PT Final Exam Part 2
Which beta-adrenergic blocking agent reduces mortality in systolic heart failure?
Bisoprolol, metoprolol succinate, Carvedilol
The pharmacist is dispensing a new prescription for pioglitazone. This medication has a risk for
Bladder tumors
Select correct MOA of candesartan
Blocking Ang II by binding directly to AT I receptor
A 33-year-old man has been prescribed medication for hyperlipidemia. He has been noted to have bleeding from his gums and easy bruisability. His prothrombin time is elevated. Which of the following agents is most likely to be involved?
Cholestyramine
A short acting diuretic that has side effects that include hypokalemic metabolic alkalosis &reversible ototoxicity.
furosemide
Which of the following requires monitoring in a patient on HCTZ? Select all that apply.
renal function, Electrolytes, Uric acid, Blood glucose
Which statin therapy is appropriate for this patient?
statin therapy is not appropriate
A 63 yo male professor suffering from chest pain upon exertion is diagnosed with classical angina. A drug formulation that you should prescribe for rapid relief of symptoms, taken as needed is:
sublingual nitroglycerin
KS is picking up a new prescription for glipizide. What are the possible side effects of this medication?
weight gain, Hypoglycemia
A patient with systolic heart failure brings a new prescription of Entresto 50 mg BID to the pharmacy. He was instructed to stop quinapril 20 mg BID but wants to know when to start the new medication. The patient should wait at least how long after stopping quinapril before taking the Entresto dose?
36 hours
A patient takes calcium citrate (21% elemental calcium) 950 mg at breakfast and dinner due to inadequate intake from dietary sources. Calculate the amount of elemental calcium per day. Round to the nearest whole number.
399
What is the therapeutic dose of digoxin for heart failure
0.5 -0.9 ng/mL
What is the therapeutic range for digoxin when used to treat heart failure?
0.5 -0.9 ng/mL
MS is a 45-year-old man who comes for his annual check-up. He takes Synthroid 100 mcg daily at 0730 and multivitamin at 2100. The physician writes a new prescription for colestipol 2 g by mouth daily. When should MS be instructed to take colestipol?
1130
Emily uses levemir Flex touch pen and injects 20 units QHS, Humalog 12 units before breakfast and lunch and 16 units before dinner using a insulinsyringe from vial. How long will her insulin pen and vial last respectively?
15 and 25 days
How many minutes before a meal should a patient administer glulisine insulin?
15 minutes before the start of a meal.
Due to acarbose's mechanism of action to lower blood glucose, what is the most appropriate way to treat a hypoglycemic reaction in a patient taking acarbose?
3 to 4 glucose tablets
Katie is a 23 year old female with past medical history of Type 1 diabetes. She takes Levemir 21 units QHS, insulin Lispro 7 units TID before meals. She tried making Tiramisu. Her blood glucose was 246 mg/dL due to the excitement of cooking the delicacy. She plans to consume 300 grams of Tiramisu (36 grams of carbohydrate/100 grams of tiramisu). Her target Blood glucose is 120 mg/dL. Calculate her correction dose and how many units of Lispro is needed to cover the carbohydrate in tiramisu and the total units of Lispro she has to inject?
3 units. 9 units and 12 units
Which of the following drug and their mechanism of action is not correct?
Acetazolamide: epithelial sodium channel blockers
A patients presents a prescription of ferrous fumarate (33% elemental iron), 324 mg - two tablets a day. The pharmacist find ferrous sulphate (20% elemental iron), 200 mg coated tablet. How many coated tablets should the patient take per day to meet approximately 200 mg of elemental iron requirement.
5
A patient experiencing a hypertensive emergency should have blood pressure lowered according to which criteria?
<25% within the first hour
Which of the following patients will benefit from high-intensity statits? (Select all that apply)
A 60-year-old with myocardial infarction, A 60-year-old with myocardial infarction
Which of the following are true regarding heart failure? A. Verapamil and diltiazem can precipitate or worsen heart failure B. Digoxin goal plasma concentrations is 2.5-5 ng/mL C. Patients with ADHF often require IV diuretics, vasodilators, and negative inotropes D. Headache, dizziness, and GI complaints are common adverse effects with hydralazine-isosorbide dinitrate
A and D
JC is a 64-year-old male with a past medical history of NYHA class III heart failure, dyslipidemia and hypertension, smokes ½ pack of cigarettes daily.
A and E
What is the correct mechanism of action of semaglutide?
A glucagon-like peptide I agonist: it increases insulin and decreases glucagon B.
What is the mechanism of action of fenofibrates?
Activate PPAR alpha
In order to reduce the risk of side effects or to eliminate contraindications to therapy, what objective measure(s) do you need to assess before you recommend canagliflozin for a patient with diabetes? Select all that apply.
