Question 1
Which process is most directly involved in cardiac remodeling in heart failure?- decompensation
- myocyte apoptosis
- venous congestion
- sodium and water retention
- increased afterload
The correct answer is B: myocyte apoptosis.
Cardiac remodeling in heart failure is characterized by ventricular wall thinning, collagen production, fibrosis, and cardiac dilatation. Myocyte apoptosis (programmed cell death) contributes to wall thinning and impaired systolic function. The other options (A, C, D, and E) are partly the result of cardiac remodeling.
Cardiac remodeling in heart failure is characterized by ventricular wall thinning, collagen production, fibrosis, and cardiac dilatation. Myocyte apoptosis (programmed cell death) contributes to wall thinning and impaired systolic function. The other options (A, C, D, and E) are partly the result of cardiac remodeling.
Question 2
A man is brought to the emergency department complaining of nausea and vomiting, blurred and abnormally colored vision, and palpitations. Which drug is most likely responsible for these effects?- dobutamine
- lisinopril
- digoxin
- milrinone
- furosemide
The correct answer is C: digoxin.
Excessive doses of digitalis glycosides cause nausea and vomiting, visual disturbances, and cardiac arrhythmias. Dobutamine and milrinone (A and D) may also cause cardiac arrhythmias but do not typically caused blurred vision, nausea, and vomiting. Lisinopril and furosemide (B and E) do not usually cause any of these adverse effects. Treatment with the digoxin antidote, Digibind, may be warranted.
Excessive doses of digitalis glycosides cause nausea and vomiting, visual disturbances, and cardiac arrhythmias. Dobutamine and milrinone (A and D) may also cause cardiac arrhythmias but do not typically caused blurred vision, nausea, and vomiting. Lisinopril and furosemide (B and E) do not usually cause any of these adverse effects. Treatment with the digoxin antidote, Digibind, may be warranted.
Question 3
Which drug has been demonstrated to increase survival in persons with heart failure?- furosemide
- carvedilol
- milrinone
- digoxin
- hydralazine-isosorbide dinitrate
The correct answer is B: carvedilol.
Carvedilol, a third generation β-blocker, has been shown to improve cardiac performance, reduce symptoms, slow disease progression, and increase survival in heart failure. Angiotensin inhibitors also increase cardiac output and reduce mortality. Inotropic agents (C and D), diuretics (A), and hydralazine-isosorbide dinitrate (E) improve symptoms but have not been shown to increase survival.
Carvedilol, a third generation β-blocker, has been shown to improve cardiac performance, reduce symptoms, slow disease progression, and increase survival in heart failure. Angiotensin inhibitors also increase cardiac output and reduce mortality. Inotropic agents (C and D), diuretics (A), and hydralazine-isosorbide dinitrate (E) improve symptoms but have not been shown to increase survival.
Question 4
A woman is given a recombinant form of a human natriuretic peptide. Which mechanism is responsible for the cardiovascular effects of this drug?- inhibition of adenylyl cyclase
- stimulation of adenylyl cyclase
- inhibition of guanylyl cyclase
- stimulation of guanylyl cyclase
- inhibition of phosphodiesterase, type III
The correct answer is D: stimulation of guanylyl cyclase.
The woman was most likely given nesiritide, a recombinant form of type B human natriuretic peptide. This drug activates guanylyl cyclase in vascular smooth muscle and endothelial cells, leading to increased cGMP and vasodilation. Nesiritide is used to treat acutely decompensated heart failure (heart failure in which the stroke volume is no longer proportional to the diastolic fiber length). Vasodilation reduces congestion and dyspnea in these patients.
The woman was most likely given nesiritide, a recombinant form of type B human natriuretic peptide. This drug activates guanylyl cyclase in vascular smooth muscle and endothelial cells, leading to increased cGMP and vasodilation. Nesiritide is used to treat acutely decompensated heart failure (heart failure in which the stroke volume is no longer proportional to the diastolic fiber length). Vasodilation reduces congestion and dyspnea in these patients.
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