Practice questions Flashcards
Clopidogrel can cause:
- Cinchocism
- Heparin-induced thrombocytopenia (HIT)
- Reye’s syndrome
- Thrombotic thrombocytopenic purpura (TTP)
Thrombotic thrombocytopenic purpura (TTP)
- TTP: Life threatening low platelet, low Hemoglobin, bleeding, bruising, fever, microthrombi, renal failure & neuro changes
- Drug-induced mechanism is unkown
Which of the following sets of drugs has the fewest Cyp450 interactions?
- Fluvastatin, Pravastatin, Rosuvastatin
- Atorvastatin, Lovastatin, Simvastatin
Fluvastatin, Pravastatin, Rosuvastatin
- Fewest P450 Interactions
Which of the following is a thiazide diuretic?
- Bumetanide
- Chlorthalidone
- Furosemide
- Triamterene
Chlorthalidone
- This has more long-term M/M evidence supporting its use in management of HTN than does hydrochlorothiazide
Which of the following can cause postural hypothension and nasal congestion?
- Atenolol
- Clonidine
- Lisinopril
- Prazosin
Prazosin
- This is an alpha-1 blocker; there are alpha-1 receptors within the nasopharynx
Which of the following is a non-selective Beta-blocker?
- Atenolol
- Bisoprolol
- Metoprolol
- Propanolol
Propanolol
True or false: Beta-blockers are the first line for HTN?
- True
- False
False
- ACE, ARB, thiazides, CCBs are first line for HTN
- BBs can be called first line in patients with co-morbid cardiac condtion such as angina, past MI, a-fib, etc.
Which of the following should NOT be used with aspirin > 81 mg/dose?
- Clopidogrel
- Dipyridamole
- Prasugrel
- Ticagrelor
Ticagrelor
- For unknown reasons, pts with PLATO trial who received ticagrelor + ASA 162 - 325mg did not do as well as patients on ticagrelor + 81 mg/day
Which ACE is NOT dosed once daily?
- Captopril
- Fosinopril
- Lisinopril
- Ramipril
Captopril
What are the active ingredients in BiDil?
- Amlodipine + benazepril
- Hydralazine + isosorbide dinitrate
- Olmesartan + hydrochlorothiazide
- Aliskiren + hydrochlorothiazide
Hydralazine + isosorbide dinitrate
- BiDil means “two dilators” Hydralazine is an arterial dilator and nitrates are venous dilators. This combo has long-term M/M benefits in CHF (not as good as ACE/ARB or BB, but better than placebo)
Which of the follwing exacerbates gout?
- Ezetimibe
- Gemfibrozil
- Niacin
- Simvastatin
Niacin
- Niacin competes with uric acid for renal excretion, thus can increase uric acid levels and precipitate gout in some patients. Loop diuretics have similar effect in persons with gout.
Which of the following treats intermittent claudication in peripheral arterial disease?
- Cilostazol
- Cholestyramine
- Dutasteride
- Finasteride
Cilostazol
- Brands name is Pletal
- It’s mechanism of action is somewhat similar to dipyridamole
What is the correct Nitroglycerin dose for SL administration?
- 0.4 mg
- 4 mg
- 40 mg
- 400 mg
0.4 mg
Which of the following causes flushing?
- Ezetimibe
- Gemfibrozil
- Niacin
- Simvastatin
Niacin
- Prostaglandin related ADR
This drug can increase BP:
- Estrogen
- PPIs
- Quinolone Antibiotics
- NSAIDs
NSAIDs
Estrogen
Increases HDL the best:
- Ezetimibe
- Gemfibrozil
- Niacin
- Simvastatin
Niacin
Which of the follwing is an Alpha-2 Adrenergic Agonist?
- Cilostazol
- Clonidine
- Prazosin
- Losartan
Clonidine
Which of the following inhibits cholesterol absorption from the gut?
- Cholestyramine
- Ezetimibe
- Gemfibrozil
- Niacin
Ezetimibe
This reduces triglycerides dramatically:
- Cholestyramine
- Ezetimibe
- Gemfibrozil
- Simvastatin
Gemfibrozil
You should use caution combining digoxin with which of these drugs?
- Lisinopril
- Metoprolol
- Nitroglycerin
- Spironolactone
Metoprolol
- The risk potential for AV nodal block is high
Which statement regarding statin-induced myopathy is FALSE?
