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  • Question 1 - A 74-year-old woman with a history of ischaemic heart disease and heart failure...

    Correct

    • A 74-year-old woman with a history of ischaemic heart disease and heart failure is complaining of worsening oedema, bloating, and a loss of appetite. She has ascites and peripheral oedema on examination. Her oedema is being controlled by an oral diuretic, but it appears that this is no longer enough. You discuss her care with the on-call cardiology registrar, who believes she is very likely to have significant gut oedema that is interfering with her diuretic absorption and that she will need to change her medication.

      Which of the following oral diuretics is most likely to help you overcome this problem?

      Your Answer: Bumetanide

      Explanation:

      Bumetanide is primarily used in patients with heart failure who have failed to respond to high doses of furosemide. Bumetanide and furosemide differ primarily in terms of bioavailability and pharmacodynamic potency. In the intestine, furosemide is only partially absorbed, with a bioavailability of 40-50 percent. Bumetanide, on the other hand, is almost completely absorbed in the intestine and has a bioavailability of about 80%. As a result, when it has a better bioavailability than furosemide, it is commonly used in patients with gut oedema.

      When taken alone, Bendroflumethiazide is a moderately potent diuretic that is unlikely to control her oedema.

      Mannitol is a type of osmotic diuretic used to treat cerebral oedema and high intracranial pressure.

      Acetazolamide is a weak diuretic that inhibits carbonic anhydrase. It’s a rare occurrence.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      14.3
      Seconds

  • Question 2 - For the treatment of his atrial fibrillation, a 59-year-old man is about to...

    Correct

    • For the treatment of his atrial fibrillation, a 59-year-old man is about to begin taking warfarin. He also takes a number of other medications.

      Which of the following medications will enhance warfarin's effects?

      Your Answer: Erythromycin

      Explanation:

      Many medications, including warfarin, require cytochrome P450 enzymes for their metabolism. When co-prescribing cytochrome p450 enzyme inducers and inhibitors with warfarin, it’s critical to be cautious.

      Inhibitors of the cytochrome p450 enzyme potentiate the effects of warfarin, resulting in a higher INR. To remember the most commonly encountered cytochrome p450 enzyme inhibitors, use the mnemonic O DEVICES:

      O– Omeprazole
      D– Disulfiram
      E– Erythromycin (And other macrolide antibiotics)
      V– Valproate (sodium valproate)
      I– Isoniazid
      C– Ciprofloxacin
      E– Ethanol (acute ingestion)
      S- Sulphonamides

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      13.1
      Seconds

  • Question 3 - You've been summoned to a young man in the resus area who has...

    Correct

    • You've been summoned to a young man in the resus area who has an SVT. You decide to use adenosine after trying several vagal manoeuvres without success.

      The use of adenosine is not contraindicated in which of the following situations?

      Your Answer: Concurrent use of a beta-blocker

      Explanation:

      The use of a beta-blocker at the same time increases the risk of myocardial depression, but it is not a contraindication.
      The use of adenosine is contraindicated in the following situations:
      Asthma
      COPD (chronic obstructive pulmonary disease)
      Decompensated heart failure 
      Long QT syndrome
      AV block in the second or third degree
      Sinusitis is a condition in which the sinuses become (unless pacemaker fitted)
      Hypotension that is severe

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      12.5
      Seconds

  • Question 4 - Swelling of the lips, tongue, and face is observed in a 59-year-old African-American...

    Correct

    • Swelling of the lips, tongue, and face is observed in a 59-year-old African-American woman. In the emergency room, she is given intramuscular adrenaline, but her symptoms do not improve. Her GP recently started her on a new medication.

      Which of the following drugs is most likely to have caused her symptoms?

      Your Answer: Ramipril

      Explanation:

      Angiotensin-converting enzyme (ACE) inhibitors are the most common cause of drug-induced angioedema in the United Kingdom and the United States, owing to their widespread use.

      Angioedema is caused by ACE inhibitors in 0.1 to 0.7 percent of patients, with data indicating a persistent and relatively constant risk year after year. People of African descent have a five-fold higher chance of contracting the disease.

      Swelling of the lips, tongue, or face is the most common symptom, but another symptom is episodic abdominal pain due to intestinal angioedema. Itching and urticaria are noticeably absent.

