Compare Warfarin, Apixaban (Eliquis), and Rivaroxaban (Xarelto) regarding mechanisms, routine monitoring, and dosing with food:

Warfarin: Inhibits VKORC1 (factors II, VII, IX, X, proteins C/S); requires frequent INR monitoring; dietary vitamin K consistency required. Apixaban: Direct oral Factor Xa inhibitor; 5 mg bid; no routine lab monitoring; taken with or without food. Rivaroxaban: Direct Factor Xa inhibitor; doses >= 15 mg MUST be taken with food for adequate systemic absorption.

Carvedilol (Coreg, Coreg CR): Receptor pharmacology, heart failure mortality benefit, and administration instructions?

Receptor profile: Non-selective beta-blocker (beta-1 and beta-2) with alpha-1 adrenergic blocking activity (vasodilator). Benefit: Proven mortality reduction in HFrEF. Administration: Must be taken with food to slow absorption rate and minimize the risk of orthostatic hypotension and syncope.

Furosemide (Lasix): Drug class, mechanism of action, indications, and toxicities?

Class: Loop diuretic. Mechanism: Inhibits the Na+/K+/2Cl- symporter in the thick ascending limb of the loop of Henle, producing profound diuresis. Indications: Acute pulmonary edema, congestive heart failure fluid overload, acute renal failure, cirrhosis ascites. Toxicities: Hypokalemia, hypocalcemia, ototoxicity (especially with rapid IV push), and hyperuricemia.

Rosuvastatin (Crestor): Drug class, potency, high-intensity dosing, and metabolism advantage?

Class: HMG-CoA Reductase Inhibitor. Potency: Most potent statin; high-intensity doses are 20 mg and 40 mg daily (lowers LDL-C >= 50%). Advantage: Hydrophilic molecule with minimal CYP3A4 metabolism (primarily CYP2C9 minor), resulting in fewer cytochrome P450-mediated drug-drug interactions compared to atorvastatin and simvastatin.

Atenolol (Tenormin): Drug class, mechanism of action, pharmacokinetic elimination, and clinical use?

Class: Cardioselective Beta-1 adrenergic blocker. Mechanism: Decreases heart rate, myocardial contractility, and cardiac output. Elimination: Hydrophilic; excreted almost entirely unchanged by the kidneys (requires renal dose adjustments in renal impairment). Indications: Hypertension, angina pectoris, post-MI management.

Valsartan (Diovan): Drug class, mechanism, indications, and key monitoring parameters?

Class: Angiotensin II Receptor Blocker (ARB). Mechanism: Blocks AT1 receptor to reduce vascular resistance and cardiac remodeling. Indications: Hypertension, heart failure, post-MI left ventricular dysfunction. Monitoring: Serum potassium (risk of hyperkalemia), blood pressure, and renal function (BUN/serum creatinine).

Sitagliptin (Januvia): Drug class, mechanism of action, effect on weight, and rare serious warning?

Class: Dipeptidyl Peptidase-4 (DPP-4) inhibitor. Mechanism: Inhibits DPP-4 enzyme, prolonging endogenous incretin hormones (GLP-1 and GIP), enhancing glucose-dependent insulin secretion and suppressing glucagon release. Weight: Weight neutral, low hypoglycemia risk. Warning: Post-marketing reports of Acute Pancreatitis and severe, disabling joint pain.

Losartan (Cozaar): Drug class, mechanism of action, and primary clinical advantage over ACE inhibitors?

Class: Angiotensin II Receptor Blocker (ARB). Mechanism: Selectively blocks the AT1 receptor, preventing angiotensin II-mediated vasoconstriction and aldosterone release. Indications: Hypertension, diabetic nephropathy in T2DM. Advantage: Does not inhibit bradykinin breakdown, so it does not cause the persistent dry cough characteristic of ACE inhibitors.

Spironolactone (Aldactone): Drug class, mechanism of action, heart failure benefits, and adverse effects?

