Physician Assistant Pharmaceutical Therapeutics 3 — Questions and Answers
Question 1: A 45-year-old with type 2 diabetes and established cardiovascular disease is started on an antidiabetic agent. Which class has demonstrated cardiovascular mortality benefit?
- Sulfonylureas
- SGLT-2 inhibitors (Correct answer)
- Alpha-glucosidase inhibitors
- Meglitinides
Correct answer: SGLT-2 inhibitors
SGLT-2 inhibitors (e.g., empagliflozin) have demonstrated significant reduction in major adverse cardiovascular events in large outcome trials.
Question 2: Which opioid analgesic has active metabolites that accumulate in renal failure and can cause CNS toxicity?
- Hydromorphone
- Fentanyl
- Morphine (Correct answer)
- Buprenorphine
Correct answer: Morphine
Morphine-6-glucuronide accumulates in renal failure and can cause prolonged sedation, respiratory depression, and seizures.
Question 3: A patient with newly diagnosed seizure disorder is started on phenytoin. Which finding on CBC would be a serious adverse effect requiring dose adjustment?
- Mild thrombocytosis
- Megaloblastic anemia (Correct answer)
- Polycythemia vera
- Basophilia
Correct answer: Megaloblastic anemia
Phenytoin inhibits folate absorption, leading to megaloblastic anemia; folic acid supplementation may be necessary.
Question 4: Which beta-blocker is cardioselective and preferred in a patient with reactive airway disease requiring antihypertensive therapy?
- Propranolol
- Carvedilol
- Metoprolol succinate (Correct answer)
- Labetalol
Correct answer: Metoprolol succinate
Metoprolol succinate is a beta-1 selective blocker with minimal effect on beta-2 receptors in the bronchi at usual doses.
Question 5: A patient on clopidogrel for ACS is found to be a CYP2C19 poor metabolizer. What is the clinical implication?
- Increased bleeding risk
- Reduced antiplatelet effect and higher thrombotic risk (Correct answer)
- No clinical significance
- Enhanced drug efficacy
Correct answer: Reduced antiplatelet effect and higher thrombotic risk
Clopidogrel requires CYP2C19 activation to its active metabolite; poor metabolizers have diminished platelet inhibition and higher risk of recurrent events.
Question 6: Which medication used for osteoporosis requires patients to remain upright for at least 30 minutes after ingestion?
- Denosumab
- Teriparatide
- Alendronate (Correct answer)
- Raloxifene
Correct answer: Alendronate
Oral bisphosphonates like alendronate can cause esophageal irritation and must be taken with water while remaining upright to prevent esophagitis.
Question 7: A patient on amiodarone develops hypothyroidism. What is the mechanism?
- Direct thyroid gland destruction
- Inhibition of iodide uptake via Wolff-Chaikoff effect (Correct answer)
- Increased TSH receptor antibodies
- Decreased GnRH secretion
Correct answer: Inhibition of iodide uptake via Wolff-Chaikoff effect
Amiodarone contains ~37% iodine by weight; the high iodine load can trigger the Wolff-Chaikoff effect, suppressing thyroid hormone synthesis.
Physician Assistant Pharmaceutical Therapeutics 3
A 45-year-old with type 2 diabetes and established cardiovascular disease is started on an antidiabetic agent.
Which class has demonstrated cardiovascular mortality benefit?