      The mechanism appears to be activated complement or other pro-inflammatory cytokines like prostaglandins and histamine, which cause rapid vasodilation and oedema.

      Other medications that are less frequently linked to angioedema include:
      Angiotensin-receptor blockers (ARBs)
      Nonsteroidal anti-inflammatory drugs (NSAIDs)
      Bupropion (e.g. Zyban and Wellbutrin)
      Beta-lactam antibiotics
      Statins
      Proton pump inhibitors

      The majority of these reactions are minor and can be treated by stopping the drug and prescribing antihistamines.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      18.7
      Seconds

  • Question 5 - Following the administration of a medication for a heart condition, a 69-year-old man...

    Correct

    • Following the administration of a medication for a heart condition, a 69-year-old man develops hypothyroidism.

      Which of the following drugs is most likely to be the cause?

      Your Answer: Amiodarone

      Explanation:

      Amiodarone has a chemical structure that is similar to that of thyroxine and can bind to the nuclear thyroid receptor. It can cause both hypothyroidism and hyperthyroidism, though hypothyroidism is far more common, with 5-10% of patients suffering from it.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      7.8
      Seconds

  • Question 6 - An 82-year-old woman was brought in an ambulance to the Emergency Department with...

    Correct

    • An 82-year-old woman was brought in an ambulance to the Emergency Department with a 1-hour history of left-sided weakness and dysphasia.

      A CT scan is performed, and primary intracerebral haemorrhage is excluded as a possible cause. She is prepared for thrombolysis when her blood pressure is recorded at 200/115 mmHg.

      Out of the following, which step would be the most appropriate as the next step in her management?

      Your Answer: Labetalol 10 mg IV

      Explanation:

      A patient suffering from acute ischemic stroke can commonly present with hypertensive emergencies. Thrombolytic therapy is contraindicated in a patient with:
      1. Systolic blood pressure greater than 185 mmHg
      2. Diastolic blood pressure greater than 110 mmHg

      But delaying thrombolytic therapy is associated with increased morbidity in patients with acute ischemic stroke.

      Managing high blood pressure in acute ischemic stroke requires a slower and more controlled reduction in BP. In the presence of an ischaemic stroke, rapid reduction of MAP can compromise blood flow, causing further ischemia and worsening of the neurological deficit.

      Intravenous labetalol is the agent of choice. The dose is 10 mg IV over 1-2 minutes. This dose can be repeated, or an infusion can be set up that runs at 2-8 mg/minute. Thrombolysis can be performed once the blood pressure is brought down to less than 180/105 mmHg.

      A nitrate infusion (for example, Isoket) can be used as an alternative in patients with contraindications to the use of beta-blockers (e.g., asthma, heart block, cardiac failure).

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      35.3
      Seconds

  • Question 7 - A 55-year-old female is urgently rushed into the Emergency Department as she complains...

    Correct

    • A 55-year-old female is urgently rushed into the Emergency Department as she complains of chest pain that is worse on breathing, shortness of breath, palpitations, and haemoptysis.

      She undergoes a CT pulmonary angiogram, which reveals a large pulmonary embolus. She is immediately started on heparin and shifted to the acute medical ward.

      Which of the following statements is true regarding heparin?

      Your Answer: It activates antithrombin III

      Explanation:

      Heparin is a polymer of glycosaminoglycan. It occurs naturally and is found in mast cells. Clinically, it is used in two forms:
      1. Unfractionated: widely varying polymer chain lengths
      2. Low molecular weight: Smaller polymers only

      Heparin works by binding to and activating the enzyme inhibitor antithrombin III. Antithrombin III inactivates thrombin (factor IIa) by forming a 1:1 complex with thrombin. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. The heparin-ATIII complex can also inactivate IX, XI, XII, and plasmin.

      Heparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics.

      Heparin is used for:
      1. Prevention and treatment of venous thromboembolism
      2. Treatment of disseminated intravascular coagulation
      3. Treatment of fat embolism
      4. Priming of haemodialysis and cardiopulmonary bypass machines

      There is no evidence that heparin is superior to low-molecular-weight heparins in preventing mortality from thrombosis.

      Vitamin K is used to reverse the effects of warfarin but not heparin. For heparin, protamine sulphate is used to counteract its effects.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      75.7
      Seconds

  • Question 8 - A 47-year-old woman comes in with palpitations that have been bothering her for...

