Pharmacology

Question 1

Dihydropyridine used in subarachnoid hemorrhage to prevent cerebral vasospasm

Answer 1

Nimodipine

Question 2

Calcium channel blocker that can cause hyperprolactinemia

Answer 2

Verapamil

Question 3

Secondary messenger elevated by hydralazine

Answer 3

cGMP

Question 4

Type of vessel that is predominantly dilated by hydralazine

Answer 4

Arterioles

Question 5

Antihypertensive that can cause cyanide toxicity

Answer 5

Nitroprusside

Question 6

Type of vessel that is predominantly dilated by nitroprusside

Answer 6

Both venous and arterial dilator

Question 7

Mechanism through which nitroprusside increases cGMP

Answer 7

Direct release of nitric oxide

Question 8

Type of vessel that is predominantly dilated by nitrates (eg, nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)

Answer 8

Veins

Question 9

Antihypertensives that develop tolerance

Answer 9

Nitrates

Question 10

Nitrates are contraindicated in which type of infarction

Answer 10

Right ventricular infarction

Question 11

Mechanism of action of ranolazine

Answer 11

Inhibits the late phase of sodium current (reducing calcium accumulation), thereby reducing diastolic wall tension (for coronary flow) and oxygen consumption

Question 12

Drug used in drug resistant angina

Answer 12

Ranolazine

Question 13

Mechanism of action of milrinone and inamrinone

Answer 13

Selective PDE-3 inhibitors

Question 14

Mechanism of action of neprilysin inhibitors

Answer 14

Prevent degradation of ANP

Question 15

Bile acid resins (eg, cholestyramine, colestipol, colesevelam) are contraindicated in patients with which type of hyperlipidemia

Answer 15

Hypertriglyceridemia

Question 16

Hypolipidemic drug that inhibits NPC1L1, thereby preventing colesterol absorption

Answer 16

Ezetimibe

Question 17

DOC for patients with hypertriglyceridemia

Answer 17

Fibrates (eg, gemfibrozil, bezafibrate, fenofibrate)

Question 18

Mechanism of action of fibrates

Answer 18

• Upregulate LPL to increase TG clearance

* Activate PPAR alpha to induce HDL synthesis

Question 19

Adverse effects of fibrates

Answer 19

• Myopathy (increased risk with statins)

* Cholesterol gallstones

Question 20

Mechanism of action of niacin

Answer 20

• Inhibit hormone-sensitive lipase in adipose tissue

* Reduces hepatic VLDL synthesis

Question 21

Mechanism of action of PCSK9 inhibitors (eg, alirocumab, evolocumab)

Answer 21

Inactivation of LDL receptor degradation, increasing amount of LDL removed from bloodstream

Question 22

Hypolipidemic drugs that have neurocognitive effects

Answer 22

PCSK9 inhibitors

Question 23

How does cardiac glycosides decrease heart rate

Answer 23

Stimulation of the vagus nerve

Question 24

Clinical use of cardiac glycosides

Answer 24

• HF (increase contractility)

* Atrial fibrillation (decreased conduction at AV node and depression of SA node)

Question 25

Factors that predispose to digoxin toxicity

Answer 25

* Renal failure (decrease excretion) * Hypokalemia (permissive for digoxin binding at K binding site on Na/K ATPase) * Drugs that displace digoxin from tissue binding sites * Decreased clearance

Question 26

Mechanism of action of nesiritide

Answer 26

Recombinant form of human B type natriuretic peptide

Question 27

Type 1 antiarrhythmics depress which type of tissue

Answer 27

Tissue that is frequently depolarized

Question 28

Type of antiarrhythmics that block fast sodium channels on an open or activated state

Answer 28

Type 1A antiarrhythmics

Question 29

Effects of type 1 antiarrhythmics on action potential (AP) duration

Answer 29

* Type 1A: increase AP * Type 1B: decrease AP * Type 1C: no effect

Question 30

Class of type 1 antiarrhythmics that preferntially affect ischemic or depolarized Purkinje and ventricular tissue

Answer 30

Type 1B

Question 31

Class of type 1 antiarrhythmics with the weakest binding to the channels

Answer 31

Type 1B

Question 32

Class of type 1 antiarrhythmic that prolongs effective refractory period (ERP) in AV node and accessory bypass tracts

Answer 32

Type 1C

Question 33

Class of type 1 antiarrhythmics with the strongest bindings to the channels

Answer 33

Type 1C

Question 34

Mechanism of action of beta blockers (as antiarrhythmics)

Answer 34

* Decrease SA and AV nodal activity by decreasing cAMP and calcium currents * Suppress abnormal pacemakers by decreasing the slope of phase 4 * Increase PR Interval (AV node is very sensitive)

Question 35

Mechanism of action of ivabradine

Answer 35

Selective inhibition of funny sodium channels

Question 36

Main contraindication of class 1A antiarrhythmics

Answer 36

Patients with prolonged QT interval

Question 37

Type of drugs used to diagnose Prinzmetal angina

Answer 37

Ergonovines

Question 38

Specific combination of drugs that show a survival benefit in African American patients with systolic heart failure

Answer 38

Hydralazine + isosorbide nitrate

Question 39

Mechanism through which fibrates exacerbate statin-associated myopathy

Answer 39

They impair statin clearance in the liver

Question 40

Intracellular event responsible for nitrates' effects

Answer 40

Myosin light chain dephosphorylation by cGMP * Decreased intracellular calcium * Activation of myosin light chain phosphatase

Question 41

Vessels that are preferentially dilated by dihydropyridines

Answer 41

Precapillary vessels (arterioles)

Question 42

vessels that are preferentially dilated by renin-angiotensin system blockers (ACE inhibitors and ARBs)

Answer 42

Postcapillary vessels (venules)

Question 43

Class 1A antiarrhythmic that has antimuscarinic and alpha 1 blocking effects and thus, increases conduction through the AV node and shortens the PR interval

Answer 43

Quinidine

Question 44

Why is hydralazine contraindicated in patients with angina

Answer 44

Because it can potentiate it through reflex tachycardia

Question 45

Resistance to methicillin (in Staph) confers resistance to what other antibiotic

Answer 45

Cephalosporins, because the mechanism of methicillin resistance involves penicillin binding protein alterations (PBPs are also used by cephalosporins)

Question 46

Only statin that is not metabolized by P450 enzyme system

Answer 46

Pravastatin

Question 47

Sypmatholytic drug that is used for opiate withdrawal

Answer 47

Clonidine