(A) BP = COxPVR
(B) BP = CO/PVR
(C) BP = PVR/CO
(D) None of the above
2. If a fibrinolytic drug is used for treatment of acute myocardial infarction, the adverse drug effect that is most likely to occur is
(A) Acute renal failure
(B) Development of antiplatelet antibodies
(C) Encephalitis secondary to liver dysfunction
(D) Hemorrhagic stroke
(E) Neutropenia
3. Increased serum levels of which of the following may be associated with a decreased risk of atherosclerosis?
(A) Very lowdensity lipoproteins (VLDL)
(B) Lowdensity lipoproteins (LDL)
(C) Intermediate – density lipoproteins (IDL)
(D) Highdensity lipoproteins (HDL)
(E) Cholesterol
4. If the patient has a history of gout, which of the following drugs is most likely to exacerbate this condition?
(A) Colestipol
(B) Gemfibrozil
(C) Lovastatin
(D) Niacin
(E) Simvastatin
5. After being counseled about lifestyle and dietary changes, the patient was started on atorvastatin. During his treatment with atorvastatin, it is important to routinely monitor serum concentrations of
(A) Blood urea nitrogen (BUN)
(B) Alanine and aspartate aminotransferase
(C) Platelets
(D) Red blood cells
(E) Uric acid
6. Six months after beginning atorvastatin, the patient’s total and LDL cholesterol concentrations remained above normal and he continued to have anginal attacks despite good adherence to his antianginal medications. His physician decided for niacin. The major recognized mechanism of action of niacin is
(A) Decreased lipid synthesis in adipose tissue
(B) Decreased oxidation of lipids in endothelial cells
(C) Decreased secretion of VLDL by the liver
(D) Increased endocytosis of HDL by the liver
(E) Increased lipid hydrolysis by lipoprotein lipase
7. Following drugs act on imidazoline receptor
(A) Moxonidine
(B) Dexmedetomidine
(C) Tizanidine
(D) All of the above
8. Which one of the following drugs increase digoxin plasma concentration by a pharmacokinetic mechanism?
(A) Captopril
(B) Hydrochorothiazide
(C) Lidocaine
(D) Quinidine
(E) Sulfasalazine
9. A 55yearold patient currently receiving other drugs for another condition is to be started on diuretic therapy for mild heart failure. Thiazides are known to reduce the excretion of
(A) Diazepam
(B) Fluoxetine
(C) Imipramine
(D) Lithium
(E) Potassium
10. A hypertensive patient has been using nifedipine for some time without untoward effects. If he experiences a rapidly developing enhancement of the antihypertensive effect of the drug, it is probably due to
(A) Concomitant use of antacids
(B) Fods containing tyramine
(C) Grapefruit juice
(D) Induction of drug metabolism
(E) Over – the – counter decongestants
11. A drug lacking vasodilator properties that is useful in angina is
(A) Isosorbide dinitrate
(B) Metoprolol
(C) NIfedipine
(D) Nitroglycerin
(E) Verapamil
12. Aldosterone release is stimulated by
(A) Angiotensin I
(B) Angiotensin
(C) Angiotensin III
(D) Both (B) and (C)
13. Which one of the following drugs is used in the treatment of male impotence and activates prostaglandin E1 receptors?
(A) Alprostadil
(B) Fluoxetine
(C) Mifepristone
(D) Sildenafil
(E) Zafirlukast
14. A treatment of angina that consistently decreases the heart rate and can prevent vasospastic angina attacks is
(A) Isosorbide dinitrate
(B) NIFedipine
(C) Nitroglycerin
(D) Propranolol
(E) Verapamil
15. In a patient receiving digoxin for congestive heart failure, condition that may facilitate the appearance of toxicity include
