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NGR 5172 - Advanced Pharmacology - Final Exam
1.Which of the following agents is beta 1 selective?: Atenolol
2.Which of the following statements about beta-adrenergic blockers is cor- rect?: Some beta-adrenergic
blockers are cardio selective, blocking only beta 1 receptors; others are not and also block beta 2 receptors in smooth muscle.
3.The beta-adrenergic agonist nebivolol:: Is highly cardio selective.
4.During diuretic therapy, levels of which electrolyte should be monitored?: -
Potassium
5.Thiazide diuretics and loop diuretics have different primary indications be- cause of which important
difference between them?: Thiazide diuretics require luminal perfusion to reach their active site.
6.During diuretic therapy, which of the following should be monitored?: Renal function
7.Which of the following is a mechanism of action of beta-adrenergic block- ers?: Preventing sympathetic
stimulation of the heart
8.Which type of diuretic is available only for oral use?: Potassium-sparing diuretics
9.Which of the following best characterizes the mechanism of action of diuret- ics?: Diuretics inhibit the transport
of ions across the tubular membrane.
10.Which of the following statements about angiotensin II receptor blockers is correct?: Renal alterations are
less common than with ACE inhibitors.
11.The baseline laboratory evaluation of patients taking ACE inhibitors should include:: Urine protein.
12.When prescribing angiotensin-converting enzyme (ACE) inhibitors, the advanced practice nurse may
anticipate all of the following:: Hypokalemia.
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13.The only absolute contraindication to ACE inhibitor use is:: Bilateral renal artery stenosis.
14.The HCN channel blocker ivabradine (Corlanor) is contraindicated for CHF patients with:: Atrial
fibrillation.
15.Angiotensin II stimulates the release of which hormone that causes sodi- um and water retention in the
kidneys?: Aldosterone
16.The most common adverse effects of calcium channel blockers are:: Re- lated to vasodilation.
17.When considering the use of valsartan/sacubitril (Ernesto) for congestive heart failure, the NP considers all
of the following except:: There are few significant drug-drug interactions.
18.Which of the following agents attenuates the hypotensive effects of ACE inhibitors?: Nonsteroidal anti-
inflammatory agents (NSAIDs)
19.The renin inhibitor, aliskiren, can significantly reduce the activity of:: Loop diuretics.
20.During triacylglycerol transport, once chylomicrons are in the circulation,
cholesterol transfers proteins to the chylomicrons.: HDL
21.Fatty acids (triacylglycerol precursors) are synthesized in the liver with
as the main precursor.: Dietary glucose
22.Which of the following is a characteristic of very low-density lipoprotein (VLDL)?: Water-soluble transport
for synthesized lipids
23. are the major dietary lipid.: Triacylglycerol
24.Fat-soluble vitamins include all of the following except:: C.
25.Which of the following is a water-soluble transport for ingested lipids?: -
Chylomicron
4 / 16 : Increases activity of lipoprotein lipase
40.Which of the following is the drug of choice for anticoagulation in the patient with heparin-induced
thrombocytopenia?: Argatroban
41.Which of the following laboratory tests is used to monitor the effects of low molecular weight heparin
(LMWH)?: Anti-Xa assay
42.Which of the following statements describes the primary difference be- tween direct factor Xa inhibitors and
indirect factor Xa inhibitors?: Direct factor Xa inhibitors act directly on thrombin; indirect factor Xa inhibitors use antithrombin III as a mediator.
43.Primary hemostasis is characterized by:: Platelet aggregation and adhesion.
44.Which phase of the clotting process is affected by activated Factor X (Factor Xa) inhibitors?:
Secondary hemostasis
45.The primary adverse effects of heparin and warfarin are related to:: Bleed- ing.
46.Antithrombin III, which limits clotting to the injured site, is greatly potenti- ated by:: Heparin
47.Secondary hemostasis is characterized by:: Formation of a fibrin clot.
48.Peripheral neuropathy and priapism is a possible adverse effect of:: He- parin
49.Which of the following is indicated for CVA and embolic risk reduction in nonvalvular atrial fibrillation?:
Dabigatran
50.The laboratory evaluation for a patient taking warfarin should include which of the following tests?:
International normalized ratio
51.Which of the following statements about prasugrel (Effient) is true?: Pra- sugrel is not indicated for a patient
with a previous CVA or TIA.
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52.Which platelet inhibitor is indicated for a patient who has had a CVA or TIA while on aspirin therapy?:
Dipyridamole and ASA (Aggrenox)
53.The mechanism of action of warfarin is:: Inhibiting the conversion of pro- thrombin to thrombin.
