EXAM 5 practice questions Flashcards
Which enzymes play key roles in the vasodilation mediated the organic nitrate glyceryl trinitrate?
A. eNOS and soluble guanylyl cyclase
B. ALDH2 and soluble guanylyl cyclase
C. ALDH2 and membrane-bound guanylyl cyclase
D. eNOS and membrane-bound guanylyl cyclase
B. ALDH2 and soluble guanylyl cyclase
MJ is a 55 year old white female. Her family history is notable for coronary artery disease.
Upon physical examination, her blood pressure is 156/80 mmHg, and her BMI is 30
kg/m3. Laboratory results reveal a total cholesterol (TC) of 320 mg/dL, LDL-C of 160
mg/dL, HDL-c of 40 mg/dL, and TG of 600 mg/dL. You calculate her ASCVD 10-year
risk score and it is 27.2% . Her GFR is >60 ml/min.
Medication Dose
Metformin 500 mg, 2 tablets BID
Trulicity 1.5 mg once weekly subq
Lisinopril 10 mg qd
Olanzapine 20 mg qd
Omeprazole 20 mg qd
PMH: hypertension, T2DM, neuropathy, schizophrenia, GERD
SH: current smoker
Which medication may be contributing to MJ’s
elevated lipid levels?
A. olanzapine
B. omeprazole
C. Trulicity
D. lisinopril
A
MJ is a 55 year old white female. Her family history is notable for coronary artery disease.
Upon physical examination, her blood pressure is 156/80 mmHg, and her BMI is 30
kg/m3. Laboratory results reveal a total cholesterol (TC) of 320 mg/dL, LDL-C of 160
mg/dL, HDL-c of 40 mg/dL, and TG of 600 mg/dL. You calculate her ASCVD 10-year
risk score and it is 27.2% . Her GFR is >60 ml/min.
You decide you want to start treatment for
dyslipidemia with this patient. What is the most
appropriate initial treatment alongside lifestyle
modifications?
A. atorvastatin 20 mg daily
B. atorvastatin 40 mg daily
C. rosuvastatin 5 mg daily
D. rosuvastatin 10 mg daily
B
MJ is a 55 year old white female. Her family history is notable for coronary artery disease.
Upon physical examination, her blood pressure is 156/80 mmHg, and her BMI is 30
kg/m3. Laboratory results reveal a total cholesterol (TC) of 320 mg/dL, LDL-C of 160
mg/dL, HDL-c of 40 mg/dL, and TG of 600 mg/dL. You calculate her ASCVD 10-year
risk score and it is 27.2% . Her GFR is >60 ml/min.
It has been 6 weeks since you initiated atorvastatin for MJ. She
returns for a FLP. Her lipid panel results are listed below. What
is the next step in therapy?
(TC) of 254 mg/dL, LDL-C of 104 mg/dL, HDL-c of 40
mg/dL, and TG of 550 mg/dL.
A. Continue the same treatment
B. Switch to a hydrophilic statin
C. Start a fibrate
D. Increase atorvastatin to 80 mg daily
D
MJ is a 55 year old white female. Her family history is notable for coronary artery disease.
Upon physical examination, her blood pressure is 156/80 mmHg, and her BMI is 30
kg/m3. Laboratory results reveal a total cholesterol (TC) of 320 mg/dL, LDL-C of 160
mg/dL, HDL-c of 40 mg/dL, and TG of 600 mg/dL. You calculate her ASCVD 10-year
risk score and it is 27.2% . Her GFR is >60 ml/min.
It has been 8 weeks since you intensified atorvastatin
for MJ. She returns for a FLP. Her lipid panel results are
listed below. What is the next step in therapy?
(TC) of 229 mg/dL, LDL-C of 89 mg/dL, HDL-c of 40
mg/dL, and TG of 500 mg/dL.
A. Initiate a PCSK-9 inhibitor
B. Initiate ezetimibe
C. Initiate a fibrate or omega-3
D. No changes, MJ is at goal
Dr
C
Which of the following drug is the best choice for treating HTN in patients
with asthma?
A. Propranolol
B. Timolol
C. Metoprolol
D. Nadolol
C
True/False
Clonidine is a CNS alpha1-antagonist.
A. True
B. False
False
Which of the following statements is CORRECT regarding the mechanism of action for Metoprolol?
A. Metoprolol is a non-selective beta-adrenergic antagonist that reduces both heart rate and stroke
volume.
B. Metoprolol tartrate is proven effective for congestive heart failure because it avoids the beta-
2 adrenergic receptor blockade induced bronchoconstriction.
C. Metoprolol is a third-generation beta blocker, which causes a vasodilatory effect by producing
nitric oxide.
D. Metoprolol is primarily used in heart failure. It works by binding and blocking both alpha-1
adrenergic receptors and beta-adrenergic receptors.
B
Which drug / target / mechanism combination is incorrect?
A. clonidine/ central alpha-2 receptor agonist/ decrease SNS
signaling
B. Metoprolol / beta1 receptor blocker/ reduce heart rate and renin
release
C. Losartan/ antagonist of AT2/ block release of angiotensin II
D. Enalapril / inhibitor of ACE / block release of angiotensin II
C
What is the primary mechanism whereby statins reduce serum LDL-C?
A. Shifting cholesterol to bile acid synthesis
B. Reducing LDL secretion by the liver
C. Upregulating LDL receptors in the liver
D. Preventing dietary uptake of cholesterol
C
Which strategy(ies) to reduce serum cholesterol listed below doesn’t/don’t
depend on increased activity of LDL receptors in the liver?
A. Inhibition of PCSK9
B. Inhibition of HMG-CoA reductase
C. Inhibition of MTTP
D. Inhibition of Angiopoietin-like protein 3
C,D
What is the key metabolite that statins mimic to exert their inhibition of
HMG-CoA reductase?
A. Mevalonate
B. 3-hydroxy-3-methylglutaryl CoA
C. Citrate
D. Cholic Acid
A
Which ionic concentration gradient across the plasma membrane
of excitable cells is poised for flow of ions from inside the cell to
outside the cell when permeable channels open?
A. Ca2+
B. K+
C. Na+
D. Cl-
B
What is the basis of the high vascular selectivity of DHPs?
A. The binding site for DHPs on Cav1.2 in the heart is very different
than the binding site on Cav1.2 in vascular smooth muscle
B. DHPs have a very frequency-dependent mode of block.
C. DHPs are not hydrophobic enough to bind Cav1.2 in the heart
D. The resting membrane potential in vascular smooth muscle is
more depolarized than in cardiac muscle.
D
Differences in the efficacy of GTN across demographics is most
likely due to:
A. Variants in Nitric Oxide synthase (soluble)
B. Variants in Nitric Oxide synthase (membrane bound)
C. Variants in ALDH2
D. Variants in protein kinase G
