Advanced Pharmacology Final Exam Review 2022

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Why are nitrate-free periods every 24 hours necessary for the patient on nitroglycerin therapy? - ANSWER To inhibit the development of tolerance What does a low level of thyroid-stimulating hormone... indicate? - ANSWER Hyperthyroidism What would be the best option to treat a newly diagnosed patient with a low TSH level with? - ANSWER Propanolol (Inderal) Spironoaldactone (Aldactone) has what mechanism of action (MOA)? - ANSWER Aldosterone antagonist Heparin exerts its therapeutic action by what? - ANSWER Upregulating the activity of one of the body's natural anticoagulant molecules, antithrombin III What physiologic action happens when the offending drug is administered during an anaphylactic reaction. - ANSWER Mast cells liberate large doses of histamine. What are two systemic psoriasis medications? - ANSWER Photo-therapy and topical corticosteroids What is the first choice of drug therapy for the majority of patients with uncomplicated stage I hypertension? - ANSWER Thiazide diuretics What is the effect of cardiac glycosides? - ANSWER Digitalis glycosides have a negative chronotropic effect on the cardiac muscle cells. Amenorrhea is the most common side effect of which birth control medication? - ANSWER Medroxyprogesterone (Depo-Provera) What is an anti-hypertensive agent which competes with epinephrine for available beta-receptor sites? - ANSWER Atenolol (Tenormin) What type of action does nitrates have on the body? - ANSWER Reduction in systemic venous tone. What is the recommended level of low-density lipoprotein cholesterol (LDL) for patients with known coronary artery disease? - ANSWER 100mg/dl or less. What is the MOA of group IV anti-dysrhythmia drugs? - ANSWER Depressing phase 4 depolarization and lengthening phases 1 and 2 repolarization. Which drug therapy should be used to lower the serum concentration of thyroid hormones and re-establish eumetabolic state in a patient with Graves' disease? - ANSWER Anti-thyroid drugs. Which type of diuretic would be used for a stage I hypertension in a patient with renal insufficiency? - ANSWER Loop diuretic. What drug should be considered as first-line therapy for a client with hypertension and heart failure? - ANSWER Enalapril (Vasotec) Which drug is considered safe for hypertension treatment during pregnancy? - ANSWER Methyldopa (Aldomet) What drug will reduce afterload because it is an alpha-adrenergic blocker? - ANSWER Prazosin (Minipress) What is an expected effect of the use of a beta-adrenergic blocker to control angina? - ANSWER Reduced force of cardiac contraction. What side effect should be monitored closely in the elderly when taking Metformin (Glucophage) for type 2 diabetes? - ANSWER Lactic acidosis. What is the primary role of cytochrome p-450 in the liver? - ANSWER Deactivate and detoxify medications and other substances. What is a component of Vitamin K-dependent clotting factors? - ANSWER Prothrombin How are IV morphine and nitroglycerin beneficial in acute heart failure? - ANSWER Decrease preload. What is the purpose of administering a vasodilating drug to a patient in heart failure? - ANSWER Decrease afterload. What are some contrindications for HMG-co A reductase inhibitors (statins)? - ANSWER They cause myopathies, especially at higher doses or in combination with certain drugs. They should never be used in patients taking Warfarin (Coumadin). Which drug can reduce serum LDL the most in patients with hyperlipidemia? - ANSWER Lovastatin (Mevacor) Which drug is contrindicated in a patient with Myasthena Gravis? - ANSWER Procainamide (Pronestyl). What action is most effective in decreasing the risk of hyperkalemia associated with the start of angiotensin-converting enzyme inhibitor (ACEI) therapy? - ANSWER Making sure that the patient is well hydrated. What factor influences plasma protein drug binding and distribution of that drug? - ANSWER The amount of albumin available in the blood stream. What does the half-life of a medication determine? - ANSWER How often the drug is to be administered. What important information should be given to a patient who is taking Metoprolol (Lopressor) for angina and hypertension? - ANSWER The drug should not be taken with milk or dairy products. Which medications should be avoided for patients with a sulfa allergy? - ANSWER Sulfamethoxazole/Trimethoprim (Bactrim) and Celecoxib (Celebrex). What should be taken into consideration when prescribing fat-soluable drugs in the elderly? - ANSWER They are associated with increased duration of drug action. Which hypolipidemic class of drugs does not have to have liver function studies? - ANSWER Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) FYI: I actually just