Toxicities

Question 1

1. 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

Answer 1

d) Hydrochlorothiazide
Rationale: Thiazide diuretics like hydrochlorothiazide can increase urination frequency as they increase the excretion of water from the body.

Question 2

2. 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

Answer 2

b) Lisinopril
Rationale: ACE inhibitors like lisinopril can cause a persistent cough due to the accumulation of bradykinin.

Question 3

3. 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

Answer 3

c) Propranolol
Rationale: Beta-blockers like propranolol can cause bradycardia and fatigue as side effects.

Question 4

4. 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

Answer 4

b) Amlodipine
Rationale: Dihydropyridine calcium channel blockers like amlodipine can cause peripheral edema.

Question 5

5. 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

Answer 5

a) Hydrochlorothiazide
Rationale: Thiazide diuretics like hydrochlorothiazide can elevate uric acid levels, precipitating gout.

Question 6

6. 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

Answer 6

b) Hydralazine
Rationale: Direct vasodilators like hydralazine can cause reflex tachycardia and headaches.

Question 7

7. 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

Answer 7

b) Losartan
Rationale: ARBs like losartan are contraindicated in pregnancy due to potential fetal toxicity.

Question 8

8. 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

Answer 8

b) Valsartan
Rationale: ARBs like valsartan can lead to hyperkalemia.

Question 9

9. 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

Answer 9

a) Minoxidil
Rationale: Minoxidil, a direct vasodilator, can cause hypertrichosis or increased hair growth.

Question 10

10. 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

Answer 10

b) Spironolactone
Rationale: Spironolactone, a potassium-sparing diuretic, can cause gynecomastia or breast enlargement in men.

Question 11

11. 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

Answer 11

a) Verapamil
Rationale: Non-dihydropyridine calcium channel blockers like verapamil can cause constipation.

Question 12

12. 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

Answer 12

a) Prazosin
Rationale: Alpha-blockers like prazosin can cause orthostatic hypotension, leading to dizziness upon standing.

Question 13

13. 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

Answer 13

a) Furosemide
Rationale: Loop diuretics like furosemide can cause ototoxicity, which may manifest as tinnitus or ringing in the ears.

Question 14

14. 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

Answer 14

a) Clonidine
Rationale: Central alpha-2 agonists like clonidine can cause dry mouth and sedation.

Question 15

15. 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

Answer 15

c) Hydrochlorothiazide
Rationale: Thiazide diuretics like hydrochlorothiazide can lead to hyponatremia or decreased sodium levels.

Question 16

16. 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

Answer 16

b) Hydrochlorothiazide
Rationale: Thiazide diuretics like hydrochlorothiazide can lead to hypercalcemia or elevated calcium levels.

Question 17

17. 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

Answer 17

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.

Question 18

18. 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

Answer 18

b) Propranolol
Rationale: Non-selective beta-blockers like propranolol can cause bronchospasm, especially in patients with asthma.

Question 19

19. 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

Answer 19

a) Propranolol
Rationale: Non-selective beta-blockers like propranolol can exacerbate peripheral arterial disease.

Question 20

20. 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

Answer 20

c) Furosemide
Rationale: Loop diuretics like furosemide can cause hypokalemia or low potassium levels, leading to muscle cramps.

Question 21

21. 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

Answer 21

b) Prazosin
Rationale: Alpha-blockers like prazosin can exacerbate urinary symptoms, especially in males with an enlarged prostate.

Question 22

22. 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

Answer 22

a) Clonidine
Rationale: Abrupt withdrawal from clonidine can lead to a rebound hypertension, which can present with headache and palpitations.

Question 23

23. 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

Answer 23

d) Hydralazine
Rationale: Direct vasodilators like hydralazine can cause flushing due to vasodilation.

Question 24

24. 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

Answer 24

b) Methyldopa
Rationale: Methyldopa can cause a positive direct Coombs test and hemolytic anemia.

Question 25

25. 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

Answer 25

b) Propranolol
Rationale: Beta-blockers like propranolol can cause nightmares and vivid dreams as side effects.

Question 26

26. 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

Answer 26

b) Losartan
Rationale: Losartan is an angiotensin II receptor blocker (ARB) that prevents the activation of angiotensin II receptors.

Question 27

27. 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

Answer 27

a) Spironolactone
Rationale: Spironolactone, a potassium-sparing diuretic, can lead to hyperkalemia. While less common, it can also contribute to hyponatremia.

