Comprehensive Pharm E1 random practice questions

32 year old female presents to the ER and is diagnosed with hyponatremia. she reports she is on medication for her epilepsy, but cannot remember which. which of the following drugs is most likely to have caused her hyponatremia?

A. valproic acid

B. oxcarbazepine

C. carbamazepine

D. phenytoin

B. oxcarbazepine (trileptal) → hyponatremia occurs in both oxcarbazepine and carbamazepine BUT it occurs more frequently in oxcarbazepine

you are planning to start a patient on carbamazepine (tegretol). which lab test should you order before they initiate the drug and continue to check frequently?

A. CBC

B. CMP

C. TSH

D. HgbA1c

B. CMP → bc it includes sodium (AR of hyponatremia) AND LFTs (AR of ↑LFTs)

one of your inpatient patients begins to have an acute seizure. what should be the first line medication given?

A. Lorazepam

B. phenobarbital (luminal)

C. levetiracetam (keppra)

D. Felbamate (felbatol)

A. lorazepam → benzos are the go-to for acute seizures

lorazepam is given IV

diazepam is given rectally

clonazepam is better for peds/chronic prevention

a patient began having a seizure and has not stopped convulsing, there is no sign of mental status regaining. what drug should be administered?

A. Diazepam

B. Phenytoin

C. Ethosuximide

D. Pentobarbital

D. pentobarbital → case of status epilepticus

can tx with phenobarbital/pentobarbital

You decide start a patient on Felbamate (felbatol) after they failed multiple AEDs, which lab should you frequently test and why?

A. CMP → increased LFTs

B. CBC → increased infections

C. CBC → aplastic anemia

D. CMP → renal toxicity

C. check CBCs for risk of aplastic anemia

also risk of hepatotoxicity! So A is right but aplastic anemia is more unique

A resident administered phenytoin IV to your epileptic patient, resulting in extravasation and purple appearance of their hand. what should you tell the resident to administer in the future instead of phenytoin?

A. pentobarbital

B. fosphenytoin

C. lorazepam

D. Topiramate

B. fosphenytoin → water soluble version of phenytoin

phenytoin should not be given IV

your 3 week old neonate patient has begun having febrile seizures. what drug is best for neonatal seizures?

A. Ethosuximide

B. Felbamate

C. Phenobarbital

D. Valproic acid

C. phenobarbital → drug of choice for neonatal seizures

you have a 14 year old patient with a history of absence seizures, recently diagnosed with epilepsy. which drug is the drug of choice for treatment of absence seizures?

A. Ethosuximide

B. valproic acid

C. phenytoin

D. oxcarbazepine

A. ethosuximide !!!!!! pure calcium channel blocker

A patient with Hx of seizures on depakote presents for acute seizure. Amongst labs, you check depakote levels and they are 25mcg (Therapeutic range 50-125mcg), LFTs are elevated, and lipase/amylase are above normal range. what is the likely cause of their breakthrough seizure?

A. increased LFTs causing hepatotoxicity

B. patient is non-compliant with drug

C. patient has pancreatitis

D. patient has taken other drugs to induce a seizure

B. patient is non compliant bc the TDM is low!

you have a patient who is 37 weeks pregnant. she tested positive for group B strep. she is allergic to penicillin. what should she be treated with to avoid neonatal sepsis?

A. ampicillin

B. pen G

C. cefazolin

D. bactrim

C. cefazolin or clinda or vanco for PCN allergies

otherwise ampicillin or pen G is first line

when prescribing gabapentin or pregabalin to a patient, what labs are critical to check beforehand?

A. CMP

B. CBC

C. Lipid panel

D. TSH

A. CMP to check renal function because these drugs are 100% renally eliminated! need to know if you should reduce dose/use another drug)

which of the following patient education plans should be provided to patients starting Lamotrigine (lamictal)?

