GGG's CV Pharm Questions

A 66-year-old woman has hypertension and stable angina is being treated with hydrochlorothiazide. Her physician decides to add metoprolol to the treatment regimen because the patient's blood pressure readings have been slightly above 140/90 mm Hg during the past several checkups. The effects of metoprolol will include A. A reduction in intracellular cAMP levels B. Exacerbation of the patients angina symptoms C. Increased activity of neural and hormonal reflex mechanism(s) D. Increased epinephrine and norepinephrine effects on the lungs E. Potentiation of the effects of tyramine on adrenergic nerve terminals

A. A reduction in intracellular cAMP levels. Metoprolol will block beta-1 adrenergic receptors, reducing the intracellular production of cAMP. The net physiologic response is to reduce calcium entry into myocytes. Less calcium in SA and AV nodal cells = less rate. Less calcium in contractile myocytes = less contraction. Both of these physiologic responses are beneficial to treat hypertension and reduce heart work in stable angina.

This drug when given to a patient stimulates a receptor that decreases intracellular cAMP production and increases potassium efflux out of the cell. A. Adenosine B. Amiodarone C. Lidocaine D. Quinidine E. Procainamide

A. Adenosine, adenosine receptors are coupled to Gi. Activation of these receptors and the g-protein increase potassium outflow as well as inhibit adenylyl cyclase.

44-year-old male patient is being treated with an antiarrhythmic drug to treat a ventricular tachy-arrhythmia. After treatment with the drug the patient's rhythm resembles sinus rhythm with an extended QT interval. Unfortunately a pulmonary function test demonstrates a sign of pulmonary fibrosis indicating that cessation of use is necessary. Which drug was used to treat this patient? A. Amiodarone B. Disopyramide C. Inamrinone D. Lidocaine E. Quinidine

A. Amiodarone: Remember to check PFT (pulmonary function), TFT (thyroid), and LFT (Liver)

Which of the following drugs prolongs the QT interval? A. Amiodarone B. Flecainide C. Lidocaine D. Propranolol E. Verapamil

A. Amiodarone: drugs that inhibit potassium conductance (class 1a and class 3) prolong the QT interval and are associated with torsades de points

A 65-year-old man now presents to the emergency department (ED) after a routine visit to his endocrinologist for follow-up of his diabetes mellitus. The endocrinologist referred him to the local ED for evaluation and potential hospitalization. The patient states that he has been gaining weight and having progressively worsening dyspnea on exertion. His shortness of breath is often worse at night, forcing him to 'sit bolt upright". He began utilizing three pillows at night one week ago without difficulty. This morning he became short of breath and diaphoretic after climbing a flight of stairs to his endocrinologist's office. 2D echocardiogram demonstrates left ventricular hypertrophy, reduced ejection fraction (calculated at 37%) and S3 heart sound is appreciated at apex and lateral positions. Oxygen, diuretic, captopril and digoxin therapy is initiated in this patient. Which of the following medications would be most likely used to slow cardiac remodeling observed in this patient? A. Captopril B. Digoxin C. Dobutamine D. Inamrinone E. Verapamil

A. Captopril. Much of the pathophysiology underlying congestive heart failure is a response to overproduction of compensatory hormones. For example, the RAAS cascade is initiated by a reduction in blood pressure. Angiotensin II can act on the heart muscle to promote fibroblast activation and collagen disposition. Captopril is an ACE inhibitor that in theory decreases the amount of angiotensin II and remodeling of the heart.

A 36-year-old female patient is pregnant and in her second trimester. During routine blood pressure monitoring she is found to have moderate hypertension. Which of the following medications is contraindicated in this patient? A. Captopril B. Labetalol C. Minoxidil D. Metoprolol E. Methyldopa

A. Captopril. U.S. Black Boxed Warning: ACE inhibitors are teratogenic (fetal renal and lung function affected, skeletal malformations) and can cause death in developing fetus. ACE inhibitor should be discontinued as soon as possible once pregnancy is detected.

A 65 year old male is experiencing progressively worse dyspnea on exertion. His shortness of breath is worse at night, forcing him to sleep upright. He is unable to do the same amount of physical exertion as he did in the previous examination. His personal medical history indicates that he has hypertension and hypercholesterolemia. Chest X-rays, PA and lateral views, show evidence of congestive heart failure and cardiomegaly, interstitial edema, and some alveolar edema. 2D echocardiogram demonstrates severe left ventricular dilation and increased left atrial dimension in end diastole that appear to be unchanged as compared to end systole. This patient is given a drug that reduces afterload and preload but unfortunately cause this patient to have a dry unproductive cough? A. Captopril B. Digoxin C. Losartan D. Inamrinone E. Spironolactone

A. Captopril: Is an ACE-I. The reduction in the production of Angiotensin 2 reduces the vasoconstrictive effects of this hormone (=decrease in after load) and decreases Ang-2-mediated aldosterone release (=less sodium retention and thus less preload). The side effect of ACE-I is a perhaps bradykinin-mediated unproductive cough.

Which of the following is correctly matched? Antiarrhythmic drug class Drug Name A. Class 1a Disopyramide B. Class 1b Verapamil C. Class II Digoxin D. Class III Lidocaine E. Class IV Dofetilide

A. Class 1a Disopyramide

Which of the following is correctly matched? Anti-arrhythmic Drug Class Drug A. Class Ib : mexiletine B. Class Ic : Ibutilide C. Class II : Verapamil D. Class III : Digoxin E. Class IV : Adenosine

A. Class Ib: mexiletine Class 1(sodium channel blockers), 1A: Disopyramide, procainamide, quinidine (Queen Amy Proclaims Diso's pyramid). Amy goes with amiodarone which affects many channels 1B: lidocaine and oral derivatives--mexiletine and tocainide 1C: Flecainide, propafenone, and moricizine Class 2 beta blockers Class 3 K+ blockers Class 4 CCB

A 65 yo man with a history of CAD, MI and CABG X 3 vessels 7 years ago presents to the clinic today with pain, which he rates as approximately 7-8 on a scale of 1-10, that comes from exertion and subsides with rest. He avoids stairs, but says he can walk approximately 100 yds before he has to stop because of chest pain and fatigue. The pain occurs as often as he attempts this level of exertion. What is a mechanistic strategy to treat this patient' symptoms? A. Decrease myocardial oxygen demand B. Decrease oxygen supply to the myocardium C. Inhibit the production of intracellular cGMP in smooth muscle D. Prolong the patients QT interval E. Stimulate phosphodiesterase activity

A. Decrease myocardial oxygen demand

Which drug listed inhibits the Na/K-ATPase pump? A. Digoxin B. Dobutamine C. Enalapril D. Inamrinone (or amrinone) E. Norepinephrine

A. Digoxin

Which drug listed above can be used to treat atrial-type arrhythmias? A. Digoxin B. Dobutamine C. Enalapril D. Inamrinone (or amrinone) E. Norepinephrine

A. Digoxin via depolarization of the vagal nerve.

The principle use for b-type natriuretic peptide (nesiritide) is to treat A. Heart failure B. Mild hypertension C. Stable Angina D. Supraventricular arrhythmias E. Vasospastic angina

A. Heart failure. Nesiritide activates guanylyl cyclase in vascular smooth muscle and endothelial cells to produce cGMP which results in a cascade of events resulting in smooth muscle relaxation. The net result is to decrease pulmonary wedge pressure and systemic arterial pressure which allows the failing heart to contract more normally.

