Pharm Board Review Part 2

Pharmacologic therapies for heart failure include

1. Removal of retained salt and water with diruretics 2. Reduction of aterload and salt and water retention with ACE inhibitors 3. reduciton of excessive sympathetic stimulation through beta blockers 4. reduction of preload or afterload with vasodilators 5. direct augmentation of depressed cardiac contractility with positive inotropic drugs (digitalis)

A 16-year-old girl has paroxysmal attacks of rapid heart rate with palpitations and hsortness of breath. These episodes occasionally terminate spontaneously but often require a visit to the emergency department. 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. proparolol E. verapamil

A

A 5-year-old child is 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

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 decision is made to treat him with nitroglycerine If a beta blocker were to be used for prophylaxis in this patient what is the most probably moa 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

A 60-year-old patient complains of paresthesias and occasional nausea associated with one of her drugs. She is found to have hyperchloremic metabolic acidosis she is probably taking A. 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

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 treating high altitude sickness is A. acetazolamide B. amiloride C. demeclocycline D. desmopressin E. ethacrynic acid.

A

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

A 70-year-old retired businessman is admitted with a history of recu rrent heart failure and metabolid 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. hydrochlorothiazide E. spironolactone

A Carbonic anhydrase inhibitors are good for patients with edema and metabolic alkalosis (don't get lost in the heart failure part)

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 nitrites not nitrates cause methemoglobinemia and we induce this in treatment of cyanide poisoning

A 26 year old woman presents with amenorrhea and galactorrhea. Her prolactin level is grossly elevated. 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 is a dopaine agonist

Digoxin on the AV node and ECG causes: AV refractory period to INCREASE or DECREASE QT interval to INCREASE or DECREASE T wave to be UPRIGHT or INVERTED

AV increased QT decreased t wave inverted

Clonidine

Alpha 2 agonist Reduces BP by reducing Cardiac output, vascular resistance, or both

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 decision is made to treat him with nitroglycerine One year later, the patient returns complaining that his nitroclycerin works well when he takes it for an acute attack but that now he is having more frequent attacks and would like something to prevent them. useful drugs for the prophylaxis of angiona of effort include A. amyl nitrate B. diltiazem C. esmolol D. sublingual isosorbide dinitrate E. sublingual nitroglycerin

B

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 or weight gain. Which one of the following drugs would be most useful? A. digoxin B. furosemide C. minoxidil D. propranolol E. spironolactone

B

A 73- year-old man with an inadequate response to other drugs is to receive digoxin for heart failure. After your patient has been receiving digoxin for three weeks 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

A 76 year old patient with rheumatoid arthritis and chronic heart disease is being considered for treatment with procainamide. She is already receiving digoxin, hydrochlorthiazide and potassium supplements for her cardiac condition. In deciding on a treatment regimen with procainamide for this patient, which of the following statements is most correct? 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 likelihood of procainamide toxicity C. procainamide can't be used if the patient has asthma because it has a beta blocking effect D. procainamide has a duration of action of 36-40 hours E. procainamide is not active by the oral route

B

When working in outlying fields, this 62-year old farmer is away from his house for 12-14 hours at a time. He has an arrhythmia that requires chronic therapy. Which of the following has the longest half life of the antiarrythmic drugs? A. adenosine B. Amiodarone C. disopyramide D. esmolol E. flecainide F. lidocaine G. mexiletine H. Procainamide I. Quinidine J. verapamil

B

Which one of the following drugs is associated with clinically useful or physiologically important positive inotropic effect? A. captopril B. dobutamine C. enalapril D. Lorsartan E. Nesiritide

B

Which one of the following is characteristic of captopril treatment in patients with essential hypertension? A. competitively blocks angiotensin II at its receptor B. decreases angiotensin II concentration in the blood C. decreases renin concentration in the blood D. increases sodium and decreases potassium in the blood E. Decreases sodium and increases potassium in the urine

B

a 73- year old man with a history of falling at home is found to have moderately severe hypertension. 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 receptor blockers C. arteriolar dilators D. beta1 selective receptor blockers E. non selective beta blockers

B

A 32-year-old woman with hypertension wishes to become pregnant. Her physician informs her that she will have to switch to another antihypertensive drug. Which of the following drugs is absolutely contraindicated in pregnancy? A. atenolol B. captopril C. methyldopa D. prazosin E propranolol

B atenolol-beta blocker (prefers beta 1) Captopril- ace inhibitor Methyldopa- alpha 2 agonist Prazosin- alpha 1 antagnoist Propranolol- non selective beta blocker

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 Smooth muscle effects of histamine are mediated by H1 receptors. Cetirizine is an antagonist, graniesetron is a serotonin 5HT3 antagonist, sumatriptan is a 5HT1 agonist, ranitidine is a H2 antagonist

