1
Q
Pharmacogenomics
A
Is the study of how genetic variations influence and individual response to medications. It helps identify which medications may be most effective or pose the highest risk based on the patient’s genetic makeup.
2
Q
Area under the curve
A
Bioavailability of a medication
3
Q
Pharmacokinetics
A
Is the study of how the body affects a drug, including absorption, distribution metabolism and excretion. It helps refers to how a medication is processed in an individual.
4
Q
Half life
A
Half life is how much time it takes a medication to decrease its concentration in the body by 50%
5
Q
Minimum inhibitory concentration
A
No concentration of an antibiotic needed to inhibit bacterial growth after overnight incubation
6
Q
INR goal for a patient with stroke, A.Fib, DVT
A
2.0 to 3.0
7
Q
INR goal for prosthetic mitral valve
A
2.5 to 3.5
8
Q
Concept of bio availability
A
Medication is absorbed and used by the body
9
Q
Main organs of bio transformation
A
Liver
10
Q
First pass metabolism
A
Medication’s administered orally must first be metabolize in the liver
11
Q
CYP450 inducer
A
Medication that increases the clearance of other medication’s
12
Q
CYP450 inhibitor
A
Medication that decreases the clearance of other medication’s
13
Q
Adverse effect of Nondihydropyridine CCB (Verapami, Diltiazem)
A
Constipation
14
Q
What type of medication is Enalapril?
A
Angiotensin-converting enzyme (ACE) inhibitor
ACE inhibitors are commonly used to treat high blood pressure and heart failure.
15
Q
A common side effect of ACE inhibitors is __________.
A
dry cough
This side effect may occur a few hours after the first dose or within weeks to months.
16
Q
If a patient has a history of asthma or chronic obstructive pulmonary disease, which medication might cause bronchospasm?
A
Atenolol
Atenolol is a beta-blocker that can lead to bronchospasm in susceptible individuals.
17
Q
What physical exam finding would likely reveal if atenolol is causing bronchospasm?
A
Wheezing
Wheezing is a common sign of bronchospasm and can be assessed during a physical examination.
18
Q
List the adverse effects of amlodipine.
A
- Peripheral edema
- Headaches
- Flushing
- Lightheadedness
Amlodipine is a dihydropyridine calcium channel blocker used for hypertension.
19
Q
What are the potential adverse effects of diltiazem?
A
- Worsened cardiac output
- Bradycardia
- Constipation
Diltiazem is a nondihydropyridine calcium channel blocker that can affect heart function.
20
Q
What is the first step to take for a patient at risk of developing a prolonged QT interval due to macrolides and calcium channel blockers?
A
A. Perform an EKG
A timely EKG is essential for diagnosis of prolonged QT interval, which can lead to torsades de pointes and ventricular tachycardia.
21
Q
True or false: An echocardiogram is the priority test after a patient is diagnosed with a prolonged QT interval.
A
FALSE
The priority is to perform an EKG, while an echocardiogram may be helpful after diagnosis to evaluate heart function.
22
Q
What should be obtained alongside the EKG for a patient with a prolonged QT interval?
A
- Serum electrolytes
- Chest x-ray (if respiratory symptoms present)
Serum electrolytes are important for diagnosis, and a chest x-ray may rule out other conditions like pneumonia.
23
Q
In the context of atrial fibrillation, what condition may prompt evaluation of thyroid-stimulating hormone?
A
Thyroid disease
Other historical and physical exam findings would indicate the need for thyroid evaluation.
24
Q
NSAIDs
A
contraindicated in patients who are taking anticoagulant, even topical diclofenac
25
What is the likely cause of **nosebleeds** and prolonged bleeding in a male patient taking **warfarin** for atrial fibrillation?
The international normalized ratio (INR) is likely elevated and should be re-checked
## Footnote
Signs of an elevated INR include prolonged bleeding from cuts, frequent nosebleeds, and excessive bruising.
26
Which **symptoms** suggest an elevated INR in a patient on warfarin?
* Prolonged bleeding from cuts
* Frequent nosebleeds
* Bloody/tarry stool
* Hematuria
* Petechiae
* Excessive bruising
* Excessive menstrual bleeding
* Persistent oozing/bleeding gums after brushing
## Footnote
These symptoms indicate the need for an INR check before adjusting the warfarin dose.
27
True or false: A patient on warfarin should increase their dose if they experience nosebleeds and prolonged bleeding.
