Pharm Case Files #3 Flashcards

1
Q

A 60-year-old male patient is brought to the emergency department with severe chest pain radiating to his arms and neck. He is a smoker and has history of uncontrolled mild hypertension and high blood cholesterol. His ECG confirms the diagnosis of myocardial infraction. He was immediately treated with a drug known to convert specifically fibrin-bound plasminogen to plasmin. Which of the following drugs has NOT been prescribed?

Alteplase
Urokinase
Tenecteplase
Streptokinase
Reteplase
A

Streptokinase— Lack of specificity leads to risk of bleeding

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2
Q

A 55-year-old female patient presents to your office complaining of pain in her right leg. She just returned from a trip to Russia. Her flight was more than 10 hours long. Duplex ultrasonography shows the presence of deep vein thrombosis in the affected leg. You decide to prescribe enoxaparin. Which of the statements describes the rational use of enoxaparin in this outpatient?

Enoxaparin can be effectively monitored by measuring the patient’s INR
Enoxaparin can be effectively monitored by measuring the patient’s aPTT
Enoxaparin has a shorter duration of action compared to heparin which reduces the likelihood of adverse effects
Enoxaparin therapy does not require monitoring–LMWH
Enoxaparin has an effective antidote called protamine sulfate

A

Enoxaparin therapy does not require monitoring–LMWH

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3
Q

Mr. Jim visits your clinic for follow-up. He has been on verapamil for six weeks for the treatment of hypertension. He complains of unusual constipation. Constipation is one of the leading adverse effects of verapamil. You prescribe an osmotic laxative to help relieve his constipation. Which of the following laxatives has been prescribed?

Senna
Lactulose
Docusate
Psyllium
Mineral oil
A

Lactulose– osmotic laxative

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4
Q

Mr. John is a 21 years old medical student with history of aspirin sensitivity. He has been eagerly preparing for Step 1 USMLE. On his way to the examination center he experiences a sudden onset of stomach cramp that is likely to be a precursor to an attack of diarrhea. He stops at the closest pharmacy to purchase an OTC antidiarrheal medication. All of the following therapeutics would be appropriate in this patient, EXCEPT:

Loperamide
Aluminum Hydroxide
Methylcellulose
Bismuth Subsalicylate
None of the above
A

Loperamide

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5
Q

A 42-year-old stock broker suffering from peptic ulcer was first treated with omeprazole. He visits his physician complaining of the recurrence of ulcer pain. He then tested positive for Helicobacter pylori with C13 labeled urea test. His physician prescribed triple therapy.
Which of the following antibiotic is commonly used for the eradication of Helicobacter pylori?

Neomycin
Streptomycin
Amoxicillin
Cefaclor
Cefazolin
A

Amoxicillin

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6
Q

Which of the following two drug pairs is first-line along with antibiotics in triple therapy for the treatment of peptic ulcer associated with Helicobacter pylori infection?

Omeprazole-Misoprostol
Misoprostol – Cimetidine
Cimetidine – Omeprazole
Omeprazole – Sucralfate
Misoprostol - Sucralfate
A

Cimetidine – Omeprazole

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7
Q

A 56-year-old female patient has been scheduled to receive 4 cycles of highly emetogenic cancer treatment for the treatment of ovarian cancer. The cycles will be administered every four weeks. Following the first cycle, her laboratory test shows: Red Blood Cells 4.0 trillion cells/L (N: 3.90 – 5.03 trillion cells/L), Platelets 102 billion cells/L (N: 150 – 450 billion cells/L). Which of the following drugs could be added to this patient’s therapeutic regimen to manage the side effect of chemotherapy?

Romiplostim
Eltrombopag--- patient friendly but this patient I throwing up so cant be given.
Sargramostin
Filgrastim
Epoetin alfa
A

Romiplostim

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8
Q

A 48-year-old with history of chronic kidney disease presents to your clinic for follow-up. He complains of fatigue, poor concentration, irritability and headache. You ordered a CBC. The results show: RBC 3.94 trillion cells/L (N: 4.32 – 5.72 trillion cells/L), Hb 10.7 g/dL (N: 13.5 – 17.5 g/dL), hematocrit 35.2 (N: 38.8 -50%), WBC 3.9 billion cells/L (N: 3.5 – 10.5 billion cells/L). Which of the following hematopoietic agents would you recommend in this patient?

Cyanocobalamin
Erythropoietin
Folic acid
Iron-dextran
Pyridoxine
A

Erythropoietin

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9
Q

An electrocardiogram (ECG) is used to record the electrical activity of the heart. It detects electrical impulses generated by the depolarization and repolarization of cardiac tissue and translates them into a measurable waveform. Which of the following statements best describes the effect of a drug that slows impulse conduction through the AV node?

