Pharmacology Block 3

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Which of the following antihypertensive drugs is most likely to cause tachycardia? a. clonidine (Catapres®) b. captopril (Capoten®) c. hydralazine (Apresoline®) d. propranolol (Inderal®) e. reserpine

C. Calcium channel blockers

Which of the following classes of drugs is NOT typically used to treat heart failure? A. Diuretics B. ACE inhibitors C. Calcium channel blockers D. Beta blockers

Which of the following describes the mechanism of action of milrinone in HF? a. Increases cardiac contractility b. Decreases intracellular calcium c. Activates phosphodiesterase d. Decreases cAMP

Which of the following diabetes drugs would be of least concern about causing hypoglycemia in your patients? a. glyburide b. insulin glargine c. metformin d. nateglinide

Which of the following diabetes medications is most appropriately paired with an adverse effect associated with its use? a. Glipizide—weight loss b. Liraglutide—lactic acidosis c. Canagliflozin—urinary tract d. infections e. Nateglinide—heart failure

Which of the following drugs binds bile acids in the intestine, thus preventing their return to the liver via the enterohepatic circulation? a. Fenofibrate b. Cholestyramine c. Fluvastatin d. Niacin

Which of the following drugs decreases cholesterol synthesis by inhibiting the enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase? a. Gemfibrozil b. Cholestyramine c. Fenofibrate d. Lovastatin

Which of the following drugs for diabetes is LEAST likely to cause weight gain? a. Pioglitazone b. Insulin glulisine c. Repaglinide d. Liraglutide

Which of the following drugs is used by the oral route, blocks sodium channels, and decreases action potential duration in ischemic tissue? A.Amiodarone B.Esmolol C.Flecainide D.Lidocaine E.Mexilitine

C. Cholestyramine

Which of the following drugs lowers cholesterol levels by binding bile acids in the intestine and preventing their return to the liver via the enterohepatic circulation? A. Niacin B. Alirocumab C. Cholestyramine D. Ezetimibe

A 15-year-old boy who has diabetes and is insulin dependent is brought to the emergency department after collapsing at a baseball game. His blood sugar is 763 mg/dL by finger stick. Which of the following routes of administration would be most efficacious for medications to bring the blood sugar down? a. Sublingual b. Subcutaneous c. Intramuscular d. Intravenous e. Oral

The degree to which the heart fibers are stretched just prior to contraction is known as: a. afterload b. cardiac output c. dosewallips d. preload

which of the following is a drug used in the treatment of systolic heart failure that shifts the Frank Starling curve upwards and to the left by inhibiting the cardiac Na/K pump? a. captopril b. clonidine c. digoxin d. furosemide e. nifedipine

An 83-year-old man with diabetes on basal-bolus insulin therapy is being prescribed a β-blocker for his angina. Which of the following is correct for this patient? An alternative should be prescribed because β-blockers are contraindicated in patients with diabetes. β-Blockers can blunt hypoglycemia awareness. Diaphoresis may become his primary alert symptom of hypoglycemia. He may experience symptoms of hypoglycemia even with normal blood glucose levels due to the effect of the β-blocker on adrenergic receptors. He will need to reduce his insulin dose because β-blockers can cause hypoglycemia.

β-Blockers can blunt hypoglycemia awareness. Diaphoresis may become his primary alert symptom of hypoglycemia.

Which of the following is correct regarding antianginal therapy in patients with heart failure with reduced ejection fraction? Nondihydropyridine calcium channel blockers should be used in patients with heart failure with reduced ejection fraction who cannot tolerate β-blockers. β-Blockers with ISA are preferred over those without ISA. Dihydropyridine calcium channel blockers should be avoided. β-Blockers have been associated with reduced mortality.

β-Blockers have been associated with reduced mortality.

β-Blockers improve cardiac function in HF by a. increasing heart rate b. decreasing cardiac remodeling c. activating norepinephrine d. increasing renin release

e. hydrochorothiazide (Hydrodiuril®)

18. M.A. is a 58-year-old man who is admitted to the Medicine service withhypertension andacute renal insufficiency with a GFR of 25 ml/min. Blood pressure is 158/92 mmHg. Whichantihypertensive diuretic agent would most likely be ineffective in thispatient? a. spironolactone (Aldactone®) b. mannitol c. furosemide (Lasix®) d. amiloride (Midamor®) e. hydrochorothiazide (Hydrodiuril®)

b. eplerenone (Inspra®)

19. A hypertensive, asthmatic male patient presented initially with a serum potassium of 3.2mEq/dL on a regimen of hydrochlorothiazide (Hydrodiuril®). He responded well to treatment with spironolactone (Aldactone®), but returned complaining of swelling in the pectoral region. The best alternative for this patient is to switch his therapy to a. a return to hydrochlorothiazide (Hydrodiuril®). b. eplerenone (Inspra®) c. labetalol (Normodyne®). d. prazosin (Minipress®). e. minoxidil (Loniten®).

A 55yr old male patient visits your clinic for a root canal treatment. History reveals that he is taking anticoagulants for heart condition and you decide not to perform operation since anticoagulant medication can contribute to severe uncontrolled bleeding. What type of arrhythmia does this patient is suffering from? A. Atrial fibrillation B. Sinus arrhythmia C. Ventricular tachycardia D. Long QT syndrome

b. eplerenone

28. Each of the following drugs interferes with some aspect of therenin/angiotensin cascade. Which drug, when given alone, is likely to lead todevelopment of plasma potassium level of 5.0 mEq/L on a normal sodium intake? a. enalapril b. eplerenone c. metoprolol d. losartan e. aliskiren

e. clonidine (Catapres®)

31. Of the following, administration of which antihypertensive agent is most likely to result in a high incidence of male sexual dysfunction? a. enalapril (Vasotec®) b. metoprolol (Lopressor®) c. pindolol (Visken®) d. prazosin (Minipress®) e. clonidine (Catapres®)

B. Metoprolol

A 66-yr old man had a myocardial infarct. Which one of the following would be appropriate prophylactic antiarrhythmic therapy? A. Lidocaine B. Metoprolol C. Procainamide D. Quinidine E. Verapamil

A. Gastric retention

56-year-old male with insulin-dependent diabetes and with poorly controlled blood sugar is on regular insulin. His primary care physician adds pramlintide to his regimen in an effort to further reduce his blood sugar levels. An important condition to rule out in this patient would be which of the following? A. Gastric retention B. Acute-angle glaucoma C. Wide-angle glaucoma D. Pneumonia E. Migraines

e. minoxidil (Loniten®)

A 30-year old woman has very severe hypertension. Her physician has prescribed a drug that is associated with tachycardia and fluid retention (which may be marked) and increased hair growth. Which of the following is most likely to be that drug? a. diazoxide (Hyperstat®) b. enalapril (Vasotec®) c. hydralazine (Apresoline®) d. clonidine (Catapres®) e. minoxidil (Loniten®)

A 33-year old African American woman with a BMI of 40 and a fasting blood glucose of 205 mg/dL has been documented with blood pressures in the range of 150-155/95-99 mm Hg in her last three clinic visits. The most logical agent for monotherapy in this patient is: a. hydrochlorothiazide (Hydrodiuril®). b. metoprolol tartrate (Lopressor®). c. esmolol (Brevibloc®). d. spironolactone (Aldactone®). e. isosorbide dinitrate/hydralazine HCl (BiDil®)

A 36-year-old man who is obese with a history of mildly elevated serum glucose levels (range from 110 to 118 mg/ dL) presents to his primary care physician for follow-up. Physical examination of the heart, lungs, and abdomen are within normal limits. Which of the following strategies will cause the lowest improvement in serum glucose in this patient? A.Corrective glasses B.Diet modification C.Exercise D.Weight loss

A 37-year-old woman with diabetes is brought to the emergency department unresponsive by her husband. She recently started taking a new medication to control her blood sugar, but her husband could not remember the name of it. Her blood sugar is 45 mg/ dL. Which of the following diabetes medications is most likely for her condition? A.Acarbose B.Glipizide C.Metformin D.Pramlintide E.Sitagliptin

A 37-year-old woman with diabetes is brought to the emergency department unresponsive by her husband. She recently started taking a new medication to control her blood sugar, but her husband could not remember the name of it. Her blood sugar is 45 mg/ dL. Which of the following diabetes medications is the most likely cause of her condition? a. Sitagliptin b. Glipizide c. Acarbose d. Metformin e. Pramlintide

A 39-year-old man with insulin-dependent diabetes mellitus is brought to the emergency department after collapsing in a shopping mall. His blood sugar is 589 mg/ dL. Which of the following preparations would have the least effect on his blood sugar levels? A.Insulin aspart B.Insulin glargine C.Insulin lispro D.Regular insulin

A 39-year-old man with insulin-dependent diabetes mellitus is brought to the emergency department after collapsing in a shopping mall. His blood sugar is 589 mg/dL. Which of the following drugs would have the least rapid effect on his blood sugar levels and would likely not be used to treat him? a. Insulin aspart b. Insulin detemir c. Insulin lispro

c. amiloride (Midamor®)