Which statement best describes the use of propranolol in the treatment of angina? A. Propranolol may exacerbate cardiac ischemia in vasospastic angina B. Propranolol may exacerbate reflex sympathetic tone produced by nitrate use C. Propranolol produces smooth muscle relaxation by increasing intracellular cGMP levels D. Propranolol should not be used in combination with isosorbide dinitrate E. The principal benefit of propranolol in the treatment of angina is to reduce afterload and preload

A. Propranolol may exacerbate cardiac ischemia in vasospastic angina. Unopposed alpha-1 activity may increase vasoconstriction.

The use of this drug is reserved for patients who have hypertension and symptoms of benign prostatic hyperplasia? A. Terazosin B. Captopril C. Carvedilol D. Hydrochlorothiazide E. Diazoxide

A. Terazosin. Terazosin is an alpha-1 antagonist that can reduce blood pressure and relax the prostate smooth muscle tissue allowing better flow. Alpha-antagonist are reserved for compelling indications because of its association with Heart Failure with long term use.

The use of non-dihydropyridine calcium channel antagonist should be used with caution in patients who A. have congestive heart failure B. have hypertension C. have Raynaud's Syndrome D. have supraventricular arrhythmias E. have vasospastic Angina

A. have congestive heart failure

A patient with paroxysmal supraventricular tachycardia would be most likely treated with A. Verapamil B. Adenosine C. Dofetilide D. Quinidine E. Amiodarone

B. Adenosine: Stimulates receptors on cardiac cells that are coupled to Gi. The activation of this intracellular g-protein results in opening of potassium channels and an inhibition of cAMP production (reducing phosphorylation / opening of calcium channels and activation of the funny-sodium channels). All of these events produce a temporary hyper polarization that allows the atrium to reset to the SA node once adenosine is metabolized (approximately 10 seconds).

Which class of antihypertensive drugs is associated with sedation? A. Alpha one adrenoceptor antagonist B. Alpha two adrenoceptor agonist C. Angiotensin converting enzyme inhibitors D. Angiotensin receptor antagonist E. Calcium channel blockers

B. Alpha two adrenoceptor agonist. Drugs like clonidine work in the CNS and are associated with drowsiness and sedation.

A patient is treated with an oral agent for a ventricular tachycardia for a year and now presents with exertional dyspnea and nonproductive cough consistent with symptoms of drug induced pulmonary fibrosis. A. Adenosine B. Amiodarone C. Lidocaine D. Quinidine E. Procainamide

B. Amiodarone

Which of the following drugs is a structural analog of HMG-CoA? A. Aprotinin B. Atorvastatin C. Colestipol D. Ezetimibe E. Niacin

B. Atorvastatin

Which calcium channel blocker is associated with arrhythmias caused by potassium channel blockade? A. Amlodipine B. Bepridil C. Nifedipine D. Nimodipine E. Verapamil

B. Bepridil is a CCB that also blocks potassium conductance

In a patient being treated for hypertension potassium levels should be monitored to avoid the potential of life threatening hyperkalemia after administering which of the following drugs? A. Amlodipine B. Captopril C. Hydrochlorothiazide D. Furosemide E. Metoprolol

B. Captopril, reduces aldosterone formation which may increases potassium levels.

A patient with a blood pressure of 145 over 95 is treated with an antihypertensive medication. At his two week follow up appointment his blood pressure is normal but he is experiencing a dry unproductive cough. A. Terazosin B. Captopril C. Carvedilol D. Hydrochlorothiazide E. Diazoxide

B. Captopril. ACE inhibitors are associated with dry unproductive cough. Perhaps by preventing the breakdown of bradykinin.

Which of the following is correctly matched? Anti-arrhythmic Drug Class Drug A. Class Ia : mexiletine B. Class Ib : lidocaine C. Class Ic : verapamil D. Class III : digoxin E. Class IV : adenosine

B. Class Ib: lidocaine. Class 1b drugs are sodium channel blockers that can reduce the duration of the ventricular action potential.

A 44-year-old male patient suffers from moderate hypertension and is currently taking Hydrochlorothiazide and Captopril. Unfortunately, his blood pressure is still well above 120/80 mM HG. A third drug is added to this combination. The patient is on no other medications. The patient now experiences dry mouth, drowsiness and constipation. Which anti-hypertensive drug listed below was most likely added to this patient's drug regimen? A. Atropine B. Clonidine C. Hydralazine D. Labetalol E. Losartan

B. Clonidine. Drowsiness occurs between 12 and 38%, xerostomia (dry mouth) occurs <40%, and constipation occurs between 2 and 10% with clonidine use

Patients taking pravastatin with muscle pain should be checked periodically for a potential increase(s) in serum A. Aminotransferase B. Creatinine Kinase C. Lactate dehydrogenase D. Phosphate E. Potassium

B. Creatinine Kinase Myalgia, myopathy, and rhabdomyolysis can occur with Statin use. The degree of muscle tissue damage is measured by CK levels.

How do nitrates produce smooth muscle relaxation? A. Beta-2 receptor activation B. Dephosphorylation of myosin light chain C. Inhibition of calcium influx into smooth muscle cells D. Muscarinic receptor activation E. Phosphorylation of calcium channels

B. Dephosphorylation of myosin light chain. Nitrates are broken down into nitrous oxide. NO activates guanylyl cyclase in smooth muscle cells and produces increases in intracellular cGMP. The cGMP cascades leads to opening of potassium channels and the activation of a phosphatase that de-phosphorylates ML-chain. Both events lead to relaxation.

Which drug listed below is an I.V. only medication reserved for hypertensive emergencies? A. Amlodipine B. Diazoxide C. Captopril D. Hydrochlorothiazide E. Losartan

B. Diazoxide. Diazoxide activates potassium channels in the vasculature as well as pancreas. Oral formulations are used to treat hyperinsulinemic hypoglycemia.

