Med Pharm II Cardio Quizzes

Furosemide is considered a "loop diuretic." Where does this term come from?

Furosemide inhibits the Na+ K+ 2Cl- cotransporter in the TALH (thick ascending loop of henle), which is where it gets its name of as a loop diuretic because of its mechanism of action in the renal tubule. It inhibits Na+ reabsorption by binding to this cotransporter mentioned previously in the TALH.

Which organ must Ramipril pass through prior to showing cardiac activity, regardless of administration route? A. Liver B. Brain C. Kidney D. Intestine E. Spleen

answer is A - Ramipril - a prodrug like Enalapril so it will have to pass through the liver to be converted into the active form - a ACE inhibitor

Which infection would generally be considered the most advanced? A. pyelonephritis B. pyelitis C. cystitis

- all three of these are considered UTIs answer is A - pyelonephritis - infection that reaches the nephrons B is wrong - pyelitis - infection of the renal pelvis C is wrong - cystitis- infection of the urinary bladder - more common in females due to shorter urethra - less time for immune system to block infection - can spread up the ureter causing pyelitis

You measure a patient's blood pressure at 130/85. Calculate the patient's pulse pressure and mean arterial pressure.

1) pulse pressure: 130 - 85 = 45 2) MAP = DP + 1/3PP 85 + 1/3 (45) = 100

Which K+ channel blocker is less selective, leading to wide-ranging side-effects? A. Amiodarone B. Dofetilide

answer is A - Amiodarone - is a K+ channel blocker but also blocks Na+ cahnels, Ca2+ channels, and alpha 1 Beta-receptors which leads to wide-ranging side-effects - lacks selectivity - prolongs APD - extremely long half-life - used for chronic treatment of all arrhythmias - adverse effects - altered thyroid function (inhibits conversion of T4 to T3)

Many ACE inhibitors are given as prodrugs. Why not give the active compound directly? Your answer should be specific to ACE inhibitors, not simply an explanation of prodrugs.

ACE inhibitors blocks angiotensin I from going into its active form angiotensin II. This will help lower the blood pressure because it blocks the effects of the renin angiotensin aldosterone system. These inhibitors are given as prodrugs because it increases their bioavailability and absorption. The active drug inhibitors have poor oral bioavailability.

A hypertensive patient is given a new prescription for 10 mg Lisinopril pills. What is the most likely daily dose that was instructed (how many pills per day). A. 1 B. 2 C. 3 D. 4 E. 5

A

What signal causes the heart to secrete atrial natriuretic hormone? A. increased blood pressure B. decreased blood pressure C. increased Na+ levels D. decreased Na+ levels

A

Which of the following processes does atmospheric pressure play a role in? A. pulmonary ventilation B. production of pulmonary surfactant C. resistance D. surface tension

A

Gas flow decreases as ________ increases. A. resistance B. pressure C. airway diameter D. friction

A Q = P/R

What is suggested by the presence of white blood cells in the urine?

A high number of white blood cells (leukocytes) in the urine may suggest an infection, like a urinary tract infection (UTI). Also can suggest that a person has developed kidney stones. There are many different infections that can occur due to white blood cells being in the urine in high concentrations.

Which endogenous ligand does Atrovent block? A. ACh B. Muscarine C. Nicotine D. Adrenaline E. Histamine

A is correct - Atrovent (Ipratropium) is a type of anticholinergic - it is a muscarinic receptor antagonist that blocks the action of ACh (causing bronchoconstriction) - by inhibiting ACh it will cause bronchodilation - a weak bronchodilator that only works when ACh is around - used in COPD to decrease cholinergic tone - used in asthma in combination with B-adrenergic agonists (eg, alubterol and salmeterol) (combination more effective and less toxic than either drug alone) - given by inhalation - has no anti-inflammatory effects

Why is adenosine not useful as a maintenance medication to control chronic arrhythmias?

Adenosine is not useful as a maintenance to control chronic arrhythmias because it shortens the refractory period of the pathway, possibly resulting in a rapid conduction of atrial fibrillation. This would increase the chances of ventricular arrhythmias, which is dangerous. Adenosine also has no effects on accessory pathways like WPW (wolf-parkinson white syndrome)

Alteplase has some amazing characteristics but is only used to treat acute blood clots. Why is it not amenable to use as a prophylactic?

Alteplase is a very powerful drug and is not used as a prophylactic drug because of its complications of possibly increasing severe bleeding by its anticoagulant mechanism.

Mannitol, as well as other sugar alcohols, is commonly used as an artificial sweetener and is poorly absorbed by the digestive tract. Eating large (but still realistic) amounts of these sugar alcohols at once can lead to severe diarrhea. This effect is chemically related to its mechanism of action when used as a diuretic. What is causing the severe diarrhea?

As a diuretic it makes you clear more salt and water out of your body by inhibiting the reabsorption. Mannitol is a diuretic is not metabolized in the body and is not reabsorbed in the tubules. So the excess sugar will cause more water in the tubules because of osmolarity which could potentially cause severe diarrhea due to the excess of water.

A patient is prescribed a loading dose of theophylline sufficient to result in 10 µg/mL plasma concentrations. Assuming a linear increase in plasma concentration, how many of these loading doses would be required to give side effects? A. 1 B. 2 C. 3 D. 4 E. 5

B

Activation of the sympathetic nervous system would have what effect on airway resistance in the bronchi? A. increase B. decrease

B

Does diltiazem indirectly increase or decrease the activity of myosin? A. Increase B. Decrease

B

Which drug would be expected to reduce leukotriene levels in the blood? A. Singulair B. Zyflo C. Proventil D. Ventolin E. Serevent

B

Which of the following is located in the pinky toe? A. conducting division of the respiratory system B. respiratory division of the respiratory system

B

Which of the following is the largest in diameter? A. respiratory bronchioles B. main bronchi C. tertiary bronchi D. Terminal bronchioles E. alveoli

B

Which process moves materials into the collecting duct? A. reabsorption B. secretion

B

Does sympathetic activation increase or decrease urination? A. increase B. decrease

B When the sympathetic nervous system is active, it causes the bladder to increase its capacity without increasing detrusor resting pressure (accommodation) and stimulates the internal urinary sphincter to remain tightly closed. In terms of urinary function, the parasympathetic nerves stimulate the detrusor to contract.

A patient with what type of medical history would be most likely to already be on a therapy that would impact the chosen therapy for a new asthma diagnosis? A. Prostate cancer B. Gout C. Heart disease D. Glaucoma E. Hemorrhoids

C

A decrease in volume leads to a(n) ________ pressure. A. decrease in B. equalization of C. increase in D. zero

C - P = 1/v -> inverse relationship

Many heart medications aim to increase intracellular Ca2+ in the heart. How does this help?

Calcium increases the toxicity of these medications for the heart. Calcium regulates muscle contraction and blood pressure. It helps the heart pump blood more efficiently. The main thing it does is help produce more cardiac contraction by increasing the calcium in the sarcoplasmic reticulum.

