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Knitting Hand Warmers
Knitting Hand Warmers
Which of the following is an angiotensin converting enzyme (ACE) inhibitor that does NOT
require metabolic conversion for its activity (i.e. is not pro-drug)?
A.
B.
C.
D.
E.
2.
H.T.N. is a 55 year old male with diabetes mellitus who has been treated for hypertension
with hydrochlorothiazide and enalapril for approximately 4 years. His blood pressure has
been extremely well controlled, but, at his annual physical examination, he complains of a
persistent cough, although he has not been ill otherwise. Assuming that the cough is a side
effect of one of these medications, what change in his therapy would be most likely to
eliminate the cough?
A.
B.
C.
D.
E.
3.
captopril
enalapril
fosinopril
losartan
valsartan
continue the enalapril but discontinue the hydrochlorothiazide until the cough
subsides
continue the enalapril and replace the hydrochlorothiazide with amiloride
continue the hydrochlorothiazide and replace the enalapril with losartan
continue the hydrochlorothiazide and replace the enalapril with captopril
replace the hydrochlorothiazide with amiloride and replace the enalapril with
captopril
A female patient who is being treated for hypertension changes her method of birth control
from barrier to pharmacological (oral contraceptives). At a check-up two months later her
blood pressure has risen significantly from her previous check-up. Which medication has she
been taking to control her blood pressure?
A.
B.
C.
D.
E.
alpha-methyl-DOPA
enalapril
hydrochlorothiazide
minoxidil
propranolol
4.
A patient who has lived in the southwest his entire life changes jobs and moves to the
Chicago are in the late spring. At his job physical he is diagnosed with moderate
hypertension which responds to drug therapy. On a chilly day in the fall he develops severe
breathing problems while outside raking leaves. Which medication has he been taking to
control his blood pressure?
A.
B.
C.
D.
E.
5.
6.
Which class of drugs is reserved for the rapid reversal of critically elevated blood pressure or
the control of severe hypertension that is refractory to other therapies?
A.
B.
C.
D.
E.
7.
alpha-methyl-DOPA
enalapril
hydrochlorothiazide
minoxidil
propranolol
alpha1-selective agonists
loop diuretics
proximal tubule diuretics
vasodilators
vasopressin agonists
What is the most likely side effect of minoxidil, hydralazine, and nifedipine?
A.
B.
C.
D.
E.
A-1
8.
A 59 year old hypertensive patient has been poorly controlled on her current medication, and
you are considering switching her to prazosin. Which side effect(s) must you take into
consideration as you do this?
A.
B.
C.
D.
E.
9.
Which of the following contribute to the clinical benefit of a beta1-selective antagonist in the
treatment of hypertension?
A.
B.
C.
D.
E.
10.
Which calcium channel blocker or vasodilator will cause a decrease in blood pressure but
will also supress the subsequent reflexive tachycardia?
A.
B.
C.
D.
E.
11.
minoxidil
hydralazine
nifedipine
nitroglycerin
verapamil
Which of the following contribute to the mechanism of clinical benefit of lisinopril in the
treatment of congestive heart failure?
A.
B.
C.
D.
E.
A-2
From the following list, select the correct drug described in items 12 to 16. EACH OF THE
CHOICES (A THROUGH E) MAY BE USED ONLY ONCE.
A.
B.
C.
D.
E.
adenosine
amiodarone
digoxin
procainamide
quinidine
12.
Super-fast and short-acting drug that opens potassium channels in the AV node_A
13.
14.
Class I antiarrhythmic that blocks the sodium and potassium channels, alpha adrenergic
receptors, and muscarinic (M2) receptors_E
15.
A long-acting antiarrhythmic that imitates Classes I, II, III, and IV and produces a variety of
serious and unusual side effects, including pulmonary fibrosis and blue coloration of the
skin_B
16.
A sodium channel blocker that is usually given IV to minimize the production of metabolites
that can induce a lupus-like syndrome and torsades de pointes, a rare ventricular tachycardia
with prolonged QT intervals_D
17.
18.
A-3
19.
Which of the following therapies is most appropriate for correcting hypertension in a patient
with heart failure?
A.
B.
C.
D.
E.
20.
21.
For a hypertensive patient with variant (Prinzmetal's type) angina and no concomitant
atherosclerotic disease, which drug could be used alone for controlling blood pressure AND
prevention of chest pain?
A.
B.
C.
D.
E.
22.
atenolol
furosemide
losartan
propranolol
verapamil
Which of the following drugs would be appropriate for treating a patient who has typical
angina (angina of effort), hypertension and also is subject to AV node-associated
arrhythmias?
