Clinical Pharmacology Cases and Principles
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What is the most likely cause of cholinergic crisis symptoms in the elderly female living on a farm?

  • Beta-adrenergic agonist therapy
  • Excessive anticholinesterase use
  • Infection causing sympathetic activation
  • Organophosphate pesticide poisoning (correct)
  • Which drug did the surgeon accidentally use that caused pupil dilation instead of constriction?

  • Pilocarpine
  • Tropicamide (correct)
  • Acetylcholine
  • Bethanechol
  • What class of drug should be considered next for a COPD patient who did not respond to a β2 agonist?

  • Muscarinic antagonist (correct)
  • Long-acting β agonist
  • Muscarinic agonist
  • α-adrenergic agonist
  • Why is it inappropriate to administer a cholinergic agonist to a patient with cholinergic crisis?

    <p>It could worsen the condition.</p> Signup and view all the answers

    What effect do muscarinic antagonists have on the pupil?

    <p>Cause mydriasis</p> Signup and view all the answers

    What mechanism causes bronchoconstriction in the presence of muscarinic agonists?

    <p>Activation of muscarinic receptors</p> Signup and view all the answers

    Which drug could potentially worsen bronchospasm in a patient with COPD?

    <p>Physostigmine</p> Signup and view all the answers

    In treating a patient with cholinergic symptoms, which drug is most appropriate?

    <p>Cholinergic antagonist</p> Signup and view all the answers

    What time frame should be expected to see a reduction in the INR after administering Vitamin K1?

    <p>24 hours</p> Signup and view all the answers

    Which medication is most likely to increase the risk of orolingual angioedema when given with alteplase?

    <p>ACE inhibitor</p> Signup and view all the answers

    In managing hyperlipidemia, which of the following is the most effective therapy for lowering LDL cholesterol levels?

    <p>Simvastatin</p> Signup and view all the answers

    What is the best advice to avoid a drug interaction between cholestyramine and levothyroxine for a patient?

    <p>Take levothyroxine 1 hour before cholestyramine on an empty stomach</p> Signup and view all the answers

    Which of the following correctly describes the role of niacin in hyperlipidemia treatment?

    <p>It lowers triglycerides or raises HDL levels</p> Signup and view all the answers

    Which statement about fenofibrate in relation to cholesterol management is correct?

    <p>It can lower LDL levels, but not as effectively as statins.</p> Signup and view all the answers

    What is a common adverse effect associated with ACE inhibitors?

    <p>Orolingual angioedema</p> Signup and view all the answers

    Which lipid-lowering medication is contraindicated to be taken simultaneously with cholestyramine?

    <p>Levothyroxine</p> Signup and view all the answers

    What effect may marijuana usage have on a patient with HIV that could discourage its use?

    <p>Progression of HIV</p> Signup and view all the answers

    Which side effect associated with LSD use could lead to significant panic in first-time users?

    <p>Exaggerated hallucinations</p> Signup and view all the answers

    In a case of alcohol withdrawal in a patient with a history of seizures, what is the most appropriate treatment?

    <p>Lorazepam</p> Signup and view all the answers

    What should be monitored in a 22-year-old patient with HIV considering marijuana use?

    <p>Progression of HIV</p> Signup and view all the answers

    Which of these substances could potentially precipitate withdrawal symptoms in users of full μ agonists like oxycodone?

    <p>Pentazocine</p> Signup and view all the answers

    What is a common psychological effect that could occur during a first-time LSD experience?

    <p>Visual distortions</p> Signup and view all the answers

    Which of the following substances is NOT commonly treated with benzodiazepines during withdrawal?

    <p>Stimulants</p> Signup and view all the answers

    What could be a beneficial effect of hyperphagia in certain patients considering marijuana use?

    <p>Weight gain for underweight individuals</p> Signup and view all the answers

    Which medication should not be used in patients with kidney disease due to the risk of lactic acidosis?

    <p>Metformin</p> Signup and view all the answers

    Which medication can be safely administered to patients with a creatinine clearance (CrCl) as low as 10 mL/min?