looked this up because it didn't seem right...From the FDA: "The good news—no more periodic blood tests for liver function. The warnings—taking a statin may increase the odds of developing type 2 diabetes or suffering reversible memory loss or problems thinking. The FDA warned that one statin, lovastatin, shouldn't be taken with some antibiotics, anti-fungal agents, or medications used to treat AIDS." What is the MOA of cardiac glycosides? - ANSWER Increase the force of cardiac contraction. What age-related changes place the elderly at risk for an exaggerated response to Warfarin (Coumadin) and Heparin? - ANSWER Protein binding changes and decrease in clotting factors. Along with diet, what drug is used to treat hypertriglyceridemia? - ANSWER Gemfibrozil (Lopid). What drug is the best choice of treatment for a newly diagnosed patient with type 2 diabetes only having postprandial glucose elevation? - ANSWER Meglitinide (Prandin). Which medication is considered the safest for a diabetic patient if hypoglycemia is a major concern? - ANSWER Metformin (Glucophage). What drug is an absolute contraindication if the patient is a smoker and taking medications for type 2 diabetes? - ANSWER Birth control. How should an oral glucocorticoid be taken? - ANSWER With food. The normal starting dose of levothyroxine is 50-100mcg per day for primary hypothroidism. What is the most appropriate starting dose in a 71-year old female patient? - ANSWER 25mcg per day. What drug class should be avoided in patients with a diagnosis of osteopenia or osteoporosis? - ANSWER Clucocorticoids like Prednisone. What thyroid drug blocks thyroid hormone production and release? - ANSWER L-thyroxine (Levothyroid). What drug class exacerbates hyperglycemia? - ANSWER Corticosteroids like Prednisone (Deltasone). What drug would you add for a patient who has been taking a sulfonylurea medication like Glipizide (Glucotrol) for type 2 diabetes when there is poor glucose control? - ANSWER Add Metformin (Glucophage) to the sulfonylurea. Which drug class may predispose an insulin dependent patient to hypoglycemia? - ANSWER A selective beta-adrenergic blocker like Nadolol (Corgard). What side effects may an elderly patient who has just been placed on a calcium channel blocker for treatment of hypertension and angina except to watch for? - ANSWER Constipation, peripheral edema, and decreased heart rate. What might be a probable cause of a decreased digoxin level of 0.5mg/ml in a 70-year old with previously stable levels be a result of? - ANSWER Antacid use. What drug used in the treatment of congestive heart failure is NOT associated with decreased mortality? - ANSWER Digoxin (Lanoxin). A patient complains of "puffy feet" shortly after beginning a new medication three months ago. There is no underlying physiological cause for this condition. What medication is most likely causing the problem? - ANSWER Amlodipine (Norvasc). What drugs affect the action of Warfarin (Coumadin)? - ANSWER Alcohol, NSAIDs, and oral antifungals. What drug has a beneficial effect on benign prostate hypertrophy that may be used to treat simultaneous hypertension? - ANSWER Doxazosin (Cardura). What anithypertensive agent is safe during pregnancy? - ANSWER Methyldopa (Aldomet). A patient is taking the ACEI Enalapril (Vasotec) for the last four months for the treatment of congestive heart failure, and is complaining of a nonproductive cough. What should the NP advise the patient regarding this side effect? - ANSWER The cough should subside 1-4 days after discontinuing the drug. Which medication classification has been found to be most helpful in managing the problems associated with congestive heart failure? - ANSWER ACE inhibitors like Trandolapril (Mavik). What potentially serious side effect should a NP monitor or suspect in a patient who has begun taking Lovastatin (Mevacor) approximately three weeks ago, and who now presents complaining of generalized muscle aches. - ANSWER Rhabdomyolysis. What drug is a dihydropyridine calcium channel blocker? - ANSWER Amlodipine (Norvasc). A 75-year old patient is taking Timolol Maleate (Timpotic) for chronic open angle glaucoma and is well controlled. What side effect might you watch for if Propanolol (Inderal) is added? - ANSWER Bradycardia. What is the preferred lab test to evaluate coagulation status in a 76-year old female who is taking Warfarin (Coumadin) for chronic atrial fibrillation, and who is being managed outpatient? - ANSWER International normalization ratio (INR). Which drug class is the only one proven to decrease cardiovascular mortality in hypertensive patients? - ANSWER Beta-adrenergic blockers like Metoprolol (Toprol). What is the most common adverse side effect of drugs taken to lower low-density lipoprotein (LDL) cholesterol, such