MCQ II Pharmacology

1. What is the absolute efficacy improvement for the primary efficacy outcome? A. 25% B. 20% C. 5% D. None of the above

5%

4. What is the relative hazard? A. 50% B. 25% C. 10% D. 5%

50%

A 64-year-old woman presents with pain in her left thigh muscle. Duplex ultrasonography indicates the presence of deep vein thrombosis (DVT) in the affected limb. The decision was made to treat this woman with enoxaparin. Relative to unfractionated heparin, enoxaparin-- A. Can be used without monitoring the patient's aPTT. B. Is more likely to cause thrombosis and thrombocytopenia. C. Has a shorter duration of action. D. Is less likely to have a teratogenic effect.

A. Can be used without monitoring the patient's aPTT ; Explanation: Enoxaparin is an Low Molecular Weight heparin. LMW heparins have a longer half-life than standard(High molecular weight) heparin and a more consistent relationship between dose and therapeutic effect. Enoxaparin is given subcutaneously, not intravenously. It is less, not more, likely to cause thrombosis and thrombocytopenia. Neither LMW heparins nor standard heparin are teratogenic. The aPTT is not useful for monitoring the effects of LMW heparins.

1. Match the pharmacologic class with an advantage and disadvantage of these agents A. Antacids B. H2Receptor AntagonistsC. Proton Pump Inhibitors D. Most potent inhibitors of acid secretion, good efficacy/safety, long duration of action, but expensive E. Prompt acting, but short duration of action F. Good efficacy, well tolerated, and safe but doses need to be adjusted when renal function is impaired

A. Antacids with E. Prompt acting, but short duration of action B. H2Receptor Antagonists with F. Good efficacy, well tolerated, and safe but doses need to be adjusted when renal function is impaired C. Proton Pump Inhibitors with D. Most potent inhibitors of acid secretion, good efficacy/safety, long duration of action, but expensive

5. A 73 year old white man having a prior medical history of COPD, CKD, and gout is admitted for a MI. Prior to discharge, you plan to start a beta blocker. Which of the following beta blockers would be the best choice based on his history? A. Atenolol B. Esmolol C. Nadolol D. Propranolol

A. Atenolol Because of the patient's COPD, a beta-1 selective agent would be preferred over a non-selective agent. Of the agents listed, atenolol and esmolol are beta-1 selective, however, esmolol is only available in an IV formulation, therefore atenolol is the correct answer.

9. Cefotaxime, or ceftriaxone, or ampicillin/ sulbactam are considered first line antibiotic treatments for SBP because: A. Because of their activity against E coli, and proteus B. Because they are useful agents for patients having a documented severe allergic reaction to penicillin C. Because of their activity against staph, strep, and atypical bacteria. D. Are only used when symptoms of infection are supported by a positive culture of ascitic fluid

A. Because of their activity against E coli, and proteus

Match the medication with the most accurate description of it's mechanism of action A. Clopidogrel B. Aspirin C. Heparin and LMWH D. Eptifibatide E. Inhibits prostaglandin and thromboxane synthesis F. An active metabolite binds to and inhibits the platelet ADP receptors G. Prevents binding of fibrinogen and vWF to the GP IIb/IIIa receptor H. Activates antithrombin

A. Clopidogrel with F. An active metabolite binds to and inhibits the platelet ADP receptors B. Aspirin with E. Inhibits prostaglandin and thromboxane synthesis C. Heparin and LMWH with H. Activates antithrombin D. Eptifibatide with G. Prevents binding of fibrinogen and vWF to the GP IIb/IIIa receptor

mechanism of action: Thiazide type diuretics

Acts on the distal tubule to reduce sodium reabsorption

6. Today's patient is a 64 year old white man with NYHA HFrEF stable while managed with enalapril and carvedilol, but now has developed angioedema. You recommend switching from enalapril to valsartan, but he asks you about Entresto because the advertisements on television and social media encouraged him to ask his Dr about Entresto. You advise him that: A. Valsartan is more effective than Entresto B. Patients with a history of angioedema should NOT take Entresto! C. He should start Entresto as soon as possible and definitely within 24 hours of his last dose of enalapril. D. Entresto is contraindicated for use with carvedilol

B. Patients with a history of angioedema should NOT take Entresto!

A patient develops severe thrombocytopenia in response to treatment with unfractionated heparin and still requires parenteral anticoagulation. Your best option is: Hint: Look this up in your favorite Pharmacology reference A. Eptifibitide B. Bivalirudin C. Abciximab D. Clopidogrel

B. Bivalirudin ; Explanation: Direct thrombin inhibitors such as bivalirudin and argatroban provide parenteral anticoagulation similar to that achieved with heparin, but the direct thrombin inhibitors do not induce formation of antiplatelet antibodies.

9. Which statement about carvedilol is correct? A. Carvedilol is a cardioselective beta antagonist B. Carvedilol is a combined alpha- and nonselective beta-blocker. C. Carvedilol and labetalol have balanced alpha and beta blocking action D. Carvedilol is contraindicated in heart failure

B. Carvedilol is a combined alpha- and nonselective beta-blocker.

3. NSAIDS and Opioids promote histamine release via: A. IgE Mediated Type I Reaction B. Direct Pharmacologic Effect C. Promotion of prostaglandin synthesis. D. Activation of central pathways that promote appreciation of pain.

