Pharm 13 Flashcards

In heart failure pharmacology, many drugs help a weak heart by doing which overall action?

A) Increasing edema formation

B) Increasing venous return

C) Lowering cardiac stress

D) Increasing vascular resistance

Which group from the notes mainly increases cardiac work or contractility rather than lowering workload?

A) Digoxin, dobutamine, milrinone

B) Thiazides, nitrates, SGLT2 inhibitors

C) ACE inhibitors, ARBs, beta blockers

D) Hydralazine, nitroprusside, nesiritide

Furosemide helps heart failure edema by producing which effect?

A) Salt and water retention

B) Salt and water removal

C) Increased afterload only

D) Increased remodeling

By removing extra salt and water, furosemide decreases which cardiac loading variable?

A) Contractility

B) Afterload

C) Preload

D) Heart rate

Furosemide decreases preload because it reduces which variable?

A) Venous return

B) AV conduction

C) Cardiac calcium

D) Vascular remodeling

Which heart failure symptom is directly improved by furosemide-mediated salt and water removal?

A) Edema

B) Arrhythmia

C) Bradycardia

D) Lupus

A weak heart benefits from furosemide because reduced preload causes which effect?

A) More ventricular stress

B) Less cardiac workload

C) More sodium reabsorption

D) More venous congestion

Empagliflozin and dapagliflozin belong to which heart failure drug class?

A) Loop diuretics

B) SGLT2 inhibitors

C) ACE inhibitors

D) Cardiac glycosides

Which name clue helps identify empagliflozin and dapagliflozin?

A) “flozin” ending

B) “sartan” ending

C) “olol” ending

D) “one” ending

SGLT2 inhibitors act primarily in which nephron segment?

A) Collecting tubule

B) Distal convoluted tubule

C) Thick ascending limb

D) Proximal tubule

Empagliflozin decreases reabsorption of which substances?

A) Calcium and chloride

B) Sodium and glucose

C) Potassium and hydrogen

D) Urea and water

Dapagliflozin helps heart failure by promoting removal of what?

A) Salt and water

B) Calcium and protein

C) Renin and ACE

D) BNP and cGMP

SGLT2 inhibitor therapy reduces preload by decreasing which variable?

A) Contractility

B) Venous return

C) AV conduction

D) Platelet count

Which heart failure problem is improved by SGLT2 inhibitor-related fluid removal?

A) Edema

B) Tachyarrhythmia

C) Lupus-like syndrome

D) AV node conduction

A heart failure patient receives dapagliflozin. Which mechanism best explains its benefit?

A) Blocks beta receptors

B) Blocks SGLT2 transport

C) Releases nitric oxide

D) Inhibits PDE-3

Hydrochlorothiazide lowers fluid burden by blocking which transporter?

A) Na/K ATPase

B) Na/Cl transporter

C) Na/K/2Cl transporter

D) SGLT2 transporter

Thiazide diuretics act mainly in which nephron segment?

A) Proximal tubule

B) Collecting tubule

C) Loop of Henle

D) Distal convoluted tubule

Hydrochlorothiazide helps heart failure mainly by removing which substances?

A) Salt and water

B) Calcium and protein

C) Angiotensin and renin

D) cAMP and cGMP

Thiazide-mediated fluid removal decreases which cardiac loading condition?

A) Preload

B) Contractility

C) Remodeling

D) AV conduction

Spironolactone and eplerenone belong to which heart failure drug class?

A) ACE inhibitors

B) Beta blockers

C) Aldosterone antagonists

D) SGLT2 inhibitors

Which name clue helps identify spironolactone and eplerenone?

A) “flozin” ending

B) “pril” ending

C) “sartan” ending

D) “one” ending

Aldosterone antagonists block receptors in which nephron region?

A) Collecting tubules

B) Proximal tubule

C) Thick ascending limb

D) Distal convoluted tubule

Spironolactone helps heart failure by promoting which overall effect?

A) Sodium and water removal

B) Calcium entry increase

C) Beta-1 stimulation

D) cAMP breakdown

Aldosterone antagonists reduce preload because they decrease which variable?

A) Venous return

B) Contractility

C) AV node conduction

D) cGMP signaling

Which listed heart failure drugs block aldosterone receptors?

A) Captopril and losartan

B) Empagliflozin and dapagliflozin

C) Spironolactone and eplerenone

D) Dobutamine and milrinone

ACE inhibition decreases formation of which molecule?

