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Module 4 > Lippincott Pharmacology > Flashcards

Lippincott Pharmacology Flashcards

1
Q

Which of the following types of drugs will have maximum oral bioavailability?
A. Drugs with high first-pass metabolism.
B. Highly hydrophilic drugs.
C. Largely hydrophobic, yet soluble in aqueous
solutions.
D. Chemically unstable drugs.
E. Drugs that are P-glycoprotein substrates.

A

C. Largely hydrophobic, yet soluble in aqueous

solutions.

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2
Q

Which of the following is true about the blood–brain barrier?
A. Endothelial cells of the blood–brain barrier have slit junctions.
B. Ionized or polar drugs can cross the blood–brain barrier easily.
C. Drugs cannot cross the blood–brain barrier through specific transporters.
D. Lipid-soluble drugs readily cross the blood–brain barrier.
E. The capillary structure of the blood–brain barrier is similar to that of the liver and spleen.

A

D. Lipid-soluble drugs readily cross the blood–brain barrier.

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3
Q 
A 40-year-old male patient (70 kg) was recently diagnosed with infection involving methicillin-resistant S. aureus. He received 2000 mg of vancomycin as an IV loading dose. The peak plasma concentration of vancomycin was reported to be 28.5 mg/L. The apparent volume of distribution is:
A. 1 L/kg. 
B. 10 L/kg. 
C. 7 L/kg. 
D. 70 L/kg. 
E. 14 L/kg.
A

A. Vd = dose/C = 2000 mg/28.5 mg/L = 70.1 L. Because the patient is 70 kg, the apparent volume of distribution in L/kg will be approximately 1 L/kg (70.1 L/70 kg).
A. 1 L/kg.

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4
Q

A 65-year-old female patient (60 kg) with a history of ischemic stroke was prescribed clopidogrel for stroke prevention. She was hospitalized again after 6 months due to recurrent ischemic stroke. Which of the following is a likely reason she did not respond to clopidogrel therapy? She is a:
A. Poor CYP2D6 metabolizer.
B. Fast CYP1A2 metabolizer. C. Poor CYP2E1 metabolizer.
D. Fast CYP3A4 metabolizer.
E. Poor CYP2C19 metabolizer.

A

E. Poor CYP2C19 metabolizer.

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5
Q 
Which of the following phase II metabolic reactions makes phase I metabolites readily excretable in urine?
A. Oxidation.
B. Reduction.
C. Glucuronidation.
D. Hydrolysis.
E. Alcohol dehydrogenation.
A

C. Glucuronidation.

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6
Q

Alkalization of urine by giving bicarbonate is used to treat patients presenting with phenobarbital (weak acid) overdose. Which of the following best describes the rationale for alkalization of urine in this setting?
A. To reduce tubular reabsorption of phenobarbital.
B. To decrease ionization of phenobarbital.
C. To increase glomerular filtration of phenobarbital.
D. To decrease proximal tubular secretion.
E. To increase tubular reabsorption of phenobarbital.

A

A. To reduce tubular reabsorption of

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7
Q 
A drug with a half-life of 10 hours is administered by continuous intravenous infusion. Which of the following best approximates the time for the drug to reach steady state?
A. 10 hours. 
B. 20 hours. 
C. 33 hours. 
D. 40 hours. 
E. 60 hours.
A

D. 40 hours

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8
Q 
A 55-year-old male patient (70 kg) is going to be treated with an experimental drug, Drug X, for an irregular heart rhythm. If the V is 1 L/kg and the desired steady-state plasm concentration is 2.5 mg/L, which of the following is the most appropriate intravenous loading dose for Drug X?
A. 175 mg. 
B. 70 mg. 
C. 28 mg. 
D. 10 mg. 
E. 1 mg.
A

A. For IV infusion, Loading dose = (Vd) × (desired steady-state plasma concentration). The Vd in this case corrected to the patient’s weight is 70 L. Thus, Loading dose = 70 L × 2.5 mg/L = 175 mg

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9
Q 
An 18-year-old female patient is brought to the emergency department due to drug overdose. Which of the following routes of administration is the most desirable for administering the antidote for the drug overdose?
A. Intramuscular. 
B. Subcutaneous.
C. Transdermal. 
D. Oral.
E. Intravenous.
A

E. Intravenous.

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10
Q 
Chlorothiazide is a weakly acidic drug with a pKa of 6.5. If administered orally, at which of the following sites of absorption will the drug be able to readily pass through the membrane?
A. Mouth (pH approximately 7.0).
B. Stomach (pH of 2.5).
C. Duodenum (pH approximately 6.1). 
D. Jejunum (pH approximately 8.0). 
E. Ileum (pH approximately 7.0).
A

B. Stomach (pH of 2.5).

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11
Q

Isoproterenol produces maximal contraction of cardiac muscle in a manner similar to epinephrine. Which of the following best describes isoproterenol?
A. Full agonist.
B. Partial agonist.
C. Competitive antagonist. D. Irreversible antagonist.
E. Inverse agonist.

A

A. Full agonist.

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12
Q

If 10 mg of naproxen produces the same analgesic response as 100 mg of ibuprofen, which of the following statements is correct?
A. Naproxen is more efficacious than is ibuprofen.
B. Naproxen is more potent than ibuprofen.
C. Naproxen is a full agonist, and ibuprofen is a partial
agonist.
D. Naproxen is a competitive antagonist.
E. Naproxen is a better drug to take for pain relief than
is ibuprofen.

A

B. Naproxen is more potent than ibuprofen.

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13
Q

If 10 mg of morphine produces a greater analgesic response than can be achieved by ibuprofen at any dose, which of the following statements is correct?
A. Morphine is less efficacious than is ibuprofen.
B. Morphine is less potent than is ibuprofen.
C. Morphine is a full agonist, and ibuprofen is a partial
agonist.
D. Ibuprofen is a competitive antagonist.
E. Morphine is a better drug to take for pain relief than
is ibuprofen.

A

E. Morphine is a better drug to take for pain relief than

is ibuprofen.

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14
Q

In the presence of naloxone, a higher concentration of morphine is required to elicit full pain relief. Naloxone by itself has no effect. Which of the following is correct regarding these medications?
A. Naloxone is a competitive antagonist.
B. Morphine is a full agonist, and naloxone is a partial
agonist.
C. Morphine is less efficacious than is naloxone.
D. Morphine is less potent than is naloxone.
E. Naloxone is a noncompetitive antagonist.

A

A. Naloxone is a competitive antagonist.

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15
Q

In the presence of pentazocine, a higher concentration of morphine is required to elicit full pain relief. Pentazocine by itself has a smaller analgesic effect than does morphine, even at the highest dose. Which of the following is correct regarding these medications?
A. Pentazocine is a competitive antagonist.
B. Morphine is a full agonist, and pentazocine is a
partial agonist.
C. Morphine is less efficacious than is pentazocine.
D. Morphine is less potent than is pentazocine.
E. Pentazocine is a noncompetitive antagonist.

A

B. Morphine is a full agonist, and pentazocine is a

partial agonist.

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16
Q

In the presence of picrotoxin, diazepam is less efficacious at causing sedation, regardless of the dose. Picrotoxin by itself has no sedative effect even at the highest dose. Which of the following is correct?
A. Picrotoxin is a competitive antagonist.
B. Diazepam is a full agonist, and picrotoxin is a partial
agonist.
C. Diazepam is less efficacious than is picrotoxin.
D. Diazepam is less potent than is picrotoxin.
E. Picrotoxin is a noncompetitive antagonist.

A

E. Picrotoxin is a noncompetitive antagonist.

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17
Q

Which of the following statements most accurately describes a system having spare receptors?
A. The number of spare receptors determines the maximum effect.
B. Spare receptors are sequestered in the cytosol.
C. A single drug–receptor interaction results in many
cellular response elements being activated.
D. Spare receptors are active even in the absence of an
agonist.
E. Agonist affinity for spare receptors is less than their
affinity for “non-spare” receptors.

A

C. A single drug–receptor interaction results in many

cellular response elements being activated.

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18
Q

Which of the following would up-regulate postsynaptic β1 adrenergic receptors?
A. Daily use of amphetamine that causes norepinephrine to be released.
B. A disease that causes an increase in the activity of norepinephrine neurons.
C. Daily use of isoproterenol, a β1 receptor agonist.
D. Daily use of formoterol, a β2 receptor agonist.
E. Daily use of propranolol, a β1 receptor antagonist.

A

E. Daily use of propranolol, a β1 receptor antagonist.

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19
Q

Which of the following is correct regarding the autonomic nervous system (ANS)?
A. Afferent neurons carry signals from the CNS to the effector organs.
B. The neurotransmitter at the parasympathetic ganglion is norepinephrine (NE).
C. The neurotransmitter at the sympathetic ganglion is acetylcholine (ACh).
D. Sympathetic neurons release ACh in the effector organs.
E. Parasympathetic neurons release NE in the effector organs.

A

C. The neurotransmitter at the sympathetic ganglion is acetylcholine (ACh).

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20
Q

Which of the following is correct regarding somatic motor neurons?
A. The neurotransmitter at the somatic motor neuron ganglion is acetylcholine.
B. The neurotransmitter at the somatic motor neuron ganglion is norepinephrine.
C. Somatic motor neurons innervate smooth muscles.
D. Somatic motor neurons do not have ganglia.
E. Responses in the somatic motor neurons are
generally slower than in the autonomic nervous system.

A

D. Somatic motor neurons do not have ganglia.

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21
Q

Which of the following physiological changes could happen when a person is attacked by a grizzly bear?
A. Increase in heart rate.
B. Increase in lacrimation (tears). C. Constriction of the pupil (miosis). D. Increase in gastric motility.

A

A. Increase in heart rate.

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22
Q

Which of the following changes could theoretically happen in a person when the parasympathetic system is inhibited using a pharmacological agent?
A. Reduction in heart rate.
B. Constriction of the pupil (miosis).
C. Increase in gastric motility.
D. Dry mouth (xerostomia).
E. Contraction of detrusor muscle in the bladder.

