PHARMA TUTORIAL 1&2 QS

27. Which is correct regarding antianginal therapy in patients with heart failure with reduced ejection fraction? A. B-Blockers have been associated with reduced mortality. B. Dihydropyridine calcium channel blockers should be avoided. C. B-Blockers with ISA are preferred over those with-out ISA. D. Nondihydropyridine calcium channel blockers should be used in patients with heart failure with reduced ejection fraction who cannot tolerate B-blockers.

*A. B-Blockers have been associated with reduced mortality.*

32. Which can precipitate a hypertensive crisis following abrupt cessation of therapy? A. Clonidine B. Diltiazem C. Valsartan D. Hydrochlorothiazide

*A. Clonidine*

12. A 63-year-old man comes to the office due to blurred vision in both eyes for the last 2 days. The blurriness is worse when he reads but is not noticeable when he drives. The patient has no associated headache, double vision, or weakness. However, he did start taking diphenhydramine several days ago for seasonal allergies. Past medical history is unremarkable. Vital signs are normal. On physical examination, there is edema and clear drainage affecting the nasal mucosa. Funduscopic examination is normal. This patient's visual symptoms are most likely due to blockade of which of the following mediators? A. Acetylcholine B. Histamine C. Leukotrienes D. Norepinephrine E. Serotonin

*A.Acetylcholine*

6. A 37-year-old man comes the emergency department due to fever, chills, and malaise. He has no significant medical history but he uses illicit intravenous drugs on a regular basis. The patient is febrile, tachycardic, and hypotensive. Auscultation reveals a heart murmur. A preliminary diagnosis of infective endocarditis is established. Blood cultures grow methicillin-resistant Staphylococcus aureus, and the patient is prescribed an intravenous antibiotic administered every 12 hours. Calculation of the maintenance dose will most likely require which of the following parameters? A.Drug clearance rate B.Number of doses needed to reach steady state C.Size of the loading dose D.Total body weight of the patient E.Volume of distribution of the drug

*A.Drug clearance rate*

30 .Which antihypertensive medication can cause the rare side effect of angioedema? A. Amlodipine B. Fosinopril C. Prazosin D. Propranolol

*B. Fosinopril*

29. A 45-year-old male complains of constipation. He was recently started on two antihypertensives due to elevated systolic blood pressure (greater than 20 mm Hgabove goal). His current medications include lisinopril,chlorthalidone, verapamil, rosuvastatin, and aspirin. Which is most likely contributing to his constipation? A. Chlorthalidone B. Verapamil C. Aspirin D. Lisinopril

*B. Verapamil*

25. Which of the following correctly ranks the calcium channel blockers from most active on the myocardium to most peripherally active? A. Diltiazem, amlodipine, verapamil B. Verapamil, diltiazem, nifedipine C. Nifedipine, verapamil, diltiazem D. Amlodipine, diltiazem, verapamil

*B. Verapamil, diltiazem, nifedipine*

2. A 71-year-old man with chronic stable angina comes to the office for routine follow-up. He has occasional episodes of chest pain that improve after taking sublingual nitroglycerin. The patient also has a history of hypertension and hypercholesterolemia and takes multiple medications for his conditions. Blood pressure is 140/80 mm Hg and pulse is 68/min and regular. Examination reveals normal heart sounds. While discussing a plan to start isosorbide dinitrate therapy, the patient becomes concerned about the high dose of oral isosorbide dinitrate compared to sublingual nitroglycerin. Which of the following is the most likely reason for using a high dose of oral nitrate? A. Drug tolerance prevention B.High first-pass metabolism C.High serum protein binding D.High volume of distribution E.Low intestinal absorption

*B.High first-pass metabolism*

4. A 34-year-old kidney transplant patient treated with cyclosporine comes to the office due to nausea and anorexia. The patient underwent transplantation 6 months ago and had been doing well until recently. On examination, his blood pressure is 160/96 mm Hg. There is no tenderness at the site of the transplanted kidney. Serum creatinine is 3.4 mg/dL, and the serum cyclosporine level is markedly increased. A month ago, he had normal blood pressure and normal levels of cyclosporine and serum creatinine. Further questioning reveals that the patient has been drinking increased amounts of grapefruit juice lately as part of an attempt to improve his overall health. Which of the following mechanisms is most likely responsible for this patient's current condition? A.Alteration of gastric acidity B.Inhibition of cytochrome P450 enzymes in the gut wall C.Modification of transmembrane drug transport D.Pharmacodynamic potent

