Dyslipidemia RxPrep Quiz, Acute Coronary Syndrome, Hypertension RxPrep Quiz, Arrhythmias, Chronic heart failure Rxprep quiz, Stroke RxPrep Quiz, Ischemic Heart Disease RxPrep Quiz
Which class of medications is most appropriate as initial therapy for TW?
calcium channel blockers
Which of the following drug classes is preferred for Prinzmetal's (variant) angina?
calcium channel blockers
A 35 year old female patient is started on hydrochlorothiazide 25 mg. Which of the following counseling statements is best?
it should be taken in the morning to reduce the risk of nocturia
Which statment/s regarding the dosing and administration of Toprol XL is/are true? select all that apply
it should be taken with or immediately after meals the tablet can be cut in half at the score line if needed
HJ is being seen in the clinic for a blood pressure follow up. HJ occasionally suffers from orthostatic hypotension and syncope. Which of the following medications is the best choice for treatment?
amlodipine
which of the following should be added to RB's regimen for better control of his chest pain?
amlodipine
a patient was prescribed Crestor 40 mg, but it is not the preferred statin on his insurance plan. Which statin would provide an equivalent dose?
Atorvastatin 80 mg
AH is being discharged from the hospital after a myocardial infarction. Two bare metal stents were placed yesterday. Upon discharge, he will continue taking his Prasugrel therapy which was started yesterday. What is the minimum period of time that AH will need to take Prasugrel?
1 year
SR is a 61-year-old female (5'3", 115 pounds) who presents to the emergency department with a NSTEMI. Her past medical history....Which medication is appropriate?
Brilinta
A patient, while gardening, experiences serious chest pain, diaphoresis, shortness of breath and left arm pain. Emergency medical personnel is contacted and arrive at the scene. What test should the emergency medical personnel perform?
12-lead ECG
LD is a 61 year old male being seen for routine follow up. What is LD's calculated LDL?
141mg/dL
Which of the following is an intravenous P2Y12 inhibitor?
Cangrelor (Kengreal)
All of the following are antiplatelet agents that can be used in the treatment of an acute coronary syndrome EXCEPT:
Dalteparin
what is the therapeutic range for digoxin when used to treat heart failure?
0.5-0.9
What is the therapeutic range for digoxin when used for atrial fibrillation?
0.8 - 2 ng/mL
If indicated, an ACE inhibitor should be started within how many days of a patient having UA/NSTEMI?
1
Which of the following medications can be used for cardiac stress testing?
Dobutamine
MS is a 45 year old man who presents to his annual checkup. He takes Synthroid 100 mcg daily at 0730 and a multivitamin daily at 2100. The physician writes a new prescription for colestipol 2 g by mouth daily. When should MS be instructed to take his colestipol?
1130 (Bile acid sequestrants can affect absorption of fat-soluble vitamins (ADEK), folate, iron and some other medications. In general, the conservative approach is to take other medications 4 hours before or 4-6 hours after bile acid sequestrants.)
what is the recommened target dose of the angiotensin receptor blocker LB is taking to treat her systolic heart failure?
160mg BID
which dose of intravenous furosemide is equivalent to the oral furosemide dose LB takes at home
20 mg BID
KG has been diagnosed with heart failure and is beginning carvedilol....what is the target dose of carvedilol immediate release for KG?
25mg BID
A patient is admitted with a STEMI to a rural hospital without a cath lab. A fibrinolytic must be given within how many minutes of hospital arrival
30 minutes
a patient with systolic heart failure brings a new prescription for entresto...the patient should wait at least how long after stopping quinapril before taking the first entresto dose?
36 hours
How long should a patient remain on anticoagulation therapy after cardioversion for atrial fibrillation?
4 weeks
A patient takes two tablespoons of KCL 10% oral sollution daily. How many miliequivalents of potassium does the patient take each day?
40
What is the most common dose of nitroglycerin in short-acting prodcuts?
400 micrograms
Which of the following patients would benefit from statin therapy? (select all that apply)
45 year old with diabetes and an LDL of 95 mg/dL 65 year old with a coronary stent placed 4 years ago (there are 4 high risk groups that should be started on therapy page 443)
GS is currently taking furosemide 120 mg PO twice daily...Which oral bumetanide dose is equivalent to the furosemide dose GS is currently taking?
6 mg daily
What is the half life of amiodarone?
60 days
GL is place on aspirin 81 mg PO daily and ticagrelor 90 mg PO BID after PCI with placement of 2 stents. She is now visiting her cardiologist and it has been just over 1 year since her stents were placed. She feels that she is still at risk and would like to continue her regimen. What dose ticagrelor is appropriate?
60 mg PO BID
JM underwent PCI yesterday for a STEMI. He was loaded with clopidogrel prior to PCI and the medical team wants to start the maintenance dose today. What dose of clopidogrel should the pharmacist recommend?
75 mg daily
MR had a stroke and has been given a prescription for clopidogrel to prevent a second stroke. What is the maintenance dose of clopidogrel for this indication?
75 mg once daily
what is TW's blood pressure goal according to the ACC/AHA hypertension guidelines?
<130/80 mmHg
Which electrolyte abnormalities can be seen with the medication started on November 20th? (Select ALL that apply)
Hyponatremia Hypercalcemia Hypomagnesmia Hypokalemia
which of the following patients would benefit from high-intensity statin therapy according to the ACC/AHA Blood Cholesterol Guidelines? (Select all that apply)
A 32-year-old with an LDL of 195 mg/dL and no other comorbidities A 60-year-old with a history of myocardial infarction
which ACC/AHA stage and NYHA functional class best describes HK's heart failure?
