Module 8 - Claude Set with 4 answers

What is the primary concern if a patient takes glyburide (Sulfonylurea) and drinks wine nightly? A) Weight gain B) Severe/prolonged hypoglycemia C) Liver toxicity D) Drug tolerance

B) Severe/prolonged hypoglycemia - Alcohol inhibits gluconeogenesis, enhancing sulfonylurea effect. Key rationale: Alcohol blocks glucose production in liver. Exam trap: Don't choose liver toxicity over hypoglycemia - alcohol + sulfonylureas = hypoglycemia risk

What should you do with metformin (Biguanide) before a CT with contrast? A) Increase dose B) Stop 48 hours before C) Continue normally D) Switch to insulin

B) Stop metformin 48 hours before IV contrast - Prevents lactic acidosis from contrast-induced renal impairment. Key rationale: Contrast can cause kidney injury, reducing metformin clearance. Exam trap: Don't choose "continue normally" - contrast + metformin = fatal acidosis risk

When should a Type 1 diabetic inject Humalog (Rapid-acting insulin) before breakfast? A) 15-30 minutes before eating B) Immediately before eating C) 1 hour before eating D) After eating

A) 15-30 minutes before eating - Matches rapid onset with meal glucose peak. Key rationale: Rapid-acting insulin peaks 30-90 minutes post-injection. Exam trap: Don't choose "immediately before" - need time for insulin to start working before glucose rises

Why avoid propranolol (Beta-blocker) in a patient on insulin? A) Increases blood sugar B) Masks hypoglycemia symptoms C) Causes weight gain D) Reduces insulin absorption

B) Masks hypoglycemia symptoms and delays recovery - Beta-blockers blunt adrenergic warning signs. Key rationale: Beta-blockers block sympathetic response to hypoglycemia. Exam trap: Don't choose "increases blood sugar" - beta-blockers can actually worsen hypoglycemia by blocking recovery mechanisms

Which diabetes drug class provides cardiovascular protection? A) Sulfonylureas (glipizide) B) SGLT2 inhibitors C) Insulin D) Biguanides (metformin)

B) SGLT2 inhibitors like empagliflozin, canagliflozin - Benefits against heart failure and CV death. Key rationale: SGLT2 inhibitors proven to reduce CV mortality in trials. Exam trap: Don't choose metformin - while cardioprotective, SGLT2 inhibitors have stronger CV outcome data

What does shakiness indicate in a patient on insulin and glyburide (Sulfonylurea)? A) Hyperglycemia B) Additive hypoglycemia risk C) Drug interaction D) Allergic reaction

B) Additive hypoglycemia risk from combined agents - Both can cause hypoglycemia independently. Key rationale: Two hypoglycemic agents increase cumulative risk. Exam trap: Don't choose hyperglycemia - shakiness is classic hypoglycemic symptom

When does NPH insulin (Intermediate-acting) peak after injection? A) 2-4 hours B) 6-14 hours C) 18-24 hours D) No peak

B) 6-14 hours - Risk of hypoglycemia during the night. Key rationale: NPH has pronounced peak unlike long-acting insulins. Exam trap: Don't choose "no peak" - that's long-acting insulin like glargine

What increases metformin (Biguanide) lactic acidosis risk the most? A) Age B) Renal impairment C) Obesity D) Alcohol use

B) Renal impairment/kidney failure - Reduced clearance leads to accumulation. Key rationale: Metformin is renally eliminated; kidney disease = drug buildup. Exam trap: Don't choose alcohol alone - while risky, kidney disease is the primary risk factor

What is the duration of action of glargine (Long-acting insulin)? A) 6-12 hours B) 18-24+ hours with no peak C) 3-5 hours D) 1-3 hours

B) 18-24+ hours with no peak - Steady basal coverage without pronounced peaks. Key rationale: Long-acting insulin provides flat, sustained insulin levels. Exam trap: Don't choose shorter durations - those are for rapid/short-acting insulins

Which oral diabetes drug is first-line for Type 2 diabetes? A) Sulfonylureas (glyburide) B) Metformin C) Thiazolidinediones (pioglitazone) D) DPP-4 inhibitors (sitagliptin)

B) Metformin (Biguanide) - Improves insulin sensitivity, low hypoglycemia risk, weight neutral. Key rationale: ADA/EASD guidelines recommend metformin as initial therapy. Exam trap: Don't choose sulfonylureas first - they cause weight gain and hypoglycemia