Blood pressure, Creatinine clearance (CrCl) or serum creatinine (SCr), Potassium concentration, Sodium concentration
Given below are the few drug mechanisms: A. Increase cGMP in smooth muscle B. Decrease Calcium in smooth muscle C. Increase cAMP in cardiac muscle D. Decrease calcium in cardiac muscle
A, B, D
Select the statement that accurately describes stable angina pain: A. It is relieved with rest or nitroglycerin B. It is caused by reduced blood flow to the heart C. It increases in intensity and duration with time D. It is often brought on by exertion or stress
A,B,D
Average glucose over preceding 2-3 months correlate with an estimated average glucose is measured by
A1C
A graduate student is planning to make a high-altitude climb in South America while on vacation. He will not have time to acclimate slowly to altitude. A drug that is useful in preventing high-altitude sickness is
Acetazolamide
A 60-year-old patient complains of paresthesias and occasional nausea associated with one of the drugs she is taking. She is found to have hyperchloremic metabolic acidosis. She is probably taking
Acetazolamide for glaucoma
TJ is a 64-year-old man with long-standing hypertension. He has recently been diagnosed with chronic kidney disease (CKD) and his estimated glomerular filtration rate (eGFR) is 24 mL/min. He is currently taking ramipril 10 mg daily. His BP is 148/86 mm Hg, HR is 58 bpm, and electrolytes notable for a potassium of 5.1 mEq/L. Upon physical examination, the patient is noted to have slight peripheral edema; however, an ECHO was without evidence of systolic HF (ejection fraction estimated at 60%). Which of the following would be the most appropriate recommendation at this time?
Add furosemide 20 mg daily.
Which of the following drugs slows conduction through the AV node and has a duration of action of 10-20 s?
Adenosine
A 43-year-old man has heterozygous familial hypercholesterolemia. His serum concentrations of total cholesterol and LDL are markedly elevated. His serum concentration of HDL cholesterol, VLDL cholesterol, and triglycerides are normal or slightly elevated. The patient's mother and older brother died of myocardial infarctions before the age of 50. This patient recently experienced mild chest pain when walking upstairs and has been diagnosed as having angina of effort. The patient is somewhat overweight. He drinks alcohol most evenings and smokes about 1 pack of cigarettes per week. After being counseled about lifestyle and dietary changes, the patient was started on atorvastatin. During his treatment with atorvastatin, it is important to routinely monitor serum concentrations of which of the following?
Alanine and aspartate aminotransferase
Identify the agents that have been associated with osteonecrosis of the jaw. Select all that apply.
Alendronate
Injection site reaction or flu-like symptoms are side effects of which of the following medications? Select all that apply.
Alirocumab, Mipomersen
Direct renin inhibitor:
Aliskiren
A 72 year old man with heart failure (EF 22%) was recently diagnosed with atrial fibrillation. His home medications include lisinopril, carvedilol, spironolactone, Furosemide, clopidogrel, digoxin, cholestyramine, and potassium. Which one of the following drugs is preferred to manage his atrial fibrillation?
Amiodarone
When evaluating SP for statin treatment, which medication on her profile will require lower maximum dose of simvastatin?
Amiodarone
When working in outlying areas, this 62-year-old rancher is away from his house for 12-14 h at a time. He has an arrhythmia that requires chronic therapy. Which of the following has the longest half-life of all antiarrhythmic drugs?
Amiodarone
In a patient with risk factors for hyperkalemia and history of hyperkalemia, which of the following agents would be acceptable treatment to avoid hyperkalemia risk?
Amlodipine
Which of the following is the best-documented mechanism of beneficial action of cardiac glycosides?
An increase in cytoplasmic calcium levels
What is the most appropriate adjunct to oral iron supplementation to improve absorption?
Ascorbic acid
Inhaled insulin is contraindicated in which type of patients?
Asthma
Which medical condition can be worsened by use of carvedilol?
Asthma
Which of the following medications has a potential warning of myopathy and rhabdomyolysis? Select all that apply.
Atorvastatin
Which statin can be taken in the morning without significantly altering the LDL lowering effect?
Atorvastatin
Which medication requires a taper when discontinuing?
Bisoprolol
Choose the correct MOA for carvedilol?
Beta 1 and beta 2 and alpha 1 blocker
Possible side effects of Lovaza include: (Select all that apply)
Burping, Taste perversions, dyspepsia
A 67-year-old man with chronic kidney disease was found to have an elevated serum PTH concentration and a low serum concentration of 25-hydroxyvitamin D. He was successfully treated with ergocalciferol. Unfortunately, his kidney disease progressed so that he required dialysis and his serum PTH concentration became markedly elevated. Which of the following drugs is most likely to lower this patient's serum PTH concentration?
Calcitriol
Which of the following drug class is prefered for prinzmetal (Variant) angina
Calcium channel blockers
Which of the following has been shown to prolong life in patients with chronic congestive failure in spite of having a negative inotropic effect on cardiac contractility?
Carvedilol
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglyceride are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. Which of the following drugs is most likely to increase this patient's triglyceride and VLDL cholesterol concentrations when used as monotherapy?
Cholestyramine
Dronedarone carries a boxed warning against use in patients with which diagnosis?
Class IV heart failure
Which medication is paired correctly with its MOA?
