1. Name this layer. 

JT is a 48 yo with a history of gastrointestinal bleed, hypertension, hyperlipidemia, type II diabetes mellitus, and obesity. He presents to the clinic for pain management for his hip osteoarthritis.  He has tried acetaminophen and topical Voltaren (diclofenac) for the past six months and he is receiving no relief. It was determined that his cardiovascular risk profile is too high to consider a Cox-2 inhibitor. Which of the following NSAIDS would present the lowest risk of gastrointestinal adverse events for JT?   

 Diltiazem and Verapamil are indicated in tachycardias including atrial fibrillation. A primary side effect of verapamil is:

In the treatment of Helicobacter pylori-associated peptic ulcer disease, which combination of therapies is commonly recommended as first line treatment? 

A 71-year-old female with severe COPD (FEV₁ 38% predicted) presents for follow-up. She has chronic bronchitis symptoms and reports two hospitalizations for COPD exacerbations in the past year despite adherence to triple inhaler therapy (fluticasone/umeclidinium/vilanterol). She quit smoking 3 years ago. FEV 1= 42%. Blood eosinophil count is 90 cells/µL. She denies asthma history. Oxygen saturation is 93% on room air. BMI is 21 kg/m². Which of the following is the most appropriate next step in pharmacologic management?  

A 60-year-old male with hypertension and prior myocardial infarction is prescribed metoprolol succinate. What is the primary pharmacologic effect that reduces blood pressure?

Which of the following best explains the mechanism by which nonsteroidal anti-inflammatory drugs (NSAIDs) contribute to the development of gastrointestinal ulcers? (Mark all that apply)

A 50-year-old woman presents with joint pain, swelling, and morning stiffness lasting more than an hour. She has tenderness and synovitis in multiple joints, including the wrists and small joints of the hands. Laboratory tests reveal positive rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Her erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are elevated. Radiographs show early erosive changes in the metacarpophalangeal joints. Which of the following is the most appropriate initial pharmacological treatment for this patient? 

A 58-year-old female undergoing chemotherapy for breast cancer develops severe nausea and vomiting. She is prescribed ondansetron. Two hours after administration, she develops palpitations and lightheadedness. ECG reveals a prolonged QT interval. Which of the following best explains the mechanism responsible for this adverse effect?  

The American Heart Association recommends the best treatment for a blood pressure > 140/90 mmHg with Cardiovascular risks to include: