Cardiovascular Drugs Practice Questions

Q: All of the following are seen in digitalis toxicity except:

Paroxysmal atrial tachycardia with fast ventricular rate. ***Paroxysmal atrial tachycardia with fast ventricular rate*** - Digitalis toxicity typically causes **bradyarrhythmias** or **tachyarrhythmias** with AV block, leading to a slow or normal ventricular rate. - A **fast ventricular rate** in the presence of paroxysmal atrial tachycardia (PAT) suggests that the AV node is conducting impulses unimpeded, which is less likely in digitalis toxicity due to its negative dromotropic effects. *Ventricular bigeminy* - This is a **classic arrhythmia** seen in digitalis toxicity, characterized by alternating normal and premature ventricular beats. - Digitalis increases intracellular calcium and can lead to **delayed afterdepolarizations**, initiating ventricular ectopy. *Regularization of atrial fibrillation* - Digitalis can **slow AV nodal conduction** and increase ventricular refractoriness, which may lead to regularization of the ventricular response in atrial fibrillation. - While not a complete reversal of atrial fibrillation, the **ventricular rhythm becomes more regular** due to increased AV nodal block. *Bidirectional ventricular tachycardia* - This is a highly specific but **rare arrhythmia** associated with severe digitalis toxicity, characterized by alternating QRS complexes in opposite directions. - It results from enhanced automaticity and altered conduction properties in the **His-Purkinje system**.

Q: The drug of choice for prompt relief of an ongoing attack of angina precipitated by exercise or emotional stress is:

Sublingual nitroglycerin. ***Sublingual nitroglycerin*** - **Sublingual nitroglycerin** acts rapidly (within 1-3 minutes) by causing **vasodilation**, primarily of veins, which reduces **preload** and myocardial oxygen demand, providing prompt relief of anginal symptoms. - It works by releasing **nitric oxide**, leading to **smooth muscle relaxation** in blood vessels, which is critical for acute attack termination. *Propranolol* - **Propranolol** is a **beta-blocker** used for long-term prevention of angina by reducing heart rate and contractility, thereby decreasing oxygen demand. - It is **not suitable for acute relief** as its onset of action is not rapid enough to abort an ongoing anginal attack. *Verapamil* - **Verapamil** is a **calcium channel blocker** that reduces heart rate, contractility, and causes vasodilation, making it useful for angina prevention. - While it can improve oxygen supply, its onset of action is **too slow** for acute symptomatic relief of an ongoing anginal attack. *Sublingual nifedipine* - **Nifedipine** is a **dihydropyridine calcium channel blocker** predominantly used for hypertension and stable angina, primarily causing arterial vasodilation. - Sublingual nifedipine can cause a **rapid and substantial drop in blood pressure**, which can lead to reflex tachycardia and potentially worsen angina or cause adverse cardiovascular events; therefore, it is **not recommended for acute anginal relief**.

Q: Which of the following is a Rho kinase inhibitor?

Fasudil. ***Fasudil*** - **Fasudil** is a well-known and clinically used **Rho kinase inhibitor**, primarily used in Japan for the treatment of **cerebral vasospasm** after subarachnoid hemorrhage. - It works by inhibiting the phosphorylation of **myosin light chain**, leading to **vasodilation**. *Ranolazine* - **Ranolazine** is an anti-anginal drug that works by selectively inhibiting the **late sodium current (I_Na)** in cardiac myocytes. - This reduces intracellular sodium and calcium overload, thereby improving myocardial relaxation and reducing oxygen demand, but it has no direct inhibitory effect on Rho kinase. *Amiloride* - **Amiloride** is a **potassium-sparing diuretic** that directly inhibits the **epithelial sodium channel (ENaC)** in the collecting duct. - It is used to treat **hypertension** and heart failure, preventing potassium loss, and is not associated with Rho kinase inhibition. *Nicorandil* - **Nicorandil** is an anti-anginal drug with a dual mechanism, acting as both a **potassium channel opener** and a **nitrate donor**. - Its vasodilatory effects are mediated through increasing cGMP (like nitrates) and hyperpolarizing vascular smooth muscle cells (like potassium channel openers), but it is not a Rho kinase inhibitor.