    Correct

    • A 47-year-old woman comes in with palpitations that have been bothering her for the past four days. Her haemodynamics are normal, but her heart rate is currently 150 beats per minute. An ECG is performed, which reveals that she is experiencing atrial flutter. The patient is examined by a cardiology registrar, who recommends starting her on verapamil to control her ventricular rate while she waits for cardioversion.

      In these circumstances, which of the following is a contraindication to the use of verapamil?

      Your Answer: Acute porphyria

      Explanation:

      In most cases of atrial flutter, ventricular rate control is used as a stopgap measure until sinus rhythm is restored. A beta-blocker (e.g. bisoprolol), diltiazem, or verapamil can be used to reduce the rate of contractions in the heart.
      Electrical cardioversion, pharmacological cardioversion, and catheter ablation can all be used to return the heart to a normal rhythm. Cardioversion should not be attempted until the patient has been fully anticoagulated for at least three weeks if the duration of atrial flutter is unknown or it has lasted longer than 48 hours. Emergency electrical cardioversion is the treatment of choice when there is a sudden onset of symptoms and haemodynamic compromise. For recurrent atrial flutter, catheter ablation is preferred.

      Verapamil is a calcium-channel blocker that is non-dihydropyridine phenylalkylamine and can be used to treat supraventricular arrhythmias. It’s a calcium channel blocker with a high negative inotropic effect that lowers cardiac output, slows the heart rate, and may impair atrioventricular conduction. At high doses, it can cause heart failure, exacerbate conduction disorders, and cause hypotension.

      Adults should take 240-480 mg of verapamil in 2-3 divided doses. 5-10 mg IV over 30 seconds is the corresponding intravenous (IV) dose. After an IV injection, the peak effect lasts 3-5 minutes, and the action lasts 10-20 minutes.

      Verapamil should not be taken with beta-blockers like atenolol or quinidine because the combination of their negatively inotropic and negatively chronotropic effects can result in severe hypotension, bradycardia, impaired atrioventricular conduction, heart failure (due to impaired cardiac contractility), and sinus arrest.
      The use of verapamil is contraindicated in the following situations:
      Acute porphyrias are a type of porphyria that occurs suddenly.
      Accessory conducting pathways are linked to atrial flutter or fibrillation (e.g. Wolff-Parkinson-White-syndrome)
      Bradycardia
      Shock caused by the heart
      Insufficiency of the heart (with reduced ejection fraction)
      Left ventricular function has been significantly harmed in the past (even if controlled by therapy)
      Hypotension (blood pressure less than 90 mmHg)
      AV block in the second and third degrees
      Sinusitis is a condition in which the sinuses become
      Sino-atrial occlusion

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      46.6
      Seconds

  • Question 9 - A 52-year-old man presents to the emergency room with chest pain. He was...

    Correct

    • A 52-year-old man presents to the emergency room with chest pain. He was recently released from the hospital after receiving abciximab during coronary angioplasty.

      Which of the following is NOT a contraindication to abciximab (ReoPro) treatment?

      Your Answer: Major surgery within the last 6 months

      Explanation:

      Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.

      The use of abciximab is contraindicated in the following situations:
      Internal bleeding is present.
      Within the last two months, you’ve had major surgery, intracranial surgery, or trauma.
      Stroke in the previous two years
      Intracranial tumour
      Aneurysm or arteriovenous malformation
      Haemorrhagic diathesis is a type of haemorrhagic diathesis.
      Vasculitis
      Retinopathy caused by hypertension

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      17.2
      Seconds

  • Question 10 - On ambulatory blood pressure monitoring, a 48-year-old Caucasian man has an average BP...

    Correct

    • On ambulatory blood pressure monitoring, a 48-year-old Caucasian man has an average BP reading of 152/96 mmHg (ABPM).

      Which of the following would be the patient's first-line drug treatment?

      Your Answer: Ramipril

      Explanation:

      An ambulatory blood pressure reading of >150/95 is classified as stage 2 hypertension, according to the NICE care pathway for hypertension, and the patient should be treated with an antihypertensive drug.

      A calcium-channel blocker, such as amlodipine, would be the most appropriate medication for a 48-year-old Afro-Caribbean man.

