Practice Exam Flashcards
When prescribing donepezil to treat Alzheimer’s disease, all of the following statements are correct
EXCEPT:
a) Starting dose is 5mg daily
b) Initial dose should be maintained for 4 weeks before any dose increase is considered
c) Rivastigmine and galantamine are believed to be more effective than donepezil
d) Weight loss is a concern
e) Donepezil is associated with GI adverse effects and headaches
C. All of the cholinesterase inhibitors are believed to be equally effective for treating mild to moderate Alzheimer’s disease (page 59, CTC 7th edn). Nausea, vomiting and anorexia are common adverse effects, frequently leading to weight loss. Initial dosing is 5mg daily and clinicians can increase the dose to 10mg daily after 4 weeks.
Which of the following drugs is NOT likely to have a drug interaction with a cholinesterase inhibitor such as donepezil or galantamine?
a) Oxybutynin (for urinary incontinence)
b) Carbamazepine
c) Ramipril
d) Timolol
e) Benztropine
C. ACE Inhibitors such as ramipril do not interact with cholinesterase inhibitors. Drugs with anticholinergic activity such as oxybutynin or benztropine, can antagonize the effect of cholinesterase inhibitors (Table 2, page 65 of Therapeutics Choices). Drugs commonly known to induce P450 CYP 3A4 or CYP 2D6 enzymes, such as carbamazepine or phenytoin, will decrease the effectiveness of cholinesterase inhibitors. Beta blockers such as timolol or metoprolol can have additive bradycardic effects.
Choose the CORRECT statement about the treatment of opioid withdrawal:
a) Methadone discontinuation should be slowly tapered over many weeks
b) Clonidine is an effective treatment against the muscle aches and cravings
c) Methadone has a half-life of about 2 to 4 hours
d) Naltrexone has no effect on the euphoric effects of opioids
e) Clonidine is used as a long-term therapy
A. Any discontinuation of methadone should be slowly tapered since drug craving can persist for several months. Methadone can be given once a day because it has a half-life of about 30 hours (page 166, CTC 7th edn). Clonidine is only used for 7-12 days to blunt the withdrawal symptoms in acute detoxification but it has no effect on the muscle aches and cravings. Naltrexone is a long-acting opioid antagonist used to block agonist effects such as euphoria.
Which of the following migraine prophylaxis medications should NOT be prescribed for an asthmatic child?
a) Flunarizine
b) Propranolol
c) Amitriptyline
d) Pizotifen
B. All of the above agents are used for migraine prophylaxis in children but, since nonselective beta-blockers can cause bronchospasm, propranolol should be avoided in this patient (page 232, CTC 7th edn)
JM is a 15-year old patient on eletriptan for migraine headaches. Which of the following could safely be given to this patient?
a) Ibuprofen
b) Escitalopram
c) Clarithromycin
d) Ketoconazole
e) Sumatriptan
A. This patient could take ibuprofen safely. Escitalopram is an SSRI, and triptans should be used with caution with these agents as well, there are concerns about increased suicidality when using an antidepressant in children. Eletriptan is contraindicated within 72 hours of CYP3A4 inhibitors (clarithromycin and ketoconazole). One triptan should not be taken within 24 hours of another triptan.
When treating neuropathic pain, which of the following is TRUE:
a) First-line agents are amitriptyline, gabapentin and pregabalin
b) Artificial saliva mouth spray cannot be given with amitriptyline if the patient experiences dry mouth
c) Gabapentin has no significant interactions with common over the counter medications like ibuprofen, cough and cold remedies or antacids
d) A stool softener should not be given with opioids and amitriptyline
e) Codeine is a good choice for treating severe neuropathic pain
- C and D
- B, D and E
- A, B and D
- C and E
- A, B, C and D
A. TCAs (amitriptyline) cause dry mouth due to their anticholinergic effects and artificial saliva is a good option. Both opioids and TCAs cause constipation and, since these agents will be used on a regular basis, a stool softener or other laxative should be given as a preventive measure (page 262 CTC, 7th edn). Amitriptyline is standard therapy for neuropathic pain, but gabapentin and pregabalin are alternative first-line agents. The bioavailability of gabapentin is reduced by OTC antacids; since this agent causes GI upset, concomitant use of these agents should be avoided. Codeine is a poor choice for treatment of severe pain because conversion of codeine to morphine in the liver can be unreliable, leading to adverse effects or poor pain control (page 261 CTC, 7th edn).
