Pharm - Unit 2 Quizzes CO 2021
On your way to the next MCQ Exam, you experience that feeling that an attack of diarrhea is imminent. Stopping at a drugstore, which one of the following antidiarrheal drugs could you buy without a prescription even though it is related chemically to the strong opioid analgesic meperidine? - Aluminum hydroxide - Diphenoxylate - Loperamide - Magnesium hydroxide
- Loperamide Explanation: Aluminum hydroxide is constipating but not related chemically to meperidine; magnesium hydroxide is a strong laxative. The 2 antidiarrheal drugs structurally related to opioids are diphenoxylate and loperamide. Loperamide is available over-the-counter; diphenoxylate is mixed with atropine, and the product (Lomotil, others) requires a prescription.
A patient taking verapamil for hypertension and angina has become constipated. Which of the following drugs is an osmotic laxative that could be used to treat the patient's constipation? - Ranitidine - Magnesium hydroxide - Aluminum hydroxide - Metoclopramide
- Magnesium hydroxide Explanation: A laxative that mildly stimulates the gut is suitable for a patient taking a smooth muscle relaxant drug like verapamil. By holding water in the intestine, magnesium hydroxide provides additional bulk and stimulates increased contractions.
A Registered Clinical Trial reported results as follows: Primary Efficacy Event Rate Test Medication: 25% Reference Medication: 20% Primary Hazard Event Rate Test Medication: 6% Reference Medication: 4% What is the absolute efficacy improvement for the primary efficacy outcome?
5%
A Registered Clinical Trial reported results as follows: Primary Efficacy Event Rate Test Medication: 25% Reference Medication: 20% Primary Hazard Event Rate Test Medication: 6% Reference Medication: 4% What is the relative hazard?
50%
Which of the following is an analgesic and antipyretic drug that lacks an anti-inflammatory action? Acetaminophen Celecoxib Colchicine Indomethacin
Acetaminophen Acetaminophen is the only drug that fits this description. Indomethacin is a nonselective COX inhibitor and celecoxib is a COX-2 inhibitor; both have analgesic, antipyretic, and anti-inflammatory effects. Colchicine is a drug used for gout that also has an anti-inflammatory action.
Which statement is correct? - Adverse events are always reported in published trials. - Spontaneous reporting is the most reliable method for reporting adverse events. - Adverse events should be reported in the abstract, results and discussion sections of every paper that claims a benefit to treatment. - Patients who withdraw from a study because of adverse effects should not be included in the results.
Adverse events should be reported in the abstract, results and discussion sections of every paper that claims a benefit to treatment.
Which classes of antihypertensive medications are most effective in low renin or volume-expanded forms of hypertension? aldosterone anatagonists ACE inhibitors Thiazide Diuretics Aldosterone antagonists and Thiazide Diuretics
Aldosterone antagonists and Thiazide Diuretics
Which statement about amiodarone is NOT correct? Amiodarone has a short half life, and is eliminated entirely by the kidney Amiodarone accumulates in the heart, lung, liver, skin and tears Dose-related pulmonary toxicity is the most important adverse effect Amiodarone can interfere with the metabolism of many drugs including statins, warfarin, and digoxin
Amiodarone has a short half life, and is eliminated entirely by the kidney
A patient develops severe thrombocytopenia in response to treatment with unfractionated heparin and still requires parenteral anticoagulation. Your best option is: Eptifibitide Bivalirudin Abciximab clopidogrel
Bivalirudin Direct thrombin inhibitors such as bivalirudin and argatroban provide parenteral anticoagulation similar to that achieved with heparin, but the direct thrombin inhibitors do not induce formation of antiplatelet antibodies.
