Questions from power points Flashcards
1
Q
What would be the effect of IV atropine (muscarinic antagonist) on resistance vessel tone?
A. Moderate increase in constrictor tone B. Slight increase in constrictor tone C. No effect on tone D. Slight vasodilatory action E. Moderate vasodilatory action
A
C
2
Q
Which set of direct action / reflex compensatory response would you see following IV administration of phenylephrine?
Direct Effect Baroreceptor Reflex Action
A. Vasodilation Reflex bradycardia
B. Vasodilation Reflex tachycardia
C. Vasoconstriction Reflex bradycardia
D. Vasoconstriction Reflex tachycardia
A
C
3
Q
In response to an acute decrease in blood pressure, what is the initial compensatory response?
A. Increased parasympathetic input to the SA node
B. Increased sympathetic input to the SA node
C. Increased release of aldosterone from the adrenal cortex
D. Increased angiotensin II in the bloodstream
A
B
4
Q
Activation of the sympathetic nervous system in response (flight-or-fight response) to an environmental stressor causes epinephrine release from the adrenal gland, resulting in which of the following actions?
A. Decreased blood glucose levels
B. Bronchoconstriction
C. Pupil constriction (miosis)
D. Increase in AV node conduction velocity
E. Increased GI motility
F. Relaxation of peripheral resistance vessels
A
D
5
Q
Which of the following autonomic nervous system drugs would be MOST likely to predispose a patient to cardiac arrhythmias due to an increase in cardiac conduction rate?
A. Albuterol B. Atenolol C. Isoproterenol D. Pilocarpine E. Propranolol
A
C
6
Q
A concern when examining patients is the possibility that they may be taking medications that interfere with the function of the baroreceptor reflex and can increase the potential for orthostatic hypotension. This would be most likely to occur with which class of autonomic nervous system drugs?
A. Atropine B. Pilocarpine C. Neostigmine D. Doxazosin E. Albuterol
A
D
7
Q
Which of the following statements concerning the ions and ion channels involved in the cardiac ion potential is FALSE?
A. “Trigger” Ca++ for cardiac muscle contraction moves into ventricular cells during phase 2 of the action potential.
B. Phase 0 current in ventricular muscle cells is carried by Na+ ions.
C. Phase 4 current in the SA node pacemaker cells is an important determinant of automaticity.
D. Repolarization (phase 3) in ventricular cells occurs when potassium channels close
A
D
8
Q
As a calcium channel blocker, diltiazem (Cardizem®) would be categorized in which class of antiarrhythmic agents?
A. Class I B. Class II C. Class III D. Class IV E. Miscellaneous
A
D
9
Q
A 58-year-old man had a myocardial infarction. Which of the following should be used to prevent life-threatening arrhythmias that can occur post-MI in this patient?
A. Flecainide B. Digoxin C. Metoprolol D. Lidocaine E. Amiodarone
A
C
10
Q
The most common mechanism of arrhythmias, accounting for as many as 85% of all arrhythmias, is:
A. Failure of impulse initiation at SA node
B>. Failure of impulse conduction thru AV node
C. Enhanced automaticity at SA node
D. Triggered automaticity in ventricular tissue
E. Abnormal impulse conduction due to reentry phenomenon
A
E
11
Q
Suppression of arrhythmias resulting from a reentry focus is most likely to occur if the drug:
A. Has vagomimetic properties on the AV node
B. Is a beta-blocker
C. Converts a unidirectional block to a bidirectional block
D. Slows conduction through the atria
E. Has atropine-like effects at the AV node
A
C
12
Q
A 78-year-old woman has been newly diagnosed with atrial fibrillation. She is currently not having symptoms of fatigue or palpitations. Which drug is appropriate to initiate for rate control?
A. Amiodarone B. Metoprolol C. Sotalol D. Lidocaine E. Flecainide
A
B
13
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 produces vagomimetic effects at the AV node
C. Digoxin is used for rhythm control in patients with atrial fibrillation
D. Digoxin increases conduction velocity through the AV node
A
B
14
Q
The drugs most commonly used for rate control in patients with atrial fibrillation include:
A. Beta-blockers B. Verapamil C. Diltiazem D. Amlodipine E. All of the above
A
A, B and C
15
Q
Which of the following beta-blockers is not available in an oral formulation?
A. Metoprolol
B. Propranolol
C. Esmolol
D. Carvedilol
A
C
16
Q
Adverse effects of amiodarone include:
A. Bluish-gray skin discoloration B. Pulmonary fibrosis C. Hyperthyroidism D. Hyperthyroidism E. All of the above
A
E
17
Q
The most effective drug available for maintenance of sinus rhythm in atrial fibrillation is:
A. Sotalol
B. Amiodarone
C. Diltiazem
D. Dronedarone
A
B
18
Q
The treatment of choice for urgent conversion of atrial fibrillation to normal sinus rhythm is:
A. Anticoagulation
B. Catheter ablation
C. DC cardioversion
D. Digoxin
A
C
19
Q
Lidocaine’s efficacy in the treatment of ventricular is related to which electrophysiologic action?
