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Drug 1 is administered as an intravenous bolus to a patient and blood pressure and heart rate are recorded as shown in the graph. After the effect of drug 1 wore off, a long-acting drug 2 was administered. After blood pressure and heart rate recording began again, drug 1 was administered again. Identify drug 2 from the following list
Drug 1 is administered as an intravenous bolus to a patient and blood pressure and heart rate are recorded as shown in the graph. After the effect of drug 1 wore off, a long-acting drug 2 was administered. After blood pressure and heart rate recording began again, drug 1 was administered again. Identify drug 2 from the following list
Which of the following drugs is most appropriate for the emergency treatment of malignant hyperthermia?
Which of the following drugs is most appropriate for the emergency treatment of malignant hyperthermia?
Each of the following neurotransmitters alters membrane excitability by decreasing the conductance for potassium ions EXCEPT
Each of the following neurotransmitters alters membrane excitability by decreasing the conductance for potassium ions EXCEPT
Which of the following medications is an appropriate first-line therapy for acute dystonic reaction?
Which of the following medications is an appropriate first-line therapy for acute dystonic reaction?
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A patient suddenly stops taking an opioid after 8 weeks because of a minor back injury. How long will it take for withdrawal symptoms to start due to physical dependence?
A patient suddenly stops taking an opioid after 8 weeks because of a minor back injury. How long will it take for withdrawal symptoms to start due to physical dependence?
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A 36-year-old woman presents to the clinic with a history of a butterfly-shaped rash over her nose for 3 months which appears to aggravate with exposure to the sun. She also complains of joint and chest pain, increasing whenever she coughs or sneezes. She has a history of peptic ulcer disease and hypertension. Her vital signs are within normal limits. Her ANA and anti-dsDNA titers are increased. She is prescribed pain medication that might aggravate her peptic ulcer disease and hypertension. Which other medication is known to cause a similar gastrointestinal side effect?
A 36-year-old woman presents to the clinic with a history of a butterfly-shaped rash over her nose for 3 months which appears to aggravate with exposure to the sun. She also complains of joint and chest pain, increasing whenever she coughs or sneezes. She has a history of peptic ulcer disease and hypertension. Her vital signs are within normal limits. Her ANA and anti-dsDNA titers are increased. She is prescribed pain medication that might aggravate her peptic ulcer disease and hypertension. Which other medication is known to cause a similar gastrointestinal side effect?
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In patients who require antiplatelet therapy after percutaneous coronary intervention, aspirin is used, which, unlike other NSAIDs
In patients who require antiplatelet therapy after percutaneous coronary intervention, aspirin is used, which, unlike other NSAIDs
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A 17-year-old girl presents with fatigue. She feels sad more than she used to. She has gained 5 kg over the last 6 months, though she feels she is eating less. Her skin is dry, and she is losing more hair than usual, which she thought was associated with stress due to her first year in college. She wears a sweater to class because she feels the classrooms are too cold. She has no significant history and takes no medications. Which of the following physical examination findings would be most likely present?
A 17-year-old girl presents with fatigue. She feels sad more than she used to. She has gained 5 kg over the last 6 months, though she feels she is eating less. Her skin is dry, and she is losing more hair than usual, which she thought was associated with stress due to her first year in college. She wears a sweater to class because she feels the classrooms are too cold. She has no significant history and takes no medications. Which of the following physical examination findings would be most likely present?
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A specific disease is found to have an incidence of 2% of the population per year. Individuals with the disease live on average 30 years. The incidence and mortality of the disease are unchanging. What is the estimated prevalence of the disease in the population?
A specific disease is found to have an incidence of 2% of the population per year. Individuals with the disease live on average 30 years. The incidence and mortality of the disease are unchanging. What is the estimated prevalence of the disease in the population?
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A 67-year-old man presents with a fever and cough. He is diagnosed with bacterial pneumonia. Treatment with antibiotics is initiated. Once treatment is started, providers must ensure that blood drug concentrations will remain constant, and a perfect balance will be reached between the amount of drug introduced and the amount of drug metabolized and eliminated. Which of the following is the best way to obtain this pharmacokinetic condition?
A 67-year-old man presents with a fever and cough. He is diagnosed with bacterial pneumonia. Treatment with antibiotics is initiated. Once treatment is started, providers must ensure that blood drug concentrations will remain constant, and a perfect balance will be reached between the amount of drug introduced and the amount of drug metabolized and eliminated. Which of the following is the best way to obtain this pharmacokinetic condition?
