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Pharm 12

front 1

A patient with acute angina symptoms needs a drug that directly reduces cardiac workload by venodilation. Which drug best fits?

A) Propranolol

B) Nitroglycerin

C) Ranolazine

D) Ivabradine

back 1

B. Nitroglycerin

front 2

Which drug class is most directly used for immediate angina relief rather than mainly prophylaxis?

A) Nitrates

B) Beta blockers

C) Calcium channel blockers

D) Late sodium inhibitors

back 2

A. Nitrates

front 3

Nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate belong to which drug class?

A) Beta blockers

B) Calcium channel blockers

C) Nitrates

D) SA node inhibitors

back 3

C. Nitrates

front 4

Which name clue helps identify nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate?

A) They end in “olol”

B) They sound nitrate-related

C) They end in “dipine”

D) They contain “iva”

back 4

B. They sound nitrate-related

front 5

Nitrates release which mediator to produce vasodilation?

A) Angiotensin II

B) Dopamine

C) Acetylcholine

D) Nitric oxide

back 5

D. Nitric oxide

front 6

Nitric oxide from nitrates activates which enzyme?

A) Guanylyl cyclase

B) ACE

C) Renin

D) Vesicular transporter

back 6

A. Guanylyl cyclase

front 7

Activation of guanylyl cyclase by nitrates increases which second messenger?

A) cAMP

B) cGMP

C) IP3

D) DAG

back 7

B. cGMP

front 8

Nitrate-induced vasodilation decreases cardiac work mainly by reducing which variable?

A) Afterload only

B) Heart rate only

C) Venous return

D) Contractility only

back 8

C. Venous return

front 9

Decreased venous return from nitrates helps angina by causing which effect?

A) Increased preload

B) Decreased heart work

C) Increased oxygen demand

D) Increased contractility

back 9

B. Decreased heart work

front 10

A patient takes nitroglycerin. Which adverse effect is most likely?

A) Headache

B) Constipation

C) Bronchoconstriction

D) QT prolongation

back 10

A. Headache

front 11

A patient takes isosorbide mononitrate. Which adverse effect best explains this?

A) Hypertension

B) Bradycardia

C) Hypotension

D) Bronchoconstriction

back 11

C. Hypotension

front 12

Which adverse effect can happen with nitrates?

A) Visual brightness changes

B) Reflex tachycardia

C) QT prolongation

D) Constipation

back 12

B. Reflex tachycardia

front 13

Which nitrate is commonly used for direct angina symptom relief?

A) Atenolol

B) Amlodipine

C) Ranolazine

D) Nitroglycerin

back 13

D. Nitroglycerin

front 14

Which drug is a long-acting nitrate listed in the notes?

A) Metoprolol

B) Isosorbide mononitrate

C) Diltiazem

D) Ranolazine

back 14

B. Isosorbide mononitrate

front 15

Beta blockers help angina mainly by decreasing which cardiac functions?

A) Venous return and preload

B) Sodium current and QT interval

C) Heart rate and contractility

D) SA node current and vision

back 15

C. Heart rate and contractility

front 16

Why are beta blockers useful in angina prophylaxis?

A) They increase oxygen supply

B) They decrease oxygen demand

C) They increase venous return

D) They increase reflex tachycardia

back 16

B. They decrease oxygen demand

front 17

Which beta blocker was listed in the angina chapter notes?

A) Propranolol

B) Prazosin

C) Nitroglycerin

D) Fenoldopam

back 17

A. Propranolol

front 18

Which pair contains beta blockers used for angina prophylaxis?

A) Verapamil and diltiazem

B) Atenolol and metoprolol

C) Ranolazine and ivabradine

D) Nitroglycerin and isosorbide

back 18

B. Atenolol and metoprolol

front 19

Which suffix commonly identifies beta blockers?

A) “dipine”

B) “sartan”

C) “olol”

D) “nitrate”

back 19

C. “olol”

front 20

Which adverse effect can occur because beta blockers slow the heart?

A) Headache

B) QT prolongation

C) Bradycardia

D) Constipation

back 20

C. Bradycardia

front 21

A patient with asthma develops wheezing after starting propranolol. Which adverse effect is most likely?

A) Bronchoconstriction

B) Visual brightness

C) Hypotension only

D) QT prolongation

back 21

A. Bronchoconstriction

front 22

Bronchoconstriction is especially concerning with which type of beta blocker?

A) Beta-1 selective blockers

B) Nonselective beta blockers

C) Calcium channel blockers

D) Late sodium inhibitors

back 22

B. Nonselective beta blockers

front 23

Which beta blocker is nonselective and therefore more concerning in asthma?