A. Block of L-type Ca++ channels at the AV node
B. Block of phase 3 K+ channels that mediate repolarization
C. Block of phase 0 Na+ channels that conduct impulses throughout the heart
D. Block of β1 receptors on cardiac muscle
E. Activation of purinergic receptors at the AV node
A
C
20
Q
Lidocaine has the greatest efficacy in the treatment of which arrhythmia?
A. Torsades de pointes B. Ventricular fibrillation C. Atrial fibrillation D. Atrial flutter E. Ventricular tachycardia F Supraventricular tachycardia
A
E
21
Q
Which drug is most likely to exacerbate heart failure?
A. Acetaminophen B. Naproxen C. Oxycodone D. Ibuprofen E. Amoxicillin F. Triazolam G. Nitrous oxide
A
B and D
22
Q
A 68-year-old white man with heart failure with reduced ejection fraction being treated with enalapril and carvedilol comes to your office complaining of shortness of breath. On physical exam, he has bilateral rales and edema in both lower extremities. Which of the following would you recommend for acute relief of symptoms in this patient?
A. Combination of hydralazine and isosorbide dinitrate B. Valsartan C. Loop diuretic D. Thiazide diuretic E. Digoxin
A
C
23
Q
Jake is a 75-year-old male who has heart failure. He is seen in your clinic today reporting shortness of breath, increased pitting edema, and a 5 pound weight gain. His current medication regimen includes lisinopril and metoprolol. He has no chest pain and is deemed stable for outpatient treatment. Which of the following is the best recommendation?
A. Increase the dose of lisinopril B. Add digoxin C. Start HCTZ D. Start furosemide E. Discontinue the metoprolol
A
D
24
Q
A 59-year-old white man presents post-MI with heart failure symptoms and a LVEF of 29%. He is currently being treated with an ACE inhibitor and metoprolol succinate ER. Which of the following drugs has been shown to prolong survival in such a patient?
A. Digoxin
B. Eplerenone
C. Hydrochlorothiazide
D. Hydralazine and isosorbide dinitrate
A
B
25
Describe the beneficial effect of spironolactone in HF:
```
A. Promotes potassium excretion
B. Promotes sodium retention
C. Activates aldosterone receptors
D. Blocks cardiac hypertrophy
E. Decreases renin release
```
D
26
A male patient is placed on a new medication for heart failure and notes that his breasts have become tender to the touch. Which medication is he most likely taking?
```
A. Carvedilol
B. Eplerenone
C. Furosemide
D. Hydrochlorothiazide
E. Spironolactone
F. Lisinopril
```
E
27
Beneficial actions of ACE inhibitors on the failing heart include:
A. Decreased adrenal release of aldosterone
B. Increased vascular resistance
C. Decreased cardiac output
D. Reduced preload
E. Reduced heart rate
F. Decreased cardiac remodeling action of angiotensin II
A, D and F
28
In patients with heart failure with reduced ejection fraction, ACE inhibitors have been shown to:
A. Improve symptoms
B. Decrease hospitalizations
C. Prolong survival
E. All of the above
D
29
The most common adverse effect of ACE inhibitors is:
A. Cough
B. Angioedema
C. Hypokalemia
D. Dizziness
A
30
Angiotensin receptor blockers (ARBs):
A. Are less effective than ACE inhibitors for treatment of chronic heart failure
B. Are more likely than ACE inhibitors to cause angioedema
C. Do not cause cough
D. All of the above
C
31
HC is a 70-year-old female who is diagnosed with HFrEF (reduced ejection fraction). Her past medical history is significant for hypertension and atrial fibrillation. She is taking furosemide, lisinopril, metoprolol, and warfarin. HC reports “feeling good” and has no shortness of breath or edema but she has been having fits of an annoying dry cough. Which is the most appropriate medication change to make at this time?
```
A. Discontinue furosemide
B. Change lisinopril to losartan
C. Decrease warfarin dose
D. Add digoxin
E. Add spironolactone
```
B
32
Inhibition of neprilysin decreases:
A. Vasoconstriction
B. Sodium retention
C. Maladaptive remodeling
D. All of the above
D
33
Entresto can cause:
A. Hypokalemia
B. Hypertension
C. Angioedema
D. All of the above
C
34
A 66-year-old man with asymptomatic (NYHA class I) heart failure with preserved ejection fraction (HFpEF) and cirrhosis asks if he should take Entresto for his heart failure. You could tell him that he cannot because:
A. His heart failure is asymptomatic
B. His ejection fraction is not reduced
C. Entresto is not recommended for patients with severe liver impairment
D. All of the above
B
35
Beta-blockers improve cardiac function in heart failure by:
```
A. Increasing heart rate
B. Decreasing heart rate
C. Increasing renin release
D. Decreasing cardiac remodeling
E. Reducing epinephrine release from the adrenal gland
```
D
36
Potential advantages of extended-release metoprolol succinate over carvedilol include:
A. Less hypotension
B. A lower risk of bronchospasm
C. Once-daily dosing
D. All of the above
D
37
Which of the following is correct regarding digoxin when used for atrial fibrillation?