Your 37-year-old pateint has been diagnosed with a rare metastatic carcinoid tumor. This neoplasm is releasing serotonin, bradykinin and several unknown peptides. The effects of serotonin in this patient are most likely to include which of the following? A. Constipation B. episodes of bronchospasm C. hypersecretion of Gastric acid D. hypotesnion E. urinary retention

B this is the only effect that serotonin can cause

A 62- year old man with advanced prostate cancer is admitted to the emergency department with mental obtundation. An electrolyte panel shows a high serum calcium. 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. Diuretic therapy of hypercalcemia requires a reduction in calcium reabsorption in the thick ascending limb, an effect of loop diuretics

A 55-year old man is admitted to the emergency department and is found to have an abnormal ECG. Overdose of an antiarryhmic 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

A 60-year old man comes to the emergency department with severe chest pain. ECG reveals ventricular tachycardia with occasional normal sinus beats and ST segment changes suggestive of ischemia. A diagnosis of myocardial infarction is made and the man is admitted to the cardiac intensive care unit. His arrythmia should be treated immediately with. A. adenosine B digoxin C. lidocaine D. quinidine Everapamil

C

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 manifestation of this intolerance? A. diarrhea B. glaucoma C. incessant cough D. lupus like syndrome E. vomiting

C

Which of the following drugs slows conduction through the AV node and has its primary action directly on L-type calcium channels? A. adenosine B. amiodarone C. diltiazem D. esmolol E. flecainide F. lidocaine G. mexiletine H. procainamide I. Quinidine

C

Which one of the following is a significant unwanted effect of the drug named? A. heart failure with hydralazine B. hemolytic anemia with atenolol C. fetal damage with lorsartan D. lupus like syndrom with hydrochlorothiazide E. tachycardia with verapamil

C

A 45 year old man is brought to the emergency department with mental obtundation. He is found to have a bp of 220/160 and retinal hemorrhages. which one of the following is used in severe hypertensive emergencies, is short acting, acts on g protein coupled receptor and must be given by IV infusion A. aliskiren B. captopril C. fenoldopam D. hydralazine E. losartan F. metoprolol G. Nifedipine H. Prazosin I. Propranolol

C Aliskiren- renin inhibitor captopril- ace inhibitor Fenoldopam- dopamine D 1 agonist Hydralazine- vasodilator Lorsartan- angiotensin II antagonist Metoprolol- beta 1 blocker Nifedipine- ca channel blocker Prazosin- alpha 1 antagonist propranolol- non selective beta blocker

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 heartrate in a dose-dependent manner A. captopril B. hydrochlorothiazide C. minoxidil D. Prazosin E. verapamil

C Captopril- ace inhibitor hydrochlorothiazide-thiazide diuretic minoxidil- vasodilator prazosin- alpha 1 antagonist verapamil- ca channel blocker

When nitrates are used in combination with other drugs for the treatment of angina, which one of the following combinations results in additive effects on the variable specified? A. beta blockers and nitrates on end-diastolic cardiac size B. beta blockers and nitrates on heart rate C. calcium channel blockers and beta blockers on cardiac force D. beta blockers and nitrates on venous tone E. calcium channel blockers and nitrates on heart rate

C Effects of beta blockers and calcium channel blockers are the same. the effects of beta blockers or calcium channel blockers and nitrates are opposite.

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 result sin high concentrations of calcium salts in the tubular urine. the most useful diuretic agent in the treatment of recurrent calcium stones is A. acetazolamide B. furosemide C. hydrochlorothiazide D. mannitol E. spironolactione

C Thiazides are useful in prevention of calcium stones

A 70- year old woman is admitted to the emergency department because of a "Fainting Spell" at home. She appears to have suffered no trauma from her fall but her BP is 120/60 when laying down and 60/20 when she stands up. neuro exam and ecg are WNL when she is laying down. She is takin water pills for a heart condition. Which of hte following drugs is th emost likely cause of her fainting spell? A. acetazolamide B. amiloride C. furosemide D. hydrochlorothiazide E. spironolactone

C- causes a reductin of blood volume sufficient to result in orthostatic hypotension

A 58-year old woman with lung cancer has abnormally low serum osmolality. A drug that increases the formation of dilute urine and is used to treat SIADH is A. Acetazolamide B. amiloride C. conivaptan D. desmopressin E. ethacrynic acid F. furosemide G. hydrochlorothiazide H. mannitol I. Spironolactone J. Triamterene

C. Antagonist of ADH

Another patient is admitted to the emergency department after a drug overdose. He is noted to have hypotension and severe tachycardia. He has been receiving therapy for hypertension and angina. Which of the following drugs often causes tachycardia A. clonidine B. diltiazem C. isosorbide dinitrate D. propranolol E. verapamil