A) Metoprolol

B) Atenolol

C) Propranolol

D) Ivabradine

back 23

C. Propranolol

front 24

Beta blockers are mainly used in angina in which way?

A) Direct acute relief

B) Prophylactically

C) Only for headache relief

D) Only for QT shortening

back 24

B. Prophylactically

front 25

Calcium channel blockers used for angina block which channel type?

A) Sodium channels

B) Potassium channels

C) Chloride channels

D) L-type calcium channels

back 25

D. L-type calcium channels

front 26

Which drug group contains calcium channel blockers listed in the notes?

A) Verapamil and diltiazem

B) Propranolol and atenolol

C) Nitroglycerin and isosorbide

D) Ranolazine and ivabradine

back 26

A. Verapamil and diltiazem

front 27

Which calcium channel blockers contain the “dipine” name clue?

A) Verapamil and diltiazem

B) Nifedipine and amlodipine

C) Propranolol and metoprolol

D) Nitroglycerin and isosorbide

back 27

B. Nifedipine and amlodipine

front 28

Calcium channel blockers improve angina mainly by causing which effect?

A) Increased contractility

B) Increased cardiac work

C) Decreased oxygen demand

D) Increased venous return

back 28

C. Decreased oxygen demand

front 29

Why does blocking L-type calcium channels help reduce angina symptoms prophylactically?

A) Less heart work is needed

B) More renin is released

C) More oxygen is consumed

D) More reflex tachycardia occurs

back 29

A. Less heart work is needed

front 30

Which listed drug is a calcium channel blocker?

A) Atenolol

B) Nitroglycerin

C) Diltiazem

D) Ranolazine

back 30

C. Diltiazem

front 31

Which listed drug is a dihydropyridine calcium channel blocker?

A) Nifedipine

B) Verapamil

C) Propranolol

D) Ivabradine

back 31

A. Nifedipine

front 32

Which listed drug is a non-dihydropyridine calcium channel blocker?

A) Isosorbide dinitrate

B) Verapamil

C) Metoprolol

D) Ranolazine

back 32

B. Verapamil

front 33

Calcium channel blockers in these notes are mainly used for angina in which way?

A) As direct acute nitrates

B) Prophylactically

C) Only for bronchospasm

D) Only for QT shortening

back 33

B. Prophylactically

front 34

A patient with angina is given amlodipine. Which mechanism best explains its benefit?

A) Blocks L-type calcium channels

B) Releases nitric oxide

C) Inhibits late sodium current

D) Blocks beta receptors

back 34

A. Blocks L-type calcium channels

front 35

Which antianginal drug inhibits the late sodium current in the heart?

A) Nitroglycerin

B) Metoprolol

C) Ranolazine

D) Amlodipine

back 35

C. Ranolazine

front 36

Inhibiting late sodium current with ranolazine causes which therapeutic effect?

A) Improves cardiac efficiency

B) Increases venous return

C) Increases heart rate

D) Activates guanylyl cyclase

back 36

A. Improves cardiac efficiency

front 37

Ranolazine decreases angina mainly by reducing which cardiac requirement?

A) Blood pressure only

B) Myocardial oxygen demand

C) Bronchial oxygen delivery

D) Venous oxygen content

back 37

B. Myocardial oxygen demand

front 38

Ranolazine is mainly used in angina therapy in which way?

A) Direct acute relief

B) Emergency vasodilation

C) Prophylactically

D) Reflex tachycardia induction

back 38

C. Prophylactically

front 39

Which adverse effect is associated with ranolazine?

A) Bronchoconstriction

B) Gynecomastia

C) Ototoxicity

D) QT prolongation

back 39

D. QT prolongation

front 40

A patient is on ranolazine. Which listed side effect does this match?

A) Dizziness

B) Headache

C) Cough

D) Reflex tachycardia

back 40

A. Dizziness

front 41

Which gastrointestinal side effect is associated with ranolazine?

A) Diarrhea

B) Constipation

C) Vomiting

D) Metallic taste

back 41

B. Constipation

front 42

A patient with angina needs prophylaxis without directly lowering symptoms like nitrates. Which drug inhibits late sodium current?

A) Ranolazine

B) Nitroglycerin

C) Isosorbide dinitrate

D) Propranolol

back 42

A. Ranolazine

front 43

Which antianginal drug inhibits the SA node pacemaker current?

A) Amlodipine

B) Ivabradine

C) Isosorbide mononitrate

D) Atenolol

back 43

B. Ivabradine

front 44

Ivabradine lowers myocardial oxygen demand primarily by decreasing which variable?

A) Venous return

B) Contractility

C) Heart rate

D) QT interval

back 44

C. Heart rate

front 45

Ivabradine decreases heart rate by inhibiting which cardiac target?

