Pharm Quizzes Exam Four

A 54-year-old man presents to your clinic today for routine follow-up on his type 2 diabetes mellitus. His mother and father are both living and have no known heart disease. He tries to follow a low sugar and low sodium diet. The patient smokes ½ pack of cigarettes per day but is otherwise healthy. His lipid panel today is: total cholesterol 250 mg/dL, HDL cholesterol 44 mg/dL, and triglycerides 180 mg/dL. What is this patient's non-HDL cholesterol and LDL cholesterol?

206 mg/dL and 170 mg/dL

Mr. S has been placed on Simvastatin for his hypercholesterolemia/hyperlipidemia. How should he be instructed to take his medication?

Any time between supper and bedtime

Which of the following choices contains statins at doses that would achieve >50% reduction in LDL in most patients?

Atorvastatin 80 mg, rosuvastatin 40 mg

A woman taking a drug for high LDL-cholesterol levels experiences muscle tenderness and pain with no apparent cause. Which agent is least likely to cause this adverse effect?

Colestipol

Rochelle is an 8-year-old white female newly diagnosed with asthma of a moderate severity. Which of the following would be considered the most beneficial for the long-term control therapy of Rochelle's asthma?

Daily Inhaled beclomethasone

Which of the following is the most accurate description of ezetimibe's mechanism of action?

Decreased gastrointestinal absorption of cholesterol

Vertigo and nausea can be treated with these antihistamine medications:

Dimenhydrinate and meclizine

A 65-year-old woman with emphysema is seen in clinic today for a checkup. Her current COPD pharmacotherapy includes tiotropium 18 mcg once daily and albuterol MDI every 4 hours as needed. She is adherent with medications and uses her inhalers correctly. She reports increasing albuterol use over the last 3 months due to increased breathlessness; she denies any recent changes in sputum purulence or volume. Her CAT score today is 23 (compared to 18 three months ago) and she has not had any exacerbations in the last 3 years. Which of the following is the most appropriate change to her current treatment regimen?

Discontinue tiotropium and start umeclidinium/vilanterol 62.5 mcg/25 mcg, one inhalation daily

A 75-year-old man with severe COPD currently treated with tiotropium, formoterol/budesonide, and an albuterol MDI as needed presents to the clinic complaining of a more frequent cough, increased sputum production, and change in sputum color. The last time he had symptoms like these was 6 months ago, and at that time he was hospitalized for 3 days. After being diagnosed with a COPD exacerbation and continuing his current maintenance therapies, which of the following is the most appropriate initial treatment recommendation?

Doxycycline 100 mg orally every 12 hours

Which type of therapy would be most appropriate to institute first for a 58-year-old female with type 2 diabetes and total cholesterol 210 mg/dL, HDL cholesterol 52 mg/dL, triglycerides 958 mg/dL, and LDL cholesterol 131 mg/dL?

Fenofibrate 160 mg daily

Mast cell release inhibitors work by blocking:

Histamine release from cells

Which of the following is the most likely adverse effect of indacaterol?

Hypokalemia

The early administration of _______ is crucial to successfully treating anaphylactic reactions.

IM epinephrine

Parasympathetic activation of the respiratory tract causes which of the following?

Increased mucus secretion

What is the preferred treatment for daily, moderate-severe, chronic allergic rhinitis treatment?

Intranasal corticosteroids

Pick the medication that is most effective for refractory nasal congestion.

Intranasal oxymetazoline

Which of the following lipoproteins do the AHA/ACC lipid guidelines focus on treating with pharmacotherapy in patients without ASCVD?

LDL

Which of the following drugs has been associated with hepatic toxicity as an adverse effect?

Leukotriene modifiers Zafirlukast & Zileuton

Identify a baseline laboratory test that is required before initiating a statin.

Liver function tests

Which of the following medication classes has a boxed warning regarding an increased risk of asthma-related deaths when used as monotherapy?

Long-acting beta-2 agonists

Xanthines such as Theophylline:

May have an effect on airway inflammation mediated by increased Interleukin-10 release & phosphodiesterase inhibition

Which of the following inhaled agents is most likely to cause oral candidiasis?

Mometasone

Which one of the following medications treats both asthma and allergic rhinitis?

Montelukast

Which side effect can be caused by statin therapy?

New onset diabetes

Which one of the following statements is true about bile acid sequestrants (BAS)?

Other drugs should be taken one hour before or four hours after BAS

A 25-year-old known asthmatic presents with an exacerbation. Nebulizer treatment with albuterol is begun. Which test would be most useful to evaluate and monitor through treatment?

