Cardiac Drugs II Angina & Heart Failure Quiz PDF

Cardiac Drugs II Angina & Heart Failure **Quiz** ======== ### **1. Which of the following drugs is used for acute attacks of stable angina?** - A\) Bisoprolol - B\) Glyceryl Trinitrate (GTN) - C\) Amlodipine - D\) Propanolol - E\) Verapamil ### **2. What is the main mechanism by wh...

Cardiac Drugs II Angina & Heart Failure **Quiz** ======== ### **1. Which of the following drugs is used for acute attacks of stable angina?** - A\) Bisoprolol - B\) Glyceryl Trinitrate (GTN) - C\) Amlodipine - D\) Propanolol - E\) Verapamil ### **2. What is the main mechanism by which glyceryl trinitrate (GTN) relieves angina?** - A\) Increases coronary blood flow by vasodilation of atheromatous vessels - B\) Decreases oxygen demand by reducing preload and afterload - C\) Increases heart rate to improve myocardial perfusion - D\) Prevents platelet aggregation in coronary arteries - E\) Decreases ventricular contractility ### **3. Which of the following drugs is associated with tolerance during continuous use?** - A\) Glyceryl Trinitrate (GTN) - B\) Bisoprolol - C\) Amlodipine - D\) Isosorbide mononitrate - E\) Verapamil ### **4. What is the effect of beta-blockers in treating angina pectoris?** - A\) Decrease oxygen demand by reducing heart rate and myocardial contractility - B\) Increase coronary vasodilation - C\) Increase preload to improve myocardial perfusion - D\) Stimulate β2 receptors to improve vascular dilation - E\) Enhance heart rate for better perfusion of the myocardium ### **5. Which of the following is an adverse effect of propranolol?** - A\) Hypertension - B\) Bronchoconstriction - C\) Increased heart rate - D\) Decreased glucose metabolism - E\) Peripheral vasodilation ### **6. Which β-adrenoreceptor antagonist is selective for β1 receptors?** - A\) Propanolol - B\) Atenolol - C\) Bisoprolol - D\) Carvedilol - E\) Labetalol ### **7. What is the primary role of amlodipine in the treatment of angina?** - A\) Increase heart rate - B\) Reduce myocardial oxygen demand by lowering afterload - C\) Inhibit platelet aggregation - D\) Increase coronary vasospasm - E\) Decrease preload and ventricular volume ### **8. Which type of angina is characterized by coronary artery vasospasm?** - A\) Stable angina - B\) Variant angina - C\) Atherosclerotic angina - D\) Unstable angina - E\) Microvascular angina ### **9. Which calcium channel blocker is most effective in treating coronary vasospasm?** - A\) Diltiazem - B\) Verapamil - C\) Amlodipine - D\) Nifedipine - E\) Bisoprolol ### **10. What is the mechanism of action of nicorandil?** - A\) It is a K/ATP channel agonist that causes hyperpolarization of vascular smooth muscle - B\) It inhibits PDE3 to increase cAMP levels in cardiac cells - C\) It directly inhibits calcium entry into cardiac muscle cells - D\) It increases nitric oxide production to dilate coronary arteries - E\) It blocks β1 adrenergic receptors in the heart ### **11. Which of the following is an inotropic agent used in the treatment of septic shock?** - A\) Dobutamine - B\) Digoxin - C\) Carvedilol - D\) Amlodipine - E\) Isosorbide mononitrate ### **12. What effect does dobutamine have on the heart?** - A\) Negative chronotropic effect - B\) Positive inotropic effect by increasing calcium entry into cells - C\) Reduces contractility without affecting heart rate - D\) Induces vasodilation through α1 receptor blockade - E\) Decreases heart rate through β2 antagonism ### **13. What is the mechanism of action of milrinone in heart failure treatment?** - A\) Increases cAMP levels by inhibiting PDE3, leading to vasodilation and increased heart contractility - B\) Decreases myocardial oxygen demand by inhibiting β-receptors - C\) Inhibits Na/K ATPase to increase intracellular calcium - D\) Reduces preload by inducing venodilation - E\) Stimulates the β1 receptor to increase heart rate ### **14. Which of the following drugs is a selective β1 blocker used in heart failure treatment?** - A\) Carvedilol - B\) Bisoprolol - C\) Propanolol - D\) Amlodipine - E\) Verapamil ### **15. What is the main advantage of using beta-blockers in chronic heart failure?** - A\) They increase heart rate to improve tissue perfusion - B\) They reduce sympathetic stimulation, decreasing oxygen demand and preventing arrhythmias - C\) They directly increase the force of contraction in heart muscle - D\) They increase vascular resistance, improving perfusion - E\) They directly inhibit the release of renin ### **16. Which of the following best describes the inotropic effect of digoxin?** - A\) It increases heart rate to improve cardiac output - B\) It decreases contractility to reduce oxygen demand - C\) It is a positive inotrope without affecting heart rate - D\) It causes coronary vasodilation - E\) It inhibits sodium-potassium ATPase, leading to decreased calcium release ### **17. What is the major cause of angina pectoris in 90% of cases?** - A\) Coronary artery vasospasm - B\) Myocardial infarction - C\) Coronary atheroma - D\) Heart failure - E\) Stress-induced tachycardia ### **18. Which drug used in angina treatment has 100% bioavailability and is taken orally?