B. Direct Pharmacologic Effect

3. Always start treatment with more than one drug at a time. A. True B. False

B. False

5. There is compelling evidence to support non-drug treatment for the following conditions: A. Hypertension, Type 1 Diabetes, insomnia and back pain B. Hypertension, Type 2 diabetes, insomnia and back pain C. Arthritis, headache, and congestive heart failure D. Non-Hodgkins Lymphoma, von Willebrands disease, and HIV

B. Hypertension, Type 2 diabetes, insomnia and back pain

6. Today's patient is a 58 yr old man, taking 8 different medications on a daily basis. Pantoprazole was started 12 weeks ago while hospitalized. He is concerned about the cost, side effects, his long term health and wants to know if all of these medications are really necessary.Which indication listed below would be eligible for deprescribing of pantoprazole? A. Severe esophagitis B. ICU Stress Ulcer Prophylaxis C. Documented history of bleeding GI ulcer D. Barrett's esophagus

B. ICU Stress Ulcer Prophylaxis

3. A patient taking verapamil for hypertension and angina has become constipated. Which of the following drugs is an osmotic laxative that could be used to treat the patient's constipation? A. Ranitidine B. Magnesium hydroxide C. Aluminum hydroxide D. Metoclopramide

B. Magnesium hydroxide A laxative that mildly stimulates the gut is suitable for a patient taking a smooth muscle relaxant drug like verapamil. By holding water in the intestine, magnesium hydroxide provides additional bulk and stimulates increased contractions.

10. Concerns about the overuse and adverse effects associated with proton pump inhibitors (PPIs) have prompted deprescribing in some situations. Deprescribing PPIs is recommended in patients with which of the following conditions? A. Barret esophagus B. Mild to moderate esophagitis C. Documented history of bleeding gastrointestinal (GI) ulcer D. Chronic nonsteroidal anti-inflammatory drug (NSAID) use with bleeding risk

B. Mild to moderate esophagitis Deprescribing of PPIs is recommended in patients with the following conditions: Mild to moderate esophagitis Gastroesophageal reflux disease treated for 4-8 weeks (esophagitis healed, symptoms controlled) Peptic ulcer disease treated for 2-12 weeks Upper GI symptoms without endoscopy (asymptomatic for 3 consecutive days)Stress ulcer prophylaxis treated beyond intensive care unit admission Uncomplicated Helicobacter pylori infection treated for 2 weeks (asymptomatic) PPI use should be continued in patients with the following conditions: Barret esophagus Chronic NSAID use with bleeding risk Severe esophagitis Documented history of bleeding GI ulcer

2. Review Slide 9 from the HF lecture. What is the patient's BUN? A. 145 B. 179 C. 20 D. 14.2

C. 20

5. An allergic reaction to a nonantibacterial sulfonamide such as celecoxib in a patient with an allergy to sulfamethoxazole may be due to: A. Both drugs have an arylamine group at the N4 position of the sulfonamide moiety B. Both drugs have a 5 or 6 member nitrogen containing ring at the N1 nitrogen C. A predispostion to drug-induced allergic reactions D. Circulating IgE antibodies to sulfamethoxazole

C. A predispostion to drug-induced allergic reactions

2. Which statement is correct? A. Adverse events are always reported in published trials. B. Spontaneous reporting is the most reliable method for reporting adverse events. C. Adverse events should be reported in the abstract, results and discussion sections of every paper that claims a benefit to treatment. D. Patients who withdraw from a study because of adverse effects should not be included in the results.

C. Adverse events should be reported in the abstract, results and discussion sections of every paper that claims a benefit to treatment.

3. Match the medication with the mechanism of action A. Heparin B. Warfarin C. Dabigatran D. Rivaroxaban E. Direct thrombin inhibitor F. Factor Xa inhibitor G. A vitamin K antagonist [inhibits clotting factors II, VII, IX, and X; inhibits anticoagulant proteins C and S] H. Activates anti-thrombin

C. Dabigatran with E. Direct thrombin inhibitor D. Rivaroxaban with F. Factor Xa inhibitor B. Warfarin with G. A vitamin K antagonist [inhibits clotting factors II, VII, IX, and X; inhibits anticoagulant proteins C and S] A. Heparin with H. Activates anti-thrombin

1. Which one of the following drugs used in HF is associated with clinically or physiologically useful inotropic effects? A. Nesiritide B. Lisonopril C. Dobutamine D. Valsartan

C. Dobutamine

Which one of the following drugs used in HF is associated with clinically or physiologically useful inotropic effects? A. Nesiritide B. Lisonopril C. Dobutamine D. Valsartan

C. Dobutamine

4. When selecting an opioid for a patient claiming an allergy to codeine: A. Choose Morphine the active metabolite of codeine. B. All patients claiming an allergy to codeine should not receive an analgesic. C. If there is a compelling reason to use an opioid you could choose an opioid such as fentanyl or meperidine because these opioids are chemically distinct from codeine. D. There is no risk of allergic reactions from opioids.

C. If there is a compelling reason to use an opioid you could choose an opioid such as fentanyl or meperidine because these opioids are chemically distinct from codeine.

5. List at least 5 examples of prescription and non prescription medications associated with liver injury.

OTC Medications: Alcohol, acetaminophen (high doses), NSAIDs especially diclofenac (some NSAIDS are safer than others) Rx Medications: Seizure meds almost all esp -Phenytoin; INH; Statins (high doses); Amiodarone; Allopurinol; Methotrexate; Antipsychotics

Clinical Benefit: ACE Inhibitors

Particularly useful in patients with chronic kidney disease, in diabetes, in heart failure and post-MI.

