Autonomic/CV Drugs — MCQs

A 6-month-old infant boy is brought to the clinic for a check-up by a couple who recently adopted him from foster care. The biological mother was from a rehabilitation facility and was found incompetent to care for the child, hence he was handed over to foster care. No other information is available regarding his prenatal or birth history. On examination, his weight is found to be below the 3rd percentile. Physical appearance is remarkable for midfacial hypoplasia with a flattened nasal bridge, smooth philtrum, and thin lips. Auscultation reveals a grade 3/6 holosystolic murmur at the left lower sternal border. Developmental delay is noted as well. Which of the following teratogens is most likely to be associated with the infant's presentation?

A 42-year-old man comes to the emergency department because of tingling in his hands and legs and palpitations for 1 week. He has also had severe cramping in his hands, feet, and abdomen during this period. Three months ago, he was hospitalized for acute pancreatitis. He discharged himself against medical advice at that time. There is no family history of illness. He does not smoke. He drinks 2–3 beers and a pint of vodka daily. He has a history of using intravenous heroin. He has not had a stable job for a year. He is only oriented to place and person. His temperature is 37.1°C (98.8°F), pulse is 90/min, and blood pressure is 110/96 mm Hg. There is a carpopedal spasm while measuring his blood pressure. Cardiopulmonary examination shows no abnormalities. Deep tendon reflexes are 4+ bilaterally. Neurologic examination shows no focal findings. Which of the following is the most appropriate pharmacotherapy?

A 30-year-old female with a history of epilepsy becomes pregnant. Her epilepsy has been well controlled by taking a medication that inhibits GABA transaminase and blocks voltage-gated sodium and calcium channels. Her obstetrician informs her that her epilepsy medication has been shown to have teratogenic effects. Of the following, which teratogenic effect is this woman's medication most likely to cause?

A 62-year-old man with a history of coronary artery disease comes to the emergency department with substernal chest pain for several hours. An ECG shows no abnormalities. Troponin T test results are negative. The patient is admitted to the hospital and treated with intravenous nitroglycerin, with an initial resolution of his symptoms. After 6 hours of continuous infusion of nitroglycerin, he reports increasing chest pain. The underlying cause of this patient's recurrent symptoms is most likely to also occur in treatment with which of the following drugs?

A 60-year-old woman is brought to the emergency department by paramedics after being found unresponsive. It is not possible to obtain a history. Her blood pressure is 75/30 mmHg and pulse is 108/min. Her extremities are cool and mottled. She is admitted to the intensive care unit (ICU) for further supportive care, where she is started on a norepinephrine intravenous drip. After several hours on this infusion, which of the following changes in vitals would be expected?

A 56-year-old man with type 2 diabetes mellitus comes to the physician for a follow-up examination. He reports that he has been compliant with his current antidiabetic medication regimen. His hemoglobin A1c concentration is 8.5%. The physician prescribes a drug that reversibly inhibits a membrane-bound enzyme that hydrolyzes carbohydrate bonds. Which of the following drugs was most likely added to this patient's medication regimen?

A 72-year-old man with type 2 diabetes mellitus, hypertension, and systolic heart failure comes to the physician because of a 5-day history of progressively worsening shortness of breath at rest. Physical examination shows jugular venous distention, diffuse crackles over the lower lung fields, and bilateral lower extremity edema. As a part of treatment, he is given a derivative of a hormone that acts by altering guanylate cyclase activity. This drug has been found to reduce pulmonary capillary wedge pressure and causes systemic hypotension as an adverse effect. The drug is most likely a derivative of which of the following hormones?

A 49-year-old man being treated for Helicobacter pylori infection presents to his primary care physician complaining of lower back pain. His physician determines that a non-steroidal anti-inflammatory drug (NSAID) would be the most appropriate initial treatment. Which of the following is the most appropriate NSAID for this patient?

A 37-year-old man is brought to the emergency department following a motor vehicle collision. His temperature is 38.1°C (100.6°F), pulse is 39/min, respirations are 29/min, and blood pressure is 58/42 mm Hg. There is no improvement in his blood pressure despite adequate fluid resuscitation. A drug is administered that causes increased IP3 concentrations in arteriolar smooth muscle cells and increased cAMP concentrations in cardiac myocytes. This drug only has a negligible effect on cAMP concentration in bronchial smooth muscle cells. Which of the following sets of cardiovascular changes is most likely following administration of this drug?

A 64-year-old man presents to the emergency department with sudden onset of pleuritic chest pain and dyspnea on exertion. He has a history of lung cancer and is currently being treated with outpatient chemotherapy. His temperature is 98.9°F (37.2°C), blood pressure is 111/64 mmHg, pulse is 130/min, respirations are 25/min, and oxygen saturation is 90% on room air. Initial laboratory values in the emergency department are seen below. Hemoglobin: 8.2 g/dL Hematocrit: 26% Leukocyte count: 7,700/mm^3 with normal differential Platelet count: 157,000/mm^3 A CT angiogram demonstrates a blood clot in the pulmonary vasculature. The patient is started on heparin and he is admitted to the ICU. Laboratory values 6 days later are shown below. Hemoglobin: 8.0 g/dL Hematocrit: 25% Leukocyte count: 7,500/mm^3 with normal differential Platelet count: 22,000/mm^3 Which of the following is the most appropriate next step in management?