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

B. NO/cGMP signaling

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

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

A. Vessels dilate

Inhaled nitric oxide gas directly activates which enzyme?

A) PDE-5

B) ACE

C) Soluble guanylyl cyclase

D) HMG-CoA reductase

C. Soluble guanylyl cyclase

Activation of soluble guanylyl cyclase increases which second messenger?

A) cAMP

B) cGMP

C) IP3

D) DAG

B. cGMP

Inhaled nitric oxide mostly works in which vascular bed?

A) Systemic veins

B) Coronary arteries

C) Renal arterioles

D) Pulmonary vessels

D. Pulmonary vessels

Inhaled nitric oxide lowers which pressure most directly?

A) Portal pressure

B) Intracranial pressure

C) Pulmonary pressure

D) Glomerular pressure

C. Pulmonary pressure

Which clinical use matches inhaled nitric oxide?

A) Hyperlipidemia

B) Pulmonary hypertension

C) Acute UTI

D) Chronic constipation

B. Pulmonary hypertension

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

A. Hypoxic respiratory failure

Which side effect is specifically listed for inhaled nitric oxide?

A) Tendon rupture

B) Bone marrow suppression

C) Liver dysfunction

D) Methemoglobinemia

D. Methemoglobinemia

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

A) cGMP

B) cAMP

C) Folate

D) LDL receptors

A. cGMP

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

B. Inhaled NO gas

Organic nitrates become what molecule in the body?

A) Angiotensin II

B) Dopamine

C) Nitric oxide

D) Acetylcholine

C. Nitric oxide

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

B. Nitroglycerin and isosorbide mononitrate

Organic nitrates increase which second messenger?

A) cGMP

B) cAMP

C) IP3

D) DAG

A. cGMP

Organic nitrates especially dilate which blood vessels?

A) Arterioles

B) Capillaries

C) Pulmonary arteries only

D) Veins

D. Veins

Venodilation from nitrates decreases which variable?

A) LDL

B) Preload

C) Folate

D) Potassium

B. Preload

Decreased preload from nitrates causes which cardiac effect?

A) More heart work

B) More afterload

C) Less heart work

D) More pulmonary edema

C. Less heart work

Which clinical use matches organic nitrates?

A) Angina

B) Toxoplasmosis

C) Hyperkalemia

D) Osteomyelitis

A. Angina

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

B. Increases cGMP-mediated vasodilation

Which organic nitrate is listed in the notes?

A) Riociguat

B) Sildenafil

C) Isosorbide mononitrate

D) Vericiguat

C. Isosorbide mononitrate

Which organic nitrate is commonly used for angina?

A) Nitroglycerin

B) Metoprolol

C) Ezetimibe

D) Aliskiren

A. Nitroglycerin

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

A) Hypertension

B) Hypotension

C) Hyperlipidemia

D) Hyperglycemia

B. Hypotension

Sildenafil belongs to which nitric oxide-related drug class?

A) Organic nitrate

B) PDE-5 inhibitor

C) Soluble cyclase activator

D) Inhaled gas

B. PDE-5 inhibitor

Sildenafil directly blocks which enzyme?

A) PDE-5

B) ACE

C) Renin

D) PCSK9

A. PDE-5

PDE-5 normally breaks down which second messenger?

A) cAMP

B) IP3

C) cGMP

D) DAG

C. cGMP

Blocking PDE-5 causes cGMP to do what?

A) Disappear faster

B) Convert to folate

C) Leave the intestine

D) Stay longer

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

B. Smooth muscle relaxation

Sildenafil causes vasodilation because it increases persistence of which mediator?

A) cGMP

B) VLDL

C) Folate

D) Angiotensin II

A. cGMP

Which clinical use matches sildenafil?

A) Osteomyelitis

B) Erectile dysfunction

C) Torsades de pointes

D) Lower UTI

B. Erectile dysfunction

Sildenafil is also used for which vascular condition?

A) Pulmonary hypertension

B) Hypertriglyceridemia

C) Atrial fibrillation

D) Soft tissue infection

A. Pulmonary hypertension

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

A) Ototoxicity

B) Myopathy

C) Hypotension

D) Lupus-like syndrome

C. Hypotension

Riociguat and vericiguat belong to which class?

