Cardiovascular Drugs Our Patients Take- C.E. Questions & answers for study

19. All of the following statements related to acute coronary syndromes (ACS), i.e., unstable angina pectoris (UA) and MI are correct EXCEPT which one?

A. Acute coronary syndromes are caused by the rupture of unstable atherosclerotic plaques that results in vasoconstriction, platelet aggregation, and thrombus formation. B. The principal clinical manifestation of UA is chest pain at reproducible workloads, e.g., walking up a flight of stairs C. The goals of prevention and treatment of ACS are to relieve ischemic symptoms, i.e., β1-adrenoceptor antagonists; and to prevent additional thrombus formation, i.e., antiplatelet agents and/or an anticoagulant. D. If pharmacological strategies are not sufficient to reestablish perfusion patients with STEMI require coronary artery bypass grafts or percutaneous coronary intervention. Answer: B

17. Which of the following statements related to hypertension is correct?

A. BP <179/109 mmHg is a minor, but not an independent risk factor for a major adverse cardiac event (MACE) in association with dental procedures performed under local dental anesthesia. B. Hypertensive urgency is characterized by gradual elevation of BP in patients with chronic, slowly progressive end-organ damage that perioperatively may manifest as stroke or myocardial infarction. C. Hypertensive emergency is a rare life-threatening condition characterized by severe, acute BP elevation associated with acute vascular injury that perioperatively may manifests as retinal hemorrhage, papilledema, and altered mental state. D. All of the above. Answer: D

9. All of the following statement related to drugs that regulate vascular tone are correct EXCEPT which one?

A. Calcium channel blockers, e.g., amlodipine, block voltage-gated L-type Ca2+ channels and are indicated for the treatment of hypertension, anginal pectoris, and cardiac arrhythmias. B. Beta-adrenoceptor blocking agents such as metoprolol selectively block β1-adrenoceptors, propranolol and nadolol also block β2-adrenoceptors, and labetalol and carvedilol also block β2- and α1- adrenoceptors. C. Alpha2-adrenoceptor agonists, e.g., clonidine, selectively activate central α2-adrenoceptors, thereby increasing sympathetic outflow from the CNS. D. Nitric oxide donors, e.g., nitroglycerin, are indicated for the treatment of acute angina pectoris and or prophylaxis for ischemic heart disease Answer: C

23. The treatment of HF includes _______________.

A. Cardiac glycosides and antiplatelet agents or anticoagulants B. Diuretics and/or nitric oxide donors C. ACE inhibitors, β1-adrenoceptor antagonists or direct-acting vasodilators D. All of the above. Answer: D

11. All of the following statement related to drugs that affect cardiac rhythm are correct EXCEPT which one?

A. Class IC antiarrhythmics such as flecainide block voltage-gated Na+ channels in ventricular myocytes. B. Class II antiarrhythmics, i.e., β1-adrenoceptor antagonists, block β1-adrenoceptors in SA and AV nodal cells. C. Class IV antiarrhythmics, i.e., Ca2+ channel blocking agents, decrease excitability of SA nodal cell and prolong AV nodal conduction. D. Cardiac glycosides, e.g., digoxin reduce the refractory period at AV nodal cell and thereby increase conduction velocity. Answer: D

16. All of the following statements related to the prescription of two or more agents from different drug classes to reach target BP in a particular patient are correct EXCEPT which one?

A. Diuretics to reduce blood volume. B. ACE inhibitors or AT II receptor antagonists to modulate the RAAS. C. β1-adrenoceptor antagonist, α1-adrenoceptor antagonists, and central α2-adrenoceptor agonists to increase sympathetic tone. D. Ca2+ channel blockers and K+ channel activators to reduce vascular tone. Answer: C

