Vital Signs and Emergency Medical Management, Exams of Pharmacology

Download Vital Signs and Emergency Medical Management and more Exams Pharmacology in PDF only on Docsity!

MSN 611 NKU Final ACLS - Pharmacology

WITH MULTIPLE QUESTIONS AND THE CORRECT

ANSWERS

A 65-year-old man presents with chronic insomnia. He reports that his sleep has improved after beginning a new medication, but he is experiencing concerning adverse effects. His wife noticed him sleepwalking, eating during the night, and attempting to drive his car at night. The patient has no recollection of these events and is concerned. Vitals signs are blood pressure 130/ mmHg, heart rate 82 bpm, respiratory rate 18 breaths/min, and temperature 98.0 F (36.7 C). Physical examination is normal. What is the mechanism of action of the medication responsible for the patient's adverse effects? - -correct ans- -GABA-A receptor agonist A 26-year-old woman is brought to the emergency department with an acute severe headache. Her partner reports that it started 6 hours ago and that she vomited several times at home. The patient is holding her hands over her eyes and reports severe unilateral retroorbital throbbing pain. She has no significant past medical history and takes no regular medications. Her vital signs are within normal limits. There is no gross neurological deficit on examination of the cranial nerves and limbs. Given the most likely diagnosis, what is the mechanism of action of the best drug for the acute treatment of this patient's condition? - -correct ans- -Cerebral vasoconstriction A 42-year-old man presents with a 6-month history of severe, throbbing headaches that are generally unilateral, worsened by light and sound, and occur biweekly and occasionally interrupt his workday. He has no significant improvement with ibuprofen, naproxen, or acetaminophen. Vital signs are blood pressure 139/80 mmHg, heart rate 82 bpm, respiratory rate 14 breaths/min, and temperature 98.0 F (36.7 C). Physical examination is normal. Which of the following effects is caused by the most appropriate treatment option? - -correct ans- -Constriction of cerebral blood vessels. A 20-year-old woman presents with a severe headache. She is G2P1 at 32 weeks gestation. Her blood pressure is 201/98 mm Hg. A urine dipstick shows 3+ protein. Preparations are made for

an emergency cesarean section. She is started on a continuous intravenous infusion of magnesium sulfate for the prevention of seizures. What is a severe, yet preventable, complication of continuous intravenous magnesium sulfate therapy? - -correct ans- -Respiratory depression A 55-year-old man presents with difficulty passing urine and suprapubic discomfort for the past 2 days. His symptoms are progressively worsening. The patient's past medical history is significant for depression, and he was recently started on a new medication due to refractory symptoms. The physical examination reveals tachycardia, a dry mouth, and suprapubic fullness. What is the class of medication that is responsible for this patient's presenting symptoms? - - correct ans- -Tricyclic antidepressants A 55-year-old man presents with a 1-month history of insomnia and fatigue. He states that he has been unable to complete work tasks and no longer enjoys his hobbies or going out with friends. He also reports a decreased appetite and bouts of crying. The patient has a past medical history of seizures, hypothyroidism, diabetes mellitus, and asthma. His blood pressure is 110/ mm Hg, and his heart rate is 75 bpm. The clinician prescribes venlafaxine. Which of the following conditions requires caution when using venlafaxine in this patient? - -correct ans- -Seizures A 34-year-old woman has been troubled by migraine headaches that typically occur 5 to 6 times monthly. Treatment of the headaches when they occur is moderately successful. She asks whether there is anything she can do to reduce the frequency with which these headaches occur. She also has been troubled by long-standing mood issues, with episodes that are weeks long where she feels sad. What therapy might be recommended that can both reduce the frequency of her migraine attacks and may also be useful in improving her mood? - -correct ans- - Venlafaxine A patient is diagnosed with metabolic acidosis. His medication record shows that he is prescribed diclofenac, atenolol, albuterol, and topiramate. Which of these medications is most likely responsible for the patient's condition? - -correct ans- -Topiramate A 60-year-old man is brought to the emergency department after an episode of syncope. The patient was watching television when he felt light-headed and lost consciousness. He regained

