Quiz 6

According to Medscape regarding apixaban (Eliquis) which of the following is/are correct? Half-life: 5-6 hr (dominant); 12 hr (apparent half-life with repeated dosing) Black Box Warning: Discontinuing in patients with nonvalvular atrial fibrillation Indicated for stroke prophylaxis with atrial fibrillation Indicated for DVT or PE treatment Adverse effects include: bleeding; major, GI, intracranial, intraocular, fatal

1, 2, 3, 4, and 5

According to Medscape regarding isosorbide dinitrate (Isordil) which of the following is/are correct? You can treat drug-induced headache with aspirin or acetaminophen Provide nitrate-free interval (10-12 hours or overnight) to prevent development of tolerance Inability to relieve chest pain after 3 doses may signal acute MI necessitating emergency management. Generic and brand name formulations are roughly bio-equivalent.

1, 2, and 3 only

According to Medscape, which of the following are correct regarding clopidogrel (Plavix)? For Unstable angina, non-ST-segment elevation MI (NSTEMI): 300 mg loading dose. Black Box Warning: Clopidogrel's antiplatelet activity is dependent on conversion to an active metabolite by the cytochrome P450 (CYP) system, principally CYP2C19. Adverse effects include chest pain, headache, and flu like symptoms Protein bound: 58% For recent MI, Stroke, or Established Peripheral Arterial Disease 300 mg loading dose.

1, 2, and 3 only

Which of the following are true regarding Magnesium Sulfate? 1. It slows the rate of SA node impulse formation and prolongs conduction time 2. Oral magnesium is effective for treating arrhythmias, it just has a longer onset of action 3. It is the drug of choice for treatment of torsades de pointes 4. It is a pregnancy category B, as it is approved for use to treat pre-term labor

1, 3

According to Medscape Rosuvastatin (Crestor #10/200): Is indicated for hypercholesterolemia, homozygous familial hypercholesterolemia, to slow progression of atherosclerosis. Inhibits sterol transporter at brush border and, consequently, intestinal absorption of cholesterol, which in turn decreases delivery of cholesterol to the liver and reduces hepatic cholesterol stores. Can cause rhabdomyolysis, pharyngitis, UTIs ,and myalgia. Is contraindicated in active liver disease, elevated LFTs, pregnancy, and lactation.

1, 3, 4

According to Medscape regarding warfarin (Coumadin) which of the following is/are correct? Half-life: 20-60 hr (patient specific) No Black Box Warnings. Indicated for stroke prophylaxis with atrial fibrillation and thromboembolic complications associated with cardiac valve replacement Indicated for prophylaxis and treatment of venous thrombosis Adverse effects include: intraocular hemorrhage, abdominal pain, flatulence, alopecia, rash, pruritus, taste disturbance, tissue necrosis

1, 3, 4, and 5 only

According to Medscape regarding digoxin (Lanoxin) which of the following is/are correct? Not recommended in patients with acute myocardial infarction. Adverse effects include: dizziness, mental disturbances, diarrhea, headache, nausea, and vomiting. Indicated for atrial fibrillation and heart failure Effective in presence of hypokalemia or hypocalcemia Very wide margin between effective therapeutic and toxic dosages.

1,2,3

According to Medscape regarding carvedilol (Coreg) which of the following is/are correct? Contraindicated in bronchial asthma, bronchospasm Contraindicated in 2°/3° AV block, sick sinus syndrome without permanent pacemaker Indicated for hypertension, immediate release: 6.25 mg PO twice daily initially Adverse effects include: dizziness, fatigue, hypotension, weight gain, hyperglycemia, and diarrhea. Is protein bound: 50%

1,2,3,4

According to Medscape, Ezetimibe (Zetia) #81/200): 1. Adverse effects include diarrhea, upper respiratory tract symptoms, cough, pain in extremity, sinusitis. 2. Inhibits sterol transporter at brush border and, consequently, intestinal absorption of cholesterol, which in turn decreases delivery of cholesterol to the liver and reduces hepatic cholesterol stores. 3. Pregnancy category: C 4. Should not be co-administered with a statin in the presence of active liver disease or persistent, unexplained elevations of hepatic transaminase levels 5. Protein bound: >90%

ALL

Which of the following are listed as adverse effects of amiodarone in Medscape? Photosensitivity (10-75%) Hyperthyroidism (3-10%) Hypothyroidism (1-22%) Involuntary movement (3-40%) Headache (3-40%)

ALL

A 35-year-old male was started on Niacin (Niaspan) sustained-release tablets 2 weeks ago for elevated triglycerides and low HDL levels. He is complaining of an uncomfortable flushing and itchy feeling that he thinks is related to the Niacin (Niaspan). Which of the following options can help him manage this adverse effect of Niacin (Niaspan) therapy?

