[Pharma B] Anti-hypertensive & Anti-angina:

Question 1

Which calcium channel antagonists has the greatest depressant effect in the heart and may decrease HR and СО?
A. Felodipine
B. Diltiazem
C. Amlodipine
D. Verapamil

Answer 1

D. Verapamil

Rationale:
Calcium channel blockers (CCBs) are a class of medications that inhibit the entry of calcium ions into cardiac and vascular smooth muscle cells, leading to relaxation and vasodilation.
There are two main classes of CCBs: dihydropyridines (e.g., felodipine, amlodipine) and non-dihydropyridines (e.g., diltiazem, verapamil).
Among these, verapamil has the most pronounced effect on the heart. It not only causes vasodilation but also has a direct depressant effect on the myocardium, leading to a decrease in heart rate (HR) and cardiac output (CO).
Diltiazem also affects the heart but to a lesser extent than verapamil.
In contrast, dihydropyridines primarily act on the vascular smooth muscle and have minimal effects on the heart.

Question 2

This drug is a selective funny sodium channel blocker which reduces cardiac rate by hyperpolarization-activated sodium channel in the sinoatrial node.
A. Trimetazidine
B. Ranolazine
C. Fasudil
D. Ivabradine

Answer 2

D. Ivabradine

Rationale:
Ivabradine is a unique anti-anginal medication that works by selectively inhibiting the “funny” (If) sodium channels in the sinoatrial (SA) node of the heart. By blocking these channels, ivabradine reduces the rate of spontaneous depolarization in the SA node, leading to a reduction in heart rate. This mechanism is different from other anti-anginal drugs and is specific to ivabradine.

Question 3

These are considered first line drugs in chronic effort angina?
A. Propranolol
B. Nifedipine
C. Nitrates
D. Amlodipine

Answer 3

A. Propranolol

Rationale:
Propranolol is a non-selective beta-blocker. Beta-blockers like propranolol are indeed considered first-line therapy for chronic effort (or stable) angina. They work by reducing the heart rate and myocardial contractility, which in turn decreases the oxygen demand of the heart. By reducing the oxygen demand, they help alleviate the symptoms of angina that arise due to an imbalance between oxygen supply and demand in the heart.

Question 4

Which of the following best describes classic/stable angina?
A. Inadequate blood flow in the presence of CAD
B. A plaque rupture leading to platelet aggregation and subendocardial ischemia at rest
C. Major coronary artery is completely obstructed by thrombus
D. Transient spasm of localized portions of blood vessels

Answer 4

A. Inadequate blood flow in the presence of CAD

Rationale:
Classic or stable angina is characterized by chest pain or discomfort that occurs with exertion and is relieved by rest. It is caused by inadequate blood flow to the myocardium in the presence of coronary artery disease (CAD). The other options describe different types of angina or coronary events, such as unstable angina or myocardial infarction.

Question 5

Which of the following describes long term regulation of blood pressure via renal blood volume-pressure control?
A. Renin increases production of angiotensin Il
B. Both
C. Angiotensin Il causes direct constriction of resistance vessels
D. Neither

Answer 5

B. Both

Rationale:
The renin-angiotensin-aldosterone system (RAAS) plays a crucial role in the long-term regulation of blood pressure.
When blood pressure drops or renal blood flow decreases, the kidneys release renin.
Renin then catalyzes the conversion of angiotensinogen to angiotensin I, which is further converted to angiotensin II. Angiotensin II has multiple effects:

-It causes direct vasoconstriction of resistance vessels, increasing blood pressure.
-3It stimulates the release of aldosterone, leading to sodium and water retention, which increases blood volume and blood pressure.

Question 5

Which of the following drugs are useful for pregnant women with hypertension?
A. Nitroprusside
B. Verapamil
C. Fenoldopam
D. Hydralazine

Answer 5

D. Hydralazine

Rationale:
Hydralazine is an arteriolar vasodilator and is one of the preferred antihypertensive agents for use during pregnancy. It is often used in combination with methyldopa for pregnant women with hypertension. The other drugs listed are not typically first choices for treating hypertension in pregnant women. Nitroprusside, for instance, can cause cyanide toxicity, and its safety in pregnancy is not well-established. Verapamil is a calcium channel blocker and is not the first choice for hypertension in pregnancy. Fenoldopam is a dopamine receptor agonist and is not commonly used in pregnancy.