(A) Hyperkalemia
(B) Hypernatremia
(C) Hypocalcemia
(D) Hypomagnesemia
(E) All of the above
16. Activation of endothelin receptor ETA, leads to
(A) Vasoconstriction
(B) Bronchoconstriction
(C) Aldosterone release
(D) All of the above
17. Methylxanthine drugs such as aminophylline cause which one of the following?
(A) Vasoconstriction in many vascular beds
(B) Decrease in the amount of cAMP in mast cells
(C) Bronchodilation
(D) Activation of the enzyme phosphodiesterase
(E) Sedation
18. Drugs used in asthma that often cause tachycardia and tremor include
(A) Beclomethasone
(B) Cromolyn sodium
(C) Ipratropium
(D) Metaproterenol
(E) All of the above
19. Following potassium sparing diuretic inhibits action of aldosterone
(A) Amiloride
(B) Triamterene
(C) Spironolactone
(D) All of the above
20. In patients with chronic granulomatous disease which of the following agents increases the synthesis of tumor necrosis factor, leading to activation of phagocytosis?
(A) Aldesleukin
(B) Cyclosporine
(C) Filgrastim
(D) Infliximab
(E) Interferon gamma
21. The mechanism of action of cyclosporine involves
(A) Activation of calcineurin
(B) Binding to cyclophilin to cause inhibition of a cytoplasmic phosphatase
(C) Blockade of interleukin – 2 receptors
(D) Inhibition of phospholipase A2
(E) Suppression of bone marrow progenitors
22. Which one of the following drugs predictably prolongs the PR interval and increases cardiac contractility?
(A) Digoxin
(B) Lidocaine
(C) Propranolol
(D) Quinidine
(E) Verapamil
23. Which of the following is the drug of choice for management of cardiac arrhythmias that occur in digitalis toxicity?
(A) Amiodarone
(B) Lidocaine
(C) Propranolol
(D) Sotalol
(E) Prazosin
24. A 54yearold woman with severe hypercholesterolemia is to be treated with a combination of niacin and atorvastatin. With this drug combination, it is important that the patient be monitored closely for signs of
(A) Agranulocytosis
(B) Gallstones
(C) Lactic acidosis
(D) Myopathy
(E) Thyrotoxicosis
25. Regarding verapamil, which one of the following statements is false?
(A) Angina pectoris is an important indication for the use of verapamil
(B) Contraindicated in the asthmatic patient
(C) Relaxes vascular smooth muscle
(D) Slows the depolarization phase of the action potential in AV nodal cells
(E) Used in management of supraventricular tachycardias
26. What drug is used to prevent embolism in the lung and during myocardial infarction?
(A) Alteplase
(B) Human growth hormone
(C) Granulocyte–macrophage colony – stimulating factor (GM–CSF)
(D) EPOGEN (EPO)
(E) None of the above
27. Which of the following cardiovascular agents is classified chemically as a glycoside?
(A) Nifedipine
(B) Digoxin
(C) Flecainide
(D) Cholestyramine
(E) Warfarin
28. Inhibition of carbonic anhydrase results in
(A) Abolition of NaHCO3 reabsorption in proximal tubule
(B) Enhanced of NaHCO3 reabsorption in proximal tubule
(C) Enhanced NAHCO3 secretion in distal tubule
(D) None of the above
29. Which of the following cyclotron produced radiopharmaceuticals is used for assessing regional myocardial perfusion as part of an exercise stress test?
(A) Thallous chloride 201TI USP
(B) Sodium iodide 123I
(C) Gallium citrate 67Ga USP
(D) Indium 111In pentetate
(E) Cobalt 57Co cyanocobalamin
30. Mary has a family history of heart disease and wonders if garlic would be beneficial to her. Which of the following statements is correct about garlic?
(A) Entericcoated tablets release their contents in the stomach
(B) Side effects include heartburn, flatulence, and sweating
(C) The safety of garlic in pregnancy is unknown
(D) Garlic does not interact with warfarin
31. Exertion–induced angina, which is relieved by rest, nitroglycerin, or both, is referred to as
(A) Prinzmetal’s angina
(B) Unstable angina
(C) Classic angina
(D) Variant angina
(E) Pre-infarction angina
32. Myocardial oxygen demand is increased by all of the following factors except
(A) Exercise
(B) Smoking
(C) Cold temperatures
(D) Isoproterenol
(E) Propranolol
33. Which of the following agents used in prinzmetal’s angina has spasmolytic actions, which increase coronary blood supply?