      An ACE inhibitor, such as ramipril, or a low-cost angiotensin-II receptor blocker (ARB), such as losartan, would be the most appropriate medication for a 48-year-old Caucasian man.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      9.6
      Seconds

  • Question 11 - A 56-year-old female visits her cardiologist complaining of a condition that has started...

    Correct

    • A 56-year-old female visits her cardiologist complaining of a condition that has started since he started her on amiodarone for atrial arrhythmia. The cardiologist recognised that she is experiencing a side effect of amiodarone.

      Which one of the following conditions will this woman NOT have?

      Your Answer: Xanthopsia

      Explanation:

      Amiodarone is a class III potassium channel blocker used to treat multiple types of arrhythmias.

      Side effects include:
      1. pulmonary fibrosis
      2. blue discolouration of the skin
      3. phototoxicity
      4. corneal deposits
      5. hepatic necrosis
      6. thyroid dysfunction
      7. sleep disturbances
      8. peripheral neuropathy.

      Xanthopsia is a condition where the patient complains of seeing yellow lines and is seen in digoxin overdose.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      13.8
      Seconds

  • Question 12 - Before a patient is discharged, you are asked to review them. He is...

    Incorrect

    • Before a patient is discharged, you are asked to review them. He is a 59-year-old man who was seen with epigastric pain that has since subsided, and he will be seen by his GP in the coming days. He's been hearing a lot about aspirin lately and wants to learn more about it.

      Which of the following statements about aspirin's mechanism of action is correct?

      Your Answer: Antagonism of glycoprotein IIb/IIIa receptors

      Correct Answer: Inhibition of cyclo-oxygenase

      Explanation:

      Aspirin works by inhibiting cyclo-oxygenase in an irreversible manner, resulting in a decrease in prostaglandin and thromboxane production. As a result, platelet activation and aggregation are reduced.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      5.4
      Seconds

  • Question 13 - The average BP reading on ambulatory blood pressure monitoring for a 59-year-old Caucasian...

    Incorrect

    • The average BP reading on ambulatory blood pressure monitoring for a 59-year-old Caucasian man is 152/96 mmHg (ABPM).

      The first-line drug treatment for this patient would be which of the following? Please only choose ONE answer.

      Your Answer: Ramipril

      Correct Answer: Amlodipine

      Explanation:

      An ambulatory blood pressure reading of >150/95 is classified as stage 2 hypertension, according to the NICE care pathway for hypertension, and the patient should be treated with an antihypertensive drug.

      A calcium-channel blocker, such as amlodipine, would be the most appropriate medication for a 59-year-old Caucasian man.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      16
      Seconds

  • Question 14 - A 66-year-old female who is a known case of atrial fibrillation comes to...

    Correct

    • A 66-year-old female who is a known case of atrial fibrillation comes to the Emergency Department with the complaint of fever and vomiting for the past two days. When her medical chart is reviewed, you see that she takes Warfarin for her arrhythmia.

      Which ONE of the following medications cannot be prescribed to this patient?

      Your Answer: Ibuprofen

      Explanation:

      Like other non-steroidal anti-inflammatory drugs, Ibuprofen cannot be given with Warfarin as it would increase the bleeding risk of this patient.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      23.7
      Seconds

  • Question 15 - In a VF arrest, a 6-year-old child is brought to your Emergency Department...

    Correct

    • In a VF arrest, a 6-year-old child is brought to your Emergency Department resuscitation area. He weighs 16 kilogrammes. He's had three DC shocks, but he's still in VF and doesn't have an output.

      What amiodarone dose should he get now, according to the most recent APLS guidelines?

      Your Answer: 80 mg

      Explanation:

      In a shockable (Vf/pVT) paediatric cardiac arrest, amiodarone should be administered after the third and fifth shocks. The dose is 5 mg/kg (maximum 300 mg) and should be administered over a three-minute period. If at all possible, administration via a central line is recommended.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      35.5
      Seconds

  • Question 16 - As part of his angina treatment, a 68-year-old man is prescribed a beta...

    Correct

    • As part of his angina treatment, a 68-year-old man is prescribed a beta blocker. He starts having nightmares and has trouble sleeping soon after starting the beta-blocker.

      Which of the beta blockers listed below is the most likely to be in his system?

      Your Answer: Propranolol

      Explanation:

      The beta-adrenoceptors in the heart, peripheral vasculature, bronchi, pancreas, and liver are blocked by beta-adrenoceptor blocking drugs (beta blockers).

