JT is a 45-year-old male who presents to your outpatient clinic for a routine follow-up. His medical history is significant for atrial fibrillation. Upon examination, you learn that JT has been skipping dinner for the past several weeks due to work-related time restraints. The efficacy of which of the following on JT’s current medication list will be least affected if administered on an empty stomach?

1. Rivaroxaban 20 mg once daily at 1900
   
2. Carvedilol CR 20 mg once daily at 1900
   
3. Dronedarone 400 mg twice daily at 0700 and 1900
   
4. Diltiazem 24H ER 120 mg once daily at 1900

PJ is a 56-year-old male who is admitted to a percutaneous coronary intervention (PCI)-capable hospital for an ST elevation myocardial infarction (STEMI). Intravenous (IV) cangrelor is bolused prior to PCI, followed immediately by a cangrelor infusion throughout the duration of PCI. An oral P2Y₁₂ platelet inhibitor is administered during the cangrelor infusion. Which of the following P2Y₁₂ platelet inhibitors would be best to use concurrently with the cangrelor infusion to prevent stent thrombosis?

1. Clopidogrel 300 mg
   
2. Clopidogrel 600 mg
   
3. Prasugrel 60 mg
   
4. Ticagrelor 180 mg

TW is a 77-year-old female with a history of atrial fibrillation, hypertension (HTN), and heart failure with reduced ejection fraction (HFrEF) who is admitted to the hospital for a total prosthetic-hip-associated infection. Vancomycin and rifampin are initiated for empiric antimicrobial therapy. The team would also like to start oral anticoagulation for stroke prevention. Which of the following oral anticoagulants may be recommended in this patient?

1. Warfarin plus therapeutic enoxaparin
   
2. Dabigatran
   
3. Rivaroxaban
   
4. Edoxaban

PY is a 42-year-old female admitted to the hospital for worsening dysuria, urinary frequency, flank pain, and intermittent fevers for the past 2 days. PMH includes paroxysmal atrial fibrillation, HTN, and dyslipidemia. Home medications include simvastatin 40 mg oral (PO) QHS, lisinopril 40 mg PO daily, carvedilol 12.5 mg PO BID, and dofetilide 500 μg PO BID. Urinalysis reveals cloudy appearance, large leukocytes, ≥100 white blood cells (WBC), plus nitrites, a 3+ leukocyte esterase, and many bacteria. Which of the following antimicrobials is best recommended for this patient?

1. Ceftriaxone
   
2. Ciprofloxacin
   
3. Levofloxacin
   
4. Trimethoprim-sulfamethoxazole

PT is a 72-year-old male who is admitted for new-onset atrial fibrillation, refractory to diltiazem. The team initiates an amiodarone drip for pharmacologic cardioversion. After 4 days on the amiodarone drip, the patient has become stable enough to transition to oral therapy. Which of the following is a reasonable strategy for conversion of IV to PO amiodarone?

1. Stop drip. Initiate 200 mg PO daily immediately after
   
2. May overlap by 1 day. Initiate 200 mg PO daily
   
3. May overlap by 1 day. Initiate 400 mg PO TID
   
4. Stop drip. Initiate 800 mg PO TID 48 h after discontinuation of the infusion

NM is an 81-year-old female who was started on amiodarone 200 mg PO once daily for maintenance of sinus rhythm approximately 9 months ago. She presents to your cardiology clinic for a routine follow-up. Labs are drawn. Which of the following abnormal labs is least likely to be caused from her amiodarone?

1. WBC 28 × 10⁹ cells/L
   
2. Aspartate aminotransferase 860 U/L
   
3. Thyroid stimulating hormone 46 mU/L
   
4. Thyroid stimulating hormone 0.004 mU/L

A 45-year-old male presents with confusion and visual disturbances. The eectrocardiogram (ECG) reveals third-degree heart block. His wife claims that the patient just picked up a 30-day supply of digoxin 250 μg PO daily this morning. Upon review of the medication vial, you note that there are only 24 tablets remaining. How many vials of digoxin immune Fab may be recommended for this patient in the setting of acute digoxin toxicity?

1. 3 vials
   
2. 6 vials
   
3. 10 vials
   
4. 20 vials

Rivaroxaban is started inpatient in a 67-year-old female for stroke prevention in the setting of atrial fibrillation. The patient’s creatinine clearance is calculated at 62 mL/min. Which of the following is the appropriate dose of rivaroxaban for this patient?

1. Rivaroxaban 20 mg PO daily
   
2. Rivaroxaban 15 mg PO BID
   
3. Rivaroxaban 10 mg PO daily
   
4. Rivaroxaban 15 mg PO daily

Which of the following genetic tests could you order as a send-out before initiating warfarin in a patient?

