Pharmacology Review Q's

Question 1

T/F: angiotensin I is converted to angiotensin II only through angiotensin-converting enzyme (ACE)

Answer 1

Cathepsin G + Chymase also convert it

Question 2

Which of the following increases calcium by releasing Ca from intracellular stores?

a. DAG
b. IP3

Answer 2

b. IP3

Question 3

The activation of which of the following causes vasodilation?

a. angiotensin type 1 receptor
b. angiotensin type 2 receptor

Answer 3

b. angiotensin type 2 receptor

Question 4

Which of the following plays a greater role in cardiac hypertrophy?

a. angiotensin type 1 receptor
b. angiotensin type 2 receptor

Answer 4

b. angiotensin type 2 receptor

Question 5

Which of the following mediates angiotensin II induced growth in the left ventricle and the arterial wall?

a. angiotensin type 1 receptor
b. angiotensin type 2 receptor

Answer 5

a. angiotensin type 1 receptor

Question 6

Which of the following increases calcium by helping influx through calcium channels?

a. DAG
b. IP3

Answer 6

a. DAG

Question 7

Which of the following are angiotensin receptor blockers?

a. aliskiren
b. lisonopril
c. captopril
d. valsaratan
e. losartan

Answer 7

d. valsaratan

+

e. losartan

Question 8

Activation of which causes vasoconstriction?

a. angiotensin type 1 receptor
b. angiotensin type 2 receptor

Answer 8

a. angiotensin type 1 receptor

Question 9

Which of the following prevents the conversion of angiotensin 1 to 2?

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

Answer 9

b. lisonopril +captopril

Question 10

Which of the following are competitive antagonists of AT1- receptors?

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

Answer 10

c. valsaratan + losartan

Question 11

Which of the following are renin competitive inhibitors?

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

Answer 11

a. aliskiren

Question 12

Which has a side effect of fetal anomalies?

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

Answer 12

b. lisonopril +captopril

Question 13

Which is more effective in reducing blood pressure and ventricular hypertrophy?

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

Answer 13

a. aliskiren

Question 14

What converts angiotensin I to angiotensin (1-7)?

Answer 14

neutral endopeptidases (NEP)

Question 15

What converts angiotensin II to angiotensin (1-7)?

Answer 15

ACE2

Question 18

What occurs to angiotensin I if ACE inhibitors are applied?

Answer 18

levels increase and may be converted to angiotensin (1-7) via NEP pathway

Question 19

Which drugs reduce arteriolar and ventricular remodeling?

Answer 19

losartan + valsartan

(Angiotensin receptor blockers)

Question 20

Which of the following has a greater side effect of coughing? explain the mechanism.

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

Answer 20

b. lisonopril +captopril

(Decrease bradykinin degradation)

Question 21

Which of the following is best to use in hypertensive diabetic patients?

a. aliskiren
b. lisonopril +captopril
c. valsaratan + losartan

Answer 21

b. lisonopril +captopril

Question 22

T/F: aliskiren levels can be detectable in plasma for 3 weeks after treatment

Answer 22

false, its in the kidneys for 3 weeks, whereas its plasma levels become undetectable at an earlier time

Question 23

What is aliskiren metabolized by?

Answer 23

P450 enzyme 3A4

Question 24

T/F: all class 1 antiarrhythmic drugs increase refractory period

Answer 24

false; class 1a increases it, 1b decreases, and 1c doesn’t change it

Question 25

Which two phases do class 1 antiarrhythmic drugs affect and how?

Answer 25

reduced rate of phase 0 and phase 4 depolarization

they do this by blocking Na channels

Question 27

Which has no effect on duration of the action potential?

a. Mexiletine
b. Disopyramide
c. Procainamide
d. Flecainide
e. Quinidine
f. Lidocaine

Answer 27

d. Flecainide

Question 28

Which of the following causes cinchonism as an adverse effect? a. Mexiletine b. Disopyramide c. Procainamide d. Flecainide e. Quinidine f. Lidocaine

Answer 28

e. Quinidine

Question 29

In which location(s) do class 1B antiarrhythmic agents reduce the duration of AP?

Answer 29

Shortens the duration of AP in Purkinje fibers and ventricular muscle. | (No difference in AP of atrial fibers)

Question 30

Which phase do class 2 and 3 antiarrhythmic drugs affect and how?

