deck_8357479 Flashcards
1
Q
Which of the following types of drugs will have maximum oral bioavailability?A. Drugs with high first-pass metabolism.B. Highly hydrophilic drugs.C. Largely hydrophobic, yet soluble in aqueoussolutions.D. Chemically unstable drugs.E. Drugs that are P-glycoprotein substrates.
A
C. Largely hydrophobic, yet soluble in aqueoussolutions.
2
Q
Which of the following is true about the blood–brain barrier?A. Endothelial cells of the blood–brain barrier have slit junctions.B. Ionized or polar drugs can cross the blood–brain barrier easily.C. Drugs cannot cross the blood–brain barrier through specific transporters.D. Lipid-soluble drugs readily cross the blood–brain barrier.E. The capillary structure of the blood–brain barrier is similar to that of the liver and spleen.
A
D. Lipid-soluble drugs readily cross the blood–brain barrier.
3
Q
A 40-year-old male patient (70 kg) was recently diagnosed with infection involving methicillin-resistant S. aureus. He received 2000 mg of vancomycin as an IV loading dose. The peak plasma concentration of vancomycin was reported to be 28.5 mg/L. The apparent volume of distribution is:A. 1 L/kg. B. 10 L/kg. C. 7 L/kg. D. 70 L/kg. E. 14 L/kg.
A
A. Vd = dose/C = 2000 mg/28.5 mg/L = 70.1 L. Because the patient is 70 kg, the apparent volume of distribution in L/kg will be approximately 1 L/kg (70.1 L/70 kg).A. 1 L/kg.
4
Q
A 65-year-old female patient (60 kg) with a history of ischemic stroke was prescribed clopidogrel for stroke prevention. She was hospitalized again after 6 months due to recurrent ischemic stroke. Which of the following is a likely reason she did not respond to clopidogrel therapy? She is a:A. Poor CYP2D6 metabolizer. B. Fast CYP1A2 metabolizer. C. Poor CYP2E1 metabolizer. D. Fast CYP3A4 metabolizer. E. Poor CYP2C19 metabolizer.
A
E. Poor CYP2C19 metabolizer.
5
Q
Which of the following phase II metabolic reactions makes phase I metabolites readily excretable in urine?A. Oxidation.B. Reduction.C. Glucuronidation.D. Hydrolysis.E. Alcohol dehydrogenation.
A
C. Glucuronidation.
6
Q
Alkalization of urine by giving bicarbonate is used to treat patients presenting with phenobarbital (weak acid) overdose. Which of the following best describes the rationale for alkalization of urine in this setting?A. To reduce tubular reabsorption of phenobarbital. B. To decrease ionization of phenobarbital.C. To increase glomerular filtration of phenobarbital. D. To decrease proximal tubular secretion.E. To increase tubular reabsorption of phenobarbital.
A
A. To reduce tubular reabsorption of
7
Q
A drug with a half-life of 10 hours is administered by continuous intravenous infusion. Which of the following best approximates the time for the drug to reach steady state?A. 10 hours. B. 20 hours. C. 33 hours. D. 40 hours. E. 60 hours.
A
D. 40 hours
8
Q
A 55-year-old male patient (70 kg) is going to be treated with an experimental drug, Drug X, for an irregular heart rhythm. If the V is 1 L/kg and the desired steady-state plasm concentration is 2.5 mg/L, which of the following is the most appropriate intravenous loading dose for Drug X?A. 175 mg. B. 70 mg. C. 28 mg. D. 10 mg. E. 1 mg.
A
A. For IV infusion, Loading dose = (Vd) × (desired steady-state plasma concentration). The Vd in this case corrected to the patient’s weight is 70 L. Thus, Loading dose = 70 L × 2.5 mg/L = 175 mg
9
Q
An 18-year-old female patient is brought to the emergency department due to drug overdose. Which of the following routes of administration is the most desirable for administering the antidote for the drug overdose?A. Intramuscular. B. Subcutaneous.C. Transdermal. D. Oral.E. Intravenous.
A
E. Intravenous.
10
Q
Chlorothiazide is a weakly acidic drug with a pKa of 6.5. If administered orally, at which of the following sites of absorption will the drug be able to readily pass through the membrane?A. Mouth (pH approximately 7.0).B. Stomach (pH of 2.5).C. Duodenum (pH approximately 6.1). D. Jejunum (pH approximately 8.0). E. Ileum (pH approximately 7.0).
A
B. Stomach (pH of 2.5).
11
Q
Isoproterenol produces maximal contraction of cardiac muscle in a manner similar to epinephrine. Which of the following best describes isoproterenol?A. Full agonist.B. Partial agonist.C. Competitive antagonist. D. Irreversible antagonist. E. Inverse agonist.
A
A. Full agonist.
12
Q
If 10 mg of naproxen produces the same analgesic response as 100 mg of ibuprofen, which of the following statements is correct?A. Naproxen is more efficacious than is ibuprofen.B. Naproxen is more potent than ibuprofen.C. Naproxen is a full agonist, and ibuprofen is a partialagonist.D. Naproxen is a competitive antagonist.E. Naproxen is a better drug to take for pain relief thanis ibuprofen.
A
B. Naproxen is more potent than ibuprofen.
13
Q
If 10 mg of morphine produces a greater analgesic response than can be achieved by ibuprofen at any dose, which of the following statements is correct?A. Morphine is less efficacious than is ibuprofen.B. Morphine is less potent than is ibuprofen.C. Morphine is a full agonist, and ibuprofen is a partialagonist.D. Ibuprofen is a competitive antagonist.E. Morphine is a better drug to take for pain relief thanis ibuprofen.
A
E. Morphine is a better drug to take for pain relief thanis ibuprofen.
14
Q
In the presence of naloxone, a higher concentration of morphine is required to elicit full pain relief. Naloxone by itself has no effect. Which of the following is correct regarding these medications?A. Naloxone is a competitive antagonist.B. Morphine is a full agonist, and naloxone is a partialagonist.C. Morphine is less efficacious than is naloxone.D. Morphine is less potent than is naloxone.E. Naloxone is a noncompetitive antagonist.
A
A. Naloxone is a competitive antagonist.
15
Q
In the presence of pentazocine, a higher concentration of morphine is required to elicit full pain relief. Pentazocine by itself has a smaller analgesic effect than does morphine, even at the highest dose. Which of the following is correct regarding these medications?A. Pentazocine is a competitive antagonist.B. Morphine is a full agonist, and pentazocine is apartial agonist.C. Morphine is less efficacious than is pentazocine.D. Morphine is less potent than is pentazocine.E. Pentazocine is a noncompetitive antagonist.
A
B. Morphine is a full agonist, and pentazocine is apartial agonist.
16
Q
In the presence of picrotoxin, diazepam is less efficacious at causing sedation, regardless of the dose. Picrotoxin by itself has no sedative effect even at the highest dose. Which of the following is correct?A. Picrotoxin is a competitive antagonist.B. Diazepam is a full agonist, and picrotoxin is a partialagonist.C. Diazepam is less efficacious than is picrotoxin.D. Diazepam is less potent than is picrotoxin.E. Picrotoxin is a noncompetitive antagonist.
A
E. Picrotoxin is a noncompetitive antagonist.
17
Q
Which of the following statements most accurately describes a system having spare receptors?A. The number of spare receptors determines the maximum effect.B. Spare receptors are sequestered in the cytosol.C. A single drug–receptor interaction results in manycellular response elements being activated.D. Spare receptors are active even in the absence of anagonist.E. Agonist affinity for spare receptors is less than theiraffinity for “non-spare” receptors.
A
C. A single drug–receptor interaction results in manycellular response elements being activated.
18
Q
Which of the following would up-regulate postsynaptic β1 adrenergic receptors?A. Daily use of amphetamine that causes norepinephrine to be released.B. A disease that causes an increase in the activity of norepinephrine neurons.C. Daily use of isoproterenol, a β1 receptor agonist.D. Daily use of formoterol, a β2 receptor agonist.E. Daily use of propranolol, a β1 receptor antagonist.
A
E. Daily use of propranolol, a β1 receptor antagonist.
19
Q
Which of the following is correct regarding the autonomic nervous system (ANS)?A. Afferent neurons carry signals from the CNS to the effector organs.B. The neurotransmitter at the parasympathetic ganglion is norepinephrine (NE).C. The neurotransmitter at the sympathetic ganglion is acetylcholine (ACh).D. Sympathetic neurons release ACh in the effector organs.E. Parasympathetic neurons release NE in the effector organs.
A
C. The neurotransmitter at the sympathetic ganglion is acetylcholine (ACh).
20
Q
Which of the following is correct regarding somatic motor neurons?A. The neurotransmitter at the somatic motor neuron ganglion is acetylcholine.B. The neurotransmitter at the somatic motor neuron ganglion is norepinephrine.C. Somatic motor neurons innervate smooth muscles.D. Somatic motor neurons do not have ganglia.E. Responses in the somatic motor neurons aregenerally slower than in the autonomic nervous system.
A
D. Somatic motor neurons do not have ganglia.
21
Q
Which of the following physiological changes could happen when a person is attacked by a grizzly bear?A. Increase in heart rate.B. Increase in lacrimation (tears). C. Constriction of the pupil (miosis). D. Increase in gastric motility.
A
A. Increase in heart rate.
22
Q
Which of the following changes could theoretically happen in a person when the parasympathetic system is inhibited using a pharmacological agent?A. Reduction in heart rate.B. Constriction of the pupil (miosis).C. Increase in gastric motility.D. Dry mouth (xerostomia).E. Contraction of detrusor muscle in the bladder.
A
D. Dry mouth (xerostomia).
23
Q
Which of the following statements is correct regarding the sympathetic and parasympathetic systems?A. Acetylcholine activates muscarinic receptors.B. Acetylcholine activates adrenergic receptors.C. Norepinephrine activates muscarinic receptors.D. Activation of the sympathetic system causes a dropin blood pressure.
A
A. Acetylcholine activates muscarinic receptors.
24
Q
Which of the following statements concerning the parasympathetic nervous system is correct?A. The parasympathetic system uses norepinephrine as a neurotransmitter.B. The parasympathetic system often discharges as a single, functional system.C. The parasympathetic division is involved in accommodation of near vision, movement of food, and urination.D. The postganglionic fibers of the parasympathetic division are long compared to those of the sympathetic nervous system.E. The parasympathetic system controls the secretion of the adrenal medulla.
A
C. The parasympathetic division is involved in accommodation of near vision, movement of food, and urination.
25
Which of the following is correct regarding neurotrans- mitters and neurotransmission?A. Neurotransmitters are released from the presynaptic nerve terminals.B. Neurotransmitter release is triggered by the arrival of action potentials in the postsynaptic cell.C. Intracellular calcium levels drop in the neuron before the neurotransmitter is released.D. Serotonin and dopamine are the primary neurotransmitters in the ANS.
A. Neurotransmitters are released from the presynaptic nerve terminals.
26
An elderly man was brought to the emergency room after he ingested a large quantity of carvedilol tablets, a drug that blocks α1, β1, and β2 adrenergic receptors, which mainly mediate the cardiovascular effects of epinephrine and norepinephrine in the body. Which of the following symptoms would you expect in this patient?A. Increased heart rate (tachycardia). B. Reduced heart rate (bradycardia). C. Dilation of the pupil (mydriasis).D. Increased blood pressure.
B. Reduced heart rate (bradycardia).
27
All of the following statements regarding central control of autonomic functions are correct except:A. Baroreceptors are pressure sensors located at various cardiovascular sites.B. The parasympathetic system is activated by the CNS in response to a sudden drop in blood pressure.C. The parasympathetic system is activated by the CNS in response to a sudden increase in blood pressure.D. The sympathetic system is activated by the CNS in response to a sudden drop in blood pressure.
B. The parasympathetic system is activated by the CNS in response to a sudden drop in blood pressure.
28
Which of the following is correct regarding membrane receptors and signal transduction?A. ANS neurotransmitters bind to membrane receptors on the effector cells, which leads to intracellular events.B. Cholinergic muscarinic receptors are examples of ionotropic receptors.C. Cholinergic nicotinic receptors are examples of metabotropic receptors.D. Metabotropic receptors activate ion channels directly.
A. ANS neurotransmitters bind to membrane receptors on the effector cells, which leads to intracellular events.
29
Botulinum toxin blocks the release of acetylcholine from cholinergic nerve terminals. Which of the following is a possible effect of botulinum toxin?A. Skeletal muscle paralysis.B. Improvement of myasthenia gravis symptoms. C. Increased salivation.D. Reduced heart rate.
A. Skeletal muscle paralysis.
30
A dentist would like to reduce salivation in a patient in preparation for an oral surgical procedure. Which of the following strategies will be useful in reducing salivation?A. Activate nicotinic receptors in the salivary glands.B. Block nicotinic receptors in the salivary glands.C. Activate muscarinic receptors in the salivaryglands.D. Block muscarinic receptors in the salivary glands.