A. Digoxin works by blocking voltage-sensitive calcium channels
B. Digoxin produces AV nodal blocking actions
C. Digoxin is used for rhythm control in patients with A Fib
D. Digoxin increases conduction velocity through the AV node
E. Digoxin levels needed for atrial fibrillation are higher than those necessary for symptom control in heart failure
B and A
38
In patients with heart failure, digoxin has been shown to:
A. Improve symptoms
B. Decrease hospitalizations
C. Prolong survival
D. All of the above
A and B
39
Which is most important to monitor in a patient taking digoxin?
```
A. Liver function
B. Serum potassium
C. Serum creatinine
D. Serum calcium
E. Troponin levels
F Serum sodium
```
B
40
The mechanism of action of digoxin involves inhibition of Na+-K+-ATPase. This action ultimately leads to an increased force of cardiac contraction by increasing intracellular levels of which of the following ions?
```
A. Calcium
B. Chloride
C. Magnesium
D. Potassium
E. Sodium
```
A
41
Hypokalemia can occur with:
```
A. ACE inhibitors
B. ARBs
C. Aldosterone antagonists
D. Digoxin – therapeutic levels
E. Digoxin – overdose levels
F. Loop diuretics
```
F
42
Drugs that relax vascular smooth muscle can produce a reflex tachycardia that can increase myocardial oxygen consumption and exacerbate symptoms in anginal patients. Which of the following anti-anginal agents are most likely to cause reflex tachycardia?
```
A. Diltiazem
B. Metoprolol
C. Nifedipine
D. Nitroglycerin
E. Verapamil
```
C and D
43
Which of the following anti-anginal agents can lower blood pressure?
```
A. Nifedipine
B. Sublingual nitroglycerin
C. Oral nitrates (e.g., isosorbide dinitrate)
D. Metoprolol
E. Verapamil
F. Diltiazem
```
All of them
44
Stable angina:
A. Is periodic, short-lived episodes of severe substernal pain
B. Can be treated by pharmacologically decreasing cardiac preload
C. Is precipitated when an atherosclerotic plaque ruptures and occludes a coronary blood vessel
D. Occurs when O2 demand of some area of the myocardium exceeds the O2 supply to that area of heart muscle
E. Results from a paroxysmal spasm in a coronary vessel
A, B and D
45
All of the following drugs can be useful for managing stable angina in a patient with coronary artery disease EXCEPT:
```
A. Amlodipine
B. Metoprolol
C. Immediate-release nifedipine
D. Isosorbide dinitrate
E. Atenolol
```
C
46
If your patient has been prescribed a sustained-release oral nitrate preparation for prophylaxis of angina, you should be most alert for which of the following side effects?
A. Arrhythmias
B. Gastric upset
C. Gingival hyperplasia
D. Postural hypotension
D
47
A patient whose angina was previously well controlled with once-daily isosorbide mononitrate states that he recently has been taking it 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. Advise continuation of isosorbide mononitrate twice daily for full 24-hour coverage of anginal symptoms
B. Switch to isosorbide dinitrate daily as this has a longer duration of action than isosorbide mononitrate
C. Switch to NTG patch for consistent drug delivery and advise him to wear the patch around the clock
D. Continue once-daily administration of isosorbide mononitrate but advise the patient to take this medication in the evening
D
48
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 prn sublingual nitroglycerin. Which intervention is most appropriate at this time?
```
A. Add amlodipine
B. Replace atenolol with metoprolol
C. Administer immediate-release nifedipine
D. Initiate isosorbide dinitrate
E. Chew 325 mg of aspirin and call 911
```
E
49
Which side effect is associated with amlodipine?
```
A. Bradycardia
B. Cough
C. Edema
D. QT prolongation
E. Hypotension
F. Facial flushing
```
C, E, and F
50
Which of the following anti-anginal drugs does NOT act as a vasodilator and should not be used in the treatment of vasospastic angina?
```
A. Diltiazem
B. Nifedipine
C. Oral nitrates (isosorbide mononitrate)
D. Metoprolol
E. Verapamil
```
D
51
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 10 times a week. One sublingual NTG 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 prn sublingual NTG spray
B. Add daily amlodipine
C. Add daily metoprolol
D. Add daily propranolol
E. Replace prn NTG with ranolazine
```
B
52
Which of the following anti-anginal agents requires a drug free interval each day to lessen the development of tolerance to its antianginal actions?
```
A. Nifedipine
B. Sublingual nitroglycerin
C. Oral nitrates (e.g., isosorbide dinitrate)
D. Transdermal nitroglycerin
E. Metoprolol
F. Verapamil
```
C and D
53
A 60-year-old white female has not reached her blood pressure goal after 3 months of treatment with a low dose of lisinopril. All of the following would be within recent guidelines for 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
D. Add on an angiotensin receptor blocker
E. Switch to an alpha-blocker
```
D and E
54
A 40-year-old male patient has recently been diagnosed with hypertension following readings of 163/102 and 165/100. He also has Type 2 diabetes that is well controlled with oral antidiabetic medications. Which is the best initial treatment regimen for management of hypertension in this patient?
