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52 Cards in this Set
- Front
- Back
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Patients with acute coronary syndrome may receive a glycoprotein IIb/IIIa receptor antagonist. These may be given in support of a PCI intervention. Choose the correct statement concerning the glycoprotein IIb/IIIa receptor antagonists: Answer ADo not use if patient has a major risk for bleeding BThey are safe to use within 1 week of major surgery CThey are safe to use in patients with thrombocytopenia DThey are safe to use with uncontrolled hypertension EDo not use if patient has an INR of 1.1 |
ADo not use if patient has a major risk for bleeding |
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A patient at the hospital is receiving morphine for chest pain. What are the advantages/reasons for using morphine in a patient with chest pain? (Select ALL that apply.) Answer AProvides analgesia BIncreases preload CReduces oxygen demand DReduces anxiety EIncreases blood pressure |
AProvides analgesia
CReduces oxygen demand DReduces anxiety |
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Which of the following medications should be avoided in a patient presenting with ACS? Answer AMetoprolol BLisinopril CCelecoxib DAspirin EEnoxaparin |
CCelecoxib |
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Maureen was diagnosed with an acute STEMI. The physician is determining if she is a candidate for fibrinolysis. Which of the following is an absolute contraindication to fibrinolysis? Answer AAn intracranial hemorrhage within the past 60 days BA BP of 165/98 CHypersensitivity to soy products DIschemic stroke within the past 4 years EConcurrent use of aspirin |
AAn intracranial hemorrhage within the past 60 days |
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The hospital where Maureen is admitted does not have the capability to perform percutaneous coronary intervention (PCI) and fibrinolysis may be done as an alternative. What is the mechanism of action of alteplase? Answer ABinds to fibrin and converts plasmin to plasminogen BBinds to antithrombin and converts thrombin to fibrin CBinds to thrombin and converts fibrinogen to fibrin DBinds to thrombin and converts fibrin to fibrinogen EBinds to fibrin and converts plasminogen to plasmin
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EBinds to fibrin and converts plasminogen to plasmin |
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Maureen was diagnosed with acute STEMI. The physician is determining if she is a candidate for fibrinolysis. Which of the following are relative contraindications to fibrinolysis? (Select ALL that apply.) Answer AHgb > 11 g/dL BPregnancy CActive peptic ulcer DCurrent use of anticoagulants: the higher the INR, the higher the risk ESevere, uncontrolled hypertension on presentation ( > 185/110 mmHg) |
BPregnancy CActive peptic ulcer DCurrent use of anticoagulants: the higher the INR, the higher the risk ESevere, uncontrolled hypertension on presentation ( > 185/110 mmHg) |
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A patient at the hospital is receiving nitroglycerin for chest pain. What are the advantages/reasons for using nitroglycerin in a patient with chest pain? (Select ALL that apply.) Answer AIncreases blood pressure BReduces systemic vascular resistance and preload CDilates coronary vessels and increases blood flow DRelieves chest pain EHelps with fibrinolysis |
BReduces systemic vascular resistance and preload CDilates coronary vessels and increases blood flow DRelieves chest pain |
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A patient at the hospital is receiving a beta blocker for chest pain. Which of the following are true regarding the use of beta blockers in this setting? (Select ALL that apply.) Answer AIn STEMI, they should not be used BThey can be administered PO or IV CThey should be combined with a long-acting non-dihydropyridine calcium antagonist DIn UA/NSTEMI, they should be initiated within the first 24 hours for patients without contraindications EThey reduce myocardial oxygen demand |
BThey can be administered PO or IV
DIn UA/NSTEMI, they should be initiated within the first 24 hours for patients without contraindications EThey reduce myocardial oxygen demand |
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All of the following are antiplatelet agents used in the treatment of ACS except? Answer AClopidogrel BDalteparin CTirofiban DTicagrelor EAspirin
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BDalteparin |
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Which of the following statements are true regarding the use of ACE inhibitors in patients with UA/NSTEMI? Answer AThey should be administered within the first 24 hours unless there is a contraindication BThey reduce preload and afterload as well as prevent cardiac remodeling CAn ARB can be substituted if the patient is intolerant to an ACE inhibitor DThey should be avoided in patients with hypokalemia EThey should not be used in combination with beta blockers |