A

D. Dry mouth (xerostomia).

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23
Q

Which of the following statements is correct regarding the sympathetic and parasympathetic systems?
A. Acetylcholine activates muscarinic receptors.
B. Acetylcholine activates adrenergic receptors.
C. Norepinephrine activates muscarinic receptors.
D. Activation of the sympathetic system causes a drop
in blood pressure.

A

A. Acetylcholine activates muscarinic receptors.

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24
Q

Which of the following statements concerning the parasympathetic nervous system is correct?
A. The parasympathetic system uses norepinephrine as a neurotransmitter.
B. The parasympathetic system often discharges as a single, functional system.
C. The parasympathetic division is involved in accommodation of near vision, movement of food, and urination.
D. The postganglionic fibers of the parasympathetic division are long compared to those of the sympathetic nervous system.
E. The parasympathetic system controls the secretion of the adrenal medulla.

A

C. The parasympathetic division is involved in accommodation of near vision, movement of food, and urination.

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25
Q

Which of the following is correct regarding neurotrans- mitters and neurotransmission?
A. Neurotransmitters are released from the presynaptic nerve terminals.
B. Neurotransmitter release is triggered by the arrival of action potentials in the postsynaptic cell.
C. Intracellular calcium levels drop in the neuron before the neurotransmitter is released.
D. Serotonin and dopamine are the primary neurotransmitters in the ANS.

A

A. Neurotransmitters are released from the presynaptic nerve terminals.

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26
Q 
An elderly man was brought to the emergency room after he ingested a large quantity of carvedilol tablets, a drug that blocks α1, β1, and β2 adrenergic receptors, which mainly mediate the cardiovascular effects of epinephrine and norepinephrine in the body. Which of the following symptoms would you expect in this patient?
A. Increased heart rate (tachycardia). 
B. Reduced heart rate (bradycardia). 
C. Dilation of the pupil (mydriasis).
D. Increased blood pressure.
A

B. Reduced heart rate (bradycardia).

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27
Q

All of the following statements regarding central control of autonomic functions are correct except:
A. Baroreceptors are pressure sensors located at various cardiovascular sites.
B. The parasympathetic system is activated by the CNS in response to a sudden drop in blood pressure.
C. The parasympathetic system is activated by the CNS in response to a sudden increase in blood pressure.
D. The sympathetic system is activated by the CNS in response to a sudden drop in blood pressure.

A

B. The parasympathetic system is activated by the CNS in response to a sudden drop in blood pressure.

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28
Q

Which of the following is correct regarding membrane receptors and signal transduction?
A. ANS neurotransmitters bind to membrane receptors on the effector cells, which leads to intracellular events.
B. Cholinergic muscarinic receptors are examples of ionotropic receptors.
C. Cholinergic nicotinic receptors are examples of metabotropic receptors.
D. Metabotropic receptors activate ion channels directly.

A

A. ANS neurotransmitters bind to membrane receptors on the effector cells, which leads to intracellular events.

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29
Q

Botulinum toxin blocks the release of acetylcholine from cholinergic nerve terminals. Which of the following is a possible effect of botulinum toxin?
A. Skeletal muscle paralysis.
B. Improvement of myasthenia gravis symptoms.
C. Increased salivation.
D. Reduced heart rate.

A

A. Skeletal muscle paralysis.

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30
Q

A dentist would like to reduce salivation in a patient in preparation for an oral surgical procedure. Which of the following strategies will be useful in reducing salivation?
A. Activate nicotinic receptors in the salivary glands.
B. Block nicotinic receptors in the salivary glands.
C. Activate muscarinic receptors in the salivary
glands.
D. Block muscarinic receptors in the salivary glands.

A

D. Block muscarinic receptors in the salivary glands.

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31
Q 
Which of the following is a systemic effect of a muscarinic agonist?
A. Reduced heart rate (bradycardia). 
B. Increased blood pressure.
C. Mydriasis (dilation of the pupil).
D. Reduced urinary frequency.
E. Constipation.
A

A. Reduced heart rate (bradycardia).

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32
Q

If an ophthalmologist wants to dilate the pupils for an eye examination, which of the following drugs/classes of drugs could be theoretically useful?
A. Muscarinic receptor activator (agonist).
B. Muscarinic receptor inhibitor (antagonist).
C. Acetylcholine.
D. Pilocarpine.
E. Neostigmine.

A

B. Muscarinic receptor inhibitor (antagonist).

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33
Q

In Alzheimer’s disease, there is a deficiency of cholinergic neuronal function in the brain. Theoretically, which of the following strategies will be useful in treating the symptoms of Alzheimer’s disease?
A. Inhibiting cholinergic receptors in the brain.
B. Inhibiting the release of acetylcholine in the brain.
C. Inhibiting the acetylcholinesterase enzyme in the brain.
D. Activating the acetylcholinesterase

A

C. Inhibiting the acetylcholinesterase enzyme in the brain.

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34
Q

An elderly female who lives in a farm house was brought to the emergency room in serious condition after ingesting a liquid from an unlabeled bottle found near her bed, apparently in a suicide attempt. She presented with diarrhea, frequent urination, convulsions, breathing difficulties, constricted pupils (miosis), and excessive salivation. Which of the following is correct regarding this patient?
A. She most likely consumed an organophosphate pesticide.
B. The symptoms are consistent with sympathetic activation.
C. Her symptoms can be treated using an anticholinesterase agent.
D. Her symptoms can be treated using a cholinergic agonist.

A

A. She most likely consumed an organophosphate pesticide.

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35
Q 
Sarin is a volatile nerve agent that inhibits cholinesterase enzymes. Which of the following symptoms would you expect to see in a patient exposed to sarin?
A. Urinary retention.
B. Tachycardia.
C. Constriction of pupils (miosis). 
D. Dilation of the pupils (mydriasis). 
E. Dry mouth.
A

C. Constriction of pupils (miosis).

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36
Q

Head and neck irradiation in cancer patients can decrease salivary secretion and cause dry mouth. All of the following drugs or classes of drugs are theoretically useful in improving secretion of saliva in these patients except:
A. Muscarinic antagonists.
B. Muscarinic agonists.
C. Anticholinesterase agents. D. Pilocarpine.
E. Neostigmine.

A

A. Muscarinic antagonists.

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37
Q 
Which of the following drugs or classes of drugs will be useful in treating the symptoms of myasthenia gravis?
A. Nicotinic antagonists.
B. Muscarinic agonists.
C. Muscarinic antagonists.
D. Anticholinesterase agents.
A

D. Anticholinesterase agents.

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38
Q

Atropa belladonna is a plant that contains atropine (a muscarinic antagonist). Which of the following drugs or classes of drugs will be useful in treating poisoning with belladonna?
A. Malathion.
B. Physostigmine.
C. Muscarinic antagonists. D. Nicotinic antagonists.

A

B. Physostigmine.

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39
Q 
During an ophthalmic surgical procedure, the surgeon wanted to constrict the pupil of the patient using a miotic drug. However, he accidentally used another drug that caused dilation of the pupil (mydriasis) instead. Most likely, which of the following drugs did he use?
A. Acetylcholine. 
B. Pilocarpine. 
C. Tropicamide. 
D. Phentolamine. 
E. Bethanechol.
A

C. Tropicamide.

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40
Q 
Sarin is a nerve gas that is an organophosphate cholinesterase inhibitor. Which of the following could be used as an antidote to sarin poisoning?
A. Pilocarpine.
B. Carbachol.
C. Atropine.
D. Physostigmine. 
E. Nicotine.
A

C. Atropine.

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41
Q

Atropine is one of the ingredients in the antidiarrheal combination diphenoxylate/atropine available in the United States. Which of the following effects is produced by atropine that contributes to its antidiarrheal effect?
A. Increase in gastrointestinal motility.
B. Reduction in gastrointestinal motility.
C. Increase in salivation.
D. Increase in acid secretion.

A

B. Reduction in gastrointestinal motility.

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42
Q 
A patient with chronic obstructive pulmonary disease (COPD) was prescribed a β2 agonist for the relief of bronchospasm. However, the patient did not respond to this treatment. Which of the following drugs or classes of drugs would you suggest for this patient as the next option?
A. β1 Agonist.
B. Muscarinic agonist. 
C. Physostigmine.
D. Ipratropium.
E. Phentolamine.
A

D. Ipratropium.

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43
Q 
Which of the following drugs would be the most effective anti–motion sickness drug for a person planning to go on a cruise?
A. Atropine.
B. Tropicamide. 
C. Scopolamine. 
D. Darifenacin. 
E. Tiotropium.
A

C. Scopolamine.

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44
Q

Which of the following is correct regarding ganglion- blocking drugs?
A. Blockade of sympathetic ganglia could result in reduced blood pressure.
B. Blockade of parasympathetic ganglia could result in reduced heart rate.
C. Nicotine is a nondepolarizing ganglion blocker.
D. Atropine is a nondepolarizing ganglion blocker.

A

A. Blockade of sympathetic ganglia could result in reduced blood pressure.

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45
Q

Which of the following is correct regarding the neuromuscular blockers (NMBs)?
A. Nondepolarizing NMBs are administered orally.
B. Cholinesterase inhibitors reduce the effects of
nondepolarizing NMBs.
C. Nondepolarizing NMBs affect diaphragm muscles
first.
D. Effects of depolarizing neuromuscular blockers can
be reversed using cholinesterase inhibitors.

A

B. Cholinesterase inhibitors reduce the effects of

nondepolarizing NMBs.

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46
Q

Whichofthefollowingiscorrectregardingdruginteractions with nondepolarizing neuromuscular blockers (NMBs)?
A. Desflurane reduces the effects of nondepolarizing NMBs.
B. Cholinesterase inhibitors increase the effects of nondepolarizing NMBs.
C. Aminoglycosides increase the effects of nondepolarizing NMBs.
D. Calcium channel blockers reduce the effects of nondepolarizing NMBs.