** - A\) Glyceryl trinitrate - B\) Isosorbide mononitrate - C\) Propanolol - D\) Amlodipine - E\) Bisoprolol ### **19. Which of the following is an adverse effect of beta-blockers on the respiratory system?** - A\) Bronchoconstriction - B\) Hyperkalemia - C\) Increased respiratory rate - D\) Pulmonary vasodilation - E\) Tachypnea ### **20. What is the role of α1-adrenoreceptor antagonism in carvedilol?** - A\) Increases heart rate by stimulating β1 receptors - B\) Reduces peripheral vascular resistance by causing vasodilation - C\) Decreases myocardial contractility - D\) Prevents tachycardia associated with β1 blockade - E\) Improves renal perfusion ### **21. Which of the following is a major effect of nitrates in the treatment of angina?** - A\) Decreases myocardial contractility - B\) Increases oxygen supply by coronary vasodilation - C\) Decreases preload and afterload, reducing myocardial oxygen demand - D\) Stimulates β1 receptors to increase heart rate - E\) Enhances cardiac output ### **22. Which drug combination should be used with caution in the presence of heart failure?** - A\) Amlodipine and propranolol - B\) Calcium channel blockers and β-blockers - C\) Glyceryl trinitrate and amlodipine - D\) Propanolol and isosorbide mononitrate - E\) Dobutamine and digoxin ### **23. Which of the following is a characteristic of variant angina?** - A\) Caused by coronary artery atheroma - B\) Ischemic areas of myocardium are maximally dilated - C\) Caused by coronary vasospasm - D\) Myocardial perfusion is continuous - E\) Associated with heart failure ### **24. Which of the following drugs would be most appropriate for a patient with heart failure and hypotension?** - A\) Dobutamine - B\) Carvedilol - C\) Propanolol - D\) Milrinone - E\) Amlodipine ### **25. Which of the following drugs would be contraindicated in a patient with heart block and angina?** - A\) Amlodipine - B\) Diltiazem - C\) Propanolol - D\) Verapamil - E\) Bisoprolol **Answer guide** ---------------- ### **1. Which of the following drugs is used for acute attacks of stable angina?** **Answer**: **B) Glyceryl Trinitrate (GTN)** - **Explanation**: GTN is used for acute attacks of stable angina due to its rapid vasodilatory effects, reducing myocardial oxygen demand. It is usually administered sublingually for fast relief. ### **2. What is the main mechanism by which glyceryl trinitrate (GTN) relieves angina?** **Answer**: **B) Decreases oxygen demand by reducing preload and afterload** - **Explanation**: GTN reduces preload (venodilation) and afterload (arterial vasodilation), which decreases the heart's oxygen demand. This is the primary mechanism for relieving angina. ### **3. Which of the following drugs is associated with tolerance during continuous use?** **Answer**: **A) Glyceryl Trinitrate (GTN)** - **Explanation**: Continuous use of GTN, especially through skin patches, can lead to tolerance. This is why patches are typically removed at night to avoid tolerance development. ### **4. What is the effect of beta-blockers in treating angina pectoris?** **Answer**: **A) Decrease oxygen demand by reducing heart rate and myocardial contractility** - **Explanation**: Beta-blockers reduce heart rate and myocardial contractility, which decreases oxygen demand, thus helping to manage angina. ### **5. Which of the following is an adverse effect of propranolol?** **Answer**: **B) Bronchoconstriction** - **Explanation**: Propranolol, being a non-selective beta-blocker, can block β2 receptors in the lungs, leading to bronchoconstriction. This can be problematic for patients with asthma or chronic obstructive pulmonary disease (COPD). ### **6. Which β-adrenoreceptor antagonist is selective for β1 receptors?** **Answer**: **C) Bisoprolol** - **Explanation**: Bisoprolol is a β1-selective antagonist, meaning it primarily affects the heart, with fewer side effects on the lungs compared to non-selective beta-blockers like propranolol. ### **7. What is the primary role of amlodipine in the treatment of angina?** **Answer**: **B) Reduce myocardial oxygen demand by lowering afterload** - **Explanation**: Amlodipine, a calcium channel blocker, primarily works by lowering systemic vascular resistance (afterload), thus reducing myocardial oxygen demand and helping manage angina. ### **8. Which type of angina is characterized by coronary artery vasospasm?** **Answer**: **B) Variant angina** - **Explanation**: Variant angina (Prinzmetal angina) is caused by coronary artery vasospasm, whereas stable angina is usually caused by atherosclerotic plaques. ### **9. Which calcium channel blocker is most effective in treating coronary vasospasm?** **Answer**: **D) Nifedipine** - **Explanation**: Nifedipine, a dihydropyridine calcium channel blocker, is particularly effective in treating coronary vasospasm, as it causes potent vasodilation of coronary arteries. ### **10. What is the mechanism of action of nicorandil?