4.3 Pharmaco Quiz Delete

An 85-year-old man presents to the primary care clinic 1 month after the death of his spouse. His medical history is significant for hypertension, hyperlipidaemia, benign prostatic hyperplasia (BPH), and major depressive disorder. His current medications include metoprolol XL 25 mg daily, atorvastatin 20 mg daily, tamsulosin 0.4mg daily, diazepam 5 mg at bedtime as needed for sleep, and Escitalopram 10 mg daily. His daughter reports that he has been more lethargic and unsteady walking during the past 3 days. The patient reports trouble sleeping, necessitating the use of Diazepam every night this past week. His blood pressure is 135/72 mm Hg and heart rate is 76 beats/minute. Urinalysis is unremarkable, thyroid- stimulating hormone (TSH) is within the reference range, and Geriatric Depression Scale score is 6/15. Which medication is most contributing to this patient’s lethargy and confusion?

Isoproterenol produces maximal contraction of cardiac muscle in a manner similar to epinephrine. Which of the following best describes Isoproterenol?

A 76-year-old woman was recently admitted to a long-term care facility for rehabilitation after several falls at home. Her medical history is significant for hypertension, hypothyroidism, Alzheimer disease (AD), hyperlipidaemia, and osteoarthritis (OA) of the knee. She takes Metoprolol succinate 50 mg daily, Levothyroxine 75 mcg daily, Atorvastatin 10 mg daily, and donepezil 10 mg daily. Her blood pressure is 126/80 mm Hg and heart rate is 66 beats/minute. Basic metabolic panel results are all within reference ranges; 25-hydroxyvitamin D concentration is 20 ng/mL, TSH is 1.89 mU/L, total cholesterol is 180 mg/dL, low-density lipoprotein cholesterol is 140 mg/dL, high-density lipoprotein cholesterol is 35 mg/dL, and triglycerides is 176 mg/dL. Her Mini–Mental State Examination (MMSE) score is 16/30, and her Geriatric Depression Scale score is 2/15. Which recommendation would be most appropriate to reduce this patient’s risk of falls?

If 0.5 mg of Alprazolam produces the same anxiolytic response as 5 mg of Diazepam which of the following statements is correct?

An 80-year-old woman presents to your clinic accompanied by her daughter, who no longer feels comfortable leaving her mother alone because of her mother’s “increasing forgetfulness.” The patient’s medical history is significant for type 2 diabetes, hypertension, coronary artery disease, congestive heart failure, and OA. She takes the following medications: Paracetamol 1g every 6 hours as needed for pain, Lisinopril 20 mg daily, furosemide 20 mg daily, Potassium chloride 20 mEq daily, Carvedilol 12.5 mg twice daily, and Glipizide 5 mg daily. Her MMSE score is 18/30. Blood tests obtained last week showed a normal basic metabolic panel, except for a fasting plasma glucose reading of 65 mg/dL. Her haemoglobin A1C (A1C) is
5.6%. A urinalysis is unremarkable. No nutritional deficiencies are noted. The patient’s blood pressure is 130/80 mm Hg and heart rate is 60 beats/minute. She receives a diagnosis of AD. Which initial intervention would be most appropriate to help with this patient’s cognitive function?

If 10 mg of Morphine produces a greater analgesic response than can be achieved by Ibuprofen at any dose, which of the following statements is correct?

In the presence of Picrotoxin (used as a central nervous system stimulant), diazepam is less efficacious at causing sedation, regardless of the dose. Picrotoxin by itself has no sedative effect even at the highest dose. Which of the following is correct?

60 year old female patient wanders around the house continuously. She often changes clothes, cries out, and asks repetitive questions. She has a background of osteoarthritis and advancing dementia. Her current medication regimen includes Rivastigmine 9.5 transdermal patch daily, which she has been taking for the past 6 months. Which would be most appropriate for this patient’s new behavioral symptoms?

Which of the following statements most accurately describes a system having spare receptors?

Which of the following would up-regulate postsynaptic β1 adrenergic receptors?

Which of the following physiological changes could happen when a person is attacked by a grizzly bear?

Which one of the following antipsychotics has been shown to be a partial agonist at the dopamine D2 receptor?

An adolescent male is newly diagnosed with schizophrenia. Which of the following antipsychotic agents may have the best chance to improve his apathy and blunted affect?

A 21-year-old male has recently begun Pimozide therapy for Tourette disorder. His parents bring him to the emergency department. They describe that he has been having “different-appearing tics” than before, such as prolonged contraction of the facial muscles. While being examined, he experiences opisthotonos (type of extrapyramidal spasm of the body in which the head and heels are bent backward and the body is bowed forward). Which of the following drugs would be beneficial in reducing these symptoms?