A

C. Aminoglycosides increase the effects of nondepolarizing NMBs.

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47
Q 
A patient was administered a neuromuscular blocker (NMB) prior to a surgical procedure to produce skeletal muscle paralysis. This NMB drug affected small, rapidly contracting muscles of the face and eyes first and diaphragm muscles last. The effect of this drug was easily reversed with neostigmine. Which of the following neuromuscular blockers was most likely administered to this patient?
A. Rocuronium.
B. Succinylcholine. 
C. Diazepam.
D. Tubocurarine.
A

A. Rocuronium.

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48
Q 
A patient was administered a neuromuscular blocker (NMB) prior to a surgical procedure to produce skeletal muscle paralysis. This NMB drug caused initial skeletal muscle fasciculations before the onset of paralysis. The effect of this drug could not be reversed with neostigmine. Which of the following neuromuscular blockers was most likely administered to this patient?
A. Cisatracurium. 
B. Succinylcholine. 
C. Diazepam.
D. Tubocurarine.
A

B. Succinylcholine.

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49
Q

Which of the following is correct regarding adrenergic neurotransmission?
A. Epinephrine is the major neurotransmitter released from sympathetic nerve terminals.
B. Norepinephrine is mainly released from the adrenal glands.
C. Tricyclic antidepressants and cocaine prevent reuptake of norepinephrine into the nerve terminals.
D. Monoamine oxidase (MAO) converts dopamine to norepinephrine in the nerve terminal.

A

C. Tricyclic antidepressants and cocaine prevent reuptake of norepinephrine into the nerve terminals.

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50
Q

All of the following are correct regarding adrenergic receptors, except:
A. α1 Receptors are primarily located on the postsynaptic membrane in the effector organs.
B. α Receptors are primarily located on the 2
presynaptic sympathetic nerve terminals.
C. β1 Receptors are found mainly in the heart.
D. β2 Receptors are found mainly in adipose tissue.

A

D. β2 Receptors are found mainly in adipose tissue.

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51
Q

A hypertensive patient was accidentally given an α 2
agonist instead of an α1 blocker. Which of the following is correct in this situation?
A. α2 Agonists can increase the release of norepinephrine from sympathetic nerve terminals.
B. α Agonists can reduce blood pressure in this 2
patient.
C. α2 Agonists can increase blood pressure in this
patient.
D. α2 Agonists will not affect blood pressure in this
patient.

A

B. α Agonists can reduce blood pressure in this 2

patient.

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52
Q

Which of the following is correct regarding responses mediated by adrenergic receptors?
A.Stimulation of α1 receptors increases blood pressure.
B.Stimulation of α receptors reduces blood pressure.
C.Stimulation of sympathetic presynaptic α receptors increases norepinephrine release.
D. Stimulation of β2 receptors increases heart rate (tachycardia).
E. Stimulation of β2 receptors causes bronchoconstriction.

A

A.Stimulation of α1 receptors increases blood pressure.

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53
Q

An asthma patient was given a nonselective β agonist to relieve bronchoconstriction. Which of the following adverse effects would you expect to see in this patient?
A. Bradycardia.
B. Tachycardia.
C. Hypotension (reduction in blood pressure). D. Worsening bronchoconstriction.

A

B. Tachycardia.

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54
Q 
Which of the following adrenergic agonists is most likely to cause CNS side effects when administered systemically?
A. Epinephrine.
B. Norepinephrine. 
C. Isoproterenol. 
D. Dopamine.
E. Ephedrine.
A

E. Ephedrine.

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55
Q 
A 12-year-old boy who is allergic to peanuts was brought to the emergency room after accidentally consuming peanuts contained in fast food. He is in anaphylactic shock. Which of the following drugs would be most appropriate to treat this patient?
A. Norepinephrine. 
B. Phenylephrine.
C. Dobutamine.
D. Epinephrine.
A

D. Epinephrine

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56
Q 
A 70-year-old patient was brought to the emergency room with a blood pressure of 76/60 mm Hg, tachycardia, and low cardiac output. He was diagnosed with acute heart failure. Which of the following drugs would be the most appropriate to improve his cardiac function?
A. Epinephrine. 
B. Fenoldopam. 
C. Dobutamine. 
D. Isoproterenol.
A

C. Dobutamine.

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57
Q 
Which of the following adrenergic agonists is commonly present in nasal sprays available over-the-counter (OTC) to treat nasal congestion?
A. Clonidine.
B. Albuterol.
C. Oxymetazoline. 
D. Dobutamine.
E. Norepinephrine.
A

C. Oxymetazoline.

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58
Q 
One of your patients who is hypertensive and gets mild asthma attacks occasionally bought an herbal remedy online to help with his asthma. He is not on any asthma medications currently but is receiving a β1-selective blocker for his hypertension. The herbal remedy seems to relieve his asthma attacks, but his blood pressure seems to increase despite the β-blocker therapy. Which of the following drugs is most likely present in the herbal remedy he is taking?
A. Phenylephrine. 
B. Norepinephrine. 
C. Dobutamine.
D. Ephedrine.
E. Salmeterol.
A

D. Ephedrine.

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59
Q 
A 60-year-old female patient started on a new antihypertensive medication recently. Her blood pressure seems to be under control, but she complains of fatigue, drowsiness, and fainting when she gets up from the bed (orthostatic hypotension). Which of the following drugs is she most likely taking?
A. Metoprolol. 
B. Propranolol. 
C. Prazosin.
D. Clonidine.
A

C. Prazosin.

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60
Q

A 30-year-old male patient was brought to the ER with amphetamine overdose. He presented with high blood pressure and arrhythmia. Which of the following is correct regarding this patient?
A. Amphetamine can activate all types of adrenergic receptors.
B. β-Blockers are the ideal antidotes for amphetamine poisoning.
C. α-Blockers can normalize the blood pressure in this patient.
D. Miosis could be a possible symptom of amphetamine poisoning.

A

A. Amphetamine can activate all types of adrenergic receptors.

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61
Q 
A new antihypertensive drug was tested in an animal model of hypertension. The drug when given alone reduces blood pressure in the animal. Norepinephrine when given in the presence of this drug did not cause any significant change in blood pressure or heart rate in the animal. The new drug is similar to which of the following drugs in terms of its pharmacological mechanism of action?
A. Prazosin.
B. Clonidine. 
C. Propranolol. 
D. Metoprolol. 
E. Carvedilol.
A

E. Carvedilol.

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62
Q 
A β-blocker was prescribed for hypertension in a female asthma patient. After about a week of treatment, the asthma attacks got worse, and the patient was asked to stop taking the β-blocker. Which of the following β-blockers would you suggest as an alternative in this patient that is less likely to worsen her asthma?
A. Propranolol. 
B. Metoprolol. 
C. Labetalol. 
D. Carvedilol.
A

B. Metoprolol.

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63
Q 
A 70-year-old male needs to be treated with an α-blocker for overflow incontinence due to his enlarged prostate. Which of the following drugs would you suggest in this patent that will not affect his blood pressure significantly?
A. Prazosin.
B. Doxazosin.
C. Phentolamine. 
D. Tamsulosin.
E. Terazosin.
A

D. Tamsulosin.

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64
Q 
A 50-year-old male was brought to the emergency room after being stung by a hornet. The patient was found to be in anaphylactic shock, and the medical team tried to reverse the bronchoconstriction and hypotension using epinephrine. However, the patient did not fully respond to the epinephrine treatment. The patient’s wife mentioned that he is taking a prescription medication for his blood pressure, the name of which she does not remember. Which of the following medications is he most likely taking that could have prevented the effects of epinephrine?
A. Doxazosin. 
B. Propranolol. 
C. Metoprolol. 
D. Acebutolol.
A

B. Propranolol.

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65
Q

Which of the following is correct regarding α-adrenergic blockers?
A. α-Adrenergic blockers are used in the treatment of hypotension in anaphylactic shock.
B. α-Adrenergic blockers are used in the treatment of benign prostatic hyperplasia (BPH).
C. α-Adrenergic blockers may cause bradycardia.
D. α-Adrenergic blockers are used in the treatment of
asthma.
E. α-Adrenergic blockers reduce the frequency of
urination.

A

B. α-Adrenergic blockers are used in the treatment of benign prostatic

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66
Q

Which of the following is correct regarding β-blockers?
A. Treatment with β-blockers should not be stopped abruptly.
B. Propranolol is a cardioselective β-blocker.
C. β-Blockers may cause orthostatic hypotension.
D. Cardioselective β-blockers worsen asthma.
E. β-Blockers decrease peripheral resistance by
causing vasorelaxation.

A

A. Treatment with β-blockers should not be stopped abruptly.

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67
Q 
Which of the following drugs is commonly used topically in the treatment of glaucoma?
A. Atropine.
B. Timolol.
C. Tropicamide. 
D. Scopolamine.
A

B. Timolol.

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68
Q

Which of the following is correct regarding carvedilol?
A. Carvedilol is a cardioselective β-blocker.
B. Carvedilol is safe for use in asthma patients.
C. Carvedilol has α -blocking activity. 1
D. Carvedilol is contraindicated in the treatment of stable chronic heart failure.

A

C. Carvedilol has α -blocking activity. 1

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69
Q

Which one of the following combinations of antiparkin- sonian drugs is an appropriate treatment plan?
A. Amantadine, carbidopa, and entacapone.
B. Levodopa, carbidopa, and entacapone.
C. Pramipexole, carbidopa, and entacapone.
D. Ropinirole, selegiline, and entacapone.
E. Ropinirole, carbidopa, and selegiline.

A

B. Levodopa, carbidopa, and entacapone.

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70
Q 
Peripheral adverse effects of levodopa, including nausea, hypotension, and cardiac arrhythmias, can be diminished by including which of the following drugs in the therapy?
A. Amantadine. 
B. Ropinirole. 
C. Carbidopa. 
D. Tolcapone. 
E. Pramipexole.
A

C. Carbidopa.

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71
Q 
Which of the following antiparkinsonian drugs may cause vasospasm?
A. Amantadine. 
B. Bromocriptine. 
C. Carbidopa.
D. Entacapone. 
E. Ropinirole.
A

B. Bromocriptine.

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72
Q

Modest improvement in the memory of patients with Alzheimer’s disease may occur with drugs that increase transmission at which of the following receptors?
A. Adrenergic.
B. Cholinergic. C. Dopaminergic. D. GABAergic. E. Serotonergic.