A 65 year old male is experiencing progressively worse dyspnea on exertion. His shortness of breath is worse at night, forcing him to sleep upright. He is unable to do the same amount of physical exertion as he did in the previous examination. His personal medical history indicates that he has hypertension and hypercholesterolemia. Chest X-rays, PA and lateral views, show evidence of congestive heart failure and cardiomegaly, interstitial edema, and some alveolar edema. 2D echocardiogram demonstrates severe left ventricular dilation and increased left atrial dimension in end diastole that appear to be unchanged as compared to end systole. Which drug listed would be used in this patient to increase cardiac contractile force and exercise tolerance in this patient by inhibiting the sodium/potassium ATPase? A. Captopril B. Digoxin C. Losartan D. Inamrinone E. Spironolactone

B. Digoxin.

A 63-year-old male with a history of mild congestive heart failure presents to the emergency room with complaints of feeling dizzy and a rapid pulse rate (140 bpm). He describes a sensation of heavy fluttering in his chest. His EKG demonstrates no P waves and a narrow QRS complex. The ER physician prescribes to him a medication to slow down his heart rate by causing atrio-ventricular cells to become more hyperpolarized. Which drug was most likely given to this patient? A. Atropine B. Digoxin C. Flecainide D. Lidocaine E. Quinidine

B. Digoxin. Digoxin inhibits the sodium potassium ATPase in cardiac myocytes as well as neurons. The parasympathetic vagal nerve innervates the AV node. Digoxin produces depolarization in the Vagal nerve, ACh release, and subsequent activation of the M2 cholinergic receptor. M2 receptors when activated produce a cascade of events that eventually lead to opening of potassium channels (=hyperpolarization).

Potassium is administered to reduce this patient bigeminal rhythm patterns that was most likely caused by administration of which drug? A. Captopril B. Digoxin C. Losartan D. Inamrinone E. Spironolactone

B. Digoxin. Potassium can displace digoxin from binding to the Na/K pump.

Which statement is true regarding the management of congestive heart failure (CHF)? A. Beta-adrenergic receptor antagonist are contraindicated in patients with CHF B. Direct acting vasodilators can be used in patients with CHF who are intolerant to ACE inhibitors C. Digoxin is contraindicated in patients who have CHF and atrial fibrillation D. Long -term clinical studies demonstrate that the use of positive inotropes is associated with increased life span in patients with CHF E. The use of diuretics should be reserved for patients with type IV (severe) congestive heart failure F. When edema is present in patients with CHF, Hydrochlorothiazide is the diuretic of first choice

B. Direct acting vasodilators can be used in patients with CHF who are intolerant to ACE inhibitors

A 34 year old woman is in her third trimester of pregnancy. Which of the following medications is contraindicated in this patient due to excessive fetal hypotension? A. Amlodipine B. Enalapril C. Labetalol D. Minoxidil E. Metoprolol

B. Enalapril. U.S. Black Boxed Warning: ACE inhibitors are teratogenic (fetal renal and lung function affected, skeletal malformations) and can cause death in developing fetus. ACE inhibitor should be discontinued as soon as possible once pregnancy is detected. Challenge: Amlodipine is classified as a pregnancy category C drug.

Which of the following drugs used for hypertensive emergencies produces vasodilation by stimulating dopamine D1 receptors? A. Diazoxide B. Fenoldopam C. Hydralazine D. Minoxidil E. Nimodipine

B. Fenoldopam

A common toxicity shared by nitroglycerin, calcium-channel-blockers, and hydralazine is which of the following? A. Angioedema B. Headache C. Hypertrichosis D. Lupus-like syndrome E. Methemoglobinemia

B. Headache: a common featured shared by all vasodilators is the potential to cause headaches

A 67 year old woman with moderate to severe hypertension is treated has been treated with a vasodilator to control her blood pressure. She has been taking this medicine for over a year. She complains to you about symptoms of abdominal pain, arthralgia and myalgia. Lab analysis demonstrates an increased titer of antinuclear antibodies. You suspect that one of the following medications she is taking is causing these symptoms. The use of which drug listed below would you discontinue in this patient? A. Amlodipine B. Hydralazine C. Losartan D. Metoprolol E. Sodium Nitroprusside

B. Hydralazine. Remember it is not HIPP to get lupus. Hydralazine, Isoniazid, procainamide, and phenytoin.

An obese 44-year-old African-American male with a body mass index (30 kg/m2) has been on the DASH eating plan, performs 30 minutes of regular exercise per day, and has reduced his alcohol consumption to less than 2 drinks per day for the last three months. Unfortunately, his blood pressure is currently at 140/90 mmHg. Which of the following agents would be most appropriate for use in the treatment of this patient's hypertension? A. Captopril B. Hydrochlorothiazide C. Guanethidine D. Prazosin E. Reserpine

B. Hydrochlorothiazide. African Americans respond best to diuretics and CCB > BB and ACE inhibitors

Which statement best describes lidocaine's effects on the heart A. Lidocaine binds equally to all states (closed, open and inactivated) of sodium channels B. Lidocaine binds more readily to sodium channels in depolarized cells C. Lidocaine has good oral bioavailability D. Lidocaine is a calcium channel antagonist E. Lidocaine only affects cardiac ion conductance

B. Lidocaine binds more readily to sodium channels in depolarized cells

A common toxicity shared by alpha-one-adrenoceptor-blockers, ganglion-blocking agents, and sympatholytic drugs like guanethidine, and reserpine is which of the following? A. Depression B. Orthostatic hypotension C. Priapism D. Reflex tachycardia E. Sedation

B. Orthostatic hypotension. All drugs that interfere with the communication of baroreceptor neurons to the brain and the sympathetic afferent neuronal control of alpha-1 receptor mediated venule contraction can produce orthostatic hypotension. This includes centrally acting drugs that reduce norepinephrine release (clonidine), ganglion blockers, neuronal norepinephrine release inhibitors (reserpine, guanethidine), and alpha-receptor antagonist.

Which statement is correct? A. Hydrochlorothiazide is a more potent diuretic than furosemide B. Propranolol may exacerbate cardiac ischemia in vasospastic angina C. Propranolol may exacerbate reflex sympathetic nerve response produced by nitroglycerin D. The principal benefit of propranolol in the treatment of angina is to reduce afterload and preload E. The use of positive inotropes in patient with congestive heart failure increases life duration

B. Propranolol may exacerbate cardiac ischemia in vasospastic angina by blocking beta-2 receptors on the vasculature that can allow unappeased alpha-1 vasoconstrictive effects to predominate.

