Pharm: Test 2
m2.A 59-year-old man in good health with no evidence of cardiovascular disease, a BMI of 29, an HbA1c of 5.9, and an LDL-C of 167 mg/dL asks whether he should be taking a statin. You could tell him that: --Statins are only approved for use in patients with documented cardiovascular disease (CVD) ---Statins have no demonstrated benefit in patients without CVD ---Statins can reduce the incidence of cardiovascular events in patients without CVD ---Statins may increase the risk of developing diabetes, but that risk is outweighed by the benefits a statin may have for him
---Statins can reduce the incidence of cardiovascular events in patients without CVD ---Statins may increase the risk of developing diabetes, but that risk is outweighed by the benefits a statin may have for him
A 60-year-old white female has not reached her blood pressure goal after 3 months of treatment with a low dose of lisinopril. All of the following would be appropriate next steps in the treatment of her hypertension EXCEPT: Increase dose of lisinopril Add a diuretic medication Add on a calcium channel blocker Add on an angiotensin receptor blocker Switch to an alpha-blocker
--Add on an angiotensin receptor blocker ---Switch to an alpha-blocker
Which of the following is correct regarding digoxin when used for atrial fibrillation? --Digoxin works by blocking voltage-sensitive calcium channels --Digoxin produces vagomimetic effects at the AV node ---Digoxin is used for rhythm control in patients with atrial fibrillation ---Digoxin increases conduction velocity through the AV node ---Digoxin levels needed for atrial fibrillation are higher than those necessary for symptom control in heart failure
--Digoxin produces vagomimetic effects at the AV node --Digoxin levels needed for atrial fibrillation are higher than those necessary for symptom control in heart failure
m1.The preferred thiazide-like diuretic for initial therapy of hypertension is: -Hydrochlorothiazide -Chlorthalidone -Furosemide -Metolazone
-Chlorthalidone
Stable angina: ---Is periodic, short-lived episodes of severe substernal pain ----Can be treated by pharmacologically decreasing cardiac preload ----Is precipitated when an atherosclerotic plaque ruptures and occludes a coronary blood vessel ---Occurs when O2 demand of some area of the myocardium exceeds the O2 supply to that area of heart muscle ---Results from a paroxysmal spasm in a coronary vessel
-Is periodic, short-lived episodes of severe substernal pain ----Can be treated by pharmacologically decreasing cardiac preload ---Occurs when O2 demand of some area of the myocardium exceeds the O2 supply to that area of heart muscle
m4.In one randomized trial, the incidence of myopathy with a CK level > 10 times the ULN among patients taking 20 mg/day of simvastatin was: 0.03% 0.9% 1.6% 3.2%
0.03%*** answer 0.9% in patients taking 80 mg/day of simvastatin
m5.In patients with acute coronary syndrome (ACS), aspirin reduces the incidence of myocardial infarction (MI) by: 5-10% 15-25% 30-40% 50-60%
15-25%
m3.According to one meta-analysis, each additional 1mmol/L reduction in LDL-C is associated with a reduction in the incidence of major vascular events of: 5% 10% 20% 30%
20%**answer 10% is all cause mortality
m9.In the PARADGM-HF trial, the composite endpoint (first hospitalization for worsening heart failure or cardiovascular death) occurred in fewer patients treated with Entresto than with enalapril. The absolute difference between the 2 groups was about: 5% 10% 15% 20%
5%
m8. Many experts would begin antihypertensive therapy with two drugs when baseline blood pressure is: > 10/5 mm Hg above goal > 20/10 mm Hg above goal > 140 mm Hg systolic > 100 mm Hg diastolic
> 20/10 mm Hg above goal
m1.Which of the following would be a reasonable choice for treatment of a 43-year-old, treatment-naïve, otherwise healthy black male with a blood pressure of 150/96 mm Hg? A thiazide-like diuretic An ACE inhibitor An ARB Any of the above
A thiazide-like diuretic
Which of the following statements concerning the ions and ion channels involved in the cardiac ion potential is FALSE? A. "Trigger" Ca++ for cardiac muscle contraction moves into ventricular cells during phase 0 of the cardiac action potential. B. Phase 0 current in ventricular muscle cells is carried by Na+ ions. C. Hypokalemia can predispose a patient to ectopic pacemaker activity. D. Phase 4 current in the SA node pacemaker cells is an important determinant of automaticity. E. Repolarization (phase 3) in ventricular cells occurs when potassium channels close.
A. "Trigger" Ca++ for cardiac muscle contraction moves into ventricular cells during phase 0 of the cardiac action potential E. Repolarization (phase 3) in ventricular cells occurs when potassium channels close.