AThey should be administered within the first 24 hours unless there is a contraindication BThey reduce preload and afterload as well as prevent cardiac remodeling CAn ARB can be substituted if the patient is intolerant to an ACE inhibitor |
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An 87 year old male presented to the Emergency Department with complaints of mid-sternal chest pain. He has had intermittent chest pain for two days. He has nausea, vomiting and diaphoresis. The patient is diagnosed with a Non-ST Segment Elevation Myocardial Infarction (NSTEMI). Which of the following are standard components used to treat a patient with an acute coronary syndrome characterized as NSTEMI? (Select ALL that apply.) Answer AMorphine BLorazepam CPhenobarbital DAspirin EOxygen |
AMorphine
DAspirin EOxygen |
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The provider orders Integrilin. What is the appropriate therapeutic substitution? Answer ATirofiban BEnoxaparin CBivalirudin DEptifibatide EAbciximab |
DEptifibatide |
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The provider orders Reopro. What is the appropriate therapeutic substitution? Answer AAbciximab BTirofiban CEnoxaparin DBivalirudin EEptifibatide |
AAbciximab |
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Which of the following orders should not be placed in a patient receiving ticagrelor? Answer AEnoxaparin 1 mg/kg every 12 hours BWarfarin 2 mg daily CMetoprolol XL 50 mg daily DMorphine 1 mg IV every 2-4 hours PRN pain EAspirin 325 mg daily |
EAspirin 325 mg daily |
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Maureen, a 58 year-old female, has just been told she had a heart attack. She feels quite healthy and cannot understand how this occurred. She feels demoralized. Maureen does not smoke but lives with her husband in an apartment. He smokes two packs per day. Maureen’s blood pressure, which she checks occasionally when she stops at the pharmacy, runs around 154/92 mmHg. Her lipid panel at the last physical had a total cholesterol of 222 mg/dL. She does not recall the other numbers. Which of the following risk factors for coronary heart disease are known to be present in this patient? (Select ALL that apply.) Answer AHypertension BFamily History CAge DDiabetes EHyperlipidemia
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AHypertension
CAge
EHyperlipidemia |
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Which of the following are likely signs/symptoms of a heart attack? (Select ALL that apply.) Answer AUncomfortable pressure, squeezing, or pain in the chest that lasts more than a few minutes, or goes away and comes back BShortness of breath CTrouble speaking and weakness predominantly on one side of the body DDecreased troponin levels EIncreased CK-MB level |
AUncomfortable pressure, squeezing, or pain in the chest that lasts more than a few minutes, or goes away and comes back BShortness of breath EIncreased CK-MB level |
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A patient at the hospital is receiving aspirin for chest pain. What is the primary reason for using aspirin in a patient with chest pain? Answer AInhibits platelet aggregation BProvides moderate degree of analgesia CAspirin increases mortality in patients with STEMI DPrevents flushing EReduces anxiety |
AInhibits platelet aggregation |
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Angelo has coronary artery disease and has had a stent placement. He has come to the pharmacy to get his clopidogrel refilled. Angelo has active peptic ulcer disease and states he has stool that looks dark and tarry. He wife notes that the toilet bowl needs more regular scrubbing. Choose the correct statement concerning clopidogrel: Answer AHe should take one 300 mg tablet daily. BHe should take one 75 mg tablet daily. CThe patient needs 2C9 pharmacogenetic testing to continue receiving clopidogrel. DThe patient should be seen right away and instructed to contact his doctor before using any more clopidogrel or aspirin. EThe pharmacist should contact the prescriber; he requires the addition of an H2 receptor antagonist. |
DThe patient should be seen right away and instructed to contact his doctor before using any more clopidogrel or aspirin. |
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Gene uses the following medications daily: clopidogrel and aspirin for CAD, losartan for blood pressure, lovastatin for cholesterol, zolpidem for sleep, omeprazole for heartburn and bupropion to help him stop smoking. The pharmacist notes that the following drugs have an interaction that requires the prescriber to be notified: Answer AClopidogrel and omeprazole. BClopidogrel and lovastatin. CClopidogrel and bupropion. DZolpidem and omeprazole. ELovastatin and omeprazole. |