    <p>Glipizide</p> Signup and view all the answers

    Which of the following drugs is inappropriate for a patient on metformin targeting postprandial glucose without using insulin?

    <p>Pramlintide</p> Signup and view all the answers

    For a postmenopausal woman with severe hot flushes and an intact uterus, which treatment is most appropriate?

    <p>Oral estradiol and medroxyprogesterone acetate</p> Signup and view all the answers

    What risk is associated with the use of raloxifene in osteoporosis treatment?

    <p>Venous thrombosis</p> Signup and view all the answers

    Which hormone therapy is suitable for providing contraception in a 26-year-old female?

    <p>Injectable medroxyprogesterone acetate</p> Signup and view all the answers

    Which of the following statements about saxagliptin in renal dysfunction is correct?

    <p>The dose may need to be reduced in renal dysfunction.</p> Signup and view all the answers

    What is the appropriate use of pramlintide in diabetes management?

    <p>It is only used with mealtime insulin.</p> Signup and view all the answers

    Which drug is largely free from sexual side effects and might be useful for a patient experiencing sexual dysfunction after fluoxetine treatment?

    <p>Mirtazapine</p> Signup and view all the answers

    For a patient with depressive symptoms and pain secondary to a past car accident, which drug would be most effective?

    <p>Duloxetine</p> Signup and view all the answers

    Which antidepressant should be avoided in a patient with major depression and angle-closure glaucoma?

    <p>Amitriptyline</p> Signup and view all the answers

    Which medication is least likely to help a patient experiencing both major depression and a chronic pain syndrome?

    <p>Fluoxetine</p> Signup and view all the answers

    What is a significant side effect associated with SSRIs such as fluvoxamine, sertraline, and citalopram?

    <p>Sexual dysfunction</p> Signup and view all the answers

    Which of the following antidepressants shows potential to negatively impact patients with glaucoma?

    <p>Amitriptyline</p> Signup and view all the answers

    Which medication is specifically noted for its activity against both depressive symptoms and chronic pain?

    <p>Duloxetine</p> Signup and view all the answers

    What class of medications do fluvoxamine, sertraline, and citalopram belong to?

    <p>SSRIs</p> Signup and view all the answers

    What is the treatment of choice for an elderly patient experiencing pulmonary edema?

    <p>Furosemide</p> Signup and view all the answers

    Which medication is recommended for preventing mountain sickness in climbers ascending above 10,000 feet?

    <p>Acetazolamide</p> Signup and view all the answers

    In a patient with hepatic cirrhosis, which drug is preferred for controlling ascites and edema?

    <p>Spironolactone</p> Signup and view all the answers

    Why is furosemide preferred in treating pulmonary edema over thiazide diuretics?

    <p>Furosemide is better at removing larger fluid volumes.</p> Signup and view all the answers

    What additional treatment may be beneficial when using spironolactone for hepatic edema?

    <p>Combining with a loop diuretic</p> Signup and view all the answers

    Which of the following is not indicated for treating acute pulmonary edema?

    <p>Chlorthalidone</p> Signup and view all the answers

    What is the mechanism of action for acetazolamide when preventing mountain sickness?

    <p>It inhibits carbonic anhydrase.</p> Signup and view all the answers

    An appropriate choice for initial intravenous treatment in a patient with pulmonary edema is:

    <p>Furosemide</p> Signup and view all the answers

    Study Notes

    Clinical Cases File

    • The Lippincott Pharmacology Textbook contains 175 clinical cases.
    • The cases were collected and summarized by Hiba Alzoubi.

    Principles of Drug Therapy

    • An 18-year-old female patient overdosed on a drug. Intravenous administration of the antidote is the most desirable route.
    • A 40-year-old male patient received 2000 mg of vancomycin. The apparent volume of distribution is approximately 1 L/kg.
    • A 65-year-old female patient with stroke prevention was prescribed clopidogrel. Poor CYP2C19 metabolism is a likely reason for recurrent ischemic stroke.

