Pharmacology Exam - Cardiology 1.

Digitalis glycosides slows the heart rate in patients with systolic dysfunction as a result of all of the following EXCEPT: 1. direct action of digitalis on the AV node to slow conduction 2. indirect effect of enhanced vagal tone on AV node 3. enhanced parasympathetic outflow from the CNS through an indirect mechanism 4. diminished sympathetic tone which is high as a compensatory mechanism in heart failure 5. enhanced responsiveness of the SA and AV node to norepinephrine through an indirect mechanism

due to its ability to: 1. slow the rate of firing of the S-A node 2. exert an atropine-like effect on the A-V node 3. slow conduction through the A-V node 4. decrease the refractory period through the AV node 5. decrease the rate of conduction through atrial muscle

5. When digitalis therapy is initiated, serious cardiac arrhythmias may be caused by a deficiency of: 1. Na+ 2. K+ 3. Cl4. Mg++ 5. 2,4

2. Which of the following drug-mechanism of action pairs is properly matched? 1. digoxin inhibits Na+ K+ ATPase pump 2. dobutamine inhibits troponin I 3. amrinone inhibits troponin I 4. dopamine inhibits troponin I 5. isoproterenol inhibits 1 and 2 receptors

3. The rapid heart rate sometimes seen after nitroglycerin administration is best explained by: 1. a direct positive chronotropic effect on the myocardium 2. reflex sympathetic discharge due to a fall in systemic blood pressure 3. the ability of nitroglycerin to release norepinephrine from sympathetic nerve endings 4. a decrease in intracranial pressure

6. The cardiac glycosides are used in the treatment of congestive heart failure and atrial fibrillation. Given the differences between the cardiac glycosides in their length of action and organs of major excretion, the correct statement concerning the use of digitoxin is: 1. gastrointestinal absorption of digitoxin is incomplete and highly variable within patients 2. digitoxin is excreted primarily unchanged in the kidney with a half life of about 24 hours 3. digitoxin is highly protein bound in the serum 4. digitoxin has a much higher incidence of toxicity in patients with renal disease 5. digitoxin is only available as an oral preparation

4. The effectiveness of digitalis in the treatment of atrial flutter is primarily

7. Digitalis toxicity manifested by premature ventricular contractions maybe treated with all of the following EXCEPT: 1. lidocaine 2. digitalis-specific immune FAB antibody

3. phenytoin 4. quinidine 5. All are correct

2. 7 days 3. 12 days 4. dependent upon the route of administration 5. dependent upon renal function

8. The correct statement regarding digitalis is: 1. in normal individuals, digitalis increases cardiac output 2. in normal individuals, digitalis increases myocardial oxygen consumption 3. in normal individuals, digitalis reduced total peripheral resistance in response to enhanced myocardial contractility 4. in normal individuals, digitalis depresses myocardial contractility 5. in normal individuals, digitalis increases heart rate

12. The maintenance dose of digoxin is primarily dependent upon: 1. renal function 2. sex, hepatic function and protein level 3. pulmonary function 4. the loading dose and the type of diuretic being used 5. level of serum potassium

9. A routine electrocardiogram reveals a borderline delay in PR interval, sagging left ventricular ST segments and a shortened RT interval. The most likely explanation would be: 1. digitalis effect 2. acute sub-endocardial ischemia 3. hypokalemia 4. hypocalcemia 5. myxedema

13. Thiocyanate toxicity is a potential adverse effect associated with: A. amrinone B. nitroglycerin C. milrinone D. nitroprusside 1. A,B,C 2. A,C 3. B,D 4. D only 5. All are correct

10. An uncommon cardiac manifestation of digitalis toxicity is: 1. premature ventricular contractions 2. second and third degree heart block 3. atrio-ventricular junctional escape beats 4. atrial fibrillation with rapid ventricular response 5. All are correct

11. The most widely used digitalis glycosides in the United States are digoxin and digitoxin. The half-life (t1/2) of digitoxin is approximately: 1. 1 day

14. A 42-year-old white male with rheumatic mitral insufficiency is seen with symptoms and findings of initial left ventricular failure. You give him digitalis and recall that all of the following are pharmacologic effects of digitalis EXCEPT: 1. decreases conduction velocity in the A-V node 2. increases the effects of normal vagal activity of the heart 3. shortens the effective refractory period of the Purkinje fibers 4. weakens myocardial contractility 5. prolongs the functional refractory period of the A-V node

15. Orthostatic hypotension is most likely to occur following the use of: 1. phenylephrine 2. reserpine 3. amyl nitrite 4. metaraminol 5. tetrahydrozoline

resulting in a decline in blood pressure. Both end-diastolic and end-systolic dimensions of the left ventricle are reduced; therefore myocardial oxygen needs are decreased primarily by a reduction of: 1. blood pressure 2. heart rate 3. coronary vascular resistance 4. intramyocardial tension 5. sulfhydryl bonds

16. The chemical configuration of a molecule may determine its degree of absorption, its distribution, and its route of metabolism. Structurally, the digitalis glycosides resemble: 1. catecholamines 2. steroids 3. salicylates 4. nitrofurantoin 5. phenothiazines

