Pharm Exam Final: Adjuncts

Question 1

Mr. Spencer is in your preoperative holding room, scheduled for a CABG x 4 this am. You realize that he has not had his beta blocker this am. Which beta-blocker will you administer???

Labetalol
Metoprolol
Carvedilol
Esmolol
Propranolol

Answer 1

The best choice for Mr. Spencer, who is scheduled for a coronary artery bypass graft (CABG) surgery and has not received his beta-blocker in the morning, would likely be Metoprolol. This is because Metoprolol is a beta-1 selective blocker that has a cardio-protective effect by decreasing heart rate, myocardial contractility, and thus myocardial oxygen demand, which is particularly beneficial in the context of ischemic heart disease and perioperative myocardial protection. It is also commonly used pre- and post-operatively in patients undergoing cardiac surgery to manage blood pressure and reduce the risk of arrhythmias.

Esmolol could be considered as well due to its rapid onset and short duration, which offers a good control over the hemodynamic status intraoperatively. However, Metoprolol’s longer duration of action makes it a more practical choice for ongoing perioperative beta-blockade, provided there is sufficient time before surgery for its effects to manifest.

Labetalol and Carvedilol, while they provide both alpha- and beta-blockade, might not be preferred in this setting due to their additional alpha-blocking effects which can lead to more pronounced hypotension. Propranolol is non-selective and not typically favored in the perioperative setting for CABG due to its non-cardioselective effects.

Question 2

You are in the process of extubating a patient immediately following a left carotid endarterectomy. His blood pressure is 210/64. Which of the following drugs would be most desirable?

Labetalol
Metoprolol
Esmolol
Propranolol

Answer 2

Esmolol would be the most desirable drug to administer.

Here’s why:

Esmolol is a short-acting, beta-1 selective blocker with a rapid onset and a very short duration of action, allowing for titratable control of blood pressure during the immediate postoperative period. This is particularly useful in a patient with marked hypertension as it helps prevent surges in blood pressure that can be detrimental following vascular surgeries, especially procedures involving the carotid artery.

Labetalol has combined alpha and beta blockade properties. While it is effective for rapid blood pressure control, the patient’s diastolic blood pressure is relatively low, and labetalol’s additional alpha-blocking effects could potentially cause further lowering of the diastolic pressure, leading to inadequate coronary perfusion.

Metoprolol is a beta-1 selective blocker that is longer-acting compared to esmolol. It may not be the best choice for immediate blood pressure control in the post-extubation period due to its slower onset of action.

Propranolol is a non-selective beta-blocker and can have a more pronounced effect on the heart rate and myocardial contractility, which may not be desirable in the immediate postoperative setting. It also has a longer duration of action and is not as easily titratable as esmolol.

Question 3

Your end-stage COPD patient needs emergent blood pressure control in the ICU. Which of the following medications might worsen his PaO2 the most?

Nitroglycerin
Sodium nitroprusside
Hydralazine
Labetalol

Answer 3

Answer: Sodium nitroprusside

dissociates immediately upon contact w/ oxyhemoglobin → Methb → releases cyanide and NO *may worsen PaO2 in COPD

Question 4

Your physician is closing the neck incision following an uneventful right carotid endarterectomy. You have reversed the muscle relaxant and the patient is spontaneously breathing at 20/min; BP 140/90 and climbing, HR 84 and climbing. Your 1st intervention is:

Answer 4

cardene gtt and narcotic
-don’t inc MAC of gas or redose NMBD (bc closing, adequate RR)

Question 5

Which beta-blocker is the most B1 selective, making it particularly important when B2 agonist receptor activity is crucial?
A) Metoprolol
B) Esmolol
C) Atenolol
D) Propranolol

Answer 5

Correct Answer: C) Atenolol

Rationale: Atenolol is the most B1 selective beta-blocker, which is significant for conditions where preservation of B2 agonist activity is essential, such as asthma.

Question 6

Labetalol’s beta to alpha blocking ratio is significant for its application. What is this ratio for its intravenous form?
A) 3:1
B) 7:1
C) 5:2
D) 1:1

Answer 6

Correct Answer: B) 7:1

Rationale: Labetalol’s beta to alpha blocking ratio of 7:1 for the IV form indicates a preferential blockade of beta receptors over alpha, affecting both blood pressure and heart rate.

Question 7

Ephedrine is the preferred sympathomimetic for which patient population, particularly during regional anesthesia?
A) Elderly
B) Pediatric
C) Parturient
D) Hypertensive

Answer 7

Correct Answer: C) Parturient

Rationale: Ephedrine is preferred in parturients (pregnant patients undergoing delivery) because it doesn’t significantly affect uterine blood flow, which is crucial during childbirth.

Question 8

What is the initial dosing for Sodium Nitroprusside when used to cause relaxation of arterial and venous smooth muscle?
A) 0.5 mcg/kg/min
B) 1 mcg/kg/min
C) 0.3 mcg/kg/min
D) 2 mcg/kg/min

Answer 8

Correct Answer: C) 0.3 mcg/kg/min

Rationale: The initial dosing of Sodium Nitroprusside is crucial for the controlled induction of hypotension and is started at a relatively low dose to monitor and control its potent effects.

titrated to 2 mcg/kg/min (micro-titration)

Question 9

Which of the following is not an effect of Phenylephrine due to its action on alpha receptors?
A) Decrease in heart rate
B) Increase in blood pressure
C) Coronary artery vasoconstriction
D) Increase in peripheral vascular resistance

Answer 9

Correct Answer: C) Coronary artery vasoconstriction

Rationale: Phenylephrine primarily causes venous constriction, which indirectly can lead to reflex bradycardia, but it does not have a direct effect on coronary artery constriction.

Very useful in CAD and AS… no tachycardia

Question 10

For patients with excessive sympathetic nervous system stimulation due to acute cocaine ingestion, which class of drugs is indicated?
A) Alpha-agonists
B) Beta-blockers
C) Calcium channel blockers
D) Nitric oxide supplements

Answer 10

Correct Answer: B) Beta-blockers

Rationale: Beta-blockers are indicated to counteract the excessive sympathetic nervous system stimulation associated with acute cocaine ingestion.

Question 11

What is the primary effect of Nicardipine, and how is it dosed for the short-term control of hypertension?
A) Increases venous capacitance; 5mg/hr
B) Decreases heart rate; 2.5 mg IV bolus
C) Arteriolar vasodilation; 5mg/hr
D) Arteriolar vasodilation; starts at 5mg/hr and can be increased in increments

Answer 11

Correct Answer: D) Arteriolar vasodilation; starts at 5mg/hr and can be increased in increments

Rationale: Nicardipine is primarily used for arteriolar vasodilation to control blood pressure and is dosed starting at 5mg/hr, with adjustments based on blood pressure response.

