3395 Krok-1 Pharmacology icon

3395 Krok-1 Pharmacology




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4. A 48-year-old patient after severe psychoemotional exertion suddenly began feeling sharp pain in the heart region, irradiating into left arm. Nitroglycerin relieved pain 10 minutes later. What pathogenetic mechanism is responsible for the development of pain in this case?

A. Occlusion of coronary vessels.

B. Compression of coronary vessels.

C. Dilation of peripheral vessels.

D. Increase of myocardial needs in oxygen.

*E. Spasm of coronary vessels.

5. A patient after tooth extraction developed persistent substernal pain. Sublingual antianginal substance relieved the pain, but the patient complained of headache and dizziness. What medicine did the patient use?

A. Metoprolol.

B. Validol.

C. Anapriline.

D. Verapamil.

*E. Nytroglycerin.

6. A patient with acute myocardial infarction was given intravenously different solutions during 8 hours with medical dropper 1500 ml and oxygen intranasally. He died because of pulmonary oedema. What caused pulmonary oedema?

A. Neurogenic reaction.

B. Inhalation of the oxygen.

C. Allergic reaction.

D. Decreased oncotic pressure due to haemodilution.

*E. Volume overload of the left ventricular.

7. Therapeutic action of β-adrenergic receptor blockers such as anaprilinum (propranolol) in angina pectoris is believed to be primarily the result of:

A. Increased sensitivity to catecholamines.

B. Dilation of the coronary vasculature.

C. Reduced production of catecholamines.

D. Increased peripheral resistance.

*E. Decreased requirement for myocardial oxygen.

8. Which of the following drugs is considered to be most effective in relieving and preventing ischaemic episodes in patients with variant angina?

A. Isosorbide dinitrate.

B. Nitroglycerin.

C. Sustac-mite.

D. Propranolol.

*E. Nifedipine.

9. A 69-year-old male with angina develops severe constipation following treatment with:

A. Nitroglycerin.

B. Captopril.

C. Propranolol.

D. Dobutamine.

*E. Verapamil.

10. Administration of which of the following antianginal agents results in antianginal effects for only 10 hours, despite detectable therapeutic plasma levels for 24 hours?

A. Verapamil.

B. Atenolol.

C. Amlodipine.

D. Validolum.

*E. Transdermal nitroglycerin.

Significant tolerance to nitroglycerin develops. Transdermal patches can produce therapeutic drug levels for 24 hours, but its effectiveness lasts between 8 and 10 hours. A nitrate-free period of at least eight hours is necessary to prevent tolerance. Amyl nitrite is inhalable, and its action lasts no longer than five minutes. Patients on atenolol and amlodipine do not develop tolerance to these agents.

11. A 70-year-old female is treated with sublingual nitroglycerin for her occasional bouts of angina. Which of the following is involved in the action of nitroglycerin?

A. α-Adrenergic activity.

B. Phosphodiesterase activity.

C. Phosphorylation of light chains of myosin.

D. Norepinephrine release.

*E. cGMP.

12. Which of the following is unlikely to occur with low concentrations of nitroglycerin?

A. Increased coronary blood flow.

B. Decreased end-diastolic blood pressure.

C. Decreased myocardial oxygen demand.

D. Decreased preload and afterload.

*E. Decreased heart rate.

13. A 61-year-old female has intermittent bouts of chest pain on exertion of two months’ duration, associated with numbness and tingling in the fourth and fifth fingers of her left hand. ECG is normal. She is placed on anaprilinum (propranolol), which relieves her symptoms. What cardiovascular effect has this drug?

A. It increases sensitivity to catecholamines.

B. It dilates the coronary vasculature.

C. It decreases production of catecholamines.

D. It increases peripheral vascular resistance.

*E. It decreases the requirement for myocardial oxygen.

14. A patient comes to your office with effort-induced angina and resting tachycardia. You choose the following drug to treat the patient because it slows heart rate by blocking L-type calcium channels in SA node:

A. Metoprolol.

B. Propranolol.

C. Nitroglycerin.

D. Isosorbide dinitrate.

*E. Verapamil.

15. Which of the following haemodynamic effects of nitroglycerin are primarily responsible for the beneficial results observed in patients with angina?

A. Increased blood flow to the subepicardium.

B. Reduction in systemic vascular resistance (afterload).

C. Increased heart rate.

D. Reduction in the force of myocardial contraction.

*E. Reduction in preload.

16. A combination of drugs, consisting of nitroglycerin patch and β-blocker, such as propranolol, is prescribed to woman to treat her attacks of angina. Which effect of propranolol would counteract adverse effect of nitroglycerin?