Which of the following antipsychotic agents is considered to be the most potent and, thus, have the highest risk of extrapyramidal symptoms?

Which antipsychotic has the most sedative potential and is sometimes questionably used as a hypnotic agent in certain clinical settings?

A 30-year-old male patient who is treated with haloperidol for his diagnosis of schizophrenia is considered to be well-managed symptomatically for his psychotic symptoms. However, he is reporting restlessness, the inability to sit still at the dinner table, and his family notices that he is pacing up and down the hallway frequently. Of the following, which is the best medication to treat this antipsychotic-induced akathisia?

Which of the following antipsychotic agents is available in a LAI formulation that may be useful for patients with difficulty adhering to therapy?

An 84-year-old widow lives at home alone. She can perform ADLs and most IADLs with her daughter’s assistance. Her current medications are hydrochlorothiazide 12.5 mg daily for hypertension, Tolterodine long acting 4 mg daily for incontinence, Citalopram 20 mg daily for depression, Paracetamol 1 g as needed
for arthritis, and Calcium/Vitamin D for prevention of osteoporosis. The patient’s physician administers the MMSE, and her score is 23/30. On physical examination, no cogwheel rigidity or tremor is noted. Which recommendation would be best at this time?

Which of the following antipsychotic agents is most associated with the possibility of a haematological dyscrasia such as agranulocytosis in a patient being treated for schizophrenia?

Which antipsychotic agent has been most associated with significant QT interval prolongation and should be used with caution in patients with pre-existing arrhythmias or patients taking other drugs associated with QT prolongation?

Which one following is most selective for serotonin reuptake?

E.S. is a 25-year-old electrician. He has had several episodes of memory lapses. His wife reports lip smacking and chewing movements during these spells. An electroencephalogram (EEG) reveals focal epileptiform spike waves. Which medication would be best for E.S.?

B.V. is a 48-year-old woman brought to your emergency department for the treatment of status epilepticus. Her blood glucose is 50 mg/dL on fingerstick. Which medication is the best next treatment step for B.V.?

J.H. is a 42-year-old man with focal onset seizures with loss of awareness for which he was prescribed Levetiracetam. He comes to the clinic where you work with concerns of agitation. He says his wife is also concerned because he is very irritable and, at times, depressed. Which best assesses J.H.’s condition?

P.P. is a 75-year-old woman who was given a diagnosis of Parkinson disease 8 years ago. During this visit to the clinic, she notes that her movements are slower and she feels stiffer. She has also experienced a worsening gait with two or three falls in the past 6 months. Her writing has also become small and illegible. She takes Carbidopa/Levodopa 25/100 mg 2 tablets four times daily. Which of P.P.’s symptoms would be controlled by this pharmacotherapy?

W.S. is a 70-year-old man with newly diagnosed Parkinson disease who is initiated on Carbidopa/Levodopa. His symptoms are well controlled, but he has concerns of nausea and vomiting. Which is the best intervention to reduce his nausea and vomiting?

Which of the following drugs is most useful for the treatment of absence seizures?

A 25-year-old woman with myoclonic seizures is well controlled on Sodium valproate. She indicates that she is interested in becoming pregnant in the next year. With respect to her anti-epilepsy medication, which of the following should be considered?

An 87-year-old man with AD receives rivastigmine 6 mg twice daily. His family notes improved functional ability but reports that he has nausea and vomiting that appear to be related to Rivastigmine. Which recommendation is best for the patient at this time?

A woman with myoclonic seizures is well controlled with Lamotrigine. She becomes pregnant and begins to have breakthrough seizures. What is most likely happening?

A 52-year-old man has had several focal complex partial seizures over the last year. Which one of the following therapies would be the most appropriate initial therapy for this patient?

T.M. is an 18-year-old woman with newly diagnosed generalized motor myoclonic-type seizures. She is in good health and takes oral contraceptives. Which is the best medication for T.M.’s seizures?

S.R. is a 37-year-old patient who began taking Phenytoin 100 mg 3 capsules orally at bedtime 6 months ago. He has had several seizures since then, the most recent of which occurred 7 days ago. At that time, his Phenytoin serum concentration was 8 mcg/mL. The treating physician increased his phenytoin dose to 100 mg 3 capsules orally twice daily. Today, which best represents his expected serum concentration?