What are the onset and peak times of regular insulin (Short-acting)? A) Onset 30-60 min, peak 1-5 hours B) Onset 15 min, peak 1 hour C) Onset 1 hour, peak 6 hours D) No peak

A) Onset 30-60 min, peak 1-5 hours - Plan meals 30-60 minutes after injection. Key rationale: Regular insulin is slower than rapid-acting but faster than NPH. Exam trap: Don't choose rapid-acting timing - regular insulin is slower onset than lispro/aspart

What vitamin deficiency occurs with metformin (Biguanide)? A) Vitamin D B) Vitamin B12 and folic acid C) Vitamin C D) Vitamin A

B) Vitamin B12 and folic acid - Long-term use interferes with B12 absorption. Key rationale: Metformin reduces B12 absorption in terminal ileum. Exam trap: Don't choose vitamin D - that's not specifically linked to metformin use

What is the black box warning for pioglitazone (Thiazolidinedione)? A) Lactic acidosis B) Heart failure due to fluid retention C) Pancreatitis D) Bone fractures

B) Heart failure due to fluid retention - Avoid in patients with CHF history. Key rationale: TZDs cause fluid retention by increasing sodium reabsorption. Exam trap: Don't choose lactic acidosis - that's metformin's BBW, not pioglitazone

What serious genital side effect is associated with SGLT2 inhibitors like canagliflozin? A) Yeast infections B) Necrotizing fasciitis (Fournier's gangrene) C) Urinary retention D) Painful urination

B) Necrotizing fasciitis (Fournier's gangrene) - Urgent surgical emergency requiring immediate intervention. Key rationale: High glucose in genital area promotes bacterial growth. Exam trap: Don't choose simple yeast infections - Fournier's gangrene is life-threatening vs common yeast infections

Which insulin can be mixed with short-acting insulin? A) Long-acting (glargine) B) NPH only C) Long-acting (detemir) D) Any insulin

B) NPH (Intermediate-acting) only - Other insulins lose effectiveness or precipitate when mixed. Key rationale: Only NPH has compatible pH and formulation. Exam trap: Don't choose long-acting insulins - mixing destroys their extended-release properties

How do GLP-1 agonists (exenatide) cause weight loss? A) Increase metabolism B) Slows gastric emptying and increases satiety C) Blocks fat absorption D) Increases insulin

B) Slows gastric emptying and increases satiety - Reduces calorie intake through appetite suppression. Key rationale: GLP-1 acts on hypothalamic satiety centers and delays gastric emptying. Exam trap: Don't choose increased metabolism - weight loss is from reduced food intake, not increased energy expenditure

What serious side effect is associated with DPP-4 inhibitors (sitagliptin)? A) Pancreatitis B) Heart failure C) Lactic acidosis D) Hypoglycemia

A) Pancreatitis - Monitor for severe abdominal pain radiating to back. Key rationale: DPP-4 inhibitors may trigger pancreatic inflammation. Exam trap: Don't choose hypoglycemia - DPP-4 inhibitors have low hypoglycemia risk compared to sulfonylureas

Why do sulfonylureas (glipizide) eventually fail? A) Drug tolerance B) Beta-cell exhaustion C) Weight gain D) Drug interactions

B) Beta-cell exhaustion/burnout - Progressive loss of pancreatic function in diabetes. Key rationale: Type 2 diabetes involves progressive beta-cell decline over time. Exam trap: Don't choose drug tolerance - it's not tolerance but actual loss of insulin-producing cells

What unexpected side effect can thiazolidinediones (pioglitazone) cause in women? A) Weight loss B) Ovulation leading to unintended pregnancy C) Hair loss D) Mood changes

B) Ovulation leading to unintended pregnancy - Can restore fertility in PCOS patients. Key rationale: TZDs improve insulin sensitivity, which can normalize ovulation. Exam trap: Don't assume infertile PCOS patients can't get pregnant on TZDs

What is a contraindication for rapid-acting inhaled insulin (afrezza)? A) Diabetes type 1 B) Chronic lung disease C) Heart disease D) Kidney disease

B) Chronic lung disease - Risk of bronchospasm and reduced lung function. Key rationale: Inhaled insulin can worsen respiratory conditions. Exam trap: Don't choose type 1 diabetes - inhaled insulin is actually approved for type 1

How should patients take levothyroxine (Thyroid hormone)? A) With breakfast B) Morning, empty stomach, 30-60 min before food C) With calcium supplements D) At bedtime