A. Reduction in coronary vasospasm.

B. Decrease in afterload.

C. Decrease in preload.

D. Increase in myocardial contractile force.

*E. Decrease in heart rate.

17. Metoprolol would produce the following beneficial effect in a patient with angina:

A. Increase in blood flow through concentric stenosis.

B. Increase in collateral blood flow.

C. Increase in afterload.

D. Decrease in preload.

*A. Increase in diastolic filling time.

18. A doctor recommended to patient, who had an acute myocardial infarction, to take acidum acetylsalicylicum in the dose 0.25 g once per 2–3 days during 3–4 months. What effect did the doctor count on?

A. Vasodilative.

B. Anti-inflammatory.

C. Antipyretic.

D. Analgesic.

*E. Antiaggregant.

19. A patient with ischaemic heart disease has not informed the doctor that he had attacks of bronchospasm. The doctor prescribed a drug, which has made the attacks of angina pectoris less frequent, but the attacks of bronchospasm have become more frequent. What drug has been prescribed?

A. Nitrosorbidum (isosorbide dinitrate).

B. Atenolol.

C. Verapamil.

D. Diltiazem.

*E. Propranolol (anaprilinum).

20. A patient has been suffering from bronchial asthma for a long time. Recently he had attacks of angina pectoris. What drug is contraindicated to him?

A. Dipyridamole.

B. Nitroglycerin.

C. Sustac-forte.

D. Nifedipine.

*E. Propranolol.

21. A 53-year-old woman suffers from attacks of angina pectoris. The patient suffers from severe chest pain, arrhythmia, and short breath. What drug is the most expedient for prescription in this case to provide first aid?

A. Amiodarone.

B. Nitrosorbidum.

C. Propranolol.

D. Sustac-forte.

*E. Nitroglycerin.

22. A doctor has prescribed hypolipidemic drug to patient with ischaemic heart disease. It is known, that this drug predominantly decreases the level of triglycerides in the blood. What drug was prescribed to the patient?

A. Nicotinic acid.

B. Prednisolone.

C. Glybenclamide.

D. Insulin.

*E. Fenofibrate.

23. A patient with acute stenocardia attack is delivered to hospital. What drug should be administered to patient for interruption of angina pectoris attack?

A. Calcium chloride.

B. Vicasolum.

C. Heparin.

D. Furosemide.

*E. Nitroglycerin.

24. A doctor has diagnosed acute attack of stenocardia which is accompanied by tachyarrhythmia and hypertension in 60-year-old patient. It is known, that this patient also suffers from diabetes mellitus and bronchial asthma. The doctor administered intravenously some antiadrenergic drug to patient. Identify this drug.

A. Octadinum.

B. Anaprilinum.

C. Phentolamine.

D. Reserpine.

*E. Metoprolol.

25. A patient suffering from bronchial asthma began to feel chest pain. Indicate the antianginal drug which is contraindicated to this patient.

A. Isoptin (verapamil).

B. Corinfar (nifedipine).

C. Nitrosorbide.

D. Sustac.

*E. Anaprilinum.

26. A patient suffering from coronary artery disease had taken a certain drug many times a day in order to arrest stenocardia attacks. Overdose of this drug finally caused intoxication. Objectively: cyanotic skin and mucous membranes, dramatic fall in the arterial pressure, tachycardia, and respiration inhibition. Blood has increased concentration of methemoglobin. The drug that was taken by patient relates to the following group:

A. α-Adrenoceptor blockers.

B. Calcium channel blockers.

C. Myotropic spasmolytics.

D. Adenosine drugs.

*E. Organic nitrates.


^ Antiarrhythmic Drugs


1. Ventricular arrhythmia followed myocardial infarction of a patient. Cardiac rhythm was normalized by the introduction of antiarrhythmic drug with local anaesthesia effect. What drug was introduced?

A. Propranolol.

B. Anaesthesinum.

C. Verapamil.

D. Panangin.

*E. Lidocaine.

2. A 45-year-old patient has diagnosis of ciliary arrhythmia and essential hypertension. What drug is it necessary to prescribe to this patient for prevention of arrhythmia attacks?

A. Lidocaine.

B. Sustac-forte.

C. Potassium chloride.

D. Strophantin.

*E. Propranolol.

3. A 55-year-old patient with continuing ventricular arrhythmias was admitted to the hospital. The patient is taking timolol drops for glaucoma, daily insulin injections for diabetes mellitus, and ACE inhibitor for hypertension. You decide to use phenytoin instead of procainamide. What is the reason?

A. Cholinergic effect of procainamide would aggravate diabetes.

B. Local anaesthetic effect of procainamide would aggravate the hypertension.

C. Local anaesthetic effect of procainamide would potentiate diabetes.

D. Hypertensive effect of procainamide would aggravate hypertension.

*E. Anticholinergic effect of procainamide would aggravate glaucoma.

