Deck 14: Drugs for the Treatment of Cardiovascular Disease

Question 1

Hypersalivation is a sign of toxicity for which of the following agents?

A) Clonidine
B) Digoxin
C) Enalapril
D) Hydrochlorothiazide
E) Nifedipine

Answer 1

Digoxin

Question 2

Dental patients with left heart failure may need to be positioned in the dental chair:

A) with their left hip elevated.
B) with their right hip elevated.
C) in a semireclined position.
D) with their feet at a higher elevation than their head.
E) lying flat.

Answer 2

in a semireclined position.

Question 3

Nitroglycerin (NTG)should be:

A) stored in plastic.
B) kept in the refrigerator.
C) administered once every 5 minutes until the anginal attack is stopped.
D) available to the dental team for treatment of an acute anginal attack.
E) all of the above.

Answer 3

available to the dental team for treatment of an acute anginal attack.

Question 4

The cells of cardiac muscles have an intrinsic rhythm called:

A) spontaneity.
B) automaticity.
C) anarchy.
D) hierarchy.

Question 5

A patient has a cardiovascular disorder for which a physician prescribes a local anesthetic drug. What might this cardiovascular disorder be?

A) Coronary artery disease
B) Hypertension
C) Arrhythmia
D) Angina pectoris

Question 6

Which of the following is true concerning what research has shown regarding the relationship between periodontal disease and cardiovascular disease?

A) Studies have shown a very strong positive correlation between periodontal disease and cardiovascular disease.
B) Studies have shown a weak but positive correlation between periodontal disease and cardiovascular disease.
C) Studies both support and reject the relationship between periodontal disease and cardiovascular disease.
D) Studies have shown there is no correlation between periodontal disease and cardiovascular disease.

Question 7

MI refers to:

A) injury or necrosis of the heart muscle.
B) transient lack of oxygen to the heart.
C) congestive heart failure (CHF).
D) abnormal sinus rhythm of the heart.

Question 8

Nitroglycerine (NTG)is a(n)_____ that produces relaxation of vascular smooth muscle throughout the body.

A) vasoconstrictor
B) vasodilator
C) beta-blocker
D) angiotensin-converting enzyme inhibitor
E) angiotensin receptor blocker

Question 9

Which of the following categories of drug is the best choice to relieve the acute symptoms of angina?

A) Nitroglycerin (NTG, Nitrostat, Nitrolingual)
B) Nitroglycerin (Nitro-Bid)
C) Propranolol
D) Verapamil (Calan, Isoptin)
E) Nifedipine (Procardia)

Question 10

Nitroglycerine (NTG)is used for what cardiovascular disease?

A) Atherosclerosis
B) Coronary artery disease
C) Arrhythmias
D) Angina pectoris

Question 11

Which of the following classes of antiarrhythmics is associated with gingival enlargement?

A) Amiodarone
B) Calcium channel blockers
C) Disopyramide
D) Procainamide
E) Quinidine

Question 12

Which of the following choices are effects of digoxin on the heart?

A) Digoxin accelerates atrioventricular (AV)conduction.
B) Digoxin prolongs the refractory period of the atrioventricular (AV)node.
C) Digoxin increases the rate of the sinoatrial (SA)node.
D) Both a and b are effects.
E) Both b and c are effects.

Question 13

Which of the following is the primary type of drug recommended for patients who have edema or fluid retention with heart failure (HF)?

A) Angiotensin converting enzyme inhibitor
B) Angiotensin receptor antagonist
C) Beta-blocker
D) Aldosterone antagonist
E) Diuretic

Question 14

In a normally functioning heart, the bundle of His receives its electrical input from the:

A) Purkinje fibers.
B) atrioventricular (AV)node.
C) sinoatrial (SA)node.
D) cardiac muscle.

Question 15

How long should a person who has had a myocardial infarction wait before receiving dental care?