AClopidogrel and omeprazole. |
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Maureen received an electrocardiogram (ECG) which showed ST segment elevation in the precordial leads (V2-V6). Her blood work was positive for troponin I and CK-MB. She was diagnosed with an ST segment elevation myocardial infarction (STEMI) and went to the cath lab to receive a primary percutaneous coronary intervention (PCI). The coronary angiogram found complete occlusion by thrombosis of the left anterior descending (LAD) coronary artery. Which of the following signs indicate the patient has had an ST segment elevation myocardial infarction (STEMI)? (Select ALL that apply.) Answer AST segment elevation on ECG BT-wave inversion on ECG CPositive cardiac enzymes DChest pain EIncreased blood pressure |
AST segment elevation on ECG
CPositive cardiac enzymes DChest pain |
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Which of the following statements are true regarding clopidogrel? (Select ALL that apply.) Answer AIt increases bleeding risk BIt is metabolized to its active form by CYP 2C19 CIt should be discontinued about 12 hours prior to major surgery DIt binds irreversibly to platelet receptors EThe typical maintenance dose is 300 mg daily |
AIt increases bleeding risk BIt is metabolized to its active form by CYP 2C19
DIt binds irreversibly to platelet receptors |
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Jack is beginning amiodarone therapy. If Jack drinks grapefruit juice or eats grapefruit when using amiodarone, the following could occur: Answer AAn increased risk for QT prolongation due to supratherapeutic amiodarone levels. BAn increased risk for arrhythmia due to subtherapeutic amiodarone levels. CNothing; amiodarone is not affected by grapefruit products. DA decreased risk for amiodarone-induced pulmonary toxicity. EA decreased risk for amiodarone-induced hepatotoxicity. |
AAn increased risk for QT prolongation due to supratherapeutic amiodarone levels. |
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Sotalol is classified in which Vaughan Williams class? Answer AIa BIb CIc DII EIII |
EIII |
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Jack has been using amiodarone for nine months. Long-term therapy with amiodarone can cause the following thyroid problems: (Select ALL that apply.) Answer AHypothyroidism, as demonstrated by a high TSH and low FT4 BHypothyroidism, as demonstrated by a low TSH and high FT4 CHyperthyroidism, as demonstrated by a low TSH and high FT4 DHyperthyroidism, as demonstrated by a high TSH and low FT4 EAmiodarone does not affect the thyroid |
AHypothyroidism, as demonstrated by a high TSH and low FT4
CHyperthyroidism, as demonstrated by a low TSH and high FT4 |
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A patient presents with a supraventricular tachycardia. The rhythm is terminated with adenosine. Which of the following correctly describes adenosine's pharmacology? Answer ABeta-1 receptor agonist BCalcium channel antagonist CPotassium channel agonist DSodium channel antagonist EAdenosine receptor agonist |
EAdenosine receptor agonist |
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Jack has been using amiodarone for fifteen months and developed hypothyroidism. His doctor switches him to Multaqto try and alleviate the problem. The doctor has read that Multaq is not quite as effective as amiodarone, but may have less pulmonary, vision and thyroid toxicities. The correct generic name for Multaq is: Answer ATocainide BFlecainide CDofetilide DMexilitine EDronedarone |
EDronedarone |
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A patient with heart failure uses lisinopril, carvedilol, spironolactone, furosemide, clopidogrel, digoxin, cholestyramine and potassium. He was recently diagnosed with atrial fibrillation. Which agent is preferred to control the patient's heart rhythm? Answer AVerapamil BAmiodarone CAdenosine DQuinidine EProcainamide
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BAmiodarone |
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The half-life of amiodarone is: Answer A4 hours B24 hours C7 days D60 days E1 year |
D60 days |
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A patient who works in the fields of a farm is seen by his primary care physician for a blue-grey skin discoloration of the face and forearms. The patient states that he normally wears a hat, a short-sleeved shirt, and pants when working. Which antiarrhythmic is the patient likely receiving? Answer AProcainamide BLidocaine CIbutilide DSotalol EAmiodarone |
EAmiodarone |
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What class of antiarrhythmic is amiodarone in according to the Vaughn Williams classification system? Answer AIa BIb CIc DIII EIV |
DIII |