A) L-type calcium channels

B) Beta receptors

C) Late sodium current

D) SA node pacemaker current

back 45

D. SA node pacemaker current

front 46

Ivabradine is mainly used in angina therapy in which way?

A) Prophylactically

B) Direct acute relief

C) Immediate nitrate reversal

D) Bronchospasm treatment

back 46

A. Prophylactically

front 47

Which adverse effect is associated with ivabradine due to reduced heart rate?

A) QT prolongation

B) Bradycardia

C) Constipation

D) Headache

back 47

B. Bradycardia

front 48

A patient on ivabradine reports unusual visual brightness. Which adverse effect does this represent?

A) Reflex tachycardia

B) Bronchoconstriction

C) Visual brightness changes

D) Ototoxicity

back 48

C. Visual brightness changes

front 49

Which set contains adverse effects of ivabradine?

A) Headache and hypotension

B) Bradycardia and visual brightness changes

C) Constipation and QT prolongation

D) Bronchoconstriction and wheezing

back 49

B. Bradycardia and visual brightness changes

front 50

Which antianginal drug reduces heart rate without directly blocking beta receptors?

A) Ivabradine

B) Propranolol

C) Atenolol

D) Metoprolol

back 50

A. Ivabradine

front 51

A patient asks why several antihypertensive drugs also help angina. Which explanation is best?

A) They increase cardiac oxygen demand

B) They increase heart work

C) They decrease heart workload

D) They increase venous return

back 51

C. They decrease heart workload

front 52

Which antianginal option most directly decreases venous return?

A) Metoprolol

B) Nitroglycerin

C) Ranolazine

D) Ivabradine

back 52

B. Nitroglycerin

front 53

Which of the following is a common direct or reflex effect of
nitroglycerin?
(A) Decreased heart rate
(B) Decreased venous capacitance
(C) Increased afterload
(D) Increased cardiac force
(E) Increased diastolic myocardial fiber tension

back 53

(D) Increased cardiac force

It increases cardiac contractile force because the decrease in blood pressure evokes a compensatory increase in sympathetic discharge.

front 54

In advising the patient about the adverse effects she may
notice, you point out that nitroglycerin in moderate doses
often produces certain symptoms. Which of the following
effects might occur due to the mechanism listed?
(A) Constipation due to reduced colonic activity
(B) Dizziness due to reduced cardiac force of contraction
(C) Diuresis due to sympathetic discharge
(D) Headache due to meningeal vasodilation
(E) Hypertension due to reflex tachycardia

back 54

(D) Headache due to meningeal vasodilation

front 55

Useful drugs for the prophylaxis of angina of effort include
(A) Amyl nitrite
(B) Esmolol
(C) Sublingual isosorbide dinitrate
(D) Sublingual nitroglycerin
(E) Verapamil

back 55

(E) Verapamil

esmolol is not going to work long enough

front 56

If a β blocker were to be used for prophylaxis in a patient,
what is the most probable mechanism of action in angina?
(A) Block of exercise-induced tachycardia
(B) Decreased end-diastolic ventricular volume
(C) Increased double product
(D) Increased cardiac force
(E) Decreased ventricular ejection time

back 56

(A) Block of exercise-induced tachycardia

front 57

In considering adverse effects of possible drugs for these conditions, you note that an adverse effect that nitroglycerin and prazosin have in common is
(A) Bradycardia
(B) Impaired sexual function
(C) Lupus erythematosus syndrome
(D) Orthostatic hypotension
(E) Weight gain

back 57

(D) Orthostatic hypotension

front 58

A 25-year-old man is admitted to the emergency department with a brownish cyanotic appearance, marked shortness of breath, and hypotension. He has needle marks in
both arms. Which of the following is most likely to cause
methemoglobinemia?
(A) Amyl nitrite
(B) Isosorbide dinitrate
(C) Isosorbide mononitrate
(D) Nitroglycerin
(E) Sodium cyanide

back 58

(A) Amyl nitrite

Nitrites, not nitrates, cause methemoglobin￾emia in adults

front 59

Another patient is admitted to the emergency department
after a drug overdose. He is noted to have hypotension and
severe bradycardia. He has been receiving therapy for hypertension and angina. Which of the following drugs in high
doses causes bradycardia?
(A) Amlodipine
(B) Isosorbide dinitrate
(C) Nitroglycerin
(D) Prazosin
(E) Verapamil

back 59

(E) Verapamil

front 60

A 45-year-old woman with hyperlipidemia and frequent
migraine headaches develops angina of effort. Which of
the following is relatively contraindicated because of her
migraines?
(A) Amlodipine
(B) Diltiazem
(C) Metoprolol
(D) Nitroglycerin
(E) Verapamil

back 60

(D) Nitroglycerin