Katzung Pharmacology - Chapter 9-16 Qs
A 23-year-old woman suffers from recurrent episodes of angioneurotic edema with release of histamine and other mediators. Which of the following drugs is the most effective physiologic antagonist of histamine in smooth muscle? (A) Cetirizine (B) Epinephrine (C) Granisetron (D) Ranitidine (E) Sumatriptan
*(B) Epinephrine*
Which of the following drugs slows conduction through the AV node and has its primary action directly on L-type cal- cium channels? (A) Adenosine (B) Amiodarone (C) Diltiazem (D) Esmolol (E) Flecainide (F) Lidocaine (G) Mexiletine (H) Procainamide (I) Quinidine
*(C)Diltiazem*
A 40-year-old patient is about to undergo cancer chemother- apy with a highly emetogenic (nausea- and vomiting-causing) drug combination. The antiemetic drug most likely to be included in her regimen is (A) Bromocriptine (B) Cetirizine (C) Cimetidine (D) Ketanserin (E) Ondansetron
*(E) Ondansetron*
Which of the following is an important effect of chronic therapy with loop diuretics? (A) Decreased urinary excretion of calcium (B) Elevation of blood pressure (C) Elevation of pulmonary vascular pressure (D) Metabolic alkalosis (E) Teratogenic action in pregnancy
*(D) Metabolic alkalosis*
9. Which of the following most resembles drug Y? (A) Atropine (B) Bethanechol (C) Epinephrine (D) Isoproterenol (E) Phenylephrine
*(E) Phenylephrine*
Which one of the following drugs is associated with clinically useful or physiologically important positive inotropic effect? (A) Captopril (B) Dobutamine (C) Enalapril (D) Losartan (E) Nesiritide
*(B) Dobutamine*
A 60-year-old patient complains of paraesthesia and occasional nausea associated with one of her drugs. She is found to have hyperchloremic metabolic acidosis. She is probably taking (A) Acetazolamide for glaucoma (B) Amiloride for edema associated with aldosteronism (C) Furosemide for severe hypertension and heart failure (D) Hydrochlorothiazide for hypertension (E) Mannitol for cerebral edema
*(A) Acetazolamide for glaucoma*
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 prevent- ing high-altitude sickness is (A) Acetazolamide (B) Amiloride (C) Demeclocycline (D) Desmopressin (E) Ethacrynic acid
*(A) Acetazolamide*
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) Acetazolamide (B) Digoxin (C) Dobutamine (D) Eplerenone (E) Hydrochlorothiazide
*(A) Acetazolamide*
The results of the test of drug Z are shown in the graph. Drug Z is probably a drug similar to (A) Acetylcholine (B) Edrophonium (C) Isoproterenol (D) Norepinephrine (E) Pralidoxime
*(A) Acetylcholine*
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
*(A) Amyl nitrite*
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) Block of exercise-induced tachycardia*
When given to a patient, phentolamine blocks which one of the following? (A) Bradycardia induced by phenylephrine (B) Bronchodilation induced by epinephrine (C) Increased cardiac contractile force induced by norepinephrine (D) Miosis induced by acetylcholine (E) Vasodilation induced by isoproterenol
*(A) Bradycardia induced by phenylephrine*
A 26-year-old woman presents with amenorrhea and galac- torrhea. Her prolactin level is grossly elevated (200 ng/mL vs normal 20 ng/mL). Which of the following is most useful in the treatment of hyperprolactinemia? (A) Bromocriptine (B) Cimetidine (C) Ergotamine (D) Ketanserin (E) LSD (F) Ondansetron (G) Sumatriptan
*(A) Bromocriptine*
Which of the following has been shown to prolong life in patients with chronic congestive failure in spite of having a negative inotropic effect on cardiac contractility? (A) Carvedilol (B) Digoxin (C) Dobutamine (D) Enalapril (E) Furosemide
*(A) Carvedilol*
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 (A) Chlorthalidone (B) Diazoxide (C) Ethacrynic acid (D) Mannitol (E) Spironolactone
*(A) Chlorthalidone*
Which one of the following is a significant unwanted effect of the drug named? (A) Constipation with verapamil (B) Heart failure with hydralazine (C) Hemolytic anemia with atenolol (D) Hypokalemia with aliskiren (E) Lupus-like syndrome with hydrochlorothiazide
*(A) Constipation with verapamil*
1. A 5-year-old child was vomiting and was brought to the emergency department with sinus arrest and a ventricular rate of 35 bpm. An empty bottle of his uncle's digoxin was found where he was playing. Which of the following is the drug of choice in treating a severe overdose of digoxin? (A) Digoxin antibodies (B) Lidocaine infusion (C) Magnesium infusion (D) Phenytoin by mouth (E) Potassium by mouth
*(A) Digoxin antibodies*
1. A patient who has been taking digoxin for several years for atrial fibrillation and chronic heart failure is about to receive atropine for another condition. A common effect of digoxin (at therapeutic blood levels) that can be almost entirely blocked by atropine is (A) Decreased appetite (B) Headaches (C) Increased atrial contractility (D) Increased PR interval on ECG (E) Tachycardia