A 40 yo woman is being treated with hydrochlorothiazide (Hydrodiuril) forStage 1essential hypertension and presents to her family physician with malaise, fatigue, muscular weakness and muscle cramps. Laboratory values on drawn blood reveal elevatedcreatinine, uric acid and reduced potassium concentrations. Which of the following interventions or drug regimens would be MOST harmful in this patient? a. potassium supplementation b. eplerenone (Inspra®) c. amiloride (Midamor®) d. replacement of hydrochlorothiazide with a higher dose of thethiazide, chlorthalidone (Thalitone®) e. reduced dosage of hydrochlorothiazide

A 42-year-old man was started on sustained-release niacin 2 weeks ago. He reports uncomfortable flushing and itchiness that he thinks is related to the niacin. Which of the following can help manage this adverse effect of niacin therapy? a. Administer aspirin 30 minutes after taking niacin. b. Change the sustained-release niacin to immediate-release niacin. c. Increase the dose of niacin. d. Administer aspirin 30 minutes prior to taking niacin.

a or d

A 43-year-old woman with Type-2 diabetes has been taking insulin with meals as well as metformin. Her blood glucose remains poorly controlled. Her doctor prescribes an additional drug, which is an analog of an endogenous peptide that inhibits glucagon secretion. What is the most likely medication this patient is taking? A.Exenatide B.Glipizide C.Miglitol D.Pramlintide E.Rosiglitazone

A 45 year old female has elevated lipid levels and is taking atorvastatin daily. Her total cholesterol levels dropped significantly over the 6 months she had been on the drug. Being aware that weight loss and a healthy diet would also help her dyslipdemia, she started a "grapefruit juice diet" in which she would daily replace one of her meals with the consumption of 1-liter of fresh-squeezed grapefruit juice instead.. Her diet was working as she lost 5 pounds in one month. However, she noticed that her muscles were often sore and she felt pronounced muscle weakness. Her physician might decide to switch her to which of the following drugs that acts by inhibiting the degradation of LDL receptors? a. pravastatin b. gemfibrozil c. a PCSK9 inhibitor d. ezetemibe

A 45 year old female has elevated lipid levels and is taking atorvastatin daily. Her total cholesterol levels dropped significantly over the 6 months she had been on the drug. Being aware that weight loss and a healthy diet would also help her dyslipdemia, she started a "grapefruit juice diet" in which she would daily replace one of her meals with the consumption of 1-liter of fresh-squeezed grapefruit juice instead.. Her diet was working as she lost 5 pounds in one month. However, she noticed that her muscles were often sore and she felt pronounced muscle weakness. What is the reason for her adverse symptoms? a. She has not been compliant with her medication. b. She has an allergy to grapefruit juice. c. Grapefruit juice inhibited metabolism/biotransformation of atorvastatin. d. She had lost too much weight in too short of a period.

A 45 year old female has elevated lipid levels and is taking atorvastatin daily. Her total cholesterol levels dropped significantly over the 6 months she had been on the drug. Being aware that weight loss and a healthy diet would also help her dyslipdemia, she started a "grapefruit juice diet" in which she would daily replace one of her meals with the consumption of 1-liter of fresh-squeezed grapefruit juice instead.. Her diet was working as she lost 5 pounds in one month. However, she noticed that her muscles were often sore and she felt pronounced muscle weakness. What is the reason for her adverse symptoms? a. She had lost too much weight in too short of a period. b. She has not been compliant with her medication. c. Grapefruit juice inhibited metabolism/biotransformation of atorvastatin. d. She has an allergy to grapefruit juice.

A 45-year-old man with insulin-dependent diabetes mellitus on insulin injection decides that he wants to "drink" the insulin instead of taking the injectable form. He is tired of the pain he gets during the injections and the inconvenience of the process. Which of the following is the most likely consequence of this action?a.Persistent hyperglycemia b. Diarrhea c. Nausea d. Uremia e. Transient ischemic attack

A 47-year-old woman presents to the clinic for her annual visit. Her last fasting blood glucose on her last visit showed she has borderline diabetes. She tried to make lifestyle changes to improve her blood sugars. However, her fasting blood glucose is 215 mg/ dL this year. She is started on metformin and encouraged to live a healthier lifestyle. What is a common side effect associated with metformin? a. Pancreatitis b. Diarrhea c. Weight gain d. Hypoglycemia

a. pre-existing severe renal artery stenosis

A 48-year-old woman experiences an acute renal failure with increased serum creatinine, BUN and a marked fall in urine output shortly after initiating therapy with lisinopril(Prinivil®). What was the most likely cause for the renal failure? a. pre-existing severe renal artery stenosis b. pre-eclampsia c. "first-dose" hypotension d. pre-existing hyperaldosteronism e. acute blockade of efferent glomerular arteriolar angiotensin IIreceptors

A 50-year old hypertensive man presents in the Emergency Department complaining of a "foreign-body" sensation in his throat. Moderate pharyngeal edema is present, but no wheezing and the patient is in no apparent distress. The patient is taking a single, longacting antihypertensive. Epinephrine (0.3 mL, 1:1000, s.c.) and diphenhydramine (50 mg, i.m.) are given. Within 10 min. a severe headache had developed, blood pressure had increased to 230/124 mm Hg and heart rate slowed to 38 beats/min. With no further treatment, cardiovascular values returned to normal over the next hour. The antihypertensive agent taken by this patient was most likely to be: a. eplerenone. b. propranolol. c. captopril. d. prazosin. e. nifedipine.

A 50-year-old woman has been taking pravastatin for hypercholesterolemia for the past 12 months. Although she reports of â€œwatching what she eats, exercising regularly, and faithfully taking her medicationâ€, there has been only a modest reduction in LDL-cholesterol over that time. If this patient's physician were to prescribe a second drug, the one expected to cause the greatest additional reduction in plasma LDL-cholesterol would act primarily by inhibiting a. LDL receptor degradation. b. triglyceride hydrolysis. c. apoprotein B100 synthesis. d. cholesterol absorption.

A 54 year-old woman comes to her follow up visit. She has Type 2 diabetes treated with metformin. Her main concern during her visit is her inability to lose weight. Her weight is 230 lb, BMI 42. Her HbA1c is 8.1%. She has no known microvascular or macrovascular complications. She has no other co-morbidities. You decide to start a second agent. Which medication from the following list will you consider as first option given her interest in weight loss? a. Glipizide b. Liraglutide c. Pioglitazone d. Insulin glargine

A 55-year-old Caucasian man consistently exhibits systolic blood pressures in the low 130s and diastolics in the high 80s. No abnormalities are noted on ECG. He is >40 lbs overweight, sedentary and consumes an "average of 3 six-packs" of regular beer/week. He cannot relate a family medical history except to say that both parents died suddenly before the age of sixty. Current recommendations suggest that to best manage cardiovascular risk in this patient, you should: a. immediately hospitalize for complete, invasive cardiac workup. b. initiate two-drug antihypertensive therapy for Stage II hypertension. c. recommend/assist compliance with life-style modifications for 6-12 months. d. indicate that moderate ethanol intake enhances cardiovascular health. e. immediately begin therapy with maximal doses of a diuretic or â-adrenoceptor antagonist.

Calcium channel blocker(s) most likely to affect myocardial contractility and AV conduction: A. Nifedipine (Procardia, Adalat) B. Nicardipine (Cardene) C. Diltiazem (Cardiazem)

A 55yr old male patient visits your clinic for a root canal treatment. History reveals that he is taking anticoagulants for his heart condition. You decide not to perform the operation since anticoagulant medications can contribute to severe, uncontrolled bleeding. What type of arrhythmia is this patient is suffering from? a. Atrial fibrillation b. Sinus arrhythmia c. Ventricular tachycardia d. Long QT syndrome

A. amylin

A 56-year-old male with insulin-dependent diabetes and with poorly controlled blood sugar is on regular insulin. His primary care physician adds pramlintide to his regimen in an effort to further reduce his blood sugar levels. Pramlintide is an analog of A. amylin B. insulin C. glucagon D. C-peptide E. None of the above

A 58-year-old male with a long-standing history of hypertension for which he takes aspirin and verapamil reports for his annual wellness exam. On exam, there is no shortness of breath, dizziness or chest pain. Blood pressure is 142/96 mm Hg, and pulse is 71. Waist circumference is 38 inches. Labs include: total cholesterol, 266 mg/dL; triglyceride, 345 mg/dL; LDL cholesterol, 195 mg/dL and HDL, 24 mg/dL. Other results are within normal limits. Of the following agents, the drug which you should expect to be the first choice drug for lowering both plasma LDL-cholesterol and triglyceride concentrations in this patient is? a. cholestyramine. b. ezetimibe. c. gemfibrozil. d. pravastatin.

