Exam 2

The majority of current guidelines recommend treatment decisions based on goals of antihypertensive therapy. How does current evidence based practice define hypertension?

Systolic blood pressure exceeds 130 mmHg or diastolic blood pressure exceeds 80 mmHg
Systolic blood pressure exceeds 140 mmHg or diastolic blood pressure exceeds 90 mmHg
Systolic blood pressure exceeds 160 mmHg or diastolic blood pressure exceeds 100 mmHg
Systolic blood pressure exceeds 120 mmHg or diastolic blood pressure exceeds 80 mmHg
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The majority of current guidelines recommend treatment decisions based on goals of antihypertensive therapy. How does current evidence based practice define hypertension?

Systolic blood pressure exceeds 130 mmHg or diastolic blood pressure exceeds 80 mmHg
Systolic blood pressure exceeds 140 mmHg or diastolic blood pressure exceeds 90 mmHg
Systolic blood pressure exceeds 160 mmHg or diastolic blood pressure exceeds 100 mmHg
Systolic blood pressure exceeds 120 mmHg or diastolic blood pressure exceeds 80 mmHg
Systolic blood pressure exceeds 130 mmHg or diastolic blood pressure exceeds 80 mmHg
What are the current evidence based recommendations for treating hypertension in patients with a past medical history of myocardial infarction?

Nonselective Beta Blockers and/or Nondihyrdropyridine Calcium Channel Blockers
Loop diuretics, alpha adrenergic antagonists and/or ACE-Inhibitors
Beta Blockers, ACE-Inhibitors or ARBs
Beta Blockers, ACE-Inhibitors or ARBs
JJ is a 68 yo WM, 5"11", 105 kg seen in clinic for annual examination. He has no complaints.
VS: 170/103; HR: 82; T=37 C; RR=20
PMH: gout; renal stones in 2003; osteoarthritis of R knee; Hypertension for 5 yearsPSH: no smoking; occasional ethanolMeds at home: Ibuprofen 800 mg prn pain; he reports taking about 7 - 10 doses a week.ROS: all WNL except tender R knee with braceLABS: Na = 140; K = 4; Cr = 1.2; Total Cholesterol = 250 mg/dL; LDL = 165 mg/dL; EKG: NSR with LVHWhat stage of hypertension does this patient have?

Stage one
Stage two
Stage three
Stage four
Stage five
Stage two
Which of the following antihypertensive agents are associated with rebound hypertension on abrupt discontinuation?

clonidine
amlodipine
hydrochlorothiazide
furosemide
chlorthalidone
clonidine
Mrs. Jones is taking and ACE inhibitor and was recently placed on spironolactone (Aldactone). After a week of therapy she starts to experience palpations and muscle weakness. What is the most likely cause of this?

hyponatremia
hypercalcemia
hyperkalemia
lactic acidosis
hyperkalemia
Select all of the following statements that apply to Niacin. Select all that apply.

Niacin can cause facial flushing.
Niacin has very little efficacy in lowering triglyceride levels.
Niacin should not be used in patients with uncontrolled diabetes.
Niacin is safe for patients with chronic liver disease.
Niacin may increase uric acid levels.
Niacin can cause facial flushing.
Niacin should not be used in patients with uncontrolled diabetes.
Niacin may increase uric acid levels.
A client taking a statin medication for 3 months calls complaining of muscle aches and pains. Which lab tests would BEST determine if this patient is experiencing myalgia, myopathy or rhabdomyolitis?

sed rate and c-reactive protein
Creatinine kinase and serum creatinine
alkaline phosphatase and bilirubin
AST and ALT
Creatinine kinase and serum creatinine
Which of the following statins would be the most appropriate choice for a patient on warfarin and rifampin?

rostuvostatin (Crestor)
atorvastatin (Lipitor)
simvustatin (Zocor)
pravastatin (Pravachol)
pravastatin (Pravachol)
For a patient who needs moderate intensity statin therapy and is taking a protease inhibitor, ketoconazole and amiodarone which of the following medications would be the most appropriate choice?

simvustatin (Zocor) 20 mg/ day
atorvastatin (Lipitor) 20 mg/day
rosuvastatin (Crestor) 80 mg/ day
pravastatin (Pravachol) 40 mg/ day
pravastatin (Pravachol) 40 mg/ day
What treatment would be the most appropriate first line agent for a patient with asymptomatic Class I heart failure and an ejection fraction of 38%?

hydralazine
spironolactone (Aldactone)
carvedilol (Coreg)
amlodipine (Norvasc)
lisinopril
lisinopril
Hedda is a 61 yo AAF, 5"4" & weighs 90 kg, seen in the Family Medicine clinic for a follow-up appointment. She reports some nasal congestion due to allergies.VS: BP= 145/92; P= 68; T=37 CPMH: CAD (MI in 2004); hypertension x 15 years; depression; renal insufficiency; peripheral vascular disease; osteoarthritis; hypothyroidismPSH: no smoking; no ethanolROS: WNL except 1+ edema in lower extremitiesMEDICATIONS AT HOME: ASA 81 mg daily; simvastatin 40 mg daily; ibuprofen 400 mg twice daily; sertraline 50 mg daily; levothyroxine 0.1 mg dailyLABS: all WNL except SCr = 2.8TESTS: Recent echocardiogram revealed an ejection fraction of 35%Which of the following dietary indiscretions would be most likely to contribute to an exacerbation of heart failure leading to hospitalization? too much fluid intake too much salt too much fat too much sugartoo much saltElvira is a 61 yo AAF, seen in the Family Medicine clinic for a follow-up appointment. She reports ongoing nasal congestion due to allergies. Her height is 5'4" and weighs 90 kg (BMI 34); VS: BP= 145/92; P= 68; T=37 C ; She has a medical history of CAD (MI in 2004); hypertension x 15 years; depression; renal insufficiency; peripheral vascular disease; osteoarthritis; hypothyroidism. She does not smoke or use ETOH. Her examination is WNL except for 1+ edema in both lower extremities. Medications at home include ASA 81 mg daily; simvastatin 40 mg daily; ibuprofen 400 mg twice daily; sertraline 50 mg daily; levothyroxine 0.1 mg daily. Her lab work today is all WNL except SCr = 2.8 Normal (0.5 to 1.0 mg/dL) for women. Her recent echocardiogram revealed an ejection fraction of 34% Hazzell is classified as having NYHA Class 1 heart failure. What medication is first line treatment for her heart failure? An ARB, a vasodilator, a loop diuretic and digoxin. A potassium-sparing diuretic, an ARB and a calcium channel blocker. An ACE inhibitor (or an ARB if she can not tolerate the ACE). Since she is only classified as a Class 1, no additional medications are required at this time. A thiazide diuretic and an ACE (or ARB)An ACE inhibitor (or an ARB if she can not tolerate the ACE).Which Calcium Channel Blocker can be used to treat cardiac dysrhythmias in addition to hypertension? Methylodopa (Aldomet) Diltiazem (Cardizem) Amlodipine (Norvasc) Procardia (Nifedipine)Diltiazem (Cardizem)Which of the following is an indication for antiplatelet therapy? Peripheral artery disease prevention Primary prevention of deep vein thrombosis Prevention of pulmonary emboli in persons with history of thromboemboli First line for stroke prevention for patients with atrial fibrillationPrimary prevention of deep vein thrombosisSmith a 65 yo with CKD and a eGFR < 30 ml/ min and is taking furosemide 20 mg qd, lisinopril 20 mg qd, careveilol 5 mg qd. He goes to an urgent care center with complaint of cough and fever. He is prescribed clarithromycin (Biaxin) for 10 days. The second day on the medication, he can't remember if he took his dose so he took another dose. His wife finds him on the floor and calls the EMTs. What most likely caused his death? ventricular fibrillation due to QT prolongation metabolic acidosis rapid drop in eGFR that led to acute heart failure caridac arrhythmia due to hyperkalemiaventricular fibrillation due to QT prolongationPaul is a 52 yo male being treated for an (anterior wall) STEMI. He received successful thrombolytic therapy and had several episodes of bradyarrhythmias during the first 24 hours. He has been in the hospital for 5 days and is scheduled to be discharged tomorrow. His medications include lisinopril 40mg daily, clopidogrel 75 mg daily, aspirin 75 mg daily, enoxaparin 75 mg SC BID. His vitals this morning were BP 132/87 mmHg, RR 18, and HR 72 bpm. Which of the following would you add to his therapy? Warfarin [Coumadin] as prophylaxis and treatment of venous thrombosis. Eplerenone [Inspra] to improve survival of stable patients with LV systolic dysfunction. Candesartan [Atacand] to help manage heart failure and left ventricular systolic dysfunction. Metoprolol [Lopressor] for prevention of MI and decrease his chance of mortality due to his recent MI.Metoprolol [Lopressor] for prevention of MI and decrease his chance of mortality due to his recent MI.Which of the following is not a characteristic of Nitroglycerin? Nitroglycerin promotes vasodilation (primarily of veins) and decreases venous return to the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin oral doses are subject to 1st pass effect. Nitroglycerin tolerance can develop rapidly and is irreversible.Nitroglycerin tolerance can develop rapidly and is irreversible.According to the Vaughan Williams Classification System, what is the primary mechanism of action of Amiodarone? Amiodarone is a sodium channel blocker that slows the depolarization in ventricular muscle fibers. Amiodarone is a