Pharm 2 questions

This drug of abuse produces mixed agonist and antagonist effects on different serotonin receptor subtypes, affecting thalamic circuits that cause a sensory overload of the cortex from multiple kinds of sensory inputs. This commonly results in a variety of visual and auditory hallucinations, where sensations may seem to "cross over", giving the user the feeling of hearing colors and seeing sounds (synesthesia). Other than flash-backs after frequent use, withdrawal from this drug is not common. Which drug best fits this profile? ? cocaine ? LSD ? marijuana ? MDMA

LSD

A 21-year-old woman is brought to the Emergency Department by a friend after attending a "techno rave" music concert. The patient complains of excessive thirst and feeling "out of it". Upon examination her pupils are enlarged. Her physical exam indicates an elevated blood pressure and heart rate, and a mild fever. When questioned, she admits to having swallowed a couple light blue tablets (marked with odd symbols) at the start of the concert. The friend who gave it to her said it was harmless, but would make her "feel really good". She said that has not smoked, inhaled or injected anything during the past 48 hours. Which of the following is the most likely causative agent responsible for her current condition? ? cocaine ? heroin ? marijuana ? MDMA

MDMA

Cocaine, amphetamines, methylphenidate, MDMA, and some ingredients found in bath salts exert their drug effects by interacting with one or more neurotransmitter "reuptake" transporters. MDMA, the active ingredient in the street drug ecstasy selectively affects one transporter more than others at commonly used doses. Which of the following transporters is affected the most? ? DAT ? NET ? SERT ? VMAT

SERT

Drugs that can produce tolerance & physiological dependence can produce withdrawal symptoms that are most severe when a patient abruptly stops taking the drug. If a patient comes to your emergency room with complaints of recent-onset depression, despair, craving, melancholy and the inability to feel pleasure, which of the following drugs would most likely have caused these withdrawal-related symptoms? ? barbiturate ? benzodiazepines ? cocaine ? ethanol

cocaine

A young man is brought to the Emergency Department by a family member after he was found in a comatous state following a suspected cocaine overdose. What additional signs or symptoms would be consistent with this diagnosis? ? bradycardia ? hypertension & tachycardia ? hypothermia ? miosis ? poikliothermia

hypertension & tachycardia

An 8th grade boy is brought into the Emergency Department by a concerned parent. His mother states that he came home after school "starving" for junk food, by seemed very "giddy" and uncoordinated. He was not able to concentrate on his homework as he normally would, and was slow to respond when asked questions. Concerned that he was "on something", she brought him to the hospital. Upon examination his eyes appeared abnormally red, and his heart rate was elevated. He did not seem to be hallucinating or agitated, but was slow to respond to questions. He admitted to having had some brownies at a friends house before coming home. His vital signs & reflexes were normal. Assuming his atypical behavior was due to consuming a "drug of abuse", which of the following could best explain his signs and symptoms? ? ketamine ? LSD ? marijuana ? N-Bomb ? Phencyclidine

marijuana

A 26-year-old man exhibiting unusual behavior is stopped by police on a side street in the French Quarter of New Orleans. The individual was exhibiting "catatonic posturing", although not dressed as a mime. When questioned by the police he became aggresively combative. He also seemed "eurphoric" and out of contact with his surroundings. He was unable or unwilling to answer questions, and had odd eye movements (nystagmus), as well as drooling (hypersalivation). Assuming these signs and symptoms were caused by drug intoxication, which of the following was the most likely causative agent? ? cocaine ? LSD ? marijuana ? MDMA ? phencyclidine

phencyclidine

While the patient's vital signs (including hypertension, tachycardia & hyperthermia) are being confirmed by an ER physician, a nurse finds a bottle of crack cocaine in the patients jacket pocket. Within the next few minutes, the patient starts to display seizure-like activity. Which of the following treatments would be LEAST useful, and potentially harmful in the acute management of this patient (e.g. within the next few minutes to hours)? ? alcohol rubs or ice packs ? benzodiazepines ? oxygen ? propranolol ? sodium bicarbonate

propranolol

A 16-year old high school football player is admitted to the emergency department after over dosing on methamphetamine - after only the second time he had used the drug to get high. In contrast to situations involving cocaine overdose, which of the following would be least likely to be observed in this patient? ? hypertension ? hyperthermia ? mydriasis ? tachycardia ? ventricular arrhythmias

ventricular arrhythmias

Multiple drug-sensitive vasoactive substances are involved in regulating renal blood flow and GFR. Which of the following regulates kidney function by producing a vasodilator effect on the afferent arteriole? ? aldosterone ? angiotensin II ? norepinephrine ? prostaglandins ? renin

prostaglandins

BD is a 23-year-old woman who arrives at the University student health clinic for treatment of the flu. During the taking of her history, she admits that she has been feeling very sad & "worthless" for the past 3 weeks. She has also suffered from a loss of appetite, resulting in an unintentional loss of 10 lbs in the past few weeks. She has been experiencing "a lack of energy", and has been finding it difficult to sleep, or make decisions. She has also lost interest in her hobbies (jogging & tennis), and can't concentrate when studying for exams. She denies any substance abuse, which is supported by a negative tox screen of blood & uring samples. Based upon DSM-V criteria, BD is diagnosed with major depressive disorder, single episode with melancholic features. BD is given a prescription for escitalopram (Lexapro ®) 10 mg qd. How long should BD have to wait before a therapeutic response is most likely achieved? ? 1-2 days ? 1-2 weeks ? 3-4 weeks ? 3-4 months ? > 1 year

3-4 weeks

John is a 63 year old alcoholic with a 5 year history of ulcers. Recently when self-medicating for a back condition John consumed 5 times the recommended daily dose of an over-the-counter pain reliever. Soon afterwards John developed a severe episode of nausea and vomiting. Twleve hours later his wife brings him to the local Emergency Department. After quizzing John about the identity of his analgesic, the ER physician draws blood samples for drug analysis and administers N-acetyl cysteine (Mucomyst) 140 mg/kg orally to prevent further toxicity. What analgesic did John most likely take to cause this problem? acetaminophen aspirin ibuprofen naproxen prednisone