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A patient presents to the emergency department complaining of fatigue and lightheadedness. He has a history of hypertension, heart failure, coronary artery disease and atrial flutter. His home medications include aspirin, metoprolol, benazepril, digoxin, furosemide, and amlodipine. The patient is found to be in third degree AV block. Which of the following drugs most likely contributed to this bradyarrhythmia? Answer AFurosemide BDigoxin CAmlodipine DBenazepril EAspirin |
BDigoxin |
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What class of antiarrhythmic is mexiletine in according to the Vaughn Williams classification system? Answer AIa BIb CIc DIII EIV |
BIb |
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Jack is a 77 year-old male with heart failure who is receiving a new prescription for amiodarone. The pharmacist will counsel the patient on risks to these organs with amiodarone therapy: Answer ALiver, kidney, and eyes BLiver, colon, and kidney CKidney, gall bladder, and CNS DThyroid, pancreas, and liver EThyroid, liver, and lungs |
EThyroid, liver, and lungs |
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Jack is a 77 year-old male with heart failure. His current medications include digoxin 0.25 mg daily, Lasix 40 mg daily,Coreg CR 20 mg daily, lovastatin 80 mg with dinner and lisinopril 40 mg daily. Jack has a diagnosis of NYHA Class 3 heart failure, dyslipidemia and stage 2 hypertension. He smokes ½ pack of cigarettes daily. Current labs: K+ = 3.2 mEq/L, SCr = 1.4, BUN 43. The pharmacist has received a faxed prescription for amiodarone. Before the prescription for amiodarone is filled, the pharmacist should call the doctor to decrease the dose of which of the following medications? (Select ALL that apply.) Answer ALovastatin BLisinopril CCarvedilol DDigoxin EAspirin |
ALovastatin
DDigoxin |
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A patient has a long QT interval. She is at risk for fatal arrhythmias. Which of the following medications carries the lowest risk of further QT prolongation? Answer AQuinidine BProcainamide CDofetilide DDiltiazem EAmiodarone |
DDiltiazem |
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To which Vaughan Williams classification does esmolol belong? Answer AIa BIb CIc DII EIII |
DII |
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Which of the following is a class Ib antiarrhythmic according to the Vaughn Williams classification system? Answer AProcainamide BLidocaine CIbutilide DAtenolol EDronedarone |
BLidocaine |
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A patient was using furosemide 40 mg twice daily (at 8 am and 12 noon) for heart failure. The doctor forgot to call in a prescription for potassium when he called the pharmacy to order the furosemide. The patient’s other medications include carvedilol, digoxin and aspirin. The patient ran out of the potassium. The patient is at increased risk for: Answer ADigoxin toxicity BCarvedilol toxicity CAspirin toxicity DFurosemide toxicity ENone of the above |
ADigoxin toxicity |
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Conrad is a 60 year-old obese male whose total cholesterol measured 312 mg/dL several years ago. He believed that high cholesterol was his only medical condition because that is all the doctor had mentioned. He refused medicine because he felt fine. The only thing he takes is a daily aspirin and one or two fish oil capsules. Recently, Conrad cut off a finger by accident while working in his wood shop. When he arrived at the hospital, he was in atrial fibrillation. What is the likely cause of atrial fibrillation in this patient? Answer AA heart valve disorder BPrescription drugs CLow magnesium DCoronary heart disease ELow potassium |
DCoronary heart disease |
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Which Vaughan Williams classification represents agents that bind to Na+ channels for a prolonged period of time (long-acting)? Answer AIa BIb CIc DII EIII
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CIc |
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For a patient being initiated on dofetilide, which of the following are considered mandatory monitoring parameters that must be documented? (Select ALL that apply.) Answer AMagnesium BPotassium CECG DLiver function tests ERenal function |
AMagnesium BPotassium CECG
ERenal function |
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What class of antiarrhythmic is verapamil in according to the Vaughn Williams classification system? Answer AIa BIb CIc DIII EIV |
EIV |
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What class of antiarrhythmic is propafenone in according to the Vaughn Williams classification system? Answer AIa BIb CIc DIII EIV |
CIc |
