Mcqs on cardiovascular pharmacology with keys and explanation

1,Relationship between arterial blood pressure (BP), cardiac output (CO) and peripheral vascular resistance (PVR) can be described as

(a) BP = COxPVR (b) BP = CO/PVR

(c) BP = PVR/CO (d) None of the above

2. If a fibrinolytic drug is used for treatment of acute myocardial infarction, the adverse drug effect that is most likely to occur is

(a) Acute renal failure

(b) Development of antiplatelet antibodies

(c) Encephalitis secondary to liver dysfunction

(d) Hemorrhagic stroke

(e) Neutropenia

3. Increased serum levels of which of the following may be associated with a decreased risk of atherosclerosis?

(a) Very low-density lipoproteins (VLDL)

(b) Low-density lipoproteins (LDL)

(c) Intermediate – density lipoproteins (IDL)

(d) High-density lipoproteins (HDL)

(e) Cholesterol

4. If the patient has a history of gout, which of the following drugs is most likely to exacerbate this condition?

(a) Colestipol

(b) Gemfibrozil

(c) Lovastatin

(d) Niacin

(e) Simvastatin

5. After being counseled about lifestyle and dietary changes, the patient was started on atorvastatin. During his treatment with atorvastatin, it is important to routinely monitor serum concentrations of

(a) Blood urea nitrogen (BUN)

(b) Alanine and aspartate aminotransferase

(c) Platelets

(d) Red blood cells

(e) Uric acid

6. Six months after beginning atorvastatin, the patient’s total and LDL cholesterol concentrations remained above normal and he continued to have anginal attacks despite good adherence to his antianginal medications. His physician decided for niacin. The major recognized mechanism of action of niacin is

(a) Decreased lipid synthesis in adipose tissue

(b) Decreased oxidation of lipids in endothelial

cells

(c) Decreased secretion of VLDL by the liver

(d) Increased endocytosis of HDL by the liver

(e) Increased lipid hydrolysis by lipoprotein

lipase

 

7. Following drugs act on imidazoline receptor

(a) Moxonidine

 (b) Dexmedetomidine

(c) Tizanidine

(d) All of the above

8. Which one of the following drugs increase digoxin plasma concentration by a pharmacokinetic mechanism?

(a) Captopril (b) Hydrochorothiazide

(c) Lidocaine (d) Quinidine

(e) Sulfasalazine

9. A 55-year-old patient currently receiving other drugs for another condition is to be started on diuretic therapy for mild heart failure. Thiazides are known to reduce the excretion of

(a) Diazepam (b) Fluoxetine

(c) Imipramine (d) Lithium

(e) Potassium

10. A hypertensive patient has been using nifedipine for some time without unto- ward effects. If he experiences a rapidly developing enhancement of the antihyper-

tensive effect of the drug, it is probably due to

(a) Concomitant use of antacids

(b) Fods containing tyramine

(c) Grapefruit juice

(d) Induction of drug metabolism

(e) Over – the – counter decongestants

11. A drug lacking vasodilator properties that is useful in angina is

(a) Isosorbide dinitrate

(b) Metoprolol

(c) NIfedipine

(d) Nitroglycerin

(e) Verapamil

12. Aldosterone release is stimulated by

(a) Angiotensin I (b) Angiotensin

(c) Angiotensin III (d) Both (b) and (c)

13. Which one of the following drugs is used in the treatment of male impotence and activates prostaglandin E1 receptors?

