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. 
B. 
C. 
D. 
E. 
F. 
G. 
H. 
2.
This drug has no therapeutic effect on variant angina
A. 
B. 
C. 
D. 
E. 
F. 
G. 
H. 
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. 
B. 
C. 
D. 
E. 
F. 
G. 
H. 
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. 
B. 
C. 
D. 
E. 
F. 
G. 
H. 
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. 
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. 
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. 
B. 
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. 
B. 
Increased cardiac contractility
C. 
Decreased arterial pressure
D. 
Decreased left ventricular end-diastolic volume
E. 
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. 
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. 
B. 
C. 
D. 
E. 
F. 
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. 
B. 
C. 
D. 
E. 
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. 
B. 
C. 
D. 
E. 
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. 
C. 
D. 
Stop isosorbide mononitrate
E. 
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. 
B. 
C. 
D. 
E. 
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. 
B. 
C. 
D. 
E. 
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. 
B. 
C. 
D. 
E. 
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. 
B. 
C. 
Increased myocardial contractility
D. 
E. 
Decreased coronary vascular tone