CME Quiz

Supplements and Featured Publications, Preventive Medicine in Managed Care - Comprehensive Adrenergic Blockade: Improving Outcomes Across t, Volume 10, Issue 1 Prevent

CONTINUING MEDICAL EDUCATION ACCREDITATION

The University of Cincinnati College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor medical education for physicians.

The University of Cincinnati College of Medicine designates this educational activity for a maximum of 2 Category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those hours that he/she actually spends in the educational activity.

Instructions

After reading "Comprehensive Adrenergic Blockade: Improving Outcomes Across the CVD Continuum," complete the program evaluation and select the 1 best answer to each of the following questions. A statement of continuing education hours will be mailed to those who successfully complete (a minimum score of 70%) the examination at the conclusion of the program.

Questions

1. In the Beta Blocker Heart Attack Trial (BHAT), a subgroup of patients with mild heart failure (HF) following the index myocardial infarction (MI) had a higher subsequent mortality and the greatest benefit from randomization to __________.

  • timolol
  • metoprolol

2. __________ have been shown to attenuate or reverse the progressive left ventricular (LV) remodeling that occurs after MI, especially in patients whose LV ejection fraction is reduced to = 40%.

  • Nitrates
  • Calcium channel blockers

3. When the results of the Carvedilol Post Infarct Survival Control in LV Dysfunction (CAPRICORN) study were analyzed, it was found that carvedilol had improved survival by __________.

  • 13%
  • 33%

4. The Carvedilol or Metoprolol European Trial (COMET), conducted in patients with HF, confirmed the superiority of a __________.

  • nonselective agent (carvedilol) over a selective agent (short-acting metoprolol)
  • selective agent (short-acting metoprolol) over a nonselective agent (carvedilol)

5. Patients with diabetes who had had a prior MI had a markedly increased risk of mortality over an 8-year follow- up period in the East-West study. The 8-year incidence of recurrent MI for patients with diabetes and a prior MI was __________.

  • 25%
  • 45%

6. The metabolic syndrome, as defined by the Adult Treatment Panel III criteria, predicts __________.

  • obesity
  • elevated blood pressure

7. The Heart Outcomes Prevention Evaluation (HOPE) study found that reduced rates of death from cardiovascular (CV) causes, MI, stroke, death from any cause, revascularization procedures, cardiac arrest, HF, and complications related to diabetes were the result of treatment with __________.

  • ramipril
  • carvedilol

8. Physicians have lingering concerns about adding beta blockers to the treatment of patients with hypertension and diabetes. These concerns include __________.

  • decreasing total cholesterol
  • masking hypoglycemia

9. Of the modifiable CV risk factors, __________ is perhaps the most influential and most prevalent.

  • hypercholesterolemia
  • low HDL cholesterol

10. Patients with diabetes without previous MI have __________ risk of MI as patients without diabetes with a previous MI.

  • a lower
  • significantly higher

11. Insulin resistance leads to hyperinsulinemia, which, in turn, is a stimulus for __________.

  • increased norepinephrine
  • increased LDL cholesterol

12. Remodeling is a process by which mechanical, neurohormonal, and possibly genetic factors alter ventricular size, shape, and function. It occurs in many heart diseases, including __________.

  • cardiomyopathy
  • all of the above

LEARNING OBJECTIVES

After completing this educational activity, participants should be able to:

  • Explain the role of the sympathetic nervous system in the pathophysiology and progression of cardiovascular disease.

Discuss the rationale for use of adrenergic antagonists after acute myocardial infarction and in patients with diabetes and hypertension.

  • Summarize results of major clinical trials of adrenergic antagonists in patients with diabetes, hypertension, and myocardial infarction.

CONTINUING MEDICAL EDUCATION ACCREDITATION

The University of Cincinnati College of Medicine designates this educational activity for a maximum of 2 Category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those hours that he/she actually spends in the educational activity.

The University of Cincinnati College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor medical education for physicians. Release Date: October 31, 2004. Expiration Date: October 31, 2005.

FUNDING

This program is supported by an educational grant from GlaxoSmithKline Pharmaceuticals.

Cardiology Review

NOTE: This material has been previously published as a supplement to , April 2004,Vol.4, No. 1, SUP.

The contents of this supplement may include information regarding the use of products that may be inconsistent with or outside the approved labeling for these products in the United States. Physicians should note that the use of these products outside current approved labeling is considered experimental and are advised to consult prescribing information for these products.