Increase 2.5 mg/hr x 4 to max of 15mg/hr

dihydropyridine L-type CCB with a selective arterial vasodilator

Question 12

Ephedrine’s effect compared to Epinephrine is:
A) Shorter-lasting and more intense
B) Longer-lasting and less intense
C) Same duration but more intense
D) Same duration but less intense

Answer 12

Correct Answer: B) Longer-lasting and less intense

Question 13

What is the mechanism of action for Labetalol?
A) Selective alpha1 and non-selective B1 agonist
B) Selective alpha1 and non-selective B1 antagonist
C) Non-selective alpha and selective B1 antagonist
D) Non-selective alpha and B1 agonist

Answer 13

Correct Answer: B) Selective alpha1 and non-selective B1 antagonist

Rationale: Labetalol has a combined antagonist effect on both alpha1 and beta receptors, which makes it effective for lowering systemic blood pressure while attenuating reflex tachycardia through beta-blockade.

Maximum effect of IV dose 5-10 minutes
Usual dose 2.5-5 mg IV; may increase to 10mg IV

Question 14

Which vasopressor is indicated for reversing catecholamine-resistant hypotension and has an antidiuretic effect?
A) Epinephrine
B) Phenylephrine
C) Ephedrine
D) Vasopressin

Answer 14

Correct Answer: D) Vasopressin

Rationale: Vasopressin, an analog of arginine vasopressin (antidiuretic hormone), can effectively reverse hypotension that does not respond to catecholamines and can increase water reabsorption in the kidneys.

Question 15

Which drug is primarily indicated for use in the immediate postoperative period for thyrotoxicosis to protect against excessive sympathetic stimulation?
A) Propofol
B) Esmolol
C) Atropine
D) Hydralazine

Answer 15

Correct Answer: B) Esmolol

Rationale: Esmolol is a short-acting beta-blocker beneficial for controlling the cardiovascular manifestations of thyrotoxicosis, such as tachycardia and hypertension.

Question 16

Propranolol is known for its beta-blocking effects, but it also decreases the clearance of which other types of drugs?
A) Diuretics
B) Antihypertensives
C) Opioids and amine local anesthetics
D) Anticoagulants

Answer 16

Correct Answer: C) Opioids and amine local anesthetics

Rationale: Propranolol, through its systemic effects, can decrease the hepatic blood flow and thereby reduce the clearance of other drugs metabolized in the liver, including opioids and amine local anesthetics.

Question 17

What is the main therapeutic effect of Atenolol that is pertinent to its perioperative use?
A) Reducing anxiety
B) Decreasing blood glucose levels
C) Limiting myocardial ischemia complications
D) Promoting diuresis

Answer 17

Correct Answer: C) Limiting myocardial ischemia complications

Rationale: Atenolol is used pre- and post-non-cardiac surgery in patients with coronary artery disease to decrease the incidence of myocardial ischemia and related complications.

Question 18

In the setting of aortic surgery, which agent is used to produce controlled hypotension?
A) Sodium nitroprusside
B) Nitroglycerin
C) Hydralazine
D) Metoprolol

Answer 18

Correct Answer: A) Sodium nitroprusside

Rationale: Sodium nitroprusside’s rapid onset and potent vasodilatory effects make it suitable for inducing controlled hypotension during surgeries like aortic procedures to reduce bleeding.

Question 19

What is the role of calcium channel blockers in anesthesia, particularly concerning the speed of conduction through the AV node?
A) They increase the speed of conduction.
B) They have no effect on the speed of conduction.
C) They decrease the speed of conduction.
D) They intermittently alter the speed of conduction.

Answer 19

Correct Answer: C) They decrease the speed of conduction.

Rationale: Calcium channel blockers decrease the influx of calcium ions through L-type channels, especially affecting the conduction through the AV node, which can be beneficial in controlling supraventricular tachycardias.

Question 20

Which drug has a primary action of arterial and venous vasodilation, has a transient duration, and requires invasive arterial monitoring during administration?
A) Nitroglycerin
B) Nicardipine
C) Sodium nitroprusside
D) Hydralazine

Answer 20

Correct Answer: C) Sodium nitroprusside

Rationale: Sodium nitroprusside is a potent vasodilator affecting both arteries and veins, used in controlled hypotensive techniques, and requires close hemodynamic monitoring due to its powerful effects.

Initial dose: 0.3 mcg/kg/min…titrated to 2 mcg/kg/min

Question 21

For a patient experiencing myocardial ischemia, which drug is preferred for its venodilating properties that alleviate pulmonary congestion?
A) Nitroglycerin
B) Esmolol
C) Metoprolol
D) Vasopressin

Answer 21

Correct Answer: A) Nitroglycerin

Rationale: Nitroglycerin is primarily a venodilator at lower doses and helps relieve pulmonary congestion and limit myocardial ischemia by reducing preload.

Question 22

Which drug is a direct arterial vasodilator, known to cause reflex tachycardia, and has a peak plasma concentration effect in about one hour?
A) Esmolol
B) Nitroglycerin
C) Nicardipine
D) Hydralazine

Answer 22

Correct Answer: D) Hydralazine

Rationale: Hydralazine is a direct arteriolar vasodilator, and its effects on lowering blood pressure can trigger a compensatory increase in heart rate. Its onset and duration of action make it suitable for acute blood pressure control but require monitoring due to possible reflex hemodynamic changes.

Onset: peak plasma concentration 1 hr
½ life: 3-7 hours

Initial dose: 2.5 mg IV

Question 23

What is a likely effect of chronic administration of beta-blockers (BB) on beta-adrenergic receptors?
A) Downregulation and decreased number of receptors
B) Upregulation and increased number of receptors
C) No change in receptor numbers but decreased sensitivity
D) Irreversible binding and inactivation of receptors

Answer 23

Correct Answer: B) Upregulation and increased number of receptors

Rationale: Chronic administration of BB leads to upregulation of beta-adrenergic receptors, which may restore receptor responsiveness after desensitization from catecholamines.

Question 24

What pharmacological feature distinguishes Atenolol from other beta-1 selective antagonists in terms of diabetic care?
A) It potentiates insulin-induced hypoglycemia.
B) It is metabolized quickly, reducing the risk of hypoglycemia.
C) It does not potentiate insulin-induced hypoglycemia.
D) It directly stimulates insulin release.

Answer 24

Correct Answer: C) It does not potentiate insulin-induced hypoglycemia.

Rationale: Atenolol is beta-1 selective and does not interfere with the beta-2-mediated glycogenolysis, making it a safer choice for diabetics.

Question 25

In the treatment of acute myocardial ischemia, what is the role of nitroglycerin (NTG)?
A) It primarily causes arterial vasodilation.
B) It induces significant bradycardia.
C) It causes venous pooling and reduction of preload to the right heart.
D) It has a sustained effect without the risk of tachyphylaxis.

Answer 25

Correct Answer: C) It causes venous pooling and reduction of preload to the right heart.

Rationale: NTG acts primarily on venous capacitance vessels at lower doses, reducing preload and relieving symptoms of pulmonary congestion associated with ischemic heart disease.

Question 26

When considering the use of beta-1 selective antagonists like Metoprolol for a patient with asthma, what is a significant concern?
A) They can potentially cause bronchoconstriction.
B) They have no effect on bronchial smooth muscle.
C) They can exacerbate hypoglycemic episodes.
D) They increase the risk of hypertensive episodes.

Answer 26

Correct Answer: A) They can potentially cause bronchoconstriction.