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Dronedarone carries a black box warning against use in which of the following types of patients: (Select ALL that apply.) Answer AClass IV heart failure BPermanent atrial fibrillation CRecurrent atrial fibrillation DParoxysmal atrial fibrillation EPeripheral arterial disease |
AClass IV heart failure BPermanent atrial fibrillation |
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Multaq has a warning against use with any of the following medications: voriconazole, ritonavir, telithromycin, ketoconazole, itraconazole, clarithromycin, cyclosporine and grapefruit. Which statement correctly describes the risk ifMultaq is administered with any of these medications? Answer AThis statement is incorrect; Multaq is preferred because it has few significant drug interactions. BThese are strong CYP 3A4 inducers; Multaq is a 3A4 substrate and concurrent use would increase the concentration and could cause an arrhythmia and other adverse reactions. CThese are strong CYP 3A4 inhibitors; Multaq is a 3A4 substrate and concurrent use would increase the concentration and could cause an arrhythmia and other adverse reactions. DIf administered together, the patient is at high risk for hypersensitivity. EIf administered together, the concentration of Multaq would decrease and the arrhythmia would not be treated. |
CThese are strong CYP 3A4 inhibitors; Multaq is a 3A4 substrate and concurrent use would increase the concentration and could cause an arrhythmia and other adverse reactions. |
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Elaine is beginning amiodarone therapy. She is easily stressed and worried about having an arrhythmia. Elaine uses furosemide and has had hypokalemia. She has been told that her potassium and magnesium need to be within normal limits to keep her heart at a normal rhythm, and that she should try to relax. The physician has decided that she wants to check magnesium and potassium and orders a Basic Metabolic Panel (BMP). Select the correct statement: Answer AThe physician should also order the potassium level; this is not included in the BMP. BThe physician should also order the magnesium level; this is not included in the BMP. CThe potassium level has no effect on the risk of arrhythmia. DThe magnesium level has no effect on the risk of arrhythmia. EThe physician should also order the sodium level; this is not included in the BMP. |
BThe physician should also order the magnesium level; this is not included in the BMP. |
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Which of the following are commonly cited side effects of amiodarone therapy? (Select ALL that apply.) Answer AHemolytic anemia BTaste perversions CHypothyroidism DMicrodeposits in the cornea EPhotosensitivity
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CHypothyroidism DMicrodeposits in the cornea EPhotosensitivity |
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Multaq is indicated for which of the following situations? Answer AMaintenance of sinus rhythm in recurrent atrial fibrillation BConversion of atrial fibrillation to sinus rhythm CSlowing of ventricular rate in atrial fibrillation DPrevention of ventricular tachycardia ETreatment of ventricular tachycardia
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AMaintenance of sinus rhythm in recurrent atrial fibrillation |
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The primary pathway of metabolism of procainamide is: Answer AOxidation BEsterification CGlucuronidation DAcetylation ESulfation |
DAcetylation |
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A patient is beginning digoxin 0.125 mg daily. The patient has mild renal insufficiency. After a few weeks, the patient develops an infection with nausea and vomiting. She is weak, dehydrated and is bradycardic. The patient is admitted to the hospital. Which of the following statements are correct? (Select ALL that apply.) Answer AHyperkalemia may increase the risk of digoxin toxicity more than hypokalemia. BDigoxin is mainly eliminated by the kidney and decreased renal function can lead to supratherapeutic levels. CAn elevated digoxin level can worsen nausea and vomiting. DMental confusion and bradycardia can be caused by an elevated digoxin level. EDigoxin toxicity should be treated with beta-agonists. |
BDigoxin is mainly eliminated by the kidney and decreased renal function can lead to supratherapeutic levels. CAn elevated digoxin level can worsen nausea and vomiting. DMental confusion and bradycardia can be caused by an elevated digoxin level. |
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Which of the following drugs is used to control ventricular rate in a patient presenting in atrial fibrillation with a rapid ventricular response? Answer AQuinidine BDigoxin CSotalol DProcainamide EMexiletine |
BDigoxin |
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What class of antiarrhythmic is disopyramide in according to the Vaughn Williams classification system? Answer AIa BIb CIc DIII EIV |
AIa |
