Adenosine triphosphate d. Cyclic guanosine monophosphate e. Adenosine diphosphate In which of the following clincal conditions are the agonists of the alpha-1 adrenoceptors found to be useful?
Nasal congestion II. Hypotension III. Sympomatic bradycardia a. Vasodilation II. Inhibition of catecholamine release III. Vasoconstriction a. These effects can be attributed to: a. Alpha-1 stimulation b. Alpha-2 stimulation c.
Beta-1 inhibition d. Beta-1 stimulation e. Beta-2 stimulation What is the dominant adrenergic receptor in the heart? Dopamine-1 b.
Alpha-2 d. Beta-1 e. Initial transient increase in blood pressure II. Lowering of the blood pressure a. Phenylphrine b. Reserpine c. Guanethidine d. Methyldopa e. Amlodipine Epinephrine is considered as the first line for the management of anaphylaxis and anaphylactic shock.
Inhibition of Histamine release by beta-2 receptor activation II. Alpha-1 activation leading to vasoconstriction III. Beta-2 activation leading to bronchodilation a. I, II, and III The activity of this drug is attributed to its metabolite which is a false neurotransmitter at the central nervous system a. Guanethidine b. Methyldopa c. Propanolol d.
Labetalol e. Phenylpropanolamine Which of the following inotropic agents is most useful for paatient with acute heart failure complicated by acute reduction in creatinine clearance? Epinephrine b. Dopamine d. Dobutamine e. Digitalis In the adrenal medulla, norepinephrine is converted to epinephrine by the action of which enzyme?
Tyrosine hydroxylase c. Cathecol nethyl transferase d. Monoamine oxidase e. Phenylethylamine N-methyl transferase As an inotropic agent, Norepinephrine Levophed has been shown in some small clinical trials to be most useful in which of the following conditions?
Cardiogenic shock b. Septic shock c. Acute renal failure d. Acute myocarditis e. Is current clinical use is in the management of hypertension in pregnancy It is associated with warm antibody type of immunohemolytic anemia Toxic doses are associated with hepatotoxicity a. I andII c. In the management of premature labor II.
As part of the interventions employed for hyperkalemia III. Management of bronchial asthma a. Propanolol b. Mathoxamine c. Isoxsuphrine d. Prazosin e. Escalating dose, staring at 1mg then increasing by 1mg every minutes d. Bronchodilator fo intermittent bronchial asthma b. Local vasoconstrictor c. Anti-arrythmic for supraventricular tachycardia d. Tocolytic agent for premature labor e.
Inotropic for cardiogenic shock A dominant alpha-1 agonist effect is expected when Epinephrine is given as an IV infusion at what doses? Dobutamine Norepinephrine a. Muscarinic-1 b. Nicotinic-N c. Presynaptic alpha-2 d. Postsynaptic alpha-2 e. Subcutaneously given as management of recalcitrant acute exacerbations of bronchial asthma II.
To increase heart rate in symptomatic bradycardia III. Adjunct treatment of malignant hypertension a. Dobutammine b. Ritodrine c. Yohimbine d. Phenoxybenzamine e. Oxymetazoline A new drug is currently being developed whose mechanism of action is stimulation of the beta-3 receptors. In which condition will this drug have most likely usefulness?
Obesity b. Bronchial asthma c. Hypertension d. Shock e. Acute renal failure A patient complains of muscle weakness after several doses of Salbutamol nebulization. Hypokalemia induced by Salbutamol therapy b. Hypocalcemia induced by Salbutamol therapy c.
Metabolic alkalosis due to bronchial asthma d. Respiratory alkalosis due to bronchial asthma Which of the following beta-blockers also has peripheral vasodilating effect similar to Prasozin?
Betaxolol c. Nadolol d. Bisoprolol e. Which of the following beta-blockers is considered cardio selective? Labetalol b. Esmolol e. Timolol Rebound tachycardia and hypertension are expected complications of abrupt withdrawal of betablocker therapy.
