Cardio 1 Flashcards
A 33-year old patient is due to undergo surgery, the patient requires venous thromboembolism prophylaxis and is renally impaired. Which of the following pharmacological options is the preferred option for patients that are renally impaired?
A) Aspirin
B) Edoxaban
C) Heparin (unfractionated)
D) Rivaroxaban
E) Warfarin
Heparin- RATIONALE: FOR PATIENTS WITH RENAL IMPAIRMENT, THE
PREFERRED OPTION FOR VENOUS THROMBOEMBOLISM
PROPHYLAXIS IS UNFRACTIONATED HEPARIN.
UNFRACTIONATED HEPARIN IS PRIMARILY CLEARED BY THE
LIVER, AND THUS DOSE ADJUSTMENTS ARE NOT REQUIRED IN
PATIENTS WITH RENAL IMPAIRMENT.
A 47-year-old patient has recently started on a low molecular weight heparin (LMWH) and starts to develop bruising of the skin. What is the likely cause of the bruising?
A) Hyperkalaemia
B) Hypokalaemia
C) Hypersensitivity
D) Thrombocytopenia
E) Lymphocytopenia
Thrombocytopenia -
RATIONALE: THE LIKELY CAUSE OF BRUISING OF THE SKIN IN
A PATIENT RECENTLY STARTED ON LOW MOLECULAR
WEIGHT HEPARIN (LMWH) IS THROMBOCYTOPENIA.
THROMBOCYTOPENIA IS A KNOWN SIDE EFFECT OF LMWH
THERAPY, AND IT IS CHARACTERIZED BY A DECREASE IN
PLATELET COUNT, WHICH CAN LEAD TO ABNORMAL
BLEEDING, BRUISING, OR PETECHIAE.
Which of the following pharmacological options is the preferred option for pregnant patients with a history of deep vein thrombosis?
A) Aspirin
B) Apixaban
C) Clopidogrel
D) Low molecular weight heparin (LMWH)
E) Warfarin
RATIONALE: FOR PREGNANT PATIENTS WITH A HISTORY OF
DEEP VEIN THROMBOSIS (DVT), THE PREFERRED OPTION FOR
PHARMACOLOGICAL PROPHYLAXIS OR TREATMENT IS LOW
MOLECULAR WEIGHT HEPARIN (LMWH).
A 55-year-old patient is admitted to the acute stroke unit following an ischaemic stroke. The patient has no co-morbidities or allergies. According to NICE guidelines, which secondary prevention therapy should be initiated in a patient following a stroke with no other co-morbidities?
A) Aspirin 75mg OD
B) Aspirin 75mg OD and Clopidogrel 75mg OD
C) Clopidogrel 75mg OD
D) Rivaroxaban 20mg OD
E) Warfarin 3mg OD
C
ACCORDING TO NICE GUIDELINES, IN A PATIENT FOLLOWING
AN ISCHEMIC STROKE WITH NO OTHER CO-MORBIDITIES,
CLOPIDOGREL 75 MG DAILY IS CONSIDERED THE STANDARD
THERAPY. IF CLOPIDOGREL CANNOT BE TOLERATED, ASPIRIN
75 MG DAILY WITH MODIFIED-RELEASE DIPYRIDAMOLE 200
MG TWICE DAILY MAY BE USED AS AN ALTERNATIVE.
A 31-year-old female patient, Miss Smith, attends a routine prenatal clinic. She is diagnosed with hypertension. Which anti-hypertensive can be safely and suitably commenced for Miss Smith?
A) Amlodipine
B) Bisoprolol
C) Hydralazine
D) Methyldopa
E) Ramipril
D
RATIONALE: IN PREGNANT PATIENTS WITH HYPERTENSION,
METHYLDOPA (D) IS TYPICALLY THE PREFERRED OPTION FOR
INITIATION OR CONTINUATION OF ANTIHYPERTENSIVE
THERAPY DUE TO ITS LONG-ESTABLISHED SAFETY RECORD IN
PREGNANCY.
A 57-year-old male patient, Andrew Smith, is admitted to the coronary care unit and diagnosed with an ST-elevation myocardial infarction. Long-term management following a STEMI involves several medications which should be started which should be started prior to discharge from hospital. Medication on discharge: Aspirin 75mg OD, Clopidogrel 75mg OD, Bisoprolol 2.5mg OD, Atorvastatin 80mg OD, GTN spray 1-2 sprays PRN. You assess the discharge letter and notice a medication is missing. Which of the following medications, if appropriate, should be prescribed for Mr Smith on discharge?
A) Amlodipine
B) Ramipril
C) Rivaroxaban
D) Verapamil
E) Warfarin
B
RATIONALE: BASED ON THE MEDICATION LIST PROVIDED, IT
APPEARS THAT THE ONLY MEDICATION MISSING FROM MR
SMITH’S DISCHARGE PRESCRIPTION THAT IS INDICATED FOR
LONG-TERM MANAGEMENT FOLLOWING A STEMI IS AN
ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITOR.