potassium channel blocker resulting in prolonged action potential and refractory period in myocardial tissue. Amiodarone is a potassium channel agonist that increases and normalizes SA and AV note activity and promotes muscle fiber repolarization. Amiodarone is a sodium channel blocker which slows depolarization in the SA and AV node tissues.Amiodarone is a potassium channel blocker resulting in prolonged action potential and refractory period in myocardial tissue.When should digoxin be initiated in a patient with heart failure? never Stage A heart failure in combination with an ARB or ACE inhibitor Stage B heart failure with an ARB or ACE Inhibitor Stage A heart failure alone Stage C after maximum tolerated doses of an ARB or ACE inhibitor, diuretic, and beta-blocker are achievedStage C after maximum tolerated doses of an ARB or ACE inhibitor, diuretic, and beta-blocker are achievedWhich of the following are likely modes of transmission of the Human rhinovirus (HRV)? Select all that apply. Direct contact. Airborne transmission by small particles (droplets). Airborne transmission by large particles. Vector transmission.Direct contact. Airborne transmission by small particles (droplets). Airborne transmission by large particles.What are common risk factors for acute rhinosinusitis (ARS)? Select all that apply. Winter season; air pollution Septal deviation; nasal polyp Allergic rhinitis Tobacco smoke Gastroesophageal reflux AsthmaWinter season; air pollution Septal deviation; nasal polyp Allergic rhinitis Tobacco smoke Gastroesophageal reflux AsthmaWhich of the following therapies are used in the management of acute asthma exacerbation? inhaled bronchodilators systemic corticosteroids supplemental O2 all of the aboveall of the aboveInhaled bronchodilators have two main mechanisms of action. Which statement most accurately describes these? muscarinic antagonists and beta 2 agonists beta 1 antagonists and beta 2 agonists beta 2 agonist and nictotinic agonists nictonic antagonist and beta 2 antagonistmuscarinic antagonists and beta 2 agonistsWhich agent would be the MOST appropriate daily treatment for a patient with moderate persistent asthma? Foradil (fomotoral fumate) 1 puff BID Theo-dur (theophylline 200 mg BID) Singulair (montelukast) 10 mg qd Flovent Advair (fluticasone and salmeterol) BIDAdvair (fluticasone and salmeterol) BIDWhat are the causes of chronic bronchitis? Select all that apply. Viral infections. Colonization of the lower airways with bacteria such as H. influenzae, M. catarrhalis, and S. pneumoniae. Exposures to environmental pollution or unknown factors. The presence of gastroesophageal reflux and/or hypersecretion of mucus in patients with asthma. Tobacco smokeViral infections. Colonization of the lower airways with bacteria such as H. influenzae, M. catarrhalis, and S. pneumoniae. Exposures to environmental pollution or unknown factors. The presence of gastroesophageal reflux and/or hypersecretion of mucus in patients with asthma. Tobacco smokeSelect the characteristics of bronchitis. Select all that apply. Rhinovirus, coronavirus, influenza virus A and B, parainfluenza virus, adenovirus, and respiratory syncytial virus (RSV) are all common causes of viral bronchitis. Bordetella pertussis, Chlamydophila pneumoniae, and Mycoplasma pneumoniae are causes of bacterial bronchitis. Bacterial bronchitis occurs approximately 90% of the time and viral bronchitis occurs less than 10% of the time. Acute bronchitis are often preceded by manifestations of an upper respiratory tract infection. The hallmark of acute bronchitis is a cough is a initially dry and nonproductive that becomes more abundant and mucoid as the production of bronchial secretions increases.Rhinovirus, coronavirus, influenza virus A and B, parainfluenza virus, adenovirus, and respiratory syncytial virus (RSV) are all common causes of viral bronchitis. Bordetella pertussis, Chlamydophila pneumoniae, and Mycoplasma pneumoniae are causes of bacterial bronchitis. Acute bronchitis are often preceded by manifestations of an upper respiratory tract infection. The hallmark of acute bronchitis is a cough is a initially dry and nonproductive that becomes more abundant and mucoid as the production of bronchial secretions increases.Bronchitis should be treated with antibiotics that are appropriate for the bacteria causing the infection. For a bronchitis caused by Moraxella catarrhalis or H. influenzae which of the following is appropriate treatment? Amoxicillin-clavulanate [Augmentin], or a second or third generation cephalosporin. With H. influenzae as a possible cause the best medications would be oseltamivir [Tamiflu] or zanamivir [Relenza]. Macrolides such as erythromycin [Eryc], clarithromycin [Biaxin] or azithromycin [Zithromax], or doxycycline [Vibramycin]. Amoxicillin [Amoxil] is first line therapy and is sufficient for these organisms.Amoxicillin-clavulanate [Augmentin], or a second or third generation cephalosporin.Which of the following are indications for use of an antibiotic in bronchitis? Select all that apply. Concomitant (COPD) Respiratory symptoms for more than 4 to 6 days. High fevers and/or purulent sputum. Patients over 45 years of age.Concomitant (COPD) Respiratory symptoms for more than 4 to 6 days. High fevers and/or purulent sputum.Mabel is a 75 yo with COPD. She has repeated exacerbations and her FEV 1 is 42%. What stage of COPD is this consistant with? mild moderate severe very severesevereWhich of the following are characteristics of metered dose inhalers. Mark all that apply. Spacers are important to use with MDIs to increase the delivery of the drug to the lungs. Patients should rinse his mouth after using glucocorticoid (corticosteroid) inhalers to prevent oral candidiasis. MDIs are only useful for management of acute bronchospasms through their ability to deliver immediate bronchodilation to the bronchial passageways. Patients should generally wait at least one minute intervals between puffs when using MDIs.Spacers are important to use with MDIs to increase the delivery of the drug to the lungs. Patients should rinse his mouth after using glucocorticoid (corticosteroid) inhalers to prevent oral candidiasis. Patients should generally wait at least one minute intervals between puffs when using MDIs.Which of the following medications have a black box warning? Theophyilline Salmeteral (Servent) Albuterol Fluticasone (Flovent)Salmeteral (Servent)Clopidogrel (Plavix) is somewhat more effective in stroke prevention than aspirin but has a worse safety profile than aspirin with regard to GI bleeding and ulceration. True FalseFalseThe most common adverse effect of aspirin therapy, GI upset and GI bleeding, are not dose related and occur with the same frequency and severity in patients taking low doses as in those taking higher doses. True FalseFalseAngiotensin receptor blockers have a class effect in CHF (ie any ARB medication will have a positive effect) True FalseFalseMatch the class of drug you would want to AVOID with the pre-existing condition in a patient with hypertension. ACE inhibitors Non-dihydropyridines calcium channel blockers non-selective beta blockers 1.renal artery stenosis 2.asthma 3.congestive heart failure1 ACE inhibitors 3 Non-dihydropyridines calcium channel blockers 2 non-selective beta blockersStrains of the influenza virus can develop resistance to any antiviral medication. True FalseTrueMatch each blood pressure medication with the PRIMARY effect it elicits to decrease blood pressure. hydrochlorothiazide (Microzide) atenolol (Tenormin) spironolactone (Aldactone) amlodipine (Norvasc) 1. decreases peripheral vascular resistance 2.inhibits aldosterone secretion 3.decreases heart rate and strength of contractility 4.increases excretion of sodium and water4hydrochlorothiazide (Microzide) 3 atenolol (Tenormin) 2 spironolactone (Aldactone) 1 amlodipine (Norvasc)Select the characteristics of Carvedilol. Select all that apply. Carvedilol is contraindicated for patients with diabetes. Carvedilol has been shown to decrease mortality and morbidiy in persons with congestive heart failure. Carvedilol has duel beta blocking and alpha adrenegeric antagonist activity. Carvedilol acts by blocking calcium channels.Carvedilol has been shown to decrease mortality and morbidiy in persons with congestive heart failure. Carvedilol has duel beta blocking and alpha adrenegeric antagonist activity.For a patient with benign prostatic hypertrophy (BPH) as a comorbidity, what would be a good choice for an additional BP lowering agent if one was required? metoprolol (beta blocker) furosemide (loop diuretic) nifedipine (calcium channel blocker) prazosin (alpha antagonist)prazosin (alpha antagonist)What is the one difference between an ACE inhibitor and an Angiotension II Receptor Antagonist (ARB)? ARBs have an increased risk of causing angioedema compared with ACE inhibitors. ARBs are less likely to have the side effect of cough than ACE inhibitors ARBs can be used safely in pregnancy as opposed to ACE inhibitors ARBs are not recommended as substitutes for patients with heart failure that can't tolerate ACE