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1. A. B. * C. D. E. 2. A. B. C. * D. E. 3. A. B. C. D. * E. 4. A. B. C. D. E. * 5. A. B. * C. D. E. 6. A. B. * C. D. E. 7. A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she does not have any pain. The nurse's response is based on knowledge that codeine also has what effect? Immunostimulant. Antitussive. Expectorant. Immunosuppressant. Antihistamine. Mother, whose child suffered from dry cough that did not let her to sleep at night, consulted a pediatrician. What preparation can’t be used in such case? Libexyn. Tusuprex. Codeine. Bromhexyn. Acetylcistein. An 81-year-old female with arteriosclerotic heart disease and pulmonaryemphysema was found to have significant bronchospasm. Her physician prescribed theophylline 400 mg every 12 hours. All of the following toxicities may be observed EXCEPT: cardiac arrhythmias nausea agitation sodium and water retention vomiting When comparing the relative adrenergic effects of the following drugs, the one which would have the least bronchodilatation effect at normal doses is: terbutaline epinephrine isoproterenol isoetharine norepinephrine. The combination of hydralazine and nitrates has been shown to improve survival in patients of heart failure. All of the following statements about this combination are true except: The combination serves to decrease both afterload and preload. Prazosin is as effective as the combination in treatment of congestive heart failure. The concept of afterload reduction is principally derived from patients of significant mitral regurgitation. The VA cooperative study was a landmark trial demonstrating the beneficial effect of hydralazine and nitrate combination in patients of heart failure. None of the above Exercise-induced ventricular tachycardia in persons without overt cardiac disease is an example of delayed after-depolarizations and is characterized by an increase in intracellular ionized calcium.This type of arrhythmia is known to often respond well to which of the following combinations? Beta-Blocker and ACE inhibitor Calcium channel antagonist and ACE inhibitor Beta-blocker and ACE inhibitor Beta-blocker and calcium channel antagonist Alpa-blocker and calcium channel antagonist Metoprolol would produce which beneficial effect in a patient with secondary angina? A. B. C. D. * E. 8. A. B. C. * D. E. 9. A. * B. C. D. E. 10. A. B. C. D. * E. 11. A. B. C. * D. E. 12. A. B. * C. D. E. 13. A. A decrease in preload An increase in collateral blood flow An increase in afterload An increase in diastolic filling time An increase in blood flow through a concentric stenosis Although most antiarrhythmic drugs (and indeed most drugs) are chemically synthesized, some compounds that occur endogenously in humans are useful. Indicate which of the following agents occurs endogenously and is a useful antiarrhythmic agent. Phenytoin Digoxin Adenosine Quinine Lidocaine A patient comes to your office with effort-induced angina and resting tachycardia.You choose the following drug to treat the patient because it slows heart rate by blocking L-type calcium channels in the SA node: Verapamil Propranolol Nitroglycerin Isosorbide dinitrate Metoprolol Which of the following hemodynamic effects of nitroglycerin are primarily responsible for the beneficial results observed in patients with secondary angina? Reduction in the force of myocardial contraction Reduction in systemic vascular resistance (afterload) Increased heart rate Reduction in venous capacitance (preload) Increased blood flow to the subepicardium A woman is prescribed a combination of drugs consisting of a nitroglycerin patch and a beta-blocker, such as propranolol, to treat her attacks of secondary angina.Which effect of propranolol would counteract an adverse effect of nitroglycerin? A decrease in preload A decrease in afterload A decrease in heart rate An increase in myocardial contractile force A reduction in coronary vasospasm A patient who has been taking propranolol for a long period for secondary angina comes to your office complaining of increased frequency of chest pains on exertion.You decide to stop the propranolol and give him diltiazem because you suspect he has a mixture of