m5.Hyperkalemia can occur with: ACE inhibitors ARBs Aldosterone antagonists Digoxin Digoxin overdose Loop diuretics All of the above
ACE inhibitors ARBs Aldosterone antagonists
m16.Which of the following antihypertensive drugs are less effective as initial therapy in blacks? ACEIs ARBs CCBs Diuretics
ACEIs ARBs
m17.Which of the following antihypertensive drugs can cause fetal and neonatal morbidity and death? ACEIs ARBs Aliskiren Beta blockers Diuretics
ACEIs ARBs Aliskiren
The most common mechanism of arrhythmias, accounting for as many as 85% of all arrhythmias, is: Failure of impulse initiation at SA node Failure of impulse conduction thru AV node Enhanced automaticity at SA node Triggered automaticity in ventricular tissue Abnormal impulse conduction due to reentry phenomenon
Abnormal impulse conduction due to reentry phenomenon
A 62-year-old patient with a history of asthma and vasospastic angina states that he gets chest pain both with exertion and at rest about 10 times a week. One sublingual NTG tablet always relieves his symptoms, but this medication gives him an "awful" headache every time he takes it. Which is the best option for improving his angina? Change to sublingual NTG spray Add amlodipine Add metoprolol Add propranolol Replace NTG with ranolazine
Add amlodipine
Alex is a 42-year-old who was started on niacin sustained-release tablets 2 weeks ago for elevated triglycerides and low HDL levels. He is complaining of an uncomfortable flushing and itchy feeling that he thinks is related to the niacin. Which of the following options can help this patient? Administer aspirin 30 minutes after taking niacin Administer an antihistamine 30 minutes prior to taking niacin Increase the dose of niacin SR to 1000 mg Continue the current dose Change the SR formulation to immediate-release niacin Administer aspirin 30 minutes prior to taking niacin
Administer aspirin 30 minutes prior to taking niacin
m1.In patients with heart failure with reduced ejection fraction, ACE inhibitors have been shown to: Improve symptoms Decrease hospitalizations Prolong survival All of the above
All of the above
m10.A 72-year-old woman undergoing knee replacement surgery who recently saw an advertisement for Pradaxa® asks her physician if she should be taking it. You should tell her that: The risk of major GI bleeding is higher with dabigatran compared with warfarin Dabigatran should be taken twice daily In patients with non-valvular A-fib at risk for stroke, the risk of ischemic or hemorrhagic stroke was significantly lower than with warfarin All of the above
All of the above
m11.Inhibition of neprilysin decreases: Vasoconstriction Sodium retention Maladaptive remodeling All of the above
All of the above
m13.Use of 2 drugs with different mechanisms of action for treatment of hypertension: --Is usually more effective in decreasing BP than increasing the dose of the first drug --Should be considered for initial therapy in patients with a baseline BP > 20/10 mm Hg above goal ---Often allows for lower doses of both drugs ---All of the above
All of the above
m3.A 65-year-old man with valvular atrial fibrillation recently saw advertisements for apixaban and rivaroxaban and asks whether he should one of the newer anticoagulants instead of warfarin. You could tell him that, compared to warfarin, the newer "DOACs": Do not require routine INR-type monitoring Have fewer interactions with other drugs Cause less intracranial bleeding All of the above
All of the above
m3.Adverse effects of amiodarone include: Bluish-gray skin discoloration Pulmonary fibrosis Hyperthyroidism Hyperthyroidism All of the above
All of the above
m4.Potential advantages of extended-release metoprolol succinate over carvedilol include: Less hypotension A lower risk of bronchospasm Once-daily dosing All of the above
All of the above
m5.ACE inhibitors: --Are less effective in black patients, unless combined with a thiazide-like diuretic or calcium channel blocker ----Cause angioedema more frequently in black patients ---Are reno- and cardioprotective --All of the above
All of the above
m5.Statins have been reported to: Increase the risk of hemorrhagic stroke Reduce the risk of overall stroke Reduce all-cause mortality All of the above
All of the above
m8.A74-year-old man with a long history of coronary artery disease has been taking atorvastatin 40 mg/day for many years. Now his LDL-C is 68, but he has seen advertisements for PCSK9 inhibitors and would like to take one in addition to atorvastatin. You could tell him that: They are expensive (> $10,000 per year) They are only approved for patients who require additional lowering of LDL-C They have not been shown to improve clinical outcomes They must be administered by the subcutaneous route All of the above
All of the above
m9.Fondaparinux can be used for: Prophylaxis of deep vein thrombosis (DVT) Treatment of venous thromboembolism (VTE) UA/NSTEMI All of the above
All of the above
Which is an appropriate drug choice for hypertension treatment during pregnancy? Lisinopril Atorvastatin Alpha-methyl dopa Aliskerin Valsartan Hydralazine
Alpha-methyl dopa Hydralazine
Which agent is considered "fibrin selective" because it rapidly activates plasminogen that is bound to fibrin? Alteplase Fondaparinux Streptokinase Urokinase Tenecteplase
Alteplase Tenecteplase
m4.The most effective drug available for maintenance of sinus rhythm is: Sotalol Amiodarone Diltiazem Dronedarone
Amiodarone