RAMIPRIL
It has been a few months since Andrew Smith has been discharged from hospital following an ST-elevated myocardial infarction. He has been experiencing nightmares which are affecting his sleep. Which medication is likely to be responsible for his nightmares?
A) Bisoprolol
B) GTN spray
C) Aspirin
D) Clopidogrel
E) Atorvastatin
A
RATIONALE: THE MEDICATION THAT IS MOST LIKELY
RESPONSIBLE FOR ANDREW SMITH’S NIGHTMARES IS
BISOPROLOL, AS IT IS A BETA-BLOCKER THAT CAN CAUSE
VIVID DREAMS OR NIGHTMARES AS A SIDE EFFECT.
A 54-year-old patient is admitted to hospital and is commenced on Verapamil by slow intravenous infusion for the treatment of supraventricular arrhythmias. Which of the following side effects commonly occurs in patients prescribed verapamil by intravenous infusion?
A) Bradycardia
B) Hypertension
C) Hyponatraemia
D) Hypoglycaemia
E) Hypokalaemia
A
RATIONALE: BRADYCARDIA COMMONLY OCCURS IN PATIENTS
PRESCRIBED VERAPAMIL BY INTRAVENOUS INFUSION.
A 54-year-old patient walks into your community pharmacy with a prescription for a new medication to aid smoking cessation. Which of the following is not a suitable treatment to aid smoking cessation?
A) Bupropion
B) Inositol nicotinate
C) NRT lozenges
D) NRT patches
E) Varenicline
B
RATIONALE: INOSITOL NICOTINATE IS NOT A SUITABLE
TREATMENT TO AID SMOKING CESSATION. IT IS A FORM OF
VITAMIN B3 THAT IS USED TO IMPROVE BLOOD FLOW AND
REDUCE CHOLESTEROL LEVELS, BUT IT HAS NO PROVEN
EFFICACY IN HELPING PATIENTS QUIT SMOKING
A 44-year-old patient walks into your community pharmacy with a prescription for Dipyridamole 200 mg MR capsules. What would be the most appropriate counselling advice for a patient prescribed Dipyridamole 200 mg MR capsules for the first time?
A) Take with or after food
B) Discard any remaining capsules 6 weeks after opening
C) Disperse the contents of the capsule into water
D) Avoid exposure to sunlight or sun lamps
E) Swallow whole with plenty of fluid
E
RATIONALE: THE MOST APPROPRIATE COUNSELLING ADVICE
FOR A PATIENT PRESCRIBED DIPYRIDAMOLE 200 MG MR
CAPSULES FOR THE FIRST TIME IS TO SWALLOW THEM
WHOLE WITH PLENTY OF FLUID. DIPYRIDAMOLE IS USED TO
PREVENT BLOOD CLOTS, AND THE MR FORMULATION IS
DESIGNED TO RELEASE THE MEDICATION GRADUALLY OVER
TIME. IT IS IMPORTANT NOT TO CRUSH, CHEW, OR DISPERSE
THE CONTENTS OF THE CAPSULE.
A 57-year-old woman is diagnosed with primary heterozygous familial hypercholesterolaemia and has a contraindication to statins. Which of the following medications is the preferred alternative monotherapy?
A) Atorvastatin 80mg OD
B) Fluvastatin 40mg OD
C) Ezetimibe 10mg OD
D) Cilostazol 100mg OD
E) Prasugrel 10mg OD
C
RATIONALE: AS THE PATIENT HAS A CONTRAINDICATION TO
STATINS, THE PREFERRED ALTERNATIVE MONOTHERAPY FOR
PRIMARY HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLAEMIA
IS EZETIMIBE 10MG OD
A 63-year-old patient is admitted into hospital with hyperkalemia. He was recently diagnosed with a non-ST elevation myocardial infarction and was started on several medications for long-term management. Which of the following medications is likely to have caused hyperkalaemia?
A) Clopidogrel
B) Aspirin
C) Atorvastatin
D) Ramipril
E) Bisoprolol
D
RATIONALE: THE MEDICATION THAT IS MOST LIKELY TO HAVE
CAUSED HYPERKALEMIA IN THIS PATIENT IS RAMIPRIL.
RAMIPRIL IS AN ANGIOTENSIN-CONVERTING ENZYME (ACE)
INHIBITOR COMMONLY USED IN THE LONG-TERM
MANAGEMENT OF PATIENTS FOLLOWING A MYOCARDIAL
INFARCTION. ONE OF THE COMMON SIDE EFFECTS OF ACE
INHIBITORS IS HYPERKALEMIA
A 54-year-old patient walks into the community pharmacy with a prescription for Naftidrofuryl oxalate 100mg TDS. What is the likely indication?