One of the following statements about the mechanism of action of anti-arrythmic agents is NOT correct. Identify the incorrect statement. Block sodium channels Block Calcium Channels Block Potassium Channels Block Premium Cable TV Channels
Block Premium Cable TV Channels
Identify the preferred triple therapy for treatment of h pylori infection. - Lansoprazole 30 mg PO twice daily with amoxicillin (1 gm twice daily) and clarithromycin (500 mg twice daily) for 10—14 days - Famotidine 40 mg PO twice daily with amoxicillin 1 gm twice daily and clarithromycin 500 mg twice daily for 10-14 days. - Pepto bizmol every hour plus ranitidine 150 mg twice a day plus ciproloxacin 750 mg twice a day plus imipenem 1 gm IV every 6 hours for 10-14 days. - Maalox 30 ml po every hour until symptoms improve
- Lansoprazole 30 mg PO twice daily with amoxicillin (1 gm twice daily) and clarithromycin (500 mg twice daily) for 10—14 days
An 18-month-old boy dies from an accidental overdose of acetaminophen. Which of the following is the most likely cause of this patient's death? Arrhythmia Hemorrhagic stroke Liver failure Ventilatory failure
Liver failure
This question refers to medications used to treat congestive heart failure. Match the class of medication with the most correct mechanism of action. Loop diuretics such as furosemide ACE-inhibitors Beta-adrenergic antagonists digoxin Decrease afterload by decreasing TPR through prevention of angiotensin induced vasoconstriction, and decrease preload by limiting aldosterone secretion Reduce sympathetic activity Inhibits Na-K-ATPase which increases intracellular calcium resulting in vagomimetic action, positive inotropic action, and reduced sympathetic response Decrease preload by decreasing vascular fluid volume
Loop diuretics such as furosemide - Decrease preload by decreasing vascular fluid volume ACE-inhibitors - Decrease afterload by decreasing TPR through prevention of angiotensin induced vasoconstriction, and decrease preload by limiting aldosterone secretion Beta-adrenergic antagonists - Reduce sympathetic activity Digoxin - Inhibits Na-K-ATPase which increases intracellular calcium resulting in vagomimetic action, positive inotropic action, and reduced sympathetic response
Portal Hypertension: Beta adrenergic antagonists are used to reduce portal pressure by reducing portal venous inflow reducing cardiac output thus reducing splanchnic blood flow. Which statement is most correct? - Metoprolol is preferred - Non selective BB are preferred as use results in reduction of varices and improved mortality - Non selective BB are preferred as use results in reduction of variceal bleeding and risk of rebleeding - Beta agonists such as isoproterenol are used to reduce portal pressure, and reduce risk of rebleeding
Non selective BB are preferred as use results in reduction of variceal bleeding and risk of rebleeding
List at least 5 examples of prescription and non prescription medications associated with liver injury.
OTC Medications: Alcohol, acetaminophen (high doses), NSAIDs especially diclofenac (some NSAIDS are safer than others) Rx Medications: Seizure meds almost all esp -Phenytoin INH Statins (high doses) Amiodarone Allopurinol Methotrexate Antipsychotics
The preferred antiviral drug for treatment of seasonal influenza in hospitalized patients is: Peramivir Oseltamivir Zanamivir Rimantadine
Oseltamivir
As you might expect from understanding the mechanism of action for digoxin this medication is cleared from the body via metabolism. However about 30% of digoxin is cleared by the kidney. Also it is known that renal failure by itself can impair the activity of Na-K ATP'ase. Based upon the above statements which response is correct? - Patients having renal insufficiency and also taking digoxin should be monitored carefully for safety and efficacy. It may be necessary to reduce the dose of digoxin in proportion to the reduced renal function to prevent serious digoxin toxicity. - Patients having renal insufficiency and also taking digoxin need not be monitored carefully for safety and efficacy. For most patients it will not be necessary to reduce the dose of digoxin to prevent serious digoxin toxicity. - Patients having renal insufficiency and also taking digoxin need not be monitored carefully for safety and efficacy. For most renal patients it will be necessary to dramatically increase the dose of digoxin to preserve digoxin efficacy. - Patients having renal insufficiency and also taking digoxin need not be monitored carefully for safety and efficacy. For most renal patients it will be necessary to add another medication that interferes with the metabolism of digoxin so that the effect of digoxin on Na-K ATP'ase is enhanced.
Patients having renal insufficiency and also taking digoxin should be monitored carefully for safety and efficacy. It may be necessary to reduce the dose of digoxin in proportion to the reduced renal function to prevent serious digoxin toxicity.
Today's Patient is a 64 year old white man with NYHA HFrEF stable while managed with enalapril and carvedilol, but now has developed angioedema. You recommend switching from enalapril to valsartan, but he asks you about Entresto because the advertisements on television and social media encouraged him to ask his Dr about Entresto. You advise him that: Valsartan is more effective than Entresto Patients with a history of angioedema should NOT take Entresto! He should start Entresto as soon as possible and definitely within 24 hours of his last dose of enalapril. Entresto is contraindicated for use with carvedilol
Patients with a history of angioedema should NOT take Entresto!
The mechanism of action of penicillin allergy toxicity is best described as: Cell walls in human skin are destroyed by penicillin resulting in the characteristic rash seen in penicillin allergy. Penicillin breakdown products form haptens which bind to cell surface proteins to form an antigen. The major breakdown product results from the degredation of the 4 member ring structure, and the minor breakdown product results from the degredation of the 5 member ring. Penicillin breakdown products act to release beta lactamase which results in the allergic reaction. Susceptible bacteria release allergic components in an effort to convince the patient to stop taking their medicine.
Penicillin breakdown products form haptens which bind to cell surface proteins to form an antigen. The major breakdown product results from the degredation of the 4 member ring structure, and the minor breakdown product results from the degredation of the 5 member ring.