B) Morning, empty stomach, 30-60 min before food with water only - Optimizes absorption. Key rationale: Food, especially high-fiber, calcium, iron reduce absorption significantly. Exam trap: Don't choose with breakfast - food reduces absorption by up to 40%

When do you recheck TSH after changing thyroid dose? A) 2-3 weeks B) 6-8 weeks C) 3 months D) 1 year

B) 6-8 weeks - Reflects steady-state thyroid hormone levels. Key rationale: Thyroid hormone has long half-life requiring time to reach equilibrium. Exam trap: Don't check too early (2-3 weeks) - levels haven't stabilized yet

What is the black box warning for testosterone gel (Androgen)? A) Heart attacks B) Secondary exposure causes virilization in children C) Liver toxicity D) Blood clots

B) Secondary exposure causes virilization in children - Skin contact can transfer hormone. Key rationale: Testosterone can cause permanent sexual development changes in children. Exam trap: Don't focus only on user risks - secondary exposure to family members is the main BBW concern

What is an absolute contraindication for sildenafil (PDE-5 inhibitor)? A) Age over 65 B) Concurrent nitrate use C) Diabetes D) High blood pressure

B) Concurrent nitrate use - Causes potentially fatal hypotension. Key rationale: Both drugs cause vasodilation; combined effect is dangerous. Exam trap: Don't choose age or diabetes - the only absolute contraindication is nitrates

How should levothyroxine (Thyroid hormone) dose be adjusted in pregnancy? A) Decrease dose B) Increase dose C) No change needed D) Stop medication

B) Increase dose - Pregnancy increases thyroid-binding globulin and metabolic demands. Key rationale: Higher TBG levels require more hormone to maintain free T4. Exam trap: Don't assume same dose is adequate - pregnancy increases thyroid hormone needs by 30-50%

How to start thyroid replacement in an 80-year-old? A) Full replacement dose B) Start low dose, titrate slowly C) Start high dose D) Use T3 instead

B) Start low dose, titrate slowly - Reduces risk of cardiac complications. Key rationale: Elderly have increased sensitivity and cardiac risk with rapid thyroid correction. Exam trap: Don't start full dose in elderly - can precipitate MI or arrhythmias

Does tamsulosin (Alpha-1 blocker) shrink the prostate? A) Yes, significantly B) No, relaxes smooth muscle only C) Yes, slightly D) Only in combination therapy

B) No, relaxes smooth muscle in bladder neck and prostate to improve flow. Key rationale: Alpha-1 blockers provide symptomatic relief without affecting prostate size. Exam trap: Don't confuse with 5-alpha reductase inhibitors which actually shrink the prostate

How long does finasteride (5-alpha reductase inhibitor) take to shrink the prostate? A) 2-4 weeks B) 6-12 months C) 1-2 years D) Works immediately

B) 6-12 months - Delayed onset due to slow tissue remodeling. Key rationale: Takes time to reduce DHT levels and shrink prostate tissue. Exam trap: Don't expect immediate relief like with alpha-blockers - finasteride has very slow onset

What food interaction affects PDE-5 inhibitors (sildenafil)? A) Grapefruit juice B) High-fat meals delay absorption C) Dairy products D) Alcohol enhances effect

B) High-fat meals delay absorption/onset - Take on empty stomach for faster effect. Key rationale: Fat delays gastric emptying and drug absorption. Exam trap: Don't choose grapefruit - that affects CYP3A4 substrates, not specifically PDE-5 inhibitors

What is levothyroxine's (Thyroid hormone) half-life and dosing frequency? A) 1-day half-life, twice daily B) 7-day half-life, once daily C) 3-day half-life, every other day D) 12-hour half-life, twice daily

B) 7-day half-life, once daily dosing - Long half-life provides steady levels. Key rationale: Long half-life eliminates need for frequent dosing. Exam trap: Don't think short half-life requires multiple daily doses

Which BPH drug shrinks the prostate over time? A) Alpha-1 blockers (tamsulosin) B) 5-alpha reductase inhibitors C) Beta-blockers D) PDE-5 inhibitors

B) 5-alpha reductase inhibitors (finasteride) - Block DHT production to reduce prostate size. Key rationale: DHT is the hormone driving prostate growth. Exam trap: Don't choose alpha-blockers - they improve symptoms without shrinking prostate