A) 2 weeks
B) 2 months
C) 6 months
D) 12 months
E) 24 months

Question 16

The use of nitroglycerin (NTG)is contraindicated if sildenafil (Viagra)has been administered within 24 hours. This is because the NTG-sildenafil combination can precipitate a hypertensive crisis.

A) Both statements are true.
B) Both statements are false.
C) The first statement is true; the second statement is false.
D) The first statement is false; the second statement is true.

Question 17

To prevent tolerance, prophylactic nitrates should be given with at least a(n):

A) week off every month.
B) day off every week.
C) 8- to 12- hour "vacation" every day.
D) 1 hour "vacation" every 12 hours.

Question 18

Which of the following conditions is an absolute contraindication to dental treatment until a consultation with the patient's provider has determined any special treatment alterations that might be warranted?

A) Recent myocardial infarct within the preceding 3 months
B) Diabetes
C) Hyperlipidemia
D) Gout

Question 19

Which of the following statements is true of heart failure?

A) Usually the right side fails first.
B) If the left side of the heart fails, the blood backs up into the pulmonary circulation.
C) If the right side of the heart fails, then the left ventricle is unable to remove all the blood from the right side of the heart.
D) Left-sided heart failure causes systemic congestion.

Question 20

The _____ has the fastest rate of depolarization and therefore directs all the other cells of the heart.

A) sinoatrial (SA)node
B) atrioventricular (AV)node
C) bundle of His
D) Purkinje fibers

Question 21

Which of the following statement is true concerning the use of b-adrenergic blocking agents for the treatment of angina pectoris?

A) These drugs block the g response to catecholamine stimulation, thereby reducing both the chronotropic and inotropic effects.
B) b-adrenergic blockers are effective in reducing exercise but not stress-induced anginal episodes.
C) Adverse effects of b-adrenergic blocking agents include tachycardia, headache, and excessive salivation.
D) The net result of the use of b-adrenergic blocking agents for the treatment of angina pectoris is a reduced myocardial oxygen demand.

Question 22

Which of the following agents can worsen asthma?

A) Propranolol (Inderal)
B) Calcium channel blocker
C) ACEIs
D) Anticholinergics

Question 23

Before administering nitroglycerine (NTG), the dental team should make sure that the patient has not used a _____ within the past 24 hours.

A) phenothiazine
B) PDE5 inhibitor
C) ranolazine
D) guanethidine

Question 24

Which of the following statements is true regarding hypertension?

A) High blood pressure occurs without regard to stress or tension.
B) Complications of hypertension are greatly increased with concomitant smoking.
C) In most cases of hypertension, the cause can be identified and associated with a specific disease process.
D) Both a and b are true.
E) Both b and c are true.

Question 25

Which diuretic acts at the ascending loop of Henle of the kidney nephron to cause rapid diuresis?

A) Hydrochlorothiazide
B) Triamterine
C) Furosemide
D) Spironolactone

Question 26

Common adverse reactions associated with thiazides include:

A) hypokalemia and hypouricemia.
B) hyperkalemia and hypouricemia.
C) hypokalemia and hyperuricemia.
D) hyperkalemia and hyperuricemia.

Question 27

Essential hypertension is:

A) of unknown cause.
B) iatrogenic hypertension.
C) precipitated by another disorder.
D) a rapidly developing form of hypertension, requiring aggressive therapy.

Question 28

b-Adrenergic blockers lower blood pressure primarily by:

A) reducing peripheral resistance.
B) decreasing cardiac output.
C) lowering plasma volume.
D) lowering plasma renin levels.

Question 29

Which of the following groups of diuretics are called the "puny" diuretics?

A) Thiazide
B) Loop
C) Potassium-sparing
D) Both a and b
E) Both b and c

Question 30

Approximately _____% of people with hypertension are properly treated.

A) 20
B) 40
C) 50
D) 60

Question 31

Eating bananas when taking thiazide diuretics will:

A) deplete calcium.
B) prevent diuresis.
C) replenish potassium.
D) inhibit the drug's metabolism.