A 44-year-old male patient suffers from moderate hypertension and is currently taking clonidine. Unfortunately, the side effects produced by the drug were intolerable resulting in the abrupt cessation of the use of this drug. The patient now presents with nervousness, agitation, headache, and elevated blood pressure. The appropriate course in the management of this patient would be to A. Administer a sedative to reduce his agitation B. Re-administer clonidine then gradually taper the dose down over 2- 4 days C. Switch medications to a ganglion blocker D. Switch medication to Reserpine E. Stop using medication and advise the patient to loose weight and go on a low sodium diet

B. Re-administer clonidine then gradually taper the dose down over 2- 4 days. Continual use of clonidine will in theory down-regulate alpha-2 receptors that can cause withdrawal symptoms. By re-administering clonidine and allowing the receptors to up-regulate upon tapering dose the withdrawal effects can me mitigated.

Captopril is used in this patient to A. bind to and competitively block angiotensin II receptors B. decrease both preload and afterload on the heart C. increase the contractile force of the heart D. to increase exercise tolerance E. to prevent the breakdown of bradykinin

B. decrease both preload and afterload on the heart. Preventing formation of AT2 reduces arteriole dilation (afterload). A reduction in aldosterone and AT2-induced-venule constriction reduces preload.

Diltiazem should be used with caution in a patient who A. has atrial fibrillation B. has congestive heart failure C. has hypertension D. has Raynaud's Syndrome E. has vasospastic angina

B. has congestive heart failure

A patient with hypertension is treated with a drug that is a mixed beta- and alpha-adrenoceptor antagonist. A. Terazosin B. Captopril C. Carvedilol D. Hydrochlorothiazide E. Diazoxide

C. Carvedilol

The absorption of warfarin can be impaired by A. Aminocaproic acid B. Aspirin C. Colestipol D. Lovastatin E. Niacin

C. Colestipol. This drug is a resin that binds to cholesterol in the gut. A side effect is that it also binds to many oral drugs and vitamins when taken together.

Drugs used almost exclusively to treat supraventricular arrhythmias and have a relatively good safety profile are ones that A. Block closed sodium channels B. Block potassium channels C. Decrease calcium ion conductance D. Increase calcium ion conductance E. Increase sodium conductance

C. Decrease calcium ion conductance. CCB and BB reduce calcium conductance in the AV node (rate control). This type of treatment is useful for arrhythmias that are generate in tissue of the atrium.

The mechanism of action of digoxin is A. Inhibition of acetylcholine synaptic release B. Inhibition of phosphodiesterase C. Inhibition of the sodium/potassium ATPase D. Stimulation of beta-adrenergic receptors E. Stimulation of cGMP production in cardiac myocytes

C. Digoxin inhibits the Na+/K+ ATPase. This results in depolarization and more intracellular calcium. The net result is an increase in ventricular myocyte contractile force and depolarization of other cell membranes including the vagal nerve.

A 55-year-old male visits his primary care physician with complaints of chest discomfort, described as heaviness, squeezing pressure located on the sternum. His discomfort last 2-5 minutes and radiates to the left shoulder and to both arms. He explains that these symptoms occur when he is in a hurry, exercising, having sex, or when he is experiencing frustration or anger and subside with rest/relaxation. His chest discomfort limits his ordinary physical activity. He was admitted to the hospital and electrocardiogram recorded at rest is normal. His lab values indicate a total cholesterol level of 250 mmol/l, 165 LDL cholesterol, and 30 HDL cholesterol (desirable ranges for each are <200, <130, and >40, respectively). His personal medical history indicates that he is a smoker (2 ppd), has chronic obstructive pulmonary disease and erectile dysfunction. After reviewing this patient's personal history you determine that the initial therapy for this patient should be a combination of a nitrous-oxide-donor and which of the following? A. Bepridil B. Digoxin C. Diltiazem D. Hydralazine E. Propranolol

C. Diltiazem. Avoid BB with obstructive lung issues. The safest alternative to a BB would be a CCB like diltiazem or verapamil because they can directly reduce heart work.

A patient is not responding to treatment for their ventricular arrhythmia and is administered a drug that is specific for blocking potassium channels A. Verapamil B. Adenosine C. Dofetilide D. Quinidine E. Amiodarone

C. Dofetilide

Which drug listed can lead to prolonged survival in this patient with congestive heart failure? A. Digoxin B. Dobutamine C. Enalapril D. Inamrinone (or amrinone) E. Norepinephrine

C. Enalapril

Which drug listed could be used in a patient with symptomatic CHF to reduce the stretching pressure in his ventricular walls prior to ventricular contraction? A. Digoxin B. Dobutamine C. Enalapril D. Inamrinone (or amrinone) E. Norepinephrine

C. Enalapril. ACE inhibitors and ARBs reduce both pre-load and afterload.

Which of the following drugs inhibit intestinal cholesterol absorption via the NPC1L1 transport protein? A. Colesevelam B. Colestipol C. Ezetimibe D. Niacin E. Simvastatin

C. Ezetimibe

Common side effect(s) of Amlodipine is (are) A. Bradycardia B. Ganglionic blockade C. Headache and peripheral edema D. Pulmonary fibrosis E. Torsades de pointes

C. Headache and peripheral edema. Vasodilators in general are associated with the side effect of headache.

A 43-year-old woman with an untreated blood pressure of 160 systolic and 100 diastolic is successfully managed with a drug combination. Upon follow up visit to her family care physician she complains experiencing symptoms of fever, malaise, arthritis, myalgias and has a rash. You suspect that one of her anti-hypertensive medications causing her lupus erythematosus. Which drug would you remove from her regimen? A. Amlodipine B. Clonidine C. Hydralazine D. Hydrochlorothiazide E. Losartan

C. Hydralazine. Drugs like hydralazine, isoniazid, phenytoin, and procainamide are associated with drug induced lupus. Remember it's not HIPP to get lupus.

A 65-year-old man now presents to the emergency department (ED) after a routine visit to his endocrinologist for follow-up of his diabetes mellitus. The endocrinologist referred him to the local ED for evaluation and potential hospitalization. The patient states that he has been gaining weight and having progressively worsening dyspnea on exertion. His shortness of breath is often worse at night, forcing him to 'sit bolt upright". He began utilizing three pillows at night one week ago without difficulty. This morning he became short of breath and diaphoretic after climbing a flight of stairs to his endocrinologist's office. 2D echocardiogram demonstrates left ventricular hypertrophy, reduced ejection fraction (calculated at 37%) and S3 heart sound is appreciated at apex and lateral positions. Oxygen, diuretic, captopril and digoxin therapy is initiated in this patient. The principle goal of digoxin therapy in this patient is to A. Decrease afterload B. Decrease preload C. Increase cardiac output D. Inhibit angiotensin converting enzyme activity E. Slow atrio-ventricular conduction rate

C. Increase cardiac output. Digoxin inhibits the Na+/K+ ATPase. This results in depolarization and more intracellular calcium. The net result is an increase in contractile force. Note: that the other effect of digoxin is to cause the depolarization of the vagal nerve. This increases release of acetylcholine which slows conduction in the SA and AV nodes.