Prolonged PR 
Prolonged QRS
Prolonged ST
Increased T wave amplitude
Increased P wave amplitude
A

Prolonged PR

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10
Q

A 62 years old with 2 years history of recurrent Atrial Fibrillation is being treated with sotalol. Sotalol is a beta blocker used as antiarrhythmic. All of the following statements describe sotalol, EXCEPT:

Diminishes slope of phase 4
Decreases automaticity 
Increases AV conduction
Exhibits Class III antiarrhythmic properties
Inhibits the efflux of K ions
A

Increases AV conduction

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11
Q

A 28 year old male patient had renal transplant. He was prescribed an immunosuppressant for the prevention of rejection. Few weeks later, he presents to your office complaining of gingival swelling. Intraoral examination revealed severe generalized gingival hyperplasia shown on the figure belowWhich of the following immunosuppressants has been most likely prescribed?

Azathioprine
Tacrolimus
Prednisone
Cyclosporine
Daclizumab
A

Cyclosporine

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12
Q

Which of the following is the mechanism of the prescribed immunosuppressant?

Inhibits the action of IL-2
Inhibits calcineurin
Inhibits purine synthesis
Inhibits folic acid pathway
Inhibit mTOR
A

Inhibits calcineurin

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13
Q

The cardiac action potential is the change in electrical potential associated with the passage of an impulse along the membrane of cardiac muscle cell. Complete inactivation of Na/Ca channel is achieved is archived at:

Phase 0
Phase 1 
phase 2
Phase 3
Phase 4
A

Phase 3

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14
Q

Thrombosis is the formation of blood clot inside blood vessels, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body activates platelets and fibrin to form a blood clot to prevent excessive blood loss. All of the following substances induce the activation of platelets, EXCEPT:

PGI2
Thromboxane A2
Serotonin
Calcium
ADP
A

PGI2

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15
Q

A new antiplatelet is being evaluated in phase 1 clinical trial to determine its pharmacokinetics profile. The new drug was found to inhibit irreversibly P2Y ADP receptor in preclinical experiments. Which of the following drugs has the same mechanism of action?

Eptifibatide
Tirofiban
Clopidogrel
Dipyridamole
Aspirin
A

Clopidogrel

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16
Q

A 58 years old presents with recurrent respiration viral infection. Following a long history of cardiovascular disease she has mild stroke three months ago. She was then placed on an antiplatelet. Her laboratory test shows: WBC 4,000/mcL (N: 4,500-10,000 white blood cells/mcL), neutrophils 2,100 (N: 2,500 and 6,000 cells/mcL). Which of the following antiplatelets has been prescribed to this patient?

Tirofiban
Clopidogrel
Ticlopidine– patient suffering from neutropenia.
Abciximab
Eptifibatide
A

Ticlopidine– patient suffering from neutropenia.

17
Q

The anticoagulant warfarin acts by blocking vitamin K epoxide reductase resulting in the inhibition of the conversion of oxidized vitamin K epoxide into its reduced form vitamin K hydroquinone. The overall effect is the prevention of vitamin K-dependent γ-carboxylation of several coagulation factors. All of the following coagulation factors are affected by warfarin, EXCEPT:

Factor II
Factor III 
Factor VII
Factor IX 
Factor X
A

Factor III

18
Q

A 60 years old patient on warfarin therapy for the management of atrial fibrillation visits your clinic for his regular blood test to monitor his INR. The results show an elevated INR of 5. He is not bleeding. You decide to omit the next dose of warfarin. Which of the following substances could be added to this patient’s therapeutic regimen to manage an elevated INR?

Protamine sulfate
Vitamin K
Heparin
Aspirin
Enoxaparin
A

Vitamin K

19
Q

A 32-year old patient with history of Atrial Fibrillation visits your office for her regular check-up. She is on warfarin and metoprolol for the management of her heart condition. During your interaction, she expresses her intention to become pregnant. How would you counsel this patient regarding her anticoagulant therapy?

The dose of warfarin should be increased during pregnancy due to reduction of bioavailability
Warfarin should be discontinued immediately and vitamin k supplement should be provided to reverse its effect
Warfarin should be replaced with heparin or LMWH
Warfarin should be replaced with aspirin at analgesic dose throughout the pregnancy
All anticoagulants are contraindicated during pregnancy

A

Warfarin should be replaced with heparin or LMWH

20
Q

A 21-year-old female was brought by the paramedics to the emergency department at 8:27am. She was found in her room by her parents in a state of altered consciousness and unable to recognize them. Her symptoms include pinpoint pupils, respiratory depression and slow heart rate. Opioid overdose is suspected. Which of the following agents is an effective antidote for the management of opioid overdose?

Naltrexone
Naloxone
Methadone
Meperidine
Pentazocine
A

Naloxone