Which of the followingagents has the least likelihood of causing rebound effects when withdrawn? Propanolol c. Pindolol d. Metropolol e. Metoprolol b. Esmolol c. Atenolol d. Pindolol Carvedilol II. Bisoprolol III. Metoprolol a. In which of the following conditions are beta-blockers found to be useful? Hypothyroidism II.
Initial therapy in Pheochromocytoma a. Among diabetic patients using insulin or oral hypoglycemic agents OHAs why are beta-blockers are used with special caution if not totally avoided? Beta-blockers can induce hyperglycemia b. Beta-blockers can mask hypoglemic symptoms c. Beta-blockers can attenuate effect of insulin and OHAs d. Beta-blockers can induce insulin or OHA failure e. Beta-blockers can increase the risk of renal failure Patients with peripheral vascular disease especially vasospastic type III.
Patients with recent myocardial infarction a. She is now admitted at the ICU for dizziness and two episodes of syncope. What course of action would you suggest? Continue her medication and suggest for a lead ECG b. Stop Metoprolol and request for a lead ECG c. Stop Diltiazem and request for a lead ECG d. Stop indapamide and Diltiazem and request for a lead ECG as well as serum potassium measurement e. Methylphenidate and Dextroamphetamine are centrally acting sympathomimetics which have found use in which of the following conditions?
Manic-depression b. Alcohol withdrawal c. Attention deficit hyperactivity disorder d. Generalized anxiety disorder e. Hypotensive epidoses Which of the following effects is are consistent with direct stimulationof the muscarinic receptors? Peripheral vasodilation II. Relaxation of the ciliary muscles III. Negative dromotropic effect a. The effect of muscarinic receptor activation in tissues like the exocrine glands and the extravascular smooth muscles have been linked with the generation of which second messenger molecule?
ATP e. Adenosine What is thw physiologic event that follows stimulation of the NM type cholinergic receptors? Opening of inward chloride channels b. Opening of outward potassium channels c.
Opening of inward sodium channels d. Opening of the outward calcium channels e. Opening of the outwad sodium channels Bethanecol is clinically used for which of the following conditions? Urinary retention in neurogenic bladder b.
Intestinal obstruction c. Chronic glaucoma d. Supraventicular tachycardia e. Congestive heart failure Reverse the effect of neuromuscular blockers after surgery II. Treatment of overdose of atropine III. Management of organophosphate poisoning a. Ambenonium, neostigmine, and pyridostigmine are most commonly used for which condition? Atropine overdose b. Myasthenia gravis c. Bronchial asthma d. COPD e. ADHD Tacrine, Donepezil, Rivastigmine and Galantamine are indicated for which of the following condition?
Supraventricular tachycardia b. Curare-induced muscle paralysis c. Accomodative esotropia d. Glaucoma Which of the following agents maybe used for the management of glaucoma? Piocarpine-Physostigmine combination therapy II. Ecothiophate III. Demecarium a. Constipation Mydriasis Peeripheral vasodilation Emesis Decreased sweating Which of the following effects can be attributed to atropine?
Ciliary muscle contraction II. Contraction of the papillary constrictor muscles III. Blockade of vagal slowing of the heart a. In comparison to other aantimuscarinic agents, Scopolamineis expected to exert significant CNS effects due to: a.
Its being a tertiary amine b. Its being a quarternary amine c. The presence of a benzene ring structure d. The tropic acid structureits isomeric structure Ipratropium, Oxytropium, and Tiotropium and antimuscarinic agents that are most useful as a. Mydriatics b. Cycloplegic agents c. Relaxants of bronchial smooth muscles d. Inhibitors of involuntary muscle contractions e. Inhibitors of bronchial gland secretions Oxynutinin, Dicyclomine, and Glycopyrrolate are clinically useful for which of the following conditions?
