A 52-year-old woman suffering from hypertension still had a blood pressure of 156/92 mm Hg after 3 months of therapy with hydrochlorothiazide and losartan. Her physician decided to add a third drug that acts by decreasing central sympathetic outflow. Which of the following adverse effects was most likely to occur after a few days of therapy with the new drug?

Correct Answer: A

Rationale: The most likely adverse effect to occur after adding a third drug that acts by decreasing central sympathetic outflow would be severe postural hypotension. This is due to the combined effect of the drugs leading to a significant drop in blood pressure upon standing up, causing dizziness and potential fainting episodes. This adverse effect is commonly associated with antihypertensive medications that affect sympathetic outflow.

Correct Answer: C

Rationale: In this question, the correct answer is C) Classic angina. Classic angina is exertion-induced chest pain caused by reduced blood flow to the heart muscle due to narrowed coronary arteries. The pain is typically relieved by rest or nitroglycerin as these interventions help increase blood flow to the heart. A) Prinzmetal's angina, also known as variant angina, is caused by coronary artery spasm rather than physical exertion. It is often seen at rest and can occur in the absence of underlying coronary artery disease. B) Unstable angina is characterized by chest pain that occurs at rest or with minimal exertion and is considered a medical emergency as it may progress to a heart attack. D) Variant angina, also called Prinzmetal's angina, is caused by coronary artery spasm rather than physical exertion. Educationally, understanding the different types of angina is crucial for healthcare professionals to accurately diagnose and manage patients with chest pain. Recognizing the characteristics of each type of angina helps in determining appropriate treatment strategies and interventions to alleviate symptoms and prevent cardiovascular complications. A solid grasp of these distinctions is vital for pharmacology students to make informed decisions regarding the use of medications like nitroglycerin in the management of angina.

Correct Answer: A

Rationale: In this question, the correct answer is A) Digoxin. Digoxin is a cardiac glycoside that can exacerbate or accentuate varient (Prinzmetal) angina due to its potential to increase myocardial oxygen demand and trigger coronary artery vasospasm, which can worsen symptoms in patients with this type of angina. Option B) Furosemide is a loop diuretic used to treat conditions like heart failure and edema by promoting diuresis. Furosemide is not known to specifically exacerbate varient angina. Option C) Enalapril is an ACE inhibitor that helps lower blood pressure and reduce strain on the heart. Enalapril is not typically associated with worsening varient angina. Option D) Amrinone is a phosphodiesterase inhibitor with positive inotropic effects. While it can increase myocardial contractility, it is not a common trigger for varient angina. Educationally, understanding the effects of different cardiovascular drugs on various cardiac conditions is crucial for healthcare professionals to make informed decisions when managing patients with cardiovascular diseases. Recognizing the specific actions of drugs like digoxin in exacerbating certain conditions like varient angina can guide appropriate medication selection and monitoring to optimize patient outcomes.

Correct Answer: A

Rationale: The correct answer is A) Enalaprilat. Enalaprilat is the active form of the ACE inhibitor Enalapril and is commonly used in hypertensive emergencies due to its rapid onset of action when administered intravenously. B) Benzalaprilat is not a recognized ACE inhibitor. C) Fosinoprilat is the active form of Fosinopril, but it is not typically used in hypertensive emergencies. D) Quinoprilat is the active form of Quinapril and is not the preferred choice in hypertensive emergencies. In an educational context, understanding the correct ACE inhibitor for hypertensive emergencies is crucial for healthcare professionals managing patients with acute hypertension. Enalaprilat's fast-acting properties make it a suitable choice in these critical situations, where rapid blood pressure control is necessary to prevent complications like stroke or organ damage. It is essential for students and practitioners to be familiar with the pharmacological properties of cardiovascular drugs to make informed decisions in emergency situations.

Correct Answer: A

Rationale: In the context of cardiovascular drugs, organic nitrates are commonly prescribed for angina due to their vasodilatory properties. The correct answer is A) Decreases preload. Organic nitrates primarily work by dilating veins, which leads to a reduction in preload. By decreasing preload, the heart has to work less to pump blood out to the body, which reduces the oxygen demand on the heart muscle and helps alleviate angina symptoms. Option B) Increases afterload is incorrect because organic nitrates do not increase the afterload. Instead, they primarily act on the preload by dilating veins. Option C) Constricts arterioles is incorrect as organic nitrates actually cause vasodilation, including dilation of arterioles, leading to decreased systemic vascular resistance. Option D) Increases preload is incorrect because, as mentioned earlier, organic nitrates decrease preload by dilating veins, which reduces the amount of blood returning to the heart. Understanding the effects of organic nitrates on the cardiovascular system is crucial for healthcare professionals when managing patients with angina. By grasping the mechanism of action of these drugs, healthcare providers can effectively optimize treatment and improve patient outcomes.