Ca2+ channel blockers exert their effects primarily in which part of the heart? A. Nodes B. Atria C. Ventricals D. Cardiomyocytes

answer is A - Ca2+ channel blockers - class IV anti-arrhythmic drugs - act primarily on slow response cells (SA and AV node), which are dependent on Ca2+ influx for Phase 0 of the AP

What type of enzyme does sacubitril inhibit? A. Peptidase B. Nuclease C. Synthase D. Lipase E. Transcriptase

answer is A - Sacubitril - new agent - inhibits breakdown of ANP, BNP, thereby enhancing the vasodilatory, diuretic, natriuretic effects of these counter regulatory hormones - adverse effects include hypotension, hyperkalemia, renal impairment, cough - these are all peptides and proteins, so they inhibit peptidase which breakdown proteins

Digibind, an antibody towards cardiac glycosides, has been developed. Why haven't antibodies towards the other medications discussed been developed?

Digoxin toxicity is a life-threatening condition and there are many symptoms of this drug but cardiac manifestations can be fatal. Therefore, the antibody Digibind can be given to rapidly lower the plasma concentration of this drug. The other medications are not life threatening like this drug, therefore there has not been a need to develop them yet.

Would stroke volume be expected to be largest in a patient with high or low blood pressure, everything else being equal? A. High B. Low

answer is B A is wrong - because the higher BP will increase afterload, which will decrease stroke volume so the person will a lower BP will have the larger stroke volume

What type of muscle tissue controls airway diameter? A. skeletal muscle B. cardiac muscle C. respiratory muscle D. smooth muscle

D

Which of the following treatments is most effective at controlling most chronic COPD symptoms? A. Atrovent B. Flovent C. Albuterol D. Stopping smoking

D

Both diabetes mellitus and diabetes insipidus produce large urine volumes, but how would other characteristics of the urine differ between the two diseases?

Diabetes mellitus causes high blood glucose levels and some of this glucose ends up in the urine. This glucose in the urine causes more water loss . In Diabetes insipidus is a more rare disease that produces larger volumes of dilute urine. This is actually either caused by decrease release of ADH, therefore not retaining as much water. Or the kidneys do not respond to the release of ADH, and therefore also do not retain water. This is how these two differ but both produce large urine volumes.

Withdrawal of digoxin after long-term therapy can lead to increased mortality; even when it is replaced with another heart medication. What is a plausible explanation for this? (It doesn't have to be the actual reason, just make logical sense.)

Digoxin is a cardiac glycoside that increases stroke volume by increasing contractility. It does this by inhibiting the Na+K+ pump which will have an indirect effect on the Na+Ca2+ exchange. This leads to more calcium in the SR, which will cause the increase cardiac contractility and therefore increased SV. After long-term use, the discontinuation of these drug has been associated with increased symptoms of heart failure and mortality because of its positive inotropic and neurohormonal modulation properties.

Many heart failure medications inhibit the sympathetic nervous system (or its effects) rather than increasing the parasympathetic nervous signaling. Why?

During heart failure, the sympathetic nervous system is upregulated, it is essentially in overdrive. This overdrive can make heart failure progress very fast so it is crucial to diagnosis heart failure immediately and be put on a beta blocker to inhibit the sympathetic nervous system to improve the outcome. There is such an imbalance between the parasympathetic and sympathetic because of the overdrive of the sympathetic. Increasing the parasympathetic would not be enough to slow down the progression of the heart failure because of the increased sympathetic nervous system. Therefore most medications would inhibit the sympathetic to improve the outcome.

Initial doses of hydrochlrothiazide decreases blood pressure by ____________. A. decreasing heart rate B. dilating blood vessels C. blocking sympathetic transmission D. increasing parasympathetic tone E. decreasing blood volume

E

Which mechanism best describes mannitol's mechanism of action as a diuretic? A. Increased Na+ reabsorption B. Decreased Na+ reabsorption C. Increased K+ reabsorption D. Decreased K+ reabsorption E. Osmosis

E

The release of which molecule is inhibited by Cromolyn? A. ACh B. Muscarine C. Nicotine D. Adrenaline E. Histamine

answer is E - Cromolyn - a drug used as anti-inflammatory - inhibits degranulation of mast cells - first step in allergen induced asthma attacks - may take up to 4-6 weeks of its treatment to be effective in chronic asthma - has no bronchodilator activity -> anti-inflammatory drug - virtually no toxicity

Esmolol has a known side effect of potential airway constriction. How does it cause this?

Esmolol is a beta-blocker, which can sometimes make it more difficult to breath because it can cause lung muscle spams. Sometimes these beta blockers are poorly selective for cardiac beta receptors over respiratory beta receptors, which will block the effects of the respiratory pathway and cause bronchoconstriction.

Oral corticosteroids have a long list of side effects. Despite that, their use is tapered down after use rather than simply withdrawing them. Why?

If you just withdraw them without tapering them down, there will be additional withdrawal symptoms like fatigue, weakness, body aches, and more. These oral corticosteroids are mimicking the corticosteroids made in the body. So when taking this medication your body will make less so that it why it is important to start tapering down so your body will react and start producing more.

A 50 year old vegan patient is diagnosed with hypercholesterolemia and is prescribed Zetia. The patient gets home, looks up Zetia on Wikipedia, and finds out it blocks intestinal cholesterol absorption. They call their physician and incredulously demand to know why they were prescribed this drug despite their diet containing very small amounts of cholesterol, so there's no cholesterol absorption to inhibit. What explanation did the physician likely give the patient?

Hypercholesterolemia is an increase in plasma cholesterol caused by mutations in the receptors that remove cholesterol. This is due to a mutation, not to even can of diet that is the cause of raising their cholesterol. The physician would let the patient know that Zetia is given to lower their cholesterol due to mutations, which is causing hypercholesterolemia.

The connexin proteins are much more highly expressed in cardiac muscle than in skeletal or smooth muscle. Why is this the case?

In cardiac muscles, the cell to cell connection is the connexon that forms gap junctions, which allow the ions that are responsible for causing the heartbeat to easily flow through the heart. Smooth muscles contain some gap junctions to allow for depolarization, while skeletal muscle does not contain these. Cardiac muscle needs more because of the connexin proteins allow the depolarization to allow for a heartbeat.

Long-term smokers often have rapid, shallow breathing patterns. Why is it shallow? What are two reasons that it is rapid?

It is rapid because there is a loss of lung compliance, so it is not as easily to expand. The irritant receptors detects this unwanted air, so the airway constricts to avoid it coming in. It is rapid because there is a decreased gas exchange and because of the decreased compliance.

Praluent shows higher efficacy and fewer side effects than statins, yet is only considered for use in patients once statins have failed to adequately control blood cholesterol levels. Why is it not the first-line treatment?

It is a newer drug so the long-term side effects are unknown. There are fewer short-term effects but the long-term effects are unknown. Also these PCSK9 inhibitors (eg, praluent) are way more expensive because since it is a newer drug, there are not any generic versions in the US. To lower cholesterol, PCSK9 inhibitors are usually the 3rd item prescribed if statins and if bile acid agents do not work.

Students that are learning to play wind instruments are often taught to "belly breathe." This means that, when they inhale, their abdomens should extend outward rather than their shoulders rising. Why is this an advantage?

It is called diaphragmatic breathing. This is an advantage because it helps increase oxygen supply to the body. It also helps prevent damage to the vocal cords. It also strengthens the diaphragm, improves stability, slows breathing rate, and more. These are all advantages.

Explain why afterload is critical in cardiac function and maintaining long-term heart health (i.e. heart failure). Hint: Decreased output, by itself, not lead to heart failure.

It is very important in health because increased afterload results in decreased SV and this can be caused by patients with chronic hypertension. When chronic hypertension persist, this could result in long-term effects including heart attacks or strokes. This increased afterload can result in atherosclerosis, which leads to these long-term health problems including heart attack and stroke.