A. at the sign of any rash immediately discontinue

B. may experience n/v or dizziness while taking it

C. do not take valproic acid because it will cause lamictal levels to increase

D. do not take carbamazepine or phenytoin bc it will cause lamictal levels to decrease

all of the above :P

A. risk of SJS!

B. N/V , dizziness and ataxia are side effects

C. VPA inhibits metabolism → results in increased levels

D. carbamazepine/phenytoin induce metabolism → leaves system faster so less effective

a mother brings her 12-year-old daughter in for her regular neuro checkup since her diagnosis of epilepsy. her mother reports the patient has increased aggression/attitude since starting a new AED. which drug most likely caused this side effect?

A. Topiramate (topamax)

B. Levetiracetam (keppra)

C. Lamotrigine (Lamictal)

D. Lacosamide (vimpat)

B. levetiracetam (Keppra) can cause aggression especially in children

you have a 15 year old patient with epilepsy presenting for check up. she reports difficulty concentrating when in school. which AED most likely cuased this?

A. Levetiracetam (keppra)

B. Oxcarbazepine (trieptal)

C. Valproic acid (depakote)

D. Topiramate (topamax)

D. Topiramate

which of the following AEDs are controlled substances?

A. Phenobarbital

B. Diazepam

C. Pregabalin

D. Lacosamide (Vimpat)

all of the above!

A. phenobarbital (C4)

B. Dizepam (C4)

C. Pregabalin (C5)

D. Lacosamide (C5)

you are treating a patient with status epilepticus. you have already secured their airway and assured they are protected from injury. you have administered diazepam rectally, but the patient is continuing to seize. what is the next step?

A. pentobarbital coma

B. administer valproic acid

C. administer keppra

D. administer phenytoin

D. administer phenytoin

steps for status epilepticus (do 3 doses before determining it isn't working) after securing airway

1. benzos

2. phenytoin or fosphenytoin

3. keppra or phenobarbital

4. valproic acid or more phenobarbital

5. general anesthesia or pentobarbital coma

which of the following drugs' MOA involves binding to the synaptic vesicle protein SC2A and preventing release of glutamate?

A. keppra

B. phenytoin

C. gabapentin

D. phenobarbital

A. keppra

- phenytoin is a Na channel blocker

- gabapentin/pregabalin enhance GABA synthesis

- phenobarbital activates/opens GABA-A channels to cause Cl- influx

Your 31 year old female patient presents for her annual neuro checkup. she has hx of epilepsy on AED. She reports she recently became pregnant. which AED should be discontinued immediately due to teratogenic effects?

A. Carbamazepine

B. Phenytoin

C. Valproic acid

D. levetiracetam

C. valproic acid is teratogenic

your 18 year old female patient on AED complains of finding coarse hairs on her chin and chest. which AED is most likely causing this adverse reaction?

A. phenytoin

B,. Felbamate

C. phenobarbital

D. valproic acid

A. phenytoin can cause hirsutism

which of the following AEDs has risk for SJS/TEN?

A. carbamazepine

B. ethosuximide

C. phenytoin

D. phenobarbital

All of the above!

oxcarbazepine and lamotrigine also have risk

your 62 year old male patient has been managing his Parkinson's with Levodopa/Carbidopa (sinemet) but reports worsening tremors. which drug would be best to add to his treatment regimen to treat his dyskinesias?

A. Selegiline

B. Amantadine (symmetrel)

C. Entacapone (Comtan)

D. Bromocriptine (Parlodel)

B. Amantadine → can help manage levodopa-induced dyskinesias

you have a patient with PMHx of epilepsy managed with carbamazepine. they report to your clinic with complaints of GERD symptoms persisting despite making lifestyle modifications. which medication would be contraindicated in this patient?