```
A. Amlodipine and a beta-blocker
B. Furosemide and lisinopril
C. Lisinopril
D. Lisinopril and hydrochlorothiazide
E. Metoprolol
```
D
55
A patient returns to her physician assistant for routine monitoring 6 months after her hypertension regimen was modified. Lab results indicated an elevated potassium level. Which agents is most likely responsible for this hyperkalemia?
```
A. Lisinopril
B. Chlorthalidone
C. Hydrochlorothiazide
D. Spironolactone
E. Atenolol
F. Furosemide
G. Valsartan
```
A, D, and G
56
A patient with low blood levels of potassium (hypokalemia) would be at increased risk for toxicity from which of the following drugs?
```
A. Lisinopril (an ACE inhibitor)
B. Digoxin
C. Hydrochlorothiazide
D. Propranolol
E. Nifedipine
```
B
57
NSAIDs can reduce the antihypertensive efficacy of which of the following drug classes?
```
A. Diuretics (e.g., hydrochlorothiazide)
B. ACE inhibitors (e.g., lisinopril)
C. Alpha-1 blockers (e.g., prazosin)
D. Calcium channel blockers (e.g., nifedipine)
E. Beta-blockers (e.g., metoprolol
```
A, B and E
58
During a routine oral examination, you notice some gum enlargement in your patient. The patient’s medical history includes the drugs listed below. If this condition is drug-induced the most likely candidate is:
```
A. Albuterol
B. Nitroglycerin tablets
C. Digoxin
D. Verapamil
E. Lisinopril
F. Hydrochlorothiazide
```
D.
59
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 antihypertensive agent is most likely to cause the peripheral edema?
```
A. Atenolol
B. Clonidine
C. Amlodipine
D. Doxazosin
E. Hydrochlorothiazide
F. Diltiazem
```
C and F
60
The use of epinephrine to treat anaphylactic shock in may result in an unexpected decrease in blood pressure if given to a patient who is also taking which class of antihypertensive agent?
A. An ACE inhibitor
B. A diuretic
C. An alpha-1 adrenergic receptor antagonist
D. A calcium channel blocker
E. A non-selective beta-1 / beta-2 adrenergic receptor antagonist
C.
61
Hypokalemia (low blood potassium levels) is a side effect most commonly observed with which of the following classes of antihypertensive agents?
```
A. ACE inhibitors
B. Alpha blockers
C. Beta blockers
D. Calcium channel blockers
E. Thiazide diuretics
```
E
62
Which is an appropriate drug choice for hypertension treatment during pregnancy?
```
A. Lisinopril
B. Atorvastatin
C. Alpha-methyl dopa
D. Aliskerin
E. Valsartan
F. Hydralazine
```
C and F
63
Which of the following would be a reasonable choice for treatment of a 43-year-old, treatment-naïve, otherwise healthy black male with a blood pressure of 150/96 mm Hg?
A. A thiazide-like diuretic
B. An ACE inhibitor
C. An ARB
D. Any of the above
A
64
The preferred thiazide-like diuretic for initial therapy:
A. Hydrochlorothiazide
B. Chlorthalidone
C. Furosemide
D. Metolazone
B
65
A 51-year-old black woman with diabetes and chronic kidney disease presents with a blood pressure of 174/106 mm Hg. A reasonable choice for initial antihypertensive therapy for this patient would be:
A. An ACEI and a beta-blocker
B. An ACEI and an ARB
C. An ACEI and a thiazide-like diuretic
D. An ACEI and aliskerin
C
66
Loop diuretics such as furosemide can be used instead of thiazide-like diuretics to lower blood pressure in patients with:
A. Diabetes
B. Hypokalemia
C. High cardiovascular risk
D. Moderate to severe renal impairment
D
67
ACE inhibitors:
A. Are less effective in black patients, unless combined with a thiazide-like diuretic or calcium channel blocker
B. Cause angioedema more frequently in black patients
C. Are reno- and cardioprotective
D. All of the above
D
68
Compared to ACE inhibitors, ARBs are:
A. Safer for use during pregnancy
B. Less likely to cause adverse effects
C. Less effective in lowering blood pressure
D. All of the above
B
69
A previously normotensive 58-year-old white man with a history of an MI and paroxysmal atrial fibrillation presents with a blood pressure of 156/96 mm Hg. The only medication he is currently taking is dabigatran for stroke prevention. Which of the following would be a reasonable choice for antihypertensive therapy for this patient?
```
A. Metoprolol
B. Felodipine
C. Nicardipine
D. Nisoldipine
E. Diltiazem
F. All of the above
```
A and E
70
Many experts would begin antihypertensive therapy with two drugs when baseline blood pressure is:
A. > 10/5 mm Hg above goal
B. > 20/10 mm Hg above goal
C. > 140 mm Hg systolic
D. > 100 mm Hg diastolic
B
71
Many experts would begin antihypertensive therapy with two drugs when baseline blood pressure is:
A. > 10/5 mm Hg above goal
B. > 20/10 mm Hg above goal
C. > 140 mm Hg systolic
D. > 100 mm Hg diastolic
B
72
Which of the following antihypertensive drugs might worsen constipation in a patient with irritable bowel syndrome with constipation (IBS-C)?