Answer 30

Reduce slope of phase 4-depolarization

Question 31

Which of the following is mainly used for ventricular arrhythmias in unresponsive patients? a. Mexiletine b. Disopyramide c. Procainamide d. Flecainide e. Quinidine f. Lidocaine

Answer 31

b. Disopyramide

Question 33

How is Quinidine taken? Where is it found in the body? Where is it metabolized and excreted?

Answer 33

taken orally, 90% found in plasma proteins, metabolized in liver and excreted in urine

Question 34

Why does Quinidine cause hypotension?

Answer 34

because it blocks alpha-adrenergic receptors, which vasoconstrict vessels

Question 35

Which has the highest anticholinergic effect? a. Quinidine b. Disopyramide c. Procainamide

Answer 35

b. Disopyramide

Question 36

Which is mostly used to treat long-term treatment of ventricular arrhythmias associated with previous myocardial infarction? a. Mexiletine b. Disopyramide c. Phenytoin d. Flecainide e. Quinidine f. Lidocaine

Answer 36

a. Mexiletine

Question 37

Which antiarrhythmic drugs are used to stimulate uterine activity?

Answer 37

Quinidine (Acts as oxytocic agent=stimulate uterine activity)

Question 38

Which of the following is used for re-entry arrhythmias and acute ventricular tachycardia? a. Mexiletine b. Disopyramide c. Procainamide d. Flecainide e. Quinidine f. Lidocaine

Answer 38

c. Procainamide

Question 39

Which is used to treat ventricular arrhythmias in children? a. Mexiletine b. Disopyramide c. Phenytoin d. Flecainide e. Quinidine f. Lidocaine

Answer 39

c. Phenytoin

Question 40

Which has an adverse effect of bone marrow depression? a. Mexiletine b. Disopyramide c. Phenytoin d. Flecainide e. Quinidine f. Lidocaine

Answer 40

f. Lidocaine

Question 41

Which of the following is mainly used with other drugs? a. Mexiletine b. Disopyramide c. Phenytoin d. Flecainide e. Quinidine f. Lidocaine

Answer 41

a. Mexiletine

Question 42

Which class of antiarrhythmic drugs increases threshold potential? What does this result in? a. class 1A b. class 1B c. class 1C

Answer 42

c. class 1C increasing threshold potential reduces automaticity

Question 43

Which drug leads to the development of lupus-like syndrome when you stop prolonged treatment?

Answer 43

Procainamide

Question 44

Which had the shortest half-life? a. Mexiletine b. Disopyramide c. Procainamide d. Flecainide e. Quinidine f. Lidocaine

Answer 44

f. Lidocaine | (1.5-2hrs)

Question 45

Which class of antiarrhythmic drugs are the most potent Na channel blockers? Describe dissociation rate. a. class 1A b. class 1B c. class 1C

Answer 45

c. class 1C they have a high affinity to the Na channels and dissociate very slowly, prolonging their effect

Question 46

How is Flecainide taken? Where is it found in the body? Where is it metabolized and excreted?

Answer 46

taken IV or oral, no first-pass metabolism. 75% found on plasma proteins and highly concentrated in cardiac tissue. partly metabolizes and partly unchanged (slow renal excretion)

Question 47

Which type of antiarrhythmic drugs act by blocking K channels? a. class I drugs b. class II drugs c. class III drugs d. class IV drugs

Answer 47

c. class III drugs | (depolarization affected)

Question 48

Which has an adverse effect of decreased hearing and disorientation? a. Mexiletine b. Disopyramide c. Phenytoin d. Flecainide e. Quinidine f. Lidocaine

Answer 48

f. Lidocaine (CNS symptoms in high concentrations ex/drowsiness)

Question 49

Which type of antiarrhythmic drugs act by blocking Ca channels? a. class I drugs b. class II drugs c. class III drugs d. class IV drugs

Answer 49

d. class IV drugs

Question 50

What type of antiarrhythmic drug is Amiodarone? How is the half-life of the drug?