Cholinomimetic agent overdose b. Gastrointestinal hypermotility and urinary incontinence c. Angina due to coronary artery vasospasm d. Motion sickness and Parkinsonism e.
COPD and bronchial asthma In most patients admitted to atropine overdose, most poison control experts recommend which of the following measures as primary management? Temperature control with cooling blankets II. Physostigmine as initial therapy III. Diazepam for seizure control a. Poisoning resulting from ingestion of high dose quarternary antimuscarinic agents can be best managed with which of th following agents? Physostigmine b. Atropine e. Scopolamine History of prostatic hyperplasia II.
Glaucoma III. Hypertension a. Trimethaphan is expected to produce which of the following effects? Excessive sweating b. Pupillary constriction c. Diarrhea d. Urinary incontinence e. Hypotension What is the mechanism of skeletal muscle paralysis produces by Succinylcholine? Competitively inhibits binding of acetylcholine to the NM receptors b.
Increased inward chloride conductance leading to hyperpolarization of the neuromuscular endplate membrane c. Sustained depolarization of the motor end plate making it unesponsive to other impulses upon repolarization cannot easily depolarized d. Repeated short depolarizations of the motor end plate leading to prolonged state of sodium channel inactivation e. Irreversible and non-competitive inhibition of the NM receptors in both the ganglia and motor end plate with attenuation of depolarizing impulses Which of the following findings is consistent with the skeletal muscle relaxant effect of Pancuronium and Rocuronium?
Effect is enhanced with administration of succinylcholine b. Effect is reduced with co-administration of tubocurarine c. Initially cause depolarization of the motor end plate leading to fassiculations d. Effect is antagonized by Neostigmine e. Sustained response to tetanic stimulation Which of the following inhilational anesthetics produces greatest augmentation of the effect of neuromuscular blockers?
Isoflurane b. Sevoflurane c. Halothane d. Desflurane e. Nitrous oxide Anaphylactoid reaction may be seen as a side effect with which of the following neuromuscular blockers? Pancuronium b. Vecuronium c. Gallamine d. Tubocurarine e. Which of the following statements correctly describes the side effects of succinylcholine?
Negative chonotropic and inotropic effects which can be attenuated by atropine Increase risk of emesis among diabetics and obese patients Hyperkalemia when given to burn or trauma patients or patients with close head injury a. Which of the following mechanism may explain the ability of beta-blockers to reduce blood pressure in hypertension? Increased compliance of the capacitance vessels b. Relaxation of the primary resistance vessels c. Inhibition of renin release d. Direct inhibition of Angiotensin II receptors e.
Decrease in total body stores of sodium Which of the following equations describe the factors that contribute to blood pressure? Which of the following mechanism explains the blood pressure-lowering effect of thiazide diuretics? Reduction in blood volume and cardiac output II. Increased vascular compliance III.
Decreased proximal tubular reabsorption of water and sodium a. Which of the following drugs inhibit enzyme carbonic anhydrase? Dichlorphenamide b. Tolazamide c. Astemizole d. Selegiline e. Donepezil What is the primary mechanism of action of the drug Indapamide? Inhinition of the 2Cl-Na-K cotransporters in the convoluted tubule b. Inhibition of the Na-Cl contransporters at the convoluted tubule c. Inhibition of the Na-Cl cotransporters at the collecting duct d.
Competitive inhibition of aldosterone binding to its receptors e. Competitive inhibition os vasopressin binding to V2 receptors Hyperuricemia b. Increased in serum LDL d. Allergic reactions e. Hyponatremia Minimize hyperglycemia due to HCTZ b. Reduce risk of renal stone formation with HCTZ c. Reduce hyperkalemia with amiloride d. Minimize bicarbonaturia with HCTZ e. Minimize hypokalemia due to HCTZ The action of the drug Eplerenone most closely resembles which of the following agents?
Spironolactone b. Amiloride c. Triamterence d. Metolazone e. Quinethazone Which of the following agents exhibits pharmacodynamic interaction with the thiazide diuretics leading to a reduced diuretic effect?
