Question 1

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 2

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

Accepted Answer

Increased white blood cell counts are not typically associated with a problem related to reductase inhibitors. The other options are potential indicators of a problem with reductase inhibitor therapy. Elevated serum transaminases may suggest liver toxicity, increased serum creatinine may indicate kidney dysfunction, and elevated creatinine kinase may suggest muscle damage.

Question 3

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

Accepted Answer

While ACE medications have been shown to decrease the rate of renal progression in diabetes mellitus patients, they should still be discontinued once advanced renal issues are present. Therefore, A is the correct answer as it acknowledges the benefit of ACE medications while also recognizing their limitations. B and C are incorrect as they both make overly optimistic claims regarding the effectiveness of ACE medications. D is incorrect as ACE medications have been shown to provide renal protection in patients with early renal dysfunction as well as those without any renal issues.

Question 4

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 early signs of rhabdomyolysis, a rare but serious adverse response to atorvastatin. It is important for Donald to report these symptoms to his healthcare provider immediately to prevent further complications. Becoming a vegetarian or experiencing abdominal cramps and diarrhea are not related to rhabdomyolysis. "Hot flash" sensations are not commonly associated with atorvastatin therapy.

Question 5

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

Accepted Answer

Reductase inhibitors are given in the evening in a single daily dose because cholesterol synthesis peaks during the night, and taking the medication in the evening can maximize its effectiveness. Additionally, taking the medication at the same time each day can help with adherence and consistency in dosing.

Question 6

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 7

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 and it is important to assess the severity of the headaches to determine if alternative treatments or adjustments to the medication regimen are necessary.

Question 8

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

Accepted Answer

Mixing ED medications with nitrates can lead to profound hypotension (low blood pressure) which can be dangerous and even life-threatening. Nitrates are commonly used to treat conditions such as angina (chest pain) or heart failure. The combination of these medications can cause a sudden drop in blood pressure, leading to dizziness, fainting, and even a heart attack or stroke. Therefore, it is important to avoid taking ED medications with nitrates or any other medication that can cause a significant drop in blood pressure.

Question 9

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

Accepted Answer

Both ACE and ARB medications can cause some retention of potassium, but ACE inhibitors are typically more likely to cause significant elevations in potassium levels. Option A is incorrect because the dry, irritating cough is a side effect primarily associated with ACE inhibitors, not ARBs. Option C is incorrect because both ACE inhibitors and ARBs are effective at controlling hypertension, but ACE inhibitors may have a slight edge over ARBs in terms of blood pressure reduction. Option D is incorrect because ACE inhibitors are generally more effective than ARBs in terms of renal protection in patients with diabetes mellitus.

Question 10

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 and sometimes cause cholecystitis (inflammation of the gallbladder), hence patients with known gallbladder disease should not use this drug. Reactive airway disease/asthma, inflammatory bowel disease, and allergy to aspirin are not contraindications for gemfibrozil.

Question 11

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

Accepted Answer

Colestipol is a bile acid sequestrant that works in the gut by exchanging chloride ions for negatively charged bile acids, which leads to increased fecal excretion of bile acids and reduced absorption of dietary cholesterol. This ultimately leads to a decrease in LDL cholesterol levels.

Question 12

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

Accepted Answer

Sublingual nitroglycerine should be placed under the tongue and allowed to dissolve, as it is absorbed through the blood vessels in this area. Swallowing the tablet or taking it every 5 minutes is not correct. Burning or tingling under the tongue is a common side effect and does not indicate effectiveness.

Question 13

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

Accepted Answer

The choice of diuretic to use in treating hypertension is based on the level of kidney function, with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40mL/min range. Loop diuretics are not recommended for patients with diabetes, and aldosterone antagonists are not specifically recommended for African Americans and older adults. Hyperlipidemia does not play a role in the choice of diuretics for hypertension.

Question 14

Direct renin inhibitors have the following properties. They:

Accepted Answer

Direct renin inhibitors "shut down" the entire RAAS cycle by inhibiting the enzymatic activity of renin, which is the first step in the formation of angiotensin II. They do not typically need to be used in combination with other RAAS medications, and their safety during pregnancy has not been established. While there are some generic direct renin inhibitors available, this is not a defining characteristic of the drug class.

Question 15

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 16

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

Accepted Answer

Mixing the powder with 4 to 6 ounces of milk or fruit juice is the correct way to take colestipol. This method helps to mask the gritty texture and makes it easier to swallow. It is also important to note that it should be taken at least one hour before or four hours after other medications to prevent interactions.

Question 17

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

Accepted Answer

Bile acid sequestering resins can bind to other drugs and reduce their absorption, so they should be administered separately from other drugs by at least 4 hours. There is no known increased risk for bleeding with these medications.

Question 18

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

Accepted Answer

Niaspan is an extended-release formulation of niacin that is less likely to cause cutaneous flushing, which is a common side effect of niacin.

Quiz 16: Drugs Affecting the Cardiovascular and Renal Systems