Question 6

The following are potassium sparing diuretics except?
A. Furosemide
B. Triamterene
C. Spinorolactone
D. Amiloride

Answer 6

A. Furosemide

Rationale:
Furosemide is a loop diuretic, not a potassium-sparing diuretic. It works on the thick ascending limb of the loop of Henle in the kidneys. Potassium-sparing diuretics, as the name suggests, reduce urinary excretion of potassium. Triamterene, spironolactone, and amiloride are all potassium-sparing diuretics.

Question 7

Which of the following antihypertensives has no effect on bradykinin and thus has no cough as side effects?
A. Losartan
B. Amlodipine
C. Enalapril
D. Captopril

Answer 7

A. Losartan

Rationale:
Losartan is an angiotensin II receptor blocker (ARB). ARBs do not increase bradykinin levels, which is associated with the cough seen with ACE inhibitors like enalapril and captopril. Amlodipine is a calcium channel blocker and also does not cause cough, but among the options, Losartan is the ARB, which is specifically known for not causing the cough side effect seen with ACE inhibitors.

Question 8

The following drugs are alpha adrenoreceptor antagonist except?
A. Terasozin
B. Prazosin
C. Clonidine
D. Doxasozin

Answer 8

C. Clonidine

Rationale:
Clonidine is an alpha-2 adrenergic agonist, not an antagonist. It acts centrally to reduce sympathetic outflow, leading to decreased blood pressure. Terazosin, prazosin, and doxazosin are all alpha-1 adrenoreceptor antagonists, which cause vasodilation and are used to treat hypertension.

Question 9

The following are the vascular smooth muscle effect of nitrates except?
A. Salt and water retention is not common
B. Improved venous capacitance
C. Pulmonary vasculature and heart size are significantly reduced.
D. Decreased preload

Answer 9

A. Salt and water retention is not common

Rationale:
Nitrates, such as nitroglycerin, primarily cause vasodilation by releasing nitric oxide in vascular smooth muscle. This leads to improved venous capacitance (decreased venous return to the heart), reduced pulmonary vasculature and heart size, and decreased preload. However, as a compensatory mechanism in response to vasodilation and decreased blood pressure, there can be salt and water retention, which is mediated by the activation of the renin-angiotensin-aldosterone system. Thus, salt and water retention can be a side effect of nitrates.

Question 10

What is the Mechanism of Action of the Drug?

Amiloride

A. Pure arterial dilator
B. Block sodium channels in the collecting tubule
C. Inhibitor of subtype 2 sodium-glucose transport protein
D. Inhibition of Na+/K+ ATPase
E. Inhibit phosphodiesterase

Answer 10

B. Block sodium channels in the collecting tubule

Rationale:
Amiloride is a potassium-sparing diuretic that works by blocking sodium channels in the collecting tubules of the kidneys. This action reduces sodium reabsorption and prevents potassium excretion, making it “potassium-sparing.”

ENaC Antagonist = Amiloride & Triamterene

Question 11

What is the Mechanism of Action of the Drug?

Dapagliflozin

A. Pure arterial dilator
B. Block sodium channels in the collecting tubule
C. Inhibitor of subtype 2 sodium-glucose transport protein
D. Inhibition of Na+/K+ ATPase
E. Inhibit phosphodiesterase

Answer 11

C. Inhibitor of subtype 2 sodium-glucose transport protein

Rationale:
Dapagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor. It works by inhibiting the SGLT2 protein in the proximal tubules of the kidneys, reducing glucose reabsorption and leading to increased glucose excretion in the urine. This mechanism is used to lower blood glucose levels in patients with diabetes.

Question 12

What is the Mechanism of Action of the Drug?

Digitalis

A. Pure arterial dilator
B. Block sodium channels in the collecting tubule
C. Inhibitor of subtype 2 sodium-glucose transport protein
D. Inhibition of Na+/K+ ATPase
E. Inhibit phosphodiesterase

Answer 12

D. Inhibition of Na+/K+ ATPase

Rationale:
Digitalis (or digoxin) is a cardiac glycoside that works by inhibiting the Na+/K+ ATPase pump in cardiac cells. This action increases intracellular sodium levels, which indirectly leads to an increase in intracellular calcium levels. The increased calcium enhances cardiac contractility, making the heart pump more efficiently.

Question 13

What is the Mechanism of Action of the Drug?

