Term
| The most common cause of cardiopulmonary arrest in adults is |
|
Definition
| C) Ventricular fibrillation |
|
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Term
| Which of the following are factors proven to enhance prehospital survival? |
|
Definition
A) Occurrence of a witnessed arrest
B) Rapid implementation of bystander CPR
C) Presence of ventricular fibrillation as the initial rhythm
D) Early defibrillation
E) All of the above |
|
|
Term
| Which of the following statements is true? |
|
Definition
| C) CPR should be performed using cycles of 30 chest compressions followed by 2 rescue breaths |
|
|
Term
| Which of the following statements is true? |
|
Definition
| B) CPR should be provided immediately to a patient with cardiac arrest with minimal interruptions in chest compressions |
|
|
Term
| Which of the following statements is true? |
|
Definition
| E) Vasopressin has a more favorable effect than epinephrine on myocardial oxygen demand in the postresuscitative phase |
|
|
Term
| Which of the following statements is true? |
|
Definition
| B) The effectiveness of epinephrine is thought to be caused by its ?2 effects |
|
|
Term
| Which of the following is an adverse effect related to intravenous amiodarone? |
|
Definition
|
|
Term
| Which of the following is the drug of choice for torsade de pointes? |
|
Definition
|
|
Term
| Which of the following statements is true? |
|
Definition
| C) The goal of therapeutic hypothermia is to protect the patient from cerebral injury caused by destructive enzymatic reactions that occur following cardiac arrest |
|
|
Term
| Which of the following is not an acceptable therapy for asystole |
|
Definition
|
|
Term
| Which of the following are causes of pulseless electrical activity (PEA)? |
|
Definition
A) Hypovolemia
B) Drug overdose
C) Tension pneumothorax
D) Hypokalemia
E) All of the above |
|
|
Term
| Which of the following is NOT a potentially harmful effect of sodium bicarbonate? |
|
Definition
|
|
Term
| If intravenous access cannot be readily obtained, which of the following is the preferred alternative route for drug administration? |
|
Definition
|
|
Term
| The first drug administered following electrical defibrillation following ventricular fibrillation is |
|
Definition
|
|
Term
| The survival rate for patients with out-of-hospital cardiac arrest presenting with asystole is approximately |
|
Definition
|
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Term
| An 80-year-old man has a past medical history of hypertension and migraine headaches. His BP today is 158/72 and 156/70 mm Hg; heart rate is 70 beats/min; serum creatinine is 1.6 mg/dL; and potassium is 4.3 mEq/L. He is currently on lisinopril 40 mg daily and verapamil SR 240 mg daily, weighs 73 kg, is 70 in tall, smokes one pack of cigarettes daily, and consumes two to three ethanol-containing drinks weekly. Which of the following is the most appropriate recommendation for his antihypertensive regimen? |
|
Definition
| C) Add hydrochlorothiazide |
|
|
Term
| An 80-year-old man has a past medical history of hypertension and migraine headaches. His BP today is 158/72 and 156/70 mm Hg; heart rate is 70 beats/min; serum creatinine is 1.6 mg/dL; and potassium is 4.3 mEq/L. He is currently on lisinopril 40 mg daily and verapamil SR 240 mg daily, weighs 73 kg, is 70 in tall, smokes one pack of cigarettes daily, and consumes two to three ethanol-containing drinks weekly. Which of the following lifestyle modifications are most reasonable to recommend in this patient to lower his blood pressure? |
|
Definition
| C) Adopting a DASH eating plan |
|
|
Term
| A 37-year-old woman has a BP measurement of 190/120 mm Hg when she first arrives for a routine physical examination by a medical assistant. She has no previous history of hypertension, and the only other time she had been seen by this physician her BP was 120/80 mm Hg. She is extensively interviewed and examined and has no signs of acute or chronic target organ damage. Her BP is measured again 20 minutes later by another person (her physician), and it is 140/88 and 140/90 mm Hg. Which of the following is the most accurate clinical assessment of her present situation? |
|
Definition
| B) Elevated blood pressure |
|
|
Term
| A 37-year-old woman has a BP measurement of 190/120 mm Hg when she first arrives for a routine physical examination by a medical assistant. She has no previous history of hypertension, and the only other time she had been seen by this physician her BP was 120/80 mm Hg. She is extensively interviewed and examined and has no signs of acute or chronic target organ damage. Her BP is measured again 20 minutes later by another person (her physician), and it is 140/88 and 140/90 mm Hg. Which of the following is most appropriate BP goal in this patient? |
|
Definition
|
|
Term
| A 60-year-old woman with hypertension and left ventricular dysfunction (systolic heart failure) is seen 2 months after an acute myocardial infarction (MI). Her present BP is 130/84 and 132/82 mm Hg with a heart rate of 60 beats/min. Her serum creatinine is 1.1 mg/dL; serum potassium is 3.5 mEq/L; and spot urinalysis shows 40 mg albumin per gram of creatinine. She has no edema. She is taking furosemide 40 mg twice daily, carvedilol 25 mg twice daily, and enalapril 20 mg twice daily. Which of the following conditions justifies the use of carvedilol in this patient |