D. Block muscarinic receptors in the salivary glands.
31
Which of the following is a systemic effect of a muscarinic agonist?A. Reduced heart rate (bradycardia). B. Increased blood pressure.C. Mydriasis (dilation of the pupil).D. Reduced urinary frequency.E. Constipation.
A. Reduced heart rate (bradycardia).
32
If an ophthalmologist wants to dilate the pupils for an eye examination, which of the following drugs/classes of drugs could be theoretically useful?A. Muscarinic receptor activator (agonist). B. Muscarinic receptor inhibitor (antagonist). C. Acetylcholine.D. Pilocarpine.E. Neostigmine.
B. Muscarinic receptor inhibitor (antagonist).
33
In Alzheimer’s disease, there is a deficiency of cholinergic neuronal function in the brain. Theoretically, which of the following strategies will be useful in treating the symptoms of Alzheimer’s disease?A. Inhibiting cholinergic receptors in the brain.B. Inhibiting the release of acetylcholine in the brain.C. Inhibiting the acetylcholinesterase enzyme in the brain.D. Activating the acetylcholinesterase
C. Inhibiting the acetylcholinesterase enzyme in the brain.
34
An elderly female who lives in a farm house was brought to the emergency room in serious condition after ingesting a liquid from an unlabeled bottle found near her bed, apparently in a suicide attempt. She presented with diarrhea, frequent urination, convulsions, breathing difficulties, constricted pupils (miosis), and excessive salivation. Which of the following is correct regarding this patient?A. She most likely consumed an organophosphate pesticide.B. The symptoms are consistent with sympathetic activation.C. Her symptoms can be treated using an anticholinesterase agent.D. Her symptoms can be treated using a cholinergic agonist.
A. She most likely consumed an organophosphate pesticide.
35
Sarin is a volatile nerve agent that inhibits cholinesterase enzymes. Which of the following symptoms would you expect to see in a patient exposed to sarin?A. Urinary retention.B. Tachycardia.C. Constriction of pupils (miosis). D. Dilation of the pupils (mydriasis). E. Dry mouth.
C. Constriction of pupils (miosis).
36
Head and neck irradiation in cancer patients can decrease salivary secretion and cause dry mouth. All of the following drugs or classes of drugs are theoretically useful in improving secretion of saliva in these patients except:A. Muscarinic antagonists.B. Muscarinic agonists.C. Anticholinesterase agents. D. Pilocarpine.E. Neostigmine.
A. Muscarinic antagonists.
37
Which of the following drugs or classes of drugs will be useful in treating the symptoms of myasthenia gravis?A. Nicotinic antagonists.B. Muscarinic agonists.C. Muscarinic antagonists.D. Anticholinesterase agents.
D. Anticholinesterase agents.
38
Atropa belladonna is a plant that contains atropine (a muscarinic antagonist). Which of the following drugs or classes of drugs will be useful in treating poisoning with belladonna?A. Malathion.B. Physostigmine.C. Muscarinic antagonists. D. Nicotinic antagonists.
B. Physostigmine.
39
During an ophthalmic surgical procedure, the surgeon wanted to constrict the pupil of the patient using a miotic drug. However, he accidentally used another drug that caused dilation of the pupil (mydriasis) instead. Most likely, which of the following drugs did he use?A. Acetylcholine. B. Pilocarpine. C. Tropicamide. D. Phentolamine. E. Bethanechol.
C. Tropicamide.
40
Sarin is a nerve gas that is an organophosphate cholinesterase inhibitor. Which of the following could be used as an antidote to sarin poisoning?A. Pilocarpine.B. Carbachol.C. Atropine.D. Physostigmine. E. Nicotine.
C. Atropine.
41
Atropine is one of the ingredients in the antidiarrheal combination diphenoxylate/atropine available in the United States. Which of the following effects is produced by atropine that contributes to its antidiarrheal effect?A. Increase in gastrointestinal motility. B. Reduction in gastrointestinal motility. C. Increase in salivation.D. Increase in acid secretion.
B. Reduction in gastrointestinal motility.
42
A patient with chronic obstructive pulmonary disease (COPD) was prescribed a β2 agonist for the relief of bronchospasm. However, the patient did not respond to this treatment. Which of the following drugs or classes of drugs would you suggest for this patient as the next option?A. β1 Agonist.B. Muscarinic agonist. C. Physostigmine.D. Ipratropium.E. Phentolamine.
D. Ipratropium.
43
Which of the following drugs would be the most effective anti–motion sickness drug for a person planning to go on a cruise?A. Atropine.B. Tropicamide. C. Scopolamine. D. Darifenacin. E. Tiotropium.
C. Scopolamine.
44
Which of the following is correct regarding ganglion- blocking drugs?A. Blockade of sympathetic ganglia could result in reduced blood pressure.B. Blockade of parasympathetic ganglia could result in reduced heart rate.C. Nicotine is a nondepolarizing ganglion blocker.D. Atropine is a nondepolarizing ganglion blocker.
A. Blockade of sympathetic ganglia could result in reduced blood pressure.
45
Which of the following is correct regarding the neuromuscular blockers (NMBs)?A. Nondepolarizing NMBs are administered orally.B. Cholinesterase inhibitors reduce the effects ofnondepolarizing NMBs.C. Nondepolarizing NMBs affect diaphragm musclesfirst.D. Effects of depolarizing neuromuscular blockers canbe reversed using cholinesterase inhibitors.
B. Cholinesterase inhibitors reduce the effects ofnondepolarizing NMBs.
46
Whichofthefollowingiscorrectregardingdruginteractions with nondepolarizing neuromuscular blockers (NMBs)?A. Desflurane reduces the effects of nondepolarizing NMBs.B. Cholinesterase inhibitors increase the effects of nondepolarizing NMBs.C. Aminoglycosides increase the effects of nondepolarizing NMBs.D. Calcium channel blockers reduce the effects of nondepolarizing NMBs.
C. Aminoglycosides increase the effects of nondepolarizing NMBs.
47
A patient was administered a neuromuscular blocker (NMB) prior to a surgical procedure to produce skeletal muscle paralysis. This NMB drug affected small, rapidly contracting muscles of the face and eyes first and diaphragm muscles last. The effect of this drug was easily reversed with neostigmine. Which of the following neuromuscular blockers was most likely administered to this patient?A. Rocuronium.B. Succinylcholine. C. Diazepam.D. Tubocurarine.
A. Rocuronium.
48
A patient was administered a neuromuscular blocker (NMB) prior to a surgical procedure to produce skeletal muscle paralysis. This NMB drug caused initial skeletal muscle fasciculations before the onset of paralysis. The effect of this drug could not be reversed with neostigmine. Which of the following neuromuscular blockers was most likely administered to this patient?A. Cisatracurium. B. Succinylcholine. C. Diazepam.D. Tubocurarine.
B. Succinylcholine.
49
Which of the following is correct regarding adrenergic neurotransmission?A. Epinephrine is the major neurotransmitter released from sympathetic nerve terminals.B. Norepinephrine is mainly released from the adrenal glands.C. Tricyclic antidepressants and cocaine prevent reuptake of norepinephrine into the nerve terminals.D. Monoamine oxidase (MAO) converts dopamine to norepinephrine in the nerve terminal.
C. Tricyclic antidepressants and cocaine prevent reuptake of norepinephrine into the nerve terminals.
50
All of the following are correct regarding adrenergic receptors, except:A. α1 Receptors are primarily located on the postsynaptic membrane in the effector organs.B. α Receptors are primarily located on the 2presynaptic sympathetic nerve terminals.C. β1 Receptors are found mainly in the heart.D. β2 Receptors are found mainly in adipose tissue.
D. β2 Receptors are found mainly in adipose tissue.
51
A hypertensive patient was accidentally given an α 2agonist instead of an α1 blocker. Which of the following is correct in this situation?A. α2 Agonists can increase the release of norepinephrine from sympathetic nerve terminals.B. α Agonists can reduce blood pressure in this 2patient.C. α2 Agonists can increase blood pressure in thispatient.D. α2 Agonists will not affect blood pressure in thispatient.
B. α Agonists can reduce blood pressure in this 2patient.
52
Which of the following is correct regarding responses mediated by adrenergic receptors?A.Stimulation of α1 receptors increases blood pressure.B.Stimulation of α receptors reduces blood pressure.C.Stimulation of sympathetic presynaptic α receptors increases norepinephrine release.D. Stimulation of β2 receptors increases heart rate (tachycardia).E. Stimulation of β2 receptors causes bronchoconstriction.
A.Stimulation of α1 receptors increases blood pressure.
53
An asthma patient was given a nonselective β agonist to relieve bronchoconstriction. Which of the following adverse effects would you expect to see in this patient?A. Bradycardia.B. Tachycardia.C. Hypotension (reduction in blood pressure). D. Worsening bronchoconstriction.
B. Tachycardia.
54
Which of the following adrenergic agonists is most likely to cause CNS side effects when administered systemically?A. Epinephrine.B. Norepinephrine. C. Isoproterenol. D. Dopamine.E. Ephedrine.
E. Ephedrine.
55
A 12-year-old boy who is allergic to peanuts was brought to the emergency room after accidentally consuming peanuts contained in fast food. He is in anaphylactic shock. Which of the following drugs would be most appropriate to treat this patient?A. Norepinephrine. B. Phenylephrine.C. Dobutamine.D. Epinephrine.
D. Epinephrine
56
A 70-year-old patient was brought to the emergency room with a blood pressure of 76/60 mm Hg, tachycardia, and low cardiac output. He was diagnosed with acute heart failure. Which of the following drugs would be the most appropriate to improve his cardiac function?A. Epinephrine. B. Fenoldopam. C. Dobutamine. D. Isoproterenol.
C. Dobutamine.
57
Which of the following adrenergic agonists is commonly present in nasal sprays available over-the-counter (OTC) to treat nasal congestion?A. Clonidine.B. Albuterol.C. Oxymetazoline. D. Dobutamine.E. Norepinephrine.
C. Oxymetazoline.
58
One of your patients who is hypertensive and gets mild asthma attacks occasionally bought an herbal remedy online to help with his asthma. He is not on any asthma medications currently but is receiving a β1-selective blocker for his hypertension. The herbal remedy seems to relieve his asthma attacks, but his blood pressure seems to increase despite the β-blocker therapy. Which of the following drugs is most likely present in the herbal remedy he is taking?A. Phenylephrine. B. Norepinephrine. C. Dobutamine.D. Ephedrine.E. Salmeterol.
D. Ephedrine.
59
A 60-year-old female patient started on a new antihypertensive medication recently. Her blood pressure seems to be under control, but she complains of fatigue, drowsiness, and fainting when she gets up from the bed (orthostatic hypotension). Which of the following drugs is she most likely taking?A. Metoprolol. B. Propranolol. C. Prazosin.D. Clonidine.
C. Prazosin.
60
A 30-year-old male patient was brought to the ER with amphetamine overdose. He presented with high blood pressure and arrhythmia. Which of the following is correct regarding this patient?A. Amphetamine can activate all types of adrenergic receptors.B. β-Blockers are the ideal antidotes for amphetamine poisoning.C. α-Blockers can normalize the blood pressure in this patient.D. Miosis could be a possible symptom of amphetamine poisoning.
A. Amphetamine can activate all types of adrenergic receptors.
61
A new antihypertensive drug was tested in an animal model of hypertension. The drug when given alone reduces blood pressure in the animal. Norepinephrine when given in the presence of this drug did not cause any significant change in blood pressure or heart rate in the animal. The new drug is similar to which of the following drugs in terms of its pharmacological mechanism of action?A. Prazosin.B. Clonidine. C. Propranolol. D. Metoprolol. E. Carvedilol.
E. Carvedilol.
62
A β-blocker was prescribed for hypertension in a female asthma patient. After about a week of treatment, the asthma attacks got worse, and the patient was asked to stop taking the β-blocker. Which of the following β-blockers would you suggest as an alternative in this patient that is less likely to worsen her asthma?A. Propranolol. B. Metoprolol. C. Labetalol. D. Carvedilol.
B. Metoprolol.
63
A 70-year-old male needs to be treated with an α-blocker for overflow incontinence due to his enlarged prostate. Which of the following drugs would you suggest in this patent that will not affect his blood pressure significantly?A. Prazosin.B. Doxazosin.C. Phentolamine. D. Tamsulosin.E. Terazosin.
D. Tamsulosin.
64
A 50-year-old male was brought to the emergency room after being stung by a hornet. The patient was found to be in anaphylactic shock, and the medical team tried to reverse the bronchoconstriction and hypotension using epinephrine. However, the patient did not fully respond to the epinephrine treatment. The patient’s wife mentioned that he is taking a prescription medication for his blood pressure, the name of which she does not remember. Which of the following medications is he most likely taking that could have prevented the effects of epinephrine?A. Doxazosin. B. Propranolol. C. Metoprolol. D. Acebutolol.