A) Angiotensin II

B) Dopamine

C) BNP

D) cGMP

Captopril helps heart failure by decreasing which two harmful effects?

A) Vasoconstriction and aldosterone

B) Contractility and perfusion

C) Diuresis and vasodilation

D) cGMP and BNP

ACE inhibitors decrease afterload mainly by reducing which process?

A) Vasoconstriction

B) Glucose excretion

C) AV node conduction

D) Platelet breakdown

ACE inhibitors decrease preload partly by reducing which hormone effect?

A) Aldosterone

B) Insulin

C) Glucagon

D) Thyroxine

Why does reduced afterload help a weak ventricle?

A) It increases resistance strongly

B) It makes pumping easier

C) It increases edema formation

D) It worsens remodeling

ACE inhibitors help heart failure partly by reducing which long-term harmful process?

A) Bronchoconstriction

B) Remodeling

C) Thrombocytopenia

D) Visual changes

Losartan belongs to which heart failure drug class?

A) ACE inhibitor

B) Beta blocker

C) Angiotensin II receptor blocker

D) Cardiac glycoside

Which name clue helps identify losartan and related ARBs?

A) “olol” ending

B) “flozin” ending

C) “sartan” ending

D) “pril” ending

Angiotensin receptor blockers improve heart failure by decreasing which effect?

A) Vasoconstriction

B) Diuresis

C) Calcium retention

D) Bradycardia

ARBs help heart failure by decreasing which disease process?

A) Ototoxicity

B) Remodeling

C) Constipation

D) Thrombocytopenia

Compared with ACE inhibitors, ARBs are associated with less of which adverse effect?

A) Cough

B) Edema

C) Tachycardia

D) Hypotension

Carvedilol, metoprolol, bisoprolol, and nebivolol belong to which class?

A) Beta blockers

B) ACE inhibitors

C) Cardiac glycosides

D) Bipyridines

Beta blockers help chronic heart failure by reducing which harmful drive?

A) Sympathetic overstimulation

B) Proximal glucose uptake

C) BNP receptor activation

D) Nitric oxide signaling

Beta blockers improve chronic heart failure by causing which heart rate effect?

A) Slows heart rate

B) Speeds heart rate

C) Stops AV conduction completely

D) Has no heart effect

Beta blockers improve survival in chronic heart failure partly by decreasing what?

A) Remodeling

B) Diuresis

C) Cyanide toxicity

D) Sodium current

Which beta blocker listed for heart failure also blocks alpha receptors?

A) Carvedilol

B) Metoprolol

C) Bisoprolol

D) Nebivolol

Which listed heart failure beta blocker is beta-1 selective?

A) Hydralazine

B) Metoprolol

C) Losartan

D) Nesiritide

Beta blockers are especially useful in which heart failure setting from the notes?

A) Chronic heart failure

B) Acute cyanide toxicity

C) Immediate inotrope rescue

D) Severe thrombocytopenia

Digoxin belongs to which drug class?

A) Cardiac glycoside

B) SGLT2 inhibitor

C) Bipyridine

D) ARB

Digoxin directly inhibits which membrane pump?

A) Na/K ATPase

B) Na/Cl transporter

C) SGLT2 transporter

D) Na/K/2Cl transporter

Inhibition of Na/K ATPase by digoxin increases which intracellular ion?

A) Sodium only

B) Calcium

C) Chloride

D) Magnesium

Digoxin helps heart failure mainly by increasing which cardiac property?

A) Contractility

B) Preload

C) Afterload

D) Remodeling

Digoxin is also useful in atrial fibrillation because it slows which conduction pathway?

A) AV node conduction

B) SA node automaticity

C) His-Purkinje conduction

D) Ventricular repolarization

Which adverse effect is most associated with digoxin toxicity in the notes?

A) Arrhythmias

B) Cyanide toxicity

C) Lupus-like syndrome

D) Thrombocytopenia

A heart failure patient with atrial fibrillation receives digoxin. Which combined benefit is expected?

A) More contractility, slower AV conduction

B) Less contractility, faster AV conduction

C) More preload, less contractility

D) Less cAMP, more congestion

Which drug increases intracellular Ca2+ by inhibiting Na/K ATPase?

A) Dobutamine

B) Digoxin

C) Milrinone

D) Nesiritide

Hydralazine belongs to which heart failure drug category in the notes?

A) Arteriolar dilator

B) Cardiac glycoside

C) Natriuretic peptide

D) SGLT2 inhibitor

Hydralazine increases which signaling pathway?