as a bile acid sequestrant like Questran and Ezetimibe (Zetia)? - ANSWER Gastrointestional symptoms. What medications are most appropriate for efectively managing a patient with moderate persistent asthma? - ANSWER An inhaled steroid (Fluticasone) and a long-acting bronchodilator (Advair). What medication class should be avoided in patients with bronchitis due to the fact it might worsen the symptoms of congestion. - ANSWER Antihistamines like Benadryl. Which antibiotic is most effective in treating community acquired pneumonia (CAP) in a young adult without co-morbid conditions? - ANSWER Azthromycin (Zithromax). What drug combination would be most effective to keeping a 20-year old patient with mild persistent asthma symptom free? - ANSWER A short-acting bronchodilator prn like Albuterol (Proventil) and an inhaled corticosteroid). What drug should be avoided in a patient who is taking Theophylline twice daily for bronchospastic disease, and who presents today with thick, discolored, tenacioius sputum, and mild shortness of breath, and fever? - ANSWER Prednisone (Deltasone). What is the optimal time to start antiviral therapy, such as Oseltamivir Phosphate (Tamiflu), in select patients with influenza? - ANSWER Within 48 hours of developing symptoms. What is the most important teaching point for a patient taking Salmeterol (Serevent) for asthma? - ANSWER It is not effective during an acute asthma attack. Which medication is most effective for patients with chronic emphysema? - ANSWER Apratropium (Atrovent). What is the most appropriate treatment of exercise induced asthma? - ANSWER An inhaled short-acting beta-agonist like Albuterol (Proventil). What is the treatment of choice for recurrent herpes simplex virus type 2 infection? - ANSWER Oral acyclovir. What is the most appropriate treatment for a patient with a history of rheumatic fever and resultant valvular disease who is about to undergo a dental procedure, and who has no known drug allergies? - ANSWER Amoxicillin (Amoxil). What antimicrobial agent would be appropriate to prescribe in a 65-year old patient who presents with a past medical history of coronary artery disease, a 101F temperature, and tachypnea of 24 breaths per minute. Chest X-ray confirms a left lower lobe pneumonia. - ANSWER Levofloxacin (Levaquin). What is the most appropriate intervention for an 8-yr old sent home from school with mucopululent discharge from his eye and suspected bacterial conjunctivitis? - ANSWER Bacitracin/polymyxin (Polysporin) opthalmic solution for 7-10 days. Which class of drugs should NOT be used to treat COPD? - ANSWER Leukotriene inhibitors, such as Zafirlukast (Aaccolate). How do antiprostaglandin drugs cause stomach mucosal injury? - ANSWER They alter the thickness of the protective mucosal layer. What do gastric parietal cells produce? - ANSWER Hydrochloric acid. How do Diphenoxylate (Lomotil) and Loperamide (Imodium) help relieve diarrhea? - ANSWER They decrease the motility of the ileum and colon, slowing the transit time and promoting more water absorption. Can antacids cause diarrhea? - ANSWER Yes, antacids containing magnesium, which decrease bowel transit time, may cause diarrhea. Most often seen in renal insufficiency. Which medication does NOT increase the incidence of constipation in an older adult? - ANSWER Warfarin (Coumadin). Which laxative is safe for long-term use? - ANSWER Methycellulose (Citrucel). Which medication given for nausea and vomiting works by affecting the chemoreceptor trigger zone, thereby stimulating uppergastrointestinal motility and increasing lower esophagealsphincter pressure? - ANSWER Antidopaminergic agents such as Prochlorperazine (Compazine). Which drug class is most likely to produce the most rapid relief for a patient who is having heartburn symptoms? - ANSWER Antacids like Calcium Carbonate (Tums). Which H2RA is most likely to cause drug interactions with Phenytoin (Dilantin) and Theophylline (Bronkodyl)? - ANSWER Cimetidine (Tagamet). Which pharmacologic intervention should you consider when treating a middle-aged man with recurrent gastric ulcers? - ANSWER Antimocrobial therapy to treat an underlying H-pylori. Which OTC supplement commonly taken by the elderly exacerbates constipation? - ANSWER Calcium. What direction would you give when prescribing Sucralfate (Carafate)? - ANSWER The drug must be taken on an empty stomach. What drug should be limited when the patient has a NSAID induced peptic ulcer? - ANSWER Misiprostol (Cytotec). A patient presents with a history of GERD and many other medical conditions. What medication would you encourage her to avoid? - ANSWER NSAIDs. What drug can exacerbate the symptoms of GERD? - ANSWER Verapamil (Calan). [Show More]

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