Which is the mechanism of action of Ezetimibe? A. Competitively inhibits urokinase B. Increases the activity of lipoprotein lipase C. Inhibits the absorption of cholesterol from the intestines D. Inhibits the degradation of VLDL E. Inhibits the secretion of VLDL from the liver

C. Inhibits the absorption of cholesterol from the intestines

A patient with a myocardial infarct and a ventricular arrhythmia is treated with a sodium channel blocker that is not associated with potassium channel blockade. A. Adenosine B. Amiodarone C. Lidocaine D. Quinidine E. Procainamide

C. Lidocaine

Which of the following is a phosphodiesterase inhibitor used mainly for refractory congestive heart failure? A. Enalapril B. Hydrochlorothiazide C. Milrinone D. Propranolol E. Spironolactone

C. Milrinone

Which drug listed below could be used on the patient to reduce the amount of work the heart has to perform without direct effects on the heart? A. Bepridil B. Diltiazem C. Nitroglycerin D. Propranolol E. Verapamil

C. Nitroglycerin. Nitroglycerin produces venule dilation, a reduction in pre-load and wall stretch. A reduction in wall stretch decreases contractile force and oxygen requirement.

A 55-year-old male visits his primary care physician with complaints of chest discomfort, described as heaviness, squeezing pressure located on the sternum. His discomfort last 2-5 minutes and radiates to the left shoulder and to both arms. He explains that these symptoms occur when he is in a hurry, exercising, having sex, or when he is experiencing frustration or anger and subside with rest/relaxation. His chest discomfort limits his ordinary physical activity. He was admitted to the hospital and electrocardiogram recorded at rest is normal. His lab values indicate a total cholesterol level of 250 mmol/l, 165 LDL cholesterol, and 30 HDL cholesterol (desirable ranges for each are <200, <130, and >40, respectively). His personal medical history indicates that he is a smoker (2 ppd), has chronic obstructive pulmonary disease and erectile dysfunction. The main pharmacologic endpoint to manage these patient's acute symptoms is to A. Increase cardiac filling pressure B. Increase cardiac contractile force C. Reduce the oxygen required by cardiac tissue D. Speed blow flow through occluded arteries E. Shunt blood from occluded ischemic tissue to healthy tissue

C. Reduce the oxygen required by cardiac tissue. This patient is suffering from stable angina. The primary treatment is to reduce heart work. It is physiological and therapeutically difficult to increase flow through an occluded vessel.

Which of the following drugs blocks L-type calcium channels in the heart leading to decreased heart contractility, and rate, as well as in smooth muscle, producing vasodilation? A. Amlodipine B. Digoxin C. Verapamil D. Metoprolol E. Propranolol

C. Verapamil: and dilitiazem are non-dyhydropyridine CCB. The important distinction between CCB are that dihydropyridine CCBs like nifedipine and amlodipine are more specific to smooth muscle and have less direct cardiac effects. The non-dihydropyridine CCB (verapamil, diltiazem) have direct cardiac effects (slows SA and AV conduction) as well as smooth muscle effects.

Antiarrhythmic drugs that block potassium channels and reduce potassium conductance A. Are the drugs of first choice for paroxysmal supraventricular arrhythmias B. can all increase the risk of pulmonary fibrosis C. can increase the risk of torsades de pointes D. shorten action potential duration E. shorten QT intervals

C. can increase the risk of torsades de pointes. Drugs that increase the QT interval are associated with torsades.

Which drugs reduce cardiac remodeling and are associated with studies demonstrating increased survival rates in patients with CHF? A. Captopril B. Digoxin C. Losartan D. Inamrinone E. Spironolactone A. A only B. B only C. C only D. A, C, E E. B and D

D. A, C, E: General rule--drugs that increase cardiac contraction are not associated with an increase in survival time in patients with CHF.

Drugs used almost exclusively to treat supraventricular arrhythmias and have a relatively good safety profile (least amount of fatal side effects) are ones that A. Block open sodium channels B. Block closed sodium channels C. Depolarize atrio-ventricular nodal cells D. Effect calcium ion conductance E. Effect potassium ion conductance

D. Effect calcium ion conductance. E.g. rate control drugs like BB and the non-dihydropyridine CCB's, verapamil, and diltiazem.

Which of the following drugs increases lipoprotein lipase (LPL) activity? A. Atorvastatin B. Colesevelam C. Ezetimibe D. Fenofibrate E. Ticlopidine

D. Fenofibrate. Fibrates are ligands for the transcriptional factor PPAR alpha. PPAR alpha, produces many transcriptional changes regarding metabolism of fat including the up-regulation of LPL enzymes. LPL functions to convert TG's into FFA that shuttles TG from VLDL to muscle.

Which of the following drugs increases the activity of LPL (lipoprotein lipase)? A. Colesevelam B. Colestipol C. Ezetimibe D. Fenofibrate E. Simvastatin

D. Fenofibrate. Ligand for nuclear transcription receptor, peroxisome proliferator-activated receptor-alpha (PPAR-a). Transcriptional up-regulate LPL, apoA-I and II, and down-regulate apoCIII (inhibitor of lipolysis) Major actions Lower LDL-C 5-20% (with normal TG) May raise LDL-C (with high TG) Lower TG 20-50% Raise HDL-C 10-20%

Which drug is correctly matched to its mechanism of action? DRUG MECHANISM OF ACTION A. Captopril Stimulates release of aldosterone B. Clonidine Nicotinic receptor antagonist C. Diazoxide Stimulates norepinephrine release D. Guanethidine Replaces norepinephrine in synaptic vesicles E. Methyldopa opens potassium channels in smooth muscle cells

D. Guanethidine Replaces norepinephrine in synaptic vesicles Captopril ACE inhibitor Clonidine Alpha-2 agonist Diazoxide opens potassium channels in smooth muscle cells Methyldopa opens potassium channels in smooth muscle cells

A 44-year old male has atrial fibrillation with a ventricular rate of 140/min. He is treated with quinidine, and the atrial fibrillation is converted to atrial flutter, but the heart rate increases to 195/min. The most likely explanation of these effects is that quinidine A. Accelerates SA nodal conduction via activation of beta 1-adrenergic receptors B. Directly stimulates the atrioventricular (AV) node C. Directly stimulates the ventricles D. Has a vagolytic effect that facilitates transmission of impulses through the AV node E. Induces hypotension and thereby causes reflex tachycardia

D. Has a vagolytic effect that facilitates transmission of impulses through the AV node. Quinidine and disopyramide have anti-muscarinic properties.