C. all other drugs here slow heart rate

A 36- year old woman with a history of poorly controlled thyrotoxicosis has recurrent episodes of tachycardia with severe shortness of breath. When she is admitted to the emergency department with one of these episodes which of the following drugs would be most suitable? A. amiodarone B. disopyramide C. esmolol D. quinidine E. verapamil

C. esmolol

Nifedipine

Ca channel blocker

Verapamil

Ca channel blocker

Diltiazem

Calcium channel blocker

Verpamil

Calcium channel blocker, antiarrythmia

Acetazolamide

Carbonic anhydrase inhibitor, causes bicarbonate diuresis resulting in metabolic acidosis, causes significant potassium wasting -can be used in the eye for glaucoma (also topical dorzolamide) -only used as a diuretic if there is significant metabolic alkalosis

potassium sparing diuretics act where in the nephron

Collecting tubule

A 20-year old woman is taking diphenydramine 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. uterine cramps

D

A 57-year old man is admitted to the emergency department with an irregular heart rate. The ECG shows an inferior myocardial infarction and ventricular tachycardia. Lidocaine is ordered. When used as an antiarrhythmic drug, lidocaine typically A. increases action potential duration B. increases contractility C. increases PR interval D. reduces abnormal automaticity E. reduces resting ptotential

D

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 decision is made to treat him with nitroglycerine 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. apnea due to cranial vasodilation 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

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 decision is made to treat him with nitroglycerine Which of the following is a common direct or reflex effect of nitroglycerin? A. decreased herat rate B. decreased venous capacitance C. increased afterload D. increased cardiac force E. increased diastolic myocardial fiber tension

D

A 73- year-old man with an inadequate response to other drugs is to receive digoxin for heart failure. Which of the following is the best-documented mechanism of beneficial action of cardiac glycosides? 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 beta adrenoceptors

D

A new 60-year-old patient presents to the medical clinic with hypertension and angina. In considering adverse effects of possible drugs for these conditions, you note than 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. throbbing headache

D

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 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

D

Comparison of prazosin with ateolol shows that A. both decreases 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 By reducing BP, both may increase central sympathetic outflow (a compensatory response)

A 45- year old woman with hyperlipidemia and frequent migraine headaches develops angina of effort. Which of the following is relative contraindicated because of her migraines A. amlodipine B. diltiazem c. metoprolol D. nitroglycerin E. verapamil

D (associated with headaches)

Afterload

Determined by arterial blood pressure and large artery stiffness -one of the systolic determinates of oxygen requriement

A 76 year old patient with rheumatoid arthritis and chronic heart disease is being considered for treatment with procainamide. She is already receiving digoxin, hydrochlorthiazide and potassium supplements for her cardiac condition. 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 channel chelator such as EDTA B. digitalis C. nitroprusside D. potassium chlroide e. sodium lactate

E

An 82-year-old woman has long-standing heart failure. which one of the following drugs has been shown to reduce mortality in chronic heart failure? A. atenolol B. digoxin C. dobutamine D. furosemide E. spironolactone

E

Which of the following diuretics would be most useful in the acute treatment of a comatose patient with brain injury and cerebral edema? A. acetazolamide B. amiloride C. ethacrynic acid D. furosemide E. Mannitol

E

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 acidosis E. ototoxicity

E

A 33 year old woman attempted to induce an abortion using ergotamine. Her legs become cold with absent arterial pulses. Which of the following is the most useful antidote for reversing severe ergot indused vasospasm? A. Bromocriptine B. cimetidine C. ergotamine D. ketanserin E. LSD F. nitroprusside G. sumatriptan H. Ondansetron

F

Certain drugs can cause severe hypotension when combined with nitrates. Which of the following interacts with nitroglycerin by inhibiting the metabolism of cGMP? A. Atenolol B. hydralazine C. isosorbidde mononitrate D. nifedipine E. ranolazine F. sildenafil G. terbutaline

F Sildenafil inhibits phosphodiesterase 5, an enzyme that inactivates cGMP. the nitrates increases the synthesis of cGMP. This combination is synergistic

A 28 year old office worker suffers from intense migraine headaches. Which of the following is a serotonin agonist useful for aborting an ac ute migraine headache? A. bromocriptine B. cimetidine C. ephedrine D. ketanserin E. loratidine F. ondansetron G. sumatotriptan

G(5HT1d agonist)

Histamine receptors are what type of receptors?

