N5334 Final Exam Questions with Answers, Exams of Pharmacology

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N5334 Final Exam Questions with Answers

1. Prescribing basics: Prescribing is regulated by state BON

2. Proper RX: Providers name and address, Telephone DEA

Pt name/DOB/Addres Name of Drug, strength, SIG(directions) with indication/Route and frequency, Quan- tity and signature.

3. Drug Schedules: Most addictive to least: 1: Heroin,LSD, MJ

2: hydrocodone, cocaine, Methamphetamine, methadone, oxycodone, meperidine, fentanyl, adderall, ritalin 3: codeine, ketamine, testosterone 4: xanax, valium, soma, ambient, tramadol 5: antidiarrheal, antitussives, lomotil, lyrica

4. Pharmicodyamics: The effects of drug on the body. Receptors are large mole- cules usually

proteins, that interact and mediate the action of drugs

5. agonist: produce receptor stimulation and a conformational change every time they bind.

Do not need all available receptors to produce a maximum response

6. Partial agonist: drugs that have properties in b/w those of full agonist and antagonist. They

bind to receptors but when they occupy the receptor sites, they stimulate only some of the receptors.

7. antagonist: drugs with affinity for a receptor but with no intrinsic activity. Affinity allows the

antagonist to bind to receptors, but lack of intrinsic activity prevents the bound antagonist from causing receptor activation. The block action of drugs (ex. Narcan)

8. Bioavailabity: % of administered dosage of the drug that survives the first pass through the

liver and reaches the blood stream

9. half life: Time required for the amount of a drug in the body to decline by 50%, drugs with

shorter half lives must be administer frequently. 4.5-5.5 times the half life to get steady state and to be limited from the body

10. what the body does to the drug: absorption, distribution, metabolism, excre- tion

11. Distribution: movement of absorbed drug in bodily fluids throughout the body to target

tissue. Properties affecting: lipid/water solubility, PH affects ionization of drug, protein binding, size of molecule (smaller molecules are more able to diffuse) Tissue: fat, bone, blood/brain barrier (only lipid soluble will pass), placental barrier (many drugs can pass)

12. Protein binding: unbound drug is free which is active, crosses membrane. Low plasma

proteins result in more free drug. Competition: when 2 highly bound drugs are given it increases the level of both drugs

13. Metabolism: take place in the liver mostly. Chemical change of a drug structure to:

Enhance excretion, inactivate the drug, increase therapeutic action, active a prodrug (inactive until metabolized in the body into the active compound, ex: levodopa), increase or decrease toxicity

14. CYP450: enzymes constitutes the most important of the phase I metabolizing enzymes

(account for about 75% of drug metabolism in the liver) Phase 2: conjugation reaction occur leading to large increases in hydrophilicity of the substrates rendering them more readily excretable

15. Substrate: an agent that is metabolized by an enzyme into a metabolite and product and

eventually excreted

16. Inhibitors: compete with other drugs for a particular enzyme affecting the me- tabolism

(decreased) of the substrate and decreases the excretion of the substrate and increasing the circulating drug

17. inducer: competes with other drugs for a particular enzyme affecting metabo- lism of the

substrate (increases) decreasing the efficacy of the drug

18. excretion: renal: passive glomerular filtration, active tubular secretion, tubular

reabsorption, gi tract, lung, sweat and salivary, mammary

19. genomics: study of the complete set of genetic information present in a cell, an organism, or

species

20. pharmacogenetics: the study of the influence of hereditary factors on the response of

individual organisms to drugs, and the study of variations of DNA and RNA characteristics as related to drug response

21. Pharmacogenetics tests: Mentioned on drug labels can be classified as "test required," "test

recommended," and "information only." Currently, four drugs are required to have pharmacogenetics testing performed before they are prescribed: cetuximab, trastuzumab, maraviroc and dasatinib wafarin, carbamazepine, valproic acid and abacavir are recommended to tests prior to initial dosing