Answer 50

type 3, but it hals actions of all the other classes. half life is very high (days or months) so toxicity is more likely

Question 51

Which type of antiarrhythmic drugs has withdrawal symptoms when the patient stops taking it after long term use? a. class I drugs b. class II drugs c. class III drugs d. class IV drugs

Answer 51

class II drugs (beta adrenergic agnoists)

Question 52

Which of the following is best for a hypertensive patient? How about a patient with an arrhythmia or angina? a. diltiazem b. nifedipine c. verapamil

Answer 52

hypertensive---\> b. nifedipine arrhythmia or angina---\> c. verapamil

Question 53

Which type of antiarrhythmic drugs decreases conduction across AV node at high concentrations only? a. class I drugs b. class II drugs c. class III drugs d. class IV drugs

Answer 53

b. class II drugs (d. class IV drugs do this also...)

Question 54

Which is the drug of choice in paroxysmal supraventricular tachycardia? a. class I drugs b. class II drugs c. class III drugs d. class IV drugs

Answer 54

d. class IV drugs

Question 55

Which type of calcium channel is most used?

Answer 55

L type Ca channel

Question 56

Which system is for short term blood pressure control? a. sympathetic nervous system b. renin-angiotensin-aldosterone system

Answer 56

a. sympathetic nervous system

Question 57

How do diuretics work in the short term versus the long term?

Answer 57

short term= decrease plasma volume + cardiac output long term= vasodilation & decreased vascular resistance

Question 58

What are the side effects of diuretics

Answer 58

Hypokalemia + Hyperglycemia (cause a reduction in insulin secretion)

Question 59

Which is a renin inhibitor? a. chlorothiazide b. hydrochlorothiazide c. furosemide d. aliskiren

Answer 59

d. aliskiren | (the rest are diuretics)

Question 60

What are some ACE inhibitors? Why do they not work in some individuals?

Answer 60

captopril, enalapril, lisinopril Don't work in some people because the ACE enzyme isn't the only one capable of making angiotensin 1 to 2

Question 61

What is the main side effect of ACE inhibitors? explain the mechanism.

Answer 61

dry cough ACE destroys bradykinin, and since we're blocking ACE, bradykinin builds up and causes the coughing.

Question 62

What are two angiotensin II receptor blockers? What do they specifically block?

Answer 62

losartan, telmisartan they block the AT1 receptors to stop angiotensin 2 stimulation

Question 63

Orthostatic hypotension is a side effect of angiotensin 2 receptor blockers. explain the mechanism.

Answer 63

the blockers prevent contraction of veins

Question 64

Which of the following Ca channel blockers is a nondihydropyridine? a. Nifedipine b. Verapamil c. Amlodipine d. Diltiazem

Answer 64

b. Verapamil

Question 65

Which Ca channel blockers is a smooth muscle selective? a. Nifedipine b. Verapamil c. Amlodipine d. Diltiazem

Answer 65

a. Nifedipine + c. Amlodipine (the Dihydropyridines)

Question 66

Which Ca channel blockers can occasionally cause the heart rate to slow too much? a. Nifedipine b. Verapamil c. Amlodipine d. Diltiazem

Answer 66

b. Verapamil (the nondihydropyridine, because its cardioselective)

Question 67

Which Beta Adrenoceptor Blocking Agent is nonselective? a. Propranolol b. Atenolol

Answer 67

a. Propranolol Atenolol= beta-1 adrenoceptor selective

Question 68

Antagonism of which receptor causes a side effect of bronchospasm? a. Alpha 1 Adrenoceptor b. Alpha 2 Adrenoceptor c. Beta 1 Adrenoceptor d. Beta 2 Adrenoceptor

Answer 68

d. Beta 2 Adrenoceptor

Question 70

Which drugs relax the muscles around the bladder and prostate?

Answer 70

Alpha-1 Adrenoceptor Blocking Agents= Doxazosin, Prazosin, Terazosin

Question 71

What type of drug is Carvedilol? When is it contraindicated?

Answer 71

it's an alpha and beta-blocker (along with Labetalol), anti-oxidant, anti-inflammatory contraindicated in conditions including bronchial asthma and severe bradycardia

Question 72

Which drug is used to treat pregnancy-induced hypertension?

Answer 72

Methyldopa

Question 73

What type of drugs are Alpha-Methyldopa + Clonidine? How do they work?