4. On your way to the next MCQ Exam, you experience that feeling that an attack of diarrhea is imminent. Stopping at a drugstore, which one of the following antidiarrheal drugs could you buy without a prescription even though it is related chemically to the strong opioid analgesic meperidine? A. Aluminum hydroxide B. Diphenoxylate C. Loperamide D. Magnesium hydroxide

C. Loperamide Aluminum hydroxide is constipating but not related chemically to meperidine; magnesium hydroxide is a strong laxative. The 2 antidiarrheal drugs structurally related to opioids are diphenoxylate and loperamide. Loperamide is available over-the-counter; diphenoxylate is mixed with atropine, and the product (Lomotil, others) requires a prescription.

6. Portal Hypertension: Beta-adrenergic antagonists are used to reduce portal pressure by: Reducing portal venous inflow Reducing Cardiac output thus reducing splanchnic blood flow Which statement is most correct? A. Metoprolol is preferred B. Non-selective BB are preferred as use results in a reduction of varices and improved mortality C. Non-selective BB are preferred as use results in a reduction of variceal bleeding and risk of rebleeding D. Beta-agonists such as isoproterenol are used to reduce portal pressure and reduce the risk of rebleeding

C. Non selective BB are preferred as use results in reduction of variceal bleeding and risk of rebleeding

1. Which of the following drugs would be the most appropriate choice for rate control in a 69-year-old woman with atrial fibrillation and asthma? A. a dihydropyridine calcium channel blocker B. a beta blockera C. Nondihydropyridine calcium channel blocker D. Amiodarone

C. Nondihydropyridine calcium channel blocker [Explanation] Diltiazem and verapamil are preferred over beta blockers for rate control in patients with asthma because beta blockers can precipitate bronchoconstriction and bronchospasm.Unlike diltiazem and verapamil, the dihydropyridine calcium channel blockers (all the other calcium channel blockers ) do not have rate-controlling activity.

4. How likely is it that the described INR event is an adverse drug reaction? A. Unlikely B. Possible C. Probable or Definite D. None of the above

C. Probable or Definite Right- I would classify this event as Probable since there is no re-challenge. When we re-challenge by prescribing a lower dose if the patient reaches a target response I would classify as definite.

1. Which statement about the mechanism of action of amiodarone is NOT correct? A. prolongs the action potential duration (and the QT interval on the ECG) by blockade of K Channels B. blocks inactivated sodium channels C. Reverses electrolyte imbalances, restores patency of coronary arteries, and balances pH D. has weak adrenergic and calcium channel-blocking actions

C. Reverses electrolyte imbalances, restores patency of coronary arteries, and balances pH

5. ACE inhibitors should be used with caution in patients withA. Diastolic blood pressure > 90 mm HgB. Serum Na >145 meq/LC. Serum K > 5 mEq/LD. Serum Creatinine > 1.2 mEq/L

C. Serum K > 5 mEq/L

8. Identify the correct initial starting dose. A. In heart failure start oral digoxin at 250 mcg per day, increase the dose by 125 mcg per day on alternating days until the daily oral dose exceeds 1000 mcg per day. B. The usual initial oral dose of metoprolol XL for heart failure is 50-100 mg twice a day. C. The usual initial dose of lisinopril for heart failure is 5 mg orally once a day. The usual maintenance dose ranges from 5-20 mg daily. D. In heart failure start oral furosemide at 200-400 mg every 6 hours.

C. The usual initial dose of lisinopril for heart failure is 5 mg orally once a day. The usual maintenance dose ranges from 5-20 mg daily.

1. Which statement about management of CDI is correct? A. Encourage frequent use of hand sanitizers B. Treatment includes oral metronidazole or IV Vancomycin C. Treatment includes oral metronidazole or oral Vancomycin D. Use fidaxomicin for initial treatment

C. Treatment includes oral metronidazole or oral Vancomycin

4. You should prescribe a newly approved drug when: A. A paid speaker tells you how much success she has with this new drug while the drug rep buys you an expensive dinner. B. Whenever a new drug has a unique mechanism of action. C. Use newly approved drugs once they have demonstrated superior safety and/or superior clinical outcomes. D. Improvements in laboratory values always result in improvements in clinical outcomes.

C. Use newly approved drugs once they have demonstrated superior safety and/or superior clinical outcomes.

3. All of the following medications are commonly associated with constipation except? A. Vincristine B. Verapamil C. Vancomycin D. Vareneicline

C. Vancomycin

3. Patient JR was on the following meds PTA: -Amiodarone 200mg q day -Furosemide 40mg q day -Levothyroxine 100mcg q day -Metoprolol tartrate 25mg BID -KCl 20 mEq q day -Atorvastatin 40mg q day -Warfarin 2mg q day -Ibuprofen 400 mg PRN mild to moderate pain As discussed in class- How should we optimize JR's Medications? Comment on each of the listed medications, (No change, decrease to xx mg, increase to xx mg, discontinue) and include any other medications and doses that should be added to his regimen.

Your Answer: -Amiodarone 200mg q day: No change -Furosemide 40mg q day: Change this to a 20 mg IV dose while in the hospital OR increase it to Furosemide 40 mg bid -Levothyroxine 100mcg q day: No change -Metoprolol tartrate 25mg BID: Change this to Metoprolol succinate extended release -KCl 20 mEq q day: No change -Atorvastatin 40mg q day: No change -Warfarin 2mg q day: No change -Ibuprofen 400 mg PRN mild to moderate pain: Discontinue Medications to add: -ARB as he is allergic to ACEI: Losartan 25 mg tablet PO daily -Acetaminophen -Consider adding an aldosterone antagonist (such as spironolactone) as his LVEF is 30% and he is Stage C, NYHA Class III and these medications are indicated in patients with Stage C, NYHA Class II-IV HF with LVEF<35% Mr. Fotis's Answer: 1. Add an ARB 2. Increase Furosemide to 40 mg bid 3. Change to Extended Release metoprolol 4. Consider aldosterone antagonist 5. Change ibuprofen to acetaminophen