Peak expiratory flow rate

The following statins are metabolized through the CYP3A4 or 2C9 system EXCEPT:

Pravastatin (Pravachol)

Which of the following antihistamines is not recommended in children < 2 years of age?

Promethazine (Phenergan)

What is the safest recommendation for providing benefit for allergy nasal symptoms in a twelve month old child?

Saline nasal spray, such as Ocean

A mother contacts the outpatient clinic stating that her 8-year-old son is having an asthma attack. She has given him two treatments of 2.5 mg of albuterol by nebulizer 20 minutes apart without relief. He continues to sit very still, leaning forward slightly, and only gives one-word answers to her questions. Which of the following would be the most appropriate next step?

Send him to the emergency department or call 9-1-1 for transport and further evaluation

An 18-year-old patient complains of wheezing and chest tightness during basketball practice. She had asthma as a child but has "outgrown" it and does not report any day or nighttime symptoms consistent with asthma. Which of the following is the most appropriate?

She should be started on two inhalations of albuterol prior to basketball practice

A 23-year-old patient comes into clinic for asthma follow-up. Which of the following would be concerning about the patient's use of albuterol HFA MDI?

She uses 2 canisters of albuterol in 1 month

Your 30-year-old patient has moderately severe new onset asthma, and you prescribe a highly selective β2 agonist inhaler to be used when needed. In considering the possible drug effects in this patient, you would note that β2 stimulants frequently cause:

Skeletal muscle tremor

According to the ACC/AHA guidelines, what intervention would be most appropriate for the patient in the previous question?

Start atorvastatin 40 mg daily

A 38-year-old woman presents to your clinic today with new onset chest pain that occurs after walking a few blocks. Her father had a heart attack at age 40. Her diet is low in saturated fats and cholesterol. The patient is otherwise healthy and does not smoke. Her lipid panel today is: total cholesterol 350 mg/dL, HDL cholesterol 40 mg/dL, and triglycerides 120 mg/dL. According to the ACC/AHA guidelines, what intervention would be most appropriate for this patient?

Start rosuvastatin 20 mg daily

Second-generation antihistamines such as fexofenadine have the following properties:

They have less CNS side effects such as sedation than first-generation agents

A 63-year-old man presents to clinic complaining of chronic cough and sputum production and shortness of breath with activity. PFTs completed prior to his visit show an FEV1/FVC ratio of 68% (0.68) and FEV1 65% of predicted. His CAT score is 12. He has not had any exacerbations. Which of the following would be most appropriate as the initial regimen for COPD?

Umeclidinium once a day

All of the following are risks for statin-induced myositis EXCEPT:

Use of a low-intensity statin therapy with a bile acid sequestrant (resin)

A 5-year-old boy is brought to the clinic by his parents who say that he often has trouble catching his breath when he has been playing hard outside. He is allergic to peanuts. At the moment, he is breathing fine. Which of the following drugs would be used to dilate his bronchioles in an acute asthma attack?

albuterol

What is true regarding Omega-3 fatty acids (fish oils)?

all of the above

Which of the following events would be considered to be due to ASCVD?

all of the above

A 32-year-old man with a history of opioid addiction presents with cough due to a viral upper respiratory system infection. Which is appropriate symptomatic treatment for cough in this patient?

benzonatate

First-generation antihistamines such as diphenhydramine and chlorpheniramine can cause or aggravate the following conditions: (Select ALL that apply.)

blurry vision confusion sedation dry mouth

A 35-year-old man has all of his asthma medications with him today. Which of the following is duplication of therapy?

budesonide/formoterol and salmeterol

Which of the following is an adverse effect of tiotropium?

dry mouth

Which side effect can be caused by niacin therapy? (Select all that apply)

hyperglycemia gout

Which of the following is a secondary cause of dyslipidemia? (Select all that apply)

hypothyroidism Atypical antipsychotics

Oral antihistamines are used for occasional, mild allergy symptoms. They provide benefit for the following symptoms: (Select ALL that apply.)

itchy nose itchy eyes runny nose

What effects do statins have on cholesterol values? (Select all that apply)

lower TG lower HDL lower LDL

An otherwise healthy 58-year-old man is found to have an LDL-C level of 170 mg/dL, an HDL-C level of 50 mg/dL, and a triglyceride level of 105 mg/dL. He has no other risk factors for CHD. In addition to TLCs, which drug treatment is most appropriate for this patient?

pravastatin