Clonidine -an alpha 2 adrenergic antagonist
Which drug prevents ADH insertion of the aquaporin water channels mediating water reabsorption in the collecting duct?
Conivaptan
RB is a 68-year-old Caucasian woman with a history of hypothyroidism. She recently had a stroke 2 months ago, and upon admission her creatinine clearance (CrCl) was 22 mL/min. She is currently in physical therapy for residual weakness on her right side post stroke. At physical therapy, she fell and broke her wrist. After further evaluation, she is diagnosed with osteoporosis. Her most recent pertinent lab work revealed thyroid stimulating hormone (TSH) 3.2 and CrCl 28 mL/min. She is also found to have hypocalcemia. She is currently on levothyroxine 50 mcg daily, aspirin 81 mg daily, and rosuvastatin 20 mg daily. She is allergic to peanuts, and she is a nonsmoker. Identify the contraindication(s) for bisphosphonate therapy for this patient? Select all that apply.
CrCl <30 mL/min, Uncorrected hypocalcemia
Which test is considered gold standard for identifying low bone density
DEXA
A patient has positive coombs test and drug induced hemolytic anemia. Which of the following medications in the patient profile would be the likely cause?
Dapsone
The symptoms related to the toxicity of loop diuretics is:
Deafness
Functions of incretin hormones are (select all that apply)
Decrease post prandial blood glucose, Stimulates insulin secretion, slows gastric emptying, Inhibit glucagon secretion
A 43-year-old man has heterozygous familial hypercholesterolemia. His serum concentrations of total cholesterol and LDL are markedly elevated. His serum concentration of HDL cholesterol, VLDL cholesterol, and triglycerides are normal or slightly elevated. The patient's mother and older brother died of myocardial infarctions before the age of 50. This patient recently experienced mild chest pain when walking upstairs and has been diagnosed as having angina of effort. The patient is somewhat overweight. He drinks alcohol most evenings and smokes about 1 pack of cigarettes per week. Six months after beginning atorvastatin, the patient's total and LDL cholesterol concentrations remained above normal, and he continued to have anginal attacks despite good adherence to his antianginal medications. His physician decided to add ezetimibe. Which of the following is the most accurate description of ezetimibe's mechanism of an action?
Decreased gastrointestinal absorption of cholesterol
What is the antidote for iron overdose?
Deferoxamine
The tolerance of the organic nitrate is due to
Depletion of free thiols
LB is a 74 year old female with systolic heart failure, paroxysmal atrial fibrillation and a history of Percutaneous Coronary Intervention with stent placement 1 year ago. She presents to the emergency department with complaints of nausea, abdominal pain, blurry vision and confusion.
Digoxin toxicity
Prinzmetal angina presents in a 25-year-old female. Pharmacological management could include:
Diltiazem, Verapamil
Which drug is correctly matched with its Vaughan Williams class?
Diltiazem: Class IV
ST is a 38 year old female with systolic heart failure secondary to radiation exposure. She is well controlled on her current treatment regime. Today she is being seen in the clinic due to missed periods. Which of the following recommendations should be made to the prescriber regarding ST's current medication regimen?
Discontinue ramipril
A patient currently uses 30 units of Lantus daily and 10 units of lispro with breakfast, lunch, and dinner. She is going to be started on pramlintide and needs to be counseled on how to adjust the dose of insulin. Select the correct adjustments.
Do not adjust lantus and reduce lispro to 5 units with meals
Which one of the following drugs is associated with clinically useful or physiologically important positive inotropic effects?
Dobutamine
Which of the following statements is/are not true of repaglinide? Select all that apply.
Dosage of repaglinide should be administered regardless of meal.
PT presents to your diabetes management clinic today. She is having problems with her postprandial blood sugars which are not at goal. Her most recent blood sugars after dinner include an average of 220 mg/dL. She currently takes metformin 1000 mg twice daily. She has expressed that she has a fear of using insulin. Her only medical condition is type 2 diabetes. All other labs are within normal limits. PT smokes half pack per day (PPD) and drinks one serving of alcohol daily. What therapy is the best option to help lower her A1c and improve glycemic control considering her specific patient profile concerns?
Dulaglutide 0.75 mg once weekly
Which of the following statements is false? A. NSAIDs, glucocorticoids, rosiglitazone, and pioglitazone may worsen HF by causing sodium and water retention B. HF is the only major CVD that is INCREASING is prevalence C. The primary manifestations of HF are dyspnea/fatigue that may limit physical activity and fluid retention D. Orthopnea, tachypnea, cough, ascites, jugular venous distention, hepatomegaly, and S3 gallop are other symptoms of HF E. Pts with an LVEF less than 55% are generally considered to have the systolic function F. Pts with dyspnea secondary to HF will have elevated plasma BNP concentrations.