Administer aspirin 30 minutes prior to taking Niacin (Niaspan).

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

Cholestyramine (Questran) is an anion-exchange resin that binds negatively charged bile acids and bile salts in the small intestine. The resin/bile acid complex is excreted in the feces, thus preventing the bile acids from returning to the liver by the enterohepatic circulation. The other choices do not bind intestinal bile acids.

Which medication(s) has FDA approval for treating all these diagnoses or conditions: angina, hypertension, Paroxysmal Supraventricular Tachycardia (PSVT), and atrial fibrillation/flutter? Digoxin (Lanoxin) Lisinopril (Prinivil, Zestril) Metoprolol (Lopressor) Amiodarone (Pacerone, Cordarone) Diltiazem (Cardizem)

Diltiazem, the rest are more limited Diltiazem: Angina, Hypertension, Paroxysmal Supraventricular Tachycardia, Atrial Fibrillation/Flutter Metoprolol: Acute Myocardial Infarction, Congestive Heart Failure, Hypertension, Hyperthyroidism, Acute Tachyarrhythmia (Off-label), Migraine (Off-label), Atrial Fibrillation/Flutter or Supraventricular Tachycardia (Off-label) Digoxin: Atrial Fibrillation, Heart Failure Lisinopril: Acute Myocardial Infarction, Hypertension, Heart Failure, Diabetic Nephropathy (Off-label) Amiodarone: Stable Monomorphic or Polymorphic Ventricular Tachycardia (Off-label), ACLS, Pulseless Ventricular Fibrillation/Ventricular Tachycardia (Off-label), Ventricular Arrhythmias

A 54-year-old man survives a myocardial infarction. Which of the following should be used to prevent life-threatening arrhythmias that can occur post-myocardial infarction?

Metoprolol

Which one of the following drugs causes a decrease in liver triglyceride synthesis by limiting available free fatty acids needed as building blocks for this pathway?

Niacin--> At gram doses, Niacin (Niaspan) strongly inhibits lipolysis in adipose tissue—the primary producer of circulating free fatty acids. The liver normally utilizes these circulating fatty acids as a major precursor for triglyceride synthesis. Thus, Niacin (Niaspan) causes a decrease in liver triglyceride synthesis, which is required for VLDL production. The other choices do not inhibit lipolysis in adipose tissue.

Which medication is most effective to treat an acute angina attack?

Nitroglycerin sublingual tablet or spray--> Nitroglycerin sublingual tablet or spray. Tablets are reactive with humidity and the spray is not (in a sealed container). The spray is significantly more expensive.($116-$305 per 12G) The other options will not provide prompt relief of angina and should not be used to treat an acute attack.

Using the Medscape Drug Interaction checker, assess if a patient taking warfarin can safely be prescribed Bactrim DS (Sulfamethoxazole/trimethoprim) for a urinary tract infection?

No. Sulfamethoxazole/trimethoprim will increase the anticoagulant effect of warfarin--> No. Sulfamethoxazole/trimethoprim has a significant drug interaction with warfarin, such that it will inhibit warfarin metabolism. Therefore, sulfamethoxazole/trimethoprim will cause increased anticoagulation, and the patient will need to have his warfarin dose decreased and INR checked frequently while he is on this antibiotic

Which electrolyte is most important to monitor in patients taking digoxin?

potassium

A 58 year old male's lipid panel reveals an LDL cholesterol level of 165 mg/dL. His nurse practitioner wishes to lower his LDL cholesterol levels. Which of the following medications is the best option to lower LDL cholesterol levels?

simvastatin--> Simvastatin (Zocor), an HMG CoA reductase inhibitor (statin), is the most effective option for lowering LDL cholesterol, achieving reductions of 30% to 41% from baseline levels. Fenofibrate (Tricor) and Niacin (Niaspan) are more effective at lowering triglyceride levels or raising HDL levels (Niacin (Niaspan)). Colesevelam (Welchol) can reduce LDL levels but not as effectively as statins. Ezetimibe (Zetia) lowers LDL levels modestly compared to the LDL reduction achieved by statins.

A 68-year-old man was prescribed atenolol and sublingual nitroglycerin after his recent hospitalization for unstable angina. Which of his current medications should be discontinued?

tadalafil (Cialis)--> Sildenafil and other PDE-5 inhibitors can potentiate the vasodilator effects of nitrates and cause an unsafe drop in blood pressure. Concomitant use of nitrates and PDE-5 inhibitors should be avoided