A 58-year-old man is diagnosed with mixed dyslipidemia characterized by moderately high LDL-cholesterol and triglyceride and low HDL. He is advised of making life style changes and prescribed a drug. Shortly after he complains of itching and flushing. The prescribed drug that MOST likely caused these symptoms is a. pravastatin. b. gemfibrozil. c. cholestyramine. d. evolocumab. e. niacin.

A 58-year-old man is diagnosed with mixed dyslipidemia characterized by moderately high LDL-cholesterol and triglyceride and low HDL. He is advised of making life style changes and prescribed a drug. Shortly after this, he complains of itching and flushing. The prescribed drug that MOST likely caused these symptoms is a. cholestyramine. b. evolocumab. c. gemfibrozil. d. niacin. e. pravastatin.

A 58-year-old woman was prescribed an agent to provide prophylaxis against migraine headaches. She was referred to you from her dentist for gingival hyperplasia. On examination, she is found to have a resting heart rate of 115 beats/min, seated blood pressure of 118/78 mm Hg. In addition, she complains of constipation. With which of the following drugs is she being treated? a. verapamil b. diltiazem c. metoprolol d. hydralazine e. amlodipine

A 60 yo woman with a history of smoking presents with the chief complaint of chest pain that occurs at night while at rest. A treadmill test is negative. A 24 hr holter recording reveals transient ST elevation and AV block (suggestive of occlusion of her right coronary artery) that are temporaly associated with anginal attacks. A coronary angiography with provocative testing with acetylcholine injection reproduces her chest pain & ECG changes. Which drug will be contraindicated in her treatment? a. verapamil b. nitroglycerin sublingually c. metoprolol d. isosorbide dinitrate e. diltiazem

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? a. digoxin b. hydralazine c. nitroglycerin d. propranolol e. verapamil

A 62-year-old female with hyperlipidemia and hypothyroidism is prescribed cholestyramine and levothyroxine (thyroid hormone). What advice would you give this patient to avoid a drug interaction between her cholestyramine and levothyroxine? a. Switch cholestyramine to colesevelam as this eliminates the interaction. b. Stop taking the levothyroxine as it can interact with cholestyramine. c. Take levothyroxine 1 hour before cholestyramine on an empty stomach. d. Switch cholestyramine to colestipol as this eliminates the interaction

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: a. verapamil b. sublingual nitroglycerin c. oral nitroglycerin d. nitroglycerin patch e. metoprolol

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: a. isosorbide dinitrate b. glucagon c. clopidogrel d. atropine e. aspirin

A 64-year-old woman with a history of type 2 diabetes is diagnosed with heart failure. Which of the following medications would be a poor choice for controlling her diabetes? a. Pioglitazone b. Exenatide c. Glyburide d. Insulin

A 65-year-old man has type 2 diabetes mellitus and an LDL-C of 165 mg/dL. Which is the best option to lower LDL-C and decrease the risk of ASCVD events in this patient? a. Ezetimibe b. Fenofibrate c. Colesevelam d. Rosuvastatin

A 65-year-old man with non- insulin-dependent diabetes mellitus presents to his primary care physician for follow-up. He is currently managed with glyburide. His weight has increased from a baseline of 195 lb to 230 lb during the past year. He walks approximately 30 min every other day throughout the year and eats three balanced meals per day. What is the most likely explanation for these findings? A.Lack of physical exercise B.Lack of proper diet C.Medication side effect D.Underlying hyperthyroidism E.Underlying malignancy

A 65-year-old man with non- insulin-dependent diabetes mellitus presents to his primary care physician for follow-up. He is currently managed with glyburide. His weight has increased from a baseline of 195 lb to 230 lb during the past year. He walks approximately 30 min every other day throughout the year and eats three balanced meals per day. What is the most likely explanation for these findings? a. Underlying hyperthyroidism b. Lack of proper diet c. Lack of physical exercise d. Medication side effect e. Underlying malignancy

A 70-year-old woman has HFrEF and hypertension. She takes lisinopril and metoprolol tartrate. She feels well and has no cough, shortness of breath, or edema. Which of the following changes is most appropriate for her drug therapy? a. Change lisinopril to losartan. b. Initiate digoxin. c. Initiate ivabradine. d. Change metoprolol tartrate to metoprolol succinate

A 72-year-old man with hyperlipidemia and renal insufficiency has been treated with high-intensity atorvastatin for 6 months. His LDL-C is 131 mg/dL; triglycerides, 710 mg/dL; and HDL-C, 32 mg/dL. His physician wishes to add another agent for hyperlipidemia. Which is the best option to address the hyperlipidemia in this patient? a. Fenofibrate b. Niacin c. Gemfibrozil d. Colestipol

A 73 year old male with type 2 diabetes comes to your office for a regular check-up. His daughter comes with him and states that he had two falls over the last 3 months. When asked in more detail, the patient describes episodes of feeling shaky, sweaty, and very hungry. Which medication could be the cause of his symptoms and possibly the frequent falls? a. Glyburide b. Sitagliptin c. Pioglitazone d. Metformin

A 75-year-old white man has HFrEF and reports stable HF symptoms. His current drug therapy includes optimal-dose enalapril, carvedilol, and spironolactone. Which is the best recommendation to improve HF symptoms and survival? a. Start fixed-dose hydralazine/isosorbide dinitrate. b. Start ivabradine. c. Replace enalapril with sacubitril/valsartan. d. Start digoxin.

A Hispanic man with HFrEF currently takes maximally tolerated doses of metoprolol succinate and enalapril, along with moderate-dose furosemide. He is euvolemic, but continues to have HF symptoms. The systolic blood pressure is low, but the patient does not have signs or symptoms of hypotension. Which is the best recommendation to improve HF symptoms and survival in this patient? a. Stop enalapril, wait 36 hours, and start sacubitril/valsartan. b. Start digoxin. c. Start fixed-dose hydralazine and isosorbide dinitrate. d. Start spironolactone.

c. ethacrynic acid

A diuretic agent which has been associated with hearing loss when given intravenously is: a. spironolactone b. triamterene c. ethacrynic acid d. chlorothiazide e. Sucrose

A drug used in the treatment of systolic HF that shifts the Frank Starling curve upwards & to the left by inhibiting the cardiac Na/K pump: a. captopril b. clonidine c. digoxin d. furosemide e. nifedipine

A female patient presents with Stage I hypertension, Type I diabetes mellitus and microalbuminuria (proteinuria). The preferred/recommended choice for initiating oral antihypertensive therapy in this individual is: a. a non-selective â-adrenoceptor antagonist b. an angiotensin I converting enzyme inhibitor. c. a thiazide diuretic. d. a selective á1-adrenoceptor antagonist. e. sodium nitroprusside.

c. decreased urinary calcium excretion

A frail, 80-year-old woman presents with isolated systolic hypertension and has had a bone density measurement indicating severe osteoporosis. From among the choices below, identify a response to hydrochlorothiazide (Hydrodiuril®) therapy that is particularly beneficial in this patient. a. decreased glucose tolerance b. increased potassium excretion c. decreased urinary calcium excretion d. carbonic anhydrase inhibition e. increased plasma renin activity

b. Furosemide

A friend of yours has a long commute to work (~2 hours). They tell you that this new drug they are taking each morning for hypertension results in them having to stop at least once along the way to use the bathroom. Your understanding of Pharmacology leads you to tell them that the drug is most likely which of the following (drug or drug class)? a. Acetazolamide b. Furosemide c. Spironolactone d. Thiazides

c. Minoxidil

A friend with severe hypertension asks you about a drug her doctor has prescribed. The physician that this drug is likely to produce tachycardia and fluid retention and is often associated with increased hair growth. Which of these compounds is most likely to produce the effects your friend described? a. Captopril b. Guanethidine c. Minoxidil d. Prazosin e. Propranolol.

c. plasma renin activity.

A male patient with Stage 1 hypertension was started on monotherapy after baseline lab and hemodynamic studies were done. You see him three weeks later and are asked to determine whether he is being treated with hydrochlorothiazide or metoprolol.The most discriminating value you can obtain to compare with baseline is: a. peripheral vascular resistance. b. cardiac output. c. plasma renin activity. d. plasma volume. e. glomerular flow rate.

A patient is newly diagnosed with HFrEF and is asymptomatic. Which is the most appropriate drug to initiate for symptomatic and survival benefits? a. Lisinopril b. Dobutamine c. Sacubitril/valsartan d. Furosemide

d. Confirm pregnancy status and begin lifestyle changes (such as weight loss) to lower blood pressure.

A patient presents at a dental clinic for a routine check-up and is found to have a blood pressure of 130/84 mmHg. When referred to a physician, she is noted to have a BMI of 34. The patient indicates she is actively trying to become pregnant and takes a lithium compound for bipolar depression. Which of the following is the best first line therapy for the patient? a. Begin lisinopril (Prinivil®) daily, as it is safe to take during pregnancy. b. Begin losartan (Cozaar®) daily, as it is safe to take during pregnancy. c. Begin hydrochlorothiazide, as it is safe to take during pregnancy. d. Confirm pregnancy status and begin lifestyle changes (such as weight loss) to lower blood pressure. e. Confirm diagnosis of bipolar depression before initiating any drug therapy.