What is the pregnancy warning for finasteride (5-alpha reductase inhibitor)? A) Safe in pregnancy B) Teratogenic to male fetus; tablets cannot be crushed C) Only dangerous in first trimester D) Causes miscarriage

B) Teratogenic to male fetus; tablets cannot be crushed - Crushing increases exposure risk. Key rationale: Finasteride blocks DHT needed for male fetal development. Exam trap: Don't think it's safe if tablets aren't crushed - even handling crushed tablets is dangerous

What is the cataract surgery warning for tamsulosin (Alpha-1 blocker)? A) Delays healing B) Floppy iris syndrome C) Increases bleeding D) Causes infection

B) Floppy iris syndrome - Inform surgeon before procedure. Key rationale: Alpha-1 blockade affects iris muscle tone during surgery. Exam trap: Don't overlook this - surgeon needs to modify technique to prevent complications

When should testosterone (Androgen) levels be monitored after starting therapy? A) 2-3 weeks post-initiation B) 6-8 weeks C) 3 months D) 1 year

A) 2-3 weeks post-initiation - Allows assessment of steady-state levels. Key rationale: Most testosterone formulations reach steady state in 2-3 weeks. Exam trap: Don't wait too long like with thyroid hormones - testosterone has shorter half-life

If TSH remains high despite levothyroxine (Thyroid hormone), what's the next step? A) Increase dose immediately B) Check free T4 levels C) Switch medications D) Add T3

B) Check free T4 levels - Assess adequacy of peripheral hormone levels. Key rationale: Free T4 shows actual available hormone despite high TSH. Exam trap: Don't just increase dose blindly - need to assess if problem is absorption, compliance, or interference

Which drugs interfere with levothyroxine (Thyroid hormone) absorption? A) Calcium, iron, PPIs B) Beta-blockers C) Statins D) ACE inhibitors

A) Calcium, iron, PPIs - Space administration by 4+ hours. Key rationale: These agents bind to or alter pH affecting absorption. Exam trap: Don't assume all medications interfere - only specific ones that affect GI absorption

What is a key difference between doxazosin and tamsulosin (Alpha-1 blockers)? A) Same mechanism B) Doxazosin lowers BP; tamsulosin is selective C) Same side effects D) Same duration

B) Doxazosin lowers BP; tamsulosin is selective for alpha-1A receptors. Key rationale: Tamsulosin's selectivity reduces cardiovascular side effects. Exam trap: Don't expect tamsulosin to cause hypotension like non-selective alpha-blockers

How does tadalafil's (PDE-5 inhibitor) duration compare to others? A) Same duration B) Tadalafil lasts 36 hours vs 4-6 hours C) Shorter duration D) Variable duration

B) Tadalafil lasts 36 hours vs 4-6 hours for sildenafil/vardenafil. Key rationale: Different pharmacokinetics allow for longer action. Exam trap: Don't assume all PDE-5 inhibitors have same duration - affects dosing timing

Which drugs can induce thyroid dysfunction? A) Amiodarone and lithium B) Metformin and insulin C) Statins and ACE inhibitors D) Beta-blockers

A) Amiodarone (Antiarrhythmic) and lithium (Mood stabilizer) - Monitor thyroid function regularly. Key rationale: Amiodarone contains iodine; lithium blocks thyroid hormone release. Exam trap: Don't overlook drug-induced thyroid disease in patients on these medications

Why use propranolol (Beta-blocker) in hyperthyroidism? A) Controls symptoms but doesn't affect hormone levels B) Blocks thyroid hormone synthesis C) Destroys thyroid tissue D) Increases metabolism

A) Controls symptoms (tachycardia, tremor) but doesn't treat underlying hyperthyroidism. Key rationale: Beta-blockade controls adrenergic symptoms of excess thyroid hormone. Exam trap: Don't think it treats hyperthyroidism - it's purely symptomatic therapy

How does radioactive iodine treat hyperthyroidism? A) Blocks hormone synthesis B) Destroys thyroid tissue C) Controls symptoms only D) Temporary effect

B) Destroys thyroid tissue - Permanent solution but often causes hypothyroidism. Key rationale: Radiation destroys hormone-producing cells. Exam trap: Don't expect temporary effect - it's permanent and usually requires lifelong thyroid replacement

Which testosterone (Androgen) route has the longest duration? A) Topical gel B) Implantable pellets C) Intramuscular injection D) Transdermal patch

