Toxicities Flashcards
- Patient Case MCQ 1:
A 65-year-old male with a history of hypertension is started on a new medication. One week later, he complains of frequent urination. Which medication was most likely started?
a) Metoprolol
b) Amlodipine
c) Lisinopril
d) Hydrochlorothiazide
d) Hydrochlorothiazide
Rationale: Thiazide diuretics like hydrochlorothiazide can increase urination frequency as they increase the excretion of water from the body.
- Patient Case MCQ 2:
A patient presents with a persistent cough after starting a new antihypertensive medication. Which drug is the most likely culprit?
a) Losartan
b) Lisinopril
c) Amlodipine
d) Metoprolol
b) Lisinopril
Rationale: ACE inhibitors like lisinopril can cause a persistent cough due to the accumulation of bradykinin.
- Patient Case MCQ 3:
A 58-year-old female is noted to have a slow heart rate and fatigue after starting a new blood pressure medication. Which drug was she most likely prescribed?
a) Furosemide
b) Amlodipine
c) Propranolol
d) Valsartan
c) Propranolol
Rationale: Beta-blockers like propranolol can cause bradycardia and fatigue as side effects.
- Patient Case MCQ 4:
A patient with hypertension is started on a new medication. After a week, she complains of swollen ankles. Which drug was she most likely given?
a) Clonidine
b) Amlodipine
c) Lisinopril
d) Prazosin
b) Amlodipine
Rationale: Dihydropyridine calcium channel blockers like amlodipine can cause peripheral edema.
- Patient Case MCQ 5:
A man with a history of gout presents with an acute flare after starting a new hypertension medication. Which drug might have contributed?
a) Hydrochlorothiazide
b) Diltiazem
c) Minoxidil
d) Losartan
a) Hydrochlorothiazide
Rationale: Thiazide diuretics like hydrochlorothiazide can elevate uric acid levels, precipitating gout.
- Patient Case MCQ 6:
A patient presents with palpitations and headache after starting a new hypertension medication. Which drug is the most likely cause?
a) Furosemide
b) Hydralazine
c) Propranolol
d) Clonidine
b) Hydralazine
Rationale: Direct vasodilators like hydralazine can cause reflex tachycardia and headaches.
- Patient Case MCQ 7:
A pregnant woman is diagnosed with hypertension. Which of the following antihypertensive agents should be avoided?
a) Methyldopa
b) Losartan
c) Nifedipine
d) Hydrochlorothiazide
b) Losartan
Rationale: ARBs like losartan are contraindicated in pregnancy due to potential fetal toxicity.
- Patient Case MCQ 8:
A patient with hypertension is noted to have elevated potassium levels after starting a new medication. Which drug was he most likely prescribed?
a) Amlodipine
b) Valsartan
c) Furosemide
d) Metoprolol
b) Valsartan
Rationale: ARBs like valsartan can lead to hyperkalemia.
- Patient Case MCQ 9:
A patient presents with increased hair growth on her face after starting a new hypertension medication. Which drug might be responsible?
a) Minoxidil
b) Diltiazem
c) Lisinopril
d) Hydrochlorothiazide
a) Minoxidil
Rationale: Minoxidil, a direct vasodilator, can cause hypertrichosis or increased hair growth.
- Patient Case MCQ 10:
A 60-year-old male complains of breast enlargement after starting a new medication for his hypertension. Which medication is most likely responsible?
a) Hydrochlorothiazide
b) Spironolactone
c) Amlodipine
d) Metoprolol
b) Spironolactone
Rationale: Spironolactone, a potassium-sparing diuretic, can cause gynecomastia or breast enlargement in men.
- Patient Case MCQ 11:
A patient presents with constipation after starting a new antihypertensive medication. Which drug is the most likely cause?
a) Verapamil
b) Losartan
c) Minoxidil
d) Furosemide
a) Verapamil
Rationale: Non-dihydropyridine calcium channel blockers like verapamil can cause constipation.
- Patient Case MCQ 12:
A patient with hypertension has been started on a new medication. She now complains of dizziness when standing up from a seated position. Which medication is most likely responsible?
a) Prazosin
b) Amlodipine
c) Hydrochlorothiazide
d) Lisinopril
a) Prazosin
Rationale: Alpha-blockers like prazosin can cause orthostatic hypotension, leading to dizziness upon standing.
- Patient Case MCQ 13:
A patient with hypertension develops ringing in the ears after starting a new medication. Which drug might be the culprit?
a) Furosemide
b) Metoprolol
c) Amlodipine
d) Losartan
a) Furosemide
Rationale: Loop diuretics like furosemide can cause ototoxicity, which may manifest as tinnitus or ringing in the ears.
- Patient Case MCQ 14:
A patient started on a new hypertension medication complains of dry mouth and drowsiness. Which drug might be responsible?
a) Clonidine
b) Amlodipine
c) Valsartan
d) Furosemide
a) Clonidine
Rationale: Central alpha-2 agonists like clonidine can cause dry mouth and sedation.
- Patient Case MCQ 15:
A man with hypertension is found to have decreased sodium levels after starting a new medication. Which drug is most likely responsible?
a) Amlodipine
b) Valsartan
c) Hydrochlorothiazide
d) Propranolol
c) Hydrochlorothiazide
Rationale: Thiazide diuretics like hydrochlorothiazide can lead to hyponatremia or decreased sodium levels.
- Patient Case MCQ 16:
A patient with hypertension is noted to have increased calcium levels after starting a new medication. Which drug is most likely responsible?
a) Furosemide
b) Hydrochlorothiazide
c) Amlodipine
d) Lisinopril
b) Hydrochlorothiazide
Rationale: Thiazide diuretics like hydrochlorothiazide can lead to hypercalcemia or elevated calcium levels.
- Patient Case MCQ 17:
A patient recently started on a new antihypertensive medication complains of swelling in her face and lips. Which drug might be responsible?
a) Amlodipine
b) Lisinopril
c) Metoprolol
d) Furosemide
b) Lisinopril
Rationale: ACE inhibitors like lisinopril can cause angioedema, which is swelling of the deeper layers of the skin, often around the eyes and lips.
- Patient Case MCQ 18:
A patient develops bronchospasm after starting a new medication for hypertension. Which drug is the most likely culprit?
a) Amlodipine
b) Propranolol
c) Valsartan
d) Minoxidil
b) Propranolol
Rationale: Non-selective beta-blockers like propranolol can cause bronchospasm, especially in patients with asthma.
- Patient Case MCQ 19:
A patient with hypertension develops worsening of her peripheral arterial disease after starting a new medication. Which drug might be responsible?
a) Propranolol
b) Amlodipine
c) Valsartan
d) Furosemide
a) Propranolol
Rationale: Non-selective beta-blockers like propranolol can exacerbate peripheral arterial disease.
- Patient Case MCQ 20:
A patient complains of frequent muscle cramps after starting a new antihypertensive medication. Laboratory tests reveal low potassium levels. Which drug might be responsible?
a) Spironolactone
b) Lisinopril
c) Furosemide
d) Valsartan
c) Furosemide
Rationale: Loop diuretics like furosemide can cause hypokalemia or low potassium levels, leading to muscle cramps.
- Patient Case MCQ 21:
A 72-year-old male with hypertension is started on a new medication. He complains of difficulty urinating. Which medication was most likely started?
a) Amlodipine
b) Prazosin
c) Clonidine
d) Metoprolol
b) Prazosin
Rationale: Alpha-blockers like prazosin can exacerbate urinary symptoms, especially in males with an enlarged prostate.
- Patient Case MCQ 22:
A patient presents with severe headache and palpitations shortly after starting a new hypertension medication. Blood pressure is noted to be significantly elevated. Which drug might be responsible?
a) Clonidine
b) Amlodipine
c) Valsartan
d) Furosemide
a) Clonidine
Rationale: Abrupt withdrawal from clonidine can lead to a rebound hypertension, which can present with headache and palpitations.
- Patient Case MCQ 23:
A patient with hypertension is started on a new medication. After a week, she complains of flushing and warmth. Which drug was she most likely given?
a) Amlodipine
b) Metoprolol
c) Lisinopril
d) Hydralazine
d) Hydralazine
Rationale: Direct vasodilators like hydralazine can cause flushing due to vasodilation.
- Patient Case MCQ 24:
A pregnant woman with hypertension is started on a medication known to cause positive Coombs test and hemolytic anemia. Which drug was she most likely prescribed?
a) Minoxidil
b) Methyldopa
c) Amlodipine
d) Valsartan
b) Methyldopa
Rationale: Methyldopa can cause a positive direct Coombs test and hemolytic anemia.
