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CARDIOVASCULAR – ANGINA1. Beneficial effects of nitrates in treatment of angina include all of the following except:a. Decreased ventricular volumeb. Decreased arterial pressurec. Decreased ejection timed. Increased collateral flowe. Reflex increase in contractility – not beneficial2. Glycerl trinitratea. Acts by effecting adenylyl cyclase – guanylyl cyclaseb. Acts by effecting nitric oxide – increase NO -> activation guanylyl cyclase -> cGMP -> dephosphorylation of myosinc. Has high oral bioavailability – low (hence SL)d. Has significant effects on cardiac muscle - SMCe. Has no effect on pulmonary vascular pressure -?3. Verapamila. Increases myocardial contractility - decreasesb. Is a positive inotrope – negative inotropec. Causes skeletal muscle weakness – Do not affect skeletal muscle b/c it uses an intracellular Ca2+ pool c.f. transmembrane influxd. Blocks active and inactive Ca2+ channels – true, intracellular side of L-typee. ?4. GTNa. Works by NO - trueb. Causes methaemoglobin – also true, but rarely of clinical significance with nitrates as even high doses are unlikely to cause this, usually from nitritesc. ?d. ?e. ?5. Regarding nitrates, they do nota. Increase collateral coronary blood flow - trueb. Demonstrate tachyphylaxis/tolerance - truec. Demonstrate physical dependence – no evidence that physical dependence results from even high dose therapeutic used. ?e. ?6. Coronary artery dilation occurs weitha. Adenosine – hypoxia -> increase in local factors including adenosine, CO2, H+, K+ -> vasodialtion (physiology!)b. High K+ - ?c. Propranolold. Enalaprile. None of the above7. With regard to verapamil, which of the following is NOT true?a. It significantly increases serum digoxin levels via a pharmacokinetic interaction - trueb. Alpha blockade contributes to peripheral vasodilation – non-specific antiadrenergic effectsc. At therapeutic levels end systolic volume is decreased – increased (undesirable effect of Ca blockers and b blockers)d. Vasospastic angina is an indication for its usee. Combination with a beta blocker may cause atrioventricular block8. Nitrates, either directly or via reflexes, cause all of the following EXCEPT:a. Tachycardiab. Decrease in contractilityc. Increase in venous capacitanced. Decrease in myocardial fibre tensione. Decrease in afterload9. With regards to calcium channel blockers, which is NOT a characteristic feature?a. They have a high first pass effectb. They are highly plasma protein boundc. They are extensively metabolizedd. They act primarily at T type voltage gated calcium channelse. They bind more effectively to channels in depolarized membranes10. Regarding calcium channel blockers:a. Verapamil blocks only activated calcium channelsb. They act from the inner side of the membrane - truec. The degree of block is unaffected by plasma concentration of calciumd. They predominantly affect the T-type calcium channels in cardiac musclee. They do not affect AV nodal conduction velocity11. Verapamila. Binds more effectively to calcium channels in depolarized membranesb. Increases the contractility of the heartc. Decreases the calcium available in skeletal muscle causing weaknessd. Lessens ankle oedema in congestive cardiac failuree. Is a weak alpha adrenergic agonist12. Verapamila. Is a positive inotropeb. ?c. inhibits activated and inactivated sodium channels - ? calcium channelsd. is a dihydropyridinee. ?13. The calcium channel blocker with the most rapid onset of action when given orally isa. Diltiazemb. Nifedipinec. Verapamild. Felodipinee. nicardipine ................
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