Question

5. A patient with chronic-stable angina begins taking metoprolol, and once blood levels reach the therapeutic range the frequency and severity of angina attacks and the need for sublingual nitroglycerin were reduced. Which of the following states the direct pharmacologic action by which the beta-blocker produced the desired effects? A. Decreased myocardial oxygen demand

B. Dilated coronary vasculature

C. Directly inhibited angiotensin II synthesis

D. Reduced total peripheral resistance

6. A patient with newly diagnosed essential hypertension starts treatment with a commonly used antihypertensive drug at a dose that is considered to be therapeutic for the vast majority of patients. Soon after starting therapy the patient experiences crushing chest discomfort. ECG changes show myocardial ischemia. Studies in the cardiac catheterization lab show episodes of coronary vasospasm, and it is likely the antihypertensive drug provoke the vasospasm. Which antihypertensive drug most likely caused the ischemia and the angina?

A. Atenolol

B. Diltiazem

C. Hydrochlorothiazide

D. Lozartan

7. A 28-year-old woman is receiving drug therapy for essential hypertension. She subsequently becomes pregnant. You realize that the drug she's been taking for her blood pressure can have serious, if not fatal, effects on the fetus. As a result, you stop the current antihypertensive drug and substitute it with another drug that is deemed to be equally effective in terms of her blood pressure, and safer for the fetus. Which of the following drugs was she most likely taking before she became pregnant?

A. Alpha-Methyldopa

B. Captopril

C. Furosemide

D. Labetalol E. Verapamil

8. The use of propranolol as an antiarrhythmic agent is contraindicated in patients with:

A. COPD

B. Asthma

C. Severe heart failure

D. A and C

E. All of the above

Answer 1

5- A - Decrease myocardial oxygen demand .

Propranolol being a non selective beta blocker decreases Heart rate , conduction velocity and contractile force. Therfore requirement for oxygen decreases which provides little benefit in the condition of angina.

6 - C - Hydrochlorothiazide .

Atenolol is cardioselective beta blocker .. has no effect on vascular beta receptors.

Diltiazem causes vasodilation due to calcium channel blockade which prevents depolarisatiom amd vasoconstriction.

Losartan by preventing the vasoconstrictory action of angiotensin brings about vasodilation.

7- Both B and C

Drugs to be avoided im preganancy are :

Sodium nitroprusside

ACE inhibhitors

Non selective beta blockers

Diuretics

8- E

Propronolol blocks bronchodilation by beta2 receptors thereby increasing airway resistance which is why it is not used in asthma and COPD (although parasympathetic tone is responsible for COPD?

And also in severe heart failure , by causing additive depression by its property of decreasing heart rate , it may lead to complete failure .