Question 28

28. 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

Answer 28

b) Propranolol
Rationale: Non-selective beta-blockers like propranolol can cause bronchospasm, especially in patients with asthma.

Question 29

29. 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

Answer 29

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.

Question 30

30. 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

Answer 30

b) Prazosin
Rationale: Alpha-blockers like prazosin are used to treat hypertension and can also alleviate urinary symptoms in males with benign prostatic hyperplasia.

Question 31

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

Answer 31

B) Headache

Rationale:
Nitroglycerin, an organic nitrate, commonly causes headaches due to its vasodilatory effects.

Question 32

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

Answer 32

C) Propranolol

Rationale:
Beta-blockers like Propranolol can cause bronchospasm, especially in patients with asthma.

Question 33

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

Answer 33

A) Verapamil

Rationale:
Verapamil, a calcium channel blocker, is known to cause constipation.

Question 34

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

Answer 34

C) Ranolazine

Rationale:
Ranolazine is known to cause QT prolongation.

Question 35

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

Answer 35

A) Nifedipine

Rationale:
Nifedipine, a calcium channel blocker, can cause peripheral edema.

Question 36

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

Answer 36

A) Stable angina

Rationale:
Stable angina is characterized by chest pain that occurs with exertion and is relieved by rest or nitroglycerin.

Question 37

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

Answer 37

C) Ranolazine

Rationale:
Ranolazine works by inhibiting the late phase of the inward sodium current.

Question 38

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

Answer 38

A) Propranolol

Rationale:
Beta-blockers like Propranolol can mask the symptoms of hypoglycemia.

Question 39

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

Answer 39

C) Nifedipine

Rationale:
Nifedipine, a calcium channel blocker, can cause dizziness due to its vasodilatory effects.

Question 40

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

Answer 40

B) Nitroglycerin

Rationale:
Nitroglycerin can cause reflex tachycardia due to its vasodilatory effects.

Question 41

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

Answer 41

C) Atenolol

Rationale:
Atenolol, a beta-blocker, reduces myocardial oxygen demand by decreasing heart rate and contractility.

Question 42

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

Answer 42

C) Verapamil

Rationale:
Verapamil, a calcium channel blocker, is used in the treatment of both angina and hypertension.

Question 43

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

Answer 43

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.

Question 44

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

Answer 44

C) Clopidogrel

Rationale:
Clopidogrel is an antiplatelet agent that inhibits platelet aggregation.

Question 45

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

Answer 45

B) Unstable angina

Rationale:
Unstable angina can occur at rest and is associated with ECG changes but without an increase in cardiac enzymes.

Question 46

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

Answer 46

C) Nifedipine

Rationale:
Nifedipine, a calcium channel blocker, causes arterial dilation and reduces afterload.

Question 47

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

Answer 47

B) Aspirin

Rationale:
Aspirin is an antiplatelet agent and can increase the risk of bleeding.

Question 48

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

Answer 48

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.

Question 49

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

Answer 49

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.

Question 50

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

Answer 50

B) Propranolol

Rationale:
Propranolol, a beta-blocker, is used in the treatment of angina and is also beneficial for migraines.

Question 51

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

Answer 51

B) Nitroglycerin

Rationale:
Nitroglycerin acts by increasing the intracellular concentration of cyclic GMP, leading to smooth muscle relaxation and vasodilation.

Question 52

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

Answer 52

C) Nifedipine

Rationale:
Nifedipine, a calcium channel blocker, can cause reflex tachycardia due to its vasodilatory effects.

Question 53

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

Answer 53

B) Verapamil

Rationale:
Verapamil, a calcium channel blocker, can lead to bradycardia and AV block.

Question 54

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

Answer 54

C) Nitroglycerin

Rationale:
Nitroglycerin reduces myocardial oxygen demand by causing venodilation, which decreases preload.

Question 55

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

Answer 55

C) Nifedipine

Rationale:
Nifedipine, a calcium channel blocker, primarily causes arterial dilation, reducing afterload.

Question 56

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

Answer 56

C) Atenolol

Rationale:
Beta-blockers like Atenolol can cause fatigue and depression as side effects.

Question 57

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

Answer 57

C) Propranolol

Rationale:
Beta-blockers like Propranolol can cause bronchospasm, especially in patients with asthma.