Class: Aldosterone antagonist / potassium-sparing diuretic. Mechanism: Competitively blocks mineralocorticoid receptors in distal tubule and collecting duct. Benefit: Reduces cardiac remodeling and mortality in HFrEF (NYHA Class II–IV). Adverse effects: Hyperkalemia, gynecomastia, breast tenderness, menstrual irregularities (due to non-selective antiandrogen and progestogenic effects; Eplerenone is selective alternative).

Pravastatin (Pravachol): Drug class, pharmacokinetic properties, and drug interaction profile?

Class: HMG-CoA Reductase Inhibitor. Properties: Hydrophilic statin. Interaction profile: Not metabolized by the cytochrome P450 enzyme system; lowest risk of pharmacokinetic drug-drug interactions among statins. Excellent choice in complex polypharmacy clients, HIV patients on protease inhibitors, and transplant recipients on immunosuppressants.

Hydralazine (Apresoline): Drug class, mechanism of action, compensatory reflexes, and characteristic drug-induced syndrome?

Class: Direct-acting arterial vasodilator. Mechanism: Direct relaxation of arteriolar smooth muscle (minimal venous dilation). Reflexes: Triggers profound reflex tachycardia and fluid retention (must co-prescribe with beta-blocker and diuretic). Syndrome: Drug-Induced Lupus Erythematosus (DILE) associated with anti-histone antibodies (higher risk in slow acetylators).

Glipizide (Glucotrol, Glucotrol XL): Drug class, mechanism of action, key side effects, and administration timing?

Class: Second-generation Sulfonylurea. Mechanism: Stimulates insulin secretion from pancreatic beta cells by closing ATP-sensitive K+ channels, causing depolarization and calcium influx. Side effects: Hypoglycemia, weight gain, sulfa allergy cross-reactivity. Timing: Administer immediate-release formulation 30 minutes before first meal of day.

Atorvastatin (Lipitor): Drug class, mechanism of action, high-intensity dosing, and major monitoring labs?

Class: HMG-CoA Reductase Inhibitor. Mechanism: Rate-limiting step of cholesterol biosynthesis; increases hepatic LDL receptor expression, clearing LDL-C from blood. Dosing: High-intensity statin at 40 mg and 80 mg daily (reduces LDL >= 50%). Labs: Baseline Liver Function Tests (ALT/AST), Creatine Kinase (CK) if myalgia occurs; report dark urine or severe muscle pain (rhabdomyolysis).

Clonidine (Catapres, Catapres-TTS): Drug class, mechanism of action, indications, and discontinuation risk?

Class: Centrally acting Alpha-2 adrenergic agonist. Mechanism: Stimulates alpha-2 receptors in brainstem, reducing sympathetic outflow, lowering peripheral resistance and heart rate. Indications: Resistant hypertension, ADHD, opioid withdrawal. Discontinuation risk: Abrupt cessation causes severe Rebound Hypertensive Crisis due to massive sympathetic surge; must taper gradually.

Chlorthalidone: Drug class, comparison with HCTZ, and clinical trial evidence?

Class: Thiazide-like diuretic. Comparison: Significantly longer elimination half-life (40–60 hours) and ~1.5 to 2 times greater potency than HCTZ. Evidence: Demonstrated superior reduction in cardiovascular events and systolic blood pressure in major landmark trials (e.g., ALLHAT); carries higher risk of hypokalemia.

Fenofibrate (Tricor, Trilipix): Drug class, mechanism of action, and primary clinical indication?

Class: Fibric acid derivative (fibrate). Mechanism: Peroxisome proliferator-activated receptor-alpha (PPAR-alpha) agonist; upregulates lipoprotein lipase, enhancing catabolism of triglyceride-rich particles. Indication: Severe hypertriglyceridemia (TG > 500 mg/dL) to prevent acute pancreatitis. Safer to combine with statins than gemfibrozil due to lower rhabdomyolysis risk.

Simvastatin (Zocor): Drug class, timing of administration, and major CYP3A4 drug interaction restrictions?

Class: HMG-CoA Reductase Inhibitor. Administration: Take in the evening because hepatic cholesterol synthesis peaks overnight (short half-life ~2–3 hours). Interactions: Extensive CYP3A4 substrate; contraindicated with strong CYP3A4 inhibitors (clarithromycin, itraconazole, protease inhibitors). Maximum 10 mg/day with verapamil/diltiazem; maximum 20 mg/day with amiodarone/amlodipine.