A 58-year-old female reports that she recently stopped taking her blood pressure medications because of swelling in her feet that began shortly after she started treatment. Which antihypertensive agent is most likely to cause the peripheral edema? Atenolol Clonidine Amlodipine Doxazosin Hydrochlorothiazide Diltiazem
Amlodipine Diltiazem
m3.A 51-year-old black woman with diabetes and chronic kidney disease presents with a blood pressure of 174/106 mm Hg. A reasonable choice for initial antihypertensive therapy for this patient would be: An ACEI and a beta-blocker An ACEI and an ARB An ACEI and a thiazide-like diuretic An ACEI and aliskerin
An ACEI and a thiazide-like diuretic
The use of epinephrine to treat anaphylactic shock in may result in an unexpected decrease in blood pressure if given to a patient who is also taking which class of antihypertensive agent? An ACE inhibitor A diuretic An alpha-1 adrenergic receptor antagonist A calcium channel blocker A non-selective beta-1 / beta-2 adrenergic receptor antagonist
An alpha-1 adrenergic receptor antagonist
m10.Entresto can cause: Hypokalemia Hypertension Angioedema All of the above
Angioedema
Which molecule must heparin bind to in order to exert its anticoagulant effect? GP IIb/IIIa Thrombin Antithrombin III von Willebrand factor Tissue factor
Antithrombin III
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglycerides are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. If this patient is pregnant which of the following drugs should be avoided because of a risk of causing harm to the fetus? Cholestyramine Atorvastatin Niacin Fenofibrate Ezetimibe Rosuvastatin
Atorvastatin Rosuvastatin
Which of the following is correct regarding digoxin when used for atrial fibrillation? A. Digoxin works by blocking voltage-sensitive calcium channels B. Digoxin produces vagomimetic effects at the AV node C. Digoxin is used for rhythm control in patients with atrial fibrillation D. Digoxin increases conduction velocity through the AV node E. Digoxin levels needed for atrial fibrillation are higher than those necessary for symptom control in heart failure
B. Digoxin produces vagomimetic effects at the AV node E. Digoxin levels needed for atrial fibrillation are higher than those necessary for symptom control in heart failure
In patients taking warfarin, the antithrombotic effect is decreased when they are given which of the following drugs? Barbiturates Heparin Cimetidine Aspirin Cholestyramine Clopidogrel
Barbiturates Cholestyramine
m12.Which of the following antihypertensive drugs are no longer recommended for initial treatment of hypertension without the presence of another indication? Thiazide-type diuretic ACEIs Beta blockers ARBs
Beta blockers
m1.The drugs most commonly used for rate control in patients with atrial fibrillation include: Beta-blockers Verapamil Diltiazem Amlodipine All of the above
Beta-blockers Verapamil Diltiazem
m7.The most common complication of glycoprotein IIIa/IIb receptor antagonists is: Bleeding at arterial access sites Leukopenia Intracranial hemorrhage All of the above
Bleeding at arterial access sites
Describe the beneficial effect of spironolactone in HF: Promotes potassium excretion Promotes sodium retention Activates aldosterone receptors Blocks cardiac hypertrophy Decreases renin release
Blocks cardiac hypertrophy
Lidocaine's efficacy in the treatment of ventricular is related to which electrophysiologic action? A. Block of L-type Ca++ channels at the AV node B. Block of phase 3 K+ channels that mediate repolarization C. Block of phase 0 Na+ channels that conduct impulses throughout the heart D. Block of β1 receptors on cardiac muscle E. Activation of purinergic receptors at the AV node
C. Block of phase 0 Na+ channels that conduct impulses throughout the heart
An elderly female with a history of heart disease is brought to the emergency department with difficulty breathing. Examination reveals that she has pulmonary edema. Which is treatment is indicated? A. Acetazolamide B. Chlorthalidone C. Furosemide D. Hydrochlorothiazide E. Spironolactone F. Mannitol
C. Furosemide
A 75-year-old woman with hypertension is being treated with a thiazide diuretic. Her BP responds well and reads at 120/76. After several months on the medication, she complains of being tired and weak. An analysis of the blood indicates low values for which of the following? A. Calcium B. Glucose C. Potassium D. Sodium E. Urea
C. Potassium
A group of college students is planning a mountain climbing trip to the Andes. Which drug would be appropriate for them to take to prevent acute mountain sickness? A. thiazide diuretic B. Scopolamine C. Acetazolamide D. Furosemide E. Metoprolol F. Dexamethasone
C: Acetazolamide F: dexamethasone
The mechanism of action of digoxin involves inhibition of Na+-K+-ATPase. This action ultimately leads to an increased force of cardiac contraction by increasing intracellular levels of which of the following ions? Calcium Chloride Magnesium Potassium Sodium
Calcium
m10.Calcium channel blockers: Should not be used for initial therapy in black patients Can cause peripheral edema Are contraindicated for use in pregnancy Should not be used in combination with ACEIs or ARBs
Can cause peripheral edema
HC is a 70-year-old female who is diagnosed with HFrEF (reduced ejection fraction). Her past medical history is significant for hypertension and atrial fibrillation. She is taking hydrochlorothiazide, lisinopril, metoprolol, and warfarin. HC reports "feeling good" and has no shortness of breath or edema but she has been having fits of an annoying dry cough. Which is the most appropriate medication change to make at this time? Discontinue hydrochlorothiazide Change lisinopril to losartan Decrease warfarin dose Add digoxin Add spironolactone