Rationale: While Metoprolol is beta-1 selective, at higher doses, selectivity can be lost, potentially affecting beta-2 receptors and causing bronchoconstriction.

but typically.. Selective B1
Bronchodilator, vasodilator, and metabolic effects of B2 receptors intact

Usually dosed 1mg q 5 minutes IV….. in blocks of 5mgs

Question 27

Which beta-blocker would be most appropriate for short-term management of increased blood pressure during surgical extubation?
A) Propranolol
B) Atenolol
C) Esmolol
D) Labetalol

Answer 27

Correct Answer: C) Esmolol

Rationale: Esmolol has the most rapid onset and offset, making it suitable for acute, short-term situations like surgical extubation.

Question 28

What is a significant consideration when administering Ephedrine to a patient who is chronically on beta-blockers?
A) Ephedrine will produce a heightened response.
B) Ephedrine’s effects will be prolonged.
C) Ephedrine may not produce the expected response due to beta-blockade.
D) Ephedrine will cause an immediate drop in heart rate.

Answer 28

Correct Answer: C) Ephedrine may not produce the expected response due to beta-blockade.

Rationale: Ephedrine exerts its effects by inducing the release of norepinephrine, which may be blunted in the presence of beta-blockers, leading to an attenuated response.

dose: 5-10mg IV

Question 29

For a patient on ACE inhibitors experiencing hypotension, which vasopressor is appropriate?
A) Epinephrine
B) Ephedrine
C) Phenylephrine
D) Vasopressin

Answer 29

Correct Answer: D) Vasopressin

Rationale: Vasopressin acts independently of the sympathetic nervous system and can be effective in reversing hypotension that does not respond to catecholamines, which is beneficial in patients on ACE inhibitors.

Question 30

What is the expected effect of activating beta-1 adrenergic receptors with a low dose of a selective agonist?

A) Decreased myocardial contractility
B) Bronchodilation
C) Increased heart rate and myocardial contractility
D) Vasoconstriction of peripheral vessels

Answer 30

Answer: C) Increased heart rate and myocardial contractility
Rationale: Beta-1 receptors are primarily located in the heart. Their activation leads to increased heart rate (positive chronotropic effect) and increased myocardial contractility (positive inotropic effect).

Question 31

Which dose of Esmolol would you administer for rapid control of a perioperative hypertension crisis?

A) 0.5 mg/kg
B) 20-30 mg as a bolus
C) 5 mg/kg
D) 1-2 mg/kg

Answer 31

Answer: B) 20-30 mg as a bolus

There is another slide with IV dosing of esmolol of 10-80mg IV.. I also found research supporting these doses.

Rationale: Esmolol is typically given in bolus doses of 20-30 mg for rapid onset in controlling acute hypertensive episodes, due to its short action and titratable nature.

Question 32

A patient with chronic obstructive pulmonary disease (COPD) is in need of a beta-blocker. Which one of the following would be most appropriate?

A) Propranolol
B) Labetalol
C) Metoprolol
D) Esmolol

Answer 32

Answer: C) Metoprolol
Rationale: Metoprolol is a beta-1 selective antagonist and is less likely to provoke bronchoconstriction, which can be exacerbated by non-selective beta-blockers in COPD patients.

Esmolol - A very short-acting beta-1 selective blocker used primarily in acute settings, such as during surgery or in intensive care units. While it is selective, its short duration of action and intravenous administration limit its use in chronic management.

Question 33

For a hypertensive episode during surgery, what initial intravenous dose of Labetalol is recommended?

A) 20 mg IV
B) 2.5 mg - 5mg IV
C) 10 mg IV
D) 15 mg IV

Answer 33

B) 2.5 mg - 5mg IV

Maximum effect of IV dose 5-10 minutes
Usual dose 2.5-5 mg IV; may increase to 10mg IV

Question 34

When using Phenylephrine for blood pressure control, what dose is typically given as an intravenous push (IVP)?

A) 100 mcg
B) 500 mcg
C) 10 mcg
D) 1 mg

Answer 34

Answer: A) 100 mcg
Rationale: Phenylephrine is commonly used in 100 mcg increments for IVP to manage hypotension.

Question 35

For patients undergoing a non-cardiac surgery, who are at risk for myocardial infarction and are already on beta-blockers, the SCIP recommends:

A) Discontinuation of beta-blockers 24 hours before surgery
B) Administration of beta-blockers within the 24 hours before surgery
C) Switching from beta-1 selective to non-selective beta-blockers
D) Doubling the dose of beta-blockers on the day of surgery

Answer 35

Answer: B) Administration of beta-blockers within the 24 hours before surgery
Rationale: The SCIP recommends continuing beta-blockers for those at risk for myocardial infarction who are already on these medications.

Does not say what type of BB or the dose.. IE can give a small dose.

Question 36

For a patient on chronic beta-blockade with a presentation of cocaine-induced tachycardia and hypertension, which beta-blocker would be contraindicated due to the risk of unopposed alpha stimulation?

A. Atenolol
B. Esmolol
C. Labetalol
D. Propranolol

Answer 36

Correct Answer: D. Propranolol
Rationale: Propranolol is a non-selective beta-blocker and can worsen cocaine-induced coronary vasoconstriction due to unopposed alpha-adrenergic activity.

Question 37

A patient in the OR shows signs of myocardial depression from the anesthetic agents used. Which concurrent medication might potentiate this effect?

A. Glycopyrrolate
B. Nicardipine
C. Ephedrine
D. Enflurane

Answer 37

Correct Answer: D. Enflurane
Rationale: Enflurane has been shown to have a synergistic effect with beta-blockers, leading to increased myocardial depression.

Question 38

For the treatment of systemic hypertension in the OR, which CCB would you choose for its pronounced effect on peripheral artery dilation without significant cardiac depression?

A. Verapamil
B. Nifedipine
C. Nicardipine
D. Diltiazem

Answer 38

Correct Answer: C. Nicardipine
Rationale: Nicardipine has the greatest effect on peripheral artery dilation with only slight myocardial depression.

Question 39

Which vasopressor would be the choice for managing hypotension in a patient under regional anesthesia due to its greater venous constriction compared to arterial constriction, helping to increase preload?

A. Epinephrine
B. Phenylephrine
C. Ephedrine
D. Vasopressin

Answer 39

Correct Answer: B. Phenylephrine
Rationale: Phenylephrine acts primarily on alpha-1 receptors causing venous constriction, which increases venous return and cardiac preload.

Question 40

How do beta antagonists contribute to the management of tachyphylaxis in the perioperative setting?

A. They increase the production of catecholamines.
B. They restore receptor responsiveness after desensitization.
C. They cause desensitization of receptors.
D. They have no effect on receptor responsiveness.

Answer 40

Correct Answer: B. They restore receptor responsiveness after desensitization.

Question 41

Which of the following is a potential cardioprotective effect of beta antagonists during surgery?

A. They increase cardiac oxygen demand.
B. They induce perioperative ischemia.
C. They protect myocytes from perioperative ischemia and infarction.
D. They increase renin release.

Answer 41

Correct Answer: C. They protect myocytes from perioperative ischemia and infarction.

Question 42

What effect do beta antagonists have on arterial vascular tone?