Question 58

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

Answer 58

A) Amlodipine

Rationale:
Amlodipine, a calcium channel blocker, acts on both cardiac and vascular smooth muscle, leading to relaxation and vasodilation.

Question 59

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

Answer 59

D) Ranolazine

Rationale:
Ranolazine works by inhibiting the late phase of the inward sodium current, reducing diastolic tension and oxygen consumption in the heart.

Question 60

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

Answer 60

D) Lisinopril

Rationale:
Lisinopril, an ACE inhibitor, can lead to hyperkalemia as a side effect.

Question 61

1. 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

Answer 61

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.

Question 62

2. 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

Answer 62

a. Yellow vision

Rationale: Yellow vision (xanthopsia) is a classic sign of digoxin toxicity. Other symptoms include nausea, vomiting, and arrhythmias.

Question 63

3. 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

Answer 63

b. Gynecomastia

Rationale: Spironolactone, an aldosterone antagonist, can cause gynecomastia due to its anti-androgenic effects.

Question 64

4. 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

Answer 64

c. Fatigue

Rationale: Fatigue is a common side effect of beta-blockers due to their negative inotropic and chronotropic effects.

Question 65

5. 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

Answer 65

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.

Question 66

6. 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

Answer 66

a. Visual disturbances

Rationale: Ivabradine can cause visual disturbances known as phosphenes.

Question 67

7. 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

Answer 67

b. Genital fungal infections

Rationale: SGLT2 inhibitors increase the excretion of glucose in the urine, which can predispose to genital fungal infections.

Question 68

8. 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

Answer 68

c. Phosphodiesterase inhibition

Rationale: Milrinone is a phosphodiesterase inhibitor, which increases intracellular cAMP, leading to increased myocardial contractility and vasodilation.

Question 69

9. 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

Answer 69

c. Hypokalemia

Rationale: Loop diuretics, such as furosemide, can lead to the excretion of potassium, causing hypokalemia.

Question 70

10. 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

Answer 70

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.

Question 71

11. 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

Answer 71

a. Beta-blockers

Rationale: Beta-blockers can cause bronchospasm, especially in patients with a history of asthma.

Question 72

12. 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

Answer 72

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.

Question 73

13. 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 73

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.

Question 74

14. 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

Answer 74

b. Enalapril

Rationale: ACE inhibitors like enalapril can cause vasodilation leading to hypotension, which may manifest as dizziness and lightheadedness.

Question 75

15. 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

Answer 75

c. Spironolactone

Rationale: Spironolactone can cause gynecomastia due to its anti-androgenic effects.

Question 76

16. 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

Answer 76

a. Ivabradine

Rationale: Ivabradine can cause phosphenes, which are described as bright visual disturbances.

Question 77

17. 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

Answer 77

a. SGLT2 inhibitors

Rationale: SGLT2 inhibitors increase the excretion of glucose in the urine, which can lead to frequent urination and increased thirst.

Question 78

18. 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

Answer 78

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.

Question 79

19. 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

Answer 79

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.

Question 80

20. 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

Answer 80

c. Enalapril

Rationale: ACE inhibitors like enalapril can cause hyperkalemia due to decreased aldosterone production.

Question 81

22. 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

Answer 81

b. Enalapril

Rationale: Enalapril is an ACE inhibitor. It works by inhibiting the conversion of angiotensin I to angiotensin II, leading to vasodilation.

Question 81

21. 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

Answer 81

a. Enalapril

Rationale: ACE inhibitors like enalapril have been shown to reduce mortality in heart failure patients.

Question 82

23. 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

Answer 82

b. Milrinone

Rationale: Milrinone is a phosphodiesterase inhibitor that increases intracellular cAMP, leading to increased myocardial contractility.

Question 83

24. 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

Answer 83

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.

Question 84

25. 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

Answer 84

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.

Question 85

26. 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

Answer 85

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.

Question 86

27. 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

Answer 86

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.

Question 87

28. 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

Answer 87

c. Dobutamine

Rationale: Dobutamine is an inotropic agent that increases cardiac output by increasing myocardial contractility. However, it can also predispose to arrhythmias.

Question 88

29. 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

Answer 88

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.

Question 89

30. 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

Answer 89

c. Diuretics

Rationale: Diuretics, especially thiazide and thiazide-like diuretics, can cause hyponatremia by increasing the excretion of sodium in the urine.