22. All of the following statements related to HF are correct EXCEPT which one?

A. Heart failure (HF) is a chronic contractile dysfunction characterized by myocyte loss and increased interstitial collagen deposits associated with structural cardiac diseases. B. Patients with Class I heart failure are typically asymptomatic at rest and ordinary physical activities do not cause fatigue, dyspnea, palpitation, or acute angina pectoris; these patients can complete physical activities requiring a FC of ≤7 METs. C. Patients with Class II heart failure are typically asymptomatic at rest; however, ordinary physical activities can cause fatigue, dyspnea, palpitation, or acute angina pectoris; these patients can only complete physical activities requiring a FC ≤5 METs. D. Patients with Class IV heart failure are typically asymptomatic; however, ordinary physical activities can cause fatigue, dyspnea, palpitation, or acute angina pectoris; these patients can only complete physical activities requiring a FC ≤2 METs. Answer: D

3. All of the following statements related to lipoproteins are correct EXCEPT which one?

A. In blood, lipoproteins transport cholesterol and triglycerides. B. Abnormalities of lipoprotein metabolism appear to be the result of genetic factors, which modify the sensitivity of individuals to adverse dietary habits and to sedentary lifestyles. C. Low levels of low-density lipoproteins (LDLs) and low levels of triglycerides (TGs) and high levels of high-density lipoproteins (HDLs) are strongly associated with atherosclerosis. D. Diet and exercise can reduce total plasma cholesterol concentrations by as much as 25%, if this approach is insufficient to normalize lipid levels drug therapy is initiated. Answer: C

20. Which of the following statements related to cardiac arrhythmias is correct?

A. In patients with atrial fibrillation systemic embolization may present clinically as a stroke-like illness characterized by sudden confusion. B. A patient with sustained VT is almost always symptomatic, if left untreated it may lead to ventricular fibrillation. C. Ventricular fibrillation, if left untreated, leads to death within about three to five minutes. D. All of the above. Answer: D

4. Which of the following classes of drugs are prescribed for the treatment of hypercholesterolemia and/or as prophylaxis for coronary atherosclerosis?

A. Inhibitors of cholesterol synthesis, i.e., the "statins, which inhibit HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis. B. Inhibitors of bile acid absorption, e.g., colestipol, which bind to bile acid and prevent enterohepatic circulation. C. Inhibitors of cholesterol absorption, e.g., ezetimibe, which decreases cholesterol transport into enterocytes. D. Omeda-3 fatty acids, which regulate nuclear transcription factors to reduce TG synthesis and increase fatty acid oxidation. Answer: A

7. All of the following statement related to drugs indicated for the treatment of hypertension and/or as adjuncts in chronic edema states, and/or as adjuncts in the prevention and treatment of MI, HF, or diabetic nephropathy are correct EXCEPT which one?

A. Thiazide diuretics, e.g., hydrochlorothiazide, inhibit Na+ reabsorption by cells of the distal convoluted tubule. B. Loop diuretics, e.g., furosemide, inhibit Na+ reabsorption by cells of the Loop of Henle. C. Spironolactone, a collecting duct (potassium sparing) diuretic, inhibits Na+ reabsorption by inhibiting aldosterone action. D. Angiotensin II receptor antagonists, i.e., the "artans", inhibit the conversion of angiotensin (AT) I to AT II and the degradation of bradykinin. Answer: D

12. Cardiac glycosides, e.g., digoxin, inhibit Na+/K+-ATPase and thereby increase intracellular Ca2+ concentration in myocytes exerting a positive inotropic effect and are indicated for the treatment of heart failure.

A. True B. False Answer: A

15. HTN is known as the "silent killer" because signs and symptoms, are not observed until the systolic BP is ≥180 mmHg or the diastolic BP ≥110 mmHg or until evidence of target organ damage manifests

A. True B. False Answer: A

2. Drugs taken by our patients are associated with at least 10,000 potential ADRs ranging from mild to severe illness and can lead to hospitalization, permanent disability, and even death; consequently, OHCPs are expected to have access to reliable informational resources

A. True B. False Answer: A

21. The goals in treating cardiac arrhythmias is to restore synchronous myocardial contraction and to prevent thromboembolic complications, when pharmacological strategies fail, a patient with cardiac arrhythmias requires a pacemaker or implanted cardiac defibrillator.

A. True B. False Answer: A

6. Excessive Na+ and H2O retention, primarily a result of renal abnormalities, is responsible for volume-based hypertension and can also lead to transudative edema associated with heart failure, cirrhosis of the liver, and nephrotic syndrome.

