Block 2 Qs

If A 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, eg, aspirin and clopidogrel for at least a year. Which of the following most accurately describes the mechanism of action of clopidogrel? (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 (E) The active metabolite of clopidogrel binds to and inhibits the platelet glycoprotein IIb/IIIa receptors

(A) Clopidogrel directly binds to the platelet ADP receptors

A 61-year-old man with osteoarthritis comes to the clinic for follow-up. His arthritis has been worsening over the past year. He has pain constantly throughout the day. He reports the only medication that was effective for him was celecoxib, which was pulled from the market. He is willing to try anything that will improve his pain at this point. What side effect is the reason for the removal of celecoxib from the market? (A) Increased risk of cardiovascular disease (B) Increased risk of gastrointestinal bleeding (C) Increased risk of pulmonary fibrosis (D) Increased risk of cancer (E) Increased risk of tuberculosis

(A) Increased risk of cardiovascular disease

Pre-conceptional intake of which of the following results in decrease in incidence of neural tube defects? (a) Vitamin A (b) Folate (c) Vitamin E (d) Vitamin C

(b) Folate

§Which of the following is given to treat thrombocytopenia secondary to anti-cancer therapy and is known to stimulate progenitor megakaryocytes? §(a) Filgrastim §(b) Oprelvekin §(c) Erythropoietin §(d) Iron dextran

(b) Oprelvekin

A 40 year old man has megaloblastic anemia and early signs of neurological abnormality. The drug most probably required is: (a)Filgastrim (b) Iron sulphate (c) Erythropoietin (d) Vitamin B12

(d) Vitamin B12

142. nA 65-year-old female is hospitalized for elective hip replacement surgery. Her blood pressure is 140/80 mmHg and her heart rate is 90 beats/min. Her BMI is 31.5 kg/m2 .The drug used to prevent perioperative venous thrombosis in this patient has which mechanism of action? nA.Binds tightly to antithrombin nB.Binds to the thrombin active site nC.Blocks ADP receptors nD.Combines with proactivator plasminogen nE.Inhibits arachidonate product formation

A.Binds tightly to antithrombin

162. A 55-year-old male presents to the physician's office with sudden onset pain, swelling and redness of the right first metatarsophalangeal joint. A needle aspirate of the joint shows needle-shaped, negatively birefringent crystals. You prescribe a medication for the patient, but he calls back in one day saying that he developed nausea,vomiting and diarrhea after taking the medication. Which of the following is the mechanism of action of the drug prescribed to this patient? A.Inhibition of microtubule formation B.Decreased renaltubular uric acid reabsorption C.Inhibition of cyclooxygenase activity D.Inhibition of xanthine oxidase activity E. Inhibition of phospholipase A2 activity

A.Inhibition of microtubule formation

An 18-year-old woman is brought to the emergency department 2 hours after she ingested approximately 100 aspirin tablets in a suicide attempt. Physical examination shows tachypnea. Two days after admission to the hospital, her hemoglobin concentration is 12 g/dL. Test of the stool for occult blood is positive. Which of the following additional hematologic findings is most likely abnormal in this patient? A) Bleeding time B) Fibrin degradation products C) Partial thromboplastin time D) Platelet count E) Prothrombin time

A) Bleeding time

156. •A 65-year-old male presents to the emergency with complaints of unbearable right foot pain that started suddenly in the middle of the night. He has never had such symptoms before. Physical examination reveals swelling and tenderness of the first metatarsophalangealjo int. Synovial fluid analysis demonstrates needle-shaped, negatively birefringent crystals and an excess of neutrophils. What would be the best initial treatment of this patient? •A. COX inhibitor •B. Antibiotics •C. Uricosuric agents •D. Xanthine oxidase inhibitor •E. Lipoxygenase antagonist •F. Glucocorticoid

A. COX inhibitor Glucocorticoid is not the answer because of the excess of neutrophils

Which of the following compounds is most likely to block ADP receptors and prevent platelet aggregation? A. Clopidogrel B. Aspirin C. Prostacyclin D. Abciximab E. Montelukast

A. Clopidogrel

•A 64-year-old female has severe osteoarthritic back pain. Which of the following aspects of her medical history would make celecoxib the preferred treatment? •A. Renal impairment •B.Peptic ulcer disease •C.Hyperlipidemia •D.Stable angina •E. Hypertension

B. Peptic ulcer disease

124. A 45-year-old man presents to the emergency with burning substernal pain. He took several tablets of antacid at home prior to presentation without any relief. His heart rate is 90/min and blood pressure is 160/90 mmHg. Electrocardiogram shows ST segment depression in leads II,III,and aVF. As part of his treatment, enoxaparin therapy is initiated. This drug is expected to bind to which of the following substances in this patient's blood? A.Fibrin B.Antithrombin Ill C.Plasminogen D.Prothrombin E. Protein C

B.Antithrombin Ill

A 56-year-old male is hospitalized with an episode of severe hematuria. He subsequently develops back pain and mild fever. He has no past medical history of hematuria. Other than a slightly elevated temperature, his vital signs are stable. Physical examination is notable for dried blood at the urethral meatus and for generalized lower back pain upon palpation. Which of the following anti-inflammatory agents does not impair platelet aggregation and thus can safely be given to this patient? A.Aspirin B.Celecoxib C.Diclofenac D.Fenoprofen E.Ibuprofen F.lndomethacin

B.Celecoxib

120. A 48-year-old male is hospitalized with unstable angina and is treated with continuous heparin infusion. Several hours after hospitalization he experiences bloody vomiting and hypotension. Heparin infusion is stopped. Which of the following can be used to reverse the anticoagulant effect of heparin? nA.Vitamin K nB.Protamine nC.Aminocaproic acid nD.Fresh frozen plasma nE.Tranexamic acid

B.Protamine

A 44-year-old man with a 1-year history of angina pectoris comes to the emergency department because of increasingly severe chest pain during the past 2 days. He has had five previous similar episodes, which required treatment with increasing doses of nitroglycerin to resolve. His temperature is 37°C (98.6°F), pulse is 105/min, respirations are 16/min, and blood pressure is 150/90 mm Hg. Cardiac examination shows an S,. An ECG shows ST-segment depression in the precordial leads. In addition to aspirin, heparin, and nitroglycerin, he is given a dose of a monoclonal antibody against the platelet Ilb/Illa receptor. This antibody will most likely prevent binding of which of the following substances to platelets? A) Adenosine B) ADP C) Fibrinogen D) Serotonin E) Thrombin F) Thromboxane

