Chapter 11: Cardiovascular Drugs 1. Hypertension is characterized by an increase in _______. a. the systolic blood pressure b. the diastolic blood pressure c. the systolic and/or diastolic blood pressure d. the afterload and preload pressures against which the heart must pump Answer: c. the systolic and/or diastolic blood pressure Correct Feedback: Hypertension (HTN) is characterized by an increase in the systolic and/or diastolic blood pressure. a. the systolic blood pressure Incorrect Feedback: This is correct, but it is not the only correct answer. b. the diastolic blood pressure Incorrect Feedback: This is correct, but it is not the only correct answer. d. the afterload and preload pressures against which the heart must pump Incorrect Feedback: The afterload is the pressure in the arterial system against which the heart must pump and the preload is the pressure in the pulmonary circulatory system and the pressure of the left ventricle during diastole. These are different than the systolic and diastolic pressures. 2. Which class of drugs promotes the excretion of sodium and water to decrease the total blood volume and lower the blood pressure? a. ACE inhibitor drugs b. beta-blocker drugs c. bile acid sequestrant drugs d. diuretic drugs Answer: d. diuretic drugs Correct Feedback: By promoting the excretion of sodium and water in the urine, diuretic drugs decrease the total blood volume, which lowers the blood pressure. a. ACE inhibitor drugs Incorrect Feedback: ACE inhibitor drugs lower the blood pressure by inhibiting angiotensin-converting enzyme, not sodium and water. b. beta-blocker drugs Incorrect Feedback: Beta-blocker drugs lower the blood pressure by blocking the action of epinephrine, not sodium and water. c. bile acid sequestrant drugs Incorrect Feedback: Bile acid sequestrant drugs are not used to lower the blood pressure. 3. Which category of drugs blocks the action of epinephrine at beta1 receptors in the heart and beta2 receptors in the blood vessels? a. aldosterone receptor inhibitor drugs b. angiotensin II receptor blocker drugs c. cardioselective beta-blocker drugs d. renin inhibitor drugs Answer: c. cardioselective beta-blocker drugs Correct Feedback: Cardioselective beta-blocker drugs block only beta1 receptors in the heart and beta2 receptors in the blood vessels (but not in the bronchi). a. aldosterone receptor inhibitor drugs Incorrect Feedback: Aldosterone receptor inhibitor drugs block the action of aldosterone, not beta receptors. b. angiotensin II receptor blocker drugs Incorrect Feedback: Angiotensin II receptor blocker drugs keep angiotensin II from activating a receptor, but have nothing to do with beta receptors. d. renin inhibitor drugs Incorrect Feedback: Renin inhibitor drugs block renin from being produced, but have nothing to do with beta receptors. 4. If serum cholesterol levels are too high, bile acid sequestrant drugs ________. a. bind with receptors in the liver so that cholesterol is not formed b. bind with bile to form an insoluble complex that is excreted in the feces c. change bile so that the cholesterol in it can be excreted by the kidneys d. inhibit cholesterol formation so that none is formed into bile in the gallbladder Answer: b. bind with bile to form an insoluble complex that is excreted in the feces Correct Feedback: If serum cholesterol levels are elevated, bile acid sequestrant drugs are given orally; they bind with bile, forming an insoluble complex that is excreted in the feces, taking the cholesterol with it. a. bind with receptors in the liver so that cholesterol is not formed Incorrect Feedback: Bile acid sequestrant drugs do not keep bile from being formed. c. change bile so that the cholesterol in it can be excreted by the kidneys Incorrect Feedback: Cholesterol is not excreted by the kidneys. d. inhibit cholesterol formation so that none is formed into bile in the gallbladder Incorrect Feedback: Bile acid sequestrant drugs do not inhibit cholesterol formation. 5. Nitrate drugs ________. a. constrict the coronary arteries and decrease the flow of oxygenated blood to the myocardium b. constrict the coronary arteries and increase the flow of oxygenated blood to the myocardium c. dilate the coronary arteries and decrease the flow of oxygenated blood to the myocardium d. dilate the coronary arteries and increase the flow of oxygenated blood to the myocardium Answer: d. dilate the coronary arteries and increase the flow of oxygenated blood to the myocardium Correct Feedback: Nitrate drugs dilate the coronary arteries and increase the flow of oxygenated blood to the myocardium. a. constrict the coronary arteries and decrease the flow of oxygenated blood to the myocardium Incorrect Feedback: Nitrate drugs do not constrict the coronary arteries. b. constrict the coronary arteries and increase the flow of oxygenated blood to the myocardium Incorrect Feedback: Nitrate drugs do not constrict the coronary arteries. c. dilate the coronary arteries and decrease the flow of oxygenated blood to the myocardium Incorrect Feedback: Nitrate drugs do dilate the coronary arteries but this does not decrease the flow of oxygenated blood to the myocardium. 6. To decrease the pain of angina pectoris, beta-blocker drugs ________. a. decrease the heart rate, which decreases the myocardium’s need for oxygen b. decrease the heart rate, which increases the myocardium’s need for oxygen c. increase the heart rate, which decreases the myocardium’s need for oxygen d. increase the heart rate, which increases the myocardium’s need for oxygen Answer: a. decrease the heart rate, which decreases the myocardium’s need for oxygen Correct Feedback: Beta-blocker drugs decrease the heart rate, which decreases the need of the myocardium for oxygen and this decreases the pain of angina. b. decrease the heart rate, which increases the myocardium’s need for oxygen Incorrect Feedback: Decreasing the heart rate does not increase the myocardium’s need for oxygen. c. increase the heart rate, which decreases the myocardium’s need for oxygen Incorrect Feedback: Beta-blocker drugs do not increase the heart rate. d. increase the heart rate, which increases the myocardium’s need for oxygen Incorrect Feedback: Beta-blocker drugs do not increase the heart rate. 7. When the drug atropine is used to treat bradycardia, its action is to ________. a. block acetylcholine receptors in the heart so that the heart rate decreases b. block acetylcholine receptors in the heart so that the heart rate increases c. stimulate acetylcholine receptors in the heart so that the heart rate decreases d. stimulate acetylcholine receptors in the heart and the heart rate increases. Answer: b. block acetylcholine receptors in the heart so that the heart rate increases Correct Feedback: Normally, the vagus nerve (of the parasympathetic division of the nervous system) releases the neurotransmitter acetylcholine to keep the heart in a slow, normal rhythm. The drug atropine blocks acetylcholine receptors in the heart, and the heart rate increases. a. block acetylcholine receptors in the heart so that the heart rate decreases Incorrect Feedback: Atropine does not cause the heart rate to decrease. c. stimulate acetylcholine receptors in the heart so that the heart rate decreases Incorrect Feedback: Atropine does not stimulate acetylcholine receptors. d. stimulate acetylcholine receptors in the heart and the heart rate increases. Incorrect Feedback: Atropine does not stimulate acetylcholine receptors. 