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cvs > Pharmacology Review Q's > Flashcards

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)

1
Q

T/F: angiotensin I is converted to angiotensin II only through angiotensin-converting enzyme (ACE)

A

Cathepsin G + Chymase also convert it

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2
Q

Which of the following increases calcium by releasing Ca from intracellular stores?

a. DAG
b. IP3

A

b. IP3

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3
Q

The activation of which of the following causes vasodilation?

a. angiotensin type 1 receptor
b. angiotensin type 2 receptor

A

b. angiotensin type 2 receptor

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4
Q

Which of the following plays a greater role in cardiac hypertrophy?

a. angiotensin type 1 receptor
b. angiotensin type 2 receptor

A

b. angiotensin type 2 receptor

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5
Q

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

a. angiotensin type 1 receptor

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6
Q

Which of the following increases calcium by helping influx through calcium channels?

a. DAG
b. IP3

A

a. DAG

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7
Q

Which of the following are angiotensin receptor blockers?

a. aliskiren
b. lisonopril
c. captopril
d. valsaratan
e. losartan

A

d. valsaratan

+

e. losartan

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8
Q

Activation of which causes vasoconstriction?

a. angiotensin type 1 receptor
b. angiotensin type 2 receptor

A

a. angiotensin type 1 receptor

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9
Q

Which of the following prevents the conversion of angiotensin 1 to 2?

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

A

b. lisonopril +captopril

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10
Q

Which of the following are competitive antagonists of AT1- receptors?

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

A

c. valsaratan + losartan

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11
Q

Which of the following are renin competitive inhibitors?

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

A

a. aliskiren

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12
Q

Which has a side effect of fetal anomalies?

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

A

b. lisonopril +captopril

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13
Q

Which is more effective in reducing blood pressure and ventricular hypertrophy?

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

A

a. aliskiren

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14
Q

What converts angiotensin I to angiotensin (1-7)?

A

neutral endopeptidases (NEP)

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15
Q

What converts angiotensin II to angiotensin (1-7)?

A

ACE2

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18
Q

What occurs to angiotensin I if ACE inhibitors are applied?

A

levels increase and may be converted to angiotensin (1-7) via NEP pathway

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19
Q

Which drugs reduce arteriolar and ventricular remodeling?

A

losartan + valsartan

(Angiotensin receptor blockers)

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20
Q

Which of the following has a greater side effect of coughing? explain the mechanism.

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

A

b. lisonopril +captopril

(Decrease bradykinin degradation)

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21
Q

Which of the following is best to use in hypertensive diabetic patients?

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

A

b. lisonopril +captopril

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22
Q

T/F: aliskiren levels can be detectable in plasma for 3 weeks after treatment

A

false, its in the kidneys for 3 weeks, whereas its plasma levels become undetectable at an earlier time

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23
Q

What is aliskiren metabolized by?

A

P450 enzyme 3A4

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24
Q

T/F: all class 1 antiarrhythmic drugs increase refractory period

A

false; class 1a increases it, 1b decreases, and 1c doesn’t change it

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25
Q

Which two phases do class 1 antiarrhythmic drugs affect and how?

A

reduced rate of phase 0 and phase 4 depolarization

they do this by blocking Na channels

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27
Q

Which has no effect on duration of the action potential?

a. Mexiletine
b. Disopyramide
c. Procainamide
d. Flecainide
e. Quinidine
f. Lidocaine

A

d. Flecainide

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28
Q

Which of the following causes cinchonism as an adverse effect?

a. Mexiletine
b. Disopyramide
c. Procainamide
d. Flecainide
e. Quinidine
f. Lidocaine

A

e. Quinidine

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29
Q

In which location(s) do class 1B antiarrhythmic agents reduce the duration of AP?

A

Shortens the duration of AP in Purkinje fibers and ventricular muscle.

(No difference in AP of atrial fibers)

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30
Q

Which phase do class 2 and 3 antiarrhythmic drugs affect and how?

A

Reduce slope of phase 4-depolarization

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31
Q

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

A

b. Disopyramide

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33
Q

How is Quinidine taken? Where is it found in the body? Where is it metabolized and excreted?

A

taken orally, 90% found in plasma proteins, metabolized in liver and excreted in urine

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34
Q

Why does Quinidine cause hypotension?

A

because it blocks alpha-adrenergic receptors, which vasoconstrict vessels

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35
Q

Which has the highest anticholinergic effect?

a. Quinidine
b. Disopyramide
c. Procainamide

A

b. Disopyramide

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36
Q

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

a. Mexiletine

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37
Q

Which antiarrhythmic drugs are used to stimulate uterine activity?