*(A) Increased PR interval on ECG*
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) Adenosine (B) Amiodarone (C) Flecainide (D) Propranolol (E) Verapamil
*(A)Adenosine*
1. Clinical studies have shown that adrenoceptor blockers have many useful effects in patients. However, a number of drug toxicities have been documented. Adverse effects that limit the use of adrenoceptor blockers include which one of the following? (A) Bronchoconstriction from α-blocking agents (B) Acute heart failure exacerbation from β blockers (C) Impaired blood sugar response with α blockers (D) Increased intraocular pressure with β blockers (E) Sleep disturbances from α-blocking drugs
*(B) Acute heart failure exacerbation from β blockers*
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? (A) ACE inhibitors (B) Alpha -selective receptor blockers 1 (C) Arteriolar dilators (D) Beta1-selective receptor blockers (E) Nonselective β blockers
*(B) Alpha -selective receptor blockers 1*
Questions 1 and 2. A 7-year-old boy with a previous history of bee sting allergy is brought to the emergency department after being stung by 3 bees. Which of the following are probable signs of the anaphylactic reaction to bee stings? (A) Bronchodilation, tachycardia, hypertension, vomiting, diarrhea (B) Bronchospasm, tachycardia, hypotension, laryngeal edema (C) Diarrhea, bradycardia, vomiting (D) Laryngeal edema, bradycardia, hypotension, diarrhea (E) Miosis, tachycardia, vomiting, diarrhea
*(B) Bronchospasm, tachycardia, hypotension, laryngeal edema*
The hospital Pharmacy Committee is preparing a formulary for staff use. Which of the following is a correct application of the drug mentioned? (A) Alosetron: for obstetric bleeding (B) Cetirizine: for hay fever (C) Ergonovine: for Alzheimer's disease (D) Ondansetron: for acute migraine headache (E) Ranitidine: for Parkinson's disease
*(B) Cetirizine: for hay fever*
A group of volunteers are involved in a phase 1 clinical trial of a new autonomic drug. When administered by intravenous bolus, the blood pressure increases. When given orally for 1 week, the blood pressure decreases. Which of the following standard agents does the new drug most resemble? (A) Atropine (B) Clonidine (C) Phentolamine (an α blocker) (D) Phenylephrine (E) Propranolol (a β blocker)
*(B) Clonidine*
10. A new drug was given by subcutaneous injection to 25 nor- mal subjects in a phase 1 clinical trial. The cardiovascular effects are summarized in the table below. Which of the following drugs does the new experimental agent most resemble? (A) Atropine (B) Epinephrine (C) Isoproterenol (D) Phenylephrine (E) Physostigmine
*(B) Epinephrine*
A 62-year-old man with advanced prostate cancer is admit- ted 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) Acetazolamide plus saline infusion (B) Furosemide plus saline infusion (C) Hydrochlorothiazide plus saline infusion (D) Mannitol plus saline infusion (E) Spironolactone plus saline infusion
*(B) Furosemide plus saline infusion*
A 65-year-old woman has been admitted to the coronary care unit with a left ventricular myocardial infarction. She develops acute severe heart failure with marked pulmonary edema, but no evidence of peripheral edema. Which one of the following drugs would be most useful? (A) Digoxin (B) Furosemide (C) Minoxidil (D) Propranolol (E) Spironolactone
*(B) Furosemide*
1. In deciding on a treatment regimen with procainamide for this patient, which of the following statements is most correct? (A) A possible drug interaction with digoxin suggests that digoxin blood levels should be obtained before and after starting procainamide (B) Hyperkalemia should be avoided to reduce the likeli-hood of procainamide toxicity (C) Procainamide cannot be used if the patient has asthma because it has a β-blocking effect (D) Procainamide cannot be used if the patient has angina because it has a β-agonist effect (E) Procainamide is not active by the oral route
*(B) Hyperkalemia should be avoided to reduce the likeli-hood of procainamide toxicity *
1. After your patient has been receiving digoxin for 3 wk, he presents to the emergency department with an arrhythmia. Which one of the following is most likely to contribute to the arrhythmogenic effect of digoxin? (A) Increased parasympathetic discharge (B) Increased intracellular calcium (C) Decreased sympathetic discharge (D) Decreased intracellular ATP (E) Increased extracellular potassium
*(B) Increased intracellular calcium*
Which row in the following table correctly shows the major effects of full therapeutic doses of digoxin on the AV node and the ECG?