A. Metoprolol
B. Verapamil
C. Chlorthalidone
D. Spironolactone
B
73
Calcium channel blockers:
A. Should not be used for initial therapy in black patients
B. Can cause peripheral edema
C. Are contraindicated for use in pregnancy
D. Should not be used in combination with ACEIs or ARBs
B
74
A 65-year-old black man with diabetes and normal renal function has recently been diagnosed with hypertension. Which of the following would you recommend for initial treatment of hypertension for this patient?
```
A. Thiazide-type diuretic
B. Aliskiren (direct renin inhibitor)
C. Angiotensin receptor blocker (ARB)
D. Angiotensin-converting enzyme inhibitor (ACEI)
E. Calcium channel blocker (CCB)
```
A and E
75
.Which of the following antihypertensive drugs are no longer recommended for initial treatment of hypertension without the presence of another indication?
A. Thiazide-type diuretic
B. ACEIs
C. Beta blockers
D. ARBs
C
76
.Use of 2 drugs with different mechanisms of action for treatment of hypertension:
A. Is usually more effective in decreasing BP than increasing the dose of the first drug
B. Should be considered for initial therapy in patients with a baseline BP > 20/10 mm Hg above goal
C. Often allows for lower doses of both drugs
D All of the above
D
77
.Most studies that have shown outcome benefits of a diuretic in treating hypertension have used:
```
A. Hydrochlorothiazide
B. Chlorthalidone
C. Metolazone
D. Ethacrynic acid
E. Bumetanide
```
B
78
A 70-year-old woman with a sulfonamide allergy asks you to recommend a diuretic as add-on therapy to lower her BP. Which of the following would be an appropriate choice for this patient?
```
A. Hydrochlorothiazide
B. Chlorthalidone
C. Furosemide
D. Ethacrynic acid
E. Bumetanide
```
D
79
Which of the following antihypertensive drugs are less effective as initial therapy in blacks?
A. ACEIs
B. ARBs
C. CCBs
D. Diuretics
A and B
80
Which of the following antihypertensive drugs can cause fetal and neonatal morbidity and death?
```
A. ACEIs
B. ARBs
C. Aliskiren
D. Beta blockers
E. Diuretics
```
A, b and C
81
One advantage of ARBs over ACEIs for treatment of hypertension is that they:
```
A. Are significantly more effective
B. Are safer for use in pregnancy
C. Generally have fewer side effects
D. Do not cause hyperkalemia
E. All of the above
```
C
82
Which of the following calcium channel blockers usually cause an initial reflex tachycardia?
```
A. Amlodipine
B. Diltiazem
C. Felodipine
D. Nicardipine
E. Nisoldipine
```
A, C and D
83
Which of the following centrally acting alpha-2 agonists is also used for the treatment of hypertensive urgencies?
A. Clonidine
B. Guanfacine
C. Methyldopa
D. All of the above
A
84
Which of the following drugs should generally be given with a beta blocker to minimize reflex tachycardia and a diuretic to avoid fluid retention?
```
A. Clonidine
B. Hydralazine
C. Prazosin
D. Lisinopril
E. Valsartan
F. Minoxidil
```
B and F
85
A group of college students is planning a mountain climbing trip to the Andes. Which drug would be appropriate for them to take to prevent acute mountain sickness?
```
A. Scopolamine
B. Acetazolamide
C. Furosemide
D. Nifedipine
E. Dexamethasone
```
B
86
An elderly female with a history of heart disease is brought to the emergency department with difficulty breathing. Examination reveals that she has pulmonary edema. Which is treatment is indicated?
```
A. Acetazolamide
B. Chlorthalidone
C. Furosemide
D. Hydrochlorothiazide
E. Spironolactone
```
C
87
A 75-year-old woman with hypertension is being treated with a thiazide diuretic. Her BP responds well and reads at 120/76. After several months on the medication, she complains of being tired and weak. An analysis of the blood would indicate low values for which of the following?
```
A. Calcium
B. Glucose
C. Potassium
D. Sodium
E. Creatinine
```
C.
88
When used chronically for hypertension, thiazide diuretics have all of the following properties or effects EXCEPT:
```
A. Decreased urinary excretion of calcium
B. Elevation of blood cholesterol
C. Elevation of blood glucose
D. Elevation of plasma uric acid
E. Ototoxicity
```
E
89
The preferred thiazide-like diuretic for initial therapy of hypertension is:
A. Hydrochlorothiazide
B. Chlorthalidone
C. Furosemide
D. Metolazone
B
90
Loop diuretics such as furosemide can be used instead of thiazide-like diuretics to lower blood pressure in patients with:
A. Diabetes
B. High cardiovascular risk
C. Hypokalemia
D. Moderate to severe renal impairment
D
91
A male patient is placed on a new medication for heart failure and notes that his breasts have become tender to the touch. Which medication is he most likely taking?
```
A. Chlorthalidone
B. Eplerenone
C. Furosemide
D. Hydrochlorothiazide
E. Spironolactone
```
E
92
A 55-year-old male with kidney stones has been placed on a diuretic to decrease calcium excretion. However, after a few weeks, he develops an attack of gout. Which diuretic was he taking?