B. Propranolol.
65
Which of the following is correct regarding α-adrenergic blockers?A. α-Adrenergic blockers are used in the treatment of hypotension in anaphylactic shock.B. α-Adrenergic blockers are used in the treatment of benign prostatic hyperplasia (BPH).C. α-Adrenergic blockers may cause bradycardia.D. α-Adrenergic blockers are used in the treatment ofasthma.E. α-Adrenergic blockers reduce the frequency ofurination.
B. α-Adrenergic blockers are used in the treatment of benign prostatic
66
Which of the following is correct regarding β-blockers?A. Treatment with β-blockers should not be stopped abruptly.B. Propranolol is a cardioselective β-blocker.C. β-Blockers may cause orthostatic hypotension.D. Cardioselective β-blockers worsen asthma.E. β-Blockers decrease peripheral resistance bycausing vasorelaxation.
A. Treatment with β-blockers should not be stopped abruptly.
67
Which of the following drugs is commonly used topically in the treatment of glaucoma?A. Atropine.B. Timolol.C. Tropicamide. D. Scopolamine.
B. Timolol.
68
Which of the following is correct regarding carvedilol?A. Carvedilol is a cardioselective β-blocker.B. Carvedilol is safe for use in asthma patients.C. Carvedilol has α -blocking activity. 1D. Carvedilol is contraindicated in the treatment of stable chronic heart failure.
C. Carvedilol has α -blocking activity. 1
69
Which one of the following combinations of antiparkin- sonian drugs is an appropriate treatment plan?A. Amantadine, carbidopa, and entacapone. B. Levodopa, carbidopa, and entacapone. C. Pramipexole, carbidopa, and entacapone. D. Ropinirole, selegiline, and entacapone.E. Ropinirole, carbidopa, and selegiline.
B. Levodopa, carbidopa, and entacapone.
70
Peripheral adverse effects of levodopa, including nausea, hypotension, and cardiac arrhythmias, can be diminished by including which of the following drugs in the therapy?A. Amantadine. B. Ropinirole. C. Carbidopa. D. Tolcapone. E. Pramipexole.
C. Carbidopa.
71
Which of the following antiparkinsonian drugs may cause vasospasm?A. Amantadine. B. Bromocriptine. C. Carbidopa.D. Entacapone. E. Ropinirole.
B. Bromocriptine.
72
Modest improvement in the memory of patients with Alzheimer’s disease may occur with drugs that increase transmission at which of the following receptors?A. Adrenergic.B. Cholinergic. C. Dopaminergic. D. GABAergic. E. Serotonergic.
B. Cholinergic.
73
Which medication is a glutamate receptor antagonist can be used in combination with an acetylcholinesterase inhibitor to manage the symptoms of Alzheimer’s disease?A. Rivastigmine. B. Ropinirole. C. Fluoxetine. D. Memantine. E. Donepezil.
D. Memantine.
74
Which of the following agents is available as a patch for once-daily use and is likely to provide steady drug levels to treat Alzheimer’s disease?A. Rivastigmine. B. Donepezil. C. Memantine. D. Galantamine. E. Glatiramer.
A. Rivastigmine.
75
Which of the following is the only medication that is approved for the management of amyotrophic lateral sclerosis?A. Pramipexole. B. Selegiline.C. Galantamine. D. Riluzole.E. Glatiramer.
D. Riluzole.
76
Which of the following medications reduces immune system–mediated inflammation via inhibition of pyrimidine synthesis to reduce the number of activated lymphocytes in the CNS?A. Riluzole.B. Rotigotine.C. Teriflunomide.D. Dexamethasone.
C. Teriflunomide.
77
Which of the following agents may cause tremors as a side effect and, thus, should be used with caution in patients with Parkinson’s disease, even though it is also indicated for the treatment of dementia associated with Parkinson’s disease?A. Benztropine.B. Rotigotine.C. Rivastigmine.D. Dimethyl fumarate.
C. Rivastigmine
78
Which of the following agents exerts its therapeutic effect in multiple sclerosis via potassium channel blockade?A. Dalfampridine. B. Donepezil.C. Riluzole.D. Bromocriptine.
A. Dalfampridine.
79
Which one of the following statements is correct regarding benzodiazepines?A. Benzodiazepines directly open chloride channels.B. Benzodiazepines show analgesic actions.C. Clinical improvement of anxiety requires 2 to 4weeks of treatment with benzodiazepines.D. All benzodiazepines have some sedative effects.E. Benzodiazepines, like other CNS depressants,readily produce general anesthesia.
D. All benzodiazepines have some sedative effects.
80
Which one of the following is a short-acting hypnotic?A. Phenobarbital.B. Diazepam.C. Chlordiazepoxide. D. Triazolam.E. Flurazepam.
D. Triazolam.
81
Which one of the following statements is correct regarding the anxiolytic and hypnotic agents?A. Phenobarbital shows analgesic properties.B. Diazepam and phenobarbital induce the cytochromeP450 enzyme system.C. Phenobarbital is useful in the treatment of acuteintermittent porphyria.D. Phenobarbital induces respiratory depression, which is enhanced by the consumption of ethanol.E. Buspirone has actions similar to those of thebenzodiazepines.
D. Phenobarbital induces respiratory depression, which is enhanced by the consumption of ethanol.
82
D. Phenobarbital induces respiratory depression, which is enhanced by the consumption of ethanol.
D. Phenobarbital induces respiratory depression, which is enhanced by the consumption of ethanol.
83
A 45-year-old man who has been injured in a car accident is brought into the emergency room. His blood alcohol level on admission is 275 mg/dL. Hospital records show a prior hospitalization for alcohol-related seizures. His wife confirms that he has been drinking heavily for 3 weeks. What treatment should be provided to the patient if he goes into withdrawal?A. None.B. Lorazepam. C. Pentobarbital. D. Phenytoin.E. Buspirone.
B. Lorazepam.
84
Which one of the following is a short-acting hypnotic and better for sleep induction compared to sleep maintenance?A. Temazepam. B. Flurazepam. C. Zaleplon.D. Buspirone.E. Escitalopram.
C. Zaleplon.
85
Which of the following agents has a rapid anxiolytic effect and would be best for the acute management of anxiety?A. Buspirone.B. Venlafaxine. C. Lorazepam. D. Escitalopram. E. Duloxetine.
C. Lorazepam.
86
Which of the following sedative–hypnotic agents utilizes melatonin receptor agonism as the mechanism of action to induce sleep?A. Zolpidem.B. Eszopiclone.C. Estazolam.D. Ramelteon.E. Diphenhydramine.
D. Ramelteon.
87
All of the following agents for the management of insomnia are controlled substances and may have a risk for addiction or dependence except:A. Zaleplon.B. Flurazepam. C. Doxepin.D. Zolpidem. E. Triazolam.
C. Doxepin.
88
All of the following agents may cause cognitive impairment, including memory problems when used at recommended doses except:A. Diphenhydramine. B. Zolpidem.C. Alprazolam.D. Phenobarbital.E. Ramelteon.
E. Ramelteon.
89
Which agent is best used in the Emergency Room setting for patients who are believed to have received too much of a benzodiazepine drug or taken an overdose of benzodiazepines?A. Diazepam. B. Ramelteon. C. Flumazenil. D. Doxepin.E. Naloxone.
C. Flumazenil.
90
A 55-year-old teacher began to experience changes in mood. He was losing interest in his work and lacked the desire to play his daily tennis match. He was preoccupied with feelings of guilt, worthlessness, and hopelessness. In addition to the psychiatric symptoms, the patient complained of muscle aches throughout his body. Physical and laboratory tests were unremarkable. After 6 weeks of therapy with fluoxetine, his symptoms resolved. However, the patient complains of sexual dysfunction. Which of the following drugs might be useful in this patient?A. Fluvoxamine. B. Sertraline.C. Citalopram. D. Mirtazapine. E. Lithium.
D. Mirtazapine.
91
A 25-year-old woman has a long history of depressive symptoms accompanied by body aches and pain secondary to a car accident 2 years earlier. Physical and laboratory tests are unremarkable. Which of the following drugs might be useful in this patient?A. Fluoxetine. B. Sertraline. C. Phenelzine. D. Mirtazapine.E. Duloxetine.
E. Duloxetine.
92
A 51-year-old woman with symptoms of major depression also has angle-closure glaucoma. Which of the following antidepressants should be avoided in this patient?A. Amitriptyline. B. Sertraline.C. Bupropion. D. Mirtazapine. E. Fluvoxamine.
A. Amitriptyline.
93
A 36-year-old man presents with symptoms of compulsive behavior. If anything is out of order, he feels that “work will not be accomplished effectively or efficiently.” He realizes that his behavior is interfering with his ability to accomplish his daily tasks but cannot seem to stop himself. Which of the following drugs would be most helpful to this patient?A. Imipramine.B. Fluvoxamine.C. Amitriptyline.D. Tranylcypromine. E. Lithium.
B. Fluvoxamine.
94
Which antidepressant has, as its two proposed principle mechanisms of action, 5-HT1a receptor partial agonism and 5-HT reuptake inhibition?A. Fluoxetine. B. Aripiprazole. C. Maprotiline. D. Vilazodone. E. Mirtazapine.
D. Vilazodone.
95
Which antidepressant is the most sedating?A. Fluoxetine. B. Duloxetine. C. Nortriptyline. D. Citalopram. E. Venlafaxine.
C. Nortriptyline.
96
Which mood stabilizer is completely renally eliminated and may be beneficial for patients with hepatic impairment?A. Valproic acid.B. Carbamazepine. C. Lithium.D. Risperidone.E. Aripiprazole.
C. Lithium.
97
Which antidepressant has, as its two principle mechanisms of action, 5-HT2A receptor antagonism and α2 receptor antagonism?A. Fluoxetine. B. Doxepin.C. Maprotiline. D. Mirtazapine. E. Selegiline.
D. Mirtazapine.
98
Which agent is best known to have the side effect of decreasing the thyroid function of the patient being chronically treated with this agent?A. Carbamazepine. B. Lithium.C. Valproic acid.D. Chlorpromazine. E. Lurasidone.
B. Lithium.
99
Which agent would be a poor choice in a 70-year- old elderly female with depressive symptoms due to the drug having significant α1 receptor antagonism and thus a higher risk for falls due to orthostatic hypotension?A. Lithium.B. Bupropion. C. Escitalopram. D. Imipramine. E. Sertraline.
A. Lithium.
100
An adolescent male is newly diagnosed with schizo- phrenia. Which of the following antipsychotic agents may have the best chance to improve his apathy and blunted affect?A. Chlorpromazine. B. Fluphenazine. C. Haloperidol.D. Risperidone.E. Thioridazine.
D. Risperidone.
101
Which one of the following antipsychotics has been shown to be a partial agonist at the dopamine D2 receptor?A. Aripiprazole. B. Clozapine. C. Haloperidol. D. Risperidone. E. Thioridazine.
A. Aripiprazole.
102
A 21-year-old male has recently begun pimozide therapy for Tourette disorder. His parents bring him to the emergency department. They describe that he has been having “different-appearing tics” than before, such as prolonged contraction of the facial muscles. While being examined, he experiences opisthotonos (type of extrapyramidal spasm of the body in which the head and heels are bent backward and the body is bowed forward). Which of the following drugs would be beneficial in reducing these symptoms?A. Benztropine.B. Bromocriptine.C. Lithium.D. Prochlorperazine. E. Risperidone.
A. Benztropine.
103
A 28-year-old woman with schizoaffective disorder (combination of mood and psychotic symptoms) reports difficulty falling asleep. Which of the following would be most beneficial in this patient?A. Lithium.B. Chlorpromazine. C. Haloperidol.D. Paliperidone.E. Ziprasidone.
B. Chlorpromazine.
104
Which of the following antipsychotic agents is con- sidered to be the most potent and, thus, have the highest risk of extrapyramidal symptoms?A. Thioridazine.B. Fluphenazine. C. Quetiapine.D. Chlorpromazine. E. Clozapine.
B. Fluphenazine.
105
Which antipsychotic has the most sedative potential and is sometimes questionably used as a hypnotic agent in certain clinical settings?A. Fluphenazine. B. Thiothixene. C. Quetiapine. D. Haloperidol. E. Iloperidone.
C. Quetiapine.
106
A 30-year-old male patient who is treated with halo- peridol for his diagnosis of schizophrenia is considered to be well-managed symptomatically for his psychotic symptoms. However, he is reporting restlessness, the inability to sit still at the dinner table, and his family notices that he is pacing up and down the hallway frequently. Of the following, which is the best medication to treat this antipsychotic-induced akathisia?A. Benztropine. B. Dantrolene.C. Amoxapine.D. Bromocriptine. E. Propranolol.
E. Propranolol.
107
Which of the following antipsychotic agents is available in a LAI formulation that may be useful for patients with difficulty adhering to therapy?A. Asenapine.B. Chlorpromazine. C. Clozapine.D. Quetiapine.E. Risperidone.
E. Risperidone.
108
Which of the following antipsychotic agents is most associated with the possibility of a hematological dyscrasia such as agranulocytosis in a patient being treated for schizophrenia?A. Chlorpromazine. B. Buspirone.C. Lithium.D. Clozapine.E. Asenapine.