What type of ADR is this? Pharmacologic Idiosyncratic Allergic None of the above
Pharmacologic
Match the antiemetic with the most accurate mechanism of action. - Phenothiazines as well as Butyrophenones for example compazine, droperidol - 5-HT3 receptor antagonists for example ondansetron - Aprepitant - Scopolamine Anticholinergic NK1 receptor antagonist Serotonin antagonist Dopamine antagonist
Phenothiazines as well as Butyrophenones for example compazine, droperidol --> Dopamine antagonist 5-HT3 receptor antagonists for example ondansetron --> Serotonin antagonist Aprepitant --> NK1 receptor antagonist Scopolamine --> Anticholinergic
How likely is it that the described INR event is an adverse drug reaction? Unlikely Possible Probable or Definite None of the above
Probable or Definite Explanation: Right- I would classify this event as Probable since there is no re-challenge. When we re-challenge by prescribing a lower dose if the patient reaches a target response I would classify as definite.
The advantages and disadvantages to antacids are:
Prompt acting but short duration of action
Match the allergy classification with the most correct time of onset; mediator; and clinical signs. Type I Type II Type III Type IV Late reaction; IgG; Drug fever Delayed reaction; T-cells; Maculopapular rash Late reaction; IgG; Interstitial nephritis Immediate onset; IgE; Anaphylaxis
Type I - Immediate onset; IgE; Anaphylaxis Type II - Late reaction; IgG; Interstitial nephritis Type III - Late reaction; IgG; Drug fever Type IV - Delayed reaction; T-cells; Maculopapular rash
Secondary Risk factors for PONV include all EXCEPT - Type of health insurance (Does not include risk of nausea when you receive your bill) - Type of surgery- laprascopic, Gyne, ENT, Neuro - Duration of surgery - Use of general anesthesia
Type of health insurance (Does not include risk of nausea when you receive your bill)
You should prescribe a newly approved drug when: - A paid speaker tells you how much success she has with this new drug while the drug rep buys you an expensive dinner. - Whenever a new drug has a unique mechanism of action. - Use newly approved drugs once they have demonstrated superior safety and/or superior clinical outcomes. - Improvements in laboratory values always result in improvements in clinical outcomes.
Use newly approved drugs once they have demonstrated superior safety and/or superior clinical outcomes.
Which of the following factors is least associated with a higher risk of developing myopathy or rhabdomyolysis in patients taking statins? Use of a low statin dose Kidney disease Female sex Age 65 years or older
Use of a low statin dose Explanation: Some of the known risk factors associated with increased or frequent side effects when using statins include the following: Age 65 years or older Female sex Using multiple cholesterol-lowering medications (eg, fibrates, high-dose niacin, lomitapide) High statin dose Smaller body frame Kidney disease Liver disease Alcohol use
All of the following medications are commonly associated with constipation except? Vincristine Verapamil Vancomycin Varenicline
Vancomycin
Warfarin This clotting factor has the shortest half life Reverses warfarin Heparin Phytonadione The aPTT is used to measure the intensity of pharmacologic effect Factor VII The normalized prothrombin time is used to measure the intensity of pharmacologic effect
Warfarin - The normalized prothrombin time is used to measure the intensity of pharmacologic effect This clotting factor has the shortest half life - Factor VII Reverses warfarin - Phytonadione Heparin - The aPTT is used to measure the intensity of pharmacologic effect
Because I want it.
Eminence-based medicine
Antiviral prophylaxis can be considered for which of the following persons exposed to influenza: - A 75-year-old man with severe immune deficiencies - A 4-year-old child with asthma who received the influenza vaccine one week ago - A 29-year-old pregnant woman - All are correct
all are correct
Which two classes of drugs interfere with the elimination of Bradykinin? ARBs and NSAIDs ACE inhibitors and Neprilysin inhibitors Nesiritide and Neprilysin inhibitors Loop diuretics and ARBs
ACE inhibitors and Neprilysin inhibitors
Which statement best describes the common factors thought to precipitate cardiac arrythmias? Ischemia, acidosis-alkalosis, electrolyte abnormalities, adverse drug reactions. Contrast studies, statins, echocardiograms MCQ exams, Capstone Projects, Moving None of the above
Ischemia, acidosis-alkalosis, electrolyte abnormalities, adverse drug reactions.
A Registered Clinical Trial reported results as follows: Primary Efficacy Event Rate Test Medication: 25% Reference Medication: 20% Primary Hazard Event Rate Test Medication: 6% Reference Medication: 4% What is the absolute difference in the primary hazard outcome?
2%
Review Slide 9 from the HF lecture. What is the patient's BUN? 145 179 20 14.2
20
A Registered Clinical Trial reported results as follows: Primary Efficacy Event Rate Test Medication: 25% Reference Medication: 20% Primary Hazard Event Rate Test Medication: 6% Reference Medication: 4% What is the NNT for the primary efficacy outcome, and what is the number needed to harm for the primary hazard outcome?