ACC/AHA stage C, NYHA class II
FD was diagnosed with an acute STEMI. The physician is determining if she is a candidate for fibrinolysis. Which of the following are contraindications to fibrinolysis for STEMI? (Select ALL that apply)
Active internal bleeding Severe uncontrolled hypertension Recent ischemic stroke
AK, a 68 year-old white male, is being treated at the clinic for hypertension. Today his BP is 147/93 mmHg. His PMH is significant for GERD, diabetes and gout. AK is currently taking Janumet XR, Motrin, Hyzaar and Zantac. Which of the following medications would be appropriate to add for better BP control?
Adalat CC
A patient presents with a supraventricular tachycardia. The rhythm is terminated with adenosine. Which of the following correctly describes the pharmacology of adenosine?
Adenosine receptor agonist
Paramedics respond to a call for a patient experiencing chest pain that was not relieved by sublingual nitroglycerin. The patient has symptoms consistent...Which of the following is correct regarding administration of aspirin to this patient, assuming there are no contraindications?
Administer chewable aspirin 324 mg immediately
Which of the following patients should be placed on statin therapy after an acute coronary syndrome
All patients who have had an acute coronary syndrome
A pharmacist covering the emergency department receives an order for tPA 15 mg IV bolus, 50 mg over 30 min, then 35 mg over 1 hour. Total dose = 100 mg. What drug is ordered?
Alteplase
A 72-year-old male with heart failure (EF 2.2%) was recently diagnosed with atrial fibrillation. His home medications include lisinopril, carvedilol, spironolactone, furosemide, clopidogrel, digoxin, cholestyramine and potassium. Which of the following drugs is preferred to manage his atrial fibrillation?
Amiodarone
A patient who works in the fields of a farm is seen by his primary care physician for a blue-grey skin discoloration of the face and forearms. The patient states that he normally wears a hat, short-sleeved shirt and pants when working. Which antiarrhythmic is the patient likely receiving?
Amiodarone
Which drug must be dispensed in a non-PVC container?
Amiodarone
SP is a 58 year old African American female with hypertension, atrial fibrillation, NYHA Class II heart failure and a history of ovarian cancer (treated with chemo 12 years ago). When evaluating SP for statin treatment, which medication on her profile would require a lower maximum dose of simvastatin?
Amiodarone (when taken concomitantly with amiodarone, the maximum dose of simvastatin is 20mg daily)
JB has a past medical history significant for systolic heart failure and hypertension. He is being seen in the clinic for a routine...Which medication can be safely added to provide better control of his blood pressure?
Amlodipine
SH, a 55-year-old white male has just been diagnosed with hypertension. He has no other known medical conditions. His blood pressure runs between 162-170/97-99 mmHg. Choose an appropriate initial treatment regimen for this patient? (Select ALL that apply)
Amlodipine and benazepril Losartan and hydrochlorothiazide Exforge
PK is a 42 year old patient who comes to the clinic for routine follow up. He has hypertension, HIV and an ASCVD risk of 22%. His calculated LDL is 159mg/dL. He is on Zestril, Vascepa and Triumeq. He is a smoker and has an alcoholic drink twice a month. Which statin regimen should be recommended for PK?
Atorvastatin 40 mg
JB has been taking ticagrelor 90 mg BID for 3 months. Which of the following new orders should not be filled by the pharmacist?
Aspirin 325 mg daily
Which label on the figure best represents the site where aspirin exerts its mechanism of action?
B
Which label on the figure of the ventricular action potential best represents rapid ventricular depolarization
B
which label on the figure best represents the site where chlorthalidone exerts its mechanism of action
B (chlorthalidone and other thiazide diuretics inhibit sodium reabsorption in the distal convoluted tubule.
Which medication is considered first-line treatment of hypertension in pregnancy?
Methyldopa
A physician wants to initiate an angiotensin- converting enzyme inhibitor in a heart failure patient with a blood pressure of 95/60 mmHg. He would like to use the shortest acting drug just in case the patient becomes hypotensive. Which angiotensin converting enzyme inhibitor has the shortest half life?
Captopril
Which of the following are symptoms of digoxin toxicity? (Select ALL that apply)
Bradycardia Greenish-yellow halos around lights Loss of appetite
An order for which additional laboratory test would futehr evaluate HK's complaints?
BNP
a patient begins experiencing chest pain during a clinic visit....Which of the following medications should be given immediately while waiting for emergency services?
Bayer aspirin, chewed
RS is a 57-year-old man, presenting for his annual cardiology appointment. He is currently...Which of the following medications must RS continue indefinitely following the myocardial infarction? (Select ALL that apply)
Benazepril Aspirin Atorvastatin Nitroglycerin
Which of the following drugs can cause sprue like enteropathy
Benicar
A patient at a hospital is receiving a beta blocker for chest pain. Which of the following is true regarding the use of beta blockers in this setting?
Beta-1 selective beta blockers without intrinsic sympathomimetic activity are preferred.
The pharmacist received an order for tenecteplase from the emergency department. What is the mechanism of action of tenecteplase?
Binds to fibrin and converts plasminogen to plasmin
A patient on clopidogrel calls the pharmacy with complaints of black, tarry stools. What side effect is he most likely experiencing?
Bleeding
Possible side effects of Lovaza include: (select all that apply)
Burping taste perversions dyspepsia
JS is a 73 year old male in the emergency department presenting with difficulty speaking clearly and a facial droop. Which diagnostic test is best to perform on JS as soon as possible upon arrival to the ED?
CT scan
The medication started on August 30th is in which drug class?
Calcium channel blocker
JG is a white male patient who presents with high blood pressure on several visits. Which classes of medications are appropriate as initial therapy for JG? (select all that apply_
Calcium channel blockers ACE inhibitors Angiotensin receptor blockers thiazide type diurectics
Which drug is correctly matched with its Vaughan Williams class?
Cardizem: Class IV
Choose the correct statement regarding carvedilol to carvedilol CR dosing:
Carvedilol 6.25 mg BID is equivalent to Coreg CR 20 mg daily.
