review for block 3 finals

Question 1

What is the first line treatment for diabetes insipidus (DI) in a hypotensive patient?

Answer 1

Vasopressin

Desmopressin is the first line treatment for DI but vasopressin is used in hypotensive patients.

Question 2

What medication has an off-label use for PTSD nightmares and hypertension?

Answer 2

Prazosin

Question 3

What medication is given for suspected vasospastic angina?

Answer 3

CCB; Amlodipine

Amlodipine is a dihydropyridine that vasodilates without affecting heart rate.

Question 4

What can be given to acutely break paroxysmal supraventricular tachycardia (SVT)?

Answer 4

Adenosine delivered by rapid venous push

Monitor for asystole.

Question 5

What medication can be added to a patient with chronic systolic heart failure to decrease mortality?

Answer 5

Carvedilol or ER Metoprolol

Question 6

What medication can be given in the acute setting for symptomatic bradycardia?

Answer 6

Atropine

Atropine elevates heart rate.

Question 7

What antihypertensive is indicated for aortic dissection?

Answer 7

Labetalol or Metoprolol

These medications reduce wall stress on vessels.

Question 8

What is a safe centrally acting anti-hypertensive medication for a pregnant female?

Answer 8

Methyldopa

Question 9

What medication is recommended for a new diagnosis of hyperlipidemia?

Answer 9

Atorvastatin

Any statin is first line for hyperlipidemia.

Question 10

What medication for hypertension has a black box warning for pregnancy?

Answer 10

ACE inhibitors

Question 11

Which class of cholesterol medications has a warning for rhabdomyolysis?

Answer 11

Statins

Question 12

What medication is best for a 17-year-old with suspected cocaine use and high blood pressure?

Answer 12

CCB - Verapamil

Avoid beta-blockers.

Question 13

What medication is indicated for migraines and essential tremor?

Answer 13

Propranolol

Also used in patients with cirrhosis and portal hypertension.

Question 14

What medication is indicated to treat ventricular tachycardia in a post-cardiac arrest patient?

Answer 14

Procainamide

Indicated in life-threatening situations.

Question 15

What class of medications should be avoided for a patient with familial hypercholesterolemia trying to get pregnant?

Answer 15

Statins

Question 16

What medication is commonly prescribed for hypertension that can cause a persistent dry cough?

Answer 16

ACE inhibitor

Most common causes of chronic cough include post nasal drip and gastroesophageal reflux.

Question 17

What is the most potent class of diuretics for chronic systolic heart failure?

Answer 17

Loop diuretics

Question 18

What class of medication can be added to HCTZ for a patient with low potassium?

Answer 18

Potassium sparing diuretics (Spironolactone or Triamterene)

Combination of HCTZ and Triamterene is McGinnis choice.

Question 19

What type of calcium channel blocker affects both blood pressure and heart rate?

Answer 19

Nondihydropyridine CCB

Question 20

What antihypertensive medication can help both blood pressure and osteoporosis?

Answer 20

HCTZ

HCTZ causes calcium retention.

Question 21

How many days until INR will likely be therapeutic for a patient on warfarin?

Answer 21

5-7 days

Question 22

What is the reversal agent for a patient with INR >5 and no serious bleed?

Answer 22

Vitamin K

Question 23

What is the reversal agent for INR 5-10 with bleeding, but not life threatening?

Answer 23

FFP

Question 24

What is the reversal agent for INR >10 with life-threatening bleeding?

Answer 24

K centra

Question 25

What medication is used for CD20+ Lymphoma?

Answer 25

Rituximab

Question 26

How would you reverse heparin in a patient who received too much?

Answer 26

Protamine sulfate

Question 27

What chemotherapy agent for ALL has off-label use for inflammatory bowel disease?

Answer 27

6-mercaptopurine

Question 28

What medication would be used to treat a patient with large vessel occlusion if there are no contraindications?

Answer 28

tPA - alteplase

Question 29

What medication can be used for a patient with HIT Type II?

Answer 29

Argatroban

Question 30

What antiplatelet medication can be used for a patient with a myocardial infarction who is allergic to aspirin?

Answer 30

Clopidogrel

Question 31

What medication causes tinnitus or Reye’s syndrome?

Answer 31

Aspirin

Question 32

What reversal agent would you choose for a patient with INR 8.0 and stable hemodynamics?

Answer 32

FFP

Question 33

What is the treatment of choice for pernicious anemia?

Answer 33

Vit B12 IM

Question 34

What medication do oncologists want to give to a patient with leukemia that has a BB warning for cardiotoxicity?

Answer 34

Doxorubicin

Question 35

What medication can treat anemia of chronic disease in a patient with CKD?