20 and 50
A Registered Clinical Trial reported results as follows: Primary Efficacy Event Rate Test Medication: 25% Reference Medication: 20% Primary Hazard Event Rate Test Medication: 6% Reference Medication: 4% What is the relative improvement in efficacy?
25%
An allergic reaction to a nonantibacterial sulfonamide such as celecoxib in a patient with an allergy to sulfamethoxazole may be due to: - Both drugs have an arylamine group at the N4 position of the sulfonamide moiety - Both drugs have a 5 or 6 member nitrogen containing ring at the N1 nitrogen - A predispostion to drug-induced allergic reactions - Circulating IgE antibodies to sulfamethoxazole
A predispostion to drug-induced allergic reactions
A 73 year old white man having a prior medical history of COPD, CKD, and gout is admitted for a MI. Prior to discharge, you plan to start a beta blocker. Which of the following beta blockers would be the best choice based on his history? - Atenolol - Esmolol - Nadolol - Propranolol
Atenolol Explanation: Because of the patient's COPD, a beta-1 selective agent would be preferred over a non-selective agent. Of the agents listed, atenolol and esmolol are beta-1 selective, however, esmolol is only available in an IV formulation, therefore atenolol is the correct answer.
Cefotaxime, or ceftriaxone, or ampicillin/ sulbactam are considered first line antibiotic treatments for SBP because: - Because of their activity against E coli, and proteus - Because they are useful agents for patients having a documented severe allergic reaction to penicillin - Because of their activity against staph, strep, and atypical bacteria. - Are only used when symptoms of infection are supported by a positive culture of ascitic fluid
Because of their activity against E coli, and proteus
In addition to an ACE-I, ARB, or ARNI all patients with HFrEF should take a beta blocker. Which statement is correct? Metoprolol is more likely than carvedilol to cause hypotention. Beta blockers should be used cautiously if at all in patients with severe bradycardia. Discontinue the beta blocker if there is no significant improvement during the first week of treatment. All beta blockers are shown to reduce hospitalizations, and mortality.
Beta blockers should be used cautiously if at all in patients with severe bradycardia.
A 64-year-old woman presents with pain in her left thigh muscle. Duplex ultrasonography indicates the presence of deep vein thrombosis (DVT) in the affected limb. The decision was made to treat this woman with enoxaparin. Relative to unfractionated heparin, enoxaparin-- - Can be used without monitoring the patient's aPTT - Is more likely to cause thrombosis and thrombocytopenia - Has a shorter duration of action - Is less likely to have a teratogenic effect
Can be used without monitoring the patient's aPTT Enoxaparin is an Low Molecular Weight heparin. LMW heparins have a longer half-life than standard(High molecular weight) heparin and a more consistent relationship between dose and therapeutic effect. Enoxaparin is given subcutaneously, not intravenously. It is less, not more, likely to cause thrombosis and thrombocytopenia. Neither LMW heparins nor standard heparin are teratogenic. The aPTT is not useful for monitoring the effects of LMW heparins.
Which statement about carvedilol is correct? Carvedilol is a cardioselective beta antagonist Carvedilol is a combined alpha- and nonselective beta-blocker Carvedilol and labetalol have balanced alpha and beta blocking action Carvedilol is contraindicated in heart failure
Carvedilol is a combined alpha- and nonselective beta-blocker
Which statement about CDI is NOT correct? C difficile is a Gram-positive, spore forming rod Primary cause of hospital-associated diarrhea in US Overgrowth in gut supported by antibiotic use Caused by Bacteroides fragilis
Caused by Bacteroides fragilis
Match the medication with the most accurate description of it's mechanism of action Clopidogrel Aspirin Heparin and LMWH Eptifibatide - Prevents binding of fibrinogen and vWF to the GIIb/IIIa receptor - Inhibits prostaglandin and thromboxane synthesis - An active metabolite binds to and inhibits the platelet ADP receptors. - Activates antithrombin
Clopidogrel - An active metabolite binds to and inhibits the platelet ADP receptors. Aspirin - Inhibits prostaglandin and thromboxane synthesis Heparin and LMWH - Activates antithrombin Eptifibatide - Prevents binding of fibrinogen and vWF to the GIIb/IIIa receptor
PMH: your patient has stage 2 hypertension and is at risk for type 2 diabetes. At the follow up appointment you note that He/she has lost a small amount of weight, has an improved diet, and has begun to exercise on a regular basis. You noted a small decrease in blood pressure. After confirming your diagnosis you initiated treatment with an ACE Inhibitor. On the next follow up appointment you note that blood pressure was reduced by about 10 mmHg after 2 months of treatment. Based on your interview and the patients response you are confident that patient adherence is to diet, exercise and medication is high. Your patient is unaware of any side effects from the ACE inhibitor. However blood pressure remains elevated. You decide it is time to change therapy for hypertension. Your next step should be to: A. Continue diet, exercise and ACE inhibitor therapy. Add a medication having a different mechanism of action and different side effects such as a thiazide diuretic. B. Keep raising the dose of ACE inhibitor until the patients reaches blood pressure goal. C. Stop the ACE inhibitor and initiate treatment with a calcium channel antagonist. D. Stop the ACE inhibitor and initiate treatment with the newest medication available.