E
Ulysses is 58 year old woman with diabetes, myocardial infarction, hypertension, dyslipidemia and osteoporosis. Her current medications are Metformin XR - 2000 mg PO daily, glipizide XL 20 mg daily, lisinopril 20 mg Po daily, Metoprolol XL 100 mg PO daily, aspirin 80 mg PO daily, alendronate 35 mg PO weekly.HER HbA1C is 8.2%, BP - 138/88 mmHg, LDL - 100 mg/dL. Which of the following medication will decrease the risk of death if added to her regimen.
Empagliflozin
AP is 82 year old female with very low bone density. Which of the following options improve bone density and reduce the risk of fracture. (Select all that apply)
Ensuring adequate calcium and vitamin D intake, Weight bearing exercise such as walking, Bisphophonates
A 58-year-old postmenopausal woman was sent for dual-energy x-ray absorptiometry to evaluate the bone mineral density of her lumbar spine, femoral neck, and total hip. The test results revealed significantly low bone mineral density in all sites. If this patient began oral therapy with alendronate, she would be advised to drink large quantities of water with the tablets and remain in an upright position for at least 30 min and until eating the first meal of the day. These instructions would be given to decrease the risk of which of the following?
Erosive esophagitis
One of the most powerful "high ceiling" diuretics that has a short duration of action, inhibits the Na/K/Cl transporter, and can block reabsorption of up to 30% of filtered sodium:
Ethacrynic acid
SJ is a 78-year-old man who was recently hospitalized for atrial fibrillation (AF) with rapid ventricular response secondary to pneumonia. Prior to admission, his medications included albuterol inhaler prn and aspirin 81 mg po daily. He is being discharged on two new medications, apixaban 5 mg po BID and metoprolol succinate 50 mg po daily. Which of the following side effects should SJ be counseled about regarding his new metoprolol? Select all that apply.
Fatigue, Bradycardia, Brochospasm, Hypoglycemic unawareness
A patient comes to ER with gall stones. He is on drugs to treat hyperlipidemia. Which of the following drug could have caused gall stone?
Fenofibrate
Ami is 18 year old female, 176 lbs diagnosed with Type 1 diabetes. She eats 3 meals per day. The physician writes a daily dose of 0.6 units/Kg/day of insulin. Using a basal bolus strategy, calculate the amount of Lantus and Humalog, Ami should take?
Lantus 24 units at bedtime and Humalog 8 units before meals
Which of the following drugs is very effective in ventricular arrhythmias but also could cause Proarrhythmia?
Flecainide
GV was brought to the emergency department for difficulty breathing and notable swelling of face, lips and tongue. His medical history is significant for diabetes and heart failure with reduced ejection fraction. He currently takes rosuvastatin, metformin, spironolactone, carvedilol, fosinopril, bumetanide, and digoxin. Which medication should be discontinued?
Fosinopril
A 68-year-old man with a history of chronic heart failure goes on vacation and abandons his low-salt diet. Three days later, he develops severe shortness of breath and is admitted to the local hospital emergency department with significant pulmonary edema. The first-line drug of choice in most cases of acute decompensation in patients with chronic heart failure is
Furosemide
A 62-year-old man with advanced prostate cancer is admitted to the emergency department with mental obtundation. An electrolyte panel shows a serum calcium of 16.5 (normal 8.5-10.5 mg/dL). Which of the following therapies would be most useful in the management of severe hypercalcemia?
Furosemide plus saline infusion
A patient with hypertension has been prescribed felodipine ER. Which of the following are possible side effects from the use of felodipine?
Gingival Hyperplasia
Which of the following regimens should be avoided in older adults with type 2 diabetes?
Glyburide
ER is a 72-year-old man who presents to clinic. He is currently on lisinopril 40 mg daily, HCTZ 25 mg daily, amlodipine 10 mg daily. His BP in clinic supports his elevated home readings, providing an average BP of 162/89 mm Hg. He is open to adding therapy in addition to altering his diet with reduced sodium intake (however, in discussion his diet seemed appropriate). You have agreed to start spironolactone 25 mg daily. What side effects do you educate the patient about?
Gynecomastia
KG is a 59-year-old postmenopausal woman who had her bone mineral density (BMD) of femoral neck checked and a T-score of -2.3. Her past medical history is unremarkable and she only takes a multivitamin with additional calcium and vitamin D. Her family history is remarkable for a mother who had osteoporosis and died of breast cancer. Which statement indicates the most appropriate management for the patient? Select all that apply.
KG may be a good candidate for risedronate 5 mg PO daily, KG may be a good candidate for raloxifene 60 mg PO daily, KG may be a good candidate for alendronate 70 mg PO weekly
VC comes to the clinic for a follow-up visit for his hypertension and diabetes management. He has been taking 4 medications to control his BP 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 effect?
Hydralazine
A 65-year-old African-American man has long-standing hypertension and moderate heart failure with reduced ejection fraction. His treatment has included furosemide plus digoxin but he continues to have symptoms of shortness of breath and easy fatigue. Which of the following combinations has been shown to be useful in this type of patient?
Hydralazine + isosorbide dinitrate
Which of the following medications are classified as direct vasodilators?