```
A. Furosemide
B. Hydrochlorothiazide
C. Mannitol
D. Spironolactone
E. Triamterene
```
B
93
A 50-year-old man has a history of frequent episodes of renal colic with high calcium renal stones. The most useful diuretic agent in the treatment of recurrent calcium stones (hypercalcuria) is:
A. Acetazolamide (carbonic anhydrase inhibitor)
B. Furosemide (loop diuretic)
C. Hydrochlorothiazide
D. Triamterene (sodium channel blocker - K+ sparing diuretic)
C
94
A 52-year-old woman is admitted to the ED with a history of drug treatment for several conditions. Her serum electrolytes are found to be as follows:
Na+: 140 mEq/L (135-145) K+: 6.5 (3.5-5)
Cl−: 100 mEq/L (98-107) pH: 7.3 (7.31-7.41)
This patient has probably been taking:
```
A. Acetazolamide
B. Atenolol
C. Digoxin
D. Furosemide
E. Lisinopril
F. Spironolactone
```
F and E
95
A 52-year-old woman is admitted to the ED with a history of drug treatment for several conditions. Her serum electrolytes are found to be as follows:
Na+: 140 mEq/L (135-145) K+: 2.5 (3.5-5)
Cl−: 100 mEq/L (98-107) pH: 7.3 (7.31-7.41)
In view of the electrolyte panel shown (and regardless of the cause) the patient will be more sensitive to the toxic actions of:
```
A. Cimetidine
B. Digoxin
C. Dobutamine
D. Fexofenadine
E. Omeprazole
```
B
96
Which diuretics lower K+ levels in the PLASMA?
1. Loop + thiazide
2. Loop of henele agents
3. Thiazides
They are in order from greatest decrease to least
97
Which of the following will lower Ca+ levels in the plasma?
A. Loop of henele agents
B. Thiazides
A.
98
True or false: Thiazides raise calcium in plasma
True
99
What diuretic class will decrease HCO3 in plasma causing alkalosis?
A. Loop of henele agents
B. Thiazides
C. Carbonic anhydrase inhibitors
D. All of the above
C
100
True or false: Diuretics that increase a solute in plasma will decrease its excretion in urine and vis versa?
True.
101
Which two diuretics can cause gout by increasing uric acid in plasma?
Loop of henele agents and thiazides
102
Increased serum levels of which of the following is associated with a decreased risk of atherosclerosis?
```
A. Total cholesterol
B. LDL
C. HDL
D. Triglyceride
E. VLDL
```
C
103
Which of the following pharmacotherapeutic interventions is associated with improvements in cardiovascular outcomes?
```
A. Lowering HDL levels
B. Lowering LDL levels
C. Raising HDL levels
D. Lowering VLDL levels
E. Raising triglyceride levels
```
B
104
.According to one meta-analysis, each additional 1mmol/L (38.67 mg/dL) reduction in LDL-C is associated with a reduction in the incidence of major vascular events of:
A. 5%
B. 10%
C. 20%
D. 30%
C
105
Which one of the following drugs causes a decrease in hepatic triglyceride synthesis by limiting availability of free fatty acid precursors?
```
A. Fenofibrate
B. Niacin
C. Cholestyramine
D. Lovastatin
E. Gemfibrozil
F. Ezetimibe
```
B
106
Alex is a 42-year-old 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 this patient?
A. Administer aspirin 30 minutes after taking niacin
B. Administer an antihistamine 30 minutes prior to taking niacin
C. Increase the dose of niacin SR to 1000 mg
D. Continue the current dose
E. Change the SR formulation to immediate-release niacin
F. Administer aspirin 30 minutes prior to taking niacin
F
107
Hazel is a 72-year-old female who is treated for hyperlipidemia with high dose atorvastatin for the past 6 months. She also has a history of renal insufficiency. Her 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. Her PA wishes to add an additional agent for her hyperlipidemia. Which of the following choices is the best option to address Hazel’s dyslipidemia?
```
A. Fenofibrate
B. Niacin
C. Cholestyramine
D. Add rosuvastatin
E. Ezetimibe
```
A
108
In one randomized trial, the incidence of myopathy with a CK level > 10 times the ULN among patients taking 20 mg/day of simvastatin was:
A. 0.03%
B. 0.9%
C. 1.6%
D. 3.2%
IDK
109
In addition to lowering LDL-C levels, statins also:
```
A. Improve endothelial function
B. Decrease platelet aggregation
C. Reduce inflammation
D. Reduce HDL levels
E. All of the above
```
IDK
110
A 59-year-old man in good health with no evidence of cardiovascular disease, a BMI of 29, an HbA1c of 5.9, and an LDL-C of 167 mg/dL asks whether he should be taking a statin. You could tell him that:
A. Statins are only approved for use in patients with documented cardiovascular disease (CVD)
B. Statins have no demonstrated benefit in patients without CVD
C. Statins can reduce the incidence of cardiovascular events in patients without CVD
D. Statins may increase the risk of developing diabetes
IDK
111
Which of the following statins is not metabolized to a clinically significant extent by CYP enzymes?