4. In patient with attacks of paroxysmal atrial tachycardia, an ideal prophylactic drug is:

A. Adenosine.

B. Procainamide.

C. Lidocaine.

D. Nifedipine.

*E. Verapamil.

5. Which of the following is an antiarrhythmic agent that has relatively few electrophysiologic effects on normal myocardial tissue but suppresses the arrhythmogenic tendencies of ischaemic myocardial tissues?

A. Disopyramide.

B. Procainamide.

C. Quinidine.

D. Propranolol.

*E. Lidocaine.

6. A 59-year-old male with a history of rheumatic heart disease is found to have atrial fibrillation, for which he is treated with digoxin. Treatment with digoxin converts his atrial fibrillation to a normal sinus rhythm. In which of the following decrease does this treatment most likely result?

A. Sinus node automatism.

B. Speed of the cardiac muscle shortening.

C. Duration of the refractory period.

D. Atrial maximum diastolic resting potential.

*E. Conduction speed in the atrioventricular node.

Digoxin is used in AF to slow ventricular rate, not usually AF itself. Digoxin acts to slow the speed of conduction, increase the atrial and AV nodal maximal diastolic resting membrane potential, and increase effective refractory period in the AV node, which prevents transmission of all impulses from the atria to the ventricles. It exerts these effects by acting directly on the heart and by indirectly increasing vagal activity.

7. A 62-year-old patient with chronic heart failure and atrial tachyarrhythmia takes simultaneously quinidine and digoxin. If these drugs are administered concurrently, which of the following influence does quinidine have on digoxin?

A. Ability of digoxin to inhibit the Na+,K+-stimulated ATPase is reduced.

B. Metabolism of digoxin is prevented.

C. Absorption of digoxin from the gastrointestinal tract is decreased.

D. Effect of digoxin on the atrioventricular node is antagonized.

*E. Concentration of digoxin in the plasma is increased.

8. Patients with genetically low levels of N-acetyltransferase are more prone to develop a lupus erythematosus-like syndrome with which of the following drug?

A. Lidocaine.

B. Propranolol.

C. Digoxin.

D. Captopril.

*E. Procainamide.

9. The first-line drug for treating an acute attack of reentrant supraventricular tachycardia is:

A. Edrophonium.

B. Digoxin.

C. Propranilol.

D. Mesatonum.

*E. Adenosine.

10. A 36-year-old male is seen in the emergency department with tachycardia, respiratory rate of 26 breaths per minute, and ECG evidence of arrhythmia. Intravenous bolus dose of antiarrhythmic agent is administered, and within 30 sec, he has a respiratory rate of 45 breaths per minute and complains of a burning sensation in his chest. Select the drug most likely to have caused these adverse effects.

A. Nifedipine.

B. Digoxin.

C. Dobutamine.

D. Lidocaine.

*E. Adenosine.

11. A 68-year-old female has atrial fibrillation, which is treated with antiarrhythmic agent that blocks Na+ channels. On the recent office visit, she complained of recurrent attacks of feeling faint and of experiencing an episode of loss of consciousness. ECG should mark prolongation of the QT interval. Plasma concentration of the drug was in the therapeutic range. Select the drug most likely to have caused these adverse effects.

A. Verapamil.

B. Amiodarone.

C. Bretylium.

D. Adenosine.

*E. Quinidine.

12. A 55-year-old male has recurrent ventricular arrhythmias after myocardial infarction, for which he is given an antiarrhythmic agent that blocks Na+ channels and prolongs the action potential. One year later, a blood test is positive for circulating antinuclear antibo-dies. Select the drug most likely to have caused this phenomenon.

A. Verapamil.

B. Amiodarone.

C. Adenosine.

D. Sotalol.

*E. Procainamide.

13. 24 hours after an acute myocardial infarction, a 46-year-old male is being treated with a continuous intravenous drip of antiarrhythmic drug to suppress frequent multifocal premature ventricular contractions. He develops generalized seizure activity. The seizure activity can be most readily explained by:

A. Ventricular asystole.

B. Systemic embolization.

C. Systemic hypotension.

D. Ventricular tachycardia.

*E. Lidocaine toxicity.

14. False statement concerning the use of calcium antagonists as antiarrhythmics:

A. They slow inward calcium current thereby decreasing the rate of spontaneous phase 4 depolarization in Purkinje fibers.

B. They slow conduction speed through the atrioventricular node and increases functional refractory period.

C. They are useful for slowing ventricular rate in atrial fibrillation.

D. Hypotension may be a limiting side effect.

*E. Verapamil, diltiazem, and nifedipine exert equally effective antiarrhythmic actions.