8. Beta-blocker drugs used to treat hypertension or tachycardia block beta receptors in the heart and keep them from responding to ________. a. acetylcholine b. angiotensin c. epinephrine d. prostaglandins Answer: c. epinephrine Correct Feedback: Beta-blocker drugs block the action of epinephrine at all beta receptors to decrease the heart rate and dilate the blood vessels. Both of these actions lower the blood pressure. Beta-blocker drugs block beta receptors in the heart from responding to epinephrine. a. acetylcholine Incorrect Feedback: Beta-blocker drugs do not keep the heart from responding to acetylcholine. b. angiotensin Incorrect Feedback: Beta-blocker drugs do not keep the heart from responding to angiotensin. d. prostaglandins Incorrect Feedback: Beta-blocker drugs do not keep the heart from responding to prostaglandins. 9. ________ drugs are used to treat diseases such as arteriosclerosis obliterans, Buerger’s disease, Raynaud’s disease, and diabetic peripheral vascular insufficiency. a. Antiarrhythmic b. Diuretic c. Peripheral vasodilator d. Thrombolytic Answer: c. Peripheral vasodilator Correct Feedback: Peripheral vasodilator drugs are used to increase peripheral blood flow to treat diseases such as arteriosclerosis obliterans, Buerger’s disease, Raynaud’s disease, and diabetic peripheral vascular insufficiency. a. Antiarrhythmic Incorrect Feedback: Antiarrhythmic drugs are used to treat arrhythmias, not these diseases. b. Diuretic Incorrect Feedback: Diuretic drugs are used to treat hypertension, not these diseases. d. Thrombolytic Incorrect Feedback: Thrombolytic drugs are used to treat thrombi, not these diseases. 10. Calcium channel blocker drugs block the movement of calcium ions into the heart muscle and smooth muscles in the blood vessels. This results in all of the following actions, EXCEPT ________. a. decreasing the heart rate b. dilating the arteries c. lowering the blood pressure d. lowering the cholesterol level Answer: d. lowering the cholesterol level Correct Feedback: Calcium channel blocker drugs have no effect on the cholesterol level. Blocking the movement of calcium ions into the heart muscle and smooth muscles in the blood vessels decreases the heart rate, dilates the arteries, and lowers the blood pressure. a. decreasing the heart rate Incorrect Feedback: Blocking the movement of calcium ions does decrease the heart rate. b. dilating the arteries Incorrect Feedback: Blocking the movement of calcium ions does dilate the arteries. c. lowering the blood pressure Incorrect Feedback: Blocking the movement of calcium ions does lower blood pressure. 11. The beta-blocker drug propranolol is used to treat all of the following conditions EXCEPT ________. a. atrial flutter/fibrillation b. hypertensive crisis c. tremors of Parkinson’s disease d. migraine headaches Answer: b. hypertensive crisis Correct Feedback: Propranolol (Inderal) is also indicated for angina pectoris, ventricular tachycardia, atrial flutter/fibrillation, myocardial infarction, as well as for migraine headaches, performance anxiety, and the tremors of Parkinson’s disease and familial tremors. a. atrial flutter/fibrillation Incorrect Feedback: Propranolol is used to treat atrial flutter/fibrillation. c. tremors of Parkinson’s disease Incorrect Feedback: Propranolol is used to treat tremors of Parkinson’s disease. d. migraine headaches Incorrect Feedback: Propranolol is used to treat migraine headaches. 12. All of these substances are part of the body’s own natural blood pressure-regulating system EXCEPT ________. a. angiotensin I b. renin c. triglycerides d. angiotensin II Answer: c. triglycerides Correct Feedback: The body has its own natural blood pressure-regulating system. In response to low blood pressure, the kidneys secrete renin, which then helps to produce angiotensin I. Angiotensin I is a relatively inactive substance, but when acted upon by angiotensin-converting enzyme (ACE), it becomes angiotensin II, a strong vasoconstrictor that raises the blood pressure. a. angiotensin I Incorrect Feedback: Angiotensin I is part of the body’s own natural blood pressure-regulating system. b. renin Incorrect Feedback: Renin is part of the body’s own natural blood pressureregulating system. d. angiotensin II Incorrect Feedback: Angiotensin II is part of the body’s own natural blood pressure-regulating system. 13. James Raucher has had asthma since he was a child. When he turned 60, he also developed hypertension. His physician prescribed a cardioselective beta-blocker drug to treat his hypertension because cardioselective beta-blocker drugs ________. a. are the best choice for older adults with hypertension b. are less likely to cause an allergic reaction than other beta-blocker drugs c. are more effective than other beta-blocker drugs for treating hypertension d. are better than other beta-blocker drugs in keeping the bronchi open Answer: d. are better than other beta-blocker drugs in keeping the bronchi open Correct Feedback: Cardioselective beta-blocker drugs block the action of epinephrine at beta1 receptors in the heart and beta2 receptors in the blood vessels. They do not block the action of beta2 receptors in the bronchi, so the bronchi remain dilated. Hypertensive patients with asthma are treated with cardioselective beta-blocker drugs because they allow the bronchi to remain open. a. are the best choice for older adults with hypertension Incorrect Feedback: Cardioselective beta-blocker drugs can be given to any person with hypertension, regardless of the age. b. are less likely to cause an allergic reaction than other beta-blocker drugs Incorrect Feedback: Cardioselective beta-blocker drugs are no more likely to cause an allergic reaction than other beta-blocker drugs. c. are more effective than other beta-blocker drugs for treating hypertension Incorrect Feedback: Cardioselective beta-blocker drugs are not more effective in treating hypertension than other beta-blocker drugs. 14. Which of the following statements is FALSE? a. Congestive heart failure was first treated with dried foxglove plant. b. The Latin name of foxglove is Digitalis lantana because the flowers resembled digits or fingers. c. The three trade names of digoxin are Digitek, Lanoxicaps, and Lanoxin. d. The drug digoxin is the only digitalis drug that remains on the market. Answer: c. The three trade names of digoxin are Digitek, Lanoxicaps, and Lanoxin. Correct Feedback: In the past, the dried foxglove plant was used to treat congestive heart failure. This plant was given the Latin name Digitalis lanata because its flowers resembled digits or fingers, and the drug derived from it was called digitalis. The modern drug digoxin (Digitek, Lanoxicaps, Lanoxin) is the only digitalis drug that remains on the market. a. Congestive heart failure was first treated with dried foxglove plant. Incorrect Feedback: This statement is true. b. The Latin name of foxglove is Digitalis lantana because the flowers resembled digits or fingers. Incorrect Feedback: This statement is true. d. The drug digoxin is the only digitalis drug that remains on the market. Incorrect Feedback: This statement is true. 15. The suffix ______ is common to many generic beta-blocker drugs. a. –azosin b. –dipine c. –olol d. –ine Answer: c. –olol Correct Feedback: The suffix –olol is common to many generic beta-blocker drugs. The suffix –azosin is common to generic alpha-blocker drugs. The suffix – dipine is common to some generic calcium channel blocker drugs. The suffix –ine means pertaining to and is not common to any generic drugs. a. –azosin Incorrect Feedback: The suffix –azosin is not common to generic beta-blocker drugs. b. –dipine Incorrect Feedback: The suffix –dipine is not common to generic beta-blocker drugs. d. –ine Incorrect Feedback: The suffix –ine is not common to generic beta-blocker drugs. 16. Which of the following is a digitalis drug used to treat congestive heart failure? a. digoxin (Digitek, Lanoxicaps, Lanoxin) b. nadolol (Corgard) c. digoxin immune Fab (Digibind, Digidote) d. valsartan (Diovan) Answer: a. digoxin (Digitek, Lanoxicaps, Lanoxin) Correct Feedback: Digoxin (Digitek, Lanoxicaps, Lanoxin) is a digitalis drug is used to treat congestive heart failure. b. nadolol (Corgard) Incorrect Feedback: Nadolol (Corgard) is not a digitalis drug. c. digoxin immune Fab (Digibind, Digidote) Incorrect Feedback: Digoxin immune Fab (Digibind, Digidote) is not a digitalis drug. d. valsartan (Diovan) Incorrect Feedback: Valsartan (Diovan) is not a digitalis drug. 17. What is the trade name of the generic beta-blocker drug propranolol? a. Xylocaine b. Mavik c. Inderal d. Tenormin Answer: c. Inderal Correct Feedback: Beta-blocker drugs for hypertension include propranolol (Inderal). a. Xylocaine Incorrect Feedback: Xylocaine is not the trade name of propranolol. b. Mavik Incorrect Feedback: Mavik is not the trade name of propranolol. d. Tenormin Incorrect Feedback: Tenormin is not the trade name of propranolol. 18. The drug used to treat congestive heart failure is ________. a. foxglove b. nitroglycerin c. digoxin d. herbs Answer: c. digoxin Correct Feedback: Digoxin (Digitek, Lanoxicaps, Lanoxin) is a digitalis drug is used to treat congestive heart failure. a. foxglove Incorrect Feedback: Foxglove is a plant, not a drug. b. nitroglycerin Incorrect Feedback: Nitroglycerin is not used to treat congestive heart failure. d. herbs Incorrect Feedback: Herbs are not used to treat congestive heart failure. 19. All of the following are calcium channel blocker drugs EXCEPT_______. a. Xylocaine b. Procardia c. Cardizem d. Calan Answer: a. Xylocaine Correct Feedback: The antiarrhythmic drug lidocaine (Xylocaine) is used to treat ventricular fibrillation and is also a topical anesthetic drug. It inhibits the flow of sodium, rather than calcium, into nerve cells. b. Procardia Incorrect Feedback: Procardia is a calcium channel blocker drug. c. Cardizem Incorrect Feedback: Cardizem is a calcium channel blocker drug. d. Calan Incorrect Feedback: Calan is a calcium channel blocker drug. 20. The step-care approach to treating hypertension involves the initial prescribing of what category of drugs? a. beta-blocker drugs b. diuretic drugs c. ACE inhibitor drugs d. antiarrhythmic drugs Answer: b. diuretic drugs Correct Feedback: The treatment of hypertension follows what is known as a stepped-care approach. Lifestyle changes are suggested first: Patients are asked to restrict the use of salt in cooking and at the table, or the physician may prescribe a low-salt diet to limit the total dietary sodium intake. In addition, the patient may be asked to lose weight, exercise, and stop smoking. If these measures cannot control the blood pressure, drugs are added to the treatment regimen. Often a diuretic drug is prescribed first. a. beta-blocker drugs Incorrect Feedback: Beta-blocker drugs are used to treat hypertension, but they are not the first category of drugs prescribed in the step-care approach. c. ACE inhibitor drugs Incorrect Feedback: ACE inhibitor drugs are used to treat hypertension, but they are not the first category of drugs prescribed in the step-care approach. d. antiarrhythmic drugs Incorrect Feedback: Antiarrhythmic drugs are used to treat cardiac arrhythmias, not hypertension. 21. All of the following are used to treat an elevated level of cholesterol EXCEPT ________. a. Lipitor b. Lopid c. Lanoxin d. Crestor Answer: c. Lanoxin Correct Feedback: Digoxin (Digitek, Lanoxicaps, Lanoxin) is used to treat congestive heart failure. a. Lipitor Incorrect Feedback: Lipitor is used to treat elevated level of cholesterol. b. Lopid Incorrect Feedback: Lopid is used to treat an elevated level of cholesterol. d. Crestor Incorrect Feedback: Crestor is used to treat an elevated level of cholesterol. 