CVS Pharmacology Flashcards
(145 cards)
1
Q
Esmolol:
Is useful in the treatment of essential hypertension
A
False. It is only given intravenously and has a short half life.
2
Q
Esmolol:
Has a half life of 2 minutes
A
False. It is around 10 minutes.
3
Q
Esmolol:
Is largely excreted unchanged in the urine
A
False. It is rapidly metabolised by red-cell esterases.
4
Q
Esmolol:
Acts selectively on beta-1 receptors
A
False. It is non-selective.
5
Q
Esmolol:
Possesses intrinsic sympathomimetic activity
A
False
6
Q
The following statements about selective phosphodiesterase (PDE) inhibitors are true:
Inhibition of isoenzyme family No. I effects a positive inotropic action
A
False. Inhibition of isoenzyme family No. III results in positive inotropy.
7
Q
The following statements about selective phosphodiesterase (PDE) inhibitors are true:
Inhibition of isoenzyme family No. III results in clinically important bronchodilatation
A
False. Bronchodilatation does occur but not to a clinically significant degree.
8
Q
The following statements about selective phosphodiesterase (PDE) inhibitors are true:
They increase myocardial oxygen consumption
A
False. There is unchanged or even slightly reduced myocardial oxygen consumption as systemic vasodilation reduces left ventricular systolic wall tension.
9
Q
The following statements about selective phosphodiesterase (PDE) inhibitors are true:
Tachycardia is a common occurrence
A
True. There is a reflex tachycardia.
10
Q
The following statements about selective phosphodiesterase (PDE) inhibitors are true:
Their use increases hblood pressure as a result of increased cardiac output and systemic vascular resistance.
A
False. Hypotension is often seen as a result of reduced systemic vascular resistance due to smooth muscle relaxation.
11
Q
Milrinone:
Is one of the bipridine derivative group of phosphodiesterase inhibitors.
A
True. Enoximone and piroximone are imidazolone derivatives.
12
Q
Milrinone:
Is structurally related to amrinone
A
False
13
Q
Milrinone:
It’s short half life makes it well suited to use as an infusion
A
False. It is used in infusion form but has a terminal half life of 2.5 hours. A loading dose is required.
14
Q
Milrinone:
Doses should be reduced in end stage renal failure
A
True. 80% is excreted unchanged via the kidneys and dose reductions are required when the creatinine clearance falls to less than 30 ml/min.
15
Q
Milrinone:
Is incompatible with intravenous frusemide when given through the same cannula
A
True
16
Q
Clonidine:
Is a selective partial agonist for the alpha-2 adrenoceptor with a ratio of approximately 200:1 (alpha2:alpha1)
A
True
17
Q
Clonidine:
Is rapidly absorbed when given orally
A
True
18
Q
Clonidine:
When given as premedication, it reduces the MAC by up to 50%
A
False. It does reduce MAC but only the highly selective drugs such as dexmedetomidine have lowered anaesthetic requirements to this degree.
19
Q
Clonidine:
Discontinuation can result in hypertension
A
True. Rebound hypertension occurs on discontinuation of long term use.
20
Q
Clonidine:
Has a diuretic effect in humans
A
True. It inhibits the release of ADH.
21
Q
Ephedrine:
Is a catecholamine
A
False. It does not have a hydroxyl substitution of the benzene ring, and therefore cannot properly be called a catecholamine.
22
Q
Ephedrine:
Causes the stimulation of both alpha and beta adrenoceptors
A
True
23
Q
Ephedrine:
Acts directly and indirectly on adrenoceptors
A
True. It’s main effects are from the release of noradrenaline but it also has some direct effect on receptors.
24
Q
Ephedrine:
Is a uterine relaxant
A
False. All anaesthetic vapours are uterine relaxants.
25
Ephedrine:
| Can exist in four isomeric forms, two of which are pharmacologically active.
False. It can exist in four isomeric forms but the only active one is the l-form. Ephedrine is supplied as the racaemic mixture or simply in the l-form.
