Pharmacology

Question 1

Anti-adrenergic will interfere with the SNS where?

Answer 1

Central nervous system
Postganglionic sympathetic nerve ending
Peripheral alpha- & beta-receptors

Question 2

When SNS is stimulated, it will release norepinephrine that will stimulates what?

Answer 2

Post-synaptic alpha- & beta- adrenergic receptors

Question 3

Cardiac output and peripheral vascular resistance are controlled by which system?

Answer 3

Sympathetic Nervous System

Question 4

Activation of alpha-1 receptor leads to what?

Answer 4

Vasoconstriction

Question 5

Where are the alpha-1 receptors?

Answer 5

Vascular smooth muscles

Question 6

Activation of alpha-2 receptor leads to what?

Answer 6

Vasoconstriction

Decrease in norepinephrine release

Question 7

Where are the alpha-2 receptors?

Answer 7

Presynaptic adrenergic nerve terminal

Vascular smooth muscle

Question 8

Activation of beta-1 receptor leads to what?

Answer 8

Increase heart rate
Increase contractility
Increase renin release
Stimulate lipolysis
Speeds up the atrioventricular node conduction

Question 9

Where are the beta-1 receptors?

Answer 9

Heart
Presynaptic adrenergic nerve terminal
Kidneys

Question 10

Activation of beta-2 receptor leads to what?

Answer 10

Vasodilatation
Bronchodilatation
Stimulate glygogenolysis

Question 11

Where are the beta-2 receptors?

Answer 11

Vascular smooth muscle
Liver
Bronchial smooth muscle

Question 12

Central adrenergic inhibitors (CNS alpha-2 agonists) will do what?

Answer 12

Diminish peripheral vascular resistance
Decrease cardiac output
Decrease heart rate and blood pressure

Question 13

What kind of drug should you give to a patient if you want to inhibit the uptake of norepinephrine or reduce the force of myocardial contraction?

Answer 13

Sympathetic nerve ending antagonist

Question 14

What are the main side-effect of sympathetic nerve ending antagonist?

Answer 14

Sedation
Impaired concentration
Psychotic depression

Question 15

Non-selective blockage of alpha-1 receptor with a peripheral alpha-adrenergic receptor antagonist will lead to what?

Answer 15

Vasodilatation
Increase in heart rate mediated by baroreceptors
Undesired reflex tachycardia
Postural hypotension
Headaches/dizziness

Question 16

Non-selective blockage of alpha-2 receptor with a peripheral alpha-adrenergic receptor antagonist will lead to what?

Answer 16

Reduction in norepinephrine
Undesired reflex tachycardia
Postural hypotension
Headaches/dizziness

Question 17

Selective blockage of alpha-1 receptor with a peripheral alpha-adrenergic receptor antagonist will lead to what? What is it good for?

Answer 17

Vasodilatation
Postural hypotension
Headaches/dizziness
good for: hypertension

Question 18

What is the third-line of treatment for heart disease?

Answer 18

Beta-adrenergic receptor antagonists

Question 19

What are the major effects of beta-blockage?

Answer 19

Lowers inotropy
Lowers heart rate
Lowers conduction velocity

Question 20

Non-selective beta-adrenergic receptor antagonists will lead to bronchospasm and bronchovaconstriction. Which beta-selective drug does not do that?

Answer 20

Beta-1 selective

Question 21

What is the clinical use of beta-adrenergic receptor antagonists?

Answer 21

Ischemic heart disease
Hypertension
Heart failure
Tachyarrhythmia

Question 22

What should you use for hypertension?

Answer 22

Alpha-blockers

Question 23

Name two beta-blockers drugs that also have alpha-blockers properties

Answer 23

Labetolol

Carvedilol

Question 24

According to the Vaughan Williams classification, what are class 1 drugs and what do they do?

Answer 24

Sodium channel blockers
Reduce automaticity and/or conduction velocity in fast channel tissue (ventricular and atrial muscles, His-Purkinje system)

Question 25

According to the Vaughan Williams classification, what are class 2 drugs and what do they do?

Answer 25

Beta-adrenergic receptors blockers | Acts on slow channel tissues (sinus and atrioventricular nodes)

Question 26

According to the Vaughan Williams classification, what are class 3 drugs and what do they do?