Which of the following medications should be taken with food? (Select ALL that apply.)
Carvedilol immediate-release Metoprolol succinate Metoprolol tartrate Carvedilol controlled-release
AC receives counseling on all of her home medications at discharge. The pharmacist tells her "this medication can cause dry mouth, constipation and fatigue". Which medication is the pharmacist referring to?
Catapres
Of the medications that AC stopped taking, which one has most likely caused her acute rise in blood pressure?
Catapres
Which of the following meds should be avoided in a pt presenting with ACS?
Celecoxib
KJ has an increased risk of bleeding because she take Plavix with which other medication?
Celexa
which of the following medications is associated with an increase in triglycerides?
Cholestyramine (bile acid sequestrants can increase TGs)
Which of the following drugs should be avoided with dronedarone?
Clarithromycin
Dronedarone carries a boxed warning against use in patients with which diagnosis?
Class IV heart failure
Which of the following medications can cause thrombotic thrombocytopenic purpura? (Select ALL that apply)
Clopidogrel Effient
Which of the following organizations sets the guidelines for the management of hypertension?
The american college of cardiology/ american heart association
The pharmacist has received a new oral amiodarone prescription for JC. Before the prescription is filled, the pharmacist should call the prescriber to recommend the following medication change/s: (Select ALL that apply.)
Decrease dose of digoxin Decrease dose of lovastatin
A physician wants to start a patient on amiodarone for rhythm control. The pharmacist notices in the chart that patient is on warfarin (INR is 2.6 today). Which of the following should the pharmacist tell the prescriber?
Decrease the current warfarin does by 30-50%
Wr has been taking digoxin...which medication is most appropriate to administer to WR?
DigiFab
Which of the following drugs is used to control ventricular rate in a patient presenting in atrial fibrillation with a rapid ventricular response?
Digoxin
CF is a 60 year old male admitted to the hospital after a motor vehicle accident. He takes digoxin 0.125 mg PO daily at home for rate control of atrial fibrillation. On admission, his serum digoxin level is therapeutic. He will be NPO for numerous surgeries over the next several days. What equivalent dose of IV digoxin should be recommended?
Digoxin 0.1 mg IV daily
A patient at the hospital is receiving nitroglycerin for chest pain. What are the advantages/reasons for using nitroglycerin in pt with chest pain
Dilates coronary arteries
Which of the following antiarrhythmic medications has the lowest risk of QT prolongation?
Diltiazem
Which of the following antihypertensive drugs are available as an injection? (select all that apply)
Diltiazem Hydralazine Chlorothiazide Nicardipine Labetalol
After a few days, AC's blood pressure is at a safe level and she is to be discontinued on her home regimen. Which of the following pharmacist recommendations would help with AC's medication compliance?
Discontinue Zestril and hydrochlorothiazide and start Zestoretic.
A patient brings a prescription for immediate release niacin (Niacor) to the pharmacy, but it is not in stock. However, Niaspan is in stock and Slo-Niacin is available over the counter. What could be recommended as a substitution?
Do not substitute with either product
Slow acetylation of procainamide increase which of the following risks? (Select ALL that apply)
Drug accumulation Increased toxicity
JL had a stroke and has been given a prescription for..... (select all that apply)
Dyspepsia heartburn headache bleeding
Which of the following side effects is common with Brilinta?
Dyspnea
Which label on the ventricular action potential best represents where the drugs dofetilide, dronedarone and sotalol exert their predominant electrophysiologic effect?
E
the pharmacist receives a new prescription for isosorbide mononitrate IR BID. When should the patient take the medication?
take at 8 am and 3 pm
Which diagnostic test is used to identify arrhythmias?
ECG
Dofetilide must be started (or restarted) in the inpatient setting in order to facilitate required monitoring of which of the following? (Select ALL that apply)
ECG Renal function
The provider orders Integrillin. What is the appropriate generic substitution?
Eptifibatide
Which of the following medications work by blocking the binding of fibrinogen, von Willebrand factor, and other ligands at the glycoprotein IIb/IIIa receptor?
Eptifibatide
how often should the ASCVD risk assessment be done if a patient is classified as low risk?
Every 4-6 years (in low risk patients)
NZ, a 64 year old female, has diabetes, heart failure, unstable angina and hyperlipidemia. She has been using atorvastatin 80mg daily for the past four months. She is adherent to therapy. Her LDL was taken today and reported to be 124mg/dL. Which of the following medications is the preferred add-on treatment to atorvastatin?
Ezetimibe (In very high risk patients (multiple ASCVD events or one ASCVD event with high risk conditions, like diabetes and heart failure) who do not achieve LDL <70mg/dL on a maximally-tolerated statin dose, ezetimibe can be added.)
what is the mechanism of action of ezetimibe?
Ezetimibe inhibits the absorption of cholesterol in the small intestine.
rank the following statins from the lowest to the highest milligram potency. Left click the mouse to highlight, drag, and order the answer options; ALL options must be used
Fluvastatin Lovastatin Simvastatin Atorvastatin Rosuvastatin
Which of the following lab abnormalities increases the risk for digoxin toxicity?
Hypokalemia
In which of the following conditions are the fenofibrates contraindicated? (select all that apply)
Gallbladder disease severe liver disease (in addition to the above conditions, these drugs cannot be used in nursing mothers or severe kidney disease)
Which of the following medication lists is the most concerning for drug-induced QT prolongation?
Geodon, lithium, Diflucan daily, and Cipro x14 days
A 76-year old male arrives at the ED complaining of dizzinesss and poor balance since yesterday. His wife states that he has been lethargic and confused since waking up today. He loses consciousness shortly after arrival at the hosptial. Which factors contributed to the arrhythmia? (Select ALL that apply)
Hypokalemia Amitriptyline Hypomagnesemia
What is the goal resting heart rate in patients with symptomatic atrial fibrillation?