26
The following are indications for the use of ACE inhibitors:
| Pre-eclampsia
False. ACE Inhibitors are contraindicated in pregnancy.
27
The following are indications for the use of ACE inhibitors:
| Essential hypertension
True
28
The following are indications for the use of ACE inhibitors:
| Hypertension secondary to bilateral renal artery stenosis
False. ACE Inhibitors are contraindicated in bilateral renal artery stenosis or unilateral renal artery stenosis supplying a single kidney as renal failure may supervene.
29
The following are indications for the use of ACE inhibitors:
| Following acute myocardial infarction
True
30
The following are indications for the use of ACE inhibitors:
| Chronic congestive cardiac failure
True
31
Regarding Digoxin:
| 25% of the oral dose is absorbed
False. It is well absorbed orally.
32
Regarding Digoxin:
| 95% is bound to plasma proteins
False. There is insignificant binding to plasma proteins.
33
Regarding Digoxin:
| It is largely excreted unchanged in the urine
True
34
Regarding Digoxin:
| Hypokalaemia may cause raised serum levels of digoxin
True
35
Regarding Digoxin:
| Toxicity may result in Mobitz type II heart block
True. All forms of heart block have been recorded in digitalis toxicity
36
The following drugs cause prolongation of the Q-T interval:
| Sotalol
True. Sotalol, a beta blocker, posesses class III activity, and both quinidine and disopyramide have class 1A actions with mild class III activity prolonging the cardiac action potential and hence the Q-T interval.
37
The following drugs cause prolongation of the Q-T interval:
| Quinidine
True
38
The following drugs cause prolongation of the Q-T interval:
| Verapamil
False
39
The following drugs cause prolongation of the Q-T interval:
| Flecainide
False. Flecainide, a class IC antiarrhythmic agent does not directly prolong the Q-T interval.
40
The following drugs cause prolongation of the Q-T interval:
| Disopyramide
True
41
The following drugs have potassium sparing diuretic effects:
| Elanapril
True. The angiotensin converting enzyme inhibitors have an anti-aldosterone effect They act as weak potassium sparing diuretics and concomittant use of such drugs should be undertaken with care.
42
The following drugs have potassium sparing diuretic effects:
| Furosemide
False. Frusemide use can result in hypokalaemia.
43
The following drugs have potassium sparing diuretic effects:
| Triamterene
True
44
The following drugs have potassium sparing diuretic effects:
| Spironolactone
True
45
The following drugs have potassium sparing diuretic effects:
| Flecainide
False. It has no diuretic effect.
46
Sodium nitroprusside:
| Acts by stimulating the release of nitric oxide in vascular tissue
True
47
Sodium nitroprusside:
| Acts as an arteriolar and venous dilator
False
48
Sodium nitroprusside:
| Is associated with a baroreceptor mediated rise in heart rate
True. Is associated with a reflex tachycardia.
49
Sodium nitroprusside:
| Rapidy decomposes in the presence of light
False. Its decomposition is surprisingly slow: 50% of its activity remains after 2 days exposure to light.
50
Sodium nitroprusside:
| Is broken down by non-specific plasma esterases
False. Breakdown occurs in red blood cells with production of cyanomethaemoglobin.
51
The following are recognised complications of amiodarone:
| Peripheral neuropathy
True
52
The following are recognised complications of amiodarone:
| Prologation of the Q-T interval
True
53
The following are recognised complications of amiodarone:
| Hyperthyoidism
True. Hypo or hyper-thyroidism may occur at higher doses.
54
The following are recognised complications of amiodarone:
| Reversible restrictive lung defect
True. Pulmonary fibrosis, if treated early and the amiodarone stopped, may regress.
55
The following are recognised complications of amiodarone:
| Optic atrophy
False. Corneal microdeposits rather than optic atrophy occur in long term use.
56
The following Beta-blockers are metabolised predominantly by the liver:
Labetolol
True
57
The following Beta-blockers are metabolised predominantly by the liver:
Propranolol
True
58
The following Beta-blockers are metabolised predominantly by the liver:
Atenolol
False. Atenolol and sotalol are water soluble and therefore predominantly metabolised by the kidney.