C) Fibrinogen

128. A 7-year-old boy receiving treatment for allergic rhinitis has flushed cheeks and dilated pupils on physical exam. These findings are best explained by: A.Antagonism of H1 receptors B.Antagonism of H2 receptors C.Antagonism of muscarinic receptors D.Antagonism of nicotinic receptors E. Stimulation of a1-adrenoreceptors

C.Antagonism of muscarinic receptors

137. A 69-year-old female is hospitalized with sudden onset of shortness of breath, tachypnea and pleuritic-type chest pain. Pulmonary ventilation/perfusion scanning reveals a large mismatched defect in the lower lobe of the right lung. The agent for long-term therapy to prevent recurrences of this patient's condition has which mechanism of action? A.Binds tightly to antithrombin B.Binds to the thrombin active site C.Blocks glutamate residue carboxylation D.Combines with proactivator plasminogen E.Inhibits arachidonate product formation

C.Blocks glutamate residue carboxylation

36. A 68-year-old male patient begins aspirin therapy for exertional chest pain. After the first dose, however, he experiences shortness of breath and wheezing. Which of the following medications would serve as a suitable aspirin alternative in this patient? A.Heparin B.Warfarin C.Clopidogrel D.Streptokinase E.Vitamin K F.Allopurinol G.Paclitaxel

C.Clopidogrel

143. A 32-year-old pregnant female comes to the physician's office because of right leg swelling and pain. She is 7 weeks pregnant. Doppler examination of the leg shows deep venous thrombosis. Which of the following is the most effective anticoagulation for this patient during her pregnancy? A.Aspirin B.Warfarin C.Heparin D.Clopidogrel E.t-PA

C.Heparin

131. A 72-year-old woman comes to the physician because of worsening dyspnea on exertion and easy fatigability. Her symptoms began several years ago, but they have been progressively affecting her daily activities. Her other medical problems include hypertension. The patient's prior surgical history includes meningioma removal and a total abdominal hysterectomy that were both performed years ago. Test of the stool for occult blood is negative. Laboratory evaluation reveals a hemoglobin level of 9.6 mg/dl. You begin therapy to supplement the deficiency. Which of the following supplements is most likely to require parenteral administration? A.Iron B.Folic acid C.Vitamin B12 D.Vitamin C E.Protein

C.Vitamin B12

A 67-year-old woman is hospitalized after injuring her right hip when she slipped on ice while carrying groceries. X-ray reveals a right femoral neck fracture, and the patient undergoes a total hip arthroplasty with no operative complications. Two days after surgery, the patient develops acute hemodynamic decompensation. A contrast-enhanced CT scan of the chest is immediately obtained; a sagittal view is shown below. In-hospital administration of which of the following is most appropriate for reducing the risk of patients developing this complication? A. Beta-adrenergic antagonist B. Fresh-frozen plasma C. Intravenous hydration D. Low-molecular-weight heparin F. Tissue plasminogen activator

D. . Low-molecular-weight heparin

A30-year-old woman with seasonal rhinitis has been treated with therapeutic doses of chlorpheniramine for 4 weeks. Which of the following adverse effects is most likely? A) Atrioventricular block B) Biliary colic C) Chronic cough D) Decreased myocardial contractility E) Drowsiness F) Increased blood glucose concentration G) Intermittent claudication H) Miosis J) Tinnitus

E) Drowsiness

• A previously healthy 42-year-old Asian woman is brought to the emergency department because of a 24-hour history of nausea, vomiting, and progressive •lethargy. She has smoked 1 pack of cigarettes daily for 25 years and drinks four glasses of wine daily. She uses high-dose acetaminophen daily for •headaches. She does not use illicit drugs. She is 155 cm (5 ft 1 in) tall and weighs 50 kg (110 Ib); BMI is 21 kg/m2. She is responsive to painful stimuli. Initial •laboratory studies show increased hepatic aminotransferase. Which of the following effects of alcohol most likely contributed to this patient's condition? •A) Decreased generation of N-acetyl-p-benzoquinoneimine •B) Increased glucuronidation •C) Increased hepatic glutathione stores •D) Increased sulfation •E) Induction of cytochrome P450

E) Induction of cytochrome P450

110. A 58-year-old man comes to the emergency department with complaint of sudden onset of severe, diffuse abdominal pain. He has experienced 3 months of epigastric pain that has been refractive to proton-pump inhibitor therapy. Physical examination reveals an exquisitely tender, rigid abdomen with rebound tenderness. Supportive therapy is initiated. Exploratory laparotomy reveals a large,perforated gastric ulcer with features suggestive of malignancy. He undergoes partial gastrectomy with gastrojejunostomy. Long-term supplementation with which of the following is most likely necessary in this patient? A. Ascorbic acid - needed to treat scurvy (the bones) B. Biotin - Your body needs biotin to metabolize carbohydrates, fats, and amino acids, the building blocks of protein. Biotin is often recommended for strengthening hair and nails, a C. Pantothenic acid - vitamin B5 helps turn food into energy D. Pyridoxine - vit b6 needed for normal brain development and for keeping the nervous system and immune system healthy. E. Iron - is the treatment or prevention of iron deficiency anemia

E. Iron - is the treatment or prevention of iron deficiency anemia

When a patient is started on an appropriate drug for chronic gout it is observed that that the plasma levels of uric acid decrease while the urine levels of uric acid increase. What drug was the patient treated with? A. Allopurinol B. Acetylsalicylic acid C. Indomethacin D. Colchicine E. Probenecid

E. Probenecid

121. A 64-year-old female is diagnosed with atrial fibrillation on routine physical examination . She has no symptoms and her past medical history is insignificant. Soon after initiation of therapy with warfarin, the patient is hospitalized with severe skin and subcutaneous fat necrosis. Drug effects on which of the following processes are most likely responsible for this patient's condition? A.Prothrombin conversion B.Fibrinogen conversion C.Factor VIia activity D.Factor Xia activity E. Protein C synthesis F.Factor IX synthesis

E. Protein C synthesis

•A nine-year-old girl is treated for a prolonged, febrile upper respiratory tract infection,Presumably of viral origin, with bacterial superinfection. Which of the following drugs is to be avoided in this case because of a possible association with Reye's syndrome? A.Acetylcysteine B.Amoxycillin C.Acetaminophen D.Azithromycin E.Aspirin