22. Carbamazepine and Asisans: Initiating carbamazepine therapy in these pa- tients (allele HLA-

B*1502) are at high risk for developing Steven Johnson syndrome or toxic epidermal necrolysis (TEN)

23. The ability of the anesthetic to penetrate the axon membrane is determined by 3 properties. What

are they?: Molecular size, Lipid solubility, degree of ioniza- tion at tissue pH

24. Why is epinephrine given with local anesthetics?: Decreases local blood flow (decreased

risk of bleeding) Delays systemic absorption of the anesthetic prolongs anesthesia reduces the risk of toxicity

25. What is the most widely used local anesthetic?: Lidocaine

26. What is a possible fatal reaction to benzocaine: Methemoglobinemia

27. What is included in application guidelines for topical anesthetics: avoid wrapping the site

and heating the site, avoid application to open skin

28. Which medication will not cause rebound headaches from overuse?: pro- pranolol

(preventative)

29. What is the best option for menstural migraine?: low dose estrogen about 3 days prior to

menses

30. What food can trigger migraines?: Hot dog d/t nitrates

31. What medication is a Seratonin 1B1D receptor agonist?: Sumatriptan

32. Butterbur can help as prevention for migraine therapy. What side effect can occur?: Liver

damage

33. What are the 3 main classes of opiod receptors?: Mu kappa delta

34. Which of the following will reserve he effects caused by opioid agonist?: -

naloxone

35. Which of the medications are used to treat OIC?: Naloxegol, methylinaltrex- one, lubiprostone

36. Tolerance is defined as: increased does of a med needed to obtain the same response

37. Which medication is used for opioid abuse?: Naltrexone

38. Euphoria induced by morphine:: An exaggerated sense of well-being caused by the activation

of mu receptors

39. Which medication is given nasally for migraines?: Butorphanol

40. Which of the following describes the mechanism of NSAIDs?: Inhibition of the cyclo-

oxygenase enzyme

41. Second generation COX 2 inhibitors:: Suppress inflammation and cause less risk for gastric

ulceration than COX 1, increase risk for heart disease

42. Which of the following medications should not be given with ASA?: Glu- cocorticoids

43. Which medication is given for acetaminophen overdose?: Acetylcysteine

44. What are non endocrine therapeutic uses for glucocorticoids?: RA, SLE, IBS, Bursitis, OA,

Gout, disorders of the eye

45. What is the danger of prolonged use of glucocorticoids?: adrenal insuffi- ciency

46. Methotrexate can cause fatal toxicities of:: Bone marrow, liver, kidneys, lungs.

Hemorrhagic enteritis and GI perforation

47. Jane is on etanercept for RA. The NP knows: Jane should be checked for TB yearly

48. What is first line treatment for gout?: Colchicine, indomethacin

49. When would you initiate a Uriosuric Medication?: more than 3 gout attacks per year

50. Antiinflammatories: inhibition of COX 1: protects against MI and stroke inhibition COX 2:

surpasses inflammation, pain and protects against colorectal cancer (less GI bleeding)

51. first generation NSAIDS: inhibit COX 1 and COX2: treatment is for relief of mild to

moderate pain, relief of cramps r/t dysmenorrhea (risk GI bleed and renal impairment)

52. generation 2 NSAIDS: only suppresses COX2, decreased risk for GI bleeding but impose risk

for increased heart disease

53. Aspirin: Non-selective inhibitor of COX, therapeutic use analgesic, fever, men- sural cramps,

anti-inflammatory, Alzheimer disease. Risk for bleeding is too high. Increased secretion of acid and pepsin therefore ruins all the protective lining of the stomaching. Pt at risk: alcoholics, smoking, older people, or people who have had PUD. Risk of ASA is not advised in pt younger than 18 r/t Reyes syndrome, pregnancy because it cause ductus arteriosis, if given with Ibuprofen it can decrease effects of ASA.