      Beta blockers come in a wide range of strengths, with the choice largely determined by the disease being treated and the patient’s unique circumstances. The intrinsic sympathomimetic activity, lipid solubility, duration of action, and cardioselectivity of beta blockers all differ.

      Some beta blockers are lipid (lipophilic) soluble, while others are water soluble (hydrophilic). Drugs that are more lipid-soluble are absorbed faster from the gut, undergo more first-pass metabolism, and are eliminated faster. They’re also more likely to get into the brain and cause central effects like insomnia and nightmares. Propranolol, pindolol, labetalol, and metoprolol are examples of lipid-soluble beta blockers. Beta blockers that are water-soluble are less likely to enter the brain and are more resistant to first-pass metabolism. They are excreted by the kidneys, and in renal impairment, dosage reduction is frequently required. Atenolol, nadolol, celiprolol, and sotalol are examples of water-soluble beta blockers.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      8.7
      Seconds

  • Question 17 - You examine a resuscitated patient who has been diagnosed with ventricular tachycardia. The...

    Incorrect

    • You examine a resuscitated patient who has been diagnosed with ventricular tachycardia. The patient's hemodynamics are normal. You intended to prescribe amiodarone to him, but you can't because he has a contraindication.

      In these circumstances, which of the following is a contraindication to using amiodarone?

      Your Answer: Long QT syndrome

      Correct Answer: Sinus node disease

      Explanation:

      Amiodarone is an anti-arrhythmic medication that can be used to treat both ventricular and atrial arrhythmias.

      The use of amiodarone is contraindicated in the following situations:
      Conduction disturbances that are severe (unless pacemaker fitted)
      Sinus node disease is a condition that affects the lymph nodes in (unless pacemaker fitted)
      Sensitivity to iodine
      Blockage of the Sino-atrial heart valve (except in cardiac arrest)
      Bradycardia in the sinuses (except in cardiac arrest)
      Thyroid disorders

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      52.8
      Seconds

  • Question 18 - You're a member of the cardiac arrest team, and you're helping to resuscitate...

    Correct

    • You're a member of the cardiac arrest team, and you're helping to resuscitate an elderly gentleman who had collapsed at home. The team leader requests that you administer an adrenaline shot.

      Which of the following statements about adrenaline is FALSE?

      Your Answer: The IM dose in anaphylaxis is 1 ml of 1:1000

      Explanation:

      Adrenaline (epinephrine) is a sympathomimetic amine that binds to alpha- and beta-adrenergic receptors and acts as an agonist. It is active at both alpha and beta receptors in roughly equal amounts.

      When taken orally, it becomes inactive. Subcutaneous absorption is slower than intramuscular absorption. In cardiac arrest, it is well absorbed from the tracheal mucosa and can be given through an endotracheal tube.

      At the adrenergic synapse, catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) metabolise it primarily. The inactive products are then passed through the kidneys and excreted in the urine.

      In adult cardiac arrest, the IV dose is 1 mg, which is equal to 10 ml of 1:10000 or 1 ml of 1:1000. In anaphylaxis, the IM dose is 0.5 ml of 1:1000. (500 mcg).

      In open-angle glaucoma, adrenaline causes mydriasis and lowers pressure.

      Adrenaline is used in cardiopulmonary resuscitation, the treatment of severe croup, and the emergency management of acute allergic and anaphylactic reactions (as a nebuliser solution).

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      32.8
      Seconds

  • Question 19 - After returning from Thailand two days ago, a 61-year-old man presents to the...

    Correct

    • After returning from Thailand two days ago, a 61-year-old man presents to the department with severe diarrhoea and vomiting. He has a history of hypertension and takes an ACE inhibitor to treat it.

      Which of the following statements about angiotensin-converting enzyme inhibitors is correct?

      Your Answer: They have been shown to reduce mortality in heart failure

      Explanation:

      Angiotensin-converting enzyme (ACE) inhibitors prevent angiotensin I from being converted to angiotensin II. Angiotensin II has a variety of effects:
      Sympathetic activity has increased.
      Vasoconstriction in the arteries
      Secretion of Vasopressin
      Secretion of aldosterone

      The increase in systemic blood pressure is caused by arteriolar vasoconstriction. Vasopressin stimulates water reabsorption in the kidneys as well as the thirst sensation. In the distal convoluted tubules and collecting ducts, aldosterone causes the reabsorption of sodium and water from the urine in exchange for potassium secretion. As a result, ACE inhibitors lower systemic blood pressure while also causing hyperkalaemia.