secondary and primary angina. Why would diltiazem be more likely to relieve the angina if your new diagnosis is accurate? Diltiazem produces a decrease in heart rate. Diltiazem dilates coronary blood vessels in spasm. Diltiazem produces AV blockade. Diltiazem reduces myocardial contractility. Diltiazem reduces afterload. Which of the following calcium channel blockers would be most likely to suppress atrial tachyarrhythmias involving the A-V node? Nifedipine B. * C. D. E. 14. A. B. C. * D. E. 15. A. * B. C. D. E. 16. A. * B. C. D. E. 17. A. B. C. * D. E. 18. A. B. C. D. E. * 19. A. B. C. Verapamil Nicardipine Amlodipine Nimodipine All of the following statements regarding the pharmacokinetics of calcium channel blockers are correct EXCEPT They are characterized by significant amount (~ 90%) of protein binding. They undergo significant first-pass metabolism. Their half-life is not altered by hepatic cirrhosis. They can be administered orally. All of the above All of the following adverse effects are likely to occur with long-term use of calcium channel blockers EXCEPT Skeletal muscle weakness Flushing Dizziness Headache None of the above A 55-year-old patient has been referred to you. She complains about a skin rash and a cough. In the course of history taking, she tells you that she takes high blood pressure medication but she doesn’t remember the name.You suspect a drug toxicity. Which of the following antihypertensive agents is the patient most likely taking? Captopril Nifedipine Prazosin Propanolol Clonidine Which of the following compounds depends least upon the release of EDRF (nitric oxide) from endothelial cells to cause vasodilation? Bradykinin Histamine Minoxidil Hydralazine Acetylcholine When a patient is treated with a thiazide diuretic for hypertension, all of the following are likely EXCEPT: The fall of blood pressure that occurs in the first 2 weeks of therapy results from a decrease of extracellular volume. The sustained fall in blood pressure that occurs after several weeks of therapy is due to a decrease of intravascular resistance. After the blood pressure is reduced, hypokalemia remains a complication. Hyperuricemia may occur. Hypoglycemia may occur. Furosemide increases the excretion of all of the following EXCEPT: Na+ K+ Ca++ D. E. * 20. A. B. C. * D. E. 21. A. B. * C. D. E. 22. A. B. * C. D. E. 23. A. * B. C. D. E. 24. A. * B. C. D. E. 25. A. * B. C. D. E. 26. Mg++ Uric acid Which of the following drugs is an appropriate initial antihypertensive therapy in an otherwise healthy adult with mild hypertension? Bumetanide Triamterene Hydrochlorothiazide Aldactone Furosemid When furosemide is administered to a patient with pulmonary edema, there is often symptomatic relief within 5 minutes of starting treatment.This relief is primarily due to: A rapid diuretic effect An increase in venous capacitance A direct effect on myocardial contractility Psychological effects All of the above A 60-year-old man with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta adrenegic blockers and calcium channel antagonisst. What is the best treatment for this patient? Aspirin, orally Coronary artery bypass grafting Antihypertensive therapy Intravenous strpetokinase Excercise testing A 5-year-old child had an attack of palpitation with nausea, dizziness, generalized fatigue. On ECG: tachycardia with heartbeat rate of 220/min. Ventricle complexes are deformed and widened. P wave is absent. What medication is to be prescribed to provide first aid? Lydocain Seduxen Novocainamides Strophantin Isoptin A 46-year-old patient has ischemic heart disease, angina on exertion, II functional class. What is the drug of choice in treatment of acute attack? Nitroglycerin sublingually Platelet inhibiting agents (aspirin) Spasmolitics (No-spa) IV Digitalis IV Sedative agents (Seduxenum) orally A 52-year-old patient complains of intensive and prolonged retrosternal pains, decreased exercise tolerance for 5 days. Which of the following groops is the most useful? nitrates dyslipidemic drugs diuretics ACE inhibitors digitalis A 50-year-old patient was admitted to resusitation department with aqute myocardial infarction . Which one of the following drugs is uneffective in this