|
Definition
A) Heart failure
B) Post-mi
D) A and B |
|
|
Term
| A 60-year-old woman with hypertension and left ventricular dysfunction (systolic heart failure) is seen 2 months after an acute myocardial infarction (MI). Her present BP is 130/84 and 132/82 mm Hg with a heart rate of 60 beats/min. Her serum creatinine is 1.1 mg/dL; serum potassium is 3.5 mEq/L; and spot urinalysis shows 40 mg albumin per gram of creatinine. She has no edema. She is taking furosemide 40 mg twice daily, carvedilol 25 mg twice daily, and enalapril 20 mg twice daily. Which of the following statements is most appropriate to include when counseling this patient regarding her antihypertensive therapy? |
|
Definition
| C) Long-term benefits of these medications include a reduced risk of CV events |
|
|
Term
| Which of the following statements is (are) true regarding diuretics in the treatment of hypertension? |
|
Definition
| A) Thiazide-type diuretics are first-line agents because they lower BP and lower risk of CV events |
|
|
Term
| Which of the following is true regarding prehypertension? |
|
Definition
| D) Patients with prehypertension have higher CV risk than patients with normal BP values |
|
|
Term
| A 70-year-old woman with hypertension and type 2 diabetes has been on hydrochlorothiazide 25 mg daily and amlodipine 5 mg daily for 6 years. She was on captopril and enalapril several years ago, but both were stopped because of a dry cough. She was first diagnosed with hypertension when her blood pressure was 180/82 mm Hg. Today, her blood pressure is 148/78 and 148/76 mm Hg with a heart rate of 100 beats/min. Her urinalysis shows microalbuminuria; serum creatinine is 1.5 mg/dL; potassium is 4.1 mEq/L; weight is 75 kg; and height is 66 in. Her only complaint is headache. Which of the following is (are) routine monitoring parameters for her antihypertensive drug therapy? |
|
Definition
A) Heart rate
B) Serum potassium, sodium, and magnesium
C) Serum creatinine and BUN
D) All of the above |
|
|
Term
| A 70-year-old woman with hypertension and type 2 diabetes has been on hydrochlorothiazide 25 mg daily and amlodipine 5 mg daily for 6 years. She was on captopril and enalapril several years ago, but both were stopped because of a dry cough. She was first diagnosed with hypertension when her blood pressure was 180/82 mm Hg. Today, her blood pressure is 148/78 and 148/76 mm Hg with a heart rate of 100 beats/min. Her urinalysis shows microalbuminuria; serum creatinine is 1.5 mg/dL; potassium is 4.1 mEq/L; weight is 75 kg; and height is 66 in. Her only complaint is headache. Losartan 50 mg daily is added to her regimen. Four weeks later, her BP is 132/82 and 134/80 mm Hg; serum creatinine is 1.9 mg/dL; and potassium has increased to 4.4 mEq/L. Which of the following is the most appropriate option to treat this patient’s hypertension? |
|
Definition
| B) Increase losartan to 100 mg daily |
|
|
Term
| Which of the following is true regarding the use of alternative agents in the treatment of hypertension? |
|
Definition
| D) Most agents should given in combination with at least a thiazide-type diuretic |
|
|
Term
| A 65-year-old woman with type 2 diabetes, hypertension, osteoporosis, and atrial fibrillation has a BP of 150/96 and 150/90 mm Hg, heart rate of 68 beats/min, potassium of 3.2 mEq/L, and a serum creatinine of 2.3 mg/dL. She reports an allergy to chlorthalidone (severe gout). Presently, she is on diltiazem CD 360 mg daily and furosemide 40 mg twice daily. At this point in her care, which of the following agents would be the most rational addition to her regimen? |
|
Definition
| E) Olmesartan 20 mg daily |
|
|
Term
| Which of the following is preferred as add-on therapy for a patient who is status post-MI (1 month ago) with a BP of 146/88 and 144/86 mm Hg while treated with metoprolol XL 200 mg daily? |
|
Definition
|
|
Term
| Which of the following is preferred as initial antihypertensive therapy for a 63-year-old woman who is diagnosed with hypertension and has a history of ischemic stroke (6 months ago), with a BP of 166/108 and 164/106 mm Hg? |
|
Definition
| A) A thiazide-type diuretic with an ACE inhibitor |
|
|
Term
| Which of the following is preferred as initial antihypertensive therapy for a 52-year-old patient with chronic stable angina and hypertension, who is experiencing chest pain twice weekly while on atenolol 100 mg daily with a BP of 146/90 and 144/92 mm Hg and heart rate of 58 beats/min? |
|
Definition
| D) Nifedipine SR 30 mg daily |
|
|
Term
|
Definition
| "microzide" diuretic thiazide, 12.5-25 mg qd HTN |
|
|
Term
|
Definition
| hypersensitivity, anuria, renal decomposition, pregnancy |
|
|
Term
|
Definition
| hypokalemia, hypomagnesemia, hyperuricemia, mild increase in cholesterol & TG, hypotension |
|
|
Term
|
Definition
| "Lasix" LOOP diuretic 10-160 mg/day 1-2 divided doses HTN |
|
|
Term
| C/I of Loop diuretic "Lasix" |
|
Definition
|
|
Term
| A/E of Loop Diuretic lasix |
|
Definition
| hypokalemia, hypomagnesemia, overdiuresis, metabolic alkalosis |
|
|
Term
|
Definition
| "tenormin" Beta blocker 25-100 mg qd OLOL, HTN |