HR < 80 BPM
KB's healthcare provider should explain to KB that treating his hypertension will reduce his risk of which of the following? (Select ALL that apply)
Heart disease Stroke Kidney disease
In addition to hypertension, Aldactone is commonly used in which of the following conditions?
Heart failure
Which of the following medications are classified as direct vasodilators? (Select all that apply)
Hydralazine Minoxidil
FS is a 40 year old female being evaluated for her dyslipidemia. She has an estimated ASCVD risk of 15%. Which of her medications could contribute to her lipid panel abnormalities?
Hydrochlorothiazide
Which of the following are risk factors for an acute coronary syndrome? (Select ALL that apply)
Hypertension Dyslipidemia Smoking Diabetes
Which medications are used only IV for treating arrhythmias?
Ibutilide and lidocaine
RC is a 58 year old male with dyslipidemia and prostate enlargement. He is currently taking pravastatin 40mg daily and tamsulosin 0.4mg daily. Today he reports with muscle aches. The physician discontinued the pravastatin and other causes of myopathy were ruled out. According to the ACC/AHA Blood Cholesterol Guidelines, what would be an appropriate next step for treating RC's dyslipidemia?
If muscle aches resolve, restart pravastatin at 20mg daily. (if muscle symptoms resolve within 2-4 weeks of discontinuing the statin, it is recommended to restart the same statin at the same or lower dose.)
The medication KB started on November 20th can cause which side effect?
Increased uric acid
A patient has hypertension and suffers from migraines. which of the following drugs can be used to lower blood pressure and prevent migraines?
Inderal LA
A patient's ECG indicates a tachyarrhythmia. Which of the following may have precipitated his arrhythmia? (Select ALL that apply)
Infection Electrolyte abnormality Illicit drug use
What is the primary reason for using aspirin in a patient with chest pain?
Inhibit platelet aggregation
FS presents to the pharmacy with a new prescription for sildenafil. He currently takes the following medications:...... Sildenafil is contraindicated with which of FS's medications
Isosorbide monoitrate
AJ is a 34 year old male with a history of type 2 diabetes, hypertension and heart failure. He was recently initiated on metoprolol succinate, What important counseling point should AJ receive about metoprolol?
It can mask the symptoms of hypoglycemia
A patient with diabetes, hypertension, and peptic ulcer disease is on aspirin, glyburide, enalapril, metoprolol, chlorthalidone, and famotidine. Which of the patient's medications may block signs and symptoms of hypoglycemia?
Metoprolol
Which of the following statements are true regarding enalapril? (Select ALL that apply)
It can retain potassium; potassium levels must be monitored It should not be used in patients with bilateral renal artery stenosis. It can cause a dry, hacking cough. It has been shown to be beneficial in slowing progression of diabetic kidney disease.
What is the mechanism of action of Plavix
It inhibits P2Y12 ADP mediated platelet activation and aggregation
Which of the following statements regarding hypertensive urgency are correct?
It is extremely high blood pressure in the absence of acute end organ dysfunction.
EG is a 67 year old white female with NYHA functional class III...which finding would prohibit the use of this medication?
K=5.6 mEq/L
which potassium chloride formulation can be cut and/or dissolved in water?
Klor-Con M10
A 32 year-old female patient has gone to see her primary care physician. The doctor is looking at her blood work, which includes the following parameters: total cholesterol 202 mg/dL, HDL 52 mg/dL, LDL 130 mg/dL, TG 96 mg/dL, BUN 18 mg/dL, SCr 0.8 mg/dL, hCG+, with a blood pressure of 168/102 mmHg. Which of the following medications can be safely administered?
Labetalol
Which medication is paired correctly with its mechanism of action?
Labetalol: blocks beta-1, beta-2 and alpha-1 receptors
Which of the following is a brand name of digoxin?
Lanoxin
JG, a 63 year-old black male, has a past medical history significant for hypertension, hypercholesterolemia, chronic kidney disease and peripheral arterial disease. What is JG's goal BP?
Less than 130/80 mmHg
In addition to medications, what lifestyle modifications are important for KB?
Limit sodium intake to < 1,500 mg daily
HG presents to the cardiology clinic one year after her STEMI for medication therapy management. Her past medical history...which of the following medications should be added to her regimen?
Metoprolol
HG was just diagnosed with chronic stable angina. Which of the following medications is recommended first line?
Metoprolol
In addition to hydrochlorothiazide, AC is taking which of the following medications for high blood pressure?
Lisinopril Clonidine
Which drug has the highest risk of myopathy when combined with a statin?
Lopid
A prescription for Altoprev 20mg PO daily was brought to the pharmacy. Which of the following is the generic name for ALtoprev?
Lovastatin
which of the following can cause LDL to increase? (select all that apply)
Lovaza Risperidone Dexamethasone Tacolimus
A pharmacist on internal medicine rounds overhears the cardiologist saying that a "rate control strategy with stroke prophylaxis" will be used for a patient. Which group of medications is most appropriate?
Metoprolol + apixaban
Which potassium chloride formualtion can be opened and spirinkled on food?
Micro-k
A 55 year old male patient with hypertension was started on lisinopril. He developed severe swelling of his mouth, with trouble breathing. Which medication would be the safest option in this patient?
Microzide
An 87 year old male presents to the Emergency Department with complaints of mid-sternal chest pain. He has had intermittent chest pain for two days with some nausea and diaphoresis. The patient is diagnosed with a Non-ST Segment Elevation Myocardial Infarction (NSTEMI). Which of the following are standard medications that may be used to treat a patient with an acute coronary syndrome characterized as NSTEMI? (Select ALL that apply.)
Morphine Aspirin
Which of the following NSAIDs would be considered the safest in patients who have had an MI?
Naproxen
When combined with a statin, which of the following increases the risk of myalgias? (select all that apply)
Niacin 1g daily fenofibrate red yeast rice
which formulation of niacin has the highest risk for liver damage?