Semaglutide (Ozempic, Rybelsus, Wegovy): Drug class, mechanism of action, Boxed Warning, and route differences?

Class: Glucagon-Like Peptide-1 (GLP-1) receptor agonist. Mechanism: Activates GLP-1 receptors, enhancing glucose-dependent insulin secretion, slowing gastric emptying, and suppressing appetite. Boxed Warning: Thyroid C-cell tumors (contraindicated in personal/family history of Medullary Thyroid Carcinoma or MEN 2). Routes: Subcutaneous weekly (Ozempic/Wegovy) and oral daily on empty stomach (Rybelsus).

Amlodipine (Norvasc): Drug class, mechanism of action, and common side effects?

Class: Dihydropyridine Calcium Channel Blocker (CCB). Mechanism: Inhibits L-type voltage-gated calcium channels in vascular smooth muscle, producing peripheral arterial vasodilation with minimal direct effect on cardiac conduction. Indications: Hypertension, chronic stable angina. Adverse effects: Peripheral dependent edema (dose-dependent), flushing, headache, dizziness, gingival hyperplasia.

Metformin (Glucophage, Glucophage XR): Drug class, mechanism of action, first-line role, and Boxed Warning?

Class: Biguanide. Mechanism: Decreases hepatic gluconeogenesis, decreases intestinal glucose absorption, and increases peripheral insulin-mediated glucose uptake. First-line: Initial drug of choice for Type 2 Diabetes Mellitus (weight neutral, no hypoglycemia). Boxed Warning: Lactic Acidosis (rare but fatal); contraindicated if eGFR < 30 mL/min; withhold before iodinated radiocontrast.

Empagliflozin (Jardiance): Drug class, mechanism of action, cardiovascular/renal benefits, and unique risks?

Class: Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitor. Mechanism: Inhibits SGLT2 in proximal renal tubule, reducing renal glucose reabsorption and promoting glucosuria. Benefits: Decreases CV mortality and heart failure hospitalizations (EMPA-REG). Risks: Euglycemic DKA, vulvovaginal candidiasis/UTIs, osmotic diuresis/hypotension, and Fournier's gangrene.

Propranolol (Inderal LA, InnoPran XL): Receptor profile, non-cardiovascular indications, and contraindications?

Class: Non-selective Beta-adrenergic blocker (Beta-1 and Beta-2). Indications: Performance anxiety (stage fright), essential tremor, migraine prophylaxis, portal hypertension/variceal bleed prophylaxis, thyroid storm/thyrotoxicosis. Contraindications: Asthma, severe COPD, and symptomatic bradycardia (due to bronchoconstriction from Beta-2 blockade).

Lisinopril (Prinivil, Zestril): Drug class, mechanism of action, primary indications, and key adverse effects?

Class: ACE Inhibitor. Mechanism: Inhibits angiotensin-converting enzyme, preventing conversion of Ang I to Ang II, reducing aldosterone and systemic vascular resistance. Indications: Hypertension, Heart Failure with reduced Ejection Fraction (HFrEF), post-MI. Adverse effects: Dry cough (bradykinin accumulation), hyperkalemia, angioedema, hypotension; contraindicated in pregnancy.

Hydrochlorothiazide (Microzide / HCTZ): Drug class, mechanism of action, and characteristic electrolyte disturbances?

Class: Thiazide diuretic. Mechanism: Inhibits Na+/Cl- cotransporter in the early distal convoluted tubule, increasing excretion of sodium, chloride, and water. Disturbances: Hypokalemia, hyponatremia, hypomagnesemia; hypercalcemia (increases calcium reabsorption), hyperuricemia (precipitates gout), and hyperglycemia.

Dulaglutide (Trulicity): Drug class, dosing frequency, CV benefits, and primary side effects?

Class: GLP-1 receptor agonist. Frequency: Once-weekly subcutaneous injection via pre-attached pen needle. CV benefit: Proven reduction in major adverse cardiovascular events (MACE) in T2DM clients with established CV disease. Side effects: Gastrointestinal disturbances (nausea, vomiting, diarrhea, abdominal pain), decreased appetite, pancreatitis warning.

