Cardiovascular Pharma MCQs (For FCPS Part 1)

Cardiovascular Pharma MCQs (For FCPS Part 1)

 

1. ACE inhibitor acts in CCF by

a. Reducing cardiac out put

b. By decreasing av conduction

c. By decreasing SA and AV conduction

.

Ans. A. Mean arterial pressure = Cardiac output X Total peripheral resistance

.

Angiotensin II increases mean arterial pressure by increasing both:

.

  • Cardiac output (by increasing preload), and
  • Total peripheral resistance

    .

    CARDIAC OUTPUT: Angiotensin II increases cardiac output by increasing:

    .

  • Aldosterone secretion (which absorbs Na+ and water in kidneys)
  • ADH secretion (which absorbs water in kidneys)
  • Thirst (which makes the person to drink water)

    .

    TPR: Angiotensin II increases total peripheral resistance (TPR) by causing vasoconstriction

    .

    ACE inhibitors decrease angiotensin II levels; thus, decreasing cardiac output and TPR. That’s why ACE inhibitors are the strongest antihypertensive drugs as they decrease B.P by multiple mechanisms.

    .

    2. A patient is in the operation room requiring general anaesthesia and has high BP . Which drug should be given to reduce BP.

    a. Glycerine trinitrate

    b. Halothane

    c. Hydralizine

    d. Metoprolol

    e. Nifidipine

.

Ans. C

.

MODERATE TO SEVERE HYPERTENSION: In moderate to severe hypertension, the following drugs are used:

.

  • Hydralazine
  • Minoxidil

    .

    HYPERTENSIVE EMERGENCY: In hypertensive emergency, the following drugs are used:

    .

  • Nitroprusside
  • Fenoldopam
  • Diazoxide

    .

    3. CCF.patient has lung crepitations. Which drug should be given

    a. Furosemide

    b. Hydrochlorthiazide

    c. Corticosteroids

    d. None of above

.

Ans. A

.

  • CCF causes increase in pulmonary pressure → Pulmonary edema → Lungs crepitations
  • Diuretics (e.g., furosemide) promotes fluid loss from the body → Decreased fluid load in the body → Decreased pulmonary pressure → Decreased pulmonary edema

    .

    4. Diqoxin toxicity is increased by :

    a- Hydrochlorothiazide

    b. Hyperkalemia

    c. Ace inhibitors

    d. None of above

.

Ans. A

.

  • Digoxin increases the force of contraction of the heart by increasing intracellular calcium in myocytes.
  • Therefore, any drug (e.g., hydrochlorthiazide) which causes hypercalcemia increases digoxin toxicity.

    .

    5. A pt with acute LVF (left ventricular failure)presents in ER , treatment should commence with:

    a. I/v frusemide

    b. I/v digoxin

    c. Hydrochlorthiazide

.

Ans. A. The best drugs for CCF (congestive cardiac failure) are ACE inhibitors/ARBs, but the first drugs which should be given in acute CCF are diuretics.

.

6. In an Asthamatic female, immediate treatment of hypertension during intraoperative hypertension, is

a. Sublingual glycerine trinitate

b. Intravenous nitroglycerine

c. Propranalol

d. Methyl dopa

.

Ans. B

.

.

7. According to recent recommendations, recurrent Ml should be treated with

a. Anticoagulants

b. Lipid lowering drugs

c. Beta blockers

.

Ans. A. Aspirin is the first line anticoagulant which decreases mortality in case of acute MI. If aspirin is contraindicated, the anticoagulant of second choice is clopidogrel.

.

8. Regarding Nitroglycerine, all are true except

a. Extensive 1st pass effect

b. Venodilator

c. Dec venous return

d. Dec. HR

e. Half life is 3-5 min

.

Ans. D. Nitrogycerine causes vasodilatation → ↓Venous return → ↓Cardiac output → ↓B.P → Baroreceptor reflex → Sympathetic stimulation → Reflex tachycardia (↑Heart rate)

.

9. In hypertrophic obstructive cardiomyopathy which Ca channel blocker is used:

a. Nifedipine

b. Nicardipine

c. Verapamil

d. None of above

.

Ans. C

.

  • Nifedipine acts on blood vessels.
  • Verapamil acts on heart (Ventricles).

    .

    10. Monotherapy for mild CCF:

    a. Digoxin

    b. Captopril

    c. Nifedipine

    d. Propranolol

.

Ans. B. ACE inhibitors/ARB’s (e.g., captopril) are the drugs of choice for CCF.

.

11. Lidocaine MOA (mode of action) is

a. Dec abnormal tissue conduction and no effect on normal tissue

b. Inc. PR interval

c. Dec atrial contraction

d. Dec AV conduction

e. Inc ORS

.

Ans. A

.