A. They may decrease arterial vascular tone and reduce afterload.
B. They may increase arterial vascular tone and increase afterload.
C. They have no effect on arterial vascular tone.
D. They increase arterial vascular resistance.

Answer 42

Correct Answer: A. They may decrease arterial vascular tone and reduce afterload.

Question 43

Beta antagonists can decrease cardiac output (CO). What additional effect on the renin-angiotensin system do they exhibit?

A. They stimulate renin release.
B. They inhibit renin release.
C. They have no effect on renin release.
D. They increase angiotensin conversion.

Answer 43

Correct Answer: B. They inhibit renin release.

Question 44

What percentage of beta receptors in the myocardium are B1 receptors?

A. 25%
B. 50%
C. 75%
D. 100%

Answer 44

Correct Answer: C. 75%

Question 45

Which of the following B1 selective agents is known for not causing vasodilation?

A. Atenolol
B. Metoprolol
C. Esmolol
D. All of the above

Answer 45

Correct Answer: D. All of the above

Question 46

Considering their selectivity for B1 receptors, which of the following is a common characteristic of the listed medications?

A. They are likely to cause bronchoconstriction.
B. They are typically used to treat hypertension and dysrhythmias.
C. They primarily have vasodilatory effects.
D. They increase myocardial oxygen demand.

Answer 46

B. They are typically used to treat hypertension and dysrhythmias.

Question 47

Which B1 selective agent is primarily cleared renally?

A. Propranolol
B. Metoprolol
C. Atenolol
D. Esmolol

Answer 47

Correct Answer: C. Atenolol

Question 48

hich agent has the shortest elimination half-life (E ½ time)?

A. Propranolol
B. Metoprolol
C. Atenolol
D. Esmolol

Answer 48

Correct Answer: D. Esmolol

about 10 min

Question 49

Regarding cardiac selectivity, which medication listed does NOT possess this property?

A. Propranolol
B. Metoprolol
C. Atenolol
D. Esmolol

Answer 49

Correct Answer: A. Propranolol

Question 50

What is the main pathway of clearance for Esmolol?

A. Hepatic
B. Renal
C. Plasma hydrolysis
D. Biliary

Answer 50

Correct Answer: C. Plasma hydrolysis

Question 51

Which of these beta-blockers has active metabolites?

A. Propranolol
B. Metoprolol
C. Atenolol
D. Esmolol

Answer 51

Correct Answer: A. Propranolol

Question 52

What is the usual adult IV dose range for Metoprolol?

A. 1-10 mg
B. 1-15 mg
C. 5-10 mg
D. 10-80 mg

Answer 52

Correct Answer: B. 1-15 mg

Question 53

What is the usual adult IV dose range for Atenolol?

A. 1-10 mg
B. 1-15 mg
C. 5-10 mg
D. 10-80 mg

Answer 53

C. 5-10 mg

Question 54

What is the usual adult IV dose range for propranolol?

A. 1-10 mg
B. 1-15 mg
C. 5-10 mg
D. 10-80 mg

Answer 54

A. 1-10 mg

Question 55

What is the usual adult IV dose range for esmolol?

A. 1-10 mg
B. 1-15 mg
C. 5-10 mg
D. 10-80 mg

Answer 55

D. 10-80 mg

Question 56

Propranolol is known as a prototypical antagonist for which receptors?

A. Alpha receptors
B. Beta-1 receptors
C. Beta-2 receptors
D. Both Beta-1 and Beta-2 receptors

Answer 56

Correct Answer: D. Both Beta-1 and Beta-2 receptors

Question 57

Which effect of Propranolol is longer-lasting?

A. Negative inotropic effect
B. Heart rate slowing effect
C. Vasodilatory effect
D. Bronchodilatory effect

Answer 57

Correct Answer: B. Heart rate slowing effect

Question 58

Propranolol affects the clearance of which substances?

A. Opioids and amine local anesthetics
B. Glucose and insulin
C. Electrolytes such as sodium and potassium
D. Vitamins and minerals

Answer 58

Correct Answer: A. Opioids and amine local anesthetics

Question 59

Why might Propranolol decrease the clearance of opioids and amine local anesthetics?

A. Because it increases hepatic blood flow
B. Because it inhibits cytochrome P450 enzymes
C. Because it increases renal excretion
D. Because it has no effect on metabolism

Answer 59

Correct Answer: B. Because it inhibits cytochrome P450 enzymes

Question 60

Why is Atenolol considered the most selective β1 blocker?

A. It primarily blocks β2 receptors.
B. It exhibits the highest affinity for β1 receptors over β2 receptors.
C. It is the only β-blocker that crosses the blood-brain barrier.
D. It is not selective and blocks all adrenergic receptors equally.

Answer 60

Correct Answer: B. It exhibits the highest affinity for β1 receptors over β2 receptors.
Rationale: The slide states that Atenolol is the most β1 selective, indicating it has higher affinity for β1 receptors, which are primarily found in the heart, compared to β2 receptors.

Question 61

For how long can Atenolol reduce complications such as myocardial ischemia in CAD patients post-surgery?

A. 6 months
B. 1 year
C. 2 years
D. Indefinitely

Answer 61

Correct Answer: C. 2 years.
Rationale: The slide mentions Atenolol is useful for reducing complications of myocardial ischemia for 2 years in patients with coronary artery disease (CAD).

Question 62

Which of the following characteristics of Atenolol makes it favorable for diabetic patients?

A. It potentiates insulin-induced hypoglycemia.
B. It does not appear to potentiate insulin-induced hypoglycemia.
C. It increases the risk of diabetic ketoacidosis.
D. It has an active metabolite that affects blood sugar levels.

Answer 62

Correct Answer: B. It does not appear to potentiate insulin-induced hypoglycemia.
Rationale: According to the slide, Atenolol does not potentiate insulin-induced hypoglycemia, which is an important consideration for diabetic patients who are at risk for fluctuations in blood glucose levels.

Question 63

Atenolol’s characteristic of not entering the CNS in large amounts leads to which patient benefit?

A. Increased sedation
B. Less risk of seizure
C. Less “fatigue”
D. Greater analgesic effect

Answer 63

Correct Answer: C. Less “fatigue”.
Rationale: The slide states that Atenolol does not enter the CNS in large amounts, which is associated with less fatigue—a common side effect of beta-blockers that do cross the blood-brain barrier in significant amounts.

Question 64

What is the standard initial IV dose of Atenolol?

A. 2.5 mg q 5 minutes
B. 5 mg q 10 minutes
C. 10 mg q 5 minutes
D. 20 mg q 10 minutes

Answer 64

B. 5 mg q 10 minutes

Question 65

What characteristic of Metoprolol makes it suitable for patients with respiratory conditions like asthma?

A. Its non-selectivity for beta receptors
B. Its selectivity for B1 receptors
C. Its bronchodilatory effects due to B2 receptor stimulation
D. Its inhibitory effect on B2 receptors

Answer 65

B. Its selectivity for B1 receptors

Question 66

Which oral formulation of Metoprolol is better suited for patients who may have compliance issues due to the frequency of dosing?

