Pharm.D. Doctor of Pharmacy Clinical Pharmacology and Therapeutics 1 — Questions and Answers
Question 1: Which drug class is the first-line treatment for type 2 diabetes mellitus in most patients without contraindications?
- Sulfonylureas
- Metformin (biguanide) (Correct answer)
- Insulin glargine
- DPP-4 inhibitors
Correct answer: Metformin (biguanide)
Metformin is the first-line pharmacological treatment for type 2 diabetes due to its efficacy, safety profile, low cost, and cardiovascular benefits.
Question 2: A patient with hypertension also has heart failure with reduced ejection fraction (HFrEF). Which antihypertensive class provides the greatest mortality benefit?
- Calcium channel blockers
- ACE inhibitors or ARBs (Correct answer)
- Thiazide diuretics
- Alpha-1 blockers
Correct answer: ACE inhibitors or ARBs
ACE inhibitors (or ARBs if ACE-intolerant) are first-line for HFrEF due to proven mortality reduction by blocking the renin-angiotensin-aldosterone system.
Question 3: Which beta-blocker is considered cardioselective due to its preferential beta-1 receptor blockade?
- Propranolol
- Carvedilol
- Metoprolol succinate (Correct answer)
- Labetalol
Correct answer: Metoprolol succinate
Metoprolol succinate is cardioselective, primarily blocking beta-1 receptors in the heart with less effect on beta-2 receptors in the lungs, making it safer in patients with mild asthma.
Question 4: Which anticoagulant is first-line for the initial and long-term treatment of venous thromboembolism (VTE) in most patients?
- Unfractionated heparin only
- Warfarin bridged with heparin
- Direct oral anticoagulants (DOACs) such as rivaroxaban or apixaban (Correct answer)
- Aspirin
Correct answer: Direct oral anticoagulants (DOACs) such as rivaroxaban or apixaban
DOACs (e.g., rivaroxaban, apixaban) are preferred for VTE treatment due to their predictable pharmacokinetics, fewer interactions, and no need for routine monitoring.
Question 5: Albuterol is a short-acting beta-2 agonist (SABA) used for acute bronchospasm. Its primary mechanism is:
- Blocking muscarinic receptors in airways
- Stimulating beta-2 receptors to relax bronchial smooth muscle (Correct answer)
- Inhibiting leukotriene synthesis
- Reducing airway inflammation via glucocorticoid receptor
Correct answer: Stimulating beta-2 receptors to relax bronchial smooth muscle
Albuterol selectively activates beta-2 adrenergic receptors on bronchial smooth muscle, causing relaxation and bronchodilation through increased cAMP.
Question 6: Which drug is the antidote for acetaminophen overdose in the US?
- Naloxone
- Flumazenil
- N-acetylcysteine (NAC) (Correct answer)
- Atropine
Correct answer: N-acetylcysteine (NAC)
N-acetylcysteine replenishes glutathione stores, allowing detoxification of NAPQI (the toxic acetaminophen metabolite) and preventing hepatocellular necrosis.
