, First-line treatment for stable angina?
Answer: Nitroglycerin (sublingual) for acute relief; beta-blockers for long-term
management
Rationale: Nitroglycerin provides immediate venodilation and coronary artery dilation
to relieve acute anginal symptoms. Beta-blockers reduce myocardial oxygen demand by
decreasing heart rate, contractility, and blood pressure, making them first-line for long-
term management of stable angina.
First-line treatment for HTN in a patient with diabetes?
Answer: ACE inhibitors or ARBs
Rationale: ACE inhibitors and ARBs provide renoprotective effects beyond blood
pressure control by reducing intraglomerular pressure and albuminuria, which is
particularly beneficial in patients with diabetes who are at increased risk for diabetic
nephropathy.
Treatment for opioid-induced constipation?
Answer: Methylnaltrexone, naloxegol, or senna with docusate
Rationale: Methylnaltrexone and naloxegol are peripherally-acting mu-opioid receptor
antagonists that block opioid effects in the GI tract without affecting central analgesia.
Senna with docusate is a stimulant laxative plus stool softener often used as first-line
over-the-counter management.
First-line therapy for neuropathic pain?
Answer: Gabapentin or pregabalin (SNRIs like duloxetine are also considered first-line)
Rationale: Gabapentin and pregabalin bind to calcium channels and reduce
neurotransmitter release, demonstrating strong efficacy in neuropathic pain conditions
such as diabetic neuropathy and postherpetic neuralgia. SNRIs provide dual reuptake
inhibition of serotonin and norepinephrine, enhancing descending inhibitory pain
pathways.
What is the mechanism of action of allopurinol?
Answer: Xanthine oxidase inhibitor; decreases uric acid production
Rationale: Allopurinol inhibits xanthine oxidase, the enzyme responsible for converting
hypoxanthine to xanthine and xanthine to uric acid, thereby reducing serum uric acid
levels and preventing gout flares.
What to monitor with methotrexate?
Answer: CBC, liver function tests, renal function, and periodic chest x-ray (for pulmonary
toxicity)
Rationale: Methotrexate can cause bone marrow suppression (requiring CBC
monitoring), hepatotoxicity (LFTs), and nephrotoxicity (renal function). Pulmonary
Answer: Nitroglycerin (sublingual) for acute relief; beta-blockers for long-term
management
Rationale: Nitroglycerin provides immediate venodilation and coronary artery dilation
to relieve acute anginal symptoms. Beta-blockers reduce myocardial oxygen demand by
decreasing heart rate, contractility, and blood pressure, making them first-line for long-
term management of stable angina.
First-line treatment for HTN in a patient with diabetes?
Answer: ACE inhibitors or ARBs
Rationale: ACE inhibitors and ARBs provide renoprotective effects beyond blood
pressure control by reducing intraglomerular pressure and albuminuria, which is
particularly beneficial in patients with diabetes who are at increased risk for diabetic
nephropathy.
Treatment for opioid-induced constipation?
Answer: Methylnaltrexone, naloxegol, or senna with docusate
Rationale: Methylnaltrexone and naloxegol are peripherally-acting mu-opioid receptor
antagonists that block opioid effects in the GI tract without affecting central analgesia.
Senna with docusate is a stimulant laxative plus stool softener often used as first-line
over-the-counter management.
First-line therapy for neuropathic pain?
Answer: Gabapentin or pregabalin (SNRIs like duloxetine are also considered first-line)
Rationale: Gabapentin and pregabalin bind to calcium channels and reduce
neurotransmitter release, demonstrating strong efficacy in neuropathic pain conditions
such as diabetic neuropathy and postherpetic neuralgia. SNRIs provide dual reuptake
inhibition of serotonin and norepinephrine, enhancing descending inhibitory pain
pathways.
What is the mechanism of action of allopurinol?
Answer: Xanthine oxidase inhibitor; decreases uric acid production
Rationale: Allopurinol inhibits xanthine oxidase, the enzyme responsible for converting
hypoxanthine to xanthine and xanthine to uric acid, thereby reducing serum uric acid
levels and preventing gout flares.
What to monitor with methotrexate?
Answer: CBC, liver function tests, renal function, and periodic chest x-ray (for pulmonary
toxicity)
Rationale: Methotrexate can cause bone marrow suppression (requiring CBC
monitoring), hepatotoxicity (LFTs), and nephrotoxicity (renal function). Pulmonary
