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
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
