2ND SHIFTING PHARMA MOCK

A diabetic patient with hypertension and nephropathy is started on a drug that decreases angiotensin II and aldosterone while increasing bradykinin. Which adverse effect is classically expected?

A. Hypocalcemia

B. Dry cough

C. Ototoxicity

D. Hyperuricemia

B. Dry cough

A hypertensive patient cannot tolerate ACE inhibitors because of persistent cough. Which drug gives renal protection without increasing bradykinin?

A. Losartan

B. Captopril

C. Enalapril

D. Ramipril

A. Losartan

Which of the following is NOT TRUE regarding ACE inhibitors?

A. They decrease aldosterone

B. They may cause hyperkalemia

C. They are useful in CHF and CKD

D. They are safe in pregnancy

D. They are safe in pregnancy

A patient with hypertension, gout tendency, and need for an ARB is prescribed a drug with uricosuric activity. Which drug is preferred?

A. Telmisartan

B. Losartan

C. Olmesartan

D. Candesartan

B. Losartan

A patient with HFrEF is given sacubitril in combination with an ARB. Which ARB is commonly used in this ARNI combination?

A. Valsartan

B. Irbesartan

C. Losartan

D. Olmesartan

A. Valsartan

A patient on antihypertensive therapy develops rare sprue-like enteropathy. Which ARB is most associated with this adverse effect?

A. Losartan

B. Valsartan

C. Olmesartan

D. Candesartan

C. Olmesartan

A patient with acute pulmonary edema needs the drug of choice that inhibits Na⁺-K⁺-2Cl⁻ in the thick ascending limb. Which drug is used?

A. Hydrochlorothiazide

B. Furosemide

C. Spironolactone

D. Amiloride

B. Furosemide

A sulfa-allergic patient requires a loop diuretic. Which drug is the best option?

A. Bumetanide

B. Ethacrynic acid

C. Torsemide

D. Furosemide

B. Ethacrynic acid

Which diuretic is DOC for essential hypertension and may cause hyperuricemia, hyperglycemia, and hypokalemia?

A. Acetazolamide

B. Furosemide

C. Hydrochlorothiazide

D. Spironolactone

C. Hydrochlorothiazide

A patient with heart failure is given an aldosterone antagonist shown to decrease mortality but later develops gynecomastia. Which drug caused this?

A. Eplerenone

B. Spironolactone

C. Amiloride

D. Triamterene

B. Spironolactone

A patient with lithium-induced diabetes insipidus is given a potassium-sparing diuretic that blocks ENaC in the collecting duct. Which drug is this?

A. Spironolactone

B. Amiloride

C. Furosemide

D. Acetazolamide

B. Amiloride

A patient with SIADH and chronic hyponatremia is given an oral V2 receptor antagonist that causes aquaresis. Which drug is used?

A. Tolvaptan

B. Conivaptan

C. Acetazolamide

D. Dapagliflozin

A. Tolvaptan

A patient with mountain sickness is treated with a drug that inhibits carbonic anhydrase in the proximal tubule and causes metabolic acidosis. Which drug is used?

A. Dorzolamide

B. Acetazolamide

C. HCTZ

D. Furosemide

B. Acetazolamide

Which is NOT TRUE about acetazolamide?

A. It inhibits carbonic anhydrase

B. It alkalinizes urine

C. It may cause kidney stones

D. It is safe in hepatic encephalopathy

B. It is safe in hepatic encephalopathy

A type 2 diabetic patient with HFrEF is prescribed a drug that blocks glucose reabsorption in the proximal tubule and gives cardiorenal protection. Which class is this?

A. SGLT2 inhibitors

B. Loop diuretics

C. Thiazides

D. Aquaretics

A. SGLT2 inhibitors

A patient on canagliflozin should be monitored for which specific adverse concern listed for this drug?

A. Cough

B. Amputations and fractures

C. Gynecomastia

D. Constipation

B. Amputations and fractures

A patient with SVT and hypertension is prescribed a non-DHP calcium channel blocker. He later develops constipation and bradycardia. Which drug is most likely responsible?