Which of the following statements regarding the treatment of neuropathic pain is FALSE?
a) Acetaminophen with codeine (Tylenol #3) is a first line treatment for neuropathic pain
b) If patients are too sedated on amitriptyline, nortriptyline may be better tolerated
c) Some patients may obtain better relief of pain with a combination of a TCA (such as amitriptyline) and a antiepileptic drug (such as gabapentin)
d) If carbamazepine must be used during pregnancy, folate supplementation (5mg/day) is recommended
e) Buproprion is has been shown to be less effective than TCAs
A. Opioid treatment is usually tried as a third line treatment option for people who have significant neuropathic pain refractory to first line agents (Figure 1, page 260 of Therapeutics choices). Nortriptyline is less sedating than amitriptyline and may be a reasonable choice. Combinations therapies such as amitriptyline and gabapentin can have synergistic effects on pain and CBZ is associated with increased risk of neural tube defects (page 262, CTC, 7th edn).
AB, a 35-year old pregnant patient of yours, presents with the Bell’s Palsy symptoms of mild facial weakness of the upper and lower face, ear pain and altered taste which began about 5 days ago and hasn’t worsened since. Which of these statements represents your best response?
a) No treatment is necessary since ~85% of cases resolve without treatment
b) Morphine 10mg q4h prn for the ear pain
c) Acyclovir 400mg 5 times daily for 10 days
d) Prednisone 1mg/kg daily for 5 days, then taper dose for 5 days
A. Up to 85% of cases recover spontaneously without treatment. Ibuprofen or acetaminophen with or without codeine may be used for pain in the first day or two, but more potent agents are not usually needed. Acyclovir is seldom given without prednisone and its’ benefit is not established (page 201, CTC, 7th edn). Prednisone would not be used since treatment is unnecessary for mild weakness that is no longer evolving (Figure 1, page 202, CTC, 7th edn).
Which of the following have been shown to be useful in the treatment of restless legs syndrome?
a) Diphenhydramine
b) Caffeine
c) Pramipexole
d) Fluoxetine
e) Alcohol
C. Pramipexole, a dopamine agonist, is one of the drugs of choice in the treatment of restless legs syndrome. All of the other agents have been shown to contribute to its’ symptoms.
MJ is a 27-year old female whose epilepsy is well-controlled on lamotrigine. She and her husband have decided that they are ready to start a family, so she wants to discuss her plans with you. You talk to her about the need for folic acid to prevent any teratogenic effects from the antiepileptic agent and recommend:
a) A good prenatal multivitamin for its folic acid content
b) Folic acid 0.4mg daily
c) Folic acid 10mcg daily
d) Folic acid 5mg daily
e) Folic acid 1mg daily
D. Women on antiepileptic drugs should receive at least 1mg (up to 5mg) daily starting before conception and during the pregnancy to prevent neural tube defects (bottom of page 306, CTC, 7th edn). All of the other choices would not provide enough folic acid.
MF is a 78-year old smoker who is newly diagnosed with the dry form of age-related macular degeneration (AMD). When counselling this patient, you recommend that:
a) She continue smoking
b) She take a vitamin compound containing beta-carotene and vitamins C and E
c) She take a vitamin compound containing copper, zinc, vitamins C and E
d) She always wear sunglasses
e) She self-monitor her vision with an Amsler grid
- A, B and E
- A, D and E
- B and D
- B, C and E
- A, C and E
C. Smoking is implicated in up to 30% of vision loss from AMD. Beta-carotene containing formulations are no longer recommended for the prevention to AMD (page 333, CTC, 7th edn). It is not known if wearing sunglasses has an impact on the condition. Self-monitoring with an Amsler grid will help detect the progression to the wet form of AMD in the 5% of patients in which this occurs.