Patients at risk for deep-vein thrombosis may be prescribed low molecular weight heparins to be self-injected immediately before a long airplane flight. With all the other options available, why do LMWHs make more sense in this situation than the other options?

LMWHs will directly inhibit thrombin, it will be used as a prophylactic drug because of its better bioavailability and longer half lives and lower risk of bleeding than other forms. So this is why LMWHs are better than other forms for patients at risk for deep-vein thrombosis, which causes the formation of blood clots.

Which drug causes a short-term decrease in ejection fraction followed by a subsequent increase? A. Digoxin B. Epinephrine C. Captopril D. Lidocaine E. Metoprolol

answer is E - Metoprolol - beta 1-AR selective antagonist (beta-blockers) - which decrease BP by blocking epinephrine (aka adrenaline) - acute effect - low dose initiation - decreased ejection fraction - chronic effect - with gradual escalation - increased ejection fraction

Describe how "stone-dissolving drugs" work to clear kidney stones.

Medications only dissolve kidney stones if the stone is composed of uric acid. If the kidney stone is composed of uric acid, then alkalizers can neutralize the acid in the urine, so these crystals start to dissolve.

A patient is given minoxidil to treat their hypertension, but after a few months they complain to their physician that they are experiencing abnormal hair growth. What is going on?

Minoxidil is a vasodilator that causes decreased intracellular Ca2+ and increased hyperpolarization by increasing K+ channels. This vasodilation will cause a decrease in total peripheral resistance and therefore blood pressure. As this drug promotes vasodilation, it will increase blood supply to hair follicles, causing the hair to move to the active phase of hair growth called anagen - this will cause hair growth.

Nitroglycerin acts as a vasodilator by increasing the levels of what chemical in the blood? A. Epinephrine B. cAMP C. Dopamine D. Digoxin E. Nitric oxide

answer is E - nitroglycerin - dilator: veins > arterioles (NO - nitric oxide) - decreases preload = decreased filling pressure, congestion - limitation - hypotension

A hypertensive patient whose blood pressure is well controlled by Metoprolol is forced to go without their medication due to inability to pay for their prescription refill. The next day they are taken to the emergency room by ambulance because of severe tachycardia. What could explain this event?

Metoprolol is a Beta 1 selective blocker, whose goal is to decrease the elevated blood pressure. The sudden withdrawal can lead to the rebound effect which will have a sudden increase in blood pressure and heart rate (tachycardia) which can make the patients symptoms worse and cause them to go to the hospital.

Everyone knows nitroglycerin as an explosive. How is it safe to give it to patients to carry around with them?

Nitroglycerin worries a lot of people because it is known as an explosive due to its chemical structure. These explosive compounds usually rely on external sources of oxygen but in nitroglycerin case, this step is skipped because nitroglycerin has a lot of oxygen molecules in its chemical structures. Nitroglycerin is made safe by diluting it with other compounds to make it safe for human use.

By blocking the Na+/K+ pump, does digoxin increase of decrease cardiac output? A. Increase B. Decrease

answer is A - Digoxin - is a cardiac glycoside (inotropic agent - digitalis) that increases stroke volume by increasing contractility - therefore it increases CO - direct cause of increase Na+ in the cell, which leads to increased Ca2+ in the cell as an indirect effect - leads to increased contractility and increased stroke volume - decreased LV end diastolic volume - decreased ventricular size/tension - increased blood flow to the kidney

Why do salty snacks make you thirsty, and how do they cause increased blood pressure?

Salty snacks make you thirsty because there is an increase in extracellular Na+, which causes the influx of H2O out of the cells. This decrease in intracellular H2O, will trigger the feeling of thirst. Your body is retaining more water to dilute the salt content in the extracellular space. This loss of water in the cells will cause you to think your thirsty. Also high salt intake will increase BP by increasing the blood volume. The kidneys are retaining more water because of the high salt content which will increase the blood volume by increasing the the afterload - putting more stress on the blood vessels. This will cause the BP to increase.

Severe inflammation that completely restricts the nasopharynx is more or less nothing more than an annoyance, but inflammation that completely restricts the oropharynx is lethal. What explains this huge difference?

Severe inflammation that completely restricts the nasopharnx is not lethal because we can breathe through the mouth due to the oropharnx being open. But if the oropharnx is completely restricted, it is lethal because this is the only route for air to enter the lungs.

Most absorption and secretion occurs in this part of the nephron. A. proximal convoluted tubule B. descending loop of Henle C. ascending loop of Henle D. distal convoluted tubule E. collecting ducts

answer is A - PCT reabsorbs about 65% of glomerular filtrate, therefore 2/3rds of water in filtrate is reabsorbed here

A number of precautions must be taken in order to prevent developing thrush during use of Flovent. How are these two things connected?

These two things are connected because you use an haler for Flovent, which puts you at a higher risk of developing thrust. This leads to the build up of fungus (yeast) in your mouth.

Which β-blocker is more likely to be given to a patient to take long-term for control of chronic arrhythmia? A. Propranolol B. Esmolol

answer is A - Propranolol - is a long acting beta-blocker given orally B is wrong - Esmolol is different than the other Class II anti-arrhythmic beta-blockers because it is given intravenously (IV) in an emergency acute arrhythmias because it has fast onset and short half-life

Do kidneys look like kidney beans, or do kidney beans look like kidneys?

The kidney beans resemble in shape and color of the human kidney.

There are two major categories of arrhythmias: ventricular and supraventricular. Why is one of the categories named "supraventricular" rather than "atrial."

The supraventricular arrhythmias occur right above the ventricles, mainly the atria. It occurs in the atria or the atrial conduction pathways. Supraventricular arrhythmias will actually cause shortness of breath, chest tightness, etc, while atrial arrhythmias can happen in response of caffeine, alcohol, etc.

Which of the following are affected by ACE inhibitors? Check all that apply. A. Cardiac muscle B. Smooth muscle C. Kidneys D. Adrenal Gland E. Central nervous system

all of them, A, B, C, D, and E

Is it more common for a patient with heart failure to have a heart that is larger or smaller than expected? A. Larger B. Smaller

answer is A

A patient arrives in the emergency department with a blood pressure of 70/45, is confused, and complaining of thirst. What is the common cause shared between these observations and how does it cause each?

This BP is very low and is really too low to circulate blood effectively throughout the body. Therefore the tissues will be inadequately perfused. This can be caused by dehydration due to low blood plasma volume. Therefore since the tissues are not being perfused effectively, there is a decrease in oxygenated blood going around and to the brain. This can end up causing the confusion and since of thirst. Also, the kidneys would release aldosterone to increase the volume, which is a thirst mechanism.

Ca2+ channel blockers can cause hypotension, which in turn can lead to peripheral edema. How does this happen?

This can occur due to the increased capillary hydrostatic pressure that results in fluid entering the tissues. There is a decrease in arteriolar resistance (so pre-capillary dilation) without a proportionate dilation in venous or post-capillary.

A hypertensive patient with a history of familial hypertension, poor diet, and alcohol abuse is given a prescription for Verapamil. They quickly develop severe side effects and bloodwork shows extremely high plasma levels of Verapamil. Why were the plasma levels higher than the physician expected?

This medication has a high first pass metabolism so since this patient has a poor diet and alcohol abuse can lead to the decreased metabolism of verapamil. So therefore if the metabolism is decreased, then there will be higher plasma levels of this medication, verapamil.

