patient who presents with a prescription for verapamil to your pharmacy. Which statement is correct?

a. Verapamil is a potent CYP3A inhibitor, so it can increase blood concentrations of fluvastatin.
b. Verapamil is a potent p-glycoprotein inhibitor, so it can decrease intracellular concentrations of digoxin.
c. Verapamil can prolong PR interval, so if metoprolol is given together with verapamil, PR interval prolongation by verapamil will be shortened.
d. Verapamil is a substrate of CYP3A, so itraconazole can increase blood concentrations of verapamil.
d. Verapamil is a substrate of CYP3A, so itraconazole can increase blood concentrations of verapamil.
Which calcium channel blocker has the highest incidence of gingival hyperplasia?

a. Diltiazem
b. Verapamil
c. Amlodipine
d. Nifedipine
d. Nifedipine
Which statement is correct regarding calcium channel blockers?

a. Diltiazem can induce more sympathetic reflex than felodipine.
b. Short acting nifedipine is used to decrease blood pressure in patients who present with myocardial infarction because hypertension can worsen myocardial infarction and short acting nifedipine can quickly decrease blood pressure.
c.. Nifedipine has higher incidence of peripheral edema than verapamil because nifedipine is more potent in peripheral vasodilation.
d. Felodipine can be safely used with tacrolimus because they do not share a metabolic pathway.
c.. Nifedipine has higher incidence of peripheral edema than verapamil because nifedipine is more potent in peripheral vasodilation.
ARB approved by the FDA for CHF
a. Apracloninde
b. Bucindolol
c. Cartelol
d. Guanfacine
e. Ketanserin
f. Olmesartan
g Tamsulosin
h. Valsartan
h. Valsartan
Beta blocker with NO and beta 2 agonist activity
a. Apracloninde
b. Bucindolol
c. Cartelol
d. Guanfacine
e. Ketanserin
f. Olmesartan
g Tamsulosin
h. Valsartan
c. Cartelol
Non selective beta blocker with beta 2 agonist and alpha 1 antagonist activity
a. Apracloninde
b. Bucindolol
c. Cartelol
d. Guanfacine
e. Ketanserin
f. Olmesartan
g Tamsulosin
h. Valsartan
b. Bucindolol
Mixed 5HT – alpha 1 antagonist activity
a. Apracloninde
b. Bucindolol
c. Cartelol
d. Guanfacine
e. Ketanserin
f. Olmesartan
g Tamsulosin
h. Valsartan
e. Ketanserin
Topical antiglaucoma agent
a. Apracloninde
b. Bucindolol
c. Cartelol
d. Guanfacine
e. Ketanserin
f. Olmesartan
g Tamsulosin
h. Valsartan
a. Apracloninde
Selective alpha 1a receptor antagonist
a. Apracloninde
b. Bucindolol
c. Cartelol
d. Guanfacine
e. Ketanserin
f. Olmesartan
g Tamsulosin
h. Valsartan
g Tamsulosin
Selective alpha 2 agonis
a. Apracloninde
b. Bucindolol
c. Cartelol
d. Guanfacine
e. Ketanserin
f. Olmesartan
g Tamsulosin
h. Valsartan
d. Guanfacine
Which statement(s) is/are correct regarding calcium channel blockers:

a) Arterial blood vessels are more sensitive to calcium channel blockers since the sarcoplasmic reticulum releases more calcium in the vasculature than in the myocardial cells
b) Calcium channel blockers administered with digoxin can cause AV-node blockade
c) Verapamil belongs to the class of dihydropyridine calcium channel blockers
d) Dihydropyridines cause reflex-bradycardia as a result of increased automaticity
e) All of the above are correct
f) None of the above are correct
b) Calcium channel blockers administered with digoxin can cause AV-node blockade
During rounds the medical team discusses the vasodilatory effects of antihypertensives. The team would like to know the effects of calcium channel blockers on the vasculature. Which response would you give?

a) Calcium channel blockers mostly reduce preload
b) Calcium channel blockers mostly reduce afterload
c) Calcium channel blockers reduce preload and afterload equally
d) Calcium channel blockers mostly cause venous vasodilation
e) All of the above are correct
f) None of the above are correct
b) Calcium channel blockers mostly reduce afterload
Ms. Jackson has recently been diagnosed with hypertension and her physician would like to use a calcium channel blocker. Recently she has been experiencing occasional constipation as a result of taking Tylenol #3 (Acetaminophen/Codeine) 2 tablets q8h prn pain consistently for the last 2 weeks. Which of the following calcium channel blockers would worsen Ms. Jackson’s constipation the most?

a) Amlodipine
b) Diltiazem
c) Verapamil
d) Felodipine
e) A and C
f) B and D
c) Verapamil
Mr. Grupp is a 55 year old male recently admitted to the hospital for an acute-myocardial infarction. Mr. Grupp’s medical history includes diabetes mellitus and heart failure. His resting heart rate is 50 bpm, blood pressure is 150/80 mmHg and his medications are listed below:
Atorvastatin 40 mg qd
Carvedilol 50 mg q12h
ASA 325 mg qd
Novolog 15 Units ac
Lantus 30 Units qhs
Despite your concern, Mr. Grupp’s physician would like him to start taking verapamil. Which of the following statement(s) is true when evaluating the use of verapamil for this patient?