A patient presents in the emergency department with severe angina pectoris, and acute myocardial ischemia is confirmed by echocardiographic and other clinical indicators. Unknown to the ED team is the fact that the ischemia is due to coronary vasospasm, not to coronary occlusion with thrombi. Given this etiology, which drug administered in usually effective doses, may actually make the vasospasm and the resulting ischemia worse? A. Alteplase (tPA) B. Aspirin C. Captopril D. Nitroglycerin E. Propranolol F. Verapamil (Isoptin, Calan)

A. Amlodipine

A patient with a history of bronchospasms complains to his doctor that he felt some shortness of breath that was accompanied with feelings of nausea when playing in a softball game. During his history, he admits that he has felt like that before when walking up a few flights of stairs. The doctor schedules a stress test and the test confirms stable angina. Which of the following drugs would be the best choice for long-term management of this patient? A. Amlodipine B. Nitroprusside C. Sildenafil D. Metolazone E. Propranolol

A sedentary, moderately obese (BMI 35) 45-year old man with a blood pressure that marks him as having "elevated blood pressure" is seen by you in your expensive private clinic. No other cardiovascular risk factors are evident. The most appropriate recommendation is: a. treatment with metoprolol tartrate (Lopressor®). b. treatment with pindolol (Visken®). c. treatment with hydrochlorothiazide (Hydrodiuril®). d. referral to a local clinic specializing in weight loss and exercise. e. No therapy is needed. This patient is not considered to be at risk.

A severely depressed hypertensive patient is brought to the Emergency Department after an attempted suicidal overdose with his antihypertensive agent. The patient has severe bradycardia with AV node block, hypotension and reduced left ventricular function. The offending drug is most likely to be: a. captopril. b. hydrochlorothiazide. c. spironolactone. d. metoprolol. e. hydralazine.

ACE inhibitors are beneficial in treating heart failure with reduced ejection fraction for a number of reasons, including which of the following: a. They reduce levels of bradykinin, thereby increasing cardiac output b. They reduce sympathetic drive on the heart by directly inhibiting catecholamine release from nerve terminals c. By lowering angiotensin II levels, they help reduce blood pressure as well as water and sodium retention d. They increase expression of BNP in the failing left ventricle of the heart

Cardiac survival during cardiac transplantation is improved by perfusing donor hearts with cardioplegic solutions containing approximately 20 mM KCl. Why is this high potassium concentration helpful? A. It can increase oxygen consumption B. Prevent bacterial growth C. Stops cardiac contractility by inactivation of Na+ and Ca2+ channels D. Increases activity of sodium channels

According to the venous return curve, which of the following statements is correct? a. As cardiac output is increased, right atrial pressure increases b. As cardiac output is decreased, right atrial pressure decreases c. As cardiac output is decreased, right atrial pressure increases d. None of these statements is correct

d. Carbonic Anhydrase Inhibitors

Acetazolamide is a member of which class of Diuretics? a. Potassium Sparing b. Thiazide and Thiazide-like c. Loop d. Carbonic Anhydrase Inhibitors e. Osmotic f. Antidiuretic Hormone Agonist and Antagonists

Activation of the angiotensin II type 1 (AT1) receptor in vascular smooth muscle cells: a. Causes vascular relaxation by inhibiting adenylyl cyclase b. Enhances production of nitric oxide (NO) to cause relaxation c. Induces the release of intracellular calcium, thereby causing smooth muscle relaxation d. Mobilizes the entry of extracellular calcium by activating the L-type calcium channel e. Forms a calcium transporting pore in the cell membrane

Activation of the angiotensin II type 1 (AT1) receptor in vascular smooth muscle cells: a. Causes vascular relaxation by inhibiting adenylyl cyclase b. Enhances production of nitric oxide (NO) to cause relaxation c. Induces the release of intracellular calcium, thereby causing smooth muscle relaxation d. Mobilizes the entry of extracellular calcium by activating the L-type calcium channel Forms a calcium transporting pore in the cell membrane

A 42 year old man was started on sustained release niacin 2 weeks ago. He reports uncomfortable flushing and itchiness that he thinks is related to the niacin. Which of the following can help manage these adverse effects? Change the sustained release niacin to immediate release niacin Administer aspirin 30 minutes prior to taking niacin Increase the dose of niacin Administer aspirin 30 minutes after taking niacin

Administer aspirin 30 minutes prior to taking niacin

Administration of metoprolol in combination with nitroglycerin for treatment of exercise-induced angina might be advantageous because metoprolol will A. Decrease preload through a direct, preferential venodilation B. Increase the cardiac 'double product', concomitantly decreasing the heart's oxygen demand C. Prevent compensatory increases in heart rate and contractility D. Slow the heart rate by prolonging phase 2 of the ventricular action potential.

A 63 year old woman with elevated LDL-C levels is unable to tolerate statins due to adverse effects, including severe muscle pain. The physician would like to prescribe a non-statin drug to effectively lower her LDL-C levels. What medication would be the most effective treatment? Niacin Ezetimibe Alirocumab Cholestyramine

Alirocumab

A 68-year-old woman experiences chest pain that requires her to take frequent rest breaks while shopping at the grocery store. She is adherent to a maximized dose of β-blocker. Her resting heart rate is low (54) and blood pressure in clinic today is elevated (154/82 mm Hg). She has been unable to tolerate an increase in isosorbide mononitrate due to headache. Which of the following is the most appropriate addition to her antianginal therapy? Verapamil Ranolazine Diltiazem Amlodipine

Amlodipine

Which of the following correctly ranks the calcium channel blockers from most peripherally active to most active centrally on the myocardium? Verapamil, diltiazem, nifedipine Nifedipine, verapamil, diltiazem Diltiazem, amlodipine, verapamil Amlodipine, diltiazem, verapamil

Amlodipine, diltiazem, verapamil

An 85-year-old man with prescriptions for furosemide (Lasix®), clonidine (Catapres®) and loratadine (Claratin®) confessed to family that he did not refill his prescriptions at his last pharmacy visit, because he "forgot his wallet". His blood pressure was found to be 175/98 mm Hg, with a heart rate of 125 beats/min. He is moderately anxious and diaphoretic. The patient medical history includes hypertension, asthma, renal artery stenosis and microalbuminuria (urine protein, 110 mg/24 hr). The most likely cause of the present clinical scenario is a. diuretic-induced hypovolemia and reflex tachycardia. b. acute exacerbation of asthma. c. sympathetic hyperactivity. d. diabetic ketoacidosis. e. a panic attack.

An elderly, frail Medicare patient is referred to you with untreated Stage I hypertension. Which of the following factors is MOST likely to affect your choice of antihypertensive therapy/therapies? a. degree of elevation of peripheral vascular resistance b. gender and race of the patient c. patient's perception of severity of hypertension d. adverse effect profile of drugs and any existing co-morbid diseases e. patient's complaints of fatigue, lack of energy and poor appetite

An insulin-dependent patient being treated for hypertension presents in the Emergency Department with diaphoresis, confusion, a heart rate of 45 beats/min, and blood pressure of 140/110 mm Hg. Blood glucose is found to be 44 mg/dL. The patient is most likely being treated for hypertension with: a. captopril (Capoten®). b. losartan (Cozaar®). c. spironolactone (Aldactone®). d. propranolol (Inderal®). e. nifedipine (Procardia®).

*b. enalapril (Vasotec®).

An obese (BMI 40) patient presents with a blood pressure of 145/95 mmHg, Type I diabetes mellitus and microalbuminuria (proteinuria). The preferred/recommended choice for initiating oral antihypertensive therapy in this individual is: a. propranolol (Inderal®). b. enalapril (Vasotec®). c. hydrochlorothiazide. d. prazosin (Minipress®). e. sodium nitroprusside (Nipride®).

Anginal medication most likely to reduce preload:A. NitroglycerineB. HydralazineC. Furosemide D. Metoprolol E. Trimetazidine

C. Propranolol

Antiarrhythmic drugs can be separated into four groups, Group I to IV. All of the following are Group I antiarrhythmic drugs EXCEPT: A. Quinidine B. Lidocaine C. Propranolol D. Procainamide

A 65 year old man presents to his physician for management of type 2 diabetes mellitus and an elevated LDL-C of 165 mg/dL . Which of the following is the best option to lower the LDL-C levels and decrease the risk of ASCVD events in this patient? Atorvastatin Colesevelam Fenofibrate Bempedoic Acid

Atorvastatin

BH is a 52-year-old African American woman who has HFrEF. She is seen in clinic today reporting stable HF symptoms, but is having occasional peripheral brightness. Otherwise, vision is unchanged. Current medication regimen includes sacubitril/valsartan, carvedilol, fixed-dose hydralazine and isosorbide dinitrate, ivabradine, and bumetanide. Which is the best recommendation to minimize the adverse effect of peripheral brightness? a. Discontinue sacubitril/valsartan only. b. Reduce the dose of ivabradine. c. Do nothing; this adverse effect will slowly improve over time. d. Stop all HF medications immediately.

