AGNP BOARD EXAM CARDIOVASCULAR
PRESRIBING (QUESTIONS WITH ANSWERS AND
EXPLANATIONS)
Question:1
Signs and symptoms of digitalis toxicity include:
A. constipation and muscle spasms.
B. bradycardia and tinnitus.
C. headache and dizziness.
D. 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.
Question:2
A side effect of beta-blockers that is more common in children than adults is:
A. decreased appetite.
B. muscle weakness.
C. vivid dreams.
D. 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.
,Question:3
Spironolactone (Aldactone) is highly protein bound and has a duration of:
A. 6 hours.
B. 12 hours.
C. 24 hours.
D. 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.
Question:4
Nonselective beta-blockers block the stimulation of:
A. beta-1 receptors in the heart.
B. beta-2 receptors in the lungs.
C. both beta-1 receptors in the heart and beta-2 receptors in the lungs. Correct
D. 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.
Question:5
Dabigatran (Pradaxa), an anticoagulant, is also classified as a:
A. direct factor Xa inhibitor.
B. direct thrombin inhibitor. Correct
, C. indirect thrombin inhibitor.
D. 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.
Question:6
The brand name for candesartan cilexetil is:
A. Atacand. Correct
B. Avandia.
C. Benicar.
D. 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.
Question:7
Gemfibrozil (Lopid), for the treatment of hypertriglyceridemia, is classified as a:
A. bile acid sequestrant.
B. nicotinic acid.
, C. fibric acid. Correct
D. 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.
Question:8
In patients with normal renal function, the diuretic that has the greater antihypertensive effect
is:
A. osmotic diuretics.
B. thiazide diuretics. Correct
C. loop diuretics.
D. 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.
Question:9
An adverse effect of statin therapy for the treatment of hyperlipidemia is:
A. hypertension.
B. myalgia. Correct
C. hypoglycemia.
PRESRIBING (QUESTIONS WITH ANSWERS AND
EXPLANATIONS)
Question:1
Signs and symptoms of digitalis toxicity include:
A. constipation and muscle spasms.
B. bradycardia and tinnitus.
C. headache and dizziness.
D. 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.
Question:2
A side effect of beta-blockers that is more common in children than adults is:
A. decreased appetite.
B. muscle weakness.
C. vivid dreams.
D. 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.
,Question:3
Spironolactone (Aldactone) is highly protein bound and has a duration of:
A. 6 hours.
B. 12 hours.
C. 24 hours.
D. 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.
Question:4
Nonselective beta-blockers block the stimulation of:
A. beta-1 receptors in the heart.
B. beta-2 receptors in the lungs.
C. both beta-1 receptors in the heart and beta-2 receptors in the lungs. Correct
D. 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.
Question:5
Dabigatran (Pradaxa), an anticoagulant, is also classified as a:
A. direct factor Xa inhibitor.
B. direct thrombin inhibitor. Correct
, C. indirect thrombin inhibitor.
D. 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.
Question:6
The brand name for candesartan cilexetil is:
A. Atacand. Correct
B. Avandia.
C. Benicar.
D. 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.
Question:7
Gemfibrozil (Lopid), for the treatment of hypertriglyceridemia, is classified as a:
A. bile acid sequestrant.
B. nicotinic acid.
, C. fibric acid. Correct
D. 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.
Question:8
In patients with normal renal function, the diuretic that has the greater antihypertensive effect
is:
A. osmotic diuretics.
B. thiazide diuretics. Correct
C. loop diuretics.
D. 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.
Question:9
An adverse effect of statin therapy for the treatment of hyperlipidemia is:
A. hypertension.
B. myalgia. Correct
C. hypoglycemia.