1) Further lowering Mr. Grupp’s heart rate is a concern since this medication is a potent negative chronotrope
2) Mr. Grupp will experience a worsening of heart failure symptoms since this medication is a potent vasodilator
3) This class of calcium channel blocker induces AV-node conduction
4) Hyperglycemia is a concern since this medication can dramatically increase serum glucose concentrations in diabetic patients

A = 1 only
B = 2 only
C = 3 only
D = 4 only
E = 1 and 3 only
F = 2 and 4 only
A = 1 only
Mr Smith is a 45 year old male with a history of dyslipidemia. He has been successfully taking simvastatin 80 mg qhs for the past 4 months and has reached his target LDL. Unfortunately his insurance no longer covers simvastatin and his physician would like to know which dose of atorvastatin would be equivalent to his current therapy. Which dose of atorvastatin is approximately equivalent to simvastatin 80 mg?

a) 10 mg qd
b) 20 mg qd
c) 60 mg qd
d) 80 mg qd
e) None of the above
b) 20 mg qd
Ms Yan is a 65 year old female with a history of atrial fibrillation and aspirin allergy. She is currently taking warfarin for atrial fibrillation and has recently been experiencing muscle tenderness as a result of working in the garden. Her physician notes that her lipid profile is still abnormal despite therapeutic lifestyle changes, and would like to start antihyperlipidemic treatment. He recognizes that you are an astute pharmacist and would like to know your opinion about starting cholestyramine. Why would it not be in the best interest of this patient to use cholestyramine?

I Cholestyramine binds to warfarin in the intestinal lumen
II Cholestyramine can cause severe flushing and she cannot take aspirin to prevent this adverse event
III Cholestyramine can cause an increased INR by binding to dietary vitamin K in intestinal lumen
IV Cholestyramine can cause myositis

a) I only
b) I, II, and III only
c) I and III only
d) II and IV only
e) All of the above are correct
c) I and III only
If your primary goal in therapy with a patient is to increase HDL, which of the following would be most efficacious?

a) Gemfibrozil
b) Atorvastatin
c) Colesevelam
d) Niacin
e) None of the above
d) Niacin
While a patient is receiving lovastatin for dyslipidemia, what should be expected to be monitored periodically?

a) Liver function tests
b) Electrolyte levels
c) Results of GI ultrasonography
d) Thyroid hormone levels
e) All of the above
f) None of the above
a) Liver function tests
Which of the following is/are correct?

1)Renin is secreted as a prohormone which must be activated
2)Macula densa cells respond to stretch to increase Renin release.
3)Renin is stored and released in Juxtaglomerular cells
4)Beta 1 receptor agonists decrease Renin release

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
B = 1,3
Which of the following is/are true?

a)Angiotensin III (2-8) is equipotent to Angiotensin II on aldosterone secretion
b)Angiotensin (1-7) is formed by action of ACE-2 on Angiotensin II
c)Increases in Na+ and Cl- concentrations decrease Renin secretion
d)Angiotensin converting enzyme converts Angiotensin III to Angiotensin IV
e) All of the above are correct
f) None of the above are correct
e) All of the above are correct
ACE inhibitors

a)All have functional groups that bind Zn ++ at the active site of the enzyme.
b)All contain sulfhydryl groups
c)Are all excreted through the kidneys
d)All exist as prodrugs which require metabolic activation
e) All of the above are correct
f)None of the above are correct
a)All have functional groups that bind Zn ++ at the active site of the enzyme.
Which of the following combinations is/are correct for the therapeutic use of ACE inhibitors

a) Decrease blood pressure - due to decrease heart rate and decrease cardiac output
b) Benefit left ventricular dysfunction – due to decrease preload, decrease afterload and increase cardiac output
c) Decrease mortality post MI – due to decrease in glomerular pressure and renal remodeling
d) Delay diabetic neuropathy – due to increased insulin secretion and decrease insulin resistance
e) All of the above are correct
f) None of the above are correct
b) Benefit left ventricular dysfunction – due to decrease preload, decrease afterload and increase cardiac output
Which of the following is/are true about the side effects associated with ACE inhibitors?

a) Dry cough – more frequently seen in men
b) Hyperkalemia – only seen in patients also taking K-sparing diuretics
c) Angioedema – due to decreased metabolism of bradykinin
d) Fetal abnormalities in pregnancy – due to altered maternal-fetal blood flow
e) All of the above are correct
ef) None of the above are correct
c) Angioedema – due to decreased metabolism of bradykinin
Advantages of Angiotensin receptor blockers over ACE inhibitors include which of the following?

1) Act as partial agonists at AT2 receptors
2)Less angioedema
3)Less effects on glomerular filtration rates
4) Decreased effects of Angiotensin II produced by alternative pathways

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
C = 2,4
Which of the following actions of beta blockers contribute to their therapeutic usefulness?