A. Amlodipine

B. Nifedipine

C. Verapamil

D. Nicardipine

C. Verapamil

A patient with subarachnoid hemorrhage is given a DHP calcium channel blocker to prevent cerebral vasospasm. Which drug is used?

A. Nimodipine

B. Amlodipine

C. Verapamil

D. Diltiazem

A. Nimodipine

A pregnant patient with hypertension is treated with a DHP calcium channel blocker. Which drug is classically used?

A. Nifedipine

B. Verapamil

C. Diltiazem

D. Clevidipine

A. Nifedipine

Which calcium channel blocker is an ultra-short acting IV drug used for hypertensive emergencies?

A. Amlodipine

B. Verapamil

C. Diltiazem

D. Clevidipine

D. Clevidipine

A patient with asthma and hypertension is prescribed a nonselective beta blocker and develops bronchospasm. Which drug most likely caused this?

A. Metoprolol

B. Atenolol

C. Esmolol

D. Propranolol

D. Propranolol

A patient with HFrEF needs a beta blocker with proven mortality benefit. Which is appropriate?

A. Propranolol

B. Labetalol

C. Metoprolol

D. Pindolol

C. Metoprolol

A pregnant patient in hypertensive crisis needs a beta blocker with additional α1 blockade considered safe in pregnancy. Which drug is used?

A. Atenolol

B. Nebivolol

C. Propranolol

D. Labetalol

D. Labetalol

A patient needs rapid IV rate control during surgery. Which β1-selective blocker has an ultra-short half-life of about 10 minutes?

A. Atenolol

B. Esmolol

C. Carvedilol

D. Nebivolol

C. Esmolol

Which beta blocker is β1-selective and increases nitric oxide availability?

A. Atenolol

B. Propranolol

C. Labetalol

D. Nebivolol

C. Nebivolol

A man with BPH and hypertension is started on an α1 blocker. He develops marked dizziness after the first dose. Which adverse effect is classic?

A. First-dose syncope

B. Ototoxicity

C. Cyanide toxicity

D. Hypoglycemia

A. First-dose syncope

A patient with urinary symptoms from BPH needs a prostate-selective α1A blocker with less blood pressure effect. Which drug is preferred?

A. Prazosin

B. Doxazosin

C. Tamsulosin

D. Phentolamine

C. Tamsulosin

Before surgery for pheochromocytoma, the patient is given an irreversible α blocker. Which drug is used?

A. Phenoxybenzamine

B. Phentolamine

C. Prazosin

D. Tamsulosin

A. Phenoxybenzamine

During intraoperative pheochromocytoma crisis, a short-acting reversible α blocker is needed. Which drug is used?

A. Phentolamine

B. Phenoxybenzamine

C. Doxazosin

D. Terazosin

A. Phentolamine

A patient with acute angina takes a sublingual drug that releases nitric oxide and decreases preload. Which drug is this?

A. Nitroprusside

B. Isosorbide mononitrate

C. Nitroglycerin

D. Hydralazine

C. Nitroglycerin

Which is CONTRAINDICATED with nitroglycerin because of severe hypotension?

A. Loop diuretics

B. PDE-5 inhibitors

C. Thiazides

D. Statins

B. PDE-5 inhibitors

A patient with hypertensive emergency is given a balanced arterial and venous dilator by IV infusion. Which toxicity must be monitored?

A. Lupus-like syndrome

B. Gynecomastia

C. Cyanide toxicity

D. Hypercalcemia

C. Cyanide toxicity

A pregnant patient with hypertension receives a direct arteriolar vasodilator that may cause lupus-like syndrome. Which drug is used?

A. Hydralazine

B. Minoxidil

C. Diazoxide

D. Fenoldopam

A. Hydralazine

A patient with severe hypertension and alopecia receives a potassium-channel opener that causes hypertrichosis. Which drug is this?