*B.Inhibition of cytochrome P450 enzymes in the gut wall*

18.A 54-year-old man is hospitalized after a planned abdominal surgery. One of his physicians administers a new drug whose mechanism of action you do not know. Shortly after administration of the drug the patient develops flushing, diaphoresis and nausea. His blood pressure is 100/70 mmHg and heart rate is 55/min. His pupils are constricted but reactive to light. This medication is most likely given for which of the following conditions? A. Urinary tract infection B. Urinary obstruction C. Atonic bladder D. Fluid overload E. Hypovolemic shock

*C. Atonic bladder*

21. A 38-year-old woman comes to the office to discuss motion sickness. She is currently feeling well. The patient is planning a vacation cruise and has previously experienced severe nausea and vomiting while sailing. She has 4 children, and her past medical history is notable only for a tubal ligation. The patient does not smoke and drinks only moderate quantities of alcohol. She is not currently taking any medications. Physical examination, including otologic and neurologic examinations, is normal. After the appropriate drug therapy is recommended, this patient should be counseled regarding which of the following side effects? A. Cough B. Diarrhea C. Dry mouth D. Frequent urination E. Nasal congestion

*C. Dry mouth*

31. The blood pressure of a patient with essential hyper-tension is at goal on treatment with enalapril. Since initiation of enalapril, the serum creatinine has increased 25% above baseline. What is the appropriate next step for the enalapril therapy? A.Discontinue enalapril. B.Reduce dose of enalapril. C.Continue current dose of enalapril. D.Increase dose of enalapril.

*C.Continue current dose of enalapril.*

1. A 57-year-old Caucasian male with severe pyelonephritis is admitted to the hospital. His past medical history is significant for diabetes, hypertension, and two episodes of transient ischemic attacks. His serum creatinine level is 3.2 mg/dL; therefore, he needs to be started on an antibiotic that depends mainly on non- renal clearance. Which of the following characteristics should the antibiotic also have if hepatic metabolism and clearance is desired? A.Low volume of distribution B.Poor oral absorption C.High lipophilicity D.Low rate of redistribution E.Poor penetration into the CNS

*C.High lipophilicity*

26. A 76-year-old man with uncontrolled hypertension is experiencing typical angina pain that is relieved with rest and sublingual nitroglycerin. He has a high blood pressure (178/92 mm Hg) and a low heart rate (54 bpm). Which is the most appropriate therapy for his angina at this time? A. Ranolazine B. Verapamil C. Metoprolol D. Amlodipine

*D. Amlodipine*

10. A 75-year-old female is brought to your office by her son because of worsening forgetfulness over the past few years and several recent episodes of getting lost while performing errands around the house. She exhibits no signs or symptoms of depression. On physical examination, the patient has a blood pressure of 139/88 mmHg. She is alert and cooperative but disoriented to time and can only recall 1 of 3 items on a short term memory test. An extensive work-up, including appropriate laboratory tests and a brain MRI scan, reveals diffuse cortical atrophy with no other abnormalities. This patient would likely benefit from treatment with which of the following: A Lorazepam B. Desipramine C. Haloperido D. Donepezil E. Folic acid F. Vitamin A G. Sertraline H. Melatonin

*D. Donepezil*

14. A 62-year-old woman is brought to the emergency department because of acute chest pain. She also complains of diaphoresis, nausea, and lightheadedness. Her blood pressure is 90/60 mm Hg and pulse is 42/min. An ECG reveals ST-segment elevation in the inferior leads. The appropriate therapy is initiated, including a medication to treat her bradycardia. After initial treatment, her blood pressure is 120/70 mm Hg and pulse is 76/min. However, she now complains of severe right-sided eye pain. Which of the following is the most likely cause for this patient's eye pain? A. Iridocyclitis B. Retinal artery thrombosis C. Acute conjunctivitis D. Glaucoma E. Cataract F. Retinal vein thrombosis G. Retinal detachment H. Vitreous hemorrhage

*D. Glaucoma*

24. Which of the following instructions is important to communicate to a patient receiving a prescription for the nitroglycerin patch? A. Apply the patch at onset of angina symptoms for quick relief. B. Remove the old patch after 24 hours of use, then immediately apply the next patch to prevent any breakthrough angina pain. C. Do not use sublingual nitroglycerin in combination with the patch. D. Have a nitrate-free interval of 10 to 12 hours every day to prevent development of nitrate tolerance.