D. Clozapine.
109
Which antipsychotic agent has been most associated with significant QT interval prolongation and should be used with caution in patients with preexisting arrhythmias or patients taking other drugs associated with QT prolongation?A. Thioridazine. B. Risperidone. C. Asenapine. D. Lurasidone. E. Aripiprazole.
A. Thioridazine.
110
A 9-year-old boy is sent for neurologic evaluation because of episodes of apparent inattention. Over the past year, the child has experienced episodes during which he develops a blank look on his face and his eyes blink for 15 seconds. He immediately resumes his previous activity. Which one the following best describes this patient’s seizures?A. Simple partial. B. Complex partial. C. Tonic–clonic.D. Absence.E. Myoclonic.
D. Absence.
111
A child is experiencing absence seizures that interrupt his ability to pay attention during school and activities. Which of the following therapies would be most appropriate for this patient?A. Ethosuximide.B. Carbamazepine.C. Diazepam.D. Carbamazepine plus primidone. E. Watchful waiting.
A. Ethosuximide.
112
Which of the following drugs is most useful for the treatment of absence seizures?A. Topiramate.B. Tiagabine.C. Levetiracetam. D. Lamotrigine. E. Zonisamide.
D. Lamotrigine.
113
A 25-year-old woman with myoclonic seizures is well controlled on valproate. She indicates that she is interested in becoming pregnant in the next year. With respect to her antiepilepsy medication, which of the following should be considered?A. Leave her on her current therapy.B. Consider switching to lamotrigine.C. Consider adding a second antiepilepsy medication. D. Decrease her valproate dose.
B. Consider switching to lamotrigine.
114
A woman with myoclonic seizures is well controlled with lamotrigine. She becomes pregnant and begins to have breakthrough seizures. What is most likely happening?A. Her epilepsy is getting worse.B. Lamotrigine concentrations are increasing.C. Lamotrigine concentrations are decreasing.D. Lamotrigine is no longer efficacious for this patient.
C. Lamotrigine concentrations are decreasing.
115
A 42-year-old man undergoes a neurologic evaluation because of episodes of apparent confusion. Over the past year, the man has experienced episodes during which he develops a blank look on his face and fails to respond to questions. Moreover, it appears to take several minutes before the man recovers from the episodes. Which one of the following best describes this type of seizure?A. Focal (simple partial). B. Focal (complex partial). C. Tonic–clonic.D. Absence.E. Myoclonic.
B. Focal (complex partial).
116
A 52-year-old man has had several focal complex partial seizures over the last year. Which one of the following therapies would be the most appropriate initial therapy for this patient?A. Ethosuximide.B. Levetiracetam.C. Diazepam.D. Carbamazepine plus primidone. E. Watchful waiting.
B. Levetiracetam.
117
A patient with focal complex partial seizures has been treated for 6 months with carbamazepine but, recently, has been experiencing breakthrough seizures on a more frequent basis. You are considering adding a second drug to the antiseizure regimen. Which of the following drugs is least likely to have a pharmacokinetic interaction with carbamazepine?A. Topiramate.B. Tiagabine.C. Levetiracetam. D. Lamotrigine. E. Zonisamide.
C. Levetiracetam.
118
Which of the following is a first-line medication for generalized tonic–clonic seizures?A. Ethosuximide. B. Felbamate.C. Vigabatrin.D. Ezogabine.E. Topiramate.
E. Topiramate.
119
A 75-year-old woman had a stroke approximately 1 month ago. She is continuing to have small focal seizures where she fails to respond appropriately while talking. Which of the following is the most appropriate treatment for this individual?A. Phenytoin.B. Oxcarbazepine. C. Levetiracetam. D. Phenobarbital.
C. Levetiracetam.
120
Which of the following is a potent analgesic but a weak anesthetic?A. Etomidate.B. Halothane. C. Midazolam. D. Nitrous oxide. E. Thiopental.
D. Nitrous oxide.
121
The potency of inhaled anesthetics is defined quantitatively as:A. Blood/gas partition coefficient. B. Cerebrovascular resistance.C. Minimum alveolar concentration. D. Diffusion hypoxia.
C. Minimum alveolar concentration.
122
Which of the following determines the speed of recovery from intravenous anesthetics used for induction?A. Liver metabolism of the drug.B. Protein binding of the drug.C. Ionization of the drug.D. Redistribution of the drug from sites in the CNS. E. Plasma clearance of the drug.
D. Redistribution of the drug from sites in the CNS
123
Which one of the following is a potent intravenous anesthetic but a weak analgesic?A. Propofol.B. Benzodiazepines. C. Ketamine.D. Fentanyl.E. Isoflurane.
A. Propofol.
124
Which of the following is correct regarding local anesthetics?A. They affect only small, unmyelinated nerve fibers.B. They have either a lipophilic or a hydrophilic group.C. They have either an amide or an ester linkage.D. They are unaffected by pH of the tissue and pKa ofthe drug.E. In their ionized form, they interact with the proteinreceptor of calcium channels.
C. They have either an amide or an ester linkage.
125
Which of the following is correct regarding malignant hyperthermia?A. It is triggered by dantrolene.B. It is triggered by local anesthetics.C. It is generally mild and clinically insignificant.D. It has no familial component.E. It involves increased skeletal muscle oxidativemetabolism.
E. It involves increased skeletal muscle oxidativemetabolism.
126
A patient with heart failure and significantly reduced cardiac output requires surgical anesthesia. Which of the following would you expect to see in this patient?A. Slower induction time with IV anesthetics.B. Need for increased dosage of IV anesthetics.C. Slower induction time with inhaled anesthetics.D. Enhanced removal of inhaled anesthetics toperipheral tissues.
A. Slower induction time with IV anesthetics.
127
An 80-year-old patient with asthma and low blood pressure requires anesthesia for an emergency surgical procedure. Which of the following agents would be most appropriate for inducing anesthesia in this patient?A. Desflurane. B. Ketamine. C. Propofol. D. Thiopental.
B. Ketamine.
128
A 52-year-old woman will be undergoing sedation with propofol for a brief diagnostic procedure. Which of the following is an advantage of propofol for this patient?A. Rapid analgesia.B. Sustained duration.C. Decreased incidence of nausea and vomiting. D. Less pain at the injection site.
C. Decreased incidence of nausea and vomiting.
129
A 32-year-old woman requests an epidural to ease labor pains. She reports that she had an allergic reaction to Novocain (procaine) at the dentist’s office. Which of the following local anesthetics would be appropriate for use in an epidural for this patient?A. Chloroprocaine. B. Mepivacaine. C. Ropivacaine.D. Tetracaine.
C. Ropivacaine.
130
A young woman is brought into the emergency room. She is unconscious, and she has pupillary constriction and depressed respiration. Based on reports, an opioid overdose is almost certain. Which of the listed phenanthrene opioids will exhibit a full and immediate response to treatment with naloxone?A. Meperidine.B. Morphine.C. Buprenorphine. D. Fentanyl.
B. Morphine.
131
A 76-year-old female with renal insufficiency pres- ents to the clinic with severe pain secondary to a compression fracture in the lumbar spine. She reports that the pain has been uncontrolled with tramadol, and it is decided to start treatment with an opioid. Which of the following is the best opioid for this patient?A. Meperidine.B. Fentanyl transdermal patch. C. Hydrocodone.D. Morphine.
C. Hydrocodone.
132
Which of the following statements about fentanyl is correct?A. Fentanyl is 100 times more potent than morphine.B. Its withdrawal symptoms can be relieved bynaloxone.C. The active metabolites of fentanyl can causeseizures.D. It is most effective by oral administration.
A. Fentanyl is 100 times more potent than morphine.
133
A56-year-old patient who has suffered with severe chronic pain with radiculopathy secondary to spinal stenosis for years presents to the clinic for pain management. Over the years, this patient has failed to receive relief from the neuropathic pain from the radiculopathy with traditional agents such as tricyclics or anticonvulsants. Based on the mechanism of action, which opioid might be beneficial in this patient to treat both nociceptive and neuropathic pain?A. Meperidine.B. Oxymorphone. C. Morphine.D. Methadone.
D. Methadone.
134
Which of the following statements regarding methadone is correct?A. Methadone is an excellent choice for analgesia in most patients since there are limited drug–drug interactions.B. The equianalgesic potency of methadone is similar to that of morphine.C. The duration of analgesia for methadone is much shorter than the elimination half-life.D. The active metabolites of methadone accumulate in patients with renal dysfunction.
C. The duration of analgesia for methadone is much shorter than the elimination half-life
135
Which of the following opioids is the LEAST lipophilic?A. Fentanyl. B. Methadone. C. Meperidine. D. Morphine.
D. Morphine.
136
A 64-year-old male is preparing for a total knee replacement. He is taking many medications that are metabolized by the CYP450 enzyme system and is worried about drug interactions with the pain medication that will be used following his surgery. Which of the following opioids would have the lowest chance of interacting with his medications that are metabolized by the CYP450 enzyme system?A. Methadone.B. Oxymorphone. C. Oxycodone.D. Hydrocodone.
B. Oxymorphone
137
Which of the following opioids is the best choice for treating pain associated with diabetic peripheral neuropathy?A. Morphine.B. Tapentadol.C. Codeine.D. Buprenorphine.
B. Tapentadol.
138
KM is a 64-year-old male who has been hospitalized following a car accident in which he sustained a broken leg and broken arm. He has been converted to oral morphine in anticipation of his discharge. What other medication should he receive with his morphine upon discharge?A. Diphenhydramine.B. Methylphenidate.C. Docusate sodium with senna. D. Docusate sodium.
C. Docusate sodium with senna.
139
AN is a 57-year-old male who has been treated with oxycodone for chronic nonmalignant pain for over 2 years. He is now reporting increased pain in the afternoon while at work. Which of the following opioids is a short-acting opioid and is the best choice for this patient’s breakthrough pain?A. Methadone. B. Pentazocine. C. Hydrocodone. D. Nalbuphine.
C. Hydrocodone.
140
A 22-year-old HIV patient has been told that marijuana may benefit him should he start using the substance. Which of the following adverse effects has been associated with marijuana usage and may be a reason for this patient to avoid use of marijuana?A. Hyperphagia.B. Hyperthermia.C. Hepatitis.D. Progression of HIV. E. Hyponatremia.
D. Progression of HIV.
141
A 21-year-old college student is curious about the effects of LSD. She asks what type of risks may be involved with using the drug for the first time. Which of the following is a correct response to her question?A. Exaggerated hallucinations. B. Cardiomyopathy.C. Hyperphagia.D. Bronchitis.
A. Exaggerated hallucinations.
142
A 58-year-old male is brought into the emergency department following an automobile accident. His blood alcohol level on admission is 280 mg/dL. He has been treated in the past for seizures related to alcohol abuse, and he confirms that he has been drinking heavily over the past month since losing his job. What treatment should be given to this patient if he begins to go into withdrawal while hospitalized?A. None.B. Lorazepam. C. Acamprosate. D. Naltrexone. E. Disulfiram.
B. Lorazepam.
143
A 35-year-old man has been abusing cocaine and is agitated, tachycardic, hypertensive, and hyperthermic. Which of the following is correct regarding treatment in this situation?A. This patient should undergo gastric lavage; that is, he should have his stomach pumped immediately.B. Cocaine toxicity commonly involves CNS depression that can be reversed with IV atropine.C. Benzodiazepines would be a good choice, as they should help calm the patient down, decrease heart rate, decrease blood pressure, and decrease body temperature.D. Phenobarbital should be the first choice as an anticonvulsant.
C. Benzodiazepines would be a good choice, as they should help calm the patient down, decrease heart rate, decrease blood pressure, and decrease body temperature.
144
A 22-year-old man with a history of substance abuse arrives in the emergency department hypertensive, hyperthermic, and tachycardic, with altered mental status and hyperreflexia. His friends say he has been snorting “bath salts.” Which of the following is correct regarding this patient?A. This patient’s clinical presentation is consistent with opioid toxicity and he should receive an opioid antagonist such as naloxone immediately.B. “Bath salts” are often labeled as “not for human consumption” and sold with an unstated understanding that they contain synthetic cathinones, which are amphetamine-like compounds.C. Treatment with a serotonin agonist might be beneficial.D. Along with cooling measures, antihypertensives, β-blockers, and monoamine oxidase inhibitors would be reasonable options for the treatment.
“Bath salts” are often labeled as “not for human consumption” and sold with an unstated understanding that they contain synthetic cathinones, which are amphetamine-like compounds.
145
A young male was brought to the emergency room by the police due to severe agitation. Psychiatric examination revealed that he had injected dextroamphetamine several times in the past few days, the last time being 10 hours previously. He was given a drug that sedated him, and he fell asleep. Which of the following drugs was most likely used to counter this patient’s apparent symptoms of dextroamphetamine withdrawal?A. Phenobarbital. B. Lorazepam. C. Cocaine.D. Hydroxyzine. E. Fluoxetine.