A.
B.
C.
D.
E.
atenolol
hydralazine
lisinopril
sildenafil
valsartan
A-4
23.
In preventing a second myocardial infarction, which drug will provide long-term suppression
of heart work, prevent angina, and suppress the onset of ventricular arrhythmias?
A.
B.
C.
D.
E.
24.
A 49 year old man with long-standing hypertension, presents to the emergency department
with crushing chest pain. An ECG reveals ST segment elevation in leads V2, V3, and V4
along with marked Q waves. While he is being prepared for further testing, he collapses;
ECG now shows ventricular fibrillation and electrical defibrillation is attempted. After 2
shocks of 200 and 300J, he is given a bolus of epinephrine and you elect to add an
antiarrhythmic agent before the 3rd shock of 350J. Which of the following antiarrhythmic
agents is currently recommended for patients in this situation?
A.
B.
C.
D.
E.
25.
amiodarone
diltiazem
flecainide
lidocaine
metoprolol
Of the following agents, which one may be used in asthmatic patients to produce a rapid,
acute bronchodilation?
A.
B.
C.
D.
E.
26.
adenosine
gemfibrozil
metoprolol
nifedipine
nitroglycerin
albuterol
budesonide
cromolyn
formoterol
montelukast
Which of the drug combinations listed below might be expected to give an enhanced effect
because each of the two drugs produces bronchodilation through a different mechanism?
A.
B.
C.
D.
E.
albuterol - budesonide
albuterol - ipratropium
cromolyn - fluticasone
cromolyn - zafirlukast
formoterol - salmeterol
A-5
27.
When considered for use in the treatment of an asthmatic patient, systemic corticosteroids:
A.
B.
C.
D.
E.
28.
Which of the following adverse effects can be associated with the use of inhaled beta 2agonist in asthma?
A.
B.
C.
D.
E.
29.
C.
D.
31.
30.
can be abruptly discontinued following a course of treatment that does not exceed 12
days
can be safely used long-term in place of a leukotriene antagonist
provide the advantage over inhalant corticosteroids of producing bronchodilation as
well as reducing inflammation
should always be avoided, even in cases of severe, persistent asthma in adults
should be administered only once in order to avoid severe side effects
A-6
32.
The mineral content of bone may be diminished in patients who receive long-term therapy
with:
A.
B.
C.
D.
E.
33.
34.
5-hydroxytryptamine receptors
dopamine receptors
GABA receptors
glutamate receptors
norepinephrine receptors
36.
Typical antipsychotic drugs are believed to exert their therapeutic effects via blockade of
dopamine receptors. The newer atypical agents also antagonize:
A.
B.
C.
D.
E.
35.
clonazepam
gabapentin
lamotrigine
phenytoin
valproic acid
Which antipsychotic agent may have particular utility in patients who are treatment-resistant
to typical antipsychotic drugs?
A.
B.
C.
D.
E.
bupropion
chlorpromazine
clozapine
fluphenazine
haloperidol
A-7
37.
38.
Flumazenil is an agent used to specifically reverse the central nervous system depressant
effects of which class of drugs?
A.
B.
C.
D.
E.
39.
In addition to their primary application, venlafaxine and fluoxetine may also be used to treat
some patients with:
A.
B.
C.
D.
E.
41.
barbiturates
benzodiazepines
hallucinogens
monoamine oxidase inhibitors
selective serotinin uptake inhibitors
After intravenous administration of single doses, the central nervous system effects of
ultrashort acting barbiturates such as thiopental are terminated primarily via:
A.
B.
C.
D.
E.
40.
anti-anxiety effects
antiarrhythmic effects
anticonvulsant effects
sedation
skeletal muscle relaxation
anorexia
epilepsy
generalized anxiety disorder
hypertension
insomnia
A-8
42.
The selective serotonin uptake inhibitors may be preferred over the tricyclic antidepressants
for initial use in patients with moderate depression because:
A.
B.
C.
D.
E.
43.
Which of the following classes of drugs is most likely to produce adverse effects that include
blurred vision, dizziness, sedation, increased appetite, weight gain, sexual dysfunction, and
orthostatic hypotension?
A.
B.
C.
D.
E.
44.
benzodiazepines
monoamine oxidase inhibitors
selective serotonin and norepinephrine uptake inhibitors
selective serotonin uptake inhibitors
tricyclic antidepressants
Which of the following drugs is used as a mood-stabilizing in patients with bipolar disorder
and requires therapeutic drug monitoring because concentrations in excess of the effective
range can produce neurologic symptoms that may progress rapidly to convulsions and death?