Question 32

Which of the following is the most common cardiovascular disease?

A) Heart failure
B) Cardiac arrhythmia
C) Angina
D) Hypertension

Question 33

Which of the following is the most important dental drug interaction with the thiazide diuretics?

A) Aspirin
B) Nonsteroidal antiinflammatory drugs (NSAIDs)
C) Penicillin
D) Chlorhexidine

Question 34

Which of the following is a b-adrenergic blocking drug that also has a-receptor blocking activity?

A) Atenolol
B) Labetalol
C) Doxazosin
D) Minoxidil

Question 35

Nonselective b-blockers can have a drug interaction with epinephrine, causing a two- to fourfold increase in vasopressor response. A gingival retraction cord containing epinephrine may be used, however.

A) Both statements are true.
B) Both statements are false.
C) The first statement is true; the second statement is false.
D) The first statement is false; the second statement is true.

Question 36

Which b-adrenergic blocking agent has partial agonist activity and causes some b-stimulation while blocking catecholamine action?

A) Atenolol
B) Acebutolol
C) Metoprolol
D) Carvedilol

Question 37

_____ should not be given to persons taking potassium supplements because hyperkalemia will occur.

A) Thiazides
B) b-Blockers
C) Angiotensin-converting enzyme inhibitors (ACEIs)
D) Angiotensin receptor blockers (ARBs)
E) Calcium channel blockers

Question 38

According to The Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure 2013 guidelines hypertension for individuals over the age of 60 without diabetes or chronic kidney disease is greater than or equal to _____ mm Hg.

A) 120/80
B) 140/90
C) 150/90
D) 160/100

Question 39

If the _____ tablet of sublingual nitroglycerin (NTG)does not stop the anginal attack, the patient should be taken to the emergency room.

A) first
B) second
C) third
D) fourth
E) fifth

Question 40

b₁-Receptor stimulation is associated with:

A) vasodilation in skeletal muscles.
B) bronchodilation in pulmonary tissues.
C) a decrease in heart rate.
D) an increase in cardiac contractility.

Question 41

Angiotensin receptor blockers (ARBs)end with the suffix:

A) -olol.
B) -dipine.
C) -pril.
D) -artan.

Question 42

Patients taking antihypertensive agents who have been supine for some time should be slowly raised from that position. They should dangle their legs over the side of the chair and wiggle them before rising to the standing position.

A) Both statements are true.
B) Both statements are false.
C) The first statement is true; the second statement is false.
D) The first statement is false; the second statement is true.

Question 43

Which of the following statements is true of ezetimibe?

A) It is an HMG Co-A reductase inhibitor.
B) This drug decreases total cholesterol, HDL cholesterol, and decreases HDL cholesterol levels.
C) Little difference exists in the cholesterol lowering abilities of ezetimibe/simvastatin and simvastatin alone.
D) Ezetimibe/simvastatin has been found to lower low-density lipoprotein (LDL)cholesterol and has a marked effect on plaque buildup.

Question 44

Severe hypotension and reflex tachycardia are caused by combination of sympathomimetics, such as epinephrine, with which antihypertensive agent class?

A) Calcium channel blockers
B) a1-Adrenergic blocking agents
C) Angiotensin receptor blockers (ARBs)
D) Potassium-sparing diuretics

Question 45

Many _____ end in the suffix -pril.

A) b-adrenergic blockers
B) calcium channel blockers
C) angiotensin-converting enzyme inhibitors (ACEIs)
D) angiotensin receptor blockers (ARBs)

Question 46

Which of the following statements is true concerning hyperlipidemia and cholesterol?

A) Hyperlipidemia includes elevations in cholesterol or triglycerides and is associated with the development of arteriosclerosis.
B) High-density lipoprotein (HDL)is good cholesterol.
C) Foam cells become filled with lipid.
D) Both a and b are correct.
E) Both b and c are correct.

Question 47

Which agent is most likely to cause xerostomia?

