South University | NSG 6001: Advanced Pharmacology
Week 4 Quiz 2 | Questions with Answers | 2026/2027 Academic Year
Part A: Ischemic Heart Disease & Angina (4 Questions)
Q1. The rapid-acting sublingual nitroglycerin is a cornerstone for aborting acute angina
attacks primarily because it:
A. Increases myocardial contractility.
B. Causes venous and arterial dilation, reducing preload and afterload, thereby
decreasing myocardial oxygen demand. [CORRECT]
C. Slows the heart rate to increase diastolic filling time.
D. Prevents platelet aggregation at the site of plaque rupture.
Correct Answer: B
Rationale: Nitrates are potent venodilators (reducing preload/ventricular filling
pressures) and arterial dilators (reducing afterload/systemic vascular resistance). This
decreases myocardial wall tension and oxygen demand, relieving ischemia. They also
dilate epicardial coronary arteries and collateral vessels, improving oxygen supply.
Nitrates do not significantly increase contractility (A)—reflex tachycardia may actually
occur. Negative chronotropy (C) is a beta-blocker effect. Antiplatelet effects (D) are
minimal with nitrates; aspirin/P2Y12 inhibitors provide antiplatelet therapy.
Q2. For secondary prevention in a patient post-MI, which medication regimen is
essential to reduce the risk of recurrent events and mortality?
A. A high-intensity statin, beta-blocker, and ACE inhibitor (or ARB). [CORRECT]
B. A moderate-intensity statin and a nitrate.
C. A diuretic and an antiarrhythmic.
D. A DOAC and clopidogrel.
Correct Answer: A
, Rationale: Guideline-directed medical therapy (GDMT) for post-MI secondary prevention
(2026/2027 ACC/AHA) includes: (1) High-intensity statin (atorvastatin 40-80 mg or
rosuvastatin 20-40 mg) for plaque stabilization and LDL <70 mg/dL; (2) Beta-blocker
(carvedilol, metoprolol succinate, or bisoprolol) to reduce cardiac workload, arrhythmia
risk, and mortality—especially if EF ≤40%; (3) ACE-I/ARB (or ARNI) to prevent adverse
ventricular remodeling and reduce mortality, particularly with reduced EF. This triple
foundation reduces recurrent MI and cardiovascular death by 20-30%. Nitrates (B) are
for symptom relief only. Diuretics/antiarrhythmics (C) are condition-specific.
DOAC/clopidogrel (D) is for specific indications (AFib, recent PCI) but not universal
post-MI therapy.
Q3. A patient with stable angina and concurrent heart failure with reduced ejection
fraction (HFrEF) requires antianginal therapy. Which medication is contraindicated in
this patient?
A. Metoprolol succinate
B. Diltiazem [CORRECT]
C. Ranolazine
D. Isosorbide mononitrate
Correct Answer: B
Rationale: Non-dihydropyridine calcium channel blockers (diltiazem, verapamil) are
negative inotropes that depress cardiac contractility and can worsen heart failure,
increase EF, and precipitate decompensation. They are contraindicated in HFrEF.
Metoprolol (A) is indicated in HFrEF (reduces mortality). Ranolazine (C) is safe in HFrEF
(no hemodynamic effects). Isosorbide mononitrate (D) is safe and often combined with
hydralazine in Black patients with HFrEF to reduce mortality (A-HeFT trial). For angina in
HFrEF: beta-blockers first-line, add nitrates or ranolazine as needed.
Q4. A 58-year-old post-ACS patient is discharged on aspirin 81 mg daily, ticagrelor 90
mg BID, atorvastatin 80 mg, metoprolol succinate 50 mg, and lisinopril 10 mg. Patient
Week 4 Quiz 2 | Questions with Answers | 2026/2027 Academic Year
Part A: Ischemic Heart Disease & Angina (4 Questions)
Q1. The rapid-acting sublingual nitroglycerin is a cornerstone for aborting acute angina
attacks primarily because it:
A. Increases myocardial contractility.
B. Causes venous and arterial dilation, reducing preload and afterload, thereby
decreasing myocardial oxygen demand. [CORRECT]
C. Slows the heart rate to increase diastolic filling time.
D. Prevents platelet aggregation at the site of plaque rupture.
Correct Answer: B
Rationale: Nitrates are potent venodilators (reducing preload/ventricular filling
pressures) and arterial dilators (reducing afterload/systemic vascular resistance). This
decreases myocardial wall tension and oxygen demand, relieving ischemia. They also
dilate epicardial coronary arteries and collateral vessels, improving oxygen supply.
Nitrates do not significantly increase contractility (A)—reflex tachycardia may actually
occur. Negative chronotropy (C) is a beta-blocker effect. Antiplatelet effects (D) are
minimal with nitrates; aspirin/P2Y12 inhibitors provide antiplatelet therapy.
Q2. For secondary prevention in a patient post-MI, which medication regimen is
essential to reduce the risk of recurrent events and mortality?
A. A high-intensity statin, beta-blocker, and ACE inhibitor (or ARB). [CORRECT]
B. A moderate-intensity statin and a nitrate.
C. A diuretic and an antiarrhythmic.
D. A DOAC and clopidogrel.
Correct Answer: A
, Rationale: Guideline-directed medical therapy (GDMT) for post-MI secondary prevention
(2026/2027 ACC/AHA) includes: (1) High-intensity statin (atorvastatin 40-80 mg or
rosuvastatin 20-40 mg) for plaque stabilization and LDL <70 mg/dL; (2) Beta-blocker
(carvedilol, metoprolol succinate, or bisoprolol) to reduce cardiac workload, arrhythmia
risk, and mortality—especially if EF ≤40%; (3) ACE-I/ARB (or ARNI) to prevent adverse
ventricular remodeling and reduce mortality, particularly with reduced EF. This triple
foundation reduces recurrent MI and cardiovascular death by 20-30%. Nitrates (B) are
for symptom relief only. Diuretics/antiarrhythmics (C) are condition-specific.
DOAC/clopidogrel (D) is for specific indications (AFib, recent PCI) but not universal
post-MI therapy.
Q3. A patient with stable angina and concurrent heart failure with reduced ejection
fraction (HFrEF) requires antianginal therapy. Which medication is contraindicated in
this patient?
A. Metoprolol succinate
B. Diltiazem [CORRECT]
C. Ranolazine
D. Isosorbide mononitrate
Correct Answer: B
Rationale: Non-dihydropyridine calcium channel blockers (diltiazem, verapamil) are
negative inotropes that depress cardiac contractility and can worsen heart failure,
increase EF, and precipitate decompensation. They are contraindicated in HFrEF.
Metoprolol (A) is indicated in HFrEF (reduces mortality). Ranolazine (C) is safe in HFrEF
(no hemodynamic effects). Isosorbide mononitrate (D) is safe and often combined with
hydralazine in Black patients with HFrEF to reduce mortality (A-HeFT trial). For angina in
HFrEF: beta-blockers first-line, add nitrates or ranolazine as needed.
Q4. A 58-year-old post-ACS patient is discharged on aspirin 81 mg daily, ticagrelor 90
mg BID, atorvastatin 80 mg, metoprolol succinate 50 mg, and lisinopril 10 mg. Patient