54. first generation non-ASA NSAIDS: inhibit COX 1 and 2, given for RA and OA, no protection

against MI or stroke. ex. Ibuprofen, alieve, diclophinac. Indicated for mild to moderate pain, antiinflammaroty and analgesic effects. risk of GI bleed

55. Celebrex: second generation non ASA nsaids, lower risk for GI but can still cause renal

impairment. given for OA, RA, dysmenorrhea. S/E: abdominal pain, renal impairment, sulfa allergies.

Drug interaction: warfarin, Decrease effects of furosemide, (increases)lithium, ACE inhibitors.

56. Acetaminophen: Analgesic and antipyretic. Hepatotoxicity risk. No more than 3 g in 24 hr

period. for overdose: acetylesistine. Can blunt immune response of vaccines

57. glucocosteroids: Risk for Cushings disease, diabetes, OA, risk for GI bleeds. If given over 7

days, needs to be tapered off unless on inhaled Corticorsteriods. Used in labor to mature lungs of infants. Therapeutic use: allergic condition, asthma and immune suppression.

58. RA: very different from OA. Autoimmune disease.Symmetrical morning stiffness that last for

over an hour. Shortens life span of patients. Increases risk for CVD and stroke. When testing these patient, you want to do a full immunological test because it comes with other autoimmune diseases.

• First line treatment are NSAIDS and first line DMARD (methotrexate, minocycline)

59. Gout: Monoarticular arthritis, d/o r/t kidney don't excrete enough uric acid. Only way to

diagnosis is joint aspiration and look for the uric crystals Prevention is best

60. Gout preventions:

61. Migraines: trial and error of medication and triggers. start with over the counter and move

to more aggressive over time. +2 a month, preventative medication is okay. Abortive medications: NSAIDS, ergoalcoloids (cause vasoconstriction), triptans (Seratonin 1b1d receptor agonist) Sumitriptan, cause vasoconstrictions, maximum dose is 200mg a day. can cause coronary vasospasm

Preventative: Beta blockers, antiseizure medications (depikote and topimax), tri- cyclic antidepressants, Calcium Channel blockers, botox, vitamin b2/Co Q enzyme and butterbur.

62. cluster headaches: intensely painful headaches that affect one side of the head and may be

associated with tearing of the eyes and nasal congestion, occur in series, 5-15 minutes prophylaxis tx with regular Headaches

63. Depression tx: SSRI, SNRI, Bupropion are first line treatments. Least side effects of any

medications Mild/moderate depression or anxiety are okay to treat but anything else needs to be referred to a psychiatric NP

64. tricyclic antidepressants: Weigh gain, drowsiness, and terrible anticholin- ergic effects.

beers list, Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine.

65. SSRIs: Fluoxetine, paroxetine, sertraline, citalopram.

effects don't start for several weeks (4-6 weeks) can cause weight gain, vivid dreams, bruxism, bleeding disorders, ED/sexual dysfunction, hyponatriemia, most can cause n/v that might go away. need to taper off these meds. can be used for panic disorder, pms, anxiety, ptsd, post menopausal women

66. SNRI: serotonin norepinephrine reuptake inhibitors, opposite of SSRI (weight loss and

increase in energy) Desvenlafaxine (Pristiq, Khedezla) Duloxetine (Cymbalta) also approved to treat anxiety and certain types of chronic pain Venlafaxine (Effexor XR) also approved to treat anxiety and panic disorder S/E:Nausea

Dry mouth Dizziness Headache Excessive sweating Other possible side effects may include: Tiredness Constipation Insomnia Changes in sexual function, such as reduced sexual desire, difficulty reaching orgasm or the inability to maintain an erection (erectile dysfunction) Loss of appetite

