Pharmacy Therapeutics 4 — Questions and Answers
Question 1: A patient with heart failure with reduced ejection fraction (HFrEF) is already on an ACE inhibitor and beta-blocker. Which additional agent has been shown to reduce mortality?
- Amlodipine
- Digoxin
- Spironolactone (Correct answer)
- Nitrate alone
Correct answer: Spironolactone
Aldosterone antagonists like spironolactone reduce mortality in HFrEF by blocking adverse cardiac remodeling caused by aldosterone.
Question 2: Which drug interaction is most likely to cause serotonin syndrome?
- Metoprolol + amlodipine
- Linezolid + sertraline (Correct answer)
- Warfarin + aspirin
- Digoxin + amiodarone
Correct answer: Linezolid + sertraline
Linezolid has MAO-inhibitory properties; combining it with an SSRI like sertraline significantly elevates synaptic serotonin and risks serotonin syndrome.
Question 3: Which antibiotic class is associated with QT prolongation and is contraindicated in patients with congenital long QT syndrome?
- Penicillins
- Fluoroquinolones (Correct answer)
- Carbapenems
- Tetracyclines
Correct answer: Fluoroquinolones
Fluoroquinolones (e.g., moxifloxacin, ciprofloxacin) block cardiac hERG potassium channels, prolonging the QT interval and increasing risk of torsades de pointes.
Question 4: A 65-year-old patient is prescribed a statin for primary prevention. Which statin and dose is recommended by ACC/AHA guidelines for moderate-intensity therapy?
- Rosuvastatin 40 mg
- Atorvastatin 40 mg
- Atorvastatin 10 mg (Correct answer)
- Simvastatin 80 mg
Correct answer: Atorvastatin 10 mg
Atorvastatin 10 mg and simvastatin 20–40 mg are moderate-intensity statins per ACC/AHA guidelines, targeting approximately 30–49% LDL reduction.
Question 5: A patient with Helicobacter pylori-positive peptic ulcer disease is prescribed triple therapy. Which combination is standard first-line treatment?
- Omeprazole + metronidazole + tetracycline
- Omeprazole + clarithromycin + amoxicillin (Correct answer)
- Ranitidine + doxycycline + azithromycin
- Pantoprazole + ciprofloxacin + levofloxacin
Correct answer: Omeprazole + clarithromycin + amoxicillin
Standard clarithromycin-based triple therapy consists of a PPI plus clarithromycin and amoxicillin for 10–14 days to eradicate H. pylori.
Question 6: Which antipsychotic is most associated with metabolic syndrome, including weight gain and dyslipidemia?
- Haloperidol
- Aripiprazole
- Olanzapine (Correct answer)
- Ziprasidone
Correct answer: Olanzapine
Olanzapine has the highest risk of metabolic side effects among antipsychotics, including significant weight gain, hyperglycemia, and dyslipidemia.
Question 7: In a patient with acute MI undergoing PCI, dual antiplatelet therapy (DAPT) typically consists of aspirin plus which agent?
- Clopidogrel or ticagrelor (Correct answer)
- Warfarin
- Dipyridamole
- Cilostazol
Correct answer: Clopidogrel or ticagrelor
Guideline-recommended DAPT after PCI for ACS includes aspirin plus a P2Y12 inhibitor such as clopidogrel, ticagrelor, or prasugrel for at least 12 months.
Pharmacy Therapeutics 4
A patient with heart failure with reduced ejection fraction (HFrEF) is already on an ACE inhibitor and beta-blocker.
Which additional agent has been shown to reduce mortality?