12. Class IA antiarrythmic drug among the following is

a. Lidocaine

b. Quinidine

c. Procainide

d. Amiodarone

.

Ans. B

.

13. Lidocaine as antiarrrythmic:

a. Blocks Na channels

b. Beta blocker

c. K channel blocker.

d. None of above

.

Ans. A

.

14. Which of the following is suitable antihypertensive for asthma & IHD patient during surgery:

a. I/V sodium nitroprusside.

b. I/V nitroglycerin.

c. Both a and b

d. Hydralazine

.

Ans. A

.

15. Digoxin is drug of choice in

a. Atrial flutter

b. Atrial Fibrillation

c. Ventricular Tachycardia

d. Bradycardia

.

Ans. B

.

16. Patient after ischemic attack has ventricular tachycardia, drug that must be used is

a. Lidocaine

b. Amiodarone

c. Verapamil

.

Ans. A. Lidocaine is the drug of choice for acute ventricular arrhythmias (especially post-MI).

.

17. Centrally acting antihypertensive is

a. Clonidine

b. Methyldopa.

c. Hydralazine

d. Labetalol

.

Ans. A

.

CLONIDINE

.

  • Clonidine is a centrally acting drug.
  • It causes CNS depression.
  • It is used for:

    .

  • Opoid withdrawl
  • Hypentensive emergency

    .

    18. In a pre eclamptic patient ,which drug is used to lower BP before surgery

    a. Hydralazine

    b. Amlodipine

    c. Nifedipine

    d. Timolol

.

Ans. A. Both hydralazine and methy dopa can be used to lower B.P in pregnancy. Remember that methy dopa (aldomet) is the drug of first choice to lower B.P in pregnancy).

.

19. Pregnancy induced hypertension is treated by

a. Methyldopa

b. Clonidine

c. Hydralizine

.

Ans. A. Methyl dopa (aldomet) is the drug of choice for the treatment of hypertension during pregnancy.

.

20. Lidocaine

a. Increase PR interval

b. Decrease Action potential duration

c. Dec automaticity

d. Decrease pr interval

.

Ans. B

.

21. Which one of the following drugs worsens angina

a. Verapamil

b. Isosorbide dinitrate

c. Propanolol

d. Lisinopril

.

Ans. C

.

22. Which one of the following drugs used in CCF but is not a vasodilator…

a. Verapamil

b. Nifedipine

c. Nimodipine

d. Metoprolol

e. Diltiazem

.

Ans. D. The drugs used in CCF include:

.

  • ACE/inhibitors (Drugs of choice for CCF)
  • Diuretics
  • Beta-blockers (e.g., metoprolol)

    .

    NOTE: Digoxin can also be used but it does not improve mortality rate.

    .

    23. Drug of choice in prinzmetal angina

    a. Isosorbide dinitrate

    b. Nitoglycerine

    c. Diltiazem

.

Ans. C. Prinzmetal angina is due to vasospasm, and calcium channel blockers block Ca++ channels in cardiac + smooth muscles, resulting in vasodilatation.

.

24. A pregnant lady has mitral stenosis. Which drug should be given to prevent atrial fibrillaton

a. Im heparin

b. Iv heparin

c. Heparin and oral anticoagulant

d. Oral anticoagulant

.

Ans. B

.

25. Rationale treatment of essenial HTN

a. Alpha blockers

b. Aldosterone

c. Angiotensin receptor blocker

.

Ans. C. ACE inhibitors/ARBs are the best antihypertensive drugs.

.

26. Drug of choice in acute ventricular failure with resp distress is

a. 1/v frusemide

b. Dopamine

c. Streptokinase

d. Oxygen

.

Ans. A

.

27. At common dose tachycardia is effect of which drug

a. Isosorbide dinitrate

b. Metoprolol

c. Methyl dopa

.

Ans. A. Venodilators (nitroglycerine, isosorbide dinitrate) cause dilatation of veins → Decreased venous return to the heart → Decreased cardiac output → Decreased B.P → Stimulation of sympathetic nervous system (in an attempt of the body to normalize B.P) → Sympathetic nervous sytem increases heart rate → Tachycardia

.

So, venodilators cause reflex tachycardia.

.

28. Which drug is not calcium channel block but given in angina

a. Metoprolol

b. Verapamil

c. Diltiazam

.

Ans. A. The drugs which are given in angina include:

.

(A) VENODILATORS (e.g., nitroglycerine, isosorbide dinitrate), which decrease preload, thus deceasing load and oxygen demand of the heart.

.

(B) CALCIUM CHANNEL BLOCKERS (e.g., verapamil, diltiazem), which causes vasodilatation, thus decreasing afterload and oxygen demand of the heart.

.

(C) BETA BLOCKERS (e.g., metoprolol), which decreases heart rate, and thus decreasing oxygen demand of the heart.

.

