A 45-year-old female presents seeking treatment for weight loss. She has tried several fad diets in the past with very little success. She exercises twice weekly at the gym for 30 minutes and tries to watch what she eats. Her BMI is 31 and she has diabetes and uncontrolled hypertension. Which of the following medications would be most appropriate to treat her obesity? A. Phentermine. B. Phentermine/topiramate. C. Orlistat. D. Diethylpropion.

Which of the following drugs requires patients to take a multivitamin while on the medication? A. Phentermine. B. Phentermine/topiramate. C. Orlistat. D. Diethylpropion. E. Lorcaserin

A 38-year-old obese male with depression is considering a weight loss medication following several failed attempts with diet and exercise. Which of the following medications should be avoided in this individual? A. Phentermine. B. Phentermine/topiramate. C. Orlistat. D. Diethylpropion. E. Lorcaserin.

A 27-year-old recently married female is asking about treatment options for her obesity. She recently stopped taking her birth control medications, as she felt these were contributing to her weight gain. Which of the following medications should be avoided in this patient? A. Phentermine. B. Phentermine/topiramate. C. Orlistat. D. Diethylpropion. E. Lorcaserin.

A fellow health care provider is concerned about prescribing orlistat to his adolescent patients. He understands that it is approved for adolescents aged 12 years and older and, therefore, prescribes this medication more often than any other for adolescent obesity. Unfortunately, many of his adolescent patients are stopping the medication during the first month of treatment. Which of the following side effects is the most likely reason these adolescents are stopping the drug? A. Tachycardia. B. Valvulopathy. C. Suicidal ideation. D. Drowsiness. E. Flatulence.

Which of the following corticosteroids is most appropriate to administer to a woman in preterm labor to accelerate fetal lung maturation? A. Betamethasone. B. Fludrocortisone. C. Hydrocortisone. D. Prednisone.

Which of the following patients would most likely have suppression of the HPA axis and require a slow taper of corticosteroid therapy? A. A patient taking 40 mg of prednisone daily for 7 days to treat an asthma exacerbation. B. A patient taking 10 mg of prednisone daily for 3 months for rheumatoid arthritis. C. A patient using mometasone nasal spray daily for 6 months for allergic rhinitis. D. A patient receiving an intra-articular injection of methylprednisolone for osteoarthritis.

All of the following are strategies to minimize the development of HPA axis suppression with corticosteroid therapy except: A. Alternate-day administration of therapy. B. Administration via topical or inhalation routes when possible. C. Using the lowest dose of corticosteroid that adequately controls symptoms. D. Administration of two-thirds of the daily dose in the morning and one-third in the afternoon.

A patient with Addison disease is being treated with hydrocortisone but is still having problems with dehydration and hyponatremia. Which of the following drugs would be best to add to the patient’s therapy? A. Dexamethasone. B. Fludrocortisone. C. Prednisone. D. Triamcinolone.

The diagnosis of congenital adrenal hyperplasia (CAH) is confirmed in a child. This condition can be effectively treated by: A. Administering a glucocorticoid. B. Administering an androgen antagonist. C. Administering ketoconazole to decrease cortisol synthesis. D. Removing the adrenal gland surgically. E. Administering adrenocorticotropic hormone.

A child with severe asthma is being treated with high doses of inhaled corticosteroids. Which of the following adverse effects is of particular concern? A. Hypoglycemia. B. Hirsutism. C. Growth suppression. D. Cushing syndrome. E. Cataract formation.

Osteoporosis is a major adverse effect caused by the glucocorticoids. It is due to their ability to: A. Increase the excretion of calcium. B. Inhibit absorption of calcium. C. Stimulate the hypothalamic–pituitary–adrenal axis. D. Decrease production of prostaglandins. E. Decrease collagen synthesis.

All of the following adverse effects commonly occur with glucocorticoid therapy except: A. Glaucoma. B. Increased risk of infection. C. Hypotension. D. Emotional disturbances. E. Peripheral edema.

Corticosteroids are useful in the treatment of all of the following disorders except: A. Addison disease. B. Allergic rhinitis. C. Cushing syndrome. D. Inflammatory bowel disease. E. Rheumatoid arthritis.

Which of the following zones of the adrenal gland is correctly paired with the type of substance it secretes? A. Adrenal medulla—corticotropin. B. Zona fasciculata—cortisol. C. Zona glomerulosa—androgens. D. Zona reticularis—catecholamines.

A 53-year-old woman has severe vasomotor symptoms (hot flushes) associated with menopause. She has no pertinent past medical or surgical history. Which of the following would be most appropriate for her symptoms? A. Conjugated estrogens vaginal cream. B. Estradiol transdermal patch. C. Oral estradiol and medroxyprogesterone acetate. D. Injectable medroxyprogesterone acetate.