Change lisinopril to losartan
m14.Most studies that have shown outcome benefits of a diuretic in treating hypertension have used: Hydrochlorothiazide Chlorthalidone Metolazone Ethacrynic acid Bumetanide
Chlorthalidone
m2.The preferred thiazide-like diuretic for initial therapy: Hydrochlorothiazide Chlorthalidone Furosemide Metolazone
Chlorthalidone
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglycerides are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. Select the major toxicity associated with gemfibrozil therapy: Bloating and constipation Cholelithiasis Hyperuricemia Liver damage Severe cardiac arrhythmia
Cholelithiasis
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglycerides are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. Which of the following drugs is most likely to increase this patient's triglyceride and VLDL cholesterol concentrations if used as monotherapy? Atorvastatin Cholestyramine Ezetimibe Gemfibrozil Colesevelam Niacin
Cholestyramine (BAS) Colesevelam (BAS)
As a calcium channel blocker, diltiazem (Cardizem®) would be categorized in which class of antiarrhythmic agents? Class I Class II Class III Class IV Miscellaneous
Class IV
m20.Which of the following centrally acting alpha-2 agonists is also used for the treatment of hypertensive urgencies? Clonidine Guanfacine Methyldopa All of the above
Clonidine
A patient whose angina was previously well controlled with once-daily isosorbide mononitrate states that he recently has been taking it twice a day to control angina symptoms that are occurring more frequently during early morning hours. Which of the following is the best option for this patient? --Continue once-daily administration of isosorbide mononitrate but advise the patient to take this medication in the evening ---Advise continuation of isosorbide mononitrate twice daily for full 24-hour coverage of anginal symptoms ---Switch to isosorbide dinitrate as this has a longer duration of action than isosorbide mononitrate ---Switch to NTG patch for consistent drug delivery and advise him to wear the patch around the clock
Continue once-daily administration of isosorbide mononitrate but advise the patient to take this medication in the evening
Suppression of arrhythmias resulting from a reentry focus is most likely to occur if the drug: -Has vagomimetic properties on the AV node -Is a beta-blocker -Converts a unidirectional block to a bidirectional block -Slows conduction through the atria -Has atropine-like effects at the AV node
Converts a unidirectional block to a bidirectional block
m2.The most common adverse effect of ACE inhibitors is: Cough Angioedema Hypokalemia Dizziness
Cough
m5.The treatment of choice for urgent conversion of atrial fibrillation to normal sinus rhythm is: Anticoagulation Catheter ablation DC cardioversion Digoxin
DC cardioversion
m4.Which of the following oral anticoagulants is a direct thrombin inhibitor? Apixaban Dabigatran Rivaroxaban Warfarin
Dabigatran
Aspirin in low doses produces an anti-clotting effect because of its action to: Increase levels of antithrombin III Decrease prostacyclin (PGI2) levels Decrease thromboxane A2 levels Activate platelet ADP receptors Decrease synthesis of prothrombin
Decrease thromboxane A2 levels
3. Beta-blockers improve cardiac function in heart failure by: Increasing heart rate Decreasing heart rate Increasing renin release Decreasing cardiac remodeling Reducing epinephrine release from the adrenal gland
Decreasing cardiac remodeling
A patient with low blood levels of potassium (hypokalemia) would be at increased risk for toxicity from which of the following drugs? Lisinopril (an ACE inhibitor) Digoxin Hydrochlorothiazide Propranolol Nifedipine
Digoxin
A 52-year-old woman is admitted to the ED with a history of drug treatment for several conditions. Her serum electrolytes are found to be as follows: Na+: 140 mEq/L (135-145) K+: 2.5 (3.5-5) Cl−: 100 mEq/L (98-107) pH: 7.3 (7.31-7.41) In view of the electrolyte panel shown (and regardless of the cause) the patient will be more sensitive to the toxic actions of: Cimetidine Digoxin Dobutamine Fexofenadine Omeprazole
Digoxin Cimetidine (H2 antagonist - inhibitor of CYP450) Digoxin (positive inotrope)****Answer Dobutamine (-1 selective agonist) Fexofenadine (2nd generation antihistamine) Omeprazole (PPI)
Hypokalemia (low blood potassium levels) is a side effect most commonly observed with which of the following classes of antihypertensive agents? ACE inhibitors Alpha blockers Beta blockers Calcium channel blockers Diuretics
Diuretics
NSAIDs can reduce the antihypertensive efficacy of which of the following drug classes? Diuretics (e.g., hydrochlorothiazide) ACE inhibitors (e.g., lisinopril) Alpha-1 blockers (e.g., prazosin) Calcium channel blockers (e.g., nifedipine) Beta-blockers (e.g., metoprolol)
Diuretics (e.g., hydrochlorothiazide) ACE inhibitors (e.g., lisinopril) Beta-blockers (e.g., metoprolol)
m3.Angiotensin receptor blockers (ARBs): --Are less effective than ACE inhibitors for treatment of chronic heart failure --Are more likely than ACE inhibitors to cause angioedema --Do not cause cough ---All of the above
Do not cause cough
m3.Angiotensin receptor blockers (ARBs): Are less effective than ACE inhibitors for treatment of chronic heart failure Are more likely than ACE inhibitors to cause angioedema Do not cause cough All of the above
Do not cause cough