54.Warfarin is susceptible to drug-drug interactions of which of its features?-
: Protein binding
55.Used in patients with unstable angina and patients undergoing percuta- neous transluminal coronary
angioplasty (PTCA) and stent placement, glyco- protein IIb/IIIa inhibitors are potent:: Platelet inhibitors.
56.1Which is the primary advantage of selective serotonin reuptake inhibitors (SSRI) over heterocyclics in the
management of depression?: SSRIs do not have negative cardiovascular effects.
57.In addition to treating depression, SSRIs are also effective in treating the following except:: Neuropathic
pain.
7 / 16 : MAO-B inhibitors
69.Which neurotransmitter is the primary inhibitory neurotransmitter in the central nervous system?:
GABA
70.Which of the anti-Parkinsonian agents requires hepatic enzyme monitor- ing for the first year?: COMT
inhibitors
71.The anti-epileptic drugs (AEDs) can produce a variety of adverse effects. Which of the following is a
particular concern with carbamazepine (Tegretol)?- : HLA-B*1502 sensitivity
72.Many pharmacologic agents used to manage chronic seizure disorders are classified as:: GABA agonists.
73.A patient presents to your office complaining of fatigue and nausea. She has a seizure disorder manage4d
with phenytoin (Dilantin) 200 mg BID. While evaluating her fatigue, you appreciate that she is bradycardic and obtain a phenytoin level. The level is 40 mcg/ml. The half-life of phenytoin is averaged at 22 hours. As the NP, you know that:: At high levels, phenytoin saturates its route of elimination.
74.When managing patients who are taking for seizure disorder, the nurse
practitioner must be aware that it is capable of autoinduction.: Carba- mazepine (Tegretol)
75.Quetiapine fumarate (Seroquel), cimetidine (Tagamet), and SSRIs may all be used to manage::
Hypersexuality.
76.The proton pump is best described as:: An active transport pump is contained within the parietal cells.
77.CTZ suppressors used to manage nausea and vomiting work by blocking:-
: Postsynaptic dopamine receptors.
78.In considering the use of probiotics for the management of diarrhea, the NP realizes all of the following are
accurate except:: Are most effective when used concomitantly with an oral antimicrobial.
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79.Which of the following is not one of the four phases of gastric acid secretion?: Bile phase
80.Which of the following drugs used to manage vomiting may cause ex- trapyramidal effects?:
Metoclopramide.
81.Motility inhibitors used for the treatment of diarrhea include all of the following except:: Calcium
polycarbophil.
82.CTZ suppressors include all of the following except:: Metoclopramide.
83.Acid output during the basal phase of digestion is controlled by back- ground levels of histamine and::
Acetylcholine.
84.Which of the following cell types is responsible for H+ secretion?: Parietal cells
85.The motor phases of swallowing are characterized by the unique features of the muscles of different GI
organs. Lower esophageal relaxation occurs during which phase of swallowing?: Esophageal
86.Which of the following antibiotics is not approved for the eradication of H. pylori?: Erythromycin
87.A PAMORA used to treat opioid-induced constipation that is available in an oral formulation and as a
subcutaneous injection is:: Methylnaltrexone.
88.While managing the needs of patients in primary care, many NPs en- counter patients who require long-
term management of a variety of inflamma- tory conditions. As a result, chronic, daily used of NSAIDs, sometimes in high doses, is not avoidable. As a result, prophylactic therapy for NSAID-induced ulcers is indicated. Prophylaxis should begin with:: Proton pump inhibitor once daily.
89.The mechanism of action of lubiprostone (Amitiza) for the treatment of IBS-C is as an:: Selective
chloride channel activator.
90.Neutropenia and thrombocytopenia are adverse effects associated with the use of:: H2 receptor agonists.
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102. While evaluating a patient on antiretroviral medications, decreased bone mineral density is an
anticipated adverse effect for which of the following drug classes?: NRTIs
103. The primary difference between the two fusion inhibitors is that:: One is administered parenterally, and
one is taken orally.
104. With respect to replication of the HIV virus, the role of reverse transcrip- tase is to allow:: Synthesis of
a DNA form of the RNA viral code.
105. Kidney stones, peripheral paresthesias, and GI symptoms are all common adverse effects of:: Protease
inhibitors.