A) PDE-5 inhibitors

B) Organic nitrates

C) Soluble guanylyl cyclase activators

D) Inhaled gases

C. Soluble guanylyl cyclase activators

Which memory clue helps identify riociguat and vericiguat?

A) “guat”

B) “flozin”

C) “AD SID”

D) “three Cs”

A) “guat”

Riociguat and vericiguat directly activate which enzyme?

A) PDE-5

B) Soluble guanylyl cyclase

C) HMG-CoA reductase

D) DNA gyrase

B. Soluble guanylyl cyclase

Direct soluble guanylyl cyclase activation increases which molecule?

A) cAMP

B) IP3

C) DAG

D) cGMP

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

A. Smooth muscle relaxation

Riociguat and vericiguat cause vasodilation by increasing which pathway?

A) Folate synthesis

B) NO/cGMP signaling

C) LDL receptor degradation

D) Sodium-glucose reabsorption

B. NO/cGMP signaling

Which clinical use matches soluble guanylyl cyclase activators

A) Pulmonary hypertension

B) Acute UTI

C) Toxoplasmosis

D) High LDL

A. Pulmonary hypertension

Vericiguat is listed for which clinical condition?

A) Anthrax

B) Heart failure

C) Osteomyelitis

D) Arrhythmia only

B. Heart failure

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

B. Directly activates soluble guanylyl cyclase

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

A) Tendon rupture

B) Hyperkalemia

C) Constipation

D) Hypotension

D. Hypotension

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

A) Nitroglycerin

B) Sildenafil

C) Riociguat

D) Vericiguat

A. Nitroglycerin

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

A) Vericiguat

B) Sildenafil

C) Nitroglycerin

D) Inhaled NO

B. Sildenafil

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

A) Isosorbide mononitrate

B) Nitroglycerin

C) Vericiguat

D) Sildenafil

C. Vericiguat

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

C. Pulmonary irritant

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

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

A. Acetylcholine and histamine

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

A) cGMP

B) cAMP

C) IP3

D) DAG

C. IP3

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

A) Sodium

B) Calcium

C) Potassium

D) Chloride

B. Calcium

Increased intracellular calcium activates which enzyme?

A) Nitric oxide synthase

B) HMG-CoA reductase

C) DNA gyrase

D) PDE-5

A. Nitric oxide synthase

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

A. Citrulline plus NO

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

B. IP3 → calcium → NOS activation

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

B. Nitric oxide synthase pathway

Which class includes nitroglycerin, other nitrates, and nitroprusside?

A) Nitric oxide donors

B) NOS activators

C) PDE-5 inhibitors

D) PCSK9 inhibitors

A. Nitric oxide donors

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

C. Releasing nitric oxide

Nitrates release nitric oxide primarily in which tissue?

A) Blood only

B) Smooth muscle

C) Bone marrow

D) Kidney glomerulus

B. Smooth muscle

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

A) Blood

B) Intestine

C) Liver

D) Prostate

A. Blood

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

A) cAMP

B) IP3

C) DAG

D) cGMP

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

A. NO release and cGMP increase

Which pairing is correct based on the table?

A) Acetylcholine—NO donor

B) Nitroglycerin—NO donor

C) Sildenafil—NOS activator

D) Riociguat—organic nitrate

B. Nitroglycerin—NO donor

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

A. Histamine—NOS activator

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

A. Nitroprusside—NO donor

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

B. Increased cGMP synthesis

What does cGMP stand for?

A) Cyclic guanosine monophosphate

B) Calcium-gated membrane protein

C) Cytosolic glucose metabolism pathway

D) Cyclic glycerol messenger phosphate

A. Cyclic guanosine monophosphate

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

Heme and hemoglobin inactivate NO. The answer is D.

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

(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

(C) Arginine

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

The inducible form of NOS is associated with inflammation,
and the enzyme is found in highest concentration in macro￾phages, cells that are particularly involved in inflammation. The answer is C.

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

(A) Acetylcholine