Which of the following is the INCORRECT response regarding the treatment of hypothyroidism?
a) The dosage of levothyroxine must be reduced during pregnancy
b) Levothyroxine dosage adjustments are made every 4 to 6 weeks
c) Levothyroxine dosage adjustments are made every 4 weeks in the elderly
d) The average adult replacement dose of levothyroxine is 1.6mcg/kg/day
e) Levothyroxine treatment may exacerbate angina
A. Thyroid binding globulins increase during pregnancy and levothyroxine requirements may increase by up to 50%. It takes about 6 weeks to reach steady state after a dosage adjustment, so no dose adjustments should be made before 6 weeks.
Which of the following drugs does NOT reduce the absorption of levothyroxine?
a) Iron
b) Calcium
c) Warfarin
d) Sucralfate
C. Levothyroxine may affect the body’s response to warfarin, leading to increased anticoagulation. All of the other drugs bind to levothyroxine preventing its absorption, and the administration of these agents should be spaced to prevent this.
JP is 43-year old female with type 2 diabetes who is taking metformin 500mg twice daily, hydrochlorothiazide 25mg daily and citalopram 20mg daily. She has been trying to lose weight to help with both her diabetes and mild hypertension but has not been able to lose more than a few pounds. The best prescription alternative for her would be:
a) Bupropion SR 450mg daily
b) Orlistat 120mg three times daily
c) Liragludite 0.6mg sc daily
d) Bupropion SR 150mg daily
e) Sibutramine 10mg daily
f) Diethylpropion SR each morning
B. Orlistat is approved for weight loss in type 2 diabetes patients for whom it improves glycemic and metabolic control. Liraglutide, at a dose higher than that currently recommended for T2DM, may promote and maintain weight loss. Bupropion has mild appetite suppressant effects but is only to be used in the short term with a max dose of 150mg bid
Which of the following statements about medications used to treat obesity is TRUE?
a) Orlistat does not interfere with the absorption of soluble vitamins
b) Anti-obesity drugs have shown a beneficial effect on mortality
c) Discontinuation of anti-obesity medications typically does NOT result in regaining weight
d) In obese individuals, total daily doses of bupropion should not exceed 300mg to minimize seizure risk.
D. Patients taking orlistat, should be advised to take a daily multivitamin >2 hours before or after orlistat. Anti-obesity medications have not been shown to have a beneficial effect on mortality. Discontinuation of anti-obesity medications typically does result in regaining weight. Single doses of bupropion of >150 mg per dose or total daily dose >300 mg/day are associated with increased seizure risk.
The most common side effect of nitrate therapy in the treatment of angina is:
1. Chest pain
2. Upset stomach
3. Muscle cramps
4. Headache
You have a patient with an established diagnosis of chronic stable angina. Which of the following drugs should this patient NOT receive?
1. ASA 80mg daily
2. Nifedipine 10mg 3 times daily
3. Simvastatin 40mg daily
4. Ramipril 10mg daily
5. Isosorbide dinitrate 10mg 3 times daily
A patient with a myocardial infarction (without any previous medical conditions) should be routinely started on all of the following medications EXCEPT:
1. Metoprolol
2. Ramipril
3. ASA
4. Simvastatin
5. Hydrochlorothiazide
All of the following antimicrobials should be given with caution, if at all, to a patient being treated with warfarin for a deep vein thrombosis (DVT) EXCEPT:
1. Erythromycin
2. Fluconazole
3. Ciprofloxacin
4. Tetracycline
5. Clindamycin
When treating DVT, warfarin is given at a dose to maintain an INR range of:
1. 0.5 - 1
2. 1 - 1.5
3. 1.5 - 5
4. 2 - 3
5. 4 - 5
When considering the use of pentoxifylline to treat intermittent claudication, all of the following is true EXCEPT:
1. Smoking cessation is more beneficial in moderate claudication
2. It causes a lot of GI upset, so should be taken with food
3. 24 weeks of therapy followed by 8 weeks drug-free can decrease the need for the drug
4. It is very effective in mild claudication
5. It will increase the risk of bleeding if given with warfarin
For a patient with Raynaud’s phenomenon, the following could be of value:
1. Avoid snowmobiling
2. Take nifedipine XL 30mg daily in the winter
3. Take nifedipine XL 30mg 30-60 min. before cold exposure
4. All of the above
5. None of the above
What is the INCORRECT statement regarding asthma therapy in infants and children?