A

B. Cholinergic.

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73
Q 
Which medication is a glutamate receptor antagonist can be used in combination with an acetylcholinesterase inhibitor to manage the symptoms of Alzheimer’s disease?
A. Rivastigmine. 
B. Ropinirole. 
C. Fluoxetine. 
D. Memantine. 
E. Donepezil.
A

D. Memantine.

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74
Q 
Which of the following agents is available as a patch for once-daily use and is likely to provide steady drug levels to treat Alzheimer’s disease?
A. Rivastigmine. 
B. Donepezil. 
C. Memantine. 
D. Galantamine.
 E. Glatiramer.
A

A. Rivastigmine.

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75
Q 
Which of the following is the only medication that is approved for the management of amyotrophic lateral sclerosis?
A. Pramipexole. 
B. Selegiline.
C. Galantamine. 
D. Riluzole.
E. Glatiramer.
A

D. Riluzole.

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76
Q 
Which of the following medications reduces immune system–mediated inflammation via inhibition of pyrimidine synthesis to reduce the number of activated lymphocytes in the CNS?
A. Riluzole.
B. Rotigotine.
C. Teriflunomide.
D. Dexamethasone.
A

C. Teriflunomide.

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77
Q 
Which of the following agents may cause tremors as a side effect and, thus, should be used with caution in patients with Parkinson’s disease, even though it is also indicated for the treatment of dementia associated with Parkinson’s disease?
A. Benztropine.
B. Rotigotine.
C. Rivastigmine.
D. Dimethyl fumarate.
A

C. Rivastigmine

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78
Q 
Which of the following agents exerts its therapeutic effect in multiple sclerosis via potassium channel blockade?
A. Dalfampridine. 
B. Donepezil.
C. Riluzole.
D. Bromocriptine.
A

A. Dalfampridine.

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79
Q

Which one of the following statements is correct regarding benzodiazepines?
A. Benzodiazepines directly open chloride channels.
B. Benzodiazepines show analgesic actions.
C. Clinical improvement of anxiety requires 2 to 4
weeks of treatment with benzodiazepines.
D. All benzodiazepines have some sedative effects.
E. Benzodiazepines, like other CNS depressants,
readily produce general anesthesia.

A

D. All benzodiazepines have some sedative effects.

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80
Q 
Which one of the following is a short-acting hypnotic?
A. Phenobarbital.
B. Diazepam.
C. Chlordiazepoxide. 
D. Triazolam.
E. Flurazepam.
A

D. Triazolam.

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81
Q

Which one of the following statements is correct regarding the anxiolytic and hypnotic agents?
A. Phenobarbital shows analgesic properties.
B. Diazepam and phenobarbital induce the cytochrome
P450 enzyme system.
C. Phenobarbital is useful in the treatment of acute
intermittent porphyria.
D. Phenobarbital induces respiratory depression, which is enhanced by the consumption of ethanol.
E. Buspirone has actions similar to those of the
benzodiazepines.

A

D. Phenobarbital induces respiratory depression, which is enhanced by the consumption of ethanol.

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82
Q

D. Phenobarbital induces respiratory depression, which is enhanced by the consumption of ethanol.

A

D. Phenobarbital induces respiratory depression, which is enhanced by the consumption of ethanol.

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83
Q 
A 45-year-old man who has been injured in a car accident is brought into the emergency room. His blood alcohol level on admission is 275 mg/dL. Hospital records show a prior hospitalization for alcohol-related seizures. His wife confirms that he has been drinking heavily for 3 weeks. What treatment should be provided to the patient if he goes into withdrawal?
A. None.
B. Lorazepam. 
C. Pentobarbital. 
D. Phenytoin.
E. Buspirone.
A

B. Lorazepam.

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84
Q 
Which one of the following is a short-acting hypnotic and better for sleep induction compared to sleep maintenance?
A. Temazepam. 
B. Flurazepam. 
C. Zaleplon.
D. Buspirone.
E. Escitalopram.
A

C. Zaleplon.

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85
Q 
Which of the following agents has a rapid anxiolytic effect and would be best for the acute management of anxiety?
A. Buspirone.
B. Venlafaxine. 
C. Lorazepam. 
D. Escitalopram. 
E. Duloxetine.
A

C. Lorazepam.

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86
Q 
Which of the following sedative–hypnotic agents utilizes melatonin receptor agonism as the mechanism of action to induce sleep?
A. Zolpidem.
B. Eszopiclone.
C. Estazolam.
D. Ramelteon.
E. Diphenhydramine.
A

D. Ramelteon.

87
Q 
All of the following agents for the management of insomnia are controlled substances and may have a risk for addiction or dependence except:
A. Zaleplon.
B. Flurazepam. 
C. Doxepin.
D. Zolpidem. 
E. Triazolam.
A

C. Doxepin.

88
Q 
All of the following agents may cause cognitive impairment, including memory problems when used at recommended doses except:
A. Diphenhydramine. 
B. Zolpidem.
C. Alprazolam.
D. Phenobarbital.
E. Ramelteon.
A

E. Ramelteon.

89
Q 
Which agent is best used in the Emergency Room setting for patients who are believed to have received too much of a benzodiazepine drug or taken an overdose of benzodiazepines?
A. Diazepam. 
B. Ramelteon. 
C. Flumazenil. 
D. Doxepin.
E. Naloxone.
A

C. Flumazenil.

90
Q 
A 55-year-old teacher began to experience changes in mood. He was losing interest in his work and lacked the desire to play his daily tennis match. He was preoccupied with feelings of guilt, worthlessness, and hopelessness. In addition to the psychiatric symptoms, the patient complained of muscle aches throughout his body. Physical and laboratory tests were unremarkable. After 6 weeks of therapy with fluoxetine, his symptoms resolved. However, the patient complains of sexual dysfunction. Which of the following drugs might be useful in this patient?
A. Fluvoxamine. 
B. Sertraline.
C. Citalopram. 
D. Mirtazapine. 
E. Lithium.
A

D. Mirtazapine.

91
Q 
A 25-year-old woman has a long history of depressive symptoms accompanied by body aches and pain secondary to a car accident 2 years earlier. Physical and laboratory tests are unremarkable. Which of the following drugs might be useful in this patient?
A. Fluoxetine. 
B. Sertraline. 
C. Phenelzine. 
D. Mirtazapine.
E. Duloxetine.
A

E. Duloxetine.

92
Q 
A 51-year-old woman with symptoms of major depression also has angle-closure glaucoma. Which of the following antidepressants should be avoided in this patient?
A. Amitriptyline. 
B. Sertraline.
C. Bupropion. 
D. Mirtazapine. 
E. Fluvoxamine.
A

A. Amitriptyline.

93
Q 
A 36-year-old man presents with symptoms of compulsive behavior. If anything is out of order, he feels that “work will not be accomplished effectively or efficiently.” He realizes that his behavior is interfering with his ability to accomplish his daily tasks but cannot seem to stop himself. Which of the following drugs would be most helpful to this patient?
A. Imipramine.
B. Fluvoxamine.
C. Amitriptyline.
D. Tranylcypromine. 
E. Lithium.
A

B. Fluvoxamine.

94
Q 
Which antidepressant has, as its two proposed principle mechanisms of action, 5-HT1a receptor partial agonism and 5-HT reuptake inhibition?
A. Fluoxetine. 
B. Aripiprazole. 
C. Maprotiline. 
D. Vilazodone. 
E. Mirtazapine.
A

D. Vilazodone.

95
Q 
Which antidepressant is the most sedating?
A. Fluoxetine. 
B. Duloxetine. 
C. Nortriptyline. 
D. Citalopram. 
E. Venlafaxine.
A

C. Nortriptyline.

96
Q 
Which mood stabilizer is completely renally eliminated and may be beneficial for patients with hepatic impairment?
A. Valproic acid.
B. Carbamazepine. 
C. Lithium.
D. Risperidone.
E. Aripiprazole.
A

C. Lithium.

97
Q 
Which antidepressant has, as its two principle mechanisms of action, 5-HT2A receptor antagonism and α2 receptor antagonism?
A. Fluoxetine. 
B. Doxepin.
C. Maprotiline. 
D. Mirtazapine. 
E. Selegiline.
A

D. Mirtazapine.

98
Q 
Which agent is best known to have the side effect of decreasing the thyroid function of the patient being chronically treated with this agent?
A. Carbamazepine. 
B. Lithium.
C. Valproic acid.
D. Chlorpromazine. 
E. Lurasidone.
A

B. Lithium.

99
Q 
Which agent would be a poor choice in a 70-year- old elderly female with depressive symptoms due to the drug having significant α1 receptor antagonism and thus a higher risk for falls due to orthostatic hypotension?
A. Lithium.
B. Bupropion. 
C. Escitalopram. 
D. Imipramine. 
E. Sertraline.
A

A. Lithium.

100
Q 
An adolescent male is newly diagnosed with schizo- phrenia. Which of the following antipsychotic agents may have the best chance to improve his apathy and blunted affect?
A. Chlorpromazine. 
B. Fluphenazine. 
C. Haloperidol.
D. Risperidone.
E. Thioridazine.
A

D. Risperidone.

101
Q 
Which one of the following antipsychotics has been shown to be a partial agonist at the dopamine D2 receptor?
A. Aripiprazole. 
B. Clozapine. 
C. Haloperidol. 
D. Risperidone. 
E. Thioridazine.
A

A. Aripiprazole.

102
Q 
A 21-year-old male has recently begun pimozide therapy for Tourette disorder. His parents bring him to the emergency department. They describe that he has been having “different-appearing tics” than before, such as prolonged contraction of the facial muscles. While being examined, he experiences opisthotonos (type of extrapyramidal spasm of the body in which the head and heels are bent backward and the body is bowed forward). Which of the following drugs would be beneficial in reducing these symptoms?
A. Benztropine.
B. Bromocriptine.
C. Lithium.
D. Prochlorperazine. 
E. Risperidone.
A

A. Benztropine.

103
Q 
A 28-year-old woman with schizoaffective disorder (combination of mood and psychotic symptoms) reports difficulty falling asleep. Which of the following would be most beneficial in this patient?
A. Lithium.
B. Chlorpromazine. 
C. Haloperidol.
D. Paliperidone.
E. Ziprasidone.
A

B. Chlorpromazine.

104
Q 
Which of the following antipsychotic agents is con- sidered to be the most potent and, thus, have the highest risk of extrapyramidal symptoms?
A. Thioridazine.
B. Fluphenazine. 
C. Quetiapine.
D. Chlorpromazine. 
E. Clozapine.
A

B. Fluphenazine.

105
Q

Which antipsychotic has the most sedative potential and is sometimes questionably used as a hypnotic agent in certain clinical settings?
A. Fluphenazine. B. Thiothixene. C. Quetiapine. D. Haloperidol. E. Iloperidone.