A. famotidine

B. cimetidine

C. nizatidine

D. omeprazole

B. cimetidine is a strong CYP3A4 INHIBITOR and carbamazepine is a CYP3A4 metabolite --> this would cause increased levels of carbamazepine in the system

you have a 72 year old male with hx of parkinson's on sinemet. PMHx includes benign prostatic hyperplasia, HTN, and HLD. he is complaining of tremors despite Sinemet and requests an additional drug to control the tremors. which drug is not appropriate to prescribe, given his PMHx?

A. Benztropine (Congentin)

B. Tolcapone (Tasmar)

C. Rasagiline

D. Ropinirole (Requip)

A. benztropine → anticholingergics are not good to prescribe to pts over 65 y/o AND he has BPH which can cause urinary retention which is a sx of anticholinergics

Your patient with parkinson's managed with sinemet presents with complaints of brown/orange discoloration of his urine. UA was negative in office. You started him on an adjunct drug at his last visit. which drug was likely caused his symptoms?

A. Pramipexole (Mirapex)

B. Entacapone (comtan)

C. Trihexyphenidyl (artane)

D. Selegiline

Entacapone → COMTi cause cause brown/orange urine

your patient with newly diagnosed parkinson's presents with complaints of N/V, tachycardia, hallucinations, and ataxia. you determine this to be an episode of serotonin syndrome due to the new drug he started. which drug likely caused this?

A. Diphenhydramine (benadryl)

B. Levodopa/carbidopa (sinemet)

C. Bromocripitine (parlodel)

D. Selegiline

D. selegiline → MAO-B inhibitors (selegiline and rasagiline) have risk for serotonin syndrome (selegiline has more AR)

also they can be used as monotherapy hence "newly diagnosed" bc once you start sinemet, you don't go off it!

which of the following dopamine agonists is an ergot derivative?

A. pramipexole (mirapex)

B. Bromocriptine (parlodel)

C. apomorphine (apokyn)

D. rotigotine (Neupro)

B. bromocriptine → has AR of pleuro/retroperitoneal and valve regurgitation but the non-ergots DO NOT!

which of the following drugs has a black box warning for hepatotoxicity?

A. Levodopa/carbidopa (sinemet)

B. Rotigotine (neupro)

C. Tolcapone (tasmar)

D. entacapone (comtan)

tolcapone

a patient w pmhx of epilepsy is in the critical care unit with hypoalbuminemia and acute renal failure. which AED is highly protein bound and can cause these symptoms/diagnoses if available albumin is bound by another drug?

A. phenobarbital

B. phenytoin

C. clonazepam

D. ethosuximide

B. phenytoin

which of the following drugs has the highest specificity for AchE?

A. donepezil (aricept)

B. Rivastigmine (exelon)

C. Memantine (namenda)

D. Galantamine (razadyne)

D. Galantamine →very specific for AchE

- Donepezil is relatively spcific

- Rivastigmine inhibits both AchE and BuChE

- memantine isn't a cholinesterase inhibitor (NMDA glutamate receptor antagonist)

which of the following drugs has no drug interactions due to the lack of hepatic transformation?

A. Rivastigmine (exelon)

B. Donepezil(aricept)

C. glantamine (razadyne)

D. Memantine (namenda)

A. rivastigmine has no CYP interactions

which of the following drugs would need to be increased in dose if a CYP3A4 inducer is added to the regimen?

A. Rivastigmine (exelon)

B. Donepezil (aricept)

C. Galantamine (razadyne)

D. Apixaban (eliquis)

B, C, AND D!! They are all CYP3A4 metabolites

why is methylprednisolone the drug of choice to treat MS exacerbations?

A. it dissolves the myelin sheath

B. it inhibits edema at the area of demyelination

C. it sedates the patient so they are asymptomatic

D. it mimics antigenic properties of myeline basic protein

B.

D is the MOA for glatiramer acetate (Copaxone)

a 47 year old female presents for her neuro check up. she reports her blood sugars have been increasing and her PCP has diagnosed her with pre-diabetes. which treatment for MS likely worsened her blood sugar control?

