Transcript Document

MCQs framed from High yield
areas of Anti-anginal
Pharmacology
•
Mr. Green, 60 years old, has severe chest pain when he
attempts to carry parcels up stairs to his apartment. The
pain rapidly disappears when he rests. A decision is
made to treat him with nitroglycerin.
1. Nitroglycerin, either directly or through reflexes,
results in which one of the following effects?
(A) Decreased heart rate
(B) Decreased venous capacitance
(C) Increased afterload
(D) Increased cardiac force
(E) Increased diastolic intramyocardial fiber tension
• Mr. Green, 60 years old, has severe chest pain when he
attempts to carry parcels up stairs to his apartment. The
pain rapidly disappears when he rests. A decision is
made to treat him with nitroglycerin.
In advising Mr. Green about the adverse effects he may
notice, you point out that nitroglycerin in moderate doses
often produces certain symptoms. These toxicities result
from all of the following EXCEPT
(A) Meningeal vasodilation
(B) Reflex tachycardia
(C) Increased cardiac force
(D) Methemoglobinemia
(E) Sympathetic discharge
• Mr. Green, 60 years old, has severe chest pain when he
attempts to carry parcels up stairs to his apartment. The
pain rapidly disappears when he rests. A decision is
made to treat him with nitroglycerin .
• Two years later, Mr. Green returns complaining that his
nitroglycerin works well when he takes it for an acute
attack but that he is having frequent attacks now and
would like something to prevent them. Useful drugs for
the prophylaxis of angina of effort include which one of
the following?
(A) Amyl nitrite
(B) Diltiazem
(C) Esmolol
(D) Sublingual isosorbide dinitrate
(E) Sublingual nitroglycerin
• The antianginal effect of propranolol may
be attributed to which one of the following?
(A) Block of exercise-induced tachycardia
(B) Decreased end-diastolic ventricular
volume
(C) Dilation of constricted coronary
vessels
(D) Increased cardiac force
(E) Increased resting heart rate
• The major common determinant of
myocardial oxygen consumption is
• (A) Blood volume
• (B) Cardiac output
• (C) Diastolic blood pressure
• (D) Heart rate
• (E) Myocardial fiber tension
• You are considering therapeutic options for a
new patient who presents with severe
hypertension and angina. In considering adverse
effects, you note that an adverse effect which
nitroglycerin, guanethidine, and ganglion
blockers have in common is
• (A) Bradycardia
• (B) impaired sexual function
• (C) Lupus erythematosus syndrome
• (D) Orthostatic hypotension
• (E) Throbbing headache
• Epidemiologic surveys suggest that, in the past, workers
exposed to high levels of organic nitrates in the
workplace had
(A) A high incidence of methemoglobinemia on the job
(B) An increased incidence of angina at work as
compared with at home
(C) A high incidence of cyanide poisoning in the
workplace
(D) An increased incidence of headaches on Mondays
as compared with other days
(E) All of the above
• A patient is admitted to the emergency
department following a drug overdose. He is
noted to have severe tachycardia. He has been
receiving therapy for hypertension and angina. A
drug that often causes tachycardia is
• (A) Diltiazem
• (B) Guanethidine
• (C) Isosorbide dinitrate
• (D) Propranolol
• (E) Verapamil
• A patient being treated for another condition
complains that whenever he takes that
medication, his angina becomes worse. Drugs
that may precipitate angina when used for other
indications include all of the following EXCEPT
• (A) Amphetamine
• (B) Hydralazine
• (C) lsoproterenol
• (D) Reserpine
• (E) Terbutaline
• When nitrates are used in combination with other drugs
for the treatment of angina, which of the following result
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) Calcium channel blockers and nitrates on cardiac
force
• (E) Calcium channel blockers and nitrates on cardiac
rate
• Which of the following is approved for the treatment of
hemorrhagic stroke?