A 70-year-old woman is being treated with raloxifene for osteoporosis. Which of the following is a concern with this therapy? A. Breast cancer. B. Endometrial cancer. C. Venous thrombosis. D. Hypercholesterolemia

Which of the following is the most appropriate oral contraceptive for a patient with moderate acne? A. Ethinyl estradiol/levonorgestrel. B. Ethinyl estradiol/norethindrone acetate. C. Ethinyl estradiol/norgestimate. D. Ulipristal.

A 26-year-old female is using injectable medroxy- progesterone acetate as a method of contraception. Which of the following adverse effects is a concern if she wishes to use this therapy long-term? A. Hyperkalemia. B. Male pattern baldness. C. Osteoporosis. D. Weight loss.

Which one of the following is the most common side effect of antihyperlipidemic drug therapy? A. Elevated blood pressure. B. Gastrointestinal disturbance. C. Neurologic problems. D. Heart palpitations. E. Migraine headaches.

Which one of the following hyperlipidemias is characterized by elevated plasma levels of chylomicrons and has no drug therapy available to lower the plasma lipoprotein levels? A. Type I. B. Type II. C. Type III. D. Type IV. E. Type V.

Which one of the following drugs decreases cholesterol synthesis by inhibiting the enzyme 3-hydroxy-3- methylglutaryl coenzyme A reductase? A. Fenofibrate. B. Niacin. C. Cholestyramine. D. Lovastatin. E. Gemfibrozil.

Which one of the following drugs causes a decrease in liver triglyceride synthesis by limiting available free fatty acids needed as building blocks for this pathway? A. Niacin. B. Fenofibrate. C. Cholestyramine. D. Gemfibrozil. E. Lovastatin.

Which one of the following drugs binds bile acids in the intestine, thus preventing their return to the liver via the enterohepatic circulation? A. Niacin. B. Fenofibrate. C. Cholestyramine. D. Fluvastatin. E. Lovastatin.

JS is a 65-year-old man who presents to his physician for management of hyperlipidemia. His most recent lipid panel reveals an LDL cholesterol level of 165 mg/ dL. His physician wishes to begin treatment to lower his LDL cholesterol levels. Which of the following therapies is the best option to lower JS’s LDL cholesterol levels? A. Fenofibrate. B. Colesevelam. C. Niacin. D. Simvastatin. E. Ezetimibe.

WW is a 62-year-old female with hyperlipidemia and hypothyroidism. Her current medications include cholestyramine and levothyroxine (thyroid hormone). What advice would you give to WW to avoid a drug interaction between her cholestyramine and levothyroxine? A. Stop taking the levothyroxine as it can interact with cholestyramine. B. Take levothyroxine 1 hour before cholestyramine on an empty stomach. C. Switch cholestyramine to colesevelam as this will eliminate the interaction. D. Switch cholestyramine to colestipol as this will eliminate the interaction. E. Take levothyroxine and cholestyramine at the same time to minimize the interaction.

AJ is a 42-year-old man who was started on niacin sustained-release tablets 2 weeks ago for elevated triglycerides and low HDL levels. He is complaining of an uncomfortable flushing and itchy feeling that he thinks is related to the niacin. Which of the following options can help AJ manage this adverse effect of niacin therapy? A. Administer aspirin 30 minutes prior to taking niacin. B. Administer aspirin 30 minutes after taking niacin. C. Increase the dose of niacin SR to 1000 mg. D. Continue the current dose of niacin. E. Change the sustained-release niacin to immediate-release niacin.

CNisa72-year-oldmalewhoistreatedforhyperlipidemia with high-dose atorvastatin for the past 6 months. He also has a history of renal insufficiency. His most recent lipid panel shows an LDL cholesterol level of 131 mg/dL, triglycerides of 510 mg/dL, and HDL cholesterol of 32 mg/dL. His physician wishes to add an additional agent for his hyperlipidemia. Which of the following choices is the best option to address CN’s dyslipidemia? A. Fenofibrate. B. Niacin. C. Colesevelam. D. Gemfibrozil. E. Ezetimibe.

Which of the following patient populations is more likely to experience myalgia (muscle pain) or myopathy with use of HMG CoA reductase inhibitors? A. Patients with diabetes mellitus. B. Patients with renal insufficiency. C. Patients with gout. D. Patients with hypertriglyceridemia. E. Patients taking warfarin (blood thinner).

What is the clinical term for angina caused by coronary vasospasm? A. Classic angina. B. Myocardial infarction. C. Prinzmetal angina. D. Unstable angina.

All of the following medications can be useful for managing stable angina in a patient with coronary artery disease except: A. Amlodipine. B. Atenolol. C. Immediate-release nifedipine. D. Isosorbide dinitrate.

A 72-year-old male presents to the primary care clinic complaining of chest tightness and pressure that is increasing in severity and frequency. His current medications include atenolol, lisinopril, and nitroglycerin. Which intervention is most appropriate at this time? A. Add amlodipine. B. Initiate isosorbide mononitrate. C. Initiate ranolazine. D. Refer the patient to the nearest emergency room for evaluation.