E.Aspirin

270. A 72-year-old male is brought to the emergency with severe chest pain and diaphoresis. His past medical history is significant for diabetes mellitus type 2, hypertension and asymptomatic right carotid artery stenosis. His blood pressure is 120/70 mmHg and his heart rate is 75/min.EKG shows ST segment elevations greater than 1mm in leads 11,Ill and aVF. The patient is treated with streptokinase, morphine, IV fluids and a low-dose beta-blocker. Several hours later, the patient is comatose with asymmetric pupils and an irregular breathing pattern. This patient's current condition is most likely caused by: A. Dissection of the ascending aorta B.Carotid artery thrombosis C.lnterventricular septum perforation D.Pulmonary embolism E.lntracerebral hemorrhage

E.lntracerebral hemorrhage

A 28-year-old man is admitted to the hospital after sustaining a gunshot wound to the abdomen. Broad-spectrum antibiotic therapy is initiated for complications from fecal contamination of the peritoneal cavity. He has been taking warfarin since receiving an artificial heart valve 6 years ago because of endocarditis secondary to intravenous drug use. During the next 6 weeks, the warfarin dosage required to maintain his prothrombin time progressively decreases. Which of the following best explains this finding? A) Decreased INR caused by drug-induced hepatotoxicity B) Decreased INR caused by hepatitis B infection C) Septic shock caused by an anaerobic commensal such as Bifidobacterium species D) Septic shock caused by a facultative anaerobe such as Escherichia coli E) Vitamin K deficiency caused by bacterial overgrowth in the small intestine F) Vitamin K deficiency caused by depletion of the normal gut flora

F) Vitamin K deficiency caused by depletion of the normal gut flora

169. •A 66-year-old female with severe joint pain and swelling is treated with colchicine. She experiences significant relief of symptoms 12 hours after the treatment was initiated. The drug used in this patient most likely affects which of the following steps shown on the diagram?

F. leukocyte attraction to inflammation

176. A 66-year-old female who was treated for acute episodes of gouty arthritis experiences some relief of symptoms but complains of diarrhea and mild nausea. The drug used in this patient most likely affects which of the following cell structures? A.Nucleus B.Rough endoplasmic reticulum C.Smooth endoplasmic reticulum D.Golgi apparatus E. Microsomes F.Cytoskeleton G.Peroxisomes

F.Cytoskeleton

133. nA 45-year-old female presents to the emergency department after vomiting a substance that resembled "coffee grounds." She reports that she now feels lightheaded as well. Her past medical history is significant for deep venous thromboses, for which she takes warfarin, and occasional joint pain, for which she takes aspirin. Her blood pressure is 90/60 mm Hg and her pulse is 110 beats per minute. Which of the following substances would provide the fastest reversal of warfarin's effects? nA.Vitamin K nB.Protamine nC.Aminocaproic acid nD.Fresh frozen plasma nE.Cryoprecipitate nF.Desmopressin

F.Desmopressin

135. A 56-year-old male comes to the physician's office complaining of mouth ulcers and fever. His past medical history is significant for long-term hypertension and an episode of transient ischemic attack which occurred one month ago and lasted 20 minutes. His complete blood count shows: Which of the following drugs is most likely to be associated with this patient's condition? A.Heparin B.Argatroban C.Warfarin D.tPA E.Aspirin F.Ticlopidine

F.Ticlopidine

•A new drug is developed that has strong anti-inflammatory properties. It works by inhibiting both COX 1 and COX 2 enzymes by irreversible acetylation. This new drug most likely resembles which of the following anti-inflammatory agents? • A.Aspirin • B.Rofecoxib • C.Diclofenac • D.Fenoprofen • E. Ibuprofen • F. lndomethacin • G.Ketorolac • H.Piroxicam

• B. Rofecoxib

•A 22-year-old woman ingests an entire bottle of acetaminophen in an attempted suicide. She unexpectedly feels well; and when her boyfriend discovers what she has done, he takes her to the emergency department. Which of the following drugs should be given in the ER? •(A) Acetylsalicylic acid •(B) Acetylcysteine •(C) Bicarbonate •(D) Fomepizole •(E) Penicillamine

•(B) Acetylcysteine

•A 53-year-old man spends his mornings outside gardening. He frequently develops tension headaches, and the only medication he keeps at home is aspirin. After taking two regular-sized aspirin tablets almost daily for a few weeks, which of the following side effects is the most at risk for? •(A) Angiodema •(B) Insomnia •(C) Postural hypotension •(D) Nephrolithiasis •(E) Tinnitus

•(E) Tinnitus

•A patient has subclinical folate deficiency. Which of the following drug will not precipitate megaloblastic anemia in this patient. •(a) Alcohol •(b) Phenytoin •(c) Chloroquine •(d) Sulfasalzine

•(c) Chloroquine

A 66-year-old female is admitted to the hospital with sudden onset of tingling of the left arm and transient numbness, which resolves completely within 20 minutes. She denies shaking movements, headache, nausea, photophobia, or anxiety. She has no other medical problems and denies any history of migraine, stroke, or cardiac ischemia. Physical examination is within normal limits. Her lipid profile reveals hypercholesterolemia. Fingerstick glucose is normal. MRI of the brain, carotid Doppler, and echocardiogram are all within normal limits. She is started on a medication to prevent similar attacks in the future. If she continues to take this medication long-term, which of the following side effects is she most likely to eventually experience? •A. Gastrointestinal bleeding •B. Nasal polyps •C. Hyperpnea and vertigo •D. Skin rash •E. Glucose intolerance •F. Gouty arthritis

•A. Gastrointestinal bleeding

•A21-year-old woman at 30 weeks' gestation is admitted to the hospital because of contractions for 1 hour. Fetal ultrasonography shows that the ductus arteriosus has closed. Inhibition of which of the following enzymes is the most likely cause of this finding? •A) Adenylyl cyclase •B) Cyclooxygenase •C) Glutathione S-transferase •D) Guanylyl cyclase •E) 5-Lipoxygenase