A

C. Quetiapine.

106
Q 
A 30-year-old male patient who is treated with halo- peridol for his diagnosis of schizophrenia is considered to be well-managed symptomatically for his psychotic symptoms. However, he is reporting restlessness, the inability to sit still at the dinner table, and his family notices that he is pacing up and down the hallway frequently. Of the following, which is the best medication to treat this antipsychotic-induced akathisia?
A. Benztropine. 
B. Dantrolene.
C. Amoxapine.
D. Bromocriptine. 
E. Propranolol.
A

E. Propranolol.

107
Q 
Which of the following antipsychotic agents is available in a LAI formulation that may be useful for patients with difficulty adhering to therapy?
A. Asenapine.
B. Chlorpromazine. 
C. Clozapine.
D. Quetiapine.
E. Risperidone.
A

E. Risperidone.

108
Q 
Which of the following antipsychotic agents is most associated with the possibility of a hematological dyscrasia such as agranulocytosis in a patient being treated for schizophrenia?
A. Chlorpromazine. 
B. Buspirone.
C. Lithium.
D. Clozapine.
E. Asenapine.
A

D. Clozapine.

109
Q 
Which antipsychotic agent has been most associated with significant QT interval prolongation and should be used with caution in patients with preexisting arrhythmias or patients taking other drugs associated with QT prolongation?
A. Thioridazine. 
B. Risperidone. 
C. Asenapine. 
D. Lurasidone. 
E. Aripiprazole.
A

A. Thioridazine.

110
Q 
A 9-year-old boy is sent for neurologic evaluation because of episodes of apparent inattention. Over the past year, the child has experienced episodes during which he develops a blank look on his face and his eyes blink for 15 seconds. He immediately resumes his previous activity. Which one the following best describes this patient’s seizures?
A. Simple partial. 
B. Complex partial. 
C. Tonic–clonic.
D. Absence.
E. Myoclonic.
A

D. Absence.

111
Q 
A child is experiencing absence seizures that interrupt his ability to pay attention during school and activities. Which of the following therapies would be most appropriate for this patient?
A. Ethosuximide.
B. Carbamazepine.
C. Diazepam.
D. Carbamazepine plus primidone. 
E. Watchful waiting.
A

A. Ethosuximide.

112
Q 
Which of the following drugs is most useful for the treatment of absence seizures?
A. Topiramate.
B. Tiagabine.
C. Levetiracetam. 
D. Lamotrigine. 
E. Zonisamide.
A

D. Lamotrigine.

113
Q

A 25-year-old woman with myoclonic seizures is well controlled on valproate. She indicates that she is interested in becoming pregnant in the next year. With respect to her antiepilepsy medication, which of the following should be considered?
A. Leave her on her current therapy.
B. Consider switching to lamotrigine.
C. Consider adding a second antiepilepsy medication.
D. Decrease her valproate dose.

A

B. Consider switching to lamotrigine.

114
Q

A woman with myoclonic seizures is well controlled with lamotrigine. She becomes pregnant and begins to have breakthrough seizures. What is most likely happening?
A. Her epilepsy is getting worse.
B. Lamotrigine concentrations are increasing.
C. Lamotrigine concentrations are decreasing.
D. Lamotrigine is no longer efficacious for this patient.

A

C. Lamotrigine concentrations are decreasing.

115
Q 
A 42-year-old man undergoes a neurologic evaluation because of episodes of apparent confusion. Over the past year, the man has experienced episodes during which he develops a blank look on his face and fails to respond to questions. Moreover, it appears to take several minutes before the man recovers from the episodes. Which one of the following best describes this type of seizure?
A. Focal (simple partial). 
B. Focal (complex partial). 
C. Tonic–clonic.
D. Absence.
E. Myoclonic.
A

B. Focal (complex partial).

116
Q 
A 52-year-old man has had several focal complex partial seizures over the last year. Which one of the following therapies would be the most appropriate initial therapy for this patient?
A. Ethosuximide.
B. Levetiracetam.
C. Diazepam.
D. Carbamazepine plus primidone. 
E. Watchful waiting.
A

B. Levetiracetam.

117
Q 
A patient with focal complex partial seizures has been treated for 6 months with carbamazepine but, recently, has been experiencing breakthrough seizures on a more frequent basis. You are considering adding a second drug to the antiseizure regimen. Which of the following drugs is least likely to have a pharmacokinetic interaction with carbamazepine?
A. Topiramate.
B. Tiagabine.
C. Levetiracetam. 
D. Lamotrigine. 
E. Zonisamide.
A

C. Levetiracetam.

118
Q 
Which of the following is a first-line medication for generalized tonic–clonic seizures?
A. Ethosuximide. 
B. Felbamate.
C. Vigabatrin.
D. Ezogabine.
E. Topiramate.
A

E. Topiramate.

119
Q

A 75-year-old woman had a stroke approximately 1 month ago. She is continuing to have small focal seizures where she fails to respond appropriately while talking. Which of the following is the most appropriate treatment for this individual?
A. Phenytoin.
B. Oxcarbazepine. C. Levetiracetam. D. Phenobarbital.

A

C. Levetiracetam.

120
Q 
Which of the following is a potent analgesic but a weak anesthetic?
A. Etomidate.
B. Halothane. 
C. Midazolam. 
D. Nitrous oxide. 
E. Thiopental.
A

D. Nitrous oxide.

121
Q 
The potency of inhaled anesthetics is defined quantitatively as:
A. Blood/gas partition coefficient. 
B. Cerebrovascular resistance.
C. Minimum alveolar concentration. 
D. Diffusion hypoxia.
A

C. Minimum alveolar concentration.

122
Q

Which of the following determines the speed of recovery from intravenous anesthetics used for induction?
A. Liver metabolism of the drug.
B. Protein binding of the drug.
C. Ionization of the drug.
D. Redistribution of the drug from sites in the CNS.
E. Plasma clearance of the drug.

A

D. Redistribution of the drug from sites in the CNS

123
Q 
Which one of the following is a potent intravenous anesthetic but a weak analgesic?
A. Propofol.
B. Benzodiazepines. 
C. Ketamine.
D. Fentanyl.
E. Isoflurane.
A

A. Propofol.

124
Q

Which of the following is correct regarding local anesthetics?
A. They affect only small, unmyelinated nerve fibers.
B. They have either a lipophilic or a hydrophilic group.
C. They have either an amide or an ester linkage.
D. They are unaffected by pH of the tissue and pKa of
the drug.
E. In their ionized form, they interact with the protein
receptor of calcium channels.

A

C. They have either an amide or an ester linkage.

125
Q

Which of the following is correct regarding malignant hyperthermia?
A. It is triggered by dantrolene.
B. It is triggered by local anesthetics.
C. It is generally mild and clinically insignificant.
D. It has no familial component.
E. It involves increased skeletal muscle oxidative
metabolism.

A

E. It involves increased skeletal muscle oxidative

metabolism.

126
Q

A patient with heart failure and significantly reduced cardiac output requires surgical anesthesia. Which of the following would you expect to see in this patient?
A. Slower induction time with IV anesthetics.
B. Need for increased dosage of IV anesthetics.
C. Slower induction time with inhaled anesthetics.
D. Enhanced removal of inhaled anesthetics to
peripheral tissues.

A

A. Slower induction time with IV anesthetics.

127
Q 
An 80-year-old patient with asthma and low blood pressure requires anesthesia for an emergency surgical procedure. Which of the following agents would be most appropriate for inducing anesthesia in this patient?
A. Desflurane. 
B. Ketamine. 
C. Propofol. 
D. Thiopental.
A

B. Ketamine.

128
Q

A 52-year-old woman will be undergoing sedation with propofol for a brief diagnostic procedure. Which of the following is an advantage of propofol for this patient?
A. Rapid analgesia.
B. Sustained duration.
C. Decreased incidence of nausea and vomiting.
D. Less pain at the injection site.

A

C. Decreased incidence of nausea and vomiting.

129
Q 
A 32-year-old woman requests an epidural to ease labor pains. She reports that she had an allergic reaction to Novocain (procaine) at the dentist’s office. Which of the following local anesthetics would be appropriate for use in an epidural for this patient?
A. Chloroprocaine. 
B. Mepivacaine. 
C. Ropivacaine.
D. Tetracaine.
A

C. Ropivacaine.

130
Q

A young woman is brought into the emergency room. She is unconscious, and she has pupillary constriction and depressed respiration. Based on reports, an opioid overdose is almost certain. Which of the listed phenanthrene opioids will exhibit a full and immediate response to treatment with naloxone?
A. Meperidine.
B. Morphine.
C. Buprenorphine. D. Fentanyl.

A

B. Morphine.

131
Q

A 76-year-old female with renal insufficiency pres- ents to the clinic with severe pain secondary to a compression fracture in the lumbar spine. She reports that the pain has been uncontrolled with tramadol, and it is decided to start treatment with an opioid. Which of the following is the best opioid for this patient?
A. Meperidine.
B. Fentanyl transdermal patch. C. Hydrocodone.
D. Morphine.