(A) Nitroglycerin
(B) Nifedipine
(C) Timolol
(D) Isosorbide mononitrate
(E) Propranolol
34. The oral absorption of following osmotic diuretic is negligible
(A) Glycerin
(B) Mannitol
(C) Isosorbide
(D) All of the above
35. Maximal medical therapy for treating angina pectoris is represented by which of the following choices?
(A) Diltiazem, verapamil, nitroglycerin
(B) Atenolol, isoproterenol, diltiazem
(C) Verapamil, nifedipine, propranolol
(D) Isosorbide, atenolol, diltiazem
(E) Nitroglycerin, isosorbide, atenolol
36. The term ischemic heart disease (IHD) is used to designate all of the following conditions except
(A) Angina pectoris
(B) Sudden cardiac death
(C) Congestive heart failur (CHF)
(D) Arrhythmias
37. Which of the following thrombolytic agents would be appropriate at this time?
(A) Anisoylated plasminogen streptokinase activator complex (APSAC)
(B) Streptokinase (SK)
(C) Recombinant tissuetype plasminogen activator (tPA)
(D) None of above
38. Strong anticholinergic effects limit the antiarrhythmic use of
(A) Quinidine
(B) Procainamide
(C) Tocainide
(D) Flecainide
(E) Disopyramide
39. Following loop diuretic is a phynoxy acetic acid derivative
(A) Furosemide
(B) Bumetanide
(C) Ethacrynic acid
(D) All of the above
40. Following potassium sparing diuretic is a mineralocorticoid receptor antagonist
(A) Amiloride
(B) Triamterene
(C) Spironolactone
(D) All of the above
41. A patient receiving a class I antiarrhythmic agent on a chronic basis complains of fatigue, lowgrade fever, and joint pain suggestive of systemic lupus erythematosus (SLE). The patient is most likely receiving
(A) Lidocaine
(B) Procainamide
(C) Quinidine
(D) Flecainide
(E) Propranolol
42. Which of the following drugs is a class IV antiarrhythmic that is primarily indicated for the treatment of supraventricular tachyarrhythmias?
(A) Lbutilide
(B) Mexiletine
(C) Diltiazem
(D) Quinidine
(E) Propranolol
43. Which of the following agents has a direct effect on the AV mode, delaying calciumchannel depolarization?
(A) Lidocaine
(B) Diltiazem
(C) Bretylium
(D) Quinidine
(E) Lbutilide
44. Which of the following drugs is a class III antiarrhythmic agent that is effective in the acute management of atrial fibrillation or atrial flutter of recent onset ?
(A) Bretylium
(B) Lbutilide
(C) Metoprolol
(D) Disopyramide
45. Which of the following groups of symptoms is most often associated with a patient who has rightsided heart failure?
(A) Nocturia, rales, paroxysmal nocturnal dyspnea
(B) Paroxysmal nocturnal dyspnea, pedal edema, jugular venous distention, hepatojugular reflux
(C) Jugular venous distention, hepatojugular reflux, pedal edema, shortness of breath
(D) Hepatojugular reflux, jugular venous distension, pedal edema, abdominal distention
(E) Paroxysmal nocturnal dyspnea, jugular venous distention, abdominal distention, shortness of breath
46. Which of the following combinations of drugs, when used together, reduce both preload and afterload?
(A) Nitroglycerin and isosorbide dinitrate
(B) Hydralazine and isosorbide dinitrate
(C) Captopril and methyldopa
(D) Prazosin and angiotension II
(E) Hydralazine and methyldopa
47. When digoxin is used in a patient with congestive heart failure (CHF), it works by exerting a positive effect on
(A) Stroke volume
(B) Total peripheral resistance
(C) Heart rate
(D) Blood pressure
(E) Venous return
48. Because of proven beneficial effects on “cardiac remodeling”, these agents are now indicated as first line therapy in CHF patients. Which of the following is representative of this group of drugs?