and the loss of her job. She has a past medical history of chronic sinusitis, for which she has been taking antihistamines for the past two months. Her current vital signs are as follows; blood pressure 126/80 mmHg, heart rate 70/min, respiratory rate 18/min, and temperature 98.6 F. What is the next best step for this patient? - -correct ans- -Start on sertraline A 17-year-old female presents for a follow-up on major depressive disorder therapy with venlafaxine. The mother and patient state that the patient's symptoms have improved. She has been performing better at school, enjoying activities with her friends, and going to the gym every day. However, the patient has trouble falling asleep. The mother states that she gives her daughter a cough medication, dextromethorphan, to make her drowsy and help her fall asleep. The mother and patient ask if they should be concerned about the use of dextromethorphan. What is the best response to their question? - -correct ans- -There is an increased risk of serotonin syndrome if dextromethorphan is used with venlafaxine. A 25-year-old woman presents with severe acute asthma exacerbation. She inadequately responds to a combination of nebulized albuterol, inhaled ipratropium, prednisone, and oxygen. The clinical team decides to administer intravenous magnesium. While placing the order, the clinician receives an alert for potential overdose with this medication. Which of the following symptoms is most likely to occur if there is an overdose? - -correct ans- -Muscle weakness A 40-year-old male with a history of bipolar 1 disorder is admitted to a psychiatric inpatient facility after an episode of aggression and is currently prescribed aripiprazole. While on the inpatient psychiatric unit, he continues to be agitated with the inpatient staff and other patients on the unit. The psychiatrist prescribes him lithium to augment treatment for agitation. Lithium, by acting on which of the neurotransmitters, will be helpful for the patient's agitation? - -correct ans- -Serotonin A 45-year-old man is brought to the hospital by his sister with a history of seeing a man following him for the last nine months. He says that only he can see this man. She also says he lost his job four months ago because of poor performance. Since then, the patient has been living in his room and does not go outside because he thinks someone might kill him. On examination, the patient's vitals are normal. The clinician prescribes a medication that is known for extrapyramidal symptoms. This patient is at increased risk of developing which of the following in the next 24 hours? - -correct ans- -Acute dystonia

A 65-year-old man presents with confusion and anuria. His past medical history is significant for hypertension, hyperlipidemia, insomnia, and diabetes mellitus with peripheral neuropathy. The patient is awake and oriented to person only. His blood pressure is 110/80 mmHg, pulse 90/min; respiratory rate is 18/min, and oxygen saturation is 98% on room air. Physical examination is normal except for suprapubic fullness. On catheterization, 800 mL of urine is drained. Which of the following drugs is most likely the cause of this patient's presentation? - -correct ans- - Amitriptyline A 32-year-old woman with schizophrenia is currently treated with haloperidol. The patient was brought to the emergency department by her mother with symptoms of confusion, diaphoresis, agitation, muscular rigidity, and tachycardia with elevated white blood count and creatine phosphokinase. Which of the following conditions is the patient most likely experiencing? - - correct ans- -Neuroleptic malignant syndrome A 50-year-old man presents with crushing substernal chest pain. Vital signs are temperature 98.6 °F (37 °C), heart rate 98 bpm, blood pressure 80/55 mm Hg, and respiratory rate 20 breaths/min. On physical examination, chest auscultation demonstrated no abnormal findings. He was diagnosed with a myocardial infarction. Following initial emergency management for the ischemic event, dobutamine is administered to counter hypotension. Which of the following accurately explains the main role of dobutamine in achieving hemodynamic stability? - -correct ans- -Predominant beta-1 receptor activity A 67-year-old man comes to the emergency department due to an acute episode of confusion, dizziness, and diaphoresis for the past three hours. A detailed history reveals that the patient took a sex-enhancing drug he ordered online. He took the drug four hours ago and started to feel dizzy soon after. His past medical history is significant for hypertension, ischemic heart disease, and diabetes mellitus. He claims to be very compliant with his medication and never misses a dose. Vital signs show a blood pressure of 80/40 mmHg, pulse of 105 bpm, respiratory rate of 18 breaths/min, and a temperature of 37 C (98.6 F). Examination of the abdomen reveals a soft, non-tender abdomen with no masses on deep palpation. Cardiopulmonary examination shows no pertinent findings as well. Emergency treatment with intravenous normal saline is started, and the patient stabilizes. What is the likely mechanism of action of the drug? - -correct ans- -Inhibition of phosphodiesterase 5 A 22-year-old patient with type 1 diabetes mellitus receives 12 units of regular insulin and 26 units of NPH insulin subcutaneously daily. Which of the following is an appropriate instruction