case? A. B. C. * D. E. 27. A. * B. C. D. E. 28. A. * B. C. D. E. 29. A. B. C. D. * E. 30. A. B. C. * D. E. 31. A. B. * C. D. E. 32. A. B. * C. D. E. Proranolol Nitroglycerin Nifedipine Phentanyl Morfin A 54-year-old patient, who suffers from IHD, stable stenocardia II, heart insufficiency I, has an attack of ventricular tachycardia, Ps 180/min, AP – 80/50 mm Hg. Choose a correct treatment: Lidocain, potassium chloride Mezaton, strofantin Verapamil, potassium chloride Digoxin ATP, cordaron A 55-year-old men has stenocardia on exertion II. Taking of nitroglycerin potentiate a sever headache. Which of the following drugs is the most useful in this case? Molsidomin Amiodaron Nifedipine Propranolol Verapamil A 49-year-old patient has ischemic heart disease, angina on exertion, II functional class. What is the drug of choice in treatment of acute attack? No-spa IV Aspirin Digitalis IV Nitroglycerin sublingually Seduxenum orally A patient of 42 year has arterial hypertension with bradyarrhythmia. Which of the following drugs is necessary to administer? Klonidine Bisoprolol Nifedipine Diltiazem Methyldopa A 58-year-old women, who suffers from IHD, stenocardia on exertion II, heart insufficiency I, has an attack of ventricular tachycardia, Ps 180/min, AP – 80/50 mm Hg. Choose a correct treatment: Digoxin, mezaton Lidocain, potassium chloride Verapamil, potassium chloride Digoxin ATP, cordaron A 55-year-old men has stenocardia on exertion II. Taking of nitroglycerin potentiate a sever headache. Which of the following drugs is the most useful in this case? Aspirin Molsidomin Captopril Propranolol Verapamil 33. A. B. * C. D. E. 34. A. * B. C. D. E. 35. A. * B. C. D. E. 36. A. * B. C. D. E. 37. A. B. C. D. E. * 38. A. * B. C. D. E. 39. A. A 6 month old patient who is in the ICU following cardiac surgery for a congenital defect develops atrial flutter with an atrial rate of 300 beats/min and second degreee (2:1) AV node block. A 3rd year medical student inadvertantly administers quinidine, instead of propranolol,and the patient's ventricular rate skyrockets to 300 beats/min. The patient faints. This most likely occured because aquinidine partial beta is: agonist antimuscarinic a sodium channel blocker a potassium channel blocker able to increase vagal tone A 45-year-old women with diagnosis: Paroxysmal arrhythmia. Arterial hypertension II. Drug of choice for stopping attack: Anaprilin Nitroglycerin Potassium chloride Digoxin Lidocain A patient has arterial hypertension with bradyarrhythmia. Which of the following drugs is necessary to administer? Nifedipine Klonidine. Propranolol Diltiazem Methyldopa A patient has bronchial asthma for a long time. Angina pectoris attacks have appeared recently Which of the following drugs is contraindicated? Propranolol Nitroglycerin Nifedipine Lovastatin Aspirin A 64-year-old patient, who suffers from IHD, stable stenocardia II functional class, heart insufficiency I, has an attack of ventricular tachycardia, Ps 180/min, AP – 80/50 mm Hg. Choose a correct treatment: ATP, cordaron Mezaton, strofantin Verapamil, potassium chloride Digoxin Lidocain, potassium chloride A 45-year-old men with diagnosis: Paroxysmal arrhythmia. Arterial hypertension II. Drug of choice for stopping attack: Metoprolol Nitroglycerin Potassium chloride Digoxin Lidocain A patient of 42 year has arterial hypertension with bradyarrhythmia. Which of the following drugs is necessary to administer? Klonidine B. * C. D. E. 40. A. * B. C. D. E. 41. A. B. * C. D. E. 42. A. * B. C. D. E. 43. A. B. C. * D. E. 44. A. B. C. D. * E. 45. A. B. * C. D. E. 46. Nifedipine Bisoprolol Diltiazem Methyldopa A patient has bronchial asthma for a long time. Angina pectoris attacks have appeared recently. Which of the following drugs is contraindicated? Propranolol Molsidomin Nifedipine Carvedilol Aspirin A 65-year-old woman with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta adrenegic blockers and calcium channel antagonists. What is the best treatment for this patient? Intravenous strpetokinase Coronary artery bypass grafting Antihypertensive therapy Aspirin, orally Excercise testing A 49-year-old women with diagnosis: Paroxysmal arrhythmia. Arterial hypertension II, heart