A

Quinidine

(Acts as oxytocic agent=stimulate uterine activity)

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38
Q

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

A

c. Procainamide

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39
Q

Which is used to treat ventricular arrhythmias in children?

a. Mexiletine
b. Disopyramide
c. Phenytoin
d. Flecainide
e. Quinidine
f. Lidocaine

A

c. Phenytoin

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40
Q

Which has an adverse effect of bone marrow depression?

a. Mexiletine
b. Disopyramide
c. Phenytoin
d. Flecainide
e. Quinidine
f. Lidocaine

A

f. Lidocaine

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41
Q

Which of the following is mainly used with other drugs?

a. Mexiletine
b. Disopyramide
c. Phenytoin
d. Flecainide
e. Quinidine
f. Lidocaine

A

a. Mexiletine

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42
Q

Which class of antiarrhythmic drugs increases threshold potential? What does this result in?

a. class 1A
b. class 1B
c. class 1C

A

c. class 1C

increasing threshold potential reduces automaticity

43
Q

Which drug leads to the development of lupus-like syndrome when you stop prolonged treatment?

A

Procainamide

44
Q

Which had the shortest half-life?

a. Mexiletine
b. Disopyramide
c. Procainamide
d. Flecainide
e. Quinidine
f. Lidocaine

A

f. Lidocaine

(1.5-2hrs)

45
Q

Which class of antiarrhythmic drugs are the most potent Na channel blockers? Describe dissociation rate.

a. class 1A
b. class 1B
c. class 1C

A

c. class 1C

they have a high affinity to the Na channels and dissociate very slowly, prolonging their effect

46
Q

How is Flecainide taken? Where is it found in the body? Where is it metabolized and excreted?

A

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)

47
Q

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

A

c. class III drugs

(depolarization affected)

48
Q

Which has an adverse effect of decreased hearing and disorientation?

a. Mexiletine
b. Disopyramide
c. Phenytoin
d. Flecainide
e. Quinidine
f. Lidocaine

A

f. Lidocaine

(CNS symptoms in high concentrations ex/drowsiness)

49
Q

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

A

d. class IV drugs

50
Q

What type of antiarrhythmic drug is Amiodarone? How is the half-life of the drug?

A

type 3, but it hals actions of all the other classes. half life is very high (days or months) so toxicity is more likely

51
Q

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

A

class II drugs (beta adrenergic agnoists)

52
Q

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

A

hypertensive—> b. nifedipine

arrhythmia or angina—> c. verapamil

53
Q

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

A

b. class II drugs
(d. class IV drugs do this also…)

54
Q

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

A

d. class IV drugs

55
Q

Which type of calcium channel is most used?

A

L type Ca channel

56
Q

Which system is for short term blood pressure control?

a. sympathetic nervous system
b. renin-angiotensin-aldosterone system

A

a. sympathetic nervous system

57
Q

How do diuretics work in the short term versus the long term?

A

short term= decrease plasma volume + cardiac output

long term= vasodilation & decreased vascular resistance

58
Q

What are the side effects of diuretics

A

Hypokalemia + Hyperglycemia (cause a reduction in insulin secretion)

59
Q

Which is a renin inhibitor?

a. chlorothiazide
b. hydrochlorothiazide
c. furosemide
d. aliskiren

A

d. aliskiren

(the rest are diuretics)

60
Q

What are some ACE inhibitors? Why do they not work in some individuals?

A

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

61
Q

What is the main side effect of ACE inhibitors? explain the mechanism.

A

dry cough

ACE destroys bradykinin, and since we’re blocking ACE, bradykinin builds up and causes the coughing.

62
Q

What are two angiotensin II receptor blockers? What do they specifically block?

A

losartan, telmisartan

they block the AT1 receptors to stop angiotensin 2 stimulation

63
Q

Orthostatic hypotension is a side effect of angiotensin 2 receptor blockers. explain the mechanism.

A

the blockers prevent contraction of veins

64
Q

Which of the following Ca channel blockers is a nondihydropyridine?

a. Nifedipine
b. Verapamil
c. Amlodipine
d. Diltiazem

A

b. Verapamil

65
Q

Which Ca channel blockers is a smooth muscle selective?

a. Nifedipine
b. Verapamil
c. Amlodipine
d. Diltiazem

A

a. Nifedipine

+

c. Amlodipine

(the Dihydropyridines)

66
Q

Which Ca channel blockers can occasionally cause the heart rate to slow too much?

a. Nifedipine
b. Verapamil
c. Amlodipine
d. Diltiazem

A

b. Verapamil

(the nondihydropyridine, because its cardioselective)

67
Q

Which Beta Adrenoceptor Blocking Agent is nonselective?
a. Propranolol

b. Atenolol

A

a. Propranolol

Atenolol= beta-1 adrenoceptor selective

68
Q

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

A

d. Beta 2 Adrenoceptor

70
Q

Which drugs relax the muscles around the bladder and prostate?