later, he presents to the emergency department with disorientation and extreme hypotension. Coadministration of which of the following medicines is most likely responsible for this presentation? - -correct ans- -Isosorbide dinitrate A patient develops endometrial carcinoma. Which of the following drugs has the patient been taking? - -correct ans- -Tamoxifen A 50-year-old male presents to the clinic complaining of numbness in the hands and feet. He also complains of an increased urinary frequency. On presentation, he is afebrile, has a pulse rate of 76 bpm, a blood pressure of 130/80 mmHg, and a respiratory rate of 14 breaths/min. A detailed physical examination does not reveal any significant findings. He has a hemoglobin of 13 g/dl, a total leukocyte count of 4800/mm^3, and a platelet count of 280,000/mm^3. His blood sugar levels are 288 mg/dl, 2 hours postprandial. He was diagnosed with hypertension two years ago, and his medical record shows he is compliant with medications. He is planning to be put on oral hypoglycemic treatment with metformin. He is also prescribed atorvastatin for vascular disease prevention; which acts by which of the following mechanisms? - -correct ans- -HMG-CoA reductase inhibition A 65-year-old man presents to the office for a follow-up. He had a stent placed in his right coronary artery two years ago for unstable angina. He reports that he exercises regularly and is compliant with a heart-healthy diet. His current medications include atorvastatin 80 mg daily for dyslipidemia. The lipid profile shows total cholesterol is 195 mg/dL, HDL is 33 mg/dL, LDL is 110 mg/dL, and triglycerides are 120 mg/dL. Which of the following has been shown to improve cardiovascular outcomes when added to statins for secondary prevention? - -correct ans- - Ezetimibe A 16-year-old girl presents with a decreased level of consciousness and abdominal pain. Her mother says that she vomited twice before coming to the hospital. She has no known medical history, and this is the first time to have these symptoms. Her family history is significant for diabetes in her mother and 2 uncles. Her glucose level is 574 mg/dL, creatinine 0.8 mg/dL, potassium 3.7 mEq/L, sodium 137 mEq/L, and white blood count 12700/microL. Her urine dipstick shows glucose 4+ and ketones 3+. She is given normal saline. She is also given an infusion of the next appropriate medication. Which of the following side effects is most likely to occur with this infusion? - -correct ans- -Hypokalemia

A 45-year-old man presents for follow-up after a diagnosis of diabetes mellitus type 2 and initiation of metformin 3 months ago. He says he would like to discontinue the metformin because of its adverse effects. He feels embarrassed at work because of metformin-associated diarrhea and has been feeling nauseous most days. The patient confirms that he followed the metformin titration regimen provided by the clinician and is currently taking metformin IR 1000 mg twice daily with meals. What is the most appropriate next step in treatment? - -correct ans- - Discontinue metformin IR and start metformin extended-release A patient is rushed to the emergency department with an apparent drug overdose. His presentation includes tachycardia, palpitations, and chest pain. An IV beta-blocker is ordered to stabilize cardiac activity. Which of the following drugs is the most likely culprit for this overdose?

• -correct ans- -Levothyroxine A patient has developed swelling in his neck, constipation, weight gain, and hair loss. His family members have noticed him crying often, and he admits to turning off the air conditioner despite the hot climate. Two years ago, he was treated with radioactive iodine for similar symptoms. Which of the following is the most appropriate drug for treating this patient's condition? - - correct ans- -Levothyroxine (T4) A patient with type 2 diabetes mellitus presents complaining of nausea, vomiting, abdominal bloating, tachypnea, and feeling weak. Palpation reveals a tender and enlarged liver and elevated liver enzymes. His serum bicarbonate is low, and his lactate level reads high at 4. mmol/L. Which anti-glycemic drug is the most likely culprit? - -correct ans- -Metformin A healthcare provider reviews home medications for a 65-year-old man with a history of hypertension, diabetes mellitus, and hyperlipidemia. He was admitted to the cardiac unit for unstable angina. Among his medications, he is on an HMG-CoA reductase inhibitor. Which of the following would need to be monitored regularly in this patient? - -correct ans- -Liver function tests A group of clinical researchers is investigating the management of osteoarthritis in patients with underlying psychiatric disorders. Patients recruited for the study are analyzed based on their medication regimen. 25% of patients in the study take a medication that binds to opioid receptors. What is a primary indication for the use of the drug mentioned above? - -correct ans- -Analgesia

