CVS Pharmacology Flashcards
A 61-year-old man with Parkinson’s disease on bro-
mocriptine dies suddenly of a cardiopulmonary arrest.
Autopsy is performed at the request of the family.
Sectioning of the lungs in this patient is most likely to
reveal which of the following findings?
(A) Adenocarcinoma
(B) Pneumonia
(C) Pulmonary embolus
(D) Pulmonary fibrosis
(E) Squamous cell carcinoma
Answer is (A)
bromocriptine is
an ergot derivative,and it cause pul-
monary and retroperitoneal fibrosis
A medical student is doing a summer research project
that involves administering b2-receptor agonists to
rats to determine the physiologic changes. Which of
the following would be expected following steady state
intravenous dosing of agent X, a b2-receptor agonist?
(A) Bronchoconstriction
(B) Hyperglycemia
(C) Hypertension
(D) Uterine spasm
(E) Vasoconstriction
Answer is (B)
b2-Receptor agonists cause hepatic glycogenolysis and muscle
glycogenolysis,
A 58-year-old woman who is obese presents to the
emergency department with diaphoresis and crushing
chest pain that radiates to her left arm. The physician
orders an ECG and checks her cardiac enzymes to
confirm his suspicion of myocardial infarction.
Because of the quick response and intervention, she
survives and is ultimately discharged with a prescrip-
tion for low-dose daily aspirin to inhibit platelet
aggregation. Two weeks after discharge, she takes
ibuprofen for a tension headache. What is the effect of
the ibuprofen on her anticoagulation regimen?
(A) Excessive antiplatelet activity because of a syn-
ergistic action between aspirin and ibuprofen on
platelets
(B) Excessive antiplatelet activity because of ibupro-
fen’s effects on endothelial cells combined with
aspirin’s effects on platelets
(C) Insufficient antiplatelet activity because ibupro-
fen induces liver cytochrome P450 metabolism
of aspirin
(D) Insufficient antiplatelet activity because of inad-
equate platelet cyclooxygenase inhibition
(E) No change
Answer is (D)
Aspirin and ibuprofen both inhibit
COX enzymes in both platelet and endothelial cells,
but aspirin inhibition is irreversible, whereas ibuprofen inhibition is reversible.
Ibuprofen can actually prevent COX deactivation in platelets by aspirin by occupying the active
site of the enzyme, so aspirin is unable to enter and
modify it.
The rationale behind the use of dopamine as a treat-
ment of shock in a 38-year-old man who was a driver
in a motor vehicle accident who was thrown from the
vehicle is
(A) Impermeability to the blood–brain barrier
(B) Long duration of action
(C) Oral administration
(D) Potentiates hypotension
(E) Slow onset of action
Dopamine is a catecholamine, which is useful in the treatment of shock. It can also be used in the
treatment of congestive heart failure and can raise
blood pressure. and also have rapid onset and IV route
A 28-year-old woman who is 24 weeks pregnant with
her first child is admitted to the hospital for monitoring
and intravenous fluid hydration. Which of the follow-
ing agents prevents the development of preterm labor?
(A) Albuterol
(B) Isoproterenol
(C) Metaproterenol
(D) Metoprolol
(E) Terbutaline
Terbutaline is used offlabel as a uterine relaxant to suppress premature labor
Albuterol is used in the treatment of asthma.
Metoprolol is an antihypertensive agent
Five patients with small pheochromocytomas are
being prepared for surgical resection. All patients
have tumors less than 3 cm in size and are confined to
the adrenal gland. Phentolamine will be given to each
patient. Which of the following patients would be
most likely to suffer an adverse event related to this
medication?
(A) A 33-year-old woman with hypertension
(B) A 41-year-old man with hypertension and kidney
stones
(C) A 45-year-old man with hyperparathyroid adenoma
and testicular cysts
(D) A 51-year-old man with angina who suffered a
heart attack 2 years ago
(E) A 60-year-old woman with hypertension, kidney
stones, and a left renal cyst
Phentolamineinduced reflex cardiac stimulation and tachycardia are
mediated by the baroreceptor reflex and by blocking
the receptors of the cardiac sympathetic nerves
Phentolamine is contraindication in patient with decreased coronary perfusion
A 78-year-old man with Alzheimer’s disease and
hypertension is given oral propranolol to treat his
hypertension because of a pharmacy clerical error.
The patient has been taking the medication for
3 weeks and now presents to his primary care physi-
cian for follow-up. Which of the following effects
would be most worrisome?
(A) Auditory hallucinations
(B) Excessive somnolence
(C) Muscular rigidity
(D) Short-term memory loss
(E) Urinary incontinence
Answer is (D)
Propranolol has CNS effect including depression, dizziness, lethargy, fatigue,
weakness, visual disturbances, hallucinations, shortterm memory loss, emotional lability, vivid dreams
(including nightmares)
A 63-year-old man with hypertension is currently tak-
ing carvedilol. He returns to his primary care physi-
cian for follow-up. His blood pressure is 130/70 mm Hg
at this office visit. His cardiac, pulmonary, and ab-
dominal examinations are within normal limits.