|
|
Term
| C/I of atenolol "tenormin" |
|
Definition
| hypersensitivity, sinus bradycardia, sinus node dysfunction, heart block greater than 1st degree, cardiogenic shock, uncompensated cardiac failure, pulmonary edema, pregnancy |
|
|
Term
|
Definition
| may aggravate asthma or other lung diseases, may cause fatiuge, insomnia, depression, nightmares, bradycardia, ED, aggravate peripheral vascular disease, mask signs of hyperglycemia, mild decrease in HDL, & mild increase in LDL |
|
|
Term
|
Definition
| "prinivil" or "Zestril" 5-401mg qd ACE-I, PRIL, HTN |
|
|
Term
|
Definition
| hypersensitivity, ANGIOEDEMA, 2nd or 3rd trimester of pregnancy |
|
|
Term
|
Definition
| hyperkalemia, COUGH, hypotension, rash, ANGIOEDEMA, acute renal failure in patients with bilateral renal artery stenosis or significant dehydration |
|
|
Term
|
Definition
| "Norvasc" CCB, 2.5-10 mg qd, HTN, DIPINE |
|
|
Term
|
Definition
|
|
Term
|
Definition
| peripheral edema, flushing. palpitation, headache, dizziness, eczema in elderly, tachycardia |
|
|
Term
|
Definition
| "lipitor" HMG CoA reductase inhibitor, STATIN 10mg qd, Hyperlipidemia |
|
|
Term
|
Definition
| hypersensitivity, active liver disease, pregnancy, breast feeding, unexplained persistant elevations of serum transaminases, use of CSA, gemfibrozil, niacin |
|
|
Term
|
Definition
| hepatic toxicity, myopathy, neuropathy |
|
|
Term
|
Definition
| "tricor" fibric acid, 145 mg qd, hyperlipidemia |
|
|
Term
|
Definition
| hypersensistivity hepatic dysfunction (primary biliary cirrhosis, unexplained persistent liver function abnormalities) severe renal dysfunction, preexistin gallbladder disease |
|
|
Term
|
Definition
| gi complaints, bile lithogenicity (stones) |
|
|
Term
|
Definition
| "Niacin" Niacor, "niaspan", 1-2 gm tid, hyperlipidemia |
|
|
Term
|
Definition
| liver disease, Type II DM, gout, hyperuricemia |
|
|
Term
|
Definition
| flushing, glucose intolerance, increase in uric acid, fulminant hepatitis |
|
|
Term
|
Definition
| "lanoxicaps" "lanoxin", anti-arrhythmic, A-FIB& CHF, loading dose 10-15 mcg/kg over 12-24 hrs, then 0.125-0.5 mcg qd |
|
|
Term
|
Definition
| hypersensitivity, V-FIB, stress & exercise (increase sympathomimetic tone) |
|
|
Term
|
Definition
| Drug interactions w/quinidine, verapamil, amiodarone |
|
|
Term
|
Definition
| "minitran" SL 0.2-0.6, (usual dose 0.4) every 5 minutes for 15, prophy 5-10 minutes prior to activity that may provoke attack |
|
|
Term
|
Definition
| IV USE: hypotension, uncorrected hypovolemia, inadequate cerebral circulation, constrictive pericarditis or tamponade, ALL- hypersensitivty to isosorbide, concurrent use with PDE-5 Inhibitors, glaucoma, head trauma or cerebral hemorrage, severe anemia |
|
|
Term
|
Definition
| Cardio:Hypotension, cresendo angina, flushing, peripheral edeam, postural hypotension, tachycardia, CNS:headache, syncope/dizzy, GI:bowel incontinenct, N&V, xerostomia, Urinary incontinence, blurred vision, diaphoresis |
|
|
Term
|
Definition
| "coumadin" anticoagulant, 4-5 mg qd, thromboembolitic disorders |
|
|
Term
|
Definition
| hypersensitivity, hemorrhage, alcoholism, surgery, dental work, spinal anesthesia or spinal injections, pregnancy |
|
|
Term
|
Definition
| hemorrhage, skin necrosis, purple toe syndrome |
|
|
Term
An African American male with a 2-year history of heart failure secondary to an acute myocardial infarction (MI) presents to the clinic with complaints of increasing shortness of breath (SOB) and slightly more difficulty sleeping. His weight is also increased 5 lb from his previous clinic visit 2 months ago. His current drug regimen includes:
Lisinopril 20 mg daily
Metoprolol succinate (Toprol XL) 200 mg daily
Furosemide 160 mg twice daily
Potassium (K) supplement 20 mEq daily
Digoxin 0.25 mg daily
Esomeprazole 25 mg daily
Acetylsalicylic acid (ASA) 81 mg daily
Simvastatin 40 mg at bedtime
His cardiovascular drug regimen is unchanged over the previous 3 months.
Vital signs (VS): blood pressure (BP), 146/98 mm Hg; pulse (P), 56 beats/min, normal sinus rhythm (NSR); respiration (R), 16 breaths/min; temperature (T): afebrile
Laboratory results:
Sodium (Na)136 mEq/L
Potassium (K)4.1 mEq/L
Chloride (CL)102 mEq/L
Bicarbonate (bicarb) 23 mEq/L
Blood urea nitrogen (BUN) 40 mg/dL
Serum creatinine (Scr)1.4 mg/dL
Glucose 98 mg/dL
Serum digoxin1.6 ng/mL
Left ventricular ejection fraction (LVEF) by echo 35%Which of the following is the most appropriate measure to immediately optimize the fluid status of this patient? |
|
Definition
| B) Add metolazone 2.5 mg daily |
|
|
Term
An African American male with a 2-year history of heart failure secondary to an acute myocardial infarction (MI) presents to the clinic with complaints of increasing shortness of breath (SOB) and slightly more difficulty sleeping. His weight is also increased 5 lb from his previous clinic visit 2 months ago. His current drug regimen includes:
Lisinopril 20 mg daily
Metoprolol succinate (Toprol XL) 200 mg daily
Furosemide 160 mg twice daily
Potassium (K) supplement 20 mEq daily
Digoxin 0.25 mg daily
Esomeprazole 25 mg daily
Acetylsalicylic acid (ASA) 81 mg daily
Simvastatin 40 mg at bedtime
His cardiovascular drug regimen is unchanged over the previous 3 months.