- Change to ezetimibe
- Check for and correct low vitamin D
- Look for Cyp450 drug interactions
- Trial a different statin
Change to ezetimibe
- Because of the strong M/M data behind statins, we usually do everything we can do to keep the patient on the statin. Ezetimibe has no eveidence of long-term M/M benefits.
Which of the follwing is a bile acid binding resin?
- Cholestyramine
- Gemfibrozil
- Niacin
- Simvastatin
Cholestyramine
Which of the following treats BPH?
- Clonidine
- Doxazosin
- Finasteride
- Spironolactone
Doxazosin and finasteride
- Finasteride and drugs like it treat BPH by shrinking the prostate. Doxazosin and other Alpha-blockers treat BPH by treating the symptoms of BPH.
Angiotensin II vasoconstricts which arteriole?
- Afferent
- Efferent
Efferent
A “triple-whammy” to the kidneys is ACE/ARB plus…
- CCB
- Loop diuretic
- NSAID
- Metformin
Loop diuretic and NSAID
- Any ACE or ARB can cause acute renal failure in a pt with bilateral renal stenosis because they can’t compensate afferently. NSAIDs block afferent compensation by blocking prostaglandin-induced vasodilation. Dehydration from diuretics also prevents the body from compensating. The 3 together are called the tripple whammy. That is what throws a CHF pt into the hospital when they take NSAIDs OTC.
This drug reduces portal vein HTN in liver failure patients
- Amlodipine
- Lisinopril
- Propanolol
- Spironolactone
Spironolactone
If you prescribe this I will personally hunt you down…
- Amlopdipine immediate release
- Nifedipine immediate release
- Nifedipine sustained release
- Verapamil sustained release
Nifedipine immediate release
- 10 mg nifedipine caps are associated with an increased risk of tachycardia, MI, angina, and death because of its short half-life and tendency to ping-pong BP
Which is most effective to prevent ASA-induced GI bleeds.
- H2 blockers (ranitidine)
- Prostaglandin replacement (misoprostil)
- PPIs (omeprazole)
- Using enteric coated aspirin
PPis
- H2 blockers are effectivem but not as effective as PPis. Misoprostil works but is poorly tolerated, 4X daily dosing, and causes diarrhea. Enteric coated aspirin does NOT prevent GI bleeds, just tummy upset.
Which of the following causes gynecomastia?
- Eplernone
- Hydrochlorothiazide
- Spironolactone
- Furosemide
Spironolactone
- The advantage of eplernone over sprionolactone is that it does not cause gynecomastia. Due to the cost, we usually reserve eplernone for patients who cannot tolerate spironolactone due to this ADR.
With simvastatin do not exceed how many milligrams per day?
- 40 mg
- 60 mg
- 80 mg
- 100 mg
40 mg
- Exceeding this dose is highly associated with an increased risk of muscle myopathy
If myopathy develops while on a statin, check this lab:
- CPK
- CBC
- LFT
- SCr
CPK
- Elevated CPK is acceptable, but if it is 10 x the upper limit of normal, must DC the statin
Fat soluble vitamins may not absorb well if taken with:
- Cholestyramine
- Gemfibrozil
- Niacin
- Simvastatin
Cholestyramine
- This drug binds with bile acid as well as many drugs and fat soluble vitamins if administered together at the same time
The therapeutic digoxin range for CHF is which of the following?
- 0.5 to 1.0
- 1.0 to 2.0
- 2.0 to 2.5
- 2.5 to 3.0
- 5 to 1.0
- Most labs report normal digoxin level as 0.5 to 2.0 or 0.8 to 2.0. When treating a-fib, you may need to shoot for 1-2 range for benefits, but when treating CHF, we actually get the neurohormonal benefits at the lower end of our dosage range
Patient education for warfarin
Make Sure you know it!
What is the typical therapeutic warfarin INR?
- 0.5 to 1.0
- 1.0 to 2.0
- 2.0 to 3.0
- 3.0 to 4.0
2.0 to 3.0
Dabigatran is FDA approved to treat which of the following?
- Everything warfarin is approved to treat
- Acute stroke
- Atrial fibrillation
- DVT prophylaxis post ortho surgery
Atrial Fibrillation
- Right now, its only FDA approved for non-valvular a-fib. You might see it used for other things and that may be ok. It is being studied for other indications and I am sure it will be FDA approved for wider variety of indications in the future.