A.
B.
C.
D.
E.
45.
carbamazepine
lamotrigine
lithium
selegiline
valproic acid
Various controlled substances, including methamphetamine, are approved for treating patients in
whom obesity is refractory to other therapy. In addition to the potential for drug abuse, what
major side effects must be considered when prescribing these drugs?
A.
B.
C.
D.
E.
A-9
46.
47.
Which drug would you choose for prophylaxis of migraine headache in an asthmatic patient?
A.
B.
C.
D.
E.
47.
metoprolol
prochlorperazine
promethazine
propranolol
sumatriptan succinate
Various controlled substances, including methamphetamine, are approved for treating patients in
whom obesity is refractory to other therapy. In addition to the potential for drug abuse, what
major side effects must be considered when prescribing these drugs?
A.
B.
C.
D.
E.
48.
Which of the following mechanisms contributes to the effects of the opioid analgesics on
pain processing cells?
A.
B.
C.
D.
E.
A-10
49.
A 64-year old white male with a history of prostate cancer is being treated with
chemotherapy for metastatic bone disease. With time his pain can no longer be managed
with moderate opioid agonists, such as oxycodone. Which of the following agents would be
most likely to alleviate pain for this patient?
A.
B.
C.
D.
E.
50.
In addition to being a very effective analgesic agent, methadone, is also used therapeutically
for treatment of:
A.
B.
C.
D.
E.
51.
codeine
levorphanol
loperamide
meperidine
pentazocine
53.
constipation
cough
nausea
opioid dependance
opioid overdose
Which of the following agents is a weak opioid receptor antagonist or partial agonist but is
a opioid receptor agonist and has low abuse potential, especially in the oral form?
A.
B.
C.
D.
E.
52.
codeine
dextromethorphan
fentanyl
naloxone
naltrexone
butorphanol
cocaine
codeine
dextromethorphan
loperamide
What restriction is placed on the prescription for a Schedule II substance, such as morphine?
A.
B.
C.
D.
54.
55.
What is the mechanism for the euphoric actions of psychostimulant drugs, such as
amphetamine?
A.
B.
C.
D.
56.
58.
57.
indolamines
lysergic acids
opiate alkaloids
serotonin-like drugs
tetrahydrocannabinoids
noradrenergic agonists
amphetamine derivatives
CB1 receptor antagonists
kappa opioid receptor antagonists
mu opioid receptor antagonists
2
diazepam
heroin
lysergic acid diethylamide
marijuana
methamphetamine
A-12
59.
60.
A group of coworkers meets after work to celebrate a birthday. They consume alcoholic
beverages but no food. All but one of them (E) are usually moderate drinkers and do not
differ significantly except as stated. Who will have the highest blood alcohol concentration
one hour after rapidly drinking as described?
A.
B.
C.
D.
E.
61.
An unconscious 16 year old male is brought to the emergency room by his friends.
According to one of the friends, they had been drinking vodka (40% v/v alcohol), and the
patient, who normally did not drink alcohol, had been drinking rapidly and consumed many
more shots than anyone else in the group. Initially, his speech had become slurred and he
was ataxic, then he became extremely belligerent, and then he passed out. When they
could not awaken him, they brought him to the ER. Of the following blood alcohol levels,
which is the lowest that would account for his condition at the time he was seen in the ER?
A.
B.
C.
D.
E.
62.
0.003 %
0.03 %
30 mg/dl
300 mg/dl
3000 mg/dl
Chronic ethanol abuse induces biochemical adaptations in the expression of receptor proteins
in the brain that allow the brain to function more normally in the presence of:
A.
B.
C.
D.
E.
A-13
63.
A 30 year old female comes to your emergency clinic shortly after midnight with tremors,
anxiety, nausea, sweating, and diarrhea. She says he has been unable to sleep the past two
nights since suddenly breaking a habit of drinking a bottle (750 ml) of red wine before bed
every night. Upon examination you find that her pupils are dilated, and her pulse, blood
pressure, and temperature are elevated. Which of the following is appropriate for the initial
treatment to relieve her symptoms?
A.
B.
C.
D.
E.
64.
Fetal alcohol syndrome is diagnosed in a newborn on the basis of three features, which
include growth retardation, CNS effects (microcephaly, mental retardation, learning and
behavioral problems) and:
A.
B.
C.
D.
E.
65.
66.
amphetamine
diazepam
disulfiram
levorphanol
naltrexone
A-14