Continue diet, exercise and ACE inhibitor therapy. Add a medication having a different mechanism of action and different side effects such as a thiazide diuretic.
Which statement is NOT correct? - Digoxin interferes with Na-K ATP'ase in cardiac tissue. The resulting increase in intracellular sodium acts to inhibit the efflux of calcium. - Digoxin has a very narrow therapeutic index, adverse effects can be frequent and severe if patients are not monitored carefully. - Digoxin acts as a vagolytic - Digoxin is rarely considered a first line drug due to its narrow therapeutic window, and lack of benefit on mortality. However in carefully selected patiients adding digoxin can improve cardiac contractility, reduce hospitalizations and reduce patient symptoms of heart failure.
Digoxin acts as a vagolytic Explanation: Digoxin interferes with Na-K ATP'ase in cardiac tissue. The resulting increase in intracellular sodium acts to inhibit the efflux of calcium. Digoxin has a very narrow therapeutic index, adverse effects can be frequent and severe if patients are not monitored carefully. Digoxin is rarely considered a first line drug due to its narrow therapeutic window, and lack of benefit on mortality. However in carefully selected patiients adding digoxin can improve cardiac contractility, reduce hospitalizations and reduce patient symptoms of heart failure. Digoxin acts as a vagoTONIC.
NSAIDS and Opioids promote histamine release via: IgE Mediated Type I Reaction Direct Pharmacologic Effect Promotion of prostaglandin synthesis. Activation of central pathways that promote appreciation of pain.
Direct Pharmacologic Effect
Which one of the following drugs used in HF is associated with clinically or physiologically useful inotropic effects? Nesiritide Lisonopril Dobutamine Valsartan
Dobutamine
Which one of the following drugs used in HF is associated with clinically or physiologically useful inotropic effects? Nesiritide Lisonopril Dobutamine Valsartan
Dobutamine
Which of the following pathways is NOT a site for neurotransmitters involved in nausea and vomiting? - Facebook - Serotonin type 3 - Neurokinin-1 - Dopamine-2
Always start treatment with more than one drug at a time. True False
False
T/F Adverse drug reactions do not result in patient harm.
False
T/F Most adverse reactions are caused by exotic medications rather than by anticoagulants or by insulin
False
Which statement about warfarin is correct: Foods containing large amounts of vitamin K can antagonize warfarin Warfarin exerts its effect on coagulation through activation of antithrombin III Patients should stop eating fruits and vegetables when treated with warfarin Warfarin has an immediate effect on coagulation
Foods containing large amounts of vitamin K can antagonize warfarin
The advantages and disadvantages to H2Receptor Antagonists are:
Good efficacy, well tolerated and safe, but doses need to be adjusted if renal function is impaired
Match the medication with the mechanism of action Heparin warfarin dabigatran Rivaroxaban Factor Xa inhibitor Direct thrombin inhibitor A vitamin K antagonist Activates anti-thrombin
Heparin - Activates anti-thrombin Warfarin - A vitamin K antagonist Dabigatran - Direct thrombin inhibitor Rivaroxaban - Factor Xa inhibitor
A 54-year-old woman presents with signs and symptoms consistent with an early stage of rheumatoid arthritis. You decide to initiate NSAID therapy. Which of the following patient characteristics is the most compelling reason for avoiding celecoxib in the treatment of her arthritis? History of alcohol abuse History of gout History of myocardial infarction History of osteoporosis
History of myocardial infarction Celecoxib is a COX-2-selective inhibitor. COX-2 inhibitors have the advantage over nonselective NSAIDs of reduced gastrointestinal toxicity, BUT clinical data suggest that they are more likely to cause arterial thrombotic events. A history of myocardial infarction would be a compelling reason to avoid a COX-2 inhibitor.
A 63-year-old man is undergoing radiation treatment as an outpatient for metastatic bone cancer. His pain is treated with a fixed combination of oxycodone plus acetaminophen taken orally. Despite increasing doses of the analgesic combination, the pain is getting worse. The most appropriate oral medication for his increasing pain is Buprenorphine Codeine plus aspirin Hydromorphone Tramadol
Hydromorphone In most situations, pain associated with metastatic carcinoma ultimately necessitates the use of an opioid analgesic that is equivalent in strength to morphine, so hydromorphone, oxymorphone, or levorphanol would be indicated. The combination of codeine plus salicylate would not be as effective as the original drug combination. Propoxyphene and Tramadol are less active than the original. Buprenorphine, a mixed agonist-antagonist, is not usually recommended for cancer-associated pain because it has a limited maximum analgesic effect ("ceiling") and because of possible dysphoric and psychotomimetic effects.