Acetaminophen

The current standard of care in the treatment of patients who suffered a recent myocardial infarction (STEMI) is to initiate therapy with a class of hypolipidemic drugs, irrespective of baseline LDL-C levels. This is because several clinical trials (e.g. JUPITER, PROVE IT-TIMI 22) have documented reduced all-cause mortality and reduced incidence of rehospitalization. These beneficial outcomes have been attributed to "pleotrophic" beneficial drug effects including reduced oxidative stress, and reduced vascular inflammation. Which drug class has these characteristics? ? bile acid-binding resins ? cholesterol absorption inhibitors ? HMG-CoA reductase inhibitors ? PCSK9 inhibitors ? PPAR-alpha activators

HMG-CoA reductase inhibitors

Aspirin is a drug commonly used for the primary prevention of cardiovascular disease in patients with elevated risk factors (e.g. advanced age, diabetes, smoking, high blood pressure, and/or coronary artery disease). While aspirin has been found to be effective in reducing cardiovascular risk in such patients, it has also been found that other drugs can significantly interfere with aspirin's beneficial effects if taken concomitantly. An example of the type of drug to be avoided in such patients is: Colchicine Ibuprofen Methotrexate Montelukast Prednisone

Ibuprofen

NSAIDs such as aspirin can produce a type of allergic response in some patients. Which step, if blocked, is responsible for causing this drug allergy?

In some patients, irreversible COX inhibition by aspirin can cause a "shunting" of prostaglandin metabolism down the LOX pathway, resulting in an accumulation of leukotrienes. Leukotrienes are one of the types of cytokines involved in producing asthma.

Bob D was recently initiated on paroxetine therapy for depression. After 3 months of therapy Bob is feeling better and decides to stop taking his expensive medication "cold turkey". Two days later Bob shows up in the emergency department complaining of a recent onset of dizziness, flu-like symptoms (achy muscles & chills), headache, insomnia & severe anxiety. He has also been having thoughts of commiting suicide. His temperature, heat rate and blood pressure are normal. Bob's symptoms are best explained by: ? a serotonin syndrome ? a withdrawal syndrome ? his having refractory depression ? the flu

a withdrawal syndrome

A patient takes a drug that has analgesic & antipyretic effects, but is not antiinflammatory. It can cause potentially fatal hepatotoxicity when large doses (e.g. 15 grams) are consumed over a short time period, especially in alcoholic patients, or those with pre-existing liver disease. Which drug best fits this description? ? acetaminophen ? aspirin ? colchicine ? ibuprofen ? methylprednisolone

acetaminophen

CK is a 53 yo woman with a history of chronic pulmonary obstructive disease & heart disease who presents with chest palpitations & dizziness of sudden onset. She has been on theophylline therapy for COPD, along with an quinopril, spironolactone, dihydrochlorothiazide and carvedilol for HF. A12 lead ECG reveals the presence of a tachycardia with narrow QRS complexes & inverted P waves buried at the end of the QRS complex. A tentative diagnosis of PSVT, most likely caused by AV node reentry is made. The best drug for acute conversion of CJ's arrhythmia would be: ? adenosine ? amiodarone ? lidocaine ? procainamide

adenosine

A 56 year-old patient recently initiated on statin therapy reports to your clinic with concerns about recent-onset feelings of discomfort, uneasiness and anorexia. When questioned, he states that he has not noticed any signs of muscle pain or dark colored urine. Which lab test should be performed to assess whether these symptoms may be related to a known drug side effect? ? alanine and aspartate transaminase ? blood urea nitrogen ? creatinine clearance ? plasma Vit B12 & folate levels

alanine and aspartate transaminase

A 27-year-old woman with a history of persistent asthma presents to the Emergency Department with complaints of agitation, muscle tremors and a "racing heart". During her history, she mentions having recently increased the number of asthma medications being taken, as well as the frequency of use of her rescue inhaler. Which of the following is most likely responsible for her current symptoms? ? albuterol ? beclomethasone ? ipratropium ? montelukast ? omalizumab

albuterol

In the setting of CHF, which hormone contributes to the development of edema by binding to intracellular receptors in the cells of the collecting duct, resulting in an upregulation of epithelial sodium channels, and increased reabsorption of sodium and water? ? aldosterone ? angiotensin I ? bradykinin ? dopamine ? norepinephrine

aldosterone

In a follow-up visit 6 months later Mr. Kingfish states that he is still having occassional flare-ups of podagra every few weeks, despite his best efforts at controlling his diet and losing 20 lbs. His recent lab tests indicate a serum urate level of 6.7 mg/dl (about the same as his lab values 6 months prior). What medication would you recommend that could reduce his rate of uric acid production, and consequently reduce his incidence of gout attacks? ? allopurinol ? etanercept ? hydroxycholorquine ? probenecid

allopurinol

KT is a 78 yo woman who has been treated for atrial fibrillation for the past year. She has a history of systolic HF and has been on a combination of digoxin, angiotensin receptor blocker, beta blocker and thiazide diuretic for the past 10 years. During her routine checkup KT complains of increased lethergy over the past 6 months. She comments that during a recent eye exam they found evidence of corneal microdeposits, but her eye doc assured her that this was not a clinical concern. Her lab work indicates elevated transaminase & TSH levels, and reduced T4 level. Her ECG shows an increased QTc. The most likely drug causing these symptoms is: ? amiodarone ? digoxin ? losartan ? metoprolol ? verapamil

amiodarone

Your asthma patient has recently discovered that his asthma becomes worse after exercise outdoors on cold dry days. You make a tentative diagnosis of exercise-induced-bronchospasm (EIB). You discuss what little is known about the pathophysiology of this condition. You then recommend that he consider wearing a scarf over his nose and mouth when exercising. What other treatment used immediately before exercise could be used to most effectively reduce his expected exercise-induced bronchoconstriction? ? an albuterol aerosol ? an inhaled corticosteroid ? an inhaled antimuscarinic ? an antihistamine

