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Advanced Pharmacology Final Exam Review
1. Why are nitrate-free periods every 24 hours necessary for the patient on
nitroglycerin therapy?: To inhibit the development of tolerance
2. What does a low level of thyroid-stimulating hormone indicate?: Hyperthroidism
3. What would be the best option to treat a newly diagnosed patient with a low TSH
level with?: Propanolol (Inderal)
4. Spironoaldactone (Aldactone) has what mechanism of action (MOA)?: Aldos-terone
antagonist
5. Heparin exerts its therapeutic action by what?: Upregulating the activity of one of the body's natural
anticoagulant molecules, antithrombin III
6. What physiologic action happens when the offending drug is administered during
an anaphylactic reaction.: Mast cells liberate large doses of histamine.
7. What are two systemic psoriasis medications?: Photo-therapy and topical corticosteroids
8. What is the first choice of drug therapy for the majority of patients with
uncomplicated stage I hypertension?: Thiazide diuretics
9. What is the effect of cardiac glycosides?: Digitalis glycosides have a negative chronotropic ettect on
the cardiac muscle cells.
10. Amenorrhea is the most common side effect of which birth control medica-
tion?: Medroxyprogesterone (Depo-Provera)
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11. What is an anti-hypertensive agent which competes with epinephrine for
available beta-receptor sites?: Atenolol (Tenormin)
12. What type of action does nitrates have on the body?: Reduction in systemic venous
tone.
13. What is the recommended level of low-density lipoprotein cholesterol (LDL)
for patients with known coronary artery disease?: 100mg/dl or less.
14. What is the MOA of group IV anti-dysrhythmia drugs?: Depressing phase 4
depolar-ization and lengthening phases 1 and 2 repolarization.
15. 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.
16. Which type of diuretic would be used for a stage I hypertension in a patient
with renal insufficiency?: Loop diuretic.
17. What drug should be considered as first-line therapy for a client with
hypertension and heart failure?: Enalapril (Vasotec)
18. Which drug is considered safe for hypertension treatment during pregnan-
cy?: Methyldopa (Aldomet)
19. What drug will reduce afterload because it is an alpha-adrenergic blocker?-
: Prazosin (Minipress)
20. What is an expected effect of the use of a beta-adrenergic blocker to control
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30. What factor influences plasma protein drug binding and distribution of that
drug?: The amount of albumin available in the blood stream.
31. What does the half-life of a medication determine?: How often the drug is to
be administered.
32. 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.
33. Which medications should be avoided for patients with a sulfa allergy?: Sul-
famethoxazole/Trimethoprim (Bactrim) and Celecoxib (Celebrex).
34. What should be taken into consideration when prescribing fat-soluable
drugs in the elderly?: They are associated with increased duration of drug action.
35. 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 suttering 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."
36. What is the MOA of cardiac glycosides?: Increase the force of cardiac contraction.
37. 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
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38. Along with diet, what drug is used to treat hypertriglyceridemia?: Gemfibrozil
(Lopid).
39. What drug is the best choice of treatment for a newly diagnosed patient
with type 2 diabetes only having postprandial glucose elevation?: Meglitinide (Prandin).
40. Which medication is considered the safest for a diabetic patient if hypo-
glycemia is a major concern?: Metformin (Glucophage).
41. What drug is an absolute contraindication if the patient is a smoker and
taking medications for type 2 diabetes?: Birth control.
42. How should an oral glucocorticoid be taken?: With food.
43. 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.
44. What drug class should be avoided in patients with a diagnosis of osteope-
nia or osteoporosis?: Clucocorticoids like Prednisone.
45. What thyroid drug blocks thyroid hormone production and release?: L-thyrox-ine
(Levothyroid).
46. What drug class exacerbates hyperglycemia?: Corticosteroids like Prednisone (Deltasone).
47. What drug would you add for a patient who has been taking a sulfonylurea
7 / months for the treatment of congestive heart failure, and is complaining of a non- productive cough. What should the NP advise the patient regarding this side effect?: The cough should subside 1-4 days after discontinuing the drug.
57. Which medication classification has been found to be most helpful in man-
aging the problems associated with congestive heart failure?: ACE inhibitors like Trandolapril (Mavik).
58. 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.- : Rhabdomyolysis.
59. What drug is a dihydropyridine calcium channel blocker?: Amlodipine (Norvasc).
60. 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?: Bradycardia.
61. 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).
62. Which drug class is the only one proven to decrease cardiovascular mortal-
ity in hypertensive patients?: Beta-adrenergic blockers like Metoprolol (Toprol).
63. What is the most common adverse side effect of drugs taken to lower low-
8 / density lipoprotein (LDL) cholesterol, such as a bile acid sequestrant like Questran and Ezetimibe (Zetia)?: Gastrointestional symptoms.
64. What medications are most appropriate for efectively managing a patient
with moderate persistent asthma?: An inhaled steroid (Fluticasone) and a long-acting bronchodila-tor (Advair).
65. What medication class should be avoided in patients with bronchitis due to the
fact it might worsen the symptoms of congestion.: Antihistamines like Benadryl.
66. Which antibiotic is most effective in treating community acquired pneumo-
nia (CAP) in a young adult without co-morbid conditions?: Azthromycin (Zithromax).
67. 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).
68. What drug should be avoided in a patient who is taking Theophylline twice
daily for bronchospastic disease, and who presents today with thick, discol- ored, tenacioius sputum, and mild shortness of breath, and fever?: Prednisone (Deltasone).
69. 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.
70. What is the most important teaching point for a patient taking Salmeterol
(Serevent) for asthma?: It is not ettective during an acute asthma attack.
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79. What do gastric parietal cells produce?: Hydrochloric acid.
80. 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.
81. Can antacids cause diarrhea?: Yes, antacids containing magnesium, which decrease bowel transit
time, may cause diarrhea. Most often seen in renal insuflciency.
82. Which medication does NOT increase the incidence of constipation in an
older adult?: Warfarin (Coumadin).
83. Which laxative is safe for long-term use?: Methycellulose (Citrucel).
84. Which medication given for nausea and vomiting works by affecting the
chemoreceptor trigger zone, thereby stimulating uppergastrointestinal motil-ity and increasing lower esophagealsphincter pressure?: Antidopaminergic agents such as Prochlorperazine (Compazine).
85. 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).
86. Which H2RA is most likely to cause drug interactions with Phenytoin
(Dilan-tin) and Theophylline (Bronkodyl)?: Cimetidine (Tagamet).
87. Which pharmacologic intervention should you consider when treating a
middle-aged man with recurrent gastric ulcers?: Antimocrobial therapy to treat an underlying H-pylori.
88. Which OTC supplement commonly taken by the elderly exacerbates consti-
pation?: Calcium.
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89. What direction would you give when prescribing Sucralfate (Carafate)?: The
drug must be taken on an empty stomach.
90. What drug should be limited when the patient has a NSAID induced peptic
ulcer?: Misiprostol (Cytotec).
91. A patient presents with a history of GERD and many other medical condi-
tions. What medication would you encourage her to avoid?: NSAIDs.
92. What drug can exacerbate the symptoms of GERD?: Verapamil (Calan).