A) Losartan
B) Clonidine
C) Enalapril
D) Atenolol

Question 48

A serious lupus-like reaction is associated with which cardiovascular drug?

A) Clonidine
B) Hydralazine
C) Isosorbide dinitrate
D) Spironolactone

Question 49

When a physician finds out that his female patient wishes to start a family, he decides to change her cholesterol-lowering medication. He changes her medication from:

A) niacin to simvastatin.
B) simvastatin to atorvastatin.
C) simvastatin to niacin.
D) gemfibrozil to candesartan.

Question 50

All of the following effects are characteristic of channel-blocking agents except which one?

A) Reduction in afterload on the heart
B) Inhibition of calcium flux through L-type channels
C) Decrease in cardiac contractility
D) Orthostatic hypotension
E) Peripheral edema

Question 51

Which of the following categories of antihypertensive agents end in the suffix -dipine?

A) Diuretics
B) b-Adrenergic blockers
C) Calcium channel blockers
D) Angiotensin receptor blockers (ARBs)

Question 52

Treatment with all of the following agents is associated with development of gingival hypertrophy except which one?

A) Verapamil
B) Phenytoin
C) Clonidine
D) Felodipine

Question 53

Which of the following categories of agents may be used to treat both hypertension and benign prostatic hypertrophy?

A) Diuretic agents
B) b-Adrenergic blocking agents
C) a1-Adrenergic blocking agents
D) Calcium channel blocking agents

Question 54

The newest guidelines from the ACC/AHA recommend using HMG-coA reductase inhibitors (statins)as the drugs of first choice for treating patients with atherosclerotic cardiovascular disease based on:

A) a total cholesterol level of over 240 mg/dL.
B) a low-density lipoprotein level over 190 mg/dL.
C) the patient's estimated 10-year atherosclerotic cardiovascular disease risk.
D) poor lifestyle factors such as being overweight and smoking.

Question 55

Which agent reduces serum cholesterol by increasing its utilization for bile acid synthesis?

A) Niacin
B) Atorvastatin
C) Gemfibrozil
D) Cholestyramine
E) Clopidogrel

Question 56

Which of the following is the first choice of therapy for most patients with atherosclerotic heart disease and elevated cholesterol levels?

A) Fenofibrate
B) Niacin
C) Cholestipol (Colesevelam)
D) Omega-3 fish oil
E) 3-Hydroxy-3- methylglutaryl coenzyme A reductase inhibitor

Question 57

NSAIDs can antagonize the effects of which of the following antihypertensive medications?

A) Angiotensin converting enzyme inhibitors (ACEIs)
B) b-Adrenergic antagonists
C) Calcium channel blockers
D) Loop diuretics
E) Centrally acting hypertensive agents

Question 58

Which of the following agents is an a₁-adrenergic receptor antagonist?

A) Amlodipine (Norvasc)
B) Benazepril (Lotensin)
C) Candesartan (Atacand)
D) Terazosin (Hytrin)
E) Atenolol (Tenormin)

Question 59

Which class of agents is of special benefit to diabetics?

A) b-Adrenergic blockers
B) Calcium channel blocker (CCB)
C) Angiotensin-converting enzyme inhibitors (ACEIs)
D) Anticholinergics

Question 60

Niacin works by:

A) inhibiting HMG-CoA reductase.
B) inhibiting the intestinal absorption of cholesterol.
C) inhibiting the secretion of very-low-density lipoproteins (VLDLs)without accumulation of triglycerides in the liver.
D) increasing lipolysis of triglycerides, decreasing lipolysis in adipose tissue, and inhibiting secretions of VLDLs from the liver.

Question 61

Myocardial infarction occurring 9 months prior to an office visit would be a contraindication to dental treatment.

Question 62

Of the vitamin K-dependent clotting factors, which has the shortest circulating half-life?

A) Factor II
B) Factor VII
C) Factor VIII
D) Factor IX
E) Factor X

Question 63

There is a danger of _____ if the dose of anticoagulant is too small.