A. Natalizumab (tysabil)

B. Fingolimod (gilenya)

C. terflunomide (aubagio)

D. methylprednisolone

D. methylprednisolone → corticosteroids can worsen glycemic control, cause sleep disturbance, and mood alterations

Your patient has been treated for acute MS exacerbation with methylpredinisolone for the last 11 days. what is the most important patient education to provide now that their exacerbation has dulled.

A. drink a lot of water to flush the drug out of their system

B. avoid strenuous exercise for 2 weeks to prevent exacerbation

C. taper the drug to avoid adrenal insufficiency

D. take vitamin D supplement to prevent hypocalcemia

C. must taper if more than one week!!!

with which disease modifying drug for treatment of MS must patients be part of the REMS program for concerns of progressive multifocal leukoencephalopathy?

A. Natalizumab (tysabil)

B. alemtuzumab

C. dimethyl fumarate (tecfidera)

D. glatiramer acetate (copaxone)

A. natalizumab

your patient with MS complains of chest tightness and flushing soon after injecting their medication. you assure them that this is a common side effect and usually lasts about 20 minutes. which drug most likely causes this reaction?

A. interferon B1b

B fingolimond (gilenya)

C. teriflunomide (aubagio)

D. glatiramer acetate (copaxone)

D. glatiramer acetate (copaxone)

which drug to treat MS has a black box warning for hepatotoxicity and teratogenicity?

A. fingolimod (gilenya)

B. interferon A

C. teriflunomide (aubagio)

D. natalizumab (tybasil

C. teriflunomide

what patient education should be provide to women of child bearing age taking teriflunomide?

A. it makes you infertile

B. it may cause amenorrhea

C. she should undergo cholestyramine washout prior to conceiving

D. she must receive vaccines prior to starting the medication

C.

which of the following is more likely to cause first dose bradycardia?

A. namenda

B. phenobarbital

C. teriflunomide

D. fingolimod

D. fingolimod → monitor for 6 hrs after first dose

patient with MS presents with complaints of dysuria and urinary frequency. Their UA is positive for acute cystitis. which MS treatment likely caused her to be more prone to infections?

A. dimethyl fumarate

B. teriflunomide

C. alemtuzumab

D. glatiramer acetate

C. Alemtuzumab → causes increased risk of infection (UTI, herpes, resp., TB) and pts are more likely to develop autoimmune diseases

you have a 39 year old female pt recently diagnosed with MS and are planning to start her on therapy. She has PMHx of UTI, anxiety and depression. which of the following disease modifying drugs would be most appropriate to initiate?

A. methylprednisolone

B. Natalizumab

C. interferon 1b

D. Glatiramer acetate

D. glatiramer acetate

A. is not a DMT

B. adverse rxn of depression

C. adverse rxn of depression

what is the first line tx for mild-moderate migraines?

A. phenothiazines

B. ergots

C. Triptans

D. NSAIDs/analgesics

D. NSAIDs/simple analgesics are first line → aspirin, ibu profen, naproxen, excedrin, tylenol (add on only), ketolorac

what is the first line for severe migraines after failing simple analgesics?

A. indomethacin

B. Ergots

C. triptans

D. lasmiditan

B and C are first line for severe symptoms

if a patient with migraines reports severe nausea and vomiting during migraine episodes, which would be most appropriate to treat their symptoms?

A. ergotamine tartrate (Ergomar)

B. naproxen

C. promethazine (phenergan)

D. excedrin

C. phenergan is a phenothiazine which treats N/V

other phenothiazines = metoclopramide (reglan), prochlorperazine (compazine)

a patient with history of chronic migraines presents with complaints of numb, painful fingers and toes that are cold to the touch and muscle weakness. which migraine treatment likely caused this side effect?