an albuterol aerosol

Multiple hormones and vasoactive substances are known to contribute to the pathophysiological changes observed in CHF. Which of these mediators produces vasoconstriction, cardiac hypertrophy, a positive inotropic effect, and enhances the release of sympathetic neurotransmitters? ? aldosterone ? angiotensin II ? angiotensin 1-7 ? bradykinin ? vasopressin

angiotensin II

TJ is a 32 year old man who has been on lithium therapy for bipolar disorder for the past year. During his most recent checkup, TJ complains of a constant need to urinate (polyuria), and constant thirst (polydypsia). You explain to TJ that these are, unfortunately, some of the known side effects of lithium that are mostly unavoidable, and are due to an interaction of lithium with: ? antidiuretic hormone ? insulin ? muscarinic receptors ? the bladder

antidiuretic hormone

Highly selective COX-2 inhibitors are anti-inflammatory drugs with fewer GI side effects compared to traditional non-selective COX inhibitors, such as aspirin. What other effect do COX-2 inhibitors lack, in contrast to aspirin? ? analgesic ? antiinflammatory ? antipyretic ? antiplatelet ? lipoxygenase inhibition

antiplatelet

After 6 weeks of therapy, Jane is doing well, and is no longer plagued by anxiety. You recommend to Jane that she continue taking venlafaxine until her next followup visit, but explain that she can start a step-wise reduction in her dose of lorazepam over the next few weeks. You warn her to not to stop taking the drug all at once ("cold turkey") because that could cause unwanted & unnecessary withdrawal symptoms. Which of the following might Jane expect to experience if she did stop taking this medication "all at once" without a gradual tapering? ? anxiety & tremors ? hypotension ? nystagmus ? sedation

anxiety & tremors

A 30 year-old pregnant woman with a history of hypertension requires treatment to lower her blood pressure. Which of the following would be the safest choice to prescribe? ? benzapril ? captopril ? losartan ? methyldopa ? valsartan

methyldopa

Your ten year old son is running a fever of 101oF after developing a cold. To help him feel better you go to the local pharmacy to purchase an a fever-lowering medication. However, as a good parent you recall that there are warnings about the risk of drug-induced Reye's syndrome in children given the wrong type of NSAID. Which NSAID is associated with this potentially serious condition? acetaminophen aspirin celecoxib montelukast

aspirin

A 26-year-old woman with hyperlipidemia comes to your clinic to discuss changing her drug therapy since she is planning to have a child in the near future. Which of the following drug therapies is considered by the FDA to have an unacceptably high risk in pregnancy (FDA pregnancy category X) due to animal studies suggesting a potential for causing congenital malformations? ? atorvastatin ? colestipol ? ezetimibe ? gemfibrozil ? omega 3 supplements

atorvastatin

A 36 year-old patient with long standing hypertension undergoes a series of diagnostic tests that determine that he has a low GFR caused by bilateral renal vascular disease. Which of the following drugs would be contraindicated in the treatment of this patient's hypertension? ? benzapril ? diltiazem ? hydrochlorothiazide ? spironolactone

benzapril

MTs condition improves after several days of treatment, and he is eventually discharged. His asthma severity is classified as moderate & persistent. What daily long term therapy should be prescribed? ? albuterol ? budesonide (inhaled) ? montelukast ? salmeterol ? theophylline

budesonide (inhaled)

After 6 weeks, BD has a follow-up visit where she is asked about signs of improvement, asa well as any side effects she has experienced. BD states that she has been sleeping better over the past 2 weeks. She recalls having mild transient bouts of nausea during the first week of treatment, but began taking her SSRI after breakfast, as instructed, and her nausea disappeared after several days. However she admits to having lost interest in having sexual relations with ther fiance, and recently has not been able to achieve orgasm (anorgasmia). You discuss the results of a clinical trial documenting improvement of sexual desire & reduced problems with achieving orgasm when a second drug is added. She elects to try augmentation with this drug. Which drug will you prescribe to produce this effect? ? bupropion (Wellbutrin ®) ? fluoxetine (Prozac ®) ? paroxetine (Paxil ®) ? sertraline (Zoloft ®) ? venlafaxine (Effexor ®)

bupropion

Jimmy T is a 56-year-old professor with a history of hypertension who recently underwent a coronary artery bypass graft (CABD) procedure. Jimmy has a past history of cigarette smoking (1/2 pack per day for the past 20 years). During the recovery phase of his open heart surgery, Jimmy is diagnosed with major depression and seeks treatment. Which antidepressant may be able to treat both his mental disorder & help him decrease his craving for cigarettes? ? bupropion (Wellbutrin / Zyban ®) ? desipramine (Norpramin ®) ? fluoxetine (Prozac ®) ? nefaxodone (generic) ? sertraline (Zoloft ®)

bupropion

Michael is a 24-year-old man recently diagnosed with major depressive disorder. Michael's medical history indicates that he suffered from several years of absence seizures when he was younger. Which of the following would have the highest risk for producing a potentially serious "side effect" if used to treat Michael's depression? ? bupropion (Wellbutrin ®) ? desipramine (generic) ? duloxetine (Cymbalta ®) ? sertraline (Zoloft ®) ? venlafaxine (Effexor ®)

bupropion

A 50-year old man with a 30 year history of alcoholism and opioid addication is diagnosed with generalized anxiety disorder. Which of the following medications would be the best choice for treating his anxiety disorder? ? buspirone ? eszopiclone ? lorazapam ? midazolam ? zaleplon

buspirone

A 47 year-old woman is diagnosed with hypertension and is initiated on antihypertensive drug therapy. A week later she returns to her physician complaining of a constant cough and a noticeable (non-itchy) swelling of her lips & tongue. Which drug was she MOST LIKELY prescribed? ? Aliskiren ? Captopril ? Hydrochlorothiazide ? Losartan ? Metoprolol

captopril

During a return visit several months later, Mr Kingfish states that the combination of NSAIDs, dietary restrictions and moderate weight loss have helped control his symptoms of gout. However taking ibuprofen has been causing him stomach pain, and he has been reluctant to take the higher doses needed to control his toe pain. What other anti-inflammatory drug could you recommend for acute therapy that doesn't have similar side effects on the stomach? ? allopurinol ? colchicine ? keterolac ? methylprednisolone