•B) Cyclooxygenase

A 63-year-old man comes to the physician with occasional squeezing chest pain while jogging or walking uphill. The pain occurs shortly after •beginning physical activity and subsides spontaneously within 1-2 minutes after he stops. He also complains of shortness of breath during these •episodes. Cardiac enzyme markers are within normal range. The use of low-dose aspirin is most likely to reduce this patient's risk of •cardiovascular events by inhibiting which of the following enzymes? •A. 5-lipoxygenase •B. 12-lipoxygenase •C. Cyclooxygenase-1 •D. Cyclooxygenase-2 •E. Phospholipase A

•C. Cyclooxygenase-1

•A 54-year-old woman with hypertension and bilateral renal artery stenosis starts taking a nonsteroidal anti-inflammatory drug •for back pain. Over the next week, her serum creatinine concentration increases from 1.0 to 5.0 mg/dL. The most likely •cause of this finding is the drug's ability to inhibit which of the following? •A) Inflammation in the glomerular capillaries •B) Inflammation in the renal interstitium •C) Vasoconstricting prostaglandins at the afferent arteriole •D) Vasoconstricting prostaglandins at the efferent arteriole •E) Vasodilating prostaglandins at the afferent arteriole •F) Vasodilating prostaglandins at the efferent arteriole

•E) Vasodilating prostaglandins at the afferent arteriole

276.A 35-year-old Caucasian male presents to office with fatigue,muscle weakness and occasional headaches. His blood pressure is 180/110 mmHg and his heart rate is 80/min. Laboratory evaluation reveals low serum potassium, severely depressed plasma renin activity, and a CT scan demonstrates a right-sided adrenal mass. After treatment for several weeks, the patient's symptoms resolve, his blood pressure is decreased to 130/70 mmHg and his heart rate is 75/min. Which of the following drugs was most likely used in this patient? •A. Clonidine •B.Propranolol •C.Captopril •D.Hydrochlorothiazide •E.Eplerenone •F.Verapamil •G.Amlodipine •H.lsosorbide dinitrate

??

119. A 46-year-old male is hospitalized with unstable angina. On the fourth day of hospitalization he develops severe foot pain and right toe paleness. His laboratory testing is significant for platelet count of 60,000/mm .Treatment with argatroban is initiated immediately. The drug (argatroban) used to treat this patient's current condition has which mechanism of action? A. Binds to the thrombin active site B. Blocks glutamate residue carboxylation C.Block ADP receptors D.Block GP lIb/Illa surface receptors E.Inhibits phosphodiesterase

A. Binds to the thrombin active site

18 .In a patient with severely impaired left ventricular function,IV digoxin administration decreases right atrial pressure,pulmonary capillary wedge pressure and increases cardiac output and. Which of the following is the initial cellular event triggering this response to digoxin? •A.Decreased sodium efflux •B.Increased calcium influx •C.Increased potassium influx •D.Increased cAMP concentration •E.Troponin sensitization to calcium

A.Decreased sodium efflux

230.A 48-year-old female presents to the emergency department with flank pain and hematuria. She has had several similar presentations in the past, which have been managed with IV hydration and analgesics. Abdominal imaging shows a radioopacity in the right ureter. Which of the following medications is most likely to prevent recurrences in this patient? • •A.Hydrochlorothiazide •B.Furosemide •C.Spironolactone •D.Triamterene •E. Mannitol •F.Acetazolamide

A.Hydrochlorothiazide

A 62-year-old male with suspected bacterial pneumonia is admitted to the hospital and given ceftriaxone and azithromycin for treatment. Soon after the first dose of ceftriaxone, he complains of difficulty breathing, lightheadedness and abdominal cramps, His current blood pressure is 70/50 mmHg, while his heart rate is 120/min. Physical examination reveals a diffuse maculopapular rash. Which of the following drugs should be administered next to this patient? •A. Corticosteroids •B. Epinephrine •C. Norepinephrine •D. Dobutamine •E. Diphenhydramine

B- Anaphylactic Shock

254. A 59-year-old Caucasian female is brought to the emergency with severe right foot pain. On physical examination, there is a swollen, tender first metatarsophalangeal joint. Her past medical history is significant for hyperlipidemia treated with lifestyle modifications and several medications. Which of the following drugs is most likely to have precipitated this patient's condition? •A. Atorvastatin •B. Niacin •C. Gemfibrozil •D. Cholestyramine •E. Ezetimibe

B. Niacin- Lipolysis and Triglyceride synthesis inhibitor(4) effective for hypertriglyceridemia. A/E is cutaneous flushing and pruritis.

3. A 72-year-old male is admitted to the hospital with complaints of heart palpitations. EKG shows an irregularly irregular rhythm and absent P waves. The patient is started on warfarin for long-term anticoagulation to prevent atrial thrombus formation. Which of the following should be monitored in this patient? A. Bleeding time B. Prothrombin time (PT) C. Activated partialthromboplastin time (aPTI) D. Fibrinogen levels E. Fibrin split products

B. Prothrombin time (PT)

A 66-year-old Caucasian female is brought to the emergency with complaints of nausea, vomiting, anorexia and confusion. She has been treated for atrial fibrillation and heart failure for the last several months. Her laboratory values are: •EKG shows a heart rate of 50 beats/min. Her blood pressure is 130/80 mmHg. Increased blood level of which of the following medications is most likely responsible for her symptoms? •A.Metoprolol •B.Digoxin •C.Verapamil •D.Furosemide •E.Spironolactone •F.Amiodarone •G.Aspirin •H.Quinidine serum sodium 140 potassium 5.7 calcium 9.3 creatinine 1.5

B. digoxin

7. 57-year-old man comes to the office for follow-up of his high blood pressure. His medical history is significant for stable angina pectoris,for which he takes sublingual nitroglycerin as needed. His blood pressure is 154/107 mm Hg and pulse is 86/min. Examination shows no abnormalities. He is started on a low dose of ATENOLOL. Which of the following cellular changes will most likely be seen after the addition of atenolol. •A.A (decreased cardiomyocyte cAMP, decreased JG cell cAMP, decreased vascular smooth muscle cAMP) •B.B (decreased cardiomyocyte cAMP, decreased JG cell cAMP, no change vascular smooth muscle cAMP) •C.C (decreased cardiomyocyte cAMP, no change JG cell cAMP, decreased vascular smooth muscle cAMP) •D.D (decreased cardiomyocyte cAMP, no change JG cell cAMP, no change vascular smooth muscle cAMP) •E.E (no change cardiomyocyte cAMP, no change JG cell cAMP, no change vascular smooth muscle cAMP)

