CME Information

This CME activity was planned and produced in accordance with the ACCME Essentials. The Emory University School of Medicine designates this continuing medical education activity for 3 credit hours in Category 1 of the Physician's Recognition Award of the American Medical Association.

Upon completion of this course of study, in order to obtain AMA Category 1 credit, please print out and complete in full the combined Answer Sheet/Evaluation Form and return by January 31, 1997. Please enclose a check for $25 made payable to: EMORY UNIVERSITY SCHOOL OF MEDICINE, to cover administrative charges.

Forward the check and completed Answer Sheet/Evaluation Form to:
Continuing Medical Education
Emory University School of Medicine
Clifton Road, NE / 107 WHSCAB
Atlanta, Georgia 30322

CME Questions

1. Identify the incorrect statement about the mechanism of action of the selective calcium channel blockers.

   A. All selective calcium channel blockers inhibit the movement of calcium through L-type calcium channels.

   B. The three classes of calcium channel blocker bind to the same receptors within the alpha1 subunit of voltage-dependent, L-type calcium channels, but the phenylalkylamines bind to these sites most readily.

   C. As a rule, calcium channel blockers do not participate in pharmacologic responses that depend on the mobilization of intracellular calcium rather than the entry of calcium through voltage-dependent channels.

   D.Calcium channels can exist in resting, open, or inactivated states, and the binding affinity of a drug may differ in each of these states.

   
   
   
2. Identify the correct statement about the pharmacokinetics of the calcium channel blockers.

   A. The calcium channel blockers are well absorbed after oral administration, and they have comparable levels of oral bioavailability.

   B. Protein binding with verapamil and diltiazem is concentration dependent, allowing for the possibility of protein-binding interactions.

   C. Protein binding is higher with the dihydropyridines than with verapamil and diltiazem.

   D. Because verapamil has a long half-life, sustained-release formulations of this agent are not needed.

   
   
   
3. Identify the correct statement about the hemodynamic effects of the calcium channel blockers.

   A. Diltiazem's activity in the sinus node, and to a lesser extent, the AV node, produces a modest but consistent reduction in heart rate.

   B. The coronary vasodilatory activity of verapamil is comparable to that of diltiazem.

   C. Diltiazem and verapamil, but not nifedipine, have a negative inotropic effect.

   D. Nifedipine slows conduction through the AV node and prolongs the AV node functional recovery period.

   
   
   
4. Identify the correct statement about the adverse-effect profiles of the calcium channel blockers.

   A. Headache is the most common adverse effect reported in patients treated with verapamil.

   B. AV conduction disturbances are more common in patients receiving diltiazem than in those receiving verapamil.

   C. Fewer adverse effects are reported with newer, extended-release formulations of dihydropyridine agents than with conventional nifedipine.

   D. The most common side effects associated with nifedipine are constipation, headaches, and peripheral edema.

   
   
   
5. Recent recommendations for a reclassification of the calcium channel blockers include:

   A. Grouping verapamil with the newer dihydropyridines because of their common negative inotropic effects.

   B. Grouping diltiazem and nifedipine because of their complementarity in treating selective monotherapy-resistant hypertensive patients.

   C. Grouping verapamil and diltiazem on the one hand, and the dihydropyridines on the other, based on tissue selectivity and overall pharmacologic effects.

   D. Establishing a separate family for each of the three main types of calcium channel blocker.

   
   
   
6. Case-control studies:

   A. are useful for detecting small differences in the safety or efficacy of therapeutic interventions

   B. are prospective, observational investigations

   C. can be used to formulate hypotheses for consideration in prospective, randomized, controlled trials

   D. all of the above

   
   
   
7. The case-control study by Psaty et al:

   A. suggested that short-acting calcium channel blockers may increase the risk of myocardial infarction (MI) in hypertensive patients

   B. showed that calcium channel blockers may increase the risk of mortality by as much as 60% in hypertensive patients

   C. ruled out selection bias as an explanation for an increased risk of MI in patients taking calcium channel blockers

   D. all of the above

   
   
   
8. The metaanalysis by Furberg et al:

   A. showed that dihydropyridine calcium channel blockers increased the risk of mortality in a homogeneous group of post-MI patients

   B. suggested that short-acting nifedipine may increase the risk of mortality among patients with cardiovascular disease

   C. provides a scientific basis for avoiding the use of calcium channel blockers in hypertensive patients

   D. found that the risk of mortality was increased by both long-acting and short-acting calcium channel blockers in post-MI patients

   
   
   
9. Which of the following statements is not correct?

   A. Nondihydropyridine calcium channel blockers have shown beneficial effects on cardiac event rates in subsets of post-MI patients enrolled in prospective, randomized trials.

   B. Increased heart rate may be the common mechanism underlying the potential cardiac risks associated with dihydropyridine and nondihydropyridine calcium channel blockers.

   C. Dihydropyridine calcium channel blockers increase heart rate, whereas nondihydropyridines lower heart rate.

   D. All of the above

   
   
   
10. The term "selection bias" refers to the selection of particular patient populations for subset analyses in retrospective studies.

    A. true

    B. false

    
    
    
11. In Western populations, systolic blood pressure generally increases throughout life.

    A. true

    B. false

    
    
    
12. Beta blockers generally have which effect on peripheral vascular resistance?

    A. decrease

    B. increase

    C. no change

    
    
    
13. A recent Department of Veterans Affairs study found that in elderly hypertensive patients, the ACE inhibitor was

    A. the most effective antihypertensive agent

    B. less effective than some other classes of antihypertensive agents

    C. of no value in reducing blood pressure

    D. as effective as other antihypertensive agents

    
    
    
14. For hypertension in older persons, the drugs of choice appear to be

    A. alpha blockers and beta blockers

    B. beta blockers and diuretics

    C. ACE inhibitors in all cases

    D. diuretics and calcium channel blockers

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