- Patient Case MCQ 25:
A man with hypertension complains of nightmares and vivid dreams after starting a new medication. Which drug might be responsible?
a) Amlodipine
b) Propranolol
c) Valsartan
d) Furosemide
b) Propranolol
Rationale: Beta-blockers like propranolol can cause nightmares and vivid dreams as side effects.
- Patient Case MCQ 26:
A patient recently diagnosed with hypertension is prescribed a medication that acts by blocking the activation of angiotensin II receptors. Which drug was he most likely given?
a) Lisinopril
b) Losartan
c) Minoxidil
d) Amlodipine
b) Losartan
Rationale: Losartan is an angiotensin II receptor blocker (ARB) that prevents the activation of angiotensin II receptors.
- Patient Case MCQ 27:
A patient presents with electrolyte abnormalities after starting a new hypertension medication. Which drug is known to cause both hyperkalemia and hyponatremia?
a) Spironolactone
b) Amlodipine
c) Propranolol
d) Hydrochlorothiazide
a) Spironolactone
Rationale: Spironolactone, a potassium-sparing diuretic, can lead to hyperkalemia. While less common, it can also contribute to hyponatremia.
- Patient Case MCQ 28:
A patient with a history of asthma is noted to have wheezing after starting a new hypertension medication. Which drug was she most likely prescribed?
a) Amlodipine
b) Propranolol
c) Valsartan
d) Hydrochlorothiazide
b) Propranolol
Rationale: Non-selective beta-blockers like propranolol can cause bronchospasm, especially in patients with asthma.
- Patient Case MCQ 29:
A patient recently started on a hypertension medication presents with lethargy, confusion, and muscle weakness. Lab tests reveal elevated potassium levels. Which drug might be responsible?
a) Amlodipine
b) Hydrochlorothiazide
c) Lisinopril
d) Furosemide
c) Lisinopril
Rationale: ACE inhibitors like lisinopril can lead to hyperkalemia or elevated potassium levels, which can present with symptoms like lethargy, confusion, and muscle weakness.
- Patient Case MCQ 30:
A 70-year-old male with hypertension and benign prostatic hyperplasia is started on a new medication to help with both conditions. He reports improvement in his urinary symptoms. Which medication was he most likely prescribed?
a) Amlodipine
b) Prazosin
c) Valsartan
d) Hydrochlorothiazide
b) Prazosin
Rationale: Alpha-blockers like prazosin are used to treat hypertension and can also alleviate urinary symptoms in males with benign prostatic hyperplasia.
Mr. Johnson, a 54-year-old male, presents with chest pain that worsens with activity and relieves with rest. He has been prescribed nitroglycerin.
Question:
Which of the following is a common side effect of nitroglycerin?
A) Diarrhea
B) Headache
C) Hyperkalemia
D) Bronchospasm
B) Headache
Rationale:
Nitroglycerin, an organic nitrate, commonly causes headaches due to its vasodilatory effects.
Mrs. Lee, a 62-year-old female, has angina and asthma. She has been prescribed a new medication for her angina.
Question:
Which drug should be used with caution in Mrs. Lee?
A) Nifedipine
B) Ranolazine
C) Propranolol
D) Isosorbide dinitrate
C) Propranolol
Rationale:
Beta-blockers like Propranolol can cause bronchospasm, especially in patients with asthma.
Mr. Ahmed, a 58-year-old male with angina, has been experiencing constipation recently after starting a new medication.
Question:
Which drug is likely responsible for his constipation?
A) Verapamil
B) Nitroglycerin
C) Atenolol
D) Ranolazine
A) Verapamil
Rationale:
Verapamil, a calcium channel blocker, is known to cause constipation.
Mrs. Smith, a 65-year-old female, is on a medication for angina which can prolong the QT interval.
Question:
Which medication is Mrs. Smith likely on?
A) Metoprolol
B) Amlodipine
C) Ranolazine
D) Aspirin
C) Ranolazine
Rationale:
Ranolazine is known to cause QT prolongation.
Mr. Rodriguez, a 60-year-old male with angina, has been experiencing peripheral edema after starting a new medication.
Question:
Which drug is likely responsible for his peripheral edema?
A) Nifedipine
B) Propranolol
C) Isosorbide dinitrate
D) Ranolazine
A) Nifedipine
Rationale:
Nifedipine, a calcium channel blocker, can cause peripheral edema.
Mrs. Green, a 59-year-old female, experiences chest pain that is relieved by sublingual nitroglycerin but returns upon exertion.
Question:
What type of angina is Mrs. Green likely experiencing?
A) Stable angina
B) Unstable angina
C) Variant angina
D) Microvascular angina
A) Stable angina
Rationale:
Stable angina is characterized by chest pain that occurs with exertion and is relieved by rest or nitroglycerin.
Mr. Patel, a 57-year-old male, has been prescribed a drug that inhibits the late phase of the inward sodium current, reducing diastolic wall tension and oxygen consumption.
Question:
Which drug has Mr. Patel been prescribed?
A) Atenolol
B) Nifedipine
C) Ranolazine
D) Nitroglycerin
C) Ranolazine
Rationale:
Ranolazine works by inhibiting the late phase of the inward sodium current.
Mrs. Turner, a 63-year-old female, is on a medication for her angina which she has been told can mask the symptoms of hypoglycemia.
Question:
Which medication is Mrs. Turner likely on?
A) Propranolol
B) Verapamil
C) Isosorbide dinitrate
D) Ranolazine
A) Propranolol
Rationale:
Beta-blockers like Propranolol can mask the symptoms of hypoglycemia.
Mr. Kim, a 56-year-old male with a history of angina, recently started experiencing dizziness after a new medication was added to his regimen.
Question:
Which drug is likely responsible for his dizziness?
A) Aspirin
B) Nitroglycerin
C) Nifedipine
D) Atenolol
C) Nifedipine
Rationale:
Nifedipine, a calcium channel blocker, can cause dizziness due to its vasodilatory effects.
Mrs. Walker, a 61-year-old female with angina, was recently prescribed a medication that can cause reflex tachycardia.
Question:
Which drug is she likely on?
A) Amlodipine
B) Nitroglycerin
C) Ranolazine
D) Propranolol
B) Nitroglycerin
Rationale:
Nitroglycerin can cause reflex tachycardia due to its vasodilatory effects.
Mr. White, a 67-year-old male, has been prescribed a drug that reduces myocardial oxygen demand by decreasing heart rate and contractility.
Question:
Which drug has he been prescribed?
A) Verapamil
B) Nitroglycerin
C) Atenolol
D) Nifedipine
C) Atenolol
Rationale:
Atenolol, a beta-blocker, reduces myocardial oxygen demand by decreasing heart rate and contractility.
Mrs. Harris, a 66-year-old female, has been prescribed a drug for her angina that also has a beneficial effect on her hypertension.
Question:
Which drug is she likely on?
A) Nitroglycerin
B) Ranolazine
C) Verapamil
D) Isosorbide dinitrate
C) Verapamil
Rationale:
Verapamil, a calcium channel blocker, is used in the treatment of both angina and hypertension.
Mr. Martinez, a 68-year-old male with angina, has been prescribed a drug that can cause hair growth as a side effect.
Question:
Which drug has he been prescribed?
A) Ranolazine
B) Atenolol
C) Nifedipine
D) Minoxidil
D) Minoxidil
Rationale:
While Minoxidil is primarily known for its use in hair growth, it is also a potent vasodilator and can be used in severe hypertension. Hair growth is a known side effect.
Mrs. Thompson, a 70-year-old female with angina, is on a medication that inhibits platelet aggregation, reducing the risk of thrombus formation.
Question:
Which medication is Mrs. Thompson likely on?
A) Ranolazine
B) Amlodipine
C) Clopidogrel
D) Verapamil
C) Clopidogrel
Rationale:
Clopidogrel is an antiplatelet agent that inhibits platelet aggregation.
Mr. Davis, a 55-year-old male, presents with chest pain that occurs at rest and is associated with transient ECG changes but without an increase in cardiac enzymes.
Question:
What type of angina is Mr. Davis likely experiencing?
A) Stable angina
B) Unstable angina
C) Variant angina
D) Microvascular angina
B) Unstable angina
Rationale:
Unstable angina can occur at rest and is associated with ECG changes but without an increase in cardiac enzymes.
Mrs. Anderson, a 58-year-old female, has been prescribed a drug for angina that decreases afterload.
Question:
Which drug has she been prescribed?