G-coupled receptors

Four groups of antiarrythmics

Group 1: Sodium channel blockers Group 2: beta blockers Group 3: Potassium channel blockers Group 4: calcium channel blockers

Mexiletine

Group IB antiarrhythmic drug: like lidocaine but orally active, sodium channel blocker

Flecainide

Group IC antiarrhythmic prototype: used in ventricular tachycardia and rapid atrial arrhythmias with Wolff−Parkinson−White syndrome. Tox: arrhythmogenic, CNS excitation sodium channel blocker

A 38-year-old man who has been running a marathon collapses and is brought to the emergency deparment. He is found to have a left ventricular myocardial infarction and heart failure with significant pulmonary edema. The first-line drug of choice in most cases of heart failure is A. atenolol B. captopril C. carvedilol D. digoxin E. diltiazem F. dobutamine G. enalapril H. Furosemide I. Metoprolol J. Spironolactone

H

Which of the following is very short acting and acts by releasing nitric oxide? A. ateolol B. captopril C. diltiazem D. fenoldopam E hydrochlorothiazide F. lorsartan G. minoxidil H. nitroprusside I. Prazosin

H Atenolol- beta blocker Captopril- ace inhibitor Diltiazem- calcium channel blocker Fenoldopam- dopamine D1 receptor agonist Hydrochlorothiazide- thiazide diuretic Lorsartan- angiotensin II antagonist Minoxidil- vasodilator, causes tachytardia Prazosin- alpha 1 antagonist

Histamine H1 receptor uses what two second messengers?

Inositol triphosphate (IP3) and diacylglycerol (DAG)

Methyldopa (methylnorepinephrine)

Methyldopa is converted to methylnorepienphrine in the brain Alpha 2 agonist used in hypertension to reduce BP

Thiazide diuretics target

Na/CL pump in the distal convoluted tubule

loop diuretics target

Na/K/2CL transporter

MOA of nitroglycerine

Nitrates release NO within smooth mucle cells which stimulates guanylyl cyclase and causes an increase of the second messenger cGMP which results in smooth muscle relaxation by dephosphorylation of myosin light chain phosphate

5HT3 Blocker

Ondansteron ,antiemetic

Ergot alkaloids in blood vessels

Produce marked and prolonged alpha receptor mediated vasoconstriction

5HT1 agonists

Sumatriptan and other triptans- used for migraines

The diuretics most important for treating hypertension are

Thiazides (hydrochlorothiazide) Loop diuretics (furosemide)

amiodarone

antiarrhythmic, group three, potassium channel blocker, most efficatious antiarrythmic drug, also blocks sodium, clacium and potassium channels and beta adrenoreceptors, but has a lot of toxicities

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 OB bleeding B. Cetirizine: for hay fever C. Ergonovine for Alzheimer's disease D. ondansetron for acute migraine headaches E. ranitidine for parkinson's disease

b

Lorsatan

blocks angiotensin II at it's receptor site (don't use this or ace inhibitors in pregnancy)

A laboratory study of new H2 blockers is planned. Which of the following will result form blockaded of H2 receptors? A. increased cAMP in cardiac muscle B. decreased channel opening in enteric nerves C. decreased cAMP in gastric mucosa D. increased IP3 in platelets E. increased IP3 in smooth muscle

c

A patient with hypertension is to receive a calcium channel blocker. Verapamil is associated with which one of the following? a. diarrhea b. hypoglycemia C. increased PR interval D. tachycardia E. thyrotoxicosis

c Cause bradycardia in the heart because inhibition of calcium influx

amlodipine

calcium channel blocker

Dofetilide and ibutilide

class III antiarrythmics that block K+ channels in the myocardium causing prolonged phase 2 and phase 3 of the AP and prolonged refractory periods

You are asked to consult on a series of cases of drug toxicities. Which of the following is a recognized adverse effect of cimetidine? A. blurred vision B. diarrhea C. orthostatic hypotension D. p450 enzyme inhibition E. sleepiness

d

Preload

diastolic filling pressure -function of blood volume and venous tone (venous tone is mainly controlled by sympathetic outflow)

A40-year old patient is about to undergo cancer chemotherapy with a highly emetogenic 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

two ways to help angina

increase oxygen delivery reduce oxygen requirement

MOA of digitalis

inhibition of Na/K ATPase resulting in increase of intracellular sodium, altering sodium concentration so less calcium is removed from the cell. Increase in intracellular calcium increases contractile force

furosemide

loop diuretic

Phenoxybenzamine

nonselective alpha antagonist, not used in hypertension because causes tachycardia

Phentolamine

nonselective alpha antagonist, not used in hypertension because causes tachycardia

mannitol

osmotic diuretic- acts on the proximal convoluted tubule

Ergot alkaloids in the uterus

produce powerful contractions

aliskiren

renin inhibitor- blocks production of angiotensin 1 from angiotensinogen

Procainamide

sodium channel blocker, antiarrythmic

Hydralazine

vasodilator, works on arterioles more than veins, appears to work through release of NO, causes vasodilation, used for hypertension to lower BP

Torsades de pointes

ventricular arrhythmia that is often induced by antiarrhythmic and other drugs that change the shape of the action potential and prolong the QT interval.