Question 1

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

Accepted Answer

Colestipol belongs to the class of bile acid sequestrants that work in the gut by exchanging negatively charged chloride ions for acidic bile acids, leading to increased fecal excretion of bile acids and reducing their recirculation to the liver. This in turn increases the conversion of cholesterol to bile acids, thereby lowering serum low-density lipoprotein levels. It does not block cholesterol synthesis in the liver, increase HDL levels the most, or block the lipoprotein lipase pathway.

Question 2

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

Accepted Answer

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

Question 3

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

Accepted Answer

Mixing the powder with milk or fruit juice can make it more palatable and easier to swallow. It is important to follow the medication's specific instructions for administration to ensure proper absorption and effectiveness.

Question 4

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

Accepted Answer

Gemfibrozil can increase the risk of gallstones or gallbladder disease, so if Dulcea has a history of gallbladder disease, it may contraindicate the use of this drug. Reactive airway disease/asthma, inflammatory bowel disease, or allergy to aspirin are not known contraindications for gemfibrozil.

Question 5

What does the provider understand about the issue of "Diabetic Renal Protection" with angiotensin-converting enzyme (ACE) medications? Diabetes mellitus patients:

Accepted Answer

ACE medications have been shown to slow the progression of renal disease in patients with diabetes mellitus. However, they should still be discontinued when advanced renal issues present. Patients with early renal dysfunction may see some reversal of the dysfunction while on ACE medications, but this is not always the case. Starting ACE medications does not guarantee that a patient will not progress to renal nephropathy.

Question 6

Direct renin inhibitors have the following properties. They:

Accepted Answer

Direct renin inhibitors inhibit the first step in the RAAS cycle, resulting in a decrease in the production of angiotensin I and II. This effectively “shuts down” the entire RAAS system.

Question 7

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

Accepted Answer

Increased white blood cell counts would not indicate a problem related to a reductase inhibitor. Elevated serum transaminase, elevated creatinine kinase, and increased serum creatinine can all be potential indicators of liver, muscle, or kidney damage, respectively, which can be caused by reductase inhibitors.

Question 8

Janice has elevated LDL, VLDL, and triglyceride levels. Niaspan, an extended-release form of niacin, is chosen to treat her hyperlipidemia. Due to its metabolism and excretion, which of the following laboratory results should be monitored?

Accepted Answer

The answer of Janice has elevated LDL, VLDL, and triglyceride...

Question 9

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

Accepted Answer

Nitrates are vasodilators that lower blood pressure. ED medications also have a vasodilatory effect, and when combined with nitrates, there is a risk of a significant drop in blood pressure and the potential for serious cardiovascular events.

Question 10

What dermatological issue is linked to Amiodarone use?

Accepted Answer

Amiodarone, a medication used for certain types of ventricular and supraventricular arrhythmias, has been associated with several side effects, including dermatological ones. One of the notable side effects is a progressive change of skin tone toward a blue or gray spectrum, especially in areas exposed to sunlight. This condition is known as amiodarone-induced skin discoloration.

Question 11

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

Option B acknowledges the patient's complaint and provides information about the common side effect of these drugs. Asking the patient about the severity of the headaches can provide further insight into the need for intervention or potential management strategies.

Option A is incorrect because nitrates cause vasodilation via nitric oxide activation of cyclic guanosine monophosphate leading to relaxation of vascular smooth muscle, which increases blood flow to the heart muscle, thereby reducing angina. Parasympathetic response is not involved.

Option C is incorrect because while smoking is a risk factor for angina, this answer does not address the patient's concern about headaches or provide an appropriate response regarding the medication.

Option D is incorrect because headaches are a common side effect of nitrates, and it is unlikely that the headaches are not related to the medication.

Question 12

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 cause kidney damage.

Question 13

When comparing angiotensin-converting enzyme (ACE) and angiotensin II receptor blocker (ARB) medications, which of the following holds true?

Accepted Answer

Both ACE inhibitors and ARBs can cause some retention of potassium, but ACE inhibitors are known to be more likely to do so. Option A is incorrect because dry, irritating cough is a side effect commonly associated with ACE inhibitors, but not ARBs. Option C is incorrect because ACE inhibitors and ARBs are equally effective in controlling hypertension. Option D is incorrect because studies have shown that ACE inhibitors and ARBs have comparable effects on renal protection in patients with diabetes mellitus.

Question 14

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

Accepted Answer

The correct way to use sublingual nitroglycerine is to place one tablet under the tongue if chest pain occurs and allow it to dissolve. The patient should not swallow the tablet, but rather let it dissolve sublingually. They should also not take more than three tablets in 15 minutes, and if their chest pain persists after three doses, they should seek medical attention. The tablet may cause a burning or tingling sensation under the tongue, which is normal and expected.

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

Muscle weakness or tenderness and dark urine are classic signs of rhabdomyolysis, a serious adverse effect of atorvastatin. Donald should report these symptoms immediately to his healthcare provider. A) The association between red meat and hyperlipidemia is not relevant to the adverse effect of atorvastatin. B) Abdominal cramps and diarrhea are not typical symptoms of rhabdomyolysis, so stopping the drug for these symptoms is not necessary. D) "Hot flash" sensations are not a common side effect of atorvastatin therapy.

Question 16

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

Accepted Answer

The level of kidney function is an important consideration when choosing a diuretic. Thiazide diuretics are generally preferred for patients with an estimated glomerular filtration rate higher than the mid-40mL/min because they are more effective in lowering blood pressure in this population. Loop diuretics are recommended for patients with edema, heart failure or chronic kidney disease with an estimated glomerular filtration rate less than 30-40mL/min. Other factors such as presence of diabetes, ethnicity or hyperlipidemia may also influence the choice of diuretic, but they are not the primary consideration.

Question 17

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

Accepted Answer

Reductase inhibitors should be given in the evening in a single daily dose because cholesterol synthesis is highest at night. This timing allows for maximal inhibition of cholesterol production.

Question 18

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

Accepted Answer

The answer of Niaspan is less likely to cause which...

Quiz 16: Drugs Affecting the Cardiovascular and Renal Systems