1. Adult doses of inhaled medication may be required in children
2. Formoterol, a LABA, has a similar onset of action to salbutamol
3. Children on ICS therapy have restricted height as adults
4. Montelukast may allow a lower dose of an ICS
5. Use of salbutamol >4 times per week indicates suboptimal asthma control
Which of the following is the CORRECT statement regarding the treatment of asthma in children?
1. Inhaled corticosteroids (ICS) can be safely stopped once symptoms are under control
2. Salbutamol prevents exercise-induced bronchospasm for up to 10 hours
3. Formoterol can be used to treat bronchospasm
4. Montelukast will allow an ASA-sensitive asthmatic to take ibuprofen safely
5. Long-acting theophylline is an effective agent for routine maintenance in asthma
Which of the following statements are TRUE regarding the treatment of Crohn’s disease or ulcerative colitis?
A) the use of NSAIDs should be avoided
B) therapy with purine antimetabolites should be accompanied by a contraceptive agent for females
C) loperamide is useful for diarrhea in patients with severe disease
D) sulfasalazine has the least incidence of side effects
E) 5-aminosalicylic acid is the most effective aminosalicylate agents for ulcerative colitis
1. A and B
2. A, C and D
3. B, D and E
4. A, B and C
5. D and E
Which is the BEST response regarding irritable bowel syndrome?
1. Probiotics are very useful in the treatment of irritable bowel syndrome
2. Lifestyle modification is more useful than medication
3. Loperamide 2mg qid is recommended for diarrhea
4. Psyllium and bran should be taken for constipation
5. Pinaverium for spasm is a mainstay of therapy
HB is a 73-year old patient with BPH who has been stabilized on Flomax CR 0.4mg daily. He has just been diagnosed with depression. Which of the following antidepressants would be contraindicated for this patient?
1. Escitalopram
2. Paroxetine
3. Venlafaxine
4. Nortriptyline
5. Moclobemide
Choose the TRUE statement regarding the adverse effects acronym “ACHES” in relation to oral contraceptives:
1. “A” refers to acne
2. “C” refers to chest pain caused by an MI
3. “H” refers to hives from an allergic reaction
4. “E” refers to elevated blood pressure
5. “S” refers to severe menstrual cramps
Choose the FALSE statement in regards to Emergency Contraception:
1. The Yuzpe method causes a higher rate of nausea than Plan B
2. All methods must be used within 24 hours of unprotected intercourse to be
effective
3. The two (2) Plan B tablets can be taken as a single dose
4. The two (2) Plan B tablets can be taken 12 hours apart
5. A copper IUD can be used up to 7 days after unprotected intercourse
All of the following are effective in the treatment of dysmenorrhea EXCEPT:
1. Topical heat therapy
2. Regular exercise
3. Mefenamic acid 500mg to start then 250mg q6h prn
4. Ibuprofen 200-600mg q6h
5. Naproxen sodium 550mg bid
Which of the following statements about the treatment of dysmenorrhea is TRUE?
1. ASA is as effective as other NSAIDs for treating dysmenorrhea
2. Diclofenac should be used in conjunction with misoprostol or a PPI when used
for dysmenorrhea for most females
3. Combined oral contraceptives (COC) have not been found to be helpful to treat
dysmenorrhea
4. NSAIDs and SSRIs used together for dysmenorrhea can increase the risk of
gastrointestinal bleeding
5. None of the above
All of the following medications can cause Female Sexual Dysfunction EXCEPT:
1. Paroxetine
2. Amitriptyline
3. Phenytoin
4. Testosterone
5. Metoprolol
Choose the TRUE statement regarding the treatment of Erectile Dysfunction:
1. SSRIs have been shown to be useful in treatment
2. Taladafil has the longest duration of action of the phosphodiesterase Type 5 (PDE5) Inhibitors
3. The PDE5 Inhibitors have no drug interactions of concern
4. Sildenafil will show an effect within 30 minutes
5. Vardenafil should be taken with a high fat meal
What would be the BEST choice for treatment of acute gout in someone with no contraindications?
1. Colchicine 0.6mg once daily
2. Indomethacin 75mg stat then 50mg q6h x 2 days
3. Allopurinol 100mg daily
4. Celecoxib 100mg bid
Which of the following statements regarding gout treatment is/are TRUE?