There is compelling evidence to support non-drug treatment for the following conditions: - Hypertension, Type 1 Diabetes, insomnia and back pain - Hypertension, Type 2 diabetes, insomnia and back pain arthritis, headache, and congestive heart failure - Non-Hodgkins Lymphoma, von Willebrands disease, and HIV
Hypertension, Type 2 diabetes, insomnia and back pain
A 16-year-old girl comes to the emergency department suffering from the effects of an aspirin overdose. Which of the following syndromes is this patient most likely to exhibit as a result of this drug overdose? Bone marrow suppression and possibly aplastic anemia Fever, hepatic dysfunction, and encephalopathy Rapid, fulminant hepatic failure Rash, interstitial nephritis, and acute renal failure Hyperthermia, metabolic acidosis, and coma
Hyperthermia, metabolic acidosis, and coma Salicylate intoxication is associated with metabolic acidosis, dehydration, and hyperthermia. If these problems are not corrected, coma and death ensue.
The most important adverse effect of loop diuretics is: Hypokalemia hyponatremia renal insufficiency angioedema
Hypokalemia
Today's patient is a 58 yr old man, taking 8 different medications on a daily basis. Pantoprazole was started 12 weeks ago while hospitalized. He is concerned about the cost,side effects, his long term health and wants to know if all of these medications are really necessary. Which indication listed below would be eligible for deprescribing of pantoprazole? - Severe esophagitis - ICU Stress Ulcer Prophylaxis - Documented history of bleeding GI ulcer - Barrett's esophagus
ICU Stress Ulcer Prophylaxis
When selecting an opioid for a patient claiming an allergy to codeine: - Choose Morphine the active metabolite of codeine. - All patients claiming an allergy to codeine should not receive an analgesic. - If there is a compelling reason to use an opioid you could choose an opioid such as fentanyl or meperidine because these opioids are chemically distinct from codeine. - There is no risk of allergic reactions from opioids.
If there is a compelling reason to use an opioid you could choose an opioid such as fentanyl or meperidine because these opioids are chemically distinct from codeine.
A 59 year old African American man with Chronic Kidney Disease (CKD) (baseline CrCl 30-35 mL/min) was diagnosed with HTN and started on lisinopril 5mg PO QD (taken at 0800). He does not like taking medications, but has a very high health literacy and takes this new medication very regularly. He reliably and accurately monitors his blood pressure at home since his diagnosis. After a month of therapy, he returns for a follow up visit and reports his 0700 SBP ranges 140-160 mmHg, his 1400 BP ranges 100-120s mmHg, and his 2100 SBP ranges 130-150 mmHg. Given his preferences about avoiding multiple medications and also his medical history, what medication change should be made at this time? Increase lisinopril to 10mg PO QD Continue lisinopril 5mg, add HCTZ 25mg PO QD Continue lisinopril 5mg, add amlodipine 5mg QD Was not on appropriate medication initially, switch to amlodipine 5mg PO QD
Increase lisinopril to 10mg PO QD Explanation: An ACEI inhibitor (or ARB) is indicated in this patient with CKD per JNC 8 guidelines. ACE inhibitors have a "flat dose response," and the patient is achieving mid-day blood pressures at goal with elevations in the PM. Therefore, the dose should be increased to sustain response for 24 hours. Polypharmacy should be minimized when possible (especially in a patient with a stated preference), and thiazides might be less effective in a patient with a reduced CrCl.
Use only a few drugs and learn to use them well. - Is an important principle of conservative prescribing - Is not recommended as clinicians are encourged to experiement with newly approved drugs - Instead clinicians should rush to prescribe newly approved drugs having unique mechanisms of action. - Clinicians should only prescribe medications that are heavily advertised to the public.
Is an important principle of conservative prescribing
A 55-year-old woman with type 1 diabetes of 40 years' duration complains of severe bloating and abdominal distress, especially after meals. Evaluation is consistent with diabetic gastroparesis. Which of the following is a prokinetic drug that could be used in this situation? - Alosetron - Cimetidine - Loperamide - Metoclopramide
Metoclopramide Explanation: Alosetron is a 5HT3 receptor blocker, cimetidine is a H2 receptor blocker, loperamide is an opioid only metoclopramide is considered a prokinetic agent (ie, one that increases propulsive motility in the gut).