67. Brupropion (wellbutrin): stimulate, appetite suppressant, helps with sexual side effects of

SSRIs, S/E: dry mouth, constipation and increase risk of seizure disorder

68. St. John's Wart (Hypericum perforatum): don't want to give this to patients with SSRIs, a lot

of drug reactions, dosed at 300mg TID, CYP450 inducer

69. lithium: Excretion is reduced with sodium levels are low. S/E: GI disturbances, n/v/d, ataxia,

thirst, tremor, high urine output, death. Very narrow therapeutic index

70. Benzodiazepines: drugs that lower anxiety and reduce stress: alprazolam, diazepam

71. alcohol abuse:

72. nicotine abuse:

73. Prior to starting antidepressants, patients should have what lab testing to rule out:

hypothyroidism

74. A 32 yo male is starting paroxetine for depression. He is complaining of not being able to obtain

an erection. What can the NP do to help?: add bupropion

75. A 6 yo us being treated with ethosuximide. She should be monitored for:: Blood dycrasias

which are uncommon but possible.

76. Sandy is taking lamotrigine for seizures and wants an rx for OCPs which can interact with

lamotrigine and cause:: reduced lamotrigine levels, requiring an increase in the dose of lamotrigine

77. The tricyclic antidepressants should be prescribed cautiously in patients with: CAD

78. Atropine: Cause pupil finalization in eye exam

79. Bethanechol (Urecholine): GI/GU stimulation following surgery, parasympath- omimetic

80. Pyridostigmine (Mestinon): Category: Cholinergic, Anticholeristinase, Use: Myasthenia

Gravis, Precautions: May cause cram,ps, increased peristalsis

81. Doxazosin (Cardura): Hypertension, BPH

82. Albuterol: Asthma inhaler

83. Scopolamine (Transderm Scop): Anticholinergic (drying effects) Used for

motion sickness Can cause sedation, anticholinergic effects

84. Phenylephrine: Sudafed PE; sympathomimetics

85. Propranolol (Inderal): Beta adrenergic blocker for hypertension

86. Dobutamine (Dobutrex): sympathomimetic

Indication: short term management of heart failure Action: Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart. Nursing Considerations:

• Monitor hemodynamics: hypertension, ‘HR, PVCs
• Skin reactions may occur with hypersensitivity
• Beta blockers may negate therapeutic effects of dobutamine
• Monitor cardiac output
• Monitor peripheral pulses before, during, and after therapy
• DO NOT confuse dobutamine with dopamine

87. Acetylcholine binds to both and receptors: nicotinic and Mus-

carinic

88. Norepinep

hrine binds to both and

89. Atropine is considered to be the antidote to

receptors: alpha and beta toxicity: Cholinergic

90. Sympathomimetic is the same as agonist: adrenergic

91. Sympatholytic means the same as Anti- : adrenegic

92. Muscarinic antagonist means the same as anti- : cholinergic

93. cholinergic means the same as

agonist and parasympathetic - : muscarinic and mimetic

94. Bradycardia, urinary urgency, bronchoconstriction, and pupillary constric- tion are the signs of

toxicity: cholinergic

95. Pupillary dilation, tachycardia, urinary retention and dry mouth are signs of muscarinic drugs

such as atropine: antagonist

96. An anticholinergic drug will acetylcholine availability to the tis- sue?:

increase

97. Alpha 1 agonist BP, while alpha 1 antagonists BP?: in-

crease, decrease

98. beta 1 receptor activation will lead to heart rate?

Beta 1 blockade will Heart rate?: increases/decrease

99. beta 2 receptor activation will lead to however, administering a non-

cardioselective beta blocker can lead to ?: bronchodialiation/bron- choconstriction

100. Alpha 2 agonist such as clonidine will BP?: lower

101. A inotrope will increase contractility; a chronotrope will

decrease HR; while a dromotrope will decrease conduction via the AV node?:

positive, negative, negative

102. Epinephrine is used in many emergency situations, such , Car-

diac and hypo : anaphylaxis, cardia arrest, hypotension

103. what "onset of actions symptoms" should be reviewed with patients who have been newly

prescribed an SSRI?: they can feel a bit of nausea but this resolves in about 1 week

104. Jaycee has been on Escitalopram for a year and is willing to try tapering off the SSRI.

What is the initial dosage adjustment when starting to taper off antidepressants?: reduce the dose by 50% for 3-4 days

105. One major drug used to treat bipolar disease is lithium. Because lithium has a narrow

therapeutic range, it is important to recognize symptoms of toxicity, such as:: GI problems, drowsiness and nausea, seizures and coma are serious problems.