Hydralazine and Minoxidil
FS is a 50-year-old woman diagnosed with osteoporosis and hypertension. Which of the following antihypertensives is likely to help the FS's osteoporosis in addition to lowering her BP?
Hydrochlorthiazide
Which of the drug contributes to her lipid panel abnormalities?
Hydrochlorthiazide
Which of the following is a potassium losing diuretic?
Hydrochlorthiazide
Which of the following is an adverse drug reaction associated with the use of erythropoietin? Select all that apply.
Hypertension
Amiodarone shall be carefully prescribed to patients suffering from
Hyperthyroidism
Which of the following lab abnormalities increase the risk for digoxin toxicity?
Hypokalemia
Symptoms associated with nitrates
Hypotension, Headache
Chlorpropamide would be problematic in this case for which of the following reasons? I. Alcohol intake II. Sulfa allergy III. Asthma IV. Hypertension
I and II only
Insulin dosing is adjusted based on the following parameters: I. Liver function test results II. Dietary intake III. Physical activity/exercise IV. Blood glucose levels V. Ophthalmic examinations
II, III, IV only
J. T. is a 20-year-old male patient who is admitted to the hospital for diabetic ketoacidosis. He has a history of type 1 diabetes mellitus, and his family reports that he has gone without his prescription insulin for several days. He is nonresponsive and has an arterial pH of 6.9, so he is sent to the medical intensive care unit. Which of the following is the insulin formulation and route of choice for treating J. T.?
IV regular insulin
Which of the following are the mechanisms of action of metformin. Select all that apply.
Improving insulin sensitivity in muscle cells, Decreasing the amount of glucose released by the liver
A 54-year old airline pilot is admitted to the emergency department with chest pain and a rapid heart rhythm. The ECG shows an inferior myocardial infarction and ventricular tachycardia. Amiodarone is ordered. Amiodarone
Increase action potential duration
A 32 year old female patient has gone to to see her primary care physician. The doctor is looking at her blood work which includes the following parameters: Total cholesterol -202 mg/dL (normal -less than 200 mg/dL), HDL 52 mg/dL (normal -50 to 90) , LDL 130 mg/dL(normal under 110), TG 96 mg/dL (less than 150), BUN 18 mg/dL (normal-6 to 24) , SCr 0.8 mg/dL (normal -0.74 to 1.35) , and hCG +. Her BP is 168/102 mmHg. Which of the following medication can be safely
Labetolol
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglyceride are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. The patient is started on gemfibrozil. Which of the following is a major mechanism of gemfibrozil's action?
Increased triglyceride hydrolysis by lipoprotein lipase
Which of the following is a usual effect of niacin?
Increases HDL
A 54-year-old man is noted to have hyperlipidemia and is prescribed lovastatin. Lovastatin reduces plasma cholesterol by which of the following processes?
Inhibiting cholesterol biosynthesis
Aspirin should not be given when furosemide is prescribed because
Inhibits prostacyclin synthesis
Which of the following has a labeled indication for use in patients with type 1 diabetes?
Insulin glargine
Which insulin can be mixed with insulin glargine in one syringe in order to decrease daily insulin injections?
Insulin glargine cannot be mixed with any insulin in a given syringe/pen/insulin pump
Which of the following is a rapidly acting insulin
Insulin lispro
JS is an 18-year-old woman who presents to urgent care with a chief complaint of increasing fatigue that has gotten progressively worse over the past 2 months. Physical examination is notable for diffuse pallor and tachycardia. Her prior medical history is significant only for occasional reflux disease that she manages with over-the-counter (OTC) omeprazole and calcium carbonate. She also notes she has a history of heavy menstrual blood flow. Laboratory examination reveals a hemoglobin level of 9.4 g/dL and a mean corpuscular volume (MCV) of 73 fL. Based on the information provided, JS most likely has anemia as a result in deficiency of
Iron
FS presents to the pharmacy with a new prescription for sildenafil (PDE-V inhibitor). He currently takes the following medications: Amlodipine Benazepril Chlorthalidone Clopidogrel Isosorbide mononitrate Levothyroxine Metformin Metoprolol tartrate Rosuvastatin Sildenafil is contraindicated within 24 hours with which FS's medications?
Isosorbide mononitrate
Select the correct mechanism of action of cholestyramine
It binds to bile acids in the gut
Which statement concerning miglitol is correct?
It is an alpha-glucosidase inhibitor
SP is a 71-year-old Caucasian woman who was recently diagnosed with osteoporosis. She has a past medical history significant for Paget disease, hypertension, and diabetes. She is currently on metformin, lisinopril, and calcium supplementation. Her physician is considering starting teriparatide therapy. Identify the correct statement regarding teriparatide for the treatment of osteoporosis in this patient.
It is contraindicated in a patient with Paget
Which of the following statements regarding hypertensive urgency are correct?