1)Competitive blockade of cardiac beta 1 receptors
2)Competitive blockade of beta receptors on Juxtaglomerular cells
3)Competitive blockade of presynaptic beta 2 receptors
4)Competitive blockade of pulmonary beta 2 receptors

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
A = 1,2,3
Which of the following is/are true?

1)Beta blockers that undergo hepatic metabolism are more likely to demonstrate ISA
2)Membrane stabilizing activity is required for antiarrhythmic activity
3)Lipid solubility predicts membrane stabilizing activity
4)Third generation agents all show significant ISA

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
F = None of the above are correct
Cardiovascular adjustments to exercise would be inhibited by

1)Atenolol
2)Verapamil
3)Clonidine
4)Enalapril

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
A = 1,2,3
Which of the following is/are true?

a)Beta blockers with ISA lower blood pressure by a sustained decrease in cardiac output
b)Beta blockers without ISA lower blood pressure by an initial increase in TPR followed by a sustained reduction below normal in TPR
c)Beta one selective blockers initially increase TPR followed by a return towards normal
d)Beta blockers with ISA are less effective at lowering blood pressure than those without ISA
e)All of the above are correct
f)None of the above are correct
c)Beta one selective blockers initially increase TPR followed by a return towards normal
Which of the following clinical indications and mechanisms are correct for beta blockers?

a)Hypertension – only works in young patients with high Renin levels
b)Glaucoma – increase outflow of aqueous humor through secondary methods
c)Hyperthyroidism – decrease release of thyroid hormone
d)Acute myocardial infarction – decrease in cardiac output and workload
e)Panic attacks – block beta 2 receptors on skeletal muscle
f)Congestive heart failure - ↑ CO, ↓ TPR, ↓ HR
f)Congestive heart failure - ↑ CO, ↓ TPR, ↓ HR
Beta blockers should be avoided in the following patients

e1) Resting heart rate < 60
f2) Raynauds disease
g3) Intermittent claudication
h4) Depression

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
E = All of the above are correct
or
A = 1,2,3
Central Sympatholytics

e1) All produce sedation
f2) Act in the posterior hypothalamus
g3) Decrease TPR
h4) Work best in older black patients

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
B = 1,3
Which of the following is/are true about alpha-methyldopa

a)It is a partial agonist at alpha 2 receptors
b) Increases salivation through a central mechanism
c)Is metabolized to alpha-methylnorepinephrine
d)Produces autoimmune responses in > 70% of patients
e)All of the above are correct
f)None of the above are correct
c)Is metabolized to alpha-methylnorepinephrine
Clonidine

a) Decreases CO by a direct action on alpha 2 receptors in the heart
b) Decreases Antidiuretic hormone secretion
c) Decreases salivation by activation of alpha 2 receptors in the salivary gland
d) Should not be combined with thiazide diuretics because of significant K elevations
e) All of the above are correct
f) None of the above are correct
b) Decreases Antidiuretic hormone secretion
Prazosin

a) Produces significant orthostatic hypotension
b) May cause significant elevations in heart rate
c) NSAIDS enhance the blood pressure response
d) Is indicated for hypertensive patients with moderate to severe congestive heart failure
e) All of the above are correct
f) None of the above are correct
a) Produces significant orthostatic hypotension
Direct acting vasodilators:

a) Directly decrease TPR
b) Directly increase sodium and water retention
c) Are effective as long term monotherapy
d) All affect both arteries and veins
e) All of the above are correct
f) None of the above are correct
a) Directly decrease TPR
Which of the following mechanisms is/are true?

a) Prazosin prevents smooth muscle contraction by increasing the conversion of Inostitol phosphate to IP3
b) Hydralazine relaxes vascular smooth muscle by increasing nitric oxide to increase cGMP
c) Minoxidil relaxes vascular smooth muscle by decreasing ATP modulated K channels
d) Nitroprusside relaxes vascular smooth muscle by increasing the movement of calcium out of the cell through calcium exchange
e) Beta 2 agonists relax vascular smooth muscle by inhibiting myosin light chain kinase
f) All of the above are correct
b) Hydralazine relaxes vascular smooth muscle by increasing nitric oxide to increase cGMP
Which of the following is/are true?

a) Hydralazine is approved for angina
b) Minoxidil may cause a Lupus like syndrome with high dose and long term therapy
c) Nitroprusside relaxes only arteries
d) Diazoxide inhibits insulin release through an action on potassium channels
e) All of the above are correct
f) None of the above are correct
d) Diazoxide inhibits insulin release through an action on potassium channels
The physiological response to nitrates includes:

1) Dilation of coronary vessels
2) Decreased platelet activation
3) Reflex tachycardia
4) Reduced preload

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above are correct
F = None of the above are correct
E = All of the above are correct
Which of the following is/are true?