A) Atenolol
B) Ranolazine
C) Nifedipine
D) Nitroglycerin
C) Nifedipine
Rationale:
Nifedipine, a calcium channel blocker, causes arterial dilation and reduces afterload.
Mr. Lewis, a 64-year-old male with angina, was recently prescribed a drug that can lead to an increased risk of bleeding.
Question:
Which drug has he been prescribed?
A) Propranolol
B) Aspirin
C) Amlodipine
D) Ranolazine
B) Aspirin
Rationale:
Aspirin is an antiplatelet agent and can increase the risk of bleeding.
Mrs. Jackson, a 60-year-old female, is on a medication that reduces anginal frequency and increases exercise tolerance but doesn’t reduce the risk of myocardial infarction or death.
Question:
Which medication is Mrs. Jackson likely on?
A) Ranolazine
B) Clopidogrel
C) Nitroglycerin
D) Lisinopril
A) Ranolazine
Rationale:
Ranolazine helps in reducing anginal frequency and increasing exercise tolerance, but it doesn’t reduce the risk of myocardial infarction or death.
Mr. Wilson, a 56-year-old male, presents with chest pain that is most severe at night and is associated with transient ECG changes.
Question:
What type of angina is Mr. Wilson likely experiencing?
A) Stable angina
B) Unstable angina
C) Variant angina
D) Microvascular angina
C) Variant angina
Rationale:
Variant angina (Prinzmetal’s angina) occurs at rest, often at night, and is associated with transient ECG changes due to coronary artery spasm.
Mrs. Taylor, a 59-year-old female, is on a drug for angina that can also be beneficial for her migraines.
Question:
Which drug is she likely on?
A) Nitroglycerin
B) Propranolol
C) Ranolazine
D) Clopidogrel
B) Propranolol
Rationale:
Propranolol, a beta-blocker, is used in the treatment of angina and is also beneficial for migraines.
Case 21:
Mr. Moore, a 62-year-old male, presents with chest pain. He has been prescribed a drug that acts by increasing the intracellular concentration of cyclic GMP.
Question:
Which drug has he been prescribed?
A) Verapamil
B) Nitroglycerin
C) Ranolazine
D) Atenolol
B) Nitroglycerin
Rationale:
Nitroglycerin acts by increasing the intracellular concentration of cyclic GMP, leading to smooth muscle relaxation and vasodilation.
Mrs. Martin, a 64-year-old female, is experiencing reflex tachycardia after starting a new medication for her angina.
Question:
Which drug is likely responsible for this side effect?
A) Atenolol
B) Ranolazine
C) Nifedipine
D) Isosorbide dinitrate
C) Nifedipine
Rationale:
Nifedipine, a calcium channel blocker, can cause reflex tachycardia due to its vasodilatory effects.
Mr. Thomas, a 60-year-old male, was prescribed a drug that can lead to bradycardia and AV block.
Question:
Which drug is he likely on?
A) Nitroglycerin
B) Verapamil
C) Ranolazine
D) Clopidogrel
B) Verapamil
Rationale:
Verapamil, a calcium channel blocker, can lead to bradycardia and AV block.
Mrs. Garcia, a 63-year-old female, is on a medication that reduces myocardial oxygen demand by decreasing preload.
Question:
Which medication is Mrs. Garcia likely on?
A) Amlodipine
B) Atenolol
C) Nitroglycerin
D) Ranolazine
C) Nitroglycerin
Rationale:
Nitroglycerin reduces myocardial oxygen demand by causing venodilation, which decreases preload.
Mr. Walker, a 66-year-old male with a history of angina, has been prescribed a drug that primarily causes arterial dilation.
Question:
Which drug has he been prescribed?
A) Nitroglycerin
B) Isosorbide dinitrate
C) Nifedipine
D) Propranolol
C) Nifedipine
Rationale:
Nifedipine, a calcium channel blocker, primarily causes arterial dilation, reducing afterload.
Mrs. Hall, a 62-year-old female, has been experiencing fatigue and depression after starting a new medication for her angina.
Question:
Which drug is likely responsible for these side effects?
A) Nifedipine
B) Ranolazine
C) Atenolol
D) Nitroglycerin
C) Atenolol
Rationale:
Beta-blockers like Atenolol can cause fatigue and depression as side effects.
Case 27:
Mr. Adams, a 57-year-old male, was prescribed a drug that can lead to bronchospasm in asthmatic patients.
Question:
Which drug has he been prescribed?
A) Nifedipine
B) Nitroglycerin
C) Propranolol
D) Ranolazine
C) Propranolol
Rationale:
Beta-blockers like Propranolol can cause bronchospasm, especially in patients with asthma.
Mrs. Lopez, a 55-year-old female with a history of angina and hypertension, has been prescribed a drug that acts on both cardiac and vascular smooth muscle.
Question:
Which drug has she been prescribed?
A) Amlodipine
B) Nitroglycerin
C) Atenolol
D) Ranolazine
A) Amlodipine
Rationale:
Amlodipine, a calcium channel blocker, acts on both cardiac and vascular smooth muscle, leading to relaxation and vasodilation.
Mr. Allen, a 59-year-old male, has been prescribed a drug that acts by inhibiting the late phase of the inward sodium current in the heart.
Question:
Which drug has he been prescribed?
A) Verapamil
B) Nitroglycerin
C) Atenolol
D) Ranolazine
D) Ranolazine
Rationale:
Ranolazine works by inhibiting the late phase of the inward sodium current, reducing diastolic tension and oxygen consumption in the heart.
Mrs. Roberts, a 63-year-old female with angina, was recently prescribed a drug that can lead to hyperkalemia as a side effect.
Question:
Which drug is she likely on?
A) Nitroglycerin
B) Verapamil
C) Ranolazine
D) Lisinopril
D) Lisinopril
Rationale:
Lisinopril, an ACE inhibitor, can lead to hyperkalemia as a side effect.
- Case: A 58-year-old man with a history of chronic heart failure presents to the clinic complaining of increasing dyspnea and fatigue. His current medications include enalapril and metoprolol.
Question: Which of the following side effects is most commonly associated with enalapril?
a. Bradycardia
b. Cough
c. Bronchospasm
d. Visual disturbances
b. Cough
Rationale: Enalapril is an ACE inhibitor. A common side effect of ACE inhibitors is a persistent dry cough, which results from the accumulation of bradykinin in the respiratory tract.
- Case: A 70-year-old woman is being treated for heart failure. She is currently taking digoxin.
Question: Which symptom would be most concerning for digoxin toxicity?
a. Yellow vision
b. Diarrhea
c. Hypertension
d. Dry mouth
a. Yellow vision
Rationale: Yellow vision (xanthopsia) is a classic sign of digoxin toxicity. Other symptoms include nausea, vomiting, and arrhythmias.
- Case: A 60-year-old man with heart failure is prescribed spironolactone.
Question: What side effect is more commonly associated with spironolactone than with other drugs in its class?
a. Hyperkalemia
b. Gynecomastia
c. Cough
d. Bradycardia
b. Gynecomastia
Rationale: Spironolactone, an aldosterone antagonist, can cause gynecomastia due to its anti-androgenic effects.
- Case: A 65-year-old woman with heart failure is started on a beta-blocker.
Question: Which of the following is a common side effect of beta-blockers?
a. Hypertension
b. Tachycardia
c. Fatigue
d. Diarrhea
c. Fatigue
Rationale: Fatigue is a common side effect of beta-blockers due to their negative inotropic and chronotropic effects.
- Case: A patient with heart failure is prescribed sacubitril/valsartan.
Question: Which mechanism of action is associated with sacubitril?
a. Aldosterone antagonism
b. Beta blockade
c. Neprilysin inhibition
d. ACE inhibition
c. Neprilysin inhibition
Rationale: Sacubitril is a neprilysin inhibitor. Neprilysin is an enzyme that degrades atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), which are beneficial in heart failure. By inhibiting neprilysin, sacubitril increases the levels of ANP and BNP.
- Case: A 50-year-old man with heart failure is started on ivabradine.
Question: Which of the following is a known side effect of ivabradine?
a. Visual disturbances
b. Cough
c. Diarrhea
d. Hypertension
a. Visual disturbances
Rationale: Ivabradine can cause visual disturbances known as phosphenes.
- Case: A patient with heart failure is prescribed an SGLT2 inhibitor.
Question: Which of the following side effects is most commonly associated with SGLT2 inhibitors?
a. Bronchospasm
b. Genital fungal infections
c. Gynecomastia
d. Dry cough
b. Genital fungal infections
Rationale: SGLT2 inhibitors increase the excretion of glucose in the urine, which can predispose to genital fungal infections.