inhibitorsARBs are less likely to have the side effect of cough than ACE inhibitorsAccording to evidence based practice which of the following medications are preferred first line treatment for HTN for an African American over the age of 18. ACE inhibitors or calcium channel blockers ACE inhibitors or beta blockers thiazide diuretics or calcium channel blockers Thiazide diuretics, ACE inhibitors or ARBsthiazide diuretics or calcium channel blockersWhich of the following may be side effects of ACE-Inhibitors? ACE inhibitors may cause decreased potassium and increased sodium retention. ACE inhibitors may cause gingival hyperplasia and cardiac arrhythmias. ACE inhibitors may cause sodium retention, rebound hypertension, and dry cough. ACE inhibitors may cause a dry cough, hyperglycemia and hypotension.ACE inhibitors may cause a dry cough, hyperglycemia and hypotension.You are prescribing a treatment plan for a patient with a total cholesterol of 160mg/dl, HDL 46mg/dl and LDL of 110mg/dl. Triglycerides are 278mg/dl. He is a smoker with a family history of heart disease. What should your initial treatment plan include? Niacin and simvastatin (Zocor) Therapeutic lifestyle changes and niacin Therapeutic lifestyle changes and Bile acid sequestrant Therapeutic lifestyle changes and ezetimibe (Zetia)Therapeutic lifestyle changes and niacinStuart is a 38 yo white male. His father and older brother have had MIs and are currently being treated for CVD and Hypertension. Stuart started taking a statin 8 weeks ago. He reports general muscle weakness and pain the last couple of days. Lab results show he has a serum creatinine of 1.1 mg/dl (normal 0.8 to 1.4 mg/dl) and a creatine kinase of 852 IU/L (normal = 10 to 70 IU/L ). His U/A is normal. What is the most appropriate thing to do? Explain that he has myopathy but if the symptoms are tolerable, it is safe to continue statin therapy and monitor continuation or progression of symptoms. Discontinue statin therapy and monitor him closely for continuation or progression of her symptoms. Consider restarting him on a lower dose of a statin medication or changing to another statin medication after his symptoms resolve Discontinue statin therapy and admit patient for rhabdomyolysis Decrease the statin dosage and monitor him closely for continuation or progression of her symptoms.Discontinue statin therapy and monitor him closely for continuation or progression of her symptoms. Consider restarting him on a lower dose of a statin medication or changing to another statin medication after his symptoms resolveStuart is a 38 yo white male. His father and older brother have had MIs and are currently being treated for CVD and Hypertension. Stuart's lipid profile reveals: Total cholesterol - 284 mg/dl, LDL - 176 mg/dl, HDL - 32 Triglycerides - 180 According to the updated ATP III guidelines, he falls into the high risk category. What is the target LDL for this patient? <200 mg/dl, He is within an acceptable range. <160 mg/dl <130 mg/dl <100 mg/dl<100 mg/dlJohn a 44 yo male has an LDL cholesterol of 196 mg/dl. According to the AHA/ACA guidelines, what is the recommended management plan if lifestyle changes have not been effective? Start him on moderate intensity statin therapy Start him on high intensity statin therapy Calculate his 10 year ASCVD and if > 7.5% start high intensity statin therapy More information about the patient is necessary to make a recommendationStart him on high intensity statin therapyAnti-platelet medications are most effective in preventing coagulation in areas of slow blood flow. True FalseFalseWhat is the role of digoxin in treating congestive heart failure? Digoxin decreases factors that contribute to cardiac remodeling. Digoxin can reduce hospitalizations in patients with advanced heart failure and can be used in symptomatic patients in Classes II - IV as indicated. Digoxin has been shown to decrease mortality in CHF and should be initiated early in treatment. Digoxin has not been found to provide any benefit in CHF and should be reserved for patients in end stage disease.Digoxin can reduce hospitalizations in patients with advanced heart failure and can be used in symptomatic patients in Classes II - IV as indicated.What treatment would be the most appropriate first line agent for a patient with Stage B heart failure and an ejection fraction of 38%? Carvedilol (Coreg) and lisinopril Spironolactone (Aldactone) and amlodipine (Norvasc) Hydralazine (Apresoline) Chlorothiadone and digoxin Amlodipine (Norvasc) and lasixCarvedilol (Coreg) and lisinoprilRandolph is a 45 yo male who has atrial flutter. A medical option for rate control is preferred for this patient. What would be the first choice for rate control in this patient? Propafenone Metoprolol Flecanide SotalolMetoprololWhich of the following would be the best strategy for monitoring a patient who has been prescribed sotalol (Sotalol AF, Betapace) for management of atrial fibrillation/flutter? Admit the patient to the hospital for monitoring while adjusting this drug Have the patient return to the office every day for 5 days for a 12 lead ECG Have the patient return to the office 2 hours his dose of Sotalol every morning for a 12 lead ECG, check BUN Cr. third day None of the aboveAdmit the patient to the hospital for monitoring while adjusting this drugTumos is on Clonidine 0.3 mg TID for his stage III hypertension. Which of the following are potential side effects of clonidine? Clonidine may result in cardiac irritability with tachycardia and palpitations. Clonidine may produce hyperactivity and insomnia in some patients. Clonidine may cause rebound hypertension from missing doses. Clonidine may result in peptic ulcer disease.Clonidine may cause rebound hypertension from missing doses.Which of the following medications often given with aldosterone antagonists have been shown to decrease mortality due to heart failure? acebutolol (Sectral) combined with ramipril (Altace) amlodipine (Norvasc) and losartan (Cozzar) hydralazine (Apresoline) combined with isosorbide dinitrate (Isordil) digoxin (Lanoxin) combined with captopril (Capoten)hydralazine (Apresoline) combined with isosorbide dinitrate (Isordil)Which of the following diuretics increases excretion of Ca+ and Mg+? lasix (furosemide) hydrochlorothiazide spinonolactone all of the abovelasix (furosemide)Justin is a 68 yo WM, 5"11", 105 kg, retired football player, seen in clinic for annual examination. He has no complaints.VS: 170/103; HR: 82; T=37 C; RR=20PMH: gout; renal stones in 2003; osteoarthritis of R knee; Hypertension for 5 yearsPSH: no smoking; occasional ethanolMeds at home: Ibuprofen 400 mg prn painROS: all WNL except tender R knee with braceLABS: Na = 140; K = 4; Cr = 1.2; Total cholesterol = 250 mg/dL; LDL = 165 mg/dL; EKG: NSR with LVHDoes he have any evidence of end organ damage due to his hypertension? Yes, decreased renal function Yes, elevated LDL Yes, cardiomegaly No, there is no evidence of damage due to his hypertension.Yes, cardiomegalyTraditional NSAIDs can increase blood pressure in hypertensive individuals because COX 1 and COX 2 inhibition results in a decrease in prostaglandins which inhibit the conversion of angiotensin I to angiotensin II They increase fluid retention They inhibit COX 1 which contributes to the regulation of vascular tone They can enhance platelet aggregation in certain individualsThey increase fluid retentionWhat are the hallmark symptoms of Acute Rhinosinusitis? Select all that apply. Cough in pediatric patients. Nasal congestion and discharge. Facial pain, headache or anosmia. Painful swallowing, cough, ear pressure, fever, and fatigue.Cough in pediatric patients. Nasal congestion and discharge. Facial pain, headache or anosmia.What is the most common cause of upper respiratory infections? Influenza virus Respiratory syncytial virus Rhinovirus CoronavirusRhinovirusMatch the medication with the best description of its action in treating respiratory disorders salmeterol montelukast ipatropium albuterol cromolyn sodium 1.a short acting beta 2 agonist 2.a long acting beta 2 agonist 3.a muscarinic antagonist 4.inhibit the activity of mast cells 5.leukotriene receptor antagonist2 salmeterol 5 montelukast 3 ipatropium 1 albuterol 4 cromolyn sodiumFluticasone exhibits which of the following properties? Fluticasone is indicated as a mono-therapy rescue inhaler for an acute asthma exacerbations. Fluticasone has a high first pass metabolism upon systemic absorption. Fluticasone has high oral bioavailability and a high affinity for glucocorticoid receptors. Fluticasone cream can be used as a topical alternative to the inhaled formulation.Fluticasone has high oral bioavailability and a high affinity for glucocorticoid receptors.An adult who is having asthma symptoms 3 times a week, is awakened at night with shortness of breath about every other week and has an FEV1 of 85% falls into which category of asthma severity? intermittant moderate persistant severe persistant mild persistantmild persistantA practitioner is selecting an antibiotic for a patient who has acute bronchitis caused by B. pertussis. What is the drug