Pharm Antianginals
When it comes to your health, with illnesses come treatments, and today we’re going to be looking at a specific kind of drug that comes with a specific kind of condition; antianginals! These are used most commonly for angina pectoris, a problem with the heart. What do you know about them?
- 1.Directions: questions 1-4 Match each antianginal drug with the appropriate description (each lettered option can be selected once, more than once, or not at all): This drug is sometimes used in case of cyanide toxicity
- A.
Amyl nitrite
- B.
Diltiazem
- C.
Isosorbide mononitrate
- D.
Metoprolol
- E.
Nifedipine
- F.
Nicardipine
- G.
Nitroglycerin
- H.
Verapamil
- 2.This drug has no therapeutic effect on variant angina
- A.
Amyl nitrite
- B.
Diltiazem
- C.
Isosorbide mononitrate
- D.
Metoprolol
- E.
Nifedipine
- F.
Nicardipine
- G.
Nitroglycerin
- H.
Verapamil
- 3.Directions: questions 1-4 Match each antianginal drug with the appropriate description (each lettered option can be selected once, more than once, or not at all): This drug has a good transdermal bioavailability
- A.
Amyl nitrite
- B.
Diltiazem
- C.
Isosorbide mononitrate
- D.
Metoprolol
- E.
Nifedipine
- F.
Nicardipine
- G.
Nitroglycerin
- H.
Verapamil
- 4.Directions: questions 1-4 Match each antianginal drug with the appropriate description (each lettered option can be selected once, more than once, or not at all): This drug has high affinity for calcium channels of cerebral vessels
- A.
Amyl nitrite
- B.
Diltiazem
- C.
Isosorbide mononitrate
- D.
Metoprolol
- E.
Nifedipine
- F.
Nicardipine
- G.
Nitroglycerin
- H.
Verapamil
- 5.A 55-y/o woman recently diagnosed with variant angina (Prinzmetal angina) started a treatment with isosorbide mononitrate and diltiazem. Which of the following actions most likely mediated the therapeutic effect of nitrates in the patient’s disease?
- A.
Increased left ventricular end-diastolic volume
- B.
Increased blood flow in large epicardial vessels
- C.
Increased heart rate
- D.
Decreased diastolic perfusion time
- E.
Increased cardiac contractility
- 6.A 59-year-old man recently diagnosed with exertional angina started a treatment with verapamil, one tablet daily. Which of the following cardiac and smooth muscle Ca++ channels is most likely a main site of action of this drug?
- A.
Ligand-gated channels in cell membranes
- B.
Store-operated channels in mitochondria
- C.
Voltage-gated channels in sarcoplasmic reticulum
- D.
Voltage-gated channels in cell membranes
- E.
Ligand-gated channels in sarcoplasmic reticulum
- 7.A 57-year-old man complained of dizziness and palpitations shortly after taking a tablet of his prescribed medication. The man, recently diagnosed with variant angina, started an appropriate therapy four days ago. Which of the following actions most likely caused the patient’s symptoms?
- A.
Coronary vasodilation
- B.
Decreased total peripheral resistance
- C.
Increased venous return to the heart
- D.
Decreased myocardial contractility
- E.
Coronary steal phenomenon
- 8.A 47-year-old man recently diagnosed with exertional angina started a treatment with sublingual nitroglycerin, as needed, and oral isosorbide mononitrate. Which of the following is a potential detrimental effect of nitrates in the prophylactic treatment of exertional angina?
- A.
Decreased ejection time
- B.
Increased cardiac rate
- C.
Increased capacitance of systemic veins
- D.
Decreased arterial pressure
- E.
Increased ventricular end-diastolic volume
- 9.A 58-year-old man complained to his physician of severe chest pain when he walked rapidly, in spite of the therapy he carefully followed for three weeks. The man recently diagnosed with exertional angina , had started a treatment with transdermal nitroglycerin and atenolol. The physician decided to add a third drug and prescribed diltiazem. Which of the following effects was most likely common to all the drugs the patient was taking?
- A.
Decreased cardiac rate
- B.
Increased cardiac contractility
- C.
Decreased arterial pressure
- D.
Decreased left ventricular end-diastolic volume
- E.
Increased ejection time
- 10.A 51-year-old man was admitted to the hospital in acute distress with extreme dyspnea, restlessness and anxiety. The patient had been suffering from chronic heart failure for three years. Vital sings were: blood pressure 115/90 mm Hg, pulse 120 bpm, respiratory rate 22/min. A chest x-ray done immediately showed marked interstitial edema. An appropriate therapy was started which included an IV infusion of nitroglycerin. Which of the following actions most likely mediated the therapeutic effect of the drug in the patient’s disorder?
- A.
Decreased ventricular end diastolic volume
- B.
Reflex increase in heart rate
- C.
Reflex increase in cardiac contractility
- D.
Decreased ventricular ejection time
- E.
Decreased afterload
- F.
Decreased platelet aggregation
- 11.A 48-year-old man was brought to the emergency department because of severe chest pain that apparently had been ongoing for over 3 hours. The man had been suffering from chronic stable exertional angina for one year, and from duodenal ulcer for 3 months. His current medication included isosorbide mononitrate and verapamil for angina, and famotidine for duodenal ulcer. One week ago the patient stopped the antianginal medications, since he had not had anginal attacks during the last month. Which of the following events most likely triggered the patient’s syndrome?