B. Lorazepam.
146
JM is a 10-year-old male who is sent to a pediatric neurologist for an evaluation due to receiving poor grades in class. JM’s parents have recently received complaints from his teacher that he is performing poorly in school and he is repeatedly caught not paying attention in class. Several times a day during class, JM is noted to be getting out of his chair and socializing with other students. He has also been getting into fights with some children, as he is being singled out by others and teased. JM is given a diagnosis of ADHD with impulsivity and irritability. Which of the following is the most appropriate recommendation for management of the ADHD?A. Clonidine.B. Caffeine.C. Dextroamphetamine. D. Haloperidol.E. Buspirone.
C. Dextroamphetamine.
147
JM is a 10-year-old male with ADHD. His symptoms are currently controlled with an oral psychostimulant. However, he and his family wish to avoid having to give a second dose of medication at school. They are looking for an alternative treatment option that could be implemented in the morning and last the entire day. Which treatment option would be best for JM’s needs?A. Mixed amphetamine salts in immediate-release oral tablet formulation.B. Methylphenidate in a transdermal delivery system.C. Nicotine in a chewing gum formulation for buccalabsorption.D. Methylphenidate in immediate-release pills.
B. Methylphenidate in a transdermal delivery system.
148
Which of the following treatments for ADHD is a controlled substance (DEA Schedule II)?A. Clonidine.B. Guanfacine.C. Atomoxetine.D. Dexmethylphenidate. E. Desipramine.
D. Dexmethylphenidate.
149
Amphetamines are contraindicated in patients with all of the following conditions except:A. Cardiovascular disease. B. Glaucoma.C. Hypertension.D. Hyperthyroidism.E. Obesity.
E. Obesity.
150
Which of the following agents is considered a first-line treatment for narcolepsy?A. Donepezil. B. Atomoxetine. C. Clonidine.D. Temazepam. E. Modafinil.
E. Modafinil.
151
Which of the following is a common adverse effect of amphetamines?A. Bradycardia. B. Somnolence. C. Constipation. D. Hypertension. E. Fatigue.
D. Hypertension.
152
Which of the following CNS stimulants occurs naturally and can be found in certain candies?A. Amphetamine. B. Clonidine.C. Modafinil.D. Caffeine.E. Atomoxetine.
D. Caffeine.
153
TT is a 35-year-old male who is interested in quitting smoking. In previous quit attempts, he has tried nicotine gum, the nicotine patch, and the “cold turkey” method. He has been unsuccessful in each of these attempts and usually resumed smoking within 4 to 6 weeks. Which of the following may be useful to assist TT in his attempt to quit smoking?A. Varenicline.B. Dextroamphetamine. C. Lorazepam.D. Methylphenidate.
A. Varenicline.
154
All of the following drugs are controlled substances with a risk for drug addiction or dependence except:A. Armodafinil.B. Lisdexamfetamine. C. Dexmethylphenidate.D. Atomoxetine.E. Methamphetamine.
C. Dexmethylphenidate.
155
A 45-year-old man was just started on therapy for hypertension and developed a persistent, dry cough. Which is most likely responsible for this side effect?A. Enalapril. B. Losartan. C. Nifedipine. D. Prazosin.E. Propranolol.
A. Enalapril.
156
Which may cause reflex tachycardia and/or postural hypotension on initial administration?A. Atenolol.B. Hydrochlorothiazide. C. Metoprolol.D. Prazosin.E. Verapamil.
D. Prazosin.
157
Which can precipitate a hypertensive crisis following abrupt cessation of therapy?A. Clonidine.B. Diltiazem.C. Enalapril.D. Losartan.E. Hydrochlorothiazide.
A. Clonidine.
158
A 48-year-old hypertensive patient has been successfully treated with a thiazide diuretic for the last 5 years. Over the last 3 months, his diastolic pressure has steadily increased, and he was started on an additional antihypertensive agent. He complains of several instances of being unable to achieve an erection and not being able to complete three sets of tennis as he once did. Which is the likely second antihypertensive medication?A. Captopril. B. Losartan. C. Metoprolol. D. Minoxidil. E. Nifedipine.
C. Metoprolol.
159
A 40-year-old male has recently been diagnosed with hypertension due to pressure readings of 163/102 and 165/100 mm Hg. He also has diabetes that is well controlled with oral hypoglycemic medications. Which is the best initial treatment regimen for treatment of hypertension in this patient?A. Felodipine.B. Furosemide.C. Lisinopril.D. Lisinopril and hydrochlorothiazide. E. Metoprolol.
D. Lisinopril and hydrochlorothiazide.
160
A 60-year-old white female has not reached her blood pressure goal after 1 month of treatment with a low dose of lisinopril. All of the following would be appropriate next steps in the treatment of her hypertension except:A. Increase dose of lisinopril.B. Add a diuretic medication.C. Add on a calcium channel blocker medication. D. Add on an ARB medication.
D. Add on an ARB medication.
161
A patient returns to her health care provider for routine monitoring 3 months after her hypertension regimen was modified. Labs reveal elevated serum potassium. Which is likely responsible for this hyperkalemia?A. Chlorthalidone. B. Clonidine.C. Furosemide.D. Losartan.E. Nifedipine.
D. Losartan.
162
A 58-year-old female reports that she recently stopped taking her blood pressure medications because of swelling in her feet that began shortly after she started treatment. Which is most likely to cause peripheral edema?A. Atenolol.B. Clonidine. C. Felodipine. D. Hydralazine. E. Prazosin.
C. Felodipine.
163
Which is an appropriate choice for hypertension treatment during pregnancy?A. Aliskiren.B. Fosinopril. C. Hydralazine. D. Valsartan.
C. Hydralazine.
164
DD is a 50-year-old male with newly diagnosed hypertension. His comorbidities include diabetes and chronic hepatitis C infection with moderate liver impairment. He requires two drugs for initial treatment of his hypertension. Which should be prescribed in combination with a thiazide diuretic?A. Lisinopril.B. Spironolactone. C. Fosinopril.D. Furosemide.E. Hydralazine.
A. Lisinopril.
165
Which drug may exacerbate HF?A. Acetaminophen. B. Cetirizine.C. Chlorthalidone. D. Ibuprofen.
D. Ibuprofen.
166
Which best describes the action of ACE inhibitors on the failing heart?A. ACE inhibitors increase vascular resistance. B. ACE inhibitors decrease cardiac output.C. ACE inhibitors reduce preload.D. ACE inhibitors increase aldosterone.
C. ACE inhibitors reduce preload.
167
What makes losartan different from other ARBs?A. Losartan is renally eliminated.B. Losartan has an active metabolite.C. Losartan has the shortest half-life.D. Losartan has a small volume of distribution.
B. Losartan has an active metabolite.
168
How do β-blockers improve cardiac function in HF?A. By decreasing cardiac remodeling. B. By increasing heart rate.C. By increasing renin release.D. By activating norepinephrine.
A. By decreasing cardiac remodeling.
169
BC is a 70-year-old female who is diagnosed with HFrEF. Her past medical history is significant for hypertension and atrial fibrillation. She is taking hydrochlorothiazide, lisinopril, metoprolol tartrate, and warfarin. BC says she is feeling “good” and has no cough, shortness of breath, or edema. Which is the most appropriate medication change to make?A. Discontinue hydrochlorothiazide.B. Change lisinopril to losartan.C. Decrease warfarin dose.D. Change metoprolol tartrate to metoprolol succinate.
D. Change metoprolol tartrate to metoprolol succinate.
170
SC is a 75-year-old white male who has HF. He is seen in clinic today, reporting shortness of breath, increased pitting edema, and a 5-pound weight gain over the last 2 days. His current medication regimen includes losartan and metoprolol succinate. SC has no chest pain and is deemed stable for outpatient treatment. Which of the following is the best recommendation?A. Increase the dose of metoprolol succinate. B. Start hydrochlorothiazide.C. Start furosemide.D. Discontinue losartan.
C. Start furosemide.
171
How is spironolactone beneficial in HF?A. Promotes potassium secretion. B. Agonizes aldosterone.C. Prevents cardiac hypertrophy. D. Decreases blood glucose.
C. Prevents cardiac hypertrophy.
172
Which is important to monitor in patients taking digoxin?A. Chloride. B. Potassium. C. Sodium.D. Zinc.
B. Potassium.
173
Which describes the mechanism of action of milrinone in HF?A. Decreases intracellular calcium. B. Increases cardiac contractility. C. Decreases cAMP.D. Activates phosphodiesterase.
B. Increases cardiac contractility.
174
What is the most common adverse effect associated with fixed-dose hydralazine/isosorbide dinitrate?A. Diarrhea.B. Drug-induced lupus. C. Headache.D. Heartburn.
C. Headache.
175
A 60-year-old woman had a myocardial infarction. Which of the following should be used to prevent life-threatening arrhythmias that can occur post– myocardial infarction in this patient?A. Digoxin.B. Flecainide.C. Metoprolol.D. Procainamide. E. Quinidine.
C. Metoprolol.
176
Suppression of arrhythmias resulting from a reentry focus is most likely to occur if the drug:A. Has vagomimetic effects on the AV node.B. Is a β-blocker.C. Converts a unidirectional block to a bidirectionalblock.D. Slows conduction through the atria.E. Has atropine-like effects on the AV node.
C. Converts a unidirectional block to a bidirectionalblock.
177
A 57-year-old man is being treated for an atrial arrhythmia. He complains of dry mouth, blurred vision, and urinary hesitancy. Which antiarrhythmic drug is he mostly like taking?A. Metoprolol.B. Disopyramide. C. Dronedarone. D. Sotalol.
B. Disopyramide.
178
A 58-year-old woman is being treated for chronic suppression of a ventricular arrhythmia. After 1 week of therapy, she complains about feeling severe upset stomach and heartburn. Which antiarrhythmic drug is the likely cause of these symptoms?A. Amiodarone. B. Digoxin.C. Mexiletine. D. Propranolol. E. Quinidine.
C. Mexiletine.
179
A 78-year-old woman has been newly diagnosed with atrial fibrillation. She is not currently having symptoms of palpitations or fatigue. Which is appropriate to initiate for rate control as an outpatient?A. Amiodarone. B. Dronedarone. C. Esmolol.D. Flecainide.E. Metoprolol.
E. Metoprolol.
180
Which of the following is correct regarding digoxin when used for atrial fibrillation?A. Digoxin works by blocking voltage-sensitive calcium channels.B. Digoxin is used for rhythm control in patients with atrial fibrillation.C. Digoxin increases conduction velocity through the AV node.D. Digoxin levels of 1 to 2 ng/mL are desirable in the treatment of atrial fibrillation.
D. Digoxin levels of 1 to 2 ng/mL are desirable in the treatment of atrial fibrillation.
181
All of the following are adverse effects of amiodarone except:A. Cinchonism.B. Hypothyroidism.C. Hyperthyroidism.D. Pulmonary fibrosis.E. Blue skin discoloration.
A. Cinchonism.
182
Which arrhythmia can be treated with lidocaine?A. Paroxysmal supraventricular ventricular tachycardia.B. Atrial fibrillation.C. Atrial flutter.D. Ventricular tachycardia.
D. Ventricular tachycardia.
183
A clinician would like to initiate a drug for rhythm control of atrial fibrillation. Which of the following coexisting conditions would allow for initiation of flecainide?A. Hypertension.B. Left ventricular hypertrophy. C. Coronary artery disease.D. Heart failure.
A. Hypertension.
184
Which statement regarding dronedarone is correct?A. Dronedarone is more effective than amiodarone.B. QT interval prolongation is not a risk withdronedarone.C. Dronedarone increases the risk of death inpatients with permanent atrial fibrillation orsymptomatic heart failure.D. There is no need to monitor liver function withdronedarone.
C. Dronedarone increases the risk of death inpatients with permanent atrial fibrillation orsymptomatic heart failure.
185
What is the clinical term for angina caused by coronary vasospasm?A. Classic angina.B. Myocardial infarction. C. Prinzmetal angina. D. Unstable angina.
C. Prinzmetal angina.
186
A 72-year-old male presents to the primary care clinic complaining of chest tightness and pressure that is increasing in severity and frequency. His current medications include atenolol, lisinopril, and nitroglycerin. Which intervention is most appropriate at this time?A. Add amlodipine.B. Initiate isosorbide mononitrate.C. Initiate ranolazine.D. Refer the patient to the nearest emergency room for evaluation.
D. Refer the patient to the nearest emergency roomfor evaluation.
187
A 62-year-old patient with a history of asthma and vasospastic angina states that he gets chest pain both with exertion and at rest, about ten times per week. One sublingual nitroglycerin tablet always relieves his symptoms, but this medication gives him an awful headache every time he takes it. Which is the best option for improving his angina?A. Change to sublingual nitroglycerin spray. B. Add amlodipine.C. Add propranolol.D. Replace nitroglycerin with ranolazine.
B. Add amlodipine.
188
Which side effect is associated with amlodipine?A. Bradycardia.B. Cough.C. Edema.D. QT prolongation.
