MCQs PHARMACOLOGY: Drugs used for treatment of heart failure

001. All of the following are normally involved in the pathogenesis of heart failure EXCEPT: a) A cardiac lesion that impairs cardiac output b) An increase in peripheral vascular resistance c) A decrease in preload d) An increase in sodium and water retention

002. All of the following are compensatory mechanisms that occur during the pathogenesis of congestive heart failure EXCEPT: a) An increase in ventricular end-diastolic volume b) An increase in the concentration of plasma catecholamines c) An increase in vagal tone d) Increased activity of the renin-angiotensin-aldosterone system 003. All of the following are recommended at the initial stages of treating patients with heart failure EXCEPT: a) Reduced salt intake b) Verapamil c) ACE inhibitors d) Diuretics

004. All of the following agents belong to cardiac glycosides EXCEPT: a) Digoxin b) Strophantin K c) Amrinone d) Digitoxin

005. The non-glycoside positive inotropic drug is: a) Digoxin b) Strophantin K c) Dobutamine d) Digitoxin

006. Sugar molecules in the structure of glycosides influence: a) Cardiotonic action b) Pharmacokinetic properties c) Toxic properties d) All of the above

007. Aglycone is essential for: a) Plasma protein binding b) Half-life c) Cardiotonic action d) Metabolism

008. Choose the derivative of the plant Foxglove (Digitalis): a) Digoxin b) Strophantin K c) Dobutamine d) Amrinone

009. All of the following statements regarding cardiac glycosides are true EXCEPT: a) They inhibit the Na+/K+-ATPase and thereby increase intracellular Ca++ in myocardial cells b) They cause a decrease in vagal tone c) Children tolerate higher doses of digitalis than do adults d) The most frequent cause of digitalis intoxication is concurrent administration of diuretics that deplete K+

010. An important action of digitalis is to increase vagal tone. It’s: a) True b) False

011. Digoxin is thought to increase intracellular concentrations of calcium in myocardial cells by indirectly slowing the action of the sodium-calcium exchanger. This consideration is: a) True b) False

012. Compare the half-life of digoxin and the half-life of digitoxin: a) Digoxin is greater than digitoxin b) Digitoxin is greater than digoxin

013. All of the following statements regarding cardiac glycosides are true EXCEPT: a) They inhibit the activity of the Na+/K+-ATPase b) They decrease intracellular concentrations of calcium in myocytes c) They increase vagal tone d) They have a very low therapeutic index

014. All of the following statements regarding cardiac glycosides are true EXCEPT: a) Digoxin is a mild inotrope b) Digoxin increases vagal tone c) Digoxin has a longer half-life than digitoxin d) Digoxin acts by inhibiting the Na+/K+ ATPase

015. The most cardiac manifestation of glycosides intoxication is: a) Atrioventricular junctional rhythm b) Second-degree atrioventricular blockade c) Ventricular tachycardia d) All the above

016. The manifestations of glycosides intoxication are: a) Visual changes b) Ventricular tachyarrhythmias c) Gastrointestinal disturbances d) All the above

017. For digitalis-induced arrhythmias the following drug is favored: a) Verapamil b) Amiodarone c) Lidocaine d) Propanolol

018. In very severe digitalis intoxication the best choice is to use: a) Lidocaine b) Digibind (Digoxin immune fab) c) Oral potassium supplementation d) Reducing the dose of the drug

019. All of the following statements regarding cardiac glycoside-induced ventricular tachyarrhythmias are true EXCEPT: a) Lidocaine is a drug of choice in treatment b) Digibind should be used in life-threatening cases c) They occur more frequently in patients with hyperkalemia than in those with hypokalemia d) They are more likely to occur in patients with a severely damaged heart

020. This drug is a selective beta-1 agonist: a) Digoxin b) Dobutamine c) Amrinone d) Dopamine

021. Tolerance to this inotropic drug develops after a few days: a) Amrinone b) Amiodarone c) Dobutamine d) Adenosine

022. This drug inhibits breakdown of cAMP in vascular smooth muscle: a) Digoxin b) Dobutamine c) Amrinone d) Dopamine

023. This drug is useful for treating heart failure because it increases the inotropic state and reduces afterload: a) Amiodarone b) Amrinone c) Propanolol d) Enalapril

024. This drug acts by inhibiting type III cyclic nucleotide phosphodiesterase: a) Amiodarone b) Milrinone c) Propanolol d) Enalapril

025. All of the following statements regarding inhibitors of type III phosphodiesterase are true EXCEPT: a) They raise cAMP concentrations in cardiac myocytes b) They reduce afterload c) They show significant cross-tolerance with beta-receptor agonists d) They are associated with a significant risk for cardiac arrhythmias
026. All of the following drugs are used in the treatment of severe congestive heart failure EXCEPT: a) Verapamil b) Digoxin c) Dobutamine d) Dopamine
027. Drugs most commonly used in chronic heart failure are: a) Cardiac glycosides b) Diuretics c) Angiotensin-converting enzyme inhibitors d) All the above
028. All of the following statements concerning angiotensin converting enzyme (ACE) inhibitors are true EXCEPT: a) They act by inhibiting the ability of renin to convert angiotensinogen to angiotensin I. b) Enalapril is a prodrug that is converted to an active metabolite c) They reduce secretion of aldosterone d) They can produce hyperkalemia in combination with a potassium-sparing diuretic
029. All of the following effects of ACE inhibitors may be useful in treating heart failure EXCEPT: a) They decrease afterload b) They increase circulating catecholamine levels c) They reduce reactive myocardial hypertrophy d) They increase myocardial beta-1 adrenergic receptor density
030. All of the following statements concerning the use of angiotensin-converting enzyme (ACE) inhibitors in the treatment of heart failure are true EXCEPT: a) They improve hemodynamics by decreasing afterload b) They can increase plasma cholesterol levels c) They may slow the progression of heart failure by preventing myocardial and vascular remodeling d) They are effective first-line agents in the treatment of chronic heart failure