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Question 1
Why are nitrate-free periods required every 24 hours in patients taking
nitroglycerin?
Correct Answer:
To prevent the development of tolerance
Rationalization:
Continuous nitrate exposure leads to tachyphylaxis (tolerance), reducing
effectiveness. A daily nitrate-free interval restores drug sensitivity.
Question 2
What is the primary action of nitrates on the cardiovascular system?
Correct Answer:
Reduction in systemic venous tone (↓ preload)
Rationalization:
Nitrates dilate veins → ↓ venous return → ↓ cardiac workload → improved
angina symptoms.
,Question 3
How do IV morphine and nitroglycerin help in acute heart failure?
Correct Answer:
They decrease preload
Rationalization:
Both drugs reduce venous return, relieving pulmonary congestion and
improving symptoms.
Question 4
What is the purpose of vasodilators in heart failure?
Correct Answer:
Decrease afterload
Rationalization:
Reducing afterload makes it easier for the heart to pump blood forward,
improving cardiac output.
Question 5
What is the expected effect of beta-blockers in angina?
Correct Answer:
Reduced force of cardiac contraction
Rationalization:
Beta-blockers decrease:
• Heart rate
• Contractility
→ Reduced oxygen demand
Question 6
,Which drug reduces afterload via alpha-adrenergic blockade?
Correct Answer:
Prazosin (Minipress)
Rationalization:
Alpha-1 blockade → vasodilation → ↓ peripheral resistance → ↓ afterload.
Question 7
What does a low TSH level indicate?
Correct Answer:
Hyperthyroidism
Rationalization:
Low TSH = negative feedback from elevated thyroid hormones (T3/T4).
Question 8
What is the best initial treatment for symptomatic hyperthyroidism?
Correct Answer:
Propranolol (Inderal)
Rationalization:
• Controls symptoms (tachycardia, tremors)
• Does NOT treat underlying cause
Question 9
What drug therapy reduces thyroid hormone production in Graves’ disease?
Correct Answer:
Antithyroid drugs (e.g., methimazole)
Rationalization:
These drugs inhibit thyroid hormone synthesis → restore euthyroid state.
, Question 10
How does heparin exert its effect?
Correct Answer:
Enhances antithrombin III activity
Rationalization:
Antithrombin III inhibits clotting factors → prevents clot formation.
Question 11
What component is part of Vitamin K–dependent clotting factors?
Correct Answer:
Prothrombin (Factor II)
Rationalization:
Vitamin K is required for synthesis of clotting factors II, VII, IX, X.
Question 12
What increases sensitivity to warfarin in elderly patients?
Correct Answer:
Decreased protein binding and reduced clotting factors
Rationalization:
• Less albumin → more free drug
• Higher bleeding risk
Question 13
What is the most serious side effect of metformin in elderly patients?
Correct Answer:
Lactic acidosis