A. Hydralazine

B. Diazoxide

C. Fenoldopam

D. Minoxidil

D. Minoxidil

A hypertensive emergency patient with renal concern is given a D1 agonist that increases renal perfusion. Which drug is used?

A. Fenoldopam

B. Diazoxide

C. Hydralazine

D. Minoxidil

A. Fenoldopam

Which centrally acting sympathoplegic is DOC for hypertension in pregnancy?

A. Clonidine

B. Methyldopa

C. Moxonidine

D. Prazosin

C. Methyldopa

A hypertensive patient abruptly stops clonidine and develops rebound hypertension. Which property explains this risk?

A. α1 blockade

B. β2 stimulation

C. Central α2 agonism

D. Direct renin inhibition

C. Central α2 agonism

A patient with chronic stable angina and HFrEF cannot tolerate beta blockers, but heart rate remains above 70. Which drug lowers heart rate by inhibiting the If channel without negative inotropy?

A. Nitroglycerin

B. Ranolazine

C. Diltiazem

D. Ivabradine

D. Ivabradine

A patient with refractory chronic angina is prescribed a drug that inhibits late Na⁺ current and can prolong QT. Which drug is used?

A. Verapamil

B. Ranolazine

C. Nitroglycerin

D. Amlodipine

B. Ranolazine

A heart failure patient with AF needs a drug that increases contractility by inhibiting Na⁺/K⁺ ATPase. Which adverse effect is expected with toxicity?

A. Arrhythmias and yellow halos

B. Hyperuricemia

C. Ototoxicity

D. Lupus-like syndrome

B. Arrhythmias and yellow halos

A patient with acute decompensated heart failure receives a PDE3 inhibitor that increases cAMP and acts as an "inodilator." Which drug is this?

A. Digoxin

B. Dobutamine

C. Milrinone

D. Dopamine

A. Milrinone

Which statins are considered DOC for long-term therapy and high-intensity LDL lowering?

A. Simvastatin and Lovastatin

B. Atorvastatin and Rosuvastatin

C. Gemfibrozil and Fenofibrate

D. Cholestyramine and Colestipol

B. Atorvastatin and Rosuvastatin

A patient on statin develops muscle pain and very high CK. Which adverse effect is most concerning?

A. Hyperkalemia

B. Enteropathy

C. Rhabdomyolysis

D. Gingival hyperplasia

C. Rhabdomyolysis

A patient has severe hypertriglyceridemia with risk of pancreatitis. Which drug class is DOC?

A. Bile acid resin

B. Statin

C. PCSK9 inhibitor

D. Fibrate

D. Fibrate

A patient with combined hyperlipidemia is given niacin but complains of intense warmth and flushing. Which statement is TRUE?

A. Flushing limits compliance

B. It is DOC as monotherapy

C. It is safe in pregnancy

D. It mainly increases VLDL secretion

B. Flushing limits compliance

Which lipid-lowering drug binds bile acids in the gut and commonly causes constipation and bloating?

A. Ezetimibe

B. Cholestyramine

C. Evolocumab

D. Lomitapide

B. Cholestyramine

A patient with familial hypercholesterolemia has persistently high LDL despite statin therapy. Which drug prevents LDL receptor degradation by blocking PCSK9?

A. Ezetimibe

B. Mipomersen

C. Lomitapide

D. Evolocumab

D. Evolocumab

A patient with homozygous familial hypercholesterolemia is given an antisense oligonucleotide against apo B-100 mRNA. Which drug is this?

A. Lomitapide

B. Mipomersen

C. Ezetimibe

D. Alirocumab

D. Mipomersen

A post-MI patient develops ventricular arrhythmia. Which class Ib antiarrhythmic is best for post-MI ventricular arrhythmias and is given IV?

A. Lidocaine

B. Mexiletine

C. Flecainide

D. Quinidine

A. Lidocaine

A patient treated for WPW develops lupus-like syndrome from a class Ia antiarrhythmic. Which drug caused it?