Vital signs (VS): blood pressure (BP), 146/98 mm Hg; pulse (P), 56 beats/min, normal sinus rhythm (NSR); respiration (R), 16 breaths/min; temperature (T): afebrile
Laboratory results: Sodium (Na) 136 mEq/L
Potassium (K)4.1 mEq/L
Chloride (CL)102 mEq/L
Bicarbonate (bicarb) 23 mEq/L
Blood urea nitrogen (BUN) 40 mg/dL
Serum creatinine (Scr)1.4 mg/dL
Glucose 98 mg/dL
Serum digoxin1.6 ng/mL
Left ventricular ejection fraction (LVEF) by echo 35%
Which of the following is the most appropriate approach to his digoxin therapy? |
|
Definition
| B) Decrease the digoxin dose to 0.125 mg/day as higher digoxin plasma concentrations can increase mortality |
|
|
Term
An African American male with a 2-year history of heart failure secondary to an acute myocardial infarction (MI) presents to the clinic with complaints of increasing shortness of breath (SOB) and slightly more difficulty sleeping. His weight is also increased 5 lb from his previous clinic visit 2 months ago. His current drug regimen includes:
Lisinopril 20 mg daily
Metoprolol succinate (Toprol XL) 200 mg daily
Furosemide 160 mg twice daily
Potassium (K) supplement 20 mEq daily
Digoxin 0.25 mg daily
Esomeprazole 25 mg daily
Acetylsalicylic acid (ASA) 81 mg daily
Simvastatin 40 mg at bedtime
His cardiovascular drug regimen is unchanged over the previous 3 months.
Vital signs (VS): blood pressure (BP), 146/98 mm Hg; pulse (P), 56 beats/min, normal sinus rhythm (NSR); respiration (R), 16 breaths/min; temperature (T): afebrile
Laboratory results:
Sodium (Na) 136 mEq/L
Potassium (K)4.1 mEq/L
Chloride (CL)102 mEq/L
Bicarbonate (bicarb) 23 mEq/L
Blood urea nitrogen (BUN) 40 mg/dL
Serum creatinine (Scr)1.4 mg/dL
Glucose 98 mg/dL
Serum digoxin1.6 ng/mL
Left ventricular ejection fraction (LVEF) by echo 35%Which of the following would be the most appropriate recommendation to improve the long-term outcome of this patient? |
|
Definition
| A) Add hydralazine/isosorbide dinitrate 37.5 mg/20 mg three times daily [no this is a combination drug product] |
|
|
Term
An African American male with a 2-year history of heart failure secondary to an acute myocardial infarction (MI) presents to the clinic with complaints of increasing shortness of breath (SOB) and slightly more difficulty sleeping. His weight is also increased 5 lb from his previous clinic visit 2 months ago. His current drug regimen includes:
Lisinopril 20 mg daily
Metoprolol succinate (Toprol XL) 200 mg daily
Furosemide 160 mg twice daily
Potassium (K) supplement 20 mEq daily
Digoxin 0.25 mg daily
Esomeprazole 25 mg daily
Acetylsalicylic acid (ASA) 81 mg daily
Simvastatin 40 mg at bedtime
His cardiovascular drug regimen is unchanged over the previous 3 months.
Vital signs (VS): blood pressure (BP), 146/98 mm Hg; pulse (P), 56 beats/min, normal sinus rhythm (NSR); respiration (R), 16 breaths/min; temperature (T): afebrile
Laboratory results:
Sodium (Na) 136 mEq/L
Potassium (K)4.1 mEq/L
Chloride (CL)102 mEq/L
Bicarbonate (bicarb) 23 mEq/L
Blood urea nitrogen (BUN) 40 mg/dL
Serum creatinine (Scr)1.4 mg/dL
Glucose 98 mg/dL
Serum digoxin1.6 ng/mL
Left ventricular ejection fraction (LVEF) by echo 35% The patient’s managed care plan has called about a formulary switch of his Toprol XL to generic immediate release metoprolol. Which of the following would be the most appropriate response to this request? |
|
Definition
| C) This switch is inadvisable because, unlike Toprol XL, immediate-release metoprolol has not been shown to improve survival in patients with heart failure |
|
|
Term
| A 74-year-old female patient has systolic heart failure with a presumed etiology of hypertension. She has minimal SOB and dyspnea on exercise (DOE) and trace pedal edema. She complains of a tickly cough that has been present since she began treatment for heart failure, and she finds the cough moderately bothersome. Her current medications include enalapril 10 mg twice daily, carvedilol 12.5 mg twice daily, and furosemide 20 mg daily. Which of the following would be most appropriate to alleviate the cough of this patient? |
|
Definition
| C) Discontinue enalapril and start candesartan |
|
|
Term
A 71-year-old female patient has a 3-year history of heart failure secondary to ischemic heart disease. She is now referred to a heart failure clinic for management. Her current medications include the following:
Ramipril 5 mg twice daily
Carvedilol 12.5 mg twice daily
Furosemide 20 mg daily
Digoxin 0.125 mg daily
ASA 81 mg daily
Lovastatin 40 mg at bedtime
VS: P, 78 beats/min; BP, 115/64 mm Hg; R, 19 breaths/min; T, 37°C (98.6°F).