A. dihydroergotamine (DHE)

B. sumatriptan

C. prochlorperazine (compazine)

D. Rimegepant

A. DHE → ergotism symptoms include cold, numb, painful extremities, paresthesias, and in serious (rare) cases, gangrenous extremities, MI, bowel/brain ischemia

your 61 year old patient with migraines was recently diagnosed with HTN and has yet to control it. their BP today was 158/102. they have been taking sumatriptan when their migraines present, however, due to the HTN diagnosis, they have been advised to discontinue it due to actions of vasoconstriction. which migraine treatment would be best suited for a patient with HTN?

A. promethazine

B. ergotamine tartrate

C. ubrogepant

D. excedrin

C. Ubrogepant and rimegepant (CGRP antagonists) have no vasoconstriction

also lasmiditan (Reyvow) lacks vasoconstriction

which of the following drugs are contraindicated in pregnant patients?

A. amlotripan (axert)

B. Rizatripan (Maxalt)

C. Ergotamine tartrate (ergomar)

D. Rimegepant (Nurtec)

C. ergots are contraindicated in pregnancy

Which triptan has the fastest onset of action?

Rizatriptan (Maxalt)

which triptans are metabolized by CYP3A4?

almotriptan (Axert)

eletriptan (Relpax)

which triptan is contraindicated in severe renal/hepatic disease?

naratriptan (Amerge)

which triptan has drug interactions with propranolol?

rizatriptan

what patient education should be provided when prescribing lasmiditan (Reyvow)?

A. take on an empty stomach

B. do not take with dairy products

C. do not drive for 8 hrs after dose

D. do not crush

C. reyvow is sedating

what is the first line therapy for prevention of migraines?

beta blocker → propranolol

patient presents with complaints of recurrent migraines. they are requesting prevention therapy. med list includes albuterol, zoloft, and zyrtec. which drug would be most appropriate to prescribe for migraine prevention in this patient?

A. propranolol

B. timolol

C. atenolol

D. topiramate

C. atenolol bc B1 selective to prevent bronchospasm

which medication can be used for prevention and treatment for migraines?

rimegepant → CGRP antagonist (but not the other CGRP antagonists)

which antidepressants are used for their vasoconstrictive actions in treatment of migraines?

TCAs

SSRIs (may worsen migraine)

19 year old female with PMHx of dysmenorrhea, acne, and depression presents with complaints of recurrent migraines. you are planning to start them on preventative therapy. which would be most effective for them?

A. amitriptyline

B. propranolol

C. rimegepant

D. erebumab

A. amitriptyline → TCAs and SSRIs can be used to prevent migraines and she has hx of depression so this is best prevention

which migraine prevention is more effective for treating aura than migraine itself?

verapamil

what is the drug of choice for migraine treatment in pregnant patients?

tylenol

can use low dose opioids for short period of time

24 year old female with PMHx of menstrual migraines presents to your clinic for a follow up. she has been taking Levonorgestrel/Ethinyl Estradiol OCP with worsening migraines. what is the next step for this patient in prevention of their migraines?

A. different OCP formula or dose

B. switch to progestin-only pill

C. advise pt to take vitamin B6

all of the above are options if OCP fails to tx menstural migraines

Which NSAID would be more likely to induce MI or stroke in patients with cardiovascular comborbidities?

A. meloxicam (mobic)

B. Diclofenac (voltaren)

C. Celecoxib

D. ibuprofen

C. celecoxib → COX2 inhibitor

your 62 year old female pt with IBS is complaining of chronic lower back pain. which NSAID would be most appropriate for you to recommend to your patient?

A. ibuprofen

B. celecoxib

C. diclofenac

D. indomethacin

B. celecoxib → COX2 inhibitor with less GI side effects

what is the tx for neonatal herpes?

acyclovir IV

your neonate patient was diagnosed with RDS and you are planning to initiate surfactant treatment. how should you dose the patient?