a) Both amyl nitrate and Diazoxide undergo bioactivation with sulfhydryl groups
b) N-acetylcysteine may help reverse Nitroprusside tolerance
c) Fenoldepam directly decrease activity of myosin light chain kinase
d) Nitroglycerin toxicity may lead to methemoglobinemia
e) A and C are correct
f) All of the above are correct
d) Nitroglycerin toxicity may lead to methemoglobinemia
ACE inhibitor not completely excreted thought the kidneys
a) Carteolol e) Olmesartan
b) Carvedilol f) Penbutolol
c) Fosinopril g) Pindolol
d) Lisinopril h) Valsartan
c) Fosinopril
Beta blocker with ISA and releases NO
a) Carteolol e) Olmesartan
b) Carvedilol f) Penbutolol
c) Fosinopril g) Pindolol
d) Lisinopril h) Valsartan
a) Carteolol
ARB requiring metabolic activation
a) Carteolol e) Olmesartan
b) Carvedilol f) Penbutolol
c) Fosinopril g) Pindolol
d) Lisinopril h) Valsartan
e) Olmesartan
Beta blocker with highest lipid solubility
a) Carteolol e) Olmesartan
b) Carvedilol f) Penbutolol
c) Fosinopril g) Pindolol
d) Lisinopril h) Valsartan
f) Penbutolol
ARB approved for heart failure
a) Carteolol e) Olmesartan
b) Carvedilol f) Penbutolol
c) Fosinopril g) Pindolol
d) Lisinopril h) Valsartan
h) Valsartan
Beta blocker with highest ISA
a) Carteolol e) Olmesartan
b) Carvedilol f) Penbutolol
c) Fosinopril g) Pindolol
d) Lisinopril h) Valsartan
g) Pindolol
ACE inhibitor that doesn’t require metabolic activation
a) Carteolol e) Olmesartan
b) Carvedilol f) Penbutolol
c) Fosinopril g) Pindolol
d) Lisinopril h) Valsartan
d) Lisinopril
Beta blocker with alpha 1 blocking activity and moderate lipid solubility
a) Carteolol e) Olmesartan
b) Carvedilol f) Penbutolol
c) Fosinopril g) Pindolol
d) Lisinopril h) Valsartan
b) Carvedilol
Antiglaucoma drug that doesn’t cross blood brain barrier
a) Apraclonidine e) Guanfacine
b) Carvedilol f) Reserpine
c) Guanabenz g) Rilmenidine
d) Gunadrel h) Tamsulosin
a) Apraclonidine
Alpha 1 antagonist, beta blocker without ISA
a) Apraclonidine e) Guanfacine
b) Carvedilol f) Reserpine
c) Guanabenz g) Rilmenidine
d) Gunadrel h) Tamsulosin
b) Carvedilol
Slow displacement of Norepinephrine form vesicles
a) Apraclonidine e) Guanfacine
b) Carvedilol f) Reserpine
c) Guanabenz g) Rilmenidine
d) Gunadrel h) Tamsulosin
d) Gunadrel
Most selective alpha 2 agonist
a) Apraclonidine e) Guanfacine
b) Carvedilol f) Reserpine
c) Guanabenz g) Rilmenidine
d) Gunadrel h) Tamsulosin
e) Guanfacine
Imidazoline receptor agonist
a) Apraclonidine e) Guanfacine
b) Carvedilol f) Reserpine
c) Guanabenz g) Rilmenidine
d) Gunadrel h) Tamsulosin
g) Rilmenidine
May cause depression and suicidal thoughts
a) Apraclonidine e) Guanfacine
b) Carvedilol f) Reserpine
c) Guanabenz g) Rilmenidine
d) Gunadrel h) Tamsulosin
f) Reserpine
Least sodium and water retention of alpha 2 agonists
a) Apraclonidine e) Guanfacine
b) Carvedilol f) Reserpine
c) Guanabenz g) Rilmenidine
d) Gunadrel h) Tamsulosin
c) Guanabenz
Alpha1a antagonist
a) Apraclonidine e) Guanfacine
b) Carvedilol f) Reserpine
c) Guanabenz g) Rilmenidine
d) Gunadrel h) Tamsulosin
h) Tamsulosin
LML is a 59 year old man brought to the emergency room with symptoms associated with a blood pressure of 220/120 mm Hg. Before he lost consciousness, he related to EMT personnel that he had missed a “few” doses of clonidine.

Which of the following would be most appropriate for this patient at this time?

a. Labetalol
b. Propranolol
c. Metoprolol
d. Esmolol
e. Timolol
f. None of the above
a. Labetalol
Which of the following most correctly characterizes the mechanism of action of metoprolol?

a. Competitive blockade of B1 adrenergic receptors only
b. Competitive blockade of B1 and B2 adrenergic receptors
c. Non-competitive blockade of B1 adrenergic receptors only
d. Non-competitive blockade of B1 and B2 adrenergic receptors only
e. Competitive blockade of B2 adrenergic receptors only
f. None of the above
a. Competitive blockade of B1 adrenergic receptors only
LEC is a 57 year old male with a history of renal dysfunction who has suffered his first acute myocardial infarction (AMI). Which of the following would be most beneficial for prevention of recurrent AMI for this patient (obj 2,3)?

a. Sotalol
b. Nadolol
c. Pindolol
d. Atenolol
e. Metoprolol
f. None of the above
e. Metoprolol
HS is a 53 year old man with end-stage liver disease (e.g. cirrhosis) and hypertension. Which of the following would be LEAST beneficial for management of this patient’s high blood pressure (obj 2, 3)?