C. Edema.
189
Which medication should be prescribed to all anginal patients to treat an acute attack?A. Isosorbide dinitrate.B. Nitroglycerin patch.C. Nitroglycerin sublingual tablet or spray. D. Ranolazine.
C. Nitroglycerin sublingual tablet or spray.
190
A 65-year-old male experiences uncontrolled angina attacks that limit his ability to do household chores. He is adherent to a maximized dose of β-blocker with a low heart rate and low blood pressure. He was unable to tolerate an increase in isosorbide mononitrate due to headache. Which is the most appropriate addition to his antianginal therapy?A. Amlodipine. B. Aspirin.C. Ranolazine. D. Verapamil.
C. Ranolazine.
191
A 68-year-old male with a history of angina had a MI last month, and an echocardiogram reveals heart failure with reduced ejection fraction. He was continued on his previous home medications (diltiazem, enalapril, and nitroglycerin), and atenolol was added at discharge. He has only had a few sporadic episodes of stable angina that are relieved with nitroglycerin or rest. What are eventual goals for optimizing this medication regimen?A. Add isosorbide mononitrate.B. Increase atenolol.C. Stop atenolol and increase diltiazem.D. Stop diltiazem and change atenolol to bisoprolol.
D. Stop diltiazem and change atenolol to bisoprolol.
192
Which of the following medications would be safe to use in a patient taking ranolazine?A. Carbamazepine. B. Clarithromycin. C. Enalapril.D. Quetiapine.
C. Enalapril.
193
A patient whose angina was previously well controlled with once-daily isosorbide mononitrate states that recently he has been taking isosorbide mononitrate twice a day to control angina symptoms that are occurring more frequently during early morning hours. Which of the following is the best option for this patient?A. Continue once-daily administration of isosorbide mononitrate but advise the patient to take this medication in the evening.B. Advise continuation of isosorbide mononitrate twice daily for full 24-hour coverage of anginal symptoms.C. Switch to isosorbide dinitrate, as this has a longer duration of action than the mononitrate.D. Switch to nitroglycerin patch for consistent drug delivery and advise him to wear the patch around the clock.
A. Continue once-daily administration of isosorbide mononitrate but advise the patient to take this medication in the evening.
194
Which of the P2Y12 ADP receptor antagonists reversibly binds the receptor?A. Clopidogrel. B. Prasugrel. C. Ticagrelor. D. Ticlopidine.
C. Ticagrelor.
195
A 70-year-old female is diagnosed with nonvalvular atrial fibrillation. Her past medical history is significant for chronic kidney disease, and her renal function is moderately diminished. All of the following anticoagulants would be expected to require a reduced dosage in this patient except:A. Apixaban.B. Dabigatran. C. Rivaroxaban. D. Warfarin.
D. Warfarin.
196
An 80-year-old male is taking warfarin indefinitely for the prevention of deep venous thrombosis. He is a compliant patient with a stable INR and has no issues with bleeding or bruising. He is diagnosed with a urinary tract infection and is prescribed sulfamethoxazole/ trimethoprim. What effect will this have on his warfarin therapy?A. Sulfamethoxazole/trimethoprim will decrease the anticoagulant effect of warfarin.B. Sulfamethoxazole/trimethoprim will increase the anticoagulant effect of warfarin.C. Sulfamethoxazole/trimethoprim will activate platelet activity.D. Sulfamethoxazole/trimethoprim will not change anticoagulation status.
B. Sulfamethoxazole/trimethoprim will increase the anticoagulant effect of warfarin.
197
In which disease state is cilostazol contraindicated?A. Peripheral arterial disease.B. Gout.C. Heart failure with reduced ejection fraction. D. Osteoporosis.
C. Heart failure with reduced ejection fraction.
198
Which must heparin bind to in order to exert its anticoagulant effect?A. GP IIb/IIIa receptor. B. Thrombin.C. Antithrombin III.D. von Willebrand factor.
C. Antithrombin III.
199
Which is considered “fibrin selective” because it rapidly activates plasminogen that is bound to fibrin?A. Alteplase.B. Fondaparinux. C. Streptokinase. D. Urokinase.
A. Alteplase.
200
A 56-year-old man presents to the emergency room with complaints of swelling, redness, and pain in his right leg. The patient is diagnosed with acute DVT and requires treatment with an anticoagulant. All of the following are approved for treatment of this patient’s DVT except:A. Rivaroxaban. B. Dabigatran. C. Enoxaparin. D. Heparin.
B. Dabigatran.
201
Which is most appropriate for reversing the anticoagulant effects of heparin?A. Aminocaproic acid. B. Protamine sulfate. C. Vitamin K1D. Tranexamic acid.
B. Protamine sulfate.
202
A 62 year old male taking warfarin for stroke prevention in atrial fibrillation presents to his primary care physician with an elevated INR of 10.5 without bleeding. He is instructed to hold his warfarin dose and given 2.5 mg of oral vitamin K1. When would the effects of vitamin K on the INR most likely be noted in this patient?A. 1 hour. B. 6 hours. C. 24 hours. D. 72 hours.
C. 24 hours.
203
A 58-year-old man receives intravenous alteplase treatment for acute stroke. Five minutes following completion of alteplase infusion, he develops orolingual angioedema. Which of the following drugs may have increased the risk of developing orolingual angioedema in this patient?A. ACE inhibitor.B. GP IIb/IIIa receptor antagonist. C. Phosphodiesterase inhibitor. D. Thiazide diuretic.
A. ACE inhibitor.
204
Which one of the following is the most common side effect of antihyperlipidemic drug therapy?A. Elevated blood pressure.B. Gastrointestinal disturbance. C. Neurologic problems.D. Heart palpitations.E. Migraine headaches.
B. Gastrointestinal disturbance.
205
Which one of the following hyperlipidemias is characterized by elevated plasma levels of chylomicrons and has no drug therapy available to lower the plasma lipoprotein levels?A. Type I. B. Type II. C. Type III. D. Type IV. E. Type V.
A. Type I.
206
Which one of the following drugs decreases cholesterol synthesis by inhibiting the enzyme 3-hydroxy-3- methylglutaryl coenzyme A reductase?A. Fenofibrate.B. Niacin.C. Cholestyramine. D. Lovastatin.E. Gemfibrozil.
D. Lovastatin.
207
Which one of the following drugs causes a decrease in liver triglyceride synthesis by limiting available free fatty acids needed as building blocks for this pathway?A. Niacin.B. Fenofibrate.C. Cholestyramine. D. Gemfibrozil.E. Lovastatin.
A. Niacin.
208
Which one of the following drugs binds bile acids in the intestine, thus preventing their return to the liver via the enterohepatic circulation?A. Niacin.B. Fenofibrate.C. Cholestyramine. D. Fluvastatin.E. Lovastatin.
C. Cholestyramine.
209
JS is a 65-year-old man who presents to his physician for management of hyperlipidemia. His most recent lipid panel reveals an LDL cholesterol level of 165 mg/ dL. His physician wishes to begin treatment to lower his LDL cholesterol levels. Which of the following therapies is the best option to lower JS’s LDL cholesterol levels?A. Fenofibrate. B. Colesevelam. C. Niacin.D. Simvastatin. E. Ezetimibe.
D. Simvastatin.
210
WW is a 62-year-old female with hyperlipidemia and hypothyroidism. Her current medications include cholestyramine and levothyroxine (thyroid hormone). What advice would you give to WW to avoid a drug interaction between her cholestyramine and levothyroxine?A. Stop taking the levothyroxine as it can interact with cholestyramine.B. Take levothyroxine 1 hour before cholestyramine on an empty stomach.C. Switch cholestyramine to colesevelam as this will eliminate the interaction.D. Switch cholestyramine to colestipol as this will eliminate the interaction.E. Take levothyroxine and cholestyramine at the same time to minimize the interaction.
B. Take levothyroxine 1 hour before cholestyramine on an empty stomach.
211
AJ is a 42-year-old man who was started on niacin sustained-release tablets 2 weeks ago for elevated triglycerides and low HDL levels. He is complaining of an uncomfortable flushing and itchy feeling that he thinks is related to the niacin. Which of the following options can help AJ manage this adverse effect of niacin therapy?A. Administer aspirin 30 minutes prior to taking niacin.B. Administer aspirin 30 minutes after taking niacin.C. Increase the dose of niacin SR to 1000 mg.D. Continue the current dose of niacin.E. Change the sustained-release niacin toimmediate-release niacin.
A. Administer aspirin 30 minutes prior to taking niacin.
212
CN is a 72 year old male who is treated for hyperlipidemia with high-dose atorvastatin for the past 6 months. He also has a history of renal insufficiency. His most recent lipid panel shows an LDL cholesterol level of 131 mg/dL, triglycerides of 510 mg/dL, and HDL cholesterol of 32 mg/dL. His physician wishes to add an additional agent for his hyperlipidemia. Which of the following choices is the best option to address CN’s dyslipidemia?A. Fenofibrate. B. Niacin.C. Colesevelam. D. Gemfibrozil. E. Ezetimibe.
B. Niacin.
213
Which of the following patient populations is more likely to experience myalgia (muscle pain) or myopathy with use of HMG CoA reductase inhibitors?A. Patients with diabetes mellitus.B. Patients with renal insufficiency.C. Patients with gout.D. Patients with hypertriglyceridemia.E. Patients taking warfarin (blood thinner).
B. Patients with renal insufficiency.
214
An elderly patient with a history of heart disease is brought to the emergency room with difficulty breathing. Examination reveals that she has pulmonary edema. Which treatment is indicated?A. Acetazolamide.B. Chlorthalidone.C. Furosemide.D. Hydrochlorothiazide. E. Spironolactone.
C. Furosemide.
215
A group of college students is planning a mountain climbing trip to the Andes. Which would be appropriate for them to take to prevent mountain sickness?A. A thiazide diuretic such as hydrochlorothiazide.B. An anticholinergic such as atropine.C. A carbonic anhydrase inhibitor such asacetazolamide.D. A loop diuretic such as furosemide.E. A β-blocker such as metoprolol.
C. A carbonic anhydrase inhibitor such asacetazolamide.
216
An alcoholic male has developed hepatic cirrhosis. To control the ascites and edema, which should be prescribed?A. Acetazolamide.B. Chlorthalidone.C. Furosemide.D. Hydrochlorothiazide. E. Spironolactone.
E. Spironolactone.
217
A 55-year-old male with kidney stones has been placed on a diuretic to decrease calcium excretion. However, after a few weeks, he develops an attack of gout. Which diuretic was he taking?A. Furosemide.B. Hydrochlorothiazide. C. Spironolactone.D. Triamterene.E. Urea.
B. Hydrochlorothiazide.
218
A 75-year-old woman with hypertension is being treated with a thiazide. Her blood pressure responds well and reads at 120/76 mm Hg. After several months on the medication, she complains of being tired and weak. An analysis of the blood indicates low values for which of the following?A. Calcium. B. Glucose. C. Potassium. D. Sodium.E. Uric acid.
C. Potassium.
219
What is the contraindicated in a patient with hyperkalemia?A. Acetazolamide. B. Chlorthalidone. C. Chlorothiazide. D. Ethacrynic acid. E. Spironolactone.
E. Spironolactone.
220
Which of the following should be avoided in a patient with a history of severe anaphylactic reaction to sulfa medications?A. Amiloride.B. Hydrochlorothiazide. C. Mannitol.D. Spironolactone.E. Triamterene.
B. Hydrochlorothiazide.
221
A male patient is placed on a new medication and notes that his breasts have become enlarged and tender to the touch. Which medication is he most likely taking?A. Chlorthalidone.B. Furosemide.C. Hydrochlorothiazide. D. Spironolactone.E. Triamterene.
D. Spironolactone.
222
A patient presents to the emergency department with an extreme headache. After a thorough workup, the attending physician concludes that the pain is due to increased intracranial pressure. Which diuretic would work best to reduce this pressure?A. Acetazolamide.B. Indapamide.C. Furosemide.D. Hydrochlorothiazide. E. Mannitol.
E. Mannitol.
223
Which diuretic has been shown to improve blood pressure in resistant hypertension or those already treated with three blood pressure medications including a thiazide or thiazide-like diuretic?A. Chlorthalidone. B. Indapamide.C. Furosemide.D. Mannitol.E. Spironolactone.
E. Spironolactone.
224
Which of the following statements is correct regarding insulin glargine?A. It is primarily used to control postprandial hyperglycemia.B. It is a “peakless” insulin.C. The prolonged duration of activity is due to slowdissociation from albumin.D. It should not be used in a regimen with insulin lisproor glulisine.E. It may be administered intravenously in emergencycases.
B. It is a “peakless” insulin.
225
DW is a patient with type 2 diabetes who has a blood glucose of 400 mg/dL today at his office visit. The physician would like to give some insulin to bring the glucose down before he leaves the office. Which of the following would lower the glucose in the quickest manner in DW?A. Insulin aspart. B. Insulin glargine. C. NPH insulin.D. Regular insulin.