and an INR of 1.1. Which of the following excludes him from consideration of alteplase at this time? - -correct ans- -His abnormal glucose testing excludes him. A 35-year-old female patient diagnosed with rheumatoid arthritis visits a rheumatology clinic. Her provider is considering prescribing a disease-modifying antirheumatic drug. Her past medication history reveals an allergic reaction to sulfa containing antibiotics. She is not planning to be pregnant. She prefers an oral drug than an injection. Which of the following drugs is most likely suitable for her? - -correct ans- -Methotrexate Emergency medical services are called to a house party where a 21-year-old man has been unresponsive. On initial assessment, he is snoring with a respiratory rate of 6 breaths/min and a Glasgow Coma Scale score (GCS) of E2V2M4. His pupils are constricted and nonreactive to light. He is given an intramuscular (IM) injection, and his GCS improves to E3V4M6 within a few minutes. What is the mechanism of action of the drug given via IM injection? - -correct ans- - Competitive antagonist Which of the following medications is known to decrease both basal and stimulated gastric acid secretion? - -correct ans- -Omeprazole A 45-year-old man presents via emergency medical services with a seizure. In the emergency department, the seizure resolves after 2 doses of lorazepam 2 mg IV. The patient is in a post-ictal state. Vital signs are blood pressure 140/90 mm Hg, heart rate 85 bpm, temperature 99 ° F (37° C), and respiratory rate 14 breaths/min. Laboratory tests show serum sodium of 91 mEq/L, potassium of 4.1 mEq/L, and chloride of 106 mEq/L. The decision is made to intubate the patient using etomidate and succinylcholine. A propofol drip is started for sedation. Twenty minutes later, the healthcare provider notices that the patient's blood pressure is now 98/65 mmHg. What caused the drop the blood pressure? - -correct ans- -Vasodilation A 21 yr old man is administered an anesthetic medication before a surgical procedure that results in visual distortions and a feeling as if he is floating and detached from reality. After the patient regains consciousness, he develops nausea and vomiting and is confused. The mechanism of action of the anesthetic affects which of the following receptors? - -correct ans- - NMDA

A 50-year-old female patient presents to the clinic for constipation for the past two weeks. She describes her stool as hard, bullet-like. The patient had no recent medical history. The patient does not smoke but drinks alcohol socially. Her blood pressure is 110/70 mmHg, her pulse rate is 70 beats per minute, and her temperature is 37.5 C (99.5 F). Physical examination is within normal. What is the first treatment plan for her constipation? - -correct ans- -Add fiber to her diet and increase water intake A 45-year-old woman presents with a runny nose with white mucus discharge, itchiness, and watery eyes. The patient is taking diphenhydramine, which is helping but makes her very sleepy at work. What is the next step in management? - -correct ans- -Stop diphenhydramine and start loratadine 10mg orally once daily. What is the advantage of loperamide over atropine/diphenoxylate? - -correct ans- -No opiate effects at normal doses A mother brings her son, who has asthma. She would like to know if she can give her child acetaminophen. She has heard reports that it may worsen asthma. What is the current consensus on acetaminophen and asthma? - -correct ans- -Acetaminophen does not worsen asthma A 42 year-old-male patient is brought to the emergency department after having been thrown off his motorbike after which his lower extremities were crushed by a passing semi-truck. His vital signs are stable although the patient is unconscious and has significant crush injuries to his bilateral lower extremities below the knees. It is decided to intubate the patient to protect his airway. Which drug is contraindicated in this scenario? - -correct ans- -Succinylcholine A 78-year-old man presents to the emergency department after being found to have ingested several packets of acetaminophen at home. His son brings the empty packets, and it is calculated that he ingested 12 grams of acetaminophen approximately 3 hours ago. The patient is currently stable. What is the most appropriate treatment for this patient's overdose? - -correct ans- -N- acetylcysteine A 65-year-old man presents to the clinic due to constipation for the past 2 weeks. He describes his stool as hard, bullet-like. The patient had a past medical history of hypertension and diabetes