Ezetimibe (Zetia): Drug class, mechanism of action, and combination clinical role?

Class: Cholesterol absorption inhibitor. Mechanism: Selectively inhibits the Niemann-Pick C1-Like 1 (NPC1L1) transporter at the brush border of the jejunum, reducing intestinal absorption of dietary and biliary cholesterol. Role: Added to maximally tolerated statin therapy to achieve additional LDL-C lowering (15–20% additional reduction; proven in IMPROVE-IT trial).

Metoprolol Tartrate (Lopressor) vs Metoprolol Succinate (Toprol-XL): Formulations, dosing intervals, and heart failure approval?

Both are cardioselective Beta-1 adrenergic blockers. Metoprolol Tartrate: Immediate-release salt, dosed twice daily with or immediately after meals; NOT approved for mortality reduction in heart failure. Metoprolol Succinate: Extended-release formulation, dosed once daily; FDA-approved for reducing mortality and hospitalizations in HFrEF.

Diltiazem (Cardizem, Tiazac, Cartia XT): Drug class, mechanism, primary indications, and drug interactions?

Class: Non-Dihydropyridine Calcium Channel Blocker (benzothiazepine). Mechanism: Inhibits calcium influx in vascular smooth muscle and cardiac conduction tissue (SA and AV nodes), slowing AV conduction and reducing heart rate. Indications: Rate control in Atrial Fibrillation/Flutter, paroxysmal SVT, angina, hypertension. Interactions: Moderate CYP3A4 inhibitor; increases levels of statins, cyclosporine, and digoxin.

Verapamil (Calan, Verelan): Drug class, mechanism of action, key clinical precautions, and classic side effect?

Class: Non-Dihydropyridine Calcium Channel Blocker (phenylalkylamine). Mechanism: Potent negative inotrope and chronotrope; inhibits calcium channels in myocardium and AV node. Indications: Angina, supraventricular arrhythmias, hypertension. Precaution: Contraindicated in severe HFrEF (worsens pump failure) and AV blocks. Classic side effect: Severe constipation (due to relaxation of gastrointestinal smooth muscle).

Glimepiride (Amaryl): Drug class, mechanism of action, and safety comparison in renal impairment?

Class: Second-generation Sulfonylurea. Mechanism: Stimulates pancreatic beta cells to release preformed insulin. Safety: Long duration of action (24 hours) with active metabolites excreted renally; carries a significantly higher risk of prolonged, severe hypoglycemia in elderly patients and those with chronic kidney disease compared to glipizide.

Pioglitazone (Actos): Drug class, mechanism of action, major contraindication, and adverse effects?

Class: Thiazolidinedione (TZD). Mechanism: Agonist at Peroxisome Proliferator-Activated Receptor-gamma (PPAR-gamma), improving peripheral target-tissue insulin sensitivity. Contraindication: Boxed Warning for Heart Failure (NYHA Class III/IV); causes peripheral fluid retention and peripheral edema. Other risks: Bone fractures in women, potential bladder cancer with long-term use.

Dapagliflozin (Farxiga): Drug class, mechanism of action, and expanded FDA approvals beyond diabetes?

Class: SGLT2 inhibitor. Mechanism: Induces urinary glucose and sodium excretion in the proximal renal tubule. Expanded approvals: FDA-approved for reducing hospitalization and CV death in Heart Failure with reduced Ejection Fraction (HFrEF) and Heart Failure with preserved Ejection Fraction (HFpEF), and slowing progression in Chronic Kidney Disease (CKD), regardless of diabetes status.

Top 200 Drugs (NAPLEX & Pharmacy) — Cardiovascular, Antihypertensive, Statin & Diabetes Brand/Generic/MOA

Essential Top 200 pharmaceuticals for pharmacy (NAPLEX/PTCB) and PA (PANCE) exams: cardiovascular agents, antihypertensives, dyslipidemia statins, and antidiabetic agents (Brand, Generic, Class, Mechanism of Action, and key clinical notes).