of choice? Oseltamivir or zanamivir Aminopenicillin (amoxicillin) Macrolide Amoxicillin + clavulanateMacrolideWhat are the characteristics of an acute exacerbation of simple chronic bronchitis? Choose all that apply. Increased sputum production and purulence and no more than 3 exacerbations per year. Microorganisms include S. pneumoniae, H. influenzae, and M. catarrhalis First line antibiotics are amoxicillin, doxycycline, macrolides or sulfamethoxazole/trimethoprim. Second line antibiotics are levofloxacin or ciprofloxacin.Increased sputum production and purulence and no more than 3 exacerbations per year.A practitioner is treating an adult patient with CAP who has suspected aspiration. What is the drug of choice? Oseltamivir or zanamivir Amoxicillin-clavulanate or clindamycin Fluoroquinolone or levofloxacin MacrolideAmoxicillin-clavulanate or clindamycinSince it is not practical to identify the causative agent in community acquired pneumonia (CAP) empiric therapy is common. Which of the following strategies would be preferred for initial treatment of a CAP with a comorbid condition? Combination therapy with a fluoroquinolone (levofloxacin) and a macrolide (azithromycin, or clarithromycin). High-dose amoxicillin or amoxicillin-clavulanate Mono therapy of trimethoprim-sulfamethoxazole (Bactrim) Combination therapy with amoxicillin/clavulanate or cephalosporin and a macrolide or doxycycline.Combination therapy with amoxicillin/clavulanate or cephalosporin and a macrolide or doxycycline.What is the single most effective way to stop the progression of COPD? Glucocorticoid therapy Annual influenza vaccination Bronchodilator therapy Smoking cessation Oxygen therapySmoking cessationWhich of the following is true concerning the use of a spacer? Spacers should only be used in patients who cannot demonstrate effective inhaler technique A spacer helps control the intake of the medication, it ensures the patient receives the prescribed amount, and it helps reduce the amount of medication that remains in the patient's nasopharynx after the inhaled dose. The use of a spacer increases systemic absorption The dose of inhaled corticosteroids needs to be doubled when using a spacer The use of a spacer requires a deep, forceful inhalation after administration of the medicationA spacer helps control the intake of the medication, it ensures the patient receives the prescribed amount, and it helps reduce the amount of medication that remains in the patient's nasopharynx after the inhaled dose.Which of the following are characteristics of the short acting inhaled beta agonists? Select all that apply. With regular use of the short acting inhaled beta agonists tolerance to the extrapulmonary side effects can develop. With regular use of the short acting inhaled beta agonists the bronchodilating effects can diminish. Short acting inhaled beta agonists are often referred to as "quick acting relievers" or "rescue medications." Short acting inhaled beta agonists have a faster onset and a shorter duration of action compared to the long acting beta-2 agonist bronchodilators. Short acting inhaled beta agonists can decrease in the basal metabolic rate with chronic use.With regular use of the short acting inhaled beta agonists tolerance to the extrapulmonary side effects can develop. With regular use of the short acting inhaled beta agonists the bronchodilating effects can diminish. Short acting inhaled beta agonists are often referred to as "quick acting relievers" or "rescue medications." Short acting inhaled beta agonists have a faster onset and a shorter duration of action compared to the long acting beta-2 agonist bronchodilators.The main advantage to low molecular weight heparin over heparin sulfate is that it can be taken orally instead of by injection. True FalseFalsePropranolol (Inderal) is better to use with elderly because it is more lipid soluble than other agents which reduces the occurance of CNS side effects. True FalseFalseCurrent evidence supports that all clients with CHF and an ejection fraction <40% should be on an ACE inhibitor or ARB whether or not they are symptomatic. True FalseTrueTrue or False, Inhaled corticosteroids are the preferred agent for persistent asthma in children younger than 5 years of age. True FalseTrueMatch the class of drug you would want to AVOID with the pre-existing condition in a patient with hypertension. ACE inhibitors Non-dihydropyridines calcium channel blockers non-selective beta blockers 1.renal artery stenosis 2.asthma 3.congestive heart failure1 ACE inhibitors 3 Non-dihydropyridines calcium channel blockers 2 non-selective beta blockersMatch each blood pressure medication with the PRIMARY effect it elicits to decrease blood pressure. spironolactone (Aldactone) hydrochlorothiazide (Microzide) amlodipine (Norvasc) atenolol (Tenormin) 1. decreases peripheral vascular resistance 2. inhibits aldosterone secretion 3. decreases heart rate and strength of contractility 4. increases excretion of sodium and water2 spironolactone (Aldactone) 4hydrochlorothiazide (Microzide) 1 amlodipine (Norvasc) 3 atenolol (Tenormin)Elvira is a 61 yo AAF, 5"4" & weighs 90 kg, seen in the Family Medicine clinic for a follow-up appointment. She reports some nasal congestion due to allergies.VS: BP= 145/92; P= 68; T=37 CPMH: CAD (MI in 2004); hypertension x 15 years; depression; renal insufficiency; peripheral vascular disease; osteoarthritis; hypothyroidismPSH: no smoking; no ethanolROS: WNL except 1+ edema in lower extremitiesMEDICATIONS AT HOME: ASA 81 mg daily; simvastatin 40 mg daily; ibuprofen 400 mg twice daily; sertraline 50 mg daily; levothyroxine 0.1 mg dailyLABS: all WNL except SCr = 2.8TESTS: Recent echocardiogram revealed an ejection fraction of 35%What conditions does the patient have that may worsen heart failure? CAD osteoarthritis renal insufficiency hypertension, CAD and hypothyroidism hypertension and CADhypertension, CAD and hypothyroidismVerapamil (Calan) should be used with caution with patients who have: cardiac dysrhythmias cardiac failure angina pectoris hypertensioncardiac failureWhat is the mode of action of Class I antiarrhythmics such as )? blocking the receptors that respond the sympathetic nervous system stimulation blocking sodium channels which shorten action potential and prolong refractory period blocking efflux of sodium which results in a shortened repolarization period blocking the calcium channels which prolonged depolarizationblocking sodium channels which shorten action potential and prolong refractory periodWhich of the following statements regarding COX 2 inhibitors are TRUE (CHOOSE ALL THAT APPLY) COX 2 selective inhibitors are associated with lower risk for GI bleeds but the same risk for renal impairment COX 2 inhibitors have different drug interactions than non-selective NSAIDs COX 2 selective inhibitors have the same efficacy in pain and inflammation management as nonselective NSAIDs COX 2 selective inhibitors decrease platelet aggregationCOX 2 selective inhibitors are associated with lower risk for GI bleeds but the same risk for renal impairment COX 2 selective inhibitors have the same efficacy in pain and inflammation management as nonselective NSAIDsWhat are the common causes of acute viral rhinosinusitis (AVRS) or acute bacterial rhinosinusitis? Select all that apply. S. pneumoniae, H. influenzae, and M. catarrhalis. Rhinovirus, influenza, and parainfluenza virus. E. coli, S. saprophyticus, Proteus species, Klebsiella species, and Enterococcus faecalis, S. pneumoniae, M. pneumoniae, and C. pneumoniae,S. pneumoniae, H. influenzae, and M. catarrhalis. Rhinovirus, influenza, and parainfluenza virus.Identify the benefits of corticosteroids in the treatment of asthma. Select all that apply. Increased number and responsiveness of beta 2 receptors in the lungs Decreasaed mucous production Smooth muscle relaxation Decreased leukocyte functionIncreased number and responsiveness of beta 2 receptors in the lungs Decreasaed mucous production Decreased leukocyte functionWhich of the following is an accurate statement about the use of Cromolyn sodium in asthma management? Cromolyn sodium is an appropriate alternative first line treatment for mild persistent asthma. Cromolyn sodium is an appropriate add on for steps 3 through 5 in all ages for asthma management. Cromolyn sodium works by inhibiting prostaglandin synthesis. Cromolyn sodium is not recommended for children under 5 years of age.Cromolyn sodium is an appropriate alternative first line treatment for mild persistent asthma.Bronchitis and pneumonia are distinctly different. Which of the following characteristics are consistent with bronchitis? Bronchitis is a reversible inflammatory condition of the tracheobronchial tree that occurs in all age groups and is usually self-limiting. Bronchitis occurs in about three to four million people each year in the United States. Bronchitis results in over one million patients requiring hospitalization yearly. Bronchitis is an infection of the lungs that leads to consolidation of the usually air-filled alveoli.Bronchitis is a reversible inflammatory condition of the