22. The trade names for nitroglycerin include all of the following EXCEPT ________. a. Zocor b. Nitro-Bid c. Transderm-Nitro d. Nitrostat Answer: a. Zocor Correct Feedback: Simvastatin (Zocor) is a statin drug used to treat hypercholesterolemia. Trade names for nitroglycerin include Minitran, Nitro-Dur, Nitrostat. b. Nitro-Bid Incorrect Feedback: Nitro-Bid is a trade name for nitroglycerin. c. Transderm-Nitro Incorrect Feedback: Transderm-Nitro is a trade name for nitroglycerin. d. Nitrostat Incorrect Feedback: Nitrostat is a trade name for nitroglycerin. 23. High levels of cholesterol in the blood can be due to ________. a. a genetic disorder Incorrect Feedback: This is true, but it is not the only correct answer. b. eating foods high in cholesterol Incorrect Feedback: This is true, but it is not the only correct answer. c. dietary intake of egg yolks, bacon, cream, and lard Incorrect Feedback: This is true, but it is not the only correct answer. d. all of the above Answer: d. all of the above Correct Feedback: Excess dietary intake of cholesterol can cause elevated serum cholesterol levels. Dietary sources of cholesterol include foods of animal origin, such as meats, egg yolks, bacon, shrimp, cream, lard, and so forth. Some patients develop extremely high serum cholesterol levels, not because of excess dietary intake, but because they have a genetic disorder with too few receptors on the cell membranes for cholesterol to bind to, and so cholesterol levels in the blood remain high. a. a genetic disorder Incorrect Feedback: This is true, but it is not the only correct answer. b. eating foods high in cholesterol Incorrect Feedback: This is true, but it is not the only correct answer. c. dietary intake of egg yolks, bacon, cream, and lard Incorrect Feedback: This is true, but it is not the only correct answer. 24. Nitroglycerin is available in all of the following drug forms EXCEPT ________. a. ointment b. sublingual tablet c. intramuscular injection d. transdermal patch Answer: c. intramuscular injection Correct Feedback: Nitrate drugs can be administered in several different ways (sublingually as a tablet, translingually as a spray, inhaled as vapors through the nose, orally as a sustained-release capsule or tablet, transdermally as a patch, topically as an ointment that is measured in inches, or intravenously). a. ointment Incorrect Feedback: Nitroglycerin is available as an ointment. b. sublingual tablet Incorrect Feedback: Nitroglycerin is available as a sublingual tablet. d. transdermal patch Incorrect Feedback: Nitroglycerin is available as a transdermal patch. 25. All of the following are beta-blocker drugs EXCEPT ________. a. betaxolol (Kerlone) b. bisoprolol (Zebeta) c. metoprolol (Lopressor, Toprol-XL) d. hydralazine (Apresoline) Answer: d. hydralazine (Apresoline) Correct Feedback: Hydralazine (Apresoline) is a peripheral vasodilator drug used to treat hypertension. The other drugs are beta-blocker drugs as seen by the suffix –olol which is common to generic name beta-blocker drugs. a. betaxolol (Kerlone) Incorrect Feedback: Betaxolol (Kerlone) is a beta-blocker drug. b. bisoprolol (Zebeta) Incorrect Feedback: Bisoprolol (Zebeta) is a beta-blocker drug. c. metoprolol (Lopressor, Toprol-XL) Incorrect Feedback: Metoprolol (Lopressor, Toprol-XL) is a beta-blocker drug. 26. Elevated levels of triglycerides can be caused by all of the following EXCEPT ________. a. excessive dietary intake of sugar b. excessive dietary intake of meat c. excessive dietary intake of oils and margarine d. all of the above Answer: b. excessive dietary intake of meat Correct Feedback: Meat is a source of cholesterol, not triglycerides. Excess dietary intake of nonanimal fats can result in excessive storage of fat in the body and high triglyceride levels in the blood. Dietary sources of triglycerides include oils and margarine. Also of interest is that excess dietary intake of sugar is converted into triglycerides. a. excessive dietary intake of sugar Incorrect Feedback: Excessive dietary intake of sugar can cause elevated triglycerides. c. excessive dietary intake of oils and margarine Incorrect Feedback: Excessive dietary intake of oils and margarine can cause elevated triglycerides. d. all of the above Incorrect Feedback: Only one of the answers is correct. 27. The trade name for the antiarrhythmic generic drug lidocaine is ____. a. Xylocaine b. Lipitor c. Tekturna d. Inderal Answer: a. Xylocaine Correct Feedback: Drugs used to treat ventricular fibrillation include lidocaine (Xylocaine). b. Lipitor Incorrect Feedback: Lipitor is the trade name for the generic drug atorvastatin. c. Tekturna Incorrect Feedback: Tekturna is the trade name for the generic drug aliskiren. d. Inderal Incorrect Feedback: Inderal is the trade name for the generic drug propranolol. 28. Which of the following drugs is not an ACE inhibitor drug used to treat hypertension? a. benazepril (Lotensin) b. telmisartan (Micardis) c. lisinopril (Prinivil, Zestril) d. captopril (Capoten) Answer: b. telmisartan (Micardis) Correct Feedback: Telmisartan (Micardis) is used to treat hypertension, but it is an angiotensin II receptor blocker drug, not an ACE inhibitor drug. The other drugs are all ACE inhibitor drugs as shown by the suffix –pril on the generic name drug. a. benazepril (Lotensin) Incorrect Feedback: Benazepril (Lotensin) is an ACE inhibitor drug. c. lisinopril (Prinivil, Zestril) Incorrect Feedback: Lisinopril (Prinivil, Zestril) is an ACE inhibitor drug. d. captopril (Capoten) Incorrect Feedback: Captopril (Capoten) is an ACE inhibitor drug. 29. Types of cardiac arrhythmias include all of the following EXCEPT ________. a. hyperlipidemia b. bradycardia c. atrial flutter or fibrillation d. asystole Answer: a. hyperlipidemia Correct Feedback: Hyperlipidemia is a condition of increased levels of cholesterol or triglycerides in the blood. Arrhythmias include bradycardia (abnormally slow heart rate), heart block, tachycardia (abnormally fast heart rate), atrial flutter and fibrillation (very rapid contractions of the atria that are not coordinated with the ventricles), ventricular flutter (very rapid contractions of the ventricles), ventricular fibrillation (ineffective, extremely rapid twitching of the ventricle), or asystole (no heart contractions). b. bradycardia Incorrect Feedback: Bradycardia is a cardiac arrhythmia. c. atrial flutter or fibrillation Incorrect Feedback: Atrial flutter or fibrillation is a cardiac arrhythmia. d. asystole Incorrect Feedback: Asystole is a cardiac arrhythmia in which there are no heart contractions. 