- Case: A 68-year-old man with heart failure is given milrinone.
Question: What is the primary mechanism of action of milrinone?
a. Beta blockade
b. ACE inhibition
c. Phosphodiesterase inhibition
d. Aldosterone antagonism
c. Phosphodiesterase inhibition
Rationale: Milrinone is a phosphodiesterase inhibitor, which increases intracellular cAMP, leading to increased myocardial contractility and vasodilation.
- Case: A patient with heart failure is given a diuretic.
Question: Which of the following electrolyte imbalances is most commonly associated with the use of loop diuretics?
a. Hyperkalemia
b. Hypernatremia
c. Hypokalemia
d. Hypercalcemia
c. Hypokalemia
Rationale: Loop diuretics, such as furosemide, can lead to the excretion of potassium, causing hypokalemia.
- Case: A 72-year-old woman with heart failure is started on an ARB.
Question: Which of the following side effects is more specific to ARBs compared to ACE inhibitors?
a. Hyperkalemia
b. Renal dysfunction
c. Cough
d. Angioedema
c. Cough
Rationale: While both ARBs and ACE inhibitors can cause hyperkalemia and renal dysfunction, cough is less commonly associated with ARBs than with ACE inhibitors.
- Case: A patient with a history of asthma and heart failure requires pharmacological management.
Question: Which class of medication should be used with caution in this patient due to the risk of bronchospasm?
a. Beta-blockers
b. Diuretics
c. ACE inhibitors
d. Aldosterone antagonists
a. Beta-blockers
Rationale: Beta-blockers can cause bronchospasm, especially in patients with a history of asthma.
- Case: A 55-year-old man with heart failure is prescribed hydralazine and isosorbide dinitrate.
Question: What is the primary benefit of this combination therapy in heart failure?
a. Increased diuresis
b. Vasodilation
c. Beta blockade
d. Inhibition of aldosterone
b. Vasodilation
Rationale: The combination of hydralazine (an arterial vasodilator) and isosorbide dinitrate (a venous vasodilator) promotes vasodilation, decreasing both preload and afterload in heart failure.
- Case: A patient with heart failure is prescribed a drug that inhibits the enzyme responsible for the degradation of natriuretic peptides.
Question: Which drug has this mechanism of action?
a. Ivabradine
b. Sacubitril
c. Eplerenone
d. Metoprolol
Answer: b. Sacubitril
Rationale: Sacubitril inhibits neprilysin, an enzyme responsible for the degradation of natriuretic peptides. By doing so, it increases the levels of beneficial natriuretic peptides in heart failure.
- Case: A 59-year-old woman with heart failure is experiencing frequent episodes of dizziness and lightheadedness.
Question: Which medication can cause hypotension as a common side effect in heart failure patients?
a. Digoxin
b. Enalapril
c. Ivabradine
d. Spironolactone
b. Enalapril
Rationale: ACE inhibitors like enalapril can cause vasodilation leading to hypotension, which may manifest as dizziness and lightheadedness.
- Case: A patient with heart failure is observed to have gynecomastia on physical examination.
Question: Which medication is most likely responsible for this finding?
a. Losartan
b. Furosemide
c. Spironolactone
d. Metoprolol
c. Spironolactone
Rationale: Spironolactone can cause gynecomastia due to its anti-androgenic effects.
- Case: A 64-year-old man with heart failure is started on a new medication. He reports seeing bright spots in his vision a week later.
Question: Which drug is most likely responsible for this visual disturbance?
a. Ivabradine
b. Enalapril
c. Digoxin
d. Hydralazine
a. Ivabradine
Rationale: Ivabradine can cause phosphenes, which are described as bright visual disturbances.
- Case: A patient with heart failure reports frequent urination and thirst after starting a new medication.
Question: Which drug class can lead to an increase in urinary glucose excretion and is most likely responsible for these symptoms?
a. SGLT2 inhibitors
b. Beta-blockers
c. ACE inhibitors
d. Aldosterone antagonists
a. SGLT2 inhibitors
Rationale: SGLT2 inhibitors increase the excretion of glucose in the urine, which can lead to frequent urination and increased thirst.
- Case: A 67-year-old woman with heart failure is started on a medication that reduces both preload and afterload.
Question: Which combination therapy achieves this effect?
a. Hydralazine and isosorbide dinitrate
b. Metoprolol and enalapril
c. Furosemide and digoxin
d. Spironolactone and losartan
a. Hydralazine and isosorbide dinitrate
Rationale: Hydralazine is an arterial vasodilator (reducing afterload) and isosorbide dinitrate is a venous vasodilator (reducing preload). The combination effectively reduces both preload and afterload.
- Case: A patient with heart failure and atrial fibrillation is prescribed a drug to improve symptoms and reduce the ventricular rate.
Question: Which drug has positive inotropic effects and can control ventricular rate in atrial fibrillation?
a. Digoxin
b. Eplerenone
c. Sacubitril
d. Dobutamine
a. Digoxin
Rationale: Digoxin has positive inotropic effects, improving symptoms in heart failure, and can also control the ventricular rate in conditions like atrial fibrillation.
- Case: A patient with heart failure is found to have elevated potassium on a routine blood test.
Question: Which of the following drugs is most likely responsible for hyperkalemia?
a. Furosemide
b. Metoprolol
c. Enalapril
d. Ivabradine
c. Enalapril
Rationale: ACE inhibitors like enalapril can cause hyperkalemia due to decreased aldosterone production.
- Case: A patient with heart failure is started on a drug that inhibits a specific enzyme leading to vasodilation.
Question: Which drug works by inhibiting the conversion of angiotensin I to angiotensin II?
a. Losartan
b. Enalapril
c. Eplerenone
d. Metoprolol
b. Enalapril
Rationale: Enalapril is an ACE inhibitor. It works by inhibiting the conversion of angiotensin I to angiotensin II, leading to vasodilation.
- Case: A 62-year-old man with heart failure is prescribed a medication to reduce the risk of hospitalization and improve life expectancy.
Question: Which drug has been shown to reduce mortality in heart failure patients?
a. Enalapril
b. Amlodipine
c. Nifedipine
d. Hydralazine
a. Enalapril
Rationale: ACE inhibitors like enalapril have been shown to reduce mortality in heart failure patients.
- Case: A 70-year-old woman with heart failure is started on a drug to improve her exercise capacity and quality of life.
Question: Which drug increases myocardial contractility by inhibiting phosphodiesterase?
a. Digoxin
b. Milrinone
c. Sacubitril
d. Furosemide
b. Milrinone
Rationale: Milrinone is a phosphodiesterase inhibitor that increases intracellular cAMP, leading to increased myocardial contractility.
- Case: A patient with heart failure reports muscle cramps and weakness after starting a new medication.
Question: Which diuretic is most likely responsible for these symptoms due to its potential to cause hypokalemia?
a. Spironolactone
b. Furosemide
c. Eplerenone
d. Hydrochlorothiazide
b. Furosemide
Rationale: Furosemide is a loop diuretic that can lead to the excretion of potassium, causing hypokalemia which can manifest as muscle cramps and weakness.
- Case: A 66-year-old man with heart failure is started on a medication to reduce the risk of sudden cardiac death.
Question: Which drug class has been shown to reduce the risk of sudden cardiac death in heart failure patients?
a. ACE inhibitors
b. Beta-blockers
c. Diuretics
d. Calcium channel blockers
b. Beta-blockers
Rationale: Beta-blockers have been shown to reduce the risk of sudden cardiac death in heart failure patients by preventing arrhythmias and improving cardiac function.
- Case: A patient with heart failure is prescribed a medication that acts as a selective antagonist of aldosterone receptors.
Question: Which drug has this mechanism of action?
a. Enalapril
b. Furosemide
c. Eplerenone
d. Metoprolol
c. Eplerenone
Rationale: Eplerenone is a selective aldosterone receptor antagonist, which means it specifically blocks the effects of aldosterone, a hormone that can cause fluid retention and increased blood pressure.
- Case: A 63-year-old woman with heart failure is started on a medication to reduce hospitalization rates and improve overall survival. She has a history of chronic dry cough with ACE inhibitors.
Question: Which medication can provide benefits similar to ACE inhibitors but has a reduced risk of causing cough?
a. Hydralazine
b. Losartan
c. Digoxin
d. Furosemide
b. Losartan
Rationale: Losartan is an Angiotensin II receptor blocker (ARB). ARBs provide benefits similar to ACE inhibitors in heart failure but have a reduced risk of causing a persistent dry cough, a known side effect of ACE inhibitors.