1. VKORC1 genotype
   
2. HLA-B^*5701 allele
   
3. HLA-B^*1502 allele
   
4. CYP2C19 genotype

FL is a 77-year-old male who presents to the emergency department with complaints of fatigue, dizziness, and shortness of breath. Upon further examination, the patient admits to melena for the past several days. A computed tomography scan is concerning for a gastrointestinal hemorrhage. Of note, the patient has been on chronic anticoagulation therapy with warfarin; INR on admission was found to be 11.2. The team would like to use Kcentra for urgent reversal. Which of the following is the best recommended dose for this patient?

1. 50 units/kg of the factor II component (maximum dose 5000 units)
   
2. 50 units/kg of the factor VII component (maximum dose 5000 units)
   
3. 50 units/kg of the factor IX component (maximum dose 5000 units)
   
4. 50 units/kg of the factor X component (maximum dose 5000 units)

Which of the following statements is correct?

1. Beta-blockers may cause peripheral vasoconstriction through their beta-1 receptor antagonism effects
   
2. Beta-blockers may cause peripheral vasoconstriction through their beta-2 receptor antagonism effects
   
3. Beta-blockers may cause peripheral vasodilation through their beta-1 receptor antagonism effects
   
4. Beta-blockers may cause peripheral vasodilation through their beta-2 receptor antagonism effects

LG is a 36-year-old female with HFrEF (left ventricular ejection fraction 30%), HTN, diabetes mellitus, and chronic kidney disease stage III. The patient has a reported allergy to valsartan with a reaction of angioedema. Current medications include carvedilol, insulin glargine, insulin lispro, and amlodipine. The team would like to start a medication to optimize the patient’s heart failure therapy. Which of the following medications may be started in this patient?

1. Lisinopril
   
2. Losartan
   
3. BiDil®
   
4. Entresto®

TN is a 40-year-old male with a past medical history that includes asthma and heart failure with preserved ejection fraction. In addition to a rescue inhaler, the patient is currently using fluticasone/salmeterol for maintenance of his asthma. The team would like to start a beta-blocker for this patient but has concerns about concomitant use of a beta-blocker and a beta-agonist. Which of the following beta-blockers would be best to use in this patient?

1. Metoprolol succinate 25 mg PO daily
   
2. Propranolol 40 mg PO BID
   
3. Labetalol 100 mg PO BID
   
4. Carvedilol 6.25 mg PO BID

Which of the following medications has an active metabolite with the longest half-life?

1. Aspirin
   
2. Clopidogrel
   
3. Prasugrel
   
4. Ticagrelor

A 36-year-old male presents with chest pain, associated with bilateral nipple tenderness and sensitivity. Cardiac enzymes are negative. Which of the following medications in this patient’s profile can mostly likely cause these symptoms?

1. Triamterene/hydrochlorothiazide
   
2. Spironolactone
   
3. Labetalol
   
4. Ranolazine

Which of the following diuretics may be used in a patient with a confirmed Stevens–Johnson reaction to trimethoprim-sulfamethoxazole?

1. Furosemide
   
2. Hydrochlorothiazide
   
3. Metolazone
   
4. Ethacrynic acid

TJ is a 54-year-old male who is started on immediate-release isosorbide mononitrate for chronic stable angina, refractory to beta-blocker monotherapy. Which of the following regimens is best to start in this patient?

1. 10 mg PO at 0700 and 1400
   
2. 10 mg PO at 0700 and 1900
   
3. 10 mg PO at 0700 and 1900 for 3 days, then 20 mg PO at 0700 and 1900
   
4. 10 mg PO at 0700 and 1500 and 2300

WL is a 68-year-old female who is placed in observation awaiting an adenosine stress test. Which of the following statements is false?

1. Chocolate milk, coffee, tea, brownies, and energy bars should be avoided prior to test
   
2. Patient must remain NPO 4–6 h prior to test
   
3. The patient is not to take Aggrenox® for at least 24 h prior to test
   
4. The patient is not to take theophylline-containing medications for at least 12 h prior to test

A 65-year-old female presents to the emergency department with severe, sharp chest pain, weak pulses, altered level of consciousness, and weakness. BP upon admission was 212/126 mmHg. Upon further examination, the team diagnosed the patient with aortic dissection in the setting of hypertensive emergency. Which agent is best to initiate in this patient to lower blood pressure?

1. IV labetalol
   
2. IV metoprolol
   
3. IV nicardipine
   
4. IV diltiazem