(a) Alprostadil

(b) Fluoxetine

(c) Mifepristone

 (d) Sildenafil

(e) Zafirlukast

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14. A treatment of angina that consistently decreases the heart rate and can prevent vasospastic angina attacks is

(a) Isosorbide dinitrate

(b) NIFedipine

(c) Nitroglycerin

(d) Propranolol

(e) Verapamil

15. In a patient receiving digoxin for congestive heart failure, condition that may facilitate the appearance of toxicity include

(a) Hyperkalemia

 (b) Hypernatremia

(c) Hypocalcemia

 (d) Hypomagnesemia

(e) All of the above

16. Activation of endothelin receptor ETA, leads to

(a) Vasoconstriction

(b) Bronchoconstriction

(c) Aldosterone release

(d) All of the above

17. Methylxanthine drugs such as aminophyl- line cause which one of the following?

(a) Vasoconstriction in many vascular beds

(b) Decrease in the amount of cAMP in mast cells

(c) Bronchodilation

(d) Activation of the enzyme phosphodiesterase

(e) Sedation

18. Drugs used in asthma that often cause tachycardia and tremor include

(a) Beclomethasone

(b) Cromolyn sodium

(c) Ipratropium

 (d) Metaproterenol

(e) All of the above

19. Following potassium sparing diuretic inhibits action of aldosterone

(a) Amiloride

(b) Triamterene

(c) Spironolactone

(d) All of the above

20. In patients with chronic granulomatousdisease which of the following agentsincreases the synthesis of tumor necrosisfactor, leading to activation of phagocy-tosis?

(a) Aldesleukin

 (b) Cyclosporine

(c) Filgrastim

 (d) Infliximab

(e) Interferon gamma

21. The mechanism of action of cyclosporine involves

(a) Activation of calcineurin

(b) Binding to cyclophilin to cause inhibition of

a cytoplasmic phosphatase

(c) Blockade of interleukin – 2- receptors

(d) Inhibition of phospholipase A2

(e) Suppression of bone marrow progenitors

22. Which one of the following drugs predictably prolongs the PR interval and increases cardiac contractility?

(a) Digoxin

 (b) Lidocaine

(c) Propranolol

 (d) Quinidine

(e) Verapamil

23. Which of the following is the drug of choice for management of cardiac arrhythmias that occur in digitalis toxicity?

(a) Amiodarone

 (b) Lidocaine

(c) Propranolol

(d) Sotalol

(e) Prazosin

24. A 54-year-old woman with severe hypercholesterolemia is to be treated with a combination of niacin and atorvastatin. With this drug combination, it is important that the patient be monitored closely for signs of

(a) Agranulocytosis

 (b) Gallstones

(c) Lactic acidosis

(d) Myopathy

(e) Thyrotoxicosis

25. Regarding verapamil, which one of the following statements is false?

(a) Angina pectoris is an important indication

for the use of verapamil

(b) Contraindicated in the asthmatic patient

(c) Relaxes vascular smooth muscle

(d) Slows the depolarization phase of the action potential in AV nodal cells

(e) Used in management of supraventricular tachycardias

26. What drug is used to prevent embolism in the lung and during myocardial infarction?

(a) Alteplase

(b) Human growth hormone

(c) Granulocyte–macrophage colony – stimulating

factor (GM–CSF)

(d) EPOGEN (EPO)

(e) None of the above

27. Which of the following cardiovascularagents is classified chemically as a gly-coside?

(a) Nifedipine

(b) Digoxin

(c) Flecainide

(d) Cholestyramine

(e) Warfarin

28. Inhibition of carbonic anhydrase results in

(a) Abolition of NaHCO3 reabsorption in proximal tubule

(b) Enhanced of NaHCO3 reabsorption in proximal tubule

(c) Enhanced NAHCO3 secretion in distal tubule

(d) None of the above

29. Which of the following cyclotron produced radiopharmaceuticals is used for assessing regional myocardial perfusion as part ofan exercise stress test?

(a) Thallous chloride 201TI USP

(b) Sodium iodide 123I

(c) Gallium citrate 67Ga USP

(d) Indium 111In pentetate

(e) Cobalt 57Co cyanocobalamin

>30. Mary has a family history of heart disease and wonders if garlic would be beneficial to her. Which of the following statements is correct about garlic?