*(B) Increased, Decreased Inverted*
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 fol- lowing drugs is absolutely contraindicated in pregnancy? (A) Atenolol (B) Losartan (C) Methyldopa (D) Nifedipine (E) Propranolol
*(B) Losartan*
When working in outlying areas, this 62-year-old rancher is away from his house for 12-14 h at a time. He has an arrhythmia that requires chronic therapy. Which of the fol- lowing has the longest half-life of all antiarrhythmic drugs? (A) Adenosine (B) Amiodarone (C) Disopyramide (D) Esmolol (E) Flecainide (F) Lidocaine (G) Mexiletine (H) Procainamide (I) Quinidine (J) Verapamil
*(B)Amiodarone*
A laboratory study of new H2 blockers is planned. Which of the following will result from blockade of H2 receptors? (A) Increased cAMP (cyclic adenosine monophosphate) in cardiac muscle (B) Decreased channel opening in enteric nerves (C) Decreased cAMP in gastric mucosa (D) Increased IP3 (inositol trisphosphate) in platelets (E) Increased IP3 in smooth muscle
*(C) Decreased cAMP in gastric mucosa*
2. If this child has signs of anaphylaxis, what is the treatment of choice? (A) Diphenhydramine (an antihistamine) (B) Ephedrine (C) Epinephrine (D) Isoproterenol (E) Methylprednisolone (a corticosteroid)
*(C) Epinephrine*
A 45-year-old man is brought to the emergency department with mental obtundation. He is found to have a blood pres- sure of 220/160 and retinal hemorrhages. Which one of the following is used in severe hypertensive emergencies, is short- acting, acts on a G protein-coupled receptor, and must be given by intravenous infusion? (A) Aliskiren (B) Captopril (C) Fenoldopam (D) Hydralazine (E) Losartan (F) Metoprolol (G) Nitroprusside (H) Prazosin (I) Propranolol
*(C) Fenoldopam*
A 70-year-old woman is admitted to the emergency depart- ment because of a "fainting spell" at home. She appears to have suffered no trauma from her fall, but her blood pres- sure 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) Acetazolamide (B) Amiloride (C) Furosemide (D) Hydrochlorothiazide (E) Spironolactone
*(C) Furosemide*
1A patient with hypertension and angina is referred for treat- ment. Metoprolol and verapamil are among the drugs con- sidered. Both metoprolol and verapamil are associated with which one of the following? (A) Diarrhea (B) Hypoglycemia (C) Increased PR interval (D) Tachycardia (E) Thyrotoxicosis
*(C) Increased PR interval*
Drug Y had the effects shown in the table below. Drug Y is probably a drug similar to (A) Acetylcholine (B) Edrophonium (C) Isoproterenol (D) Norepinephrine (E) Prazosin
*(C) Isoproterenol*
A new drug was administered to an anesthetized animal with the results shown here. A large dose of epinephrine (epi) was administered before and after the new agent for comparison. Which of the following agents does the new drug most closely resemble? (A) Atenolol (B) Atropine (C) Labetalol (D) Phenoxybenzamine (E) Propranolol
*(C) Labetalol*
1. A patient is to receive epinephrine. She has previously received an adrenoceptor-blocking agent. Which of the following effects of epinephrine would be blocked by phentol- amine but not by metoprolol? (A) Cardiac stimulation (B) Increase of cAMP (cyclic adenosine monophosphate) in fat (C) Mydriasis (D) Relaxation of bronchial smooth muscle (E) Relaxation of the uterus
*(C) Mydriasis*
3. A 65-year-old woman with impaired renal function and a necrotic ulcer in the sole of her right foot is admitted to the ward from the emergency department. She has long-standing type 2 diabetes mellitus and you wish to examine her retinas for possible vascular changes. Which of the following drugs is a good choice when pupillary dilation—but not cyclople- gia—is desired? (A) Isoproterenol (B) Norepinephrine (C) Phenylephrine (D) Pilocarpine (E) Tropicamide
*(C) Phenylephrine*
A 36-year-old woman with a history of poorly controlled thy- rotoxicosis 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 follow- ing drugs would be most suitable? (A) Amiodarone (B) Disopyramide (C) Esmolol (D) Quinidine (E) Verapamil