A) Nitric oxide signaling

B) Beta-1 signaling

C) BNP signaling

D) Sodium-glucose signaling

Hydralazine helps heart failure by decreasing which loading variable?

A) Afterload

B) Preload

C) Contractility

D) AV conduction

Why does decreased afterload help a weak ventricle pump?

A) Less resistance opposes ejection

B) More edema reaches ventricles

C) Less calcium enters cells

D) More sodium is retained

Which side effect is associated with hydralazine?

A) Reflex tachycardia

B) Cyanide toxicity

C) Thrombocytopenia

D) Visual brightness

Which side effects are associated with hydralazine?

A) Headache and flushing

B) Cough and angioedema

C) Bradycardia and vision

D) Edema and cyanosis

Hydralazine can cause which autoimmune-like adverse effect?

A) Lupus-like syndrome

B) Guillain-Barré syndrome

C) Myasthenic syndrome

D) Nephrotic syndrome

Nitroprusside is best described as which type of heart failure vasodilator?

A) Pure arteriolar dilator

B) Pure venous dilator

C) Combined arterial and venous dilator

D) Pure renal tubule dilator

Nitroprusside directly releases which mediator?

A) Nitric oxide

B) Angiotensin II

C) Aldosterone

D) Dopamine

Nitroprusside helps acute heart failure by rapidly decreasing which loading variables?

A) Preload and afterload

B) Contractility and calcium

C) Heart rate and rhythm

D) AV conduction and remodeling

Which heart failure setting best matches nitroprusside use in these notes?

A) Acute heart failure

B) Chronic remodeling prevention

C) Stable outpatient edema only

D) Atrial fibrillation rate control

Which toxicity is associated with nitroprusside?

A) Cyanide toxicity

B) Lupus-like syndrome

C) Bronchoconstriction

D) Gynecomastia

Which additional toxicity is associated with nitroprusside?

A) Thiocyanate toxicity

B) Ototoxicity

C) Visual brightness

D) Constipation

A patient on nitroprusside develops a dangerous BP drop. Which adverse effect is this?

A) Severe hypotension

B) Bradycardia only

C) Hyperkalemia only

D) Reflex hypertension

Dobutamine belongs to which drug category?

A) Beta-adrenoceptor agonist

B) ACE inhibitor

C) Natriuretic peptide

D) Cardiac glycoside

Dobutamine primarily activates which receptor?

A) Beta-1 receptor

B) Alpha-1 receptor

C) D1 receptor

D) BNP receptor

Beta-1 agonism by dobutamine increases which second messenger?

A) cAMP

B) cGMP

C) IP3

D) DAG

Dobutamine helps acute decompensated heart failure by increasing which cardiac property?

A) Contractility

B) Preload

C) Afterload

D) Remodeling

Dobutamine temporarily improves which hemodynamic outcome?

A) Cardiac output

B) Venous congestion

C) Aldosterone release

D) Sodium retention

Which heart failure setting best matches dobutamine use in the notes?

A) Acute decompensated heart failure

B) Chronic outpatient remodeling prevention

C) Isolated edema without low output

D) Stable hypertension without symptoms

Which adverse effect is associated with dobutamine?

A) Tachycardia

B) Lupus-like syndrome

C) Cyanide toxicity

D) Thrombocytopenia

Dobutamine can trigger which rhythm-related adverse effect?

A) Arrhythmias

B) AV slowing

C) Bradycardia

D) QT shortening

Why can dobutamine be risky in ischemic patients?

A) Increases myocardial oxygen demand

B) Decreases contractility too much

C) Blocks coronary vasodilation

D) Causes severe sodium retention

Milrinone belongs to which drug category?

A) Bipyridine

B) Cardiac glycoside

C) ARB

D) Loop diuretic

Milrinone directly inhibits which enzyme?

A) PDE-3

B) ACE

C) Renin

D) Na/K ATPase

PDE-3 inhibition by milrinone causes which intracellular effect?

A) Decreased cAMP breakdown

B) Increased cAMP breakdown

C) Decreased cGMP formation

D) Increased Na/K ATPase activity

Milrinone improves output partly by increasing which cardiac property?

A) Contractility

B) Preload

C) Edema

D) Remodeling

Milrinone decreases afterload through which effect?

A) Vasodilation

B) Venoconstriction

C) Aldosterone release

D) Beta blockade

Which adverse effect is associated with milrinone?