Antiviral prophylaxis can be considered for which of the following persons exposed to influenza: a 75-year-old man with severe immune deficiencies. a 4-year-old child with asthma who received the influenza vaccine one week ago. a 29-year-old pregnant woman. all are correct

all are correct

2. What is the absolute difference in the primary hazard outcome? A. 2% B. 4% C. 6% D. None of the above

2%

5. What is the NNT for the primary efficacy outcome, and what is the number needed to harm for the primary hazard outcome? A. 5 and 10 B. 50 and 75 C. 20 and 50 D. 1 and 2

20 and 50

3. What is the relative improvement in efficacy? A. 10% B. 15% C. 20% D. 25%

25%

1. PMH: your patient has stage 2 hypertension and is at risk for type 2 diabetes. At the follow up appointment you note that He/she has lost a small amount of weight, has an improved diet, and has begun to exercise on a regular basis. You noted a small decrease in blood pressure. After confirming your diagnosis you initiated treatment with an ACE Inhibitor. On the next follow up appointment you note that blood pressure was reduced by about 10 mmHg after 2 months of treatment. Based on your interview and the patients response you are confident that patient adherence is to diet, exercise and medication is high. Your patient is unaware of any side effects from the ACE inhibitor. However blood pressure remains elevated. You decide it is time to change therapy for hypertension. Your next step should be to: A. Continue diet, exercise and ACE inhibitor therapy. Add a medication having a different mechanism of action and different side effects such as a thiazide diuretic. B. Keep raising the dose of ACE inhibitor until the patients reaches blood pressure goal. C. Stop the ACE inhibitor and initiate treatment with a calcium channel antagonist. D. Stop the ACE inhibitor and initiate treatment with the newest medication available.

A. Continue diet, exercise and ACE inhibitor therapy. Add a medication having a different mechanism of action and different side effects such as a thiazide diuretic.

1. Which of the following pathways is NOT a site for neurotransmitters involved in nausea and vomiting? A. Facebook B. Serotonin type 3 C. Neurokinin-1 D. Dopamine-2

A. Facebook Absolutely right Facebook is not a site for neurotransmitters involved in nausea and vomiting! Thank goodness you knew this!

2. Which statement about warfarin is correct? A. Foods containing large amounts of vitamin K can antagonize warfarin B. Warfarin exerts its effect on coagulation through activation of antithrombin III C. Patients should stop eating fruits and vegetables when treated with warfarin D. Warfarin has an immediate effect on coagulation

A. Foods containing large amounts of vitamin K can antagonize warfarin

1. Match the responses to the correct statement. A. Harms are the opposite of benefits. B. Most adverse reactions are caused by exotic medications rather than by anticoagulants or by insulin. C. Adverse drug reactions do not result in patient harm. D. Because I want it. E. False F. Eminence Based Medicine G. True H. False

A. Harms are the opposite of benefits. with G. True B. Most adverse reactions are caused by exotic medications rather than by anticoagulants or by insulin. with E. False C. Adverse drug reactions do not result in patient harm. with H. False D. Because I want it. with F. Eminence Based Medicine

8. The most important adverse effect of loop diuretics is: A. Hypokalemia B. Hyponatremia C. Renal insufficiency D. Angioedema

A. Hypokalemia

6. A 59 year old African American man with Chronic Kidney Disease (CKD) (baseline CrCl 30-35 mL/min) was diagnosed with HTN and started on lisinopril 5mg PO QD (taken at 0800). He does not like taking medications, but has a very high health literacy and takes this new medication very regularly. He reliably and accurately monitors his blood pressure at home since his diagnosis. After a month of therapy, he returns for a follow up visit and reports his 0700 SBP ranges 140-160 mmHg, his 1400 BP ranges 100-120s mmHg, and his 2100 SBP ranges 130-150 mmHg. Given his preferences about avoiding multiple medications and also his medical history, what medication change should be made at this time? A. Increase lisinopril to 10mg PO QD B. Continue lisinopril 5mg, add HCTZ 25mg PO QD C. Continue lisinopril 5mg, add amlodipine 5mg QD D. Was not on appropriate medication initially, switch to amlodipine 5mg PO QD

A. Increase lisinopril to 10mg PO QD An ACEI inhibitor (or ARB) is indicated in this patient with CKD per JNC 8 guidelines. ACE inhibitors have a "flat dose response," and the patient is achieving mid-day blood pressures at goal with elevations in the PM. Therefore, the dose should be increased to sustain response for 24 hours. Polypharmacy should be minimized when possible (especially in a patient with a stated preference), and thiazides might be less effective in a patient with a reduced CrCl.