*D. Have a nitrate-free interval of 10 to 12 hours every day to prevent development of nitrate tolerance.*

17.A 66-year-old man comes to the office with diplopia that progressively worsens toward the end of the day. The patient has no shortness of breath, trouble swallowing, or generalized weakness. He is currently receiving low-dose pyridostigmine for treatment of his condition and claims good compliance without significant side effects. Physical examination reveals fatigable asymmetric ptosis and binocular horizontal diplopia. Infusion of edrophonium elicits a significant improvement in his symptoms. Which of the following is the best next step in management of this patient? A. Add atropine B. Administer pralidoxime C. Change long-term therapy to edrophonium D. Increase pyridostigmine dosage E. Stop pyridostigmine temporarily

*D. Increase pyridostigmine dosage*

22. A 63-year-old man hospitalized for chronic obstructive pulmonary disease exacerbation develops hypercapnic respiratory failure. He is transferred to the intensive care unit, where he undergoes intubation after premedication with muscle relaxant X and an appropriate sedative. The patient is then started on mechanical ventilation; however, he remains apneic longer than expected. Anesthesiology is consulted, and the patient's neuromuscular blockade is assessed by electrically stimulating a peripheral nerve 4 times in quick succession and observing the muscular response. The procedure is repeated 30 minutes later and the results are shown below. Muscle relaxant X is most likely to be which of the following medications? A. Dantrolene B. Midazolam C. Pancuronium D. Succinyicholine E. Tubocurarine

*D. Succinyicholine*

3. A 64-year-old man is evaluated for persistent fever and weakness. He has a history of aortic valve replacement for aortic stenosis. Physical examination reveals a new cardiac murmur with scattered petechiae and splinter hemorrhages seen on his extremities. Echocardiogram shows a vegetation involving one of the aortic valve leaflets, and blood cultures grow enterococci. As part of the patient's treatment, 240 mg of intravenous gentamicin is started. The pharmacy calculates that, in this patient, gentamicin has a volume of distribution of 30 L, a half-life of 4 hours, and demonstrates first-order and one- compartment kinetics. Which of the following is the most likely serum drug concentration just before the next dose 8 hours later? A.0.5 mg/L B.1 mg/L C.1.5 mg/L D.2 mg/L E.3 mg/L

*D.2 mg/L*

8. A new antibiotic developed for the treatment of infections caused by resistant gram-positive cocci has a volume of distribution of 11L. It is eliminated by first-order kinetics and has a half-life of 10 hours. If given by a continuous infusion, approximately how much time would it require for the drug to achieve a 95% plasma steady state concentration? A.10 hours B.20 hours C.30 hours D.40 hours

*D.40 hours *

7. A group of investigators is performing an experiment designed to assess genetic variability in drug biotransformation. A fixed dose of isoniazid is given to a group of volunteers, and the plasma drug concentration is measured four hours following administration of the drug. The following distribution of plasma drug concentration in these subjects is obtained. Variation of which of the following processes provides the best explanation for the shaded area of the curve? A. Methylation B.Glucuronidation C.Hydrolysis D.Acetylation E.Amine oxidation

*D.Acetylation*

28. A 45-year-old woman with type 1 diabetes has been diagnosed with Prinzmetal angina. Which of the following is correct regarding management of angina in this patient? A.B-Blockers are the treatment of choice but should be avoided because of her diabetes. B.Nitroglycerin is not beneficial for this type of angina. C.She should be counseled to take nitroglycerin before physical activity to prevent symptoms. D.Felodipine will be more effective than verapamil.

*D.Felodipine will be more effective than verapamil.*

9. A 43-year-old man comes to the office due to occasional dyspnea that awakens him at night. This symptom started approximately a year ago after a severe upper respiratory tract infection, and since then he has also had an episodic cough. The patient has no other medical problems and takes no medications. He has no drug allergies and does not use tobacco, alcohol, or illicit drugs. His older brother has atopic dermatitis. Vital signs are normal. Lung auscultation reveals bilateral normal breath sounds with no wheezing or crackles. Heart sounds are normal, and there is no extremity edema. Pulmonary function tests are as follows: FEV1: 88% of predicted FEV1/FVC: 84% Diffusion capacity for carbon monoxide 95% of predicted Administration of which of the following medications would be most useful during further diagnostic evaluation of this patient? A. Epinephrine B. Gadolinium C. Ipratropium bromide D. Levalbuterol

*E. Methacholine*

20. A 60-year-old farmer is brought to the emergency department due to acute-onset confusion, muscle weakness, and difficulty breathing. The patient has vomited twice and has had 3 loose bowel movements over the past 2 hours. His medical history is insignificant and he currently takes no medications. Blood pressure is 110/70 mm Hg, pulse is 58/min, and respirations are 26/min. His pupils are constricted, symmetric, and reactive to light. Examination reveals excessive sweating, lacrimation, and wheezing. He is incontinent of urine. Intravenous atropine is administered. Which of the following findings is most likely to persist in this patient without additional therapy? A. Bradycardia B. Bronchospasm C. Diarrhea D. Miosis E. Muscle weakness F. Urinary incontinence