*(C)Esmolol*
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 sug- gestive 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) Adenosine (B) Digoxin (C) Lidocaine (D) Quinidine (E) Verapamil
*(C)Lidocaine*
A 55-year old man is admitted to the emergency department and is found to have an abnormal ECG. Overdose of an anti- arrhythmic drug is considered. Which of the following drugs is correctly paired with its ECG effects? (A) Quinidine: Increased PR and decreased QT intervals (B) Flecainide: Increased PR, QRS, and QT intervals (C) Verapamil: Increased PR interval (D) Lidocaine: Decreased QRS and PR interval (E) Metoprolol: Increased QRS duration
*(C)Verapamil: Increased PR interval*
Questions 1-2. A 73-year-old man with an inadequate response to other drugs is to receive digoxin for chronic heart failure. He is in normal sinus rhythm with a heart rate of 88 and blood pressure of 135/85 mm Hg. Which of the following is the best-documented mechanism of beneficial action of cardiac glycosides? (A) A decrease in calcium uptake by the sarcoplasmic reticulum (B) An increase in ATP synthesis (C) A modification of the actin molecule (D) An increase in systolic cytoplasmic calcium levels (E) A block of cardiac β adrenoceptors
*(D) An increase in systolic cytoplasmic calcium levels*
Comparison of prazosin with atenolol shows that (A) Both decrease heart rate (B) Both increase cardiac output (C) Both increase renin secretion (D) Both increase sympathetic outflow from the CNS (E) Both produce orthostatic hypotension
*(D) Both increase sympathetic outflow from the CNS*
When nitrates are used in combination with other drugs for the treatment of angina, which one of the following combi- nations 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
*(D) Calcium channel blockers and β blockers on cardiac force*
1. Which one of the following is characteristic of nifedipine treatment in patients with essential hypertension? (A) Competitively blocks angiotensin II at its receptor (B) Decreases calcium efflux from skeletal muscle (C) Decreases renin concentration in the blood (D) Decreases calcium influx into smooth muscle (E) Decreases calcium flux into the urine
*(D) Decreases calcium influx into smooth muscle*
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
*(D) Headache due to meningeal vasodilation*
1. A significant number of patients started on ACE inhibitor therapy for hypertension are intolerant and must be switched to a different class of drug. What is the most common mani- festation of this intolerance? (A) Angioedema (B) Glaucoma (C) Headache (D) Incessant cough (E) Ventricular arrhythmias
*(D) Incessant cough*
Questions 1-4. A 60-year-old man presents to his primary care physician with a complaint of severe chest pain when he walks uphill to his home in cold weather. The pain disappears when he rests. After evaluation and discussion of treatment options, a deci- sion is made to treat him with nitroglycerin. 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
*(D) Increased cardiac force*
Questions 8 and 9. Several new drugs with autonomic actions were studied in preclinical trials in animals. Autonomic drugs X and Y were given in moderate doses as intravenous boluses. The systolic and diastolic blood pressures changed as shown in the diagram below. 8. Which of the following drugs most resembles drug X? (A) Atropine (B) Bethanechol (C) Epinephrine (D) Isoproterenol (E) Phenylephrine
*(D) Isoproterenol*
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 dose- dependent manner? (A) Captopril (B) Hydrochlorothiazide (C) Losartan (D) Minoxidil (E) Verapamil
*(D) Minoxidil*