- Case: A patient with heart failure is prescribed a medication to improve cardiac output but starts experiencing arrhythmias after initiation.
Question: Which inotropic agent might be responsible for these symptoms?
a. Eplerenone
b. Enalapril
c. Dobutamine
d. Losartan
c. Dobutamine
Rationale: Dobutamine is an inotropic agent that increases cardiac output by increasing myocardial contractility. However, it can also predispose to arrhythmias.
- Case: A 68-year-old man with heart failure is started on a drug that decreases heart rate without affecting blood pressure significantly.
Question: Which drug primarily reduces heart rate as its mechanism of action?
a. Digoxin
b. Hydralazine
c. Ivabradine
d. Furosemide
c. Ivabradine
Rationale: Ivabradine specifically reduces heart rate by inhibiting the If (“funny”) current in the sinoatrial node, without causing significant effects on blood pressure.
- Case: A patient with heart failure is found to have decreased serum sodium levels after starting a new medication.
Question: Which class of drugs is most likely responsible for this hyponatremia?
a. Beta-blockers
b. ACE inhibitors
c. Diuretics
d. Aldosterone antagonists
c. Diuretics
Rationale: Diuretics, especially thiazide and thiazide-like diuretics, can cause hyponatremia by increasing the excretion of sodium in the urine.
Case: A 35-year-old woman presents with frequent palpitations. Her ECG shows a regular narrow QRS complex tachycardia. She is given a drug and her symptoms quickly resolve.
A. Quinidine
B. Adenosine
C. Amiodarone
D. Flecainide
B. Adenosine
Rationale: The description is consistent with paroxysmal supraventricular tachycardia (PSVT). Adenosine is the first-line drug for terminating PSVT.
Case: A 55-year-old man with a history of heart failure is diagnosed with atrial fibrillation. Which drug is contraindicated?
A. Sotalol
B. Dronedarone
C. Propafenone
D. Metoprolol
B. Dronedarone
Rationale: Dronedarone is contraindicated in patients with heart failure due to an increased risk of death.
Case: A 65-year-old patient on an antiarrhythmic drug presents with bluish-gray skin discoloration and photosensitivity. Which drug is he likely taking?
A. Lidocaine
B. Mexiletine
C. Amiodarone
D. Verapamil
C. Amiodarone
Rationale: Amiodarone can cause blue-gray skin discoloration and photosensitivity as side effects.
A 50-year-old man with a history of ventricular tachycardia is on an antiarrhythmic drug. He complains of dizziness and ringing in his ears. The likely drug is?
A. Quinidine
B. Esmolol
C. Sotalol
D. Diltiazem
A. Quinidine
Rationale: The patient is experiencing cinchonism, a side effect of Quinidine, characterized by tinnitus and dizziness.
Case: A patient with atrial fibrillation is started on a drug. He later presents with a lupus-like syndrome. Which drug was he likely given?
A. Flecainide
B. Procainamide
C. Lidocaine
D. Verapamil
B. Procainamide
Rationale: Procainamide can cause a lupus-like syndrome as a side effect.
Case: A 70-year-old patient presents with constipation and peripheral edema after starting a new medication for atrial fibrillation. Which drug is responsible?
A. Adenosine
B. Quinidine
C. Verapamil
D. Sotalol
C. Verapamil
Rationale: Verapamil, a calcium channel blocker, can cause constipation and peripheral edema as side effects.
Case: A patient with frequent ventricular premature contractions is given a drug. He later presents with tremors and nausea. The drug is?
A. Quinidine
B. Lidocaine
C. Mexiletine
D. Amiodarone
C. Mexiletine
Rationale: Mexiletine, an antiarrhythmic, can cause tremors and nausea as side effects.
A 62-year-old patient is started on a drug for ventricular tachycardia. He later complains of visual disturbances characterized by yellow vision. Which drug is he on?
A. Digoxin
B. Diltiazem
C. Lidocaine
D. Flecainide
A. Digoxin
Rationale: Yellow vision is a known side effect of Digoxin.
A 58-year-old man presents with wheezing after starting a new medication for atrial fibrillation. Which drug is responsible?
A. Propranolol
B. Quinidine
C. Amiodarone
D. Adenosine
A. Propranolol
Rationale: Beta-blockers like Propranolol can cause bronchospasm, especially in asthmatics.
Case: A patient on an antiarrhythmic drug develops torsades de pointes. Which drug is likely responsible?
A. Quinidine
B. Lidocaine
C. Metoprolol
D. Propafenone
A. Quinidine
Rationale: Quinidine is known to cause torsades de pointes, a type of ventricular tachycardia.
Case: A 45-year-old woman is started on a drug for paroxysmal atrial fibrillation. She later complains of drowsiness and confusion. The likely drug is?
A. Lidocaine
B. Amiodarone
C. Verapamil
D. Adenosine
C. Verapamil is a calcium channel blocker and can cause drowsiness and confusion, especially if overdosed or if there’s an interaction with another medication.
Case: A patient with atrial flutter is given a drug that blocks potassium channels. He later develops pulmonary fibrosis. Which drug is responsible?
A. Sotalol
B. Amiodarone
C. Flecainide
D. Lidocaine
B. Amiodarone
Rationale: Amiodarone can cause pulmonary fibrosis as a side effect.
Case: A 60-year-old woman with atrial fibrillation is started on a drug. She later complains of heartburn and has anticholinergic symptoms. Which drug is she on?
A. Quinidine
B. Disopyramide
C. Lidocaine
D. Adenosine
B. Disopyramide
Rationale: Disopyramide can cause anticholinergic effects and heartburn.
Case: A patient on an antiarrhythmic drug develops a ventricular arrhythmia. Which drug is likely responsible?
A. Flecainide
B. Esmolol
C. Amiodarone
D. Lidocaine
A. Flecainide
Rationale: Flecainide is known to have proarrhythmic effects.
Case: A patient with ventricular tachycardia is started on a drug. She later develops thyroid dysfunction. Which drug is responsible?
A. Sotalol
B. Dronedarone
C. Amiodarone
D. Quinidine
C. Amiodarone
Rationale: Amiodarone can cause thyroid dysfunction, both hyper- and hypothyroidism.
Case: A 72-year-old man with atrial fibrillation is on an antiarrhythmic drug. He presents with bradycardia and heart block. Which drug is he likely taking?
A. Verapamil
B. Flecainide
C. Mexiletine
D. Adenosine
A. Verapamil
Rationale: Verapamil, a calcium channel blocker, can cause bradycardia and heart block.
Case: A patient with atrial fibrillation is given a drug. He later presents with flushing and chest pain. Which drug was administered?
A. Adenosine
B. Disopyramide
C. Sotalol
D. Lidocaine
A. Adenosine
Rationale: Adenosine can cause transient flushing and chest pain shortly after administration.
Case: A 68-year-old woman with atrial flutter complains of nausea after starting a new medication. Which drug is responsible?
A. Digoxin
B. Esmolol
C. Diltiazem
D. Quinidine
A. Digoxin
Rationale: Nausea is a known side effect of Digoxin.
Case: A patient presents with seizures after taking a drug for ventricular tachycardia. Which drug did he likely ingest?
A. Lidocaine
B. Amiodarone
C. Verapamil
D. Adenosine
A. Lidocaine
Rationale: Lidocaine, when taken in toxic amounts, can cause CNS symptoms, including seizures.
Case: A 40-year-old man with a history of ventricular tachycardia is on an antiarrhythmic. He presents with visual disturbances characterized by corneal deposits. Which drug is responsible?
A. Flecainide
B. Amiodarone
C. Sotalol
D. Diltiazem
B. Amiodarone
Rationale: Amiodarone can cause corneal deposits leading to visual disturbances.
Case: A patient with atrial fibrillation is given a drug that prolongs the action potential duration. He later develops torsades de pointes. Which drug was given?
A. Quinidine
B. Sotalol
C. Lidocaine
D. Propafenone
B. Sotalol
Rationale: Sotalol prolongs the action potential duration and can cause torsades de pointes.
Case: A 52-year-old man presents with muscle weakness after starting a new medication for ventricular tachycardia. Which drug is responsible?
A. Magnesium sulfate
B. Diltiazem
C. Flecainide
D. Adenosine
A. Magnesium sulfate
Rationale: Magnesium sulfate can cause muscle weakness if levels become too high.
A patient presents with respiratory depression after being treated for torsades de pointes. Which drug was likely administered?