A 62-year-old patient with a history of asthma and vasospastic angina states that he gets chest pain both with exertion and at rest, about ten times per week. One sublingual nitroglycerin tablet always relieves his symptoms, but this medication gives him an awful headache every time he takes it. Which is the best option for improving his angina? A. Change to sublingual nitroglycerin spray. B. Add amlodipine. C. Add propranolol. D. Replace nitroglycerin with ranolazine.

Which side effect is associated with amlodipine? A. Bradycardia. B. Cough. C. Edema. D. QT prolongation.

Which medication should be prescribed to all anginal patients to treat an acute attack? A. Isosorbide dinitrate. B. Nitroglycerin patch. C. Nitroglycerin sublingual tablet or spray. D. Ranolazine.

A 65-year-old male experiences uncontrolled angina attacks that limit his ability to do household chores. He is adherent to a maximized dose of β-blocker with a low heart rate and low blood pressure. He was unable to tolerate an increase in isosorbide mononitrate due to headache. Which is the most appropriate addition to his antianginal therapy? A. Amlodipine. B. Aspirin. C. Ranolazine. D. Verapamil.

A 68-year-old male with a history of angina had a MI last month, and an echocardiogram reveals heart failure with reduced ejection fraction. He was continued on his previous home medications (diltiazem, enalapril, and nitroglycerin), and atenolol was added at discharge. He has only had a few sporadic episodes of stable angina that are relieved with nitroglycerin or rest. What are eventual goals for optimizing this medication regimen? A. Add isosorbide mononitrate. B. Increase atenolol. C. Stop atenolol and increase diltiazem. D. Stop diltiazem and change atenolol to bisoprolol.

Which of the following medications would be safe to use in a patient taking ranolazine? A. Carbamazepine. B. Clarithromycin. C. Enalapril. D. Quetiapine.

A patient whose angina was previously well controlled with once-daily isosorbide mononitrate states that recently he has been taking isosorbide mononitrate twice a day to control angina symptoms that are occurring more frequently during early morning hours. Which of the following is the best option for this patient? A. Continue once-daily administration of isosorbide mononitrate but advise the patient to take this medication in the evening. B. Advise continuation of isosorbide mononitrate twice daily for full 24-hour coverage of anginal symptoms. C. Switch to isosorbide dinitrate, as this has a longer duration of action than the mononitrate. D. Switch to nitroglycerin patch for consistent drug delivery and advise him to wear the patch around the clock.

A 60-year-old woman had a myocardial infarction. Which of the following should be used to prevent life-threatening arrhythmias that can occur post– myocardial infarction in this patient? A. Digoxin. B. Flecainide. C. Metoprolol. D. Procainamide. E. Quinidine.

Suppression of arrhythmias resulting from a reentry focus is most likely to occur if the drug: A. Has vagomimetic effects on the AV node. B. Is a β-blocker. C. Converts a unidirectional block to a bidirectional block. D. Slows conduction through the atria. E. Has atropine-like effects on the AV node.

A 57-year-old man is being treated for an atrial arrhythmia. He complains of dry mouth, blurred vision, and urinary hesitancy. Which antiarrhythmic drug is he mostly like taking? A. Metoprolol. B. Disopyramide. C. Dronedarone. D. Sotalol.

A 58-year-old woman is being treated for chronic suppression of a ventricular arrhythmia. After 1 week of therapy, she complains about feeling severe upset stomach and heartburn. Which antiarrhythmic drug is the likely cause of these symptoms? A. Amiodarone. B. Digoxin. C. Mexiletine. D. Propranolol. E. Quinidine.

A 78-year-old woman has been newly diagnosed with atrial fibrillation. She is not currently having symptoms of palpitations or fatigue. Which is appropriate to initiate for rate control as an outpatient? A. Amiodarone. B. Dronedarone. C. Esmolol. D. Flecainide. E. Metoprolol.

Which of the following is correct regarding digoxin when used for atrial fibrillation? A. Digoxin works by blocking voltage-sensitive calcium channels. B. Digoxin is used for rhythm control in patients with atrial fibrillation. C. Digoxin increases conduction velocity through the AV node. D. Digoxin levels of 1 to 2 ng/mL are desirable in the treatment of atrial fibrillation.

All of the following are adverse effects of amiodarone except: A. Cinchonism. B. Hypothyroidism. C. Hyperthyroidism. D. Pulmonary fibrosis. E. Blue skin discoloration.

Which arrhythmia can be treated with lidocaine? A. Paroxysmal supraventricular ventricular tachycardia. B. Atrial fibrillation. C. Atrial flutter. D. Ventricular tachycardia.

A clinician would like to initiate a drug for rhythm control of atrial fibrillation. Which of the following coexisting conditions would allow for initiation of flecainide? A. Hypertension. B. Left ventricular hypertrophy. C. Coronary artery disease. D. Heart failure.

Which statement regarding dronedarone is correct? A. Dronedarone is more effective than amiodarone. B. QT interval prolongation is not a risk with dronedarone. C. Dronedarone increases the risk of death in patients with permanent atrial fibrillation or symptomatic heart failure. D. There is no need to monitor liver function with dronedarone.