Q: Atenolol is indicated in all except:

Partial heart block. ***Partial heart block*** - Beta-blockers like atenolol are **contraindicated** in patients with **partial heart block** (second- or third-degree AV block) as they can further depress AV nodal conduction, worsening the block and potentially leading to **bradycardia** or complete heart block [3]. - This adverse effect is due to their action on beta-1 adrenergic receptors in the heart, which reduces heart rate and conduction velocity [3]. *Hypertension* - Atenolol is a **beta-1 selective blocker** commonly used in the treatment of hypertension [1]. - It lowers blood pressure by reducing cardiac output and inhibiting **renin release** from the kidneys [1]. *Hypertrophic obstructive cardiomyopathy* - Beta-blockers, including atenolol, are often used in **hypertrophic obstructive cardiomyopathy (HOCM)** to reduce the **left ventricular outflow tract (LVOT)** obstruction. - They achieve this by increasing **diastolic filling time** and reducing myocardial contractility. *Classical angina* - Atenolol is effective in managing **classical angina** (stable angina) by reducing **myocardial oxygen demand** [2]. - It decreases heart rate, contractility, and blood pressure, thereby alleviating anginal symptoms [2].

Q: Which of the following medications is known to cause dysgeusia?

Captopril. ***Captopril*** - **Captopril**, an ACE inhibitor, is well-known for causing taste disturbances, specifically **dysgeusia** (altered taste sensation) or **ageusia** (loss of taste). - This side effect is thought to be related to its **sulfhydryl group** [1], which can chelate zinc, a metal crucial for normal taste perception. *Enalapril* - While also an ACE inhibitor, **enalapril** rarely causes taste disturbances compared to captopril. - It lacks the **sulfhydryl group** present in captopril, which is implicated in the mechanism of dysgeusia. *Ramipril* - **Ramipril** is another ACE inhibitor not commonly associated with dysgeusia. - Its chemical structure does not contain the **sulfhydryl group** that is linked to taste alterations. *Lisinopril* - **Lisinopril**, like enalapril and ramipril, is an ACE inhibitor that **seldom** causes dysgeusia. - The absence of the **sulfhydryl group** is a key differentiator from captopril regarding this specific side effect.

Q: Which drug is primarily associated with QT prolongation?

Quinidine. ***Quinidine*** - **Quinidine** is a Class IA antiarrhythmic drug that blocks **sodium channels** and also prolongs the **repolarization** phase of the action potential by blocking potassium channels, leading to **QT prolongation**. - Significant **QT prolongation** can predispose to **Torsades de pointes**, a polymorphic ventricular tachycardia. *Magnesium Sulfate* - **Magnesium sulfate** is used to treat **Torsades de pointes**, not cause it, as it stabilizes cardiac membranes and reduces arrhythmogenic activity. - While it can affect cardiac conduction, its primary effect is not **QT elongation** in a proarrhythmic way. *Lignocaine* - **Lignocaine** (Lidocaine) is a Class IB antiarrhythmic drug that primarily blocks **sodium channels** and **shortens** the action potential duration in some cardiac tissues. - It typically **does not cause QT prolongation** and is often used for ventricular arrhythmias without significant risk of Torsades de pointes. *Amiodarone* - **Amiodarone** is a Class III antiarrhythmic drug that causes **QT prolongation** by blocking potassium channels. - While it can prolong the QT interval, **Quinidine** is more classically and primarily associated with this effect, especially in causing **Torsades de pointes** as a side effect.

Q: Which of the following is a late inward sodium channel blocker?

Ranolazine. ***Ranolazine*** - **Ranolazine** selectively inhibits the **late inward sodium current (I_Na)** in cardiac myocytes. - By reducing this current, it helps to decrease intracellular **sodium and calcium overload**, thereby improving myocardial relaxation and reducing angina and ischemia. *Ivabradine* - **Ivabradine** is a selective **funny channel (If) inhibitor** in the sinoatrial node. - It slows down the heart rate by reducing the rate of diastolic depolarization, primarily used for **chronic stable angina** and **heart failure**. *Fasudil* - **Fasudil** is a **rho-kinase inhibitor** used primarily in Japan and China for **cerebral vasospasm** following subarachnoid hemorrhage. - It works by inhibiting the phosphorylation of myosin light chain, leading to **vasodilation**. *Trimetazidine* - **Trimetazidine** is an **anti-ischemic metabolic agent** that inhibits the enzyme 3-ketoacyl-CoA thiolase, shifting cardiac metabolism from fatty acid oxidation to glucose oxidation. - This improves myocardial glucose utilization, which is more efficient in **ischemic conditions**, thereby reducing angina symptoms.