1. Indomethacin is more effective than other NSAIDs in the treatment of gout.
2. Colchicine should be as first line therapy in patients with acute gout and renal failure (CrCl < 10 mL/min)
3. Probenecid should be started during an attack of acute gouty arthritis.
4. Allopurinol is not associated with gastrointestinal side effects.
5. None of the above
When initiating therapy with allopurinol all of the following are true EXCEPT:
1. Start with allopurinol 100mg daily and gradually titrate upwards
2. The patient should be told to reduce wine intake
3. Colchicine 0.6mg twice daily will reduce the possibility of an acute flare
4. The patient should be told to reduce beer and liquor intake
5. Indomethacin 25mg twice daily will reduce the possibility of an acute flare
Which of the following statements regarding the use of NSAIDs in the treatment of rheumatoid arthritis is/are TRUE?
1. They are safe when used during early pregnancy (first or second trimester)
2. COX-2 inhibitors are as equally effective as traditional NSAIDs
3. Misoprostol should be added if the patient is at risk of peptic ulcer disease
4. NSAIDs are used initially in patients with rheumatoid arthritis to reduce joint
pain and swelling.
5. All of the above
Which of the following statements about rosacea are TRUE?
A) Alcohol can act as a trigger
B) Topical corticosteroids are useful to treat the redness and inflammation
C) Tetracycline should be avoided because it causes photosensitivity reactions
D) Topical metronidazole should be continued for 12 weeks
E) Sunlight can be helpful as a treatment
1. A and E
2. B, C and D
3. A and D
4. A
5. E
While tetracycline is an effective treatment for rosacea, it has several disadvantages. These disadvantages include:
1. High cost
2. Telangiectasia results from its use
3. Topical metronidazole cannot be used at the same time
4. Some food restrictions are required
5. Concurrent antacids are required to prevent GI upset
Which of the following agents would NOT be implicated in a phototoxic reaction?
1. Tretinoin
2. Doxycycline
3. Ciprofloxacin
4. Hydrochlorothiazide 5. Amoxicillin
SB is a 19-year old fair-skinned woman who has sunburn after visiting a tanning salon. Any of the following would be useful to reduce erythema and/or pain EXCEPT:
1. Diclofenac 1% gel applied 6 and 10 hours after exposure
2. Betamethasone dipropionate 0.025% cream applied prn
3. Prednisone 5mg po daily x 5 days
4. Ibuprofen 400mg q6h x 4 doses
5. Tap water compresses for 20 min. 4 to 6 times daily
TJ is a 35kg 6-year old boy with a scald on his outer right arm between the wrist and elbow. There is minimal blistering, though the skin is very red and the child is complaining of pain. You would tell the parent to:
1. Give ibuprofen 175-350mg every 6 to 8 hours for pain
2. Give ibuprofen 175-350mg every 6 to 8 hours if needed for pain
3. Give acetaminophen 350-525mg every 4 to 6 hours for pain
4. Give acetaminophen 350-525mg every 4 to 6 hours if needed for pain
5. Apply silver sulfadiazine cream to the area once daily
Which of the following is FALSE regarding the treatment of infestations?
1. In scabies, continued itching is a sign of treatment failure
2. Retreatment within 7 to 10 days is recommended for all types of infestations
3. Only contacts with live lice or nits within 1cm of the scalps should be treated
4. For body lice, bathing and laundering of infested clothing & linens in hot water
are sufficient
5. Nits should be mechanically removed after pharmacologic treatment
Which is the following is TRUE regarding the use of pediculocides?
1. Permethrin rinse is safe to use in patients with ragweed allergy
2. Pyrethrins/piperonyl shampoo is safe to use in patients with ragweed and chrysanthemum
3. Lindane is the agent of choice for pregnant women
4. Permethrin rinse can be used after any type of shampoo
5. Pyrethrins/piperonyl shampoo is the drug of choice for most patients
When treating a patient with an infected cat bite, which of the following would you prescribe?
1. Clindamycin 300mg q6h
2. Cephalexin 500mg q6h
3. Cloxacillin 500mg q6h
4. Amoxicillin/clavulanate 500mg q8h
5. Cefadroxil 1gm daily
Which drug would be the safest to use for a skin infection in a patient with a recent history of anaphylaxis from a dose of intravenous penicillin G?