1. Use only a few drugs and learn to use them well. A. Is an important principle of conservative prescribing B. Is not recommended as clinicians are encouraged to experiment with newly approved drugs C. Instead clinicians should rush to prescribe newly approved drugs having unique mechanisms of action. D. Clinicians should only prescribe medications that are heavily advertised to the public

A. Is an important principle of conservative prescribing

3. Which statement best describes the common factors thought to precipitate cardiac arrythmias? A. Ischemia, acidosis-alkalosis, electrolyte abnormalities, adverse drug reactions. B. Contrast studies, statins, echocardiograms C. MCQ exams, Capstone Projects, Moving D. None of the above

A. Ischemia, acidosis-alkalosis, electrolyte abnormalities, adverse drug reactions.

2. Identify the preferred triple therapy for treatment of h pylori infection. A. Lansoprazole 30 mg PO twice daily with amoxicillin (1 gm twice daily) and clarithromycin (500 mg twice daily) for 10—14 days B. Famotidine 40 mg PO twice daily with amoxicillin 1 gm twice daily and clarithromycin 500 mg twice daily for 10-14 days. C. Pepto bizmol every hour plus ranitidine 150 mg twice a day plus ciproloxacin 750 mg twice a day plus imipenem 1 gm IV every 6 hours for 10-14 days. D. Maalox 30 ml po every hour until symptoms improve

A. Lansoprazole 30 mg PO twice daily with amoxicillin (1 gm twice daily) and clarithromycin (500 mg twice daily) for 10—14 days

7. This question refers to medications used to treat congestive heart failure. Match the class of medication with the most correct mechanism of action. A. Loop diuretics such as furosemide B. ACE-inhibitors C. Beta-adrenergic antagonists D. Digoxin E. Reduce sympathetic activity F. Inhibits Na-K ATPase which increases cellular calcium resulting in vagomimetic action; positive inotropic action G. Decrease preload by decreasing vascular fluid volume H. Decrease afterload by decreasing total peripheral resistance through prevention of angiotensin induced vasoconstriction

A. Loop diuretics such as furosemide with G. Decrease preload by decreasing vascular fluid volume B. ACE-inhibitors with H. Decrease afterload by decreasing total peripheral resistance through prevention of angiotensin induced vasoconstriction C. Beta-adrenergic antagonists with E. Reduce sympathetic activity D. Digoxin with F. Inhibits Na-K ATPase which increases cellular calcium resulting in vagomimetic action; positive inotropic action

As you might expect from understanding the mechanism of action for digoxin this medication is cleared from the body via metabolism. However about 30% of digoxin is cleared by the kidney. Also it is known that renal failure by itself can impair the activity of Na-K ATP'ase. Based upon the above statements which response is correct? A. Patients having renal insufficiency and also taking digoxin should be monitored carefully for safety and efficacy. It may be necessary to reduce the dose of digoxin in proportion to the reduced renal function to prevent serious digoxin toxicity. B. Patients having renal insufficiency and also taking digoxin need not be monitored carefully for safety and efficacy. For most patients it will not be necessary to reduce the dose of digoxin to prevent serious digoxin toxicity. C. Patients having renal insufficiency and also taking digoxin need not be monitored carefully for safety and efficacy. For most renal patients it will be necessary to dramatically increase the dose of digoxin to preserve digoxin efficacy. D. Patients having renal insufficiency and also taking digoxin need not be monitored carefully for safety and efficacy. For most renal patients it will be necessary to add another medication that interferes with the metabolism of digoxin so that the effect of digoxin on Na-K ATP'ase is enhanced.

A. Patients having renal insufficiency and also taking digoxin should be monitored carefully for safety and efficacy. It may be necessary to reduce the dose of digoxin in proportion to the reduced renal function to prevent serious digoxin toxicity.

5. What type of ADR is this? A. Pharmacologic B. Idiosyncratic C. Allergic D. None of the above

A. Pharmacologic

3. Match the antiemetic with the most accurate mechanism of action. A. Phenothiazines as well as Butyrophenones for example compazine, droperidol B. 5-HT3 receptor antagonists for example ondansetron C. Aprepitant D. Scopolamine E. Anticholinergic F. NK 1 Receptor antagonist G. Dopamine antagonists H. Serotonin antagonists

A. Phenothiazines as well as Butyrophenones for example compazine, droperidol with G. Dopamine antagonistsB. 5-HT3 receptor antagonists for example ondansetron with H. Serotonin antagonistsC. Aprepitant with F. NK 1 Receptor antagonistD. Scopolamine with E. Anticholinergic

3. Match the pharmacologic class of medication to the correct clinical benefit. A. Thiazide diuretics B. ACE Inhibitors C. Beta Adrenergic Antagonists D. Calcium Channel Antagonists E. Particularly useful in patients with chronic kidney disease, in diabetes, in heart failure, and post-MI F. Reduce mortality after MI and in heart failure. Prevent reflex tachycardia associated with use of vasodilators G. Use of short acting agents in this class is associated with increased risk of MI and an increase in mortality H. Demonstrate improvements in mortality in most patients. Also useful to offset fluid retention caused by vasodilators

A. Thiazide diuretics with H. Demonstrate improvements in mortality in most patients. Also useful to offset fluid retention caused by vasodilators B. ACE Inhibitors with E. Particularly useful in patients with chronic kidney disease, in diabetes, in heart failure, and post-MI C. Beta Adrenergic Antagonists with F. Reduce mortality after MI and in heart failure. Prevent reflex tachycardia associated with use of vasodilators D. Calcium Channel Antagonists with G. Use of short acting agents in this class is associated with increased risk of MI and an increase in mortality

2. Match the drug class with the correct mechanism of action. No partial credit for this question. A. Thiazide type diuretics B. Beta adrenergic antagonists C. Angiotensin converting enzyme inhibitors D. Calcium Channel antagonists [Match] E. Reduces the activity of the sympathetic nervous system F. Relaxes vascular smooth muscle and reduces total peripheral resistance G. Acts on distal tubule to reduce sodium reabsorption H. Reduces the activity of the Renin system

A. Thiazide type diuretics with G. Acts on distal tubule to reduce sodium reabsorption B. Beta adrenergic antagonists with E. Reduces the activity of the sympathetic nervous system C. Angiotensin converting enzyme inhibitors with H. Reduces the activity of the Renin system D. Calcium Channel antagonists with F. Relaxes vascular smooth muscle and reduces total peripheral resistance