colchine

A 27 year-old patient with a history of familial hypercholesterolemia that has been well controlled for the past 3 years arrives in the Emergency Department with severe muscle pain. Blood tests confirm a lovastatin plasma level 10 times higher than normal. If taken concomitantly, which of the following could account for the development of these symptoms? ? concentrated grapefruit juice ? ethanol ? rifampin ? St John's wort

concentrated grapefruit juice

Conditions of intracellular calcium overload caused by hypercalcemia or excessive catecholamine stimulation (e.g. in a patient on digoxinor toxic levels of amphetamines) can result in arrhythmias due to: ? delayed after depolarizations ? early after depolarizations ? enhanced Purkinje fiber automaticity ? reentry ? AV conduction block

delayed after depolarizations

Like many other drugs used in treating different psychiatric disorders, atyipcal "antipsychotics" have been approved for treating more than one type of psychiatric disorder. Which other condition are these drugs commonly used for? ? dementia ? depression ? diabetes ? Parkinson's disease

depression

A 67 yo man with a history of coronary artery disease presents to the ED with chronic atrial fibrillation, an average ventricular rate of 120-140 beats/min, and an ejection fraction of 35%. The best drug for controlling his ventricular rate would be: ? digoxin ? diltiazem ? nifedipine ? quinidine ? propranolol

digoxin

A 69 yo man presents with symptoms of nausea, vomiting, weakness, psychic dreams & a yellow-hued change in color perception. His ECG indicates a sinus bradycardia with the presence of a 2nd degree AV conduction block. The patient's history indicates that he is taking digoxin 0.25 mg/day and hydrochlorothiazide 25 mg/day for systolic heart failure & both warfarin & amiodarone 400 mg qd for atrial fibrillation. This patient's symptoms are most consistent with toxicity caused by elevated levels of: ? amiodarone ? digoxin ? hydrochlorothiazide ? warfarin

digoxin

A 69 yo woman presents to the Tulane ED with signs of ankle edema, shortness of breath & other symptoms consistent with CHF. Her echocardiogram indicates that she has a relatively normal EF of 54%. A drug that would be contraindicated in treating this patient is: ? digoxin ? hydrochlorothiazide ? metoprolol ? quniapril ? spironolactone ? verapamil

digoxin

A 64 yo man with a history of systolic HF develops pulmonary edema with difficulty breathing. Which drug is the best choice to acutely increase cardiac output in this patient within the next 30 mins? ? captopril ? digoxin ? dobutamine ? epinephrine ? norepinephrine

dobutamine

DC is a 58 year old post-menotpausal woman who is suffering from major depression. Her medical history indicates that she had an inadequate clinical benefit from previous trials of fluoxetine and imipramine. After discussion, you decide that she should start a trial with an SNRI after tapering her dose of fluoxetine. What drug will you prescribe? ? amitriptyline (Elavil ®) ? duloxetine (Cymbalta ®) ? escitalopram (Lexapro ®) ? paroxetine (Paxil ®) ? sertraline (Zoloft ®)

duloxetine (Cymbalta)

Gout is a relatively common inflammatory condition affecting 4% of all adults, and has been estimated to account for ~4 million outpatient visits per year in the US. It is 3-4 times more common in men than women, and is typically observed in adults over 40 years of age. Which of the following variables is most closely associated with the development of this condition? ? diet ? endogenous metabolism of purines ? kidney disease ? TNF-alpha

endogenous metabolism of purines

CW is a 14 year-old boy who is escorted by his father to the local hospital Emergency Department after developing an anaphylactic-like reaction including severe uriticaria and bronchoconstriction. The drug of choice for treating CW's condition is: ? diphenhydramine i.v. ? epinephrine i.m. ? isoproterenol i.v. ? norepinephrine i.m. ? salmeterol by MDI

epinephrine i.m.

A 23-year-old woman is brought to a psychiatric hospital in Pineville LA after being arrested for threatening to harm a family member. She has been hospitalized three times in the past year due to poor adherence to her prescribed medications, and has been hearing voices whenever she is off her medications for more than a few days. She states that she "hates" clozapine and olanzapine because of the 30 lbs of weight she gained while taking them. Her medical history indicates that she had responded well to haloperidol in the past, but had trouble taking it several times daily, as prescribed. After a long discussion with the patient regarding possible alternative treatments, she agrees to starting therapy with a long-acting i.m. depot formulation of haloperidol deconate, with the agreement that she return once a month for a maintenance dose. Two weeks later you learn that she appeared at a local emergency department complaining about drug side effects. Which of the following complaints would be LEAST likely caused by her antipsychotic medication? ? difficulty reading a book ? difficulty urinating ? dizziness upon standing up ? excessive salivation ? sedation

excessive salivation

Torsade de pointes is a potentially fatal arrhythmia that can be caused by more than 40 different drugs. Which of the following clinical conditions is also associated with an increased risk of this arrhythmia? ? female gender ? hyperkalemia ? hypermagnesemia ? tachycardia

female gender

During a daily visit with your 95-year-old grandmother (who is suffering from severe dementia and rheumatoid arthritis) you realize that half of the bottle of 100 aspirin tablets that you brought her yesterday are gone. She can't recall what happen to the missing tablets. Worried that she may have taken an overdose of aspirin for her arthritis, you realize that she may have also fed them to her tropical fish (one of her quirky habits). Which of the following signs or symptoms would be most consistent with grandma having taken a drug overdose? ? dead fish ? hypertension ? fever ? shallow breathing

fever

Physiological levels of enhanced vagal tone, such as that produced by carotid artery massage or a Valsalva maneuver can reproducibly produce this condition. ? atrial fibrillation ? first degree AV node block ? second degree AV node block ? shortened RR interval ? sinus tachycardia

first degree AV node block

Both drugs (drug side effects), and sudden withdrawal from drug therapy can be a cause of depressive symptoms. Which of the following drugs is LEAST likely to be associated with depressive symptoms when chronic administration is suddenly discontinued? ? dextroamphetamine ? cocaine ? fluoxetine ? methamphetamine ? venlafaxine