30. Which of the following statements is TRUE concerning digitalis drugs? a. They have a positive inotropic effect. b. They have a negative chronotropic effect. c. They contain chains of glucose molecules. d. All of the above are true. Answer: d. All of the above are true. Correct Feedback: Digitalis drugs are also known as cardiac glycoside drugs because they have a molecular structure that consists of chains of glucose sugars known as glycosides and they are used to treat the heart (cardiac). Digitalis drugs cause the release of acetylcholine, a neurotransmitter that depresses the SA node in the heart; this slows the electrical conduction and the heart rate. This action is known as a negative chronotropic effect (Chron/o- means time). Digitalis drugs also inhibit the flow of positive sodium ions into the cell; instead, positive calcium ions flow in and this results in a stronger, more forceful contraction of the myocardial cells. This action is known as a positive inotropic effect. a. They have a positive inotropic effect. Incorrect Feedback: This is true, but it is not the only correct answer. b. They have a negative chronotropic effect. Incorrect Feedback: This is true, but it is not the only correct answer. c. They contain chains of glucose molecules. Incorrect Feedback: This is true, but it is not the only correct answer. 31. Symptoms of digitalis toxicity include all of the following EXCEPT _________. a. pulse rate below 60 beats per minute b. myocardial infarction c. nausea, vomiting, and diarrhea d. hallucinations or yellow-green halos around lights Answer: b. myocardial infarction Correct Feedback: Myocardial infarction is cellular death in the heart muscle; it is not related to digitalis toxicity. Symptoms of toxicity include a pulse rate below 60 beats per minute, confusion, restlessness, nausea and vomiting, diarrhea, hallucinations, or seeing yellow-green halos around lights. a. pulse rate below 60 beats per minute Incorrect Feedback: This is a symptom of digitalis toxicity. c. nausea, vomiting, and diarrhea Incorrect Feedback: This is a symptom of digitalis toxicity. d. hallucinations or yellow-green halos around lights Incorrect Feedback: This is a symptom of digitalis toxicity. 32. All of the following are used to treat an elevated level of cholesterol EXCEPT ________. a. Zocor b. Zetia c. Lopressor d. WelChol Answer: c. Lopressor Correct Feedback: Lopressor is a cardioselective beta-blocker drug used to treat hypertension. Zocor is a HMG-CoA reductase inhibitor drug used to treat hypercholesterolemia. Zetia is used to treat hypercholesterolemia and hypertriglyceridemia. WelChol is a bile acid sequestrant drug used to treat hypercholesterolemia. a. Zocor Incorrect Feedback: Zocor is used to treat an elevated level of cholesterol. b. Zetia Incorrect Feedback: Zetia is used to treat an elevated level of cholesterol. d. WelChol Incorrect Feedback: WelChol is used to treat an elevated level of cholesterol. 33. Which of the following drugs is NOT a calcium channel blocker drug used to treat hypertension? a. amlodipine (Norvasc) b. nifedipine (Adalat CC, Procardia) c. isradipine (DynaCirc) d. prazosin (Minipress) Answer: d. prazosin (Minipress) Correct Feedback: Prazosin (Minipress) is used to treat hypertension, but it is an alpha-blocker drug (as seen by its suffix –azosin), not a calcium channel blocker drug. The other drugs have the suffix –dipine which is common to generic calcium channel blocker drugs. a. amlodipine (Norvasc) Incorrect Feedback: Amlodipine (Norvasc) is a calcium channel blocker drug. b. nifedipine (Adalat CC, Procardia) Incorrect Feedback: Nifedipine (Adalat CC, Procardia) is a calcium channel blocker drug. c. isradipine (DynaCirc) Incorrect Feedback: Isradipine (DynaCirc) is a calcium channel blocker drug. 34. How are symptoms of digitalis toxicity treated? a. by changing the dose to a less frequent schedule b. by decreasing the dose c. by administering a drug that inactivates digitalis. d. all of the above Answer: d. all of the above Correct Feedback: Symptoms of digitalis toxicity may be treated in one of three ways: (1) decreasing the dose of the digitalis drug, (2) giving the digitalis drug less frequently, or, in severe cases, (3) administering an antidote drug to reverse the toxic effects of the digitalis drug. a. by changing the dose to a less frequent schedule Incorrect Feedback: This is true, but it is not the only correct answer. b. by decreasing the dose Incorrect Feedback: This is true, but it is not the only correct answer. c. by administering a drug that inactivates digitalis. Incorrect Feedback: This is true, but it is not the only correct answer. 35. _______ drugs are also known as statin drugs. a. digitalis b. calcium channel blocker c. beta-blocker d. HMG-CoA reductase inhibitor Answer: d. HMG-CoA reductase inhibitor Correct Feedback: HMG-CoA reductase inhibitor drugs. These drugs are also known as statin drugs because their generic drug names end in the suffix –statin a. digitalis Incorrect Answer: Digitalis drugs are not known as statin drugs. b. calcium channel blocker Incorrect Feedback: Calcium channel blocker drugs are not known as statin drugs. c. beta-blocker Incorrect Feedback: Beta-blocker drugs are not known as statin drugs. 36. Drugs used to treat angina pectoris include all of the following EXCEPT ________. a. antiarrhythmic drugs b. nitrate drugs c. beta-blocker drugs d. calcium channel blocker drugs Answer: a. antiarrhythmic drugs Correct Feedback: Antiarrhythmic drugs are used to treat cardiac arrhythmias. Drugs used to treat angina pectoris include nitrate drugs, beta-blocker drugs, calcium channel blocker drugs, and other drugs. b. nitrate drugs Incorrect Feedback: Nitrate drugs are used to treat angina pectoris. c. beta-blocker drugs Incorrect Feedback: Beta-blocker drugs are used to treat angina pectoris. d. calcium channel blocker drugs Incorrect Feedback: Calcium channel blocker drugs are used to treat angina pectoris. 37. Suzi Choi is a professional golfer. She takes a beta-blocker drug to help ease the performance anxiety she feels when she has to play in front of large crowds or in a televised golf tournament. The beta-blocker drug relieves all of the following symptoms EXCEPT ________. a. arrhythmias b. cold extremities c. inability to concentrate d. tremors Answer: a. arrhythmias Correct Feedback: Several beta-blocker drugs are prescribed to treat performance anxiety (stage fright). Some professional musicians, actors, and even professional golfers use beta-blocker drugs to block the effect of excess epinephrine (dry mouth, tremors, cold extremities, GI upset, inability to concentrate) that impairs their ability to perform. Beta-blocker drugs are used to treat diagnosed arrhythmias, but arrhythmia is not an effect of epinephrine and is not part of performance anxiety. b. cold extremities Incorrect Feedback: Beta-blocker drugs do relieve cold extremities caused by performance anxiety. c. inability to concentrate Incorrect Feedback: Beta-blocker drugs do relieve an inability to concentrate caused by performance anxiety. d. tremors Incorrect Feedback: Beta-blocker drugs do relieve tremors caused by performance anxiety. 