What is suggested by the presence of albumin in the urine?

Too much albumin in the urine is called albuminuria, which is a sign of kidney damage or disease. A healthy kidney does not allow albumin to pass from blood to the urine but when the kidney is damaged, albumin passes through and is present in the urine.

Patients suffering from hemophilia A lack Factor VIII. Which clotting pathway is nonfunctional in these patients? A. Intrinsic pathway B. Extrinsic pathway

answer is A

The cardiovascular centers are located in which area of the brain? A. medulla oblongata B. pons C. mesencephalon (midbrain) D. cerebrum

answer is A

The endothelium is found in the ________. A. tunica interna B. tunica media C. tunica externa D. lumen

answer is A

Which of the following lists the valves in the order through which the blood flows from the vena cava through the heart? A. tricuspid, pulmonary semilunar, bicuspid, aortic semilunar B. mitral, pulmonary semilunar, bicuspid, aortic semilunar C. aortic semilunar, pulmonary semilunar, tricuspid, bicuspid D. bicuspid, aortic semilunar, tricuspid, pulmonary semilunar

answer is A

Which type of arrhythmia would appear on an ECG as a large downward peak occurring before any upwards peaks? A. Premature ventricular beat B. Atrial fibrillation C. Torsade de Pointes D. Ventricular fibrillation

answer is A

Would Amicar be expected to increase or decrease the presence of fibrin at blood clots? A. Increase B. Decrease

answer is A - Amicar blocks Fibrinolysis which normally would degrade fibrin - inhibitor of plasminogen activators - can be used after extractions (eg, dental surgeries) or surgery where there is local bleeding

We think of high cholesterol as being a problem associated with middle- and old-age. The diet eaten by people of this age is no worse than younger people, and their genetics didn't change as they got older. Why do we start to develop problems as we get older?

We start developing problems as we get older because the LDL receptors decrease with age. Therefore as we age, cholesterol might get higher.

Which drug is only appropriate for treating hypertension in the emergency room? A. Sodium Nitroprusside B. Spironolactone C. Hydralazine D. Propranolol E. Aliskiren

answer is A - Sodium Nitroprusside - dilates arterioles = veins: decreased TPR = decreased BP - a vasodilator B is wrong - Spironolactone is a aldosterone antagonist in the collecting duct C is wrong - Hydralazine is a vasodilator drug - dilates arterioles > veins -- decreased TPR = decreased BP - decreases intracellular Ca2_ or increases K+ channel (causing hyperpolarization D is wrong - propranolol is a Beta blocker that is nonselective and will block both Beta 1 and 2

Which mechanism of arrhythmia is triggered by the ANS? A. Enhanced normal automaticity B. Early afterdepolarizations C. Delayed afterdepolarizations

answer is A - enhanced normal automaticity - caused by sympathetic activation (the ANS) B is wrong - early afterdepolarizations - interrupt repolarization C is wrong - delayed afterdepolarizations - occurs after repolarization - exacerbated by fast HR - high intracellular Ca2+ - digitalis toxicity

When blood pressure increases, blood vessels supplying the kidney will ________ to mount a steady rate of filtration. A. contract B. relax

answer is A - if arterial BP increases then afferent arteriole is stretched. So afferent arteriole constricts and prevents blood flow into the glomerulus from changing

Nitroglycerin must be used to produce what molecule before becoming biologically active? A. NO B. Trinitroglycerin C. Dinitroglycerin D. GlycerinNitrate

answer is A - nitroglycerin is not active itself so it gets converted in NO, which is active

Is spironolactone expected to increase or decrease urination? A. Increase B. Decrease

answer is A - spironolactone is an aldosterone antagonists - so they decrease Na+ and water reabsorption - can contribute decreased BP - decrease K+ excretion - decrease sympathetic tone - limitations - hyperkalemia, male impotence

Which class of drugs has the most direct effect on cardiac hypertrophy itself? A. ACE inhibitor B. Vasodilator C. Diuretic D. Inotropic agents

answer is A - ACE inhibitors and ARBs have direct effect on hypertrophy remodeling hypertrophy - increases in ventricular mass, will help bring greater force of contraction which will help stroke volume ACE inhibitors (captopril, enalapril, lisinopril) and ARBs (losartan, valsartan, Candasartan) help with heart failure 1) decreased afterload (vasodilation) = increased stroke volume 2) venodilation = decreased preload = decreased congestion 3) decreased aldosterone = decreased blood volume 4) Slows progression of hypertrophy/remodeling (decreased mortality) B, C, D are wrong because they do not have direct effect, there are multiple steps B is wrong - Vasodilator - affects preload and afterload so indirect effect on hypertrophy C is wrong - Diuretic - affects stroke volume (preload and afterload) and Ang II so it has indirect effect on hypertrophy D is wrong - Inotropic agents direct effect on cardiac output

Is Lipitor used to increase or decrease the LDL:HDL ratio? A. Increase B. Decrease

answer is B

The force the heart must overcome to pump blood is known as ________. A. preload B. afterload C. cardiac output D. stroke volume

answer is B

Which drug has irreversible effects on cells? A. Warfarin B. Aspirin C. Heparin D. Altepase E. Amicar

answer is B

Which of the following best describes veins? A. thick walled, small lumens, low pressure B. thin walled, large lumens, low pressure C. thin walled, small lumens, high pressure D. thick walled, large lumens, high pressure

answer is B

Which of the following is a negative inotrope? A. Na+ B. K+ C. Ca2+ D. both Na+ and K+

answer is B

Which type of arrhythmia would appear on an ECG as a repeated pattern of small, irregular P waves (sometimes not even considered to be true p waves) with interspersed QRS waves? A. Premature ventricular beat B. Atrial fibrillation C. Monomorphic ventricular tachycardia D. Torsade de Pointes E. Ventricular fibrillation

answer is B

Which drug could be used to inhibit clotting of a blood sample in a test tube? A. Warfarin B. Heparin

answer is B - both of these drugs are anti-coagulants - they prevent new formation of blood clots - Heparin does not cross the placenta - therefore much safer to sue during pregnancy

Which statement best describes the process of arteriosclerosis? A. Buildup of plaques in blood vessels, restricting blood flow B. Stiffening of blood vessels due to loss of elastic fibers

answer is B A is wrong - this is atherosclerosis

Which antiarrhythmic drug is a Na+ channel blocker that decreases APD? A. Quinidine B. Lidocaine C. Propranolol D. Amiodarone E. Digoxin

answer is B Class I anti-arrhythmic drugs - are all Na+ channel blockers A is wrong - Class IA anti-arrhythmic drugs (procainimide, quinidine, and disopyramide) - prolong AP and prolonged ERP B is correct - a Class IB anti-arrhythmic drug (lidocaine, mexilotine) - shorten duration of AP and shorten ERP C is wrong - Class II anti-arrhythmic drug - Beta-blocker ("olol") - slow conduction through AV node, results in decreased HR and decreased contractility D is wrong - Class III anti-arrhythmic drug - blocks K+ channels - includes Amiodarone (which also blocks Na+ channels, Ca2+ channels), Dronedarone, Sotalol, Dofetilide, Ibutilide - increases duration of AP and increase ERP

Would Alteplase be expected to increase or decrease the presence of fibrin at blood clots? A. Increase B. Decrease

answer is B - Alteplase is a tissue type plasminogen activator (t-PA) which activates plasminogen that is bound to fibrin - degrades fibrin