Furosemide b. Enalapril d. Hydralzine e. Digoxin Which of the following mechanism explain the effects of the drug Torsemide and Bumetanide? Inhibition of carbonic anhydrase at the proximal convoluted tubule b. Inhibition of the Na-Cl co-transporter at the thin ascending limb of the Loop of Henle d.
Inhibition of the Na-Cl co-transporter at the distal convoluted tubule e. Inhibition of the Na-Cl co-transporter at the distal tubule and collecting duct Nephrogenic Diabetis Insidipus a. III only c. I and II d. II and III e.
Infusion-diuresis in hypercalcemia II. Oliguric acute renal failure III. Acute pulmonary edema a. Which of the folling agents is primarily indicated for the management of increased intracranial pressure a. Acetazolamide c. Furosemide d. Chlorthalidone e. Bumetanide Which of the following agents is most useful for the management of nephrolithiasisndue to idiopathic hypercalciuria?
Ethacrynic acid b. HCTZ c. Dorzolamide d. Vasopressin e. Triamterene Which of the following statements correctly describes the characteristics of Indapamide as a drug for hypertension? Its diuretic effect is self-limiting, and may not account for its hypertensive effect after about weeks of therapy II. Long-term use leads to improved blood vessel compliance III. Has modest vasodilating property a. II only c. I and III d. Which of the following agents maybe associated with ototoxicity which may have increased risk of occuring when patient also recieve aminoglycoside antibiotic?
Chlorthalidone c. Amiloride e. Spironolactone Which of the following mechanisms explains best the action of drug methyldopa?
The molecule releases norepinephrine in the presynaptic vesicles and is released by nerve stimulation to interact with postsynaptic adrenergic receptors b. The molecule is converted first to alpha-methyldopamine and alphamethylnorepinephrine which replace norepinephrine in the presynaptic vesicles and are released by nerve stimulation to interact with postsynaptic adrenergic receptors c.
The molecule is converted first to alpha-methyldopamine and alpha-norepinephrine which stimulate central alpha receptors d. The molecule is converted first to alpha-methyldopamine and alpha-norepinephrine which inhibit central alpha receptors e. The molecule directly inhibits peripheral alpha and beta receptors What is the most frequent side effect of methyldopa which can be seen particularly at the onset of treatment?
Sedation b. Depression c. Extrapyramidal signs d. Galactorrhea A 45 years old female in clonidine 1. Her last intake of clonidine was last 2 days prior to admission. Re-institute Clonidine 1. II and III Hypertrichosis b. Glucose intolerance c. Reflex tachycardia d. Lupus-like side effect e. Dyslipidemia In which subset of patients should Hydralazine be avoided or used with caution? Patients with arrythmias b. Patient with hypertension c. Patients with DM d.
Patients with Ischemic Heart disease e. Patients with CHF Amlodipine e. In the management of Pparoxysmal hypertensionin pheochromocytoma, which of the following drugs is the most appropriate initial therapy? Phentolamine b. Metoprolol c. Guanfacine d. Reserpine e.
Clonidine Orthostatic hypotension and syncope are manifestations of a phenomenon associated with the first dose of which agent? Fenoldopam d. Irbesartan e. Doxazosin Propanolol Carvedilol Guanethidine Reserpine Constipation, Urinary retention, tachycardia, mydriasis and anhidrosis are expected effects based on the mechanism of action of which of the following drugs?
Clonidine b. Trimethaphan c. Sodium nitropusside e. Nicardipine Which of the following drugs may be used safely for the control of hypertension in pregnant patients with pre-eclampsia? Magnesium Sulfate II. Methyldopa III. Hydralazine a. Which of the following mechanisms explains the action of the drug Sodium Nitropusside?
