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NEW QUESTION 45
An 18-year-old female is referred to a dermatologist for treatment of severe acne vulgaris. The dermatologist wants to start her on tetracycline.
What test should the patient have prior to starting treatment?

• A. Chest X-ray
• B. Complete blood count
• C. Creatine kinase
• D. Liver function tests
• E. Pregnancy test

Answer: E

Explanation:
Explanation
Pregnancy test. Tetracyclines are effective in the treatment of severe cases of acne. They are however teratogenic. As such, it is imperative to make sure female patients are not pregnant prior to starting this medication. In many instances patients are started on concurrent birth control to mitigate this risk even further.
A chest x-ray (B) is an important exam to obtain prior to starting drugs which have pulmonary toxicity as a side effect such as amiodarone. A complete blood count (C) would be useful prior to starting a medication that causes anemia, such as immunosuppressive and chemotherapeutic agents. Liver function tests (D) are important to establish as a baseline prior to starting anti-mycobacterial agents. Creatine kinase levels (E) are used to establish as a baseline prior to starting statins.

NEW QUESTION 46
TM is a 78 YOW with a history of hypertension, hypercholesterolemia and arthritis was admitted for proximal arterial fibrillation.
While in the hospital she was placed on diltiazem drip and eventually, converted to oral diltiazem 240mg. Pt's home medication includes Simvastatin 40mg po daily , hydrochlorothiazide 25mg po daily , Lisinopril 20mg daily and Acetaminophen. Her LDL-C is 100mg /dL.
What would be the most appropriate change to make on her therapy?

• A. Discontinue Statins.
• B. Increase Simvastatin to 80mg po daily
• C. Change Simvastatin to Lovastatin 20mg po daily
• D. Keep Simvastatin at 40mg po daily
• E. Change Simvastatin 40mg to Atorvastatin 40mg po daily

Answer: E

Explanation:
Explanation
Diltiazem has a major drug interaction with Simvastatin. Diltiazem is a CYP3A4 inhibitor, and since Simvastatin is metabolized by CYP3A4, its level can build up and the risk of myopathy increases. It is recommended to switch to a non-CYP3A inhibitor such as Pitavastatin, Pravastatin, or Rosuvastatin, and if Simvastatin is to be kept on it should not exceed 10 mg/day. The same interaction also exists with lovastatin, and the recommendation is to not exceed a total dose of 20 mg/day po of Lovastatin. Given the current options, the best choice is to change to Atorvstatin 40 mg po daily.

NEW QUESTION 47
According to the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, which of the following medications and dosing regimens is considered moderate-intensity statin therapy?

• A. Atorvastatin 20mg PO QHS
• B. Rosuvastatin 40 mg PO QHS
• C. Atorvastatin 80 mg PO QHS
• D. Lovastatin 20 mg PO QHS
• E. Simvastatin 40 mg PO QHS

Answer: A

Explanation:
Explanation
Moderate-Intensity Statin Therapy: Atorvastatin 10 (20) mg, Rosuvastatin (5) 10 mg, Simvastatin 20-40 mg, Pravastatin 40 (80) mg, Lovastatin 40 mg, Fluvastatin XL 80 mg, Fluvastatin 40 mg bid, Pitavastatin 2-4 mg

NEW QUESTION 48
Select the class of Anti-diabetic medication that works in the specified organ to prevent hyperglycemia. Select all that applies. Brain (E)

• A. Glucagon-like peptide-1 receptor agonists
• B. Thiazolidinediones
• C. Sulfonylureas
• D. SGLT2 inhibitors
• E. Alpha- Glucosidase Inhibitors
• F. DPP4 Inhibitors
• G. Biguanide

Answer: A

Explanation:
Explanation
Glucagon-like peptide-1 receptor agonists Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha-Glucosidase Inhibitors stop -glucosidase enzymes in the small intestine and delay digestion and absorption of starch and disaccharides which lowers the levels of glucose after meals. DPP4 blocks the degradation ofGLP-1, GIP, and a variety of other peptides, including brain natriuretic peptide. Glucagon-like peptide-1 receptor agonists work in various organs of the body.
Glucagon-like peptide-1 receptor agonists enhance glucose homeostasis through: (i) stimulation of insulin secretion; (ii) inhibition of glucagon secretion; (iii) direct and indirect suppression of endogenous glucose production; (iv) suppression of appetite; (v) enhanced insulin sensitivity secondary to weight loss; (vi) delayed gastric emptying, resulting in decreased postprandial hyperglycaemia. Thiazolidinediones are the only true insulin-sensitising agents, exerting their effects in skeletal and cardiac muscle, liver, and adipose tissue. It ameliorates insulin resistance, decreases visceral fat. Biguanides work in liver, muscle, adipose tissue via activation of AMP-activated protein kinase (AMPK) reduce hepatic glucose production. SGLT2 inhibitors work in the kidneys to inhibit sodium-glucose transport proteins to reabsorb glucose into the blood from muscle cells; overall this helps to improve insulin release from the beta cells of the pancreas.

NEW QUESTION 49
Your patient, a 25-year-old G1P0 female at 26 weeks gestation presents due to an abnormal glucose tolerance test. One week prior, she was given 50 g of oral glucose and demonstrate a venous plasma glucose level of
156 mg/dL one hour later.
Which of the following is the most appropriate next step of management?

• A. Administer an oral, 3-hour 100 g glucose dose
• B. Order a fetal ultrasound examination
• C. Repeat the 50 g oral glucose challenge
• D. Begin insulin treatment
• E. Advise the patient to follow an American Diabetic Association diet plan

Answer: A

Explanation:
Gestational diabetes is typically asymptomatic but identified via a 1-hour 50g oral glucose challenge administered at 24-28 weeks of gestation. A venous plasma glucose blood level of > 140 mg/dL is suggestive, and must be confirmed with a 3-hour 100g oral glucose tolerance test. After administration of the 100g glucose challenge, at least two of the following are required for diagnosis: (1) fasting glucose > 95 mg/dL, (2) one-hour glucose >180 mg/dL, (3) two hour glucose >155 mg/dL, and (4) three hour glucose > 140 mg/dL. Choice A - To diagnose gestational diabetes, a positive 1-hour 50g oral glucose challenge must be followed up by a three- hour 100g oral glucose challenge. The diagnosis is only confirmed after both challenges are completed and the thresholds are met. Choice C - Following the diagnosis of gestational diabetes, the first step is strict glycemic control (fasting glucose).

NEW QUESTION 50
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