When used chronically for hypertension, thiazide diuretics have all of the following properties or effects EXCEPT: A. Decreased urinary excretion of calcium B. Elevation of blood cholesterol C. Elevation of blood glucose D. Elevation of plasma uric acid E. Ototoxicity
E. Ototoxicity NOTE: Ototoxicity is associated with loop diuretics, esp. ethacrynic acid (also aminoglycoside abx: tobramycin - gentamicin)
Which side effect is associated with amlodipine? Bradycardia Cough Edema QT prolongation Hypotension Flushing
Edema Hypotension Flushing
m7.A 59-year-old white man presents post-MI with heart failure symptoms and a LVEF of 29%. He is currently being treated with an ACE inhibitor and metoprolol succinate ER. Which of the following drugs has been shown to prolong survival in such a patient? Digoxin Eplerenone Hydrochlorothiazide Hydralazine and isosorbide dinitrate
Eplerenone
m2.Which of the following beta-blockers is not available in an oral formulation? Metoprolol Propranolol Esmolol Carvedilol
Esmolol
m15.A 70-year-old woman with a sulfonamide allergy asks you to recommend a diuretic as add-on therapy to lower her BP. Which of the following would be an appropriate choice for this patient? Hydrochlorothiazide Chlorthalidone Furosemide Ethacrynic acid Bumetanide
Ethacrynic acid
m9.Because there is no evidence that adding it to a statin improves cardiovascular outcomes, the FDA has withdrawn approval of which of the following for use in addition to a statin? Alirocumab Ezetimibe Extended-release niacin All of the above
Extended-release niacin
m7.Which of the following drugs has been shown to improve clinical outcomes when added to a statin? Ezetimibe (cholesterol absorption inhibitor) Alirocumab (PCSK9 inhibitor) Gemfibrozil (fibrate) Niacin
Ezetimibe (cholesterol absorption inhibitor)
m19.Which of the following calcium channel blockers usually cause an initial reflex tachycardia? Diltiazem Felodipine Nicardipine Nisoldipine Verapamil
Felodipine Nicardipine Nisoldipine
Hazel is a 72-year-old female who is treated for hyperlipidemia with high dose atorvastatin for the past 6 months. She also has a history of renal insufficiency. Her most recent lipid panel shows an LDL cholesterol level of 131 mg/dL, triglycerides of 510 mg/dL, and HDL cholesterol of 32 mg/dL. Her PA wishes to add an additional agent for her hyperlipidemia. Which of the following choices is the best option to address Hazel's dyslipidemia? Fenofibrate Niacin Cholestyramine Add rosuvastatin Ezetimibe
Fenofibrate
m18.One advantage of ARBs over ACEIs for treatment of hypertension is that they: Are significantly more effective Are safer for use in pregnancy Generally have fewer side effects Do not cause hyperkalemia All of the above
Generally have fewer side effects
Increased serum levels of which of the following is associated with a decreased risk of atherosclerosis? Total cholesterol LDL HDL Triglyceride VLDL
HDL
m8.Compared to unfractionated heparin (UFH), low-molecular weight heparin (LMWH): Is more likely to cause heparin-induced thrombocytopenia Has a more predictable anticoagulant response Is more completely neutralized by protamine May be safer in patients with renal impairment
Has a more predictable anticoagulant response
Which of the following medical conditions is commonly treated with ACE inhibitors and diuretics, in addition to an agent that increases cardiac contractility? Hypertension Angina Pectoris Pulmonary edema Bradycardia Heart failure
Heart failure
A 58-year-old business executive is brought to the emergency department 2 hours after the onset of severe chest pain during a vigorous tennis game. She has a history of poorly controlled moderate hypertension and elevated blood cholesterol but does not smoke. EKG changes confirm the diagnosis of myocardia infarction and the decision is made to attempt to open her occluded artery. Which of the following adverse effects is most likely to occur if a fibrinolytic drug is used for treatment of her acute MI? Acute renal failure Development of antiplatelet antibodies Encephalitis secondary to liver dysfunction Hemorrhagic stroke Neutropenia
Hemorrhagic stroke
Which of the following drugs can increase bleeding tendencies in patients by inactivating the activated clotting factors IIa (thrombin) and Xa? Tissue plasminogen activator Clopidogrel (Plavix) Rivaroxaban (Xarelto) Heparin Low molecular weight heparin (Enoxaparin) Dabigatran Warfarin
Heparin
All of the following drugs are associated with the potential for excessive bleeding as a side effect. Administration of protamine is the initial treatment of choice for bleeding caused by an excess of: Aspirin Clopidrogel (Plavix) Dabigatran (Pradaxa) Heparin Enoxaparin Tissue plasminogen activator (tPA) Warfarin
Heparin Enoxaparin
m12.A 66-year-old man with asymptomatic (NYHA class I) heart failure with preserved ejection fraction (HFpEF) and cirrhosis asks if he should take Entresto for his heart failure. You could tell him that he cannot because: ---His heart failure is asymptomatic ---His ejection fraction is not reduced ---Entresto is not recommended for patients with severe liver impairment ---All of the above
His ejection fraction is not reduced
m21.Which of the following drugs should generally be given with a beta blocker to minimize reflex tachycardia and a diuretic to avoid fluid retention? Clonidine Hydralazine Prazosin Lisinopril Valsartan Minoxidil
Hydralazine Minoxidil
A 55-year-old male with kidney stones has been placed on a diuretic to decrease calcium excretion. However, after a few weeks, he develops an attack of gout. Which diuretic was he taking? Furosemide Hydrochlorothiazide Mannitol Spironolactone Triamterene
Hydrochlorothiazide