fluoxetine

What combination of medications & patient conditions are contraindicated? ? losartan & a patient with a BP of 140/90 ? metoprolol & a patient with HR=70/min ? diltiazem & a patient with Prinzmetal's angina ? furosemide & a patient with leg cramps ? verapamil & a patient with diastolic HF

furosemide & a patient with leg cramps

A patient on statin therapy has achieved their target goal for lowering LDL-C, but has high triglyceride levels. Which class of drug, if added to their therapy, would be the best choice to correct this remaining dyslipidemia? ? colestipol ? ezetimibe ? gemfibrozil ? alirocumab

gemfibrozil

Lab results obtained for a 58 year-old man on statin therapy indicates high triglyceride levels despite adequate lowering of his LDL level to an acceptable range. His physician discusses the possiblity of adding a controlled release formation of niacin to reduce his triglyceride level. Which of the following would be a contraindication for use of this medication? ? acne ? gout ? hypertension ? pellagra (skin inflammation & muscle weakness)

gout

A condition that can enhance Purkinje fiber (ectopic) automaticity more than automaticity of the SA node. A cause for ventricular tachyarrhythmias. ? hypercalcemia ? hyperkalemia ? hypokalemia ? hyponatremia

hypokalemia

A premature newborn suffering from cyanosis is found to have a heart murmur upon auscultation. A 2D doppler echocardiogram indicates the presence of a patent ductus arteriosis. A drug is prescribed, and during the next followup exam, the murmur is gone. A new echocardiogram indicates a normal pattern of blood flow inside the heart. The drug prescribed was most likely: ibuprofen montelukast PGE2 propranolol

ibuprofen

Mr Kingfish, a 67 year old man (5'4", 280 lbs) complains of significant pain associated with the region immediately behind his left big toe. His toe appears red and swollen, consistent with podagra. When asked about his diet, he admits to eating shrimp several times a week, and drinking 3-4 beers with dinner most evenings. Recently he has been eating steak every other evening following a successful deer hunting trip. His blood tests indicate a moderately high level of uric acid (7 mg/dl). In addition to recommended weight loss and changes in diet, which of the following would be a treatment of first choice for Mr. Kingfish's condition? ? acetaminophen ? allopurinol (high dose) ? ibuprofen ? methotrexate ? pegloticase

ibuprofen

PJ, a 64 yo man with a history of diastolic dysfunction comes to your clinic for an annual checkup. In reviewing his current list of daily medications (he brought his pill containers with him in a paper bag), which of the following would be considered contraindicated, and warrent further discussion with PJ? ? atenolol ? diltiazem ? hydrochlorothiazide ? ibuprofen ? spironolactone

ibuprofen

Jane is a 35-year-old young woman who comes to your family practice clinic with the chief complaint that she has been abnormally tired, irritable, "stressed out" and tense the past 9 months, and these symptoms have not been getting any better. Her feelings of anxiety have been so difficult to control that she feels it is affecting her ability to deal with family and coworkers without "snapping" at them. She says that her constant struggle with anxiety is making her feel depressed as well. When asked questions about her past medical history, she does not appear to have had any prior issues with compulsive thoughts or behavior, or other forms of mental illness. She has not abused alcohol, or suffered from suicidal ideation. She has had difficulty falling asleep. After additional questioning, a provisional diagnosis of generalized anxiety disorder (GAD) is made, and you discuss beginning a treatment regimen that includes venlafaxine XR and a benzodiazepine. SNRI's have an onset of therapeutic effect that requires many weeks of continuous therapy. In contrast, for treating her anxiety disorder what is the expected onset of action of the benzodiazepine? ? immediate ? 1 week ? 3-6 weeks ? several months

immediate

As a 3rd yr medical student in Baton Rouge you are helping with the longitudinal care of a EJ, a 68 yo woman suffering from coronary artery disease. One day you are called to the ED where you find EJ complaining of chest pain that radiates down her left arm which began less than an hour ago. She has been given a chewable aspirin, sublingual nitroglycerin, oxygen by nasal canula, and i.v. morphine. Her ECG indicates ST segment elevation, and her cardiac enzymes (CPK-MB & troponin I) are elevated. She is given clopidegrel & is scheduled for an immediate coronary angioplasty. While talking to EJ, she complains to you of shortness of breath. Auscultation of her lungs reveals inspiratory crackles at both bases. You make a tentative diagnosis of pulmonary edema secondary to an MI that requires drug management. Your resident agrees with you & asks you what effect would amrinone (a phosphodiesterase inhibitor), digoxin or a high dose of dopamine have in common if you administered any of them for her pulmonary edema. Having ace'd the Med Pharm course, you answer that they would produce a(n): ? decrease in cytoplasmic cAMP ? decrease in heart rate ? decrease in venous return ? decrease in total peripheral resistance ? increase in ventricular contractility

increase in ventricular contractility

The lab results from a patient with newly diagnosed severe hypertension indicate a high plasma renin level. What altered physiological parameter, if present, could account for this observation? ? increased adrenergic (beta-1 mediated) tone ? increased blood pressure ? increased blood volume ? increased renal blood flow ? increased plasma levels of sodium

increased adrenergic (beta-1 mediated) tone

Weight gain & edema occur in patients with CHF in response to: ? decreased renin levels ? decreased vascular resistance ? decreased angiotensin levels ? increased aldosterone levels ? increased diuresis

increased aldosterone levels

A 76 yo man being treated with digoxin, captopril & furosemide for systolic HF & hypertension presents to the ED with complaints of dizziness & fatigue. His lab values indicate a plasma K level of 2.5 mM. While waiting for his X-ray results the patient faints and his current ECG indicates the presence of sinus bradycardia & 3rd degree AV conduction block. The most likely explanation for this patient's rhythm disturbance is: ? a direct effect of hypokalemia on SA node automaticity & AV conduction ? captopril overdose ? furosemide interacting with captopril ? increased vagal tone caused by digoxin