recovering uneventfully at home. She takes hydrochlorothiazide for hypertension, which is well- controlled. She has been taking acetaminophen for pain at home as prescribed by her surgeon. Vital signs show a blood pressure of 150/90 mmHg, pulse 110/min, respiratory rate 18/min, temperature 101.4 F, and SpO2 97% on room air. A physical exam is significant for tachycardia, diaphoresis, muscle rigidity, and mild confusion (able to state her name, location, but not date). La - -correct ans- -Promethazine A 33-year-old patient presents to the emergency department with a two-day history of nausea and vomiting. The initial workup includes a urine pregnancy test, which is negative. The patient reports a medical history of depression and anxiety, for which she takes sertraline, as well as chronic pain, for which she takes tramadol. The patient is started on intravenous ondansetron. Which of the following may occur? - -correct ans- -Serotonin syndrome A 50-year-old woman presents to the clinic with new-onset bowel symptoms. She is straining to have a bowel motion and describes her stools as hard and pellet-like. She had a hip fracture repair 2-weeks ago and is on oral morphine for pain control. She is a 10-pack-year smoker and consumes alcohol occasionally. She is afebrile, and her vitals are stable. The abdominal exam is unremarkable. Of the following, what is the mechanism of action of the medication that could have avoided this patient's problem? - -correct ans- -Decreases the surface tension of the stool- water interface and facilitates stool passage A 17-year-old boy with a heart rate of 110 bpm and blood pressure of 100/60 mm Hg requires emergency surgery after he is diagnosed with appendicitis. The clinician uses an agent for induction for his appendectomy, which is often used in patients with asthma. Which of the following side effects of this particular agent may require prophylactic treatment? - -correct ans- -Nausea and vomiting A 58-year-old man is brought to the emergency department with confusion and slow breathing. His wife found him on the floor and was unable to arouse him. His wife says he has been unable to get any relief lately and thinks he may be using more medication than prescribed. He has had terminal colon cancer for two years and was about to enter palliative care. He is currently taking transdermal fentanyl patches, opioids, and an oxygen tank. His blood pressure is 100/60 mm Hg, and his respiratory rate is 8 breaths/min. He has pinpoint pupils and is difficult to arouse. What is the mechanism of the drug that should be administered first? - -correct ans- -Antagonizes opioid effects by competing for the μ opiate receptor sites

A 50-year-old man presents to the clinic with epigastric pain that began four months ago. He has a history of obesity, drinks three beers per night and has a 30-pack-year smoking history, and currently smokes one pack per day. His vital signs are blood pressure 120/70 mmHg, heart rate 75/min, and temperature 37.0°C (98.6°F). The physical exam is non-contributory. Inhibition of which of the following mediators will most likely resolve the patient's chief complaint? - -correct ans- -Histamine A 21-year-old man is admitted to the intensive care unit (ICU) after a motor vehicle collision in which he was the restrained driver. He has a past medical history of type 1 diabetes, is well- controlled with insulin, has no surgical history, and does not drink alcohol or use recreational drugs. His physical exam reveals an average build, facial abrasions, and ecchymosis on his chest and abdomen in the shape of his seat belt. CT scan reveals a left orbital blowout fracture. He is in a coma and does not respond to stimuli. Famotidine is started to reduce the possibility of developing which of the following? - -correct ans- -Stress-induced ulcer A 42-year-old male comes into the emergency department after being struck as a pedestrian by a truck at 30 mph. When he arrived at the hospital, his Glasgow Coma Scale was 6, and he had significant facial trauma. Additionally, he had a positive FAST exam, and emergent surgery was indicated. Before being transferred to the operating room, the emergency department physician attempted rapid sequence intubation with rocuronium as the paralytic agent. Unfortunately, due to the extensive facial trauma, intubation was unsuccessful. What pharmacological agent should be used in this scenario due to the difficulties in intubation? - -correct ans- -Sugammadex A 55-year-old woman with a past medical history of type 1 diabetes mellitus presents with nausea and vomiting for the past 3 days. She also reports feeling dizzy when she gets up quickly from a seated position. Her blood pressure is 125/85 mmHg, and her heart rate is 102 bpm. The provider writes the patient a prescription for metoclopramide. Which of the following is the most appropriate side effect to focus on during patient education about this drug? - -correct ans- -Dystonia A 68-year-old man is undergoing treatment in an inpatient palliative care setting. Since yesterday, he has been complaining of nausea and vomiting related to chemotherapy treatment. Which of the following medications is most likely to be effective for the patient's symptoms? - -correct ans- -Ondansetron