Activation of guanylyl cyclase with increase of cGMP b. Release of N20 with subsequent increase in cAMP c. Inhibition of the secretion of renin d. Stimulation of A1 receptors e. Increase conductance of outward potassium channels Which of the following agents is pure anteriolar vasodilaator? Prazosin b. Sodium Nitropusside c.
Diazoxide d. Phentolamine e. Which of the following agents can be used for hypertensive emergencies I. Enalaprilat II. Diazoxide III. Sodium nitropusside a. The decrease in arterial tone due to vasorelaxant action of sodium nitropusside is associated with a. Increase in smooth muscle cGMP levels b. Increase in smooth muscle cAMP levels c.
A decrease in calcium entry through L-type channels d. A local anethetic effect on smooth muscle cells e. Whgich of the following effects can be attributed to Angiotensin II? Stimulation of release of nitric oxide Stimulation of synthesis and release of Aldosterone Stimulation of release of Norepinephrine a.
Lesser incidence of coughs b. Absence of risk interstitial nephritis c. Safe for pregnant patients with hypertension d. Faster onset of action e. Lesser incidence of hyperkalemia Enalapril II. Ramipril III. Perindopril a. In which of the following conditions are ACE-inhibitors found to be clinically useful as first-line treatment?
Angina pectoris II. Diabetic Nephropathy a. Ibuprofen b. Felodipine c. Indapamide d. Eprenolone e. Hydralazine In which subset of patients which are ACE-inhibitors avoided as treatment option? Patients with bilateral renal artery stenosis II. Patients with hyperkalemia III. Pregnant patients in their 2nd and 3rd trimesters of pregnancy a. Which of the following calcium channel blockers has greater activity on calcium channels in myocardial tissues than calcium channels in the vascular smooth muscles?
Diltiazem b. Verapamil c. Nifedipine d. Felodipine What is the mechanism of action of the diydropyridine calcium channel blockers?
Inhibit the L-type calcium channels in the arteriolar smooth muscles b. Inhibit the L-type calcium channels in the anteriolar and venous smooth muscles c. Equally inhibit the L-type calcium channels in the vascular and cardiac tissues d. Inhibit the S-type calcium channels in the anteriolar smooth muscles e. Inhibit the S-type calcium channels in the anteriolar and venous smooth muscles Regular Nifedipine capsules II.
Enalapril tablets III. Indapamide tablets a. What is the most common side effect of Enalapril? Angioedema b. Interstitial nephritis c.
Coughs d. Hypotension e. Drug fever Which of the following anti-hypertensive agents is the most appropriate for elderly male patients with benign prostatic hyperplasia? Amlodipine c. Metoprolol d. HCTZ e. Enalapril Which of the following anti-hypertensive agents may be more appropriate to use for diabetic patients with evidence of renal disease?
Chinese patients are most likely to be more sensitiveto effects of which of the following drugs for hypertension that lower doses may have to be used? Rapid normalization of the blood pressure within 24 hours II. Initiation of oral hypertensives early as soon adequate blood pressure lowering has been achieved a. Which of the following are important considerations regarding the proper handling of Nitroglycerin tablets I.
Formulations used in the medicine are explosive II. Sublingual tablets lose their potency when stored in plastic containers III. These are sensitive to light a. Isosorbide mononitrate b.
Isosorbide dinitrate c. Amyl nitrite d. Glyceryl trinitrate e. None aqs all undergo significant first pass effect when given orally Which of the following statements most closelydescribes the primary mechanism of action of the nitrovasodilator?
Denitrification by glutathione S-transferase leads to release of nitrite ion which is then converted to nitric oxide, a molecule that activates adenylyl cyclase leading to increase cAMP b.
Denitrification by glutathione S-transferase leads to release of nitrite ion which is then converted to nitric oxide, a molecule that activates guanylyl cyclase leading to increase cGMP c. Nitrate ion released upon denitrification directly stimulas outward K-channels leading to hyperpolarization of the vascular smooth muscles d. Nitrate ion released upon denitrification directly stimulas outward K-channels leading to hyperpolarization of the vascular smooth muscles e.
