You prescribe doxepin to a 37-year-old woman to treat neurotic excoriations on her arms. The patient is concerned about the side effects of this drug. Which of the following is not a side effect of doxepin:
A,C,D,E -- False -- Doxepin is a tricyclic antidepressant with H1 and H2 antihistamine activity. Side effects include sedation and anticholinergic effects (dry mouth, urinary retention, and constipation). Although extensively metabolized by the liver and excreted by the kidney, liver toxicity is very rare. Nephrotoxicity, on the other hand, is a well-known serious adverse effect of long term doxepin use.
Which of the following beta-blocker is NOT proven to reduce mortality in patients with Systolic CHF?
Nadolol is not proven to reduce mortality in patients with systolic CHF. The efficacy of nadolol in HF has not been determined. For patients taking nadolol, it should be used with caution in those with compensated heart failure and patients should be monitored for a worsening of the condition. Bisoprolol, carvedilol, and sustained- release metoprolol succinate are the beta-blockers that have been proven to reduce mortality in patients with systolic CHF. These 3 beta-blockers have been effective in reducing the risk of death in patients with chronic HFrEF. Other beta-blockers were found to be less effective. Bucindolol did not exhibit uniform effectiveness across different populations. Metoprolol tartrate was found to be less effective in HF clinical trials.
http://circ.ahajournals.org/content/128/16/e240
Which of the following is recommended to be monitored in patients on Divalproex Sodium?
A, B, C. Hepatotoxicity, including hepatic failure, has been fatal and may more commonly occur in the first 6 months of treatment. Valproic acid and its analogs are contraindicated in patients with known urea cycle disorders. Patients with urea cycle disorders have a genetic enzyme defect leading to an impaired ability to produce urea. Hyperammonemic encephalopathy has been reported following initiation of valproate therapy. Because of, inhibition of the secondary phase of platelet aggregation, and abnormal coagulation parameters complete blood counts and coagulation tests are recommended before initiating valproic acid therapy and at periodic intervals.
The administration of dapsone gel for the topical treatment of acne vulgaris in patients with G6PD deficiency may produce which of these?
Dapsone treatment has produced dose-related hemolysis and hemolytic anemia. Individuals with glucose-6 phosphate dehydrogenase (G6PD) deficiency are more prone to hemolysis.
RL is a 54 YOM who's calculated 10-year atherosclerotic cardiovascular disease (ASCVD) risk is 18 %.
Which of the following is the most appropriate pharmacotherapy recommendation for CR?
This patient belongs in one of the four statin benefit groups because his estimated 10-year ASCVD risk is over 7.5%. Adults 40 to 75 years of age with LDL--C 70 to 189 mg/dL, with an estimated 10-year ASCVD risk 7.5% and without clinical ASCVD or diabetes should receive either a moderate-intensity or high-intensity statin. Since the extent of reducing the risk of ASCVD is proportionally related to the degree of LDL-C reduction, risk could be reduced more so with a high intensity statin. Considering the given options, Atorvastatin 80 mg PO QHS is the best choice.