2. Reserve unproven and off-label use for situations when your patients is unable to use recommended and proven treatments. A. True B. False

A. True

2. Secondary Risk factors for PONV include all EXCEPT A. Type of health insurance (Does not include risk of nausea when you receive your bill) B. Type of surgery- laprascopic, Gyne, ENT, Neuro C. Duration of surgery D. Use of general anesthesia

A. Type of health insurance (Does not include risk of nausea when you receive your bill)

7. Which of the following factors is least associated with a higher risk of developing myopathy or rhabdomyolysis in patients taking statins? A. Use of a low statin dose B. Kidney disease C. Female sex D. Age 65 years or older

A. Use of a low statin dose Some of the known risk factors associated with increased or frequent side effects when using statins include the following: Age 65 years or older Female sex Using multiple cholesterol-lowering medications (eg, fibrates, high-dose niacin, lomitapide) High statin dose Smaller body frame Kidney disease Liver disease Alcohol use

3. The most effective antiarrhythmic drug for maintenance of sinus rhythm is: A. amiodarone B. propafenone C. dronedarone D. sotalol

A. amiodarone

6. Which statement about amiodarone is NOT correct? A. amiodarone has a short half life, and is eliminated entirely by the kidney B. amiodarone accumulates in the heart, lung, liver, skin and tears C. Dose-related pulmonary toxicity is the most important adverse effect D. amiodarone can interfere with the metabolism of many drugs including statins, warfarin, and digoxin E. Use of amiodarone may result in hypothyroidism or hyperthyroidism

A. amiodarone has a short half life, and is eliminated entirely by the kidney

Remdesivir provides a modest benefit to patients infected with Covid-19. How does Remdesivir work against the Covid-19 Virus? Put your answer in English please.

A: Active against RNA viruses · inhibits RNA polymerases · competes with adenosine-triphosphate for incorporation into developing viral RNA chains · Once incorporated into viral RNA remdesivir terminates RNA synthesis; remdesivir can evade proofreading by viral RNA protective enzymes · delays RNA chain termination

4. Which two classes of drugs interfere with the elimination of Bradykinin? A. ARBs and NSAIDs B. ACE inhibitors and Neprilysin inhibitors C. Nesiritide and Neprilysin inhibitors D. Loop diuretics and ARBs

B. ACE inhibitors and Neprilysin inhibitors

Which two classes of drugs interfere with the elimination of Bradykinin? A. ARBs and NSAIDs B. ACE inhibitors and Neprilysin inhibitors C. Nesiritide and Neprilysin inhibitors D. Loop diuretics and ARBs

B. ACE inhibitors and Neprilysin inhibitors

7. In addition to an ACE-I, ARB, or ARNI all patients with HFrEF should take a beta-blocker. Which statement is correct? A. Metoprolol is more likely than carvedilol to cause hypotension. B. Beta-blockers should be used cautiously if at all in patients with severe bradycardia. C. Discontinue the beta-blocker if there is no significant improvement during the first week of treatment. D. All beta-blockers are shown to reduce hospitalizations and mortality.

B. Beta-blockers should be used cautiously if at all in patients with severe bradycardia.

2. The mechanism of action of penicillin allergy toxicity is best described as: A. Cell walls in human skin are destroyed by penicillin resulting in the characteristic rash seen in penicillin allergy. B. Penicillin breakdown products form haptens which bind to cell surface proteins to form an antigen. The major breakdown product results from the degredation of the 4 member ring structure, and the minor breakdown product results from the degredation of the 5 member ring. C. Penicillin breakdown products act to release beta lactamase which results in the allergic reaction. D. Susceptible bacteria release allergic components in an effort to convince the patient to stop taking their medicine.

B. Penicillin breakdown products form haptens which bind to cell surface proteins to form an antigen. The major breakdown product results from the degredation of the 4 member ring structure, and the minor breakdown product results from the degredation of the 5 member ring.

4. Therapeutically useful anti-arrhythmic medications: A. Open the sodium channel and enhance conduction. B. Reduce conduction and excitability and increase the refractory period to a greater extent in depolarized tissue than in normally polarized tissue. C. Shorten the refractory period to cancel out blocked impulses D. Activate the sympathetic nervous system to enhance contractility

B. Reduce conduction and excitability and increase the refractory period to a greater extent in depolarized tissue than in normally polarized tissue.

8. Ascites Treatment- which statement is most correct? A. Spironolactone is classified as an angiotensin receptor antagonist B. Spironolactone is combined with a loop diuretic C. The furosemide dose is 100 mg day to 40 mg per day for Spironolactone D. No answer text provided.

B. Spironolactone is combined with a loop diuretic

7. When used to manage portal hypertension the dosing strategy for beta adrenergic antagonists is best described as: A. Start at the maximum or target dose and down titrate once pressure is under control B. Start with the lowest recommended starting dose, and titrate towards the target efficacy dose while carefully monitoring heart rate. C. Start with metoprolol XL and switch to immediate release once target heart rate is reached.

B. Start with the lowest recommended starting dose, and titrate towards the target efficacy dose while carefully monitoring heart rate.

3. An INR was measured two days after the dose increase. Why didn't this lab value predict that the new dose was too high? A. The INR should only be used to monitor low molecular weight heparins B. The half life of warfarin is approximately 40 hours. The half life of Factor II is 72 hours, and Factor X half life is 40 hours. The INR was measured at best after only one half life, probably less than one half life. We were no where near the maximum inhibition of clotting factors. The INR should have been repeated after 5-7 days at the new dose. C. The INR should have been measured one half hour before, and two hours after the dose increase. D. All of the above

B. The half life of warfarin is approximately 40 hours. The half life of Factor II is 72 hours, and Factor X half life is 40 hours. The INR was measured at best after only one half life, probably less than one half life. We were no where near the maximum inhibition of clotting factors. The INR should have been repeated after 5-7 days at the new dose.