SGLT2 inhibitors improve HF symptoms through what mechanism? Increasing cardiac output Increasing ketone bodies Reducing preload Reducing blood glucose

Reducing preload

Bronchiolar constriction is a rare but potentially dangerous side effect of: a. quinidine b. lidocaine c. procainamide d. phenytoin e. propranolol

Cardiac survival during cardiac transplantation is improved by perfusing donor hearts with cardioplegic solutions containing approximately 20 mM KCl. Why is this high potassium concentration helpful? A.It can increase oxygen consumption B.Prevent bacterial growth C.Stops cardiac contractility by inactivation of Na+ and Ca2+ channels D.Increases activity of sodium channels

Which of the following drugs binds bile acids in the intestine, thus preventing their return to the liver via the enterohepatic circulation? Simvastatin Niacin Gemfibrozil Cholestyramine

Cholestyramine

d. third-degree AV node block: verapamil (Calan®) and metoprolol tartrate (Lopressor®)

Choose the pair below that most correctly associates a drug or drugs with an adverse effect characteristic to that agent or combination of agents? a. drug-induced lupus: propranolol (Inderal®) b. gingival hyperplasia: diazoxide (Hyperstat®) c. pericardial effusion: clonidine (Catapres®) and prazosin (Minipress®) d. third-degree AV node block: verapamil (Calan®) and metoprolol tartrate (Lopressor®) e. sinus tachycardia: hydralazine (Apresoline®) and propranolol

During the holidays, you are asked by a relative, who has very severe hypertension, about her physician's comments about the drug with which she is being treated. It was said to cause weight gain, a rapid heartbeat and excessive hair growth. You recognize the drug as: a. minoxidil (Loniten®). b. enalapril (Vasotec®). c. hydralazine (Apresoline®). d. clonidine (Catapres®). e. diazoxide (Hyperstat®).

From the cartoon below, what represents the most common side effect of Metformin? a. A and C b. B and D c. E and F d. C and E

From the cartoon below, what represents the most common side effect of SGLT inhibitors?

false

From the graph below, Regular insulin acts faster than Insulin aspart?

A 19 year old man is diagnosed with type I hyperlipidemia characterized by elevated plasma levels of chylomicrons. Which of the following treatment options would be most appropriate to address the dyslipidemia ezetimibe simvastatin PC5K9 inhibitor Dietary adjustments to include a low-fat diet

Dietary adjustments to include a low-fat diet

A. Benzothiazepines

Diltiazem falls into which class of calcium channel blockers? A. Benzothiazepines B. Dihydropyridines C. Phenylalkylamines D. Nonspecific

A man with HFrEF is taking carvedilol, candesartan, and spironolactone and is experiencing left breast pain and tenderness. There is no breast enlargement. What is the best option to minimize this symptom while continuing optimal management of HF? Discontinue spironolactone and start eplerenone Discontinue spironolactone and start enalapril Continue spironolactone at current dose Reduce the dose of spironolactone

Discontinue spironolactone and start eplerenone

A 57 year old man is being treated for atrial arrhythmia. He complains of dry mouth, blurred vision, and urinary hesitancy. Which antiarrhythmic drug is he most likely taking? Dronedarone Disopryramide Sotalol Metoprolol

Disopryramide

a. enalapril

Each of the following drugs interferes with some aspect of therenin/angiotensin cascade. Which drug, when given alone, is likely to causethe development of a persistent cough? a. enalapril b. eplerenone c. metoprolol d. losartan e. aliskiren

e. aliskiren

Each of the following drugs interferes with some aspect of therenin/angiotensin cascade. Which drug, when given alone, is likely to lead toa reduction of plasma renin activity by 50% from control?a. enalapril b. eplerenone c. metoprolol d. losartan e. aliskiren

Which of the following instructions is important to communicate to a patient receiving a prescription for the nitroglycerin patch? Remove the old patch after 24 hours of use, then immediately apply the next patch to prevent any breakthrough angina pain. Do not use sublingual nitroglycerin in combination with the patch. Apply the patch at onset of angina symptoms for quick relief. Ensure a nitrate-free interval of 10 to 12 hours every day to prevent development of nitrate tolerance.

Ensure a nitrate-free interval of 10 to 12 hours every day to prevent development of nitrate tolerance.

a. True

Eplerenone is not recommended for use in patients with hyperkalemia (elevated potassium levels)? a. True b. False

Ezetimibe is indicated for the treatment of hypercholesterolemia because it inhibits a. cholesterol synthesis in the liver. b. cholesterol transport by enterocytes. c. lipoprotein lipase expressed in vascular endothelium. d. passive transfer of cholesterol from VLDL to LDL. e. ubiquitination of LDL receptors.

Ezetimibe is indicated for the treatment of hypercholesterolemia because it inhibits a. lipoprotein lipase expressed in vascular endothelium. b. cholesterol transport by enterocytes. c. passive transfer of cholesterol from VLDL to LDL. d. cholesterol synthesis in the liver. e. ubiquitination of LDL receptors.

A 45-year-old woman with type 1 diabetes has been diagnosed with Prinzmetal angina. Which of the following is correct regarding management of angina in this patient? β-Blockers are the treatment of choice but should be avoided because of her diabetes. Nitroglycerin is not beneficial for this type of angina. She should be counseled to take nitroglycerin before physical activity to prevent symptoms. Felodipine will be more effective than verapamil.

Felodipine will be more effective than verapamil.

From the cartoon below, sulfonylureas, Glinides, and Thiazolidinediones all have in common this particular side effect. It is

From the cartoon below, the most common side effect of a-glucosidase (alpha-glucosidase) inhibitors is:

From the cartoon below, the most feared side effect of sulfonylureas is:

From the cartoon below, what represents the most common side effect of DPP-4 inhibitors?

From the graph below, if a classmate that you saw take an insulin injection, became agitated, incoherent, and disoriented 20 minutes later; which insulin or insulin type would you conclude that they had most likely just taken?

From the graph below, which insulin or insulin type is considered a "rapid acting" insulin?

e and f

From the graph below, which insulin or insulin type would give you the longest coverage? (two answers)

c. Loop

Furosemde is a member of which class of Diuretics? a. Potassium Sparing b. Thiazide and Thiazide-like c. Loop d. Carbonic Anhydrase Inhibitors e. Osmotic f. Antidiuretic Hormone Agonist and Antagonists

A 47 year old woman presents to her family medicine physician for her annual exam. She has a past medical history of hypertension, obesity, tobacco use, (20 pack year history). A fasting lipid panel reveals an LDL of 125 mg/dL, and her estimated ASCVD risk is calculated to be 10%. Which of the following best characterizes the statin benefit group for this patient. Group 1 - history of clinical ASCVD Group 3 - Age 40 to 75 years with diabetes Group 4 - Age 40 to 75 years without diabetes and ASCVD risk > 7.5% Does not fit into any statin benefit group

Group 4 - Age 40 to 75 years without diabetes and ASCVD risk 7.5%

HB is a 55-year-old obese female who has had type 2 diabetes for 10 years. She is currently being treated with metformin, but her HbA1c is above goal. She has a history of heart failure and chronic obstructive pulmonary disorder. Her physician would like to add a medication that will not cause any weight gain. Which of the following would be most appropriate to control HB's diabetes? a. Pioglitazone b. Inhaled insulin c. Glimepiride d. Linagliptin

A 62 year old man is being discharged from the hospital today after suffering a myocardial infarction. Which of the following is the most appropriate intensity of statin therapy for this patient? High-intensity statin Statin not indicated Low-intensity statin Moderate-intensity statin

High-intensity statin

How is spironolactone beneficial in HF? a. Acts as aldosterone agonist b. Promotes potassium secretion c. Decreases blood glucose d. Prevents cardiac hypertrophy

A 49-year-old man is currently hospitalized for acute heart failure with a low cardiac output. The team would like to start a positive inotrope while continuing metoprolol succinate. What is the most appropriate positive inotrope to initiate? Dobutamine Milrinone Digoxin Diltiazem

Milrinone

An 85-year-old woman has HFpEF. She is not on any medications for HF and has elevated blood pressure. Which is the most appropriate drug to initiate? FDC hydralazine/isosorbide dinitrate Ramipril Sacubitril/valsartan Empagliflozin

Ramipril

A 55 year old woman presents to her primary care physician for her annual exam. Her past medical history includes prediabetes, hypertension, and obesity. Her estimated ASCVD risk is calculated at 6.5%, and her fasting lipid panel reveals hypertriglyceridemia (triglycerides 655 mg/dL). Which of the following treatments would be most important to start immediately? Simvastatin Ezetimibe Alirocumab Icosapent ethyl

Icosapent ethyl

If a classmate that you saw take an insulin injection, became agitated, incoherent, and disoriented 20 minutes later, which of the following drugs would you suggest using as an antidote? a. Glucagon b. There is no antidote for this c. scenario. d. Ethanol e. Methotrexate f. Potassium Iodide g. Insulin

e. Enalapril - but not losartan- causes a high incidence of cough in treated patients.