A. Magnesium sulfate
B. Quinidine
C. Lidocaine
D. Sotalol
A. Magnesium sulfate
Rationale: Magnesium sulfate can cause respiratory depression at high levels.
Case: A patient with atrial fibrillation develops liver toxicity after starting a new medication. Which drug is responsible?
A. Sotalol
B. Dronedarone
C. Lidocaine
D. Adenosine
B. Dronedarone
Rationale: Dronedarone can cause liver toxicity.
Case: A 70-year-old man presents with heart failure exacerbation after starting a new medication for atrial fibrillation. Which drug is responsible?
A. Flecainide
B. Lidocaine
C. Mexiletine
D. Esmolol
A. Flecainide
Rationale: Flecainide can exacerbate heart failure.
Case: A patient on an antiarrhythmic drug presents with bronchospasm. Which drug is he likely on?
A. Esmolol
B. Quinidine
C. Amiodarone
D. Propafenone
A. Esmolol
Rationale: Beta-blockers like Esmolol can cause bronchospasm, especially in patients with asthma.
Case: A patient recently started on a drug for atrial fibrillation. He now presents with a systemic lupus erythematosus (SLE)-like syndrome. Which drug is responsible?
A. Procainamide
B. Lidocaine
C. Sotalol
D. Verapamil
A. Procainamide
Rationale: Procainamide can cause an SLE-like syndrome as a side effect.
Case: A 60-year-old woman with ventricular tachycardia is started on a drug. She later presents with anticholinergic effects. Which drug is she on?
A. Disopyramide
B. Lidocaine
C. Quinidine
D. Sotalol
A. Disopyramide
Rationale: Disopyramide can cause anticholinergic effects.
Case: A patient with atrial fibrillation develops thrombocytopenia after starting a new medication. Which drug is likely responsible?
A. Quinidine
B. Lidocaine
C. Metoprolol
D. Amiodarone
A. Quinidine
Rationale: Quinidine can cause thrombocytopenia as a side effect.
Case: A 55-year-old man with a history of myocardial infarction is on a medication for ventricular premature contractions. He now complains of tremors. Which drug is he likely taking?
A. Lidocaine
B. Mexiletine
C. Verapamil
D. Sotalol
B. Mexiletine
Rationale: Mexiletine can cause tremors as a side effect.
Case 1:
Mr. A, a 55-year-old male, has been started on Atorvastatin for his elevated cholesterol levels. Which of the following side effects is most commonly associated with this medication?
A) Diarrhea
B) Myopathy
C) Pulmonary fibrosis
D) Anemia
B) Myopathy
Rationale: Atorvastatin belongs to the statin class of drugs, which are primarily associated with myopathy as a side effect. The other side effects mentioned are not commonly linked to statins.
Case 2:
Ms. B, a 62-year-old woman, presents with constipation and bloating. She mentions that she has been on Colesevelam for her cholesterol. What is the likely cause of her symptoms?
A) Colesevelam
B) Irritable bowel syndrome
C) Colon cancer
D) Dietary issues
A) Colesevelam
Rationale: Colesevelam is a bile acid sequestrant. Gastrointestinal discomfort, including constipation and bloating, is a known side effect of this class of medications.
Mr. C, a 58-year-old male, has been started on Fenofibrate. Which of the following side effects is he most at risk for?
A) Myopathy
B) Hypertension
C) Thrombocytopenia
D) Hyponatremia
A) Myopathy
Rationale: Fenofibrate belongs to the fibrate class of drugs. One of the primary side effects of fibrates is myopathy, especially when used with statins.
Ms. D, a 50-year-old woman, has been using Niacin for her cholesterol. She complains of a warm, tingling sensation after taking her medication. What is this most likely attributed to?
A) Hyperglycemia
B) Hepatotoxicity
C) Cutaneous flushing
D) Hyperuricemia
C) Cutaneous flushing
Rationale: Niacin (Nicotinic Acid) is commonly associated with cutaneous flushing and itching. This is a result of prostaglandin-mediated vasodilation.
Mr. E, a 45-year-old male, has been started on Ezetimibe. Which of the following side effects is a known risk associated with this medication?
A) Myopathy
B) Hyponatremia
C) Pulmonary fibrosis
D) Hypercalcemia
A) Myopathy
Rationale: Myopathy is a known side effect of Ezetimibe, especially when used in conjunction with statins.
Ms. F, a 60-year-old woman, has been prescribed Evolocumab. What side effect might she experience at the injection site?
A) Muscle spasm
B) Pigmentation
C) Injection site reactions
D) Atrophy
C) Injection site reactions
Rationale: Evolocumab is a PCSK9 inhibitor. Injection site reactions are a known side effect of this class of drugs.
Mr. G, a 52-year-old male, started taking a medication containing Omega-3 Fatty Acids. He complains of a peculiar aftertaste. What is the likely cause?
A) Dietary issues
B) Fishy aftertaste from the medication
C) Gastrointestinal infection
D) Oral candidiasis
B) Fishy aftertaste from the medication
Rationale: Omega-3 Fatty Acids, derived from fish oil, can sometimes cause a fishy aftertaste, which is a known side effect.
Ms. H, a 65-year-old woman, has been on Gemfibrozil. She complains of abdominal pain and has been diagnosed with gallstones. Is her medication a likely cause?
A) Yes
B) No
A) Yes
Rationale: Fibrates, like Gemfibrozil, have gallstones as a known side effect.
Mr. I, a 56-year-old male, started on Niacin therapy. He has a history of gout. Which side effect of Niacin might exacerbate his condition?
A) Hepatotoxicity
B) Hyperglycemia
C) Hyperuricemia
D) Myopathy
C) Hyperuricemia
Rationale: Niacin can cause hyperuricemia, which might exacerbate conditions like gout.
Ms. J, a 59-year-old woman, has been prescribed Cholestyramine. She complains of vitamin deficiency symptoms. Which vitamins’ absorption might be affected by her medication?
A) Water-soluble vitamins
B) Fat-soluble vitamins
C) B-complex vitamins
D) Vitamin C
B) Fat-soluble vitamins
Rationale: Bile acid sequestrants like Cholestyramine can reduce the absorption of fat-soluble vitamins (A, D, E, K).
Mr. K, a 50-year-old male, has been on Atorvastatin. He is concerned about the potential risk of developing which condition?
A) Diabetes
B) Hypothyroidism
C) Addison’s disease
D) Cushing’s syndrome
A) Diabetes
Rationale: Statins, including Atorvastatin, have been associated with a slightly increased risk of developing diabetes.
Ms. L, a 53-year-old woman, has started Fenofibrate. She should be monitored for which of the following adverse effects?
A) Hypercalcemia
B) Gallstones
C) Hypoglycemia
D) Hypothyroidism
B) Gallstones
Rationale: Fibrates, like Fenofibrate, can increase the risk of gallstones.
Mr. M, a 57-year-old male, has been on Colestipol. He complains of bloating and fullness. What is the likely cause?
A) Irritable bowel syndrome
B) Colestipol
C) Gastric ulcer
D) Gastroenteritis
B) Colestipol
Rationale: Bile acid sequestrants like Colestipol can cause gastrointestinal discomfort, including bloating and fullness.
Case 14:
Ms. N, a 48-year-old woman, has been using Niacin. She recently had a blood test which showed elevated glucose levels. Could her medication be the cause?
A) Yes
B) No
A) Yes
Rationale: Niacin can lead to hyperglycemia, which is an elevation in blood glucose levels.
Mr. O, a 55-year-old male, has been started on Ezetimibe. He complains of muscle pain and tenderness. What should be done next?
A) Discontinue Ezetimibe immediately
B) Check Creatine Kinase (CK) levels
C) Start him on antipyretics
D) Increase the dose of Ezetimibe
B) Check Creatine Kinase (CK) levels
Rationale: Muscle pain and tenderness in a patient on Ezetimibe (especially if combined with a statin) might indicate myopathy. Checking CK levels will help determine if there’s muscle damage.
Ms. P, a 54-year-old woman, has been prescribed Alirocumab. She complains of redness and swelling after administering the injection. What is she most likely experiencing?
A) Skin infection
B) Allergic reaction
C) Injection site reactions
D) Deep vein thrombosis
C) Injection site reactions
Rationale: Alirocumab is a PCSK9 inhibitor, and injection site reactions are a known side effect of this class of drugs.
Mr. Q, a 60-year-old male, has been consuming Omega-3 Fatty Acids supplements for his cholesterol. He reports frequent episodes of diarrhea. Is this related to his medication?