• (A) Amyl nitrite
• (B) Hydralazine
• (C) Isosorbide mononitrate
• (D) Nifedipine
• (E) Nimodipine
• (F) Nitroglycerin (sublingual)
• (G) Nitroglycerin (transdermal)
• (H) Propranolol
• (I) Terbutaline
• (J) Verapamil
• Which of the following drugs used for the treatment of angina by
inhalation has a very rapid onset and a brief duration of effect (2-5
minutes)?
• (A) Amyl nitrite
• (B) Hydralazine
• (C) [sosorbide mononitrate
• (D) Nifedipine
• (E) Nimodipine
• (F) Nitroglycerin (sublingual)
• (G) Nitroglycerin (transdermal)
• (H) Propranolol
• (I) Terbutaline
• (J) Verapamil
• Which of the following drugs is capable of maintaining blood levels
for 24 hours but with useful therapeutic effects lasting only about 10
hours?
• (A) Amyl nitrite
• (B) Hydralazine
• (C) Isosorbide mononitrate
• (D) Nifedipine
• (E) Nimodipine
• (F) Nitroglycerin (sublingual)
• (G) Nitroglycerin (transdermal)
• (H) Propranolol
• (I) Terbutaline
• (J) Verapamil
• Which of the following is a vasodilator drug used for hypertension
that lacks a direct effect on autonomic receptors but may provoke
anginal attacks?
• (A) Amyl nitrite
• (B) Hydralazine
• (C) Isosorbide mononitrate
• (D) Nifedipine
• (E) Nimodipine
• (F) Nitroglycerin (sublingual)
• (G) Nitroglycerin (transdermal)
• (H) Propranolol
• (I) Terbutaline
• (J) Verapamil
• Your patient has been experiencing chest pain on
exertion. One of his friends told him that he has been
taking a drug for hypertension and that it is very effective
in lowering blood pressure. The friend suggests that your
patient try some of the drug: "It won't hurt anything and it
may save the expense of a doctor's visit." He tries the
agent and experiences severe chest pain, worse than
before. The explanation of this phenomenon may be
• (A) "coronary steal" occurred
• (B) a nitrate arteriolar dilator should have been used
• (C) reflex vasoconstriction occurred
• (D) the drug suppressed the heart
• (E) venous dilation occurred
• Erectile dysfunction has been treated by
numerous agents over the centuries. The
effectiveness of these agents depends on intact
parasympathetic innervation and
• (A) a bladder or urethral irritant (Spanish fly)
• (B) a reduction in the levels of cyclic guanosine
monophosphate (cGMP)
• (C) an alpha2 antagonist to relax nonvascular
smooth muscle in the penis
• (D) an inhibitor of phosphodiesterase isoform 5
• (E) blockade of prostaglandin El (PGEl)
• A 49-year-old man is suffering from hypertension, and he
has a history of atrial tachycardia. In selecting a calcium
channel blocker to manage the tachycardia, the most
appropriate agent would be
• (A) amlodipine
• (B) isradipine
• (C) nifedipine
• (D) propranolol
• (E) verapamil
• (Answer:E) Due to the fact that it is more selective for
the heart, the most appropriate agent would be
verapamil.
• A 55-year-old woman presents with angina pectoris and
she is placed on a beta-adrenergic blocking agent. The
rationale for the use of a beta blocker is
• (A) that an increase in end-diastolic volume will increase
contractile force development
• (B) production of a decrease in heart rate, blood
pressure, and contractility
• (C) production of an increase in myocardial oxygen
demand
• (D) production of coronary artery vasodilation
• (E) redistribution of coronary blood flow to ischemic
areas
• A 46-year-old man who is overweight and in a highpressure executive position has been treated with a
beta-adrenergic blocking agent (propranolol) for
episodes of angina pectoris. The diagnosis is angina of
effort. Lately, the effectiveness of propranolol has been
less than desired, and he is also complaining that he
feels tired. The most appropriate approach to therapy
would be to
• (A) add metoprolol to the regimen
• (B) add nifedipine to the regimen
• (C) advise him to quit his job and find another profession
• (D) increase the dose of propranolol
• (E) revise the therapy to combine a beta blocker, a
calcium channel blocker, and a nitrate