A

C. Hydrocodone.

132
Q

Which of the following statements about fentanyl is correct?
A. Fentanyl is 100 times more potent than morphine.
B. Its withdrawal symptoms can be relieved by
naloxone.
C. The active metabolites of fentanyl can cause
seizures.
D. It is most effective by oral administration.

A

A. Fentanyl is 100 times more potent than morphine.

133
Q

A56-year-old patient who has suffered with severe chronic pain with radiculopathy secondary to spinal stenosis for years presents to the clinic for pain management. Over the years, this patient has failed to receive relief from the neuropathic pain from the radiculopathy with traditional agents such as tricyclics or anticonvulsants. Based on the mechanism of action, which opioid might be beneficial in this patient to treat both nociceptive and neuropathic pain?
A. Meperidine.
B. Oxymorphone. C. Morphine.
D. Methadone.

A

D. Methadone.

134
Q

Which of the following statements regarding methadone is correct?
A. Methadone is an excellent choice for analgesia in most patients since there are limited drug–drug interactions.
B. The equianalgesic potency of methadone is similar to that of morphine.
C. The duration of analgesia for methadone is much shorter than the elimination half-life.
D. The active metabolites of methadone accumulate in patients with renal dysfunction.

A

C. The duration of analgesia for methadone is much shorter than the elimination half-life

135
Q 
Which of the following opioids is the LEAST lipophilic?
A. Fentanyl. 
B. Methadone. 
C. Meperidine. 
D. Morphine.
A

D. Morphine.

136
Q 
A 64-year-old male is preparing for a total knee replacement. He is taking many medications that are metabolized by the CYP450 enzyme system and is worried about drug interactions with the pain medication that will be used following his surgery. Which of the following opioids would have the lowest chance of interacting with his medications that are metabolized by the CYP450 enzyme system?
A. Methadone.
B. Oxymorphone. 
C. Oxycodone.
D. Hydrocodone.
A

B. Oxymorphone

137
Q 
Which of the following opioids is the best choice for treating pain associated with diabetic peripheral neuropathy?
A. Morphine.
B. Tapentadol.
C. Codeine.
D. Buprenorphine.
A

B. Tapentadol.

138
Q 
KM is a 64-year-old male who has been hospitalized following a car accident in which he sustained a broken leg and broken arm. He has been converted to oral morphine in anticipation of his discharge. What other medication should he receive with his morphine upon discharge?
A. Diphenhydramine.
B. Methylphenidate.
C. Docusate sodium with senna. 
D. Docusate sodium.
A

C. Docusate sodium with senna.

139
Q

AN is a 57-year-old male who has been treated with oxycodone for chronic nonmalignant pain for over 2 years. He is now reporting increased pain in the afternoon while at work. Which of the following opioids is a short-acting opioid and is the best choice for this patient’s breakthrough pain?
A. Methadone. B. Pentazocine. C. Hydrocodone. D. Nalbuphine.

A

C. Hydrocodone.

140
Q 
A 22-year-old HIV patient has been told that marijuana may benefit him should he start using the substance. Which of the following adverse effects has been associated with marijuana usage and may be a reason for this patient to avoid use of marijuana?
A. Hyperphagia.
B. Hyperthermia.
C. Hepatitis.
D. Progression of HIV. E. Hyponatremia.
A

D. Progression of HIV.

141
Q 
A 21-year-old college student is curious about the effects of LSD. She asks what type of risks may be involved with using the drug for the first time. Which of the following is a correct response to her question?
A. Exaggerated hallucinations. 
B. Cardiomyopathy.
C. Hyperphagia.
D. Bronchitis.
A

A. Exaggerated hallucinations.

142
Q 
A 58-year-old male is brought into the emergency department following an automobile accident. His blood alcohol level on admission is 280 mg/dL. He has been treated in the past for seizures related to alcohol abuse, and he confirms that he has been drinking heavily over the past month since losing his job. What treatment should be given to this patient if he begins to go into withdrawal while hospitalized?
A. None.
B. Lorazepam. 
C. Acamprosate. 
D. Naltrexone. 
E. Disulfiram.
A

B. Lorazepam.

143
Q

A 35-year-old man has been abusing cocaine and is agitated, tachycardic, hypertensive, and hyperthermic. Which of the following is correct regarding treatment in this situation?
A. This patient should undergo gastric lavage; that is, he should have his stomach pumped immediately.
B. Cocaine toxicity commonly involves CNS depression that can be reversed with IV atropine.
C. Benzodiazepines would be a good choice, as they should help calm the patient down, decrease heart rate, decrease blood pressure, and decrease body temperature.
D. Phenobarbital should be the first choice as an anticonvulsant.

A

C. Benzodiazepines would be a good choice, as they should help calm the patient down, decrease heart rate, decrease blood pressure, and decrease body temperature.

144
Q

A 22-year-old man with a history of substance abuse arrives in the emergency department hypertensive, hyperthermic, and tachycardic, with altered mental status and hyperreflexia. His friends say he has been snorting “bath salts.” Which of the following is correct regarding this patient?
A. This patient’s clinical presentation is consistent with opioid toxicity and he should receive an opioid antagonist such as naloxone immediately.
B. “Bath salts” are often labeled as “not for human consumption” and sold with an unstated understanding that they contain synthetic cathinones, which are amphetamine-like compounds.
C. Treatment with a serotonin agonist might be beneficial.
D. Along with cooling measures, antihypertensives, β-blockers, and monoamine oxidase inhibitors would be reasonable options for the treatment.

A

“Bath salts” are often labeled as “not for human consumption” and sold with an unstated understanding that they contain synthetic cathinones, which are amphetamine-like compounds.

145
Q 
A young male was brought to the emergency room by the police due to severe agitation. Psychiatric examination revealed that he had injected dextroamphetamine several times in the past few days, the last time being 10 hours previously. He was given a drug that sedated him, and he fell asleep. Which of the following drugs was most likely used to counter this patient’s apparent symptoms of dextroamphetamine withdrawal?
A. Phenobarbital. 
B. Lorazepam. 
C. Cocaine.
D. Hydroxyzine. 
E. Fluoxetine.
A

B. Lorazepam.

146
Q 
JM is a 10-year-old male who is sent to a pediatric neurologist for an evaluation due to receiving poor grades in class. JM’s parents have recently received complaints from his teacher that he is performing poorly in school and he is repeatedly caught not paying attention in class. Several times a day during class, JM is noted to be getting out of his chair and socializing with other students. He has also been getting into fights with some children, as he is being singled out by others and teased. JM is given a diagnosis of ADHD with impulsivity and irritability. Which of the following is the most appropriate recommendation for management of the ADHD?
A. Clonidine.
B. Caffeine.
C. Dextroamphetamine. D. Haloperidol.
E. Buspirone.
A

C. Dextroamphetamine.

147
Q

JM is a 10-year-old male with ADHD. His symptoms are currently controlled with an oral psychostimulant. However, he and his family wish to avoid having to give a second dose of medication at school. They are looking for an alternative treatment option that could be implemented in the morning and last the entire day. Which treatment option would be best for JM’s needs?
A. Mixed amphetamine salts in immediate-release oral tablet formulation.
B. Methylphenidate in a transdermal delivery system.
C. Nicotine in a chewing gum formulation for buccal
absorption.
D. Methylphenidate in immediate-release pills.

A

B. Methylphenidate in a transdermal delivery system.

148
Q 
Which of the following treatments for ADHD is a controlled substance (DEA Schedule II)?
A. Clonidine.
B. Guanfacine.
C. Atomoxetine.
D. Dexmethylphenidate. E. Desipramine.
A

D. Dexmethylphenidate.

149
Q 
Amphetamines are contraindicated in patients with all of the following conditions except:
A. Cardiovascular disease. 
B. Glaucoma.
C. Hypertension.
D. Hyperthyroidism.
E. Obesity.
A

E. Obesity.

150
Q 
Which of the following agents is considered a first-line treatment for narcolepsy?
A. Donepezil. 
B. Atomoxetine. 
C. Clonidine.
D. Temazepam. 
E. Modafinil.
A

E. Modafinil.

151
Q 
Which of the following is a common adverse effect of amphetamines?
A. Bradycardia. 
B. Somnolence. 
C. Constipation. 
D. Hypertension. 
E. Fatigue.
A

D. Hypertension.

152
Q 
Which of the following CNS stimulants occurs naturally and can be found in certain candies?
A. Amphetamine. 
B. Clonidine.
C. Modafinil.
D. Caffeine.
E. Atomoxetine.
A

D. Caffeine.

153
Q

TT is a 35-year-old male who is interested in quitting smoking. In previous quit attempts, he has tried nicotine gum, the nicotine patch, and the “cold turkey” method. He has been unsuccessful in each of these attempts and usually resumed smoking within 4 to 6 weeks. Which of the following may be useful to assist TT in his attempt to quit smoking?
A. Varenicline.
B. Dextroamphetamine. C. Lorazepam.
D. Methylphenidate.

