Pharm 19 Flashcards

Which broad pathway is central to the drugs in the nitric oxide chapter?

A) Histamine release

B) NO/cGMP signaling

C) Beta receptor blockade

D) Folate pathway blockade

The big-picture effect of increased NO/cGMP signaling is which change?

A) Smooth muscle contraction

B) Sodium retention

C) Increased platelet production

D) Smooth muscle relaxation

Why does smooth muscle relaxation from NO/cGMP lower vascular pressure?

A) Vessels dilate

B) Vessels constrict

C) Blood volume increases

D) Heart rate rises

Inhaled nitric oxide gas directly activates which enzyme?

A) PDE-5

B) ACE

C) Soluble guanylyl cyclase

D) HMG-CoA reductase

Activation of soluble guanylyl cyclase increases which second messenger?

A) cAMP

B) cGMP

C) IP3

D) DAG

Inhaled nitric oxide mostly works in which vascular bed?

A) Systemic veins

B) Coronary arteries

C) Renal arterioles

D) Pulmonary vessels

Inhaled nitric oxide lowers which pressure most directly?

A) Portal pressure

B) Intracranial pressure

C) Pulmonary pressure

D) Glomerular pressure

Which clinical use matches inhaled nitric oxide?

A) Hyperlipidemia

B) Pulmonary hypertension

C) Acute UTI

D) Chronic constipation

Inhaled nitric oxide can be used in which respiratory condition?

A) Hypoxic respiratory failure

B) Stable angina only

C) Soft tissue infection

D) Benign prostatic hyperplasia

Which side effect is specifically listed for inhaled nitric oxide?

A) Tendon rupture

B) Bone marrow suppression

C) Liver dysfunction

D) Methemoglobinemia

A patient receives inhaled NO for pulmonary hypertension. Which mediator increases downstream?

A) cGMP

B) cAMP

C) Folate

D) LDL receptors

Which drug form is nitric oxide itself in this chapter?

A) Oral nitrate tablet

B) Inhaled NO gas

C) Transdermal statin

D) IV beta blocker

Organic nitrates become what molecule in the body?

A) Angiotensin II

B) Dopamine

C) Nitric oxide

D) Acetylcholine

Which drugs are organic nitrates in these notes?

A) Sildenafil and riociguat

B) Nitroglycerin and isosorbide mononitrate

C) Vericiguat and inhaled NO

D) Aliskiren and losartan

Organic nitrates increase which second messenger?

A) cGMP

B) cAMP

C) IP3

D) DAG

Organic nitrates especially dilate which blood vessels?

A) Arterioles

B) Capillaries

C) Pulmonary arteries only

D) Veins

Venodilation from nitrates decreases which variable?

A) LDL

B) Preload

C) Folate

D) Potassium

Decreased preload from nitrates causes which cardiac effect?

A) More heart work

B) More afterload

C) Less heart work

D) More pulmonary edema

Which clinical use matches organic nitrates?

A) Angina

B) Toxoplasmosis

C) Hyperkalemia

D) Osteomyelitis

A patient with angina takes nitroglycerin. Which mechanism explains the benefit?

A) Blocks folate synthesis

B) Increases cGMP-mediated vasodilation

C) Inhibits DNA gyrase

D) Activates PPAR-alpha

Which organic nitrate is listed in the notes?

A) Riociguat

B) Sildenafil

C) Isosorbide mononitrate

D) Vericiguat

Which organic nitrate is commonly used for angina?

A) Nitroglycerin

B) Metoprolol

C) Ezetimibe

D) Aliskiren

Which side effect is a main concern for nitric oxide vasodilator drugs overall?

A) Hypertension

B) Hypotension

C) Hyperlipidemia

D) Hyperglycemia

Sildenafil belongs to which nitric oxide-related drug class?

A) Organic nitrate

B) PDE-5 inhibitor

C) Soluble cyclase activator

D) Inhaled gas

Sildenafil directly blocks which enzyme?

A) PDE-5

B) ACE

C) Renin

D) PCSK9

PDE-5 normally breaks down which second messenger?

