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CARDIOVASCULAR – ANTIHYPERTENSIVES1. Which of the following statements regarding antihypertensives and their site of action is INCORRECT?a. Vasomotor centre – methyldopab. Beta receptors of the heart – propranololc. Alpha receptors of vessels – hydralazined. Vascular smooth muscle – nitroprussidee. Angiotensin receptors of vessels – losartan2. Hydralazinea. Dilates veins but not arterioles – arterioles >veinsb. Has low first pass metabolism – well absorbed, high FPM – 25% BAc. Works best as single therapy for hypertension – often in combinationd. In patients with ischaemic heart disease, may provoke angina or ischaemic arrythmias – due to reflex tachycardiae. Has a half life of 10-12 hours – low t? but effects last longer due to tissue binding3. Hydralazinea. classically has a biphasic response to BP controlb. should not be used in eclampsiac. causes significant postural hypotension – no, but causes reflex tachycardiad. predominantly a vasodilator - correcte. ?4. Diazoxidea. can be used in a hypertensive emergency – trueb. structurally related to thiazide – true, but has no diuretic activityc. ?d. ?e. ?5. ACE inhibitorsa. Can be used in second and third trimesters – no, cause fetal hypotension, renal failureb. Have been associated with angioedema - truec. ?d. ?e. ?6. alpha methyl-dopaa. can cause a positive Coombs testb. is a potent vasoconstrictorc. ?d. ?e. ?7. prazosina. has a half life of 18 hours – 3-4hrb. adversely affects lipid profiles – b-blockers do thisc. produces a reflex bradycardia – selective a1 blocker, so less reflex tachy than non-selectived. has a first dose hypotensive effecte. can increase CO by decreasing preload and leaving afterload unchanged – works on both resistance and capacitance8. Female patient on ACE inhibitor, which is most likely to impair hypotensive effects?a. Prostaglandin inhibitor (indomethacin)b. ?c. ?d. ?e. ?9. With respect to angiotensin converting enzyme (ACE) inhibitors:a. Decreased levels of bradykinin are associated with their useb. They cause reflex tachcardiac. There is a strong correlation between plasma renin activity and antihypertensive responsed. Concomitant use of NSAIDs may decrease the hypotensive effectse. Most ACE inhibitors are cleared by hepatic metabolism – mostly renal10. Which of the following is selective for arteriolar dilation only?a. Glyceryl trinitrateb. Nifedipinec. Prazosind. Hydralazine – arteries, not veinse. Clonidine11. With regard to sodium nitroprusside, which is not true?a. It dilates both arterial and venous vessels - trueb. Toxicity can be managed with sodium thiosulfate and hydroxycobalamin -?c. It is rapidly metabolized by the liver to cyanide and to thiocyanate – rapidly by RBCs -> cyanide, then by liver -> thiocyanated. It acts by activating guanylyl cyclase - truee. Its effects disappear within 1 to 10 minutes of discontinuing an infusion - true12. Regarding methyl-dopa, which is NOT true?a. It undergoes extensive metabolism by GIT mucosa resulting in low bioavailabilityb. It is metabolized to alpha-methylnoradrenaline in order to be activec. Its antihypdertensive effect results primarily from peripheral action – central -adrenoceptorsd. Long use is associated with a positive Coombs test and haemolytic anaemiae. Common side effects are sedation and impaired concentration13. Regarding antihypertensive medicationa. Thiazide diuretics are the drugs of choice in cases of moderate to severe hypertensionb. Losartan inhibits synthesis of angiotensin IIc. Clonidine causes a brief rise in blood pressure followed by prolonged hypotension - trued. Propranolol does not prevent reflex tachycardiae. Bioavailability of captopril may increase if taken with food14. The adverse effects of captopril includea. Hypokalaemia – hyperkalaemia (esp w/ K sparring diuretics)b. Hypoglycaemia – no, prolonged hypoglycemia in T1DM due to decr glycogenolyisc. Increased cholesterol – b-blockerd. Polycythaemia -?e. Dry cough - true15. Hydralazinea. May provoke angina through reflex sympathetic stimulation - trueb. Exerts its effect through arteriolar and venous dilation – arterioles, not veinsc. Decreases heart rate – reflex tachyd. Has high oral bioavailabilitye. Tachyphylaxis precludes intravenous use16. Inhibition of angiotensin converting enzyme results in which of the following?a. A decrease in vascular toneb. Inhibition of aldosterone releasec. Increase in plasma renin activityd. All of the abovee. None of the above17. Indications for an ACEI include all of the following EXCEPT:a. Hypertensionb. Heart failurec. Diabetic nephropathyd. Post myocardial infarcte. Angioedema18. AT2 receptor antagonists have which of the following actions?a. Inhibit increased aldosterone releaseb. Reduce K+ plasma concentrationc. Reduce Na+ plasma concentrationd. Inhibit bradykinin breakdowne. Inhibit H+ secretion19. Sodium nitroprussidea. Increases cGMP by release of nitric oxideb. Decreases vascular resistance but increases blood pressurec. Is a complex of calcium and cyanide groupsd. Is predominantly an arterodilatore. Has its onset of action in 10-15 minutes20. ACE inhibitorsa. Cause a concomitant reduction in bradykininb. Directly inhibit angiotensin receptorsc. Work predominantly by venodilationd. Can cause angioneurotic oedemae. Are only available intravenously21. Regarding diazoxide, which of the following is INCORRECT?a. Is used to treat severe hypertensionb. Acts by direct smooth muscle relaxationc. Causes salt and water retentiond. ?e. is a thiazide derivative22. Hydralazinea. Causes an abrupt but transient fall in blood pressureb. Displays a biphasic blood pressure responsec. ?d. ?e. ?23. Losartan differs from enalapril in:a. Its selective action on angiotensin type 1 receptorsb. Its enhanced effect on bradykinin metabolismc. Its prolonged half lifed. Its higher incidence of drug related angioedemae. Its increased incidence of cough24. All of the following anti-hypertensives act directly on vascular smooth muscle EXCEPT:a. Felodipineb. Nitroprussidec. Indapamided. Prazosine. Hydralazine ................
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