29. Diqoxin is contraindicated in:

a. Supraventricular tachycardia

b. Atrial fibrillation

c. Congestive heart failure

d. Hypertrophic obstructive cardiomyopathy

.

Ans. D. Digoxin increases force of contraction of the the heart, resulting in further obstruction.

.

30. Which of the following causes hepatic granuloma

a. Amiodarone

b. Alcohol

c. Cimetidine

d. Metronidazole

.

Ans. A. Amiodarone (which is a class II antiaarythmic drug) causes:

.

  • Hepatotoxicity
  • Pulmonary fibrosis
  • Hypothroidism/hyperthyroidism

    .

    So, if a patent is using amiodarone, remember to check his:

    .

  • LFT’s
  • PFT’s
  • TFT’s

    .

    31. All of the following are useful intravenous therapy for hypertensive emergencies except:

    a. Fenoldopam.

    b. Urapidil.

    c. Enalapril.

    d. Nifedipine.

.

Ans. D

.

32. Diqoxin is not indicated in:

a. Atrial flutter

b. Atrial fibrillation

c. High output failure

d. Paroxysmal supraventricular tachycardia

.

Ans. C. Digoxin increases the force of contraction of the heart, resulting in further increase in cardiac output.

.

33. Hepatic granuloma is caused by which of the following

a. Alcohol

b. Amiodarone

c. Cimetidine

d. Metronidazole

.

Ans. B.

.

34. A pregnant lady has mitral stenosis. To prevent atrial fibrillaton which treatment should be given

a. Im heparin

b. Iv heparin

c. Heparin and oral anticoagulant

d. Oral anticoagulant

.

Ans. B

.

35. A patient presents with acute ventricular failure and respitory distress with crackles. Drug of choice is

a. 1/v frusemide

b. Dopamine

c. Streptokinase

d. Oxygen

.

Ans. A

.

36. A 35 years old african american was found to have BP of 150/100 mm Hg and no secondary cause was found. What

will be the best drug for him to control his blood pressure

a. Lisinopril

b. Losartan

c. Atenolol

d. Nifedipine

e. Hydrochiorothiazide

.

Ans. D. African Americans and elderly patients respond well to calcium channel blockers (e.g., nifedepine)

.

37. Which is not the function of nitroglycerin

a. Decrease afterload

b. Increase venous capacitance

c. Decrease cardiac output

d. Decrease intramyocardial tension

.

Ans. C

.

38. Action of methyl dopa

a. Central action

b. Stimulation of beta-adrenergic

c. Stimulation of adrenergic ending at postganglionic fiber

d. Stimulator of both alpha and beta receptors

.

Ans. A. Centrally acting antihypertensives include:

.

  • Clonidine
  • Methydopa

    .

    39. A 70 year old woman presented with a history of pancreatitis and persistent diarrhoea. She also gave history of osteoporosis and had a deep vein thrombosis. Which one of the following drugs will become less effective after she starts taking Cholestyramine to relieve intolerable itching

    a. Aspirin

    b. Folic Acid

    c. Thiamine

    d. Vitamin D

    e. Warfarin

.

Ans. D. Cholestyramine belongs to “bile acid resins”, which is a group of lipid-lowering drugs; it decreases intestinal absorption of bile acids. As bile acids are involved in absorption of lipids and lipid soluble vitamins (vitamin A, D, E, K), deficiency of bile acids impairs absorption of lipids and lipid soluble vitamins (vitamin A, D, E, K).

.

40. a college friend consults you regarding the suitability of t:-.1e Therapy his doctor has prescribed for severe hypertension. He Complains of postural and exercise hypotension (“dizziness”), Some diarrhea, and problems with ejaculation during sex.which Of the following is most likely to produce the effects that Your friend has described

A. Captopril

B. .guanethidine

C. Hydralazine

D. Prazosin

E. Propranolol

.

Ans. B

.

41. the biochemical mechanism of action of digitalis is associated With

A. A block of sodium/calcium exchange

B. A modification of the actin molecule

C. A shortening of the action potential duration

D. An increase in atp synthesis

E. An increase in systolic intracellular calcium levels

.

Ans. E

.

42. A 45 year old teacher, with acute chest pain, was diagnosed .!-o Be having an attack of angina pectoris. He was prescribed Nitroglycerine tablet to be kept under the tongue. This was Advised because if he swallowed the tablet, nitroglycerine Would be

A. Inactivated in blood after absorption

B. Inactivated in liver during first passage

C. Inactivated in the intestines

D. Inactivated in the stomach

E. Poorly absorbed from g.i.t.

.

Ans. B

.