B) Implantable pellets - Last 3-6 months vs weeks for other routes. Key rationale: Pellets provide slow, sustained hormone release. Exam trap: Don't assume injections last longest - pellets have the most sustained release

What is the mechanism of 5-alpha reductase inhibitors (finasteride)? A) Blocks testosterone to DHT conversion B) Relaxes smooth muscle C) Increases testosterone production D) Blocks estrogen receptors

A) Blocks testosterone to DHT conversion - Reduces the more potent androgen driving prostate growth. Key rationale: DHT is 5x more potent than testosterone for prostate stimulation. Exam trap: Don't confuse with alpha-blockers which work on muscle, not hormones

What is testosterone's (Androgen) controlled substance schedule? A) Schedule III B) Schedule IV C) Schedule II D) Not controlled

A) Schedule III - Has moderate potential for abuse. Key rationale: Anabolic effects make it subject to abuse by athletes. Exam trap: Don't assume it's not controlled - testosterone has abuse potential requiring DEA regulations

When should PDE-5 inhibitors (sildenafil) be avoided with alpha-blockers? A) Avoid within 24 hours B) Never combine C) Always safe together D) Only with meals

A) Avoid within 24 hours - Risk of severe additive hypotension. Key rationale: Both drugs cause vasodilation with potential for dangerous BP drop. Exam trap: Don't think they're always contraindicated - timing matters for safety

How must patients take alendronate (Bisphosphonate)? A) With food to reduce GI upset B) Morning, empty stomach, upright 30+ min C) At bedtime D) With calcium for better absorption

B) Morning, empty stomach, upright 30+ min, full glass water - Prevents esophageal irritation. Key rationale: Bisphosphonates can cause severe esophagitis if not taken properly. Exam trap: Don't choose with calcium - calcium actually reduces bisphosphonate absorption

What is the black box warning for raloxifene (SERM)? A) Increased risk of VTE & stroke B) Liver toxicity C) Bone fractures D) Kidney problems

A) Increased risk of VTE & stroke death, especially in women with cardiac history. Key rationale: SERM effects on coagulation increase clotting risk. Exam trap: Don't focus only on benefits - raloxifene has significant thrombotic risks

What is a bisphosphonate (alendronate) absolute contraindication? A) Age over 65 B) Esophageal abnormalities or inability to stay upright C) Mild kidney disease D) Osteoarthritis

B) Esophageal abnormalities or inability to remain upright 30+ minutes. Key rationale: Risk of severe esophageal ulceration and stricture. Exam trap: Don't overlook swallowing problems or mobility issues - these prevent safe administration

What serious jaw complication occurs with bisphosphonates (alendronate)? A) Osteonecrosis of the jaw B) TMJ disorder C) Tooth decay D) Gingivitis

A) Osteonecrosis of the jaw - Especially with dental procedures or poor dental hygiene. Key rationale: Bisphosphonates impair bone remodeling needed for healing. Exam trap: Don't dismiss as minor dental issue - ONJ can be devastating and permanent

How do SERMs (raloxifene) act on bone vs breast tissue? A) Same effect on both tissues B) Agonist in bone, antagonist in breast C) Antagonist in both tissues D) Agonist in both tissues

B) Agonist in bone (protects), antagonist in breast (reduces cancer risk). Key rationale: SERMs have tissue-selective estrogen effects. Exam trap: Don't expect same effect everywhere - SERMs are designed for selective action

How does teriparatide's (PTH analog) mechanism differ from bisphosphonates? A) Same mechanism of action B) Teriparatide builds bone; bisphosphonates block breakdown C) Both have identical effects D) Both only prevent fractures

B) Teriparatide builds bone (anabolic); bisphosphonates block breakdown (anti-resorptive). Key rationale: Anabolic vs anti-catabolic approaches to bone health. Exam trap: Don't think all osteoporosis drugs work the same way - mechanisms are opposite

When should raloxifene (SERM) be discontinued before surgery? A) 24 hours before B) Stop 72 hours before prolonged immobilization C) 1 week before D) Not necessary to stop

B) Stop 72 hours before prolonged immobilization - Reduces VTE risk during high-risk period. Key rationale: Immobilization + SERM = very high clotting risk. Exam trap: Don't forget to stop before surgery - combination of immobilization and raloxifene is dangerous

Where do bisphosphonate (alendronate) atypical fractures occur? A) Vertebral spine B) Femur shaft C) Hip joint D) Wrist bones