insufficiency 0. Introduce drug of choice for stopping attack: Metoprolol Nitroglycerin Potassium chloride Digoxin Lidocain A patient suffers from arterial hypertension with bradyarrhythmia. Which of the following drugs is necessary to administer? Atenolol Furosemid. Nifedipine Diltiazem Methyldopa A patient has chronic obstructive pulmonary desease for a long time. Angina pectoris attacks have appeared recently. Which of the following drugs is contraindicated? Nifedipine Isosorbide dinitrate Lovastatin Propranolol Aspirin A woman 56 years old with hypertension edema develops on lower extremities, moist wheezes in the lower parts of lungs. What must be administered in the complex therapy of the patient? Beta-adrenomimetics, Diuretics, Glucocorticoids, Preparations of calcium, M-cholinolitics. A woman 51 years old has arterial hypertension. Which group of drugs may be used for her treatment? A. B. * C. D. E. 47. A. B. C. D. * E. 48. A. B. C. * D. E. 49. A. B. C. D. E. * 50. A. B. * C. D. E. 51. A. B. C. * D. E. Betaadrenomimetics, Angiotensin-converting enzyme inhibitors, Glucocorticoids, Preparations of calcium, M-cholinolitics. A man 36, years old, has arterial hypertension. Which group of drugs may be used for her treatment? Beta-adrenomimetics Preparations of calcium, Glucocorticoids, Calcium-channel inhibitors, M-cholinolitics. Patients suffering from congestive heart failure will show signs and symptoms of peripheral vasoconstriction, moist skin, pale complextion because of: Na and water retention decreased renin release increased sympathetic tone decreased vagal tone decreased aldosterone levels A 67 year old patient with a history of heart disease presents to the ER with chronic atrial fibrillation, an average ventricular rate of 120-140 beats/min, and an ejection fraction of 35 %. The best drug for controlling his ventricular rate would be: propranolol quinidine nifedipine diltiazem digoxin A 76 year old patient being treated with digoxin, captopril and furosemide for systolic heart failure and hypertension presents to the ER with complaints of dizziness and fatigue. The patient faints immediately after an ECG recording indicates the presence of sinus bradycardia and intermittent 3rd degree AV conduction block. The most likely explanation for this patient's rhythm disturbance is: captopril overdose increased vagal tone caused by digoxin decreased vagal tone caused by furosemide increased sympathetic tone caused by digoxin hyperkalemia caused by furosemide A 59 year old patient with a history of systolic heart failure arrives in the ER with complaints of chest palpitations, nausea and GI upset. His chart indicates that he is currently taking digoxin, captopril, metoprolol and furosemide. A 12 lead ECG is recorded and reveals the presence of frequent runs of ventricular bigeminy. His echocardiogram indicates an ejection fraction of 40%. His blood tests indicate a serum potassium level of 4.0 mM, and an elevated digoxin level of 2.2 ng/ml. The most appropriate drug for treating this patient's arrhythmia would be: propranolol quinidine lidocaine verapamil atropine 52. A. B. C. D. * E. 53. A. B. * C. D. E. 54. A. B. C. D. E. * 55. A. B. C. * D. E. 56. A. B. * C. D. E. 57. A. * B. C. D. E. A patient being treated for heart failure with digoxin and furosemide is discharged from the hospital after being initiated on quinidine therapy to reduce the incidence of atrial tachyarrhythmias. The next day the patient reappears in your office complaining of fatigue, visual difficulties and nausea. The patient's ECG reveals a prolong PR interval, with occasional runs of bigeminy and 2nd degree (Mobitz type I) AV conduction block. The most likely cause of these symptoms is: furosemide induced hyperkalemia an interaction between quinidine and furosemide worsening heart failure an interaction between quinidine and digoxin quinidine toxicity The 56 years old woman with hypertensive disease appealed to the doctor. Methyldopa was prescribed to her. Indicate a mechanism of action of this drug. Violation of noradrenalin synthesis alpha-adrenoreceptors blockers Block of beta-adrenoreceptors Depression of angiotensin converting enzyme activity Increasing of acetylcholine synthesis