A. True B. False Answer: A

8. Vascular smooth muscle cells are the functional regulatory units responsible for maintaining vascular tone, which is ultimately is determined by the intracellular Ca2+ ion concentration.

A. True B. False Answer: A

10. All of the following statement related to cardiac arrhythmias are correct EXCEPT which one?

A. Under the influence of the autonomic nervous system, the sinoatrial (SA) node paces the heart at normal resting rates between 60 and 100 beats per minute. B. The atrioventricular (AV) node and the ventricular conducting system contain pacemaker cells. C. Abnormal impulse generation and/or impulse conduction lead to cardiac arrhythmias. D. The most common cause of cardiac arrhythmias is primary electrophysiological disorders and genetically determined ion-channel abnormalities. Answer: D

24. All of the following statements related to thromboembolic complications are correct EXCEPT which one?

A. Venous thrombi develop in areas of slow blood flow, e.g., in a lower extremity, small emboli tend to detach and travel to and wedge into pulmonary arteries preventing deoxygenated blood from entering the lung. B. Arterial thrombi cause coronary artery thrombosis, coronary artery rethrombosis after thrombolysis, occlusion of coronary artery grafts and lead to unstable angina pectoris, MI, recurrent MI, and sudden cardiac death. C. Arterial thrombi contribute to systemic embolization in patients with atrial fibrillation or prosthetic heart valves and cause transient ischemic attacks and stroke. D. The risk of perioperative and postoperative bleeding complications in patients in whom antiplatelet and anticoagulation therapy is continued is predictably high and far outweighs the small risk of serious and sometimes fatal embolic events when antithrombotic therapy is interrupted. Answer: D

14. All of the following statements related to drugs that affect hemostasis and thrombosis are correct EXCEPT which one? ​

A. When a patient is taking both aspirin and clopidogrel it is most likely to prevent systemic embolism in association with prosthetic heart valves. B. Traditional anticoagulants such as warfarin inhibit hepatic peroxide reductase that catalyzes the regeneration of reduced vitamin K, which is required for the synthesis of biologically active coagulation factors II, VII, IX, and X C. Rivaroxaban and apixaban competitively inhibit factor Xa by binding to the active side on the enzyme. D. Dabigatran directly binds to thrombin and thereby inhibit secondary hemostasis. Answer: A

5. All of the following statement related to plasma volume depletion are correct EXCEPT which one? Plasma volume depletion _______________

A. activates the renin-angiotensin-aldosterone system (RAAS) B. promotes the release of natriuretic peptides C. promotes antidiuretic hormone release D. increases renal sympathetic activity Answer: B

25. Before elective dental care _______________.

A. estimate the patient's perioperative risk for MACE B. if the combined procedure- and patient-specific variables predict low-risk for MACE and the patient's FC is ≥4 METs no further preoperative evaluation may be needed C. if the FC is <4 METs and/or the risk for MACE is elevated, before initiating any elective dental care, the patient should undergo medical evaluation D. All of the above Answer: D

13. Thrombosis is characterized by the uncontrolled enlargement of clots that occlude blood vessels as a result of _______________.

A. injury of the endothelium associated with hyperlipidemia and hypertension B. abnormal blood flow, i.e. turbulence or stasis associated with atherosclerosis, arrhythmias, valvular problems, and heart failure C. genetic or acquired hypercoagulability D. All of the above. Answer: D

1. Which of the following statements related to cardiovascular drugs apply to oral healthcare providers (OHCPs)? OHCPs must _______________.

A. recognize them by name (generic and/or brand name) B. know their mechanisms of action and indications for use C. be aware of the spectrum of ADRs and be actively involved in monitoring for and reporting such drug effects D. All of the above. Answer: D

18. In addition to aggressive lipid lowering therapy and BP control, focused therapy in patients with chronic coronary artery disease, i.e., chronic stable angina pectoris may include _______________.

A. β1-adrenoceptor antagonists reduce heart rate and contractility B. Ca2+ channel blocking agents decrease cardiac contractility and systemic vascular resistance C. nitric oxide donors to decrease preload and dilate peripheral capacity veins D. All of the above. Answer: D