Cardiovascular drugs Pharmacology

1

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?

1

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?

1

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

1

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?

1

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

1

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

1

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?

1

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

1

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?

1

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

1

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?

1

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

1

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?

1

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

1

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

1

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

1

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

1

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?

1

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

1

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?

1

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

1

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

1

Diuretics

1

Methyl dopa

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

. 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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

1

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

Cardiovascular drugs Pharmacology

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 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 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?

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 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 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 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 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?

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 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

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

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

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