A

A. Varenicline.

154
Q 
All of the following drugs are controlled substances with a risk for drug addiction or dependence except:
A. Armodafinil.
B. Lisdexamfetamine. 
C. Dexmethylphenidate.D. Atomoxetine.
E. Methamphetamine.
A

C. Dexmethylphenidate.

155
Q 
A 45-year-old man was just started on therapy for hypertension and developed a persistent, dry cough. Which is most likely responsible for this side effect?
A. Enalapril. 
B. Losartan. 
C. Nifedipine. 
D. Prazosin.
E. Propranolol.
A

A. Enalapril.

156
Q 
Which may cause reflex tachycardia and/or postural hypotension on initial administration?
A. Atenolol.
B. Hydrochlorothiazide. C. Metoprolol.
D. Prazosin.
E. Verapamil.
A

D. Prazosin.

157
Q 
Which can precipitate a hypertensive crisis following abrupt cessation of therapy?
A. Clonidine.
B. Diltiazem.
C. Enalapril.
D. Losartan.
E. Hydrochlorothiazide.
A

A. Clonidine.

158
Q 
A 48-year-old hypertensive patient has been successfully treated with a thiazide diuretic for the last 5 years. Over the last 3 months, his diastolic pressure has steadily increased, and he was started on an additional antihypertensive agent. He complains of several instances of being unable to achieve an erection and not being able to complete three sets of tennis as he once did. Which is the likely second antihypertensive medication?
A. Captopril. 
B. Losartan. 
C. Metoprolol. 
D. Minoxidil. 
E. Nifedipine.
A

C. Metoprolol.

159
Q 
A 40-year-old male has recently been diagnosed with hypertension due to pressure readings of 163/102 and 165/100 mm Hg. He also has diabetes that is well controlled with oral hypoglycemic medications. Which is the best initial treatment regimen for treatment of hypertension in this patient?
A. Felodipine.
B. Furosemide.
C. Lisinopril.
D. Lisinopril and hydrochlorothiazide. 
E. Metoprolol.
A

D. Lisinopril and hydrochlorothiazide.

160
Q

A 60-year-old white female has not reached her blood pressure goal after 1 month of treatment with a low dose of lisinopril. All of the following would be appropriate next steps in the treatment of her hypertension except:
A. Increase dose of lisinopril.
B. Add a diuretic medication.
C. Add on a calcium channel blocker medication.
D. Add on an ARB medication.

A

D. Add on an ARB medication.

161
Q 
A patient returns to her health care provider for routine monitoring 3 months after her hypertension regimen was modified. Labs reveal elevated serum potassium. Which is likely responsible for this hyperkalemia?
A. Chlorthalidone. 
B. Clonidine.
C. Furosemide.
D. Losartan.
E. Nifedipine.
A

D. Losartan.

162
Q 
A 58-year-old female reports that she recently stopped taking her blood pressure medications because of swelling in her feet that began shortly after she started treatment. Which is most likely to cause peripheral edema?
A. Atenolol.
B. Clonidine. 
C. Felodipine. 
D. Hydralazine. 
E. Prazosin.
A

C. Felodipine.

163
Q 
Which is an appropriate choice for hypertension treatment during pregnancy?
A. Aliskiren.
B. Fosinopril. 
C. Hydralazine. 
D. Valsartan.
A

C. Hydralazine.

164
Q 
DD is a 50-year-old male with newly diagnosed hypertension. His comorbidities include diabetes and chronic hepatitis C infection with moderate liver impairment. He requires two drugs for initial treatment of his hypertension. Which should be prescribed in combination with a thiazide diuretic?
A. Lisinopril.
B. Spironolactone. 
C. Fosinopril.
D. Furosemide.
E. Hydralazine.
A

A. Lisinopril.

165
Q 
Which drug may exacerbate HF?
A. Acetaminophen. 
B. Cetirizine.
C. Chlorthalidone. 
D. Ibuprofen.
A

D. Ibuprofen.

166
Q

Which best describes the action of ACE inhibitors on the failing heart?
A. ACE inhibitors increase vascular resistance.
B. ACE inhibitors decrease cardiac output.
C. ACE inhibitors reduce preload.
D. ACE inhibitors increase aldosterone.

A

C. ACE inhibitors reduce preload.

167
Q

What makes losartan different from other ARBs?
A. Losartan is renally eliminated.
B. Losartan has an active metabolite.
C. Losartan has the shortest half-life.
D. Losartan has a small volume of distribution.

A

B. Losartan has an active metabolite.

168
Q 
How do β-blockers improve cardiac function in HF?
A. By decreasing cardiac remodeling. 
B. By increasing heart rate.
C. By increasing renin release.
D. By activating norepinephrine.
A

A. By decreasing cardiac remodeling.

169
Q

BC is a 70-year-old female who is diagnosed with HFrEF. Her past medical history is significant for hypertension and atrial fibrillation. She is taking hydrochlorothiazide, lisinopril, metoprolol tartrate, and warfarin. BC says she is feeling “good” and has no cough, shortness of breath, or edema. Which is the most appropriate medication change to make?
A. Discontinue hydrochlorothiazide.
B. Change lisinopril to losartan.
C. Decrease warfarin dose.
D. Change metoprolol tartrate to metoprolol succinate.

A

D. Change metoprolol tartrate to metoprolol succinate.

170
Q

SC is a 75-year-old white male who has HF. He is seen in clinic today, reporting shortness of breath, increased pitting edema, and a 5-pound weight gain over the last 2 days. His current medication regimen includes losartan and metoprolol succinate. SC has no chest pain and is deemed stable for outpatient treatment. Which of the following is the best recommendation?
A. Increase the dose of metoprolol succinate.
B. Start hydrochlorothiazide.
C. Start furosemide.
D. Discontinue losartan.

A

C. Start furosemide.

171
Q 
How is spironolactone beneficial in HF?
A. Promotes potassium secretion. 
B. Agonizes aldosterone.
C. Prevents cardiac hypertrophy. 
D. Decreases blood glucose.
A

C. Prevents cardiac hypertrophy.

172
Q 
Which is important to monitor in patients taking digoxin?
A. Chloride. 
B. Potassium. 
C. Sodium.
D. Zinc.
A

B. Potassium.

173
Q 
Which describes the mechanism of action of milrinone in HF?
A. Decreases intracellular calcium. 
B. Increases cardiac contractility. 
C. Decreases cAMP.
D. Activates phosphodiesterase.
A

B. Increases cardiac contractility.

174
Q 
What is the most common adverse effect associated with fixed-dose hydralazine/isosorbide dinitrate?
A. Diarrhea.
B. Drug-induced lupus. 
C. Headache.
D. Heartburn.
A

C. Headache.

175
Q 
A 60-year-old woman had a myocardial infarction. Which of the following should be used to prevent life-threatening arrhythmias that can occur post– myocardial infarction in this patient?
A. Digoxin.
B. Flecainide.
C. Metoprolol.
D. Procainamide. 
E. Quinidine.
A

C. Metoprolol.

176
Q

Suppression of arrhythmias resulting from a reentry focus is most likely to occur if the drug:
A. Has vagomimetic effects on the AV node.
B. Is a β-blocker.
C. Converts a unidirectional block to a bidirectional
block.
D. Slows conduction through the atria.
E. Has atropine-like effects on the AV node.

A

C. Converts a unidirectional block to a bidirectional

block.

177
Q 
A 57-year-old man is being treated for an atrial arrhythmia. He complains of dry mouth, blurred vision, and urinary hesitancy. Which antiarrhythmic drug is he mostly like taking?
A. Metoprolol.
B. Disopyramide. 
C. Dronedarone. 
D. Sotalol.
A

B. Disopyramide.

178
Q 
A 58-year-old woman is being treated for chronic suppression of a ventricular arrhythmia. After 1 week of therapy, she complains about feeling severe upset stomach and heartburn. Which antiarrhythmic drug is the likely cause of these symptoms?
A. Amiodarone. 
B. Digoxin.
C. Mexiletine. 
D. Propranolol. 
E. Quinidine.
A

C. Mexiletine.

179
Q 
A 78-year-old woman has been newly diagnosed with atrial fibrillation. She is not currently having symptoms of palpitations or fatigue. Which is appropriate to initiate for rate control as an outpatient?
A. Amiodarone. 
B. Dronedarone. 
C. Esmolol.
D. Flecainide.
E. Metoprolol.
A

E. Metoprolol.

180
Q

Which of the following is correct regarding digoxin when used for atrial fibrillation?
A. Digoxin works by blocking voltage-sensitive calcium channels.
B. Digoxin is used for rhythm control in patients with atrial fibrillation.
C. Digoxin increases conduction velocity through the AV node.
D. Digoxin levels of 1 to 2 ng/mL are desirable in the treatment of atrial fibrillation.

A

D. Digoxin levels of 1 to 2 ng/mL are desirable in the treatment of atrial fibrillation.

181
Q 
All of the following are adverse effects of amiodarone except:
A. Cinchonism.
B. Hypothyroidism.
C. Hyperthyroidism.
D. Pulmonary fibrosis.
E. Blue skin discoloration.
A

A. Cinchonism.

182
Q

Which arrhythmia can be treated with lidocaine?
A. Paroxysmal supraventricular ventricular tachycardia.
B. Atrial fibrillation.
C. Atrial flutter.
D. Ventricular tachycardia.

A

D. Ventricular tachycardia.

183
Q 
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?
A. Hypertension.
B. Left ventricular hypertrophy. 
C. Coronary artery disease.
D. Heart failure.
A

A. Hypertension.

184
Q

Which statement regarding dronedarone is correct?
A. Dronedarone is more effective than amiodarone.
B. QT interval prolongation is not a risk with
dronedarone.
C. Dronedarone increases the risk of death in
patients with permanent atrial fibrillation or
symptomatic heart failure.
D. There is no need to monitor liver function with
dronedarone.

A

C. Dronedarone increases the risk of death in
patients with permanent atrial fibrillation or
symptomatic heart failure.

185
Q

What is the clinical term for angina caused by coronary vasospasm?
A. Classic angina.
B. Myocardial infarction. C. Prinzmetal angina.
D. Unstable angina.

A

C. Prinzmetal angina.

186
Q

A 72-year-old male presents to the primary care clinic complaining of chest tightness and pressure that is increasing in severity and frequency. His current medications include atenolol, lisinopril, and nitroglycerin. Which intervention is most appropriate at this time?
A. Add amlodipine.
B. Initiate isosorbide mononitrate.
C. Initiate ranolazine.
D. Refer the patient to the nearest emergency room for evaluation.

A

D. Refer the patient to the nearest emergency room

for evaluation.

187
Q

A 62-year-old patient with a history of asthma and vasospastic angina states that he gets chest pain both with exertion and at rest, about ten times per week. One sublingual nitroglycerin tablet always relieves his symptoms, but this medication gives him an awful headache every time he takes it. Which is the best option for improving his angina?
A. Change to sublingual nitroglycerin spray.
B. Add amlodipine.
C. Add propranolol.
D. Replace nitroglycerin with ranolazine.