      Angiotensin-converting enzyme inhibitors (ACE inhibitors) are used in a variety of clinical settings, including heart failure. According to a meta-analysis, ACE inhibitors reduce death, MI, and overall admission in patients with heart failure by 28%.
      ACE inhibitors are also used in the following clinical settings:
      Hypertension
      Chronic kidney disease
      Diabetic nephropathy 
      Following a myocardial infarction

      In the presence of renal artery stenosis, ACE inhibitors are contraindicated because they can cause or exacerbate renal failure.
      The most common side effect of ACE inhibitors is a dry cough caused by increased bradykinin production. There is, however, no known link to fibrosis of the lungs.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      36.4
      Seconds

  • Question 20 - A 55-year-old female is urgently rushed into the Emergency Department as she complains...

    Correct

    • A 55-year-old female is urgently rushed into the Emergency Department as she complains of chest pain that is worse on breathing, shortness of breath, palpitations, and haemoptysis.

      She undergoes a CT pulmonary angiogram, which reveals a large pulmonary embolus. She is immediately started on heparin and shifted to the acute medical ward.

      Which of the following does heparin activate?

      Your Answer: Antithrombin III

      Explanation:

      Heparin works by binding to and activating the enzyme inhibitor antithrombin III.

      Antithrombin III inactivates thrombin (factor IIa) by forming a 1:1 complex with thrombin. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. The heparin-ATIII complex can also inactivate IX, XI, XII, and plasmin.

      Heparin is a polymer of glycosaminoglycan. It occurs naturally and is found in mast cells. Clinically, it is used in two forms:
      1. Unfractionated: widely varying polymer chain lengths
      2. Low molecular weight: Smaller polymers only

      Heparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics.

      Heparin is used for:
      1. Prevention and treatment of venous thromboembolism
      2. Treatment of disseminated intravascular coagulation
      3. Treatment of fat embolism
      4. Priming of haemodialysis and cardiopulmonary bypass machines

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      14.2
      Seconds

  • Question 21 - A 59-year-old man presents to the emergency room with chest pain. He was...

    Correct

    • A 59-year-old man presents to the emergency room with chest pain. He was recently released from the hospital after receiving abciximab during coronary angioplasty.

      Which of the following is abciximab (ReoPro) mechanism of action?

      Your Answer: Antagonism of the glycoprotein IIb/IIIa receptor

      Explanation:

      Abciximab (ReoPro) is a glycoprotein IIb/IIIa receptor antagonist that is a chimeric monoclonal antibody. It is primarily used during and after coronary artery procedures such as angioplasty to inhibit platelet aggregation.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      7.6
      Seconds

  • Question 22 - A 68-year-old man has a very fast heartbeat' and is out of breath....

    Correct

    • A 68-year-old man has a very fast heartbeat' and is out of breath. He has had a heart transplant in the past. His electrocardiogram reveals supraventricular tachycardia.

      Which of the following is the most appropriate adenosine dose for him to receive as a first dose?

      Your Answer: Adenosine 3 mg IV

      Explanation:

      A rapid IV bolus of adenosine is given, followed by a saline flush. The standard adult dose is 6 mg, followed by 12 mg if necessary, and then another 12 mg bolus every 1-2 minutes until an effect is seen.

      Patients who have had a heart transplant, on the other hand, are extremely sensitive to the effects of adenosine and should start with a lower dose of 3 mg, then 6 mg, and finally 12 mg.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      7.8
      Seconds

  • Question 23 - You review a sick patient in resus who has been prescribed mannitol as...

    Correct

    • You review a sick patient in resus who has been prescribed mannitol as part of his treatment protocol.
      Which SINGLE statement regarding mannitol is true?

