Advanced Pharmacology Final Exam Review

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Why are nitrate-free periods every 24 hours necessary for the patient on nitroglycerin therapy?
To inhibit the development of tolerance

What does a low level of thyroid-stimulating hormone indicate?

What would be the best option to treat a newly diagnosed patient with a low TSH level with?
Propanolol (Inderal)

Spironoaldactone (Aldactone) has what mechanism of action (MOA)?
Aldosterone antagonist

Heparin exerts its therapeutic action by what?
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.
Mast cells liberate large doses of histamine.

What are two systemic psoriasis medications?
Photo-therapy and topical corticosteroids

What is the first choice of drug therapy for the majority of patients with uncomplicated stage I hypertension?
Thiazide diuretics

What is the effect of cardiac glycosides?
Digitalis glycosides have a negative chronotropic effect on the cardiac muscle cells.

Amenorrhea is the most common side effect of which birth control medication?
Medroxyprogesterone (Depo-Provera)

What is an anti-hypertensive agent which competes with epinephrine for available beta-receptor sites?
Atenolol (Tenormin)

What type of action does nitrates have on the body?
Reduction in systemic venous tone.

What is the recommended level of low-density lipoprotein cholesterol (LDL) for patients with known coronary artery disease?
100mg/dl or less.

What is the MOA of group IV anti-dysrhythmia drugs?
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?
Anti-thyroid drugs.

Which type of diuretic would be used for a stage I hypertension in a patient with renal insufficiency?
Loop diuretic.

What drug should be considered as first-line therapy for a client with hypertension and heart failure?
Enalapril (Vasotec)

Which drug is considered safe for hypertension treatment during pregnancy?
Methyldopa (Aldomet)

What drug will reduce afterload because it is an alpha-adrenergic blocker?
Prazosin (Minipress)

What is an expected effect of the use of a beta-adrenergic blocker to control angina?
Reduced force of cardiac contraction.

What side effect should be monitored closely in the elderly when taking Metformin (Glucophage) for type 2 diabetes?
Lactic acidosis.

What is the primary role of cytochrome p-450 in the liver?
Deactivate and detoxify medications and other substances.

What is a component of Vitamin K-dependent clotting factors?

How are IV morphine and nitroglycerin beneficial in acute heart failure?
Decrease preload.

What is the purpose of administering a vasodilating drug to a patient in heart failure?
Decrease afterload.

What are some contrindications for HMG-co A reductase inhibitors (statins)?
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?
Lovastatin (Mevacor)

Which drug is contrindicated in a patient with Myasthena Gravis?
Procainamide (Pronestyl).

What action is most effective in decreasing the risk of hyperkalemia associated with the start of angiotensin-converting enzyme inhibitor (ACEI) therapy?
Making sure that the patient is well hydrated.

What factor influences plasma protein drug binding and distribution of that drug?
The amount of albumin available in the blood stream.

What does the half-life of a medication determine?
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?
The drug should not be taken with milk or dairy products.

Which medications should be avoided for patients with a sulfa allergy?
Sulfamethoxazole/Trimethoprim (Bactrim) and Celecoxib (Celebrex).

What should be taken into consideration when prescribing fat-soluable drugs in the elderly?
They are associated with increased duration of drug action.

Which hypolipidemic class of drugs does not have to have liver function studies?
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?
Increase the force of cardiac contraction.

What age-related changes place the elderly at risk for an exaggerated response to Warfarin (Coumadin) and Heparin?
Protein binding changes and decrease in clotting factors.

Along with diet, what drug is used to treat hypertriglyceridemia?
Gemfibrozil (Lopid).

What drug is the best choice of treatment for a newly diagnosed patient with type 2 diabetes only having postprandial glucose elevation?
Meglitinide (Prandin).

Which medication is considered the safest for a diabetic patient if hypoglycemia is a major concern?
Metformin (Glucophage).

What drug is an absolute contraindication if the patient is a smoker and taking medications for type 2 diabetes?
Birth control.

How should an oral glucocorticoid be taken?
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?
25mcg per day.

What drug class should be avoided in patients with a diagnosis of osteopenia or osteoporosis?
Clucocorticoids like Prednisone.