Concerns about the overuse and adverse effects associated with proton pump inhibitors (PPIs) have prompted deprescribing in some situations. Deprescribing PPIs is recommended in patients with which of the following conditions? - Barret esophagus - Mild to moderate esophagitis - Documented history of bleeding gastrointestinal (GI) ulcer - Chronic nonsteroidal anti-inflammatory drug (NSAID) use with bleeding risk
Mild to moderate esophagitis Explanation: Deprescribing of PPIs is recommended in patients with the following conditions: Mild to moderate esophagitis Gastroesophageal reflux disease treated for 4-8 weeks (esophagitis healed, symptoms controlled) Peptic ulcer disease treated for 2-12 weeks Upper GI symptoms without endoscopy (asymptomatic for 3 consecutive days) Stress ulcer prophylaxis treated beyond intensive care unit admission Uncomplicated Helicobacter pylori infection treated for 2 weeks (asymptomatic) PPI use should be continued in patients with the following conditions: Barret esophagus Chronic NSAID use with bleeding risk Severe esophagitis Documented history of bleeding GI ulcer
The advantages and disadvantages to PPIs are:
Most potent inhibitors of acid secretion, good efficacy/safety, long duration of action, but expensive
Therapeutically useful anti-arrythmic medications: Open the sodium channel and enhance conduction. Reduce conduction and excitability and increase the refractory period to a greater extent in depolarized tissue than in normally polarized tissue. Shorten the refractory period to cancel out blocked impulses Activate the sympathetic nervous system to enhance contractility
Reduce conduction and excitability and increase the refractory period to a greater extent in depolarized tissue than in normally polarized tissue.
Which statement about the mechanism of action of amiodarone is NOT correct? Prolongs the action potential duration (and the QT interval on the ECG) by blockade of K Channels Blocks inactivated sodium channels Reverses electrolyte imbalances, restores patency of coronary arteries, and balances pH Has weak adrenergic and calcium channel-blocking actions
Reverses electrolyte imbalances, restores patency of coronary arteries, and balances pH
Which of the following is NOT a primary risk factor for PONV? (Post-Operative Nausea and Vomiting) - Female Gender - Non-smoker - History of PONV and/or Motion Sickness - Riding a rental bicycle without wearing a helmet. - Postoperative use of opioid analgesics
Riding a rental bicycle without wearing a helmet.
ACE inhibitors should be used with caution in patients with Diastolic blood pressure > 90 mm Hg serum Na >145 meq/L Serum K > 5 mEq/L Serum Creatinine > 1.2 mEq/L
Serum K > 5 mEq/L
Ascites Treatment- which statement is most correct? - Spironolactone is classified as an angiotensin receptor antagonist - Spironolactone is combined with a loop diuretic - The furosemide dose is 100 mg day to 40 mg per day for Spironolactone - No answer text provided.
Spironolactone is combined with a loop diuretic
A 55-year-old pharmacology professor is brought to the emergency department 2 h after the onset of severe chest pain during a stressful question and answer session. He has a history of poorly controlled mild hypertension and elevated blood cholesterol but does not smoke. ECG changes (ST elevation) and cardiac enzymes confirm the diagnosis of myocardial infarction. The decision is made to attempt to open his occluded artery. If this patient undergoes a percutaneous coronary angiography procedure and placement of a stent in a coronary blood vessel, he will need to be on dual antiplatelet therapy, for example aspirin and clopidogrel for at least a year. Which response most accurately describes the mechanism of action of clopidogrel? - Clopidogrel directly binds to the platelet ADP receptors - Clopidogrel irreversibly inhibits cyclooxygenase - Clopidogrel facilitates the action of antithrombin III - The active metabolite of clopidogrel binds to and inhibits the platelet ADP receptors
The active metabolite of clopidogrel binds to and inhibits the platelet ADP receptors Explanation: Clopidogrel is a prodrug that is activated by CYP2C9 and CYP2C19. It irreversibly binds to the ADP receptor on the surface of platelets that serves as a key role in platelet aggregation. Aspirin and clopidogrel help prevent platelet-induced occlusion of coronary stents.
An INR was measured two days after the dose increase. Why didn't this lab value predict that the new dose was too high? - The INR should only be used to monitor low molecular weight heparins - The half life of warfarin is approximately 40 hours. The half life of Factor II is 72 hours, and Factor X half life is 40 hours. The INR was measured at best after only one half life, probably less than one half life. We were no where near the maximum inhibition of clotting factors. The INR should have been repeated after 5-7 days at the new dose. - The INR should have been measured one half hour before, and two hours after the dose increase. - All of the above
The half life of warfarin is approximately 40 hours. The half life of Factor II is 72 hours, and Factor X half life is 40 hours. The INR was measured at best after only one half life, probably less than one half life. We were no where near the maximum inhibition of clotting factors. The INR should have been repeated after 5-7 days at the new dose.
