Medications is 35% of the scored PTCE (the PTCB exam). Answer 10 exam style questions on cardiovascular drugs and see exactly which concepts would cost you points on test day.
Start the 10 questions →Three weeks after starting amlodipine 10 mg daily, a patient mentions at pickup that both ankles have become swollen. Which known side effect of amlodipine best fits this complaint?
These questions cover side effects: calcium channel blockers, serious adverse effects: ACE inhibitors, boxed warnings: ARBs and ACE inhibitors, side effects: potassium-sparing diuretics and counseling points: beta blockers. Each one shows the correct answer and why every other option is wrong, so a miss tells you exactly what to review before the PTCE.
Prefer to read first? Every question from the practice set above, with the correct answer and why each wrong option is wrong.
Answer: C. Dose-related swelling of the feet and ankles (peripheral edema) is one of the most common side effects of amlodipine. The technician refers the patient's question to the pharmacist.
Why not A: A dry cough is the classic side effect of ACE inhibitors such as lisinopril, not amlodipine.
Why not B: Tendinitis and tendon rupture are boxed warnings for fluoroquinolone antibiotics, not calcium channel blockers.
Why not D: Low potassium is linked to loop and thiazide diuretics. Amlodipine does not lower potassium.
Exam tactic: Amlodipine = ankle swelling. ACE inhibitor = cough. Diuretic = potassium changes.
Answer: B. Angioedema is swelling of the face, lips, tongue or throat. It is a rare but potentially life-threatening effect of ACE inhibitors and can block the airway. The patient needs emergency care and the pharmacist must be involved right away.
Why not A: Rhabdomyolysis is muscle breakdown, a rare serious effect linked to statins, not ACE inhibitors.
Why not C: Orthostatic hypotension is dizziness on standing. It does not cause swelling of the lips or tongue.
Why not D: Peripheral neuropathy is nerve damage causing tingling or numbness, for example with isoniazid.
Exam tactic: ACE inhibitor + swelling of lips, tongue or throat = angioedema = emergency.
Answer: D. Drugs acting directly on the renin-angiotensin system (ACE inhibitors, ARBs such as valsartan, and aliskiren) carry a boxed warning for fetal toxicity. They should be stopped as soon as pregnancy is detected.
Why not A: Suicidality in children and young adults is the boxed warning for antidepressants, not ARBs.
Why not B: Tendon rupture is a boxed warning for fluoroquinolone antibiotics such as ciprofloxacin.
Why not C: Lactic acidosis is the boxed warning for metformin, a diabetes medication.
Exam tactic: -pril and -sartan drugs: boxed warning = pregnancy (fetal toxicity).
Answer: C. Spironolactone has anti-androgen effects and can cause gynecomastia (breast enlargement and tenderness) in men. It can also raise potassium. The technician refers the concern to the pharmacist.
Why not A: Angioedema is swelling of the face, lips or throat, linked mainly to ACE inhibitors.
Why not B: Spironolactone does not lower blood glucose.
Why not D: Light sensitivity of the eyes is not a typical spironolactone effect.
Exam tactic: Spironolactone: high potassium + gynecomastia.
Answer: A. Carvedilol should be taken with food. Food slows absorption and lowers the risk of orthostatic hypotension (dizziness on standing).
Why not B: Carvedilol is dosed twice daily, not once at bedtime.
Why not C: Grapefruit juice is not a dosing instruction for carvedilol.
Why not D: Carvedilol tablets are swallowed. Chewing is not a label instruction.
Exam tactic: Carvedilol = with food, to reduce dizziness from low blood pressure.
Answer: B. Doxazosin, terazosin and prazosin (-azosin) are alpha-1 blockers. They relax blood vessels and the prostate, and can cause marked orthostatic hypotension with the first dose or a dose increase.
Why not A: Beta-1 selective blockers end in -olol, such as metoprolol and atenolol.
Why not C: Calcium channel blockers include amlodipine (-dipine), diltiazem and verapamil.
Why not D: Clonidine is the central alpha-2 agonist. Doxazosin blocks alpha-1 receptors.
Exam tactic: -azosin (doxazosin, terazosin, prazosin) = alpha-1 blocker = dizziness on standing, worst after the first dose.
Answer: D. Labetalol blocks alpha-1 and both beta-1 and beta-2 receptors, lowering blood pressure through vasodilation and reduced heart rate. Carvedilol is the other commonly dispensed alpha and beta blocker.
Why not A: Beta-1 selective drugs include metoprolol and atenolol. Labetalol also blocks alpha-1.
Why not B: Pure alpha-1 blockers are the -azosin drugs, such as doxazosin.
Why not C: Clonidine acts on central alpha-2 receptors. Labetalol does not.
Exam tactic: Alpha + beta blockers: labetalol, carvedilol. Most other -olol drugs are beta only.
Answer: C. Diltiazem and verapamil are non-dihydropyridine calcium channel blockers. They slow conduction through the AV node, so they are used for rate control in atrial fibrillation as well as hypertension and angina.
Why not A: Amlodipine is a dihydropyridine (-dipine). It relaxes blood vessels but has little effect on heart rate.
Why not B: Nifedipine is a dihydropyridine (-dipine) acting mainly on blood vessels, not heart rate.
Why not D: Felodipine is a dihydropyridine (-dipine) used for hypertension, not rate control.
Exam tactic: -dipine = vessels only. Diltiazem and verapamil = also slow the heart.
Answer: D. The clonidine transdermal system is applied once every 7 days. Like oral clonidine, it should not be stopped abruptly because of the risk of rebound hypertension.
Why not A: Daily replacement applies to patches such as nicotine, not the clonidine system.
Why not B: Every 72 hours is the usual schedule for fentanyl patches, not clonidine.
Why not C: No clonidine transdermal system is labeled for 14-day wear.
Exam tactic: Clonidine patch = weekly. Fentanyl patch = every 72 hours.
Answer: A. Thiazide diuretics reduce uric acid excretion, so uric acid can rise and precipitate gout attacks in susceptible patients. Thiazides can also lower potassium and sodium and raise glucose.
Why not B: Thiazides tend to lower potassium, not raise it.
Why not C: Thiazides can raise blood glucose slightly. They do not lower it.
Why not D: Thiazides reduce calcium excretion and can raise calcium, not lower it.
Exam tactic: Thiazide side effects: up uric acid, glucose, calcium. Down potassium, sodium.
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