AGNP Board Exam – Cardiovascular Prescribing Exam
1. Question:
Signs and symptoms of digitalis toxicity include:
constipation and muscle spasms.
bradycardia and tinnitus.
headache and dizziness.
blurred vision and persistent diarrhea. Correct
Explanation:
Signs and symptoms of digitalis toxicity include: confusion, irregular pulse, loss of
appetite, nausea, vomiting, diarrhea, fast heart beat, and visual changes (blurred vision,
blind spots, green-yellow color disturbances, halo effect). Regardless of route of
administration, digoxin levels should be checked at 12-24 hours after the last dose.
However, depending on the clinical situation, wait at least 6-8 hours after the last dose
to check levels.
2. Question:
A side effect of beta-blockers that is more common in children than adults is:
decreased appetite.
muscle weakness.
vivid dreams.
a cough that produces mucus. Correct
Explanation:
Side effects of beta-blockers that are more common in children than adults may include
a mucus-producing cough, difficulty breathing, or tightness in the chest. Beta-blockers
are not recommended as initial therapy in children due to potential adverse outcomes
including increased bronchial obstruction and airway reactivity in children with
asthma.
3. Question:
Spironolactone (Aldactone) is highly protein bound and has a duration of:
6 hours.
, 12 hours.
24 hours.
48 hours. Correct
Explanation:
Spironolactone (Aldactone) is greater than 90% protein bound, has a half-life
elimination of 1.4 hours and a duration of 48-72 hours. It is classified as an aldosterone
receptor antagonist. This class blocks the effects of aldosterone, which increases sodium
reabsorption by the kidneys.
4. Question:
Nonselective beta-blockers block the stimulation of:
beta-1 receptors in the heart.
beta-2 receptors in the lungs.
both beta-1 receptors in the heart and beta-2 receptors in the lungs. Correct
neither beta-1 receptors in the heart nor beta-2 receptors in the lungs.
Explanation:
Nonselective beta-blockers (i.e., propranolol [Inderal]) block the stimulation of both
beta-1 receptors in the heart and beta-2 receptors in the lungs. Selective beta-blockers
(i.e. metoprolol [Lopressor]) specifically block beta-1 receptors, but may also block beta-
2 receptors at higher doses. Because they also block beta-2 receptors in the lungs,
nonselective beta-blockers are contraindicated in patients with asthma or chronic
obstructive pulmonary disease.
5. Question:
Dabigatran (Pradaxa), an anticoagulant, is also classified as a:
direct factor Xa inhibitor.
direct thrombin inhibitor. Correct
indirect thrombin inhibitor.
factor V inhibitor.
Explanation:
,Dabigatran (Pradaxa) is a direct thrombin inhibitor (DTI). Medications in this class
inactivate circulating and clotting thrombin (factor IIa). They prevent thrombin (central
to the generation of a thrombus) from attaching fibrinogen to fibrin. DTIs bind directly
to thrombin and do not require a cofactor such as antithrombin to exert their effect.
They can inhibit both soluble thrombin and fibrin-bound thrombin. Key advantages of
using DTIs instead of heparin is that they: produce a more predictable anticoagulant
effect due to their lack of binding to other plasma proteins; exert an antiplatelet effect;
and do not cause immune-mediated thrombocytopenia.
6. Question:
The brand name for candesartan cilexetil is:
Atacand. Correct
Avandia.
Benicar.
Cozaar.
Explanation:
The brand name for candesartan cilexetil is Atacand. The generic name for Avandia is
rosiglitazone; Benicar is olmesartan medoxomil (an ARB); Cozaar is losartan.
Candesartan, olmesartan and losartan are classified as angiotensin receptor blockers
(ARBs) and are used in the treatment of hypertension. Notice that they all end in
"sartan." Rosiglitazone is a thiazolidinedione and is used in the treatment of diabetes.
7. Question:
Gemfibrozil (Lopid), for the treatment of hypertriglyceridemia, is classified as a:
bile acid sequestrant.
nicotinic acid.
fibric acid. Correct
statin.
Explanation:
Gemfibrozil (Lopid) is a fibric acid. It is indicated in the treatment of
hypertriglyceridemia and mixed dyslipidemia. Fibric acid derivatives, also known as
, fibrates, are the recommended treatment for very high triglyceride levels (>500 mg/dL).
Fibrates lower serum triglyceride levels by reducing the liver's production of VLDL
(triglyceride-carrying particle circulating in the blood) and by speeding up the removal
of triglycerides from the blood. Gemfibrozil should not be used concurrently with
statins.
8. Question:
In patients with normal renal function, the diuretic that has the greater antihypertensive
effect is:
osmotic diuretics.
thiazide diuretics. Correct
loop diuretics.
potassium-sparing diuretics.
Explanation:
Among patients with normal renal function, thiazide diuretics, particularly
chlorthalidone (Thalitone), have a greater antihypertensive effect than the loop
diuretics. This may be related to the longer duration of action of thiazides compared to
most loop diuretics. Diuretics lower blood pressure, at least initially, by inducing
sodium and fluid loss. Other thiazide diuretics include hydrochlorothiazide (Microzide)
and methyclothiazide.
9. Question:
An adverse effect of statin therapy for the treatment of hyperlipidemia is:
hypertension.
myalgia. Correct
hypoglycemia.
edema.