1. Amoxicillin
2. Dicloxacillin
3. Erythromycin
4. Cephalexin
5. Cefuroxime
Staphylococcus aureus is a common etiologic agent in:
1. Urinary tract infection
2. Folliculitis
3. Acute exacerbations of chronic bronchitis
4. Pseudomembranous colitis
Which drug would be safe and effective for the treatment of cellulitis in a pregnant woman who is allergic to penicillin?
1. Minocycline
2. Levofloxacin
3. Clindamycin
4. Silver sulfadiazine
5. Cephalexin
Which statement about iron supplementation is FALSE?
1. Iron is poorly absorbed from enteric-coated tablets
2. The dosing of iron supplementation is slowly increased to minimize gastric upset
3. Elemental iron has few drug interactions
4. The target daily dose of elemental iron is 105-200mg per day
5. An equivalent strength of ferrous fumarate provides more elemental iron than ferrous
For the majority of cases, the recommended treatment for a patient with latent TB infection (LTBI) in order to reduce the risk of TB developing is:
1. Isoniazid 900mg twice weekly
2. Pyrazinamide 50mg/kg twice weekly
3. Levofloxacin 500mg daily
4. Ethambutol 50mg/kg twice weekly
5. Rifabutin 300mg daily
Reasons for nonadherence to TB medications, leading to drug resistance, include:
1. Complicated dosage regimens
2. Frequent and uncomfortable side effects
3. Long treatment periods
4. All of the above
5. None of the above
Which of the following agents cannot be used to treat active TB during pregnancy? 1. Isoniazid
2. Rifampin
3. Ethambutol
4. Pyrazinamide
5. Streptomycin
Post-exposure prophylaxis against meningitis caused by N. meningitidis in an adult can include:
1. Rifampin 600mg q12h x 2 days
2. Ciprofloxacin 500mg as a single dose
3. Ceftriaxone 250mg IM as a single dose 4. All of the above
5. None of the above
In the treatment of sexually transmitted infections, all of the following are true EXCEPT:
1. Metronidazole interacts with alcohol
2. Single-dose fluconazole can be an effective treatment
3. Fluconazole interacts with warfarin
4. Intravaginal metronidazole is effective against trichomoniasis
5. Clindamycin can cause C. difficile diarrhea
In which of the following would you NOT routinely treat the sexual partner?
1. Trichomoniasis
2. Candidiasis
3. Chlamydia
4. Pelvic inflammatory disease
5. Gonorrhea
Which of the following would damage a latex condom?
1. Metronidazole vaginal gel
2. Miconazole vaginal ovule
3. Nystatin vaginal cream
4. Clotrimazole vaginal tablet
5. Miconazole vaginal cream
When treating recurrent cold sores, it is important that topical therapy be started: 1. Within 1 hour of first symptoms
2. Within 2 hours of first symptoms
3. Within 12 hours of first symptoms
4. Within 48 hours of first symptoms
5. Within 72 hours of first symptoms
Which of the following statements about travellers’ diarrhea are CORRECT?
A) antibiotics are not required unless there is fever and blood or mucous in the stool
B) loperamide is a good treatment to prevent travellers’ diarrhea
C) ciprofloxacin 500mg bid x 3 days is the antibiotic of choice in Asia and India
D) cholera vaccine has a high rate of efficacy
E) mild travellers’ diarrhea usually resolves in 24 hours with ORS and loperamide
1. A, B and E
2. A and E
3. B, C and D
4. All of them
5. None of them
Which of the following statements about malaria prevention is FALSE?
