Drugs Used for Treatment of Ischemic Heart Disease

1. Therapy with propranolol has positively affected the course of the disease of a 44-year-old woman with angina pectoris. What is the mechanism of antianginal action of this drug?

*A. Inhibition of ₁-adrenoceptors and decrease of the need of the myocardium for oxygen

B. Decrease of the oxidative exchange in the myocardium due to the inhibition of the enzymes of Krebs cycle

C. Decrease of myocardium energy consumption due to the decrease of load

D. Increase of oxygen coming into the myocardium

E. Decrease of the need for oxygen and increase of the coming of oxygen into the myocardium

2. The bronchlospasm was developed in patient with angina pectoris after taking of antianginal drug. What drug could provoke this effect?

*A. Propranolol

B. Nitroglycerin

C. Sustac-forte

D. Dipyridamolum

E. Nifedipinum

3. Anaprilinum therapy caused positive effect in the dynamic of the disease of 44-year-old woman suffering from stenocardia. What is the main mechanism of the effect of this drug?

*A. Blockade of -adrenoceptors and decrease myocardial requirements to the oxygen

B. Increased oxygen supply to the myocardium

C. Decreased power inputs of myocardium due to reduced loading

D. Decreased need in increasing of oxygen supply to the myocardium

E. Decrease of oxidative exchange in myocardium due to enzyme blockade of Krebs’ cycle

4. A 48-year-old patient after severe psychoemotional exertion suddenly began feeling sharp pain in the heart region, irradiating into left arm. Nitroglycerin relieved pain 10 minutes later. What pathogenetic mechanism is responsible for the development of pain in this case?

*A. Spasm of coronary vessels

B. Compression of coronary vessels

C. Dilation of peripheral vessels

D. Increase of myocardial needs in oxygen

E. Occlusion of coronary vessels

5. A patient after tooth extraction developed persistent substernal pain. Sublingual antianginal substance relieved the pain, but the patient complained of headache and dizziness. What medicine did the patient use?

*A. Nytroglycerin

B. Validol

C. Anapriline

D. Verapamil

E. Metoprolol

6. The patient with acute myocardial infarction was given intravenously different solutions during 8 hours with medical dropper 1500 ml and oxygen intranasally. He died because of pulmonary edema. What caused the pulmonary edema?

*A. Volume overload of the left ventricular

B. Inhalation of the oxygen

C. Allergic reaction

D. Decreased oncotic pressure due to hemodilution

E. Neurogenic reaction

7. The therapeutic action of β-adrenergic receptor blockers such as Anaprilinum (propranolol) in angina pectoris is believed to be primarily the result of:

*A. Decreased requirement for myocardial oxygen

B. Dilation of the coronary vasculature

C. Reduced production of catecholamines

D. Increased peripheral resistance

E. Increased sensitivity to catecholamines

8. Which of the following drugs is considered to be most effective in relieving and preventing ischemic episodes in patients with variant angina?

*A. Nifedipine

B. Nitroglycerin

C. Sustac- mite

D. Propranolol

E. Isosorbide dinitrate

9. A 69-year-old male with angina develops severe constipation following treatment with:

*A. Verapamil

B. Captopril

C. Propranolol

D. Dobutamine

E. Nitroglycerin

10. Administration of which of the following antianginal agents results in antianginal effects for only 10 hours, despite detectable therapeutic plasma levels for 24 hours?

*A. Transdermal nitroglycerin

B. Atenolol

C. Amlodipine

D. Validolum

Significant tolerance to nitroglycerin develops. Transdermal patches ca produce therapeutic drug levels for 24 hours, but its effectiveness lasts between 8 and 10 hours. A nitrate-free period of at least eight hours is necessary to prevent tolerance. Amyl nitrite is inhalable, and its action lasts no longer than five minutes. Patients on atenolol and amlodipine do not develop tolerance to these agents.

11. A 70-year-old female is treated with sublingual nitroglycerin for her occasional bouts of angina. Which of the following is involved in the action of nitroglycerin?

*A. cGMP

B. Phosphodiesterase activity

C. Phosphorylation of light chains of myosin

D. Norepinephrine release

E. α-Adrenergic activity

12. Which of the following is unlikely to occur with low concentrations of nitroglycerin?

*A. Decreased heart rate

B. Decreased end-diastolic blood pressure

C. Decreased myocardial oxygen demand

D. Decreased preload and afterload

E. Increased coronary blood flow

13. A 61-year-old female has intermittent bouts of chest pain on exertion of two months’ duration, associated with numbness and tingling in the fourth and fifth fingers of her left hand. An EKG is normal. She is placed on anaprilinum (propranolol), which relieves her symptoms. What cardiovascular effect has this drug?

