Autonomic/CV Drugs — MCQs

A new drug X is being tested for its effect on renal function. During the experiments, the researchers found that in patients taking substance X, the urinary concentration of sodium decreases while urine potassium concentration increase. Which of the following affects the kidneys in the same way as does substance X?

A 7-year-old girl presents with a low-grade fever, lethargy, and fatigue for the past week. The patient’s mother says she also complains of leg pain for the past couple of weeks. No significant past medical history. The patient was born at term via spontaneous transvaginal delivery with no complications. On physical examination, the patient shows generalized pallor. Cervical lymphadenopathy is present. A bone marrow biopsy is performed which confirms the diagnosis of acute lymphoblastic leukemia (ALL). The patient is started on a chemotherapy regimen consisting of vincristine, daunorubicin, L-asparaginase, and prednisolone for induction, followed by intrathecal methotrexate for maintenance. Following the 4th cycle of chemotherapy, she develops bilateral ptosis. Physical examination shows a normal pupillary reflex and eye movements. She is started on pyridoxine and pyridostigmine, and, in 7 days, she has complete resolution of the ptosis. Which of the following drugs is most likely associated with this patient’s adverse reaction?

A 23-year-old woman is brought to the emergency department by her friend because of a 1-hour episode of confusion. Earlier that night, they were at a dance club, and the patient was very energetic and euphoric. Thirty minutes after arriving, she became agitated and nauseous. She no longer seemed to know where she was or how she got there, and she began talking to herself. She has no major medical illness. She is an undergraduate student at a local college. She does not smoke but drinks 10–14 mixed drinks each week. Her temperature is 38.3°C (100.9°F), pulse is 115/min and regular, respirations are 16/min, and blood pressure is 138/84 mm Hg. She oriented to self but not to time or place. Throughout the examination, she grinds her teeth. Her pupils are 7 mm in diameter and minimally reactive. Her skin is diffusely flushed and diaphoretic. Cardiopulmonary examination shows no abnormalities. Serum studies show: Na+ 129 mEq/L K+ 3.7 mEq/L HCO3- 22 mEq/L Creatinine 1.2 mg/dL Glucose 81 mg/dL Which of the following substances is the most likely cause of this patient's presentation?

A 30-year-old woman presents complaining of shortness of breath, chest pain, and fatigue. The patient complains of dyspnea upon exertion, generalized fatigue, lethargy, and chest pain associated with strenuous activities. Her history is notable for an atrial septal defect at birth. Her temperature is 99.5°F (37.5°C), blood pressure is 147/98 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. On exam, she has a wide, fixed splitting of S2. Which of the following medications most directly treats the underlying pathophysiology causing this patient's presentation?

Please refer to the summary above to answer this question Which of the following is the most appropriate pharmacotherapy? Patient Information Age: 30 years Gender: F, self-identified Ethnicity: unspecified Site of Care: office History Reason for Visit/Chief Concern: "I'm so anxious about work." History of Present Illness: 7-month history of sensation that her heart is racing whenever she gives oral presentations at work she has also had moderate axillary sweating during these presentations and feels more anxious and embarrassed when this happens feels otherwise fine when she is interacting with her colleagues more casually around the workplace Past Medical History: alcohol use disorder, now abstinent for the past 2 years acute appendicitis, treated with appendectomy 5 years ago verrucae planae Medications: disulfiram, folic acid, topical salicylic acid Allergies: no known drug allergies Psychosocial History: does not smoke, drink alcohol, or use illicit drugs Physical Examination Temp Pulse Resp BP O2 Sat Ht Wt BMI 36.7°C (98°F) 82/min 18/min 115/72 mm Hg – 171 cm (5 ft 7 in) 58 kg (128 lb) 20 kg/m2 Appearance: no acute distress Pulmonary: clear to auscultation Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs Abdominal: has well-healed laparotomy port scars; no tenderness, guarding, masses, bruits, or hepatosplenomegaly Extremities: no tenderness to palpation, stiffness, or swelling of the joints; no edema Skin: warm and dry; there are several skin-colored, flat-topped papules on the dorsal bilateral hands Neurologic: alert and oriented; cranial nerves grossly intact; no focal neurologic deficits Psychiatric: describes her mood as "okay"; speech has a rapid rate but normal rhythm; thought process is organized

A 70-year-old man is brought to the emergency department unconscious after a fall. He appears pale and is pulseless. A 12-lead EKG reveals wide, monomorphic sawtooth-like QRS complexes. He undergoes synchronized cardioversion three times at increasing voltage with no effect. Epinephrine is administered with minimal effect. Which drug will minimize his risk of developing multifocal ventricular tachycardia?

A 27-year-old P1G1 who has had minimal prenatal care delivers a newborn female infant. Exam reveals a dusky child who appears to be in distress. Her neck veins are distended and you note an enlarged v wave. She has a holosystolic murmur. Following echocardiogram, immediate surgery is recommended. For which of the following conditions was the mother likely receiving treatment during pregnancy?

A 50-year-old woman presents to the ED 6 hours after ingesting three bottles of baby aspirin. She complains of nausea, vomiting, dizziness, and tinnitus. Her blood pressure is 135/80 mmHg, pulse is 110/min, respirations are 32/min, temperature is 100.1 deg F (37.8 deg C), and oxygen saturation is 99% on room air. Arterial blood gas at room air shows, PCO2 11 mmHg, and PO2 129 mmHg. Blood salicylate level is 55 mg/dL. Management should involve which of the following acid-base principles?

A 72-year-old man of Asian descent seeks evaluation at your medical office and is frustrated about the frequency he wakes up at night to urinate. He comments that he has stopped drinking liquids at night, but the symptoms have progressively worsened. The physical examination is unremarkable, except for an enlarged, symmetric prostate free of nodules. Which of the following should you prescribe based on the main factor that contributes to the underlying pathogenesis?

An endocrinologist is working with a pharmaceutical research company on a new drug for diabetes mellitus type 2 (DM2). In their experimental studies, they isolated a component from Gila monster saliva, which was found to have > 50% homology with glucagon-like peptide-1 (GLP1). During the animal studies, the experimental drug was found to have no GLP1 agonist effect. Instead, it irreversibly binds DPP-IV with a higher affinity than GLP1. Which of the following drugs has a similar mechanism of action to this new experimental drug?