NMS Q&A Family Medicine

326 NMS Q&A Family Medicine7 A 45-year-old man has been treated for hypertensionwith clonidine (e.g., Catapres), titrated to 0.2 mgdaily. However, he has begun to complain of fatigue,and the primary care doctor makes a decision tochange the antihypertensive medication to the beta-1selective blocking agent, atenolol. Which of the followingis the wisest method for making the change?(A) Start the atenolol as 50 mg daily 2 days beforediscontinuation of the clonidine.(B) Start atenolol 4 days before the discontinuanceof clonidine as 25 mg daily and increase it to50 mg daily 2 days before the change.(C) Start the atenolol at the maintenance dosage of50 mg on the day after the last dose of clonidine.(D) Discontinue clonidine and wait 2 days beforestarting atenolol at a prudent beginning dosage.(E) Taper the clonidine off as the atenolol is startedlow and accelerates, with the two drugsoverlapping in their subtherapeutic levels over a4-day period.8 Besides the manifestations of Cushing syndrome, whichof the following may be a complication of systemic glucocorticoidadministration over several weeks?(A) Decreased insulin requirements in diabetics(B) Lymphoproliferative disorder(C) Atrophic gastritis(D) Premature closure of epiphyses in growingchildren(E) Glaucoma9 A 33-year-old woman is brought to an emergencydepartment in stupor with a history of attemptingsuicide with a prescribed benzodiazepine. Which ofthe following is the specifically indicated drug for thisemergency?(A) Naloxone(B) Buprenorphine(C) Flumazenil(D) Dextroamphetamine(E) Phenobarbital10 Fluoxetine (Prozac, an SSRI antidepressant) has beenprescribed for a 35-year-old woman with depression.Which of the following side effects would be morelikely, given this combination, if she is to be giventolterodine (Detrol) for her recurrent trigonitis thatis causing urinary frequency (Detrol, urinary antispasmodicagent)?(A) Bradycardia(B) Gastritis(C) Gastroesophageal reflux disease (GERD)(D) Dry mouth(E) Decreased near point of visual focus11 A 34-year-old male patient is seen by a physician forthe first time; he presents himself as depressed andtaking tranylcypromine (Parnate) prescribed by adoctor in another city for the past 4 months. Thepatient expressed doubt, insecurity, and frustrationwith the current regimen because of the necessity toavoid aged cheeses, wines, and other foods to avoidthe risk of serious behavioral and neurological sideeffects. The adopting physician conducts her owninterview and is satisfied that the man is indeeddepressed and still in need of completing a 1-yearcourse of medication. The new doctor is consideringa change to fluoxetine (Prozac, an SSRI) for thepatient’s depression. Which of the following is thebest technique for effecting the transition from tranylcypromineto fluoxetine?(A) Continue tranylcypromine and start fluoxetine.Discontinue tranylcypromine after 2 days.(B) Continue tranylcypromine and start fluoxetine.Discontinue tranylcypromine after 2 weeks.(C) Discontinue tranylcypromine and startfluoxetine the next day.(D) Discontinue tranylcypromine and wait 2 weeksbefore starting fluoxetine.(E) Discontinue tranylcypromine and wait 4 weeksbefore starting fluoxetine.12 Risperidone (Risperdal), an antipsychotic agent, iscontraindicated in which of the following groups ofpeople?(A) Teenaged patients(B) Elderly patients(C) Schizophrenic patients(D) Patients with pneumonia(E) Patients with urinary tract infections13 A 37-year-old male patient with schizophrenia hasbeen treated with pimozide (Orap) with satisfactorycontrol. He now has developed a communityacquiredpneumonia. Which of the following antibioticsis contraindicated?(A) Clarithromycin(B) Ampicillin(C) Amoxicillin(D) Sulfamethoxazole(E) Doxycycline14 The high-potency topical glucocorticoid, betamethasone,is indicated for certain inflammatory skinconditions on a temporary basis. Each of the followingside effects is known to be caused by prolonged applicationof this preparation, except for which one?(A) Cushing syndrome(B) Adrenocorticotropin suppression