A 39-year-old woman with multiple sclerosis presents to a healthcare provider with a complaint of muscle spasms. The provider decides to administer a benzodiazepine to manage the condition. Which of the following benzodiazepines will most likely be used to manage her condition? - - correct ans- -Diazepam A 78-year-old woman reports that her memory loss over the past few years has progressed to the point where she has difficulty conducting daily activities. She has trouble remembering why she left her house to run errands and has found it increasingly difficult to manage her finances. The Mini-Mental State Examination (MMSE) score is 23/30. Physical examination is unremarkable, and routine blood test results are within normal limits. Given the likely diagnosis, what is the mechanism of the most appropriate pharmacotherapy for this patient? - -correct ans- -Acetylcholinesterase inhibition A 73-year-old male presents with worsening symptoms of Parkinson disease. He was diagnosed five years ago and was started on ropinirole. Over the past month, he has been having more difficulty walking. He states he feels sluggish and has noticed his "pill-rolling" tremor has gotten progressively worse. His provider recommends that he be started on a combination extended- release capsule containing both levodopa and carbidopa. The addition of carbidopa has what effect on this patient's treatment regimen? - -correct ans- -Increased central nervous system uptake of levodopa A 65-year-old man recently underwent a difficult colon resection and is in the ICU with signs of heart failure. His urine output had dropped to less than 10 mL/hour, and he has developed significant edema and ascites. His ejection fraction is about 40%, but his renal function seems intact. Which of the following may be of the most benefit to him? - -correct ans- -Mannitol A provider plans to prescribe carbamazepine for an adult woman diagnosed with trigeminal neuralgia. Further inquiry reveals she takes combined oral contraceptive pills. What significant medication interaction should the provider consider? - -correct ans- -Reduced contraceptive protection A 22-year-old female suffers from seasonal allergies as well as mild persistent asthma. She is currently on fluticasone/salmeterol and salbutamol. The physician prescribes a new asthmatic prophylaxis asthmatic medication to control both her comorbidities. Which of the following best

describes the mechanism of action for this medication? - -correct ans- -Blocks the action of leukotriene D A 50-year-old man presents with complaints of cough with a copious amount of yellow sputum production for the past two years. He also feels fatigued most of the time and complains of dyspnea. The patient has no history of fever. He has had a significant history of cigarette smoking for the past 30 years. The physical examination is significant for peripheral cyanosis and diffuse wheezes throughout both lung fields. The clinician prescribes a medication that acts on muscarinic receptors to cause which of the following effects for symptomatic relief? - -correct ans- -Reduces cholinergic effects on bronchial smooth muscle causing bronchodilation A 17-year-old boy with a history of asthma presents to the urgent care with an asthma exacerbation due to having an upper respiratory infection. His daily medications are a short- acting beta-agonist, loratadine, and a corticosteroid inhaler to control his asthma and allergies. He reports using his albuterol (short-acting beta agonist) daily. On physical examination, he has diffuse bilateral wheezing bilaterally and is not using accessory muscles. The provider adds an oral medication to control his asthma symptoms and allergies. What is one of the most serious adverse effects of the medication? - -correct ans- -Neuropsychiatric events A 68-year-old man diagnosed with Parkinson's disease six years ago was initially treated with ropinirole. Still, his symptoms have worsened over the past few months, and he comes in seeking additional treatment options. He is started on an immediate-release combination pill of carbidopa/levodopa. What is a common problem related to dosing with this combination of medications? - -correct ans- -The effectiveness of the medications fluctuates during the day A 16-year-old presents for staring spells that occur several times a day. Each episode lasts only a few seconds and occurs at random times of the day. The patient continues regular activity after the event and is not confused. The patient is otherwise healthy with no recent trauma or infections. The patient is not on any medications. EEG reveals a 3-Hz spike and waveform. Which of the following is the first-line treatment for this patient? - -correct ans- -Ethosuximide A 25-year-old woman with a history of generalized seizure disorder got married recently. She had juvenile myoclonic seizures during her teenage which evolved into her present generalized convulsive seizures. She states she wants to start a family with her husband. She takes sodium valproate 1 g twice daily to control her seizures. She has not had a seizure for the past year. She