(a) Enteric-coated tablets release their contents in the stomach

(b) Side effects include heartburn, flatulence, and sweating

(c) The safety of garlic in pregnancy is unknown

(d) Garlic does not interact with warfarin

31. Exertion– induced angina, which is relieved by rest, nitroglycerin, or both, is referred to as

(a) Prinzmetal’s angina

(b) Unstable angina

(c) Classic angina

(d) Variant angina

(e) Preinfarction angina

32. Myocardial oxygen demand is increased by all of the following factors except

(a) Exercise

(b) Smoking

(c) Cold temperatures

(d) Isoproterenol

(e) Propranolol

33. Which of the following agents used in prinzmetal’s angina has spasmolytic actions, which increase coronary blood supply?

(a) Nitroglycerin

(b) Nifedipine

(c) Timolol

(d) Isosorbide mononitrate

(e) Propranolol

34. The oral absorption of following osmotic diuretic is negligible

(a) Glycerin

(b) Mannitol

(c) Isosorbide

 (d) All of the above

35. Maximal medical therapy for treating angina pectoris is represented by which of the following choices?

(a) Diltiazem, verapamil, nitroglycerin

(b) Atenolol, isoproterenol, diltiazem

(c) Verapamil, nifedipine, propranolol

(d) Isosorbide, atenolol, diltiazem

(e) Nitroglycerin, isosorbide, atenolol

36. The term ischemic heart disease (IHD) is used to designate all of the following conditions except

(a) Angina pectoris

(b) Sudden cardiac death

(c) Congestive heart failur (CHF)

(d) Arrhythmias

37. Which of the following thrombolytic agents would be appropriate at this time?

(a) Anisoylated plasminogen streptokinase activator complex (APSAC)

(b) Streptokinase (SK)

(c) Recombinant tissue-type plasminogen activator (t-PA)

38. Strong anticholinergic effects limit the antiarrhythmic use of

(a) Quinidine

(b) Procainamide

(c) Tocainide

 (d) Flecainide

(e) Disopyramide

39. Following loop diuretic is a phynoxy acetic acid derivative

(a) Furosemide

 (b) Bumetanide

(c) Ethacrynic acid

(d) All of the above

40. Following potassium sparing diuretic is a mineralocorticoid receptor antagonist

(a) Amiloride

 (b) Triamterene

(c) Spironolactone

(d) All of the above

41. A patient receiving a class I antiarrhyth-mic agent on a chronic basis complains of fatigue, low-grade fever, and joint pain suggestive of systemic lupus erythe-

matosus (SLE). The patient is most likely receiving

(a) Lidocaine

 (b) Procainamide

(c) Quinidine

 (d) Flecainide

(e) Propranolol

42. Which of the following drugs is a class IV antiarrhythmic that is primarily indicated for the treatment of supraventricular tachyarrhythmias?

(a) Lbutilide

 (b) Mexiletine

(c) Diltiazem

(d) Quinidine

(e) Propranolol

43. Which of the following agents has a direct effect on the AV mode, delaying calcium- channel depolarization?

(a) Lidocaine

(b) Diltiazem

(c) Bretylium

 (d) Quinidine

(e) Lbutilide

44. Which of the following drugs is a class III CARDIO–VASCULAR DRUGS 125 antiarrhythmic agent that is effective in the acute management of atrial fibrilla- tion or atrial flutter of recent onset ?

(a) Bretylium

 (b) Lbutilide

(c) Metoprolol

 (d) Disopyramide

>45. Which of the following groups of symptoms is most often associated with a patient who has right-sided heart failure?