A. Quinidine

B. Disopyramide

C. Procainamide

D. Lidocaine

C. Procainamide

Which class Ic antiarrhythmic is contraindicated in structural or ischemic heart disease due to increased mortality post-MI?

A. Lidocaine

B. Flecainide

C. Amiodarone

D. Verapamil

B. Flecainide

A patient with life-threatening ventricular tachycardia needs a "Swiss army knife" antiarrhythmic that blocks K⁺, Na⁺, Ca²⁺, and β receptors. Which drug is used?

A. Sotalol

B. Dronedarone

C. Amiodarone

D. Dofetilide

C. Amiodarone

Which serious adverse effect is associated with amiodarone?

A. Pulmonary fibrosis

B. Hypocalcemia

C. Hemolytic anemia

D. Hypertrichosis

C. Pulmonary fibrosis

A patient with acute PSVT receives an IV bolus drug with half-life less than 10 seconds. Which drug is DOC?

A. Verapamil

B. Lidocaine

C. Sotalol

D. Adenosine

D. Adenosine

Which antiarrhythmic is blocked by caffeine and may cause flushing, chest pain, and bronchospasm?

A. Adenosine

B. Amiodarone

C. Dofetilide

D. Flecainide

A. Adenosine

A patient with torsades de pointes requires acute therapy. Which electrolyte/drug is used?

A. Potassium

B. Magnesium

C. Procainamide

D. Flecainide

A. Magnesium

A patient undergoing PCI is placed on an anticoagulant that activates antithrombin III and requires aPTT monitoring. Which drug is this?

A. Enoxaparin

B. Fondaparinux

C. Unfractionated heparin

D. Apixaban

C. Unfractionated heparin

A patient on unfractionated heparin develops serious bleeding. Which antidote is used?

A. Vitamin K

B. Idarucizumab

C. Protamine sulfate

D. Andexanet alfa

D. Protamine sulfate

A pregnant patient needs anticoagulation for VTE prophylaxis. Which drug is safest because it does not cross the placenta?

A. Warfarin

B. Unfractionated heparin

C. Dabigatran

D. Rivaroxaban

D. Unfractionated heparin

A patient with HIT still requires anticoagulation. Which direct thrombin inhibitor is safe in HIT and metabolized in the liver?

A. Argatroban

B. Bivalirudin

C. Dabigatran

D. Hirudin

A. Argatroban

A patient with mechanical prosthetic valve needs lifetime oral anticoagulation. Which drug is classically used and monitored by INR?

A. Dabigatran

B. Apixaban

C. Rivaroxaban

D. Warfarin

D. Warfarin

Which adverse effect is classically associated with warfarin and requires heparin bridging at initiation?

A. Ototoxicity

B. Skin necrosis

C. Hypercalcemia

D. Bronchospasm

A. Skin necrosis

A patient taking dabigatran develops life-threatening bleeding. Which antidote is specific?

A. Andexanet alfa

B. Protamine sulfate

C. Idarucizumab

D. Vitamin K

D. Idarucizumab

A patient on apixaban develops major bleeding. Which antidote reverses factor Xa inhibitors?

A. Vitamin K

B. Idarucizumab

C. Protamine sulfate

D. Andexanet alfa

D. Andexanet alfa

A patient with STEMI within 6 hours receives recombinant human tPA that activates fibrin-bound plasminogen. Which drug is this?

A. Alteplase

B. Streptokinase

C. Urokinase

D. Tranexamic acid

D. Alteplase

A patient receives a fibrinolytic from bacterial protein source and develops allergic reaction. Which drug is this?

A. Alteplase

B. Reteplase

C. Streptokinase

D. Tenecteplase

C. Streptokinase

Which fibrinolytic is a mutant tPA with increased fibrin specificity and single IV bolus dosing?

A. Tenecteplase

B. Alteplase

C. Urokinase

D. Streptokinase

A. Tenecteplase

A patient with ACS is given aspirin. What is the antiplatelet mechanism?