106. monitoring of a patient on gabapentin to treat seizures includes:: Record- ing seizure

frequency, duration and severity

107. Sam, aged 65, is started on L-dopa for his Parkinson's disease (PD). He asks why this is

necessary. You tell him:: the primary goal of therapy is to replace depleted stores of dopamine

108. A 55yo patient develops parkinson's disease characterized by unilateral tremors only. The

NP will refer the patient to a neurologist and should expect initial treatment to be: Ropinirole (lesser symptoms need lighter drug)

109. Inattention and sleep-wake cycle disturbance are hallmark symptoms of:: delirium

110. 3 types of information needed for neuropharmacologic drugs:: type or types of

receptors through which the drug acts. Normal response to the activation of those receptors (Agonist vs antagonist) What the drug in question does to receptor function

111. cholinergic receptors and adrenergic receptors are mediated each by?: -

Cholinergic by acetylcholine and adrenergic by epinephrine and norepinephrine

112. what are the subtypes of cholinergic and adrenergic receptors?: choliner- gic: nicotinic

and mu Adrenergic: Alpha1, alpha2, beta1, beta 2 and dopamine

113. what are the functions of alpha1 receptors?: Vasoconstriction, ejaculation and

contraction of bladder neck and prostate

114. what are the functions of alpha 2 receptors?: minimal clinical significance

115. what are the functions of Beta 1 receptors?: Heart: increases heart rate, force of

contraction, velocity of conduction in AV node. Kidney: renin release

116. what are the functions of beta 2 receptors?: Bronchial dilation relaxation

of uterine muscle vasodilation glycogenolysis

117. what are the functions of Dopamine receptors?: dilates renal blood vessels

118. what are the functions of cholinergic drug receptors?: Blocks the action of

acetylcholine. Cholinesterase inhibitors prevent the breakdown of acetylcholine

119. Examples of anticholinergic drugs: bethanechol, atropine, oxybutynin,

scopolamine, ipratropium bromide They turn everything off and dry everything

120. Side effects of anticholinergics: dry mouth, blurred vision, constipation, pho- tophobia,

urinary retention "I can't see, can't pee, can't spit, can't shit"

121. understand alzheimer's medications:

122. understand parkinsons medications:

123. Know psychiatric drugs (1st and 2nd line) for:

depression anxiety bipolar OCD:

124. Sterling's Law of the Heart: the more the cardiac muscle is stretched, the stronger

the contraction

125. Calcium Channel Blockers: agents that inhibit the entry of calcium ions into heart

muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension s/e: constipation, lower extremity edema, increased risk of heart block and gingival hyperplasia

126. Know the stages of hypertension/heart failure:

127. bond williams classification:

128. Renin Inhibitors: Aliskiren (Tekturna) binds

tightly with renin and inhibits the cleavage catalyzes the conversion of angiotensin i (inactive) to angiotensin II (highly active)

129. ACE inhibitors: contstricts renal blood vessels

acts on the Kidney to promote retention of sodium and water and excretion of potassium "PRIL" Captopril, Enalapril, Afosiopril Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. Check BP before giving (hypotension) *Orthostatic Hypotension

130. ARBS: block access of angiotensin II

cause dilation of arterioles and veins Prevent angiotensin II from inducing pathologic changes in cardiac structure Reduce excretion of potassium Decrease release of aldosterone Increase Renal excretion of sodium and water DO not inhibit Kinase II do not increase levels of bradykinin