59
The following Beta-blockers are metabolised predominantly by the liver:
Metoprolol
True
60
The following Beta-blockers are metabolised predominantly by the liver:
Sotalol
False. Atenolol and sotalol are water soluble and therefore predominantly metabolised by the kidney.
61
Labetolol:
| Acts on alpha and beta receptors with higher affinity for alpha-receptors
False. It has more affinity for beta receptors: beta:alpha 3:1 following oral ingestion and 7:1 after IV administration.
62
Labetolol:
| May cause retrograde ejaculation by its beta-blocking action
False. This can occur secondary to it's alpha action.
63
Labetolol:
| Has significant intrinsic sympathomimetic activity (ISA)
True. It does have significant ISA.
64
Labetolol:
| Causes significant postural hypotension
True
65
Labetolol:
| Is contraindicated in pregnancy
False. It is one of the drugs used in pre-eclampsia.
66
The following are natural precursors of adrenaline:
False
67
The following are natural precursors of adrenaline:
False
68
The following are natural precursors of adrenaline:
False
69
The following are natural precursors of adrenaline:
True
70
The following are natural precursors of adrenaline:
False. Dopamine is a precursor of adrenaline. Dobutamine is a synthetic compound.
71
Hyoscine:
| Is a less potent anti-sialagogue than atropine
False. It is a more potent anti-sialagogue than atropine.
72
Hyoscine:
| Does not cross the blood-brain barrier
False. It has central and peripheral effects, which include sedative, anti-emetic and anti-sialogogue actions.
73
Hyoscine:
| Is largely excreted unchanged in the urine
False. Only 1% is excreted unchanged.
74
Hyoscine:
| Is an effective anti-emetic which can be delivered transdermally
True
75
Hyoscine:
| May produce excitement and restlessness
True. Through paradoxical central stimulation.
76
Isoprenaline:
| Has alpha and beta adrenergic activity
False. It acts on beta-1 and beta-2 receptors only.
77
Isoprenaline:
| Increases peripheral vascular resistance
False. It causes a fall in peripheral vascular resistance via it's beta-2 effets.
78
Isoprenaline:
| Is a naturally occuring catecholamine
False. Isoprenaline is a synthetic catecholamine.
79
Isoprenaline:
| May decrease mean arterial pressure
True
80
Isoprenaline:
| It's effects are mediated via adenylate cyclase
True
81
Hydralazine:
| Dilates arterioles and veins equally
False. Hydralazine is predominantly an arteriolar dilator.
82
Hydralazine:
| It's first pass metabolism is dependent on the acetylator status of the patient
True
83
Hydralazine:
| Increases cerebral blood flow
True
84
Hydralazine:
| May cause a lupus-like syndrome
True. After chronic usage. Peripheral neuropathies and blood dyscrasias have also been reported.
85
Hydralazine:
| Is contraindicated in pre-eclampsia
False
86
```
Nitric oxide (NO):
Is synthesised exclusively by vascular endothelium
```
False. Nitric oxide is also produced by macrophages and thrombocytes.
87
```
Nitric oxide (NO):
Is synthesised from L-asparagine
```
False. It is synthesised from L-arginine.
88
```
Nitric oxide (NO):
Is produced by the lung
```
True
89
```
Nitric oxide (NO):
Binds to haemoglobin with an affinity equal to that of carbon monoxide (CO)
```
False. The haemoglobin molecule has an affinity 1500 times higher to NO than to CO. Nitrosyl haemoglobin is produced, which in the presence of oxygen, is oxidised to methaemoglobin.
90
```
Nitric oxide (NO):
Ultimately is metabolised to nitrate which is excreted by the kidneys
```
True
91
The following drugs exhibit tachyphylaxis:
| GTN
True
92
The following drugs exhibit tachyphylaxis:
| Ephidrine
True
93
The following drugs exhibit tachyphylaxis:
| Suxemethonium
False. Repeated doses can result in a prolonged dual block.