J.B. is a 25-year-old man with a history of seizure disorder. He has been treated with Carbamazepine for 1 year, and his current Carbamazepine concentration is 12 mcg/mL. Which adverse effect is J.B. most likely to have with Carbamazepine at this concentration?

G.Z., a 26-year-old woman, presents with a 6-month history of “spells.” The spells are all the same, and all begin with a feeling in the abdomen that is difficult for her to describe. This feeling rises toward the head. The patient believes that she will then lose awareness. After a neurologic workup, she is given a diagnosis of focal seizures evolving to a bilateral, convulsive seizure. The neurologist is considering initiating either Carbamazepine or Oxcarbazepine.
Which is the most accurate comparison of carbamazepine and oxcarbazepine?

JM is a 10-year-old male with ADHD. His symptoms are currently controlled with an oral psychostimulant. However, he and his family wish to avoid having to give a second dose of medication at school. They are looking for an alternative treatment option that could be implemented in the morning and last the entire day. Which treatment option would be best for JM’s needs?

Amphetamines are contraindicated in patients with all of the following conditions except?

Which of the following agents is considered a first-line treatment for narcolepsy?

TT is a 35-year-old male who is interested in quitting smoking. In previous quit attempts, he has tried nicotine gum, the nicotine patch, and the “cold turkey” method. He has been unsuccessful in each of these attempts and usually resumed smoking within 4 to 6 weeks. Which of the following may be useful to assist TT in his attempt to quit smoking?

S.B. is 55-year-old man referred to a neurologist for numbness, burning, and tingling in his feet that has progressively worsened over the past year. On neurologic examination, he has decreased sensations bilaterally to midcalf. He takes no medications except for non-prescription analgesics as needed for pain. His current body mass index (BMI) is 32 kg/m2. Which therapy is best for S.B.?

All of the following drugs are controlled substances with a risk for drug addiction or dependence except?

Which one of the following combinations of antiparkinsonian drugs is an appropriate treatment plan?

Peripheral adverse effects of levodopa, including nausea, hypotension, and cardiac arrhythmias, can be diminished by including which of the following drugs in the therapy?

Which of the following antiparkinsonian drugs may cause vasospasm?

Modest improvement in the memory of patients with Alzheimer’s disease may occur with drugs that increase transmission at which of the following receptors?

Which of the following is the only medication that is approved for the management of amyotrophic lateral sclerosis?

Which of the following agents may cause tremors as a side effect and, thus, should be used with caution in patients with Parkinson’s disease, even though it is also indicated for the treatment of dementia associated with Parkinson’s disease?

A 25-year-old woman has a long history of depressive symptoms accompanied by body aches and pain secondary to a car accident 2 years earlier. Physical and laboratory tests are unremarkable. Which of the following drugs might be useful in this patient?

A 36-year-old man presents with symptoms of compulsive behavior. If anything is out of order, he feels that “work will not be accomplished effectively or efficiently.” He realizes that his behavior is interfering with his ability to accomplish his daily tasks but cannot seem to stop himself. Which of the following drugs would be most helpful to this patient?

55-year-old teacher began to experience changes in mood. He was losing interest in his work and lacked the desire to play his daily tennis match. He was preoccupied with feelings of guilt, worthlessness, and hopelessness. In addition to the psychiatric symptoms, the patient complained of muscle aches throughout his body. Physical and laboratory tests were unremarkable. After 6 weeks of therapy with fluoxetine, his symptoms resolved. However, the patient complains of sexual dysfunction. Which of the following drugs might be useful in this patient?

Jesse a 65 year-old veteran is taking Carbidopa/Levodopa 25 mg/100 mg orally four times daily, six month later he complain that dose is wearing off before his next dose is due, because his tremor and slow movements are worse before the next dose of Carbidopa/Levodopa. Which recommendation is best?

A 75-year-old woman with AD who lives at home with her husband has been treated with Donepezil 10 mg daily for about 3 years. When she began therapy, her MMSE score was 21/30; her present MMSE score is 17/30. The patient cannot perform most IADLs but can perform most ADLs with cueing. About 2 months ago, her Donepezil dose was increased to 23 mg, but she could not tolerate it, and it was reduced back to 10 mg daily. Her husband asks about changing her drug treatment to help maintain her function. Which is the next best course of action?

30 year old female, diagnosed generalized motor myoclonic-type seizures. She is in good health and takes oral contraceptives. is concerned about the impact of Levetiracetam on her oral contraceptives. Which response is best?

Jane. is a 34-year-old patient who presents to the emergency department in status epilepticus. All of her laboratory values are normal. Which drug is best to use first?