A patient with a blood pressure of 145 over 95 is treated with an antihypertensive medication. At his two week follow up appointment his blood pressure is normal but he is experiencing hypokalemia, hyperglycemia, and hyperuricemia. A. Terazosin B. Captopril C. Carvedilol D. Hydrochlorothiazide E. Diazoxide

D. Hydrochlorothiazide. Remember the mnemonic HyperGlUC, hyperglycemia, hyperlipidemia, and hyperuricemia.

A 65-year-old man now presents to the emergency department (ED) after a routine visit to his endocrinologist for follow-up of his diabetes mellitus. The endocrinologist referred him to the local ED for evaluation and potential hospitalization. The patient states that he has been gaining weight and having progressively worsening dyspnea on exertion. His shortness of breath is often worse at night, forcing him to 'sit bolt upright". He began utilizing three pillows at night one week ago without difficulty. This morning he became short of breath and diaphoretic after climbing a flight of stairs to his endocrinologist's office. 2D echocardiogram demonstrates left ventricular hypertrophy, reduced ejection fraction (calculated at 37%) and S3 heart sound is appreciated at apex and lateral positions. Oxygen, diuretic, captopril and digoxin therapy is initiated in this patient. The use of Furosemide in these patient results in hypokalemia and the patient now experiences symptoms nausea, diarrhea, bradycardia and visual disturbances. Which of the following is the most likely mechanism that promotes these side effects? A. Furosemide exacerbates captopril-induced side effects B. Furosemide-induced decrease in the metabolism of captopril C. Furosemide-induced decrease in the metabolism of digoxin D. Hypokalemia results in tighter binding of digoxin to its effector protein E. Hypokalemia results in less binding of digoxin to plasma membrane proteins

D. Hypokalemia results in tighter binding of digoxin to its effector protein. Potassium competes for binding of digoxin on the Na/K ATPase. With reduced potassium levels more digoxin toxicity can be observed. Note: Other ions can influence the toxicity of digoxin as well. For example, an increase in serum calcium can produce a calcium overload state in myocytes leading to ectopic afterdepolarizations. Magnesium has the opposite effect of calcium.

A 65 year old male is experiencing progressively worse dyspnea on exertion. His shortness of breath is worse at night, forcing him to sleep upright. He is unable to do the same amount of physical exertion as he did in the previous examination. His personal medical history indicates that he has hypertension and hypercholesterolemia. Chest X-rays, PA and lateral views, show evidence of congestive heart failure and cardiomegaly, interstitial edema, and some alveolar edema. 2D echocardiogram demonstrates severe left ventricular dilation and increased left atrial dimension in end diastole that appear to be unchanged as compared to end systole. Which drug listed above requires norepinephrine release to be effective? A. Captopril B. Digoxin C. Losartan D. Inamrinone E. Spironolactone

D. Inamrinone. Inamrinone is a phosphodiesterase inhibitor. Norepinephrine activating beta-1 receptors to produce cAMP is the first series in the cascade. Once cAMP is produced the phosphodiesterase inhibitor, inamrinone, prevents the breakdown of cAMP. No longer sold in US. Milrinone can be substituted as a distractor.

Which drug is correctly matched to its mechanism of action? DRUG MECHANISM OF ACTION A. Digoxin Nicotinic receptor antagonist B. Dobutamine Aldosterone antagonist C. Hydralazine Angiotensin-converting enzyme inhibitor D. Inamrinone Phosphodiesterase inhibitor E. Spironolactone Beta one adrenergic receptor agonist

D. Inamrinone: Phosphodiesterase inhibitor Inamrinone is now discontinued in the US but was used clinically for short term management of heart failure to increase contractility. Inamrinone's principle mechanism of action is to inhibit the phosphodiesterase enzyme responsible for the breakdown of cAMP in ventricular cardiac myocytes.The increase in intracellular levels results in a more pronounced PKA effect. In cardiac myocytes PKA phosphorylates calcium channels resulting in more calcium influx and release from SR increasing contraction. Digoxin is a Na/K ATPase inhibitor, dobutamine is "da" beta agonist, hydralazine is a vasodilator, and spironolactone is an aldosterone antagonist.

A 65-year-old man with a history of asthma, erectile dysfunction, CAD, and CABG X 3 vessels 7 years ago is admitted to the emergency department for increasingly frequent chest pain (substernal in location, crushing in character with radiating pain through arms). The pain, which he rates as approximately 7-8 on a scale of 1-10, comes from exertion and subsides with rest. His EKG demonstrates normal sinus rhythm. He avoids stairs, but says he can walk approximately 100 yds before he has to stop because of chest pain and fatigue. The pain occurs as often as he attempts this level of exertion. The patient frequently has some baseline shortness of breath due to his asthma, but that also worsens with exertion. The patient is prescribed sublingual nitroglycerin to treat his acute chest pain, aspirin and a lipid-lowering agent. This patient would be cautioned not to take drugs like sildenafil, tadalafil, and vardenafil to treat his erectile dysfunction because they both result in A. Decrease in intracellular cAMP B. Decrease in intracellular inositol tris-phosphate production C. Increased intracellular cAMP D. Increased intracellular cGMP E. Increased nitrous oxide release

D. Increased intracellular cGMP. D. Nitroglycerin breaks down to NO. NO activates guanylyl cyclase to increase the production of cGMP. Sildenafil and the rest inhibit the enzyme, phosphodiesterase, responsible for the breakdown of cGMP. This combinations leads to an excess amount of intracellular cGMP. Patients on this medication have an increased potential for life-threatening hypotension.

Beta adrenergic blockers are used as adjunct therapy in acute A. Bleeding from varicose veins B. Deep venous thrombosis C. Heparin induced paradox thromboembolism D. Myocardial infarction E. Vitamin K deficiency

D. Myocardial infarction

Which drug is correctly matched A. Amlodipine :Poor oral bioavailability B. Clonidine :Does not cross the blood brain barrier C. Reserpine :First line therapy for mild hypertension D. Nimodipine :Reduces consequences of subarachnoidal hemorrhage E. Nicardipine :Calcium channel blocker with the least reflex tachycardia

D. Nimodipine : Reduces consequences of subarachnoidal hemorrhage--reduces local vasospasm.

Which of the following drugs is used to treat subarachnoid hemorrhage? A. Bepridil B. Esmolol C. Isosorbide dinitrate D. Nimodipine E. Nitroglycerin (sublingual)

D. Nimodipine. This drug has been shown to reduce the incidence of ischemic complications (cerebral vasospasm) following aneurysmal subarachnoid hemorrhage. Nitrates are contraindicated.