(A) Hydrochlorothiazide
(B) Enalapril
(C) Furosemide
(D) Carvedilol
(E) Bumetanide
49. For treating the patient with congestive heart failure (CHF), which of the following dosages of dopamine isselected for its positive inotropic effects?
(A) 2.0 mg/kg/min
(B) 5–10 mg/kg/min
(C) 10–20 mg/kg/min
(D) 40 mg/kg/min
(E) 40 mg/kg/min
50. Milrinone is an example of
(A) Phosphodiesterase I inhibitor
(B) Phosphodiesterase II inhibitor
(C) Phosphodiesterase III inhibitor
(D) Phosphodiesterase IV inhibitor
51. Situations that predispose a digitalistreated patient to toxicity include
(A) Hypercalcemia
(B) Hyperkalemia
(C) Hypermagnesemia
(D) None of these
52. Unfractionated heparin binds to antithrombin III and inactivates clotting factor(s)
(A) Xa
(B) Ixa
(C) Iia
(D) All of the above
(E) None of the above
53. A patient to be commenced on oral anticoagulant therapy for DVT would be treated with
(A) Oral anticoagulant therapy with warfarin for a goal intenational normalized ration (INR) of 2–3
(B) Oral anticoagulant therapy with warfarin for a goal INR of 2.5–3.5
(C) Oral anticoagulant therapy with aspirin for a goal INR of 2–3
(D) All of above
54. A patient on oral anticoagulant therapy is commenced on sulfamethoxazoletrimethoprim, doublestrength twice daily. One may expect to see the international normalized ratio
(A) Increase
(B) Decrease
(C) Remain unchanged
(D) None of these
55. When compared to unfractionated heparin, low molecular weight heparins have
(A) Preferential binding affinity to factor Xa relative to Iia (thrombin)
(B) Shorter halflives
(C) Dose – dependent renal clearance
(D) None of above
56. Acute renal failure (ARF) may be caused by all of the following except
(A) Acute tubular necrosis (ATN) due to drug therapy (e.g., aminoglycosides, contrast media)
(B) Severe hypotension or circulatolry collapse
(C) Decreased cardiac output, as from congestive heart failure
(D) Hemolysis, myoglobinuria
(E) Hyperkalemia
57. During Phase 2 of action potential in cardiac cell, depolarizing current through calcium channels is balanced by
(A) Delayed rectifier potassium current
(B) outward chloride channel
(C) Both (A) and (B)