It is extremely high BP in the absence of acute end-organ dysfunction E. Acute, progressive end-organ dysfunction is present due to severely elevated BP
A 60-year-old woman comes to the emergency department with atypical chest pain. Her ECG reveals ventricular tachycardia with rare normal sinus beats, and ST-segment elevation. Troponin C levels are markedly increased, suggesting myocardial damage. A diagnosis of myocardial infarction is made, and the woman is admitted to the cardiac intensive care unit. Her arrhythmia will probably be treated initially with
Lidocaine
Which medication is used only IV for treating arrhythmias?
Lidocaine
Which of the following antiarrhythmic drugs is preferred in a patient with a baseline prolonged QT interval?
Lidocaine
A pharmacist is counseling a patient Niacin ER. He asks him to consult the doctor right away if passing brown dark colored urine, feels fatigue more than normal, his skin or white of the eyes become yellow. These symptoms are associated with:
Liver failure
LJ is a 38-year-old woman who recently underwent gastric resection for the management of extreme obesity that was complicated by hypertension and type 2 diabetes. Twelve weeks after her surgery she is complaining of fatigue and become short of breath when climbing steps. Laboratory evaluation revealed a hemoglobin level of 10.2 g/dL and an MCV of 120 fL. LJs anemia is best described as:
Macrocytic anemia due to deficiency of intrinsic factor
Tolerance developed by organic nitrates can be eliminated by
Maintaining nitrate free intervals
Which of the following diuretics would be most useful in the acute treatment of a comatose patient with traumatic brain injury and cerebral edema?
Mannitol
Which type of drug can pull water out of cells all over the body?
Mannitol
Cardioselective beta blocker is
Metaprolol
A patient with diabetes, hypertension and peptic ulcer disease is on aspirin, glyburide, enalapril, metoprolol, chlorthalidone and famotidine. Which of the patients medication may block signs and symptoms of hypoglycemia?
Metoprolol
Which of the following are well established side effects of amiodarone therapy?
Microdeposits in the cornea, Photosensitivity, Hypothyroidism
Which one the following is not centrally acting antihypertensive:
Minoxidil
A 43-year-old man has heterozygous familial hypercholesterolemia. His serum concentrations of total cholesterol and LDL are markedly elevated. His serum concentration of HDL cholesterol, VLDL cholesterol, and triglycerides are normal or slightly elevated. The patient's mother and older brother died of myocardial infarctions before the age of 50. This patient recently experienced mild chest pain when walking upstairs and has been diagnosed as having angina of effort. The patient is somewhat overweight. He drinks alcohol most evenings and smokes about 1 pack of cigarettes per week. If the patient has a history of gout, which of the following drugs is most likely to exacerbate this condition?
Niacin
Patient JW is a 30-year-old female patient who presents at the clinic with fatigue, pallor, and paresthesia in extremities. She was diagnosed with general anxiety disorder and heartburn and has been a strict vegan for the last five years. Her current medication regiment is fluoxetine 20mg daily, and Tums as needed. Her lab results are shown below with normal values in parentheses.
Patient by labs has macrocytic anemia, Patient is at risk for pernicious anemia
Which of the following drug belongs to the DHP category?
Nifedipine
Which medication is considered first-line treatment of hypertension in pregnancy?
Nifedipine ER
A 45-year-old woman with hyperlipidemia and frequent migraine headaches develops angina of effort. Which of the following is relatively contraindicated because of her migraines?
Nitroglycerin
Preferred for acute management of angina
Nitroglycerin
Which of the following insulins would be best for controlling elevated postprandial blood glucose levels?
Novolog-Insulin Aspart
Which of the following drugs can cause sprue-like enteropathy?
Olmesartan
Vitamin B12 supplementation is available by which of the following routes? Select all that apply.
Oral, Injectable, Intranasal
A patient is picking a new prescription for sitagliptin. Which of the following risks should be discussed with the patient.
Pancreatitis
Adenosine is used to treat what type of arrhythmia?
Paroxysmal supraventricular tachycardia
Which of the following best describes the mechanism of action of erythropoietin in patients with anemia secondary to chronic kidney disease (CKD)?
Pharmaceutical erythropoietin compensates for decreased renal production of endogenous erythropoietin that results from CKD
SC has a past medical history of hypertension and chronic kidney disease. Her daily medication include atenolol, prednisone, famotidine, calcium, vitamin D and ibuprofen. For the past 3 days, she has been taking OTC cold medicine that contains acetaminophen, phenyl ephrine and guaifenesin. Which of SC's medications can worsen her blood pressure control?
Phenylephrine, Prednisone, Ibuprofen
Which of the following beta-blockers has intrinsic sympathomimetic activity (ISA)?
Pindolol
JO takes several medications to treat his NYHA Class III heart failure and diabetes. His daily regimen consists of irbesartan, carvedilol, furosemide, spironolactone, glimepiride, and metformin. His renal clearance is 34 mL/min. The potassium level is 4.3 mEq/L. Which medication should be avoided if further treatment is required for JO's diabetes.