A patient is diagnosed with hypertension but there is no singular identifiable cause. Which type of hypertension does this patient likely have? A. Secondary hypertension B. Essential hypertension

answer is B - Essential hypertension comprises 90% of elevated BPs - these individuals all have increased TPR that is caused by increases vasoconstrictors, increased SNS, hormonal factors (epinephrine, vasopressin, renin), genetic factors, or lifestyle changes (like diet, smoking, stress, physical activity, etc.) A is wrong - Secondary hypertension is due to renal disease, thyroid disease, or endocrine disease

Fenofibrate would be least likely to be used to treat which condition? A. Hyperlipidemia B. Hypercholesterolemia C. Hyperlipemia D. Mixed hyperlipidemia

answer is B - Fenofibrate and Genfibrozil are both Fibric Acid Derivatives - they decrease triglycerides (VLDL) levels by stimulation of LPL (hydrolysis of VLDL) - so used primarily in hypertriglyceridemia - may decrease VLDL synthesis in the liver - may be used in mixed hyperlipidemia - variable effects on LDL (some increase, some decrease) so not used in hypercholesterolemia adverse effects - risk of myopathy increases when used with statin - increases effects of Warfarin because of its binding to plasma proteins which displaces Warfarin so more free Warfarin = more effective (possibly increases bleeding due to free Warfarin)

Which antiarrhythmic drug works better in ischemic cardiac tissue than in well-oxygenated tissue? A. Quinidine B. Lidocaine C. Propranolol D. Amiodarone E. Digoxin

answer is B - Lidocaine - Class 1B anti-arrhythmic drugs, which are Na+ channel blockers that slightly decrease APD A is wrong - Quinidine - Class 1A anti-arrhythmic drugs, which are Na+ channel blockers that increase APD C is wrong - Propranolol - Class II anti-arrhythmic drug that is a beta-blocker D is wrong - Amiodarone - Class III anti-arrhythmic drug that is K+ channel blocker (prolongs repolarization) E is wrong - Digoxin is a cardiac glycoside that increases contractility

Lovaza is most closely related to which nutritional supplement? A. Ginkgo biloba B. Fish oil C. St. John's wort D. Melatonin E. Echinacea

answer is B - Lovaza is an omega 3 fatty acid - so it decreases very high triglycerides levels - has been found to increase LDL receptors in some patients so monitor it

Does nitroglycerin lead to the phosphorylation or dephosphorylation of myosin light chain? A. Phosphorylation B. Dephosphrylation

answer is B - NO will lead to the myosin light chain phosphatase so the dephosphrylation

Which medication would most likely be prescribed as a single-agent maintenance medication for asthma? A. Propranolol B. Theophylline C. Ipratropium D. Albuterol E. Salmeterol

answer is B - Theophylline - relaxes smooth muscle of the bronchi - must be given orally - less effective bronchodilator and has slower onset of action than albuterol because it is orally - an adenosine receptor antagonist and PDE inhibition (which normally would degrade cAMP -> AMP) - so it increase cAMP and inhibits adenosine (normally causes bronchoconstriction) to cause bronchodilation - not used as much because of many drug interaction (P450 interactions) A is wrong C is wrong - Ipratropium - a muscarinic receptor antagonist - a weak bronchodilator, only works when ACh is around - inhibits ACh effects of causing bronchoconstriction to cause bronchodilation - no anti-inflammatory activity D and E are wrong - Albuterol (short) and Salmeterol (long) are both beta-agonist that increase cAMP to cause bronchodilation

The majority of warfarin in the body is located where after administration? A. Liver B. Bound to plasma proteins C. Platelets D. Free in the plasma E. Kidneys

answer is B - Warfarin is an anticoagulant - used to treat and prevent blood clots - inhibits proper synthesis of Vitamin K dependent factors - highly bound to plasma proteins -> low volume of distribution and high half-life - can cross the placenta so do not use in pregnancy - used in venous thrombosis, pulmonary embolism, atrial fibrillation, or MI - overdose can increase bleeding - drug interactions include aspirin and other NSAIDs that increase its anticoagulant functions that leads to increased bleeding

In a healthy young adult, what happens to cardiac output when heart rate increases above 160 bpm? A. It increases. B. It decreases. C. It remains constant. D. There is no way to predict.

answer is B - at excessively high HRs (> 160 bpm), diastole becomes too brief for adequate filling, so both stroke volume and cardiac output are reduced

If you were to drink a liter of cola, the increased blood pressure due to increased blood volume would be detected by _______. A. Chemoreceptors B. Baroreceptors C. Baroreflexes D. Farva-receptors

answer is B - baroreceptors are the stretch receptors that directly measure pressure A is wrong - chemoreceptors - detect the conc. of compounds dissolved in the blood, not directly detecting pressure

β-blockers have which of the following effects in the heart? A. Increased oxygen consumption B. Decreased oxygen consumption C. Increased oxygen supply D. Decreased oxygen supply

answer is B - beta-blockers 1) reduce cardiac sympathetic effects - decrease HR, contractility, and therefore O2 demand 2) coronary blood flow (no significant effect) - use - prophylaxis (oral), decrease severity, frequency of stable angina

If the goal is to have a large effect on Na+reabsorption, which drug is most likely to be prescribed? A. Hydrochlorothiazide B. Furosemide C. Triamterene D. Spironolactone E. Amiloride

answer is B - furosemide is a loop diuretic that inhibits the reabsorption of 35% of NaCl A is wrong - Hydrochlorothiazide inhibits the NCC transporter in the DCT where normally 10% of NaCl is reabsorbed C and E are wrong - Triamterene and Amiloride are wrong because they decrease Na+ reabsorption by blocking Na+ channels in the collecting duct D is wrong - Spironolactone is an antagonist of aldosterone, which also inhibits Na+ reabsorption in collecting duct - Spironolactone, Triamterone, and Amiloride all work in the collecting duct. These diuretics are all K+ sparing diuretics - meaning they inhibit Na+ reabsorption and K+ secretion. These drugs could cause hyperkalemia in some patients which would increase in patients with renal disease

Which layer of the bladder would be in direct contact with urine? A. muscularis B. mucosa C. peritoneum D. adventitia

answer is B - mucosa is at the entrance of each ureter acts as a valve into bladder - keeps urine from backing up into ureter when bladder contracts - begins at minor calyces and extends through the bladder A is wrong - muscularis - a detrusor (a muscle which forms a layer of the wall of the bladder) - 3 layers of smooth muscle D is wrong - adventitia - connective tissue layers that connects ureter to surrounding structures

Does spironolactone increase or decrease blood volume? A. Increase B. Decrease

answer is B - spironolactone - aldosterone antagonist in the collecting duct so it decreases reabsorption of NA+ and water so decrease blood volume

________ pressure must be greater on the capillary side of the filtration membrane to achieve filtration. A. Osmotic B. Hydrostatic

answer is B Net Filtration Pressure = Blood Hydrostatic Pressure - (Osmotic + Capsular Pressure) - if BP increases then hydrostatic pressure and we will have more filtration pressure

Which drug, when administered by itself, can relieve both congestive and low cardiac output symptoms? A. Inotropic agent B. Vasodilator C. Diuretic

answer is B Inotropic agent - helps increase stroke volume by increasing contractility but will not help with end diastolic volume (preload) Vasodilator - causes blood vessels to expand therefore increases blood flow - helps lower end-diastolic volume (preload) but raises SV diuretic - agent that increases urine output and therefore lowers blood volume - reduces end diastolic volume (preload) but also reduces SV