a. Nadolol
b. Atenolol
c. Metoprolol
d. Sotalol
e. Timolol
f. None of the above
c. Metoprolol
TJS is a 37 year old woman with insulin dependent diabetes who has suffered an acute myocardial infarction (AMI) and her cardiologist begins propranolol to prevent another AMI. The patient has read on the internet that propranolol causes hyperglycemia and is concerned about this problem. Which of the following describes the most likely effect of propranolol on this patient’s circulating glucose concentration (obj 1)?

a. Propranolol has no effects on serum glucose concentration
b. Propranolol is more likely to cause hyperglycemia than hypoglycemia
c. Propranolol enhances release of insulin and, as such, may cause hypoglycemia
d. Propranolol enhances glycogenolysis and, as such, my cause hypoglycemia
e. Propranolol enhances glycogenolysis and, as such, may cause hyperglycemia
f. None of the above
a. Propranolol has no effects on serum glucose concentration
The following blood pressures and heart rates were observed in a 45 year old man taking metoprolol for management of coronary artery disease (i.e angina at rest and/or with minimal activity):

At Rest After Activity
blood pressure (mm Hg) 130/80 130/85
heart rate (beats/min) 90 95

Based only on these observations, which of the following most correctly describes how therapy with metoprolol should be changed? (obj 1)?

a. Dose of metoprolol needs to be increased (see heart rates at rest and with activity)
b. Dose of metoprolol needs to be decreased (see heart rate at rest)
c. There is no need to change dose of metoprolol (see heart rates at rest and with activity)
d. Dose of metoprolol need to be increased (see heart rate change with activity)
e. None of the above
a. Dose of metoprolol needs to be increased (see heart rates at rest and with activity)
Mr. AT is a 55 year old man who complains of chest pain while working as a garbage collector. He is thought to have myocardial ischemia (i.e angina) and therapy with atenolol is begun. Which of the following is most likely to occur after he begins atenolol?

a. He will be able to work with less chest pain
b. Since use of atenolol is accompanied by intrinsic sympathomimetic activity (ISA) his ability to work will be further impaired
c. Due to its membrane stabilizing activity, use of atenolol in this patient will further impair his ability to work
d. Since atenolol is highly lipid soluble, it is likely to cause fatigue and further impair his ability to work
e. The negative inotropy and ISA properties of atenolol cancel out each other and, as a result, use of atenolol will have no effect on his ability to work
f. None of the above are correct
a. He will be able to work with less chest pain
JFS is a 45 year old man with heart failure who is given a prescription for carvedilol. Which of the following most correctly characterizes use of this agent in the patient?

a. Since carvedilol is a negative inotrope, its use is contraindicated for this patient
b. Since carvedilol is a negative chronotrope, its use is contraindicated in this patient
c. Use of carvedilol will likely be associated with an increase in total peripheral resistance (peripheral vascular resistance) due to selective blockade of vascular B receptors
d. Since carvedilol is highly lipid soluble, it will exacerbate fatigue and, as such, should not be used in this patient
e. Use of carvedilol will increase cardiac output and lower peripheral vascular resistance in this patient
f. None of the above are correct
e. Use of carvedilol will increase cardiac output and lower peripheral vascular resistance in this patient
Which of the following most correctly characterizes the effect of carvedilol on JFS’s exercise capacity (presuming it is used correctly)?

a. Since carvedilol is a negative inotrope, it will lower his exercise capacity
b. Since carvedilol is a negative chronotrope, it will lower his exercise capacity
c. Carvedilol will increase this patient’s exercise capacity in association with an increase in cardiac output
d. Since carvedilol is known to be highly lipid soluble, it will exacerbate fatigue and reduce his exercise capacity
e Carvedilol will increase this patient’s exercise activity in association with a corresponding increase in total peripheral resistance
f. None of the above are correct
c. Carvedilol will increase this patient’s exercise capacity in association with an increase in cardiac output
MAL is a 55 year old man with asthma and severe migraine headaches. His physician wants him to try atenolol (Tenormin) to prevent the headaches. The patient asks you about the effect this drug may have on his asthma. Which of the following is the most appropriate answer?

a. Since atenolol is a non-selective B-blocker, it will likely exacerbate his asthma
b. Since atenolol is a non-selective B-blocker, it will likely improve his asthma
c. Since atenolol is a B1 selective B-blocker, it will likely exacerbate his asthma
d. Since atenolol is a B1 selective B-blocker, it will likely improve his asthma
e. Since atenolol is a B1 selective B-blocker, it will either exacerbate or have no effect at all on his asthma
e. Since atenolol is a B1 selective B-blocker, it will either exacerbate or have no effect at all on his asthma
Which of the following correctly describes the relative effects of the 3 classes of calcium channel blockers on suppression of AV node conduction?

