Cardiovascular drugs Pharmacology

A 32-year-old woman with hypertension wishes to become pregnant. Her physician informs her that she will have to switch to another antihypertensive drug. Which of the following drugs is absolutely contraindicated in pregnancy?

A patient is admitted to the emergency department with severe tachycardia after a drug overdose. His family reports that he has been depressed about his hypertension. Which one of the following drugs increases the heart rate in a dosedependent manner?

Which one of the following is characteristic of nifedipine treatment in patients with essential hypertension?

A 73-year-old man with a history of a recent change in his treatment for moderately severe hypertension is brought to the emergency department because of a fall at home. Which of the following drug groups is most likely to cause postural hypotension and thus an increased risk of falls?

Which of the following is very short-acting and acts by releasing nitric oxide?

In deciding on a treatment regimen with procainamide for this patient, which of the following statements is most correct?

If this patient should take an overdose and manifest severe acute procainamide toxicity with markedly prolonged QRS, which of the following should be given immediately?

A 57-year-old man is admitted to the emergency department with chest pain and a fast irregular heart rhythm. The ECG shows an inferior myocardial infarction and ventricular tachycardia. Lidocaine is ordered. When used as an antiarrhythmic drug, lidocaine typically

A 36-year-old woman with a history of poorly controlled thyrotoxicosis has recurrent episodes of tachycardia with severe shortness of breath. When she is admitted to the emergency department with one of these episodes, which of the following drugs would be most suitable?

A 16-year-old girl has paroxysmal attacks of rapid heart rate with palpitations and shortness of breath. These episodes occasionally terminate spontaneously but often require a visit to the emergency department of the local hospital. Her ECG during these episodes reveals an AV nodal tachycardia. The antiarrhythmic of choice in most cases of acute AV nodal tachycardia is

A 55-year-old man is admitted to the emergency department and is found to have an abnormal ECG. Overdose of an antiarrhythmic drug is considered. Which of the following drugs is correctly paired with its ECG effects?

A 60-year-old man comes to the emergency department with severe chest pain. ECG reveals ventricular tachycardia with occasional normal sinus beats, and ST-segment changes suggestive of ischemia. A diagnosis of myocardial infarction is made, and the man is admitted to the cardiac intensive care unit. His arrhythmia should be treated immediately with

A 70-year-old retired businessman is admitted with a history of recurrent heart failure and metabolic derangements. He has marked peripheral edema and metabolic alkalosis. Which of the following drugs is most appropriate for the treatment of his edema?

A 50-year-old man has a history of frequent episodes of renal colic with calcium-containing renal stones. A careful workup indicates that he has a defect in proximal tubular calcium reabsorption, which results in high concentrations of calcium salts in the tubular urine. The most useful diuretic agent in the treatment of recurrent calcium stones is

Which of the following is an important effect of chronic therapy with loop diuretics?

Which drug is correctly associated with its actions in the following table? (+ indicates increase and – indicates decrease.)

Which of the following diuretics would be most useful in the acute treatment of a comatose patient with traumatic brain injury and cerebral edema?

A 62-year-old man with advanced prostate cancer is admitted to the emergency department with mental obtundation. An electrolyte panel shows a serum calcium of 16.5 (normal 8.5–10.5 mg/dL). Which of the following therapies would be most useful in the management of severe hypercalcemia?

A 60-year-old patient complains of paresthesias and occasional nausea associated with one of her drugs. She is found to have hyperchloremic metabolic acidosis. She is probably taking

A 70-year-old woman is admitted to the emergency department because of a “fainting spell” at home. She appears to have suffered no trauma from her fall, but her blood pressure is 120/60 when lying down and 60/20 when she sits up. Neurologic examination and an ECG are within normal limits when she is lying down. Questioning reveals that she has recently started taking “water pills” (diuretics) for a heart condition. Which of the following drugs is the most likely cause of her fainting spell?

A 58-year-old woman with lung cancer has abnormally low serum osmolality and hyponatremia. A drug that increases the formation of dilute urine and is used to treat SIADH is

A graduate student is planning to make a high-altitude climb in South America while on vacation. He will not have time to acclimate slowly to altitude. A drug that is useful in preventing high-altitude sickness is

Diuretics

Methyl dopa

Propranolol a. Is a B1 specific blocker b. Causes prominent postural hypotension c. Inhibits the stimulation of renin production by catecholamines d. Has a half life of 12 hours e. Has no effect on plasma lipids

Hydralazine a. Dilates veins but not arterioles b. Is contraindicated in the treatment of preeclampsia c. Can cause an SLE type syndrome in up to 10 – 20% of patients d. Causes orthostatic hypotension in many cases e. Is extremely useful as a single agent in treatment of hypertension

Which of the following drug’s metabolism characteristics are bimodally distributed in the population? a. Sodium nitroprusside b. Clonidine c. Minoxidil d. Hydralazine e. Phentolamine

The ACE inhibitors a. Inhibit peptidyl dipeptidase thus preventing the inactivation of bradykinin b. Captopril is a prodrug c. Are to be used with caution in patients with IHD as reflex sympathetic activation occurs secondary to the hypotensive effects of the ACE inhibitors d. Have no role in treating the normotensive diabetic patients e. Are useful antihypertensive agents in late pregnancy