(D) None of the above
58. The action of quinidine differs from that of digitalis in
(A) Decreasing irritability of cardiac muscle
(B) Preventing passage of impulses to the ventricle
(C) Increasing irritability of heart muscle
(D) Reducing conductivity
(E) None of the above
59. Overuse of digitalis may result in
(A) Habituation
(B) Tolerance
(C) Addiction
(D) Physical dependence
(E) Cummulative poisoning
60. The action of digitalis is enhanced by
(A) Sodium
(B) Calcium
(C) Magnesium
(D) Potassium
(E) Chloride
61. In case of acute pain of angina pectoris the most effective treatment would be to administer
(A) Mannitol hexanitrate
(B) Erythrityl tetranitrate
(C) Sodium nitrate
(D) Pentaerythritol tetranitrate
(E) Nitroglycerin
62. Which of the following is used to lower blood lipid levels?
(A) Trimethadione
(B) Clofibrate
(C) Flucytosine
(D) Coumarin
(E) Propranolol
63. The chief use of levoarterenol is to treat
(A) Shock
(B) Diabetes
(C) Hypertension
(D) Cardiac arrhythmias
(E) Iron deficiencies
64. Tolerance to nitroglycerin may be overcome by
(A) Initially using the largest safe dose of the drug
(B) Using other nitrites
(C) Temporarily discontinuing the drug for one or two weeks
(D) Use of higher doses
(E) None of the above
65. Quinidine can cause paradoxical tachycardia in a patient of
(A) Stick sinus syndrome
(B) Auricular extrasystoles
(C) Auricular fibrillation
(D) Ventricular extrasystoles
66. Quinidine is now used primarily for
(A) Conversion of auricular fibrillation to sinus rhythm
(B) Control of ventricular rate in atrial flutter
(C) Termination of ventricular tachycardia
(D) Prevention of recurrences of atrial and ventricular extrasystoles/tachycardias
67. Procainamide differs from quinidine in the following respect
(A) It does not cause paradoxical tachycardia
(B) It has no alfa adrenergic blocking activity
(C) It has little antivagal action
(D) Both (B) and (C)
68. In heart, potassium channels determine
(A) Pacemaker function
(B) Resting potential
(C) Action potential duration
(D) All of the above
69. Lidocaine is the preferred antiarrhythmic for emergency control of cardiac arrhythmias following acute myocardial infarction because
(A) It has a rapidly developing and titratable antiarrhythmic action
(B) It casues little myocardial depression and hypotension
(C) It has broad spectrum antiarrhythmic efficacy in atrial as well as ventricular arrhythmias
(D) Both (A) and (B)
70. Hypothyroidism is a possible consequence of prolonged therapy with
(A) Procainamide
(B) Mexiletine
(C) Sotalol
(D) Amiodarone
71. Which of the following drugs is preferred for termination of paroxysmal supraventricular tachycardia
(A) Digoxin
(B) Quinidine
(C) Propranolol
(D) Verapamil
72. The following drug is used to reduce the frequency of angina pectoris as well as to terminate an acute attack
(A) Digoxin
(B) Furosemide
(C) Enalapril
(D) Amrinone
73. Antianginal drugs afford the following benefit/benefits
(A) Terminate anginal attacks
(B) Decrease the frequency of anginal attacks
(C) Retard the progression of coronary artery disease
(D) Both (A) and (B)
74. Choose the correct statement about the action of nitrates on coronary vessels
(A) They mitigate angina pectoris by increasing total coronary flow
(B) They preferentially dilate conducting arteries without affecting resistance arterioles
(C) They preferentially dilate autoregulatory arterioles without affecting the larger arteries
(D) They increase subepicardial blood flow without affecting subendocardial blood flow
75. Organic nitrates relax vascular smooth muscle by
(A) Increasing intracellular cyclic AMP
(B) Increasing intracellular cyclic GMP
(C) Decreasing intracellular cyclic AMP
(D) Both (B) and (C)
76. Select the organic nitrate which undergoes minimal firstpass metabolism in the liver
(A) Glyceryl trinitrate
(B) Isosorbide dinitrate
(C) Isosorbide mononitrate
(D) Erythrityl tetranitrate
77. The primary mechanism of beneficial effect of glyceryl trinitrate in classical angina pectoris is
(A) Increase in total coronary blood flow
(B) Redistribution of coronary blood flow
(C) Reduction of cardiac preload
(D) Reduction of cardiac after load
78. Enhanced automaticity in cardiac cells may occur because of
(A) Badrenergic stimulation
(B) Hypokalemia
(C) Mechanical stretch of cardiac muscles
(D) All of the above
79. Glyceryl trinitrate is administratered by all of the following routes except
(A) Oral
(B) Sublingual
(C) Intramuscular
(D) Intravenous
80. A patient of acute myocardial infarction being treated in intensive care unit developed left ventricular failure with raised central venous pressure. It was decided to use glyceryl trinitrate. Which route/method of administration would be most suitable.