1. Match the correct response: A. Warfarin B. This clotting factor has the shortest half life C. Reverses warfarin D. Heparin E. Factor VII F. Phytonadione (Vitamin K) G. The aPTT is used to measure the intensity of pharmacologic effect H. The normalized prothrombin time is used to measure the intensity of pharmacologic effect

B. This clotting factor has the shortest half life with E. Factor VII C. Reverses warfarin with F. Phytonadione (Vitamin K) D. Heparin with G. The aPTT is used to measure the intensity of pharmacologic effect A. Warfarin with H. The normalized prothrombin time is used to measure the intensity of pharmacologic effect

PMH: your patient has stage 2 hypertension and is at risk for type 2 diabetes. At the follow up appointment you note that He/she has lost a small amount of weight, has an improved diet, and has begun to exercise on a regular basis. You noted a small decrease in blood pressure. After confirming your diagnosis you initiated treatment with an ACE Inhibitor. On the next follow up appointment you note that blood pressure was reduced by about 10 mmHg after 2 months of treatment. Based on your interview and the patients response you are confident that patient adherence to diet, exercise and medication is high. Your patient is unaware of any side effects from the ACE inhibitor. However blood pressure remains elevated. You decide it is time to change therapy for hypertension. Your next step should be to: Continue diet, exercise and ACE inhibitor therapy. Add a medication having a different mechanism of action and different side effects such as a thiazide diuretic. Keep raising the dose of ACE inhibitor until the patients reaches blood pressure goal. Stop the ACE inhibitor and initiate treatment with a calcium channel antagonist. Stop the ACE inhibitor and initiate treatment with the newest medication available.

Continue diet, exercise and ACE inhibitor therapy. Add a medication having a different mechanism of action and different side effects such as a thiazide diuretic.

4. Which classes of antihypertensive medications are most effective in low renin or volume-expanded forms of hypertension? A. Aldosterone anatagonists B. ACE inhibitors C. Thiazide Diuretics D. Aldosterone antagonists and Thiazide Diuretics

D. Aldosterone antagonists and Thiazide Diuretics [Explanation] Thiazides, loops, and potassium-sparing diuretics (including aldosterone antagonists) and most effective in low renin patient populations (African Americans, elderly patients). ACE inhibitors are more effective in high-renin patients (white patients, comparatively).

2. One of the following statements about the mechanism of action of anti-arrythmic agents is NOT correct. Identify the incorrect statement. A. Block sodium channels B. Block Calcium Channels C. Block Potassium Channels D. Block Premium Cable TV Channels

D. Block Premium Cable TV Channels

2. Which statement about CDI is NOT correct A. C difficile is a Gram-positive, spore forming rod B. Primary cause of hospital-associated diarrhea in US C. Overgrowth in gut supported by antibiotic use D. Caused by Bacteroides fragilis

D. Caused by Bacteroides fragilis

2. The treatment of choice for urgent conversion of symptomatic unstable atrial fibrillation is: A. IV magnesium sulfate B. IV amiodarone C. IV digoxin D. DC cardioversion

D. DC cardioversion

5. A 55-year-old woman with type 1 diabetes of 40 years' duration complains of severe bloating and abdominal distress, especially after meals. Evaluation is consistent with diabetic gastroparesis. Which of the following is a prokinetic drug that could be used in this situation? A. Alosetron B. Cimetidine C. Loperamide D. Metoclopramide

D. Metoclopramide Alosetron is a 5HT3 receptor blocker, cimetidine is a H2 receptor blocker, loperamide is an opioid. Only metoclopramide is considered a prokinetic agent (ie, one that increases propulsive motility in the gut).

4. Which of the following is NOT a primary risk factor for PONV? (Post-Operative Nausea and Vomiting) A. Female Gender B. Non-smoker C. History of PONV and/or Motion Sickness D. Riding a rental bicycle without wearing a helmet. E. Postoperative use of opioid analgesics

D. Riding a rental bicycle without wearing a helmet.

A 55-year-old pharmacology professor is brought to the emergency department 2 h after the onset of severe chest pain during a stressful question and answer session. He has a history of poorly controlled mild hypertension and elevated blood cholesterol but does not smoke. ECG changes (ST elevation) and cardiac enzymes confirm the diagnosis of myocardial infarction. The decision is made to attempt to open his occluded artery. If this patient undergoes a percutaneous coronary angiography procedure and placement of a stent in a coronary blood vessel, he will need to be on dual antiplatelet therapy, for example aspirin and clopidogrel for at least a year. Which response most accurately describes the mechanism of action of clopidogrel?Read all of the responses carefully before selecting the best answer!! A. Clopidogrel directly binds to the platelet ADP receptors B. Clopidogrel irreversibly inhibits cyclooxygenase C. Clopidogrel facilitates the action of antithrombin III D. The active metabolite of clopidogrel binds to and inhibits the platelet ADP receptors

D. The active metabolite of clopidogrel binds to and inhibits the platelet ADP receptors ; Explanation: Clopidogrel is a prodrug that is activated by CYP2C9 and CYP2C19. It irreversibly binds to the ADP receptor on the surface of platelets that serves as a key role in platelet aggregation. Aspirin and clopidogrel help prevent platelet-induced occlusion of coronary stents.