Nitrate ion released upon denitrification stimulates the production of prostacylin leading to vasodilation Which of the following tissues exhibit the greatest sensitivity to nitrovasodilators at the lowest effective doses? Arteries b. Capillaries d. Veind e. Myocardial tissues Which of the following statements correctly explains the primary mechanism of relief of angina pectoris with the use of nitrovasodilators when given at usual doses? Peripheral dilation of the veins leading to reduction in cardiac preload and myocardial oxygen demand b.
Vasodilation of epicardial coronary arteries leading to improved oxygen delivery to myocardial tissues c. Increase in diastolic perfusion time leading to improved perfusion to ischemic myocardium d. Decrease total peripheral resistance with arteriolar vasodilation e. Decrease in myocardial contractility leading to reduction in myocardial oxygen demand Which of the following agents classified as nitrovasodilators is useful in the management of cyanide poisoning?
Sodium nitrite b. Amyl nitrite c. Sodium thiosulfate d. Nitroglycerin e. Isosorbide mononitrate Which of the following nitrovasodilators may induce conversion of hemoglobin to methemoglobin methemoglobinemia which can lead to cyanosis? Nitroglycerin b. Isosorbide mononitrate c. Isosorbide dinitrate d. Tetrathyl trinitrate e. Amyl nitrite This side effect of nitrovasodilators is explained in part by the depletion of sulfhydryl moieties in vascular smooth muscles with continuous use of the drugs, and may be partly reversed bysulfhydryl-regenerating compunds.
Tolerance b. Increased intracranial pressure c. Methemoglobenia e. Nitrovasodilators II. Beta-blockers III. Calcium channel blockers a. What is the primary limitation with the use of Dihydropyridine Calcium Channel Blockers in the management of angina pectoris?
Tendency to reduce cardiac preload b. Tendency to induce reflex vasospam when stopped d. Tendency to cause peripheral edema e. Tendency to reduce cardiac end-diastolic pressure What is the most important role of beta-blockers in the management of angina pectoris a. Causes coronary artery vasodilatation thus useful in the management of acute anginal attacks b.
Dilates the epicardial coronary vessels thus useful in patients with ongoing prinzmetal angina c. Reduces myocardial oxygen demand by reducing the total peripheral resistance making it useful for chronic stable angina pectoris d.
Reduces myocardial oxygen demand by reducing myocardial perfusion time making it useful for chronic stable angina pectoris e. Reduces myocardial oxygen demand by decreasing myocardial perfusion time making it useful for all types of angina pectoris Regular release Nifedipine capsule II. Metoprolol tablet III.
What is the principal mechanism of action of cardiac Glycosides? Stimulate the release of calcium for the sarcoplasmic reticulum leading to release in an increase intracellular calcium b. Inhibition of the cell membrane outward calcium transporter preventing calcium extrusion c.
Stimulation of inward calcium transporter leading to an increase in intacellular calcium d. Inhibition of the Na-K-ATPase leading to increase in intracellular sodium and preventing calcium extrusion e.
Inhibition oh the Na-Ca exchanger in the sarcoplasmic reticulum leading to increase in intracellular calcium Which of the following statements on pharmacokinetic parameters must be considered for patients taking Digoxin?
Renal clearance of the drug is inversely proprtional to the creatinine clearance c. Half-life is long, at about hours due in part to extensive enterohepatic recirculation d. It is primarily distributed within the intravascular space due to its high protein binding Increase in contractility of myocardial tissues II. A positive inotropic effect a. Decrease in the refractory period of atrial muscles II.
Which of the following condition may augment the effect of digitalis glycosides in myoccardial tissues? Concurrent use of captopril II. Reduced oxygenation of myocardial tissues III. Concurrent administration of calcium gluconate a. Useful in controlling the rate of ventricular response in atrial fibrillation III.
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