      Your Answer: It is irritant to veins and causes phlebitis

      Explanation:

      Mannitol is a low molecular weight compound and is therefore freely filtered at the glomerulus and is not reabsorbed. It, therefore, increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).
      Mannitol is primarily used to reduce the pressure and volume of cerebrospinal fluid (CSF). It decreases the volume of CSF by:
      Decreasing the rate of CSF formation,and;
      Withdrawing extracellular fluid from the brain across the BBB
      Other uses of mannitol include:
      Short-term management of glaucoma
      Treatment of rhabdomyolysis
      Preserve renal function in peri-operative jaundiced patients
      To initiate diuresis in transplanted kidneys
      Bowel preparation prior to colorectal procedures
      The recommended dose of mannitol for the reduction of CSF pressure/cerebral oedema is 0.25-2g/kg as an intravenous infusion over 30-60 minutes. This can be repeated 1-2 times after 4-8 hours if needed.
      Circulatory overload and rebound increases in intracranial pressure may occur following the use of mannitol. It is irritant to tissues and veins and can cause inflammation and phlebitis.
      Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:
      Anuria
      Intracranial bleeding (except during craniotomy)
      Severe cardiac failure
      Severe dehydration
      Severe pulmonary oedema

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      24.3
      Seconds

  • Question 24 - A 67-year-old female is admitted under your care with the complaint of shortness...

    Correct

    • A 67-year-old female is admitted under your care with the complaint of shortness of breath and massive pedal oedema. There are fine crepitations up to the mid zones on both lung fields on chest auscultation. When questioned about her medication, she doesn't remember everything she takes but knows that there is a tablet to get rid of excess water.

      Out of the following medications, which one increases the osmolality of the filtrate in the glomerulus and the tubule, creating an osmotic effect?

      Your Answer: Mannitol

      Explanation:

      Mannitol is an osmotic diuretic that stops the absorption of water throughout the tubule, thus increasing the osmolality of both glomerular and tubular fluid. It is used to:
      1. decrease intraocular pressure in glaucoma
      2. decrease intracerebral pressure
      3. oliguria.

      Furosemide is a loop diuretic that inhibits the Na/K/2Cl transported in the ascending limb of the Loop of Henle.

      Bendroflumethiazide is a thiazide diuretic which inhibits the Na/Cl transporter.

      Spironolactone is a potassium-sparing diuretic that acts as an aldosterone receptor antagonist.

      Acetazolamide is a carbonic anhydrase inhibitor.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      23
      Seconds

  • Question 25 - A 23-year-old female has been prescribed a medication in the first trimester of...

    Correct

    • A 23-year-old female has been prescribed a medication in the first trimester of pregnancy due to a life-threatening medical problem. After delivery, the foetus is found to have nasal hypoplasia, stippling of his bones and atrophy of bilateral optic discs along with growth retardation.

      Which ONE of the following drugs has this woman most likely received?

      Your Answer: Warfarin

      Explanation:

      Warfarin is teratogenic and can cause a host of abnormalities in the growing foetus. These include hypoplasia of the nasal bridge, stippling of the epiphyses, multiple ophthalmic complications, growth retardation, pectus carinatum, atrial septal defect, ventriculomegaly and a patent ductus arteriosus.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      14.4
      Seconds

  • Question 26 - You examine a patient who is experiencing a worsening of his chronic heart...

    Correct

    • You examine a patient who is experiencing a worsening of his chronic heart failure. You discuss his care with the on-call cardiology registrar, who recommends switching him from furosemide to bumetanide at an equivalent dose. He's on 80 mg of furosemide once a day right now.

      What is the recommended dose of bumetanide?

      Your Answer: 2 mg

      Explanation:

      Bumetanide is 40 times more powerful than furosemide, and one milligram is roughly equivalent to 40 milligrams of furosemide. This patient is currently taking 80 mg of furosemide and should be switched to a 2 mg bumetanide once daily.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      9.5
      Seconds

  • Question 27 - You have been called to review a patient and his management in the...

    Correct

    • You have been called to review a patient and his management in the resuscitation room. A very sick patient has been started on mannitol in his treatment protocol.

      Out of the following, what is NOT an FDA-recognized indication for the use of mannitol?

      Your Answer: Congestive cardiac failure

      Explanation:

      Mannitol is the most widely used osmotic diuretic that is most commonly used to reduce cerebral oedema and intracranial pressure.
      Mannitol has four FDA approved uses clinically:
      1. Reduction of intracranial pressure and brain mass
      2. reduce intraocular pressure if this is not achievable by other means
      3. promote diuresis for acute renal failure to prevent or treat the oliguric phase before irreversible damage
      4. promote diuresis to promote the excretion of toxic substances, materials, and metabolites

      It can be used in rhabdomyolysis-induced renal failure, especially in crush injuries. Mannitol reduces osmotic swelling and oedema in the injured muscle cells and helps restore skeletal muscle function.