Excessive hypotension is most likely to occur when this patient self-administers the phosphodiesterase (cGMP specific) inhibitors, sildenafil, while taking which of the following medications. A. Aspirin B. Captopril C. Propranolol D. Nitroglycerin E. Verapamil

D. Nitroglycerin. NO stimulates guanylyl cyclase to produce cGMP and smooth muscle relaxation. Inhibition of the phosphodiesterase responsible for the breakdown of cGMP can lead to excessive hypotension.

A 55-year-old male visits his primary care physician with complaints of chest discomfort, described as heaviness, squeezing pressure located on the sternum. His discomfort last 2-5 minutes and radiates to the left shoulder and to both arms. He explains that these symptoms occur when he is in a hurry, exercising, having sex, or when he is experiencing frustration or anger and subside with rest/relaxation. His chest discomfort limits his ordinary physical activity. He was admitted to the hospital and electrocardiogram recorded at rest is normal. His lab values indicate a total cholesterol level of 250 mmol/l, 165 LDL cholesterol, and 30 HDL cholesterol (desirable ranges for each are <200, <130, and >40, respectively). His personal medical history indicates that he is a smoker (2 ppd), has chronic obstructive pulmonary disease and erectile dysfunction. Which of the following medications is used for prompt relief of symptoms by relaxing all segments of the vascular system (arteries and veins)? A. Aspirin B. Clopidogrel C. Hydralazine D. Nitroglycerin E. Propranolol

D. Nitroglycerin. Nitroglycerin is primarily a venule dilator and is associated with a reduction in preload. However, at higher doses it can dilate arteries.

A 60 year old male patient is being treated with digoxin for his congestive heart failure is given erythromycin to treat his pneumonia. He now presents with symptoms of an arrhythmia, hypokalemia, nausea, vomiting, blurred vision, and anorexia. What would the appropriate next step in the management of this patient? A. Cardioversion therapy B. Increase the dose of Erythromycin C. Oral calcium and withdrawal of digoxin D. Oral potassium and withdrawal of digoxin E. Start quinidine antiarrhythmic therapy

D. Oral potassium and withdrawal of digoxin. In 10% of the population enteric organism affect the bio disposition of digoxin. If bacterial flora is reduced with antibiotics more digoxin reaches systemic circulation. Potassium is used to reduce the binding of digoxin to the Na/K ATPase.

A 44-year-old white male who has been taking Hydrochlorothiazide for mild hypertension develops a second-degree heart block. His hypertensive condition worsens, and the physician prescribes a standard dosage of a second hypertensive drug as an addition to the treatment regimen. Soon after taking the first dose, the patient stands up quickly, and collapses due to a brief loss of consciousness. Which of the following medications was this patient most likely administered? A. Candesartan B. Clonidine C. Enalapril D. Prazosin E. Propranolol

D. Prazosin: Orthostatic hypotension is associated with drugs that block the sympathetic (baro receptive adaptive) response to postural changes. In this case, the blockade of alpha-1 receptors prevents venule constriction upon standing so the blood pools in large leg veins by gravity.

A 44-year-old male begins treatment with an antiarrhythmic agent to suppress ventricular tachycardia. Two weeks later, he experiences arthralgia and other arthritic symptoms similar to lupus erythematosus and is hypotensive. Which drug listed below was most likely used in this patient? A. Disopyramide B. Lidocaine C. Ibutilide D. Procainamide E. Quinidine

D. Procainamide. Drugs like hydralazine, isoniazid, phenytoin, and procainamide are associated with drug induced lupus. Remember it's not HIPP to get lupus.

A 44-year old male patient with a family history of hypertension is monitored using an ambulatory-blood-pressure-monitor (ABPM) and found to have an awake blood pressure of 140/90 mmHg and during sleep 125/80 mmHg. Laboratory analysis demonstrates that this patient has elevated renin levels. Treatment with which of the following would be most likely to reduce blood pressure and suppress renin release in this patient? A. Benazepril B. Diazoxide C. Minoxidil D. Propranolol E. Valsartan

D. Propranolol. Beta-1 receptors are associated with an increase in renin release from the juxtaglomerular cells of the kidney.

A patient with a drug that lengthens the ventricular action potential duration, has antimuscarinic effects, and increases free digoxin levels by displacement from protein-binding sites. A. Adenosine B. Amiodarone C. Lidocaine D. Quinidine E. Procainamide

D. Quinidine

Administration this drug can increase"free" plasma levels of digoxin and its subsequent toxicity A. Propranolol B. Adenosine C. Dofetilide D. Quinidine E. Amiodarone

D. Quinidine: and other drugs like verapamil can displace digoxin (a relative fat soluble drug) from its plasma-carrier-protein resulting in more free levels of digoxin.

A 65-year-old man with a history of asthma, erectile dysfunction, CAD, and CABG X 3 vessels 7 years ago is admitted to the emergency department for increasingly frequent chest pain (substernal in location, crushing in character with radiating pain through arms). The pain, which he rates as approximately 7-8 on a scale of 1-10, comes from exertion and subsides with rest. His EKG demonstrates normal sinus rhythm. He avoids stairs, but says he can walk approximately 100 yds before he has to stop because of chest pain and fatigue. The pain occurs as often as he attempts this level of exertion. The patient frequently has some baseline shortness of breath due to his asthma, but that also worsens with exertion. The patient is prescribed sublingual nitroglycerin to treat his acute chest pain, aspirin and a lipid-lowering agent. The nitroglycerin is used in this patient to achieve which physiologic response? A. Constriction of both arterioles and veins B. Decrease the oxygen supply to the heart C. Dilate obstructed coronary vessels D. Reduce oxygen demand of individual myocytes E. Slow the heart rate

D. Reduce oxygen demand of individual myocytes. Nitroglycerin breaks down to NO, which produces relaxation of veins--less ventricular preload--less diastolic pressure--less ventricular wall stress--less output-- = less O2 demand.