A. Tartrate, requiring bid-qid dosing
B. Succinate, allowing for once-daily dosing
C. Both require the same dosing frequency
D. Neither, as Metoprolol is not available in oral formulations

Answer 66

Correct Answer: B. Succinate, allowing for once-daily dosing.

Question 67

If a patient on Metoprolol presents with tachycardia, what could be a potential reason?

A. Drug withdrawal
B. Non-compliance with medication regimen
C. Overdose of Metoprolol
D. Both A and B could be potential reasons

Answer 67

Correct Answer: D. Both A and B could be potential reasons.

Question 68

how is Metoprolol typically administered intravenously?

A. 1 mg over 1 minute
B. 5 mg over 5 minutes
C. 1 mg over 5 minutes in blocks of 5 mg
D. 5 mg as a bolus every 5 min

Answer 68

D. 5 mg as a bolus every 5 min

1 mg every 5 minutes in blocks of 5 mg. This dosing allows for careful titration of the medication’s effects on the heart rate and blood pressure.
Comes in an amp of 5mg

Question 69

What is the mechanism of action that allows Esmolol to have a short duration?
A. Renal excretion
B. Hepatic metabolism
C. Hydrolysis by plasma esterases
D. Excretion through the lungs

Answer 69

Correct Answer: C. Hydrolysis by plasma esterases
Rationale: Esmolol is rapidly hydrolyzed by plasma esterases, which contributes to its short half-life and allows for quick titration and adjustments during surgery.

Question 70

In the context of potential cocaine or epinephrine absorption during surgery, which effect of Esmolol is particularly beneficial?
A. Bronchodilation
B. Coronary vasodilation
C. Mitigation of pulmonary edema
D. Reduction of peripheral vascular resistance

Answer 70

Correct Answer: C. Mitigation of pulmonary edema and CV collapse

Rationale: Esmolol can help in treating or preventing pulmonary edema resulting from cocaine or epinephrine absorption by attenuating the sympathetic surge that can exacerbate this condition.

Question 71

The initial dose of Esmolol for an adult patient is typically in the range of:
A. 2-5 mg IV
B. 10-15 mg IV
C. 20-30 mg IV
D. 50-100 mg IV

Answer 71

Correct Answer: C. 20-30 mg IV

also dosed @ 10-80 mg IV

Rationale: Esmolol’s usual initial dose is 20-30 mg IV, providing a quick onset of beta-blocking activity suitable for acute situations such as during induction or in response to noxious stimuli like intubation.

Question 72

What is the primary method of clearance for Atenolol?

A) Hepatic metabolism
B) Renal excretion
C) Plasma hydrolysis
D) Biliary excretion

Answer 72

Answer: B) Renal excretion
Rationale: Atenolol is cleared primarily through the kidneys, which is particularly important in patients with impaired renal function.

Question 73

Why might Labetalol be a preferred choice for controlling blood pressure intraoperatively compared to pure beta-blockers?

A) It lacks alpha-blocking effects
B) It has intrinsic sympathomimetic activity
C) It has both alpha and beta-blocking effects
D) It is a direct vasodilator

Answer 73

Answer: C) It has both alpha and beta-blocking effects
Rationale: Labetalol’s combined alpha and beta antagonist effects can help reduce blood pressure while mitigating reflex tachycardia.

Question 74

When considering drug interactions, which combination could potentially lead to a hazardous decrease in contractility if not monitored carefully?

A) Beta-blockers and Calcium Channel Blockers
B) Beta-blockers and Diuretics
C) Beta-blockers and ACE inhibitors
D) Beta-blockers and NSAIDs

Answer 74

A) Beta-blockers and Calcium Channel Blockers

Rationale: Both agents can decrease myocardial contractility and heart rate, thus close monitoring is required to avoid excessive cardiac depression.

Question 75

Which G-protein coupled receptor subtype, when activated, primarily increases vascular smooth muscle tone and blood pressure?

A) Alpha-1
B) Alpha-2
C) Beta-1
D) Beta-2

Answer 75

Answer: A) Alpha-1
Rationale: Alpha-1 receptors, when activated by agonists, lead to the synthesis of secondary messengers like IP3, which increases Ca++ release from the sarcoplasmic reticulum and affects vascular smooth muscle tone, causing vasoconstriction and an increase in blood pressure.

Question 76

Phenylephrine acts on which alpha receptor subtype to exert its vasoconstrictive effects?

A) Alpha-1
B) Alpha-2
C) Both Alpha-1 and Alpha-2
D) Beta receptors

Answer 76

Answer: A) Alpha-1
Rationale: Phenylephrine is a selective alpha-1 adrenergic receptor agonist, which causes vasoconstriction primarily in the venous system and to a lesser extent in the arterial system, leading to an increase in blood pressure. It is used clinically to treat hypotension resulting from anesthesia-induced sympathetic nervous system blockade.

Question 77

Why is it important to monitor heart rate when administering Phenylephrine?

A) It can cause reflex tachycardia.
B) It can cause reflex bradycardia.
C) It is a direct chronotrope.
D) It has beta-receptor activity.

Answer 77

Answer: B) It can cause reflex bradycardia.
Rationale: Phenylephrine’s vasoconstrictive action on alpha-1 receptors can lead to an increase in blood pressure, which may trigger the baroreceptor reflex, resulting in reflex bradycardia as the body attempts to balance the hemodynamic changes. This reflex must be monitored to prevent excessive bradycardia.

Question 78

Which of the following is a primary effect of alpha-2 adrenergic receptor activation in the central nervous system?

A) Increased release of norepinephrine
B) Decreased release of norepinephrine
C) Vasodilation and decreased blood pressure
D) Tachycardia and increased cardiac contractility

Answer 78

Answer:
B) Decreased release of norepinephrine

Rationale:
Alpha-2 adrenergic receptors are G-protein coupled receptors that, when activated, inhibit the release of norepinephrine from presynaptic nerve terminals in the brainstem. This action is part of a negative feedback mechanism that modulates the release of norepinephrine to prevent overstimulation of the nervous system, often leading to sedative effects.

think clonidine

Question 79

Labetalol has a unique profile as an antihypertensive medication due to its action on multiple adrenergic receptors. What is the clinical implication of its selective alpha-1, non-selective beta-1, and beta-2 antagonist effects?

A) It will likely cause a reflex tachycardia due to vasodilation.
B) It is associated with a higher risk of bronchoconstriction due to its beta-2 blocking effects.
C) It exclusively lowers diastolic blood pressure without affecting systolic blood pressure.
D) It offers the benefit of blood pressure reduction without significant reflex tachycardia.

Answer 79

Answer:
D) It offers the benefit of blood pressure reduction without significant reflex tachycardia.

Maximum effect of IV dose 5-10 minutes
Usual dose 2.5-5 mg IV; may increase to 10mg IV

Question 80

Which of the following is a potential consequence of using sympathomimetic agents that lack beta-1 specificity?
A) Hypotension
B) Bradycardia
C) Tachycardia
D) Hypertension

Answer 80

Correct Answer: B) Bradycardia
Rationale: Sympathomimetic agents that lack beta-1 specificity may cause intense vasoconstriction, leading to an increase in blood pressure, which can trigger a reflex-mediated bradycardia as a compensatory mechanism.