Which CCB lowers HR?
- Amlodipine
- Diltiazem
- Nifedipine
- Verapamil
Verapamil and diltiazem
- Verapamil and diltiazem are the only CCBs that lower HR, the others do not.
Side effects of digoxin are exacerbated by which of the following?
- Hyperkalemia
- Hypokalemia
- Neither
- I do not know
Hypokalemia
Remember that we TREAT digoxin toxicity by administering K+. A low K+ makes digoxin more powerful; a high K+ protects against the effects of digoxin.
Which statement about isosorbide dinitrate is FALSE?
- Has a low risk of tolerance
- Preferentially exerts effects on the smooth muscle of veins
- Reduces preload
- Relaxes coronary artery smooth muscles
Has a low risk of tolerance
- All nitrates have a high risk of tolerance; thus the value in a nitrate-free interval.
Which of the following is a good anti-HTN for patients with DM, CHF, and/or CRI?
- ACE
- B-blocker
- CCB
- Thiazide
ACE
- Benefits of ACE and ARB in the management of HTN in patients with diabetes, heart failure, and chronic renal insufficiency are well documented.
Treats angina:
- Amlodipine
- Chlorthalidone
- Furosemide
- Isosorbide mononitrate
Amlodipine & Isosorbide mononitrate
- Any CCB, nitrate, or BB can be used to treat exertional angina. Only CCBs and nitrates will treat variant angina.
What is the Drug of Choice for treating exertional angina?
- Amlodipine
- Metoprolol
- Nitroglycerin
Metoprolol
- CCBs, nitrates, and BB can all be used to treat exertional angina, but the BBs have the strongest evidence supporting their benefits on long-term M/M in this patient population.
Which of the following treats glaucoma?
- ACE
- B-blocker
- CCB
- Thiazide
B-blocker
- B-blockers can be used ophthalmically to treat glaucoma
Which of the following causes cough and angioedema?
- ACE
- B-blocker
- CCB
- Thiazide
ACE
Niacin is also known as:
- B1
- B3
- B6
- B12
B3
Treats recurrent calcium-based kidney stones?
- Eplerenone
- Furosemide
- Hydrochlorothiazide
- Spironolactone
Hydrochlorothiazide
- A fact related to thiazide diuretics are that they cause the body to retain calcium (prevent the kidneys from excreting as much calcium into the urine). This can be beneficial in pts suffering from calcium-based kidney stones.
Aldosterone receptor blocker?
- Eplerenone
- Furosemide
- Hydrochlorothiazide
- Spironolactone
Eplerenone & Spironolactone
What is the “official” name of the angiotensin-converting enzyme?
- Dihydrofolate reductase
- Cyclooxygenase
- Peptidyl dipeptidase
- Phosphodiesterase
Peptidyl dipeptidase
- Just a trivia question
Warfarin works by antagonzing…
- Adenosine diphosphate
- Factor Xa
- Thrombin
- Vitamin K epoxide reductase complex 1 (VKORC1)
Vitamin K epoxide reductase complex 1 (VKORC1)
Warfarin is reversed with the use of what?
- Fresh frozen plasma
- Phytonadione
- Potassium
- Protamine sulfate
Fresh frozen plasma & Phytonadione
- Phytonadione and aquamephyton are other names for vitamin K. Aqua-mephyton is injectable vitamin K. If quick reversal is needed you’ll have to use plasma infusion which contains active clotting factors. Protamine sulfate reverses heparin. Potassium is helpful in digoxin toxicity.
Which of the following is a prodrug that requires CYP2C19 for activation?
- Aspirin
- Clopidogrel
- Prasugrel
- Ticagrelor
Clopidogrel
- Because clopidogrel is a prodrug requiring CYP2C19 for activation, taking Plavix with CYP2C19 inhibitors such as some of the PPIs may cause it to not work as well.
Which of these causes bradycardia and heart block?
- Amlodipine
- Diltiazem
- Metoprolol
- Hydrochlorothiazide
Diltiazem & Metoprolol
- BBs and diltiazem and verapamil
Which causes hyperkalemia and Acute Renal Failure?
- ACE
- B-blocker
- CCB
- Thiazide
ACE
- True for ACEs & ARBs
