Questions Pharmcology
Questions Pharmcology
Questions Pharmcology
(B) Hypoglycemia
(C) Increased PR interval
(D) Tachycardia
(E) Thyrotoxicosis
9. A 45-year-old man is brought to the emergency department with mental
obtundation. He is found to have a blood pressure of 220/160 and retinal
hemorrhages. Which one of the following is used in severe hypertensive
emergencies, is shortacting, acts on a G protein-coupled receptor, and must be
given by intravenous infusion?
(A) Aliskiren
(B) Captopril
(C) Fenoldopam
(D) Hydralazine
(E) Losartan
(F) Metoprolol
(G) Nitroprusside
(H) Prazosin
(I) Propranolol
10. Which of the following is very short-acting and acts by releasing nitric oxide?
(A) Atenolol
(B) Captopril
(C) Diltiazem
(D) Fenoldopam
(E) Hydrochlorothiazide
(F) Losartan
(G) Minoxidil
(H) Nitroprusside
(I) Prazosin
ANTIARRYTHMETIC DRUGS
QUESTIONS
Questions 1 and 2. A 76-year-old patient with rheumatoid arthritis and chronic heart
disease is being considered for treatmentwith procainamide. She is already
receiving digoxin, hydrochlorothiazide, and potassium supplements for her cardiac
condition.
1. In deciding on a treatment regimen with procainamide for this patient, which of
the following statements is most correct?
(A) A possible drug interaction with digoxin suggests that digoxin blood levels
should be obtained before and after starting procainamide
(B) Hyperkalemia should be avoided to reduce the likelihood of procainamide
toxicity
(C) Procainamide cannot be used if the patient has asthma because it has a blocking effect
(D) Procainamide cannot be used if the patient has angina because it has a agonist effect
(E) Procainamide is not active by the oral route
2. If this patient should take an overdose and manifest severe acute procainamide
toxicity with markedly prolonged QRS, which of the following should be given
immediately?
(A) A calcium chelator such as EDTA
(B) Digitalis
(C) Nitroprusside
(D) Potassium chloride
(E) Sodium lactate
3. A 57-year-old man is admitted to the emergency departmentwith chest pain and
a fast irregular heart rhythm. TheECG shows an inferior myocardial infarction and
ventriculartachycardia. Lidocaine is ordered. When used as an antiarrhythmic drug,
lidocaine typically
(A) Increases action potential duration
(B) Increases contractility
7. A 60-year-old man comes to the emergency department with severe chest pain.
ECG reveals ventricular tachycardia with occasional normal sinus beats, and STsegment changes suggestive of ischemia. A diagnosis of myocardial infarction is
made, and the man is admitted to the cardiac intensive care unit. His arrhythmia
should be treated immediately with
(A) Adenosine
(B) Digoxin
(C) Lidocaine
(D) Quinidine
(E) Verapamil
8. Which of the following drugs slows conduction through the AV node and has its
primary action directly on L-type calcium channels?
(A) Adenosine
(B) Amiodarone
(C) Diltiazem
(D) Esmolol
(E) Flecainide
(F) Lidocaine
(G) Mexiletine
(H) Procainamide
(I) Quinidine
9. When working in outlying areas, this 62-year-old rancher is away from his house
for 1214 h at a time. He has an arrhythmia that requires chronic therapy. Which of
the following has the longest half-life of all antiarrhythmic drugs?
(A) Adenosine
(B) Amiodarone
(C) Disopyramide
(D) Esmolol
(E) Flecainide
(F) Lidocaine
(G) Mexiletine
(H) Procainamide
(I) Quinidine
(J) Verapami
10. A drug was tested in the electrophysiology laboratory to
determine its effects on the cardiac action potential in normal
ventricular cells. The results are shown in the diagram.
0 mV
80 mV
Control
Drug
Which of the following drugs does this agent most resemble?