increased vagal tone caused by digoxin

JQ is a professional 40 year old golfer who has developed a progressively more painful stiffness in her arms and legs over the past year that interferes with her ability to compete in golf tournaments. During her most recent medical checkup, her lab results reveal an elevated erythrocyte sedimentation rate (ESR), elevated CRP level and a high RF level. Xray imaging revealed the presence of bilateral erosion of several joints in her arms and legs. After being referred to a rheumatologist, she is prescribed methotrexate. Which of the following best describes the mechanism of action of this drug? ? increases adenosine levels ? inhibits dihydrofolate reductase ? inhibits IL-6 signal transduction ? small molecule kinase inhibitor ? TNF-alpha receptor antagonist

increases adenosine levels

In a follow-up visit, JQ is still exhibiting significant signs of RA, and has not achieved her therapeutic goal. After some discussion about treatment options, adalimumab (s.c. every 2 weeks) is added to her treatment regimen. Major side effects with this class of medication include: ? infections & malignancy ? mucosal ulcers ? osteoporosis ? renal impairment

infections & malignancy

The most commonly used asthma control medication produces a variety of therapeutic effects including a reduction in the levels of inflammatory cytokines, reduced COX-2 expression, and a reduced number of eosinophils in lung tissue. At the same time, it also produces relatively few systemic side effects. The drug formulation most likely to produce these effects is an: ? inhaled anticholinergic ? inhaled corticosteroid ? inhaled long acting beta-2 agonist ? inhaled short acting beta-2 agonist ? oral leukotriene inhibitor

inhaled corticosteroid

If a short-acting beta-2 agonist had been given, and it only partially relieved MT's symptoms of bronchoconstriction, what other drug could be given next that might produce additional short-term (vs long term) relief? ? ipratropium bromide by MDI ? inhaled perbuterol ? oral montelukast ? systemic prednisone (oral or iv) ? zileuton orally

ipratropium bromide by MDI

A 63 yo woman with exertional angina is taking atenolol (Tenormin) 100 mg qd for management of her angina. While the drug appears to be effective in reducing her heart rate, it has not provided an adequate change in her double product (heart rate x systolic blood pressure) at the time of onset of anginal pain during a treadmill test. A second drug that could be added to her drug regimen that could improve her treadmill performance would be: ? aspirin ? atropine ? clopidogrel ? glucagon ? isosorbide dinitrate

isosorbide dinitrate

Mikey is a twleve year old boy who has suffered from asthma for the past five years. His asthma has become worse after a recent episode of pneumonia, and now requires some form of chronic, preventative therapy. His parents express concern about the harmful effects associated with the long-term use of inhaled corticosteroids, and ask about possible therapeutic alternatives. After further discussion, it is decided to have Mikey try taking an oral formulation of montelukast for three months until his next regular appointment. The mechanism of action of this drug involves: COX-1 inhibition COX-2 inhibition leukotriene receptor antagonism lipoxygenase inhibition

leukotriene receptor antagonism

MT is a 10 year old boy who is brought into the Tulane Emergency Department by his parents. Their chief complaint is that MT has been constantly coughing and having trouble breathing for the past 3 days. MT recently recovered from an upper respiratory infection, and has had multiple bouts of bronchitis in the past year. His physical exam reveals moderate to severe respiratory distress with bilateral expiratory wheezing. His respiratory rate is 32/min, BP=120/83 mm Hg, heart rate = 135/min, temperature 37.8 C. HIs pO2 is 93%. What drug should be given to MT to rapidly relieve his symptoms? ? aminophylline orally ? cromolyn sodium ? ipratroprium by nebulizer (with oxgen) ? levalbuterol by nebulizer (with oxygen) ? salmeterol by MDI

levalbuterol by nebulizer (with oxygen)

A 59 yo man with a history of systolic HF arrives in the ED with complaints of chest palpitations, nausea and visual (color) disturbances. His chart indicates that he is currently taking digoxin, captopril, metoprolol & furosemide. An ECG reveals the presence of frequent runs of ventricular bigeminy. His echocardiogram indicates an ejection fraction of 40%. His lab results show cardiac enzymes to be within normal limits, a serum potassium of 4.0 mM, and an elevated digoxin level of 2.2 ng/ml. The most appropriate drug for treating this patient's arrhythmia would be: ? amiodarone ? atropine ? lidocaine ? propranolol ? verapamil

lidocaine

A mental status exam by a staff psychiatrist confirms the intial diagnosis (bipolar). What would be an appropriate drug of first choice for treating Tom's psychiatric disorder? ? amitriptyline ? chlorpromazine ? duloxetine ? haloperidol ? lithium

lithium

Rheumatoid arthritis is a relatively common autoimmune disease, with multiple treatment options. Which of the following is an example of a drug class that has been shown to halt or reverse the progression of this disease in most patients? ? aspirin ? azathioprine ? everolimus ? methotrexate ? prednisone

methotrexate

A 60 yo woman with a history of smoking presents with the chief complaint of chest pain that occurs at night while at rest. A treadmill test is negative. A 24 hr holter recording reveals transient ST elevation and AV block (suggestive of occlusion of her right coronary artery) that are temporaly associated with anginal attacks. A coronary angiography with provocative testing with acetylcholine injection reproduces her chest pain & ECG changes. Which drug will be contraindicated in her treatment? ? diltiazem ? isosorbide dinitrate ? metoprolol ? nitroglycerin sublingually ? verapamil

metoprolol

JW is a 6 year-old boy recently diagnosed with mild persistent asthma. You counsel him & his parents to consider daily therapy with an inhaled corticosteroid (1 puff, twice daily). However, after a two week trial, it is realized that JW strongly dislikes using an inhaler, and his parents request another therapeutic option that can be given orally, with few side effects. Which option below would be a good alternative prophylactic choice for JW's asthma? ? formoterol ? ipratropium bromide ? montelukast ? omalizumab ? salmeterol

montelukast

A 50-year-old man who recently began combination therapy for dyslipidemia (high LDL, low HDL, high triglycerides) arrives in your clinic suffering from flushing, diarrhea, itchiness, dry skin, and a rapid pulse. Which of the following agents is most likely responsible for these side effects? ? cholestyramine ? ezetimibe ? gemfibrozil ? lovastatin ? niacin

niacin

A 57 yo man with a history of atrial fibrillation is diagnosed with classic angina. Which of the following would be contraindicated in this patient? ? diltiazem ? metoprolol ? nifedipine ? verapamil ? warfarin