A 50-year-old man has a history of frequent episodes of renal colic with high calcium renal stones. The most useful diuretic agent in the treatment of recurrent calcium stones (hypercalcuria) is: Acetazolamide (carbonic anhydrase inhibitor) Furosemide (loop diuretic) Hydrochlorothiazide Mannitol (osmotic diuretic) Triamterene (sodium channel blocker - K+ sparing diuretic)
Hydrochlorothiazide NOTE: Saline infusion loop diuretics are choice for treating hypercalcemia
All of the following drugs can be useful for managing stable angina in a patient with coronary artery disease EXCEPT: Amlodipine Metoprolol Immediate-release nifedipine Isosorbide dinitrate Atenolol
Immediate-release nifedipine
m1.In addition to lowering LDL-C levels, statins also: Improve endothelial function Decrease platelet aggregation Reduce inflammation Reduce HDL levels All of the above
Improve endothelial function Decrease platelet aggregation Reduce inflammation
m6.In patients with heart failure, digoxin has been shown to: Improve symptoms Decrease hospitalizations Prolong survival All of the above
Improve symptoms Decrease hospitalizations
A 43-year-old man has HeFH (heterozygous familial hypercholesterolemia). His serum concentrations of total cholesterol and LDL are markedly elevated. HDL cholesterol, VLDL cholesterol, and triglycerides are normal or slightly elevated. The patient's mother and older brother died of myocardial infarctions before the age of 50. This patiently recently experienced mild chest pain when walking up stairs and has been diagnosed was having angina of effort. The patient is somewhat overweight. He drinks most evenings and smokes a pack of cigarettes a day. Consumption of alcohol is associated with which lipid changes? Decreased chylomicrons Increased HDL cholesterol Decreased VLDL cholesterol Increased LDL cholesterol Increased triglycerides
Increased HDL cholesterol Increased triglycerides
A patient presents to his primary care physician. On his last visit, he was diagnosed with hypertension and started on hydrochlorothiazide. What would be the initial changes in electrolytes that you would now expect to see in this patient with use of this diuretic? Urine Na, K levels and blood pH levels
Increased Urine Na & K, Increased blood pH
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglycerides are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. It is decided to start this patient on gemfibrozil. Which of the following is a major mechanism of gemfibrozil's action? Increased secretion of bile acid salts Increased expression of high-affinity LDL receptors on hepatocytes Increased secretion of VLDL by the liver Increased triglyceride hydrolysis by lipoprotein lipase Reduced uptake of dietary cholesterol
Increased triglyceride hydrolysis by lipoprotein lipase
The risk of bleeding in patients receiving heparin is increased by aspirin because aspirin: Inhibits heparin anticoagulant activity Inhibits platelet function Displaces heparin from plasma protein-binding sites Inhibits prothrombin formation Causes thrombocytopenia
Inhibits platelet function
m6.A 70-year-old man taking clopidogrel for ACS has recently been diagnosed with erosive esophagitis and asks his physician which PPI he should take. Which of the following would be the most appropriate choice for this patient? Esomeprazole Lansoprazole Omeprazole Pantoprazole Rabeprazole
Lansoprazole Pantoprazole Rabeprazole
m6.Compared to ACE inhibitors, ARBs are: Safer for use during pregnancy Less likely to cause adverse effects Less effective in lowering blood pressure All of the above
Less likely to cause adverse effects
A 52-year-old woman is admitted to the ED with a history of drug treatment for several conditions. Her serum electrolytes are found to be as follows: Na+: 140 mEq/L (135-145) K+: 6.5 (3.5-5) Cl−: 100 mEq/L (98-107) pH: 7.3 (7.31-7.41) This patient has probably been taking: Acetazolamide Atenolol Digoxin Furosemide Lisinopril Spironolactone
Lisinopril Spironolactone
A patient returns to her physician assistant for routine monitoring 6 months after her hypertension regimen was modified. Lab results indicated an elevated potassium level. Which agents is most likely responsible for this hyperkalemia? Lisinopril Chlorthalidone Hydrochlorothiazide Spironolactone Atenolol Furosemide Valsartan
Lisinopril Spironolactone Valsartan
A 40-year-old male patient has recently been diagnosed with hypertension following readings of 163/102 and 165/100. He also has Type 2 diabetes that is well controlled with oral antidiabetic medications. Which is the best initial treatment regimen for management of hypertension in this patient? Amlodipine Furosemide Lisinopril Lisinopril and hydrochlorothiazide Metoprolol
Lisinopril and hydrochlorothiazide
m8.A 68-year-old white man with heart failure with reduced ejection fraction being treated with enalapril and carvedilol comes to your office complaining of shortness of breath. On physical exam, he has bilateral rales and edema in both lower extremities. Which of the following would you recommend for acute relief of symptoms in this patient? Combination of hydralazine and isosorbide dinitrate Valsartan Loop diuretic Digoxin
Loop diuretic
A patient presents to the emergency department with an extreme headache. After a thorough workup, the attending physician concludes that the pain is due to increased intracranial pressure. Which agent would work best to reduce the ICP and pain? Acetazolamide Chlorthalidone Fentanyl Furosemide Mannitol Spironolactone
Mannitol
