Module 5 Review Questions

Question 1

Renin inhibitors MOA

Answer 1

• Binds tightly with renin and inhibits the cleavage of angiotensinogen to angiotensin I
• Inhibits the conversion of angiotensin I (inactive) to angiotensin II (highly active)

Question 2

ACE inhibitors MOA

Answer 2

• Reduce levels of angiotensin II through inhibition of ACE
• Increasing levels of bradykinin through inhibition of Kinase II
• Dilate blood vessels and reduce blood volume
• Reverse pathologic changes in the heart and blood vessels mediated by angiotensinII and aldosterone

Question 3

ARBs MOA

Answer 3

• Block access of angiotensin II
• Cause dilation of arterioles and veins
• Prevent angiotensin II from inducing pathologic changes in cardiac structure
• Reduce excretion of K+
• Decrease release of aldosterone
• Increase renal excretion of Na+ and H2O
• Do not inhibit Kinase II
• Do not increase levels of bradykinin

Question 4

Aldosterone antagonists MOA

Answer 4

• Selective blockade of aldosterone receptors in the kidney

- Promotes excretion of Na+ and H2O and thereby reduces blood volume

Question 5

Calcium channel blockers
A. have exact same effect on heart as beta blockers
B. Increase force of contraction of the heart
C. Speed up the heart rate
D. Increase conduction through AV node

Answer 5

A. Have exact same effect on the heart as Beta Blockers - they suppress calcium influx and reduce force of contraction and slow heart and suppress conduction through the AV node

Question 6

Common side effects of CCBs are:

Answer 6

constipation, edema of lower extremities, gingival hyperplasia

Question 7

Which of the following are therapeutic uses for Nifedipine? (Select all that apply)
A. Post MI
B. Migraines
C. CHF
D. Angina
E. HTN

Answer 7

B. Migraines
D. Angina
E. HTN

Question 8

Beta blockers ___ the adverse cardiac effects of Nifedipine, but can ___ the adverse cardiac effects of Verapamil and Diltiazem.

Answer 8

decrease, intensify

Question 9

John is taking Hydralazine for elevated BP. He comes in arthralgias. What blood test might be elevated?
A. Creatinine
B. ANA
C. RA
D. ALT/AST

Answer 9

B. ANA (antinuclear body test) ; Hydralazine can manifest with s/sx of SLE

Question 10

Untreated HTN can lead to: Check all that apply.
A. Angina
B. CHF
C. MI
D. Kidney disease
E. Stroke

Answer 10

All of the above.

Question 11

Sympatholytics are ___.

Answer 11

Anti-adrenergic drugs

Question 12

How is stage A CHF managed?
A. Beta blocker started
B. Manage risks only
C. Start ACE
D. Start Furosemide

Answer 12

B. Manage risks only

Question 13

True or False: Virtually all dysrhythmics can also cause dysrhythmias.

Answer 13

True

Question 14

Which medication is used to treat Digoxin induced dysrhythmias?
A. Quinidine
B. Phenytoin
C. Mexiletine
D. Lidocaine

Answer 14

B. Phenytoin

Question 15

Bill is taking Amiodarone for his atrial fibrillation. What diagnostics will need to be done?
A. BUN/Cr yearly
B. CBC yearly
C. TSH and chest x-ray every 6 months
D. Electrolytes every 3 months

Answer 15

C. TSH and chest x-ray every 6 months.

Question 16

Recommended cholesterol screening is:

Answer 16

Every 5 years after age 20.

Question 17

Lucy is taking gemfibrozil and warfarin. You know to check INR and expect that:
A. INR might be elevated
B. INR will be subtherapeutic
C. INR will be unchanged
D. None of the above.

Answer 17

A. INR might be elevated (Gemfibrozil displaces Warfarin from plasma protein)

Question 18

Bill has Prinzmetal's angina and it is wakening him at night. What will the NP prescribe?
A. Beta blocker
B. CCB
C. Digoxin
D. ASA

Answer 18

B. CCB

Question 19

How do you prevent nitrate intolerance. Check all that apply.
A. Give smallest dose possible.
B. Give largest dose possible.
C. Keep patches on at all times.
D. Have 8 free hours per day with long acting nitrates.
E. Do not use spray

Answer 19

A. Give smallest dose possible.

D. Have 8 free hours per day with LA nitrates.

Question 20

Mary has been admitted with unstable angina. You know she will be treated with:

Answer 20

ASA
Plavix (Clopidogrel)
Beta blocker
Statin
ACE

Question 21

What happens when clopidogrel is given with a PPI?