Answer 73

Centrally acting Alpha-2 Adrenergic Agonists They stimulate alpha-2 receptors within the medulla, preventing the release of noradrenaline

Question 74

What's the side effect of direct vasodilators (EX/Hydralazine + Nitrates)

Answer 74

headache, swelling in the lower legs

Question 75

Minoxidil side effect

Answer 75

excessive hair growth

Question 76

Which is made up of plants? a. digoxin b. digitoxin c. both d. neither

Answer 76

c. both

Question 77

Which of the following does liver failure enhance toxicity? How about renal failure a. digoxin b. digitoxin c. both d. neither

Answer 77

renal failure= increase toxicity in a. digoxin liver failure= increase toxicity in b. digitoxin \*\* both have a low therapeutic index

Question 78

Explain the mechanism of action of digoxin

Answer 78

stop Na+/K+ ATPase (**↑Na in cell**), less effective Na+ /Ca2+ exchange (due to ↑Na), so now **↑Ca in cell**= **↑** contraction force

Question 79

T/F: Digoxin is used to treat heart failure because of its ability to increase HR

Answer 79

false, it increases contractility and decreases HR

Question 81

How do Inotropic Drugs increase cAMP levels?

Answer 81

by inhibiting phosphodiesterases (stop using cAMP) OR activating adenylyl cyclase (to produce cAMP)

Question 83

In which condition does giving Digitalis Glycosides lead to toxicity? a. hypokalaemia b. hypocalcemia

Answer 83

a. hypokalaemia (hypocalcemia= Digitalis Glycosides are less effective)

Question 84

Mechanism of action of Dobutamine

Answer 84

Question 86

Mechanism of action of Thiazides

Answer 86

Question 87

Which of the following Inotropic Drugs can be given orally? a. Amrinone b. Milrinone c. both d. neither

Answer 87

c. both | (both orally or parenterally)

Question 88

T/F: Amrinone and Milrinone have vasoconstrictive effects

Answer 88

false, they have a vasodilating effect (which may contribute to their therapeutic effect.)

Question 89

ACE inhibitors mechanism of action

Answer 89

Question 91

How do dilator drugs aid in treating heart failure?

Answer 91

decreasing preload (venodilation) decreasing afterload (arteriolar dilation)

Question 93

Which blocks β1-and β2-adrenoceptors? a. Atenolol b. Carvedilol c. both d. neither

Answer 93

b. Carvedilol | (Atenolol= only block β1-adrenoceptors)

Question 94

Which exhibits anti-oxidant activity? a. Atenolol b. Carvedilol c. both d. neither

Answer 94

b. Carvedilol

Question 96

Patient comes in with diabetic nephropathy and some swelling in the ankles. Which do you prescribe?

Answer 96

Angiotensin-converting enzyme inhibitors to prevent loss of kidney function associated with diabetic nephropathy

Question 97

What's the most common side effect of ACE inhibitors?

Answer 97

dry cough

Question 98

Which undergoes extensive first-pass hepatic metabolism? a. telmisartan b. losartan c. both d. neither

Answer 98

b. losartan

Question 99

T/F: both Angiotensin II receptor blockers and ACE inhibitors are contraindicated in pregnant women

Answer 99

true (ACEIs are contraindicated during pregnancy because they cause fetal injury and death.)

Question 100

Which do Angiotensin II receptor blockers (ex/losartan, telmisartan) block? a. AT1 receptors b. AT2 receptors c. both d. netiher

Answer 100

a. AT1 receptors

Question 101

Which of the following can cause hyperkalemia? a. Eplerenone b. Spironolactone c. both d. neither

Answer 101

c. both

Question 102

Which of the following is a selective aldosterone receptor antagonist? a. Eplerenone b. Spironolactone c. both d. neither

Answer 102

a. Eplerenone

Question 103

Which of the following reduces K reabsorption? a. Eplerenone b. Spironolactone c. both d. neither

Answer 103

d. neither | (both reduce Na+ reabsorption)

Question 104

Which of the following has less hormonal side effects? a. Eplerenone b. Spironolactone c. both d. neither

Answer 104

a. Eplerenone

Question 105

What is LCZ696? How does it work?

Answer 105

Sacubitril/valsartan, its a combination drug for use in heart failure **Sacubitril**= neprilysin inhibitor→ neprilysin degrades natriuretic peptides and bradykinin. These increase and cause vasodilation + sodium excretion **valsartan**= angiotensin receptor blocker→ prevent stimulation by angiotensin II