FALSE
## Footnote
The INR must be checked before providing any advice on changing the dose.
28
What dietary factor can **reduce the anticoagulant effect** of warfarin?
High intake of vitamin K foods (e.g., kale, spinach, collards/mustard/beet greens, broccoli rabe)
## Footnote
Increased consumption of green, leafy vegetables can decrease INR.
29
What should be done before advising a patient on changing their **warfarin dose**?
The INR must be checked
## Footnote
Frequent missed doses can lead to a subtherapeutic INR level.
30
According to the **American College of Cardiology/American Heart Association guideline**, what should initial antihypertensive therapy in Black patients include?
* Thiazide-type diuretic (e.g., chlorthalidone)
* Calcium channel blocker
## Footnote
These options are preferred for managing hypertension in Black patients.
31
True or false: **Atenolol** is a suitable initial treatment for this patient with COPD.
FALSE
## Footnote
Atenolol should be avoided in patients with COPD due to the risk of bronchoconstriction.
32
What is **spironolactone** primarily used for?
* Primary aldosteronism
* Common add-on therapy in resistant hypertension
## Footnote
It is a mineralocorticoid receptor antagonist.
33
What lifestyle changes were suggested for the patient?
* Increased exercise
* Diet modifications
## Footnote
These are part of nonpharmacologic therapy but not the initial intervention in this case.
34
Which pharmacologic intervention is most appropriate for HFrEF EF <40%
Valsartan and Carvedilol
35
What are the **initial pharmacologic therapies** recommended for heart failure?
* Angiotensin receptor neprilysin inhibitors (ARNIs)
* Angiotensin-converting enzyme inhibitors (ACEIs)
* Angiotensin receptor blockers (ARBs)
* Beta-blockers
* Loop diuretics
* Aldosterone antagonists
* Hydralazine/isosorbide dinitrate (HYD/ISDN)
* Ivabradine
## Footnote
These therapies are based on American College of Cardiology/American Heart Association guidelines.
36
Which **beta-blocker** is preferred in heart failure with reduced ejection fraction (HFrEF)?
Carvedilol, metoprolol succinate and bisoprolol.
Foot note: Only specific beta blockers are recommended for HFrEF. Atenolol is not one of the approved agents
37
True or false: **Atenolol** is an approved agent for heart failure treatment.
FALSE
## Footnote
Atenolol lacks mortality benefit in heart failure.
38
Why is **digoxin** rarely used in heart failure treatment?
Narrow therapeutic index
## Footnote
This increases the risk of toxicity.
39
What is the **best treatment option** for patient with acne who has not responded to OTC products?
Topical azelaic acid
## Footnote
Topical prescription remedies are preferred for mild acne after OTC products fail.
40
True or false: **Oral isotretinoin** is indicated for mild acne.
FALSE
## Footnote
Oral isotretinoin is indicated for severe acne and carries significant risks of teratogenicity.
41
What is required for patients taking **oral isotretinoin**?
Participation in the PLEDGE® REMS
## Footnote
This is a Risk Evaluation and Mitigation Strategy due to the risks associated with isotretinoin.
42
After how many months of therapy could **oral tetracycline** or minocycline be considered?
3 to 6 months
## Footnote
These medications have significant side effects and are not first-line treatments.
43
What could **oral spironolactone** be considered as in acne treatment?
An adjunct if other interventions fail
## Footnote
It is not a first-line treatment but can be used in combination with other therapies.
44
What is the **best treatment option** for a male patient with a worsening skin infection caused by **methicillin-resistant Staphylococcus aureus (MRSA)** and a sulfa allergy?
Clindamycin
## Footnote
Clindamycin is an appropriate alternative for MRSA in patients with a sulfa allergy.
45
True or false: **Ceftriaxone** is effective against MRSA.
FALSE
## Footnote
Ceftriaxone is primarily indicated for gram-negative bacterial infections and is not effective against MRSA.
46
Which first-line treatment for MRSA is contraindicated in this patient due to a **sulfa allergy**?
Trimethoprim-sulfamethoxazole
## Footnote
This treatment cannot be used due to the patient's allergy to sulfa drugs.
47
What is the risk associated with using **ciprofloxacin**?
Achilles tendon rupture
## Footnote
Ciprofloxacin should always be used with caution due to this risk.