A) Yes
B) No
A) Yes
Rationale: Omega-3 Fatty Acids can cause gastrointestinal disturbances, including diarrhea.
Ms. R, a 49-year-old woman, has been on Colesevelam. She is planning to start a new medication. What should she be cautious about?
A) Reduced appetite
B) Reduced absorption of other drugs
C) Sleep disturbances
D) Memory loss
B) Reduced absorption of other drugs
Rationale: Bile acid sequestrants like Colesevelam can reduce the absorption of other drugs, so there should be a time gap between taking Colesevelam and other medications.
Mr. S, a 50-year-old male, has started Rosuvastatin. He complains of fatigue and weakness. What lab test should be ordered to check for a common side effect?
A) Thyroid function test
B) Liver function test
C) Serum electrolytes
D) Blood culture
B) Liver function test
Rationale: Statins, like Rosuvastatin, can cause elevations in liver enzymes, leading to hepatotoxicity. A liver function test will help in assessing this.
Ms. T, a 57-year-old woman, has been using Gemfibrozil. She complains of muscle pain. What should be the immediate concern?
A) Myopathy
B) Arthritis
C) Fibromyalgia
D) Bone fracture
A) Myopathy
Rationale: Gemfibrozil belongs to the fibrate class of drugs. One of the primary side effects of fibrates is myopathy.
Mr. U, a 64-year-old male, has been on Niacin therapy. On his recent blood test, an unexpected finding was noted. What could that be related to his medication?
A) Hyperkalemia
B) Hyperuricemia
C) Hypocalcemia
D) Hyponatremia
B) Hyperuricemia
Rationale: Niacin can cause hyperuricemia, which might exacerbate conditions like gout.
Ms. V, a 45-year-old woman, has been prescribed Evolocumab. What side effect might she experience cognitively?
A) Memory enhancement
B) Neurocognitive effects
C) Increased alertness
D) Improved concentration
B) Neurocognitive effects
Rationale: Evolocumab is a PCSK9 inhibitor. Neurocognitive effects are a known side effect of this class of drugs, though the exact nature and frequency are still under study.
Mr. W, a 53-year-old male, started taking Cholestyramine. He is now concerned about potential vitamin deficiencies. What vitamin group is most affected by his medication?
A) Vitamin B complex
B) Fat-soluble vitamins
C) Vitamin C and D
D) Water-soluble vitamins
B) Fat-soluble vitamins
Rationale: Bile acid sequestrants like Cholestyramine can reduce the absorption of fat-soluble vitamins (A, D, E, K).
Ms. X, a 40-year-old woman, has been using Atorvastatin. She is planning to start a family. What should she be cautious about regarding her medication?
A) It causes infertility
B) It is teratogenic
C) It can cause early menopause
D) It can lead to multiple pregnancies
B) It is teratogenic
Rationale: Statins, like Atorvastatin, are teratogenic in animals and hence are contraindicated during pregnancy.
Mr. Y, a 59-year-old male, has been started on Fenofibrate. He has been diagnosed with liver dysfunction. Could his medication be the cause?
A) Yes
B) No
A) Yes
Rationale: Fibrates, like Fenofibrate, can cause liver dysfunction as a side effect.
Ms. Z, a 47-year-old woman, has been taking Ezetimibe. She reports a sudden severe pain in the abdomen. What could be a potential side effect causing this symptom?
A) Pancreatitis
B) Gastritis
C) Peptic ulcer
D) Appendicitis
A) Pancreatitis
Rationale: Pancreatitis is a known side effect of Ezetimibe.
Mr. AA, a 56-year-old male, has been on Niacin therapy. He complains of joint pain. Which side effect of his medication might be exacerbating his symptoms?
A) Hyperglycemia
B) Hepatotoxicity
C) Hyperuricemia
D) Myopathy
Answer:
C) Hyperuricemia
Rationale: Niacin can cause hyperuricemia, which might exacerbate conditions like gout leading to joint pain.
Ms. BB, a 58-year-old woman, has been prescribed Evolocumab. She reports forgetfulness and difficulty in concentrating. Which potential side effect of her medication might she be experiencing?
A) Hypertension
B) Neurocognitive effects
C) Hyperkalemia
D) Hypoglycemia
B) Neurocognitive effects
Rationale: Evolocumab, a PCSK9 inhibitor, has been associated with neurocognitive effects, although the exact nature and frequency are still under study.
Mr. CC, a 63-year-old male, has been on Gemfibrozil. He now presents with symptoms suggestive of gallstones. Which side effect of Gemfibrozil might be responsible for his symptoms?
A) Myopathy
B) Hepatotoxicity
C) Gallstones
D) Pancreatitis
C) Gallstones
Rationale: Fibrates, like Gemfibrozil, have gallstones as a known side effect.
Ms. DD, a 50-year-old woman, has been using Colesevelam. She has recently started on a new medication and reports that it doesn’t seem to be effective. What interaction related to Colesevelam might be causing this issue?
A) Increased metabolism of the new drug
B) Reduced absorption of the new drug
C) Colesevelam causing a diuretic effect
D) Hypersensitivity reaction to the new drug
B) Reduced absorption of the new drug
Rationale: Bile acid sequestrants like Colesevelam can reduce the absorption of other drugs, potentially making them less effective. It is advised to maintain a time gap between taking Colesevelam and other medications.
Case 1:
A 65-year-old male with a history of congestive heart failure is prescribed furosemide. Which of the following side effects is most likely associated with this medication?
a) Hyperkalemia
b) Hypokalemia
c) Hypercalcemia
d) Metabolic acidosis
b) Hypokalemia
Rationale: Furosemide is a loop diuretic that can cause hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, dehydration, ototoxicity, hyperuricemia, and metabolic alkalosis.
Case 2:
A 50-year-old female with hypertension starts taking hydrochlorothiazide. She presents with muscle weakness and fatigue. Which electrolyte disturbance is she most likely experiencing?
a) Hyperkalemia
b) Hypokalemia
c) Hypernatremia
d) Hypocalcemia
b) Hypokalemia
Rationale: Hydrochlorothiazide is a thiazide diuretic that can cause hypokalemia, hyponatremia, hypercalcemia, hyperlipidemia, hyperglycemia, hyperuricemia, and metabolic alkalosis.
A 40-year-old male is prescribed spironolactone for heart failure. Which of the following side effects is he at risk of developing?
a) Gynecomastia
b) Ototoxicity
c) Hypercalcemia
d) Metabolic acidosis
a) Gynecomastia
Rationale: Spironolactone, an aldosterone antagonist, can lead to hyperkalemia, gynecomastia, menstrual irregularities, and metabolic acidosis.
Case 4:
A patient with increased intracranial pressure is given mannitol. Which side effect is primarily associated with mannitol administration?
a) Hypernatremia
b) Hypocalcemia
c) Metabolic alkalosis
d) Hyperkalemia
a) Hypernatremia
Rationale: Mannitol, an osmotic diuretic, can lead to dehydration, hypernatremia, headache, nausea, and vomiting.
Case 5:
A patient diagnosed with glaucoma is prescribed acetazolamide. What side effect is commonly associated with this medication?
a) Ototoxicity
b) Hyperkalemia
c) Renal stones
d) Gynecomastia
c) Renal stones
Rationale: Acetazolamide, a carbonic anhydrase inhibitor, can cause metabolic acidosis, hypokalemia, renal stones, drowsiness, and paresthesias.
Case 6:
A patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH) is started on tolvaptan. What is the primary concern with the rapid correction of sodium?
a) Hyperkalemia
b) Hypocalcemia
c) Metabolic acidosis
d) Osmotic demyelination syndrome
d) Osmotic demyelination syndrome
Rationale: ADH antagonists like tolvaptan can cause over-rapid correction of hyponatremia leading to osmotic demyelination syndrome, hypernatremia, and thirst.
Case 7:
A 60-year-old patient with chronic kidney disease is started on lisinopril. Which side effect should be monitored closely in this patient?
a) Cough
b) Hypercalcemia
c) Ototoxicity
d) Metabolic alkalosis
a) Cough
Rationale: ACE inhibitors like lisinopril can lead to cough, angioedema, hyperkalemia, renal dysfunction, and fetal toxicity.
Case 8:
A patient with hypertension is started on losartan. Unlike ACE inhibitors, what side effect is less likely with losartan?
a) Hyperkalemia
b) Cough
c) Angioedema
d) Fetal toxicity
b) Cough
Rationale: ARBs like losartan are associated with a lower risk of cough and angioedema compared to ACE inhibitors but have similar risks for hyperkalemia, renal dysfunction, and fetal toxicity.