Question 81

The primary action of sympathomimetics at the cellular level involves:
A) Inhibiting cyclic AMP (cAMP) production
B) Decreasing calcium influx into the cytosol
C) Enhancing calcium influx into the cytosol
D) Preventing actin and myosin interaction

Answer 81

Correct Answer: C) Enhancing calcium influx into the cytosol
Rationale: Sympathomimetics activate adrenergic receptors, which in turn increase cyclic AMP (cAMP) levels. Increased cAMP enhances calcium influx into the cytosol, leading to a more forceful interaction between actin and myosin, thus increasing cardiac contractility and vasomotor tone.

Question 82

Which of the following is a direct-acting sympathomimetic agent?

A) Ephedrine
B) Dopamine
C) Norepinephrine
D) B and C

Answer 82

Correct Answer: D- B and C Norepinephrine
Rationale: Norepinephrine acts directly on adrenergic receptors without needing to induce the release of endogenous catecholamines, unlike ephedrine, which is both direct and indirect-acting, and phenylephrine which has a small indirect action.

Question 83

At what infusion rate does epinephrine predominantly exhibit alpha-adrenergic activity?

A) 1-2 mcg/min
B) 4 mcg/min
C) 10-20 mcg/min
D) 2-8 mcg/min

Answer 83

Correct Answer: C) 10-20 mcg/min
Rationale: At an infusion rate of 10-20 mcg/min, epinephrine acts primarily on alpha-adrenergic receptors, leading to vasoconstriction and an increase in blood pressure. Lower infusion rates will have more beta-adrenergic activity, causing vasodilation and bronchodilation.

1-2 mcg/min….beta-2
4 mcg/min….beta-1

Question 84

Which of the following epinephrine dosing regimens is commonly used to target beta-1 adrenergic receptor activity?

A) Single bolus dose of 2-8 mcg
B) Infusion rate of 1-2 mcg/min
C) Infusion rate of 4 mcg/min
D) Infusion rate of 10-20 mcg/min

Answer 84

Correct Answer: C) Infusion rate of 4 mcg/min

Rationale: An infusion rate of 4 mcg/min of epinephrine primarily stimulates beta-1 adrenergic receptors, which increases myocardial contractility and heart rate. The single bolus dose of 2-8 mcg is intended for short-term effects lasting 1-5 minutes and may not be specific to beta-1 activity at this range. Lower infusion rates like 1-2 mcg/min are more inclined towards beta-2 activity, and higher rates like 10-20 mcg/min focus on alpha-adrenergic activity, primarily vasoconstriction.

Question 85

Which medication listed has the strongest alpha-adrenergic receptor activity?

A) Epinephrine
B) Ephedrine
C) Phenylephrine
D) Vasopressin

Answer 85

Correct Answer: C) Phenylephrine
Rationale: Phenylephrine has the strongest alpha-adrenergic receptor activity (+++), indicating potent vasoconstrictive effects.

Question 86

What is the recommended single IV dose range for ephedrine?

A) 1-2 mcg
B) 5-10 mg
C) 50-100 mcg
D) 1-2 units

Answer 86

Correct Answer: B) 5-10 mg
Rationale: The slide specifies that the single IV dose for ephedrine is 5-10 mg.

Question 87

Which vasopressor is indicated to have the greatest effect on cardiac output?

A) Epinephrine
B) Ephedrine
C) Phenylephrine
D) Vasopressin

Answer 87

Correct Answer: A) Epinephrine
Rationale: Epinephrine is indicated to have the most significant effect on cardiac output (+++), enhancing myocardial contractility and increasing stroke volume.

Question 88

Which 2 drugs have no beta-1 adrenergic activity?

A) Epinephrine
B) Ephedrine
C) Phenylephrine
D) Vasopressin

Answer 88

C) Phenylephrine & D) Vasopressin

Question 89

For which drug is indicate a single IV dose of 1-2 mcg?

A) Epinephrine
B) Ephedrine
C) Phenylephrine
D) Vasopressin

Answer 89

Correct Answer: A) Epinephrine
Rationale: The slide lists a single IV dose of 1-2 mcg for epinephrine, which is within the dose range for its use in acute settings.

Vasopressin is 1-2 units

Question 90

What characteristic of ephedrine’s blood pressure response sets it apart from epinephrine?

A) It has a more intense blood pressure response than epinephrine.
B) It has an equal duration of blood pressure response as epinephrine.
C) It has a less intense, but longer duration of blood pressure response than epinephrine.
D) It leads to a permanent increase in blood pressure.

Answer 90

Correct Answer:
C) It has a less intense, but 10X longer duration of blood pressure response than epinephrine.

Tachyphylaxis, or the rapid decrease in the response to a drug after repeated doses, occurs with ephedrine due to depletion of norepinephrine stores.

Question 91

A common gastrointestinal side effect of vasopressin is:
A) Diarrhea
B) Constipation
C) Abdominal pain and nausea/vomiting
D) Gastrointestinal bleeding

Answer 91

Answer: C) Abdominal pain and nausea/vomiting
Rationale: Vasopressin stimulates GI smooth muscle, which can lead to abdominal pain and nausea/vomiting.

Question 92

Regarding the dose and action of vasopressin, which of the following is correct?
A) Increases heart rate due to V2 receptor activity
B) Decreases renal-collecting duct permeability
C) Can cause coronary artery vasoconstriction as a side effect
D) Acts as a beta-agonist in cardiac tissue

Answer 92

Answer: C) Can cause coronary artery vasoconstriction as a side effect
Rationale: While vasopressin primarily acts on V1 receptors to cause systemic vasoconstriction, it can also constrict coronary arteries as a side effect, potentially leading to ischemic complications.

Question 93

Which of the following is an indirect effect of vasopressin?
A) Increased platelet counts
B) Decreased antibody formation
C) Increased blood glucose levels
D) Decreased systemic vascular resistance

Answer 93

Answer: B) Decreased antibody formation

Also decreases platelet count
Rationale: Besides its direct effects on vasoconstriction and renal collecting ducts, vasopressin can have an indirect effect by decreasing antibody formation.

Question 94

What is the primary action of nitric oxide on smooth muscle?
A) It stimulates the release of calcium from the sarcoplasmic reticulum.
B) It inhibits the release of calcium from the sarcoplasmic reticulum.
C) It inhibits calcium entry into smooth muscle and increases uptake by the endoplasmic reticulum.
D) It increases calcium entry into smooth muscle.

Answer 94

Answer: C) It inhibits calcium entry into smooth muscle and increases uptake by the endoplasmic reticulum.
Rationale: NO acts as a signaling molecule and through cGMP it relaxes smooth muscle by inhibiting calcium entry and promoting its sequestration in the endoplasmic reticulum.

Question 95

Nitric oxide plays a role in modulating which of the following functions?
A) Platelet aggregation
B) Hemoglobin affinity for oxygen
C) Red blood cell production
D) Myosin light chain kinase activity

Answer 95

Answer: A) Platelet aggregation
Rationale: NO helps to regulate platelet function and prevents platelets from aggregating in blood vessels, thus maintaining a smooth flow of blood.