Niacin CR highest risk of hepatotoxicity but a lower risk of flushing
DL is a 77 year old male (6'3", 315 pounds) who presents to the emergency department with a STEMI. He was given aspirin 325 mg in the field and was started on a nitroglycerin drip at 100 mcg/min. His oxygen saturation is 94% and he has received morphine sulfate 2 mg IV x 2 and metoprolol 5 mg IV in the past 30 minutes. His blood pressure is 164/101, HR is 95 BPM, and his respiratory rate is 22 BPM. Which of the following medications should not be given to the patient due to increased mortality?
Nifedipine immediate-release
JC has systolic heart failure with an ejection fraction....
Procainamide alogliptin daunorubicin itraconazole
Which of the following drugs can cause QT prolongation? (Select ALL that apply)
Ondansetron Methadone Celexa Zyprexa
A patient presenting with chest pain underwent a procedure to open a coronary artery. This was done by inflating a small balloon inside the artery... What procedure did this patient have done?
PCI
Adenosine is used to treat what type of arrhythmia?
Paroxysmal supraventricular tachycardia
A patient with hypertension has been prescribed nicardipine ER. Which of the following are possible side effects from the use of nicardipine? (Select ALL that apply.)
Peripheral edema Flushing Gingival hyperplasia
Which of the following antihypertensives should not be taken with grapefruit or grapefruit juice?
Procardia XL
The pharmacist does not process this order because the patient would be at risk of which of the following?
Profound hypotension
Which of the following are well- established side effects of amiodarone therapy? (Select ALL that apply)
Photosensitivity Microdeposits in the cornea Hypotension Hypothyroidism
A woman calls the pharmacy in a panic. She thinks her husband may be having a heart attack. The pharmacist determines that the husband has a prescription for Nitrostat (sublingual nitroglycerin) at home. What instructions should the pharmacist provide? (Select ALL that apply)
Place one Nitrostat under the tongue and let it dissolve. Use one tablet every 5 minutes for up to 3 doses. Call 911 if the pain persists or worsens after the first dose of nitroglycerin.
SC has a past history of hypertension and chronic kidney disease. Her daily medications include atenolol...Which of SC's medications can worsen her blood pressure control? (Select ALL that apply)
Prednisone Phenylephrine Ibuprofen
Clopidogrel interacts with which of GH's medications?
Prilosec
which of the following medications can increase triglycerides?
Propofol
A patient at the hospital is receiving morphine for chest pain. What are the advantages/reasons for using morphine in a patient with chest pain?
Provides analgesia Reduces preload Reduces myocardial oxygen demand
which of the following is a warning for ranolazine?
QT prolongation
MJ is a 52 yo male with paroxysmal afib, htn, and dyslipidemia. He presents to the pharmacy complaining of ringing in the ears, blurred vision and confusion. Which antiarrhythmic is most likely causing his symptoms?
Quinidine
Which antiarrhythmic drug/s are associated with drug induced lupus erythematosus? (Select ALL that apply)
Quinidine Procainamide
JF is a 62 year old African American male. His potassium level is 4.2 mEq/L, sodium is 141 mEq/L, BUN is 24 mg/dL and his serum creatinine is 1.2 mg/dL. JF's current medications include atenolol and citalopram. The physician is considering starting fosinopril. JF has risk factor for developing angioedema. Which risk factor for angioedema is present in this patient?
Race
What causes an acute coronary syndrome?
Reduce bloodflow to the heart caused by plaque rupture in the coronary arteries
A prescription for simvastatin 20 mg PO QHS is brought into the pharmacy. Which of the following counseling point/s is/are correct? (select all that apply)
Report muscle pain to the prescriber. Do not take if you are pregnant or trying to get pregnant. (simvastatin is taken at bedtime, with or without food. Simvastatin has a short half life and must be in the body during sleep when most cholesterol synthesis occurs. Statins are teratogenic and should not be taken during pregnancy.)
Which of the following medications should be added to RB's regimen? Select all that apply:
Rosuvastatin Aspirin
LD is a 61 year old male being seen for routine follow up. What would be the most appropriate statin regimen for LD?
Rosuvastatin 20 mg daily
SP is a 58 year old African American female with hypertension, atrial fibrillation, NYHA Class II heart failure and a history of ovarian cancer (treated with chemo 12 years ago). SP's 10 year ASCVD risk is found to be 17%. Which of the following regimens would be appropriate for SP?
Rosuvastatin 20 mg daily (SP has an LDL >190. She should receive a high intensity statin regardless of her ASCVD risk score)
KW is a 45 year old male with type 2 diabetes, hypertension and seasonal allergies. His current medications include Vasotec 10 mg daily, hydrochlorothiazide 25 mg daily, Glucophage 850 mg BID Claritin 10 mg daily. Current labs include total cholesterol (mg/dL) = 238 (<200), TG (mg/dL)=215 (150), HDL (mg/dL)=50 (>40) and LDL (mg/dL)=145 (<100). Which of the following is the most appropriate statin to initiate?
Rosuvastatin 5 mg (KW has diabetes and requires a moderate-intensity statin. Rosuvastatin 5 mg is a moderate intensity statin.)
A patient gave the pharmacist a prescription for Catapres TTS-1 #4. Choose the correct counseling statement/s for this medication. (Select ALL that apply)
Rotate the site where you place the patch. The dose must be tapered to discontinue Replace the patch weekly This patch needs to be removed before an MRI procedure
Put the following steps of normal electrical cardiac conduction in the correct order. (All options must be used)
SA node AV node Bundle of His Right and left bundle branches Purkinje fibers
GR received an electrocardiogram (ECG) which showed ST segment elevation in the precordial leads (V2-V6). In the emergency room her troponin I and CK-MB were positive. Her glucose, amylase and blood pressure were elevated, but other labs and vital signs were normal. She went to the cath lab for primary percutaneous coronary intervention (PCI). The coronary angiogram found 100% blockage of the left anterior descending (LAD) coronary artery. Which of the following indicate that GR has had an ST segment elevation myocardial infarction (STEMI)? (Select ALL that apply.)