Answer 21

The anti-platelet effect is decreased.

Question 22

What role does O2 play in STEMI?
ASA?
Morphine?
Nitro?
BB?

Answer 22

O2: Although oxygen is recommended, and using it seems to make sense, the practice is not evidence-based.
ASA: A study by ISIS-2, aspirin caused substantial reduction in mortality.
Morphine: In addition to relieving pain, morphine can improve hemodynamics. By promoting venodilation, the drug reduces cardiac preload
Nitro: (1) reduce preload and thereby reduce O2 demand; (2) increase collateral blood flow in the ischemic region of the heart; (3) control HTN caused by STEMI-associated anxiety; and (4) limit infarct size and improve LV function. However, Nitro does not reduce mortality
BB: Decreases myocardial O2 demand, reduce cardiac pain, infarct size, and short-term mortality; recurrent ischemia and re-infarction are also decreased

Question 23

Which must Heparin bind to in order to exert its anticoagulant effect?

Answer 23

Antithrombin III (Heparin binds to antithrombin III then activates thrombin and Factor Xa)

Question 24

Which one of the following drugs binds bile acids in the intestine, thus preventing their return to the liver via the enterohepatic circulation?
A. Niacin
B. Fenofibrate
C. Cholestyramine
D. Lovastatin

Answer 24

C. Cholestyramine

Question 25

A 58 year old female reports that she recently stopped taking her blood pressure meds because of swelling in her feet that began shortly after she started treatment. Which of the following is most likely to cause peripheral edema? A. Atenolol B. Clonidine C. Felodipine D. Hydralazine

Answer 25

C. Felodipine (calcium channel blocker)

Question 26

Jack is taking Colesevelam. The NP tells him to: A. Beware of flushing B. He might have muscle aches C. He needs to increase fluids and fiber for constipation D. He might have itching a few days after starting

Answer 26

C. He needs to increase fluids and fiber for constipation. | Colesevelam is a bile acid-binding resin used to lower cholesterol.

Question 27

A 54 year old male is noted to have hyperlipidemia, and is prescribed atorvastatin. This drug reduces plasma cholesterol by which of the following processes? A. inhibiting ApoB synthesis B. Inhibiting cholesterol absorption C. inhibiting cholesterol biosynthesis D. interfering with bile acid reabsorption

Answer 27

C. Inhibiting cholesterol biosynthesis

Question 28

A 42 year old woman is noted to have Type II diabetes. She has HTN with BP 150/94. The UA shows mild albuminuria. Which of the following drugs would be the best choice to treat HTN? A. Enalapril B. Propranolol C. HCTZ D. Amlodipine

Answer 28

A. Enalapril (ACE inhibitor)

Question 29

Brad has HTN and is found to have enlarged prostate on exam. His BP has been running in the 150/90 range. Which of the following meds would offer treatment for both? A. Furosemide B. Aliskiren C. Propranolol D. Terazosin

Answer 29

D. Terazosin (Terazosin is in a class of medications called alpha-blockers. It relieves the symptoms of BPH by relaxing the muscles of the bladder and prostate)

Question 30

``` Which best describes the action of ACE inhibitors on the failing heart? A. Increases vascular resistance B. Decreases cardiac output C. Reduces preload D. Increases aldosterone ```

Answer 30

C. Reduces preload

Question 31

Which of the following is the most accurate statement regarding Digoxin? A. Decreases mortality in patients with CHF. B. Increases vagal tone and decreases AV node conduction C. Lengthens the action potential and increases the refractoriness of the heart D. Useful in treating Wolff-Parkinson-White syndrome

Answer 31

B. Increases vagal tone and decreases AV node conduction

Question 32

``` Which of the following is a limiting adverse effect of ACE inhibitors? A. Hyperkalemia B. Hypokalemia C. Hyponatremia D. Hypernatremia ```

Answer 32

A. Hyperkalemia