Mary, a 29-year-old woman, has throbbing right-sided headaches. She has nausea, phonophobia, and photophobia with these headaches but no aura. She usually has headaches twice a month. She has hypertension and morbid obesity. She takes Bendroflumethiazide 2.5 mg/day orally for hypertension, the only medications she is taking. Which drug is best for prophylaxis of her headaches?

Sandra is a 54-year-old businesswoman with squeezing, band-like headaches that occur three or four times weekly. She rates the pain of these headaches as 7/10 and finds Paracetamol, Aspirin, Ibuprofen and Naproxen only partly effective. She wants to take a prophylactic drug to prevent his headache disorder. Which drug is best for prophylaxis of his headaches?

Dave is a 49-year-old male computer programmer who describes piercing right-eye pain and lacrimation several times a day for 2–3 days in a row. He will have no episodes for 2–3 weeks but then will have recurrent episodes. In the office, he receives oxygen by nasal cannula during an episode, and his pain is relieved. Which drug is best for prophylaxis of his headaches?

You are evaluating the medication profile of an 87-year-old woman who resides in a secure advanced dementia unit. Her medical history includes dementia (likely AD), Parkinson disease, and osteoarthritis. She needs assistance with all ADLs, including total assistance with bathing and dressing, as well as help with feeding. She transfers with minimal help to a wheelchair. Her medication regimen includes Donepezil 10 mg daily, Memantine 10 mg twice daily, Carbidopa/Levodopa 25/100 mg four times daily, and a multivitamin supplement daily. The patient’s most recent MMSE score is 5/30. When reviewing the nursing notes, you see several references to the patient’s continuously crying out, “Help me, help me,” beginning around 5 p.m. On medical evaluation, reversible causes of her hypervocalization are ruled out. Which initial approach is most appropriate for this patient?

T.C. is a 30-year-old woman with migraine headaches. She takes sumatriptan 100 mg, which provides immediate relief. However, about 2 hours later, her headache symptoms return. Which would be best for her?

Michelle is a 44-year-old woman with right-sided headaches of moderate intensity that are accompanied by severe nausea and vomiting. Which drug is best for M.K.’s migraine headaches?

87 year old female patient’s with diagnosis of dementia, his agitation increases such that the nursing staff cannot bathe or feed her. Assuming nonpharmacologic approaches are ineffective which is the best pharmacologic approach to treat her behavioral symptoms?

A 16-year-old female adolescent with asthma, a history of ventricular septal defect, and attention deficit hyperactivity disorder (ADHD) was initially treated with Methylphenidate immediate release, but her ADHD symptoms persisted at home and school. Her therapy was then changed to Methylphenidate Concerta (long acting). The dose was maximized during the next several weeks; however, her symptoms were still not well controlled throughout the day. She and her family report adherence to the treatment regimen. Which is the best recommendation to make for treating her ADHD?

A 7-year-old child with absence seizures is having breakthrough episodes on ethosuximide. Which is the most appropriate alternative therapy?

A 14-year-old female adolescent with moderate obesity comes to the clinic with an erythematous pruritic rash. She was given Oxcarbazepine about 3 weeks ago for the management of focal seizures. Her medical history is significant only for seizures. She recently became sexually active with a male and admits inconsistent contraceptive use. Which intervention is best for her?

A 9-year-old boy has a new diagnosis of ADHD. At school, he is disruptive, talks when the teacher is talking, and runs around the classroom. His parents report extreme difficulty in getting him to do his homework after school. Which is best for his initial drug therapy?

All of the following adverse effects are manifestations of cholinergic agonists except?

Which of the following drugs is considered to be the agent of choice for anaphylactic reactions?

Which of the following neuromuscular blocking agents can cause muscarinic responses such as bradycardia and increased glandular secretions?

Which of the following agents would not be appropriate in the treatment of glaucoma?

Which of the following best describes the mechanism of diazepam to cause a sedative effect?

Which of the following mechanisms of action is true and most likely contributes to the treatment of parkinsonism?

All of the following adverse effects are associated with the use of Levodopa except?

Which of the following agents would not be an alternative to Phenytoin in the treatment of tonic-clonic seizure?

The activity of which of the following drugs depends on a p-phenyl-N-alkylpiperidine moiety?

Amphetamine exemplifies the pharmacologic mechanism of?

Sometimes, combination treatment of Parkinson disease is warranted. Which of the following drug combinations could work cooperatively to enhance a clinical anti-parkinsonian response?

A patient with major depression should aim to receive antidepressant therapy for at least?