B) Femur shaft - Distinct pattern from typical osteoporotic fractures. Key rationale: Long-term bisphosphonate use can impair bone remodeling. Exam trap: Don't confuse with typical fragility fractures - atypical fractures have different location and pattern

What is a contraindication for teriparatide (PTH analog)? A) Age over 80 B) History of bone cancer C) Mild kidney disease D) Previous fractures

B) History of bone cancer - Risk of osteosarcoma development. Key rationale: PTH can stimulate bone tumors in predisposed patients. Exam trap: Don't overlook cancer history - bone-building drugs can promote malignancy

How long do bisphosphonates (alendronate) remain in bone after stopping? A) Few weeks B) Years to decades C) Few months D) Few days

B) Years to decades - Effects persist long after discontinuation, consider drug holidays. Key rationale: Bisphosphonates bind tightly to bone mineral. Exam trap: Don't think effects stop immediately - long bone retention affects dosing decisions

What organs are involved in methotrexate (DMARD) black box warnings? A) Liver, lungs, kidneys, bone marrow B) Heart and brain only C) Stomach and intestines D) Eyes and ears

A) Liver, lungs, kidneys, bone marrow - Requires regular monitoring of CBC, LFTs, creatinine. Key rationale: MTX affects rapidly dividing cells in multiple organs. Exam trap: Don't focus on just one organ - MTX toxicity is multi-system

What is the black box warning for TNF inhibitors (etanercept)? A) Serious infections and lymphoma B) Liver failure only C) Heart attacks D) Kidney failure

A) Serious infections and lymphoma, especially in children - Screen for latent TB before starting. Key rationale: TNF suppression impairs immune response. Exam trap: Opportunistic infections can be fatal if overlooked

Can prednisone (Corticosteroid) 20mg for 6 weeks be stopped abruptly? A) Yes, always safe to stop B) No, must taper to avoid adrenal insufficiency C) Only if patient feels better D) Depends on age

B) No, must taper - Risk of life-threatening adrenal crisis. Key rationale: Prolonged steroids suppress HPA axis. Exam trap: Don't assume short courses are always safe — 6 weeks is long enough to suppress adrenal function

Can live vaccines be given with etanercept (TNF inhibitor)? A) No, live vaccines contraindicated B) Yes, all vaccines are safe C) Only in pediatrics D) With dose reduction

A) No, live vaccines contraindicated - Risk of serious infection; only killed vaccines allowed. Key rationale: Immunosuppression allows live vaccine infection. Exam trap: Live vaccines in immunosuppressed = disaster

How do corticosteroids (prednisone) affect blood glucose? A) Lower B) Significantly increase C) No effect D) Variable

B) Significantly increase blood sugar - May need diabetes medication adjustment. Key rationale: Steroids promote gluconeogenesis + insulin resistance. Exam trap: Even non-diabetics can become hyperglycemic

When is corticosteroid (prednisone) taper not required? A) Use <5 days or physiologic doses B) Never safe to stop abruptly C) Always taper D) Only in young patients

A) Use <5 days or physiologic doses - Low risk of HPA suppression. Key rationale: Short courses don't suppress adrenal axis. Exam trap: Don't over-taper <5 days — safe to stop

What is the first-line DMARD for rheumatoid arthritis? A) Methotrexate B) Sulfasalazine C) Hydroxychloroquine D) Corticosteroids

A) Methotrexate - Most effective, best safety data. Key rationale: Early DMARD use prevents joint damage. Exam trap: Don't delay MTX — cornerstone of RA therapy

Do NSAIDs (ibuprofen) slow RA progression? A) Yes B) No, symptom relief only C) Only high-dose D) Only with DMARDs

B) No, symptom relief only - No disease-modifying effects. Key rationale: DMARDs prevent damage, NSAIDs just mask symptoms

Why supplement folic acid with methotrexate? A) Reduces toxicity by bypassing folate antagonism B) Improves efficacy C) FDA requirement D) Prevents weight gain

A) Reduces toxicity (stomatitis, GI upset, anemia) without reducing efficacy. Key rationale: MTX blocks folate metabolism; folic acid rescues normal cells

What is infliximab's (TNF inhibitor) black box warning? A) Severe and potentially fatal infections B) Heart failure only C) Malignancy only D) Liver toxicity

A) Severe and potentially fatal infections - Screen for TB, hepatitis before starting. Key rationale: TNF vital for infection control. Exam trap: Don't skip infection screening — reactivation can be fatal