(A) Sublingual
(B) Oral
(C) Intravenous bolus injection
(D) Slow intravenous infusion
81. A patient suffers from spisodic pain diffusely localized over the chest and upper abdomen, which is relieved by sublingual glyceryl trinitrate. He could be suffering from
(A) Angina pectoris
(B) Biliary colic
(C) Esophageal spasm
(D) All of the above
82. The dihydropyridines block the following type of calcium channels.
(A) Ltype voltage sensitive channels
(B) Ttype voltage sensitive channels
(C) Ntype voltage sensitive channels
(D) Receptor operated calcium channels
83. Which of the following drugs is most likely to accentuate varient (Prinzmetal) angina ?
(A) Digoxin
(B) Furosemide
(C) Enalapril
(D) Amrinone
84. In cardiac cells, adenosine
(A) Causes shortening of action potential duration
(B) Depolarization
(C) Increase in normal automaticity
(D) All of the above
85. Which of the following antianginal drugs is most likely to produce tachycardia as a side effect ?
(A) Amlodipine
(B) Nifedipine
(C) Diltiazem
(D) Verapamil
86. Which of the following is not an attribute of amlodipine ?
(A) High and consistent oral bioavailability
(B) Large volume of distribution
(C) Generation of an active metabolite
(D) Long elimination halflife
87. Propranolol should not be prescribed for a patient of angina pectoris who is already receiving
(A) Nifedipine
(B) Felodipine
(C) Verapamil
(D) Isosorbide mononitrate
88. Which of the following drugs is a potassium channel opener ?
(A) Pinacidil
(B) Hydralazine
(C) Glibenclamide
(D) Amiloride
89. Though nitrates and calcium channel blockers are both vasodilators, they are used concurrently in angina pectoris because
(A) They antagonize each other’s side effects
(B) Nitrates primarily reduce preload while calcium channel blockers primarily reduce after load
(C) Nitrates increase coronary flow while calcium
(D) Both (B) and (C)
90. ‘Coronary steal phenomenon’ has been noted most frequently with
(A) Glyceryl trinitrate
(B) Dipyridamole
(C) Propranolol
(D) Diltiazem
91. Which of the following drugs is believed to improve microcirculation in peripheral vascular diseases by promoting RBC flexibility ?
(A) Cyclandelate
(B) Theophyline
(C) Pentoxiphyline
(D) Nicotinic acid
92. Higher incidence of myocardial infarction and increased mortality has been noted with the use of the following antihypertensive drug
(A) Nifedipine
(B) Verapamil
(C) Diltiazem
(D) Lisinopril
93. Cardiac glycosides are obtained from following plant source.
(A) Rauwolfia serpentina
(B) Strophanthus gratus
(C) Ricinus commounts.
(D) Atropa belladonna
94. Therapeutic dose of digoxin in a normal individual has the following effects, except
(A) Increase in the speed of myocardial contractility
(B) No significant change in cardiac output
(C) Relaxation of peripheral vascular bed
(D) Increase in the force of myocardial contractility
95. Digoxin given for cardiac failure is extremely valuable in patients of
(A) Thyrotoxicosis
(B) Beriberi
(C) Cor pulmonale
(D) Atrial fibrillation
96. The agent given sublingually in an acute attack of angina pectoris is
(A) Glyceryl trinitrate
(B) Amyl nitrite
(C) Erythrital tetranitrate
(D) Pentaerythritol tetranitrate
97. Following statement is true about lidocaine
(A) Reduce the slope of Phase 4
(B) Threshold excitability is not altered
(C) Action potential is not affected
(D) All of the above
98. Aspirin in small doses (50 to 150 mg per day)
(A) Is of benefit in patients of unstable angina
(B) Has thrombolytic action
(C) PREFerentially inhibits prostacyclin synthetase enzyme
(D) MAY Alleviate need for Verapamil in variant angina
99. Major beneficial effect of nitrates in classical angina is due to
(A) Dilation of veins more than arteries
(B) Increase in total coronary blood flow
(C) An increase in the end diastolic size of the heart
(D) An increase in the heart rate
100. Major lipid class present in chylomicrons is
(A) Endogenous triglycerides
(B) Cholesterol esters
(C) Dietary triglycerides
(D) All of the above
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