43. a 55 year old patient of congestine heart failure is receiving Digoxin and hydrochlorothiazide. After about a week of this Treatment, he develops signs and symptoms of digoxin cardir.0 Toxicity. Laboratory investigations reveal that his bloi.id Digoxin level is within safe acceptable level. Digoxin toxicity in Such a situation may have resulted because Hydrochlorothiazide produced

A. Hypercalcemia

B. Hyperlipidernia

C. Hyperur

D. Hypolcalemia

E. Hyponatremia

.

Ans. D

.

44. dopamine (half life 2 minutes) administration is started by Intravenous infusion in a patient in a dose which will produce Therapeutically effective blood levels on reaching steady state concentration. After starting the infusion in this patient, Dopamine actions will begin after;

A 15 minutes

B. 30 minutes

C. 4 minutes

D. 45 minutes

E. 9 minutes

.

Ans. E

.

45. drugs which produce postural hypotension include.

A. Metoclopran-.ide

B. Sucralfate.

C. Propranolol.

D. Misoprostol.

E. Nifedipine.

.

Ans. E

.

46. Nitroglycerine Is not given orally but given sublingually or parenteral, because:

A. It is inactivated in stomach

B. It is inactivated in small intestine

C. Due to its extensive first pass metabolism in Liver

D. It is not absorbed

E. It has short half life

.

Ans. C

.

47- Digoxin Is drug of choice for:

A. A-V nodal arrhythmias

B. Atrial Fibrillation

C. Ventricular Fibrillation

D. Atrial tachycardia

E. Ventricular tachycardia

.

Ans. B

.

48. ALL drugs can be given in partial seizures except:

A. Phenytoin

B. Lamotrigin

C. Carbamazipine

D. Ethosuxarnide

.

Ans. D

.

49. In a patient with diabetes, which is the best antihypertensive drug

A. Captopril

B. Diuretic

C. Verapamil

D. Propranolol

E. Diltiazim

.

Ans. A

.

50. In a patient with Bronchial Asthma, which is the best antihypertensive drug?

A. Verapamit

B. Propranolol

C. ACE inhibitor

D. Minoxidil

E. Hydralazine

.

Ans. A

.

51- Drug of choice for mild heart failure as monotherapy

A. ACE inhibitors

B. Digoxin

C. Thiazide

D. Loop diuretic

.

Ans. A

.

52. Patient uses diuretic drug, he is hypertensive , type 11 diabetic and have bilateral pedal edema. Which diuretic impair in glycemic control.

A. Thiazide diuretics

B. Loop Diuretics

C. Spironcittone

D. Carbonic anhydrase inhibitors

.

Ans. A

.

53. An asthamatic pt which IHD is being operated on OT table. His BP Suddenly shoot6d up. What will be the drug of choice

A. I/V nitroglycerine

B. IN hydratazine

C. I/V nitroprusside

D. I/V beta Mockers

.

Ans. C

.

54. Captopril

A. Can be given in large doses in hypertensive crisis

.

Ans. A

.

55. Andarrythemic action of lidocaine on heart is

A. Prolonged action potential duration

B. Act specifically on foci of necrosed heart

C. Shortens RMP of heart

D. Deep prolonged effective refractory period •

.

Ans. B

.

56. A patient Is given WM injection of Vit 812 after gastrectomy . B12 is given due to failure Of factor released from which cells

A. Mucous cells

B. Chief cells

C. Enterocromaf fin cells

D. Parietal cells

.

Ans. D

.

57. Digoxin toxicity is increased by

A. Hyberkalerma

B. Quinidine

C. Hyperrnagnesenua

D. Hypocalcemia

.

Ans. B

.

58. Vasodilator not causing increase in heart rate useful in treatment of angina:

A. Metaprolot

B. Nitroglycerine

C. Verapamil

D. :so sorbide duntrate

.

Ans. A

.

59. Drug useful in sub arachnoid hemorrhage:

A. Nimodipine

B. Nifedipine

.

Ans. A

.

ANESTHESIA

60. Regarding Nitroglycerine, all are true except

A. Extensive 1st pass effect

B. Venodilator

C. Dec venous return

D. Dec HR

E. T1/2 is 3-5 min

.

Ans. D

.

61. Noxin toxicity

a. Inc K

b. Inc Mg

c. dec. Ca

d. dec Na

e. alkalosis.

Ans. E

.

62. In hypertonic obscarthomyopathy, which Ca•• channel blacker is used

a. Nifeciipine

b. Nicardipine

C. Verapamtl

.

Ans. C

.

63. Monotherapy for mild CCF:

a. digoxin

b. captopril

c. nifedipine

d. propranotal

.

Ans. B

.

64. Class IA antiarrythmic drugs

a. Lidocaine

b. quinidine

c. procainide

d. amiodarone

.

Ans. B

.

65. Liclocalne as antiarrrythmic:

a. blocks Na channels

b. Beta blocker

c. K channel blocker

.

Ans. A

.

.

.

Be nice whenever possible. It is always possible.