Laboratory results:
Na132 mEq/L
K4.7 mEq/L
Cl98 mEq/L
Bicarb26 mEq/L
BUN28 mg/dL
SCr2.8 mg/dL
Glucose79 mg/dL Which of the following would be most appropriate? |
|
Definition
| A) Increase carvedilol to 25 mg twice daily |
|
|
Term
| A patient with New York Heart Association class III heart failure who was recently hospitalized for heart failure exacerbation continues to experience symptoms of volume overload and dyspnea on exertion despite treatment with maximal doses of an ACE inhibitor, ß-blocker, loop diuretic, and digoxin. Which of the following would be the most appropriate addition to this patient’s drug therapy? |
|
Definition
|
|
Term
| A patient with stage C heart failure also has hypertension. Current medications include amlodipine 5 mg daily, digoxin 0.25 mg daily, and furosemide 40 mg daily. The patient’s vital signs are currently: BP 145/90 mm Hg and pulse 82 beats/min. Which of the following changes should be recommended in this patient’s drug therapy? |
|
Definition
| C) Discontinue amlodipine and initiate lisinopril and carvedilol therapy |
|
|
Term
| Which of the following should be monitored in a patient receiving ACE inhibitor therapy? |
|
Definition
|
|
Term
| A heart failure patient in normal sinus rhythm is currently receiving an ACE inhibitor, ?-blocker, and loop diuretic. In spite of these therapies, the patient continues to experience symptoms. Current vital signs are BP 120/75 mm Hg and pulse 88 beats/min. Which of the following would be the preferred treatment option? |
|
Definition
| D) Digoxin should not be used because this patient is in sinus rhythm |
|
|
Term
| A patient with stage C heart failure is treated appropriately with lisinopril, carvedilol, furosemide, and digoxin. Today he comes into your community pharmacy to purchase ibuprofen to treat his left knee pain. Which of the following do you recommend? |
|
Definition
| B) Naproxen instead of ibuprofen |
|
|
Term
| A 58-year-old male with a history of ischemic cardiomyopathy presents to clinic with orthopnea, dyspnea with minimal exertion, 3+ pitting edema, fatigue, anorexia, nausea, and early satiety. These signs and symptoms are consistent with: |
|
Definition
|
|
Term
| A 58-year-old male with a history of ischemic cardiomyopathy presents to clinic with orthopnea, dyspnea with minimal exertion, 3+ pitting edema, fatigue, anorexia, nausea, and early satiety. This patient is admitted, and a Swan-Ganz catheter is placed. The pulmonary artery occlusion pressure (PAOP) is 28 mm Hg, and the cardiac index is 1.8 L/min/m2. These hemodynamic values are consistent with which one of the following subsets? |
|
Definition
|
|
Term
| All of the following therapeutic options would be reasonable to overcome diuretic resistance in a patient currently taking furosemide 40 mg orally twice a day except |
|
Definition
| D) Adding metolazone 2.5 mg orally twice daily |
|
|
Term
| A patient is admitted with decompensated chronic heart failure. The patient’s current medications include lisinopril 20 mg daily, furosemide 40 mg twice daily, metoprolol CR/XL 200 mg daily, and digoxin 0.125 mg daily. The patient has been stable on these doses for the previous 4 months. It is decided that positive inotropic therapy is indicated, along with IV diuretics. Which of the following would you recommend? |
|
Definition
| A) Discontinue metoprolol and start dopamine |
|
|
Term
| A 62-year-old man presents with substernal chest discomfort that usually lasts for 2 to 10 minutes that is pressure-like and radiates up to his jaw and down the left arm and is brought on by walking four blocks or by arguments with his wife over money. Past medical history (PMH) includes hypercholesterolemia total cholesterol (TC), 320 mg/dL; low-density lipoprotein [LDL], 252 mg/dL; triglyceride [TG], 180 mg/dL; and high-density lipoprotein [HDL], 32 mg/dL), smoking two packs per day for 30 years, benign prostatic hypertrophy (BPH), and hypertension (HTN) (blood pressure [BP], 156/92 mm Hg). Resting electrocardiogram (ECG) is normal. He currently takes terazosin 2 mg at bedtime. The most likely diagnosis is: |
|
Definition
|
|
Term
| A 62-year-old man presents with substernal chest discomfort that usually lasts for 2 to 10 minutes that is pressure-like and radiates up to his jaw and down the left arm and is brought on by walking four blocks or by arguments with his wife over money. Past medical history (PMH) includes hypercholesterolemia total cholesterol (TC), 320 mg/dL; low-density lipoprotein [LDL], 252 mg/dL; triglyceride [TG], 180 mg/dL; and high-density lipoprotein [HDL], 32 mg/dL), smoking two packs per day for 30 years, benign prostatic hypertrophy (BPH), and hypertension (HTN) (blood pressure [BP], 156/92 mm Hg). Resting electrocardiogram (ECG) is normal. He currently takes terazosin 2 mg at bedtime. Which of the following medications could be given acutely to the patient to relieve his chest discomfort? |
|
Definition
| A) Sublingual nitroglycerin |
|
|
Term
| The principal determinant(s) of myocardial oxygen demand is (are): |
|
Definition
|
|
Term
| A 62-year-old man presents with substernal chest discomfort that usually lasts for 2 to 10 minutes that is pressure-like and radiates up to his jaw and down the left arm and is brought on by walking four blocks or by arguments with his wife over money. Past medical history (PMH) includes hypercholesterolemia total cholesterol (TC), 320 mg/dL; low-density lipoprotein [LDL], 252 mg/dL; triglyceride [TG], 180 mg/dL; and high-density lipoprotein [HDL], 32 mg/dL), smoking two packs per day for 30 years, benign prostatic hypertrophy (BPH), and hypertension (HTN) (blood pressure [BP], 156/92 mm Hg). Resting electrocardiogram (ECG) is normal. He currently takes terazosin 2 mg at bedtime. Which one of the following classes of drugs should be used first to prevent recurrent episodes of chest pain for chronic therapy? |
|
Definition
|
|
Term
| Which category of drug therapy should be avoided in patients with vasospastic or Prinzmetal’s angina? |
|
Definition
|
|
Term
| In chronic stable angina, if a patient cannot tolerate a ß-blocker (bronchospasm/asthma), then the patient can be switched to: |
|
Definition
| C) Calcium channel blocker |
|
|
Term
| Aspirin should routinely be prescribed to patients with chronic angina because aspirin has been shown to reduce myocardial infarction and other vascular events in patients with known coronary artery disease (CAD). |
|
Definition
| A) The statement is correct, and the reason is correct |
|
|
Term
| Verapamil should be effective in the treatment of chronic angina because it: |
|