In comparing angiotensin receptor blockers (ARBs) with angiotensin converting enzyme inhibitors (ACEIs), which one of the following is most correct? a. Losartan (Cozaar®) causes a much higher incidence of angioedema than does enalapril (Vasotec®). b. Enalapril - but not losartan - can reduce aldosterone secretion from the adrenal gland. c. Enalapril - but not losartan - is contraindicated in bilateral renal artery stenosis. d. Enalapril - but not losartan - is contraindicated in pregnancy. e. Enalapril - but not losartan- causes a high incidence of cough in treated patients.

d. act more distally in the nephron and then only affect one of several mechanisms for sodium reabsorption

In comparison to loop diuretics, K sparing diuretics are less efficacious because they a. Are extensively bound to plasma proteins and consequently achieve lower luminal concentrations. b. Are more extensively inactivated by proximal tubular cells during secretion into the tubular lumen. c. Elicit more pronounced compensatory neurohumoral responses. d. act more distally in the nephron and then only affect one of several mechanisms for sodium reabsorption.

KD is a 69-year-old male with type 2 diabetes and chronic pancreatitis. Which of the following diabetes medications is contraindicated in this patient? a. Glipizide b. Insulin lispro c. Dulaglutide d. Metformin

A patient is newly diagnosed with HFrEF and is asymptomatic. Which is the most appropriate drug to initiate for symptomatic and survival benefits? Sacubitril/valsartan Dobutamine Lisinopril Furosemide

Lisinopril

MC is a patient with type 2 diabetes currently being treated with insulin detemir. The physician determines that MC needs additional insulin therapy for control of postprandial glucose. Which agent is most appropriate to add at this time? a. Insulin degludec b. NPH insulin c. Insulin lispro d. NPH/regular 70/30 insulin

Maximum permissible doses of local anesthetics should be reduced when treating patients medicated with which of the following? A. HCTZ B. Verapamil (Calan) C. Amiodarone (Cordarone) D. Digoxin (Lanoxin)

Maximum permissible doses of local anesthetics should be reduced when treating patients medicated with which of the following?A. HCTZ B. Verapamil (Calan) C. Amiodarone (Cordarone) D. Digoxin (Lanoxin)

A 60 year old woman had a myocardial infarction. Which agent should be used to prevent life-threatening arrhythmias that can occur post myocardial infarction in this patient? Procainamide Digoxin Metoprolol Flecainide

Metoprolol

A 74-year-old man with a recent MI is experiencing typical angina pain that is relieved with rest and sublingual nitroglycerin. His blood pressure is well controlled (126/73 mm Hg), and his heart rate is 81 bpm. Which is the most appropriate therapy for his angina? Metoprolol Felodipine Verapamil Nitroglycerin patch

Metoprolol

Mr. Jones is diagnosed with chronic angina and is prescribed Ranexa (ranolazine). Shortly after starting on the medication, Mr. Jones complains that at times his heart will start to beat erratically and he often feels faint. Which of the following best explains Mr. Jones complaint? a. A metabolic shift from oxidation of fatty acids to glucose b. Decreased heart rate due to inhibition of nodal funny current c. Increased cardiac contractility due to a modest sympathomimetic action on cardiac muscle d. QT prolongation e. Reduced preload due to venodilation

Which of the following medications should be prescribed to all angina patients to treat an acute attack? Ranolazine Propranolol Isosorbide mononitrate Nitroglycerin sublingual tablet or spray

Nitroglycerin sublingual tablet or spray

D. niacin

Of the following drugs used for treatment of dyslipidemias, which one is MOST likely to cause the greatest increase in HDL levels? A. atorvastatin B. cholestyramine C. gemfibrozil D. niacin E. pravastatin

Of the following drugs used for treatment of dyslipidemias, which one is MOST likely to cause the greatest increase in HDL levels? a. cholestyramine b. gemfibrozil c. niacin

Of the following drugs used for treatment of dyslipidemias, which one is MOST likely to cause the greatest increase in HDL levels? a. pravastatin b. niacin c. cholestyramine d. gemfibrozil e. atorvastatin

One of the newer drugs available in a physician's "toolbox" to treat patients with diabetes is canagliflozin. This drug lowers plasma glucose levels by acting to a. stimulate insulin secretion. b. inhibit SGLT2 (sodium-glucose cotransporter 2). c. stimulate GLUT2 (Glucose transporter 2). d. stimulate glucagon breakdown. e. inhibit DPP IV (dipeptidyl peptidase IV)

b. alpha1-adrenoceptor antagonists.

Postural hypotension upon first dose administration is a common adverse effect of a. ACE inhibitors. b. alpha1-adrenoceptor antagonists. c. arteriolar vasodilators. d. nonselective beta-adrenoceptor antagonists. e. thiazide diuretics.

Pravastatin was prescribed for a 50-year-old man for treatment of mixed dyslipidemia. Although LDL-cholesterol concentration resolved satisfactorily, plasma triglyceride concentrations remained elevated. Of the following drugs, which one could be used to lower plasma triglyceride in this patient by activation of peroxisome proliferator-activated receptors? a. alirocumab b. cholestyramine c. ezetimibe d. gemfibrozil e. niacin

Pravastatin was prescribed for a 50-year-old man for treatment of mixed dyslipidemia. Although LDL-cholesterol concentration resolved satisfactorily, plasma triglyceride concentrations remained elevated. Of the following drugs, which one could be used to lower plasma triglyceride in this patient by activation of the peroxisome proliferator-activated receptor? a. alirocumab b. gemfibrozil c. niacin d. ezetimibe e. cholestyramine

Principal ion responsible for action potentials in specialized conducting SA nodal and AV nodal tissues: A. potassium B. calcium C. sodium

Principal ion responsible for action potentials in specialized conducting SA nodal and AV nodal tissues: a. potassium b. calcium c. sodium

B. Diltiazem (calcium channel blocker)

Prinzmetal's angina is best treated with which of the following drugs? A. Trimetazidine (pFOX inhibitor) B. Diltiazem (calcium channel blocker) C. Propranolol (beta blocker) D. Captopril (ACE inhibitor)

Prolonged use of NSAIDs may reduce the antihypertensive efficacy of all the following drug classes EXCEPT: a. calcium channel blockers b. beta-blockers c. ACE inhibitors d. Diuretics

A 56-year-old man with stable angina is being evaluated in the emergency department for an asthma exacerbation. Which of his home medications may impact the effectiveness of bronchodilator therapy? Amlodipine Nitroglycerin spray Propranolol Valsartan

Propranolol

A 75-year-old white man has HFrEF and reports stable HF symptoms. His current drug therapy includes optimal-dose enalapril, carvedilol, and spironolactone. Which is the most appropriate recommendation to improve HF symptoms and survival? Start vericiguat. Start ivabradine. Replace enalapril with sacubitril/valsartan. Start fixed-dose hydralazine/isosorbide dinitrate

Replace enalapril with sacubitril/valsartan.

Robert Wiggins is a 40 year old man who asks for a prescription for sildenafil (Viagra). Because of the risk of serious drug interaction, Mr. Wiggins should not be prescribed sildenafil if he is currently taking which of the following medications? a. Atenolol (beta blocker) b. Enalapril (ace inhibitor) c. Lipitor (statin) d. Isordil (isosorbide dinitrate) e. Zyrtec (H1-receptor antagonist)

Which of the following drugs decreases cholesterol synthesis by inhibiting the enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase? Rosuvastatin Colestipol Fenofibrate Gemfibrozil

Rosuvastatin

Several different drugs are known to increase the effect & toxicity of digoxin when given concomitantly. This is of great concern because of digoxin's very low therapeutic index (~2) and potentially life-threatening toxicity. A drug that does NOT significantly increase either digoxin levels or effect is: a. amiodarone b. furosemide c. metoprolol d. quinidine e. verapamil

Several different drugs are known to increase the effect and toxicity of digoxin when given concomitantly (at the same time). This is of great concern because of digoxin's very low therapeutic index (~2) and potentially life-threatening toxicity. A drug that does NOT significantly increase either digoxin levels or effect is: a. amiodarone b. furosemide c. metoprolol d. quinidine e. verapamil

a. Potassium Sparing

Spironolactone is a member of which class of Diuretics? a. Potassium Sparing b. Thiazide and Thiazide-like c. Loop d. Carbonic Anhydrase Inhibitors e. Osmotic f. Antidiuretic Hormone Agonist and Antagonists

A 55-year-old white man has HFrEF and reports stable HF symptoms. Current drug therapy includes optimal-dose sacubitril/valsartan, metoprolol succinate, and spironolactone. Which is the best recommendation to improve HF symptoms and survival? Start vericiguat. Start torsemide. Start dapagliflozin. Start milrinone.