A) Asthma
B) Ischaemic heart disease
C) Hypertension
D) Chronic obstructive pulmonary disease
E) Peripheral vascular disease
E
RATIONALE: THE LIKELY INDICATION FOR NAFTIDROFURYL
OXALATE 100MG TDS IS PERIPHERAL VASCULAR DISEASE.
What are the monitoring requirements for Naftidrofuryl oxalate 100mg TDS?
A) LFTs after 3 months
B) Renal function after 3-6 months
C) Assessed for improvement after 3-6 months
D) U&Es after 6 months
E) LFTs and U&Es after 3 months
C
RATIONALE: PATIENTS MAY BE ASSESSED FOR IMPROVEMENT
AFTER 3-6 MONTHS OF TREATMENT. ADDITIONALLY, ROUTINE
MONITORING OF LIVER FUNCTION TESTS (LFTS) AND RENAL
FUNCTION (U&ES) IS OFTEN RECOMMENDED FOR PATIENTS ON
LONG-TERM MEDICATION, ESPECIALLY IF THEY HAVE
UNDERLYING LIVER OR RENAL DISEASE.
A 61-year-old man with a history of asthma has been taking Verapamil for long term prevention of chest pain due to stable angina. He is still experiencing symptoms despite being on Verapamil for the past few months. Which of the following is a suitable medication that can be added to control angina symptoms?
A) Atenolol
b) Amlodipine
C) Ivabradine
D) Metoprolol
E) Ramipril
C
RATIONALE: SINCE THE PATIENT IS ALREADY ON VERAPAMIL
AND BETA-BLOCKERS ARE CONTRAINDICATED DUE TO HIS
ASTHMA, IVABRADINE IS RECOMMENDED. IVABRADINE WORKS
BY REDUCING THE HEART RATE WITHOUT AFFECTING BLOOD
PRESSURE OR RESPIRATORY FUNCTION, MAKING IT A
SUITABLE CHOICE FOR PATIENTS WITH ASTHMA.
QUESTION 16
A 41-year-old patient is diagnosed with stable angina by the general practitioner due to chest pain on exertion. Which of the following medications is not indicated to treat a patient with stable angina?
A) Bisoprolol
B) Verapamil
C) Eplerenone
D) Nicorandil
E) Ranolazine
C
RATIONALE: EPLERENONE IS NOT INDICATED TO TREAT A
PATIENT WITH STABLE ANGINA AS IT IS A POTASSIUM-
SPARING DIURETIC USED IN THE TREATMENT OF HEART
FAILURE.
A 72-year-old patient is started on atorvastatin. Three months later the patient attends a follow-up appointment with regards to the new medication. Which blood test should be taken after 3 months to monitor for any side effects associated with atorvastatin?
A) Full blood count
B) Liver function tests
C) Thyroid function tests
D) HbA1c level
E) Brain natriuretic peptide
B
RATIONALE: LIVER FUNCTION TESTS SHOULD BE TAKEN
AFTER 3 MONTHS TO MONITOR FOR ANY SIDE EFFECTS
ASSOCIATED WITH ATORVASTATIN. ATORVASTATIN, LIKE
OTHER STATINS, CAN CAUSE LIVER DAMAGE.
A 54-year-old patient who is known to you, Andrew Smith, was started on a new medication for the treatment of atrial fibrillation. He comes into the community pharmacy as he has noticed visual impairment and is concerned that it is associated with the new medication. Which of the following medications is likely to have been prescribed for the treatment of atrial fibrillation?
A) Bisoprolol
B) Ramipril
C) Amiodarone
D) Verapamil
E) Losartan
C
RATIONALE: AMIODARONE IS A MEDICATION COMMONLY
USED FOR THE TREATMENT OF ATRIAL FIBRILLATION.
A 47-year old male patient starts to experience chest pain on exertion, he visits the cardiorespiratory admission unit at the hospital as he is concerned. He is diagnosed with stable angina. Which of the following medications is likely to be prescribed as first-line for a patient with stable angina to prevent further episodes of chest pain?
A) Spironolactone
B) Ivabradine
C) Glyceryl trinitrate
D) Amlodipine
E) Bisoprolol
E
RATIONALE: BISOPROLOL IS A BETA-BLOCKER MEDICATION
THAT WORKS BY BLOCKING THE EFFECTS OF THE HORMONE
ADRENALINE ON THE BODY’S BETA RECEPTORS, RESULTING IN
A SLOWER HEART RATE AND REDUCED BLOOD PRESSURE. BY
DOING SO, IT CAN HELP TO REDUCE THE WORKLOAD ON THE
HEART, IMPROVE BLOOD FLOW TO THE HEART, AND REDUCE
THE FREQUENCY AND SEVERITY OF EPISODES OF CHEST PAIN
IN PATIENTS WITH STABLE ANGINA.