The concentration of what compound in the blood would be expected to increase following administration of a phosphodiesterase inhibitor? A. Epinephrine B. cAMP C. Dopamine D. Digoxin E. Nitric oxide

answer is B PDE is responsible for the breakdown of cAMP into AMP - milrinone is a PDE inhibitor drug that inhibits cAMP into AMP - inhibits PDE = increased cAMP - increased cAMP = increased contractility and increased S.V. - increased cAMP in the blood vessels = decreased afterload (vasodilation) - little/no change in HR A and C are both wrong, they are both beta-agonist

Assuming equal diuretic effects, which drug would be more appropriate for an 80 year old woman with a history of bone fractures? A. Furosemide B. Hydrochlorothiazide

answer is B - Hydrochlorothiazide - inhibits NaCl- reabsorption in the DCT - unlike Furosemide, it actually increases Ca2+ reabsorption and decreases excretion of it and therefore helps with osteoporosis - due to increased in Ca2+ so it will actually be more appropriate for an 80 year old woman with a history of bone fractures - are moderately powerful diuretics - increases K+ excretion and cause hypokalemia - not effective in renal disease (low GFR) unlike Furosemide A is wrong - Furosemide - inhibits NaCl reabsorption in TAL and inhibits the NKCC2 exchanger and blocks the reabsorption by binding to the exchanger - a loop diuretic which is the most powerful diuretic because this is where 35% of NaCl is reabsorbed - used in pulmonary edema and chronic heart failure - increase RBF so useful in patients with renal disease - increase urine flow - increases Ca2_ excretion, useful in acute hypercalcemia

Emotional states are integrated by the __________, which generates an output that creates such respiratory variations as laughing and crying. A. VRG B. PRG C. DRG D. SRG

answer is B - PRG (pontine respiratory group) - adapts breathing to special circumstances such as sleep, exercise, vocalization, and emotional responses A is wrong - VRG (ventral respiratory group) - in front - primary generator of the respiratory rhythm - normal rhythm - produces a respiratory rhythm of 12 breaths per minute C is wrong - DRG (dorsal respiratory group) - in back - modifies the rate and depth of breathing

Voluntary control of urination comes from which structure? A. cerebral cortex B. pons C. medulla oblongata D. hypothalamus E. midbrain

answer is B - pons - voiding urine - voluntary control, is located in the brainstem - also receives signals from stretch receptors just like the micturition (the act of urinating) reflex but this is the involuntary spinal reflex that partly controls urination, comes from spinal cord - if it is timely to urinate, the pons excite (contract), detrusor and relaxes internal urethral sphincter - urine is voided - do not want to urinate, pons keep external urethral sphincter contracted - shut and urine is retained in the bladder

Renin is released in response to ________. A. increased blood pressure B. decreased blood pressure C. ACE D. diuretics

answer is B in response to a drop in BP, baroreceptor in carotid and aorta stimulate the SNS - sympathetic fibers trigger release of renin by kidneys granular cells - renin (an enzyme) converts angiotensinogen (a blood protein) into angiotensin I - in lungs and kidneys, ACE converts angiotensin I into angiotensin II A is wrong - increase BP would release ANP to decrease it

Altered levels of the following ions can lead to toxicity in patients receiving digitalis. Which one must be low prior to beginning digitalis treatment? A. K+ B. Ca2+ C. Mg2+

answer is B - because hypercalcemia - calcium and digoxin have additive inotropic effects

Amlodipine has which of the following effects in the heart? Select all that apply. A. Increased oxygen consumption B. Decreased oxygen consumption C. Increased oxygen supply D. Decreased oxygen supply

answer is B and C - amlodipine is a Ca2+ channel blocker - newer agent, it is a dihydropyridine agent - dihydropyridine CCBs tend to be more potent vasodilators than non-DHP agents like verapamil and diltiazem - decreased afterload, decreased O2 demand, decreased coronary resistance => increased O2 supply - decreased HR, decreased contractility = decreased O2 demand

Nitrates have which of the following effects in the heart when given at low to moderate doses? Select all that apply. A. Increased oxygen consumption B. Decreased oxygen consumption C. Increased oxygen supply D. Decreased oxygen supply

answer is B and C - nitrates - mainly decrease O2 demand by decreasing venous return - includes: nitroglycerin, isosorbide mono, and dinitrate

Closer to the heart, arteries would be expected to have a higher percentage of ________. A. endothelium B. smooth muscle fibers C. elastic fibers D. collagenous fibers

answer is C

Heparin inhibits which clotting pathway? A. Intrinsic B. Extrinsic C. Both intrinsic and extrinsic

answer is C

Where is the primary site of action of diuretics? A. Cardiac muscle B. Smooth muscle C. Kidneys D. Adrenal Gland E. Central nervous system

answer is C

Which chamber initially receives blood from the systemic circuit? A. left atrium B. left ventricle C. right atrium D. right ventricle

answer is C

Which of the following is the best definition of angina? A. Clogged aorta B. Stoppage of heart beat C. Pain or pressure in the central chest D. Necrosis of cardiac tissue

answer is C

Lisinopril directly blocks which process? A. Release of renin B. Production of Ang I C. Production of Ang II D. Activation of Ang receptor

answer is C Lisinopril is an ACE Inhibitor ("pril") - Ang I -> Ang II is converted by ACE but is blocked by ACE-inhibitors D is wrong - ARBs ("sartan" like losartan, valsartan, candasartan") will prevent Ang II from stimulating the angiotensin receptors

Albuterol increases bronchial diameter by increasing the production of ________. A. Adenylate cyclase B. PDE C. cAMP D. Adenosine E. Histamine

answer is C - Albuterol - a beta2-adrenergic agonist (short) - Salmaterol - beta2-adrenergic agonist (long) - both are beta-agonist that increase cAMP which leads to bronchodilation B is wrong - Theophyline - inhibits cAMP breakdown by inhibiting PDE, which will lead to bronchodilation D is wrong - Adenosine - causes bronchoconstriction (opposite of bronchodilation) - Theophyline - antagonizes Adenosine to lead to bronchodilation E is wrong - Histamine, leukotrienes, and adenosine all cause broncho-constriction

Which drug is known to cause kidney damage to a developing fetus with standard dosing? A. Digoxin B. Epinephrine C. Captopril D. Lidocaine E. Metoprolol

answer is C - Captopril - is an ACE inhibitor and adverse effects of ACE inhibitors and ARBs include hypotension, fetopathic potential (renal toxicity), cough with ACE inhibitors (increased bradykinin and stimulates increased prostaglandins), and angioedema with ACE inhibitors - Captopril is the only ACE inhibitor in this class

Which adverse effect of Clonodine is most likely to result in increased blood pressure? A. Sedation B. Dry mouth C. Fluid retention D. Impotence

answer is C - Clonodine is a CNS acting drug and is a alpha2 AR agonist, decreases sympathetic drive, decreases HR, decreases CO, decreases BP, and slightly decreases PR - adverse effects - sedation, dry mouth, fluid retention, impotence