A) cAMP

B) IP3

C) cGMP

D) DAG

Blocking PDE-5 causes cGMP to do what?

A) Disappear faster

B) Convert to folate

C) Leave the intestine

D) Stay longer

When cGMP stays longer after sildenafil, what increases?

A) Smooth muscle contraction

B) Smooth muscle relaxation

C) LDL receptor degradation

D) Bacterial DNA copying

Sildenafil causes vasodilation because it increases persistence of which mediator?

A) cGMP

B) VLDL

C) Folate

D) Angiotensin II

Which clinical use matches sildenafil?

A) Osteomyelitis

B) Erectile dysfunction

C) Torsades de pointes

D) Lower UTI

Sildenafil is also used for which vascular condition?

A) Pulmonary hypertension

B) Hypertriglyceridemia

C) Atrial fibrillation

D) Soft tissue infection

Which side effect is a main concern with sildenafil’s vasodilating action?

A) Ototoxicity

B) Myopathy

C) Hypotension

D) Lupus-like syndrome

Riociguat and vericiguat belong to which class?

A) PDE-5 inhibitors

B) Organic nitrates

C) Soluble guanylyl cyclase activators

D) Inhaled gases

Which memory clue helps identify riociguat and vericiguat?

A) “guat”

B) “flozin”

C) “AD SID”

D) “three Cs”

Riociguat and vericiguat directly activate which enzyme?

A) PDE-5

B) Soluble guanylyl cyclase

C) HMG-CoA reductase

D) DNA gyrase

Direct soluble guanylyl cyclase activation increases which molecule?

A) cAMP

B) IP3

C) DAG

D) cGMP

More guanylyl cyclase activity causes which downstream effect?

A) Smooth muscle relaxation

B) Smooth muscle contraction

C) LDL receptor breakdown

D) Folate depletion

Riociguat and vericiguat cause vasodilation by increasing which pathway?

A) Folate synthesis

B) NO/cGMP signaling

C) LDL receptor degradation

D) Sodium-glucose reabsorption

Which clinical use matches soluble guanylyl cyclase activators

A) Pulmonary hypertension

B) Acute UTI

C) Toxoplasmosis

D) High LDL

Vericiguat is listed for which clinical condition?

A) Anthrax

B) Heart failure

C) Osteomyelitis

D) Arrhythmia only

A patient receives riociguat for pulmonary hypertension. Which mechanism best explains its effect?

A) Blocks PDE-5

B) Directly activates soluble guanylyl cyclase

C) Becomes NO in veins

D) Blocks cholesterol absorption

Which side effect is a main concern with riociguat and vericiguat?

A) Tendon rupture

B) Hyperkalemia

C) Constipation

D) Hypotension

Which drug becomes nitric oxide in the body to increase cGMP?

A) Nitroglycerin

B) Sildenafil

C) Riociguat

D) Vericiguat

Which drug prevents cGMP breakdown rather than making or activating it?

A) Vericiguat

B) Sildenafil

C) Nitroglycerin

D) Inhaled NO

Which drug directly activates soluble guanylyl cyclase rather than blocking PDE-5?

A) Isosorbide mononitrate

B) Nitroglycerin

C) Vericiguat

D) Sildenafil

Nitrogen dioxide formed from inhaled nitric oxide is harmful because it acts as what?

A) Renal toxin

B) Liver toxin

C) Pulmonary irritant

D) Bone marrow toxin

Which side effect set best matches inhaled nitric oxide gas from the table?

A) Constipation and bloating

B) Myopathy and liver dysfunction

C) Rash and hyperkalemia

D) Hypotension, methemoglobinemia, nitrogen dioxide

Which endogenous substances are listed as nitric oxide synthase activators?

A) Acetylcholine and histamine

B) Nitroglycerin and nitroprusside

C) Riociguat and vericiguat

D) Sildenafil and tadalafil

Nitric oxide synthase activators increase which signaling molecule first in the pathway?

A) cGMP

B) cAMP

C) IP3

D) DAG

In NOS activator signaling, increased IP3 causes an increase in which intracellular ion?