Question 90

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

Answer 90

B. Adenosine
Rationale: The description is consistent with paroxysmal supraventricular tachycardia (PSVT). Adenosine is the first-line drug for terminating PSVT.

Question 91

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

Answer 91

B. Dronedarone
Rationale: Dronedarone is contraindicated in patients with heart failure due to an increased risk of death.

Question 92

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

Answer 92

C. Amiodarone
Rationale: Amiodarone can cause blue-gray skin discoloration and photosensitivity as side effects.

Question 93

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

Answer 93

A. Quinidine
Rationale: The patient is experiencing cinchonism, a side effect of Quinidine, characterized by tinnitus and dizziness.

Question 94

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

Answer 94

B. Procainamide
Rationale: Procainamide can cause a lupus-like syndrome as a side effect.

Question 95

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

Answer 95

C. Verapamil
Rationale: Verapamil, a calcium channel blocker, can cause constipation and peripheral edema as side effects.

Question 96

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

Answer 96

C. Mexiletine
Rationale: Mexiletine, an antiarrhythmic, can cause tremors and nausea as side effects.

Question 97

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

Answer 97

A. Digoxin
Rationale: Yellow vision is a known side effect of Digoxin.

Question 98

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

Answer 98

A. Propranolol
Rationale: Beta-blockers like Propranolol can cause bronchospasm, especially in asthmatics.

Question 99

Case: A patient on an antiarrhythmic drug develops torsades de pointes. Which drug is likely responsible?

A. Quinidine
B. Lidocaine
C. Metoprolol
D. Propafenone

Answer 99

A. Quinidine
Rationale: Quinidine is known to cause torsades de pointes, a type of ventricular tachycardia.

Question 100

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

Answer 100

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.

Question 101

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

Answer 101

B. Amiodarone
Rationale: Amiodarone can cause pulmonary fibrosis as a side effect.

Question 102

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

Answer 102

B. Disopyramide
Rationale: Disopyramide can cause anticholinergic effects and heartburn.

Question 103

Case: A patient on an antiarrhythmic drug develops a ventricular arrhythmia. Which drug is likely responsible?
A. Flecainide
B. Esmolol
C. Amiodarone
D. Lidocaine

Answer 103

A. Flecainide
Rationale: Flecainide is known to have proarrhythmic effects.

Question 104

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

Answer 104

C. Amiodarone
Rationale: Amiodarone can cause thyroid dysfunction, both hyper- and hypothyroidism.

Question 105

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

Answer 105

A. Verapamil
Rationale: Verapamil, a calcium channel blocker, can cause bradycardia and heart block.

Question 106

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

Answer 106

A. Adenosine
Rationale: Adenosine can cause transient flushing and chest pain shortly after administration.

Question 107

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

Answer 107

A. Digoxin
Rationale: Nausea is a known side effect of Digoxin.

Question 108

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

Answer 108

A. Lidocaine
Rationale: Lidocaine, when taken in toxic amounts, can cause CNS symptoms, including seizures.

Question 109

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

Answer 109

B. Amiodarone
Rationale: Amiodarone can cause corneal deposits leading to visual disturbances.

Question 110

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

Answer 110

B. Sotalol
Rationale: Sotalol prolongs the action potential duration and can cause torsades de pointes.

Question 111

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

Answer 111

A. Magnesium sulfate
Rationale: Magnesium sulfate can cause muscle weakness if levels become too high.

Question 112

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

Answer 112

A. Magnesium sulfate
Rationale: Magnesium sulfate can cause respiratory depression at high levels.

Question 113

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

Answer 113

B. Dronedarone
Rationale: Dronedarone can cause liver toxicity.

Question 114

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

Answer 114

A. Flecainide
Rationale: Flecainide can exacerbate heart failure.

Question 115

Case: A patient on an antiarrhythmic drug presents with bronchospasm. Which drug is he likely on?
A. Esmolol
B. Quinidine
C. Amiodarone
D. Propafenone

Answer 115

A. Esmolol
Rationale: Beta-blockers like Esmolol can cause bronchospasm, especially in patients with asthma.

Question 116

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

Answer 116

A. Procainamide
Rationale: Procainamide can cause an SLE-like syndrome as a side effect.

Question 117

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

Answer 117

A. Disopyramide
Rationale: Disopyramide can cause anticholinergic effects.

Question 118

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

Answer 118

A. Quinidine
Rationale: Quinidine can cause thrombocytopenia as a side effect.

Question 119

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

Answer 119

B. Mexiletine
Rationale: Mexiletine can cause tremors as a side effect.

Question 120

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

Answer 120

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.