```
A. Lovastatin
B. Pravastatin
C. Simvastatin
D. Rosuvastatin
E. Fluvastatin
```
IDK
112
Which of the following patient populations is more likely to experience myalgia 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 fibrates
```
IDK
113
A74-year-old man with a long history of coronary artery disease has been taking atorvastatin 40 mg/day for many years. Now his LDL-C is 68, but he has seen advertisements for PCSK9 inhibitors and would like to take one in addition to atorvastatin. You could tell him that:
A. They are expensive
B. They are only approved for patients who require additional lowering of LDL-C
C. They have not been shown to improve clinical outcomes
D. They must be administered by the subcutaneous route
E. All of the above
IDK
114
Which of the following drugs has been shown to improve clinical outcomes when added to a statin?
A. Ezetimibe (cholesterol absorption inhibitor)
B. Alirocumab (PCSK9 inhibitor)
C. Gemfibrozil (fibrate)
D. Niacin
IDK
115
Because there is no evidence that adding it to a statin improves cardiovascular outcomes, the FDA has withdrawn approval of which of the following for use in addition to a statin?
A. Alirocumab
B. Ezetimibe
C. Extended-release niacin
D. All of the above
IDK
116
A 43-year-old man has HeFH (heterozygous familial hypercholesterolemia). His serum concentrations of total cholesterol and LDL are markedly elevated. HDL cholesterol, VLDL cholesterol, and triglycerides are normal or slightly elevated. The patient’s mother and older brother died of myocardial infarctions before the age of 50. This patiently recently experienced mild chest pain when walking up stairs and has been diagnosed was having angina of effort. The patient is somewhat overweight. He drinks most evenings and smokes a pack of cigarettes a day. Consumption of alcohol is associated with which lipid changes?
```
A. Decreased chylomicrons
B. Increased HDL cholesterol
C. Decreased VLDL cholesterol
D. Increased LDL cholesterol
E. Increased triglycerides
```
IDK
117
A 62-year-old man presents to his PA for management of hyperlipidemia. His most recent lipid panel reveals an LDL cholesterol level of 165 mg/dL. His PA wishes to begin treatment to lower his LDL. Which of the following therapies is the best option for this patient?
```
A. Fenofibrate
B. Cholestyramine
C. Niacin
D. Ezetimibe
E. Atorvastatin
```
IDK
118
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglycerides are elevated. Her serum concentration of HDL cholesterol is somewhat reduced.
Which of the following drugs is most likely to increase this patient’s triglyceride and VLDL cholesterol concentrations if used as monotherapy?
```
A. Atorvastatin
B. Cholestyramine
C. Ezetimibe
D. Gemfibrozil
E. Niacin
```
IDK
119
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglycerides are elevated. Her serum concentration of HDL cholesterol is somewhat reduced.
If this patient is pregnant which of the following drugs should be avoided because of a risk of causing harm to the fetus?
```
A. Cholestyramine
B. Niacin
C. Fenofibrate
D. Ezetimibe
E. Rosuvastatin
```
IDK
120
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglycerides are elevated. Her serum concentration of HDL cholesterol is somewhat reduced.
It is decided to start this patient on gemfibrozil. Which of the following is a major mechanism of gemfibrozil's action?
A. Increased secretion of bile acid salts
B. Increased expression of high-affinity LDL receptors on hepatocytes
C. Increased secretion of VLDL by the liver
D. Increased triglyceride hydrolysis by lipoprotein lipase
E. Reduced uptake of dietary cholesterol
IDK
121
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglycerides are elevated. Her serum concentration of HDL cholesterol is somewhat reduced.
Select the major toxicity associated with gemfibrozil therapy:
```
A. Bloating and constipation
B. Cholelithiasis
C. Hyperuricemia
D. Liver damage
E. Severe cardiac arrhythmia
```
IDK
122
.In patients with acute coronary syndrome (ACS), aspirin reduces the incidence of myocardial infarction (MI) by:
A. 5-10%
B. 15-25%
C. 30-40%
D. 50-60%
B
123
A 72-year-ols man with nonvalvular atrial fibrillation and a CHADS2-VASc of 2 asks you whether or not he needs to be on anticoagulant activity. Considering the new US guidelines, which of the following would you recommend?
A. Oral anticoagulation therapy
B. Omit antithrombotic therapy
C. Either aspirin or oral anticoagulant therapy
D. Aspirin
A
124
A 70-year-old female is diagnosed with non-valvular 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
D
125
A 65-year-old man with valvular atrial fibrillation recently saw advertisements for apixaban and rivaroxaban and asks whether he should use one of the newer anticoagulants instead of warfarin. You could tell him that, compared to warfarin, the newer “DOACs”:
A. Do not require routine INR-type monitoring
B. Have fewer interactions with other drugs
C. Cause less intracranial bleeding
D. All of the above
D
126
A 72-year-old woman undergoing knee replacement surgery who recently saw an advertisement for Pradaxa® asks her physician if she should be taking it. You should tell her that:
A. The risk of major GI bleeding is higher with dabigatran compared with warfarin
B. Dabigatran should be taken twice daily
C. In patients with non-valvular A-fib at risk for stroke, the risk of ischemic or hemorrhagic stroke was significantly lower than with warfarin
D. All of the above
D
127
In patients taking warfarin, the antithrombotic effect is decreased when they are given which of the following drugs?
