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MCQs framed from High yield areas of Anti-anginal Pharmacology • Mr. Green, 60 years old, has severe chest pain when he attempts to carry parcels up stairs to his apartment. The pain rapidly disappears when he rests. A decision is made to treat him with nitroglycerin. 1. Nitroglycerin, either directly or through reflexes, results in which one of the following effects? (A) Decreased heart rate (B) Decreased venous capacitance (C) Increased afterload (D) Increased cardiac force (E) Increased diastolic intramyocardial fiber tension • Mr. Green, 60 years old, has severe chest pain when he attempts to carry parcels up stairs to his apartment. The pain rapidly disappears when he rests. A decision is made to treat him with nitroglycerin. In advising Mr. Green about the adverse effects he may notice, you point out that nitroglycerin in moderate doses often produces certain symptoms. These toxicities result from all of the following EXCEPT (A) Meningeal vasodilation (B) Reflex tachycardia (C) Increased cardiac force (D) Methemoglobinemia (E) Sympathetic discharge • Mr. Green, 60 years old, has severe chest pain when he attempts to carry parcels up stairs to his apartment. The pain rapidly disappears when he rests. A decision is made to treat him with nitroglycerin . • Two years later, Mr. Green returns complaining that his nitroglycerin works well when he takes it for an acute attack but that he is having frequent attacks now and would like something to prevent them. Useful drugs for the prophylaxis of angina of effort include which one of the following? (A) Amyl nitrite (B) Diltiazem (C) Esmolol (D) Sublingual isosorbide dinitrate (E) Sublingual nitroglycerin • The antianginal effect of propranolol may be attributed to which one of the following? (A) Block of exercise-induced tachycardia (B) Decreased end-diastolic ventricular volume (C) Dilation of constricted coronary vessels (D) Increased cardiac force (E) Increased resting heart rate • The major common determinant of myocardial oxygen consumption is • (A) Blood volume • (B) Cardiac output • (C) Diastolic blood pressure • (D) Heart rate • (E) Myocardial fiber tension • You are considering therapeutic options for a new patient who presents with severe hypertension and angina. In considering adverse effects, you note that an adverse effect which nitroglycerin, guanethidine, and ganglion blockers have in common is • (A) Bradycardia • (B) impaired sexual function • (C) Lupus erythematosus syndrome • (D) Orthostatic hypotension • (E) Throbbing headache • Epidemiologic surveys suggest that, in the past, workers exposed to high levels of organic nitrates in the workplace had (A) A high incidence of methemoglobinemia on the job (B) An increased incidence of angina at work as compared with at home (C) A high incidence of cyanide poisoning in the workplace (D) An increased incidence of headaches on Mondays as compared with other days (E) All of the above • A patient is admitted to the emergency department following a drug overdose. He is noted to have severe tachycardia. He has been receiving therapy for hypertension and angina. A drug that often causes tachycardia is • (A) Diltiazem • (B) Guanethidine • (C) Isosorbide dinitrate • (D) Propranolol • (E) Verapamil • A patient being treated for another condition complains that whenever he takes that medication, his angina becomes worse. Drugs that may precipitate angina when used for other indications include all of the following EXCEPT • (A) Amphetamine • (B) Hydralazine • (C) lsoproterenol • (D) Reserpine • (E) Terbutaline • When nitrates are used in combination with other drugs for the treatment of angina, which of the following result in additive effects on the variable specified? • (A) Beta-blockers and nitrates on end-diastolic cardiac size • (B) Beta-blockers and nitrates on heart rate • (C) Calcium channel blockers and beta-blockers on cardiac force • (D) Calcium channel blockers and nitrates on cardiac force • (E) Calcium channel blockers and nitrates on cardiac rate • Which of the following is approved for the treatment of hemorrhagic stroke? • (A) Amyl nitrite • (B) Hydralazine • (C) Isosorbide mononitrate • (D) Nifedipine • (E) Nimodipine • (F) Nitroglycerin (sublingual) • (G) Nitroglycerin (transdermal) • (H) Propranolol • (I) Terbutaline • (J) Verapamil • Which of the following drugs used for the treatment of angina by inhalation has a very rapid onset and a brief duration of effect (2-5 minutes)? • (A) Amyl nitrite • (B) Hydralazine • (C) [sosorbide mononitrate • (D) Nifedipine • (E) Nimodipine • (F) Nitroglycerin (sublingual) • (G) Nitroglycerin (transdermal) • (H) Propranolol • (I) Terbutaline • (J) Verapamil • Which of the following drugs is capable of maintaining blood levels for 24 hours but with useful therapeutic effects lasting only about 10 hours? • (A) Amyl nitrite • (B) Hydralazine • (C) Isosorbide mononitrate • (D) Nifedipine • (E) Nimodipine • (F) Nitroglycerin (sublingual) • (G) Nitroglycerin (transdermal) • (H) Propranolol • (I) Terbutaline • (J) Verapamil • Which of the following is a vasodilator drug used for hypertension that lacks a direct effect on autonomic receptors but may provoke anginal attacks? • (A) Amyl nitrite • (B) Hydralazine • (C) Isosorbide mononitrate • (D) Nifedipine • (E) Nimodipine • (F) Nitroglycerin (sublingual) • (G) Nitroglycerin (transdermal) • (H) Propranolol • (I) Terbutaline • (J) Verapamil • Your patient has been experiencing chest pain on exertion. One of his friends told him that he has been taking a drug for hypertension and that it is very effective in lowering blood pressure. The friend suggests that your patient try some of the drug: "It won't hurt anything and it may save the expense of a doctor's visit." He tries the agent and experiences severe chest pain, worse than before. The explanation of this phenomenon may be • (A) "coronary steal" occurred • (B) a nitrate arteriolar dilator should have been used • (C) reflex vasoconstriction occurred • (D) the drug suppressed the heart • (E) venous dilation occurred • Erectile dysfunction has been treated by numerous agents over the centuries. The effectiveness of these agents depends on intact parasympathetic innervation and • (A) a bladder or urethral irritant (Spanish fly) • (B) a reduction in the levels of cyclic guanosine monophosphate (cGMP) • (C) an alpha2 antagonist to relax nonvascular smooth muscle in the penis • (D) an inhibitor of phosphodiesterase isoform 5 • (E) blockade of prostaglandin El (PGEl) • A 49-year-old man is suffering from hypertension, and he has a history of atrial tachycardia. In selecting a calcium channel blocker to manage the tachycardia, the most appropriate agent would be • (A) amlodipine • (B) isradipine • (C) nifedipine • (D) propranolol • (E) verapamil • (Answer:E) Due to the fact that it is more selective for the heart, the most appropriate agent would be verapamil. • A 55-year-old woman presents with angina pectoris and she is placed on a beta-adrenergic blocking agent. The rationale for the use of a beta blocker is • (A) that an increase in end-diastolic volume will increase contractile force development • (B) production of a decrease in heart rate, blood pressure, and contractility • (C) production of an increase in myocardial oxygen demand • (D) production of coronary artery vasodilation • (E) redistribution of coronary blood flow to ischemic areas • A 46-year-old man who is overweight and in a highpressure executive position has been treated with a beta-adrenergic blocking agent (propranolol) for episodes of angina pectoris. The diagnosis is angina of effort. Lately, the effectiveness of propranolol has been less than desired, and he is also complaining that he feels tired. The most appropriate approach to therapy would be to • (A) add metoprolol to the regimen • (B) add nifedipine to the regimen • (C) advise him to quit his job and find another profession • (D) increase the dose of propranolol • (E) revise the therapy to combine a beta blocker, a calcium channel blocker, and a nitrate