B.B (decreased cardiomyocyte cAMP, decreased JG cell cAMP, no change vascular smooth muscle cAMP)

115. A 34-year-old female with a history of Munchausen syndrome presents to the emergency room with bleeding gums, epistaxis, bruises and petechiae. She has an episode of bloody emesis and has guaiac positive stool.After much questioning, she admits to having ingested rat poison. Immediate treatment of this patient should include: A.Syrup of ipecac B.Fresh frozen plasma C.Cryoprecipitate D.Platelet infusion E.Protamine sulfate

B.Fresh frozen plasma

A 68-year-old woman comes to the emergency room with complaints of hip pain and inability to walk. After orthopedic evaluation and appropriate radiographic studies, the patient is hospitalized with a diagnosis of hip fracture. Her bone density,measured by quantitative x-ray densitometry,corresponds to the lowest 10%. Her other medical problems include hypertension,migraine headaches,and congestive heart failure. The attending physician suggests that if this patient had received long-term treatment with a drug affecting calcium metabolism, her fracture may have been avoided. The physician is most likely referring to which of the following drugs? A.Furosemide B.Hydrochlorothiazide C.Spironolactone D.Digoxin E.Enalapril F.Glyburide G.Acarbose

B.Hydrochlorothiazide

26. A 55-year-old Caucasian male is brought to the Emergency with complaints of palpitations and fatigue. He has never had symptoms like this before, and his past medical history is not significant. He smokes one pack per day and consumes alcohol only occasionally. His blood pressure is 110/70 mmHg, heart rate is 120/min,and his rhythm is irregularly irregular. After initial treatment with IV digoxin, his heart rate drops to 82/min and remains irregular. Which of the following best explains the effect of digoxin observed in this patient? •A. Delayed afterdepolarizations •B.Increased parasympathetic tone •C.Decreased action potential duration •D.Decreased atrial refractoriness •E.Increased ventricular contractility

B.Increased parasympathetic tone

6.An 75-year-old man is transferred to the hospital from a nursing home for altered mental status and fever. Upon arrival, the patient is admitted directly to the intensive care unit with a presumptive diagnosis of septic shock. Antibiotic therapy is initiated. The patient is unable to provide any history,but his caretakers state that he has been having non-specific symptoms,including fever,for the past few days. The patient has a history of cardiovascular disease,diverticulitis,and dementia. His blood pressure is 60/40 mm Hg despite aggressive intravenous hydration. Norepinephrine is administered in response to the patient's hypotension.Which of the following cellular changes occurs directly in response to norepinephrine therapy? •A.cAMP increase in vascular smooth muscle cells •B.DAG decrease in vascular smooth muscle cells •C.cAMP increase in cardiac muscle cells •D.cAMP decrease in bronchial smooth muscle cells •E. IP3 increase in cardiac muscle cells

C- Second messengers

258. A 68-year-old Caucasian male presents to physician with muscle pain and fatigue. His past medical history is significant for hypertension and a myocardial infarction two years ago. His serum creatine kinase activity is elevated. Which of the following drug combinations is most likely to be responsible for this patient's condition? •A. Atorvastatin and ezetimibe •B. Atorvastatin and cholestyramine •C. Atorvastatin and gemfibrozil •D. Gemfibrozil and ezetimibe • E. Niacin and ezetimibe •F. Niacin and gemfibrozil

C. Atorvastatin and gemfibrozil

247. A 43-year-old man is found to have dyslipidemia. His other medical problems include a myocardial infarction 2 week ago. His father died of myocardial infarction at the age of 48 years. Several other family members have had myocardial infarctions and hypertension. The patient smoked cigarettes and drank alcohol occasionally but quit after his myocardial infarction. He is started on simvastatin and cholestyramine. Which of the following best describes the independent effects of simvastatin and cholestyramine, respectively, on hepatic cholesterol synthesis? •A. Increase and increase •B. Increase and decrease •C. Decrease and increase •D. Decrease and decrease •E. Increase and no change

C. Decrease and increase

241. 48-year-old female is being treated with atorvastatin following an acute myocardial infarction. Her blood cholesterol level decreases significantly after starting treatment. Which of the following is likely to increase? •A.VLDL concentration •B .Sterol absorption •C. LDL receptor density •D. Plasma free fatty acids •E. ApoB 100 concentration •F. Biliary excretion of cholestero

C. LDL receptor density

7.An new experiment is conducted in which low-dose epinephrine is infused intravenously into dogs. Hemodynamic parameters are recorded during the experiment. The effects of epinephrine on diastolic blood pressure and heart rate are presented on the graph below (epinephrine). A different group of dogs is pretreated with drug A, and then infused with low-dose epinephrine to produce a new set of curves ( epinephrine + drugA). Which of the following medications is most likely to be drug A? A. Phentolamine B. Phenylephrine C. Propranolol D. lsoproterenol E. Atropine

C. Propranolol

232.A 69-year-old female is treated for congestive heart failure. A multidrug treatment regimen results in marked improvement of the patient's symptoms. An agent is added to this patient's regimen that is believed to benefit the overall survival. Which of the following is the drug used in this patient? • •A. Hydrochlorothiazide •B. Furosemide •C. Spironolactone •D. Triamterene •E. Mannitol •F. Acetazolamide

C. Spironolactone

236.A 68-year-old man comes to the emergency department with severe shortness of breath and inability to lie down. His past medical history is significant for long-standing hypertension and myocardial infarction one year ago. Physical examination reveals crackles on edematous swelling of his lower extremities and lung auscultation. After initial pharmacotherapy, the patient experiences brisk diuresis with significant symptom relief. The drug used to treat this patient's condition predominantly acts on which of the following nephron segments? •A.A - pct •B.B - loh •C.C - thick alh •D.D - dct •E.E- vr nephron pic

C. thick ALH

•A previously healthy 47-year-old male undergoes an elective hernia repair under spinal anesthesia. Bladder catheterization shows a post-void residual of 300cc of urine and he complains of difficulty voiding. This patient would most likely benefit from which of the following medications? •A.Finasteride •B.Phenylephrine •C.Bethanechol •D.Oxybutynin •E.lmipramine

C.Bethanechol

259. A 48-year-old Caucasian female presents to physician with unbearable cutaneous flushing and pruritus. He says that the symptoms appear shortly after he takes his new cholesterol-lowering medication. The drug being used in this patient acts on which of the following steps of cholesterol metabolism? • •A.A •B.B •C.C •D.D •E.E diagram needed