A) Arrhythmias

B) Cyanide toxicity

C) Lupus-like syndrome

D) Cough

Milrinone can cause which blood pressure adverse effect?

A) Hypotension

B) Hypertension

C) Reflex hypertension

D) No BP change

Which hematologic adverse effect is associated with milrinone?

A) Thrombocytopenia

B) Polycythemia

C) Neutrophilia

D) Eosinophilia

Nesiritide belongs to which drug category?

A) Natriuretic peptide

B) Beta blocker

C) Bipyridine

D) Cardiac glycoside

Nesiritide activates which receptor pathway?

A) BNP receptors

B) Beta-1 receptors

C) Angiotensin II receptors

D) Aldosterone receptors

BNP receptor activation by nesiritide increases which second messenger?

A) cGMP

B) cAMP

C) IP3

D) DAG

Nesiritide helps acute heart failure by causing?

A) Diuresis

B) Bronchoconstriction

C) AV slowing

D) Calcium retention

Nesiritide decreases which loading variables in acute heart failure?

A) Preload and afterload

B) Contractility and output

C) cAMP and calcium

D) Sodium and glucose reabsorption

Which adverse effect is associated with nesiritide?

A) Hypotension

B) Arrhythmias

C) Lupus-like syndrome

D) Cyanide toxicity

Which heart failure drug directly increases contractility by increasing intracellular calcium?

A) Digoxin

B) Furosemide

C) Losartan

D) Nesiritide

Which heart failure drug increases contractility by preventing cAMP breakdown?

A) Milrinone

B) Metoprolol

C) Losartan

D) Hydrochlorothiazide

Which heart failure drug has tachycardia, arrhythmias, and increased myocardial oxygen demand as listed side effects?

A) Dobutamine

B) Digoxin

C) Milrinone

D) Losartan

Which heart failure drug has arrhythmias, hypotension, and thrombocytopenia as listed side effects?

A) Milrinone

B) Captopril

C) Furosemide

D) Carvedilol

Which heart failure drug has cyanide toxicity, thiocyanate toxicity, and severe hypotension as listed side effects?

A) Nitroprusside

B) Hydralazine

C) Nesiritide

D) Dobutamine

Which of the following is the best-documented mechanism
of beneficial action of cardiac glycosides?
(A) A decrease in calcium uptake by the sarcoplasmic reticulum
(B) An increase in a late transmembrane sodium current
(C) A modification of the actin molecule
(D) An increase in systolic cytoplasmic calcium levels
(E) A block of cardiac β adrenoceptors

A patient who has been taking digoxin for several years for
atrial fibrillation and chronic heart failure is about to receive
atropine for another condition. A common effect of digoxin
(at therapeutic blood levels) that can be almost entirely
blocked by atropine is
(A) Decreased appetite
(B) Headaches
(C) Increased atrial contractility
(D) Increased PR interval on ECG
(E) Tachycardia

A 65-year-old woman has been admitted to the coronary
care unit with a left ventricular myocardial infarction. She
develops acute severe heart failure with marked pulmonary
edema, but no evidence of peripheral edema. Which one of
the following drugs would be most useful?
(A) Digoxin
(B) Furosemide
(C) Minoxidil
(D) Propranolol
(E) Spironolactone

A 72-year-old woman has long-standing heart failure. Which
one of the following drugs has been shown to reduce mortality in chronic heart failure?
(A) Atenolol
(B) Digoxin
(C) Furosemide
(D) Nitroprusside
(E) Spironolactone

Which of the following drugs increases the plasma levels of
endogenous BNP and also blocks angiotensin receptors?
(A) Furosemide
(B) Losartan
(C) Nesiritide
(D) Valsartan
(E) Spironolactone

Which one of the following drugs is associated with clinically
useful or physiologically important positive inotropic effect?
(A) Captopril
(B) Dobutamine
(C) Enalapril
(D) Losartan
(E) Nesiritide

Which of the following has been shown to prolong life in
patients with chronic congestive failure in spite of having a
negative inotropic effect on cardiac contractility?
(A) Carvedilol
(B) Digoxin
(C) Dobutamine
(D) Enalapril
(E) Furosemide

Which of the following is the drug of
choice in treating a severe overdose of digoxin?
(A) Digoxin antibodies
(B) Lidocaine infusion
(C) Magnesium infusion
(D) Phenytoin by mouth
(E) Potassium by mouth

What is the main mechanism of levosimendan?