tracheobronchial tree that occurs in all age groups and is usually self-limiting.Which of the following agents are effective for both Type A and B strains of the influenza virus? Amantadine (Symmetrel) & Rimantadine (Flumadine) Zanamivir (Relenza) & Rimantadine (Flumadine) Zanamivir (Relenza) & Oseltamivir (Tamilflu) Amantadine (Symmetrel) & Oseltamivir (Tamilflu)Zanamivir (Relenza) & Oseltamivir (Tamilflu)Doubling the dosage of a statin medication usually results in an extra 20 - 25% decrease in LDL and triglyceride levels. True FalseFalseA patient with hypokalemia and low magnesium due to taking loop diuretics is at risk for developing metabolic acidosis. True FalseFalseWhat is/are the most commonly reported adverse effect(s) of bulk forming agents used in the treatment of constipation? Addictive effect of medication Muscle cramping and diarrhea Flatulence and bloating Stool incontinence or leakageFlatulence and bloatingWhich regimen is considered appropriate therapy for treating infection with Helicobacter pylori associated ulcers? All of the regimens included in this question are considered appropriate. Metronidazole 500 mg and augmentin 300 three times daily for 14 days Proton pump inhibitor, clarithromycin 500 mg and metronidazole 500 mg all twice daily for 14 days PPI, levaquin 500mg qd and clarithromycin 500 mg BID for 21 daysProton pump inhibitor, clarithromycin 500 mg and metronidazole 500 mg all twice daily for 14 daysWhich of the following class of drugs has been found to be most effective in reducing nausea and vomiting in patients who are receiving chemotherapy or who are undergoing anesthesia? Seratonin antagonists Anticholinergic drugs H1 receptor antagonists H2 receptor antagonistsSeratonin antagonistsWhich of the following drugs therapeutic effect is that it inhibits peristalsis? Sorbitol Castor oil Loperamide BisacodylLoperamideWhich of the following laxative drugs belong to osmotic laxatives? Magnesium Citrate Senna Doscusate calcium PsylliumMagnesium CitrateWhich of the following class of antacids has diarrhea as a common side effect? aluminum hydroxide a combination agent with aluminum and magnesium calcium carbonate magnesium hydroxidemagnesium hydroxideCimetidine, famotidine and nizatidine belong to the class of medication which is effective in treating ulcers and gastritis by which of the following mechanisms of action? This class of drug inhibits the entry of H+ into the stomach lumen which block the parietal cells ability to produce acid. This class of drug binds with H2 receptors which renders histamine, a stimulus for acid production physiologically inactive. This class of drug increases the production of bicarbonate which stimulates the formation of mucous and strengthens the mucosal barrier. This class of drug combines with proteins and adhering to ulcers forming a protective barrier.This class of drug binds with H2 receptors which renders histamine, a stimulus for acid production physiologically inactive.Which of the following is a characteristic of osmotic laxatives? Magnesium containing osmotic laxatives are the safest agents in this group to use in patients with renal insufficiency. Improper use of osmotic laxatives can lead to electrolyte disturbances. Osmotic laxatives rarely cause the common side effects of bloating, cramping and gas. The primary mechanism of action of osmotic laxatives is stimulation of the nerve plexus of intestinal smooth muscle leading to increased motility.Improper use of osmotic laxatives can lead to electrolyte disturbances.Which of the following drugs is a H2 antagonist known to interfere with drugs metabolized by the CYP-450 system? famotidine (Pepcid) cimetidine (Tagamet) ranitadine (Zantac) nizatidine (Axid)cimetidine (Tagamet)Which of the following has direct influence or control of gastric acid secretion? Select all that apply. Serotonin Histamine Acetylcholine GastrinHistamine Acetylcholine GastrinAntibody concentrations and responses to individual antigens vary. Typically, how long does it take for a protective level of antibodies to develop in healthy adults? Two to Three weeks. Five to seven days. Six to eight weeks. An immune response maybe immediate, but it will take 48 to 72 hours to become efficacious.Two to Three weeks.What is the first immunization recommended for children? They usually receive this at birth or shortly thereafter. Influenza Diphtheria, tetanus and pertussis (DTaP) Hepatitis B (HepB) Measles, mumps, rubella (MMR)Hepatitis B (HepB)What is the goal of immunosuppressive therapy? The goal of drug therapy is to inhibit rejection of transplanted tissues through selective development of antibodies that suppress cell mediated aspects of the immune system. The goal of drug treatment is to stop inappropriate destruction of the patient's own tissues and/or damage to transplanted tissues, while preventing immunological compromise. The goal of suppressive drug therapy is to stimulate the body's own immune system to protect the person against subsequent infection or disease. The goal of suppressive drug therapy is comprehensive suppression of both the antibody-mediated (humoral) and cell-mediated aspects of the immune system.The goal of drug treatment is to stop inappropriate destruction of the patient's own tissues and/or damage to transplanted tissues, while preventing immunological compromise.Which of the following are strategies employed in organ and tissue transplants? Select all that apply. Use of multiple immunosuppressants to promote stimulation of circulating T cells and prevent apoptosis of activated T cells. Maintenance immunosuppressant therapy using less potent drugs to provide long term protection. Induction therapy, powerfully suppress the immune system at the time of transplant through the use of polyclonal or monoclonal antibodies. Use of multiple immunosuppressants at lower dosages to maintain adequate immunosuppression while minimizing adverse effects.Maintenance immunosuppressant therapy using less potent drugs to provide long term protection. Induction therapy, powerfully suppress the immune system at the time of transplant through the use of polyclonal or monoclonal antibodies. Use of multiple immunosuppressants at lower dosages to maintain adequate immunosuppression while minimizing adverse effects.Which of the following drugs used in the treatment of gout acts by preventing the migration of granulocytes? Allopurinol Colchicine Febuxostat IndomethacinColchicineWhich of the following is the drug of choice for chronic tophaceous gout and for clients with frequent attacks? Allopurinol Colchicine Voltaren IndomethacinAllopurinolJohn is a 35 yo who has a uric acid level of 9.6 mg /dl. Because of his history of renal calculi, prophylactic treatment is recommended. Which represents the best option for John? after acute attack has resolved, start allopurinol and adjust dose according to renal function testing Start probenicid and monitor uric acid to ensure his uric acid level reaches the goal of < 8 mg / dl. both allopurinol and probenicid are contraindicated in patients with renal insufficiency Do a 24 hour urine test to measure uric acid excretion and if excretion is suboptimal start probenicidafter acute attack has resolved, start allopurinol and adjust dose according to renal function testingWhich of the following is TRUE regarding cochecine? Colchicine It has few GI side effects. Colchicine taken concomitantly with medications including erythromycin, clarithromycin, and ketoconazole can cause toxic reactions and occasionally fatal overdoses of colchicine. Colchicine It is associated with a rare but life threatening reaction that resembles Steven's Johnson's Syndrome. Colchicine is the drug of choice of treatment of an acute attack of gout.Colchicine taken concomitantly with medications including erythromycin, clarithromycin, and ketoconazole can cause toxic reactions and occasionally fatal overdoses of colchicine.Bob is a 68 yo male who presents with a swollen painful first metatarsal joint in his right foot. He has had one episode of gout 3 months ago. He has a history of CHF, dyslipidema and HTN. He is currently taking ASA 80 mg, Lipitor 20 mg, Hydrochlorithiazide 25 mg- and Lisinopril 20 mg. Diagnostic tests reveal: Serum Uric acid - 8.6 mg/dl GFR < 30% of expected WBC - 8,200 cmm (normal 4,300cmm - 10.8 cmm) Joint fluid analysis - uric acid crystals Which of the following medications would be the most appropriate medication for treating this acute episode of gout? Indomethicin (Indocin) Allopurinol Ketorolac (Toradol) ColchicineColchicineWhich of the following therapies have not been shown to reduce the risk of non-vertebral fractures? Select all that apply. Calcitonin SERMS Ibandronate (Boniva) Alendronate (Fosamax)Calcitonin SERMS Ibandronate (Boniva)Teriparatide (Forteo) is a parathyroid hormone analog which is indicated in the treatment of osteoporosis. Treatment with teriparatide results in increased bone mineral density, bone mass, and strength; however, when should the practitioner avoid using teriparatide? In patients with current breast or uterine cancer or those who have a history of those cancers. In patients with a history of bone cancer or who have an increased risk for bone cancer. In patients who are unable to sit up for at least 30 minutes after taking the medication. In patients with current CVD or those who have a history of cardiovascular disease.In patients with a history of bone cancer or who have an increased risk for bone cancer.Which of the following will minimize the risk of occurrence of the main adverse effects from bisphosphonates? Sitting up or standing for 30 minutes after taking the medication. Taking proton pump inhibitors with the medication. Taking the medication with food. Taking the medication at bedtime.Sitting up or standing for 30 minutes after taking the medication.What is the recommended dosage of calcium for a post menopausal women? 