54-year old patient is admitted to the coronary care unit following a non-ST elevation myocardial infarction. During his admission, he is diagnosed with heart failure with a left ventricular ejection fraction of 30%. The cardiology consultant wants to commence the patient on an aldosterone antagonist alongside his current therapy. Which of the following medications is the most suitable aldosterone antagonist for a patient with heart failure post myocardial infarction?
A) Ranolazine
B) Ivabradine
C) Eplerenone
D) Spironolactone
E) Verapamil
C
RATIONALE: EPLERENONE HAS BEEN SHOWN TO REDUCE
MORBIDITY AND MORTALITY IN PATIENTS WITH HEART
FAILURE AND LEFT VENTRICULAR DYSFUNCTION FOLLOWING A
MYOCARDIAL INFARCTION, ACCORDING TO THE EPHESUS
(EPLERENONE POST-AMI HEART FAILURE EFFICACY AND
SURVIVAL STUDY) TRIAL. WHILE SPIRONOLACTONE IS ALSO
AN EFFECTIVE ALDOSTERONE ANTAGONIST, EPLERENONE IS
OFTEN PREFERRED IN POST-MI HEART FAILURE PATIENTS
DUE TO ITS MORE FAVORABLE SIDE EFFECT PROFILE,
PARTICULARLY IN REDUCING THE INCIDENCE OF
GYNECOMASTIA AND OTHER HORMONAL SIDE EFFECTS.
A 54-year-old patient walks into the community pharmacy with a prescription for Glyceryl Trinitrate 400 micrograms/dose pump sublingual spray for the prophylaxis of angina. Which of the following is the correct administration advice for a patient prescribed Glyceryl Trinitrate 400 micrograms/dose pump sublingual spray for the treatment of angina?
A) 1 tablet, to be administered prior to activity likely to cause angina
B) 1 tablet, the dose may be repeated at 5-minute intervals if required; if symptoms have not resolved after 3 doses, medical attention should be sought
C) 400–800 micrograms, to be administered under the tongue and then close mouth prior to activity likely to cause angina
D) 400–800 micrograms, to be administered under the tongue and then close mouth, dose may be repeated at 5 minute intervals if required; seek urgent medical attention if symptoms have not resolved 5 minutes after the second dose, or earlier if the pain is intensifying or the person is unwell.
E) 2-3 sprays under the tongue and then close mouth, the dose may be repeated at 5-minute intervals if required; if symptoms have not resolved after 3 doses, seek medical attention
D
A 54-year-old walks into your community pharmacy as he is experiencing side effects to his new medication, he was recently started on propranolol for the treatment of arrhythmias. Since starting his new medication, he experiences nightmares and he is concerned. Which of the following beta blockers is less likely to cause nightmares?
A) Labetalol
B) Metoprolol
C) Pindolol
D) Atenolol
E) Ramipril
D
RATIONALE: ATENOLOL IS THE LEAST LIKELY TO CAUSE
NIGHTMARES. LABETALOL, METOPROLOL AND PINDOLOL ARE
ALL FAT SOLUBLE BETA BLOCKERS, SO ARE MORE LIKELY TO
CROSS THE BLOOD BRAIN BARRIER TO CAUSE NIGHTMARES.
ATENOLOL IS MORE WATER SOLUBLE.
A 57-year-old patient is started on a new medication for heart failure alongside ramipril, he walks into the community pharmacy as he has started to notice swelling of his face and lips. Which of the following medications is likely to cause these side effects when taken alongside ramipril?
A) Spironolactone
B) Eplerenone
C) Amiloride
D) Sacubitril/valsartan
E) Bisoprolol
D
RATIONALE: AN IMPORTANT AND SERIOUS SIDE EFFECT OF
ACEIS IS ANGIOEDEMA CAUSED BY A REDUCTION IN
BRADYKININ DEGRADATION.
QUESTION 24
A 63-year-old patient is started on a medication for the treatment of atrial fibrillation and he has started to notice a predominance of yellow in vision. Which of the following medications is likely to cause this side effect?
A) Ramipril
B) Bisoprolol
C) Losartan
D) Amiloride
E) Digoxin
E
RATIONALE: THE MEDICATION THAT IS MOST LIKELY TO
CAUSE A PREDOMINANCE OF YELLOW IN VISION IS E)
DIGOXIN. DIGOXIN CAN CAUSE YELLOW VISION OR
XANTHOPSIA AS A SIDE EFFECT, WHICH IS A DISTURBANCE
IN COLOR VISION WHERE THERE IS A YELLOW TINT TO
EVERYTHING. IT IS IMPORTANT TO NOTE THAT ANY VISUAL
DISTURBANCES SHOULD BE REPORTED TO A HEALTHCARE
PROFESSIONAL AS SOON AS POSSIBLE.