(A) Adenosine
(B) Flecainide
(C) Mexiletine
(D) Procainamide
(E) Verapamil
ANTIANGIAL DRUGS
Questions 14. A 60-year-old man presents to his primary care physician with a
complaint of severe chest pain when he walks uphill to his home in cold weather.
The pain disappears when he rests. After evaluation and discussion of treatment
options, a decision is made to treat him with nitroglycerin.
1. Which of the following is a common direct or reflex effect of nitroglycerin?
(A) Decreased heart rate
(B) Decreased venous capacitance
(C) Increased afterload
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
6. A man is admitted to the emergency department with a brownish cyanotic
appearance, marked shortness of breath, and hypotension. Which of the following is
most likely to cause methemoglobinemia?
(A) Amyl nitrite
(B) Isosorbide dinitrate
(C) Isosorbide mononitrate
(D) Nitroglycerin
(E) Sodium cyanide
7. 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
8. 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
9. When nitrates are used in combination with other drugs for the treatment of
angina, which one of the following combinations results in additive effects on the
variable specified?
(A) Beta blockers and nitrates on end-diastolic cardiac size
(B) Beta blockers and nitrates on heart rate
(C) Beta blockers and nitrates on venous tone
(D) Calcium channel blockers and blockers on cardiac force
(E) Calcium channel blockers a
10. Certain drugs can cause severe hypotension when combined with nitrates.
Which of the following interacts with nitroglycerin by inhibiting the metabolism of
cGMP?
(A) Atenolol
(B) Hydralazine
(C) Isosorbide mononitrate
(D) Nifedipine
(E) Ranolazine
(F) Sildenafil
(G) Terbutalinend nitrates on heart rate
HEART FAILURE
Questions 12. A 73-year-old man with an inadequate response to
other drugs is to receive digoxin for chronic heart failure. He is in
normal sinus rhythm with a heart rate of 88 and blood pressure of
135/85 mm Hg.
1. 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
(C) Minoxidil
(D) Propranolol
(E) Spironolactone
5. 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) Dobutamine
(D) Furosemide
(E) Spironolactone
6. Which row in the following table correctly shows the major effects of full
therapeutic doses of digoxin on the AV node and the ECG?
Row
AV Refractory
Period QT Interval T Wave
(A) Increased Increased Upright
(B) Increased Decreased Inverted
(C) Decreased Increased Upright
(D) Decreased Decreased Upright
(E) Decreased Increased Inverted
7. 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
8. A 68-year-old man with a history of chronic heart failure goes on vacation
and abandons his low-salt diet. Three days later, he develops severe
shortness of breath and is admitted to the local hospital emergency
department with significant pulmonary edema. The first-line drug of choice in
most cases of acute decompensation in patients with chronic heart failure is
(A) Atenolol
(B) Captopril
(C) Carvedilol
(D) Digoxin
(E) Diltiazem
(F) Dobutamine
(G) Enalapril
(H) Furosemide
(I) Metoprolol
(J) Spironolactone
9. Which of the following has been shown to prolong life inpatients 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
10. A 5-year-old child was vomiting and was brought to the emergency
department with sinus arrest and a ventricular rate of 35 bpm. An empty
bottle of his uncles digoxin was found where he was playing. 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
DIEURETICS
1. A 70-year-old retired businessman is admitted with a history of
recurrent heart failure and metabolic derangements. He has marked
peripheral edema and metabolic alkalosis. Which of the following
drugs is most appropriate for the treatment of his edema?
(A) Acetazolamide
(B) Digoxin
(C) Dobutamine
(D) Eplerenone
(E) Hydrochlorothiazide
2. A 50-year-old man has a history of frequent episodes of renal colic with
calcium-containing renal stones. A careful workup indicates that he has a
defect in proximal tubular calcium reabsorption, which results in high
concentrations of calcium salts in the tubular urine. The most useful
diuretic agent in the treatment of recurrent calcium stones is
(A) Chlorthalidone
(B) Diazoxide
(C) Ethacrynic acid
(D) Mannitol
(E) Spironolactone
3. Which of the following is an important effect of chronic therapy with
loop diuretics?