```
A. Heparin
B. Cimetidine
C. Aspirin
D. Cholestyramine [BAS]
E. Clopidogrel
```
D
128
Which of the following oral anticoagulants is a direct thrombin inhibitor?
A. Apixaban
B. Dabigatran
C. Rivaroxaban
D. Warfarin
B
129
Information regarding a patient’s INR (International Normalized Ratio) is utilized in the management of patients who are taking:
```
A. Aspirin
B. Clopidrogel (Plavix)
C. Apixaban (Eliquis)
D. Warfarin (Coumadin)
E. Heparin
F. Enoxaparin (Low molecular weight heparin [LMWH])
G. Rivaroxaban (Xarelto
```
D
130
Which molecule must heparin bind to in order to exert its anticoagulant effect?
```
A. GP IIb/IIIa
B. Thrombin
C. Antithrombin III
D. von Willebrand factor
E. Tissue factor
```
C
131
Compared to unfractionated heparin (UFH), low-molecular weight heparin (LMWH):
A. Is more likely to cause heparin-induced thrombocytopenia
B. Has a more predictable anticoagulant response
C. Is more completely neutralized by protamine
D. May be safer in patients with renal impairment
B
132
Which of the following drugs can increase bleeding tendencies in patients by inactivating the activated clotting factors IIa (thrombin) and Xa?
```
A. Tissue plasminogen activator
B. Clopidogrel (Plavix)
C. Rivaroxaban (Xarelto)
D. Heparin
E. Low molecular weight heparin (Enoxaparin)
F. Dabigatran
G. Warfarin
```
D
133
Which of the following oral anticoagulants is recommended for patients with atrial fibrillation associated with a mechanical valve, a bioprosthetic valve, prior mitral valve repair, mitral stenosis?
A. Apixaban
B. Dabigatran
C. Rivaroxaban
D. Warfarin
D
134
Aspirin in low doses produces an anti-clotting effect because of its action to:
```
A. Increase levels of antithrombin III
B. Decrease prostacyclin (PGI2) levels
C. Decrease thromboxane A2 levels
D. Activate platelet ADP receptors
E. Decrease synthesis of prothrombin
```
C
135
The risk of bleeding in patients receiving heparin is increased by aspirin because aspirin:
A. Inhibits heparin anticoagulant activity
B. Inhibits platelet function
C. Displaces heparin from plasma protein-binding sites
D. Inhibits prothrombin formation
E. Causes thrombocytopenia
B
136
Which agent is considered “fibrin selective” because it rapidly activates plasminogen that is bound to fibrin?
A. Alteplase
B. Fondaparinux
C. Streptokinase
D. Urokinase
A
137
All of the following drugs are associated with the potential for excessive bleeding as a side effect. Administration of protamine is the initial treatment of choice for bleeding caused by an excess of:
```
A. Apixaban (Eliquis)
B. Clopidrogel (Plavix)
C. Heparin
D. Enoxaparin
E. Tissue plasminogen activator (tPA)
F. Warfarin
```
C
138
A 58-year-old business executive is brought to the emergency department 2 hours after the onset of severe chest pain during a vigorous tennis game. She has a history of poorly controlled moderate hypertension and elevated blood cholesterol but does not smoke. EKG changes confirm the diagnosis of myocardia1 infarction and the decision is made to attempt to open her occluded artery.
If this patient undergoes a PCI with placement of a stent in a coronary blood vessel, she may be given eptifibatide. Which of the following most accurately describes the antithrombotic mechanism of eptifibatide?
A. Activation of antithrombin III
B. Inhibition of thromboxane production
C. Irreversible inhibition of platelet ADP receptors
D. Reversible inhibition of platelet GPIIb/IIIa receptors
D
139
A 58-year-old business executive is brought to the emergency department 2 hours after the onset of severe chest pain during a vigorous tennis game. She has a history of poorly controlled moderate hypertension and elevated blood cholesterol but does not smoke. EKG changes confirm the diagnosis of myocardial infarction and the decision is made to attempt to open her occluded artery.
Which of the following drugs accelerates the conversion of plasminogen to plasmin?
```
A. Clopidrogel (Plavix)
B. Tranexamic acid
C. Warfarin
D. Enoxaparin
E. Alteplase
```
E
140
A 58-year-old business executive is brought to the emergency department 2 hours after the onset of severe chest pain during a vigorous tennis game. She has a history of poorly controlled moderate hypertension and elevated blood cholesterol but does not smoke. EKG changes confirm the diagnosis of myocardial infarction and the decision is made to attempt to open her occluded artery.
Which of the following adverse effects is most likely to occur if a fibrinolytic drug is used for treatment of her acute MI?
A. Acute renal failure
B. Development of antiplatelet antibodies
C. Encephalitis secondary to liver dysfunction
D. Hemorrhagic stroke
D
