Pharmacology Review Q's Flashcards
1. renin system (1-23) 2. antiarrhythmic drugs (24-55) 3. manage hypertension (56-75) 4. heart failure treatmetn (76-105)
T/F: angiotensin I is converted to angiotensin II only through angiotensin-converting enzyme (ACE)
Cathepsin G + Chymase also convert it
Which of the following increases calcium by releasing Ca from intracellular stores?
a. DAG
b. IP3
b. IP3
The activation of which of the following causes vasodilation?
a. angiotensin type 1 receptor
b. angiotensin type 2 receptor
b. angiotensin type 2 receptor
Which of the following plays a greater role in cardiac hypertrophy?
a. angiotensin type 1 receptor
b. angiotensin type 2 receptor
b. angiotensin type 2 receptor
Which of the following mediates angiotensin II induced growth in the left ventricle and the arterial wall?
a. angiotensin type 1 receptor
b. angiotensin type 2 receptor
a. angiotensin type 1 receptor
Which of the following increases calcium by helping influx through calcium channels?
a. DAG
b. IP3
a. DAG
Which of the following are angiotensin receptor blockers?
a. aliskiren
b. lisonopril
c. captopril
d. valsaratan
e. losartan
d. valsaratan
+
e. losartan
Activation of which causes vasoconstriction?
a. angiotensin type 1 receptor
b. angiotensin type 2 receptor
a. angiotensin type 1 receptor
Which of the following prevents the conversion of angiotensin 1 to 2?
a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan
b. lisonopril +captopril
Which of the following are competitive antagonists of AT1- receptors?
a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan
c. valsaratan + losartan
Which of the following are renin competitive inhibitors?
a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan
a. aliskiren
Which has a side effect of fetal anomalies?
a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan
b. lisonopril +captopril
Which is more effective in reducing blood pressure and ventricular hypertrophy?
a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan
a. aliskiren
What converts angiotensin I to angiotensin (1-7)?
neutral endopeptidases (NEP)
What converts angiotensin II to angiotensin (1-7)?
ACE2
What occurs to angiotensin I if ACE inhibitors are applied?
levels increase and may be converted to angiotensin (1-7) via NEP pathway
Which drugs reduce arteriolar and ventricular remodeling?
losartan + valsartan
(Angiotensin receptor blockers)
Which of the following has a greater side effect of coughing? explain the mechanism.
a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan
b. lisonopril +captopril
(Decrease bradykinin degradation)
Which of the following is best to use in hypertensive diabetic patients?
a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan
b. lisonopril +captopril
T/F: aliskiren levels can be detectable in plasma for 3 weeks after treatment
false, its in the kidneys for 3 weeks, whereas its plasma levels become undetectable at an earlier time
What is aliskiren metabolized by?
P450 enzyme 3A4
T/F: all class 1 antiarrhythmic drugs increase refractory period
false; class 1a increases it, 1b decreases, and 1c doesn’t change it
Which two phases do class 1 antiarrhythmic drugs affect and how?
reduced rate of phase 0 and phase 4 depolarization
they do this by blocking Na channels
Which has no effect on duration of the action potential?
a. Mexiletine
b. Disopyramide
c. Procainamide
d. Flecainide
e. Quinidine
f. Lidocaine
d. Flecainide
Which of the following causes cinchonism as an adverse effect?
a. Mexiletine
b. Disopyramide
c. Procainamide
d. Flecainide
e. Quinidine
f. Lidocaine
e. Quinidine
In which location(s) do class 1B antiarrhythmic agents reduce the duration of AP?
Shortens the duration of AP in Purkinje fibers and ventricular muscle.
(No difference in AP of atrial fibers)
Which phase do class 2 and 3 antiarrhythmic drugs affect and how?
Reduce slope of phase 4-depolarization
Which of the following is mainly used for ventricular arrhythmias in unresponsive patients?
a. Mexiletine
b. Disopyramide
c. Procainamide
d. Flecainide
e. Quinidine
f. Lidocaine
b. Disopyramide
How is Quinidine taken? Where is it found in the body? Where is it metabolized and excreted?
taken orally, 90% found in plasma proteins, metabolized in liver and excreted in urine
Why does Quinidine cause hypotension?
because it blocks alpha-adrenergic receptors, which vasoconstrict vessels
Which has the highest anticholinergic effect?
a. Quinidine
b. Disopyramide
c. Procainamide
b. Disopyramide
Which is mostly used to treat long-term treatment of ventricular arrhythmias associated with previous myocardial infarction?
a. Mexiletine
b. Disopyramide
c. Phenytoin
d. Flecainide
e. Quinidine
f. Lidocaine
a. Mexiletine
Which antiarrhythmic drugs are used to stimulate uterine activity?