48
Which antibiotic covers some gram-positive and gram-negative bacteria but is not indicated for the treatment of **MRSA**?
Azithromycin
## Footnote
Azithromycin is not effective for treating MRSA infections.
49
What is the **best empiric treatment** for a 75-year-old female patient with dysuria and a urine dipstick showing large leukocytes, nitrates, and trace blood?
Nitrofurantoin
## Footnote
This choice is preferred due to the patient's current medication of warfarin and the need to avoid trimethoprim-sulfamethoxazole unless absolutely necessary.
50
True or false: **Fluoroquinolones** are indicated as first-line therapy for uncomplicated urinary tract infections.
FALSE
## Footnote
Fluoroquinolones are never indicated as first-line therapy for uncomplicated urinary tract infections.
51
Which medication should be avoided in a patient taking **warfarin** unless it is the only option?
Trimethoprim-sulfamethoxazole
## Footnote
If prescribed, the international normalized ratio must be closely monitored.
52
What is the significance of **Amoxicillin** in treating urinary tract infections?
It has some gram-negative coverage but resistance is high
## Footnote
Its coverage can be augmented with the addition of clavulanic acid.
53
What visual changes are associated with **Digoxin** overdose?
Yellow-green-tinged color vision
## Footnote
This symptom is indicative of Digoxin toxicity.
54
Which medication is suggested by the symptoms of **increased confusion** and **first-degree atrioventricular (AV) block**?
Digoxin
## Footnote
These signs are consistent with Digoxin overdose.
55
True or false: **Furosemide** is known to cause visual changes and AV blocks.
FALSE
## Footnote
Furosemide can cause ototoxicity but not these specific side effects.
56
What are common signs and symptoms of **Digoxin** toxicity?
* Gastrointestinal symptoms (nausea, vomiting)
* Hyperkalemia
* Bradydysrhythmias (AV blocks)
* Tachydysrhythmias (ventricular tachycardia/fibrillation or atrial tachycardia with 2:1 block)
* Confusion
* Visual changes (yellow-green-tinged color vision)
## Footnote
Digoxin has a narrow therapeutic window, making toxicity a concern.
57
What is a potential side effect of **Warfarin**?
* Increased bleeding risk
* Skin necrosis
## Footnote
Warfarin does not cause visual changes or AV blocks.
58
What is a common side effect of **Lisinopril** overdose?
* Severe hypotension
* Hyperkalemia
* Cough
* Reduction in glomerular filtration rate
* Angioedema
* Anaphylactoid reactions
## Footnote
These side effects are not related to visual changes or AV blocks.
59
Fill in the blank: **Digoxin** can be used as second-or third-line therapy for _______.
heart failure
## Footnote
Digoxin is often used in patients with heart failure.
60
What is the **systolic blood pressure range** for Stage 1 hypertension according to the ACC/AHA?
130 to 139 mmHg
## Footnote
This range is part of the classification for hypertension stages.
61
What is the **diastolic blood pressure range** for Stage 1 hypertension according to the ACC/AHA?
80 to 89 mmHg
## Footnote
This range is part of the classification for hypertension stages.
62
Fill in the blank: **Normal blood pressure** is defined as systolic < _______ mmHg and diastolic < _______ mmHg.
120
## Footnote
Normal blood pressure is characterized by systolic <120 mmHg and diastolic <80 mmHg.
63
Fill in the blank: **Elevated blood pressure** is defined as systolic _______ to _______ mmHg and diastolic <80 mmHg.
120 to 129
## Footnote
Elevated blood pressure indicates a systolic range of 120-129 mmHg.
64
True or false: A blood pressure reading of 135/85 mmHg is classified as **Stage 2 hypertension**.
FALSE
## Footnote
A reading of 135/85 mmHg is classified as Stage 1 hypertension, not Stage 2.
65
What is the **systolic blood pressure threshold** for Stage 2 hypertension according to the ACC/AHA?
>140 mmHg
## Footnote
Stage 2 hypertension is characterized by a systolic blood pressure greater than 140 mmHg.
66
What is the **diastolic blood pressure threshold** for Stage 2 hypertension according to the ACC/AHA?
>90 mmHg
## Footnote
Stage 2 hypertension is characterized by a diastolic blood pressure greater than 90 mmHg.
67
What is the **preferred first-line agent** for treating Neisseria gonorrhoeae infection?