Question 121

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

Answer 121

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.

Question 122

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

Answer 122

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.

Question 123

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

Answer 123

C) Cutaneous flushing

Rationale: Niacin (Nicotinic Acid) is commonly associated with cutaneous flushing and itching. This is a result of prostaglandin-mediated vasodilation.

Question 124

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

Answer 124

A) Myopathy

Rationale: Myopathy is a known side effect of Ezetimibe, especially when used in conjunction with statins.

Question 125

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

Answer 125

C) Injection site reactions

Rationale: Evolocumab is a PCSK9 inhibitor. Injection site reactions are a known side effect of this class of drugs.

Question 126

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

Answer 126

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.

Question 127

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

Answer 127

A) Yes

Rationale: Fibrates, like Gemfibrozil, have gallstones as a known side effect.

Question 128

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

Answer 128

C) Hyperuricemia

Rationale: Niacin can cause hyperuricemia, which might exacerbate conditions like gout.

Question 129

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

Answer 129

B) Fat-soluble vitamins

Rationale: Bile acid sequestrants like Cholestyramine can reduce the absorption of fat-soluble vitamins (A, D, E, K).

Question 130

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

Answer 130

A) Diabetes

Rationale: Statins, including Atorvastatin, have been associated with a slightly increased risk of developing diabetes.

Question 131

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

Answer 131

B) Gallstones

Rationale: Fibrates, like Fenofibrate, can increase the risk of gallstones.

Question 132

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

Answer 132

B) Colestipol

Rationale: Bile acid sequestrants like Colestipol can cause gastrointestinal discomfort, including bloating and fullness.

Question 133

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

Answer 133

A) Yes

Rationale: Niacin can lead to hyperglycemia, which is an elevation in blood glucose levels.

Question 134

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

Answer 134

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.

Question 135

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

Answer 135

C) Injection site reactions

Rationale: Alirocumab is a PCSK9 inhibitor, and injection site reactions are a known side effect of this class of drugs.

Question 136

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

Answer 136

A) Yes

Rationale: Omega-3 Fatty Acids can cause gastrointestinal disturbances, including diarrhea.

Question 137

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

Answer 137

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.

Question 138

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

Answer 138

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.

Question 139

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

Answer 139

A) Myopathy

Rationale: Gemfibrozil belongs to the fibrate class of drugs. One of the primary side effects of fibrates is myopathy.

Question 140

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

Answer 140

B) Hyperuricemia

Rationale: Niacin can cause hyperuricemia, which might exacerbate conditions like gout.

Question 141

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

Answer 141

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.

Question 142

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

Answer 142

B) Fat-soluble vitamins

Rationale: Bile acid sequestrants like Cholestyramine can reduce the absorption of fat-soluble vitamins (A, D, E, K).

Question 143

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

Answer 143

B) It is teratogenic

Rationale: Statins, like Atorvastatin, are teratogenic in animals and hence are contraindicated during pregnancy.

Question 144

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

Answer 144

A) Yes

Rationale: Fibrates, like Fenofibrate, can cause liver dysfunction as a side effect.

Question 145

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

Answer 145

A) Pancreatitis

Rationale: Pancreatitis is a known side effect of Ezetimibe.

Question 146

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:

Answer 146

C) Hyperuricemia

Rationale: Niacin can cause hyperuricemia, which might exacerbate conditions like gout leading to joint pain.

Question 147

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

Answer 147

B) Neurocognitive effects

Rationale: Evolocumab, a PCSK9 inhibitor, has been associated with neurocognitive effects, although the exact nature and frequency are still under study.

Question 148

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

Answer 148

C) Gallstones

Rationale: Fibrates, like Gemfibrozil, have gallstones as a known side effect.

Question 149

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

Answer 149

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.

Question 150

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

Answer 150

b) Hypokalemia

Rationale: Furosemide is a loop diuretic that can cause hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, dehydration, ototoxicity, hyperuricemia, and metabolic alkalosis.

Question 151

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

Answer 151

b) Hypokalemia

Rationale: Hydrochlorothiazide is a thiazide diuretic that can cause hypokalemia, hyponatremia, hypercalcemia, hyperlipidemia, hyperglycemia, hyperuricemia, and metabolic alkalosis.