ST segment elevation on ECG Positive cardiac enzymes
FS is a 40 year old female being evaluated for her dyslipidemia. She has an estimated ASCVD risk of 15%. Which of the following is accurate as it pertains to the reported ASCVD risk?
She has a 15% likelihood of having a cardiovascular event in the next 10 years
RH has a past medical history of heart failure... which of RF's curent medicaitons is contrindicated with Bidil?
Sildenafil
In the above image, influx of which ion is responsible for the Phase labeled B
Sodium
A patient begins niacin IR and finds she suffers from red, itchy skin. She does not believe she can tolerate the medicine. Which of the following would be appropriate advice for the pharmacist to give the patient? (select all that apply)
Speak to your prescriber to switch to a different formulation. If your physician permits it, take 325 mg of aspirin 30 minutes before the dose. Avoid alcohol, hot beverages and spicy food near the time of the dose. (after several weeks of consistent use, this side effect may subside. Niaspan is extended-release niacin, which has less flushing than immediate-release formulations. Flushing with niacin is prostaglandin-mediated, so an antihistamine such as Benadryl will not help)
A hospitalized patient was given the potassium binding resin Kayexalate this morning. The pharmacist is reviewing her medications. Which of the following medications on the profile most likely needs to be discontinued?
Spironolactone
FS is a 40 year old female being evaluated for her dyslipidemia. She has an estimated ASCVD risk of 15%. What statin therapy is most appropriate for FS?
Statin therapy is not appropriate
Chronic atrial fibrillation increases the risk of which of the following conditions?
Stroke
Which of the following are likely signs/symptoms of a heart attack? (Select ALL that apply)
Sweating Radiating pain Shortness of breath Chest pain or pressure that lasts more than a few minutes
Which of the following recommendations should the pharmacist make?
Switch Prilosec to Protonix
What is the main difference between a transient ischemic attack (TIA) and an ischemic stroke?
TIA is a temporary blockage, ischemic stoke requires intervention
The pharmacist has received a new oral amiodarone prescription for JC. The pharmacist should counsel the patient on risks to which organs with amiodarone therapy? (Select ALL that apply.)
Thyroid Liver Lungs Eyes
What is the function of a Holter monitor?
To detect intermittent arrhythmias in an ambulatory setting
Welchol is approved for use in which of the following conditions?
To help lower postprandial blood glucose in diabetes
Dyazide is a combination of hydrochlorothiazide and which other medication
Triamterene
Which of the following laboratory tests is the most sensitive marker for detecting myocardial damage in a patient with an acute coronary syndrome?
Troponins
MG was admitted to the hospital for complaints of shortness of breath, sweating and squeezing chest pain that is radiating to his arm and back. In the emergency room...What is the most likely diagnosis?
Unstable angina
Which of the following statements is correct regarding nitroglycerin ointment?
Use the dose measuring applicator to measure and apply the medication.
Which of the following cholesterol-lowering medications can increase bleeding risk?
Vascepa (there is a heightened bleeding risk with fish oils. To be safe, watch for patients with increased bleeding risk and counsel on symptoms of bleeding. With warfarin use, the INR and bleeding signs and symptoms should be monitored. Use fish oils cautiously in combination with aspirin or other antiplatelets.)
which of the following medication will help to lower triglycerides? (select all that apply)
Vascepa Lovaza TriCor Trilipix (fish oils (eg Lovaza, Vascepa) and fibrates (Trilipix, TriCor) lower triglycerides.)
Which of the following is the primary use of lidocaine in the treatment of arrhythmias?
Ventricular arrhythmias
JF has systolic heart failure with an ejection fraction of 33%. Which of the following medications could potentially worsen his heart failure condition?
Verapamil
JS suffers from constipation. She spends a....Which medication could be contributing to JS's chronic constipation?
Verapamil
Which of the following cholesterol medications should not be taken with grapefruit or grapefruit juice?
Zocor
A patient experiencing a hypertensive emergency should have a blood pressure lowered according to which criteria?
_<25% within the first hour
A 63 year old female with a past medical history of heart failure, dyslipidemia, osteo.....what type of stroke is she most likely experiencing?
a cardioembolic stroke due to the occurrence of atrial fibrillation
Which of the following represents the correct definition of high-intensity statin therapy?
a daily dose that decreases LDL by greater than or equal to 50%
Upon discharge, AC has a blood pressure of 138/86 mmHg. What change should be made to AC's regiment for hypertension?
add hydrochlorothiazide
what is the correct mechanism of action of fenofibrates?
activate peroxisome proliferate receptor alpha
which fibrinolytic is used to treat an ischemic stroke?
alteplase
Which of the following drugs is correctly paired with its mechanism of action?
alteplase: binds to fibrin in a thrombus and concerts plasminogen to plasmin which results in lysis of the clot
Which of the following is the most appropriate counseling for extended release niacin (Niaspan) administration?
take at bedtime, after a low fat snack.
which of the following parameters are used to calculate ASCVD risk? (Select all that apply)
antihypertensive use systolic bp total cholesterol HDL diabetes smoking status (these are part of the nine parameters that are used to calculate ASCVD risk.)