A. Reversible P2Y12 inhibition

B. Irreversible COX inhibition decreasing TXA2

C. GP IIb/IIIa receptor blockade

D. PDE inhibition increasing cAMP

B. Irreversible COX inhibition decreasing TXA2

A patient on ticlopidine develops leukopenia. Which antiplatelet class does this drug belong to?

A. GP IIb/IIIa inhibitor

B. PDE inhibitor

C. Thienopyridine P2Y12 inhibitor

D. Fibrinolytic inhibitor

C. Thienopyridine P2Y12 inhibitor

Which P2Y12 inhibitor is reversible, potent, and may cause dyspnea?

A. Prasugrel

B. Ticagrelor

C. Clopidogrel

D. Cangrelor

B. Ticagrelor

Which GP IIb/IIIa inhibitor is a chimeric monoclonal antibody and considered the most potent?

A. Abciximab

B. Eptifibatide

C. Tirofiban

D. Cilostazol

C. Abciximab

A patient with intermittent claudication is given a PDE inhibitor with vasodilator and antiplatelet effects. Which drug is used?

A. Dipyridamole

B. Cilostazol

C. Ticagrelor

D. Abciximab

D. Cilostazol

Which drug is contraindicated in heart failure but useful for intermittent claudication?

A. Cilostazol

B. Dipyridamole

C. Aspirin

D. Clopidogrel

B. Cilostazol

A patient with mild hemophilia A or von Willebrand disease needs a drug before minor surgery to increase factor VIII and vWF release. Which drug is used?

A. Vitamin K

B. Cryoprecipitate

C. FFP

D. Desmopressin

B. Desmopressin

A patient with fibrinogen deficiency needs blood product replacement. Which product is best?

A. Cryoprecipitate

B. Fresh frozen plasma

C. Vitamin K

D. rFVIIa

A. Cryoprecipitate

A patient with fibrinolytic bleeding is treated with a lysine analog that blocks plasminogen activation. Which drug is more potent than aminocaproic acid?

A. Vitamin K

B. Tranexamic acid

C. Desmopressin

D. Warfarin

D. Tranexamic acid

A patient with peptic ulcer disease is given aluminum hydroxide. Which adverse effect is expected?

A. Constipation

B. Diarrhea

C. Hyperkalemia

D. Gynecomastia

A. Constipation

A patient with PUD takes magnesium hydroxide and develops an expected GI adverse effect. Which is it?

A. Constipation

B. Diarrhea

C. Black stool

D. QT prolongation

B. Diarrhea

A patient on cimetidine has increased effects of multiple drugs due to CYP inhibition. Which H2 blocker causes this interaction?

A. Famotidine

B. Nizatidine

C. Cimetidine

D. Ranitidine

C. Cimetidine

A patient taking an anti-ulcer drug develops antiandrogenic effects. Which drug is most likely responsible?

A. Famotidine

B. Nizatidine

C. Ranitidine

D. Cimetidine

C. Cimetidine

Which PPI is an irreversible H⁺/K⁺ ATPase inhibitor and may cause vitamin B12 deficiency with long-term use?

A. Omeprazole

B. Sucralfate

C. Misoprostol

D. Bismuth subsalicylate

B. Omeprazole

A pregnant patient with NSAID-induced ulcer is mistakenly given a PGE1 analog and develops uterine contractions. Which drug caused this?

A. Sucralfate

B. Bismuth subsalicylate

C. Misoprostol

D. Omeprazole

C. Misoprostol

A patient with traveler's diarrhea is given a drug that coats ulcers, has antibacterial effect, and may cause black stools. Which drug is this?

A. Bismuth subsalicylate

B. Sucralfate

C. Loperamide

D. Cholestyramine

A. Bismuth subsalicylate

Which antidiarrheal is combined with atropine to prevent abuse?