Level: basic
Languages: en → en
Cards: 32
Markdown: Top 200 Drugs (NAPLEX & Pharmacy) — Cardiovascular, Antihypertensive, Statin & Diabetes Brand/Generic/MOA (.md)

Flashcards (32)

#	Front (Term / Question)	Back (Definition / Answer)
1	Compare Warfarin, Apixaban (Eliquis), and Rivaroxaban (Xarelto) regarding mechanisms, routine monitoring, and dosing with food:	Warfarin: Inhibits VKORC1 (factors II, VII, IX, X, proteins C/S); requires frequent INR monitoring; dietary vitamin K consistency required. Apixaban: Direct oral Factor Xa inhibitor; 5 mg bid; no routine lab monitoring; taken with or without food. Rivaroxaban: Direct Factor Xa inhibitor; doses >= 15 mg MUST be taken with food for adequate systemic absorption.
2	Carvedilol (Coreg, Coreg CR): Receptor pharmacology, heart failure mortality benefit, and administration instructions?	Receptor profile: Non-selective beta-blocker (beta-1 and beta-2) with alpha-1 adrenergic blocking activity (vasodilator). Benefit: Proven mortality reduction in HFrEF. Administration: Must be taken with food to slow absorption rate and minimize the risk of orthostatic hypotension and syncope.
3	Furosemide (Lasix): Drug class, mechanism of action, indications, and toxicities?	Class: Loop diuretic. Mechanism: Inhibits the Na+/K+/2Cl- symporter in the thick ascending limb of the loop of Henle, producing profound diuresis. Indications: Acute pulmonary edema, congestive heart failure fluid overload, acute renal failure, cirrhosis ascites. Toxicities: Hypokalemia, hypocalcemia, ototoxicity (especially with rapid IV push), and hyperuricemia.
4	Rosuvastatin (Crestor): Drug class, potency, high-intensity dosing, and metabolism advantage?	Class: HMG-CoA Reductase Inhibitor. Potency: Most potent statin; high-intensity doses are 20 mg and 40 mg daily (lowers LDL-C >= 50%). Advantage: Hydrophilic molecule with minimal CYP3A4 metabolism (primarily CYP2C9 minor), resulting in fewer cytochrome P450-mediated drug-drug interactions compared to atorvastatin and simvastatin.
5	Atenolol (Tenormin): Drug class, mechanism of action, pharmacokinetic elimination, and clinical use?	Class: Cardioselective Beta-1 adrenergic blocker. Mechanism: Decreases heart rate, myocardial contractility, and cardiac output. Elimination: Hydrophilic; excreted almost entirely unchanged by the kidneys (requires renal dose adjustments in renal impairment). Indications: Hypertension, angina pectoris, post-MI management.
6	Valsartan (Diovan): Drug class, mechanism, indications, and key monitoring parameters?	Class: Angiotensin II Receptor Blocker (ARB). Mechanism: Blocks AT1 receptor to reduce vascular resistance and cardiac remodeling. Indications: Hypertension, heart failure, post-MI left ventricular dysfunction. Monitoring: Serum potassium (risk of hyperkalemia), blood pressure, and renal function (BUN/serum creatinine).
7	Sitagliptin (Januvia): Drug class, mechanism of action, effect on weight, and rare serious warning?	Class: Dipeptidyl Peptidase-4 (DPP-4) inhibitor. Mechanism: Inhibits DPP-4 enzyme, prolonging endogenous incretin hormones (GLP-1 and GIP), enhancing glucose-dependent insulin secretion and suppressing glucagon release. Weight: Weight neutral, low hypoglycemia risk. Warning: Post-marketing reports of Acute Pancreatitis and severe, disabling joint pain.
8	Losartan (Cozaar): Drug class, mechanism of action, and primary clinical advantage over ACE inhibitors?	Class: Angiotensin II Receptor Blocker (ARB). Mechanism: Selectively blocks the AT1 receptor, preventing angiotensin II-mediated vasoconstriction and aldosterone release. Indications: Hypertension, diabetic nephropathy in T2DM. Advantage: Does not inhibit bradykinin breakdown, so it does not cause the persistent dry cough characteristic of ACE inhibitors.