Questions 3-6. Four new synthetic drugs (designated W, X, Y, and Z) are to be studied for their cardiovascular effects. They are given to 4 anesthetized animals while the heart rate is recorded. The first animal has received no pretreatment (control); the sec- ond has received an effective dose of hexamethonium; the third has received an effective dose of atropine; and the fourth has received an effective dose of phenoxybenzamine. The net changes induced by W, X, Y, and Z in the animals are described in the following questions. Drug W increased heart rate in the control animal, the atropine-pretreated animal, and the phenoxybenzamine- pretreated animal. However, drug W had no effect on heart rate in the hexamethonium-pretreated animal. Drug W is probably a drug similar to (A) Acetylcholine (B) Edrophonium (C) Isoproterenol (D) Nicotine (E) Norepinephrine
*(D) Nicotine*
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
*(D) Nitroglycerin*
A 60-year-old immigrant from Latin America was told she had hypertension and should be taking antihypertensive medication. She decides to take an herbal medication from an online "holistic pharmacy." One week after starting the medication, she is found unconscious in her apartment. In the emergency department, her blood pressure is 50 over 0 mm Hg and heart rate is 40 bpm. Respirations are 20/min; pupils are slightly constricted. Bowel sounds are present. Which of the following would be the most effective cardiovascular stimulant? (A) Amphetamine (B) Clonidine (C) Isoproterenol (D) Norepinephrine (E) Tyramine
*(D) Norepinephrine*
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 pos- sible 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
*(D) Orthostatic hypotension*
You are asked to consult on a series of cases of drug toxici- ties. Which of the following is a recognized adverse effect of cimetidine? (A) Blurred vision (B) Diarrhea (C) Orthostatic hypotension (D) P450 hepatic enzyme inhibition (E) Sedation
*(D) P450 hepatic enzyme inhibition*
A 56-year-old man has hypertension and an enlarged pros- tate, which biopsy shows to be benign prostatic hyperplasia. He complains of urinary retention. Which of the following drugs would be the most appropriate initial therapy? (A) Albuterol (B) Atenolol (C) Metoprolol (D) Prazosin (E) Timolol
*(D) Prazosin*
A 20-year-old woman is taking diphenhydramine for severe hay fever. Which of the following adverse effects is she most likely to report? (A) Muscarinic increase in bladder tone (B) Nausea (C) Nervousness, anxiety (D) Sedation (E) Vertigo
*(D) Sedation*
Your 30-year-old patient has moderately severe new onset asthma, and you prescribe a highly selective β2 agonist inhaler to be used when needed. In considering the possible drug effects in this patient, you would note that β2 stimulants frequently cause (A) Direct stimulation of renin release (B) Hypoglycemia (C) Itching due to increased cGMP (cyclic guanine mono-phosphate) in mast cells (D) Skeletal muscle tremor (E) Vasodilation in the skin
*(D) Skeletal muscle tremor*
A 57-year-old man is admitted to the emergency depart- ment 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 antiar- rhythmic drug, lidocaine typically (A) Increases action potential duration (B) Increases contractility (C) Increases PR interval (D) Reduces abnormal automaticity (E) Reduces resting potential
*(D)Reduces abnormal automaticity*
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) Acetazolamide (B) Amiloride (C) Chlorthalidone (D) Furosemide (E) Mannitol
*(E) Mannitol*
Drug X had the effects shown in the table below. Drug X is probably a drug similar to (A) Acetylcholine (B) Albuterol (C) Edrophonium (D) Isoproterenol (E) Norepinephrine
*(E) Norepinephrine*
Mr Green, a 54-year-old banker, had a cardiac transplant 6 months ago. His current blood pressure is 120/70 mm Hg and heart rate is 100 bpm. Which of the following drugs would have the least effect on Mr Green's heart rate? (A) Albuterol (B) Epinephrine (C) Isoproterenol (D) Norepinephrine (E) Phenylephrine
*(E) Phenylephrine*