38. Very low-density lipoproteins carry _________ in the blood. a. triglycerides b. sodium c. monoclonal antibodies d. cholesterol Answer: a. triglycerides Correct Feedback: Caduet (amlodipine, atorvastatin) is a combination drug contains a calcium channel blocker drug (amlodipine) to treat hypertension and an HMG-CoA reductase inhibitor drug (atorvastatin) to lower serum cholesterol levels. b. sodium Incorrect Feedback: Very low-density lipoproteins do not carry sodium in the blood. c. monoclonal antibodies Incorrect Feedback: Very low-density lipoproteins do not carry monoclonal antibodies. d. cholesterol Incorrect Feedback: Very low-density lipoproteins do not carry cholesterol in the blood. 39. Which of the following is a combination drug that contains a calcium channel blocker drug to treat hypertension and a drug to lower the serum cholesterol level? a. Lopid b. Nitro-Dur c. Caduet d. Rythmol Answer: c. Caduet Correct Feedback: Very low-density lipoproteins (VLDLs) carry triglycerides in the blood. a. Lopid Incorrect Feedback: Lopid is not a combination drug. b. Nitro-Dur Incorrect Feedback: Nitro-Dur is not a combination drug. d. Rythmol Incorrect Feedback: Rythmol is not a combination drug. 40. All of the following categories of drugs are used to treat congestive heart failure EXCEPT ________. a. digitalis drugs b. ACE inhibitor drugs c. statin drugs d. angiotensin II receptor blocker drugs Answer: c. statin drugs Correct Feedback: Statin drugs are another name for HMG-CoA reductase inhibitor drugs that are used to treat hypercholesterolemia. Drugs used to treat congestive heart failure include digitalis drugs, ACE inhibitor drugs, and angiotensin II receptor blocker drugs. a. digitalis drugs Incorrect Feedback: Digitalis drugs are used to treat congestive heart failure. b. ACE inhibitor drugs Incorrect Feedback: ACE inhibitor drugs are used to treat congestive heart failure. d. angiotensin II receptor blocker drugs Incorrect Feedback: Angiotensin II receptor blocker drugs are used to treat congestive heart failure. 41. Which of the following statements is FALSE concerning drugs used to treat digitalis toxicity? a. Digoxin immune Fab (Digibind, Digidote) is given intravenously to treat digitalis toxicity. b. Bile acid sequestrant drugs bind with bile and cause it to be excreted in the feces. c. Bile acid sequestrant drugs are used to treat digitalis toxicity and to decrease the level of cholesterol in the blood. d. Digitalis toxicity occurs mostly in elderly patients with normal kidney function. Answer: d. Digitalis toxicity occurs mostly in elderly patients with normal kidney function. Correct Feedback: Nearly one-third of patients taking a digitalis drug develop symptoms of digitalis toxicity and the long half-life of digitalis is even more prolonged in elderly patients with decreased kidney function. Bile acid sequestrant drugs (cholestyramine, colestipol) bind with digitalis in the intestines and cause it to be excreted in the feces. The other use of bile acid sequestrant drugs is to decrease the serum cholesterol level. Digoxin immune Fab is an antibody drug that is given intravenously. a. Digoxin immune Fab (Digibind, Digidote) is given intravenously to treat digitalis toxicity. Incorrect Feedback: This is a true statement. b. Bile acid sequestrant drugs bind with bile and cause it to be excreted in the feces. Incorrect Feedback: This is a true statement. c. Bile acid sequestrant drugs are used to treat digitalis toxicity and to decrease the level of cholesterol in the blood. Incorrect Feedback: This is a true statement. 42. Hyperlipidemia is a category that encompasses both hypercholesterolemia and hypertriglyceridemia. Answer: True Feedback: Hyperlipidemia is a category that encompasses both hypercholesterolemia (increased levels of serum cholesterol) and hypertriglyceridemia (increased levels of serum triglycerides). 43. HMG-CoA reductase inhibitor drugs block HMG-CoA reductase, an enzyme that is involved in one of the steps in the production of cholesterol in the body. Answer: True Feedback: HMG-CoA reductase is an enzyme that is involved in one of the steps in the production of cholesterol in the body. HMG-CoA reductase inhibitor drugs block this enzyme. 44. High levels of HDL are undesirable, while high levels of LDL are desirable. Answer: False Feedback: High levels of HDL are desirable. High levels of LDL are undesirable. 45. By blocking an enzyme, ACE inhibitor drugs cause vasodilation and decrease the blood pressure against which the heart must pump. Answer: True Feedback: By blocking this enzyme, ACE inhibitor drugs cause vasodilation and decrease the blood pressure, the resistance against which the heart must pump. 46. In patients with angina pectoris, anticoagulant drugs are prescribed to prevent a blood clot that would cause a myocardial infarction. Answer: True Feedback: Anticoagulant drugs are used in patients with angina pectoris to prevent a blood clot that would cause a myocardial infarction. 47. Drugs that are used to treat ventricular fibrillation are also commonly used in resuscitative measures when the heart has stopped (asystole, cardiac arrest). Answer: False Feedback: Drugs used to treat ventricular fibrillation have no effect if the heart has already stopped (asystole, cardiac arrest). 48. Most beta-blocker drugs, calcium channel blocker drugs, and peripheral vasodilator drugs can be given intravenously to quickly lower the blood pressure to treat patients in hypertensive crisis. Answer: True Feedback: Most beta-blocker drugs, calcium channel blocker drugs, and peripheral vasodilator drugs can be given intravenously to quickly lower the blood pressure. 49. Digitalis drugs have a positive inotropic effect in treating congestive heart failure because they increase the strength of contraction of the heart muscle. Answer: True Feedback: Digitalis drugs also inhibit the flow of positive sodium ions into the cell; instead, positive calcium ions flow in and this results in a stronger, more forceful contraction of the myocardial cells. This action is known as a positive inotropic effect. 