C.C - niacin

269. A 65-year-old Caucasian male was diagnosed with stable angina and underwent coronary stenting. His past medical history was also significant for hypertension and Type 2 diabetes mellitus. If treated with niacin for hyperlipidemia, which of the following adjustments of his hypertension and diabetes medications, respectively, would most likely be necessary? •A.Increase,Increase •B.Increase,Decrease •C.Decrease,Increase •D.Decrease,Decrease •E.Increase,No change

C.Decrease,Increase - side effect of niacin is hypotension and hyperglycemia so you want to decrease the hypertensive meds and increase the diabetes meds

280. A 67-year-old Caucasian female is being evaluated for hyperlipidemia. She has a history of unstable angina and long-standing hypertension. As you prescribe the appropriate medications to this patient, you explain that She will likely experience skin flushing and warmth after taking his pills. Which of the following mediates the side effect you describe? • A.Histamine •B.Serotonin •C.Prostaglandin •D.Substance P •E.Platelet-activating factor (PAF)

C.Prostaglandin

27. Drug milrinone is a strong inotropic agent. Its mechanism ofaction involves inhibition of phosphodiesterase isoenzyme 3. Which of the following additional responses is most likely an extension of its pharmacologic effect? •A.Angioedema •B.Antiarrhythmic action •C.Vasodilation •D.Increased right atrial pressure •E.Sodium and water retention •F.AV conduction block

C.Vasodilation

194. A 11-year-old African American male treated with cromolyn sodium for bronchial asthma experiences a significant decrease in the frequency of his symptoms. The drug used in this patient most likely affects which of the following? A.A B.B C.C D.D E.E

D (drug releasing from mass cell)

A 72-year-old man is brought to the hospital with complaints of severe substernal chest pain and shortness of breath. Physical examination reveals bilateral crackles,the presence of a third heart sound,distended jugular veins, and 2+ edema of the lower extremities. The patient is diagnosed with an acute myocardial infarction and is found to be in cardiogenic shock. He is started on dobutamine,furosemide,and nitroglycerin. Compared with his other medications, which of the following effects is most specific for dobutamine? •A. Increased urine output •B.Decreased pulmonary capillary wedge pressure •C. Increased heart rate •D. Increased myocardial oxygen consumption •E. Decreased peripheral vascular resistance

D. Increased myocardial oxygen consumption

246. A 66-year-old female presents to office with recent-onset fatigue and muscle pain. Her past medical history is significant for an acute myocardial infarction five months ago. Laboratory testing reveals elevated serum creatine kinase activity. These findings are most likely related to the patient's use of a medication for which of the following conditions? •A. Hypertension •B. Recurrent venous thrombosis •C. Heart failure •D. Lipid abnormalities •E. Osteoarthritis •F. Migraine headaches

D. Lipid abnormalities

146. 45-year-old man comes to the physician with complaints of decreased appetite and malaise. He has no muscle aches. His medical problems include hyperlipidemia that has not responded to dietary changes. Laboratory studies show a current LDL cholesterol level of 190 mg/dl. His father died of a heart attack at age 50 and his mother has a history of stroke. Three months ago, his physician started him on a new medication to treat his hypercholesterolemia. Which of the following is the best next step in the management of this patient? •A.Serum .creatinine and BUN •B. CBC with differential •C. Thyroid function tests •D. Liver function tests •E. Serum cortisol •F. Reassurance and routine care

D. Liver function tests

263. A 46-year-old Caucasian female is being treated for elevated cholesterol levels. His past medical history is significant for hypertension, stable angina and diabetes mellitus. Which of the following drugs, when used as monotherapy,would be most likely to increase triglyceride levels in this patient? •A.Atorvastatin •B.Niacin •C.Gemfibrozil •D.Cholestyramine •E.Ezetimibe

D.Cholestyramine - resins increase TGA levels

181. A 57-year-old Caucasian female was diagnosed with hyperlipidemia that responded poorly to dietary changes. Her past medical history is significant for acute cholecystitis that required a seven-days previous hospitalization. Her father died of a myocardial infarction at the age of 54 and her mother had diabetes mellitus. Which of the following drug combinations is most likely to precipitate gallstone formation in this patient? • •A.Atorvastatin and ezetimibe •B.Atorvastatin and cholestyramine •C.Atorvastatin and gemfibrozil •D.Gemfibrozil and cholestyramine •E. Niacin and ezetimibe •F. Niacin and gemfibrozil

D.Gemfibrozil and cholestyramine

179.A 65-year-old man presents to the emergency with muscle weakness and cramping. He has been taking hydrochlorothiazide for recently diagnosed hypertension. Which of the following is the most likely cause of his symptoms? •A.Hyperuricemia •B.Hypocalcemia •C.Hyponatremia •D.Hypokalemia •E.Hypophosphatemia •F.Hypoglycemia

D.Hypokalemia

228. A 69-year-old man comes to the physician for a follow-up appointment. He experienced acute myocardial infarction 2 years ago and has a long history of hypertension. After physical examination and laboratory testing, the physician decides to change the diuretic. Repeat laboratory studies indicate that his serum calcium level increases after this adjustment. The diuretic used in this patient acts predominantly on which of the following nephron segments? • •A.A - PCT •B.B - THICK DLH •C.C - LOH •D.D - THICK ALH •E.E - DCT •F.F - VR nephron picture

E - DISTAL CONVOLUTED TUBULE

243. 21-year-old Caucasian female with recurrent episodes of abdominal pain and vomiting is found to have a serum triglyceride concentration of 1500 mg/d (normal < 200 mg/d ). Which of the following combinations of drugs would be most helpful in preventing recurrences of this patient's condition? •A. Atorvastatin and ezetimibe •B. Atorvastatin and cholestyramine •C. Atorvastatin and gemfibrozil •D. Gemfibrozil and cholestyramine •E. Niacin and ezetimibe •F. Niacin and gemfibrozil