94
The following drugs exhibit tachyphylaxis:
| Trimetaphan
True
95
The following drugs exhibit tachyphylaxis:
| Hydralazine
False
96
Verapamil:
| Is a derivative of papaverine
True. Verapamil is a synthetic papaverine derivative.
97
Verapamil:
| Has poor oral absorption
False. It is well absorbed following oral administration, but undergoes extensive first pass metabolism with a bioavailability of 10-20%.
98
Verapamil:
| Has a bioavailability following oral administration of about 75%
False
99
Verapamil:
| Is highly bound to plasma proteins
True
100
Verapamil:
| Is largely excreted by the kidney
True. 70% of metabolites are excreted by the kidney.
101
Trimetaphan:
| Blocks parasympathetic ganglia to produce hypotension
False. Trimetaphan induces hypotension by blocking sympathetic ganglia but it also exhibits some direct vasodilatation.
102
Trimetaphan:
| Is an arteriolar and venous dilator
True
103
Trimetaphan:
| Is inactivated by plasma cholinesterase
True
104
Trimetaphan:
| Has a long half life
False. It has a plasma half-life of only 2 minutes.
105
Trimetaphan:
| May potentiate the effect of suxemthonium
True. Side-effects include histamine release, mydriasis, and potentiation of suxemthonium, urinary retention and impotence due to the non-selective ganglion blockade.
106
Phenoxybenzamine:
| Is a non-selective alpha-adrenergic antagonist
True. Phenoxybenzamine is a non-selective alpha blocker.
107
Phenoxybenzamine:
| Acts predominantly on pre-synaptic alpha-1 receptors
False. It predominantly acts post-synaptically.
108
Phenoxybenzamine:
| Can be given orally or intravenously
True
109
Phenoxybenzamine:
| May result in nasal stuffiness
True. Doses are often limited by this, along with postural hypotension.
110
Phenoxybenzamine:
| Is useful in the management of craniopharyngioma
False. It is often used in the treatment of phaeochromocytomas
111
The following are side effects of thiazide diuretics:
| Hyperuricaemia
True
112
The following are side effects of thiazide diuretics:
| Hyponatraemia
True
113
The following are side effects of thiazide diuretics:
| Hypoglycaemia
False. They can cause hyperglycaemia.
114
The following are side effects of thiazide diuretics:
| Hypokalaemic, hypochloraemic acidosis
False. Thiazides tend to result in hypokalaemic, hypochloraemic metabolic alkalosis.
115
The following are side effects of thiazide diuretics:
| Hypercalcaemia
True.
116
Ephedrine is unlikely to be effective in reversing hypotension in patients chronically receiving the following medication:
Reserpine
True. Indirectly acting sympathomimetics like ephedrine are unlikely to increase blood pressure in patients taking drugs which alter neuronal storage, uptake, metabolism or release of neurotransmitters. Reserpine depletes neuronal granules of noradrenaline.
117
Ephedrine is unlikely to be effective in reversing hypotension in patients chronically receiving the following medication:
Alpha-methyl dopa
True. Alpha-methyl dopa acts as a false transmitter.
118
Ephedrine is unlikely to be effective in reversing hypotension in patients chronically receiving the following medication:
Phenoxybenzamine
True. Phenoxybenzamine and propranolol block peripheral receptors and industrial doses of directly acting sympathomometics may be required to overcome their blockade.
119
Ephedrine is unlikely to be effective in reversing hypotension in patients chronically receiving the following medication:
Clonidine
False. Clonidine works on central adrenergic receptors and the peripheral effect of indirectly acting sympathomimetics is not decreased, in fact smaller doses may be required due to receptor up regulation.
120
Ephedrine is unlikely to be effective in reversing hypotension in patients chronically receiving the following medication:
Propranolol
True
121
The following statements are true:
| ACE Inhibitors slow the onset of chronic renal disease secondary to hypertension
True. ACE Inhibitors do slow the onset of chronic renal disease secondary to hypertension and diabetes.