5. Identify the correct maintenance dose for amiodarone: A. To control supraventricular arrythmia the maintenance dose is 800 to 1600 mg orally each day B. To control supraventricular arrythmia the maintenance dose is 50 mg/kg orally each day C. To control supraventricular arrythmia start at 200 mg orally a day, and double the dose every other day until the dose is up to 2 Grams per day D. To control supraventricular arrythmia the maintenance dose is usually 200 mg orally each day

D. To control supraventricular arrythmia the maintenance dose is usually 200 mg orally each day

Clinical Benefit: Thiazide diuretics

Demonstrate improvements in mortality in most patients. Also useful to offset fluid retention caused by vasodilators.

7. An 87-year-old woman was recently seen in a hospital emergency department (ED) for pain in her back and buttocks after a fall 2 weeks earlier. She was diagnosed with sciatica and given prescriptions for a short course of prednisone and baclofen and sent home. Three days later, she developed delirium, necessitating another trip to the ED and a subsequent admission to the hospital. Her mental status returned to baseline 2 days later and she was discharged home. The final diagnosis was drug-induced delirium. A few weeks later, she returned to the ED complaining of stomach pain. She was given prescriptions for an antibiotic and a proton-pump inhibitor and asked to follow up with a gastroenterologist.Within a month, she developed severe diarrhea of several days' duration, and again returned to the ED, where this time she was given a prescription for dicyclomine. Two days after beginning this new drug regimen, she again became delirious and was readmitted to the hospital for several days. She was subjected to multiple laboratory tests and imaging studies, the results of which were all normal. Thankfully, she was again discharged home. 1. Which medications were unintentionally prescribed to manage a side effect of another medication? 2. Which prescribed medications for this case were unnecessary?

Question 1 -Antibiotics and PPI: The stomach pain was likely a side effect of the prednisone and the antibiotics and PPI were prescribed to manage the stomach pain.-Dicyclomine: The diarrhea was likely a side effect of the antibiotic and dicyclomine was prescribed to manage the diarrhea. Question 2-Prednisone and Baclofen: According to Clinical Pharmacology sciatica is not an indication to prescribe prednisone or baclofen. Additionally, the patient's pain was likely due to her fall 2 weeks earlier so she likely did not need these two medications to begin with and they likely caused her first episode of delirium. -Antibiotics and PPI: The stomach pain she came back with was likely a side effect of the prednisone and thus she did not require the antibiotics and PPI nor did she require a GI referral.-Dicyclomine: The diarrhea she developed was likely a side effect of the previously prescribed antibiotic and she did not need the dicyclomine. Additionally an adverse effect of dicyclomine is drug-reduced delirium and it should not have been given to the patient who had a recent history of drug-induced delirium.

Clinical Benefit: Beta Adrenergic Antagonists

Reduce mortality after MI, and in heart failure. Prevent reflex tachycardia associated with use of vasodilators.

mechanism of action: Angiotensin converting enzyme inhibitors

Reduces the activity of the Renin system

mechanism of action: Beta adrenergic antagonists

Reduces the activity of the sympathetic nervous system

mechanism of action: Calcium Channel antagonists

Relaxes vascular smooth muscle and reduces total peripheral resistance

1. Match the allergy classification with the most correct time of onset; mediator; and clinical signs. A. Type I Reaction B. Type II Reaction C. Type III Reaction D. Type IV Reaction E. Late reaction; IgG; Interstitial Nephritis F. Delayed reaction; T-cells; Maculopapular rash G. Immediate onset; IgE; Anaphylaxis H. Late reaction; IgG; Drug Fever

See Gell and Coombs classification A. Type I Reaction with G. Immediate onset; IgE; Anaphylaxis B. Type II Reaction with E. Late reaction; IgG; Interstitial Nephritis C. Type III Reaction with H. Late reaction; IgG; Drug Fever D. Type IV Reaction with F. Delayed reaction; T-cells; Maculopapular rash

Today's patients is a 41-year-old otherwise healthy woman presenting with fever, myalgia, and cough that began the day before. Rapid antigen testing is positive for influenza A. Which statement about antiviral treatment for this patient is correct? Treatment with oseltamivir could be considered since onset of symptoms was <48 hours ago. Treatment is not recommended because her symptoms began >24 hours ago. Treatment with amantadine could be considered since onset of symptoms was <48 hours ago. Otherwise healthy persons should not receive antiviral treatment for influenza.

Treatment with oseltamivir could be considered since onset of symptoms was <48 hours ago.

The preferred antiviral drug for treatment of seasonal influenza in hospitalized patients is:

oseltamivir (tamiflu)

A Registration Clinical Trial reported results as follows: Results Primary Efficacy Event Rate Test Medication 25% Reference Medication 20% Primary Hazard Event Rate Test Medication 6% Reference Medication 4%

reference values for the other questions

Clinical Benefit: Calcium Channel Antagonists

use of short acting agents in this class is associated with increased risk of MI and an increase in mortality.

Earlier this spring there was a great deal of interest in the use of hydroxychloroquine in the treatment of Covid-19. Of course completed trials found very limited efficacy, and a high degree of toxicity, and this medication is not recommended by the medical community. There are several potential mechanisms by which hydroxychloroquine may be active against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In English: What are the mechanisms of this activity?

· A: inhibition of viral enzymes or processes such as viral DNA and RNA polymerase, viral protein glycosylation, virus assembly, new virus particle transport, and virus release. · ACE2 cellular receptor inhibition, · acidification at the surface of the cell membrane inhibiting fusion of the virus, and · immunomodulation of cytokine release