1. Chloroquine should be started 2 weeks before departure
2. Primaquine is known for its severe neuropsychiatric reactions
3. Mefloquine should be continued for 4 weeks after leaving a malarious area
4. Primaquine must be taken daily
5. Chloroquine is safe to use during pregnancy
When treating fever in children, you have to consider that:
A) dosing of acetaminophen and ibuprofen should be by age
B) fever is defined as a rectal temperature consistently over 38oC
C) fever itself it not harmful and can enhance some host defense mechanisms
D) acetaminophen is recommended over ibuprofen because it has a larger body of safety data
E) alcohol is a good sponging agent to reduce fever
1. A, D and E
2. B and D
3. C and D
4. B, C and D
5. A, C and D
When considering the use of pentoxifylline to treat intermittent claudication, all of the following is true EXCEPT:
a) It is not recommended for patients with marked renal or hepatic dysfunction
b) It causes a lot of GI upset, so should be taken with food
c) 24 weeks of therapy followed by 8 weeks drug-free can decrease the need for the drug
d) It is very effective in mild claudication
e) It will increase the risk of bleeding if given with warfarin
D. It only produces marginal improvement in pain-free and maximal walking distance, so is not indicated for mild claudication (page 513, CTC, 7th edn). Pentoxifylline causes nausea, vomiting, dyspepsia, belching, bloating and flatulence; the incidence of these can be reduced by taking the medication with food. A drug-free period as exercise tolerance increases can reduce the need for pentoxifylline. It increases the effect of warfarin by an unknown mechanism, leading to an increased risk of bleeding. It is not recommended for patients with marked renal or hepatic dysfunction
A patient with a myocardial infarction, with preserved LV function and without any previous medical conditions should be routinely started on all of the following medications EXCEPT:
a) Metoprolol
b) Ramipril
c) ASA
d) Simvastatin
e) Spironolactone
E. Among high risk patients, antiplatelet agents such as ASA, beta-blockers, ACE inhibitors and lipid-lowering therapies independently reduce the incidence of vascular events and have been shown to reduce mortality. Aldosterone antagonists should be considered in patients with significant LV dysfunction.
The most common side effect of nitrate therapy in the treatment of angina is:
a) Chest pain
b) Upset stomach
c) Muscle cramps
d) Headache
D. Headache is extremely common and can be severe due to the vasodilatory effects of the nitrate. Chest pain is a symptom of an angina attack and nitrates are taken to prevent these. Upset stomach and muscle cramps rarely occur with nitrates.
Which of the following is TRUE regarding the treatment of stable angina?
a) Organic nitrates should be prescribed with a nitrate-free interval of 4-6 hours to avoid the development of tolerance
b) Substitution with an ARB is reasonable if a patient that is prescribed an ACE inhibitor cannot tolerate it due to a cough
c) Verapamil and diltiazem are recommended for patients with LV systolic dysfunction
d) Beta-blockers are the agents of choice for patients with Prinzmetal’s angina
B. Organic nitrates should be prescribed with a nitrate-free interval of 10-12 hours to avoid the development of tolerance (page 568, CTC, 7th edn). Verapamil and diltiazem should be avoided for patients with LV systolic dysfunction (page 568, CTC 7th edn). Calcium channel blockers and nitrates are the agents of choice for patients with Prinzmetal’s angina (page 568, CTC 7th edn).
For a patient with Raynaud’s phenomenon, the following could be of value:
a) Avoid snowmobiling
b) Take nifedipine XL 30mg daily in the winter
c) Take nifedipine XL 30mg 30-60 min. before cold exposure
d) All of the above
e) None of the above
D. Patients with Raynaud’s phenomenon should be advised to avoid cold exposure and the use of vibrating tools; snowmobiling combines both of these factors. Calcium channel blockers (CCBs) are the first-line agents in treatment of this condition and reduce the frequency and severity of the attacks. A CCB can be taken either before cold exposure or on a regular basis during the winter months; daily use rather than prn will increase tolerance to the side effects.
Which of the following statements about medications used to treat obesity is TRUE?
1. Sibutramine and orlistat have been found in well designed trials to have a beneficial effect on prolonging life in those with BMI >35
2. Sibutramine is a pancreatic and lipase inhibitor
3. Discontinuation of anti-obesity medications typically does NOT result in regaining weight
4. Sibutramine is contraindicated in patients with coronary artery disease, arrhythmias and cerebrovascular disease
5. In obese individuals, doses of bupropion of 450 mg daily are not associated with increased seizure risk than doses of 150 mg daily.
JP is 43-year old female with type 2 diabetes who is taking metformin 500mg twice daily, hydrochlorothiazide 25mg daily and citalopram 20mg daily. She has been trying to lose weight to help with both her diabetes and mild hypertension but has not been able to lose more than a few pounds. The best prescription alternative for her would be:
1. Sibutramine 10mg daily
2. Orlistat 120mg three times daily
3. Diethylpropion SR each morning
4. Bupropion SR 150mg daily