800 mg /day 1200 mg /day 1000 mg /day 1500 mg /day1500 mg /dayWhich of the following would prompt discontinuation of the drug methotrexate? nausea sudden onset of dry, hacking cough orange discoloration of urine low grade feversudden onset of dry, hacking coughWhat vitamin deficiency will decrease the effectiveness and increase the risk of adverse effects of methotrexate? Vitamin A deficiency Vitamin C deficiency B12 deficiency Folate deficiencyFolate deficiencyWhich of the following adverse events can be caused by the drug interaction of alcohol and Tylenol (acetaminophen)? vasospastic effect hepatotoxicity gastric ulcerations hypoglycemiahepatotoxicityWhat is the main difference between aspirin and traditional NSAIDs? Traditional NSAIDs only inhibit COX-2 and ASA inhibits both COX-1 and COX-2. There is no significant difference between aspirin and traditional NSAIDs Side effects like GI bleeding, renal failure and bleeding are not associated with the use of traditional NSAIDs Traditional NSAIDs inhibit COX-1 and COX-2 but the inhibition is reversible, unlike with ASA where the inhibition is irreversible.Traditional NSAIDs inhibit COX-1 and COX-2 but the inhibition is reversible, unlike with ASA where the inhibition is irreversible.In a hypertensive client who requires NSAID therapy, which of the following classes of antihypertensives would be most appropriate to use to avoid BP elevations related to NSAID use? ARBS Beta blockers ACE inhibitors Calcium channel blockersCalcium channel blockersWhich drug has a mechanism of action to irreversibly inhibit cyclo-oxygenase 1; and, normally acts upon arachidonic acid to produce prostaglandin G2, prostaglandin H2, and subsequently thromboxane A2; and, ultimately results in decreased ability for platelet aggregation? Prasugrel Aggrenox Aspirin ClopidogrelAspirinWhich of the following statements is a brief description of the theory of the cause of an increase in incidence of MIs in persons taking COX2 inhibitors (such as Vioxx)? The COX2 inhibitors did not have a role in an increased incidence of MIs, an observed association was an incidental finding. They exert strongly inhibit production of thromboxane 2. They suppress prostacyclin production and the effect is not counter balanced by inhibition of thromboxane 2. They suppress prostaglandin activity in blood vessels leading to vasoconstriction.They suppress prostacyclin production and the effect is not counter balanced by inhibition of thromboxane 2.Which of the following patients would be at least risk for complications from long term NSAID therapy? a 32 year old female stay at home mother in the later part of her 8th month of pregnancy. a 79 year old male retired truck driver with osteoarthritis but no other health conditions. a 42 year old female seamstresses with congestive heart failure. a 26 year old male athlete with a history of childhood asthma 18 to 20 years ago.a 26 year old male athlete with a history of childhood asthma 18 to 20 years ago.Recommended preferred treatment for HIV PEP for Occupational Exposure? atazanavir 300 mg PO daily + ritonavir 100 mg PO daily tenofovir/emtricitabine tablet PO daily PLUS raltegravir 400 mg PO bid. zidovudine/lamivudine PO bid lopinavir/ritonavir 2 tablets PO bidtenofovir/emtricitabine tablet PO daily PLUS raltegravir 400 mg PO bid.Which of the following is a PI-based recommended regimen for initial treatment of HIV infection? Raltegravir + tenofovir/emtricitabine Elvitegravir/cobicistat/tenofovir/emtricitabine Dolutegravir + abacavir/lamivudine Darunavir/ritonavir + tenofovir/emtricitabineDarunavir/ritonavir + tenofovir/emtricitabineWith effective treatment of HIV, the expectation would be that no HIV virus can be detected in serum testing. True FalseTrueWhich two classes of antihypertensives are indicated for persons after an MI. thiazide diuretics and ACE inhibitors beta Blockers and ACE-Inhibitors OR ARB Nonselective Beta Blockers and/or Nondihyrdropyridine Calcium Channel Blockers Beta Blockers and/or Dihydropyridine Calcium Channel Blockersbeta Blockers and ACE-Inhibitors OR ARBBert is a 54 yo male who today provides a month long record of home blood pressure readings taken at various times of the day, his blood pressure averages around 150/ 98. His BP in the office today is 148/94. He has no documented CAD. His cholesterol is below 100 mg/dL on treatment of atorvastatin [Lipitor] 40 mg once daily. What would be the best initial treatment for this patient's elevated blood pressure? Chlorthalidone (Hydon) with nifedipine (Procardia) after patient tolerance is established Cydrocholorothiazide Amlodipine (Norvasc) and lisinopril Atenolol (Tenormin) and spironolactone (Aldactone)Amlodipine (Norvasc) and lisinoprilWhat agent is first line for the management of hypertension in pregnancy? hydrochlorothiazide methyldopa nifedipine furosemide magnesiummethyldopaNon-selective beta blockers should be used in caution in patients with: asthma renal stenosis hypertension goutasthmaWhich electrolytes are most commonly adversely affected by heart failure treatment (ace inhibitor and angiotensin receptor blockers)? potassium none of the above calcium sodium magnesiumpotassiumStuart is a 38 yo white male. His father and older brother have had MIs and are currently being treated for CVD and Hypertension. Stuart's lipid profile reveals: Total cholesterol - 284 mg/dl, LDL - 176 mg/dl, HDL - 32 Triglycerides - 180 You decide to start RS on a statin medication. Which of the following medications would be most likely to achieve a decrease in his LDL that would meet his target goal? Pravastatin (Pravachol) 10 mg Atorvastatiin (Lipitor) 10 mg Rosuvastatin (Crestor) 10 mg Simvastatin (Zocor) 10 mgRosuvastatin (Crestor) 10 mgRupert is a 48 y/o white male. His lipid profile reveals: Total cholesterol - 284 mg/dl, LDL - 176 mg/dl, HDL - 32 Triglycerides - 180 According to the updated ATP III guidelines, he falls into the high risk category. What is the target LDL for this patient? <160 mg / dl <130 mg / dl <100 mg / dl <70 mg / dl<100 mg / dlSuzie is a 22 yo female with a family history of heart disease she as ask about cholesterol screening recommendations. Her Total Cholesterol level is currently 120 mg/dl and HDL is 50mg/dl. What is the correct advice for cholesterol screening in this patient? She should have total cholesterol and preferably total lipid panel including LDL, HDL, and triglycerides checked every 5 years. None of the answers here are appropriate. Have total cholesterol checked yearly. Have total cholesterol and HDL checked yearly.She should have total cholesterol and preferably total lipid panel including LDL, HDL, and triglycerides checked every 5 years.Which of the following are goals in the pharmacologic treatment in the treatment of congestive heart failure? Decrease afterload, reduce volume overload, and improve cardiac output. Reduce bradycardia and other arrhythmias, and reduce the back pressure in the hepatic portal system. Increase the preload, increase left end-diastolic pressure and reduce cardiac output. Decrease afterload, decrease dyspnea, reduce hyperkalemia and improve hypotension.Decrease afterload, reduce volume overload, and improve cardiac output.Which of the following are characteristics of HMG CoA Reductase Inhibitors (statin drugs)? Select all that apply. Promotes plaque stability by reducing inflammation at the plaque site. Side effects include hepatotoxicity and myopathy. Do not require further liver function testing if liver functions at onset are normal. Increases LDL receptors on hepatocytes which in turn will inhibit cholesterol synthesis.Promotes plaque stability by reducing inflammation at the plaque site. Side effects include hepatotoxicity and myopathy. Increases LDL receptors on hepatocytes which in turn will inhibit cholesterol synthesis.Which of the following is true regarding the use of NSAIDs (non-steroidal antiinflammatory drugs) in persons with heart failure or hypertension? NSAIDS may increase the retention of sodium and water NSAIDs increase the risk of hyperkalemia with ACE inhibitors NSAIDs can decrease the effectiveness of beta blocker medications NSAIDs are safe in persons with normal renal functionNSAIDS may increase the retention of sodium and waterWhat is the mode of action of Class I antiarrhythmics such as? blocking the calcium