ANS pharmacology & pathophysiology 5

Question 1

Direct-acting vasodilators exert

Answer 1

an arterial relaxing effect without interfering with systemic or local constrictor mechanisms or Ca2+ channels

Question 2

The primary action of nitroglycerin is

Answer 2

venodilator with reduced preload

Question 3

The primary action of nitroprusside is

Answer 3

reduces afterload and preload

Question 4

The primary action of hydralazine is

Answer 4

arterial smooth muscle dilator

Question 5

The vasodilatory effect of NTG is greater on

Answer 5

venules than arterioles

Question 6

Nitroglycerin exerts its action via the

Answer 6

liberation of nitric oxide, a vascular dilator

Question 7

Nitroglycerin improves the balance of

Answer 7

myocardial O2 supply and demand due to its direct coronary artery vasodilator and systemic effects

Question 8

____________ is an excellent first-line treatment of cardiac ischemia

Answer 8

Nitroglycerin

Question 9

Cautioned should be used when using nitroglycerin in the setting of

Answer 9

a patient with myocardial ischemia who is hypovolemic–> risk of severe hypotension
when using nitric oxide liberation drug like sildenafil d/t risk of severe hypotension

Question 10

Unlike nitroglycerin, nitroprusside is NOT used in _____

Answer 10

MI b/c it will induce “coronary steal”

Question 11

Sodium nitroprusside is an ultra-short-acting

Answer 11

nitric oxide donor with potent venous and arteriolar vasodilator activity decreasing preload and afterload

Question 12

____________ may be seen more so with sodium nitroprusside than nitroglycerine.

Answer 12

reflex tachycardia

Question 13

_____________ is produced in sodium nitroprusside metabolism inhibiting aerobic metabolism

Answer 13

Cyanide

Question 14

Cyanide also binds with hemoglobin forming

Answer 14

methemoglobin and binding to sulfur to form thiocyanate

Question 15

The direct vasodilating activity of hydralazine is a result of

Answer 15

activation of KATP channels reducing intracellular Ca2+

Question 16

____________ can be seen with hydralazine

Answer 16

Reflex tachycardia

Question 17

Hydralazine preserves ___________ as it does not dilate

Answer 17

LV preload; venous capacitance vessels

Question 18

Minoxidil’s strong, direct vasodilating effect is limited by

Answer 18

reflex-mediated tachycardia, necessitating co-administration of a beta antagonist

Question 19

Use of minoxidil is uncommon due to

Answer 19

causing hypertrichosis (hair growth), salt and water retention, and rare reports of pericardial effusion

Question 20

Phosphodiesterase 5 inhibitors include

Answer 20

sildenafil
tadalafil
vardenafil

Question 21

PDE5 inhibitors work by

Answer 21

increasing levels of cGMP and targeting the lungs and penis (viagra)
induce smooth muscle relaxation and increase blood flow

Question 22

PDE4 inhibitors include

Answer 22

roflumilast
apremilast
ibudilast

Question 23

PDE4 inhibitors work by

Answer 23

increasing levels of cAMP, targeting the airways, skin, and immune system

Question 24

PDE4 inhibitors are used for

Answer 24

airway smooth muscle relaxation in those with hyperreactive airways
useful in inflammatory states that affect the skin, bowel, and joints

Question 25

PDE3 inhibitors include

Answer 25

milrinone and cilostazol

Question 26

PDE3 inhibitors work by

Answer 26

increasing the levels of cAMP and cGMP and are used in those with CV disease

Question 27

Uses of PDE3 inhibitors include

Answer 27

prevent platelet aggregation for thrombosis prophylaxis
promote vasodilation in peripheral vessels to treat intermittent claudication
increased inotropy and relaxation of vascular and airway smooth muscle

Question 28

________ is a positive inotrope and is frequently used in weaning the patient from cardiopulmonary bypass.

Answer 28

Milrinone

Question 29

Vasopressin acts on

Answer 29

V1, V2 and V3 cellular receptors

Question 30

What is the function of V1 receptors?

Answer 30

mediate CV effects such as increased SVR

Question 31

What is the function of V2 receptors?

Answer 31

function in the kidney as an antidiuretic hormone

Question 32

What is the function of V3 receptors?

Answer 32

found in the pituitary gland and modulate autocoids

Question 33

Vasopressin is indicated for those in

Answer 33

vasodilatory shock states who are resistant or refractory to catecholamine fluid therapy

Question 34

The dry cough associated with an ACE-inhibitor is MOST likely due to:
a. paradoxical effect of drug-induced pulmonary vasoconstriction
b. accumulation of bradykinin
c. direct irritant effects of the ACE-inhibitor
d. dysregulation of catecholamines in the lung

Answer 34

b. accumulation of bradykinin

Question 35

The ___________ is essential in cardiovascular homeostasis.

Answer 35

renin-angiotensin-aldosterone system (RAAS)

Question 36

Lidocaine is a ______________

Answer 36

Class 1B antiarrhythmic

Question 37

Class 1B antiarrhythmics suppress automaticity by

Answer 37

increasing the electrical stimulation threshold of the ventricle and His-Purkinje system & inhibiting spontaneous depolarization during diastole

Question 38

ARBs have a greater affinity for the

Answer 38

AT1 receptor, impeding angiotensin 2’s effect at the AT1 receptor

Question 39

ACE inhibitors imapir the activity of

Answer 39

both AT1 and AT2 receptors

Question 40

Side effects of ARBs are

Answer 40

similar to ACEi but are milder and without the dry cough

Question 41

ARBs are indicated for the treatment of

Answer 41

HTN, CHF, and coronary disease

Question 42

ACE-inhibitors are best suited for

Answer 42

hypertension d/t increased renin production and are first-line therapy for HTN, CHF, mitral regurgitation, and LV dysfunction

Question 43

ACE inhibitors decreasethe

Answer 43

generation of angiotensin, reduce arterial tone, and reduce left ventricular afterload

Question 44

ACE inhibitors exert __________ in diabetic patients

Answer 44

renal protective effects

Question 45

Important side effects of ACE-inhibitors include

Answer 45

dry cough d/t blockade of ACE-induced degradation of bradykinin
angioedema d/t inhibition of bradykinin breakdown
profound hypotension with GA