The following drugs when combined with ACE inhibitors may produce troublesome problems EXCEPT a. Diclofenac b. Potassium supplements c. Spironolactone d. Lithium e. Theophylline

The nitrates a. Have an antianginal effect via vasodilation of arterioles only b. Serve to increase preload c. Have a direct effect on cardiac muscle to cause a decrease in anginal symptoms d. All have high oral bioavailability e. Are contraindicated in the presence of increased intracranial pressure

Regarding Calcium channel blockers a. Calcium channel blockers are not bound to plasma proteins b. Nifedipine has less vascular potency than verapamil c. Felodipine has been shown to inhibit insulin release in humans d. Diltiazem has a plasma half life of 3 – 4 hours e. Verapamil has high affinity for cerebral blood vessels thus decreasing vasospasm post subarachnoid haemorrhage

Which of the following calcium channel blockers is excreted predominantly in the faeces? a. Nifedipine b. Felodipine c. Diltiazem d. Nimodipine e. Verapamil

Which of the following calcium channel blockers has the longest plasma half life? a. Felodipine b. Diltiazem c. Amlodipine d. Nimodipine e. Verapamil

The following include major actions of digoxin on cardiac electrical functions EXCEPT a. Decreased PR interval on ECG b. Decreased conduction velocity at the AV node c. Increased automaticity of the atrial muscle d. Decreased effective refractory period in purkinje system/ventricles e. Bigeminy can be induced by digoxin

Which of the following increases the risk of digoxin induced arrhythmias? a. Hyperkalaemia b. Hypercalcaemia c. Hypermagnesaemia d. Hyperuricaemia e. Hypernatraemia

. Digoxin a. Is poorly lipid soluble b. Is extensively metabolized c. Has a half life in the body of 40 hours d. Has minimal GI toxicity e. Is 80% bound to plasma proteins

. Drugs which may increase digoxin effect include all of the following EXCEPT a. Amiodarone b. Diltiazem c. Frusemide d. Quinidine e. Antacids

Which of the following drugs has the smallest volume of distribution? a. Chloroquine b. Verapamil c. Imipramine d. Warfarin e. Digoxin

Which of the following is a common direct or reflex effect of nitroglycerin? (A) Decreased heart rate (B) Decreased venous capacitance (C) Increased afterload (D) Increased cardiac force (E) Increased diastolic myocardial fiber tension

In advising the patient about the adverse effects he may notice, you point out that nitroglycerin in moderate doses often produces certain symptoms. Which of the following effects might occur due to the mechanism listed? (A) Constipation (B) Dizziness due to reduced cardiac force of contraction (C) Diuresis due to sympathetic discharge (D) Headache due to meningeal vasodilation (E) Hypertension due to reflex tachycardia

One year later, the patient returns complaining that his nitroglycerin works well when he takes it for an acute attack but that he is now having more frequent attacks and would like something to prevent them. Useful drugs for the prophylaxis of angina of effort include (A) Amyl nitrite (B) Esmolol (C) Sublingual isosorbide dinitrate (D) Sublingual nitroglycerin (E) Verapamil

If a β blocker were to be used for prophylaxis in this patient, what is the most probable mechanism of action in angina? (A) Block of exercise-induced tachycardia (B) Decreased end-diastolic ventricular volume (C) Increased double product (D) Increased cardiac force (E) Decreased ventricular ejection time

A new 60-year-old patient presents to the medical clinic with hypertension and angina. He is 1.8 meters tall with a waist measurement of 1.1 m. Weight is 97 kg. Blood pressure is 150/95 and pulse 85. In considering adverse effects of possible drugs for these conditions, you note that an adverse effect that nitroglycerin and prazosin have in common is (A) Bradycardia (B) Impaired sexual function (C) Lupus erythematosus syndrome (D) Orthostatic hypotension (E) Weight gain

A man is admitted to the emergency department with a brownish cyanotic appearance, marked shortness of breath, and hypotension. Which of the following is most likely to cause methemoglobinemia? (A) Amyl nitrite (B) Isosorbide dinitrate (C) Isosorbide mononitrate (D) Nitroglycerin (E) Sodium cyanide

Another patient is admitted to the emergency department after a drug overdose. He is noted to have hypotension and severe bradycardia. He has been receiving therapy for hypertension and angina. Which of the following drugs in high doses causes bradycardia? (A) Amlodipine (B) Isosorbide dinitrate (C) Nitroglycerin (D) Prazosin (E) Verapamil

A 45-year-old woman with hyperlipidemia and frequent migraine headaches develops angina of effort. Which of the following is relatively contraindicated because of her migraines? (A) Amlodipine (B) Diltiazem (C) Metoprolol (D) Nitroglycerin (E) Verapamil

When nitrates are used in combination with other drugs for the treatment of angina, which one of the following combinations results in additive effects on the variable specified? (A) Beta blockers and nitrates on end-diastolic cardiac size (B) Beta blockers and nitrates on heart rate (C) Beta blockers and nitrates on venous tone (D) Calcium channel blockers and β blockers on cardiac force (E) Calcium channel blockers and nitrates on heart rate

Certain drugs can cause severe hypotension when combined with nitrates. Which of the following interacts with nitroglycerin by inhibiting the metabolism of cGMP? (A) Atenolol (B) Hydralazine (C) Isosorbide mononitrate (D) Nifedipine (E) Ranolazine (F) Sildenafil (G) Terbutaline