Aminophylline

A. Pure arterial dilator
B. Block sodium channels in the collecting tubule
C. Inhibitor of subtype 2 sodium-glucose transport protein
D. Inhibition of Na+/K+ ATPase
E. Inhibit phosphodiesterase

Answer 13

E. Inhibit phosphodiesterase

Rationale:
Aminophylline is a bronchodilator used to treat asthma and chronic obstructive pulmonary disease (COPD). It works by inhibiting phosphodiesterase enzymes, leading to increased levels of cyclic AMP. Elevated cyclic AMP levels cause bronchial smooth muscle relaxation, resulting in bronchodilation.

Question 14

What is the Mechanism of Action of the Drug?

Hydralazine

A. Pure arterial dilator
B. Block sodium channels in the collecting tubule
C. Inhibitor of subtype 2 sodium-glucose transport protein
D. Inhibition of Na+/K+ ATPase
E. Inhibit phosphodiesterase

Answer 14

A. Pure arterial dilator

Rationale:
Hydralazine is an antihypertensive agent that acts as a pure arterial dilator. It relaxes the smooth muscles of the arteries, leading to vasodilation. This action reduces peripheral resistance and lowers blood pressure. The exact mechanism of how hydralazine causes arterial dilation is not fully understood, but it is known to be a direct-acting vasodilator.

Question 15

What is the Adverse Drug Effect?
Nitroprusside

A. Disorders of developing bones and teeth
B. Ototoxicity
C. Blurred vision
D. Impaired carbohydrate tolerance
E. Orthostatic hypotension

Answer 15

E. Orthostatic hypotension

Rationale:
Nitroprusside is a potent vasodilator used in hypertensive emergencies. Its rapid vasodilatory effect can lead to a sudden drop in blood pressure, causing orthostatic hypotension, which is a drop in blood pressure upon standing.

Question 16

What is the Adverse Drug Effect?
Demeclocycline

A. Disorders of developing bones and teeth
B. Ototoxicity
C. Blurred vision
D. Impaired carbohydrate tolerance
E. Orthostatic hypotension

Answer 16

A. Disorders of developing bones and teeth

Rationale:
Demeclocycline is a tetracycline antibiotic. Tetracyclines are known to bind to calcium in developing bones and teeth, leading to discoloration and impaired development. This is why they are typically avoided in children and pregnant women.

Question 17

What is the Adverse Drug Effect?
Furosemide

A. Disorders of developing bones and teeth
B. Ototoxicity
C. Blurred vision
D. Impaired carbohydrate tolerance
E. Orthostatic hypotension

Answer 17

B. Ototoxicity

Rationale:
Furosemide is a loop diuretic. One of the known side effects of loop diuretics, especially when given in high doses or rapidly as an intravenous injection, is ototoxicity, which can manifest as hearing loss or tinnitus.

Question 18

What is the Adverse Drug Effect?
Digitalis (Digoxin)

A. Disorders of developing bones and teeth
B. Ototoxicity
C. Blurred vision
D. Impaired carbohydrate tolerance
E. Orthostatic hypotension

Answer 18

C. Blurred vision

Rationale:
Digitalis toxicity, also known as digoxin toxicity, can manifest with a variety of symptoms, including gastrointestinal, cardiac, and neurological effects. One of the classic symptoms of digitalis toxicity is visual disturbances, which can include blurred vision, yellow-green halos, and photophobia.

Question 19

What is the Adverse Drug Effect?
Thiazide

A. Disorders of developing bones and teeth
B. Ototoxicity
C. Blurred vision
D. Impaired carbohydrate tolerance
E. Orthostatic hypotension

Answer 19

D. Impaired carbohydrate tolerance

Rationale:
Thiazide diuretics can lead to impaired glucose tolerance by decreasing insulin secretion. This can result in hyperglycemia, especially in patients with a predisposition to diabetes. Additionally, thiazides can also cause electrolyte imbalances, like hypokalemia and hyponatremia.

Question 20

Procainamide has anticholinergic effects.
Select one:
A. True
B. False

Answer 20

A. True

Question 21

Choose the most predominant class type.

Lupus like effect

A. Class |
B. Class Il
C. Class IV
D. Class III
E. Miscellaneous

Answer 21

A. Class I
Rationale:
Class I anti-arrhythmics, (a Class IA drug), are known to cause a lupus-like syndrome in some patients. This syndrome can manifest as symptoms similar to systemic lupus erythematosus, including rash, joint pain, and other systemic symptoms.