A

Alpha-1 Adrenoceptor Blocking Agents=

Doxazosin, Prazosin, Terazosin

71
Q

What type of drug is Carvedilol? When is it contraindicated?

A

it’s an alpha and beta-blocker (along with Labetalol), anti-oxidant, anti-inflammatory

contraindicated in conditions including bronchial asthma and severe bradycardia

72
Q

Which drug is used to treat pregnancy-induced hypertension?

A

Methyldopa

73
Q

What type of drugs are Alpha-Methyldopa + Clonidine? How do they work?

A

Centrally acting Alpha-2 Adrenergic Agonists

They stimulate alpha-2 receptors within the medulla, preventing the release of noradrenaline

74
Q

What’s the side effect of direct vasodilators (EX/Hydralazine + Nitrates)

A

headache, swelling in the lower legs

75
Q

Minoxidil side effect

A

excessive hair growth

76
Q

Which is made up of plants?

a. digoxin
b. digitoxin
c. both
d. neither

A

c. both

77
Q

Which of the following does liver failure enhance toxicity? How about renal failure

a. digoxin
b. digitoxin
c. both
d. neither

A

renal failure= increase toxicity in a. digoxin

liver failure= increase toxicity in b. digitoxin

** both have a low therapeutic index

78
Q

Explain the mechanism of action of digoxin

A

stop Na+/K+ ATPase (↑Na in cell), less effective Na+ /Ca2+ exchange (due to ↑Na), so now ↑Ca in cell= ↑ contraction force

79
Q

T/F: Digoxin is used to treat heart failure because of its ability to increase HR

A

false, it increases contractility and decreases HR

81
Q

How do Inotropic Drugs increase cAMP levels?

A

by inhibiting phosphodiesterases (stop using cAMP)

OR

activating adenylyl cyclase (to produce cAMP)

83
Q

In which condition does giving Digitalis Glycosides lead to toxicity?

a. hypokalaemia
b. hypocalcemia

A

a. hypokalaemia

(hypocalcemia= Digitalis Glycosides are less effective)

84
Q

Mechanism of action of Dobutamine

A
86
Q

Mechanism of action of Thiazides

A
87
Q

Which of the following Inotropic Drugs can be given orally?

a. Amrinone
b. Milrinone
c. both
d. neither

A

c. both

(both orally or parenterally)

88
Q

T/F: Amrinone and Milrinone have vasoconstrictive effects

A

false, they have a vasodilating effect (which may contribute to their therapeutic effect.)

89
Q

ACE inhibitors mechanism of action

A
91
Q

How do dilator drugs aid in treating heart failure?

A

decreasing preload (venodilation)

decreasing afterload (arteriolar dilation)

93
Q

Which blocks β1-and β2-adrenoceptors?

a. Atenolol
b. Carvedilol
c. both
d. neither

A

b. Carvedilol

(Atenolol= only block β1-adrenoceptors)

94
Q

Which exhibits anti-oxidant activity?

a. Atenolol
b. Carvedilol
c. both
d. neither

A

b. Carvedilol

96
Q

Patient comes in with diabetic nephropathy and some swelling in the ankles. Which do you prescribe?

A

Angiotensin-converting enzyme inhibitors to prevent loss of kidney function associated with diabetic nephropathy

97
Q

What’s the most common side effect of ACE inhibitors?

A

dry cough

98
Q

Which undergoes extensive first-pass hepatic metabolism?

a. telmisartan
b. losartan
c. both
d. neither

A

b. losartan

99
Q

T/F: both Angiotensin II receptor blockers and ACE inhibitors are contraindicated in pregnant women

A

true

(ACEIs are contraindicated during pregnancy because they cause fetal injury and death.)

100
Q

Which do Angiotensin II receptor blockers (ex/losartan, telmisartan) block?

a. AT1 receptors
b. AT2 receptors
c. both
d. netiher

A

a. AT1 receptors

101
Q

Which of the following can cause hyperkalemia?

a. Eplerenone
b. Spironolactone
c. both
d. neither

A

c. both

102
Q

Which of the following is a selective aldosterone receptor antagonist?

a. Eplerenone
b. Spironolactone
c. both
d. neither

A

a. Eplerenone

103
Q

Which of the following reduces K reabsorption?

a. Eplerenone
b. Spironolactone
c. both
d. neither

A

d. neither

(both reduce Na+ reabsorption)

104
Q

Which of the following has less hormonal side effects?

a. Eplerenone
b. Spironolactone
c. both
d. neither

A

a. Eplerenone

105
Q

What is LCZ696? How does it work?

A

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

cvs (13 decks)

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