How does HPA suppression occur with corticosteroids? A) Prolonged use suppresses adrenal glands B) Only acute high-dose C) Only elderly D) Only IV steroids

A) Prolonged use suppresses adrenal glands - Risk of adrenal crisis if stopped abruptly. Key rationale: Exogenous steroids shut down natural cortisol production

What is methotrexate's pregnancy category? A) Safe B) Contraindicated; teratogenic C) Safe with monitoring D) Only dangerous 3rd trimester

B) Contraindicated; teratogenic - Causes fetal death & birth defects. Key rationale: Folate antagonist disrupts DNA synthesis. Exam trap: No role in pregnancy

What infection screening is required before biologic DMARDs? A) TB testing B) HIV C) Hep B D) None

A) TB testing - TNF inhibitors risk latent TB reactivation. Key rationale: TNF maintains granulomas. Exam trap: Always screen for TB pre-treatment

What serious toxicity is linked to leflunomide (DMARD)? A) Hepatotoxicity & teratogenicity B) Kidney C) Bone marrow suppression D) Cardiac

A) Hepatotoxicity & teratogenicity - Monitor LFTs, contraindicated in pregnancy. Key rationale: Long half-life requires washout before conception

What is the treatment progression for RA? A) NSAIDs + Glucocorticoids → Methotrexate B) Biologics first C) Surgery before meds D) Steroids only

A) NSAIDs + Glucocorticoids → Methotrexate - Early aggressive DMARD therapy. Key rationale: Window of opportunity to prevent damage. Exam trap: Don't delay DMARDs

What vitamin deficiencies occur with orlistat? A) Fat-soluble A, D, E, K B) B vitamins C) Vitamin C D) Water-soluble

A) Fat-soluble vitamins A, D, E, K - Due to fat malabsorption. Key rationale: Orlistat blocks pancreatic lipase. Exam trap: Not water-soluble — only fat-soluble lost

What is the GLP-1 agonist (liraglutide) black box warning? A) Thyroid C-cell tumors B) Pancreatitis C) Heart attacks D) Kidney failure

A) Thyroid C-cell tumors - Contraindicated in MTC or MEN2. Key rationale: Rodent data, human relevance unclear. Exam trap: Always screen family history

Are any weight loss drugs safe in pregnancy? A) Some B) No, all contraindicated C) Only FDA-approved D) With monitoring

B) No, all contraindicated - Risk of fetal harm. Key rationale: Pregnancy requires weight gain — weight loss is unsafe

When should phentermine be taken? A) Before 4:00 PM B) Bedtime C) With dinner D) Anytime

A) Before 4:00 PM - Prevent insomnia. Key rationale: Sympathomimetic stimulant lasts hours

Contraindications for naltrexone/bupropion (Contrave)? A) Seizure & eating disorders B) Heart disease C) Kidney disease D) Age restrictions

A) Seizure & eating disorders - Bupropion lowers seizure threshold. Key rationale: High seizure risk. Exam trap: Don't miss psych history

What family history contraindicates GLP-1 agonists? A) Type 2 DM B) Medullary thyroid cancer or MEN2 C) Heart disease D) Obesity

B) Medullary thyroid cancer or MEN2 - Contraindication. Key rationale: GLP-1 may promote C-cell tumors

How does orlistat cause vitamin deficiency? A) Blocks fat absorption → ↓ A, D, E, K B) Increases metabolism C) Intestinal damage D) Appetite loss

A) Blocks fat absorption → fat-soluble vitamin deficiency. Key rationale: Only A, D, E, K need fat. Exam trap: Not all vitamins affected

What is phentermine's schedule? A) Schedule III B) Schedule IV C) Schedule II D) Not controlled

B) Schedule IV - Moderate abuse risk. Key rationale: Stimulant weight loss drugs are scheduled

What CV conditions contraindicate phentermine? A) Heart disease or uncontrolled HTN B) Controlled HTN C) Age >65 D) Family history

A) Heart disease or uncontrolled HTN - Risk of arrhythmias, MI, stroke. Key rationale: Stimulant ↑HR, ↑BP

How does bariatric surgery affect oral meds? A) No effect B) ↓ absorption; dose adjust C) ↑ absorption D) Only fat-soluble affected

B) ↓ absorption; may need liquid forms. Key rationale: Less surface area & contact time. Exam trap: Standard doses may fail post-surgery