Definition
| B) (down) heart rate, (down) contractility, (down) SBP |
|
|
Term
| Short-acting nifedipine is an excellent choice for the treatment of chronic angina because it has a rapid onset of activity and can acutely lower blood pressure. |
|
Definition
| B) The statement is false, and the reason is correct |
|
|
Term
| Which of the following risk factors for CAD should be treated vigorously in patients with angina? |
|
Definition
A) Dyslipidemia
B) Hypertension
C) Smoking cessation
D) Diabetes
E) All of the above |
|
|
Term
| Antioxidant vitamins such as vitamin E and vitamin C should routinely be given to patients with angina because their use will delay the growth of atherosclerotic lesions and reduce cardiovascular events such as myocardial infarction (MI) and stroke. |
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Definition
| D) The statement is false, and the reason is false |
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Term
| Clopidogrel 75 mg/day should be used along with aspirin following primary coronary intervention with balloon angioplasty and stent placement for up to 1 year because the combination of antiplatelet agents reduces MI, stroke, or death compared to aspirin alone. |
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Definition
| A) The statement is correct, and the reason is correct |
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Term
| The most common cause of an acute coronary syndrome (ACS) is: |
|
Definition
| C) Atherosclerotic plaque rupture with superimposed clot |
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Term
| Which of the following characteristics describes an ACS patient who is at the highest risk of immediate death? |
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Definition
| A) ST-segment elevation and heart failure symptoms |
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Term
| The reason that troponin is preferred over creatinine kinase (CK) in the diagnosis of myocardial infarction (MI) is that |
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Definition
| D) Troponin is more specific for myocardial cell necrosis than CK |
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Term
| Which of the following treatment scenarios describes a patient who has received optimal reperfusion therapy for ST-segment elevation MI? |
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Definition
| C) Patient presented to the hospital at 0810 and received primary percutaneous coronary intervention (PCI) at 0900 |
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Term
| Based on evidence-based practice guidelines, which of the following antithrombotic drug therapy regimens is preferred for a patient undergoing primary PCI? |
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Definition
| D) Clopidogrel, aspirin, unfractionated heparin, abciximab |
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Term
| A 65-year-old man presents with to the emergency department of a hospital with no interventional cardiology services with ST-segment elevation MI 3 hours after the onset of symptoms. He has a history of hypertension (HTN) over 10 years and hemorrhagic stroke. His current blood pressure is 90/50 mm Hg, and his heart rate is 98 beats/min. In addition to aspirin and intravenous nitroglycerin (NTG), what additional pharmacotherapy should be administered in the emergency department to prevent death, stroke, or reinfarction? |
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Definition
| A) Unfractionated heparin and clopidogrel |
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Term
| A 65-year-old man presents to the emergency department of a hospital with no interventional cardiology services with non–ST-segment elevation MI 6 hours since the onset of chest discomfort. His current blood pressure is 130/80 mm Hg, and his heart rate is 88 beats/min. On physical examination he has rales and an S3. His 12-lead electrocardiogram shows ST-segment depression, and his troponin is elevated. In addition to aspirin and intravenous nitroglycerin, what additional pharmacotherapy should be administered in the emergency department to treat symptoms, prevent death, stroke, and reinfarction? |
|
Definition
| B) Clopidogrel, enoxaparin, eptifibatide, furosemide |
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Term
| Which of the following best describes patients who should receive eplerenone following myocardial infarction? |
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Definition
| C) All patients with heart failure symptoms and serum potassium less than 5.5 mEq/L |
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Term
| Which of the following statements regarding laboratory tests which should be monitored for adverse effects is correct? |
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Definition
| D) Eptifibatide–serum creatinine, platelet count |
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Term
| Which of the following best describes a patient with non–ST-segment elevation ACS who is a candidate for treatment with diltiazem? |
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Definition
| B) Continued chest discomfort despite nitrates and atenolol |
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Term
| Poor adherence with which of the following medications is associated with stent thrombosis following PCI? |
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Definition
|
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Term
| Which of the following therapies reduce the risk of stroke following MI? |
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Definition
A) Warfarin
B) Aspirin
C) Simvastatin
D) All of the above |
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Term
| Which of the following reduce mortality following non-ST-segment myocardial infarction (NSTE)? |
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Definition
|
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Term
| Which of the following is a desired fasting blood glucose goal for a patient with acute MI? |
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Definition
|
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Term
| The goal low-density lipoprotein cholesterol for a patient with recent MI is: |
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Definition
|
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Term
You are following a patient who is receiving chronic oral amiodarone. Because of the toxicities of amiodarone, which of the following tests would you monitor?