*A. It decreased the requirement for myocardial oxygen

B. It dilated the coronary vasculature

C. It decreased production of catecholamines

D. It increased peripheral vascular resistance

E. It increased sensitivity to catecholamines

14. A patient comes to your office with effort-induced angina and resting tachycardia. You choose the following drug to treat the patient because it slows heart rate by blocking L-type calcium channels in the SA node:

*A. Verapamil

B. Propranolol

C. Nitroglycerin

D. Isosorbide dinitrate

E. Metoprolol

15. Which of the following hemodynamic effects of nitroglycerin are primarily responsible for the beneficial results observed in patients with angina?

*A. Reduction in preload

B. Reduction in systemic vascular resistance (afterload)

C. Increased heart rate

D. Reduction in the force of myocardial contraction

E. Increased blood flow to the subepicardium

16. A combination of drugs, consisting of a nitroglycerin patch and β-blocker, such as propranolol, is prescribed for woman to treat her attacks of angina. Which effect of propranolol would counteract an adverse effect of nitroglycerin?

*A. A decrease in heart rate

B. A decrease in afterload

C. A decrease in preload

D. An increase in myocardial contractile force

E. A reduction in coronary vasospasm

17. Metoprolol would produce the following beneficial effect in a patient with angina:

*A. An increase in diastolic filling time

B. An increase in collateral blood flow

C. An increase in afterload

D. A decrease in preload

E. An increase in blood flow through a concentric stenosis

18. A doctor recommended to patient, who had an acute myocardial infarction, to take acidum acetylsalicylicum in the dose 0.25 g once per 2-3 days during 3-4 months. What effect did the doctor count on?

*A. Antiaggregant

B. Antiinflammatory

C. Antipyretic

D. Analgesic

E. Vasodilative

19. A patient with ischemic heart disease has not informed the doctor that he had attacks of bronchospasm. The doctor prescribed a drug, which has made the attacks of angina pectoris less frequent, but the attacks of bronchospasm have become more frequent. What drug has been prescribed?

*A. Propranolol (anaprilinum)

B. Atenololum

C. Verapamilum

D. Diltiazemum

E. Nitrosorbidum

20. A patient has been suffering from bronchial asthma during long time. Recently he had attacks of angina pectoris. What drug is contraindicated to him?

*A. Propranolol

B. Nitroglycerin

C. Sustac-forte

D. Nifedipinum

E. Dipyridamolum

21. A 53-year-old woman suffers from attacks of angina pectoris. The patient is bothered by severe chest pain, arrhythmia, and short breath. What drug is the most expedient for prescription in this case to provide first aid?

*A. Nitroglycerin

B. Nitrosorbidum

C. Propranolol

D. Sustac-forte

E. Amiodaronum

22. The doctor has prescribed the hypolipidemic drug to patient with ischemic heart disease. It is known, that this drug predominantly decreases the level of triglycerides in the blood. What drug was been prescribed to patient?

*A. Fenofibrate

B. Prednisolon

C. Glybenclamide

D. Insulin

E. Nicotinic acid

23. The patient with acute stenocardia attack is delivered to hospital. What drug should be administered to patient for interruption of angina pectoris attack?

*A. Nitroglycerin

B. Vicasolum

C. Heparin

D. Furosemide

E. Calcium chloride

24. The doctor has diagnosed the acute attack of stenocardia which accompanied by tachyarrhythmia and hypertension in 60-year-old patient. It is known, that this patient also suffers from diabetes mellitus and bronchial asthma. The doctor administered intravenously to patient the certain antiadrenergic drug. Identify this drug.

*A. Metoprolol

B. Anaprilinum

C. Phentolamine

D. Reserpine

E. Octadinum

25. The patient suffering from bronchial asthma began percept the retrosternal pain. Indicate the antianginal drug which is contraindicated to this patient.

*A. Anaprilinum

B. Corinfar (nifedipine)

C. Nitrosorbide

D. Sustac

E. Isoptin (verapamil)

26. A patient suffering from coronary artery disease had taken a certain drug many times a day in order to arrest stenocardia attacks. Overdose of this drug finally caused intoxication. Objectively: cyanotic skin and mucous membranes, dramatic fall in the arterial pressure, tachycardia, and respiration inhibition. Blood has increased concentration of methemoglobin. The drug thet patient had taken relates to the following group:

*A. Organic nitrates

B. Calcium channel blockers

C. Myotropic spasmolytics

D. Adenosine drugs

E. α-Adrenoceptor blockers