Pioglitazone
Your patient, who is 55-years-old, is prescribed to take Digoxin. Which of the following finding, requires you to hold the dose of Digoxin and notify the physician? A. Digoxin level of 1.2 ng/mL B. Blood glucose 82 C. Heart rate 61 bpm D. Potassium 2.8 mEq/L
Potassium 2.8 mEq/L
Alfie is 45-year-old male patient who is newly diagnosed with diabetes with an A1c value of 8.1% which is down from 6 weeks ago. Despite improvements in lifestyle choices, he has met the diagnosis for diabetes. As the clinical pharmacist in charge of the diabetes management clinic, you provide him options of lifestyle, medications, or both. At this time, he would like to start a drug therapy in addition to more stringent lifestyle modifications. Which drug therapy would be the best for Alfie to trial?
Pramlintide subcutaneously 15 μg twice daily, Metformin 500 mg daily by mouth with an upward titration to 2000 mg/d
A 58-year-old postmenopausal woman was sent for dual-energy x-ray absorptiometry to evaluate the bone mineral density of her lumbar spine, femoral neck, and total hip. The test results revealed significantly low bone mineral density in all sites. Chronic use of which of the following medications is most likely to have contributed to this woman's osteoporosis?
Prednisone
Which angina is mainly associated with coronary artery spasm
Prinzmetal Angina
What is the clinical term for angina caused by coronary vasospasm?
Prinzmetal angina
Which of the following drugs are associated with drug-induced lupus erythematosus? A. Procainamide B. Flecainide C. Quinidine D. Disopyramide E. Dofetilide F. Mexiletine
Procainamide, Quinidine
Rank the following in order from class I antiarrhythmic to class IV antiarrhythmic. A. Dofetilide B. Diltiazem C. Metoprolol D. Procainamide
Procainamide, metoprolol, dofetilide, diltiazem
Which of the following is a warning for ranolazine
QT prolongation
MJ is a 52-year old man with paroxysmal atrial fibrillation, hypertension and dyslipidemia. He presents to the pharmacy complaining of ringing in the ears, blurred vision and confusion. Which antiarrhythmic most likely causes his symptoms?
Quinidine
Identify the antiresorptive agent that would be contraindicated in a pregnant patient
Raloxifene
SL is a 57-year-old man who is admitted to the hospital for pneumonia. During his clinical and laboratory evaluation he was found to have a microcytic anemia. Which of the following additional diagnostic tests would be most useful in determining if SL has anemia as a result of iron deficiency
Red cell distribution width
CE is a 72-year-old man with no clinical atherosclerotic cardiovascular disease (ASCVD), no diabetes, and a 10-year ASCVD risk of 12%. Which of the following is recommended for this patient?
Rosuvastatin 10 mg daily
Which of the following drugs increases the plasma levels of endogenous BNP and is combined with another agent that blocks angiotensin receptors?
Sacubitril
A patient has been using calcium citrate 315 mg elemental calcium/tablet for many years. She takes 4 tablets with breakfast.She does not consume dairy products or much in the way of vegetables. Which statement is correct.
She should separate the doses (2 tablets twice daily) as absorption is saturable above 600 mg of elemental calcium
Certain drugs can cause severe hypotension when combined with nitrates. Which of the following interacts with nitroglycerin by inhibiting the metabolism of cGMP?
Sildenafil
EP is a 56-year-old patient who has had diabetes for the past 5 years. Her A1c is currently uncontrolled at 7.3%. The patient is adherent to metformin 1000 mg twice daily. Her past medical history is significant for thyroid cancer and recurrent genital urinary infections. She states she is not ready to start insulin, but has heard about newer drug therapies that help limit weight gain or actually cause weight loss. Based on EP's profile, which of the agents would be able to obtain an A1c goal of less than 7% with limited side effects projected to occur?
Sitagliptin
Which of the following parameters are required to calculate ASCVD risk?
Smoking, Total cholesterol, Diabetes, HDL, Systolic BP
Side effects for this particular diuretic include hyperkalemic metabolic acidosis &gynecomastia
Spiranolactone
Which of the following statement is false?
Spiranolactone and amiloride cause potassium excretion by same mechanism
A 72-year-old woman has long-standing heart failure. Which one of the following drugs has been shown to reduce mortality in chronic heart failure?
Spironolactone
Which of the following is true regarding the action of insulin?
Stimulates glucose uptake in the periphery
Which of the following is the mechanism of action (MOA) for the sulfonylureas?
Stimulates pancreatic beta cells to secrete insulin
Chronic atrial fibrillation increases the risk of which of the following conditions?
Stroke
A 59-year-old female was referred to your clinic for evaluation of osteopenia. She was diagnosed with adult-onset cystic fibrosis (CF). She reported being treated with prednisone 2 times in the past for CF exacerbations. Since menopause at 52 years of age, she had been treated with raloxifene for osteoporosis prevention. She also was on daily calcium and vitamin D supplementation. Her bone mineral density test revealed a T score of -1.6 at the lumbar spine, -2.2 at the left femoral neck, and -1.6 at the total left hip. Which of the following drugs can be used to reduce the fracture risk by further stimulating bone formation in this patient?