the girl's sudden worsening of symptoms? - -correct ans- -Hypersensitivity to fluticasone/salmeterol inhalation powder formulation A 37-year-old man with chronic persistent asthma is currently prescribed salbutamol, fluticasone, and salmeterol. Which of the following changes in potassium levels is most likely to be seen? - - correct ans- -Hypokalemia due to an intracellular shift A 30-year-old woman presents to the emergency department for dizziness and ataxia that occurred recently. Her current medications include vitamin D, metformin, and carbamazepine. It is discovered that the patient recently started a weight loss diet based on natural ingredients. Which of the following ingredient in her diet that could cause her current symptoms? - -correct ans- -Grapefruit juice A 35-year-old Asian woman with a history of substance abuse stabilized on methadone and clonazepam for many years is recently started on carbamazepine by a healthcare provider. The patient reports that she has been having fatigue, fever, teary eyes, sweating, blisters in the mouth, and joint pain. What is the most likely cause of her symptoms? - -correct ans- -Steven Johnson syndrome A 68-year-old man with end-stage chronic obstructive pulmonary disease (COPD) is undergoing palliative therapy for worsening dyspnea and productive cough. The patient has a 20-pack-year smoking history and quit smoking 12 months ago. The patient is currently using a handheld nebulizer treatment with albuterol. The patient then reports a rapid heart rate, increased mental alertness, and insomnia. Activation of which of the following systems is primarily responsible for the patient's symptoms? - -correct ans- -Sympathetic nervous systems A 25-year-old man who takes clonidine for Tourette syndrome reports a recent worsening of his tics which is causing him emotional distress. The clinician recommends discontinuing the clonidine and starting pimozide. The patient is advised to slowly taper the clonidine to prevent which of the following from occurring? - -correct ans- -Rebound hypertension When starting a patient on warfarin, approximately how long does it take for anticoagulation to increase the INR? - -correct ans- -48 to 72 hours

A 32-year-old primigravida at 34 weeks gestation presents with severe headache, blurring of vision, vomiting, and epigastric pain from the past 6 hours. She has no past medical history. Vital signs are oxygen saturation 98% on room air, respiratory rate 20 breaths/min, heart rate 80 bpm, blood pressure 170/110 mmHg, and temperature 36.7 C (98 F). She is started on IV medication for control of her severe hypertension. By which of the following mechanisms will this drug reduce the patient's blood pressure? - -correct ans- -Relaxation of arteriolar smooth muscles A 56-year-old man presents after consuming several tablets. He complains of nausea, vomiting, and ringing in both ears. His history is significant for bipolar disorder and hypothyroidism. His medications include levothyroxine and lithium carbonate, and he takes aspirin prophylactically to prevent colon cancer. A few weeks ago, he started acetaminophen and diazepam for back muscle spasms. What medication is the likely cause of his signs and symptoms? - -correct ans- - Aspirin A 65-year-old man presents with blurry vision while changing position for the last month. He also had a fall last week but did not have any major injuries. His history is significant for hypertension, heart failure with preserved ejection fraction, diabetes mellitus, chronic kidney disease, and cirrhosis. His last visit was 3 months ago. During the last visit, amlodipine (10 mg daily) was prescribed due to elevated blood pressure in the clinic. His other medications include aspirin, lisinopril, atorvastatin, furosemide, insulin, and multivitamins. His symptoms are concerning for orthostatic hypotension. What is the best next intervention? - -correct ans- -Stop amlodipine A 65-year-old man presents with a blood pressure of 159/88 mmHg. This is confirmed with ambulatory blood pressure monitoring at home over the following 7 days. A once-daily amlodipine regime is prescribed. When counseling the patient about this medication, which of the following statements best describes possible ankle edema? - -correct ans- -Ankle edema occurs in approximately 10% of patients taking amlodipine 10 mg once daily A 65-year-old man presents with orthopnea, dyspnea on climbing a few steps, vomiting, diarrhea, and visual changes. The patient also complains of urinary incontinence and cannot recall his daily prescribed medications. Physical examination shows a raised jugular venous pressure, expiratory wheezing, and a significant S3 heart sound. An EKG shows decreased QT interval, prolongation of the PR interval, and T wave inversion/flattening. Increased levels of