Answer 35

Epoetin alfa

Question 36

What is the MOA of heparin?

Answer 36

Stops expansion of thrombi and prevents new thrombi; stabilizes existing thrombus.

Question 37

What medication should be used for post-op N/V that works at both peripheral and CNS serotonin receptors?

Answer 37

Ondansetron (Zofran)

Question 38

What anticholinergic can be prescribed for seasickness?

Answer 38

Scopolamine

Question 39

What mucosal medication is not systemically absorbed and coats gastric ulcers?

Answer 39

Sucralfate (Carafate)

Question 40

What medication should be avoided for treating gastritis in a childbearing age female?

Answer 40

Misoprostol

Question 41

What medication can be used for GERD if a patient cannot tolerate PPI?

Answer 41

H2 blocker like famotidine (Pepcid)

Question 42

What medication is associated with risks of kidney disease and bone fracture for duodenal ulcer treatment?

Answer 42

PPI

Question 43

What irreversibly inactivates the hydrogen/potassium ATPase enzyme?

Answer 43

PPI

Question 44

What antibiotic can be used as a substitute for amoxicillin in H. pylori triple therapy for a patient with penicillin allergy?

Answer 44

Metronidazole

Question 45

What OTC medication has a warning for the risk of sudden cardiac death?

Answer 45

Loperamide (Imodium)

Question 46

What OTC medication might a classmate taking for N/V with black stools likely be using?

Answer 46

Bismuth subsalicylate (Pepto bismol)

Question 47

What can you prescribe for short-term use only for post-op constipation?

Answer 47

Stimulant laxative - Bisacodyl

Question 48

What isotonic solution containing an osmotic laxative can be prescribed for a 45 year old patient undergoing screening colonoscopy?

Answer 48

Polyethylene glycol (OTC Miralax) or GoLytely

Question 49

What medication can be given to a 33 year old female with constipation predominant IBS whose MOA activates guanylate cyclase C?

Answer 49

Linaclotide (Linzess)

Question 50

What antispasmodic medication can be used for a 44 year old female with IBS and frequent abdominal cramping?

Answer 50

Dicyclomine (Bentyl) or hyoscyamine

Question 51

How would you deliver 5 aminosalicylic acid for a 25 year old patient recently diagnosed with Crohn's disease confined to the rectum?

Answer 51

Enema or suppository - deliver locally.

Question 52

What is a typical biologic used to treat Crohn's disease in a 26 year old patient switching from high dose steroids?

Answer 52

Adalimumab (Humira) ## Footnote BBW = infection and malignancy

Question 53

What medication would you start for a 68 year old man with melena and a history of esophageal varices and portal hypertension?

Answer 53

Octreotide and a proton pump inhibitor

Question 54

What medication did you start for a 37 year old female with DMT1 and gastroparesis that led to abnormal mouth movements?

Answer 54

Metoclopramide ## Footnote Risk of tardive dyskinesia when used long term, which is not reversible in many cases.

Question 55

Why should chlorpromazine or metoclopramide not be used in an 86 year old patient with significant N/V?

Answer 55

Beer’s criteria (high risk in elderly patients)

Question 56

How do we treat constipation in a 10 year old with 7 days of constipation and 2 days of N/V?

Answer 56

Enema (Sodium Phosphate Rectal)

Question 57

What is the most common side effect of anticholinergic medications in a 63 year old female with overactive bladder?

Answer 57

Dry mouth (xerostomia) ## Footnote Older people could over hydrate themselves and present with hyponatremia.

Question 58

What medication is used to augment labor in a 24 year old woman in labor with her first child?

Answer 58

Oxytocin (Pitocin)

Question 59

What medication was given for overactive bladder in a 73 year old on HCTZ who developed a gastric ulcer?

Answer 59

Oxybutynin ## Footnote Caution when using with potassium supplement because it increases risk for gastric ulcers.

Question 60

What class of medication is contraindicated for a 56 year old male patient with ED who is prescribed tadalafil?

Answer 60

Alpha blockers

Question 61

What alternative medication can be prescribed for a 60 year old patient with ED who wants something longer lasting than sildenafil?

Answer 61

Tadalafil

Question 62

What class of medication can you prescribe to help a 57yo man with trouble maintaining an erection?

Answer 62

PDE-5 inhibitor

Question 63

How long will the effect of sildenafil last for a 60yo with ED?

Answer 63

3-5 hours ## Footnote Duration of action of sildenafil.

Question 64

What side effect should you warn a 63yo female patient about when prescribing OTC phenazopyridine for bladder spasms?