A. one large dose IV

B. divide into 3 aliquots 1 minute apart in different positions

C. divide into 3 doses 1 hour apart in different positions

D. one large dose via ET tube

B. each dose is divided into 2-4 aliquots one minute apart via ET tube in different positions to try to distribute the surfactant

in a patient with CF, what should be administered prior to used chest physiotherapy?

A. pulmozyme (dornase alfa)

B. colistimethate

C. aerosolized aminoglycoside abx

D. dicloxacillin PO

A. pulmozyme is a mucolytic to be used before CPT → cleaves DNA from degenerating neutrophils (what cuases thick mucous) to decrease viscosity causes

patient with CF is having a pulmonary exacerbation. sputum culture is positive for H. influenza. which oral abx would be most appropriate to prescribe?

A. dicloxacillin

B. keflex

C. azithromycin

D. augmentin

D. augmentin

abx for H. flu → amoxicillin, augmentin, 2/3rd gen cephalosporin

what IV antibiotics should be administered for a CF patient with pulmonary infection?

aminoglycoside PLUS anti-pseudomonal beta lactam (cefepime, ceftazidime, zosyn, timentin)

may need to add 3rd abx for staph (vanco) or burkholderia (bactrim)

which drug can be given to CF patients with F508 deletion to help with secretions?

Lumacaftor and ivacaftor (Orkambi) → take with fatty foods

why are anticholinergics contraindicated in patients with CF?

increases mucous secretion

your 14 year old female patient with CF recently started a new medication to treat her CF. she reports irregulary menstruation despite taking OCP. which drug likely causes this?

A. OCP

B. ursodeoxycholic acid

C. omeprazole

D. orkambi

orkambi

what is always the first line tx for GERD?

lifestyle mod

how to antacids work to treat GERD?

neutralize gastric acid (tums and maalox)

long term use is not recommended

which drugs treat GERD by providing coating relief?

mucosal protectants → sodium alginate and sucralfate

not really effective

a mother presents with her 9 month old daughter. she reports her daughter has not had a bowel movement in 3 days. which of the following would be most appropriate to treat the patient's constipation?

A. erythromycin PO

B. saline enema

C. sodium phosphate enema

D. glycerin suppository

D. glycerin suppository is best for infants

phosphate enema can cause fatal hyperphosphatemia

you 68 year old patient is s/p left hip replacement 2 days ago. tthey have hx of DVT s/p knee replacement 10 years ago. what should you pre-treat with?

A. compression socks

B. fondaparinux

C. eliquis

D. aspirin

B. fondaparinux, enoxaparin, and unfractionated heparin are used for pts at high risk for thrombosis

Which anti-diarrheal is used for infectious diarrhea and imparts a black color to the oral cavity and feces?

a) Loperamide (Imodium)

b) Diphenoxylate (Lomotil)

c) Pepto-Bismol

d) Docusate sodium (Colace)

C

What is the primary pharmacologic option for treating NSAID-induced ulcers?

a) Proton Pump Inhibitors (PPI)

b) H2-receptor antagonists

c) Misoprostol

d) Sucralfate (Carafate)

A (take 30 mins before meal)

A 58-year-old patient with Type 2 Diabetes Mellitus presents to the emergency room with pruritis, fatigue, pallor, and bruising. Further investigation reveals aplastic anemia. The patient has been on a drug for diabetes management. Which of the following drugs is most likely responsible for the development of aplastic anemia in this patient?

A) Metformin (Glucophage)

B) Pioglitazone (Actos)

C) Repaglinide (Prandin)

D) Glyburide (Diabeta)

D

sulfonylureas have a risk of aplastic anemia!!

other side effects:

hypoglycemia, weight gain, constipation, n/d, rash, pruritis, leucopenia, ttp, aplastic anemia, resistance may develop

Which drug is used for chemical abortion and is contraindicated in pregnancy?

a) Misoprostol

b) Pepto-Bismol

c) Sucralfate (Carafate)

d) Ondansetron (Zofran)

A (used for tx of NSAID-induced ulcers!!)