nifedipine

A class of antianginal medications with multiple mechanisms of action that include: decreased preload, decreased oxygen demand, decreased afterload (at high doses), and increased myocardial oxygen delivery by dilating large epicardial arteries. ? beta blockers ? dihydropyridine calcium channel blockers ? nitrates ? non-dihydropyridine calcium channel blockers

nitrates

A 60-year-old Caucasian woman experiences progressive dyspnea while traveling from New Orleans to Washington, DC by airplane (nonstop). You are asked to examine her, and you make the diagnosis of acute pulmonary edema. The flight attendant brings an oxygen tank and a nasal cannula to provide supportive therapy, and you take off your tie and summon other passengers to do the same to apply rotating tourniquets to the patient's extremities. You then ask the other passengers if they carry which of the following drugs with them, with hope of inducing peripheral venous pooling and reducing cardiac preload in this patient? ? digoxin ? hydralazine ? nitroglycerin ? propranolol ? verapamil

nitroglycerin

Julie is a 27-year-old veterinarian who has been struggling with allergies caused by exposure to cat dander. Her current drug regimen of daily fluticasone and salmeterol (Advair ®) has not been sufficient to control her symptoms of severe persistent asthma. Considering her occupation, what additional form of prophylactic treatment would be the best choice to add to her therapy, and would require treatment only once or twice a month? ? beclomethasone (QVAR ®) ? formoterol ? montelukast ? omalizumab ? salmeterol

omalizumab

Your asthma patient requires a "step up" in their daily control medication. When discussing therapeutic options, your patient mentions hearing about an asthma drug having a "Black Box" warning related to causing potentially life-threatening anaphylactic reactions. Which drug is this? ? formoterol ? omalizumab ? salmeterol ? zafirlukast ? zileuton

omalizumab

A patient suffering from a severe asthmatic attack arrives in your Emergency Department seeking treatment. His lips have a blue color, and pulse oximetry indicates a pO2 level of 80%. Which treatment should you apply first? ? albuterol by nebulizer ? epinephrine. s.c. ? levoalbuterol by nebulizer ? oxygen by face mask ? pirbuterol by nebulizer

oxygen by face mask

Your asthma patient requires the addition of a daily control medication after beginning to need the use of an albuterol rescue inhaler over 4 times a week for the past 3 weeks. You discuss the various therapeutic options for asthma control medications, and rank their advantages and disadvantages. Which of the options listed below would have the greatest potential for producing significant systemic side effects? ? albuterol MDI ? levalbuterol MDI ? montelukast orally ? prednisone, orally ? zileuton, orally

prednisone, orally

Mr Kingfish's gout continues to flare up occassionally, despite treatment, and his physician recommends that he try adding an additional "uricosuric" drug that can be taken along with his other medications for preventing gout flare-ups. This drug acts by inhibiting anionic transporters in the proximal tubule, which reduces the renal reabsorption of uric acid by by 30-40%. On the downside, it can also promote the formation of uric acid kidney stones in patients with high urinary uric acid levels, and is not very effective in patients with reduced renal function. Which drug best fits this description? ? anakinra ? azathioprine ? colchicine ? febuxostat ? probenecid

probenecid

A 43 yo man being treated for a recent myocardial infarction develops symptoms of arthralgia, myalgia, fever & pleuritis. Upon exam the patient is found to have a high titer of antinuclear antibodies. Which of the following medications is most likely responsible for these symptoms? ? amiodarone ? propranolol ? procainamide ? quinidine ? verapamil

procainamide

A drug prescribed for prophylaxis for the exertional (classical) form of angina, but NOT for variant (vasospastic) angina is: ? clopidogrel ? nifedipine ? nitroglycerin ? propranolol ? verapamil

propranolol

A 49 year-old patient who was initiated on antihypertensive drug therapy a month ago arrives at your clinic with complaints of muscle weakness. His ECG indicates the presence of tall peaked T waves & a relatively short QTc. A blood sample is taken, and his serum potassium level is determined to be 7.0 meq/L. What drug was this patient most likely taking? ? chlorothiazide ? diltiazem ? indapamide ? nebivolol ? ramipril

ramipril

A patient diagnosed with very levels of LDL-C caused by familial hypercholesterolemia is treated with combination drug therapy in order to reduce their likelihood for developing eary onset atherosclerotic cardiovascular disease. The patient's therapy includes a statin, ezetimibe a PCSK9 antibody. What is the mechanism of action of this antibody? ? decreased cholesterol synthesis ? decreased dietary cholesterol absorption ? disrupted enterohepatic circulation of bile acids ? increased synthesis of LDL receptors ? reduced rate of LDL receptor degredation

reduced rate of LDL receptor degredation

Jane is prescribed venlafaxine XR (Effexor ®) 150 mg qd every morning, and lorazepam 0.5 mg tid. You warn Jane about drug side effects that include decreased balance & coordination & delayed reaction time (e.g. when driving). What other other concern should you mention to her? ? increased insomnia ? increased risk of seizures ? inttractable hiccups ? muscle stiffness ? respiratory depression if combined with alcohol

respiratory depression if combined with alcohol

While TNF-alpha inhibitors are the most commonly used biologic DMARDs, an IL-6 receptor antagonist has also been found to be effective in treating arthritis. An example of this drug class is: ? abatacept ? leflunomide ? methotrexate ? sarilumab

sarilumab

Before writing the prescription for BD, you ask a few more questions about her past medical history. What prior condition would be a contraindication for prescribing burproprion? ? alcohol use ? energy loss ? ideation ? seizures ? smoking

seizures

MTs clinical status does not improve despite aggressive conventional therapy with a short acting beta-2 agonist and systemic corticosteroids. He is admitted to the hospital, and placed in the intensive care unit. It is decided to try a trial dose of theophylline, which has a narrow therapeutic window of 5-15 ug/ml. What toxic side effects should you be looking for if MT's theophylline levels become too high? ? hyperkalemia ? bradycardia ? sedation ? seizures & arrhythmias