17. All of the following are actions of nitrates in angina pectoris EXCEPT: 1. reflex increase in heart rate 2. ventricular size decrease 3. ejection fraction increased 4. peripheral venous poolingdecrease in preload 5. systolic blood pressure decrease

18. The sympathomimetic which may promote diuresis by a direct effect on the kidney is: 1. isoproterenol 2. dobutamine 3. norepinephrine 4. dopamine 5. epinephrine

20. Digitalis must be used with caution in patients with acute myocardial infarction. Which of the following is true of digitalis use? A. in normal hearts, it increases contractility and myocardial O2 consumption B. it is recommended in uncomplicated myocardial infarction C. in failing hearts, it decreases or leaves unchanged myocardial O2 consumption D. in acute myocardial infarction, patients are less sensitive to the development of arrhythmias due to digitalis toxicity 1. A only 2. A,B,C 3. A,C 4. B,D 5. D only

19. Nitroglycerin administered sublingually reduces venous tone, causing pooling of blood in peripheral veins and lowers peripheral arterial resistance,

21. Digitalis may slow the heart rate by: 1. blocking the activity of the carotid and aortic arch baroreceptors 2. exerting an atropine-like effect on the A-V node 3. stimulation of vagal center in the medulla to increase efferent firing 4. increasing the rate of conduction through the A-V node 5. None of the above

22. Compared to digitoxin, digoxin is or has: 1. more highly protein-bound 2. more extensive enterohepatic circulation 3. prolonged elimination half-life 4. less completely absorbed orally 5. more extensively hepatically cleared

23. The beneficial effects of digitalis are derived from its effect on myocardial contractility and on myocardial conduction and excitability. In therapeutic doses, digitalis: 1. slows the atrial rate in atrial fibrillation 2. enhances atrioventricular conduction 3. slows the atrial rate in sinus tachycardias 4. slows the ventricular rate in atrial fibrillation 5. decreases ventricular automaticity

myocardium 3. digitalis has proven value in prophylaxis for diastolic dysfunction 4. digitalis causes vasoconstriction in the normal heart secondary to enhanced sympathetic outflow and blocking the Na+-K+ ATPase in smooth muscle 5. digitalis causes an increase in heart rate in the normal heart

24. Digitalis-induced emesis is: 1. only seen when digoxin is given orally 2. of no true clinical importance 3. due to stimulation of the chemoreceptor trigger zone 4. related to Na+ K+ ATPase inhibition within the GI tract 5. commonly seen with rapid parenteral administration

25. Digitalis has a beneficial effect on the failing myocardium via its action to increase the availability of calcium to the contractile machinery. As with many drugs, digitalis has also been overused. The correct statement concerning the use of digitalis in the ischemic and non-ischemic myocardium is: 1. there is a net increase in oxygen consumption in the non-failing myocardium 2. there is a net increase in oxygen consumption in the failing dilated

Correct Answers 1. Item Number: 9623 correct answer: 5 category: Inotropes/Vasodilators 2. Item Number: 11356 correct answer: 1 category: Inotropes/Vasodilators 3. Item Number: 1161 correct answer: 2 category: Inotropes/Vasodilators 4. Item Number: 1158 correct answer: 3 category: Inotropes/Vasodilators 5. Item Number: 3828 correct answer: 5 category: Inotropes/Vasodilators 6. Item Number: 3961 correct answer: 3 category: Inotropes/Vasodilators 7. Item Number: 11384 correct answer: 4 category: Inotropes/Vasodilators 8. Item Number: 11359 correct answer: 2 category: Inotropes/Vasodilators 9. Item Number: 3718 correct answer: 1 category: Inotropes/Vasodilators 10. Item Number: 11367 correct answer: 4 category: Inotropes/Vasodilators 11. Item Number: 4751 correct answer: 2 category: Inotropes/Vasodilators 12. Item Number: 119 correct answer: 1 category: Inotropes/Vasodilators 13. Item Number: 11408 correct answer: 4 category: Inotropes/Vasodilators 14. Item Number: 2722 correct answer: 4 category: Inotropes/Vasodilators 15. Item Number: 1193 correct answer: 3 category: Inotropes/Vasodilators 16. Item Number: 4600 correct answer: 2 category: Inotropes/Vasodilators 17. Item Number: 13697 correct answer: 3 category: Inotropes/Vasodilators 18. Item Number: 11398 correct answer: 4 category: Inotropes/Vasodilators 19. Item Number: 13704 correct answer: 4 category: Inotropes/Vasodilators 20. Item Number: 8090 correct answer: 3 category: Inotropes/Vasodilators 21. Item Number: 1160 correct answer: 3 category: Inotropes/Vasodilators 22. Item Number: 11412 correct answer: 4 category: Inotropes/Vasodilators 23. Item Number: 11390 correct answer: 4 category: Inotropes/Vasodilators 24. Item Number: 4696 correct answer: 3 category: Inotropes/Vasodilators 25. Item Number: 4593 correct answer: 4 category: Inotropes/Vasodilators