a. Phenylalkylamines > benzothiazepines > dyhydropyridines
b. Dyhydropyridines > benzothiazepines > phenylalkylamines
c. Benzothiazepines > dyhydropyridines > phenylalkylamines
d. Dyhydropyridines > phenylalklyamines > benzothiazepines
e None of the above are correct
a. Phenylalkylamines > benzothiazepines > dyhydropyridines
TL is a 59 yo BM with a past medical history of hypertension and recent renal transplant. His current medications are lisinopril, irbesartan, cyclosporine and prednisone. TL’s transplant medications are stable, but his BP is not controlled. TL’s physician asks your opinion about starting verapamil. You respond that verapamil is a poor choice because it:

a. Has additive negative inotropic and chronotropic effects with lisinopril.
b. Is not an effective antihypertensive agent.
c. Is contraindicated in renal failure.
d. May cause renal toxicity by increasing cyclosporine concentrations.
e None of the above are correct
d. May cause renal toxicity by increasing cyclosporine concentrations.
Which of the following statements is true regarding the benzothiazepines?

a. They are the most potent vasodilators of the calcium channel blockers.
b. They delay recovery of the slow channel to suppress AV node conduction
c. They are the only calcium channel blockers useful for patients with GERD.
d. They are potent CYP2C9 inhibitors.
e. None of the above are correct
b. They delay recovery of the slow channel to suppress AV node conduction
LB is a 52 yo WF with a past medical history significant only for hypertension being treated with felodipine. She comes to the pharmacy to have her prescription filled and would like to know what the most common adverse effects are. Which of the following is correct?

a. Headache, edema, flushing
b. Gallstones, fatigue, diarrhea
c. Constipation, heart block, skin reactions
d. Gingival hyperplasia, renal impairment, Bradycardia
e None of the above are correct
a. Headache, edema, flushing
Out of the following combinations, which are both pressor agents?
a. Vasopressin – Bradykinin
b. Atrial natriuretic factor - Serotonin
c. Prostaglandins – Histamine
d. Serotonin – Vasopressin
e. All of the above are correct
f. None of the above are correct
d. Serotonin – Vasopressin
YG is a 60 yo WF with a history of hypertension status post renal transplant. YG’s medications include diltiazem, cyclosporine, and prednisone. His physician recently drew a lipid profile and found RT’s LDL 162 mg/dL (goal < 130 mg/dL), TGs and HDL were at goal. The physician asks which of the following statins would be most appropriate for YG. You recommend:

a. Atorvastatin
b. Simvastatin
c. Lovastatin
d. Pravastatin
e. None of the above
d. Pravastatin
While rounding with the Internal Medicine team, your attending asks you to explain the primary mechanism by which the bile acid sequestrants can increase triglycerides to the medical residents on the team. Which of the following is the best response?

a. “Increased hepatic secretion of VLDL”
b. “Binding bile acids in gut resulting in decreased LDL receptor density”
c. “Increased endogenous bile acid synthesis”
d. “Binding bile acids in gut thereby decreasing lipoprotein lipase activity”
e. None of the above
a. “Increased hepatic secretion of VLDL”
Which of the following best describes the effect of ezetimibe on LDL cholesterol concentrations when given in combination with statins:

a. Synergistic
b. Additive
c. Neutral
d. Antagonistic
e. None of the above
b. Additive
Describe the effects of doubling the dose of statin on LDL (linear or curvilinear) and doubling the niacin dose on HDL cholesterol concentrations (linear or curvilinear) (Answers denote statin effect/niacin effect).

a. linear/linear
b. curvilinear/curvilinear
c. curvilinear/linear
d. linear/curvilinear
e. None of the above
b. curvilinear/curvilinear
Which of the following is/are true?

1. Renin cleaves 4 amino acids off of Angiotensin I to form Angiotensin II
2. Renal changes in sodium stimulate the macula densa to release renin.
3. Blockade of beta 1 receptors increases renin secretion
4. Renal baro-receptor activation increases renin secretion from Juxtaglomerular cells

A = 1,2,3
B = 1, 3
C = 2, 4
D = 4 only
E = All are correct
F = None are correct
C = 2, 4
Angiotensin II

a. May stimulate renin release
b. Increases Norepinephrine release by activation of presynaptic AT1 receptors
c. Causes hypertrophy and cardiac remodeling by actions on AT2 receptors
d. Is the primary agent maintaining renal function in normal individuals
e. All of the above are correct
f. None of the above are correct
b. Increases Norepinephrine release by activation of presynaptic AT1 receptors
ACE inhibitors

1. All have sulfhydryl groups which bind the Zinc at the active site of the enzyme
2. Should be given to all patients with left ventricular dysfunction unless contraindicated.
3. Are equally effective in afro-Americans and Caucasians
4. Are contraindicated in renal stenosis

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All are correct
F = None are correct
C = 2,4
Which of the following is/are true of ACE inhibitors?

a. Decrease glomerular pressure in Diabetic nephropathy
b. All can produce a dry cough
c. They all inhibit Bradykinin metabolism
d. Cause angioedema due to bradykinin accumulation
e. All of the above are correct
f. None of the above are correct
e. All of the above are correct
Angiotensin receptor blockers

a. All therapeutic actions are due to blockade of AT1 receptors
b. Would be preferred over ACE inhibitors in someone with liver disease
c. Are equally effective to ACE inhibitors in left ventricular dysfunction
d. Can replace the use of ACE inhibitors during pregnancy
e. All of the above are correct
f. None of the above are correct
f. None of the above are correct
Which of the following is/are true?