I. Chest x-ray
II. Thyroid function tests
III. Liver function tests
IV. Ophthalmologic examinations |
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Definition
|
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Term
| Which of the following properties does propafenone possess? |
|
Definition
| B) Vaughan-Williams type Ic and II |
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Term
| Of the Vaughan-Williams type I agents, the Ic antiarrhythmics such as flecainide slow conduction velocity through sodium-dependent tissue the most at normal heart rates. The reason for this is that flecainide does which of the following? |
|
Definition
| A) It has “slow-on/off” kinetics for the sodium channel |
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Term
| You are asked to see a patient with new onset atrial fibrillation, a rapid ventricular response (heart rate, 179 beats/min), and thyrotoxicosis. Currently, his only symptoms are weakness and palpitations. Which of the following do you suggest as initial therapy? |
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Definition
| C) Intravenous esmolol to control his ventricular rate |
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Term
You see a patient in clinic with paroxysmal atrial fibrillation receiving the following medications: digoxin 0.25 mg orally daily (last digoxin level 1.1 ng/mL), warfarin 6 mg orally daily (international normalized ratio [INR] 2–3 for the past 4 weeks). Now the physician would like to attempt to restore and maintain sinus rhythm with oral amiodarone. Which of the following recommendations should you make regarding the management of this patient?
I. To avoid the drug interactions, try quinidine instead of amiodarone.
II. Decrease the warfarin dose to 4 mg orally daily.
III. Decrease the digoxin dose to 0.125 mg orally daily.
IV. Discontinue the warfarin the day after sinus rhythm is restored. |
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Definition
|
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Term
| The December 5, 2002 issue of the New England Journal of Medicine published two landmark studies (AFFIRM and Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation) [RACE]) regarding the approach to patients with atrial fibrillation. Which of the following is consistent with the results of these trials? |
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Definition
| A) Use a “rate-control” strategy (leaving the patient in atrial fibrillation) with digoxin, calcium blockers, and/or ß-blockers. |
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Term
| Which of the following drugs would be most appropriate to restore sinus rhythm in a patient with atrioventricular (AV) nodal reentry or orthodromic AV reentry? |
|
Definition
|
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Term
| A 19-year-old female patient with a history of Wolf Parkinson White (WPW) syndrome is seen in the emergency room. She has no other medical problems or known heart disease. Her current electrocardiogram (ECG) shows a wide QRS tachycardia (irregular) (heart rate, 178 beats/min). Her blood pressure (BP) is stable, and she does not feel syncopal. Which of the following agents would be the most appropriate to administer to this patient at this time? |
|
Definition
| C) Intravenous procainamide |
|
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Term
| A 68-year-old man with a past medical history of hypertension and dyslipidemia presents to clinic complaining of dizziness and palpitations that have been occurring for the past 2 to 3 days. An ECG reveals that he is in atrial fibrillation (heart rate [HR], 120 beats/min). Which of the following drug regimens would be most appropriate for stroke prevention in this patient? |
|
Definition
| B) Warfarin (titrated to an INR of 2–3) |
|
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Term
| Which of the following is not consistent with the clinical profile of drug-induced torsade de pointes? |
|
Definition
| C) It is always dose-related, (i.e., large doses = higher risk) |
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Term
| The Cardiac Arrhythmia Suppression Trial (CAST) was one of the most important studies ever completed. Which of the following did not result from the CAST? |
|
Definition
| A) We learned that complex PVCs should not be treated with type III antiarrhythmics, such as sotalol |
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Term
| You are asked to see a patient who suffered a cardiac arrest and was successfully resuscitated at the local airport by an automated external defibrillator. He is transported to your hospital and admitted to the cardiac care unit (CCU). His cardiac enzymes are markedly elevated and demonstrate that he had an myocardial infarction (MI). Which of the following would be the most appropriate chronic treatment strategy for this patient? |
|
Definition
| C) Revascularization (if possible) and then chronic oral metoprolol |
|
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Term
| A patient in an internal medicine floor of the hospital suddenly goes into ventricular fibrillation. On arrival to the code as the pharmacist, you learn that the patient has had 4 defibrillations and 40 units of vasopressin with no response (remains in ventricular fibrillation). Which of the following drugs would be most appropriate to administer to this patient at this time? |
|
Definition
| A) Intravenous amiodarone |
|
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Term
| A 65-year-old man has a history of MI (6 months ago; current ejection fraction [EF], 25%) and recurrent sustained ventricular tachycardia. During his electrophysiologic study, he experienced inducible sustained ventricular tachycardia (heart rate, 240 beats/min) that caused him to pass out. Which of the following will probably be the treatment of choice for this patient’s arrhythmia? |
|
Definition
| B) Implantable cardioverter-defibrillator |
|
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Term
| A 55-year-old female with a history of atrial fibrillation is admitted for the restoration of sinus rhythm. In the CCU, she is given 2 mg of intravenous ibutilide, which terminates the atrial fibrillation. However, shortly thereafter, she suffers several long episodes of polymorphic ventricular tachycardia with a prolonged QT interval during sinus rhythm. Which of the following would be the most appropriate treatment for this arrhythmia? |
|
Definition
| D) Intravenous magnesium 2 g |
|
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Term
