Nokea
A 62-year-old man has developed worsening hypertension despite therapy. His physician wants to prescribe an additional medication that will dilate his blood vessels to help lower his blood pressure. Which of the following is a calcium channel blocker that works primarily on vascular smooth muscle?
- A. Amlodipine
- B. Diltiazem
- C. Losartan
- D. Nitroprusside
Correct Answer: A
Rationale: Amlodipine, a dihydropyridine calcium channel blocker, primarily dilates peripheral arteries, unlike diltiazem and verapamil, which also affect cardiac muscle, or losartan and nitroprusside, which act via different mechanisms.
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Which of the following local anesthetics is a thiophene derivative?
- A. Procaine
- B. Ultracaine
- C. Lidocaine
- D. Mepivacaine
Correct Answer: B
Rationale: The correct answer is B: Ultracaine. Ultracaine is a thiophene derivative because it contains a thiophene ring in its chemical structure. Thiophene is a five-membered heterocyclic compound containing sulfur. Procaine (A) is an ester local anesthetic, Lidocaine (C) is an amide local anesthetic, and Mepivacaine (D) is an amide local anesthetic. Therefore, they do not belong to the thiophene derivative class. Ultracaine is the only option that fits the description of being a thiophene derivative.
Hyperglycemia induced by epinephrine is due to:
- A. Gluconeogenesis (beta2)
- B. Inhibition of insulin secretion (alfa)
- C. Stimulation of glycogenolysis (beta2)
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D because epinephrine acts on different receptors to induce hyperglycemia. Epinephrine stimulates beta2 receptors to increase gluconeogenesis and glycogenolysis, leading to elevated blood glucose levels. It also inhibits insulin secretion from alpha receptors, further contributing to hyperglycemia. Therefore, all options A, B, and C are correct mechanisms through which epinephrine induces hyperglycemia.
Indication for calcium administration is:
- A. Failure of formation of vitamin D in skin
- B. Malabsorption of vitamin D from intestine
- C. Hypercalcemia of malignancy
- D. Vitamin D deficiency
Correct Answer: B
Rationale: Step-by-step rationale:
1. Calcium administration is indicated in malabsorption of vitamin D because vitamin D is necessary for calcium absorption in the intestine.
2. Malabsorption of vitamin D leads to decreased calcium absorption, which can result in calcium deficiency.
3. Administering calcium can help compensate for the decreased absorption of calcium due to vitamin D malabsorption.
Summary:
- Option A is incorrect as the formation of vitamin D in the skin is not directly related to calcium administration.
- Option C is incorrect as hypercalcemia of malignancy indicates excess calcium, not a need for calcium administration.
- Option D is incorrect as it mentions the deficiency of vitamin D, not the malabsorption of vitamin D, which is the indication for calcium administration.
Insulin can not be administered by:
- A. Oral route
- B. Intravenous route
- C. Subcutaneous route
- D. Intramuscular route.
Correct Answer: A
Rationale: The correct answer is A: Oral route. Insulin cannot be administered orally because it gets degraded by stomach enzymes. The correct routes for insulin administration are B: Intravenous route, C: Subcutaneous route, and D: Intramuscular route. These routes allow for direct absorption into the bloodstream without degradation. Intravenous route ensures rapid onset, subcutaneous route is commonly used for self-administration, and intramuscular route provides slower absorption.
We have a 50-year-old man with asymptomatic hyperuricemia, and we are about to start therapy for newly diagnosed essential hypertension (BF 136/90 mm Hg). Which of the following antihypertensive drugs is most likely to-increase his serum uric acid levels further; and-possibly precipitate a gout attack?
- A. Captopril
- B. Hydrochlorothiazide
- C. Labetalol
- D. Losartan
Correct Answer: B
Rationale: Hydrochlorothiazide increases uric acid by reducing its excretion, risking gout.