131. Aldosterone Antagonists: selective blockade of aldosterone receptors in the kidney

promotes excretion of sodium and water and thereby reduces blood volume (spiralonlatome)

132. Calcium Channel Blockers do what to the heart: have exact same effect on heart as

beta blockers. They suppress calcium influx and reduce force of contraction and slow heart rate and suppress conduction through the AV node

133. what are common side effects of CCBS are:: constipation, LE edema, gin- gival

hyperplasia

134. what are the therapeutic uses for nifedipine?: Migraines, angina, HTN

135. beta blockers

the adverse cardiac effects of nifedipine but can the adverse cardiac effects of verapamil and diltiazem: decrease; intensify

136. john is taking hydralazine for elevated BP. He comes in with arthralgia. What blood test

might be elevated?: ANA

137. Untreated HTN can lead to what?: angina, CHF, MI, kidney disease, stroke

138. SYMPHATHOLYTICS are: antiadrenergic drugs

139. how is stage A CHF managed?: Manage risks only

140. true or false: virtually all dysrhythmias can also cause dysrhythmias: -

TRUE

141. Which medication is used to treat digoxin induced dysrhythmias?: Pheny- toin

142. bill is taking amiodarone for his atrial fibrillation. What diagnostics will need to be

done?: TSH and chest x ray every 6 months

143. recommended cholesterol screening is:: every 5 years after 20

144. Lucy is taking gemfibrozil and warfarin. You know how to check INR and expect that: INR

might be Elevated (gemfibrozil displaces warfarin from plasma protein)

145. Bill has prinzmetal's angina and it is wakening him at night. What will the NP prescribe?:

CCB

146. How do you prevent nitrate intolerance?: Give smallest possible dose and have 8 free

hours per day with long acting nitrates

147. Mary has been admitted with unstable angina. You know she will be treated with?:

ASA

Plavix Beta blocker Statin ACE

148. What happens when clopidogrel is given with a PPI?: the anti platelet effect is

decreased

149. What role does O2 play in STEMI?: Although oxygen is recommended and using it

seems to make sense, the practice is not evidence based

150. What role does ASA play in STEMI?: ASA caused a substantial reduction in mortality

151. What role does morphine play in STEMI?: in addition to relieving pain, morphine can

improve hemodynamics by promoting ventilation, the drug reduces cardiac preload

152. What role does Nitro play in STEMI?: 1. reduce preload and thereby reduce oxygen

demand

2.increase collateral blood flow in the ischemic region of the heart

3.control hypertension caused by stemi-associated anxiety

4. limit infract size and improve LV function however, despite these useful effects,

nitroglycerin does not reduce mortality

153. What role does BB play in STEMI?: decreases myocardial oxygen demand; reduce

cardiac pain, infract size, and short term mortality; recurrent ischemia and reinfarction are also decreased

154. Which must heparin bind to in order to exert its anticoagulant effects?-

: Antithrombin III- heparin binds to antithrombin III then inactivates thrombin and factor Xa

155. Which one of the following drugs binds bile acids in the intestine, thus preventing their

return to the liver via the enterohepatic circulation?: - cholestyramine

156. A 58 yo female reports that she recently stopped taking her blood pres- sure meds

because of swelling in her feet that began shortly after she started treatment. Which of the following is most likely to cause peripheral edema?: - Felodipine (CCB)

157. Jack is taking Colesevelam. The NP tells him to:: He needs to increase fluid and fiber

158. A 54 yo male is noted to have hyperlipidemia, and is prescribed atorvas- tatin. This drug

reduces plasma cholesterol by which processes?: Inhibiting cholesterol biosynthesis

159. A 42 yo woman is noted to have type 2 Diabetes. She has HTN with BP 150/94. The UA

shows mild albuminuria. Which of the following drugs would be the best choice to treat HTN?: Enalapril

160. Brad has HTN and is found to have enlarged prostate on exam. His BP has been running

in the 150/90 range. Which of the following meds would offer treatment for both?: terazosin