122
The following statements are true:
| Angiotensin II causes glomerular afferent arteriolar vasodilatation
False. Angiotensin II causes glomerular arteriolar vasoconstriction (in the efferent arterioles to a greater extent than the afferent).
123
The following statements are true:
| The fetus has high renin and angiotensin II levels
False. Renin levels are high, but angiotensin II levels are low due to the limited pulmonary blood flow.
124
The following statements are true:
| Angiotensin II stimulates the release of aldosterone from the adrenal medulla
False. Angiotensin II stimulates the release of aldosterone from the adrenal cortex.
125
The following statements are true:
| All ACE inhibitors have similar antihypertensive efficacy at equipotent doses.
True
126
The following may be used to control the ventricular rate in atrial fibrillation:
Quinidine
False. Although it may be used in atrial arrhythmias, it has a slight vagolytic effect and may accelerate the ventricular rate in AF unless digoxin is given concomitantly.
127
The following may be used to control the ventricular rate in atrial fibrillation:
Atenolol
True
128
The following may be used to control the ventricular rate in atrial fibrillation:
Amiodarone
True
129
The following may be used to control the ventricular rate in atrial fibrillation:
Digoxin
True
130
The following may be used to control the ventricular rate in atrial fibrillation:
Disopyramide
False. Disopyramide has both class Ia and III activity and an anticholinergic effect. For similar reasons to quinidine it should not be used for AF alone.
131
In the treatment of cardiogenic shock:
| Enoximone increases the left ventricular end diastolic pressure
False. It reduces afterload i.e. left ventricular end diastolic pressure due to it's vasodilating effects.
132
In the treatment of cardiogenic shock:
| Adrenaline increases the systemic vascular resistance
True. Adrenaline acts on both alpha and beta receptors. At low doses, beta effects predominate (tachycardia, increased cardiac output, lower SVR) but at higher doses alpha effects take over with peripheral vasoconstriction.
133
In the treatment of cardiogenic shock:
| Cardiac output is increased by noradrenaline
False. Noradrenaline is mainly an alpha-agonist and increasing systemic vascular resistance and hence reducing cardiac output.
134
In the treatment of cardiogenic shock:
| Isoprenaline reduceses myocardial oxygen consumption
False. Isoprenaline produces a tachycardia viaits beta-agonist effect, increasing myocardial consumption.
135
In the treatment of cardiogenic shock:
| Dobutamine reduces systemic vascular resistance
True. Dobutamine vasodilates by acting on beta 2-adrenergic receptors.
136
The following have calcium antagonistic actions on smooth muscle:
Dantrolene
False. Dantrolene is a direct-acting skeletal muscle relaxant. It has no action on smooth muscle.
137
The following have calcium antagonistic actions on smooth muscle:
Diltiazem
True
138
The following have calcium antagonistic actions on smooth muscle:
Nicardipine
True
139
The following have calcium antagonistic actions on smooth muscle:
Hydralazine
False
140
The following have calcium antagonistic actions on smooth muscle:
Nitroglycerine
False. Neither hydralazine nor nitrglycerine act as calcium antagonists.
141
Adenosine:
| Is an effective treatment stable ventricular tachycardia
False. Adenosine is effective in SVTs, depressing the SA node activity and blocking AV node conduction. Although ineffective in VTs, it can serve to distinguish SVT with associated bundle branch block from VT in a patient with broad complex tachycardia.
142
Adenosine:
| Has a half life of approximately 2 minutes
False. It has a very short half life (<10 seconds).
143
Adenosine:
| Should be given as slow intravenous bolus
False. Beacause of it's very short half life, it should be given as a rapid bolus.
144
Adenosine:
| Can result in wheezing
True. Though all side effects should be short lived due to it's short half life.
145
Adenosine:
| Causes coronary vasoconstriction
False. It is a potent coronary vasodilator and may cause coronary steal in susceptible patients.