50. The pain of angina pectoris occurs when the heart muscle cells die because of insufficient oxygenated blood. Answer: False Feedback: The pain of angina pectoris occurs when cells of the myocardium receive insufficient oxygenated blood to meet their needs. The pain of angina pectoris denotes cellular ischemia but not cellular death of the heart muscle cells. 51. All beta receptors are stimulated by the hormone epinephrine in response to stress or danger. Answer: True Feedback: All beta receptors are stimulated by the hormone epinephrine in response to stress or danger (the so-called “fight or flight” response). 52. In 1967 when it was approved by the FDA, propranolol became the first drug in the beta-blocker category. Answer: True Feedback: Propranolol was the first drug in the beta-blocker drug category. It was approved by the FDA in 1967 for treating hypertension. 53. After a myocardial infarction, drugs can be given to limit the extent of the dead tissue and then reverse the process of cellular death. Answer: False Feedback: When myocardial cell ischemia associated with angina pectoris is not treated, it may progress to cellular death, which is known as a myocardial infarction. Once the tissue has died, this process cannot be reversed. However, drugs can be given to limit the extent of the area of dead tissue and to improve the survival rate following a myocardial infarction. 54. Christine Zanzone has just discovered that she has a hyperlipidemia. Drug therapy, not lifestyle changes, is the first choice of treatment for hyperlipidemia. Answer: False Feedback: Dietary therapy rather than drug therapy is the first choice of treatment for hyperlipidemia. In addition, these lifestyle changes may be recommended: exercise, weight loss, decreased alcohol consumption, or cessation of smoking. If diet and lifestyle changes are not enough to decrease the cholesterol level, drug therapy is added. 55. Beta-blocker drugs block beta receptors in the blood vessels. This causes the blood vessels to constrict and this decreases the blood pressure in patients with hypertension. Answer: False Feedback: In patients with hypertension, beta-blocker drugs block the action of epinephrine on beta receptors and this slows the heart rate and dilates the blood vessels; both of these actions decrease the blood pressure. 56. The painting The Starry Night by Vincent van Gogh may show evidence of digitalis toxicity in the way in which the stars were painted. Answer: True Feedback: Vincent van Gogh's The Starry Night (1889) is felt by some to show evidence of digitalis toxicity in the way the Dutch painter depicted yellow-green halos around the stars. 57. The suffix –sartan is common to generic angiotensin II receptor blocker drugs. Answer: True Feedback: The suffix –sartan is common to generic angiotensin II receptor blocker drugs. 58. Alpha-blocker drugs are used to treat hypertension because they block alpha receptors in both the arteries and veins and cause them to dilate to lower the blood pressure. Answer: True Feedback: Alpha1 receptors are located in the peripheral blood vessels in both arteries and veins. Blocking these receptors causes both the arteries and veins to dilate, and this lowers the blood pressure. 59. The drug sildenafil (Revatio) is used to treat pulmonary arterial hypertension, and it is also available under the trade name Viagra and used to treat erectile dysfunction in men. Answer: True Feedback: Sildenafil (Revatio) for pulmonary arterial hypertension is also available under the trade name Viagra and is used to treat erectile dysfunction in men. 60. HMG-CoA reductase inhibitor drugs are used to treat hypercholesterolemia. Answer: True Feedback: HMG-CoA reductase is an enzyme that is involved in one of the steps in the production of cholesterol in the body. HMG-CoA reductase inhibitor drugs block this enzyme and are used to treat hypercholesterolemia. These drugs are also known as statin drugs. 61. Digoxin often causes toxicity because this drug has a short half-life. Answer: False Feedback: Nearly one-third of patients taking a digitalis drug develop symptoms of digitalis toxicity. This is because these drugs have a low therapeutic index (i.e., there is a narrow margin between the therapeutic dose and the toxic dose) and a long half-life. 62. A patient in hypertensive crisis has an extremely high blood pressure. Answer: True Feedback: A patient in hypertensive crisis exhibits an extremely high blood pressure. 63. Oatmeal in the diet is an effective way to reduce the cholesterol level of the blood. Answer: True Feedback: Oatmeal is effective in lowering the cholesterol level in the blood. The oat fiber binds to bile in the intestines and keeps it from being reabsorbed back into the blood. 64. Nesiritide (Natrecor), a drug used to treat severe congestive heart failure, is made using recombinant DNA technology and the bacterium E. coli. Answer: True Feedback: Nesiritide (Natrecor), which is used to treat severe congestive heart failure, is manufactured from E. coli bacteria using recombinant DNA technology 65. Bile acid sequestrant drugs are useful for treating angina pectoris. Answer: False Feedback: Bile acid sequestrant drugs are used to treat hypercholesterolemia. 66. Inderide is a combination drug that contains the beta-blocker drug propranolol (Inderal) and the diuretic drug hydrochlorothiazide. Answer: True Feedback: Inderide is a combination drug containing the beta-blocker propranolol and the diuretic hydrochlorothiazide. 67. The American Heart Association recommends eating fish and taking fish oil supplements that contain omega-3 fatty acids to reduce cholesterol and triglyceride levels. Answer: False Feedback: Omega-3 fatty acids are found in the oil of cold water fish. While the American Heart Association recommends eating fish, it does not endorse the use of fish oil supplements. 68. The abbreviation HTN stands for ________. Answer: hypertension Feedback: Hypertension (HTN) is characterized by an increase in the systolic and/or diastolic blood pressure. 69. Aldosterone causes reabsorption of sodium and water from the kidney tubules back into the blood. Aldosterone receptor inhibitor drugs block this action and so these drugs are used to treat ________. Answer: hypertension Feedback: The action of aldosterone is to increase the reabsorption of sodium from the kidney tubules back into the blood. As sodium moves back into the blood, it brings water with it and this increases the blood pressure. Aldosterone receptor inhibitor drugs block the action of aldosterone and this lowers the blood pressure (to treat hypertension). 