Which statin can be taken in the morning without significantly affecting the LDL-lowering effectiveness?
atorvastatin
choose the correct mechanism of action for carvedilol
beta-1 and beta-2 blocker and alpha 1 blocker
which of the following medications should be avoided with lovastatin? (select all that apply)
biaxin voriconazole lopid (and itraconazole and ketoconazole should be avoided)
which beta adrenergic blocking agent reduces mortality in systolic heart failure?
bisoprolol
which medication requires a taper when discontinuing?
bisoprolol
select the mechanism of action ofor aldactone
blocks aldosterone receptors in the distal convoluted tubule
select the correct mechanism of action for candesartan.
blocks angiotensin II by binding directly to the ATI receptor
Select the correct mechanism of action for Entresto
blocks neprilysin from degrading vasodilatory peptides
rapid intravenous administration of which medication increases the risk of ototoxicity?
bumetanide
What are the key component of the American Stroke Assocoation's public health initiative called FAST (select all that apply)
call 911 or get to the hospitalfast. Brain cells are dying. a is for arms: ask the person to raise both arms. does one arm drift downward? t is for time: if the person shows any of these symptoms, time is important
which of HK's current medicaitons can worsen heart failure?
cardizem CD
Which of the following non-drug treatment interventions should be implemented for RB? Select all that apply:
consume a heart healthy diet; he is overweight limit alcohol intake
which label on the figure best represents the site where lasix exerts its mechanism of action?
d
What causes the antiplatelet effect of aspirin?
decreased thromboxane A2
which medical condition/s can be worsened by the use of carvedilol? select all that apply
diabetes erectile dysfunction asthma
a patient with systolic heart failure is taking ramipril... reduced by 50% when starting amiodarone?
digoxin
What is the most likely cause of LB's symptoms?
digoxin toxicity
which of the following recommendations should be made to the prescriber regarding ST's current medication regimen?
discontinue ramipril
A systolic heart failure patient takes vasotec 5... which medication change is most appropriate for this patient?
discontinue vasotec and begin valsartan
A 47 year old male comes to the clinic for routine follow up. He has hypertension and is a smoker. His ASCVD risk is 8.5%. Laboratory assessment reveals the following: Which of the following would be the best treatment recommendation according to the ACC/AHA Blood Cholesterol Guidelines?
do not initiate treatment
How should Rb be counseled on his nitrate prescription? select all that apply
do not shake call 911 if chest pain is not relieved after the first dose this medication can cause a headache, flushing or a drop in blood pressure
which of the following physical exam finding are consistent with symtomatic heart failure?
dyspnea jugular venous distention peripheral edema rales
which medication can be substituted for the ACE inhibitor on AM's profile for further mortality reduction
entresto
Which of the follwoing medications require monitoring of serum potassium?
entresto lanoxin eplerenone vasotec candesartan
which of the follwoing medications is most appropriate to decrease fluid volume in a patient with a sulfa allergy?
ethacrynic acid
which of the following natural products may have a beneficial effects on heart failure? select all that apply
fish oilds coenzyme q10 hawthorne
Vascepa should be dispensed with caution to a patient with this allergy:
fish or shellfish (vascepa is concentrated omega-3 fatty acids from fish and should be used with caution in patients with fish and/or shellfish allergies.)
which of the following are side effects of niacin? (select all that apply)
flushing and/or itching increase in uric acid increase in blood sugar (niacin does not increase blood pressure (it can lower it) or cause renal impairment)
Which statin is the least potent?
fluvastatin
GV was broguht to the emergency department for difficulty breathing...Which mediation should be discontinued?
fosinopril
the generic name of HK's current diuretic is:
furosemide
Epierenone is a suitable alternative for patients experiecneing which side effect of spironolactone?
gynecomastia
which of the following is a common side effect of Bidil
headache
Which of the following accurately describes HK heart failure?
heart failure with reduced ejection fraction
what condition is a contraindication to using lomitapide (juxtapid)?
hepatic disease or moderate to sever hepatic impairment
which of the follwoing lifestyle modifications is appropriate to recommend for AC?
her BMI is approximately 34kg/m2 weight reduction is needed
when used to treat systolic heart failure, digoxin has been shown to decrease:
hospitalizations
VC comes to the clinic for a follow up visit for his hypertension and diabetes management. He has been taking four medications to control his blood pressure for a long time. Today, the pharmacist notices a butterfly rash across VC's nose and upper cheeks. Which of the following medications is most likely to cause this side effects?
hydralazine
which medication would be best to recommend adding to JG's regimen?
hydralazine and isosorbide dinitrate
which electrolyte abnormality increases the risk for digoxin toxicity
hypercalcemia hypomagnesemia
what risk factors for ischemic stroke does AC have? (select all that apply)
hypertension diabetes smoking
AC is a 67 year old female who presents to the urgent care clinic with headache and confusion. After reviewing her information, the urgent care clinic sends AC to the emergency room. Based on the information provided, AC is likely experiencing:
hypertensive emergency
a patient is started on Lipitor 20 mg daily. According to the ACC/AHA Blood Cholesterol Guidelines, when should the lipid panel be checked?
in 4-12 weeks (after initial dose or dose increase)
what change should be made to AM's current regimen?
increase the Toprol XL dose
Low cardiac output results in the activation of compensatory neurohormal pathways. Activation of the sympothetic nervous system results in which of the following physiologic effects?
increased heart rates
which laboratory abnormalities can occur with chronic use of Lasix? (select all that apply)
increased triglycerides increase blood glucose decreased magnesium decrease potassium
TM, a 51 year old male, is being seen for a routine physical exam. His past medical history is significant for hypertension and a previous ischemic stroke. Which of the following actions would be in accordance with the ACC/AHA Blood Cholesterol Guidelines?
initiate a high intensity statin
Which of the following is the most likely side effect of a PCSK9 inhibitor?
injection site swelling
select the correct mechanism of action of cholestyramine:
it binds to bile acids in the gut
What is the role of mannitol in stroke treatment?