In the complex medical treatment of hypertensive disease a diuretic was prescribed to the patient. In a few days the BP went down, but the signs of hypokaliaemia arose up. What drug could cause such complication? Triamterene Clofeline С. Enalapril Spironolactone Furosemide The patient has cranial trauma. The brain edema threat developed in the postoperative period. To prescribe drug for the removal of this complication. Spironolactone Papaverini hydrochloride Furosemide Dihlothiazid Diacarb In the patient with the considerable peripheral edema the by turns using of dihlothiazid, ethacrynic acid and furosemide did not result in the considerable diuretic effect. The analysis of blood indicated the considerable increasing of aldosteron level. Prescribe drug for treatment. Mannitol Spironolactone Clopamid Triamterene Amiloride To the 55 years old man for the medical treatment of gout was prescribed etamid. What is the mechanism of uric actions of the drug? Depression of reabsorbing of urinary acid Increasing of secretion of urinary acid Decreasing of production of urinary acid Depression of activity of xantinoxydase Production of easy soluble salts 58. A. * B. C. D. E. 59. A. B. C. D. * E. 60. A. B. * C. D. E. 61. A. B. C. D. E. * 62. A. B. C. * D. E. 63. A. B. C. D. E. * At the 46 years old patient with blink arrhythmia the edema of lungs began. What drug is necessary to inject in the first turn? Furosemide Triamterene Verospirone Amiloride Euphylline To the patient with edema of cardiac origin the doctor must prescribe diuretics. What drugs are contraindicated in this situation? Hypothiazide Spironolactone Furosemide Mannitol Diacarb In the patient with the considerable peripheral edema using of dihlothiazid did not result in the considerable diuretic effect. The analysis of blood indicated the considerable increasing of aldosteron level. Prescribe drug for treatment in this situation. Mannitol Spironolactone Ethacrynic acid Furosemide Diacarb In the complex medical treatment of hypertensive disease a diuretic was prescribed to the patient. In a few days the BP went down, but the signs of hypokaliaemia arose up. What drug could cause such complication? Triamterene Clofeline Enalapril Spironolactone Furosemide Patients suffering from congestive heart failure will show signs and symptoms of peripheral vasoconstriction, moist skin, pale complextion because of: Na and water retention decreased renin release increased sympathetic tone decreased vagal tone decreased aldosterone levels A 67 year old patient with a history of heart disease presents to the ER with chronic atrial fibrillation, an average ventricular rate of 120-140 beats/min, and an ejection fraction of 35%. The best drug for controlling his ventricular rate would be: propranolol verapamil quinidine nifedipine diltiazem digoxin 64. A. B. * C. D. E. 65. A. B. C. D. * E. 66. A. B. * C. D. E. 67. A. B. * C. D. E. 68. A. B. C. D. * E. 69. A 76 year old patient being treated with digoxin, captopril and furosemide for systolic heart failure and hypertension presents to the ER with complaints of dizziness and fatigue. The patient faints immediately after an ECG recording indicates the presence of sinus bradycardia and intermittent 3rd degree AV conduction block. The most likely explanation for this patient's rhythm disturbance is: captopril overdose increased vagal tone caused by digoxin decreased vagal tone caused by furosemide increased sympathetic tone caused by digoxin hyperkalemia caused by furosemide A patient being treated for heart failure with digoxin and furosemide is discharged from the hospital after being initiated on quinidine therapy to reduce the incidence of atrial tachyarrhythmias. The next day the patient reappears in your office complaining of fatigue, visual difficulties and nausea. The patient's ECG reveals a prolong PR interval, with occasional runs of bigeminy and 2nd degree (Mobitz type I) AV conduction block. The most likely cause of these symptoms is: furosemide induced hyperkalemia an interaction between quinidine and furosemide worsening heart failure an interaction between quinidine and digoxin quinidine toxicity An elderly male patient has essential hypertension, congestive