Explanation:
Statins may cause myalgia. The pain may be experienced as a soreness, fatigue or
weakness in the muscles. The pain can be a mild discomfort, or it can be severe enough
1. Question:
Signs and symptoms of digitalis toxicity include:
constipation and muscle spasms.
bradycardia and tinnitus.
headache and dizziness.
blurred vision and persistent diarrhea. Correct
Explanation:
Signs and symptoms of digitalis toxicity include: confusion, irregular pulse, loss of
appetite, nausea, vomiting, diarrhea, fast heart beat, and visual changes (blurred vision,
blind spots, green-yellow color disturbances, halo effect). Regardless of route of
administration, digoxin levels should be checked at 12-24 hours after the last dose.
However, depending on the clinical situation, wait at least 6-8 hours after the last dose
to check levels.
2. Question:
A side effect of beta-blockers that is more common in children than adults is:
decreased appetite.
muscle weakness.
vivid dreams.
a cough that produces mucus. Correct
Explanation:
Side effects of beta-blockers that are more common in children than adults may include
a mucus-producing cough, difficulty breathing, or tightness in the chest. Beta-blockers
are not recommended as initial therapy in children due to potential adverse outcomes
including increased bronchial obstruction and airway reactivity in children with
asthma.
3. Question:
Spironolactone (Aldactone) is highly protein bound and has a duration of:
6 hours.
, 12 hours.
24 hours.
48 hours. Correct
Explanation:
Spironolactone (Aldactone) is greater than 90% protein bound, has a half-life
elimination of 1.4 hours and a duration of 48-72 hours. It is classified as an aldosterone
receptor antagonist. This class blocks the effects of aldosterone, which increases sodium
reabsorption by the kidneys.
4. Question:
Nonselective beta-blockers block the stimulation of:
beta-1 receptors in the heart.
beta-2 receptors in the lungs.
both beta-1 receptors in the heart and beta-2 receptors in the lungs. Correct
neither beta-1 receptors in the heart nor beta-2 receptors in the lungs.
Explanation:
Nonselective beta-blockers (i.e., propranolol [Inderal]) block the stimulation of both
beta-1 receptors in the heart and beta-2 receptors in the lungs. Selective beta-blockers
(i.e. metoprolol [Lopressor]) specifically block beta-1 receptors, but may also block beta-
2 receptors at higher doses. Because they also block beta-2 receptors in the lungs,
nonselective beta-blockers are contraindicated in patients with asthma or chronic
obstructive pulmonary disease.
5. Question:
Dabigatran (Pradaxa), an anticoagulant, is also classified as a:
direct factor Xa inhibitor.
direct thrombin inhibitor. Correct
indirect thrombin inhibitor.
factor V inhibitor.
Explanation:
,Dabigatran (Pradaxa) is a direct thrombin inhibitor (DTI). Medications in this class
inactivate circulating and clotting thrombin (factor IIa). They prevent thrombin (central
to the generation of a thrombus) from attaching fibrinogen to fibrin. DTIs bind directly
to thrombin and do not require a cofactor such as antithrombin to exert their effect.
They can inhibit both soluble thrombin and fibrin-bound thrombin. Key advantages of
using DTIs instead of heparin is that they: produce a more predictable anticoagulant
effect due to their lack of binding to other plasma proteins; exert an antiplatelet effect;
and do not cause immune-mediated thrombocytopenia.
6. Question:
The brand name for candesartan cilexetil is:
Atacand. Correct
Avandia.
Benicar.
Cozaar.
Explanation:
The brand name for candesartan cilexetil is Atacand. The generic name for Avandia is
rosiglitazone; Benicar is olmesartan medoxomil (an ARB); Cozaar is losartan.
Candesartan, olmesartan and losartan are classified as angiotensin receptor blockers
(ARBs) and are used in the treatment of hypertension. Notice that they all end in
"sartan." Rosiglitazone is a thiazolidinedione and is used in the treatment of diabetes.
7. Question:
Gemfibrozil (Lopid), for the treatment of hypertriglyceridemia, is classified as a:
bile acid sequestrant.
nicotinic acid.
fibric acid. Correct
statin.
Explanation:
Gemfibrozil (Lopid) is a fibric acid. It is indicated in the treatment of
hypertriglyceridemia and mixed dyslipidemia. Fibric acid derivatives, also known as
, fibrates, are the recommended treatment for very high triglyceride levels (>500 mg/dL).
Fibrates lower serum triglyceride levels by reducing the liver's production of VLDL
(triglyceride-carrying particle circulating in the blood) and by speeding up the removal
of triglycerides from the blood. Gemfibrozil should not be used concurrently with
statins.
8. Question:
In patients with normal renal function, the diuretic that has the greater antihypertensive
effect is:
osmotic diuretics.
thiazide diuretics. Correct
loop diuretics.
potassium-sparing diuretics.
Explanation:
Among patients with normal renal function, thiazide diuretics, particularly
chlorthalidone (Thalitone), have a greater antihypertensive effect than the loop
diuretics. This may be related to the longer duration of action of thiazides compared to
most loop diuretics. Diuretics lower blood pressure, at least initially, by inducing
sodium and fluid loss. Other thiazide diuretics include hydrochlorothiazide (Microzide)
and methyclothiazide.
9. Question:
An adverse effect of statin therapy for the treatment of hyperlipidemia is:
hypertension.
myalgia. Correct
hypoglycemia.
edema.
Explanation:
Statins may cause myalgia. The pain may be experienced as a soreness, fatigue or
weakness in the muscles. The pain can be a mild discomfort, or it can be severe enough