Teriparatide
Which of the following is true regarding the use of combination treatment with an angiotensin converting enzyme inhibitor (ACEI) and an angiotensin receptor blocker (ARB) for the treatment of hypertension?
The combination increases the risk of hyperkalemia.
A patient with atrial fibrillation is currently taking aspirin, verapamil, metoprolol, and digoxin. The physician wants to start the patient on simvastatin. Which of the following statements are correct regarding drug interactions in this patient?
The maximum dose of simvastatin is 10 mg due to its interaction with verapamil
Which of the following information about Folic acid is NOT TRUE?
The recommended daily allowance is 400 mg per day.
A patient with severe systolic heart failure (very low ejection fraction) and subsequent decreased renal function &low GFR may sometimes fail to respond to a loop diuretic alone (a situation commonly refered to as diuretic resistance). In this case, adding an additional diuretic that acts on an different portion of the nephron can produce a more potent diuresis. The class of diuretic that can be added to a loop diuretic to produce a more potent diuresis is:
Thiazide
Choose the correct statement regarding clevidipine:
This lipid emulsion, It is a DHP CCB
A 58-year-old woman with lung cancer has abnormally low serum osmolality and hyponatremia. A drug that increases the formation of dilute urine and is used to treat SIADH is
Tolvaptan
Acts on the collecting duct and can block reabsorption of only 3% of filtered sodium.
Triamterene
Which of the following statement is correct regarding nitroglycerin ointment?
Use the dose-measuring applicator to measure and apply the medication
A 57-year-old woman presents to her primary care physician with a complaint of severe chest pain when she walks uphill in cold weather. The pain disappears when she rests. She has a 40-pack-year history of smoking but her plasma lipids are within the normal range. After evaluation and discussion of treatment options, a decision is made to treat her with nitroglycerin. One year later, the patient returns complaining that her nitroglycerin works well when she takes it for an acute attack but that she is now having more frequent attacks and would like something to prevent them. Useful drugs for the prophylaxis of angina of effort include
Verapamil
Calcium channel blocker associated with predominant cardiac effects
Verapamil
JF has systolic heart failure with an ejection fraction of 33%. Which of the following medications could potentially worsen his heart failure?
Verapamil
Deficiency in which of the following can result in severe neurologic complications?
Vitamin B12
Long term use of Metformin can result in:
Vitamin B12 deficiency
Physiological effect of low dose nitrates
arteriolar dilation
A 50-year-old man has a history of frequent episodes of renal colic with calcium containing renal stones. A careful workup indicates that he has a defect in proximal tubular calcium reabsorption, which results in high concentrations of calcium salts in the tubular urine. The most useful diuretic agent in the treatment of recurrent calcium stones is
chlorthalidone
Mechanism of action of antianginal effect of beta blockers
decrease blood pressure during exercise
DM is a 62 year old African-American man who has had poorly controlled hypertension for the past 10 years, and now presents with signs of ankle edema, a low GFR and a serum creatinine of 2.5 mg/dL. The most effective drug for producing a diuresis and fall in blood pressure in DM is:
furosemide
A diuretic used for treatment of hypertension &heart failure that can decrease glucose tolerance, produce hypokalemia (in high doses), aggrevate gout by interfering with uric acid secretion, and produce a small rise in LDL.
hydrochlorthiazide
BP is picking up a new prescription for repaglinide. What is a possible side effect of this medication
hypoglycemia
Which of the following IV iron preparation has the highest risk for anaphylaxis and requires a test dose prior to administration
iron dextran
A 63 yo woman with exertional angina is taking atenolol (Tenormin) 100 mg qd for management of her angina. While the drug appears to be effective in reducing her heart rate, it has not provided an adequate change in her double product (heart rate x systolic blood pressure) at the time of onset of anginal pain during a treadmill test. A second drug that could be added to her drug regimen that could improve her treadmill performance would be:
isosorbide dinitrate
Which of the following is a potentially fatal adverse drug event of Metformin?
lactic acidosis
What advantage does darbepoetin have over epoetin alpha?
longer half life
Which of the following medication is best chosen for monotherapy to improve glycemic control in a patient with diabetes who is over weight, concerned about weight gain, and prone to hypoglycemia?
metformin
A class of antianginal medications with multiple mechanisms of action that include: decreased preload, decreased oxygen demand, decreased afterload (at high doses), and increased myocardial oxygen delivery by dilating large epicardial arteries.
nitrates
A 60-year-old Caucasian woman experiences progressive dyspnea while traveling from New Orleans to Washington, DC by airplane (nonstop). You are asked to examine her, and you make the diagnosis of acute pulmonary edema. The flight attendant brings an oxygen tank and a nasal cannula to provide supportive therapy, and you take off your tie and summon other passengers to do the same to apply rotating tourniquets to the patient's extremities. You then ask the other passengers if they carry which of the following drugs with them, with hope of inducing peripheral venous pooling and reducing cardiac preload in this patient?
nitroglycerin
Which of the following medications on the medication list, in this case, can mask the symptoms of hypoglycemia?
propranolol