A. Insulin aspart.
226
Which of the following classes of oral diabetes drugs is paired most appropriately with its primary mechanism of action?A. DPP-4 inhibitor—inhibits breakdown of complex carbohydrates.B. Glinide—increases insulin sensitivity.C. Sulfonylurea—increases insulin secretion.D. Thiazolidinedione—decreases hepaticgluconeogenesis.
C. Sulfonylurea—increases insulin secretion.
227
Which of the following statements is characteristic of metformin?A. Metformin is inappropriate for initial management of type 2 diabetes.B. Metformin decreases hepatic glucose production.C. Metformin undergoes significant metabolism via thecytochrome P450 system.D. Metformin should not be combined withsulfonylureas or insulin.E. Weight gain is a common adverse effect.
B. Metformin decreases hepatic glucose production.
228
Which of the following is the most appropriate initial oral agent for management of type 2 diabetes in patients with no other comorbid conditions?A. Glipizide.B. Insulin.C. Metformin. D. Pioglitazone.
C. Metformin.
229
A 64-year-old woman with a history of type 2 diabetes is diagnosed with heart failure. Which of the following medications would be a poor choice for controlling her diabetes?A. Exenatide. B. Glyburide. C. Nateglinide. D. Pioglitazone. E. Sitagliptin.
D. Pioglitazone.
230
KD is a 69-year-old male with type 2 diabetes and advanced chronic kidney disease. Which of the following diabetes medications is contraindicated in this patient?A. Glipizide.B. Insulin lispro. C. Metformin. D. Saxagliptin.
C. Metformin.
231
Which of the following drugs for diabetes would be LEAST likely to cause weight gain?A. Glimepiride.B. Liraglutide.C. Pioglitazone.D. Repaglinide.E. Insulin glulisine.
B. Liraglutide.
232
A patient with type 2 diabetes is taking metformin. The fasting glucose levels are in range, but the postprandial glucose is uncontrolled. All of the following drugs would be appropriate to add to metformin to target postprandial glucose except:A. Acarbose.B. Exenatide.C. Insulin aspart. D. Pramlintide.
D. Pramlintide.
233
Which of the following diabetes medications is most appropriately paired with an adverse effect associated with its use?A. Canagliflozin—lactic acidosis.B. Metformin—urinary tract infections. C. Nateglinide—heart failure.D. Liraglutide—pancreatitis.
D. Liraglutide—pancreatitis.
234
Which of the following zones of the adrenal gland is correctly paired with the type of substance it secretes?A. Adrenal medulla—corticotropin. B. Zona fasciculata—cortisol.C. Zona glomerulosa—androgens. D. Zona reticularis—catecholamines.
B. Zona fasciculata—cortisol.
235
Corticosteroids are useful in the treatment of all of the following disorders except:A. Addison disease.B. Allergic rhinitis.C. Cushing syndrome.D. Inflammatory bowel disease. E. Rheumatoid arthritis.
C. Cushing syndrome.
236
All of the following adverse effects commonly occur with glucocorticoid therapy except:A. Glaucoma.B. Increased risk of infection. C. Hypotension.D. Emotional disturbances. E. Peripheral edema.
C. Hypotension.
237
Osteoporosis is a major adverse effect caused by the glucocorticoids. It is due to their ability to:A. Increase the excretion of calcium.B. Inhibit absorption of calcium.C. Stimulate the hypothalamic–pituitary–adrenal axis.D. Decrease production of prostaglandins.E. Decrease collagen synthesis.
B. Inhibit absorption of calcium.
238
A child with severe asthma is being treated with high doses of inhaled corticosteroids. Which of the following adverse effects is of particular concern?A. Hypoglycemia.B. Hirsutism.C. Growth suppression. D. Cushing syndrome. E. Cataract formation.
C. Growth suppression.
239
The diagnosis of congenital adrenal hyperplasia (CAH) is confirmed in a child. This condition can be effectively treated by:A. Administering a glucocorticoid.B. Administering an androgen antagonist.C. Administering ketoconazole to decrease cortisolsynthesis.D. Removing the adrenal gland surgically.E. Administering adrenocorticotropic hormone.
A. Administering a glucocorticoid.
240
A patient with Addison disease is being treated with hydrocortisone but is still having problems with dehydration and hyponatremia. Which of the following drugs would be best to add to the patient’s therapy?A. Dexamethasone. B. Fludrocortisone. C. Prednisone.D. Triamcinolone.
B. Fludrocortisone.
241
All of the following are strategies to minimize the development of HPA axis suppression with corticosteroid therapy except:A. Alternate-day administration of therapy.B. Administration via topical or inhalation routes whenpossible.C. Using the lowest dose of corticosteroid thatadequately controls symptoms.D. Administration of two-thirds of the daily dose in themorning and one-third in the afternoon.
D. Administration of two-thirds of the daily dose in themorning and one-third in the afternoon.
242
Which of the following patients would most likely have suppression of the HPA axis and require a slow taper of corticosteroid therapy?A. A patient taking 40 mg of prednisone daily for 7 days to treat an asthma exacerbation.B. A patient taking 10 mg of prednisone daily for 3 months for rheumatoid arthritis.C. A patient using mometasone nasal spray daily for 6 months for allergic rhinitis.D. A patient receiving an intra-articular injection of methylprednisolone for osteoarthritis.
B. A patient taking 10 mg of prednisone daily for 3 months for rheumatoid arthritis.
243
Which of the following corticosteroids is most appropriate to administer to a woman in preterm labor to accelerate fetal lung maturation?A. Betamethasone. B. Fludrocortisone. C. Hydrocortisone. D. Prednisone.
A. Betamethasone.
244
A 53-year-old woman has severe vasomotor symptoms (hot flushes) associated with menopause. She has no pertinent past medical or surgical history. Which of the following would be most appropriate for her symptoms?A. Conjugated estrogens vaginal cream.B. Estradiol transdermal patch.C. Oral estradiol and medroxyprogesterone acetate. D. Injectable medroxyprogesterone acetate
C. Oral estradiol and medroxyprogesterone acetate.
245
A 70-year-old woman is being treated with raloxifene for osteoporosis. Which of the following is a concern with this therapy?A. Breast cancer.B. Endometrial cancer. C. Venous thrombosis. D. Hypercholesterolemia.
C. Venous thrombosis.
246
Which of the following is the most appropriate oral contraceptive for a patient with moderate acne?A. Ethinyl estradiol/levonorgestrel.B. Ethinyl estradiol/norethindrone acetate. C. Ethinyl estradiol/norgestimate.D. Ulipristal.
C. Ethinyl estradiol/norgestimate.
247
A 26-year-old female is using injectable medroxy- progesterone acetate as a method of contraception. Which of the following adverse effects is a concern if she wishes to use this therapy long-term?A. Hyperkalemia.B. Male pattern baldness. C. Osteoporosis.D. Weight loss.
C. Osteoporosis.
248
All the following drugs maybe beneficial in the patients with arcomegaly except:A. LanreotideB. OctreotideC. PegvisomantD. Somatropin
D. Somatropin
249
A 40 year old female is undergoing infertility treatments. Which of the ff. drugs might be included in her treatment regimen?A. CabergolineB. FollitropinC. MethimazoleD. Vasopressin
B. Follitropin
250
Which of the ff. is the treatment of choice for hypothyroidism?A. IodineB. LevothyroxineC. LiothyronineD. LiotrixE. Propylthiouracil
B. Levothyroxine
251
```
A 64-year-old male presents with mild to moderate musculoskeletal back pain after playing golf. He states he has tried acetaminophen and that it did not help. His past medical history includes diabetes, hypertension, hyperlipidemia, gastric ulcer (resolved), and coronary artery disease. Which of the following is the most appropriate NSAID regimen to treat this patient’s pain?
A. Celecoxib.
B. Indomethacin and omeprazole.
C. Naproxen and omeprazole.
D. Naproxen.
```
C. Naproxen and omeprazole.
252
```
Which of the following correctly represents the mecha- nism of action of tofacitinib in the treatment of RA?
A. TNF-α inhibitor.
B. Inhibitor of Janus kinases.
C. IL-6 receptor blocker.
D. Dihydrofolate reductase inhibitor.
```
B. Inhibitor of Janus kinases.
253
```
A 64-year-old male presents with signs and symptoms of an acute gouty flare. His doctor wishes to treat him accordingly to improve his symptoms. Which of the following strategies would be the LEAST likely to acutely improve his gout symptoms and pain?
A. Naproxen.
B. Colchicine.
C. Probenecid.
D. Prednisone.
```
C. Probenecid
254
```
Which of the following drugs for headache is contra- indicated in patients with peripheral vascular disease?
A. Ergotamine.
B. Aspirin.
C. Acetaminophen.
D. Naproxen
E. Ibuprofen.
```
A. Ergotamine.
255
```
A 24-year-old pregnant female presents to the urgent care clinic with fever, frequency, and urgency. She is diagnosed with a urinary tract infection (UTI). Based on potential harm to the fetus, which of the following medications should be avoided in treating her UTI?
A. Nitrofurantoin.
B. Amoxicillin.
C. Cephalexin.
D. Tobramycin.
```
D. Tobramycin.
256
Which of the following is the primary method of β-lactam resistance with Streptococcus pneumoniae?
A. Modification of target site.
B. Decreased drug levels due to changes in
permeability.
C. Decreased drug levels due to an efflux pump.
D. Enzymatic inactivation.
A. Modification of target site.
257
```
Which of the following agents is considered a narrow- spectrum antibiotic?
A. Ceftriaxone.
B. Ciprofloxacin.
C. Isoniazid.
D. Imipenem.
```
C. Isoniazid.
258
```
Which of the following antibiotics exhibits concentration- dependent killing?
A. Clindamycin.
B. Linezolid.
C. Vancomycin.
D. Daptomycin.
```
D. Daptomycin.
259
```
Which of the following antibiotics exhibits a long post- antibiotic effect that permits once-daily dosing?
A. Gentamicin.
B. Penicillin G.
C. Vancomycin.
D. Aztreonam.
```
A. Gentamicin.
260
```
A 58-year-old male with a history of hepatitis C, cirrhosis, and ascites presents with spontaneous bacterial peritonitis. Which of the following antibiotics requires close monitoring and dosing adjustment in this patient given his liver disease?
A. Penicillin G.
B. Tobramycin.
C. Erythromycin.
D. Vancomycin.
```
C. Erythromycin.
261
```
Which of the following antibiotics is considered safe to use in neonates?
A. Chloramphenicol.
B. Sulfamethoxazole/trimethoprim.
C. Tetracycline.
D. Penicillin G.
```
D. Penicillin G.
262
All of the following factors influence the penetration and concentration of an antibacterial agent in the cerebrospinal fluid except:
A. Lipid solubility of the drug.
B. Minimum inhibitory concentration of the drug. C. Protein binding of the drug.
D. Molecular weight of the drug.
B. Minimum inhibitory concentration of the drug.
263
A 72-year-old male presents with fever, cough, malaise, and shortness of breath. His chest x-ray shows bilateral infiltrates consistent with pneumonia. Bronchial wash cultures reveal Pseudomonas aeruginosa sensitive to cefepime. Which of the following is the best dosing scheme for cefepime based on the drug’s time- dependent bactericidal activity?
A. 1 g every 6 hours given over 30 minutes.
B. 2 g every 12 hours given over 3 hours.
C. 4 g every 24 hours given over 30 minutes.
D. 4 g given as continuous infusion over 24 hours.
D. 4 g given as continuous infusion over 24 hours.
264
Which of the following adverse drug reactions precludes a patient from being rechallenged with that drug in the future?
A. Itching/rash from penicillin.
B. Stevens-Johnson syndrome from
sulfamethoxazole–trimethoprim.
C. Gastrointestinal (GI) upset from clarithromycin.
D. Clostridium difficile superinfection from
moxifloxacin.
B. Stevens-Johnson syndrome from
| sulfamethoxazole–trimethoprim.
265
```
A 45-year-old male presented to the hospital 3 days ago with severe cellulitis and a large abscess on his left leg. Incision and drainage were performed on the abscess, and cultures revealed methicillin-resistant Staphylococcus aureus. Which of the following would be the most appropriate treatment option for once- daily outpatient intravenous therapy?
A. Ertapenem.
B. Ceftaroline.
C. Daptomycin.
D. Piperacillin/tazobactam.
```
C. Daptomycin.
266
Which of the following adverse effects is associated with daptomycin?
A. Ototoxicity.
B. Red man syndrome. C. QTc prolongation.
D. Rhabdomyolysis.
D. Rhabdomyolysis.
267
A 72-year-old male is admitted to the hospital from a nursing home with severe pneumonia. He was recently discharged from the hospital 1 week ago after open heart surgery. The patient has no known allergies. Which of the following regimens is most appropriate for empiric coverage of methicillin- resistant Staphylococcus aureus and Pseudomonas aeruginosa in this patient?
A. Vancomycin + cefepime + ciprofloxacin. B. Vancomycin + cefazolin + ciprofloxacin. C. Telavancin + cefepime + ciprofloxacin. D. Daptomycin + cefepime + ciprofloxacin.