(a) Nocturia, rales, paroxysmal nocturnal dyspnea

(b) Paroxysmal nocturnal dyspnea, pedal edema,

jugular venous distention, hepatojugular reflux

(c) Jugular venous distention, hepatojugular

reflux, pedal edema, shortness of breath

(d) Hepatojugular reflux, jugular venous

distension, pedal edema, abdominal

distention

(e) Paroxysmal nocturnal dyspnea, jugular

venous distention, abdominal distention,

shortness of breath

46. Which of the following combinations of drugs, when used together, reduce both preload and afterload?

(a) Nitroglycerin and isosorbide dinitrate

(b) Hydralazine and isosorbide dinitrate

(c) Captopril and methyldopa

(d) Prazosin and angiotension II

(e) Hydralazine and methyldopa

47. When digoxin is used in a patient with congestive heart failure (CHF), it works by exerting a positive effect on

(a) Stroke volume

(b) Total peripheral resistance

(c) Heart rate

(d) Blood pressure

(e) Venous return

48. Because of proven beneficial effects on “cardiac remodeling”, these agents are now indicated as first line therapy in CHF patients. Which of the following is representative of this group of drugs?

(a) Hydrochlorothiazide

(b) Enalapril

(c) Furosemide

(d) Carvedilol

(e) Bumetanide

>49. For treating the patient with congestive heart failure (CHF), which of the following dosages of dopamine is selected for its

positive inotropic effects?

(a) 2.0 mg/kg/min

(b) 5–10 mg/kg/min

(c) 10–20 mg/kg/min

(d) 40 mg/kg/min

(e) 40 mg/kg/min

50. Milrinone is an example of

(a) Phosphodiesterase I inhibitor

(b) Phosphodiesterase II inhibitor

(c) Phosphodiesterase III inhibitor

(d) Phosphodiesterase IV inhibitor

#Answer keys of the above MCQS

1. a 

2. d

 3. d

 4. d 

5. d

 6. c

7. a 

8. d 

9. d 

10. c

11. b 

12. d

13. a 

14. e

15. d

16. d

17. c 

18. d

19. c 

20. e

21. b

22. a 

23. b

24. d

25. b 

26. a 

27. b 

28. a 

29. a 

30. b

31. c 

32. e 

33. b 

34. b

35. d 

36. c

37. c

 38. e 

39. c 

40. c 

41. b

 42. c

43. b 

44. b

45. d

46.b 

47.a 

48. b

49. b 

50. c

Explanation of some Mcqs

1. a Arterial blood pressure is directly proportional to the blood flow, i.e., cardiac output and peripheral vascular resistance. This relationship is correctly represented by equation in ‘A’

7. d Moxonidine acts mainly on imidazline I1 receptors and produces antihypertensive effect. Dexmedetomidine is a α2-adrenergic receptor agonist. Tizanidine is a spasmolytic agent.

12. d Both angiotensin II and III promote aldosterone release. Aldosterone promotes the reabsorption of sodium by distal renal tubules and this may increase the plasma volume and hypertension. Angiotensin I is inactive.

16. d Activation of ETA receptors leads to vasocon-striction, bronchoconstriction and stimulation of aldosterone release. Affinity of various endothelins for ETA receptor is ET1 = ET2 > ET3.

19. c Spironolactone binds with cytoplasmic mineralocorticoid receptors. It also decreases the interacellular formation of active metabolites of aldosterone. Triamterene and amiloride directly interfere with sodium entry.

28. a Carbonic anhydrase inhibitors inhibit both the membrane and cytoplasmic forms of carbonic anhydrase and thus completely inhibit reabsorption of sodium bicarbonate in the proximal tuble.

34. b Both glycerin and isosorbide are orally active osmotic diuretics and hence show good oral absorption. Mannitol shows negligible absorption.

39. c Ethacrynic acid is a phenoxy acetic acid derivative. Furosemide and bumetanide contain sulfonamide moiety in their structure.

40. c Spironolactone is an aldosterone antagonist. Aldosterone is a mineralocorticoid and miner- alcorticoid receptors are present in epithelial  cells of late distal tubule and collecting duct.

50. c Milrinone is an inhibitor of phosphodiesterase III and it produces positive inotropism via inhibition of cGMP. Examples of inhibitors of

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