heart failure, and type I insulin-dependent diabetes. His congestive failure developed secondary to coronary vascular disease associated with hyperlipidemia. What antihypertensive drug(s) may be most appropriate for this Chlorothiazide (Diuril) patient? captopril (Capoten) propranolol (Inderal) metoprolol (Lopressor) none of the above An elderly male patient has essential hypertension, congestive heart failure, and type I insulin-dependent diabetes. His congestive failure developed secondary to coronary vascular disease associated with hyperlipidemia. What antihypertensive drug(s) may be most appropriate for this chlorothiazide patient? lisinopril propranolol metoprolol all of the above A patient presents with a blood pressure of 160/110 mm Hg. The patient has a history of coronary vascular disease, resulting in angina, but has no evidence of congestive heart failure. The patient also has asthma and has been treated mainly using terbutaline (Brethine), by aerosol inhalation Propranolol (Inderal) was prescribed to manage essential hypertension. Was this action appropriate? Propranolol (Inderal) is appropriate because it will reduce heart rate and cardiac output. Negative inotropism will help reduce the incidence of angina. It is an effective antihypertensive agent Propranolol (Inderal) is inappropriate because it is only useful in mild hypertension; a better drug would be minoxidil or hydralazine because they are more effective in lowering blood pressure Propranolol (Inderal) is appropriate because it is an effective, low-cost antihypertensive. It will augment the effects of terbutaline, an additional benefit Propranolol (Inderal) is inappropriate because its use is contraindicated in a patient with asthma. all of the above The patient with severe allergic bronchial asthma has been treated by oral drug during 7 months. Hypertension, “moon face”, obese trunk, oedema, insomnia occur. What drugs does he used? A. * B. C. D. E. 70. A. * B. C. D. E. 71. A. B. C. D. * E. 72. A. B. C. D. * E. 73. A. B. C. * D. E. 74. A. B. C. * D. E. Patient used one of orally used glucocorticoids, e.g. prednisolonum. Patient used one of beta-agonists. Patient used cromolynum. Patient used euphyllinum Patient used all above. Patient 65 years old suffers from bronchial asthma. Adrenergic receptor activator is used for treatment, After two weeks of management a pain near heart, palpitation. How can these side effects be prevent? It is necessary to prescribe selective beta2-adrenergic receptor stimulator, for example salbutamolum. glucocorticoids. theophylline. anticholinergics cromolyn sodium. An 81-year-old female with arteriosclerotic heart disease and pulmonary emphysema was found to have significant bronchospasm. Her physician prescribed theophylline 400 mg every 12 hours. All of the following toxicities may be observed EXCEPT: cardiac arrhythmias nausea and vomiting agitation sodium and water retention tremulousness A patient complains of severe expiratory dyspnea, paroxysmal dry cough, general asthenia. This condition lasts for 28 hours and is not benefite after usage of salbutamol. Data of examination: the patient is staying and leaning against window-still, diffuse cyanosis add swelling of neck veins are observed, weezes are heard on the distance, by percussion bundbox sound is heard, by auscultation – weakened wesicular breathing, elongated expiration, difuse dry rales. Which medical preparation is the most important for the patient? beta-agonists, beta-blockers; Expectorants: Parenteral administrations of corticosteroids. M-cholinolithics, During auscultation of patient P., 60 years old, with chronic non-obstructive bronchitis, dry buzzling rales above all parts of the lungs were heard as well as weakened vesicular breathing. What medical preparation is it necessary to prescribe to the patient? Diuretics; Antitussive agents; Expectorants; Broncholitics; beta-blockers. A 56-yr-old man wheezes and coughs. He has tried to give up smoking, but he finds it very difficult. He is thin and healthy looking with a rounded chest. His breathing is noisy. His cough is unproductive. What treatment has to be prescribed? Amoxycillin Prednisolone Ipratropium Salbutamol Bronchial lavage