1. Clonidine can increase vagus nerve activity
2. Central Sympatholytics work equally well in the nucleus tractus solitarius and the rostral ventral lateral medulla
3. Central Sympatholytics all cause sedation
4. Central Sympatholytics cause a reflex increase in heart rate

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All are correct
F = None are correct
B = 1,3
lpha-methyldopa (Aldomet®)

a. Affects both alpha 2 and Imidazoline 1 receptors
b. May cause sodium and water retention
c. May be used in liver disease
d. Can be used during pregnancy
e. A and C are correct
f. B and D are correct
f. B and D are correct
Clonidine (Catapress®)

a. Would be a good choice for an antihypertensive in a male with Erectile Dysfunction
b. Effects are decreased when combined with a diuretic
c. Due to the decrease in TPR causes a significant reflex tachycardia
d. May cause hyperglycemia
e. All of the above are correct
f. None of the above are correct
d. May cause hyperglycemia
Which of the following is/are False?

1. Myosin light chain kinase (MLCK) dephosphorylates myosin to allow the interaction with actin
2. Extracellular sodium is approximately 140 mM
3. AT1 receptors increase IP3 which interacts with calmodulin to activate myosin light chain kinase
4. Beta receptors cause relaxation in vascular smooth muscle by increasing cAMP mediated calcium movement out of cells

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All are correct
F = None are correct
B = 1,3
Prazosin (Minipress®)

1. Increases Angiotensin I synthesis
2. May have beneficial effects on LDL and Triglycerides
3. Response is attenuated by NSAIDS
4. May cause significant orthostatic hypotension on the first dose

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All are correct
F = None are correct
E = All are correct
Direct acting vasodilators

a. Relax arterioles more than veins
b. Directly increase heart rate
c. Decrease renin release
d. Directly increases norepinephrine release
e. All of the above are correct
f. None of the above are correct
a. Relax arterioles more than veins
Hydralazine (Apresoline®)

a. Activates cAMP modulated potassium channels
b. Increases phosphorylation of myosin
c. Activates adenylate cyclase
d. Excreted unchanged by kidney
e. All of the above are correct
f. None of the above are correct
f. None of the above are correct
Minoxidil (Loniten®)

a. Inactivated by sulfation in liver
b. Should always be used in combination with beta blockers and diuretics
c. Minimal effects on sodium balance
d. Is the drug of choice for a hypertensive crisis
e. All of the above are correct
f. None of the above are correct
b. Should always be used in combination with beta blockers and diuretics
Nitroprusside (Nitropress®)

a. Works by production of cyanide which directly relaxes vascular smooth muscle
b. Always given with Sodium Thiosulfate
c. Effective only in arterioles
d. May turn stools black
e. All of the above are correct
f. None of the above are correct
f. None of the above are correct
Nitrates

1. Reduce preload
2. Decrease cardiac output
3. Undergo bio-activation with sulfhydryl groups
4. Tolerance can be reversed by N-Acetylcycteine

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All are correct
F = None are correct
E = All are correct
Which of the following is/are true about erectile dysfunction

a. Vardenafil (Levitra®) acts as a NO donor
b. Sidenafil (Viagra®) may cause visual disturbances due to direct action on the retina
c. Erectile dysfunction is due to overproduction of NO leading to smooth muscle relaxation
d. Tadalifil (Cialis®) potentiates the actions of nitrates by preventing their metabolism
e. All of the above are correct
f. None of the above are correct
b. Sidenafil (Viagra®) may cause visual disturbances due to direct action on the retina
or
f. None of the above are correct
Which of the following is/are symptoms of cyanide poising