9	Spironolactone (Aldactone): Drug class, mechanism of action, heart failure benefits, and adverse effects?	Class: Aldosterone antagonist / potassium-sparing diuretic. Mechanism: Competitively blocks mineralocorticoid receptors in distal tubule and collecting duct. Benefit: Reduces cardiac remodeling and mortality in HFrEF (NYHA Class II–IV). Adverse effects: Hyperkalemia, gynecomastia, breast tenderness, menstrual irregularities (due to non-selective antiandrogen and progestogenic effects; Eplerenone is selective alternative).
10	Pravastatin (Pravachol): Drug class, pharmacokinetic properties, and drug interaction profile?	Class: HMG-CoA Reductase Inhibitor. Properties: Hydrophilic statin. Interaction profile: Not metabolized by the cytochrome P450 enzyme system; lowest risk of pharmacokinetic drug-drug interactions among statins. Excellent choice in complex polypharmacy clients, HIV patients on protease inhibitors, and transplant recipients on immunosuppressants.
11	Hydralazine (Apresoline): Drug class, mechanism of action, compensatory reflexes, and characteristic drug-induced syndrome?	Class: Direct-acting arterial vasodilator. Mechanism: Direct relaxation of arteriolar smooth muscle (minimal venous dilation). Reflexes: Triggers profound reflex tachycardia and fluid retention (must co-prescribe with beta-blocker and diuretic). Syndrome: Drug-Induced Lupus Erythematosus (DILE) associated with anti-histone antibodies (higher risk in slow acetylators).
12	Glipizide (Glucotrol, Glucotrol XL): Drug class, mechanism of action, key side effects, and administration timing?	Class: Second-generation Sulfonylurea. Mechanism: Stimulates insulin secretion from pancreatic beta cells by closing ATP-sensitive K+ channels, causing depolarization and calcium influx. Side effects: Hypoglycemia, weight gain, sulfa allergy cross-reactivity. Timing: Administer immediate-release formulation 30 minutes before first meal of day.
13	Atorvastatin (Lipitor): Drug class, mechanism of action, high-intensity dosing, and major monitoring labs?	Class: HMG-CoA Reductase Inhibitor. Mechanism: Rate-limiting step of cholesterol biosynthesis; increases hepatic LDL receptor expression, clearing LDL-C from blood. Dosing: High-intensity statin at 40 mg and 80 mg daily (reduces LDL >= 50%). Labs: Baseline Liver Function Tests (ALT/AST), Creatine Kinase (CK) if myalgia occurs; report dark urine or severe muscle pain (rhabdomyolysis).
14	Clonidine (Catapres, Catapres-TTS): Drug class, mechanism of action, indications, and discontinuation risk?	Class: Centrally acting Alpha-2 adrenergic agonist. Mechanism: Stimulates alpha-2 receptors in brainstem, reducing sympathetic outflow, lowering peripheral resistance and heart rate. Indications: Resistant hypertension, ADHD, opioid withdrawal. Discontinuation risk: Abrupt cessation causes severe Rebound Hypertensive Crisis due to massive sympathetic surge; must taper gradually.
15	Chlorthalidone: Drug class, comparison with HCTZ, and clinical trial evidence?	Class: Thiazide-like diuretic. Comparison: Significantly longer elimination half-life (40–60 hours) and ~1.5 to 2 times greater potency than HCTZ. Evidence: Demonstrated superior reduction in cardiovascular events and systolic blood pressure in major landmark trials (e.g., ALLHAT); carries higher risk of hypokalemia.
16	Fenofibrate (Tricor, Trilipix): Drug class, mechanism of action, and primary clinical indication?	Class: Fibric acid derivative (fibrate). Mechanism: Peroxisome proliferator-activated receptor-alpha (PPAR-alpha) agonist; upregulates lipoprotein lipase, enhancing catabolism of triglyceride-rich particles. Indication: Severe hypertriglyceridemia (TG > 500 mg/dL) to prevent acute pancreatitis. Safer to combine with statins than gemfibrozil due to lower rhabdomyolysis risk.