Start dapagliflozin

A Hispanic man with HFrEF currently takes maximally tolerated doses of metoprolol succinate and enalapril, along with moderate-dose furosemide. He is euvolemic but continues to have HF symptoms. The systolic blood pressure is low, but the patient does not have signs or symptoms of hypotension. Which is the best recommendation to improve HF symptoms and survival in this patient? Start fixed-dose hydralazine and isosorbide dinitrate. Stop enalapril, wait 36 hours, and start sacubitril/valsartan. Start spironolactone. Start digoxin.

Start spironolactone

The absolute refractory period prevents the generation of another action potential and is mediated by: a.Activation of Na+ channels b.Inactivation of Na+ channels c.Activation of the K+ channels d.Deactivation of K+ channels

The absolute refractory period prevents the generation of another action potential and is mediated by: a. Activation of Na+ channels b. Inactivation of Na+ channels c. Activation of the K+ channels d. Deactivation of K+ channels

The action potential of pacemaker cells of the heart is distinguished by which feature: a. A sustained influx of calcium during phase 2 b. A prominent transient repolarization after initial depolarization (phase 1) c. Funny currents d. No effect of the autonomic nervous system

The action potential of pacemaker cells of the heart is distinguished by which of the following: a. A sustained influx of calcium during phase 2 b. A prominent transient repolarization after initial depolarization (phase 1) c. Funny currents d. No effect of the autonomic nervous system

A. Potassium.

The activation of this ion channel is mainly associated with cardiac cell repolarization. A. Potassium. B. Sodium. C. Calcium. D. Magnesium.

The beneficial effects of calcium channel blockers on the heart in a patient with angina A. Result, at least in part, from a paradoxical increases in sodium current and, thus, the force with which cardiomyocytes contract. B. Result, at least in part, from a reduction in peripheral vascular resistance. C. Result from a leftward shift in the hemoglobin-oxygen dissociation curve. D. Result, in the long-term, from their ability to promote revascularization of the myocardium. E. Result primarily from their interactions with low threshold T-type calcium channels.

The calcium-activated potassium channel of vascular smooth muscle cells is important for the following reason: a. Inhibition of nitric oxide production and vascular contraction b. Vascular relaxation due to cellular hyperpolarization c. Generation of the funny current and spontaneous contractions. d. Entry of extracellular calcium into the cell in response to depolarization

The degree to which the heart fibers are stretched just prior to contraction is known as: a. afterload b. cardiac output c. dosewallips d. preload

The degree to which the heart fibers are stretched just prior to contraction is known as: a. Afterload b. Cardiac output c. Dosewallips d. Preload

The efficacy of cholestyramine in the treatment of dyslipidemia results primarily from inhibition of a. apoprotein B48 synthesis in the GI tract. b. enterohepatic recycling of bile acids. c. triglyceride synthesis in the liver. d. LDL receptor degradation

The efficacy of cholestyramine in the treatment of dyslipidemia results primarily from inhibition of a. enterohepatic recycling of bile acids. b. apoprotein B48 synthesis in the GI tract. c. LDL receptor degradation d. triglyceride synthesis in the liver.

B. Rebound angina or time zero effect

The intermittent therapeutic use of nitrates may be associated with which of the following? A. Tolerance B. Rebound angina or time zero effect C. Vasospastic angina D. Claudication

The ionic gradients primarily responsible for cardiac transmembrane potential are: a. sodium b. Potassium c. Calcium d. All of the above

e. Amiloride

The mechanism of action of which of the following drugs or drug class involves blocking sodium channels at the collecting tubule and duct in the kidneys? a. Acetazolamide b. Furosemide c. Spironolactone d. Thiazides e. Amiloride

The most efficacious antiarrhythmic drug that blocks K, Na, Ca channels and beta-adrenergic receptors is which of the following? a. Adenosine b. Amiodarone c. Lidocaine d. Flecainide

The normal cardiac impulse propagation sequence is: a. AV node, His-Purkinje, ventricle, SA node b. SA node, His-Purkinje, AV node, ventricle c. SA node, AV node, His-Purkinje, ventricle d. AV node, SA node, His-Purkinje, ventricle

e. fenoldopam mesylate (Corlopam®)

This antihypertensive agent targets dopamine D1 receptors. a. minoxidil (Loniten®) b. minoxidil (Rogaine®) c. alpha-methyldopa (Aldomet®) d. labetalol (Normodyne®, etc.) e. fenoldopam mesylate (Corlopam®) f. diazoxide (Hyperstat®) g. reserpine (Serpasil®) h. diltiazem (Cardizem®)

This diuretic is most often used in the acute management of congestive heart failure and pulmonary edema. a. Clordiazepoxide b. Chlorthalidone c. Furosemide d. Ethacrynic acid e. Spironolactone

f. diazoxide (Hyperstat®)

This drug is an arterial vasodilator that elevates plasma glucose. a. minoxidil (Loniten®) b. minoxidil (Rogaine®) c. alpha-methyldopa (Aldomet®) d. labetalol (Normodyne®, etc.) e. fenoldopam mesylate (Corlopam®) f. diazoxide (Hyperstat®) g. reserpine (Serpasil®) h. diltiazem (Cardizem®)

c. alpha-methyldopa (Aldomet®)

This indirect alpha2-adrenoceptor agonist is used as an antihypertensive. a. minoxidil (Loniten®) b. minoxidil (Rogaine®) c. alpha-methyldopa (Aldomet®) d. labetalol (Normodyne®, etc.) e. fenoldopam mesylate (Corlopam®) f. diazoxide (Hyperstat®)

A. C-peptide levels

To conclusively classify a new patient as having either Type 1 or Type 2 diabetes, one would measure which of the following? A. C-peptide levels B. glucagon levels C. thyroxin levels D. angiotensin II levels E. HbA1c levels

Torsade de Pointes, a polymorphic ventricular arrhythmia, is associated with prolongation of Q-T intervals. Which antiarrhythmic agent is most likely to cause this arrhythmia? A. Digoxin B. Metoprolol C. Lidocaine D. Quinidine

Torsades de Pointes, a polymorphic ventricular arrhythmia, is associated with prolongation of Q-T intervals. Which antiarrhythmic agent is most likely to cause this arrhythmia? a. Propranolol b. Digoxin c. Lidocaine d. Quinidine

What arrhythmia can be treated with lidocaine Ventricular tachycardia atrial fibrillation paroxysmal supraventricular ventricular tachycardia Atrial flutter

Ventricular tachycardia

A 62 year old man is complaining of peripheral edema. Which of the following medications is most likely contributing to this? Digoxin Verapamil Sotalol Atenolol

Verapamil

C. Reduces free intracellular calcium

Verapamil reduces contractility by which mechanism? A. Inhibits cAMP production B. Promotes calcium binding to troponin C. Reduces free intracellular calcium D. Inhibits beta adrenergic receptor activity E. Blocks ABC transporters

Very high sympathetic neural activity to the heart can a.Lead to tetanic contraction of the cardiac muscle b.Does not lead to tetanic contraction of the cardiac muscle c.Prevent heart contractility d.None of the above

Which of the following can be safely used with ranolazine? Carbamazepine Fluconazole Warfarin Quetiapine

Warfarin

B. The action potential duration is prolonged.

What are the effects of potassium channel blockers on the action potential? A. The resting potential is increased (hyperpolarized). B. The action potential duration is prolonged. C. The action potential amplitude is decreased. D. The action potential conduction velocity is increased.

What happens when an intervention promotes early activation of the "delayed rectifier" K+ channel (IK) in a cardiac muscle? A.The resting potential is increased (hyperpolarized). B.The action potential duration is decreased. C.The action potential amplitude is decreased. D.The action potential conduction velocity is increased.`

What happens when an intervention promotes early activation of the "delayed rectifier" K+ channel (IK) in a cardiac muscle?A.The resting potential is increased (hyperpolarized). B.The action potential duration is decreased. C.The action potential amplitude is decreased. D.The action potential conduction velocity is increased.

b. propranolol (Inderal®)

When administered in recommended dose ranges for treatment of uncomplicated mild (Stage 1) essential hypertension, which of the following is most likely to reduce the bronchodilating effects of epinephrine? a. metoprolol tartrate (Lopressor®) b. propranolol (Inderal®) c. aliskiren (Tekturna®) d. prazosin (Minipress®) e. hydralazine (Apresoline®)

Which class of oral diabetes drugs is paired most appropriately with its primary mechanism of action? a. SGLT2 inhibitor—increases urinary excretion of glucose b. Thiazolidinedione—decreases hepatic gluconeogenesis c. DPP-4 inhibitor—inhibits breakdown of complex carbohydrates d. Sulfonylurea—increases insulin sensitivity

