Quiz 2 Antiangina/CHF Flashcards
A patient comes to your office complaining of intermittent chest pain. After a number of tests you determine that he has angina and you prescibe nitroglycerin for him. Nitroglycerin is an effective vasodilator because it slowly breaks down yielding nitric oxide. The nitric oxide produced acts to stimulate which of the following enzymes?
A. adenylate cyclase B. guanylate cyclase C. cyclic GMP-dependent protein kinse D. protein kinase C E. cyclic AMP-dependent protein kinase
B. guanylate cyclase
A man has an aneurysm in the aortic root, a consequence of Marfan’s syndrome. He experiences a hypertensive crisis that requires prompt blood pressure control. Nitroprusside will be infused for its immediate antihypertensive effects. Which of the following drugs must we administer along with the nitroprusside to minimize the risk of aneurysm rupture as blood pressure falls?
a. Atropine
b. Diazoxide
c. Furosemide
d. Phentolamine
e. Propranolol
e. Propranolol
prevent baroreceptor reflex
- **A patient, who has excessively slow AV nodal conduction rates that unfortunately haven’t been recognized, is started on a drug. As soon as blood levels climb towards the usual therapeutic range the patient goes into complete heart block. Which of the following drugs most likely provoked this further prolongation of the P-R interval, ultimately leading to the complete heart block?
a. Captopril
b. Losartan
c. Nifedipine
d. Nitroglycerin
e. Prazosin
f. Verapamil
f. Verapamil
For many hypertensive patients we can prescribe either lisinopril (or an alternative in the same class) or losartan. Which one of the following statements correctly summarizes how losartan differs from lisinopril or its related drugs?
a. Lisinopril competitively blocks catecholamine-mediated vasoconstriction, losartan does not
b. Lisinopril effectively inhibits synthesis of Angiotensin II, losartan does not
c. Losartan causes a higher incidence of bronchospasm and hyperuricemia
d. Losartan is preferred for managing hypertension during pregnancy, whereas captopril is contraindicated
e. Losartan is suitable for administration to patients with heart failure, whereas captopril and related drugs should be avoided
b. Lisinopril effectively inhibits synthesis of Angiotensin II, losartan does not
Two years later, Mr. Green returns complaining that his nitroglycerin works well when he takes it for an acute attack but that he is having frequent attacks now and would like something to prevent them. Useful drugs for the prophylaxis of angina of effort include which one of the following?
A. Sublingual nitroglyceride B. Esmolol C. Sublingual Insosorbide Dinitrate D. Amylnitrite E. Diltiazem
E. Diltiazem
(Ca+ Channel blockers)
esmolol - shot
sublingual only acute
Following an acute myocardial infarction, a patient develops signs of pulmonary edema requiring drug management. What effect would amrinone, digoxin, and a high dose dopamine have in common if each was administered individually to the patient?
A. decreased AV conduction B. decreasd venous return C. decreased PVR D. increased ventricular contractility E. Decreased cAMP
D. increased ventricular contractility
all positive inotropic on heart
A 71 year old man has a lengthy history of coronary ischemia but has had minimal chest pain since his coronary bypass surgery 4 years ago; however, he does require medications to control his blood pressure nd to treat his benign prostatic hyperplasia. He also occasionally takes vardenafil to improve erectile dysfunction. Which of the following medications is most appropriate for this patient to take if he continues to use vardenafil?
A. Terazosin B. Doxazosin C. Nitroglycerin D. Erythromycin E. Tamsulosin
E. Tamsulosin
Only with “denafil”
Alpha blockers for BPH - “osins”
Calcium channel blockers are commonly used cardiovascular drugs that are effective antihypertensives, antianginals, and antiarrhythmics. Diltiazem is more effective than nifedipine for cardiac indications because diltiazem slows the recovery of the slow calcium channel while also reducing the influx of calcium into the myocyte. Which of the following is an effect of diltiazem?
A. Increase in cardiac inotropy B. Decrease in cardiac chronotropy C. Increase in conduction velocity D. Increase in vascular smooth muscle tone E. All of the above
B. Decrease in cardiac chronotropy
A 62 year old man with a history of DM and HTN arrives in the ER with substernal chest pain for the last hour. He is given IV nitroglycerin to help reduce the pain. Which of the following could be expected with the use of nitrates?
A. Atrial blood pressure is increased
B. Myocardial oxygen demand is decreased
C. Left ventricular wall stress is increased
D. Coronary blood flow is decreased
E. Venous return to the heart is increased
B. Myocardial oxygen demand is decreased
A 61 year old man with erectile dysfunction asks his physician to prescibe Viagra (sildenafil ciltrate). Sildenafil produces its physiological effects by blocking the enzyme that hydrolyzes the second messenger by which nitric oxide produces its physiological effects. Which of the following is the second messenger?
a. G protein
b. Cyclic GMP
c. Diacylglycerol
d. Guanylate cyclase
e. cGMP phosphodiesterase
b. Cyclic GMP
A 60 year old patient presents to the office with complaints of chest pain. During the conversation, the patient indicates that he is under a lot of stress at his job. His blood pressure is 175/102 mmHg, pulse is 84bpm. ECG showed slightly negative T-waves in II, III, and aVF. You decide to intiate the treatment with metoprolol-XL, 50mg a day instructing the patient not to stop the medication abrupty without doctor’s supervision. Out of the following, what described the best reason behind your warning?
A. Decrease of after load B. AV nodal depression C. Precipitation of ischemic events D. Increase of myocardial relaxation E. Inefficient therapeutic response F. Undesirable negative inotropic action
C. Precipitation of ischemic events
A 61-year-old female has intermittent bouts of chest pain on exertion of two months’ duration, associated with numbness and tingling in the fourth and fifth fingers of her left hand. An EKG is normal. She is placed on propranolol, which relieves her symptoms. What cardiovascular effect did the drug have?
A. It decreased production of catecholamines
B. It dilated the coronary vasculature
C. It decreased the requirement for myocardial oxygen
D. It increased peripheral vascular resistance
E. It increased sensitivity to catecholamines
C. It decreased the requirement for myocardial oxygen
- **We have a patient who is diagnosed with variant (vasospastic) angina. Which of the following drugs would be most appropriate, and gen- erally regarded as most effective, for long-term therapy aimed at reducing the incidence or severity of the coronary vasospasm?
a. Aspirin
b. Atorvastatin
c. Diltiazem
d. Nitroglycerin
e. Propranolol
c. Diltiazem
- ***A patient has periodic episodes of paroxysmal supraventricular tachycardia (PSVT). Which of the following drugs would be most suitable for outpatient prophylaxis of these worrisome electrophysiologic events?
a. Adenosine
b. Lidocaine
c. Nifedipine
d. Nitroglycerin
e. Verapamil
e. Verapamil
Although not strictly "alternative medicine" the incubation of a west indian centipede in alchohol for several weeks is alleged to result in the formation of a compound that has effectiveness in erectile dysfunction. If this compound is similar to sildenafil and inhibits phosphodiesterases, it would be contraindicated in a patient who is being treated with A. Propanolol B. Hydrochlorthiazide C. Isosorbide dinitrate D. Lovastatin E. Amiodarone
C. Isosorbide dinitrate
Sildenafil is contraindicated by nitrates