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A 58-year-old woman with chronic hypertension and diabetes mellitus is admitted to the hospital for heart failure and recent onset of atrial fibrillation. After being discharged from the hospital, she visits you and although she is feeling better, she is still in atrial fibrillation. An echocardiogram showed an ejection fraction of 40%, with no valvular abnormalities. Atrial fibrillation is detected on the ECG. You calculate your stroke risk using the CHADS-2 score, which indicates that she is suitable for anticoagulant rather than antiplatelet therapy. She tells you that she does not want oral anticoagulant therapy with acenocoumarol so that she does not have to come to the laboratory frequently to have blood drawn. You agree to use the alternative oral anticoagulant apixaban. You thoroughly explain to her how important it is to take the medicine every day, as stopping it suddenly can cause
A 58-year-old woman with chronic hypertension and diabetes mellitus is admitted to the hospital for heart failure and recent onset of atrial fibrillation. After being discharged from the hospital, she visits you and although she is feeling better, she is still in atrial fibrillation. An echocardiogram showed an ejection fraction of 40%, with no valvular abnormalities. Atrial fibrillation is detected on the ECG. You calculate your stroke risk using the CHADS-2 score, which indicates that she is suitable for anticoagulant rather than antiplatelet therapy. She tells you that she does not want oral anticoagulant therapy with acenocoumarol so that she does not have to come to the laboratory frequently to have blood drawn. You agree to use the alternative oral anticoagulant apixaban. You thoroughly explain to her how important it is to take the medicine every day, as stopping it suddenly can cause
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A 68-year-old man with a past medical history of heart failure with reduced ejection fraction secondary to coronary artery disease and end-stage renal disease on hemodialysis presents for a follow-up visit. He takes aspirin 81 mg daily, pitavastatin 4 mg daily, lisinopril 2.5 mg daily, and amlodipine 10 mg daily. Which of the following changes should be made to his medication regimen?
A 68-year-old man with a past medical history of heart failure with reduced ejection fraction secondary to coronary artery disease and end-stage renal disease on hemodialysis presents for a follow-up visit. He takes aspirin 81 mg daily, pitavastatin 4 mg daily, lisinopril 2.5 mg daily, and amlodipine 10 mg daily. Which of the following changes should be made to his medication regimen?
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A patient is admitted to the Emergency Department after a drug overdose. The patient has hypotension and severe bradycardia. He was treated for hypertension and ischemic heart disease. Which of the following drugs in high doses causes bradycardia
A patient is admitted to the Emergency Department after a drug overdose. The patient has hypotension and severe bradycardia. He was treated for hypertension and ischemic heart disease. Which of the following drugs in high doses causes bradycardia
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A 45-year-old man presents with nausea and vomiting that started 3 days ago after eating at a restaurant. He is urinating less today because he cannot drink water or other fluids. His history is significant for hypertension and hypothyroidism, for which he takes valsartan and levothyroxine. Vital signs are temperature 37 C (98.6 F), blood pressure 100/60 mmHg, heart rate 98 bpm, and respiratory rate 22 breaths/min. Physical examination demonstrates reduced skin turgor. What is the best next step in management?
A 45-year-old man presents with nausea and vomiting that started 3 days ago after eating at a restaurant. He is urinating less today because he cannot drink water or other fluids. His history is significant for hypertension and hypothyroidism, for which he takes valsartan and levothyroxine. Vital signs are temperature 37 C (98.6 F), blood pressure 100/60 mmHg, heart rate 98 bpm, and respiratory rate 22 breaths/min. Physical examination demonstrates reduced skin turgor. What is the best next step in management?
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A 55-year-old man with a family history of cardiovascular disease has a history of moderate hypertension and angina pectoris. Today, my blood pressure is 160/109 mmHg and the ECG shows left ventricular hypertrophy. There are no other pathological findings from the physical status and from the laboratory tests. Angina occurs during exercise. An antihypertensive drug that can reduce or prevent angina pectoris is
A 55-year-old man with a family history of cardiovascular disease has a history of moderate hypertension and angina pectoris. Today, my blood pressure is 160/109 mmHg and the ECG shows left ventricular hypertrophy. There are no other pathological findings from the physical status and from the laboratory tests. Angina occurs during exercise. An antihypertensive drug that can reduce or prevent angina pectoris is
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A meta-analysis of the effect of ferric carboxymaltose (FCM) in HF with ID, using data from the AFFIRM, CONFIRM, and HEART-FID trials has demonstrated that when compared to placebo, FCM is associated with which of the following?:
A meta-analysis of the effect of ferric carboxymaltose (FCM) in HF with ID, using data from the AFFIRM, CONFIRM, and HEART-FID trials has demonstrated that when compared to placebo, FCM is associated with which of the following?:
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A 59-year-old woman, with the past medical history of diabetes mellitus type 2 and coronary artery disease has a chief complaint of dizziness and palpitations. On examination, she was found to have an irregularly irregular pulse and a heart rate of 104. Her other vitals were within the normal range. She was given a medication which is known to cause blockage of fast sodium channels (class 1 antiarrhythmic) which of the drugs mentioned in the answer options could have been given to the patient?