Ceftriaxone
## Footnote
Ceftriaxone is a third-generation cephalosporin and the preferred treatment for gonococcal infections.
68
Which type of antibiotic is **Ceftriaxone**?
Third-generation cephalosporin
## Footnote
It is specifically used for treating gonorrhea.
69
True or false: **Cephalexin** is the preferred first-line therapy for gonorrhea.
FALSE
## Footnote
Cephalexin is a first-generation cephalosporin, not preferred for gonococcal infections.
70
List the **types of cephalosporins** mentioned in the treatment options.
* Cephalexin (first generation)
* Cefuroxime (second generation)
* Cefdinir (third generation)
* Ceftriaxone (third generation)
## Footnote
Only ceftriaxone is the preferred treatment for gonorrhea.
71
What is the boxed warning associated with **fluoroquinolones** like levofloxacin?
Increased risk of tendinitis and acute tendon rupture
## Footnote
This risk is particularly high in patients older than 60 years, those on steroid treatment, or those who have received an organ transplant.
72
True or false: **Cephalexin**, **amoxicillin**, and **doxycycline** are more likely to cause acute tendon rupture compared to fluoroquinolones.
FALSE
## Footnote
These antibiotics are less likely to cause acute tendon rupture compared to fluoroquinolones.
73
Patients are advised to avoid _______ while on fluoroquinolone medication.
strenuous activity
## Footnote
This precaution is due to the increased risk of tendon injuries.
74
List the antibiotics mentioned that are less likely to cause acute tendon rupture compared to fluoroquinolones.
* Cephalexin
* Amoxicillin
* Doxycycline
## Footnote
These antibiotics belong to different classes: cephalosporins, penicillins, and tetracyclines.
75
What is the classification of **Clobetasol (Temovate)**?
Superpotent (group 1) topical steroid
## Footnote
Clobetasol is the most potent category of topical steroids.
76
What potency classification does **Halcinonide** fall under?
High potency (group 2)
## Footnote
Halcinonide is less potent than Clobetasol but more potent than mometasone furoate.
77
What is the potency classification of **mometasone furoate**?
High/medium potency (group 3)
## Footnote
Mometasone furoate is used for various inflammatory skin conditions.
78
What potency classification does **desonide gel** have?
Medium/low potency (group 5)
## Footnote
Desonide is often used for sensitive areas of the skin.
79
What is the **preferred agent** for the treatment of **Rocky Mountain spotted fever (RMSF)**?
Doxycycline
## Footnote
Doxycycline is effective for RMSF and all other tickborne rickettsial diseases in adults and children.
80
What are the **early signs** of illness in Rocky Mountain spotted fever?
* Fever
* Headache
* Malaise
* Myalgias
## Footnote
These symptoms are nonspecific and can occur in the early stages of RMSF.
81
When does a **petechial or maculopapular rash** typically develop in RMSF patients?
Between the **third and fifth day** of illness
## Footnote
This rash is a common feature in most patients with RMSF.
82
True or false: **Chloramphenicol** is more effective than doxycycline for treating RMSF.
FALSE
## Footnote
Chloramphenicol is an alternative but is less effective than doxycycline.
83
What type of drugs may worsen the clinical course of RMSF?
Sulfa-containing drugs
## Footnote
These drugs increase the risk of death when treating RMSF.
84
Which antibiotics are **not indicated** or effective for the treatment of RMSF?
* Amoxicillin
* Clindamycin
## Footnote
These antibiotics do not work for treating Rocky Mountain spotted fever.
85
Which herbal supplement is commonly used in patients with **benign prostate hyperplasia (BPH)**?
C. Saw palmetto
## Footnote
Extracts of the fruit from the saw palmetto (Serenoa repens) have been historically used to treat BPH.
86
What is the primary use of **St. John's wort**?
Management of depression
## Footnote
It is not used for BPH.
87
What conditions has **Ginkgo biloba** been studied for?
* Treatment of memory issues
* Prevention of cognitive impairment
* Prevention of dementia
## Footnote
Ginkgo biloba is not used for BPH.
88
What is **Kava kava** commonly used for?
* Anxiety
* Insomnia
## Footnote
Kava kava is not indicated for BPH.
89
Fill in the blank: **Extracts of the fruit from the saw palmetto** (Serenoa repens) have been used to treat _______.
benign prostate hyperplasia (BPH)
## Footnote
This herbal supplement is commonly associated with BPH treatment.
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