Q: The drug mainly causing afterload reduction is:

Captopril. ***Captopril*** - Captopril is an **ACE inhibitor** that blocks the conversion of angiotensin I to angiotensin II, leading to **vasodilation** of both arteries and veins. - This vasodilation primarily reduces **systemic vascular resistance (SVR)**, thereby decreasing the **afterload** on the heart. *Digoxin* - Digoxin is a **positive inotropic** drug that increases the force of myocardial contraction. - While it can improve cardiac output, its primary effect is not afterload reduction but rather enhancing **cardiac contractility** and slowing heart rate. *Frusemide* - Frusemide is a **loop diuretic** that works by inhibiting sodium and chloride reabsorption in the loop of Henle, leading to increased urinary output. - Its main effect is **preload reduction** (by decreasing blood volume), not directly reducing afterload. *Dobutamine* - Dobutamine is a **beta-1 adrenergic agonist** that primarily increases myocardial contractility and heart rate. - It is often used to improve cardiac output in conditions like **heart failure** through enhanced inotropy, rather than primarily reducing afterload.

Q: Which of the following drugs is not typically associated with an increased risk of ischemic stroke?

Barbiturates. ***Barbiturates*** - While barbiturates can have various adverse effects due to central nervous system depression, they are **not typically associated with an increased risk of ischemic stroke**. - Their primary risks involve **respiratory depression, dependence, and overdose**, rather than thrombotic events. *Cocaine* - **Cocaine use is a significant risk factor for ischemic stroke**, particularly in younger individuals, by inducing vasoconstriction and promoting thrombus formation. - It can cause **acute hypertension**, **coronary vasospasm**, and cardiac arrhythmias, all contributing to stroke risk. *Oral contraceptives* - **Oral contraceptives, especially those with high estrogen doses**, can increase the risk of ischemic stroke by promoting a hypercoagulable state. - This risk is compounded in women who have **other risk factors** such as smoking, hypertension, or migraine with aura. *Amphetamines* - **Amphetamines are associated with an increased risk of ischemic stroke** due to their sympathomimetic effects, leading to vasoconstriction and elevated blood pressure. - They can also induce **vasculitis** and may contribute to clot formation.

Question 1

All of the following are seen in digitalis toxicity except:

Accepted Answer

Paroxysmal atrial tachycardia with fast ventricular rate

Answer

Ventricular bigeminy

Answer

Regularization of atrial fibrillation

Answer

Bidirectional ventricular tachycardia

Question 2

The drug of choice for prompt relief of an ongoing attack of angina precipitated by exercise or emotional stress is:

Accepted Answer

Sublingual nitroglycerin

Answer

Propranolol

Answer

Verapamil

Answer

Sublingual nifedipine

Question 3

Which of the following is a Rho kinase inhibitor?

Accepted Answer

Fasudil

Answer

Ranolazine

Answer

Amiloride

Answer

Nicorandil

Question 4

Atenolol is indicated in all except:

Accepted Answer

Partial heart block

Answer

Hypertension

Answer

Hypertrophic obstructive cardiomyopathy

Answer

Classical angina

Question 5

Which of the following medications is known to cause dysgeusia?

Accepted Answer

Captopril

Answer

Enalapril

Answer

Ramipril

Answer

Lisinopril

Question 6

Which drug is primarily associated with QT prolongation?

Accepted Answer

Quinidine

Answer

Magnesium Sulfate

Answer

Lignocaine

Answer

Amiodarone

Question 7

The positive inotropic effect of digitalis is due to inhibition of Na+/K+ ATPase pump in cardiac muscle cell membrane leading to:

Accepted Answer

Decreased activity of Na+/Ca++ exchanger causing decreased influx of sodium and decreased efflux of Ca++ in the sarcolemma

Answer

Increased intracellular Na+ decreasing the activity of Ca++ pump in the sarcoplasmic reticulum

Answer

Increased intracellular Na+ causing increased efflux of Na+ and increased influx of Ca++ through Na+/Ca++ exchanger in the sarcolemma

Answer

Decreased efflux of Na+ leading to less negative resting membrane potential and opening of voltage gated Ca++ channels on the T tubules

Question 8

Which of the following is a late inward sodium channel blocker?

Accepted Answer

Ranolazine

Answer

Fasudil

Answer

Ivabradine

Answer

Trimetazidine

Question 9

The drug mainly causing afterload reduction is:

Accepted Answer

Captopril

Answer

Frusemide

Answer

Digoxin

Answer

Dobutamine

Question 10

Which of the following drugs is not typically associated with an increased risk of ischemic stroke?

Accepted Answer

Barbiturates

Answer

Cocaine

Answer

Oral contraceptives

Answer

Amphetamines

Cardiovascular Drugs — MCQs

Cardiovascular Drugs — MCQs

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