E. Niacin and ezetimibe

279. A 63-year-old male is recovering from an acute myocardial infarction and comes for a follow-up examination. He currently weighs 100 kg (220 lb) and is 178 cm (70 in) tall. He takes metoprolol and one aspirin daily. His father has hypertension,and his mother has hypertension and type 2 diabetes mellitus. He smoked two packs of cigarettes daily, but quit after his recent myocardial infarction. His total serum cholesterol level is 155 mg/d , with an HDL of 30 mg/dl. Examination reveals an obese male with no other abnormalities. Which of the following agents would most greatly increase this patient's HDL cholesterol? •A. Enzyme inhibitor •B.Transcription factor ligand •C.Absorption inhibitor •D.Cationic exchange resin •E.Pharmacologic vitamin •F.Diet,exercise and weight loss •G.Omega-3 fatty acids

E.Pharmacologic vitamin - non pharmaceutical treatment would be below 160 mg/d

41.A 67-year-old female presents to the office with complaints of fatigue and muscle weakness. Her past medical history is significant for congestive heart failure for which she has been taking medication for the past several months. Her laboratory evaluation reveals a serum potassium level of 2.2 mEq/L. You add an additional medication to her regimen, and her fatigue and muscle weakness resolve. This new medication acts primarily on which of the following nephron segments nephron graph •A.A •B.B •C.C •D.D •E.E

F - collecting duct

273.A 67-year-old man comes to the physician for a follow-up appointment. He is being treated for long-standing hypertension and stable angina. Physical examination is within normal limits. His serum laboratory results are as follows: •Which of the following drugs in combination with lisinopril is most likely to account for this patient's laboratory abnormality? •A. Verapamil •B. Metoprolol •C. lndapamide •D. Hydrochlorothiazide •E. Furosemide •F. Amiloridne •G. Amlodipine sodium 138 mEq/L potassium 5.6 mEq/L Chloride 104 mEq/L Bicarb 24 mEq/L Calcium 9.5 mg/L Creatinine 1.0 mg/dL

F. Amiloridne

233.A 45-year-old female who is being treated for bipolar disorder complains of excessive thirst and frequent urination. She wakes up 3-4 times nightly to void. Her urinalysis results after 8 hours of "nothing per mouth reveals the following: Which of the following parts of the nephron is most likely affected by this patient's condition? •A.A - PCT •B.B - DLH •C.C - LOH •D.D- ALH •E.E - DCT •F.F - VR nephron picture

F. Vasa recta

5.A 38-year-old man comes to the office with complaints of a 2-week history of nasal congestion. He has used a topical decongestant every few hours since his symptoms began. He experienced relief for almost 1 week, but then his nasal congestion returned. The patient has a history of allergic rhinitis and has had episodes of rhinorrhea in the past, but none of them lasted longer than a few days. He denies fever, throat pain, headaches, cough, and lymph node enlargement. Aside from his allergic rhinitis, the patient has no other medical problems. Physical examination shows nasal mucosa that appears edematous and red with a few areas of punctate bleeding. The remainder of the examination reveals no abnormalities. Which of the following is the most appropriate next step in the management of this patient? •A. Stop the decongestant •B. Switch to ephedrine •C. Add oral corticosteroids •D. Add antihistamines •E. Start antibiotics

•A- DRUG INDUCED ADR-FIRST STEP STOP THE DRUG

3.A 66-year-old male is brought to the emergency with complaints of frequent falls and lightheadedness. The symptoms are especially pronounced in the morning when he gets up from his bed. His past medical history is significant for hypertension treated with a drug that he cannot recall the name. He also has osteoarthritis of the right knee and takes ibuprofen occasionally when the joint pain is severe. His blood pressure is 120/80 mmHg while supine and 90/60 mmHg while standing. Which of the following receptors is most likely understimulated in this patient? •A. a1-adrenergic •B.a2-adrenergic •C.β1-adrenergic •D. β 2-adrenergic •E. D1-dopaminergic

•A- role of alpha in TPR

231.A 67-year-old man comes to the emergency with severe left-sided eye pain and ipsilateral headache. Furthermore,the patient reports severe nausea and describes seeing "halos" around objects. After initial treatment with the appropriate medication,the severity of his pain decreases. He also experiences increased diuresis with highly alkaline urine. The drug used to treat this patient's eye condition predominantly acts on which of the following nephron segments? •A.A - PCT •B.B - THICK DLH •C.C - LOH •D.D - THICK ALH •E.E - DCT •F.F - VR nephron picture

•A.A - Proximal convoluted tubule

16. 1.A 55-year-old Caucasian male presents to the office after a long period without medical follow-up complaining of disturbed color perception, anorexia, nausea, vomiting and diarrhea. His past medical history is significant for congestive heart failure that is effectively controlled with multiple medications. Which of the following is the most likely complication of this patient's current condition? •A.Arrhythmia •B.Angioedema (cause by beta blocker toxicity) •C.Bronchoconstriction (cause by organophosphate toxicity) •D.Pulmonary edema (seen in uncontrolled heart failure) •E.Hypotension (not common side effect - BPH drug)

•A.Arrhythmia

268.A 56-year-old Caucasian male presents to physician with several month history of straining during urination, hesitancy and intermittent urinary flow. Upon reviewing his medical record, Physician also note that his blood pressure was high (160-170/95-100 mmHg) during his last several check-ups. He is not taking any medications. Which of the following drug would be the best for both of this patient's current problems? •A.Doxazosin •B.Metoprolol •C.Ramipril •D.Hydrochlorothiazide •E. Eplerenone •F.Amlodipine

•A.Doxazosin

248. A new drug has been developed that inhibits one of the steps in fatty acid oxidation. It has considered most promising for the treatment of stable angina. Which of the following is the mechanism explaining the potentially beneficial effect of the drug in patients with this condition? •A. Increased protein synthesis •B. Less ATP use per one contraction cycle • C. Less oxygen use per one ATP synthesized •D. More oxygen extraction per minute •E. Increased oxidative/non-oxidative ATP synthesis ratio

•B. Less ATP use per one contraction cycle

237.A 76-year-old female with chronic renal insufficiency is hospitalized for mild shortness of breath and peripheral edema. She also complains of fever, burning during urination and frequency. She is treated with gentamicin for a urinary tract infection. Several days after admission the patient feels much better but notes that she has difficulty hearing. She turns her TV very loud disturbing her family members. Which of the following drugs can be responsible for this patient's problem? • •A.Hydrochlorothiazide •B.Furosemide •C.Spironolactone •D.Triamterene •E. Mannitol •F.Acetazolamide