A young man is brought to the emergency department in an anxious and agitated state. He informs the attending physician that he uses "street drugs" and that he gave himself an intravenous "fix" approximately 12 h ago. After an initial period of contentment and relaxation, he now has chills and muscle aches and has also been vomiting. His symptoms include hyperventilation and hyperthermia. You note that his pupil size is larger than normal. What is the most likely cause of these signs and symptoms? The patient had injected dextroamphetamine The patient has overdosed with an opioid The signs and symptoms are those of the opioid abstinence syndrome The patient has hepatitis B
The signs and symptoms are those of the opioid abstinence syndrome The signs and symptoms are those of withdrawal in a patient physically dependent on an opioid agonist, especially morphine or heroin. They usually start within 6-10 h after the last dose; their intensity depends on the degree of physical dependence, and peak effects usually occur at 36-48 h. Mydriasis is a prominent feature of the abstinence syndrome; other symptoms include rhinorrhea, lacrimation, piloerection, muscle jerks, and yawning. An overdose of dextroamphetamine would not produce an initial feeling of contentment and relaxation.
Identify the correct initial starting dose. In heart failure start oral digoxin at 250 mcg per day, increase the dose by 125 mcg per day on alternating days until the daily oral dose exceeds 1000 mcg per day. The usual initial oral dose of metoprolol XL for heart failure is 50-100 mg twice a day. The usual initial dose of lisinopril for heart failure is 5 mg orally once a day. The usual maintenance dose ranges from 5-20 mg daily. In heart failure start oral furosemide at 200-400 mg every 6 hours.
The usual initial dose of lisinopril for heart failure is 5 mg orally once a day. The usual maintenance dose ranges from 5-20 mg daily.
Match the pharmacologic class of medication to the correct clinical benefit. Thiazide diuretics ACE Inhibitors Beta Adrenergic Antagonists Calcium Channel Antagonists Use of short-acting agents in this class is associated with an increased risk of MI and an increase in mortality Particularly useful in patients with chronic kidney disease, in diabetes, in heart failure, and post-MI Reduce mortality after MI, and in HF Demonstrates improvement in mortality in most patients
Thiazide diuretics - Demonstrates improvement in mortality in most patients ACE Inhibitors - Particularly useful in patients with chronic kidney disease, in diabetes, in heart failure, and post-MI Beta Adrenergic Antagonists - Reduce mortality after MI, and in HF Calcium Channel Antagonists - Use of short-acting agents in this class is associated with an increased risk of MI and an increase in mortality
Match the drug class with the correct mechanism of action. No partial credit for this question. Thiazide type diuretics Beta adrenergic antagonists Angiotensin converting enzyme inhibitors Calcium Channel antagonists Relaxes vascular smooth muscle and reduces TPR Reduces activity of SNS Reduces activity of the renin system Acts on distal tubule to reduce sodium resorption
Thiazide type diuretics - Acts on distal tubule to reduce sodium resorption Beta adrenergic antagonists - Reduces activity of SNS Angiotensin converting enzyme inhibitors - Reduces activity of the renin system Calcium Channel antagonists - Relaxes vascular smooth muscle and reduces TPR
Identify the correct maintenance dose for amiodarone: To control supraventricular arrythmia the maintenance dose is 800 to 1600 mg orally each day To control supraventricular arrythmia the maintenance dose is 50 mg/kg orally each day To control supraventricular arrythmia start at 200 mg orally a day, and double the dose every other day until the dose is up to 2 Grams per day To control supraventricular arrythmia the maintenance dose is usually 200 mg orally each day
To control supraventricular arrythmia the maintenance dose is usually 200 mg orally each day
Which statement about management of CDI is correct? Encourage frequent use of hand sanitizers Treatment includes oral metronidazole or IV Vancomycin Treatment includes oral metronidazole or oral Vancomycin Use fidaxomicin for initial treatment
Treatment includes oral metronidazole or ORAL Vancomycin
Today's patients is a 41-year-old otherwise healthy woman presenting with fever, myalgia, and cough that began the day before. Rapid antigen testing is positive for influenza A. Which statement about antiviral treatment for this patient is correct? - Treatment with oseltamivir could be considered since onset of symptoms was <48 hours ago. - Treatment is not recommended because her symptoms began >24 hours ago. - Treatment with amantadine could be considered since onset of symptoms was <48 hours ago. - Otherwise healthy persons should not receive antiviral treatment for influenza.
Treatment with oseltamivir could be considered since onset of symptoms was <48 hours ago.
Reserve unproven and off-label use for situations when your patients is unable to use recommended and proven treatments. True False
True
T/F Harms are the opposite of benefits.
True
When used to manage portal hypertension the dosing strategy for beta adrenergic antagonists is best described as: -start at the maximum or target dose and down titrate once pressure is under control - start with the lowest recommended starting dose, and titrate towards the target efficacy dose while carefully monitoring heart rate. - start with metoprolol XL and switch to immediate release once target heart rate is reached.
start with the lowest recommended starting dose, and titrate towards the target efficacy dose while carefully monitoring heart rate.
