5.0 of 7 Ratings
A 73-year-old man presents to his primary care physician with chest pain. He noticed the pain after walking several blocks, and the pain is relieved by sitting. On exam, he has a BP 155/89 mmHg, HR 79 bpm, and T 98.9 F. The physician refers the patient to a cardiologist and offers prescriptions for carvedilol and nitroglycerin. Which of the following describes the mechanism or effects of each of these medications, respectively?
Increased cAMP; Increased cAMP
Increased contractility; Decreased endothelial nitrous oxide
Decreased cAMP; Increased cGMP
Decreased cGMP; Increased venous resistance
Increased heart rate; Decreased arterial resistance
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A 55-year-old male is started on nitrate therapy for treatment of stable angina. He experiences significant and immediate relief of his symptoms within minutes of starting therapy. Approximately 48 hours after initiating this new medication, he notes return of chest pain and pressure with exertion that no longer responds to continued nitrate use. Which of the following 24-hour dosing schedules would most likely explain this patient's response to nitrate treatment?
Transdermal nitroglycerin patch placed at 7AM then removed and replaced with another at 7PM
PO regular-release isosorbide dinitrate taken at 8AM, noon, and 5PM
Transdermal nitroglycerin patch placed at bedtime and removed at 7AM without replacement
Transdermal nitroglycerin patch placed upon awakening in the morning and removed at 7PM without replacement
PO extended release isosorbide-5-mononitrate once daily at 8AM
A 58-year-old male presents with an acutely elevated blood pressure of 220/140 mmHg. The patient complains of a headache and chest pain, and he has been vomiting for the last several hours. Physical exam demonstrates papilledema and a depressed level of consciousness. To treat this patient's hypertensive emergency, he is started on an IV medication commonly used in this situation. The agent exerts its effect by releasing nitric oxide as a metabolite, which subsequently activates guanylate cyclase and increases production of cGMP in vascular smooth muscle. Which of the following clinical effects would be expected from administration of this medication?
Decreased cardiac contractility
Increased left ventricular end-diastolic pressure
Decreased stroke volume
Decreased pulmonary capillary wedge pressure
Increased systemic vascular resistance
A 66-year-old gentleman presents to a new primary care physician to establish care after a recent relocation. His past medical history is significant for gout, erectile dysfunction, osteoarthritis of bilateral knees, mitral stenosis, and diabetic peripheral neuropathy. He denies any past surgeries along with the use of any tobacco, alcohol, or illicit drugs. He has no known drug allergies and cannot remember the names of the medications he is taking for his medical problems. He states that he has recently been experiencing chest pain with strenuous activities. What part of the patient's medical history must be further probed before starting him on a nitrate for chest pain?
Diabetic peripheral neuropathy
A 56-year-old man with substernal chest pain calls 911. When paramedics arrive, they administer drug X sublingually for the immediate relief of angina. What is the most likely site of action of drug X?
A 62-year-old Caucasian male receiving treatment for stable angina experiences intermittent throbbing headaches. What is the most likely cause?
Transient ischemic attack
Elevated creatine kinase
Beta adrenergic inactivation
Vasodilation of cerebral arteries
A 45-year-old Caucasian man is given nitroglycerin for the management of his stable angina. Nitroglycerin given for the rapid relief of acute angina would most likely be given through what route of administration?