Quinidine
(Acts as oxytocic agent=stimulate uterine activity)
Which of the following is used for re-entry arrhythmias and acute ventricular tachycardia?
a. Mexiletine
b. Disopyramide
c. Procainamide
d. Flecainide
e. Quinidine
f. Lidocaine
c. Procainamide
Which is used to treat ventricular arrhythmias in children?
a. Mexiletine
b. Disopyramide
c. Phenytoin
d. Flecainide
e. Quinidine
f. Lidocaine
c. Phenytoin
Which has an adverse effect of bone marrow depression?
a. Mexiletine
b. Disopyramide
c. Phenytoin
d. Flecainide
e. Quinidine
f. Lidocaine
f. Lidocaine
Which of the following is mainly used with other drugs?
a. Mexiletine
b. Disopyramide
c. Phenytoin
d. Flecainide
e. Quinidine
f. Lidocaine
a. Mexiletine
Which class of antiarrhythmic drugs increases threshold potential? What does this result in?
a. class 1A
b. class 1B
c. class 1C
c. class 1C
increasing threshold potential reduces automaticity
Which drug leads to the development of lupus-like syndrome when you stop prolonged treatment?
Procainamide
Which had the shortest half-life?
a. Mexiletine
b. Disopyramide
c. Procainamide
d. Flecainide
e. Quinidine
f. Lidocaine
f. Lidocaine
(1.5-2hrs)
Which class of antiarrhythmic drugs are the most potent Na channel blockers? Describe dissociation rate.
a. class 1A
b. class 1B
c. class 1C
c. class 1C
they have a high affinity to the Na channels and dissociate very slowly, prolonging their effect
How is Flecainide taken? Where is it found in the body? Where is it metabolized and excreted?
taken IV or oral, no first-pass metabolism. 75% found on plasma proteins and highly concentrated in cardiac tissue. partly metabolizes and partly unchanged (slow renal excretion)
Which type of antiarrhythmic drugs act by blocking K channels?
a. class I drugs
b. class II drugs
c. class III drugs
d. class IV drugs
c. class III drugs
(depolarization affected)
Which has an adverse effect of decreased hearing and disorientation?
a. Mexiletine
b. Disopyramide
c. Phenytoin
d. Flecainide
e. Quinidine
f. Lidocaine
f. Lidocaine
(CNS symptoms in high concentrations ex/drowsiness)
Which type of antiarrhythmic drugs act by blocking Ca channels?
a. class I drugs
b. class II drugs
c. class III drugs
d. class IV drugs
d. class IV drugs
What type of antiarrhythmic drug is Amiodarone? How is the half-life of the drug?
type 3, but it hals actions of all the other classes. half life is very high (days or months) so toxicity is more likely
Which type of antiarrhythmic drugs has withdrawal symptoms when the patient stops taking it after long term use?
a. class I drugs
b. class II drugs
c. class III drugs
d. class IV drugs
class II drugs (beta adrenergic agnoists)
Which of the following is best for a hypertensive patient? How about a patient with an arrhythmia or angina?
a. diltiazem
b. nifedipine
c. verapamil
hypertensive—> b. nifedipine
arrhythmia or angina—> c. verapamil
Which type of antiarrhythmic drugs decreases conduction across AV node at high concentrations only?
a. class I drugs
b. class II drugs
c. class III drugs
d. class IV drugs
b. class II drugs
(d. class IV drugs do this also…)
Which is the drug of choice in paroxysmal supraventricular tachycardia?
a. class I drugs
b. class II drugs
c. class III drugs
d. class IV drugs
d. class IV drugs
Which type of calcium channel is most used?
L type Ca channel
Which system is for short term blood pressure control?
a. sympathetic nervous system
b. renin-angiotensin-aldosterone system
a. sympathetic nervous system
How do diuretics work in the short term versus the long term?
short term= decrease plasma volume + cardiac output
long term= vasodilation & decreased vascular resistance
What are the side effects of diuretics
Hypokalemia + Hyperglycemia (cause a reduction in insulin secretion)
Which is a renin inhibitor?
a. chlorothiazide
b. hydrochlorothiazide
c. furosemide
d. aliskiren
d. aliskiren
(the rest are diuretics)
What are some ACE inhibitors? Why do they not work in some individuals?
captopril, enalapril, lisinopril
Don’t work in some people because the ACE enzyme isn’t the only one capable of making angiotensin 1 to 2
What is the main side effect of ACE inhibitors? explain the mechanism.
dry cough
ACE destroys bradykinin, and since we’re blocking ACE, bradykinin builds up and causes the coughing.
What are two angiotensin II receptor blockers? What do they specifically block?
losartan, telmisartan
they block the AT1 receptors to stop angiotensin 2 stimulation
Orthostatic hypotension is a side effect of angiotensin 2 receptor blockers. explain the mechanism.
the blockers prevent contraction of veins
Which of the following Ca channel blockers is a nondihydropyridine?
a. Nifedipine
b. Verapamil
c. Amlodipine
d. Diltiazem
b. Verapamil
Which Ca channel blockers is a smooth muscle selective?
a. Nifedipine
b. Verapamil
c. Amlodipine
d. Diltiazem
a. Nifedipine
+
c. Amlodipine
(the Dihydropyridines)
Which Ca channel blockers can occasionally cause the heart rate to slow too much?
a. Nifedipine
b. Verapamil
c. Amlodipine
d. Diltiazem
b. Verapamil
(the nondihydropyridine, because its cardioselective)
Which Beta Adrenoceptor Blocking Agent is nonselective?
a. Propranolol
b. Atenolol
a. Propranolol
Atenolol= beta-1 adrenoceptor selective
Antagonism of which receptor causes a side effect of bronchospasm?
a. Alpha 1 Adrenoceptor
b. Alpha 2 Adrenoceptor
c. Beta 1 Adrenoceptor
d. Beta 2 Adrenoceptor
d. Beta 2 Adrenoceptor
Which drugs relax the muscles around the bladder and prostate?