A 59-year-old woman, with the past medical history of diabetes mellitus type 2 and coronary artery disease has a chief complaint of dizziness and palpitations. On examination, she was found to have an irregularly irregular pulse and a heart rate of 104. Her other vitals were within the normal range. She was given a medication which is known to cause blockage of fast sodium channels (class 1 antiarrhythmic) which of the drugs mentioned in the answer options could have been given to the patient?
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Which condition can directly lead to cardiac arrhythmia (more than one answer is possible)
Which condition can directly lead to cardiac arrhythmia (more than one answer is possible)
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A student plans to climb a high mountain peak in North America during vacation. He will not have time to acclimatize slowly to the altitude. A medicine that can prevent altitude sickness is
A student plans to climb a high mountain peak in North America during vacation. He will not have time to acclimatize slowly to the altitude. A medicine that can prevent altitude sickness is
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In which of the following patients would administration of amoxicillin present a problem?
In which of the following patients would administration of amoxicillin present a problem?
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Study Notes
Test 8 - Drug Identification and Malignant Hyperthermia
- Drug 1: Causes strong pressor effect and bradycardia, likely a reflex compensatory response. Likely norepinephrine or phenylephrine.
- Drug 2: Unmasks tachycardia (beta-adrenoceptor effect) caused by drug 1. Phenylephrine has no beta-agonist effects, so drug 1 is probably norepinephrine. Drug 2 is an alpha-blocker, without beta-blocking action.
- Malignant Hyperthermia Treatment: Dantrolene is the most appropriate first-line treatment. It interacts with RyR1 channels to block calcium release, preventing the interaction between actin and myosin.
Drug Treatment for Malignant Hyperthermia
- Dantrolene: Essential for managing malignant hyperthermia. Interacts with RyR1 channels to prevent calcium release, stopping the interaction between actin and myosin.
Neurotransmitters and Excitability
- Neurotransmitters: Most neurotransmitters alter membrane excitability by decreasing potassium ion conductance, except dopamine.
- Excitatory neurotransmitters: Acetylcholine (M1 receptors), glutamate, norepinephrine (alpha-1 and beta-1), serotonin (5-HT2A receptors).
- Excitability: A decrease in potassium conductance leads to neuronal excitability.
Acute Dystonic Reaction Treatment
- First-line therapy: Diphenhydramine or benztropine (IV route preferred).
- Second-line therapy: IV benzodiazepines (lorazepam or diazepam) can be used for non-responsive patients.
Opioid Withdrawal Symptoms
- Time to onset: Withdrawal symptoms from physical opioid dependence can occur within 24-48 hours of the last opioid dose.
- Symptoms: Irritability, diaphoresis, restlessness, muscle twitching, tachycardia, and hypertension.
Drug-Induced Gastrointestinal Side Effects
- Meloxicam and NSAIDs: Can cause GI upset, renal, and cardiovascular issues.
- COX-2 Inhibitor (Celecoxib): Less likely to cause GI disturbance but still can cause renal and cardiovascular problems.
Prevalence of a Disease
- Prevalence Calculation: Prevalence = (Incidence) x (Duration of Disease).
- Example: If 2% incidence of a disease and average duration is 30 years, the estimated prevalence is 60%.
Bacterial Pneumonia Treatment and Pharmacokinetics
- Maintaining Constant Blood Drug Concentrations: Administering maintenance doses of drugs according to their half-lives is the best way to maintain a steady-state plasma concentration.
- Loading Dose: A loading dose helps reach steady state quickly, but does not maintain it.
- Probenecid: Competitively inhibits renal excretion of some drugs, but not all.
- First-Pass Metabolism: Bypassing first-pass metabolism increases bioavailability, but does not maintain a steady state.
Hypothyroidism Symptoms
- Fatigue: General feeling of tiredness.
- Weight gain (5 kg): Gain across several months.
- Reduced Appetite: Feeling hungry for less food.
- Dry skin: Less moist appearance of skin.
- Hair loss: Gradual loss during 6 month period.
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