Clinical Pharmacology Midterm II 08/11/2023 PDF

Clinical Pharmacology Midterm II 08.11.2023 1. A 55-year-old lawyer is brought to the emergency department 2 h after the onset of severe chest pain during a stressful meeting. He has a history of poorly controlled mild hypertension and elevated blood cholesterol but does not smoke. ECG chan...

Clinical Pharmacology Midterm II 08.11.2023 1. A 55-year-old lawyer is brought to the emergency department 2 h after the onset of severe chest pain during a stressful meeting. He has a history of poorly controlled mild hypertension and elevated blood cholesterol but does not smoke. ECG changes (ST elevation) and cardiac enzymes confirm the diagnosis of myocardial infarction. The decision is made to attempt to open his occluded artery. Which of the following drugs accelerates the conversion of plasminogen to plasmin? A. Aminocaproic acid B. Heparin C. Argatroban D. Warfarin E. Reteplase 2. A 55-year-old lawyer is brought to the emergency department 2 h after the onset of severe chest pain during a stressful meeting. He has a history of poorly controlled mild hypertension and elevated blood cholesterol but does not smoke. ECG changes (ST elevation) and cardiac enzymes confirm the diagnosis of myocardial infarction. The decision is made to attempt to open his occluded artery. If a fibrinolytic drug is used for treatment of this man’s acute myocardial infarction, which of the following adverse drug effects is most likely to occur? A. Acute renal failure B. Development of antiplatelet antibodies C. Encephalitis secondary to liver dysfunction D. Hemorrhagic stroke E. Neutropenia 3. A 58-year-old woman with chronic hypertension and diabetes mellitus was recently admitted to the hospital for congestive heart failure and new onset atrial fibrillation. She is now seeing you after discharge and, though feeling better, is still in atrial fibrillation. An echocardiogram shows an ejection fraction of 40%; there are no valvular abnormalities. An ECG reveals only atrial fibrillation. You calculate her risk using the CHADS (2) system and the score indicates that she requires anticoagulation rather than antiplatelet therapy. You are discussing the risks and benefits of anticoagulation therapy with her, including the option of using direct thrombin inhibitors. Which of the following anticoagulants is a direct inhibitor of thrombin? A. Abciximab B. Dabigatran C. Rivaroxaban D. Warfarin 4. A 67-year-old woman presents with pain in her left thigh muscle. Duplex ultrasonography indicates the presence of deep vein thrombosis (DVT) in the affected limb. During the next week, the patient was started on warfarin and her enoxaparin was discontinued. Two months later, she returned after a severe nosebleed. Laboratory analysis revealed an INR (international normalized ratio) of 7.0(INR value in such a warfarin- treated patient should be 2.0–3.0). To prevent severe hemorrhage, the warfarin should be discontinued, and this patient should be treated immediately with which of the following? A. Aminocaproic acid B. Desmopressin C. Factor VIII D. Protamine E. Vitamin K1 5. 43-year-old man has heterozygous familial hypercholesterolemia. His serum concentrations of total cholesterol and LDL are markedly elevated. His serum concentration  of HDL cholesterol, VLDL cholesterol, and triglycerides are normal or slightly elevated. The patient’s mother and older brother died of myocardial infarctions before the age of 50. This patient recently experienced mild chest pain when walking upstairs and has been diagnosed as having angina of eff ort. The patient is somewhat overweight. He drinks alcohol most evenings and smokes about 1 pack of cigarettes per week. If the patient has a history of gout which of the following drugs is most likely to exacerbate this condition? A. Colestipol B. Ezetimibe C. Niacin D. Gemfibrozil E. Simvastatin 6. If the patient is pregnant, which of the following drugs should be avoided because of a risk of harming the fetus? A. Cholestyramine B. Ezetimibe C. Fenofibrate D. Niacin E. Pravastatin 7. A 4-year-old boy. At his checkup, the pediatrician notices cutaneous xanthomas and orders a lipid panel. Repeated measures confirm that the patient’s serum cholesterol levels are high(936mg/dL). Further testing confirms a diagnosis of homozygous familial hypercholesterolemia. Which of the following interventions will be least effective in this patient? A. Atorvastatin B. Ezetimibe C. Lomitapide D. Mipomersen E. Niacin  8. One effect that theophylline, nitroglycerin, isoproterenol, and histamine have in common is. A. Direct stimulation of cardiac contractile force B. Tachycardia C. Bronchodilation D. Postural hypotension E. Throbbing headache 9. A 23-year-old woman is using an albuterol inhaler for frequent acute episodes of asthma and complains of symptoms that she ascribes to the albuterol. Which of the following is not a recognized action of albuterol? A. Diuretic effect B. Positive inotropic effect C. Skeletal muscle tremor D. Smooth muscle relaxation E. Tachycardia 10. 19-year-old college student has well-controlled asthma but on reporting to the college health clinic, complains of a sore throat. On examination, he has typical signs of thrush, a fungal infection with Candida albicans. The asthma controller medication most likely to be associated with candida infection is: A. Albuterol by aerosol B. Beclomethasone by aerosol C. Ipratropium by inhaler D. Prednisone by mouth E. Theophylline in long – acting oral form 11. A 16-year-old patient is in the emergency department receiving nasal oxygen. She has a heart rate of 125 bpm, a respiratory rate of 40 breaths/min, and a peak expiratory flow