Your 75-year-old patient with angina and glaucoma is to receive a β-blocking drug. Which of the following statements is most correct regarding β-blocking drugs? (A) Esmolol's pharmacokinetics are compatible with chronic topical use (B) Metoprolol blocks β2 receptors selectively (C) Nadolol lacks β2-blocking action (D) Pindolol is a β antagonist with high membrane-stabiliz-ing (local anesthetic) activity (E) Timolol lacks the local anesthetic effects of propranolol
*(E) Timolol lacks the local anesthetic effects of propranolol*
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 hyper- tension and angina. Which of the following drugs in high doses causes bradycardia? (A) Amlodipine (B) Isosorbide dinitrate (C) Nitroglycerin (D) Prazosin (E) Verapamil
*(E) Verapamil*
One year later, the patient returns complaining that his nitro- glycerin 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
*(E) Verapamil*
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) A calcium chelator such as EDTA (B) Digitalis (C) Nitroprusside (D) Potassium chloride (E) Sodium lactate
*(E)Sodium lactate*
A 33-year-old woman attempted to induce an abortion using ergotamine. She is admitted to the emergency department with severe pain in both legs. On examination, her legs are cold and pale with absent arterial pulses. Which of the fol- lowing is the most useful antidote for reversing severe ergot- induced vasospasm? (A) Bromocriptine (B) Cimetidine (C) Ergotamine (D) Ketanserin (E) LSD (F) Nitroprusside (G) Sumatriptan (H) Ondansetron
*(F) Nitroprusside*
Certain drugs can cause severe hypotension when combined with nitrates. Which of the following interacts with nitro- glycerin by inhibiting the metabolism of cGMP? (A) Atenolol (B) Hydralazine (C) Isosorbide mononitrate (D) Nifedipine (E) Ranolazine (F) Sildenafil (G) Terbutaline
*(F) Sildenafil*
A 28-year-old office worker suffers from intense migraine headaches. Which of the following is a serotonin agonist use- ful for aborting an acute migraine headache? (A) Bromocriptine (B) Cimetidine (C) Ephedrine (D) Ketanserin (E) Loratadine (F) Ondansetron (G) Sumatriptan
*(G) Sumatriptan*
A 68-year-old man with a history of chronic heart failure goes on vacation and abandons his low-salt diet. Three days later, he develops severe shortness of breath and is admitted to the local hospital emergency department with significant pulmo- nary edema. The first-line drug of choice in most cases of acute decompensation in patients with chronic heart failure is (A) Atenolol (B) Captopril (C) Carvedilol (D) Digoxin (E) Diltiazem (F) Dobutamine (G) Enalapril (H) Furosemide (I) Metoprolol (J) Spironolactone
*(H) Furosemide*
Which of the following is very short-acting and acts by releas- ing nitric oxide? (A) Atenolol (B) Captopril (C) Diltiazem (D) Fenoldopam (E) Hydrochlorothiazide (F) Losartan (G) Minoxidil (H) Nitroprusside (I) Prazosin
*(H) Nitroprusside*
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) Acetazolamide (B) Amiloride (C) Desmopressin (D) Ethacrynic acid (E) Furosemide (F) Hydrochlorothiazide (G) Mannitol (H) Spironolactone (I) Triamterene (J) Tolvaptan
*(J) Tolvaptan*
Your 37-year-old patient has been diagnosed with a rare metastatic carcinoid tumor. This neoplasm is releasing sero- tonin, bradykinin, and several unknown peptides. The effects of serotonin in this patient are most likely to include (A) Constipation (B) Episodes of bronchospasm (C) Hypersecretion of gastric acid (D) Hypotension (E) Urinary retention
**(B) Episodes of bronchospasm
A drug was tested in the electrophysiology laboratory to determine its effects on the cardiac action potential in normal ventricular cells. The results are shown in the diagram. Which of the following drugs does this agent most resemble? (A) Adenosine (B) Flecainide (C) Mexiletine (D) Procainamide (E) Verapamil
*Flecainide*
A 72-year-old woman has long-standing heart failure. Which one of the following drugs has been shown to reduce mortal- ity in chronic heart failure? (A) Atenolol (B) Digoxin (C) Dobutamine (D) Furosemide (E) Spironolactone
*Spironolactone*