Which diuretic can improve survival in stage IV congestive heart failure by reducing cardiac remodeling and fibrosis formation, but unfortunately is associated with hyperkalemia, gynecomastia, decreased libido, and gastric dyspepsia? A. Captopril B. Furosemide C. Hydrochlorothiazide D. Spironolactone E. Verapamil

D. Spironolactone: Cardiac remodeling is a negative term. The heart can become enlarged, thicker and more fibrotic when it is placed under to much after load, preload, or is damaged. Spironolactone can reduce preload by blocking aldosterone receptors and can directly inhibit cell signaling that leads to fibroblast growth and collagen disposition.

Which statement is true regarding sublingual nitroglycerin use? A. Sublingual nitroglycerin can be also used to reduce elevated intracranial pressure B. Sublingual nitroglycerin has a half-life of approximately 6-10 hours C. Sublingual nitroglycerin has poor bioavailability due to first-pass hepatic metabolism D. Sublingual nitroglycerin used continually can result in loss of effect E. Sublingual nitroglycerin usually results in bradycardia

D. Sublingual nitroglycerin used continually can result in loss of effect Nitroglycerin is contraindicated in patients with elevated ICP (us produces vasodilation and increased pressure). SC NG is used for acute episodes of stable angina (duration of action) 10-30 min. SC avoids first pass. NG induced vasodilation = reflex tachycardia.

Oral nitroglycerin A. is used to treat subarachnoid hemorrhages B. is not associated with reflex tachycardia C. has a half-life of approximately 6-10 hours D. has poor bioavailability due to first-pass hepatic metabolism E. used continually can result in complete loss of effect

D. has poor bioavailability due to first-pass hepatic metabolism. E is partially true. However, complete loss of effect probably won't occur. Certainly there will be loss of affect (tolerance) but the word complete makes D a better choice.

A patient is treated with an oral agent for a ventricular tachycardia for a year and now presents with exertional dyspnea and nonproductive cough consistent with symptoms of drug induced pulmonary fibrosis. A. Verapamil B. Adenosine C. Dofetilide D. Quinidine E. Amiodarone

E. Amiodarone: pulmonary fibrosis, hepatotoxicity, and thyroid function are some of the more serious complication of amiodarone use. Other stand out side effects are produce from the iodine on the molecule--corneal deposits and blue-grey skin discolorations.

A patient with hypertensive emergency is treated with a drug that can also be used to prevent hypoglycemia in patients with excess insulin release. A. Terazosin B. Captopril C. Carvedilol D. Hydrochlorothiazide E. Diazoxide

E. Diazoxide: can increase potassium outflow in both smooth muscle and in pancreatic cells.

HMG-CoA reductase inhibitor drugs A. Are all inactive before hydrolyzed in the intestine B. Bind irreversibly to the reductase enzyme C. Have a low first pass effect D. Inhibit cholesterol degradation in the liver E. Inhibit steroid biosynthesis in the liver

E. Inhibit steroid biosynthesis in the liver. Statins resemble HMG-CoA in molecular shape and when bound act as competitive antagonist (bind reversible). These drugs are used to treat hypercholesterolemia by decreasing cholesterol synthesis in the liver resulting in the up-regulation of liver LDL receptors. Note: only lovastatin and simvastatin are inactive until hydrolyzed in the gut.

Which of the following drugs is recombinant b-type natriuretic peptide? A. Captopril B. Isosorbide dinitrate C. Losartan D. Milrinone E. Nesiritide

E. Nesiritide

Which of the following drugs is most effective in reducing the level of triglycerides in plasma? A. Cholestyramine B. Colesevelam C. Ezetimibe D. Lovastatin E. Niacin

E. Niacin

Glucose intolerance in a patient with latent diabetes can be worsened by A. Colestipol B. Ezetimibe C. Fluvastatin D. Gemfibrozil E. Niacin

E. Niacin. Niacin use is associated with carbohydrate intolerance (decrease insulin sensitivity) and pronounced impairment in latent diabetes (relative contraindication)

Lovastatin and other statins can be safely administered to women who are A. Lactating B. Likely to get pregnant C. Pregnant D. Displaying elevated (3X) serum creatine kinase levels E. None of the above (A-D)

E. None of the above (A-D)

A 65-year-old man with a history of asthma, erectile dysfunction, CAD, and CABG X 3 vessels 7 years ago is admitted to the emergency department for increasingly frequent chest pain (substernal in location, crushing in character with radiating pain through arms). The pain, which he rates as approximately 7-8 on a scale of 1-10, comes from exertion and subsides with rest. His EKG demonstrates normal sinus rhythm. He avoids stairs, but says he can walk approximately 100 yds before he has to stop because of chest pain and fatigue. The pain occurs as often as he attempts this level of exertion. The patient frequently has some baseline shortness of breath due to his asthma, but that also worsens with exertion. The patient is prescribed sublingual nitroglycerin to treat his acute chest pain, aspirin and a lipid-lowering agent. This patient experiences some reflex tachycardia shortly after taking his nitroglycerin. Which of the following agents would you most likely use in combination with sublingual nitroglycerin to treat his angina and reduce reflex increases in heart rate? A. Bepridil B. Digoxin C. Nifedipine D. Propranolol E. Verapamil

E. Verapamil. Bepridil is a sodium channel blocker that also inhibits potassium channel conductance. Digoxin is a cardiac glycoside used for CHF. Propranolol is indicated for angina but should be used with caution in patients with asthma. A better choice is to use a CCB with cardiac effects. Verapamil has more direct cardiac effects (decrease conductance in SA and AV nodal cells) as compared to nifedipine.

Which of the following calcium channel blockers can be used to treat supraventricular arrhythmias as well as stable angina? A. Amiodarone B. Amlodipine C. Nifedipine D. Nimodipine E. Verapamil

E. Verapamil. Diltiazem and verapamil have pronounced cardiac and smooth muscle effects as compared to the dihydropyridine type CCB (nifedipine, amlodipine, etc.) which have mainly vascular effects.

Which of the following drugs is most likely to reduce peripheral vascular resistance and slow atrio-ventricular conduction velocity? A. Amlodipine B. Digoxin C. Nicardipine D. Nitroglycerin E. Verapamil

E. Verapamil. Verapamil is a non-dihydropyridine CCB that produces vasodilation and slow conduction in the SA and AV nodes.

A common toxicity of niacin is A. Gall stone formation B. Hypotension C. Migraine headache D. Myositis E. Warm flushes

E. Warm flushes. Niacin activates prostaglandin release producing cutaneous vasodilation. This effect can be mitigated by pre-administration of an NSAID or aspirin.

Which of the following is a frequent toxicity of niacin? A. Gall stone formation B. Hypertension C. Migraine headache D. Myositis E. Warm flushes

E. Warm flushes. Niacin stimulates prostaglandin release in the skin resulting in vasodilation. Flush can be blocked by using an NSAID or aspirin prior to niacin administration.