A patient who has received citalopram 40 mg/day for 2 weeks for the treatment of major depression complains that the medication is not working and would like to be switched to another agent. What is the appropriate recommendation?

Which of the following medications would most likely exacerbate a pre-existing seizure disorder?

A patient diagnosed with depression was unsuccessfully treated with Fluoxetine. Fluoxetine was discontinued, and 14 days later, the patient started therapy with phenelzine. Then, 3 days after Phenelzine was started, the patient presented with hyperreflexia, fever, elevated blood pressure, confusion, and diarrhoea. What is the most likely cause of this clinical presentation?

90 year-old male patient diagnosed with bipolar disorder is taking Lithium. Which of the following is a late adverse effect of Lithium?

Which of the following is the appropriate therapeutic range for Lithium in the treatment of mania?

Buspirone mechanism of action can best be described as which of the following?

Which benzodiazepine is approved for the treatment of panic disorder?

Mrs DW is a 32-year-old with a 10-year history of ‘emotional problems’. These have largely been dealt with by her primary care doctor who has prescribed low dose TCAs for the last 3years. Mrs DW’s life is severely restricted by a number of rituals which she obsessively carries out. They include washing of sinks, baths and toilets, disinfection of kitchen surfaces, and vacuuming. These activities occupy up to 8 hours a day. What is appropriate therapy for OCD ?

Ms AC is a 32-year-old personal assistant to a director of a leading investment company. She has recently been promoted to this role and is now expected to entertain potential clients by dining out with the director at local restaurants. She has always preferred eating alone in the comfort of her own home and the thought of eating in public while promoting the business fills her with dread, which brings on palpitations and shortness of breath. What drug therapy is available which may provide some immediate relief of her anxiety symptoms?

Which of the following drugs is a Catechol-O Methyltransferase (COMT) inhibitor and has reports of fatal liver toxicity with it?

James 25-year-old businessman with squeezing, band-like headaches that occur three or four times weekly. He rates the pain of these headaches as 7/10 and finds Paracetamol, Aspirin, Ibuprofen, Naproxen only partly effective. He wants to take a prophylactic drug to prevent his headache disorder. Which drug is best for prophylaxis of his headaches?

Which of the following medications due to its lack of active metabolites and dependency on phase II hepatic reactions is least likely to cause a fall in a geriatric patient?

A patient on Indinavir an antiretroviral therapy (ART)) begins taking St. John’s wort for depression and suffers unexpected reduction in CD4 count. This is most likely due to?

William works the swing shift at the local manufacturing plant. Based on a recommendation from a friend at work, William would like to try Melatonin to help him get to sleep faster. Which of the following is true regarding William’s use of Melatonin?

A 9-year-old boy is sent for neurologic evaluation because of episodes of apparent inattention. Over the past year, the child has experienced episodes during which he develops a blank look on his face and his eyes blink for 15 seconds. He immediately resumes his previous activity. Which one the following best describes this patient’s seizures?

A 58-year-old male is brought into the emergency department following a car accident. His blood alcohol level on admission is 280 mg/dL. He has been treated in the past for seizures related to alcohol abuse, and he confirms that he has been drinking heavily over the past month since losing his job. What treatment should be given to this patient if he begins to go into withdrawal while hospitalized?

Amphetamines are contraindicated in patients with all of the following conditions except?

Modest improvement in the memory of patients with Alzheimer’s disease may occur with drugs that increase transmission at which of the following receptors?

Charles is a 70-year-old with tremors in his right hand that have progressively worsened for the past 6 months. He has difficulty walking. He also has backaches and no longer plays golf. In addition, he is losing his sense of taste. His wife notes that he is moving more slowly and that his handwriting has deteriorated. He is given a diagnosis of Parkinson disease. Which is the best treatment for this gentleman?

Protamine reverse the action of Heparin by which mechanism?

A 43-year-old non-pregnant woman has received a diagnosis of Graves disease. She is reluctant to try ablative therapy and wants to try oral pharmacotherapy first. Her thyroid laboratory values today include TSH 0.22 mIU/L (normal 0.5–4.5 mIU/L) and free T4 3.2 ng/dL (normal 0.8–1.9 ng/dL). She is anxious and always feels warm when others say it is too cold. Which is best for initial treatment of her condition?

A 63-year-old woman has Hashimoto disease. Her thyroid laboratory values today include TSH 10.6 mIU/L (normal 0.5–4.5 mIU/L) and free T4 0.5 ng/dL (normal 0.8–1.9 ng/dL). She feels consistently rundown and has dry skin that does not respond to the use of hand creams. Which is the best drug for initial treatment of her condition?