The electrical impulse responsible for cardiac contraction begins in what location? A. Atria B. AV node C. SA node D. Purkinje fibers E. Ventricles

answer is C - cardiac contraction starts in the SA node

Pathologic examination of cardiac muscle from a patient with cardiac hypertrophy shows narrowed cardiomyocytes. What type of hypertrophy does this patient have? A. Physiologic hypertrophy B. Concentric hypertrophy C. Eccentric hypertrophy

answer is C - eccentric hypertrophy - cardiomyocytes decrease width (narrow) A is wrong - physiologic hypertrophy - cardiomyocytes increase length and width - eg, exercise, pregnancy B is wrong - concentric hypertrophy - cardiomyocytes increase width

Which type of arrhythmia features the least control of heart contractions? A. Bradycardia B. Tachycardia C. Fibrillation

answer is C - fibrillation is the most serious form of arrhythmia, is fast, uncoordinated (least control) beats, which are contractions of individual heart-muscle fibers A and C are wrong - Tachycardia and Bradycardia are controlled by are either too fast or too slow, respectively

The functional unit of the kidney is called ________. A. the renal hilus B. the renal corpuscle C. the nephron D. Bowman's capsule

answer is C - the nephron is the function part of the kidney - carries out the filtration function of the kidney - 2 main parts: 1) renal corpuscle - filters the blood plasma - has 2 parts: parietal (outer) layer of glomerular capsule and visceral (inner) layer of glomerular capsule 2) renal tubule - converts the filtrate into urine

Which type of angina is least likely to be affected by diet? A. Atypical B. Typical C. Variant

answer is C - variant (prinzmetal) angina pectoris - caused by coronary vasospasm rather than atherosclerotic discomfort at rest - treated with Ca2+ channel blockers and nitrates A is wrong - atypical (unstable) angina - caused by atherosclerotic plaque rupture, thrombosis - treated with anticoagulants, anti-platelet drugs B is wrong - typical (stable) angina - most often occurs with stress rather than rest - fixed atherosclerotic narrowing (of the coronary vessels) - relieved by nitroglycerin and B-blockers

In which septum is it normal to find openings in the adult? A. interatrial septum B. interventricular septum C. atrioventricular septum

answer is C - lies between the atria and ventricles A is wrong - IAS is between the right atrium and left atrium B is wrong - IVS separates the right right ventricle from left ventricle

Which drug is not given orally? A. Lipitor B. Zetia C. Vytorin D. Praluent E. Lovaza

answer is D

Which portion of the ECG corresponds to repolarization of the atria? A. P wave B. QRS complex C. T wave D. atrial repolarization is masked by ventricular depolarization

answer is D A is wrong - P-wave - atrial depolarization B is wrong - QRS complex - ventricular depolarization C is wrong - T-wave - ventricular repolarization

The pH of the cerebrospinal fluid is monitored by which of these brainstem centers? A. PRG B. Hypothalamic osmoreceptors C. Medullary baroreceptors D. Central chemoreceptors

answer is D - Central chemoreceptors - how fast we should be breathing - regulating respiration to maintain stable pH (eg, if pH decreases, breathe faster to get rid of CO2 (acid) to increase pH

A Ca2+ channel blocker would be expected to alleviate which mechanism of arrhythmia? A. Enhanced normal automaticity B. Abnormal automaticity C. Early afterdepolarizations D. Delayed afterdepolarizations

answer is D - Delayed afterdepolarizations - are prevented by reducing intracellular calcium by using a calcium channel blocker or beta-blocker

Which type of antiarrhythmic would extend the length of an action potential? A. β-receptor antagonist B. Ca2+ channel blocker C. ACh D. K+ channel blocker

answer is D - K+ channels cause repolarization so blocking it would increase the AP duration

Treatment with an NSAID generally precedes treatment with which category of drug? A. Statins B. Inhibitors of sterol absorption C. Fibric acid derivatives D. Niacin E. Bile acid binding agents

answer is D - Niacin - vitamin B3 - decreases VLDL (triglycerides) - the adverse effects can be decreased by pretreatment with aspirin (NSAIDs) A is wrong - Statins are HMG-reductase inhibitors - very effective at lowering cholesterol (most effective in decreasing LDL cholesterol in plasma) C is wrong - Fibric acid derivatives include Genfibrozil and Fenofibrate - they decrease VLDL (triglyceride) levels by stimulation of LPL - so used primarily in hpertriglyceridemia E is wrong - Bile acid binding agents include Colestipal, Cholestyramine, Colesevelon - used for patients who cannot tolerate statin or other lipid lowering drugs or in combination with other drugs

Which antiarrhythmic drug works by increasing parasympathetic activity? A. Quinidine B. Lidocaine C. Propranolol D. Amiodarone E. Digoxin

answer is E - digoxin - decreases AV conduction by increasing parasympathetic activity - it increases contractility and stroke volume but decreases HR - use - slow or prevent acceleration of ventricular rate during atrial tachycardias particularly in patients with systolic heart failure

Venoconstriction increases which of the following? A. blood pressure within the vein B. blood flow within the vein C. return of blood to the heart D. all of the above

answer is D - Venoconstriction - constriction of veins - veins cannot constrict as much as arteries but some of them are capable of a little bit - if you constrict a blood vessel, you will increase blood pressure (answer A) and if you increase BP, then you will increase blood flow (answer B) so if you increase blood flow in the veins, then you increase return of blood to the heart (answer C)

What hormone directly opposes the actions of natriuretic hormones? A. renin B. nitric oxide C. dopamine D. aldosterone

answer is D - aldosterone - "salt-retaining hormone" - causes DCT to reabsorb Na+, in return reabsorb water - triggers for aldosterone secretion -> when blood Na+ conc falls -> when K+ conc rises -> there is a drop in BP, we reabsorb Na+, water follows, leads to increase in blood volume = increased BP - stimulates reabsorption of Na+ and secretion of K+. Leads to water and Cl- follows the Na+, leads to increased blood volume and therefore increased BP and urine volume is decreased natriuertic hormones (ANP) - secreted by atrial myocardium of the heart in response to high BP - leads to decreased blood volume and pressure by: 1) dilates afferent arteriole and constricts efferent arteriole - leads to increased GFR by increasing filtration rate 2) inhibits renin and aldosterone secretion 3) inhibits secretion of ADH 4) inhibits NaCl reabsorption by collecting duct

People who live in cold climates (or people in Florida when it gets below about 40 degrees) often say that it's so cold outside that it takes their breath away. What system is invoking this response? A. central chemoreceptors B. peripheral chemoreceptors C. stretch receptors D. irritant receptors E. Caribbean jealousy receptors

answer is D - irritant receptors - respond to smoke, dust, pollen, chemical fumes, cold air, and excess mucus - trigger protective reflexes like broncho-constriction, shallower breathing, breathe holding, or coughing - detects something in the airway that we do not want so airway constricts A is wrong - central chemoreceptors respond to changes in pH (if pH decreases, breathe faster to get rid of CO2 (acid) to increase pH) B is wrong - peripheral chemoreceptors - located in the carotid and aortic bodies of the large arteries above the heart - respond to the O2 and CO2 content and the pH of the blood C is wrong - stretch receptors - found in the smooth muscle of bronchi and bronchioles - respond to inflation of the lungs - inflation (Hering Breur) reflex - triggered by excessive inflation (eg, when you inhale fully, you want to breath out = relax; same with deflation reflex - breathe out fully, you want to breathe in)