161. Which best describes the action of ACE inhibitors on the failing heart?: -

Reduces preload

162. Which of the following is the most accurate statement regarding digox- in?: Increases

vagal tone and decreases AV node conduction

163. Which of the following is a limiting adverse effect of ACE inhibitors?: hy- perkalemia

164. Which of the following medications can be used to treat gestational diabetes?:

Metformin and insulin

165. What is the 4 step approach in the treatment of DM type 2?: Step 1: lifestyle

+metformin step 2: continue step 1 and add second drug step 3: step up to 3 drugs (including metformin) step 4: more complex insulin regimen

166. John comes in with random glucose of 250? Does he need any further testing?: NO

167. Jane has type 1 diabetes and is taking a beta blocker. what does she need to be aware

of?: Beta blockers impair glycogenolysis and glycogenolysis is a means which the body can respond to and counteract a fall in blood glucose

168. Gina is taking canagliflozin for her diabetes. The NP tells her this may increase her

risk for?: UTIs

169. SGLT-2 inhibitors cannot be given if GFR <35. t or f?: FALSE: can be given with GFR less

than 35

170. opitmally at what interval should the TSH be reassessed after a levothy- roxine dosage is

adjusted?: 6-8 weeks

171. which of the following can induce thyroid dysfunction?: Amiodarone

172. Irma is an 80 yo with CAD. She has an elevated TSH with a low free T4. She weighs 80kg.

What dosage of levothyroxine are you going to initiate?: 12.5-25 mcg

173. Stacy is 30 yo that has elevated TSH and low free T4. She weight is 100lbs. What does of

levothyroxine will you give her?: 75 mcg

174. Jane is in her first trimester of pregnancy and has symptomatic hyperthy- roidism. What is

the endocrinologist going to prescribe?: Propylthiouracil

175. Mary is postmenopausal is having severe vasomotor symptoms. She has a uterus. She

would like to start on hormones. The NP: Will start her on estrogen and progesterone

176. Julie is wanting to start OCPs but would like to discontinue in 1 year to try for

pregnancy. The NP will prescribe:: Beyaz due to having added folic acid

177. A patient just call you and she missed a pill. She is on a 28 day cycle. you tell her:: take

the pill as soon as possible and continue the pack. Use another form of contraception for 7 days

178. Lisa has migraines with aura. You are discussing contraception. You rec- ommend::

Mirena IUD

179. One of the main reasons women stop progestin only pills:: break through bleeding

180. Sally is post menopausal ands been having frequent UTIs. The NP:: rec- ommend

vaginal estrace 1gm vaginally weekly

181. David is prescribed sildenafil for ED. Side effects can be?: Ischemic optic neuropathy,

hearing loss and priapism

182. What are possible side effects of testosterone?: Disorders of the liver, prostate

cancer, edema, abuse potential, elevated LDL and decreased HDL

183. What is the MOA of alpha adrenergic agents?: Blockade of alpha 1 receptors and relaxes

smooth muscle in the bladder neck

184. High FBG levels:: NPH dose needs to be increased

185. hyperglycemia after breakfast: not enough SA insulin or too many carbs or calories at

the meal

186. hypoglycemia before lunch: intermediate acting insulin is peaking before lunch is

eaten or patient not eating enough breakfast

187. hypoglycemia in the afernoon: its from the peak and tail of the intermediate acting

insulin

188. hyperglycemia in the afternoon: intermediate acting insulin needs to be increased

or die of lunch is too large

189. hyperglycemia after evening meal: short acing insulin needs to be increased

190. hypoglycemia overnight (2-3 am): afternoon NPH is peaking and causing low BS, patient

needs less intermediate acting insulin

191. John is a type 1 diabetic and is on insulin glargine at HS and insulin lisper ac each meal.

He is having his wisdom teeth removed. How should he manage his insulin?: continue the glargine and take lisper only as a supplement