1. All of the following are true concerning statins (HMG-CoA reductase inhibitors) EXCEPT [1]:

   A. Cannot be combined with niacin for increased cholesterol reduction
   B. Reduces primary and secondary risk of stroke 15-25%
   C. Reduce restenosis rates after coronary angioplasty including stent placement
   D. Significantly reduce progression of atherosclerotic plaques
   E. As primary prevention, reduce risk of first myocardial infarction >20%

2. Imitinab (Gleevec®) is the first of new class of anticancer agents (signal transduction inhibitors) that blocks specific receptor tyrosine kinase molecules including the bcr-abl oncogenic protein and the c-kit protein. Concerning the use of imitinab in the treatment of chronic myelogenous leukemia (CML), which of the ONE following statements is TRUE [2] ?

   A. Imitinab induced major hematologic remissions in >80% with interferon alpha relapsed CML
   B. Imitinab induced major hematologic remissions in >50% of patients in CML blast crisis
   C. Most patients receiving imitinab experience severe, dose limiting mucositis and hair loss
   D. Imitinab is directly cytotoxic to CML cells by interfering with mitotic chromosomal segregation
   E. Imitinab must be given with granulocyte (or granulocyte-macrophage) colony stimulating factors to prevent severe neutropenia

3. Compared with ciprofloxacin, the newer fluoroquinolones levofloxacin, grepafloxacin, trovafloxacin, and moxifloxacin have improved coverage of which ONE of the following [3] ?

   A. Anaerobes
   B. Anthrax (Bacillus anthraces)
   C. Pseudomonas aurugenosa
   D. Haemophilus influenzae
   E. Streptococcus pneumoniae

4. Bosentan is a novel endothelin receptor antagonist which blocks types A and B endothelin receptors. Endothelin has recently been approved for the treatment of pulmonary hypertension (P-HTN). All of the following statements concerning endothelin and bosentan are true EXCEPT [4]:

   A. Endothelin is a potent vasoconstrictor which can act independently of other vasoconstrictive mecanisms
   B. Bosentan reduced pulmonary pressures and improved functional class in patients with severe, symptomatic pulmonary HTN
   C. Bosentan is only effective in primary P-HTN, and is not active in scleroderma associated P-HTN
   D. For the treatment of P-HTN, bosentan is the preferred initial agent due to good efficacy and oral dosing
   E. The effects of endothelin and angiotensin II are antagonistic

5. Natriuretic peptides are produced by the heart and other organs and act on the kidney and vasculature. A synthetic form of B-type natriuretic peptide (BNP) is now available as a parenteral agent (nesiritide, Natrecor®). All of the following statements concerning BNP and nesiritide are true EXCEPT [5]:

   A. Nesiritide should be considered for treatment of patients with decompensated heart failure with dyspnea at rest
   B. Nesiritide is recommended in patients with suboptimal response to standard diuretics and nitroglycerin

• Denileukin Difitox (Ontak®) is a fusion protein of Interleukin 2 and a (toxic) fragment diphtheria toxin. Which ONE of the following statements concerning Denileukin Difitox is TRUE [6] ?

  A. Denileukin Difitox kills leukemia or lymphoma cells by interrupting IL2 receptor mediated signalling
  B. Denileukin Difitox kills not only the cells to which it binds, but cells close to the bound cell (bystander effect)
  C. Denileukin Difitox may be useful for treating any CD25 (IL2 receptor) expressing lymphoma or leukemia
  D. Vascular leak syndrome is not a prominant problem with Denileukin Difitox
  E. Denileukin Difitox primarily kills cells of the macrophage and B cell lineage

• All of the following are true concerning vasopeptidase Inhibitors EXCEPT [7]:

  A. Simultaneously inhibits both neutral endopeptidase and ACE
  B. Increase availability of peptides with vasodilatory and other effects
  C. Inhibit the production of angiotensin II and increase levels of bradykinin
  D. Vasopeptidase inhibitors reduce blood pressure independent of age or race
  E. Incidence of cough and angioedema appear to be substantially less frequent than angiotensin converting enzyme (ACE) inhibitors

• All of the following can be used in patients with heparin induced thrombocytopenia EXCEPT [8]:

  A. Argatroban (Novastan®)
  B. Hirudin (Revasc®)
  C. Warfarin (Coumadin® and others)
  D. Lepirudin (Refludan®)
  E. Bivalirudin (Angiomax®)

• The treatment of Painful Crises in patients with Sickle Cell (HbSS) may include all of the following EXCEPT [9]

  A. Oxygen
  B. Diuresis to prevent fluid overload
  C. Maintain bowel motility wth senekot, magnesium citrate
  D. Mild to moderate pain treated with acetaminophen, NSAIDs, or oxycodone
  E. Poloxamer 188 (experimental surfactant)

• All of the following are true concerning the use of radiolabelled monoclonal antibodies (MAb) in cancer therapy EXCEPT [10]:
A. Compared with naked anti-CD20 MAb (rituxumab, Rituxan®), anti-CD20 radiolabelled with I-131 (Bexxar®) or 90-Y (Zevalin®) increases response rates considerably in patients with low grade non-Hodgkin's Lymphoma (NHL)
B. Radiolabelled MAb kill only those cells to which they bind
C. The major side effect of 90-Y (Yttrium) conjugated is myeloablation including thrombocytopenia
D. Zevalin® is approved for rituxumab-refractory low grade NHL
E. Radiolabelled MAbs can be used for tumor imaging as well as therapy

Answers

1. A (May be combined cautiously but effectively with niacin.)
2. A
3. E
4. C
5. D
6. C
7. E (Incidence of cough and angioedema appear to be similar to ACE inhibitors.)
8. C (Warfarin can precipitate gangrene due to its reduction of Protein C.)
9. B
10. B