15. Although most antiarrhythmic drugs (and indeed most drugs) are chemically synthesized, some compounds that occur endogenously in humans are useful. Indicate which of the following agents occurs endogenously and is a useful antiarrhythmic agent.

A. Lidocaine.

B. Digoxin.

C. Phenitoin.

D. Quinidine.

*E. Adenosine.

16. Which of the following calcium channel blockers would most likely suppress atrial tachyarrhythmias involving the AV node?

A. Diltiazem.

B. Nifedipine.

C. Nicardipine.

D. Amlodipine.

*E. Verapamil.

17. Which of the following statements is incorrect?

*A. Lidocaine is used mainly for atrial arrhythmias.

B. Lidocaine must be given parenterally.

C. Procainamide is associated with a reversible lupus phenomenon.

D. Quinidine is active orally.

E. All antiarrhythmic drugs can suppress cardiac contractions.

18. Bronchoobstructive syndrome appeared in a patient during the treatment of ciliary arrhythmia. What antiarrhythmic drug can cause such complication?

A. Novocainamidum.

B. Ajmalin.

C. Nifedipine.

D. Verapamil.

*E. Propranolol.

19. A patient with myocardial infarction and cardiac insufficiency has ventricular arrhythmia. What antiarrhythmic agent is a drug of choice in this case?

A. Disopyramide.

B. Quinidine.

C. Verapamil.

D. Novocainamidum.

*E. Lidocaine.

20. A drug was prescribed to a 56-year-old patient who suffers from ischaemic heart disease with atrial extrasystoles. It is known, that drug blocks K+ channels, decreases the adrenergical influence upon the heart, significantly increases the duration of action potential, and dilates the coronary vessels. What drug was prescribed?

A. Lisinopril.

B. Corglycon.

C. Nitroglycerin.

D. Dobutamine.

*E Amiodarone.

21. In experiment on the heart muscle antiarrhythmic agent lowered excitability of cardiomyocytes, not influencing the action potential form. Identify this agent.

A. Amiodarone.

B. Novocainamide.

C. Verapamil.

D. Quinidine.

*E. Lidocaine.


^ Antihypertensive and Hypertensive Drugs


1. A 58-year-old female has undergone surgery for necrotic bowel. Despite having been treated with antibiotics, on postoperative day 5, she develops symptoms (fever, hypotension, tachycardia, declining urine output, and confusion) consistent with septic shock. What haemodynamic support would be helpful?

A. Antibiotic administration.

B. Dobutamine infusion.

C. Atropine administration.

D. Fluid administration.

*E. Fluid and dobutamine infusion.

2. In a hypertensive patient who is taking insulin to treat diabetes, which of the following drugs is to be used with extra caution and advice to the patient?

A. Methyldopa.

B. Prazosin.

C. Guanethidine.

D. Hydralazine.

*E. Propranolol.

3. Drugs that block catecholamine uptake process (e.g., cocaine, tricyclic antidepressants) are apt to block the antihypertensive action of which of the following drugs?

A. Diazoxide.

B. Propranolol.

C. Prazosin.

D. Hydralazine.

*E. Guanethidine.

4. Nonselective β-adrenergic blocking agent that is also a competitive antagonist at α1-adrenoceptors is:

A. Timolol.

B. Nadolol.

C. Pindolol.

D. Acebutolol.

*E. Labetalol.

5. A 35-year-old female with pheochromocytoma is treated with labetalol. Select the mechanism of labetalol action.

A. α-Adrenergic agonist.

B. α-Adrenergic antagonist.

C. β-Adrenergic agonist.

D. β-Adrenergic antagonist.

*E. Mixed α- and β-antagonist.

6. A 65-year-old male has a blood pressure of 170/105 mmHg. Which of the following would be effective in lowering this patient’s blood pressure?

A. Scopolamine.

B. Terbutaline.

C. Dobutamine.

D. Proserinum.

*E. Prazosin.

7. A 66-year-old male with a one-year history of essential hypertension has minimal response to diet and diuretic. His blood pressure is now 160/105 mmHg. The diuretic is discontinued and propranolol is given. Select the mechanism of action that is associated with propranolol.

A. β-Adrenergic agonist.

B. α-Adrenergic antagonist.

C. M-cholinergic agonist.

D. Sodium channel antagonist.

*E. β-Adrenergic antagonist.

8. A patient you are treating in the hospital has a hypertensive emergency with blood pressure of 210/140 mm Hg. Which of the following drugs would be most effective intravenously?

A. Atropine.

B. Pirilenum (pempidine).

C. Pachycarpine.

D. Scopolamine.

*E. Arfonade (trimethaphan).
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