A

B. Add amlodipine.

188
Q 
Which side effect is associated with amlodipine?
A. Bradycardia.
B. Cough.
C. Edema.
D. QT prolongation.
A

C. Edema.

189
Q

Which medication should be prescribed to all anginal patients to treat an acute attack?
A. Isosorbide dinitrate.
B. Nitroglycerin patch.
C. Nitroglycerin sublingual tablet or spray. D. Ranolazine.

A

C. Nitroglycerin sublingual tablet or spray.

190
Q 
A 65-year-old male experiences uncontrolled angina attacks that limit his ability to do household chores. He is adherent to a maximized dose of β-blocker with a low heart rate and low blood pressure. He was unable to tolerate an increase in isosorbide mononitrate due to headache. Which is the most appropriate addition to his antianginal therapy?
A. Amlodipine. 
B. Aspirin.
C. Ranolazine. 
D. Verapamil.
A

C. Ranolazine.

191
Q

A 68-year-old male with a history of angina had a MI last month, and an echocardiogram reveals heart failure with reduced ejection fraction. He was continued on his previous home medications (diltiazem, enalapril, and nitroglycerin), and atenolol was added at discharge. He has only had a few sporadic episodes of stable angina that are relieved with nitroglycerin or rest. What are eventual goals for optimizing this medication regimen?
A. Add isosorbide mononitrate.
B. Increase atenolol.
C. Stop atenolol and increase diltiazem.
D. Stop diltiazem and change atenolol to bisoprolol.

A

D. Stop diltiazem and change atenolol to bisoprolol.

192
Q 
Which of the following medications would be safe to use in a patient taking ranolazine?
A. Carbamazepine. 
B. Clarithromycin. 
C. Enalapril.
D. Quetiapine.
A

C. Enalapril.

193
Q

A patient whose angina was previously well controlled with once-daily isosorbide mononitrate states that recently he has been taking isosorbide mononitrate twice a day to control angina symptoms that are occurring more frequently during early morning hours. Which of the following is the best option for this patient?
A. Continue once-daily administration of isosorbide mononitrate but advise the patient to take this medication in the evening.
B. Advise continuation of isosorbide mononitrate twice daily for full 24-hour coverage of anginal symptoms.
C. Switch to isosorbide dinitrate, as this has a longer duration of action than the mononitrate.
D. Switch to nitroglycerin patch for consistent drug delivery and advise him to wear the patch around the clock.

A

A. Continue once-daily administration of isosorbide mononitrate but advise the patient to take this medication in the evening.

194
Q 
Which of the P2Y12 ADP receptor antagonists reversibly binds the receptor?
A. Clopidogrel. 
B. Prasugrel. 
C. Ticagrelor. 
D. Ticlopidine.
A

C. Ticagrelor.

195
Q 
A 70-year-old female is diagnosed with nonvalvular atrial fibrillation. Her past medical history is significant for chronic kidney disease, and her renal function is moderately diminished. All of the following anticoagulants would be expected to require a reduced dosage in this patient except:
A. Apixaban.
B. Dabigatran. 
C. Rivaroxaban. 
D. Warfarin.
A

D. Warfarin.

196
Q

An 80-year-old male is taking warfarin indefinitely for the prevention of deep venous thrombosis. He is a compliant patient with a stable INR and has no issues with bleeding or bruising. He is diagnosed with a urinary tract infection and is prescribed sulfamethoxazole/ trimethoprim. What effect will this have on his warfarin therapy?
A. Sulfamethoxazole/trimethoprim will decrease the anticoagulant effect of warfarin.
B. Sulfamethoxazole/trimethoprim will increase the anticoagulant effect of warfarin.
C. Sulfamethoxazole/trimethoprim will activate platelet activity.
D. Sulfamethoxazole/trimethoprim will not change anticoagulation status.

A

B. Sulfamethoxazole/trimethoprim will increase the anticoagulant effect of warfarin.

197
Q

In which disease state is cilostazol contraindicated?
A. Peripheral arterial disease.
B. Gout.
C. Heart failure with reduced ejection fraction. D. Osteoporosis.

A

C. Heart failure with reduced ejection fraction.

198
Q 
Which must heparin bind to in order to exert its anticoagulant effect?
A. GP IIb/IIIa receptor. 
B. Thrombin.
C. Antithrombin III.
D. von Willebrand factor.
A

C. Antithrombin III.

199
Q 
Which is considered “fibrin selective” because it rapidly activates plasminogen that is bound to fibrin?
A. Alteplase.
B. Fondaparinux. 
C. Streptokinase. 
D. Urokinase.
A

A. Alteplase.

200
Q 
A 56-year-old man presents to the emergency room with complaints of swelling, redness, and pain in his right leg. The patient is diagnosed with acute DVT and requires treatment with an anticoagulant. All of the following are approved for treatment of this patient’s DVT except:
A. Rivaroxaban. 
B. Dabigatran. 
C. Enoxaparin. 
D. Heparin.
A

B. Dabigatran.

201
Q 
Which is most appropriate for reversing the anticoagulant effects of heparin?
A. Aminocaproic acid. 
B. Protamine sulfate. 
C. Vitamin K1
D. Tranexamic acid.
A

B. Protamine sulfate.

202
Q

A 62 year old male taking warfarin for stroke prevention in atrial fibrillation presents to his primary care physician with an elevated INR of 10.5 without bleeding. He is instructed to hold his warfarin dose and given 2.5 mg of oral vitamin K1. When would the effects of vitamin K on the INR most likely be noted in this patient?
A. 1 hour. B. 6 hours. C. 24 hours. D. 72 hours.

A

C. 24 hours.

203
Q

A 58-year-old man receives intravenous alteplase treatment for acute stroke. Five minutes following completion of alteplase infusion, he develops orolingual angioedema. Which of the following drugs may have increased the risk of developing orolingual angioedema in this patient?
A. ACE inhibitor.
B. GP IIb/IIIa receptor antagonist. C. Phosphodiesterase inhibitor. D. Thiazide diuretic.

A

A. ACE inhibitor.

204
Q 
Which one of the following is the most common side effect of antihyperlipidemic drug therapy?
A. Elevated blood pressure.
B. Gastrointestinal disturbance. 
C. Neurologic problems.
D. Heart palpitations.
E. Migraine headaches.
A

B. Gastrointestinal disturbance.

205
Q 
Which one 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 I. 
B. Type II. 
C. Type III. 
D. Type IV. 
E. Type V.
A

A. Type I.

206
Q 
Which one of the following drugs decreases cholesterol synthesis by inhibiting the enzyme 3-hydroxy-3- methylglutaryl coenzyme A reductase?
A. Fenofibrate.
B. Niacin.
C. Cholestyramine. 
D. Lovastatin.
E. Gemfibrozil.
A

D. Lovastatin.

207
Q 
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?
A. Niacin.
B. Fenofibrate.
C. Cholestyramine. 
D. Gemfibrozil.
E. Lovastatin.
A

A. Niacin.

208
Q 
Which one of the following drugs binds bile acids in the intestine, thus preventing their return to the liver via the enterohepatic circulation?
A. Niacin.
B. Fenofibrate.
C. Cholestyramine. 
D. Fluvastatin.
E. Lovastatin.
A

C. Cholestyramine.

209
Q 
JS is a 65-year-old man who presents to his physician for management of hyperlipidemia. His most recent lipid panel reveals an LDL cholesterol level of 165 mg/ dL. His physician wishes to begin treatment to lower his LDL cholesterol levels. Which of the following therapies is the best option to lower JS’s LDL cholesterol levels?
A. Fenofibrate. 
B. Colesevelam. 
C. Niacin.
D. Simvastatin. 
E. Ezetimibe.
A

D. Simvastatin.

210
Q

WW is a 62-year-old female with hyperlipidemia and hypothyroidism. Her current medications include cholestyramine and levothyroxine (thyroid hormone). What advice would you give to WW to avoid a drug interaction between her cholestyramine and levothyroxine?
A. Stop taking the levothyroxine as it can interact with cholestyramine.
B. Take levothyroxine 1 hour before cholestyramine on an empty stomach.
C. Switch cholestyramine to colesevelam as this will eliminate the interaction.
D. Switch cholestyramine to colestipol as this will eliminate the interaction.
E. Take levothyroxine and cholestyramine at the same time to minimize the interaction.

A

B. Take levothyroxine 1 hour before cholestyramine on an empty stomach.

211
Q

AJ is a 42-year-old man who was started on niacin 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. Which of the following options can help AJ manage this adverse effect of niacin therapy?
A. Administer aspirin 30 minutes prior to taking niacin.
B. Administer aspirin 30 minutes after taking niacin.
C. Increase the dose of niacin SR to 1000 mg.
D. Continue the current dose of niacin.
E. Change the sustained-release niacin to
immediate-release niacin.

A

A. Administer aspirin 30 minutes prior to taking niacin.

212
Q

CN is a 72 year old male who is treated for hyperlipidemia with high-dose atorvastatin for the past 6 months. He also has a history of renal insufficiency. His most recent lipid panel shows an LDL cholesterol level of 131 mg/dL, triglycerides of 510 mg/dL, and HDL cholesterol of 32 mg/dL. His physician wishes to add an additional agent for his hyperlipidemia. Which of the following choices is the best option to address CN’s dyslipidemia?
A. Fenofibrate. B. Niacin.
C. Colesevelam. D. Gemfibrozil. E. Ezetimibe.

A

B. Niacin.

213
Q

Which of the following patient populations is more likely to experience myalgia (muscle pain) or myopathy with use of HMG CoA reductase inhibitors?
A. Patients with diabetes mellitus.
B. Patients with renal insufficiency.
C. Patients with gout.
D. Patients with hypertriglyceridemia.
E. Patients taking warfarin (blood thinner).

A

B. Patients with renal insufficiency.

Module 4 (5 decks)

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