A 58-year-old man had a myocardial infarction. Which of the following should be used to prevent life-threatening arrhythmias that can occur post-MI in this patient? Flecainide Digoxin Metoprolol Esmolol Lidocaine Amiodarone
Metoprolol
A 78-year-old woman has been newly diagnosed with atrial fibrillation. She is currently not having symptoms of fatigue or palpitations. Which drug is appropriate to initiate for rate control? Amiodarone Metoprolol Esmolol Lidocaine Flecainide
Metoprolol
Which of the following anti-anginal drugs does NOT act as a vasodilator and should not be used in the treatment of vasospastic angina? Diltiazem Nifedipine Nitroglycerin Oral nitrates (e.g., isosorbide dinitrate) Metoprolol Verapamil
Metoprolol
m7.A previously normotensive 58-year-old white man with a history of an MI and paroxysmal atrial fibrillation presents with a blood pressure of 156/96 mm Hg. The only medication he is currently taking is dabigatran for stroke prevention. Which of the following would be a reasonable choice for antihypertensive therapy for this patient? Metoprolol Felodipine Nicardipine Nisoldipine Diltiazem All of the above
Metoprolol Diltiazem
Loop diuretics such as furosemide can be used instead of thiazide-like diuretics to lower blood pressure in patients with: Diabetes Hypokalemia High cardiovascular risk Moderate to severe renal impairment
Moderate to severe renal impairment
m2.Loop diuretics such as furosemide can be used instead of thiazide-like diuretics to lower blood pressure in patients with: Diabetes High cardiovascular risk Hypokalemia Moderate to severe renal impairment
Moderate to severe renal impairment
Which drug(s) is most likely to exacerbate heart failure? Acetaminophen Naproxen Oxycodone Ibuprofen Amoxicillin Triazolam Nitrous oxide
Naproxen Ibuprofen
Which one of the following drugs causes a decrease in hepatic triglyceride synthesis by limiting availability of free fatty acid precursors? Fenofibrate Niacin Cholestyramine Lovastatin Gemfibrozil Ezetimibe
Niacin
Drugs that relax vascular smooth muscle can produce a reflex tachycardia that can increase myocardial oxygen consumption and exacerbate symptoms in anginal patients. Which of the following anti-anginal agents are most likely to cause reflex tachycardia? Diltiazem Metoprolol Nifedipine Nitroglycerin Verapamil
Nifedipine Nitroglycerin
Which of the following anti-anginal agents can lower blood pressure? Nifedipine Sublingual nitroglycerin Oral nitrates (e.g., isosorbide dinitrate) Metoprolol Verapamil Diltiazem
Nifedipine Sublingual nitroglycerin Oral nitrates (e.g., isosorbide dinitrate) Metoprolol Verapamil Diltiazem
m1.A 72-year-ols man with nonvalvular atrial fibrillation and a CHADS2-VASc of 2 asks you whether or not he needs to be on anticoagulant activity. Considering the new US guidelines*, which of the following would you recommend? Oral anticoagulation therapy Omit antithrombotic therapy Either aspirin or oral anticoagulant therapy Aspirin
Oral anticoagulation therapy CHADS2-VASc Score Guidelines ≥ 2 oral anticoagulant 1 no antithrombotic therapy or aspirin or oral anticoagulant 0 omit antithrombotic therapy
Which of the following anti-anginal agents requires a drug free interval each day to lessen the development of tolerance to its antianginal actions? Nifedipine Sublingual nitroglycerin Oral nitrates (e.g., isosorbide dinitrate) Transdermal nitroglycerin Metoprolol Verapamil Diltiazem
Oral nitrates (e.g., isosorbide dinitrate) Transdermal nitroglycerin
Which of the following patient populations is more likely to experience myalgia or myopathy with use of HMG CoA reductase inhibitors? Patients with diabetes mellitus Patients with renal insufficiency Patients with gout Patients with hypertriglyceridemia Patients taking fibrates
Patients with renal insufficiency Patients taking fibrates
If your patient has been prescribed a sustained-release oral nitrate preparation for prophylaxis of angina, you should be most alert for which of the following side effects? Arrhythmias Gastric upset Gingival hyperplasia Erectile dysfunction Postural hypotension Increased bleeding tendencies
Postural hypotension
m6.Which of the following statins is not metabolized to a clinically significant extent by CYP enzymes? Lovastatin Pravastatin Simvastatin Rosuvastatin Fluvastatin
Pravastatin Rosuvastatin
m6.In patients with heart failure, digoxin has not been shown to: Improve symptoms Decrease hospitalizations Prolong survival All of the above
Prolong survival
A 65-year-old male experiences uncontrolled angina attacks that limit his ability to do household chores. He is adherent to a maximum dose of a beta-blocker with a low heart rate and low blood pressure. He was unable to tolerate an increase in isosorbide mononitrate due to headache. Which is the most appropriate addition to his therapy? Amlodipine ??? Diltiazem ??? Ranolazine Aspirin Nitroglycerin patch
Ranolazine
The beneficial action of ACE inhibitors on the failing heart is best described as producing: Increased vascular resistance Decreased cardiac output Reduced preload Reduced heart rate Increased adrenal release of aldosterone Anti-remodeling effects
Reduced preload Anti-remodeling effects
A 72-year-old male presents to the primary care clinic complaining of chest tightness and pressure that is increasing in severity and frequency. His current medications include atenolol, lisinopril, and prn sublingual nitroglycerin. Which intervention is most appropriate at this time? Add amlodipine Replace atenolol with metoprolol Administer immediate-release nifedipine Initiate isosorbide dinitrate Initiate ranolazine Refer the patient to the nearest ED for evaluation
