Pharmacology Flashcards

A patient started on lisinopril develops lip and tongue swelling without urticaria. What is the most likely mechanism?

Answer: Decreased bradykinin degradation

ACE also breaks down bradykinin, so inhibiting it lets bradykinin build up and cause angioedema.

Which electrolyte abnormality most increases the risk of digoxin toxicity?

Answer: Hypokalemia

Low potassium increases digoxin binding to Na+/K+-ATPase, which makes toxicity more likely.

A patient in hypertensive emergency on a prolonged high-dose infusion develops metabolic acidosis and confusion. Which drug is responsible?

Answer: Sodium nitroprusside

Nitroprusside releases cyanide as it is metabolized, and cyanide builds up with long or high-dose infusions.

A patient on long-term therapy for atrial fibrillation develops progressive dyspnea and bilateral interstitial infiltrates. Which drug is most likely the cause?

Answer: Amiodarone

Amiodarone causes dose-related pulmonary fibrosis, so patients need baseline and follow-up pulmonary function testing.

Which drug, added to hydralazine, lowers mortality in self-identified Black patients with HFrEF?

Answer: Isosorbide dinitrate

The A-HeFT trial showed a mortality benefit for hydralazine plus isosorbide dinitrate in this group.

Adding which lipid-lowering drug to a statin most increases the risk of rhabdomyolysis?

Answer: Gemfibrozil

Gemfibrozil blocks statin glucuronidation, which raises statin levels and the risk of myopathy.

A man with heart failure develops painful gynecomastia on spironolactone. Which aldosterone antagonist should he be switched to?

Answer: Eplerenone

Eplerenone is a more selective mineralocorticoid receptor antagonist with little antiandrogenic effect.