| Mr. Jones develops a deep-vein thrombosis (DVT) while receiving unfractionated heparin for venous thromboembolism (VTE) prophylaxis for the past 7 days. The patient’s platelet count has dropped by 50% to less than 100,000 cumm, therefore heparin-induced thrombocytopenia is strongly suspected. Mr. Jones is 5 ft 11 in tall and weighs 100 kg. Which of the following strategies would be the most appropriate in the initial management for Mr. Jones? |
|
Definition
| C) Stop heparin and start argatroban 200 mcg/min intravenous infusion |
|
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Term
| Which of the following patients would be at greatest risk for developing a DVT in the next month? |
|
Definition
| D) A 78-year-old obese female with severe osteoarthritis for the past 15 years who will have an elective knee replacement tomorrow |
|
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Term
| Which of the signs or symptoms listed below are the least consistent with the diagnosis of DVT? |
|
Definition
| B) The patient’s right and left ankles are very swollen |
|
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Term
| The probability of developing a fatal pulmonary embolism (PE) following knee replacement surgery, in the absence of any prophylactic measures, is: |
|
Definition
|
|
Term
| Graduate compression stockings for VTE prophylaxis are: |
|
Definition
| A) An appropriate prevention strategy for the patient at moderate risk |
|
|
Term
| Which of the following statements regarding warfarin sodium is true? |
|
Definition
| A) Warfarin slows the production of protein C in the liver |
|
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Term
| Low-dose unfractionated heparin (5,000 units subcutaneously every 12 hours) would be an appropriate choice to prevent VTE for which of following patients? |
|
Definition
| C) A 51-year-old male with benign prostatic hyperplasia and undergoing an abdominal prostatectomy |
|
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Term
| Which of the following statements regarding the low-molecular-weight heparins (LMWHs) is true? |
|
Definition
| B) The LMWHs are a heterogenous mixture of molecules of varying weights and lengths |
|
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Term
| Which of the following statements regarding unfractionated heparin (UFH) is true? |
|
Definition
| D) Even when weight-based dosing protocols are used, UFH produces an unpredictable degree of anticoagulation |
|
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Term
| Which of the following individuals would be the most appropriate candidate for outpatient VTE treatment? |
|
Definition
| A) A 64-year-old male who uses insulin to control his diabetes |
|
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Term
| In addition to starting warfarin sodium therapy, which of the following would be the most appropriate initial acute treatment regimen for a 57-year-old, 120-kg, male who has a proximal DVT and no other comorbid conditions? |
|
Definition
| C) Fondaparinux 10 mg subcutaneously every 24 hours |
|
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Term
| Which of following interventions would be the most appropriate for a 71-year-old female with chronic atrial fibrillation taking warfarin for primary stroke prevention and has a prothrombin time (PT) of 32.5 sec, international normalized ratio (INR) of 8.4, stable vital signs, and no evidence of bleeding? |
|
Definition
| B) Administer vitamin K 2.5 mg orally, omit next dose of warfarin, and remeasure PT/INR in 24 to 48 hours |
|
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Term
| Which of the following individuals would be at the greatest risk for a major bleed if given warfarin therapy? |
|
Definition
| A) A 81-year-old woman with frequent tonic-clonic seizures who had neurosurgery last week |
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Term
| A 76-year-old male who is taking amiodarone needs to start warfarin for DVT prophylaxis following hip replacement surgery. Which of the following would be the most appropriate initial dose of warfarin for this patient? |
|
Definition
|
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Term
| Ms. Smith is a 67-year-old female who has had recurrent DVTs and has been taking warfarin for the past 3 years. Her last six INR values have been within the goal range. Today, the patient’s INR is 1.2. Which of the following would be the most likely explanation? |
|
Definition
| C) Ms. Smith ate spinach and basil pesto fettuccine for dinner last night |
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Term
| A patient is receiving enoxaparin subcutaneously and warfarin sodium orally for the treatment of deep vein thrombosis on an outpatient basis. Which of the following laboratory monitoring plans is the most appropriate to determine response and toxicity to this drug treatment regimen? |
|
Definition
| B) Measure PT/INR in 2 days and platelet count in 7 days |
|
|
Term
| Which one of the following LDL cholesterol levels is considered to be “optimal”? |
|
Definition
|
|
Term
| Small, dense LDL cholesterol (Pattern B) is more atherogenic than Pattern A because Pattern B LDL increases susceptibility to oxidation and enhances arterial uptake of LDL |
|
Definition
| A) The statement is true, and the reason is true |
|
|
Term
| Which lipid component is elevated in type IIa of the Fredrickson-Levy-Lees classification? |
|
Definition
|
|
Term
| Which one of the following is not a coronary heart disease (CHD) risk equivalent? |
|
Definition
|
|
Term
| What is the LDL cholesterol target for someone with diabetes? |
|
Definition
|
|
Term
| What is the LDL target for a man with a waist circumference of 42 in, blood pressure (BP) of 145/92 mm Hg, fasting glucose of 126 mg/dL, and triglycerides of 78 mg/dL? |
|
Definition
|
|
Term
| Which one of the following drugs produces the greatest reduction in triglycerides? |
|
Definition
|
|
Term
| Which statin produces the greatest reduction in LDL cholesterol? |
|
Definition
|
|
Term
| What is the most common adverse effect of niacin? |
|
Definition
|
|
Term
| A patient has been receiving simvastatin 80 mg/day for the past 6 months, and 2 weeks ago he was diagnosed with stage 1 hypertension and started on verapamil 240 mg/day. In clinic today, the patient is complaining of aches in his arms and legs, which is not associated with excessive exertion or trauma. What laboratory test should be ordered? |
|
Definition
|
|
Term
| What counseling points should be given to a patient starting on immediate release niacin? |
|
Definition
A) Take with food
B) Take aspirin before niacin
C) Avoid hot liquids
D) Avoid alcohol
E) All of the above |
|
|
Term
| Which factor increases the risk of myositis with fibric acids? |
|
Definition
| C) Coadministration with niacin |
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