Answer 64

Red/orange urine

Question 65

What medication(s) are indicated for a 70yo female with overactive bladder after ruling out infection?

Answer 65

Oxybutynin or Tolterodine

Question 66

What typical medication for prostate cancer is a 66yo patient likely on?

Answer 66

Leuprolide (leopron)

Question 67

What is the initial effect of leuprolide based on its MOA?

Answer 67

LH-RH agonist initially increases testosterone but ultimate effect is to decrease testosterone

Question 68

What causes the flair of pain/worsening symptoms in a 25yo with endometriosis after her first injection of leuprolide?

Answer 68

Increase in gonadotropins prior to downregulation of LH-RH receptors, estrogen levels increase causing more pain

Question 69

What cholinergic agonist would you prescribe for a 63yo patient with urinary retention suspected to be neurogenic bladder?

Answer 69

Bethanechol

Question 70

What injectable medication for ED would you prescribe to a 64yo man who has not had adequate response to oral meds?

Answer 70

Alprostadil (Caverject)

Question 71

What class of antihypertensive causes profound hypotension when combined with PDE-5 inhibitors?

Answer 71

Alpha Blockers

Question 72

What uricosuric inhibitor would you start for a 52yo female patient with recurrent episodes of gout?

Answer 72

Probenecid; MOA is blocking tubular reabsorption of urate

Question 73

Why is it a bad choice to add buprenorphine to a patient on scheduled morphine?

Answer 73

Can precipitate a withdrawal syndrome ## Footnote Some receptors are populated by the partial when they are used to getting the full.

Question 74

What topical medication can you prescribe for a 75yo patient with advanced esophageal cancer who cannot swallow pills?

Answer 74

Fentanyl patch (comes in different strengths)

Question 75

Why can't patients be put on 2 biologic medications?

Answer 75

Due to increased risk of infection and immune suppression.

Question 76

What medication can be changed for a 40-year-old RA patient with refractory dyspepsia?

Answer 76

Change the NSAID to a more selective one; celecoxib (Celebrex).

Question 77

What is the drug of choice for moderate to severe RA?

Answer 77

Methotrexate.

Question 78

What should be added for a 54-year-old RA patient with disease progression on NSAIDs and methotrexate?

Answer 78

TNF inhibitors - etanercept.

Question 79

What is the best option to reduce symptoms quickly for a 33-year-old with first episode of gout?

Answer 79

Colchicine, indomethacin, or prednisone.

Question 80

What should be done besides starting urate lowering therapy for a 58-year-old with recurrent gout?

Answer 80

Prescribe NSAIDs or colchicine for acute gout flares that may still occur at the beginning of treatment. ## Footnote Do not start this treatment during an acute flare.

Question 81

What is the first line therapy for gout in a 58-year-old with normal urine output?

Answer 81

Allopurinol, a xanthine oxidase inhibitor.

Question 82

What is recommended before starting ibandronate for a 55-year-old female with osteoporosis?

Answer 82

Get a full dental exam. ## Footnote Ibandronate can cause jaw necrosis.

Question 83

What medication can reverse alprazolam in a patient presenting obtunded?

Answer 83

Flumazenil.

Question 84

Why did the patient become tachycardic and seize after flumazenil administration?

Answer 84

The patient has dependence on benzodiazepines, and the reversal stimulated abstinence, putting them into withdrawal.

Question 85

What medication has fewer opioid withdrawal symptoms and can be used in opioid dependence?

Answer 85

Methadone, due to its longer half-life.

Question 86

What should be done for an 18-year-old male who presents obtunded after one dose of naloxone?

Answer 86

Administer another dose of naloxone due to the short half-life.

Question 87

What parental NSAID should be chosen for a 49-year-old in ER with acute MSK pain?

Answer 87

Ketorolac.

Question 88

What should a patient with advanced liver disease take for a headache instead of acetaminophen?

Answer 88

Ibuprofen.

Question 89

What phenomenon causes a 74-year-old patient with advanced lung cancer to need higher doses of opioids?

Answer 89

Tolerance.

Question 90

What dose adjustment is needed for a post-op patient transitioning from IV to oral pain meds?

Answer 90

Increase dosage due to first-pass metabolism; oral medication has lower bioavailability than IV preparation.

Question 91

What NSAID should not be used long-term for a patient with acute MSK pain due to arthritis?

Answer 91

Ketorolac, only use for 3-5 days.

Question 92

What treatment can be prescribed for a 30-year-old with osteoarthritis and a history of gastritis?

Answer 92

Ibuprofen and PPI.

Question 93

What is a good medication to start in the outpatient setting for a patient with a history of DVT?

Answer 93

A DOAC, rivaroxaban or apixaban.