Additional beneficial effects of this medication may be
which of the following?
(A) Hypoglycemia
(B) Hyperglycemia
(C) Improved vascular wall thickening
(D) Increased lipid peroxidation
(E) Vasoconstriction
Answer is (C)
Carvedilol is a reversible b-blocker that produces peripheral vasodilation and decreased blood pressure.
Additionally, this agent decreases lipid peroxidation
and vascular wall thickening, which may be helpful in
patients with heart failure.
A 59-year-old black man with uncontrolled hyper-
tension is brought to the urgent care center for evalu-
ation. His blood pressure is 190/100 mm Hg. He
currently takes no medications. Physical examination
of the heart, lungs, and abdomen are noncontribu-
tory. Which of the following agents will have limited
efficacy in the management of this patient?
(A) Labetalol
(B) Methyldopa
(C) Pindolol
(D) Triamterene
(E) Verapamil
Answer is (c) Triamterene is k sparing Diuretic
A 47-year-old man with a 9-cm right adrenal tumor is
going to undergo a laparoscopic surgical procedure to
remove the tumor. It is anticipated that the procedure
will take approximately 16 h. The patient has a his-
tory of hypertension controlled with a b-blocker.
Which of the following agents, used intraoperatively,
will provide efficacious blood pressure control for the
duration of the procedure?
(A) Acebutolol
(B) Esmolol
(C) Metoprolol
(D) Nadolol
(E) Pindolol
Answer is (A)Nadolol has a half-life of 12 to 24 h and would be the best agent for bblockade in a patient who is undergoing a long duration surgical procedure.
A 78-year-old black male with hypertension is cur-
rently well controlled in terms of his blood pressure.
He is presently taking an agent that blocks the
Mg21/ATP-dependent transport of biogenic amines
from the cytoplasm into storage vesicles in the adren-
ergic nerves. Which of the following medications is
this patient most likely taking?
(A) Atenolol
(B) Esmolol
(C) Guanethidine
(D) Reserpine
(E) Timolol
Answer is (D)
Reserpine is a plant alkaloid that blocks the Mg21/ATP-dependent transport of
biogenic amines from the cytoplasm into storage vesicles in the adrenergic nerves.
Guanethidine blocks norepinephrine release from
storage vesicles
A 43-year-old man with depression who has been in
and out of the psychiatric unit because of noncompli-
ance with medications decides to take intranasal
cocaine on a regular basis. He notes that he feels
better and thinks that this helps his depression.
Through which of the following mediators does this
effect likely occur?
(A) Dopamine
(B) Epinephrine
(C) Glutamine
(D) Norepinephrine
Answer is (A) Chronic intake of cocaine depletes dopamine. This depletion triggers the vicious cycle of craving for cocaine that temporarily relieves severe depression. In particular, the prolongation of dopaminergic effects in the brain’s pleasure system (limbic system) produces the intense euphoria that cocaine initially causes.
A 24-year-old man with myopia decides to undergo
LASIK surgery to correct his vision. Prior to the pro-
cedure, the ophthalmologist dilates his pupils with
phenylephrine, a sympathomimetic. Which of the fol-
lowing describes an effect of the sympathetic nervous
system?
(A) Contraction of the detrusor muscle
(B) Decreasing heart rate
(C) Stimulating vascular smooth muscle in arterioles
supplying the stomach
(D) Stimulating vascular smooth muscle in arterioles
supplying the quadriceps femoris
(E) Stimulating bronchiolar smooth muscle
Answer is(C) Phenylephrine
causes contraction of the dilator muscle by stimulating a2-receptors to induce mydriasis.
Contraction of the detrusor muscle of the bladder is mediated acetylcholine (ACh)
A 56-year-old man presents to his primary care physi-
cian complaining of difficulty urinating. Digital rectal
exam reveals an enlarged prostate. The patient is
started on a trial of terazosin, after which his symp-
toms improve dramatically. Which of the following
describes terazosin’s drug class?
(A) a1-Adrenergic antagonist
(B) a2-Adrenergic antagonist
(C) Anticholinergic
(D) b2-Adrenergic agonist
(E) b2-Adrenergic antagonist
Answer is (A) The -zosin drugs such as terazosin, prazosin, and doxazosin are Stimulation of a1-receptors leads to an increase in intracellular calcium and smooth muscle contraction a1-adrenergic antagonists
A 64-year-old man is brought to the emergency
department complaining of crushing chest pain radi-
ating to his left arm. He is admitted, stabilized, and
treated for an acute myocardial infarction. Later, he
developed ventricular tachycardia and is treated with
an antiarrhythmic. After a week of antiarrhythmic
treatment, he began having difficulty breathing.
A chest X-ray reveals pulmonary fibrosis. Which anti-
arrhythmic was he taking?
(A) Amiodarone
(B) Digoxin
(C) Lidocaine
(D) Procainamide
(E) Verapamil
Amiodarone is an antiarrhythmic notorious for its pulmonary side effects including pulmonary fibrosis Amiodarone is a class III antiarrhythmic and also functions as a vasodilator