1. Muscle spasms
2. Convulsions
3. Tinnitis
4. Trembling

A = 1,2,3
B = 1,3
C = 2,4
D = 4 only
E = All of the above
F = None of the above
C = 2,4
Most selective for alpha 2 receptors
A. Diazoxide (Hyperstat)
B. Fenoldopam (Corlopam)
C. Guanabenz (Wytensin)
D. Guanadrel (Hylorel)
E. Guanfacine (Tenex)
F. Ketanserin (Sufrexal)
G. Ketoralac (Toradol)
H. Rilmenifdine (Albarel)
I. Tadalafil (Cialis)
J. Zolmitirptan (Zomig)
E. Guanfacine (Tenex)
Imidazoline type 1 receptor agonist
A. Diazoxide (Hyperstat)
B. Fenoldopam (Corlopam)
C. Guanabenz (Wytensin)
D. Guanadrel (Hylorel)
E. Guanfacine (Tenex)
F. Ketanserin (Sufrexal)
G. Ketoralac (Toradol)
H. Rilmenifdine (Albarel)
I. Tadalafil (Cialis)
J. Zolmitirptan (Zomig)
H. Rilmenifdine (Albarel)
Mixed 5HT, alpha 2 antagonist
A. Diazoxide (Hyperstat)
B. Fenoldopam (Corlopam)
C. Guanabenz (Wytensin)
D. Guanadrel (Hylorel)
E. Guanfacine (Tenex)
F. Ketanserin (Sufrexal)
G. Ketoralac (Toradol)
H. Rilmenifdine (Albarel)
I. Tadalafil (Cialis)
J. Zolmitirptan (Zomig)
F. Ketanserin (Sufrexal)
Guanethidine analog
A. Diazoxide (Hyperstat)
B. Fenoldopam (Corlopam)
C. Guanabenz (Wytensin)
D. Guanadrel (Hylorel)
E. Guanfacine (Tenex)
F. Ketanserin (Sufrexal)
G. Ketoralac (Toradol)
H. Rilmenifdine (Albarel)
I. Tadalafil (Cialis)
J. Zolmitirptan (Zomig)
D. Guanadrel (Hylorel)
Activates ATP dependent potassium channels
A. Diazoxide (Hyperstat)
B. Fenoldopam (Corlopam)
C. Guanabenz (Wytensin)
D. Guanadrel (Hylorel)
E. Guanfacine (Tenex)
F. Ketanserin (Sufrexal)
G. Ketoralac (Toradol)
H. Rilmenifdine (Albarel)
I. Tadalafil (Cialis)
J. Zolmitirptan (Zomig)
A. Diazoxide (Hyperstat)
Selective for PDE 5
A. Diazoxide (Hyperstat)
B. Fenoldopam (Corlopam)
C. Guanabenz (Wytensin)
D. Guanadrel (Hylorel)
E. Guanfacine (Tenex)
F. Ketanserin (Sufrexal)
G. Ketoralac (Toradol)
H. Rilmenifdine (Albarel)
I. Tadalafil (Cialis)
J. Zolmitirptan (Zomig)
I. Tadalafil (Cialis)
Less sodium and water retention than clonidine
A. Diazoxide (Hyperstat)
B. Fenoldopam (Corlopam)
C. Guanabenz (Wytensin)
D. Guanadrel (Hylorel)
E. Guanfacine (Tenex)
F. Ketanserin (Sufrexal)
G. Ketoralac (Toradol)
H. Rilmenifdine (Albarel)
I. Tadalafil (Cialis)
J. Zolmitirptan (Zomig)
C. Guanabenz (Wytensin)
Agent: Niacin
Maximal % change in serum HDL cholesterol:
A. 100%
B. 35%
C. 15%
D. 20%
B. 35%
Agent: Fibrate
Maximal % change in serum HDL cholesterol:
A. 100%
B. 35%
C. 15%
D. 20%
D. 20%
Agent: Statin
Maximal % change in serum HDL cholesterol:
A. 100%
B. 35%
C. 15%
D. 20%
C. 15%
Agent: CETP Inhibitor
Maximal % change in serum HDL cholesterol:
A. 100%
B. 35%
C. 15%
D. 20%
A. 100%
The general side effects of central sympatholytic agents include which of the following?

a. Sedation
b. Dry mouth
c. Sexual dysfunction
d. Rebound hypertension upon acute withdrawal
e. A and C
f. All of the above
f. All of the above
Which of the following is/are true?

a. Alpha-methyldopa (Aldomet) blocks central alpha2-receptors
b. Clonidine (Catapress) may produce a positive Coombs test
c. Guanabenz (Wytensin) causes less sodium and water retention than clonidine
d. Guanfacine (Tenex) is more potent and more selective for 2-receptors than clonidine
e. Rilmenidine (Albarel) is a selective Imidazoline type 1 receptor antagonist.
f. None of the above
c. Guanabenz (Wytensin) causes less sodium and water retention than clonidine
Prazosin side effects include:

a. Orthostatic hypotension
b. Significant reflex tachycardia
c. Increased sodium and water retention
d. Depression and suicide
e. A and C
f. All of the above
e. A and C
Direct acting vasodilators:

a. Directly decrease TPR
b. Show Tachyphylaxis
c. Increase fluid retention
d. Increase CO
e. A and C
f. All of the above
f. All of the above
Hydralazine (Apresoline)

a. Increases cGMP and NO
b. Is equally effective in arteries and veins
c. May cause a “Lupus Like syndrome”
d. Useful in patients with uncontrolled angina
e. A and C
f. All of the above
e. A and C
Which of the following is/are true about Minoxidil (Loniten) ?

a. Activates ATP-modulated K+ channels
b. Requires sulfation to produce active form
c Always requires concomitant use of -blockers and diuretics.
d. May activate cardiac K+ channels leading to arrhythmias
e. All of the above
f. None of the above.
e. All of the above
Which of the following are direct responses to nitrates?

a. Reduced preload
b. Reduced oxygen demand
c. Increased coronary blood flow
d. Decreased platelet adhesion
e. A and C
f. All of the above
f. All of the above
Tolerance to nitrates includes which of the following?

a. Free radical formation
b. Increased metabolism
c.. Depletion of Sulfhydryl groups
d. Inhibition of counter regulatory mechanisms
e. A and C
f. All of the above
e. A and C