Case 9:
A patient with hypertension is prescribed aliskiren. Which of the following side effects is he most likely to encounter?
a) Diarrhea
b) Ototoxicity
c) Hypocalcemia
d) Hyperlipidemia
a) Diarrhea
Rationale: Aliskiren, a renin inhibitor, can lead to hyperkalemia, diarrhea, angioedema, renal dysfunction, and fetal toxicity.
Case 10:
A 55-year-old male with a history of gout is prescribed furosemide for edema. Which side effect related to his condition should he be aware of?
a) Hyperkalemia
b) Ototoxicity
c) Hyperuricemia
d) Hypocalcemia
c) Hyperuricemia
Rationale: Furosemide can lead to hyperuricemia, which can exacerbate gout.
Case 11:
A patient is prescribed chlorthalidone. Which of the following lab findings might be seen in this patient?
a) Low blood glucose
b) Low serum potassium
c) Low serum uric acid
d) Low serum calcium
b) Low serum potassium
Rationale: Thiazide diuretics like chlorthalidone can cause hypokalemia.
Case 12:
A female patient on spironolactone comes in with menstrual irregularities. Which of the following is responsible for her symptoms?
a) Hypokalemia
b) Hyperkalemia
c) Aldosterone antagonism
d) Sodium channel blockade
c) Aldosterone antagonism
Rationale: Spironolactone, an aldosterone antagonist, can lead to menstrual irregularities due to its anti-androgenic effects.
Case 13:
A patient with nephrotic syndrome is treated with mannitol before a procedure. What is the primary mechanism of mannitol?
a) Inhibition of sodium reabsorption
b) Osmotic diuresis
c) Blockage of aldosterone receptors
d) Inhibition of carbonic anhydrase
b) Osmotic diuresis
Rationale: Mannitol works by inducing osmotic diuresis.
Case 14:
A mountaineer takes acetazolamide prophylactically for altitude sickness. What side effect can he experience with the drug?
a) Drowsiness
b) Hyperkalemia
c) Hypercalcemia
d) Ototoxicity
a) Drowsiness
Rationale: Acetazolamide can cause drowsiness, which might be risky for a mountaineer who needs to stay alert in potentially hazardous environments.
Case 15:
A patient with a recent history of heart failure is prescribed eplerenone. Which of the following laboratory findings should be closely monitored?
a) Serum potassium levels
b) Serum calcium levels
c) Blood glucose levels
d) Serum magnesium levels
a) Serum potassium levels
Rationale: Eplerenone, an aldosterone antagonist, can lead to hyperkalemia, which can be dangerous, especially in patients with heart failure.
Case 16:
A 70-year-old female with edema is prescribed torsemide. What potential side effect related to her auditory system should she be informed about?
a) Vertigo
b) Ototoxicity
c) Tinnitus
d) Hearing amplification
b) Ototoxicity
Rationale: Loop diuretics, including torsemide, can cause ototoxicity, especially at high doses or with rapid administration.
Case 17:
A patient with metabolic alkalosis is prescribed triamterene. What is the primary mechanism of action of this drug?
a) Inhibition of sodium reabsorption
b) Osmotic diuresis
c) Blockage of aldosterone receptors
d) Sodium channel blockade
d) Sodium channel blockade
Rationale: Triamterene works by blocking sodium channels in the collecting ducts, leading to potassium retention and sodium excretion.
Case 18:
A patient with a recent history of heart attack is started on ramipril. Which of the following side effects should the patient be warned about?
a) Dry cough
b) Hyperglycemia
c) Metabolic acidosis
d) Hypocalcemia
a) Dry cough.
This is a well-known side effect of ACE inhibitors, caused by the accumulation of bradykinin in the respiratory tract. Some patients may need to switch to another class of medication, like an angiotensin II receptor blocker (ARB), if the cough becomes bothersome.
Case 19:
A patient is diagnosed with hypertension and prescribed candesartan. Which side effect is less likely with this drug compared to ACE inhibitors?
a) Hyperkalemia
b) Angioedema
c) Renal dysfunction
d) Dry cough
d) Dry cough
Rationale: ARBs like candesartan have a lower risk of causing a dry cough compared to ACE inhibitors, though they share other side effects like hyperkalemia and renal dysfunction.
Case 20:
A 45-year-old female with a family history of osteoporosis is prescribed indapamide. Which of the following effects might be beneficial for her bone health?
a) Hypokalemia
b) Hypercalcemia
c) Hypocalcemia
d) Hyperkalemia
b) Hypercalcemia
Rationale: Thiazide diuretics like indapamide can lead to hypercalcemia, which might be beneficial for patients at risk of osteoporosis.
Case 21:
A patient is given conivaptan for hyponatremia. What is the primary mechanism of action of this drug?
a) Inhibition of sodium reabsorption
b) Osmotic diuresis
c) ADH antagonism
d) Sodium channel blockade
c) ADH antagonism
Rationale: Conivaptan works by antagonizing the effects of antidiuretic hormone (ADH), leading to increased free water excretion.
Case 22:
A patient with a history of diabetes is prescribed hydrochlorothiazide. Which of the following effects related to his condition should he be informed about?
a) Hypoglycemia
b) Hyperglycemia
c) Ketoacidosis
d) Insulin resistance
b) Hyperglycemia
Rationale: Thiazide diuretics can lead to hyperglycemia, which might require adjustment of antidiabetic medications.
Case 23:
A patient with hypertension and chronic kidney disease is started on valsartan. What is the primary mechanism of action of this drug?
a) Inhibition of angiotensin-converting enzyme
b) Blockage of aldosterone receptors
c) Blockage of angiotensin II receptors
d) Sodium channel blockade
c) Blockage of angiotensin II receptors
Rationale: Valsartan is an ARB that works by blocking angiotensin II receptors, leading to vasodilation and reduced blood pressure.
Case 24:
A 60-year-old male with a history of renal stones is prescribed acetazolamide for altitude sickness. Which side effect related to his condition should he be cautious about?
a) Hyperuricemia
b) Hyperkalemia
c) Renal stones
d) Hyperglycemia
c) Renal stones
Rationale: Acetazolamide can lead to the formation of renal stones, which might exacerbate the patient’s pre-existing condition.
Case 25:
A patient diagnosed with Meniere’s disease is prescribed amiloride. What is the primary mechanism of action of this drug?
a) Inhibition of sodium reabsorption
b) Osmotic diuresis
c) Blockage of aldosterone receptors
d) Sodium channel blockade
d) Sodium channel blockade
Rationale: Amiloride works by blocking sodium channels in the collecting ducts, leading to potassium retention.
Case 26:
A patient with a history of chronic bronchitis is prescribed an ACE inhibitor. Which side effect should he be warned about that might exacerbate his condition?
a) Dry cough
b) Hyperglycemia
c) Metabolic acidosis
d) Hypocalcemia
a) Dry cough
Rationale: ACE inhibitors can lead to a persistent dry cough, which might worsen respiratory symptoms in patients with chronic bronchitis.
Case 27:
A patient with chronic kidney disease is prescribed metolazone. Which laboratory finding might be seen in this patient?
a) Elevated blood glucose
b) Reduced serum potassium
c) Reduced serum uric acid
d) Elevated serum magnesium
b) Reduced serum potassium
Rationale: Thiazide-like diuretics like metolazone can cause hypokalemia.
Case 28:
A 58-year-old female is prescribed eplerenone. Which of the following side effects is she least likely to encounter compared to spironolactone?
a) Hyperkalemia
b) Menstrual irregularities
c) Gynecomastia
d) Metabolic acidosis
c) Gynecomastia
Rationale: Eplerenone is more selective than spironolactone and has a reduced risk of causing gynecomastia and menstrual irregularities.
Case 29:
A patient with a history of gout is prescribed chlorthalidone. Which side effect related to his condition should he be cautious about?
a) Hyperkalemia
b) Ototoxicity
c) Hypocalcemia
d) Hyperuricemia
d) Hyperuricemia
Rationale: Thiazide diuretics like chlorthalidone can lead to hyperuricemia, which can exacerbate gout.
Case 30:
A 70-year-old female with a history of osteoporosis is prescribed bumetanide for edema. Which electrolyte imbalance commonly associated with this drug might be of concern for her bone health?
a) Hyperkalemia
b) Hyponatremia
c) Hypocalcemia
d) Hypernatremia
c) Hypocalcemia
Rationale: Loop diuretics like bumetanide can lead to hypocalcemia, which can be detrimental for patients with osteoporosis as calcium is crucial for bone health.