Question 96

Which area of the body is specifically affected by the vasodilatory effects of nitric oxide?
A) Coronary arteries
B) Pulmonary arteries
C) Systemic arterioles
D) Renal arteries

Answer 96

Answer: B) Pulmonary arteries
Rationale: NO specifically causes vasodilation in the pulmonary arteries, which can reduce pulmonary hypertension and improve oxygenation.

Question 97

Nitric oxide serves as a neurotransmitter in which system?
A) Peripheral nervous system
B) Central nervous system
C) Autonomic nervous system
D) Enteric nervous system

Answer 97

Answer: B) Central nervous system
Rationale: NO functions as a neurotransmitter within the CNS, mediating various neurological processes including neural plasticity.

Question 98

In the context of gastrointestinal (GI) function, NO is responsible for:
A) Increasing GI motility
B) Decreasing GI motility
C) GI smooth muscle relaxation
D) GI smooth muscle contraction

Answer 98

Answer: C) GI smooth muscle relaxation
Rationale: NO induces relaxation of the GI smooth muscle, helping to regulate the digestive process and prevent spasm.

Question 99

What is the initial dosing range for Sodium Nitroprusside?
A. 0.1-0.5 mcg/kg/min
B. 0.3-2 mcg/kg/min
C. 1-5 mcg/kg/min
D. 5-10 mcg/kg/min

Answer 99

Answer: B. 0.3-2 mcg/kg/min
Rationale: Sodium Nitroprusside acts quickly and has a transient duration, which requires micro-titration and continuous administration, as indicated in the initial dosing range provided on the slide.

Question 100

Which of the following scenarios would Sodium Nitroprusside NOT be typically used?
A. Aortic surgery
B. Pheochromocytoma
C. Spine surgery
D. Elective knee replacement

Answer 100

Answer: D. Elective knee replacement
Rationale: The slide indicates that Sodium Nitroprusside is used for controlled hypotension in specific surgeries like aortic and spine surgeries, and for hypertensive emergencies such as carotid surgery, not typically for elective orthopedic procedures like knee replacements.

Question 101

Which condition is Sodium Nitroprusside indicated for during carotid surgery?
A. Hypotensive anesthesia
B. Hypertensive emergencies
C. Intraoperative analgesia
D. Postoperative pain management

Answer 101

Answer: B. Hypertensive emergencies
Rationale: The slide suggests that Sodium Nitroprusside is used for hypertensive emergencies, which can occur during carotid surgeries due to manipulation of the carotid sinus.

Question 102

Sodium Nitroprusside requires which of the following for safe administration?
A. Invasive arterial monitoring
B. Non-invasive blood pressure monitoring
C. Continuous electrocardiography
D. Peripheral venous access

Answer 102

Answer: A. Invasive arterial monitoring
Rationale: Given the immediate onset and powerful effects of Sodium Nitroprusside, invasive arterial monitoring is required to closely monitor the blood pressure and titrate the drug accurately.

Question 103

Sodium Nitroprusside dissociates upon contact with oxyhemoglobin to release:
A. Lactic acid and CO2
B. Methemoglobin and cyanide
C. Cyanide and nitric oxide
D. ATP and carbon monoxide

Answer 103

C. Cyanide and nitric oxide

dissociates immediately upon contact w/ oxyhemoglobin → Methb → releases cyanide and NO *may worsen PaO2 in COPD

Question 104

Which of the following is NOT a sign of suspicion for cyanide toxicity?
A. Increasing doses of Sodium Nitroprusside needed
B. Decreased mixed venous oxygen saturation
C. Respiratory alkalosis
D. CNS dysfunction or change in the level of consciousness (LOC)

Answer 104

Answer: C. Respiratory alkalosis
Rationale: Respiratory alkalosis is not typically associated with cyanide toxicity. Signs of cyanide toxicity include increased SNP dosing needed, decreased mixed-venous saturations indicating tissues aren’t using oxygen, metabolic acidosis, and CNS dysfunction or changes in LOC, as noted on the slide.

Question 105

Which lab finding can raise the suspicion of cyanide toxicity in a patient on Sodium Nitroprusside?
A. Hyperglycemia
B. Increased mixed venous oxygen saturation
C. Hypokalemia
D. Hypernatremia

Answer 105

Answer: B. Increased mixed venous oxygen saturation
Rationale: Increased mixed venous oxygen saturation suggests that tissues are not utilizing oxygen properly, which can be a sign of cyanide toxicity, especially relevant when a patient is on Sodium Nitroprusside infusion.

Question 106

In the setting of Sodium Nitroprusside infusion, metabolic acidosis may indicate:
A. An expected side effect of the drug
B. Cyanide toxicity
C. Respiratory compensation
D. Renal failure

Answer 106

Answer: B. Cyanide toxicity
Rationale: Metabolic acidosis in the context of Sodium Nitroprusside infusion can be a sign of cyanide toxicity, as it indicates that tissues aren’t using oxygen, leading to an accumulation of lactic acid.

Question 107

Nitroglycerin primarily acts by:
A) Constraining venous capacitance vessels
B) Dilating small peripheral veins
C) Dilating venous capacitance vessels and large coronary arteries
D) Causing systemic vasoconstriction

Answer 107

Correct Answer: C) Dilating venous capacitance vessels and large coronary arteries
Rationale: According to the first slide, nitroglycerin acts on venous capacitance vessels causing venous pooling, and on large coronary arteries by promoting the relaxation of arterial vascular smooth muscle, especially at higher doses.

Question 108

Tachyphylaxis to Nitroglycerin refers to:
A) An increase in drug effect with repeated dosing
B) A consistent drug effect with repeated dosing
C) A decrease in drug effect with repeated dosing
D) No change in drug effect regardless of dosing

Answer 108

Correct Answer: C) A decrease in drug effect with repeated dosing
Rationale: Tachyphylaxis, as stated on the first slide, is a phenomenon where there is a rapid decrease in the effect of a drug after its administration. This can be dose-dependent and duration-dependent, and typically occurs within 24 hours with nitroglycerin. This limits vasodilation over time.

Question 109

The initial recommended dose of Nitroglycerin for infusion is:
A) 2-4 mcg/min
B) 5-10 mcg/min
C) 10-15 mcg/min
D) 15-20 mcg/min

Answer 109

Correct Answer: B) 5-10 mcg/min
Rationale: As indicated in the first slide, the initial dose for nitroglycerin infusion should be 5-10 mcg/min, which can then be titrated according to the clinical response.

Question 110

Which condition is Nitroglycerin less effective in controlling compared to Sodium Nitroprusside (SNP)?
A) Acute MI
B) Controlled Hypotension
C) Sphincter of Oddi Spasm
D) Retained placenta

Answer 110

Correct Answer: B) Controlled Hypotension
Rationale: Sodium Nitroprusside (SNP) is more potent than nitroglycerin for inducing controlled hypotension, as mentioned in the second slide. Therefore, nitroglycerin is less potent and less effective in comparison for this specific indication.

Question 111

Hydralazine is classified as a:
A) Beta-blocker
B) Calcium channel blocker
C) Systemic arterial vasodilator
D) Diuretic

Answer 111

Correct Answer: C) Systemic arterial vasodilator
Rationale: Hydralazine is a direct, systemic arterial vasodilator, as indicated on the slide.