A. Increases calcium sensitivity

B. Blocks beta-1 receptors

C. Inhibits sodium channels

D. Activates Na/K ATPase

How does the NCX exchanger normally move sodium and calcium?

A. Two Na inward, one Ca outward

B. Three Na inward, one Ca outward

C. One Na inward, three Ca outward

D. Three Na outward, one Ca inward

The Na+/K+ ATPase is a major determinant of what inside cardiac cells?

A. Calcium sensitivity

B. Potassium release

C. cAMP concentration

D. Intracellular sodium concentration

Which type of heart failure responds best to positive inotropic drugs?

A. Systolic heart failure

B. Diastolic heart failure

Which group contains common GI effects of digoxin toxicity?

A. Nausea, vomiting, diarrhea

B. Constipation, jaundice, reflux

C. Hematemesis, pancreatitis, ileus

D. Dysphagia, melena, ascites

Digoxin also increases activity of which part of the autonomic nervous system?

A. Sympathetic system

B. Parasympathetic system

C. Somatic motor system

D. Enteric system only

Which cranial nerve mediates digoxin's parasympathetic cardiac effects?

A. CN VII

B. CN IX

C. CN X

D. CN XII

Why is hyperkalemia relatively protective against digoxin toxicity?

A. It reduces digoxin pump inhibition

B. It activates calcium channels

C. It increases digoxin absorption

D. It blocks vagal activity

Why can hypercalcemia worsen digoxin-related arrhythmias?

A. It reduces cardiac force

B. It blocks sodium entry

C. It further increases contractile activity

D. It prevents automaticity

Which electrolyte can counteract some effects of high calcium in digoxin toxicity?

A. Sodium

B. Chloride

C. Phosphate

D. Magnesium

Milrinone belongs to which drug class?

A. Cardiac glycosides

B. Bipyridines

C. Catecholamines

D. Nitrates

How can milrinone cause vascular smooth muscle relaxation?

A. Activates MLCK

B. Reduces cAMP

C. Inhibits MLCK activity

D. Activates alpha-1 receptors

Which aldosterone antagonist is used in heart failure?

A. Eplerenone

B. Furosemide

C. Spironolactone

D. Hydrochlorothiazide

What important electrolyte effect does spironolactone have?

A. Wastes potassium

B. Wastes calcium

C. Wastes magnesium

D. Spares potassium

ACE inhibitors provide long-term benefit partly by reducing what cardiac process?

A. Cardiac remodeling

B. AV conduction

C. Calcium sensitivity

D. Ventricular automaticity

Nesiritide was approved mainly for which setting?

A. Chronic stable angina

B. Hypertrophic cardiomyopathy

C. Acute heart failure

D. Ventricular fibrillation

Sacubitril increases natriuretic peptide activity by inhibiting which enzyme?

A. ACE

B. Renin

C. Aldosterone synthase

D. Neprilysin

What does neprilysin normally do to BNP?

A. Degrades BNP

B. Releases BNP

C. Activates BNP receptors

D. Produces BNP

A patient has heart-failure risk factors but no symptoms. Which AHA stage fits best?

A patient has structural heart disease but no obvious resting symptoms and develops symptoms with exercise. Which stage fits these notes?

A patient has known structural heart disease with clear heart-failure symptoms. Which AHA stage fits best?

Heart failure that remains severe despite ordinary therapy is classified as which stage?

A patient takes digoxin and a loop diuretic. What is the biggest arrhythmia concern?

A. Hypernatremia

B. Hypokalemia

C. Hypermagnesemia

D. Hyperphosphatemia

Why does hypokalemia increase digoxin toxicity?

A. It blocks digoxin absorption

B. It activates SERCA

C. It favors digoxin pump binding

D. It inhibits calcium entry

What effect does enalapril have on preload and afterload?

A. Decreases both

B. Increases both

C. Decreases preload only

D. Decreases afterload only

According to these notes, can digoxin be used in atrial fibrillation?

Which conduction disorder is a contraindication to digoxin in these notes?

A. First-degree AV block

B. Sinus tachycardia

C. Wolff-Parkinson-White syndrome

D. Premature atrial contractions

Which beta-blocker is listed as effective in both systolic and diastolic heart failure?

A. Propranolol

B. Atenolol

C. Esmolol

D. Nebivolol

Nebivolol has an additional vasodilating effect associated with which receptor?

A. Beta-3

B. Alpha-1

C. D1

D. Beta-2