Which antacid can cause increased kidney pH and kidney stones?

a) Sodium bicarbonate

b) Calcium carbonate (Tums)

c) Aluminum hydroxide (Amphagel)

d) Magnesium hydroxide (Milk of Magnesia)

B

Patient newly diagnosed with HIV admits to being a poorly compliant drug-taker. which HIV drug would be more appropriate for someone who does not take multiple pills well?

A. Bictegravir (Biktarvy)

B. Maraviroc (Selzentry)

C. Enfuviride (Fuzeon)

D. Raltegravir (Isentress)

A ***

co-formulated with emtricitabine and tenofovir so it is the 2 NRTI + an integrase inhibitor!

cabotegravir is a long-acting IM integrase inhibitor that would also be good for compliance

Which anti-emetic drug has only antimuscarinic actions and is beneficial for preventing motion sickness without sedation?

a) Metoclopramide

b) Ondansetron (Zofran)

c) Scopolamine

d) Diphenoxylate (Lomotil)

C

Which antacid has drug interactions due to chelation?

a) Sodium bicarb

b) Calcium carbonate (Tums)

c) Aluminum hydroxide (Amphagel)

d) Magnesium hydroxide (Milk of magnesia)

C

A 45-year-old patient with a history of depression presents to the emergency department with confusion, dry mouth, and urinary retention. An electrocardiogram (ECG) reveals a widened QRS complex. Which drug most likely caused this presentation?

A. Milnacipran (Savella)

B. Mirtazapine (Remeron)

C. Fluvoxetine (Luvox)

D. Clomipramine (Anafranil)

D. Clomipramine is a TCA → TCAs cause anti-cholinergic effects d/t muscarinic blockade (dry mouth, retention, confusion) and prolonged QRS complex

A 45-year-old patient with a history of bipolar disorder is admitted to the emergency department with altered mental status, hyperthermia, autonomic dysregulation, and generalized muscle rigidity. The patient had recently started a new antipsychotic medication for the treatment of manic episodes.

Considering the symptoms, which antipsychotic medication is most likely responsible?

A) Risperidone (Risperdal)

B) Olanzapine (Zyprexa)

C) Quetiapine (Seroquel)

D) Fluphenazine (Prolixin)

D

Haldol and Prolixin both are more likely to cause Neuroleptic malignant syndrome and EPS than other FGAs/SGAs

A 22-year-old patient is brought to the emergency department after ingesting a large quantity of pills in a suicide attempt. The healthcare provider identifies the ingestion of a tricyclic antidepressant (TCA) based on the patient's medication history. Which of the following physiological effects is most commonly associated with TCAs and requires immediate attention?

A) Bradycardia

B) Hypotension

C) Hyperthermia

D) Prolonged QT interval

B →TCAs cause hypotension bc of alpha receptor blockade

they prolong the QRS not the QT!!

73 year old female presents with complaints of insomnia. She reports that she cannot fall asleep and often wakes up in the middle of the night. Which of the following would be most appropriate to treat her with?

A. Diazepam

B. Clonazepam

C. Triazolam

D. Atomoxetine (Strattera)

C

Part of the LOTT drugs → hydrophilic, with less (if any) active metabolites → cleared better in elderly/organ failure pts

50-year-old patient with bipolar disorder is prescribed a mood stabilizer. The patient develops symptoms of hypothyroidism, including fatigue and weight gain. Which mood stabilizer is known for its potential to cause hypothyroidism?

A) Lithium

B) Carbamazepine

C) Valproic Acid

D) Lamotrigine

A

A 35-year-old patient is diagnosed with attention-deficit/hyperactivity disorder (ADHD) and is prescribed a stimulant medication. The patient experiences increased heart rate, elevated blood pressure, and reduced appetite. Which of the following stimulant medications is most likely responsible for these cardiovascular and appetite-related side effects?