What thyroid drug blocks thyroid hormone production and release?
L-thyroxine (Levothyroid).

What drug class exacerbates hyperglycemia?
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?
Add Metformin (Glucophage) to the sulfonylurea.

Which drug class may predispose an insulin dependent patient to hypoglycemia?
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?
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?
Antacid use.

What drug used in the treatment of congestive heart failure is NOT associated with decreased mortality?
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?
Amlodipine (Norvasc).

What drugs affect the action of Warfarin (Coumadin)?
Alcohol, NSAIDs, and oral antifungals.

What drug has a beneficial effect on benign prostate hypertrophy that may be used to treat simultaneous hypertension?
Doxazosin (Cardura).

What anithypertensive agent is safe during pregnancy?
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?
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?
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.

What drug is a dihydropyridine calcium channel blocker?
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?

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?
International normalization ratio (INR).

Which drug class is the only one proven to decrease cardiovascular mortality in hypertensive patients?
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)?
Gastrointestional symptoms.

What medications are most appropriate for efectively managing a patient with moderate persistent asthma?
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.
Antihistamines like Benadryl.

Which antibiotic is most effective in treating community acquired pneumonia (CAP) in a young adult without co-morbid conditions?
Azthromycin (Zithromax).

What drug combination would be most effective to keeping a 20-year old patient with mild persistent asthma symptom free?
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?
Prednisone (Deltasone).

What is the optimal time to start antiviral therapy, such as Oseltamivir Phosphate (Tamiflu), in select patients with influenza?
Within 48 hours of developing symptoms.

What is the most important teaching point for a patient taking Salmeterol (Serevent) for asthma?
It is not effective during an acute asthma attack.

Which medication is most effective for patients with chronic emphysema?
Apratropium (Atrovent).

What is the most appropriate treatment of exercise induced asthma?
An inhaled short-acting beta-agonist like Albuterol (Proventil).

What is the treatment of choice for recurrent herpes simplex virus type 2 infection?
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?
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.
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?
Bacitracin/polymyxin (Polysporin) opthalmic solution for 7-10 days.

Which class of drugs should NOT be used to treat COPD?
Leukotriene inhibitors, such as Zafirlukast (Aaccolate).

How do antiprostaglandin drugs cause stomach mucosal injury?
They alter the thickness of the protective mucosal layer.

What do gastric parietal cells produce?
Hydrochloric acid.

How do Diphenoxylate (Lomotil) and Loperamide (Imodium) help relieve diarrhea?
They decrease the motility of the ileum and colon, slowing the transit time and promoting more water absorption.

Can antacids cause diarrhea?
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?
Warfarin (Coumadin).

Which laxative is safe for long-term use?
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?
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?
Antacids like Calcium Carbonate (Tums).

Which H2RA is most likely to cause drug interactions with Phenytoin (Dilantin) and Theophylline (Bronkodyl)?
Cimetidine (Tagamet).

Which pharmacologic intervention should you consider when treating a middle-aged man with recurrent gastric ulcers?
Antimocrobial therapy to treat an underlying H-pylori.

Which OTC supplement commonly taken by the elderly exacerbates constipation?

What direction would you give when prescribing Sucralfate (Carafate)?
The drug must be taken on an empty stomach.

What drug should be limited when the patient has a NSAID induced peptic ulcer?
Misiprostol (Cytotec).

A patient presents with a history of GERD and many other medical conditions. What medication would you encourage her to avoid?

What drug can exacerbate the symptoms of GERD?
Verapamil (Calan).

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy Define drug any chemical that can affect living systems/processes Pharmacology The study of the effects of drugs and how …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy The drug’s____name is protected ny copyright TRADE The drug’s____name describes the atomic & molecular structure. CHEMICAL WE WILL WRITE …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy First-Pass Effect Drug absorbed from GI tract and carried to the liver through portal circulation. Some drugs extensively metablized …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy CHAPTER 22 —-ANTIHYPERTENSIVE DRUGS Captaopril (Capoten) The first available ACE inhibitor and is considered the prototypical drug for the …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy What is the side effect of lorazepam or Ativan Sedation The nurse should instruct the patient taking clonidine or …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy Define pharmacokinetics Study of what the body does to the drug Define absorption movement of the drug from its …

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