Question 1

When comparing ACE and ARB medications, which of the following holds true?

Accepted Answer

Both ACE inhibitors and ARBs can lead to increased potassium levels in the blood, which is known as hyperkalemia.

Question 2

Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be:

Accepted Answer

Headaches are a common side effect of nitrates due to their vasodilating effects, which can cause increased blood flow to the brain and result in headaches.

Question 3

Which comment by a patient indicates a need for more education concerning his nitrate medication?

Accepted Answer

Nitrate medications, such as those used for chest pain, should not be left out on a bedside table as they need to be stored properly to maintain their effectiveness. Exposure to air, light, or moisture can degrade the medication, making it less effective or ineffective.

Question 4

The choice of diuretic to use in treating hypertension is based on:

Accepted Answer

Thiazide diuretics are typically used for patients with an estimated glomerular filtration rate (eGFR) higher than the mid-40 mL/min range, as they are less effective in patients with significant kidney function impairment.

Question 5

Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other antilipidemics, this drug:

Accepted Answer

Colestipol is a bile acid sequestrant that works by exchanging chloride ions for negatively charged bile acids in the bowel, leading to the excretion of bile acids in the stool. This process reduces the bile acid pool, causing the liver to convert more cholesterol into bile acids, which can lower LDL cholesterol levels in the blood. It does not directly block cholesterol synthesis in the liver (like statins do), significantly increase HDL levels compared to other classes, or block the lipoprotein lipase pathway.

Question 6

In teaching about the use of sublingual nitroglycerine, the patient should be instructed:

Accepted Answer

Sublingual nitroglycerine is designed to be placed under the tongue where it dissolves and is absorbed directly into the bloodstream, providing rapid relief from chest pain. Swallowing the tablet, expecting a "burn" for effectiveness, or taking it repeatedly without specific instructions can be incorrect or dangerous practices.

Question 7

Because of their site of action, bile acid sequestering resins:

Accepted Answer

The answer of Because of their site of action, bile...

Question 8

Which formulation of nitrate is appropriate for acute anginal pain?

Accepted Answer

Sublingual nitrate formulations, such as nitroglycerin, are appropriate for the acute relief of anginal pain due to their rapid onset of action.

Question 9

Which of the following diagnostic results would NOT indicate a problem related to a reductase inhibitor?

Accepted Answer

Increased white blood cell count is not typically associated with issues related to reductase inhibitors. Reductase inhibitors, such as statins, are more commonly linked to liver enzyme elevations (elevated serum transaminase), kidney function alterations (increased serum creatinine), and muscle damage (elevated creatinine kinase).

Question 10

How is diabetic renal protection affected by ACE medications? Diabetes mellitus patients:

Accepted Answer

ACE inhibitors are known to slow the progression of renal disease in patients with diabetes by reducing intraglomerular pressure, but they may need to be discontinued in advanced renal disease due to potential for hyperkalemia and worsening renal function.

Question 11

What dermatological issue is linked to Amiodarone use?

Accepted Answer

Amiodarone, a medication used for certain types of arrhythmias, can cause a variety of side effects, including dermatological ones. One notable side effect is the progressive change of skin tone towards a blue or gray spectrum, particularly in areas exposed to the sun. This is due to the drug's deposition in the skin, which can interact with sunlight.

Question 12

Direct renin inhibitors have the following properties. They:

Accepted Answer

Direct renin inhibitors, like aliskiren, inhibit the RAAS at its initial step by blocking renin, thus impacting the entire RAAS cycle.

Question 13

Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct.

Accepted Answer

Combining fibric acid derivatives like gemfibrozil with reductase inhibitors (statins) is not recommended due to an increased risk for rhabdomyolysis, a serious condition that involves the breakdown of muscle tissue leading to the release of muscle fiber contents into the bloodstream, which can lead to kidney damage.

Question 14

Colestipol comes in a powdered form. The patient is taught to:

Accepted Answer

Colestipol powder should be mixed with four to six ounces of milk or fruit juice before ingestion to ensure it is properly diluted and to facilitate its intake, improving patient compliance and reducing the risk of gastrointestinal discomfort.

Question 15

Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to:

Accepted Answer

Rhabdomyolysis is a serious condition that can be caused by statins like atorvastatin, characterized by muscle breakdown and the release of muscle fiber contents into the bloodstream, which can lead to kidney damage. Symptoms include muscle weakness or tenderness and dark-colored urine. Patients are advised to report these symptoms immediately to their healthcare provider for evaluation and possible adjustment of their medication regimen.

Question 16

Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why?

Accepted Answer

Erectile dysfunction medications, such as sildenafil (Viagra), can cause a significant drop in blood pressure when taken with nitrates. Nitrates are often prescribed for chest pain (angina) and, when combined with ED medications, can lead to profound hypotension (very low blood pressure), which can be dangerous.

Question 17

Because of the pattern of cholesterol synthesis, reductase inhibitors are given:

Accepted Answer

Cholesterol synthesis in the body peaks at night, so reductase inhibitors (statins), which target the enzyme HMG-CoA reductase involved in cholesterol synthesis, are most effective when taken in the evening in a single daily dose.

Question 18

Niaspan, an extended-release form of niacin, was previously prescribed to treat a patient’s hypertriglycerides. However, the FDA withdrew its approval of the drug. Which of the following drugs with research efficacy should be substituted?

Accepted Answer

Statins and fibrates are both effective in treating hypertriglyceridemia. Statins primarily lower LDL cholesterol but can also reduce triglycerides, while fibrates specifically target triglycerides and are often used when triglyceride levels are very high. Omega-3 supplements can also lower triglycerides, but statins and fibrates are more commonly prescribed for this condition and have a more established research background for efficacy.

Question 19

Dulcea has type 2 diabetes and a high triglyceride level. She has been prescribed gemfibrozil to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug?

Accepted Answer

Gemfibrozil is contraindicated in patients with gallbladder disease because it can exacerbate this condition. It affects lipid metabolism and can lead to the formation of gallstones, posing a risk to individuals with a history of gallbladder disease.

Question 20

Niaspan is less likely to cause which side effect that is common to niacin?

Accepted Answer

Niaspan, an extended-release form of niacin, is specifically designed to reduce the incidence of cutaneous flushing, a common side effect associated with immediate-release niacin.

Quiz 13: Drugs Affecting the Cardiovascular and Renal Systems