Alpha-1 Adrenoceptor Blocking Agents=
Doxazosin, Prazosin, Terazosin
What type of drug is Carvedilol? When is it contraindicated?
it’s an alpha and beta-blocker (along with Labetalol), anti-oxidant, anti-inflammatory
contraindicated in conditions including bronchial asthma and severe bradycardia
Which drug is used to treat pregnancy-induced hypertension?
Methyldopa
What type of drugs are Alpha-Methyldopa + Clonidine? How do they work?
Centrally acting Alpha-2 Adrenergic Agonists
They stimulate alpha-2 receptors within the medulla, preventing the release of noradrenaline
What’s the side effect of direct vasodilators (EX/Hydralazine + Nitrates)
headache, swelling in the lower legs
Minoxidil side effect
excessive hair growth
Which is made up of plants?
a. digoxin
b. digitoxin
c. both
d. neither
c. both
Which of the following does liver failure enhance toxicity? How about renal failure
a. digoxin
b. digitoxin
c. both
d. neither
renal failure= increase toxicity in a. digoxin
liver failure= increase toxicity in b. digitoxin
** both have a low therapeutic index
Explain the mechanism of action of digoxin
stop Na+/K+ ATPase (↑Na in cell), less effective Na+ /Ca2+ exchange (due to ↑Na), so now ↑Ca in cell= ↑ contraction force
T/F: Digoxin is used to treat heart failure because of its ability to increase HR
false, it increases contractility and decreases HR
How do Inotropic Drugs increase cAMP levels?
by inhibiting phosphodiesterases (stop using cAMP)
OR
activating adenylyl cyclase (to produce cAMP)
In which condition does giving Digitalis Glycosides lead to toxicity?
a. hypokalaemia
b. hypocalcemia
a. hypokalaemia
(hypocalcemia= Digitalis Glycosides are less effective)
Mechanism of action of Dobutamine
Mechanism of action of Thiazides
Which of the following Inotropic Drugs can be given orally?
a. Amrinone
b. Milrinone
c. both
d. neither
c. both
(both orally or parenterally)
T/F: Amrinone and Milrinone have vasoconstrictive effects
false, they have a vasodilating effect (which may contribute to their therapeutic effect.)
ACE inhibitors mechanism of action
How do dilator drugs aid in treating heart failure?
decreasing preload (venodilation)
decreasing afterload (arteriolar dilation)
Which blocks β1-and β2-adrenoceptors?
a. Atenolol
b. Carvedilol
c. both
d. neither
b. Carvedilol
(Atenolol= only block β1-adrenoceptors)
Which exhibits anti-oxidant activity?
a. Atenolol
b. Carvedilol
c. both
d. neither
b. Carvedilol
Patient comes in with diabetic nephropathy and some swelling in the ankles. Which do you prescribe?
Angiotensin-converting enzyme inhibitors to prevent loss of kidney function associated with diabetic nephropathy
What’s the most common side effect of ACE inhibitors?
dry cough
Which undergoes extensive first-pass hepatic metabolism?
a. telmisartan
b. losartan
c. both
d. neither
b. losartan
T/F: both Angiotensin II receptor blockers and ACE inhibitors are contraindicated in pregnant women
true
(ACEIs are contraindicated during pregnancy because they cause fetal injury and death.)
Which do Angiotensin II receptor blockers (ex/losartan, telmisartan) block?
a. AT1 receptors
b. AT2 receptors
c. both
d. netiher
a. AT1 receptors
Which of the following can cause hyperkalemia?
a. Eplerenone
b. Spironolactone
c. both
d. neither
c. both
Which of the following is a selective aldosterone receptor antagonist?
a. Eplerenone
b. Spironolactone
c. both
d. neither
a. Eplerenone
Which of the following reduces K reabsorption?
a. Eplerenone
b. Spironolactone
c. both
d. neither
d. neither
(both reduce Na+ reabsorption)
Which of the following has less hormonal side effects?
a. Eplerenone
b. Spironolactone
c. both
d. neither
a. Eplerenone
What is LCZ696? How does it work?
Sacubitril/valsartan, its a combination drug for use in heart failure
Sacubitril= neprilysin inhibitor→ neprilysin degrades natriuretic peptides and bradykinin. These increase and cause vasodilation + sodium excretion
valsartan= angiotensin receptor blocker→ prevent stimulation by angiotensin II
