PEBC PRACTICE EXAM QUESTIONS WITH
COMPLETE SOLUTIONS
Which CYP-interacting drugs increase the levels of propranolol
and metoprolol? correct answer: CYP2D6 inhibitors (e.g.
amiodarone, paroxetine)
How does digoxin benefit CHF? Atrial fibrillation? correct
answer: Digoxin is a mild positive ionotrope to help HF and is a
negative chronotrope to help Afib.
Which beta-blocker is more likely to cause CNS side effects,
such as depression and insomnia? Why correct answer:
Propranolol will have more CNS side effects due to its greater
lipid solubility and ability to cross the BBB.
Name 4 cardioselective beta-blockers. What are the implications
of this selectivity? correct answer: Atenolol
Acebutolol
Bisoprolol
Metoprolol
Higher selectivity means less non-cardiac side effects, such as
bronchospasm.
Which 2 beta blockers have intrasympathetic activity or ISA?
What are the implications of this? correct answer: Pindolol
Acebutolol
This may be preferred beta blocker agents in patients that are
already bradycardic at rest as they have less effect on the heart
rate.
,The 3 DHP-CCBs. correct answer: Amlodipine
Felodipine
Nifedipine
Characteristics side effects of DHP-CCBs. correct answer:
Ankle edema
Flushing
The 2 non-DHP-CCBs correct answer: Diltiazem
Verapamil
Out of the 2 non-DHP CCBs, which one is more likely to cause
constipation? correct answer: Verapamil > Diltiazem
Instructions on how to use nitroglycerin SL tablets or spray.
correct answer: Use 1 spray or tablet when anginal symptoms
occur. Use 1 dose every 5 minutes for a total of 3 doses. If there
is no improvement after the first dose or no resolution after 3
doses, seek medical help (call ambulance)!
Characteristic side effect of nitrates. correct answer: Headache!
How does verapamil interact with digoxin? correct answer:
Verapamil reduces the renal clearance of digoxin, increasing
digoxin levels.
Where do nitrates have their effect? correct answer: Veins!
Reduces afterload!
, Why must individuals have a 10-12 hour nitrate-free period?
correct answer: To prevent tolerance!
Characteristic drug interaction with nitrates. correct answer:
PDE-5 Inhibitors (sildenafil, tadalafil, vardenafil)
Definition of syncope correct answer: Reversible loss of
consciousness not requiring resuscitative measures or related to
a seizure
Non-pharmacological options for vasovagal syncope. correct
answer: Increased sodium intake (3-5 grams daily) and fluid
intake (2.5 L).
Effects of fludrocortisone. correct answer: Potent
mineralcorticoid: retains sodium, increases loss of potassium
Glucocorticoid effects as well
Non-pharmacological choices for orthostatic hypotension
correct answer: Avoid hypotensive, volume depleting drugs as
much as possible.
Increased sodium and fluid intake.
Elevate head while laying down.
Avoid hemodynamic stress (e.g. getting up too quickly).
Drug(s) that can be used for both vasovagal syncope and
orthostatic hypotension. correct answer: Fludrocortisone
Midodrine (?)
COMPLETE SOLUTIONS
Which CYP-interacting drugs increase the levels of propranolol
and metoprolol? correct answer: CYP2D6 inhibitors (e.g.
amiodarone, paroxetine)
How does digoxin benefit CHF? Atrial fibrillation? correct
answer: Digoxin is a mild positive ionotrope to help HF and is a
negative chronotrope to help Afib.
Which beta-blocker is more likely to cause CNS side effects,
such as depression and insomnia? Why correct answer:
Propranolol will have more CNS side effects due to its greater
lipid solubility and ability to cross the BBB.
Name 4 cardioselective beta-blockers. What are the implications
of this selectivity? correct answer: Atenolol
Acebutolol
Bisoprolol
Metoprolol
Higher selectivity means less non-cardiac side effects, such as
bronchospasm.
Which 2 beta blockers have intrasympathetic activity or ISA?
What are the implications of this? correct answer: Pindolol
Acebutolol
This may be preferred beta blocker agents in patients that are
already bradycardic at rest as they have less effect on the heart
rate.
,The 3 DHP-CCBs. correct answer: Amlodipine
Felodipine
Nifedipine
Characteristics side effects of DHP-CCBs. correct answer:
Ankle edema
Flushing
The 2 non-DHP-CCBs correct answer: Diltiazem
Verapamil
Out of the 2 non-DHP CCBs, which one is more likely to cause
constipation? correct answer: Verapamil > Diltiazem
Instructions on how to use nitroglycerin SL tablets or spray.
correct answer: Use 1 spray or tablet when anginal symptoms
occur. Use 1 dose every 5 minutes for a total of 3 doses. If there
is no improvement after the first dose or no resolution after 3
doses, seek medical help (call ambulance)!
Characteristic side effect of nitrates. correct answer: Headache!
How does verapamil interact with digoxin? correct answer:
Verapamil reduces the renal clearance of digoxin, increasing
digoxin levels.
Where do nitrates have their effect? correct answer: Veins!
Reduces afterload!
, Why must individuals have a 10-12 hour nitrate-free period?
correct answer: To prevent tolerance!
Characteristic drug interaction with nitrates. correct answer:
PDE-5 Inhibitors (sildenafil, tadalafil, vardenafil)
Definition of syncope correct answer: Reversible loss of
consciousness not requiring resuscitative measures or related to
a seizure
Non-pharmacological options for vasovagal syncope. correct
answer: Increased sodium intake (3-5 grams daily) and fluid
intake (2.5 L).
Effects of fludrocortisone. correct answer: Potent
mineralcorticoid: retains sodium, increases loss of potassium
Glucocorticoid effects as well
Non-pharmacological choices for orthostatic hypotension
correct answer: Avoid hypotensive, volume depleting drugs as
much as possible.
Increased sodium and fluid intake.
Elevate head while laying down.
Avoid hemodynamic stress (e.g. getting up too quickly).
Drug(s) that can be used for both vasovagal syncope and
orthostatic hypotension. correct answer: Fludrocortisone
Midodrine (?)