      It is a low molecular weight compound and can be freely filtered at the glomerulus and not reabsorbed. This way increases the osmolality of the glomerular filtrate and tubular fluid, increasing urinary volume by an osmotic effect. It also does not cross the blood-brain barrier (BBB).

      Mannitol causes an expansion of the extracellular fluid space, which may worsen congestive cardiac failure. Contraindications to the use of mannitol include:

      1. Anuria due to renal disease
      2. Acute intracranial bleeding (except during craniotomy)
      3. Severe cardiac failure
      4. Severe dehydration
      5. Severe pulmonary oedema or congestion
      6. Known hypersensitivity to mannitol

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      10
      Seconds

  • Question 28 - A 45-year-old woman presents with persistent palpitations for the past two days. She...

    Correct

    • A 45-year-old woman presents with persistent palpitations for the past two days. She has a good haemodynamic balance. An ECG is performed, which reveals that she has atrial flutter. The patient is examined by a cardiology registrar, who recommends using a 'rate control' strategy while she waits for cardioversion.

      Which of the drugs listed below is the best fit for this strategy?

      Your Answer: Bisoprolol

      Explanation:

      In atrial flutter, ventricular rate control is usually used as a stopgap measure until sinus rhythm can be restored. A beta-blocker (such as bisoprolol), diltiazem, or verapamil can be used to lower the heart rate.

      Electrical cardioversion, pharmacological cardioversion, or catheter ablation can all be used to restore sinus rhythm. Cardioversion should not be attempted until the patient has been fully anticoagulated for at least three weeks if the duration of atrial flutter is unknown or has lasted for more than 48 hours. Emergency electrical cardioversion is the treatment of choice when there is an acute presentation with haemodynamic compromise. For the treatment of recurrent atrial flutter, catheter ablation is preferred.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      48.8
      Seconds

  • Question 29 - A 63-year-old man complains of chest pain and syncope on occasion. His heart...

    Correct

    • A 63-year-old man complains of chest pain and syncope on occasion. His heart rate is 37 beats per minute, and he has a second-degree heart block, according to his rhythm strip.

      Which of the following would be the most appropriate next step in his management, according to the ALS bradycardia algorithm?

      Your Answer: Give atropine 500 mcg

      Explanation:

      Atropine is used to treat bradycardia (sinus, atrial, or nodal) or AV block when the patient’s haemodynamic condition is compromised by the bradycardia.

      If any of the following adverse features are present, the ALS bradycardia algorithm recommends a dose of atropine 500 mcg IV:
      Shock
      Syncope
      Myocardial ischemia
      Insufficiency of the heart

      If this does not work, give additional 500 mcg doses at 3-5 minute intervals until a maximum dose of 3 mg is reached. The heart rate can be slowed paradoxically if the dose is higher than 3 mg.

      The ALS bradycardia algorithm also suggests the following interim measures:
      Transcutaneous pacing
      Isoprenaline infusion 5 mcg/min
      Adrenaline infusion 2-10 mcg/minutes
      Alternative drugs (aminophylline, dopamine, glucagon, glycopyrrolate)

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      8.6
      Seconds

  • Question 30 - A 62-year-old man complains of chest pain and goes to the emergency room....

    Correct

    • A 62-year-old man complains of chest pain and goes to the emergency room. You diagnose him with an acute coronary syndrome and prescribe enoxaparin as part of his treatment plan.

      Enoxaparin inactivates which of the following?

      Your Answer: Thrombin

      Explanation:

      Enoxaparin is a low molecular weight heparin (LMWH) that works in the same way as heparin by binding to and activating the enzyme inhibitor antithrombin III. Antithrombin III inactivates thrombin by forming a 1:1 complex with it. Factor Xa and a few other clotting proteases are also inhibited by the heparin-antithrombin III complex.

    • This question is part of the following fields:

      • Cardiovascular Pharmacology
      • Pharmacology
      9.6
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular Pharmacology (27/30) 90%
Pharmacology (27/30) 90%
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