seizures & arrhymthmias

George is a 24-year-old man who arrives at the student health clinic with a chief complaint of fatigue & a depressed mood that has lasted for more than 4 weeks. Since this onset of his symptoms, George has been sleeping 12-14 hours per day, and has gained over 20 lbs. George also states that he has developed a fear of enclosed spaces, and has started to avoid the use of elevators. What medication would you use as a drug of first choice for treating George's condition? ? amitriptyline (Elavil ®) ? desipramine (generic) ? phenelzine (Nardil ®) ? sertraline (Zoloft ®)

sertraline

Concerns about abuse & dependence are two major drawbacks associated with the clinical use of benzodiazepines. When dependence does develop, withdrawal symptoms can range in severity from anxiety & tremors to mania, seizures & death, when suddenly discontinued. A drug having which of the following characteristics would produce the most severe withdrawal symptoms if suddenly discontinued? ? hepatic metabolism ? long half-life ? renal clearance ? short half-life

short half-life

A 59 yo man with a history of angina is given a prescription for an oral nitrate formulation (isosorbide dinitrate) 20 mg bid. A second agent that this patient should be warned "NOT" to take while on this oral nitrate formulation is: ? aspirin (low dose) ? grapefruit juice ? metoprolol ? sildenafil ? St. John's wort

sildenafil

A 47 year-old patient recently diagnosed with high LDL-C (190 mg/dL) caused by a heterozygous familial hypercholesterolemia is initiated on hypolipidemic mono-therapy to try and achieve an LDL-C goal of <70 mg/dL, before considering the need for combination drug therapy. Within a week after initiating drug therapy the patient returns to your clinic complaining of severe shoulder pain, difficulty moving their arms and legs, and dark brown urine. Which of the following agents is most likely responsible for producing these side effects? ? bile acid binding resin ? fibric acid derivative ? inhibitor of cholesterol absorption ? nicotinic acid ? statin

statin

A 63 yo male professor suffering from chest pain upon exertion is diagnosed with classical angina. A drug formulation that you should prescribe for rapid relief of symptoms, taken as needed is: ? metoprolol ? nitroglycerin patch ? oral nitroglycerin ? sublingual nitroglycerin ? verapamil

sublingual nitroglycerin

Before prescribing your 19 year old patient an antidepressant, you discuss its most common side effects, drug interactions and the expected time course of onset of its therapeutic effects. You also discuss the fact that ALL antidepressant medications share the same black box warning. The issue described in this black box warning concerns: ? efficacy in treating depression ? interactions with migraine medications ? seizures ? sexual dysfunction ? suicidal ideation

suicidal ideation

Within a few minutes acute myocardial ischemia results in: ? membrane hyperpolarization ? narrowing of the QRS ? necrosis ? tissue hyperkalemia

tissue hyperkalemia

HMG-Co A reductase inhibitors are the drugs of choice for treating most patients with high LDL cholesterol. In addition to reducing cholesterol synthesis, what other mechanism contributes significantly to their ability to lower LDL levels? ? activation of PPAR-alpha ? inhibiting hormone-sensitive lipase ? preventing reabsorption of bile ? prevention of LDL receptor destruction ? upregulation of LDL receptors

upregulation of LDL receptors

A 62 yo man with diastolic dysfunction develops pulmonary edema caused by the sudden onset of atrial fibrillation with a rapid ventricular response. To prevent the deterioration of the heart's ability to maintain circulation, which of the following should be given? ? lidocaine ? digoxin ? dobutamine ? nifedipine ? verapamil

verapamil

A 64 yo woman who is experiencing progressive dyspnea of effort comes to your office for a physical exam. Her pulse is regular at 95 beats/min, and her blood pressure is 126/84 mm Hg. Auscultation of her lungs reveals inspiratory crackles at both bases. There is no peripheral edema, and the cardiac apical pulse is not displaced. An echocardiogram reveals a left ventricular chamber that is not dilated, with an estimated EF of 55%. Based upon your observations, which of the following would be most likely to reduce this patient's symptoms? ? digoxin ? dobutamine ? dopamine ? hydralazine ? verapamil

verapamil

After confirming the absence of a carotid bruit, the cardiologist confirms the diagnosis of PSVT by firmly massaging CJ's right carotid artery for approximately 5 seconds, which produced a conversion to normal sinus rhythm for several minutes. She then inserts an IV line thru a peripheral vein until its tip is relatively close to the heart, and injects a 6 mg bolus of adenosine as fast as possible, followed immediately by a flush of 5 mls of saline. After observing no effect, the dose was increased to 12 mg, and then to 18 mg. Shortly thereafter, the patient became hypoxic, and PSVT persisted. Concluding that the chronic use of theophylline (an adenosine receptor antagonist) may be producing too much antagonism, she considers trying a slower i.v. infusion of a different drug that could also be taken orally for chronic prophylaxis against PSVT. This drug is: ? nifedipine ? nitroglycerin ? ranolazine ? verapamil

verapamil

Patients with chronic atrial fibrillation are typically on multiple medications for different indications. Which of the following would you expect to see being prescribed in "all" patients with chronic atrial fibrillation? ? adenosine ? bretylium ? lidocaine ? nifedipine ? warfarin

warfarin

A 42-year-old CEO comes to your family practice clinic complaining of insomnia and difficulty falling asleep. She has no symptoms of anxiety, and admits having taken some triazolam (Halcion ®) provided by her secretary, but it made her drowsy and sluggish the following day. Which of the following could be used to treat her condition, has a relatively short duration of action, and targets a subset of benzodiazepine receptors expressing alpha-1 subunits? ? buspirone ? chlordiazepoxide ? fluoxetine ? phenobarbital ? zolpidem

zolpidem

A young woman comes to your clinic seeking treatment for a sleep disorder that she has been having the past few weeks since starting a new job. After further discussion you recommend that she try short term treatment with a "benzodiazepine related" sleep aid that has been on the market since 1993, but has an "unusual" recommended initial dose for women that is 50% lower than for men. Compared to benzodiazepines, it produces less next day impairment, and has a lower potential for causing dependence & addiction. Which medication is this? ? doxepin ? estazolam ? ramelteon ? suvorexant ? zolpidem

zolpidem