channels which prolonged depolarization blocking efflux of sodium which results in a shortened repolarization period blocking sodium channels which shorten action potential and prolong refractory period blocking the receptors that respond the sympathetic nervous system stimulationblocking sodium channels which shorten action potential and prolong refractory periodHow does warfarin work to prevent clotting? ADP receptor antagonist Inhibits the formation of Vitamin K dependent clotting factors Cyclooxygenase inhibition Phosphodiesterase inhibitionInhibits the formation of Vitamin K dependent clotting factorsAmoxicillin-clavulanate if preferred over amoxicillin as first line therapy for ABRS (Acute Bacterial Rhinosinusitis). Second line medications are initiated if there is no improvement in symptoms in 3 to 5 days. Which of the following are common second line antibiotic therapy for ABRS? Trimethoprim-sulfamethoxazole, erythromycin, and azithromycin. Oxymetazoline hydrochloride, phenylephrine hydrochloride, and fluticasone propionate. Levofloxacin, moxifloxacin, or doxycycline. Cefpodoxime and Cefixime.Levofloxacin, moxifloxacin, or doxycycline.Current non-pharmacological management of asthma includes which of the following? Development of an action plan and avoidance of asthma triggers Development of an action plan and home spirometry Avoidance of asthma triggers and home oxygen therapy Avoidance of asthma triggers and home spirometry Development of an action plan and avoidance of physical activityDevelopment of an action plan and avoidance of asthma triggersA practitioner is prescribing an antitussive for a patient with acute infectious rhinitis. What drug acts as an antitussive? Pseudoephedrine Dextromethorphan Guaifenesin Oxymetazoline hydrochloridDextromethorphanCarla is a 56 yo woman with COPD whose FEV1 on pulmonary function testing is 75%. According to the Gold Criteria, what stage of COPD would this patient have? Stage 1 Stage 3 Stage 4 Stage 2Stage 2The difference(s) between levalbuterol and albuterol. Select all that apply. Levalbuterol contains an beta-blocker ismoer that potentiates bronchodilation. Levalbuterol is more expensive than albuterol. Levalbuterol causes less tachycardia and tremors than albuterol. Levalbuterol is available in an oral formulation unlike albuterol.Levalbuterol is more expensive than albuterol. Levalbuterol causes less tachycardia and tremors than albuterol.Some NSAIDs (such as dicolfenac) impart slightly higher risk for CV adverse outcomes than others (such as naprosyn sodium) True FalseTrueAspirin is an effective primary stroke prevention strategy for men. True FalseFalseChildren using inhaled corticosteroids for asthma maintenance medications do experience minor but progressive decreases in linear growth. True FalseFalseThe lipid level most affected by dietary intake is: Total cholesterol Triglycerides VLDL cholesterol Apolipoprotein BTriglyceridesA practitioner is prescribing oral Benadryl (Diphenhydramine) for a 14- year-old patient who is diagnosed with chronic rhinosinusitis. Should this patient be receiving an adult dose of this medication, and what is the appropriate dosage? Yes, and he should receive 100 mg q6-12h No, but a dose of 220 mg q8-12h is appropriate for this patient. Yes, the adult dose is 25-50 mg q4-6h No, he should be given 20 mg/kg/d Q8hYes, the adult dose is 25-50 mg q4-6hThe MAIN reason beta blockers lower blood pressure is because they decrease cardiac output. True FalseTrueIn order to choose medications that address the problem, it is important to recognize the underlying process of COPD. What is included in the 'triad' of the pathogenesis of COPD? Chronic inflammation, allergic response, oxidative stress Oxidative stress, protease-antiprotease imbalance, chronic inflammation None of the above Allergic response, protease-antiprotease imbalance, oxidative stress Chronic inflammation, protease-antiprotease imbalance, allergic responseOxidative stress, protease-antiprotease imbalance, chronic inflammationWhich of the following are characteristics of regarding leukotriene antagonists? Select all that apply. Leukotriene antagonists can decrease inflammation, bronchoconstriction, and mucus secretion. Leukotriene antagonists undergo hepatic metabolism. Leukotriene antagonists are to be initiated as a first line treatment in patients with mild intermittent asthma. Leukotriene antagonists are approved for maintenance therapy of chronic asthma of adults and children over 12 years of age.Leukotriene antagonists can decrease inflammation, bronchoconstriction, and mucus secretion. Leukotriene antagonists undergo hepatic metabolism. Leukotriene antagonists are approved for maintenance therapy of chronic asthma of adults and children over 12 years of age.A patient being followed for latent tuberculosis has been on isoniazid therapy for 2 months. While reviewing the laboratory test results, the nurse notes that the AST has increased to 3 times the normal level. This is an indication for changing the drug regimen to one that does not include INH. True FalseTrueWhich class of anti-emetic medication has black box warnings on both medications used for nausea and vomiting treatment? H1 antagonists phenothiazines (dopamine antagonists) serotonin antagonists antimuscarinicsphenothiazines (dopamine antagonists)Which of the following pharmacologic agents has the potential to cause increased biliary tree pressure? phenytoin morphine ibuprofen warfarinmorphineWhich of the following are physiological and/or pathophysiological effects of Helicobacter pylori? H. pylori is the most common cause of community acquired pneumonia in the U.S. H. pylori causes a pro-inflammatory response in the body. H. pylori is the most common cause of chronic gastritis. H. pylori causes degradation of glycoprotein-lipid mucus layer complexes in the stomach. H. pylori causes the production of damaging bacterial proteins in the stomach.H. pylori causes a pro-inflammatory response in the body. H. pylori is the most common cause of chronic gastritis. H. pylori causes degradation of glycoprotein-lipid mucus layer complexes in the stomach.Vaccines are used in Immunoprophylaxis. Immunoprophylaxis involves stimulating the patient's immune system defenses against future natural exposure. Indicate the major constituents of vaccines from the selections below. Select all that apply. Attenuated virus or bacteria Toxoids Antibiotics and or adjuvants Preservatives or stabilizersAttenuated virus or bacteria Toxoids Antibiotics and or adjuvants Preservatives or stabilizersWhich of the following class of medication are the first immunosuppressive pharmacologic agents, used in both transplantation and in various autoimmune disorders? Antiproliferatives, such as azathioprine and mycophenolate. Calcineurin inhibitors, such as cyclosporine and tacrolimus. Corticosteroids, such as prednisone, prednisolone, and methylprednisolone. Costimulation blockers, such as Calcineurin inhibitorsCorticosteroids, such as prednisone, prednisolone, and methylprednisoloneYani M is a 52 year old male with gout. He has had a history of renal calculi in the past and due to hypertension, he has developed renal insufficiency. This is his first episode of gout. What would be an appropriate treatment for his acute gouty arthritis? Indomethicin (Indocin) Colchicine Ketorolac (Toradol) AllopurinolColchicineWhich of the following are the two most effective medications for treatment of an acute flare up of gouty arthritis? Probenicid and low dose aspirin Allupurinol and ibuprophen Colchicine and NSAIDs Hydrochloroquine and naproxenColchicine and NSAIDsWhich of the following is a characteristic of chronic NSAID therapy and cardiovascular risk? An increase of MI risk only occurs in COX 2 selective NSAIDs because they produce fluid retention and can worsen CHF. All NSAIDs increase risk of MI even in persons with no or few cardiovascular risk factors. NSAIDs enhance the antiplatelet effect of low dose ASA with minimal or no cardiovascular risk. Evidence strongly supports an increase of MI risk in long term use of NSAIDs and naproxen has the highest CV risk and should consequently be avoided in patients with any CV risk factors.All NSAIDs increase risk of MI even in persons with no or few cardiovascular risk factors.What is the main reason it is considered unsafe to give ibuprofen or other NSAIDs to children under six months of age? Their liver isn't fully able to produce the enzymes necessary to metabolize the medication. Their stomach lining isn't fully functional. They have a larger proportion of body water than adults. The GFR and active tubular secretion iis decreased.The GFR and active tubular secretion iis decreased.What is the main cause of the of GI adverse effects of aspirin (acetylsalicylic acid [ASA])? Aspirin [ASA] forms toxic metabolites which damage the liver. Aspirin [ASA] inhibits of COX-2 resulting in down regulation of acute stage of inflammation. Aspirin [ASA] has a high acid content, the pKa of aspirin is 3.5. Aspirin [ASA] inhibits of COX-1 resulting in reduction production of the natural mucus lining that