    PK Equations

    • Single-Dose Equations: Volume of distribution (Vd)
    • Multiple Doses or Infusion Rate Equations: Infusion rate (ko), Loading dose (LD), Maintenance dose (MD)
    • Numerous formulas are included

    Drugs Affecting the Autonomic Nervous System

    • An elderly female ingested a liquid that may have been an organophosphate pesticide. Her symptoms were those of cholinergic crisis.
    • The case featured a patient with dangerously high symptoms suggestive of cholinergic crisis (e.g., diarrhea, frequent urination, convulsions, breathing difficulties, constricted pupils, and excessive salivation.)
    • The symptoms of the patient are consistent with cholinergic crisis which is commonly caused by organophosphates pesticides and are not consistent with sympathetic activation.

    Cholinergic Agonists and Antagonists

    • A patient accidentally administered a drug causing pupil dilation (mydriasis) instead of constriction. The most likely culprit was a cholinergic antagonist like atropine or ropicamide instead of a miotic like pilocarpine.
    • A patient experiencing organophosphate poisoning (from organophosphate pesticides) will exhibit symptoms of cholinergic crisis.
    • Treatment for cholinergic crisis requires anticholinesterase agents, not cholinergic agonists

    Drugs Affecting the Respiratory System

    • A patient with asthma who was prescribed a β2 agonist, but did not respond to the treatment, may require a muscarinic agonist as an alternative.
    • A patient with chronic obstructive pulmonary disease (COPD) who does not respond to β2 agonists may benefit from a muscarinic agonist, like ipratropium (a SAMA; short-acting muscarinic antagonist).

    Drugs Affecting the Central Nervous System

    • An elderly man ingested carvedilol, a drug that blocks α1, β1, and β2 adrenergic receptors, causing symptoms that point to cholinergic crisis (e.g., reduced heart rate, bradycardia, etc.)

    Clinical Toxicology

    • A patient presents to the emergency room with elevated levels of blood alcohol (275mg/dL) after a bout of heavy drinking for three weeks. The appropriate treatment choice for seizures associated with alcohol withdrawal is benzodiazepines (e.g., lorazepam, diazepam).
    • A patient who is suffering from a benzodiazepine overdose should receive flumazenil.

    Drugs for Neurodegenerative Diseases

    • Patients with levodopa therapy may experience adverse gastrointestinal and cardiovascular side effects that can be managed with carbidopa.

    Drugs for Anxiety and Hypnosis

    • A patient presenting with seizures secondary to alcohol withdrawal and an elevated blood alcohol level would benefit from benzodiazepines.

    Drugs for Mood Disorders

    • If a patient is experiencing mood changes (loss of interest, feelings of guilt, worthlessness, and hopelessness), the appropriate treatment would include antidepressant agents such as SSRIs, SNRIs, or TCAs (tricyclic antidepressants).

    Drugs for Hypertension

    • Patients with hypertension and asthma should be considered for a selective β1-blocker (e.g., metoprolol) to prevent exacerbating their asthma symptoms.
    • Patients already taking a β-blocker who need a second-line treatment drug for hypertension should not use non-selective β-blockers. These can cause adverse effects.

    Drugs for Anesthesia

    • When a patient is experiencing difficulty breathing due to bronchospasm, an appropriate treatment would involve using a β2 agonist. These drugs cause bronchodilation.
    • When considering anesthetic drugs and their possible interactions with certain patient conditions, it is important to consider the patient's overall health status, such as kidney conditions or allergies. An example case shows a patient with a history of hypertension and diabetes. Intravenous drugs like propofol should be used carefully.

    Drugs of Abuse

    • A patient with a history of substance abuse or opioid use is likely to have similar symptoms if there is a possible overdose.

    Drugs for Obesities

    • A 45-year-old woman with hypertension and uncontrolled diabetes should not use a weight loss drug that interacts with blood pressure. Orlistat is an option that does not affect blood pressure.

    Other Drugs for Various Disorders

    • Various conditions and drug treatments are included as outlined in the text provided.

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    Description

    Explore a series of clinical cases compiled from the Lippincott Pharmacology Textbook. This quiz covers drug therapy principles, pharmacokinetic equations, and drugs affecting the autonomic nervous system. Test your knowledge of clinical scenarios and relevant pharmacological concepts.

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