A) Sodium

B) Calcium

C) Potassium

D) Chloride

Increased intracellular calcium activates which enzyme?

A) Nitric oxide synthase

B) HMG-CoA reductase

C) DNA gyrase

D) PDE-5

Activated nitric oxide synthase converts arginine into which products?

A) Citrulline plus NO

B) Ornithine plus urea

C) Glutamate plus ammonia

D) Angiotensin plus aldosterone

Which sequence best describes NOS activator signaling?

A) cGMP → PDE-5 → calcium

B) IP3 → calcium → NOS activation

C) LDL receptors → PCSK9 blockade

D) Folate blockade → DNA failure

Acetylcholine and histamine increase NO production by activating which enzyme pathway?

A) Soluble guanylyl cyclase directly

B) Nitric oxide synthase pathway

C) PDE-5 degradation pathway

D) HMG-CoA reductase pathway

Which class includes nitroglycerin, other nitrates, and nitroprusside?

A) Nitric oxide donors

B) NOS activators

C) PDE-5 inhibitors

D) PCSK9 inhibitors

Nitric oxide donors increase cGMP by doing what?

A) Blocking cGMP breakdown only

B) Activating beta receptors

C) Releasing nitric oxide

D) Blocking calcium channels

Nitrates release nitric oxide primarily in which tissue?

A) Blood only

B) Smooth muscle

C) Bone marrow

D) Kidney glomerulus

Nitroprusside releases nitric oxide primarily in which location according to the table?

A) Blood

B) Intestine

C) Liver

D) Prostate

Nitroglycerin causes smooth muscle relaxation by increasing synthesis of which second messenger?

A) cAMP

B) IP3

C) DAG

D) cGMP

Nitroprusside causes vasodilation through which broad mechanism?

A) NO release and cGMP increase

B) Folate pathway blockade

C) LDL receptor preservation

D) Beta receptor blockade

Which pairing is correct based on the table?

A) Acetylcholine—NO donor

B) Nitroglycerin—NO donor

C) Sildenafil—NOS activator

D) Riociguat—organic nitrate

Which pairing is correct based on the table?

A) Histamine—NOS activator

B) Nitroprusside—PDE-5 inhibitor

C) Inhaled NO—bile acid binder

D) Nitroglycerin—folate antagonist

Which pairing is correct based on the table?

A) Nitroprusside—NO donor

B) Acetylcholine—organic nitrate

C) Histamine—PDE-5 inhibitor

D) Inhaled NO—PCSK9 inhibitor

Which pathway directly explains smooth muscle relaxation from nitric oxide donors?

A) Less VLDL secretion

B) Increased cGMP synthesis

C) Increased folate blockade

D) Less LDL receptor breakdown

What does cGMP stand for?

A) Cyclic guanosine monophosphate

B) Calcium-gated membrane protein

C) Cytosolic glucose metabolism pathway

D) Cyclic glycerol messenger phosphate

Which of the following is an endogenous inhibitor/inactivator
of nitric oxide?
(A) Arginine
(B) Angiotensinogen
(C) Arachidonic acid
(D) Hemoglobin
(E) Thromboxane

Which of the following is a recognized effect of nitric oxide
(NO)?
(A) Arrhythmia
(B) Bronchoconstriction
(C) Constipation
(D) Inhibition of acute graft rejection
(E) Pulmonary vasodilation

The primary endogenous substrate for the enzyme nitric
oxide synthase (NOS) is
(A) Acetylcholine
(B) Angiotensinogen
(C) Arginine
(D) Citrulline
(E) Heme

The inducible isoform of nitric oxide synthase (iNOS,
isoform 2) is found primarily in which of the following?
(A) Adipose tissue
(B) Eosinophils
(C) Macrophages
(D) Platelets
(E) Vascular endothelial cells

Which one of the following is not a nitric oxide donor but
causes it to be synthesized and released from endogenous
precursors, resulting in vasodilation?
(A) Acetylcholine
(B) Arginine
(C) Isosorbide mononitrate
(D) Nitroglycerin
(E) Nitroprusside