A. Vancomycin + cefepime + ciprofloxacin.
268
A 23-year-old male presents with acute appendicitis that ruptures shortly after admission. He is taken to the operating room for surgery, and postsurgical cultures reveal Escherichia coli and Bacteroides fragilis, susceptibilities pending. Which of the following provides adequate empiric coverage of these two pathogens?
A. Cefepime.
B. Piperacillin/tazobactam. C. Aztreonam.
D. Ceftaroline.
B. Piperacillin/tazobactam.
269
```
A 68-year-old male presents from a nursing home with fever, increased urinary frequency and urgency, and mental status changes. He has a penicillin allergy of anaphylaxis. Which of the following β-lactams is the most appropriate choice for gram-negative coverage of this patient’s urinary tract infection?
A. Cefepime.
B. Ertapenem.
C. Aztreonam.
D. Ceftaroline.
```
C. Aztreonam.
270
A 25-year-old male presents to the urgent care center with a painless sore on his genitals that started 1 to 2 weeks ago. He reports unprotected sex with a new partner about a month ago. A blood test confirms the patient has Treponema pallidum. Which of the following is the drug of choice for the treatment of this patient’s infection as a single dose?
A. Benzathine penicillin G. B. Ceftriaxone.
C. Aztreonam.
D. Vancomycin.
A. Benzathine penicillin
271
```
A 20-year-old female presents to the emergency room with headache, stiff neck, and fever for 2 days and is diagnosed with meningitis. Which of the following agents is the best choice for the treatment of meningitis in this patient?
A. Cefazolin.
B. Cefdinir.
C. Cefotaxime.
D. Cefuroxime axetil.
```
C. Cefotaxime.
272
```
Which of the following cephalosporins has activity against gram-negative anaerobic pathogens like Bacteroides fragilis?
A. Cefoxitin.
B. Cefepime.
C. Ceftriaxone.
D. Cefazolin.
```
A. Cefoxitin.
273
In which of the following cases would it be appropriate to use telavancin?
A. A 29-year-old pregnant female with ventilator- associated pneumonia.
B. A 76-year-old male with hospital-acquired pneumonia also receiving amiodarone for atrial fibrillation.
C. A 36-year-old male with cellulitis and abscess growing MRSA.
D. A 72-year-old female with a diabetic foot infection growing MRSA who has moderate renal dysfunction.
C. A 36-year-old male with cellulitis and abscess growing MRSA.
274
```
An 18-year-old female presents to the urgent care clinic with urinary frequency, urgency, and fever for the past 3 days. Based on symptoms and a urinalysis, she is diagnosed with a urinary tract infection. Cultures reveal Enterococcus faecalis that is pan sensitive. Which of the following is an appropriate oral option to treat the urinary tract infection in this patient?
A. Cephalexin.
B. Vancomycin.
C. Cefdinir.
D. Amoxicillin.
```
D. Amoxicillin.
275
```
A 43-year-old heavy machine operator complains of seasonal allergies. Which one of the following medi- cations would be most appropriate for management of his allergy symptoms?
A. Cyclizine.
B. Doxylamine.
C. Hydroxyzine.
D. Fexofenadine.
```
A. Cyclizine.
276
Which one of the following statements concerning
H antihistamines is correct? 1
A. Second-generation H1 antihistamines are relatively free of adverse effects.
B. Because of established long-term safety of first generation H1 antihistamines, they are the first choice for allergic rhinitis
C.The motor coordination involved in driving an
automobile is not affected by the use of first-
generation H1 antihistamines.
D. H1 antihistamines can be used in the treatment of
acute anaphylaxis.
E. Both first- and second-generation
H1 antihistamines readily penetrate the blood– brain barrier.
A. Second-generation H1 antihistamines are relatively free of adverse effects.
277
```
Which of the following medications has the most potential to significantly impair the ability to drive an automobile?
A. Diphenhydramine.
B. Levocetirizine.
C. Fexofenadine.
D. Ranitidine.
```
A. Diphenhydramine.
278
```
Which of the following histamine receptor antagonists is known to enter the central nervous system readily and is known to be sedative?
A. Hydroxyzine.
B. Cetirizine.
C. Desloratadine.
D. Loratadine.
E. Fexofenadine.
```
A. Hydroxyzine.
279
Which of the following statements about histamine receptor antagonists is MOST ACCURATE?
A. Most antihistamines have no antimuscarinic effects.
B. α-Adrenergic effects of antihistamines may cause
hypertension.
C. First-generation antihistamines have no sedative
side effects.
D. Because of their cholinergic properties,
antihistamines may not be effective in the relief of
vertigo associated with motion sickness.
E. Headache may be associated with some second-generation antihistamines.
E. Headache may be associated with some second-generation antihistamines.
280
```
A passenger sitting next to you in a plane boasts that he was a famous biochemist. He said he carboxylated a sedating antihistamine, and it is now only partially sedating and is a very well-known drug in the market. Which drug is he talking about?
A. Hydroxyzine.
B. Cetirizine.
C. Diphenhydramine.
D. Doxylamine.
E. Cyproheptadine.
```
B. Cetirizine.
281
```
Which of the following is an H1-receptor antagonist that also has serotonin receptor antagonism on the appetite center with the ability to stimulate appetite?
A. Hydroxyzine.
B. Loratadine.
C. Diphenhydramine.
D. Cetirizine.
E. Cyproheptadine.
```
E. Cyproheptadine.
282
```
Your neighbor said she used an H1 antihistamine that was available over-the-counter (OTC), and it caused her marked drowsiness and dry mouth and she slept quite longer than usual. Which is the most possible drug that she used?
A. Loratadine.
B. Levocetirizine.
C. Diphenhydramine.
D. Fexofenadine.
E. Desloratadine.
```
C. Diphenhydramine.
283
A patient is going on a deep sea fishing trip and is worried about motion sickness. Which of the following would be the most appropriate?
A. Dimenhydrinate 1 hour prior to departure.
B. Desloratadine 1 hour prior to departure.
C. Doxylamine 1 hour prior to departure.
D. Meclizine at onset of symptoms.
A. Dimenhydrinate 1 hour prior to departure.
284
```
A patient has a severe ear infection that is associated with significant vertigo. Which of the following might be helpful?
A. Azelastine.
B. Brompheniramine.
C. Meclizine.
D. Olopatadine.
```
C. Meclizine.
285
```
A 12-year-old girl with a childhood history of asthma complained of cough, dyspnea, and wheezing after visiting a riding stable. Her symptoms became so severe that her parents brought her to the emergency room. Which of the following is the most appropriate drug to rapidly reverse her bronchoconstriction?
A. Inhaled fluticasone.
B. Inhaled beclomethasone.
C. Inhaled albuterol.
D. Intravenous propranolol.
E. Oral theophylline.
```
C. Inhaled albuterol.
286
```
A 9-year-old girl has severe asthma, which required three hospitalizations in the last year. She is now receiving therapy that has greatly reduced the frequency of these severe attacks. Which of the following therapies is most likely responsible for this benefit?
A. Inhaled albuterol.
B. Inhaled ipratropium.
C. Inhaled fluticasone.
D. Oral theophylline.
E. Oral zafirlukast.
```
C. Inhaled fluticasone.
287
```
A 68-year-old male has COPD with moderate airway obstruction. Despite using salmeterol twice daily as prescribed, he reports continued symptoms of shortness of breath with mild exertion. Which one of the following agents would be an appropriate addition to his current therapy?
A. Systemic corticosteroids.
B. Albuterol.
C. Tiotropium.
D. Roflumilast.
E. Theophylline.
```
B. Albuterol.
288
A 58-year-old female ceramics worker with a COPD exacerbation has recently been discharged from the hospital. This is the third hospitalization in the past year for this condition, although the patient reports only mild symptoms in between exacerbations. The patient is currently still on the same drug regimen prior to her admission of salmeterol inhalation twice daily and tiotropium inhalation once daily. Her current FEV1 is below 60%. Which of the following would be an appropriate change in her medication regimen?
A. Chronic systemic corticosteroids.
B. Discontinue the tiotropium.
C. Discontinue the salmeterol.
D. Change the salmeterol to a combination product that
includes both a LABA and an inhaled corticosteroid
(for example, salmeterol/fluticasone DPI).
E. Theophylline.
D. Change the salmeterol to a combination product that
includes both a LABA and an inhaled corticosteroid
(for example, salmeterol/fluticasone DPI).
289
A 32-year-old male with a history of opioid addiction presents with symptoms of an upper respiratory system infection for the past 5 days. It is determined to be viral in nature, and no treatment of the underlying infection is appropriate. Which of the following is appropriate symptomatic treatment for this patient’s cough?
A. Guaifenesin/dextromethorphanB. Guaifenesin/codeine.
C. Cromolyn.
D. Benzonatate.
E. Montelukast.
B. Guaifenesin/codeine.
290
```
Due to its anti-inflammatory mechanism of action, which of the following medications requires regular administration for the treatment of asthma?
A. Tiotropium MDI.
B. Salmeterol DPI.
C. Mometasone DPI.
D. Albuterol MDI.
```
C. Mometasone DPI.
291
```
All of the following are preferred antihistamines for the management of allergic rhinitis except:
A. Chlorpheniramine.
B. Fexofenadine.
C. Loratadine.
D. Cetirizine.
E. Intranasal azelastine.
```
A. Chlorpheniramine.
292
```
Which of the following medications inhibits the action of 5-lipoxygenase and consequently the action of leukotriene B4 and the cysteinyl leukotrienes?
A. Cromolyn.
B. Zafirlukast.
C. Zileuton.
D. Montelukast.
E. Theophylline.
```
C. Zileuton.
293
Which of the following describes appropriate inhaler technique for a dry powder inhaler?
A. Inhale slowly and deeply just before and throughout actuation of the inhaler.
B. Use a large-volume chamber (spacer) to decrease deposition of drug in the mouth caused by improper inhaler technique.
C. Inhale quickly and deeply to optimize drug delivery to the lungs.
D. Rinse mouth in a “swish-and-spit” method with water prior to inhaler use to decrease the chance of adverse events.
C. Inhale quickly and deeply to optimize drug delivery to the lungs.
294
Which of the following categories of allergic rhinitis medications is most likely to be associated with rhinitis medicamentosa (rebound nasal congestion) with prolonged use?
A. Intranasal corticosteroid.
B. Intranasal decongestant.
C. Leukotriene antagonist. D. Oral antihistamine.
B. Intranasal decongestant.
295
```
All of the following are classifications of dietary deficiencies causing nutritional anemia except:
A. Vitamin B12 (cyanocobalamin).
B. Folic acid.
C. Vitamin D.
D. Iron.
```
C. Vitamin D.
296
```
Which of the following iron supplements contains the highest percentage of elemental iron?
A. Ferrous sulfate.
B. Carbonyl iron.
C. Ferrous gluconate.
D. Ferric ammonium citrate.
```
B. Carbonyl iron.
297
```
A 56-year-old female is discovered to have megaloblastic anemia. Her past medical history is significant for alcoholism. Which of the following would be the best treatment option for this patient?
A. Oral vitamin B12.
B. Parenteral vitamin B12.
C. Oral folate.
D. Oral vitamin B12 with oral folate.
```
D. Oral vitamin B12 with oral folate.
298
A 60-year-old female presents to her primary care physician complaining of dizziness and fatigue. Following laboratory testing, the patient is diagnosed with iron deficiency anemia, and oral iron supplementation is needed. Which of the following would be the most appropriate dosing regimen for the patient?
A. Ferrous fumarate 325 mg once daily.
B. Ferrous gluconate 256 mg once daily.
C. Polysaccharide–iron complex 150 mg two to three
times daily.
D. Ferrous sulfate 325 mg two to three times daily.
D. Ferrous sulfate 325 mg two to three times daily.
299
A 63-year-old female patient with anemia secondary to chronic kidney disease and a hemoglobin level of 8.6 g/dL is treated with epoetin alfa. Eight days after the initial dose of epoetin alfa, the patient’s hemoglobin is 11.3 mg/dL. Why is it appropriate to discontinue treatment with epoetin alfa?
A. Treatment goals of hemoglobin greater than
12 g/dL and a rise in hemoglobin of greater than 1 g/dL in a 2-week period are associated with cardiovascular events and decreased survival.
B. The patient has not responded to the epoetin alfa and therefore requires treatment with a different agent for her anemia.
C. Epoetin alfa is less effective than darbepoetin alfa, and treatment with epoetin alfa should be transitioned to darbepoetin to receive maximum benefit.
D. Epoetin alfa is not indicated for treatment of anemia secondary to chronic kidney disease.
A. Treatment goals of hemoglobin greater than
12 g/dL and a rise in hemoglobin of greater than 1 g/dL in a 2-week period are associated with cardiovascular events and decreased survival.
300
```
Which of the following might be beneficial to reduce the frequency of painful crises in a patient with sickle cell disease?
A. Epoetin alfa.
B. Filgrastim.
C. Hydroxyurea.
D. Sargramostim.
```
C. Hydroxyurea.