Which is the most appropriate initial oral agent for management of type 2 diabetes in patients with no other comorbid conditions? a. Metformin b. Pioglitazone c. Glipizide d. Empagliflozin

b. can cause fetal abnormalities if given in pregnancy

Which of the following actions/effects are shared between the angiotensin I converting enzyme (ACE) inhibitors and angiotensin II AT-1 receptor blockers (ARBs)? a. produce acute increase in GFR and diuresis in patients with bilateral renal artery stenosis b. can cause fetal abnormalities if given in pregnancy c. are associated with a high incidence of dry, non-productive cough d. cause a similar incidence of angioedema

b. Furosemide

Which of the following drugs or drug classes causes the largest increase in urine volume but can also be problematic because it can also drastically reduce potassium levels? a. Acetazolamide b. Furosemide c. Spironolactone d. Thiazides e. Amiloride

f. Mannitol

Which of the following drugs or drug classes is an osmotic diuretic and can be used to reduce intracranial pressure in patients? a. Acetazolamide b. Furosemide c. Spironolactone d. Thiazides e. Amiloride f. Mannitol

b. Furosemide

Which of the following drugs or drug classes is considered a "loop diuretic"? a. Acetazolamide b. Furosemide c. Spironolactone d. Thiazides e. Amiloride f. Mannitol

c. Spironolactone

Which of the following drugs or drug classes is considered a "potassium sparing" diuretic but can result in side effects such as gynecomastia? a. Acetazolamide b. Furosemide c. Spironolactone d. Thiazides e. Amiloride f. Mannitol

e. Amiloride

Which of the following drugs or drug classes is considered a "potassium sparing" diuretic that can be used if one is already predisposed to gynecomastia? a. Acetazolamide b. Furosemide c. Spironolactone d. Thiazides e. Amiloride f. Mannitol

Which of the following hyperlipidemias is characterized by elevated plasma levels of chylomicrons and has no drug therapy available to lower the plasma lipoprotein levels? a. Type II b. Type IV c. Type I d. Type III

A. A person with low LDL and high HDL

Which of the following individuals would be at the least risk for developing Coronary Heart Disease (CHD)? A. A person with low LDL and high HDL B. A person with low LDL and low HDL C. A person with high LDL and high HDL D. LDL and HDL are not predictors for CHD outcomes

B. Alirocumab

Which of the following is a non-statin drug that would lower LDL cholesterol levels most effectively? A. Niacin B. Alirocumab C. Cholestyramine D. Ezetimibe

C. glucagon

Which of the following is an antidote to insulin overdose and the subsequent hypoglycemia, especially when an individual has passed out and is non-responsive? A. amylin B. insulin C. glucagon D. C-peptide E. None of the above

b. It decreases the formation of angiotensin II

Which of the following is characteristic of captopril (ACE inhibitor) treatment in patients with essential hypertension? a. It competitively blocks the vasoconstrictor effects of angiotensin II on the AT1 receptor b. It decreases the formation of angiotensin II c. It decreases renin secretion. d. It increases potassium excretion and often leads to hypokalemia. e. It decreases Ca excretion and is often uses to treat patients with recurrent Ca stones.

Which of the following is important to monitor in patients taking digoxin? a. Chloride b. Zinc c. Potassium d. Sodium

Which of the following is the Phase of the Purkinje fiber action potential composed of the combination of inward depolarizing calcium current balanced by an outward repolarizing potassium current (delayed rectifier)? a. Phase 0 b. Phase 1 c. Phase 2 d. Phase 3 e. Phase 4

Which of the following is the most common adverse effect of antihyperlipidemic drug therapy? a. Heart palpitations b. Gastrointestinal disturbance c. Elevated blood pressure d. Neurologic problems

Which of the following nonstatin drugs lowers LDL-C most effectively? a. Niacin b. Alirocumab c. Cholestyramine d. Ezetimibe

A. Decreased heart rate due to inhibition of pacemaker current in the sinoatrial node

Which of the following phrases best describes the effects of ivabradine in the treatment of angina? A. Decreased heart rate due to inhibition of pacemaker current in the sinoatrial node B. Increased contractility and rate due to a modest sympathomimetic action on cardiomyocytes C. Increased coronary flow secondary to activation of guanylyl cyclase D. Reduced preload due to venodilation

e. All of the above are contraindications

Which of the following represent contraindications for or cautions to the use of enalapril (Vasotec®) in a fertile, 30-year-old woman with blood pressures consistently in the range of145/95 mm Hg? a. concurrent therapy with oral potassium supplementation b. unreliable contraceptive use c. renal artery stenosis d. a history of laryngeal swelling and breathing difficulty following treatment with captopril(Capoten®) e. All of the above are contraindications

Which of the following statements about Nesiritide is TRUE: a. It decreases cGMP and causes smooth muscle relaxation b. It was recently approved to treat angina c. It is approved in combination with hydralazine (BiDil) for heart failure patients intolerant of ACE inhibitors or beta blockers d. It may be used to treat acute decompensated heart failure

Which of the following statements about Nesiritide is TRUE? a. It decreases cGMP and causes smooth muscle relaxation b. It is approved in combination with hydralazine (BiDil) for heart failure patients intolerant of ACE inhibitors or beta blockers c. It may be used to treat acute decompensated heart failure d. It was recently approved to treat angina

D. It directly blocks the funny current channel

Which of the following statements about carvedilol is FALSE? A. It is a non-selective beta-adrenoreceptor blocker B. It also blocks alpha-adrenoreceptors C. It is commonly prescribed to treat heart failure D. It directly blocks the funny current channel

Which of the following statements best describes the action of ACE inhibitors on the failing heart? a. Increased vascular resistance. b. Reduced preload. c. Decreased cardiac output. d. Increased aldosterone.

D. They may be prescribed to treat heart failure

Which of the following statements is TRUE of the thiazide diuretics? A. They are loop diuretics that may cause hypokalemia B. They are highly effective in patients with renal failure C. They are associated with a loss of both plasma calcium and magnesium D. They may be prescribed to treat heart failure

Which of the following statements is characteristic of metformin? a. Metformin decreases hepatic glucose production. b. Metformin contains a boxed warning due to the potential for increased risk of myocardial infarction. c. Weight gain is a common adverse effect. d. Metformin can be used safely in patients with renal dysfunction.

Which of the following statements is correct regarding insulin glargine? a. It is a "peakless" insulin. b. It should not be used in a regimen with insulin lispro or glulisine. c. It is primarily used to control postprandial hyperglycemia. d. The prolonged duration of activity is due to slow dissociation from albumin.

Which one of the following drugs is relatively contraindicated for treatment of angina of effort in a patient who frequently presents with migraine headaches?A. amlodipineB. atenololC. nitroglycerinD. metoprololE. verapamil

Which patient population is most likely to experience myalgia (muscle pain) or myopathy with use of HMG CoA reductase inhibitors? a. Patients with renal insufficiency b. Patients taking warfarin (blood thinner) c. Patients with gout d. Patients with hypertriglyceridemia

*a. -pril; an angiotensin I converting enzyme inhibitor

Which suffix is correctly paired with its class of antihypertensive drug? a. -pril; an angiotensin I converting enzyme inhibitor b. -sartan; a cardioselective beta-adrenoceptor antagonist c. -azem; a dihydropyridine calcium channel blocker d. -dipine; a thiazide/thiazide-like diuretic e. -olol; an ACE inhibitor

b. captopril

You are reviewing a case report of a female hypertensive patient who, upontreatment witha single antihypertensive agent, showed a several-fold increase in serumcreatinine levelsand a reduction in urine output. A bilateral abdominal bruit was also noted.The drug wasmost likely to be: a. clonidine. b. captopril .c. chlorthalidone. d. guanethidine .e. reserpine

e. renal collecting tubule and therefore have minimal effect on potassium secretion.

Your patient is receiving spironolactone (Aldactone®) as part of his therapy for hypertension. Which of the following best describes its actions? a. central sympathetic nervous system and have no effect on potassium absorption or excretion. b. renal glomerulus, before any potassium has been absorbed or secreted in the kidney. c. loop of Henle, therefore allowing potassium to be excreted in higher levels. d. reduction of central sympathetic outflow with minimal effect on potassium excretion. e. renal collecting tubule and therefore have minimal effect on potassium secretion.

All of the following are adverse effects of amiodarone except pulmonary fibrosis blue skin discoloration cinchonism hypothyroidism

cinchonism

β-Blockers improve cardiac function in HF by: Increasing renin release Increasing heart rate Activating norepinephrine Decreasing cardiac remodeling

decreasing cardiac remodeling

A clinician would like to initiate a drug for rhythm control of atrial fibrillation. Which of the following coexisting conditions would allow for initiation of flecainide? Hypertension heart failure coronary artery disease left ventricular hypertrophy

hypertension

Which of the following statements best describes the action of ACE inhibitors on the failing heart? Decreased cardiac output Increased vascular resistance Increased aldosterone Reduced preload

reduced preload

A 47 year old man with a history of renal insufficiency, gout, atrial fibrillation, and hypertriglyceremia is being started on HMG CoA reductase inhibitor. Which risk factor will most likely increase the possibility of myalgia or myopathy with the new medication? atrial fibrillation gout renal insufficiency hypertriglyceridemia

renal insufficiency

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