- A.
Worsening of cardiac ischemia due to inadequate therapy
- B.
Famotidine-induced inhibition of verapamil metabolism
- C.
Abrupt withdrawal from nitrate therapy
- D.
Famotidine induced inhibition of isosorbide mononitrate metabolism
- E.
Reflex tachycardia due to nitrate therapy
- 12.A 48-year-old woman come to her physician complaining of episodes of chest pain on exertion during the last two days. Physical examination showed a woman in no apparent distress. Physical signs were: blood pressure 105/60 mm Hg, pulse 85 bpm, respiration 15 breaths/min. Cardiac auscultation revealed a regular rhythm with no abnormal cardiac sounds or murmurs. An ECG was unremarkable. A presumptive diagnosis of exertional angina was made and a therapy with sublingual nitroglycerin and isosorbide mononitrate was ordered. Which of the following adverse effects might most likely occur in this patient?
- A.
Cough and wheezing
- B.
Postural hypotension
- C.
Reflex bradycardia
- D.
Methemoglobinemia
- E.
Diarrhea
- F.
Venous thrombosis
- 13.A 46-year-old man complained to his physician of insomnia, nightmares, fatigue, diminished libido and blanching of the fingers when exposed to cold. The man, recently diagnosed with exertional angina had been taking an antianginal drug for one month. Which of the following drugs most likely caused the patient’s symptoms?
- A.
Propranolol
- B.
Isosorbide mononitrate
- C.
Nitroglycerin
- D.
Nifedipine
- E.
Verapamil
- 14.A 47-year-old man complained to his physician of some mild angina attacks during exertion. The patient, recently diagnosed with exertional angina, had started a therapy with a transdermal nitroglycerin preparation two weeks previously. He carefully applied a new patch every morning immediately after removing the old one. Anginal attacks had disappeared completely during the first week of therapy but were back thereafter. Which of the following phrases best explains the reason of his anginal episodes?
- A.
Vasospastic angina complicating the exertional angina
- B.
Cellular tolerance to nitroglycerin
- C.
Increased metabolism of nitroglycerin
- D.
Insufficient nitroglycerin dosage
- E.
Decreased absorption of nitroglycerin from the skin
- 15.A 54-year-old patient has been recently diagnosed with variant angina. The patient has been suffering from a cerebellar astrocytoma for two years and from a second degree AV block for one year. Which of the following antianginal drugs would be appropriate for this patient?
- A.
Isosorbide mononitrate
- B.
Diltiazem
- C.
Verapamil
- D.
Nifedipine
- E.
Propranolol
- 16.A 55-year-old woman complained to her physician of palpitations, flushing of the face and vertigo. The woman, suffering from diabetes mellitus, was giving herself three daily doses of insulin. She had been recently diagnosed with exertional angina and nitrate therapy was started with transdermal nitroglycerin and oral isosorbide mononitrate. After three weeks of therapy anginal attacks were less frequent but not completely prevented. Which of the following would be an appropriate therapeutic conduct for this patient?
- A.
Reduce the dosage of both nitrates
- B.
Add propranolol
- C.
Add nifedipine
- D.
Stop isosorbide mononitrate
- E.
Add diltiazem
- 17.A 77-year-old woman was brought to the emergency department with an acute myocardial infarction. Six months ago she suffered from a myocardial infarction and began taking propranolol, aspirin and lovastatin. Her current medications also included captopril and hydrochlorothiazide for hypertension. Two days ago she became nauseous and vomited and she stopped taking all her medications. The abrupt withdrawal from which of the following drugs did most likely trigger the recent myocardial infarction?
- A.
Aspirin
- B.
Propranolol
- C.
Lovastatin
- D.
Captopril
- E.
Hydrochlorothiazide
- 18.A 48-year-old man was brought to the emergency department with an acute myocardial infarction. The man was taking sildenafil before intercourse because of an erectile dysfunction. Recently he was diagnosed with exertional angina and an appropriate therapy was prescribed. Which of the following drugs most likely caused the patient’s disease?
- A.
Propranolol
- B.
Diltiazem
- C.
Nitroglycerin
- D.
Nifedipine
- E.
Verapamil
- 19.A 54-year-old man complained to his physician of palpitations, flushing of the face and vertigo. The man had been suffering for gastroesophageal reflux disease for three years. Two week ago he was diagnosed with exertional angina and started the prescribed therapy. Which of the following drugs most likely caused the patient’s symptoms?
- A.
Propranolol
- B.
Verapamil
- C.
Diltiazem
- D.
Nitroglycerin
- E.
Nifedipine
- 20.A 50-year-old woman was admitted to the hospital with a 3 week history of early morning chest pain that caused her to awaken from sleep. The pain lasted 10-15 minutes and frequently radiated to the left arm. An exercise tolerance test failed to elicit precordial pain. A diagnosis of angina was made and she was discharged from the hospital with a prescription of nifedipine. Which of the following actions most likely mediated the therapeutic effect of the drug in the patient’s disease?
- A.
Decreased preload
- B.
Decreased afterload
- C.
Increased myocardial contractility
- D.
Increased heart rate
- E.
Decreased coronary vascular tone
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