Class IA anti-arrhythmics:
(Double Quarter Pounder)
Disopyramide
Quinidine
Procainamide

Question 22

Choose the most predominant class type.

Vascular effect is smooth muscle relaxation

A. Class |
B. Class Il
C. Class IV
D. Class III
E. Miscellaneous

Answer 22

C. Class IV
Rationale: Class IV anti-arrhythmics are calcium channel blockers: Non-DHP.
Cause smooth muscle relaxation, leading to vasodilation.

Class IV anti-arrhythmics:
Diltiazem
Verapamil

Question 23

Choose the most predominant class type.

Fatal pulmonary fibrosis

A. Class |
B. Class Il
C. Class IV
D. Class III
E. Miscellaneous

Answer 23

D. Class III
Rationale:
Class III anti-arrhythmic, is known to cause pulmonary toxicity, which can manifest as potentially fatal pulmonary fibrosis in rare cases.

Class III Anti-arrhythmics
(Br Ibu D Am Sot)

Bretylium
Ibutilide
Dofetilide
Dronedarone
Amiodarone
Sotalol

Question 24

Choose the most predominant class type.

Drug of choice for paroxysmal supraventricular tachycardia

A. Class |
B. Class Il
C. Class IV
D. Class III
E. Miscellaneous

Answer 24

E. Miscellaneous
Rationale: Adenosine, which falls under the miscellaneous category, is often considered the drug of choice for acute termination of PSVT. It works by slowing down conduction through the AV node.

Question 25

Choose the most predominant class type.

Vascular effect is smooth muscle contraction

A. Class |
B. Class Il
C. Class IV
D. Class III
E. Miscellaneous

Answer 25

B. Class II
Rationale:
Class II anti-arrhythmics are beta-blockers. Beta-blockers can lead to smooth muscle contraction in the airways, which is why they can exacerbate asthma symptoms. However, in the vasculature, beta-blockers generally do not cause contraction; instead, they reduce heart rate and contractility. The association of beta-blockers with smooth muscle contraction is more relevant to bronchial smooth muscle than to vascular smooth muscle.

Class II Anti-Arrhythmics
Beta Blockers (-olol)
Propranolol
Esmolol
Acebutolol

Question 26

Class IC has the most pronounced sodium channel blocking property.
A. True
B. False

Answer 26

True

Rationale:
Anti-arrhythmic drugs are classified into different classes based on their mechanism of action. Class I anti-arrhythmics are sodium channel blockers. Within Class I, there are three subclasses: IA, IB, and IC. Among these, Class IC drugs, such as flecainide and propafenone, have the most potent and prolonged sodium channel blocking effects. This strong sodium channel blockade slows conduction in the heart, especially in the atria and ventricles.

Question 27

Propranolol has smooth muscle vasodilatation effects.
A. True
B. False

Answer 27

False

Rationale:
Propranolol is a non-selective beta-blocker, primarily acting on beta-1 and beta-2 adrenergic receptors. While it reduces heart rate and myocardial contractility by blocking beta-1 receptors in the heart, it does not have direct vasodilatory effects on smooth muscle. In fact, blocking beta-2 receptors can lead to bronchoconstriction in the lungs, which is why non-selective beta-blockers like propranolol can exacerbate asthma symptoms. The primary antihypertensive effect of propranolol is due to its reduction in cardiac output and its central action, not direct vasodilation.

Question 28

Dronedarone is a structural analogue of thyroid hormones.
A. True
B. False

Answer 28

True

Rationale:
Dronedarone is an anti-arrhythmic drug that is structurally related to amiodarone. Both amiodarone and dronedarone have a structure that is similar to thyroid hormones, specifically thyroxine (T4). This structural similarity is the reason why amiodarone, in particular, can have significant effects on thyroid function, either causing hypothyroidism or hyperthyroidism. Dronedarone was developed to have fewer side effects than amiodarone, including a reduced impact on the thyroid, but the structural resemblance to thyroid hormones remains.

Question 29

Question 6
Large dose of Diltiazem may produce AV block.
A. True
B. False

Answer 29

A. True

Large doses of Diltiazem can produce AV (atrioventricular) block. Diltiazem is a calcium channel blocker used to treat high blood pressure, angina, and certain heart rhythm disorders. One of its effects is to slow down the electrical conduction in the heart, and in high doses, it can lead to AV block, where the electrical signals from the atria (the upper chambers of the heart) are not properly conducted to the ventricles (the lower chambers of the heart).