protects the stomach.Aspirin [ASA] inhibits of COX-1 resulting in reduction production of the natural mucus lining that protects the stomach.Therapy with DMARD in rheumatoid arthritis should be delayed until early signs of joint damage develop due to their toxicity of the medication. True FalseFalseThe MOST effective medications for the treatment of Barrett's esophagus is: H2 antagonists Cytotec Sulfracate Proton Pump inhibitorsProton Pump inhibitorsWhat is the best treatment for mild to moderate clostridium difficile infection? Amoxicillin 850 mg BID for 10 - 14 days or clarithromycin (Biaxin) 500 mg BID x 10 - 14 days Flagyl (metronidazole) 500 mg BID x 10 - 14 days or Amoxicillin 850 mg BID x 10 - 14 days Flagyl (metronidazole) 500 mg TID x 10 - 14 days or vancomycin (Vancocin) 125 mg QID x 10 - 14 days clarithromycin (Biaxin) 500 mg BID x 10 - 14 days or vancomycin 500 mg QID x 10 - 14 daysFlagyl (metronidazole) 500 mg TID x 10 - 14 days or vancomycin (Vancocin) 125 mg QID x 10 - 14 daysThe newer medications (lubiprostone (Amitiza) and linactolide (Linzess) are chloride channel activators. What are these medications indicated for the treatment of ? IBS with diarrhea predominant IBS with constipation predominant Crohn's disease ulcerative colitisIBS with constipation predominantWhat is true regarding medication therapy for obesity management? All of the currently FDA approved medications are contraindicated in pregnancy Medication dosage should be slowly tapered then discontinued after the patient has lost 7.5% of total body weight Most obesity management guidelines recommend starting medication therapy in any patient who has a BMI that indicates a patient is overweight or obese. The recommended initial agent are the lipase inhibitors (ie Orlistat) due to its limited side effects and lack of absorption into systemic circulationAll of the currently FDA approved medications are contraindicated in pregnancyChronic use of antacid medication, such as proton pump inhibitors, in a person taking aspirin for inhibition of platelet aggregation would have what effect on the absorption of aspirin from the stomach? It would have no effect on the absorption It would decrease the absorption It would increase the absorptionIt would decrease the absorptionWhich best describes the role of misoprostol (Cytotec) in preventing peptic ulcers (PUD)? It is a synthetic prostaglandin with gastroprotective effects when used with NSAIDs It combines with proteins and adheres to the ulcer to form a protective barrier It is a synthetic NSAID with none of the COX-1 effects implicated in PUD It is a synthetic proton pump inhibitor, useful in all phases of PUD therapyIt is a synthetic prostaglandin with gastroprotective effects when used with NSAIDsWhich of the following drugs form a physical barrier to HCL and Pepsin? Ranitidine Sucralfate Omeprazole EsomeprazoleSucralfateWhat immunization is recommended for healthy adults 65 and over? The healthy patient may receive this immunization earlier but it is recommended at and above 65 y/o. Influenza Hepatitis B (HepB) Pneumococcal VaricellaPneumococcalYani is a 52 year old male with gout. He has had a history of renal calculi in the past and due to hypertension, he has developed renal insufficiency. Yani has been found to test positive for HLA B 5801. The practitioner knows there is a strong association between the human leukocyte antigen HLA-B5801 and allopurinol induced Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). What does this positive finding mean for Yani's gout therapy? The finding means that allopurinol will have less efficacy in lowering his uric acid levels; so, an additional agent will be necessary to manage his gout. The finding means that he is at high risk for developing kidney stones if treated with allopurinol; so, treatment should include increased fluid intake. The finding means that his risk for developing a hypersensitivity reaction to allopurinol is negligible, however, an oral antihistamines should be given in conjunction with the allopurinol. The finding means he is at high risk for developing a reaction to allopurinol; so, another medication should be used instead.The finding means he is at high risk for developing a reaction to allopurinol; so, another medication should be used instead.Which of the following is TRUE regarding urate lowering therapy? once tophi have formed, no treatment will cause them to regress. Therapy should start with maximum doses and be tapered down after uric acid target is reached Urate therapy should not be initiated during an acute attack and discontinued during any subsequent flare. Medication such as NSAIDs or low dose steroids should be started when iniitating urate lowering therapy and continued for as long as 6 months to prevent acute flaresMedication such as NSAIDs or low dose steroids should be started when iniitating urate lowering therapy and continued for as long as 6 months to prevent acute flaresWhen is treatment with calcitonin is indicated? First line treatment of osteopenia when estrogen fails. Prevention of osteoporosis when there is evidence of osteopenia. First line prevention of osteoporosis in premenopausal women. Treatment of osteoporosis when estrogen and bisphosphonates fail.Treatment of osteoporosis when estrogen and bisphosphonates fail.Elsa is a 56 yo woman with a strong family history of osteoporosis. Her bone density test was -1.45 ; Which indicates osteopenia. The other relevant item in her health history is that she had a DVT when she was pregnant (30 years ago) and she had another 6 years ago after an 2 hour airplane trip. Which of the following treatments would the practitioner avoid due to an increased risk of DVT in this patient? denosumab (Prolia) injections and calcium supplements Calcium supplements alone. raloxifene (Evista) and estrogen replacement therapy alendronate (Fosamax) and calcium supplementsraloxifene (Evista) and estrogen replacement therapyWhich of the following can cause a decrease in bone density? testosterone replacement therapy depo-provera oral contraceptives combined estrogen and progestin hormone replacement therapydepo-proveraWhich of the following best describes glucocorticoids? Glucocorticoids are recommended treatment for many immune disorders such as asthma. Glucocorticoids reduce lipogenesis. Glucocorticoids inhibit COX-1 and COX-2 as well as prostaglandins. Glucocorticoids are naturally produced by the adrenal cortex, suppress immune system and suppress histamine release.Glucocorticoids are naturally produced by the adrenal cortex, suppress immune system and suppress histamine releaseWhich of the following monitoring regimens would be the most appropriate for a patient with rheumatoid arthritis who has been on the same dose of methotrexate for the last year? CBC, urine dip for protein and AST every 3 months CBC and creatinine every 2-3weeks, urine dip for protein every 6 months and yearly ophthalmology exam. CBC, LFTs and creatinine every 4-8 weeks CBC, LFTs and creatinine every 2-3 weeks and yearly ophthalmology examination.CBC, LFTs and creatinine every 4-8 weeksWhich of the following patients would be at risk for adverse effects from prolonged aspirin ingestion? Mr. B, a 75 year old man who has mild to moderate osteoarthritis, but no other chronic illnesses. Mrs. G, a 42 year old pt with mild CHF which resulted from a viral cardiomyopathy, but is otherwise healthy Mrs. D, a 51 year old woman who is presently healthy but has a history of asthma, allergic rhinitis and nasal polyposis. All of the aboveAll of the aboveWhen is long- term treatment with corticosteroids is indicated? When disease modifying drugs are available but the expense of the drugs outweigh the efficacy. When the disease is life threatening disease or has the potential to cause permanent disability and no other treatment options are available. When it is desirable to slow or retard the progression of a disease such as rheumatoid arthritis. When the disease is life-threatening and only then as a last resort measure.When the disease is life threatening disease or has the potential to cause permanent disability and no other treatment options are available.Which of the following NSAIDs must be limited to a maximum duration of 5 days due to the risk of development of renal insufficiency and/or gastric perforation? naproxen (Naprosyn) celecoxib (Celebrex) diclofenac (Clinoril) ketorolac (Toradol)ketorolac (Toradol)Diarrhea due to lactose intolerance is an example of secretory diarrhea. True FalseFalseWhich of the following strategies help to minimize the risk of occurrence of the main adverse effects from the bisphosphonate Fosamax? sitting up or standing for 30 minutes after taking the medication taking proton pump inhibitors with the medication taking the medication at bedtime taking the medication with foodsitting up or standing for 30 minutes after taking the medicationNSAIDs are the first line treatment recommended for managing the pain associated with osteoarthritis. True FalseFalseProbenecid is the drug of choice for gout prevention for persons with renal insufficiency True FalseFalse