*E. Muscle weakness*

11. A medical research center is studying therapeutic options for the treatment of neuromuscular disorders. During experimentation, scientists develop a new drug that seems to have partial agonist/antagonist activity against receptor X. When the experimental drug is applied to cells expressing receptor X, there is an immediate change in transmembrane calcium, sodium, and potassium flow secondary to the opening of the receptor channel. Receptor X is most likely which type of receptor? A. a1 adrenoreceptor B. b1 adrenoreceptor C. b2 adrenoreceptor D. Muscarinic cholinergic receptor E. Nicotinic cholinergic receptor

*E. Nicotinic cholinergic receptor*

19. A 78-year-old man was found to have a perihilar mass on screening CT scan. The patient's medical history is remarkable for chronic obstructive pulmonary disease, for which he takes albuterol inhalers as needed. He has smoked a pack of cigarettes daily for the last 50 years and does not drink alcohol or use illicit drugs. The patient is admitted for bronchoscopy and is premedicated with intramuscular atropine and becomes acutely restless, disoriented, and combative. Temperature is 38.1 C (100.5 F), blood pressure is 116/72 mm Hg, pulse is 110/min, and respirations are 15/min. Oxygen saturation is 99% on room air. On physical examination, his pupils are widely dilated and nonreactive to light. ECG shows sinus tachycardia. Which of the following agents will reverse all of this patient's signs and symptoms? A.Diazepam B.Edrophonium C. Haloperidol D. Neostigmine E. Physostigmine

*E. Physostigmine*

16. A 45-year-old quadriplegic man with suspected bacterial pneumonia is admitted to the hospital and started on intravenous antibiotics. Over the next 24 hours, he develops progressive respiratory failure requiring mechanical ventilation. Prior to intubation, a skeletal muscle relaxant is administered and the patient subsequently goes into cardiac arrest. His attached cardiac monitor shows ventricular fibrillation. While he is being resuscitated, his serum potassium level is drawn and later comes back as 10.0 mEq/L. Administration of which of the following agents is most likely responsible for this patient's condition? A.Atracurium B.Baclofen C.Dantrolene D.Succinyicholine E.Vecuronium

*E.Vecuronium*

5. Healthy adult volunteers are enrolled in a phase | clinical trial investigating the properties of a newly developed oral antimicrobial agent. The drug is administered in different amounts to the volunteers over the course of several weeks to determine the best dosage that minimizes toxicity while maintaining trough levels above the minimum inhibitory concentration. While reviewing the data, the researchers note that the drug's half-life seems to vary amongst the study participants. An increase in which of the following pharmacologic parameters is most likely responsible for the longer half-life seen in certain individuals? A.Drug glucuronidation B.Glomerular filtration rate C.Oral bioavailability D.Peak serum drug levels E.Volume of distribution

*E.Volume of distribution *

13. A 28-year-old male experiences fever and muscle rigidity soon after a major surgical procedure. His blood pressure is 190/100 mmHg and his heart rate is 130/min. Physical examination reveals muscle stiffness and cyanotic skin mottling. The appropriate treatment for this patient's condition includes an agent that affects which of the following physiologic processes? A. Alpha-receptor mediated sympathetic hyperactivity B. GABA-mediated neuron hyperpolarization C. Acetylcholine release in neuromuscular junction D. Ligand-receptor interaction in cholinergic synapses E. Acetylcholine degradation in cholinergic synapses F. Intracellular calcium release in skeletal muscles

*F. Intracellular calcium release in skeletal muscles *

15. A 50-year-old man is brought to the emergency department after developing blurred vision and confusion. Earlier today, he was clearing and burning foliage and weeds on his property. His medical history is insignificant, and he does not take any medications. The patient has no history of illicit drug use. Temperature is 38.9 C (102 F), blood pressure is 110/76 mm Hg, pulse is 120/min, and respirations are 16/min. He is disoriented to time, place, and person. Physical examination shows flushed skin and dry oral mucosa. Both pupils are dilated and nonreactive to light and accommodation. Bowel sounds are decreased. Which of the following drugs can potentially reverse this patient's condition? A. Atropine B. Benztropine C. Diazepam D. Haloperido! E. Metoprolol F. Morphine G. Naloxone H. Physostigmine I. Thiamine

*H. Physostigmine*

23. A 64-year-old man was prescribed atenolol and sub- lingual nitroglycerin after his recent hospitalization for unstable angina. Which of his current medications should be discontinued? A. Sildenafil B. Amlodipine C. Metformin D. Lisinopril

*Sildenafil*