The renal pyramids are separated from each other by extensions of the renal cortex called ________. A. renal medulla B. minor calyces C. medullary cortices D. renal columns

answer is D - renal columns separate the renal pyramids - outer part is the renal cortex A is wrong - renal medulla is the innermost part of the kidney. - is split up into a number of sections, known as the renal pyramids - has 2 parts: renal columns and renal pyramids B is wrong - minor calyces - tube that connects directly to the base of the pyramid and collects its urine

Which of these is a vasoconstrictor? A. nitric oxide B. natriuretic hormone C. bradykinin D. angiotensin II

answer is D - the active hormone that increases BP - potent vasoconstrictor increases BP throughout our body - leads to reabsorption of NaCl and therefore H2O (follows the NaCl) - stimulates adrenal cortex to secrete aldosterone, which promotes Na+ and H2O reabsorption in DCT and collecting duct - stimulates Na+ and H2O reabsorption in PCT - stimulates posterior pituitary to secrete ADH which promotes water reabsorption by collecting duct - stimulates thirst - causes us to drink water, which increases blood volume, which increases BP

Furosemide inhibits which enzyme? A. Carbonic anhydrase B. NHE3 C. Na+ transport proteins D. Na+/K+/Cl- cotransporter E. ACE

answer is D - Furosemide is a Na+/K+/Cl- cotransporter inhibitor in the loop diuretic and thick ascending limb (TALH) A is wrong - Acetazolamide is a carbonic anhydrase inhibitor in the PCT

Many diuretics may cause hypokalemia as a side effect. Which of these drugs would be used to avoid this? A. Acetazolamide B. Furosomide C. Hydrochlorothiazide D. Amiloride E. Mannitol

answer is D - Spironolactone, Triamterone, and Amiloride all work in the collecting duct. - these diuretics are all K+ sparing diuretics - meaning they inhibit Na+ reabsorption and K+ secretion

Which class of lipoproteins has the largest proportion of cholesterol? A. Chylomicrons B. VLDL C. IDL D. LDL E. HDL

answer is D - because LDL is bad cholesterol and is the main carrier of cholesterol in the bloodstream A is wrong - chylomicrons contain mostly triglycerides (>92%) from dietary lipids B is wrong - VLDL - main carrier of triglycerides (>64%) C is wrong - IDL - has both cholesterol and triglycerides E is wrong - HDL is good cholesterol and has very little cholesterol and are rich in apoproteins (>45%)

What is the primary difference between inhalation and oral therapy for asthma? A. Inhalation therapy generally has more side effects B. Inhalation therapy is generally used for longer lasting treatment C. Oral therapy provides quicker relief D. Oral therapy better targets medication to the source of the problem E. Inhalation therapy is used to treat acute asthma attacks

answer is E A and B are wrong - both describe oral therapy C and D are wrong - both describe inhalation therapy Inhalation therapy - delivers drug directly to the site of action - rapid and efficient - drug not absorbed well - used for rescue and maintenance medications because it is rapid and avoids toxicity Oral therapy - longer onset and duration of action - frequent side effects because absorbed systemically - used for maintenance medications only because longer onset

Which of the following is a biologic drug that can be used to treat digoxin overdose? A. Epinephrine B. Atropine C. Lidocaine D. Potassium E. Digibind

answer is E B is wrong - atropine blocks vagal effects - blocks the slowing of the HR C is wrong - lidocaine - ventricular arrhythmias - a class IB anti-arrhytmias drug - blocks Na+ channels - decreases APD

Which class of drugs has 0% bioavailability? A. Statins B. Inhibitors of sterol absorption C. Fibric acid derivatives D. Niacin E. Bile acid binding agents

answer is E - Bile acid binding agents include Colestipal, Cholestyramine, Colesevelon - used for patients who cannot tolerate statin or other lipid lowering drugs or in combination with other drugs - the liver increases LDL receptors to increase uptake of LDL (cholesterol) form the plasma - may increase triglycerides and cause a small increase in HDL - not absorbed, no systemic adverse effects - interferes with absorption of fat soluble vitamins and drugs like digoxin, Warfarin so since less absorption, means less effective

Kidney stones form in what structure? A. collecting duct B. loop of Henle C. bladder D. urethra E. renal pelvis

answer is E - small stones usually pass unnoticed in the urine flow - large stones might block renal pelvis or ureter and can cause pressure buildup in kidney which destroys nephrons because it does not let urine pass through - causes include hypercalcemia (increased Ca2+), dehydration (high conc. of Ca2_), pH imbalances, frequent UTIs, and enlarged prostate gland causing urine retention - treatments include - stone-dissolving drugs, surgery

Fast inactivation of a Na+ channel is accomplished through which mechanism? A. Binding of K+ B. Large-scale conformation change C. Channel internalization D. Protein binding E. Movement of the inactivation gate

answer is E Sodium channels - Na+ channels activate to open at -70 mV - carry large inward current to depolarize the cell - inactivate quickly - while inactivated, a Na+ channel cannot activate at or above its threshold potential - Na+ channels undergo fast inactivation by the IG (inactivation gate) - Na+ channels undergo slow inactivation that involves a conformation change resulting in occlusion of the Na+ channel pore

Commercials for cholesterol medications often mention "good cholesterol" and "bad cholesterol." What are they referring to as "good cholesterol?" A. Chylomicrons B. VLDL C. IDL D. LDL E. HDL

answer is E which is good cholesterol - has very little cholesterol and very rich in apoproteins D is wrong - LDL is bad cholesterol - main carrier of cholesterol in bloodstream

Acetazolamide inhibits which enzyme? A. Carbonic anhydrase B. NHE3 C. Na+ transport proteins D. Na+/K+/Cl- cotransporter E. ACE

correct answer is A - Acetazolamide is a carbonic anhydrase inhibitor in the PCT B is wrong C is wrong - Amiloride/Triameterene - block epithelial Na+ channels and are also K+ sparing diuretic D is wrong - Furosemide is a Na+/K+/Cl- cotransporter inhibitor in loop diuretic and thick ascending limb (TAL) E is wrong

Explain how nitroglycerin and Viagra cooperate to increase vasodilation.

nitroglycerin increases cGMP by activating freely diffusing into the smooth muscle cell and acting with ALDH-2 to produce NO, which produces guanylyl cyclase to increase the production of cGMP, which relaxes smooth muscle tissue. Viagra is a PDE5 inhibitor so it prevents the conversion of cGMP to GMP, therefore it also causes relaxation of smooth muscle. Therefore if you combine both of these, there would be large increase in vasodilation

Describe one cardiac cycle, beginning with both atria and ventricles relaxed.

one cycle goes from: lungs -> pulmonary veins -> left atrium -> mitral valve -> left ventricle -> aortic valve -> aorta -> systemic circulation -> vena cava -> right atrium -> tricupsid valve -> right ventricle -> pulmonary valve -> pulmonary arteries -> lungs Cardiac Cycle - relaxed period is during diastole. This causes blood to flow from the atrium (left and right) into the ventricles through the AV valves (mitral - left side and tricupsid - right side). Then during systole, the contracting period will cause blood to be ejected from the ventricles into teh aorta and pulmonary artery. The AV valves are closed during systole but the aortic valve and pulmonic valves are open.

For acute angina, nitroglycerin is usually given sublingually. Why?

sublingual administration works rapidly by diffusing directly into the bloodstream. It does not have to pass through the GI tract. Also when given this way, it can be used to prevent angina. This usually works in 1 to 5 minutes, so very rapidly.