it causes osmotic diuresis and reduces intracranial pressure
Select the statements that accurately describe stable angina pain: (Select all that apply)
it is caused by reduced blood flow to the heart muscle it is often brought on by exertion or stress it is relieved with rest or nitroglycerin
choose the correct statements concering clevidipine: (select all that apply)
it is contraindicated in patients with a soy or egg allergy this lipid emulsion provides 2kcal/mL it is milky white in color
A lifestyle recommendation that should be made to patients with hyperlipidemia is to:
limit intake of saturated and trans fat
Counseling for HK should include these recommendations: select all that apply
limit sodium intake to <1500 mg per day monitor and document body weight daily receive influenza and pneumococcal vaccinations, when indicated notify a healthcare provider if weight increases by >3-5 pounds in 1 week
the combination of hydralazine and isosbide dinitrate is a suitable alternative to which medication in a patient with heart failure and bilateral renal artery stenosis?
lisinopril
Which of the follwoing medicaitons has been shown to improve survival in systolic heart failure? (select all that apply)
lisinopril spironolactone metoprolol succinate
losartan can decrease renal clearnace and increase the toxicity risk of which medication?
lithium
A pharmacist who is counseling a patient regarding a new prescription for niacin ER instructs a patient to contact the doctor right away if he is passing brown or dark colored urine, feeling more tired than usual or is his skin and/or whites of the eyes become yellow. These signs and symptoms are consistent with which possible side effect?
liver failure
which of the following statins should be taken with the evening meal?
lovastatin immediate release
EK has systolic heart failure and is taking quinapril...EK is likely experiencing the adverse drug effect:
lupus like syndrome
a 57 year old male is given alteplase for stroke management. His.....Which side effect is he at greatest risk for developing?
major bleeding
A 54 year old female has hypertension and COPD. She is already using...Which of the following drugs is most appropriate?
metoprolol
which of the following are common causes of heart failure? select all that apply
myocardial infarction chronic hypertension
Which lipid lowering therapy can increase blood glucose?
niacin
Whcih of the following is an appropraite route of administration of nimodripine?
oral
Elevated triglycerides are most likely to cause:
pancreatitis (hypertriglyceridemia, can cause pancreatitis. Acute pancreatitis often presents with a sharp pain in the upper abdomen)
AC will need treatment to prevent a second stroke in the future. WHich of the folllowing options is most appropriate?
plavix
which of the following correctly describes the hemodynamic effects of digoxin?
positive inotrope, negative chronotrope
Which monitoring parameters are appropriate given AM's current medication regimen? select all that apply
potassium levels serum creatinine heart rate
select the correct mechanism of action for Zestril
prevents the conversion of angiotensin I to angiotensin II
Which of the following effects do statin have on cholesterol values? (select all that apply)
raises HDL lowers triglycerides lowers LDL
TW will begin home blood pressure monitoring. Which of the following are correct instructions? Select all that apply
rest arm at the level of heart be at rest for at least 5 minutes before taking measurement sit in a chair with both feet on the flood avoid caffeine, smoking or exercise 30 minutes prior use the appropriate cuff size
Ivabradine is indicated in heart failure patients with
resting HR > 70bpm
A 55 year old woman who was started on simvastatin three weeks ago presents to her prescriber's office reporting decreased urination, muscle soreness and weakness. Labs are drawn, and her CPK is 11,000 IU/L. Which of the following is the most appropriate diagnosis?
rhabdomyolysis (her signs and symptoms of rhabdomyolysis include muscle pain, a CPK over 10,000 IU/L and a decrease in urination.)
which of the following best describes safe dosing practices for the use of digoxin in treating heart failur?
start at 0.25mg daily; reduce dose when CrCl<50ml/min
which of the following is appropriate with regards to evaluating and managing dyslipidemia in AC?
start high intensity statin
Select the correct mechanism of action of statins.
statins inhibit the enzyme HMG-CoA reductase, blocking cholesterol synthesis. (Statins block cholesterol synthesis by inhibiting the enzyme HMG-CoA reducatse, which catalyzes the rate-limiting step in cholesterol synthesis)
What counseling point should the pharmacist provide on Nitrostat?
store tablets in the original amber bottle at room temperature
A patient with atrial fibrillation is currently taking aspirin, metoprolol, digoxin and verapamil. The physician wants to start the patient on lovastatin. Which of the following statements is correct regarding drug interactions in this patient?
the maximum dose of lovastatin is 40mg daily due to the interaction with verapamil. (the maximum dose of lovastatin (a major CYP3A4 substrate) is lower when a patient is taking verapamil)
HJ uses a nitroglycerin transdermal patch 0.6 mg/hr for stable ischemic heart disease. Which of the following is true?
the preferred site of application is the chest
A 58 year old female is seen in the clinic with a blood pressure of 144/92 mmHg and advance kidney disease, CrCl 25mL/min. Which medication class would not be effective for lowering her blood pressure?
thiazide type diuretics
A pharmacist is counseling a patient beginning therapy with clopidogrel.....The pharmacist is counseling the patient about:
thrombotic thrombocytopenic purpura
What is the indication for Lovaza?
to lower triglycerides in patients with TGs> or eaqual to 500mg/dL as a n adjunct to diet.
an imaging study confirms acute ischemic stroke within 30 minutes of arrival at the emergency department. Which contraindication does AC have for fibrinolytic treatment?
too much time has passed since her symptoms
which medication should be added to HK's heart failure treatment regimen to provide additional mortality reduction?
toprol XL
JB is a 68 year old white male diagnosed with NYHA Class III heart fsilure....which medications should be initiated to treat JB's heart failure? select all that apply
torsemide ramipril coreg
a woman with heart failue comes to the community pharmacy.... over the counter analgesic to recommend?
tylenol
SR presents to the emergency room and is diagnosed with an ischemic stroke... Which of the following represents the most appropriate course of action for the pharmacist?
verify this order as written and dispense 90 mg of alteplase.
What other name/s us niacin known by? (select all that apply)
vitamin b3 nicotinic acid
How should Welchol tablets be administered?
with a meal and liquid