17	Simvastatin (Zocor): Drug class, timing of administration, and major CYP3A4 drug interaction restrictions?	Class: HMG-CoA Reductase Inhibitor. Administration: Take in the evening because hepatic cholesterol synthesis peaks overnight (short half-life ~2–3 hours). Interactions: Extensive CYP3A4 substrate; contraindicated with strong CYP3A4 inhibitors (clarithromycin, itraconazole, protease inhibitors). Maximum 10 mg/day with verapamil/diltiazem; maximum 20 mg/day with amiodarone/amlodipine.
18	Semaglutide (Ozempic, Rybelsus, Wegovy): Drug class, mechanism of action, Boxed Warning, and route differences?	Class: Glucagon-Like Peptide-1 (GLP-1) receptor agonist. Mechanism: Activates GLP-1 receptors, enhancing glucose-dependent insulin secretion, slowing gastric emptying, and suppressing appetite. Boxed Warning: Thyroid C-cell tumors (contraindicated in personal/family history of Medullary Thyroid Carcinoma or MEN 2). Routes: Subcutaneous weekly (Ozempic/Wegovy) and oral daily on empty stomach (Rybelsus).
19	Amlodipine (Norvasc): Drug class, mechanism of action, and common side effects?	Class: Dihydropyridine Calcium Channel Blocker (CCB). Mechanism: Inhibits L-type voltage-gated calcium channels in vascular smooth muscle, producing peripheral arterial vasodilation with minimal direct effect on cardiac conduction. Indications: Hypertension, chronic stable angina. Adverse effects: Peripheral dependent edema (dose-dependent), flushing, headache, dizziness, gingival hyperplasia.
20	Metformin (Glucophage, Glucophage XR): Drug class, mechanism of action, first-line role, and Boxed Warning?	Class: Biguanide. Mechanism: Decreases hepatic gluconeogenesis, decreases intestinal glucose absorption, and increases peripheral insulin-mediated glucose uptake. First-line: Initial drug of choice for Type 2 Diabetes Mellitus (weight neutral, no hypoglycemia). Boxed Warning: Lactic Acidosis (rare but fatal); contraindicated if eGFR < 30 mL/min; withhold before iodinated radiocontrast.
21	Empagliflozin (Jardiance): Drug class, mechanism of action, cardiovascular/renal benefits, and unique risks?	Class: Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitor. Mechanism: Inhibits SGLT2 in proximal renal tubule, reducing renal glucose reabsorption and promoting glucosuria. Benefits: Decreases CV mortality and heart failure hospitalizations (EMPA-REG). Risks: Euglycemic DKA, vulvovaginal candidiasis/UTIs, osmotic diuresis/hypotension, and Fournier's gangrene.
22	Propranolol (Inderal LA, InnoPran XL): Receptor profile, non-cardiovascular indications, and contraindications?	Class: Non-selective Beta-adrenergic blocker (Beta-1 and Beta-2). Indications: Performance anxiety (stage fright), essential tremor, migraine prophylaxis, portal hypertension/variceal bleed prophylaxis, thyroid storm/thyrotoxicosis. Contraindications: Asthma, severe COPD, and symptomatic bradycardia (due to bronchoconstriction from Beta-2 blockade).
23	Lisinopril (Prinivil, Zestril): Drug class, mechanism of action, primary indications, and key adverse effects?	Class: ACE Inhibitor. Mechanism: Inhibits angiotensin-converting enzyme, preventing conversion of Ang I to Ang II, reducing aldosterone and systemic vascular resistance. Indications: Hypertension, Heart Failure with reduced Ejection Fraction (HFrEF), post-MI. Adverse effects: Dry cough (bradykinin accumulation), hyperkalemia, angioedema, hypotension; contraindicated in pregnancy.
24	Hydrochlorothiazide (Microzide / HCTZ): Drug class, mechanism of action, and characteristic electrolyte disturbances?	Class: Thiazide diuretic. Mechanism: Inhibits Na+/Cl- cotransporter in the early distal convoluted tubule, increasing excretion of sodium, chloride, and water. Disturbances: Hypokalemia, hyponatremia, hypomagnesemia; hypercalcemia (increases calcium reabsorption), hyperuricemia (precipitates gout), and hyperglycemia.