•B.Furosemide

274.A 72 year-old man admitted for right lower lobe pneumonia subsequently develops hypotension and lactic acidosis. He is started on a norepinephrine intravenous drip. A few hours later the antecubital vein being used for the infusion blanches and the tissues surrounding the IV site become cold,hard,and pale. Local injection of the affected tissues with which of the following agents is most likely to be of greatest benefit: •A.Calcium gluconate •B.Phentolamine •C.Heparin •D.lsoproterenol •E.Lidocaine

•B.Phentolamine

4.A medical student is conducting a pharmacology experiment. He infuses Drug X intravenously over different dose ranges and measures several important hemodynamic parameters. Graphs plotting the recorded measurements of renal blood flow and cardiac output change with increasing doses of Drug X are shown below. Which of the following drug is most likely to be used in the experiment? A. Epinephrine B. Phenylephrine C. Dopamine D. Edrophonium E. Esmolol

•C- Dose dependent actions of Dopamine

216.A 55-year-old female with mild to moderate chronic obstructive pulmonary disease secondary to cigarette smoking is admitted to the hospital because of sudden onset chest pain. Evaluation shows elevated cardiac troponin and ST elevation in the inferior leads. You decided to administer a beta blocker. Which of the following is the most appropriate for this patient? • •A.Propranolol •B.Nadolol •C. Metaprolol •D.Timolol •E.lsoproterenol

•C. Metaprolol

267.In an experiment of investigating arterial wall tension, two samples of isolated arterial vessels are studied. In the first group, vessel tension is measured before and after application of norepinephrine. The second group of vessels is pretreated with experimental Drug A,an adrenergic blocking agent, before norepinephrine is applied. Graphs of the study results are depicted below. •Drug A is most similar to which of the following agents? •A. Labetalol •B. Phentolamine •C. Phenoxybenzamine •D. Propranolol •E. Atropin

•C. Phenoxybenzamine

194. A 34-year-old Caucasian female has asthma that is not adequately controlled with occasional (PRN) albuterol. You decide to start him on aerosol flunisolide therapy. The patient should be instructed to follow which of the following recommendations? • •A.Low sodium diet •B.Foot care •C.Oral rinsing •D.Fluid restriction •E.Vitamin supplementation

•C.Oral rinsing

222.A 54-year-old male is treated for congestive heart failure, hypertension and diabetes mellitus. He experienced myocardial infarction two years ago. He presents to your office saying that he has 'cancer' because his right breast got enlarged. Which of the following drugs can be responsible for this patient's problem? • A. Hydrochlorothiazide •B. Torsemide •C.Spironolactone •D.Triamterene •E. Acetazolamide

•C.Spironolactone

194. A new drug has been developed that seems promising for the treatment of asthma. Its mechanism of action by reversing irritant-induced bronchoconstriction. In vagectomized animals,the compound has no bronchodilatory effects. The drug is most similar to which of the following medications? • •A.Albuterol •B.Theophylline •C.lpratropium •D.Zileuton •E.Flunisolide •F. Nifedipine

•C.lpratropium

A 56-year-old man comes to the physician with complaints of worsening exertional dyspnea and lower extremity edema. He tells you "I'm starting to get winded during my normal morning walks, and I've noticed my feet get pretty swollen by the time I get home. I try and elevate my legs a lot at home, but the swelling never seems to completely go away." His past medical history is significant for hypertension and a myocardial infarction two years ago. His medications include aspirin and hydrochlorothiazide. Addition of which of the following agents will most likely decrease long-term mortality in this patient? •A.Furosemide •B. Nitrates •C. Amiodarone •D. Carvedilol •E. Milrinone •F. Digoxin

•D. Carvedilol - improved mortality rate - cause vasodilation

113.A 45-year-old asthmatic male has the finding shown in the image below on routine examination (image shows glossitis) •.Acyclovir •B.Amphotericin-B •C.Griseofulvin •D.Nystatin •E. Penicillin •F.Terbinafine

•D.Nystatin

223.An unresponsive 68-year-old man is brought to the emergency after multiple injuries in motor vehicle accident. He was obtunded but responds to painful stimuli. His blood pressure was 160/90 mm Hg, pulse is 72/min, and respirations 10/min. A few hours after initial treatment and stabilization, he develops severe tachypnea and decreased oxygenation. His chest x-ray shows evidence of pulmonary edema. He is rapidly intubated and given oxygen but acutely worsens and dies a few hours later, despite aggressive measures. Which of the following drugs could have caused this patient's condition? •A. Chlorthalidone •B.Bumetanide •C.Spironolactone •D.Triamterene •E. Mannitol

•E. Mannitol

48.A 55-year-old male with a prolong history of diabetes mellitus admitted to the hospital after fracturing his femur in a motor vehicle accident. In the hospital he receives NPH insulin and regular insulin. His blood sugar readings drop below 50 mg/dl at several points during his hospitalization, but he never experiences symptoms of hypoglycemia. This is most likely because he is also taking which of the following medications? •A.Verapamil •B.Losartan •C.Doxazosin •D.Hydrochlorothiazide •E. Propranolol •F.Atorvastatin

•E. Propranolol

194. A 16-year-old Caucasian female is brought to the emergancy following a suicide attempt. Several hours ago, she swallowed several of her grandfather's theophylline tablets. Which of the following describes the most likely clinical presentation of this patient? • •A.Upper gastrointestinal bleeding •B.Bradycardia,hypotension and cardiovascular collapse •C.Severe sedation and respiratory depression •D.Latent period with subsequent hepatic necrosis •E.Abdominal pain,vomiting and seizures

•E.Abdominal pain,vomiting and seizures

194. A 52-year-old Caucasian male dies in the intensive care unit two hours after being admitted with a chief complaint of increasing shortness of breath. The patient had not been taking any medications regularly at home. Autopsy shows hyperinflated lungs, cellular infiltration and airway mucus plugging of the bronchial wall. Which of the following drugs, taken over the long-term, would have best prevented the cellular reaction in this patient's airways? • •A.Albuterol •B.Theophylline •C.lpratropium •D.Zileuton •E.Fluticasone •F.Nifedipine

•E.Fluticasone

23.A 66-year-old African American female is diagnosed with essential hypertension. She has no symptoms or comorbid illnesses. You prescribe hydrochlorothiazide. In response to this treatment, the serum level of which of the following is most likely to increase? •A.Potassium •B.Sodium •C.Creatinine •D.Cholesterol •E.High density lipoprotein •F.Alkaline phosphatase

•E.High density lipoprotein