Rosh/Smarty Pance Pharm Review Mod I

A 40-year-old man with a history of intermittent asthma treated with as-needed albuterol presents with worsening asthma symptoms over the past 3 weeks. Cough, shortness of breath, and wheezing have limited his ability to perform his normal activities, such as gardening. He reports using his albuterol inhaler daily to control his symptoms. He is also waking up at night once or twice a week with cough and wheezing. Which of the following would be the preferred medication to control his asthma at this time?

• Mometasone dry powder inhaler 110 mcg/actuation 1 puff at night

• Cromolyn nebulizer 1 ampule four times per day

• Montelukast 10 mg at bedtime

• Theophylline 300 mg daily

A 25-year-old female is brought to the emergency department with an acute asthma exacerbation. The patient takes combination fluticasone propionate and salmeterol for long-term management of severe asthma. Her symptoms are well-controlled while on medication, but for the past few days she has not taken her medication after she left her inhaler at her tennis club. Her pulse is 100/min and respirations are 26/min. On physical examination, she is using accessory muscles of respiration. Rhonchi and wheezing are present in both lung fields. Oxygen saturation is 85% on room air. The patient is started on 2L/min nasal cannula oxygen. Which of the following is the most appropriate next step in management?

• Inhaled albuterol

• Oral montelukast

• Systemic corticosteroids

• IV theophylline

A 57 year-old male with history of hypertension presents with acute gouty arthritis. Which of the following anti- hypertensive classes should be avoided in this patient?

• Thiazide diuretics

• Beta-blockers

• ACE inhibitors

• Calcium channel blockers

A 45-year-old obese Caucasian gentleman arrives at your clinic for a routine check-up after having some blood work done during a workplace health screening. He is found to have an LDL cholesterol level of 720 mg/dL. He states that his father and brother had high cholesterol and both died at a young age from a heart attack. He has a follow-up appointment with his cardiologist because of some occasional chest pain and abnormalities seen on his EKG. Additionally, you notice that he has well-demarcated yellow deposits around his eyes. He is started on high dose statin and his LDL at 12 weeks is 350 mg/dL. What is the next best step in this patient's management?

• Continue high dose statin, the patient's LDL is at goal

• Add niacin 100 mg three times daily

• Add ezetimibe 10 mg daily

• Add a PCSK9 inhibitor

A 57 year-old male recently on a high protein diet presents with an exquisitely tender, erythematous, warm right great toe. Which of the following is the treatment of choice for this patient?

• Corticosteroids

• Probenecid

• Allopurinol

• Non-steroidal antiinflammatory agents

Which of the following medications is the initial treatment of choice for suppressing the progression of rheumatoid arthritis (RA)?

• Naproxen sodium

• Prednisone

• Methotrexate

• Gold salts

A 50-year-old woman presents to the clinic for a 2-week follow-up to post COPD exacerbation. She is still taking the medications used to treat her exacerbation. Her shortness of breath has improved, but she has developed forgetfulness, insomnia, anxiety, and increased irritability. Which medication that she likely received for COPD exacerbation would explain her symptoms?

• Albuterol-ipratropium

• Azithromycin

• Budesonide-formoterol

• Prednisone

A 17 year-old male who is trying out for the track team notes excessive coughing with chest tightness when running. Which of the following is the most appropriate preventive agent for this patient?

• Albuterol inhaler

• Inhaled corticosteroids

• Aminophylline

• Ipratropium

A 43-year-old female presents with a two-year history of frequent episodes of pain and morning stiffness in both hands and wrists. She experiences some symptomatic relief with ibuprofen but feels that the episodes are becoming more frequent and severe. On examination, you observe joint swelling of several MCP joints on both hands. X-ray of the hands shows joint space narrowing of the MCP joints. In addition to NSAIDs, what is the most appropriate first-line long-term medication to treat this patient?

• Prednisone

• Infliximab

• Methotrexate

• Sulfasalazine

Answer explanation

Methotrexate is the standard first-line medication in the treatment of rheumatoid arthritis. This DMARD is generally effective, well-tolerated, and affordable.

A 67 year-old female presents with progressive pain in her left knee that is worse with activity and relieved with rest. She notes stiffness of the knee that last about 20 minutes after activity is resumed. She exercises regularly. No known drug allergies. On physical exam she is 5' 5", 225 pounds. Her left knee exam reveals mild effusion without erythema or warmth. Radiographs of the left knee reveal medial joint space narrowing and subchondral bone sclerosis. Her sodium is 138 mEq/L, potassium 4.3 mEq/L, bicarbonate 24 mEq/L, chloride 104 mEq/L, BUN 23 mg/dl and creatinine 1.8 mg/dl. Which of the following medications is most appropriate for this patient's worsening pain?

• naprosyn

• prednisone

• acetaminophen

• methotrexate

Answer explanation

Naprosyn is contraindicated in patients with abnormal renal function

Acetaminophen is recommended as first-line pharmacotherapy in patients with osteoarthritis