70. To be transported through the blood, cholesterol and triglycerides must bind to certain carrier molecules, which are known as __________. Answer: lipoproteins Feedback: To be transported through the blood, cholesterol and triglycerides must bind to certain carrier molecules, which are known as lipoproteins. 71. __________ drugs are also known as cardiac glycoside drugs because they have a molecular structure that consists of chains of glucose sugar known as glycosides and they are used to treat the heart (cardiac). Answer: Digitalis Feedback: Digitalis drugs are also known as cardiac glycoside drugs because they have a molecular structure that consists of chains of glucose sugars known as glycosides and they are used to treat the heart (cardiac). 72. ________ is the most frequently prescribed nitrate drug used to treat angina pectoris. Answer: nitroglycerin Feedback: The most frequently prescribed nitrate drug is nitroglycerin. 73. The generic drug used to treat ventricular arrhythmias and also to numb the skin when injected is known as ________. Answer: lidocaine Feedback: The antiarrhythmic drug lidocaine (Xylocaine) is also a topical anesthetic drug. It inhibits the flow of sodium into nerve cells. This stops electrical impulses along sensory nerves, and then there is no perception/transmission of pain. 74. Hypertension is caused by arteriosclerosis or kidney failure, but ________ hypertension has no identifiable cause. Answer: essential Feedback: Hypertension is caused by arteriosclerosis, kidney disease, and other diseases, or it may have no identified cause (in which case, it is known as essential hypertension). 75. Beta receptors located in the ______ are designated as beta1 receptors. Answer: heart Feedback: Beta receptors in the heart are designated as beta1 receptors. 76. Combination drugs used to treat hypertension often contain the diuretic drug hydrochlorothiazide, and this is shown because the trade name of the drug contains the abbreviation ________. Answer: HCT Feedback: Combination drugs that include hydrochlorothiazide often reflect this by including the abbreviation HCT in their trade names. 77. The drug ________ is given during resuscitation for a patient in cardiac arrest (asystole) and can actually stimulate contractions of the myocardium. Answer: epinephrine Feedback: In cardiac arrest (asystole), epinephrine can actually stimulate contractions of the myocardium. 78. Cholesterol in the blood comes from cholesterol that is produced by the ________ as well as from cholesterol contained in foods. Answer: liver Feedback: Cholesterol is produced by the liver, and a certain amount of cholesterol is needed by the body for the production of hormones and bile and as a component of skin and nerve fibers. 79. Digoxin immune Fab, which is used to treat digitalis toxicity, is an antigen-binding fragment obtained from ________ that have been treated to produce antibodies against the basic molecule of digoxin. Answer: sheep Feedback: Digoxin immune Fab is an antigen-binding fragment obtained from sheep that have been treated to produce antibodies against the basic molecule of digoxin. 80. The peripheral vasodilator drug minoxidil is used to treat hypertension, but it is also used topically under the trade name Rogaine to treat ________. Answer: baldness (or thinning hair) Feedback: Minoxidil is also marketed under the trade name Rogaine and is used to treat thinning hair and baldness in men and women. Applied topically to the scalp, its vasodilator action reestablishes blood flow to the hair follicles, resulting in new hair growth. 81. Define these abbreviations. ACE _________ HDL _________ HTN __________ LDL __________ VLDL _________ Answer: Angiotensin-converting enzyme, high-density lipoprotein, hypertension, low-density lipoprotein, very low-density lipoprotein Matching Questions 82. 1. diltiazem (Cardizem) A. ACE inhibitor drug 2. hydralazine (Apresoline) B. peripheral vasodilator drug 3. losartan (Cozaar) C. angiotensin II receptor blocker drug 4. propranolol (Inderal) D. beta-blocker drug 5. quinapril (Accupril) E. calcium channel blocker drug Answer: E Answer: B Answer: C Answer: D Answer: A Feedback: These drugs and their categories are found in the Drugs Used to Treat Hypertension section. 83. 1. adenosine (Adenocard) A. atrial flutter and fibrillation 2. lidocaine (Xylocaine) B. bradycardia 3. atropine C. asystole 4. digoxin (Lanoxicaps, Lanoxin) D. tachycardia 5. epinephrine (Adrenalin) E. ventricular fibrillation Answer: D Answer: E Answer: B Answer: A Answer: C Feedback: These drugs and their categories are found in the Drugs Used to Treat Arrhythmias section. 84. Explain why cardioselective beta-blocker drugs are different from regular betablocker drugs. Answer: Beta-blocker drugs block all beta1 and beta2 receptors. Cardioselective beta-blocker drugs are more selective in their action and block only beta1 receptors in the heart and beta2 receptors in the blood vessels (but not in the bronchi). 85. In the body, the hormone epinephrine has three actions, and the manufactured drug epinephrine has those same three actions. Describe one of the three actions. Answer: 1. Stimulating alpha receptors to constrict the peripheral blood vessels and raise the blood pressure. 2. Stimulating beta1 receptors in the heart to increase the heart rate and cardiac output. 3. Stimulating beta2 receptors in the lungs to relax bronchial smooth muscle, dilate the bronchi, and increase air flow to the lungs. 86. List at least three lifestyle changes that are suggested to patients before they are started on a drug for hypertension. Answer: The treatment of hypertension follows what is known as a stepped-care approach. Lifestyle changes are suggested first: Patients are asked to restrict the use of salt in cooking and at the table, or the physician may prescribe a low-salt diet to limit the total dietary sodium intake. In addition, the patient may be asked to lose weight, exercise, and stop smoking. If these measures cannot control the blood pressure, drugs are added to the treatment regimen. Often a diuretic drug is prescribed first. Test Bank for Understanding Pharmacology for Health Professionals Susan M. Turley 9780135145708, 9780133911268
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