A) Methylphenidate

B) Atomoxetine

C) Modafinil

D) Guanfacine

A

A patient with irritable bowel syndrome (IBS) is prescribed a medication that acts as a 5-HT3 receptor antagonist. Which of the following drugs is most likely to be prescribed?

A) Ondansetron (Zofran)

B) Prochlorperazine (Compazine)

C) Loperamide (Imodium)

D) Lubiprostone (Amitzia)

A

A patient with diarrhea-predominant irritable bowel syndrome (IBS) is prescribed a medication that acts as a 5-HT3 receptor antagonist to reduce gastrointestinal motility. Which of the following medications is most likely prescribed?

A) Loperamide (Imodium)

B) Alosetron (Lotronex)

C) Dicyclomine (Bentyl)

D) Psyllium (Metamucil)

B

A patient with gastroesophageal reflux disease (GERD) is prescribed a medication that directly neutralizes stomach acid. Which of the following drugs belongs to this category?

A) Omeprazole (Prilosec)

B) Famotidine (Pepcid)

C) Sodium Bicarbonate

D) Sucralfate (Carafate)

C

A patient with a history of kidney stones should avoid which antacid due to its potential to increase kidney pH?

A) Sodium Bicarbonate

B) Calcium Carbonate (Tums)

C) Aluminum Hydroxide

D) Magnesium Hydroxide

B

Why are aluminum hydroxide and magnesium hydroxide commonly used together?

A) To enhance gastric emptying

B) To prevent kidney stone formation

C) To balance constipating and diarrhea-inducing effects

D) To increase mucosal protection

C

(AKA Mylanta)

A 28 year old pregnant patient presents with complaints of gastric reflux. Which drug should be avoided in this patient due to the risk of edema?

A) Pepto-Bismol

B) Misoprostol

C) Sodium Bicarbonate

D) Ondansetron (Zofran)

C

A 7-year-old child presents to the ER with confusion, vomiting, diarrhea, and hepatomegaly. The mother reports giving the child a drug to help with the child's nausea they have been experiencing when they were sick with the flu. Which drug is most likely to have caused the child's symptoms?

A. Acetaminophen (tylenol)

B. Colloidal bismuth (Pepto-Bismol)

C. Misoprostol (Cyotec)

D. Sucralfate (Carafate)

B (Reye's syndrome --> pepto bismol has salicylates)

A patient with a history of peptic ulcer disease experiences black stools and notices a black coloration in the oral cavity. The patient recalls taking a medication for ulcer relief. Which of the following medications is most likely to have caused the patient's symptoms?

A) Sucralfate (Carafate)

B) Misoprostol (Cytotec)

C) Omeprazole (Prilosec)

D) Pepto-Bismol

D

A patient presents with chronic drooling, and the healthcare provider is considering an anti-emetic for symptomatic relief. The patient desires a non-sedating option. Which of the following anti-emetics is most suitable for chronic drooling without sedative effects?

A) Scopolamine

B) Ondansetron (Zofran)

C) Glycopyrrolate

D) Metoclopramide (Reglan)

C

A patient experiences abdominal cramping and seeks relief. The healthcare provider is considering an anti-emetic specifically for abdominal cramping.

Which of the following anti-emetics is most suitable for providing relief from abdominal cramping?

A) Hyoscyamine (Levsin)

B) Ondansetron (Zofran)

C) Aprepitant (Emend)

D) Dronabinol (Marinol)

A

A 65-year-old patient with a history of depression presents with severe nausea and vomiting. The patient has been taking an anti-emetic for the past week. On examination, the ECG reveals QT prolongation. Which of the following antiemetics is most likely responsible for the observed QT prolongation in this patient?

A) Promethazine (Phenergan)

B) Dimenhydramine (Dramamine)

C) Granisetron (Kytril)

D) Nabilone (Cesamet)

C

(anti-serotonergic anti-emetics: zofran, dolasetron and granisetron (-setron) can cause QT prolongation)