A) embolism
B) hemorrhage
C) chronic obstructive pulmonary disease
D) angina

Question 64

A patient taking warfarin (Coumadin)may experience interactions with which of the following?

A) Phenobarbital
B) Erythromycin
C) Aspirin
D) All of the above

Question 65

Which of the following drugs is a direct inhibitor of thrombin?

A) Rivaroxaban (Xarelto)
B) Dabigatran (Pradaxa)
C) Clopidogrel (Plavix)
D) Ticlopidine (Ticlid)
E) Alteplase (Activase)

Question 66

Long chain omega-3 polyunsaturated fatty acids can decrease fasting triglyceride concentrations by:

A) 5% to 10%.
B) 10% to 20%.
C) 20% to 50%.
D) 50% to 70%.

Question 67

Which of the following antihyperlipidemic agents can promote gallstone formation?

A) HGM CoA reductase inhibitors
B) Niacin
C) Cholestyramine
D) Gemfibrozil

Question 68

Which of the following antibiotics can increase the toxicity of digoxin in some patients? (Select all that apply.)

A) Penicillin
B) Erythromycin
C) Tetracycline
D) Metronidazole
E) Ampicillin

Question 69

Which of the following agents has the most serious drug interaction with warfarin?

A) Omeprazole
B) Aspirin
C) Digitalis
D) Lomotil

Question 70

The therapeutic target international normalized ratio (INR)for most indications, such as thrombophlebitis is:

A) less than 1.
B) between 2 and 3.
C) between 3.5 and 4.5.
D) over 4.5.

Question 71

Blood returning from the pulmonary circulation enters the left atrium.

Question 72

The presence of _____ in the oral cavity can be a sign of an adverse effect associated with the oral anticoagulants.

A) lichen planus
B) petechial hemorrhages
C) linear gingival erythema
D) hairy tongue

Question 73

Angiotensin-converting enzyme inhibitors (ACEIs)are a treatment of choice for congestive heart failure (CHF).

Question 74

Diuretics can produce _____, which can predispose a patient to serious arrhythmias. (Select all that apply.)

A) hyperkalemia
B) hypokalemia
C) hyperuricemia
D) hypouricemia

Question 75

Which of the following are true of both apixaban (Eliquis)and rivaroxaban (Xarelto)? (Select all that apply.)

A) Both are indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.
B) Both are indicated for the treatment of deep vein thrombosis (DVT)and pulmonary embolism (PE).
C) Both drugs have a marked treatment benefit when contrasted with warfarin.
D) INR monitoring is not required with these drugs.

Question 76

What precautions should the dental professional exercise with a patient taking an a-adrenergic receptor blocker? (Select all that apply.)

A) Raise and lower the dental chair slowly.
B) Use local anesthetic with no or low-dose epinephrine.
C) Use caution and local measures for excessive bleeding tendency.
D) Nonsteroidal antiinflammatory drugs (NSAIDs)will exacerbate the antihypertensive effect of the a1-blockers to produce a hypertensive crisis.

Question 77

All of the following agents inhibit platelet function except for which one?

A) Clopidogrel
B) Dipyridamole
C) Ticlopidine
D) Aspirin

Question 78

Calcium channel blockers may be used to treat which of the following? (Select all that apply.)

A) Angina
B) Cardiac arrhythmia
C) Hypertension
D) Hyperlipidemia

Question 79

Some studies have found that the presence of periodontal disease predicts an increase in morbidity and mortality resulting from cardiovascular disease and others have failed to show a relationship.

Question 80

Which of the following is true regarding digitalis glycosides (digoxin, Lanoxin, Digitek)? (Select all that apply.)

A) Can reduce pulmonary edema
B) Increases contractility of the heart
C) Have a narrow therapeutic index
D) Is considered a first-line therapy for the treatment of heart failure (HF)
E) Causes diuresis due to a direct effect on the kidneys.