Question 112

One of the adverse effects of Hydralazine is:
A) Bradycardia
B) Rebound hypertension
C) Rebound tachycardia
D) Reduced cardiac output

Answer 112

Correct Answer: C) Rebound tachycardia
Rationale: The slide mentions that an extreme hypotension effect of Hydralazine can lead to rebound tachycardia.

Question 113

The initial dose of Hydralazine for intravenous administration is:
A) 1.0 mg
B) 2.5 mg
C) 5.0 mg
D) 10 mg

Answer 113

Correct Answer: B) 2.5 mg
Rationale: According to the slide, the initial dose of Hydralazine administered intravenously is 2.5 mg.

Question 114

The half-life of Hydralazine is approximately:
A) 1-2 hours
B) 3-7 hours
C) 8-12 hours
D) 12-24 hours

Answer 114

Correct Answer: B) 3-7 hours
Rationale: The slide states that the half-life of Hydralazine is between 3-7 hours.

Question 115

After administration, the peak plasma concentration of Hydralazine is reached in:
A) 15 minutes
B) 30 minutes
C) 1 hour
D) 2 hours

Answer 115

Correct Answer: C) 1 hour

Question 116

Which type of calcium channel blocker is selective for the atrioventricular (AV) node?
A) Phenylalkylamines
B) Benzothiazepines
C) Dihydropyrimidines
D) None of the above
E) Both A and B

Answer 116

E) Both A and B

Phenylalkylamines: selective for AV node
Benzothiazepines: selective for AV node

Question 117

What is the main mechanism of action of calcium channel blockers?
A) They increase calcium influx into the cells.
B) They bind to receptors on potassium channels.
C) They bind to receptors on voltage-gated calcium channels and decrease calcium influx.
D) They have no effect on excitation-contraction coupling.

Answer 117

Correct Answer: C) They bind to receptors on voltage-gated calcium channels and decrease calcium influx.
Rationale: As per the slide, calcium channel blockers bind to receptors on voltage-gated calcium channels (specifically L-type), leading to a decrease in calcium influx, which inhibits excitation-contraction coupling.

Question 118

Calcium channel blockers decrease systemic vascular resistance (SVR) by:
A) Increasing vascular smooth muscle contractility
B) Decreasing peripheral vasodilation
C) Increasing coronary blood flow
D) Decreasing vascular smooth muscle contractility

Answer 118

Correct Answer: D) Decreasing vascular smooth muscle contractility
Rationale: The second slide indicates that calcium channel blockers decrease vascular smooth muscle contractility, which results in peripheral vasodilation, thus decreasing SVR and systemic blood pressure.

Question 119

The therapeutic effects of calcium channel blockers include all of the following EXCEPT:
A) Increased systemic vascular resistance
B) Decreased speed of conduction through the AV node
C) Increased coronary blood flow
D) Peripheral vasodilation

Answer 119

Correct Answer: A) Increased systemic vascular resistance
Rationale: Increased systemic vascular resistance is not an effect of CCBs; they actually decrease SVR as one of their therapeutic effects by causing peripheral vasodilation.

Question 120

Dihydropyrimidines are a type of calcium channel blocker that is selectively used for:
A) Atrioventricular node effects
B) Arteriolar bed effects
C) Ventricular myocardium effects
D) Platelet aggregation effects

Answer 120

Correct Answer: B) Arteriolar bed effects

Question 121

Which calcium channel blocker has the greatest effect on coronary artery dilation?
A) Verapamil
B) Nifedipine
C) Nicardipine
D) Diltiazem

Answer 121

Correct Answer: C) Nicardipine
Rationale: According to the slide, Nicardipine has the ‘Greatest’ effect on coronary artery dilation compared to the other listed CCBs.

Question 122

Regarding heart rate (HR) effects, which CCB tends to decrease HR?
A) Nifedipine
B) Nicardipine
C) Verapamil
D) All of the above equally

Answer 122

Correct Answer: C) Verapamil
Rationale: The slide indicates that Verapamil decreases heart rate, whereas Nifedipine shows an increase or no change, and Nicardipine shows no change.

Diltiazem decreases HR as well but according to the chart it would be less pronounced then verapamil

Question 123

Which calcium channel blocker is noted for causing marked depression of AV node conduction?
A) Diltiazem
B) Nifedipine
C) Verapamil
D) Nicardipine

Answer 123

Correct Answer: C) Verapamil
Rationale: The slide specifies that Verapamil causes ‘Marked’ depression of AV node conduction.

Question 124

Compared to other CCBs listed, which one is associated with the least myocardial depression?
A) Verapamil
B) Nifedipine
C) Nicardipine
D) Diltiazem

Answer 124

Correct Answer: C) Nicardipine
Rationale: The slide shows that Nicardipine causes ‘Slight’ myocardial depression, which is less than the ‘Moderate’ depression caused by Verapamil, Nifedipine, and Diltiazem.

Question 125

Which 2 CCB is least likely to cause depression of the sinoatrial (SA) node?
A) Diltiazem
B) Nifedipine
C) Verapamil
D) Nicardipine

Answer 125

Correct Answer: B) Nifedipine & D) Nicardipine

Rationale: The slide indicates that Nifedipine has zero effect (‘0’) on SA node depression, whereas Diltiazem causes ‘Slight’ and Verapamil causes ‘Moderate’ depression of the SA node. Nicardipine is also indicated to have zero effect on the SA node.

Question 126

Nicardipine is indicated for:
A) Long-term treatment of hypertension
B) Short-term control of hypertension
C) Treatment of tachycardia
D) Prophylactic treatment of angina

Answer 126

Correct Answer: B) Short-term control of hypertension
Rationale: The slide specifies that Nicardipine is used for short-term control of hypertension.

Question 127

What is the starting dose for Nicardipine when used for hypertension?
A) 2.5 mg/hr
B) 5 mg/hr
C) 10 mg/hr
D) 15 mg/hr

Answer 127

Correct Answer: B) 5 mg/hr
Rationale: According to the slide, the starting dose for Nicardipine is 5 mg/hr.

Question 128

By how much can the dose of Nicardipine be increased incrementally?
A) 1.25 mg/hr
B) 2.5 mg/hr
C) 5 mg/hr
D) 7.5 mg/hr

Answer 128

Correct Answer: B) 2.5 mg/hr
Rationale: The slide indicates that the dose of Nicardipine can be increased by 2.5 mg/hr increments. To a max of 15mg/hr

Question 129

What is the maximum dose of Nicardipine per hour for hypertension control?
A) 5 mg/hr
B) 10 mg/hr
C) 15 mg/hr
D) 20 mg/hr

Answer 129

Correct Answer: C) 15 mg/hr

Question 130

How soon after discontinuation does Nicardipine’s effect decrease by 50%?
A) Immediately
B) 15 minutes
C) 30 minutes
D) 1 hour

Answer 130

Correct Answer: C) 30 minutes
Rationale: The slide mentions that there is a 50% decrease in the drug’s effect 30 minutes after discontinuation.