** **Answer**: **A) It is a K/ATP channel agonist that causes hyperpolarization of vascular smooth muscle** - **Explanation**: Nicorandil has a dual mechanism. It acts as a nitrate (producing nitric oxide) and also opens K/ATP channels, causing hyperpolarization and vasodilation of vascular smooth muscle. ### **11. Which of the following is an inotropic agent used in the treatment of septic shock?** **Answer**: **A) Dobutamine** - **Explanation**: Dobutamine is a β1-selective agonist that increases myocardial contractility (positive inotropic effect), which is crucial in septic shock to improve cardiac output. ### **12. What effect does dobutamine have on the heart?** **Answer**: **B) Positive inotropic effect by increasing calcium entry into cells** - **Explanation**: Dobutamine increases calcium entry into cardiac muscle cells, which enhances contractility (positive inotropic effect) without significantly affecting heart rate. ### **13. What is the mechanism of action of milrinone in heart failure treatment?** **Answer**: **A) Increases cAMP levels by inhibiting PDE3, leading to vasodilation and increased heart contractility** - **Explanation**: Milrinone inhibits phosphodiesterase 3 (PDE3), which prevents the breakdown of cAMP, increasing heart contractility and causing vasodilation. ### **14. Which of the following drugs is a selective β1 blocker used in heart failure treatment?** **Answer**: **B) Bisoprolol** - **Explanation**: Bisoprolol is a β1-selective beta-blocker that is used in heart failure to reduce the risk of arrhythmias and improve cardiac function by decreasing heart rate and contractility. ### **15. What is the main advantage of using beta-blockers in chronic heart failure?** **Answer**: **B) They reduce sympathetic stimulation, decreasing oxygen demand and preventing arrhythmias** - **Explanation**: Beta-blockers reduce sympathetic nervous system activity, which lowers oxygen demand, reduces arrhythmias, and improves survival in heart failure patients. ### **16. Which of the following best describes the inotropic effect of digoxin?** **Answer**: **C) It is a positive inotrope without affecting heart rate** - **Explanation**: Digoxin increases the force of contraction by inhibiting the Na/K ATPase pump, leading to increased intracellular calcium, but it does not directly affect the heart rate in most cases. ### **17. What is the major cause of angina pectoris in 90% of cases?** **Answer**: **C) Coronary atheroma** - **Explanation**: In 90% of cases, angina pectoris is caused by coronary atherosclerosis (atheroma), which leads to reduced coronary blood flow. ### **18. Which drug used in angina treatment has 100% bioavailability and is taken orally?** **Answer**: **B) Isosorbide mononitrate** - **Explanation**: Isosorbide mononitrate has nearly 100% bioavailability when taken orally and works similarly to GTN by generating nitric oxide for vasodilation. ### **19. Which of the following is an adverse effect of beta-blockers on the respiratory system?** **Answer**: **A) Bronchoconstriction** - **Explanation**: Non-selective beta-blockers (like propranolol) can block β2 receptors in the lungs, causing bronchoconstriction. This is a particular concern for asthma patients. ### **20. What is the role of α1-adrenoreceptor antagonism in carvedilol?** **Answer**: **B) Reduces peripheral vascular resistance by causing vasodilation** - **Explanation**: Carvedilol is a β-blocker with additional α1-adrenoreceptor antagonism. This helps reduce peripheral vascular resistance through vasodilation. ### **21. Which of the following is a major effect of nitrates in the treatment of angina?** **Answer**: **C) Decreases preload and afterload, reducing myocardial oxygen demand** - **Explanation**: Nitrates like GTN reduce preload (venodilation) and afterload (arterial vasodilation), which helps reduce myocardial oxygen demand and relieve angina. ### **22. Which drug combination should be used with caution in the presence of heart failure?** **Answer**: **B) Calcium channel blockers and β-blockers** - **Explanation**: Combining calcium channel blockers (especially non-dihydropyridines) with beta-blockers can worsen heart failure, particularly in patients with reduced ejection fraction. ### **23. Which of the following is a characteristic of variant angina?** **Answer**: **C) Caused by coronary vasospasm** - **Explanation**: Variant angina (Prinzmetal angina) is caused by spontaneous coronary artery vasospasm, unlike stable angina, which is due to atherosclerotic plaques. ### **24. Which of the following drugs would be most appropriate for a patient with heart failure and hypotension?** **Answer**: **D) Milrinone** - **Explanation**: Milrinone is a phosphodiesterase inhibitor that increases cAMP levels, providing both inotropic support and vasodilation, making it useful in heart failure with hypotension. ### **25. Which of the following drugs would be contraindicated in a patient with heart block and angina?** **Answer**: **D) Verapamil** - **Explanation**: Verapamil is a calcium channel blocker that can worsen heart block by further inhibiting conduction through the AV node. It is contraindicated in patients with heart block.