Answer 26

Potassium channel blockers | Increase action potential duration in fast channel tissue (ventricular and atrial muscles, His-Purkinje system)

Question 27

According to the Vaughan Williams classification, what are class 4 drugs and what do they do?

Answer 27

Calcium channel blockers | Acts on slow-channel tissues (sinus and atrioventricular nodes)

Question 28

On the ECG, what is the conduction time through the AV node?

Answer 28

The PR interval

Question 29

On the ECG, slower ventricular conduction will show what?

Answer 29

A longer QRS complex

Question 30

What is Vagal enhancement and what does it do?

Answer 30

Enhancement of basal K+ current | Hyperpolarize the cell to take it away from firing threshold

Question 31

With respect to calcium, what does a beta-blocker do?

Answer 31

Remove Ca2+ current

Question 32

What do purinergic agonists do?

Answer 32

Produce "Vagal-like effect" via purinergic receptor activation

Question 33

What are the effects of class 2 & 4 drugs on the ECG?

Answer 33

PR interval in made longer | Heart rate is diminished

Question 34

Are drugs of class 2 & 4 recommended for atrial fibrillation?

Answer 34

Yes. Atrial fibrillation is determined by the atrioventricular node refractory period. Increasing this refractory period will reduce ventricular response and symptoms

Question 35

Are beta-blockers drugs useful for atrioventricular node reentry termination and/or atrial fibrillation termination?

Answer 35

No that much for reentry Absolutely not for atrial fibrillation termination Good for prevention

Question 36

Is vagal enhancement useful for atrial fibrillation?

Answer 36

No

Question 37

Is vagal enhancement useful for atrioventricular node reentry termination?

Answer 37

Yes

Question 38

Is vagal enhancement useful for rate control?

Answer 38

Yes

Question 39

Is Ca2+ channel blockers useful for atrial fibrillation?

Answer 39

No

Question 40

Is Ca2+ channel blockers useful for atrioventricular node reentry termination?

Answer 40

Really useful

Question 41

Is Ca2+ channel blockers useful to slow ventricular response rate?

Answer 41

Yes

Question 42

In terms of treatment, what is the disadvantage of purinergic agonists?

Answer 42

They are very temporary

Question 43

Are purinergic agonists useful for atrioventricular node reentry termination?

Answer 43

Highly effective (but not for prevention)

Question 44

Are purinergic agonists useful for atrial fibrillation termination?

Answer 44

No

Question 45

Are purinergic agonists useful for ventricular rate control?

Answer 45

No

Question 46

Beta-blockers, Vagal enhancement, Ca2+ channel blockers, Purinergic agonists belong to which class of drugs?

Answer 46

Class 2 and 4

Question 47

What are the effects of class 3 drugs on the ECG?

Answer 47

Increase of the QT interval

Question 48

What are the effects of class 1 drugs on the ECG?

Answer 48

Increase of the QRS complex duration

Question 49

How does a class 3 drug terminate reentry?

Answer 49

By increasing refractory period

Question 50

What is the most important determinant of refractory period in fast channel tissues?

Answer 50

Action potential duration

Question 51

How does a class 1 drug decreases DAD arrythmia?

Answer 51

Supresses extrasystoles (premature ventricular and atrial contractions) that can act as triggers

Question 52

What are the most effective drugs for atrial fibrillation on the long term?

Answer 52

``` Amiodarone (class 1 to 4) Sotalol (class 2 & 3, but increases risk of long QT syndrome) ```

Question 53

What is the most effective drug for ventricular tachycardia on the long term?

Answer 53

Amiodarone (class 1 to 4)

Question 54

CPVT is a congenital ventricular tachycardia syndrome, and is caused by what? What drug is useful to treat it?

Answer 54

Ryanodine receptor mutation | Beta-blocker is useful

Question 55

Long QT syndrome is a congenital ventricular tachycardia syndrome. What drug is useful to treat it?

Answer 55

Beta-blocker is useful. If not, go for the implanted defibrillator

Question 56

Acquired ventricular tachycardia requires what to correct it?

Answer 56

Intravenous lidocaine/amiodarone | Direct current