Refer the patient to the nearest ED for evaluation
A 58-year-old business executive is brought to the emergency department 2 hours after the onset of severe chest pain during a vigorous tennis game. She has a history of poorly controlled moderate hypertension and elevated blood cholesterol but does not smoke. EKG changes confirm the diagnosis of myocardia infarction and the decision is made to attempt to open her occluded artery. Which of the following drugs accelerates the conversion of plasminogen to plasmin? Clopidrogel (Plavix) Reteplase Tranexamic acid Warfarin Enoxaparin Alteplase
Reteplase Alteplase
A 58-year-old business executive is brought to the emergency department 2 hours after the onset of severe chest pain during a vigorous tennis game. She has a history of poorly controlled moderate hypertension and elevated blood cholesterol but does not smoke. EKG changes confirm the diagnosis of myocardia infarction and the decision is made to attempt to open her occluded artery. If this patient undergoes a PCI with placement of a stent in a coronary blood vessel, she may be given eptifibatide. Which of the following most accurately describes the antithrombotic mechanism of eptifibatide? Activation of antithrombin III Block of posttranslational modification of clotting factors Inhibition of thromboxane production Irreversible inhibition of platelet ADP receptors Reversible inhibition of platelet GPIIb/IIIa receptors
Reversible inhibition of platelet GPIIb/IIIa receptors
m11.A 55-year-old man with nonvalvular A-fib asks physician to recommend a treatment to reduce his risk of thromboembolic stroke. You could tell him that: --Rivaroxaban is non-inferior to warfarin and does not require INR monitoring ---Apixaban is more effective than warfarin, but requires monitoring to keep the INR in the therapeutic range ---Dabigatran is more than warfarin and has an FDA-approved antidote to reverse its anticoagulant effect --All of the above
Rivaroxaban is non-inferior to warfarin and does not require INR monitoring Dabigatran is more than warfarin and has an FDA-approved antidote to reverse its anticoagulant effect
Which is most important to monitor in a patient taking digoxin? Liver function Serum potassium Serum creatinine Serum calcium Troponin levels Serum sodium
Serum potassium
A 62-year-old man presents to his PA for management of hyperlipidemia. His most recent lipid panel reveals an LDL cholesterol level of 165 mg/dL. His PA wishes to begin treatment to lower his LDL. Which of the following therapies is the best option for this patient? Fenofibrate Cholestyramine Niacin Simvastatin Ezetimibe Atorvastatin
Simvastatin Atorvastatin
A male patient is placed on a new medication for heart failure and notes that his breasts have become tender to the touch. Which medication is he most likely taking? Chlorthalidone Eplerenone Furosemide Hydrochlorothiazide Spironolactone Triamterene
Spironolactone
Jake is a 75-year-old male who has heart failure. He is seen in your clinic today reporting shortness of breath, increased pitting edema, and a 5 pound weight gain. His current medication regimen includes lisinopril and metoprolol. He has no chest pain and is deemed stable for outpatient treatment. Which of the following is the best recommendation? Increase the dose of lisinopril Add digoxin Start HCTZ Start furosemide Discontinue the metoprolol
Start furosemide
m11.A 65-year-old black man with diabetes and normal renal function has recently been diagnosed with hypertension. Which of the following would you recommend for initial treatment of hypertension for this patient? Thiazide-type diuretic Aliskiren (direct renin inhibitor) Angiotensin receptor blocker (ARB) Angiotensin-converting enzyme inhibitor (ACEI) Calcium channel blocker (CCB)
Thiazide-type diuretic Calcium channel blocker (CCB)
Lidocaine has the greatest efficacy in the treatment of which arrhythmia? Torsades de pointes Ventricular fibrillation Atrial fibrillation Atrial flutter Ventricular tachycardia Supraventricular tachycardia
Ventricular tachycardia
During a routine oral examination, you notice some gum enlargement in your patient. The patient's medical history includes the drugs listed below. If this condition is drug-induced the most likely candidate is: Albuterol Nitroglycerin tablets Digoxin Verapamil Lisinopril Hydrochlorothiazide
Verapamil
m9.Which of the following antihypertensive drugs might worsen constipation in a patient with irritable bowel syndrome with constipation (IBS-C)? Metoprolol Verapamil Chlorthalidone Spironolactone
Verapamil
A 70-year-old female is diagnosed with non-valvular atrial fibrillation. Her past medical history is significant for chronic kidney disease, and her renal function is moderately diminished. All of the following anticoagulants would be expected to require a reduced dosage in this patient EXCEPT: Apixaban Dabigatran Rivaroxaban Warfarin
Warfarin
Which of the following oral anticoagulants is recommended for patients with atrial fibrillation associated with a mechanical valve, a bioprosthetic valve, prior mitral valve repair, mitral stenosis? Apixaban Dabigatran Rivaroxaban Warfarin
Warfarin
Information regarding a patient's INR (International Normalized Ratio) is utilized in the management of patients who are taking: Aspirin Clopidrogel (Plavix) Dabigatran (Pradaxa) Warfarin (Coumadin) Heparin Low molecular weight heparin Rivaroxaban (Xarelto)
Warfarin (Coumadin)
What medication masks the effects of hypoglycemia
beta blockers
What beta blocker is vasodilating?
carvedilol