A. Loperamide

B. Diphenoxylate

C. Kaolin-pectin

D. Cholestyramine

B. Diphenoxylate

A patient with IBS-C is prescribed a chloride channel activator that increases intestinal fluid secretion. Which drug is this?

A. Alosetron

B. Tegaserod

C. Lubiprostone

D. Dicyclomine

D. Lubiprostone

A patient with IBS-D is given a 5-HT3 antagonist to reduce GI motility and visceral pain. Which drug is used?

A. Tegaserod

B. Lubiprostone

C. Alosetron

D. Prucalopride

D. Alosetron

A diabetic patient with gastroparesis receives a D2 antagonist that increases GI motility and acts as an antiemetic. Which drug is used?

A. Metoclopramide

B. Ondansetron

C. Dexamethasone

D. Aprepitant

A. Metoclopramide

A patient with Ogilvie's syndrome is given an acetylcholinesterase inhibitor to increase motility. Which drug is used?

A. Bethanechol

B. Neostigmine

C. Erythromycin

D. Metoclopramide

D. Neostigmine

A patient undergoing chemotherapy receives a 5-HT3 antagonist for nausea and vomiting. Which drug is prototypical?

A. Ondansetron

B. Promethazine

C. Droperidol

D. Aprepitant

A. Ondansetron

A patient with chemotherapy-induced nausea receives an NK1 receptor antagonist that blocks substance P. Which drug is this?

A. Ondansetron

B. Aprepitant

C. Dronabinol

D. Meclizine

D. Aprepitant

A patient with mild ulcerative colitis is treated with a 5-ASA drug that inhibits COX/LOX and suppresses NF-kB. Which drug belongs to this group?

A. Azathioprine

B. Infliximab

C. Mesalamine

D. Natalizumab

C. Mesalamine

A patient with severe Crohn disease and fistula prevention receives an anti-TNF-α drug. Which serious risk must be screened for?

A. Reactivation tuberculosis

B. Ototoxicity

C. Cyanide toxicity

D. Hypercalcemia

C. Reactivation tuberculosis

A patient with severe Crohn disease receives an anti-integrin drug but is warned about progressive multifocal leukoencephalopathy. Which drug is this?

A. Infliximab

B. Natalizumab

C. Mesalamine

D. Sulfasalazine

A. Natalizumab

A patient with acute variceal bleeding is given a somatostatin analog to decrease splanchnic blood flow. Which drug is used?

A. Lactulose

B. Octreotide

C. Rifaximin

D. Ursodiol

B. Octreotide

A patient with hepatic encephalopathy is prescribed a nonabsorbable disaccharide that decreases ammonia absorption. Which drug is used?

A. Rifaximin

B. Neomycin

C. Lactulose

D. Ursodiol

B. Lactulose

A patient with hepatic encephalopathy needs an oral drug that reduces ammonia-producing gut bacteria and is often combined with lactulose. Which drug is used?

A. Rifaximin

B. Octreotide

C. Vasopressin

D. Chenodiol

C. Rifaximin

A patient with CKD anemia receives a recombinant erythropoietin that stimulates erythroid progenitor proliferation. Which adverse effect must be monitored?

A. Hypertension and thrombosis

B. Bronchospasm

C. Ototoxicity

D. Gynecomastia

D. Hypertension and thrombosis

A chemotherapy patient develops neutropenia and receives G-CSF. Which drug stimulates neutrophil precursors?

A. Sargramostim

B. Eltrombopag

C. Filgrastim

D. Romiplostim

C. Filgrastim

A patient with chronic immune thrombocytopenia receives a peptibody that activates thrombopoietin receptors to increase platelets. Which drug is this?

A. Romiplostim

B. Epoetin alfa

C. Filgrastim

D. Ferrous sulfate

D. Romiplostim

A patient with sickle cell disease receives a drug that binds HbS, increases oxygen affinity, and decreases HbS polymerization. Which drug is this?

A. Eltrombopag

B. Voxelotor

C. Darbepoetin alfa

D. Sargramostim

B. Voxelotor