25	Dulaglutide (Trulicity): Drug class, dosing frequency, CV benefits, and primary side effects?	Class: GLP-1 receptor agonist. Frequency: Once-weekly subcutaneous injection via pre-attached pen needle. CV benefit: Proven reduction in major adverse cardiovascular events (MACE) in T2DM clients with established CV disease. Side effects: Gastrointestinal disturbances (nausea, vomiting, diarrhea, abdominal pain), decreased appetite, pancreatitis warning.
26	Ezetimibe (Zetia): Drug class, mechanism of action, and combination clinical role?	Class: Cholesterol absorption inhibitor. Mechanism: Selectively inhibits the Niemann-Pick C1-Like 1 (NPC1L1) transporter at the brush border of the jejunum, reducing intestinal absorption of dietary and biliary cholesterol. Role: Added to maximally tolerated statin therapy to achieve additional LDL-C lowering (15–20% additional reduction; proven in IMPROVE-IT trial).
27	Metoprolol Tartrate (Lopressor) vs Metoprolol Succinate (Toprol-XL): Formulations, dosing intervals, and heart failure approval?	Both are cardioselective Beta-1 adrenergic blockers. Metoprolol Tartrate: Immediate-release salt, dosed twice daily with or immediately after meals; NOT approved for mortality reduction in heart failure. Metoprolol Succinate: Extended-release formulation, dosed once daily; FDA-approved for reducing mortality and hospitalizations in HFrEF.
28	Diltiazem (Cardizem, Tiazac, Cartia XT): Drug class, mechanism, primary indications, and drug interactions?	Class: Non-Dihydropyridine Calcium Channel Blocker (benzothiazepine). Mechanism: Inhibits calcium influx in vascular smooth muscle and cardiac conduction tissue (SA and AV nodes), slowing AV conduction and reducing heart rate. Indications: Rate control in Atrial Fibrillation/Flutter, paroxysmal SVT, angina, hypertension. Interactions: Moderate CYP3A4 inhibitor; increases levels of statins, cyclosporine, and digoxin.
29	Verapamil (Calan, Verelan): Drug class, mechanism of action, key clinical precautions, and classic side effect?	Class: Non-Dihydropyridine Calcium Channel Blocker (phenylalkylamine). Mechanism: Potent negative inotrope and chronotrope; inhibits calcium channels in myocardium and AV node. Indications: Angina, supraventricular arrhythmias, hypertension. Precaution: Contraindicated in severe HFrEF (worsens pump failure) and AV blocks. Classic side effect: Severe constipation (due to relaxation of gastrointestinal smooth muscle).
30	Glimepiride (Amaryl): Drug class, mechanism of action, and safety comparison in renal impairment?	Class: Second-generation Sulfonylurea. Mechanism: Stimulates pancreatic beta cells to release preformed insulin. Safety: Long duration of action (24 hours) with active metabolites excreted renally; carries a significantly higher risk of prolonged, severe hypoglycemia in elderly patients and those with chronic kidney disease compared to glipizide.
31	Pioglitazone (Actos): Drug class, mechanism of action, major contraindication, and adverse effects?	Class: Thiazolidinedione (TZD). Mechanism: Agonist at Peroxisome Proliferator-Activated Receptor-gamma (PPAR-gamma), improving peripheral target-tissue insulin sensitivity. Contraindication: Boxed Warning for Heart Failure (NYHA Class III/IV); causes peripheral fluid retention and peripheral edema. Other risks: Bone fractures in women, potential bladder cancer with long-term use.
32	Dapagliflozin (Farxiga): Drug class, mechanism of action, and expanded FDA approvals beyond diabetes?	Class: SGLT2 inhibitor. Mechanism: Induces urinary glucose and sodium excretion in the proximal renal tubule. Expanded approvals: FDA-approved for reducing hospitalization and CV death in Heart Failure with reduced Ejection Fraction (HFrEF) and Heart Failure with preserved Ejection Fraction (HFpEF), and slowing progression in Chronic Kidney Disease (CKD), regardless of diabetes status.