Question 152

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

Answer 152

a) Gynecomastia

Rationale: Spironolactone, an aldosterone antagonist, can lead to hyperkalemia, gynecomastia, menstrual irregularities, and metabolic acidosis.

Question 153

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

Answer 153

a) Hypernatremia

Rationale: Mannitol, an osmotic diuretic, can lead to dehydration, hypernatremia, headache, nausea, and vomiting.

Question 154

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

Answer 154

c) Renal stones

Rationale: Acetazolamide, a carbonic anhydrase inhibitor, can cause metabolic acidosis, hypokalemia, renal stones, drowsiness, and paresthesias.

Question 155

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

Answer 155

d) Osmotic demyelination syndrome

Rationale: ADH antagonists like tolvaptan can cause over-rapid correction of hyponatremia leading to osmotic demyelination syndrome, hypernatremia, and thirst.

Question 156

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

Answer 156

a) Cough

Rationale: ACE inhibitors like lisinopril can lead to cough, angioedema, hyperkalemia, renal dysfunction, and fetal toxicity.

Question 157

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

Answer 157

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.

Question 158

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

Answer 158

a) Diarrhea

Rationale: Aliskiren, a renin inhibitor, can lead to hyperkalemia, diarrhea, angioedema, renal dysfunction, and fetal toxicity.

Question 159

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

Answer 159

c) Hyperuricemia

Rationale: Furosemide can lead to hyperuricemia, which can exacerbate gout.

Question 160

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

Answer 160

b) Low serum potassium

Rationale: Thiazide diuretics like chlorthalidone can cause hypokalemia.

Question 161

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

Answer 161

c) Aldosterone antagonism

Rationale: Spironolactone, an aldosterone antagonist, can lead to menstrual irregularities due to its anti-androgenic effects.

Question 162

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

Answer 162

b) Osmotic diuresis

Rationale: Mannitol works by inducing osmotic diuresis.

Question 163

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

Answer 163

a) Drowsiness

Rationale: Acetazolamide can cause drowsiness, which might be risky for a mountaineer who needs to stay alert in potentially hazardous environments.

Question 164

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

Answer 164

a) Serum potassium levels

Rationale: Eplerenone, an aldosterone antagonist, can lead to hyperkalemia, which can be dangerous, especially in patients with heart failure.

Question 165

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

Answer 165

b) Ototoxicity

Rationale: Loop diuretics, including torsemide, can cause ototoxicity, especially at high doses or with rapid administration.

Question 166

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

Answer 166

d) Sodium channel blockade

Rationale: Triamterene works by blocking sodium channels in the collecting ducts, leading to potassium retention and sodium excretion.

Question 167

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

Answer 167

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.

Question 168

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

Answer 168

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.

Question 169

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

Answer 169

b) Hypercalcemia

Rationale: Thiazide diuretics like indapamide can lead to hypercalcemia, which might be beneficial for patients at risk of osteoporosis.

Question 170

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

Answer 170

c) ADH antagonism

Rationale: Conivaptan works by antagonizing the effects of antidiuretic hormone (ADH), leading to increased free water excretion.

Question 171

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

Answer 171

b) Hyperglycemia

Rationale: Thiazide diuretics can lead to hyperglycemia, which might require adjustment of antidiabetic medications.

Question 172

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

Answer 172

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.

Question 173

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

Answer 173

c) Renal stones

Rationale: Acetazolamide can lead to the formation of renal stones, which might exacerbate the patient’s pre-existing condition.

Question 174

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

Answer 174

d) Sodium channel blockade

Rationale: Amiloride works by blocking sodium channels in the collecting ducts, leading to potassium retention.

Question 175

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

Answer 175

a) Dry cough

Rationale: ACE inhibitors can lead to a persistent dry cough, which might worsen respiratory symptoms in patients with chronic bronchitis.

Question 176

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

Answer 176

b) Reduced serum potassium

Rationale: Thiazide-like diuretics like metolazone can cause hypokalemia.

Question 177

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

Answer 177

c) Gynecomastia

Rationale: Eplerenone is more selective than spironolactone and has a reduced risk of causing gynecomastia and menstrual irregularities.

Question 178

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

Answer 178

d) Hyperuricemia

Rationale: Thiazide diuretics like chlorthalidone can lead to hyperuricemia, which can exacerbate gout.

Question 179

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

Answer 179

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.