106. Neuraminidase inhibitors are characterized by:: Coverage of influenza types A and B.
107. Because of its ability to inhibit steroid biosynthesis in humans at high doses, ketoconazole is sometimes
used in the medical management of which endocrine abnormality.: Cushing syndrome
108. Antiviral drugs used to manage HIV are not effective in the management of patients with herpes virus
infection. This is because:: Herpes viruses do not have reverse transcriptase.
109. Headache, peripheral neuritis, lethargy, photosensitivity, and drug-in- duced hepatitis are all
potential adverse effects of:: Griseofulvin.
110. There are a variety of drugs available to serve as post-exposure pro- phylaxis of influenza or to
shorten the duration of symptoms after influenza occurs. Which one of them is contraindicated in patients with preexisting reactive airway disease or COPD?: Zanamivir
111. Eradicating fungal infection requires different classes of drugs than those used for both bacterial and
viral infection. A primary target of drug therapy in the management of fungal infection is:: Ergosterol, the structural unit of the fungal membrane.
112. Amphotericin B is an antifungal agent used in the management of serious fungal infection. This drug is
characterized by a variety of significant adverse effects. Which of the following is the electrolyte abnormality
11 / 16 most often asso- ciated with amphotericin B?: Hypokalemia
113. Which of the following types of virus vaccines can precipitate infection in an immunocompromised
host?: Attenuated
114. Fluconazole can be considered for the treatment or prevention of all of the following fungal
infections except:: Pulmonary aspergillosis.
115. Inactivated vaccines include all of the following except:: Rotavirus.
116. Opioid therapy frequently results in constipation. This is because of the drug's action on:: Mu
receptors.
117. The process of a nerve impulse being carried to the brain is called:: Trans- mission.
118. The mechanism of action of opiate analgesics can best be described as:: Binding of mu receptors to
inhibit nociceptors in the CNS.
119. Which of the following opioids exhibits dual mechanism of action that include a mu agonist and
norepinephrine reuptake inhibitor?: Tapentadol
120. Which of the following best describes morphine's effect on healthy my- ocardium?: No effect
121. The mechanism of action of celecoxib is through inhibition of:: COX-2 only.
122. All of the following are opiate agonist/antagonist combinations except:: -
Hydrocodone/ibuprofen (Vicoprofen).
123. The most recent data suggest that acetaminophen is best described as a:: Highly selective COS-
inhibitor.
124. Which of the following should be monitored in a patient with chronic use of NSAIDs?: Potassium
125. The two neurotransmitters that are primarily responsible for endogenous pain suppression are
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137. Ointments are predominantly composed of:: Oil.
138. Which anti-acne topical agent is characterized by its bleaching effect on hair and materials?: Benzoyl
peroxide
139. High-dose topical corticosteroids should be avoided in children due to risk of:: Skin atrophy.
140. Scabicides are characterized by a mechanism of action in which they block sodium channels on
parasites. Older agents such as lindane and malathion have a greater risk of systemic absorption, and in high or prolonged doses can produce CNS toxicity characterized by:: Bradycardia and vomiting.
141. All of the following glaucoma medications decrease the production of aqueous humor except::
Parasympathomimetic.
142. Which of the following is not a common mechanism of pain medications?-
: Catalyzes neurotransmitters
143. The two main endogenous pain suppressors include serotonin and:: -
Enkephalin.
144. The process of the brain interpreting messages from the periphery is called:: Perception.
145. Slow pain would most likely be described as:: Throbbing.
146. Which of the following neurotransmitters communicates the message of pain rather than attenuates
the message?: Substance P
147. The part of the nerve cell that receives stimuli is/are the:: Dendrites.
148. The mechanism of action for opiate analgesics impacts which of the following physiologic
mechanisms?: Activation of u receptors
149. Neurotransmitters that modify the message of pain include all of the following except::
14 / 16 Acetylcholine.
150. The process of the stimulus being converted to a nerve impulse is called:-
: Transduction.
151. Which of the following is false regarding chronic pain?: Chronic pain continues to require an acute
stimulus to persist.
152. H. influenzae's primary mechanism of antimicrobial resistance is via:: -
Beta-lactamase production.
153. Which of the following characteristics apply to the macrolides?: Effective against atypical pathogens
154. The decision-making process where a clinician chooses an agent based on patient characteristics and
site of infection is called:: Empiric therapy.
155. The use of which of the following agents should be avoided in children and pregnant women due to
the possibility of teeth staining?: Tetracycline
156. Which of the following best describes the mechanism of action of
beta-lactams?: Disrupt synthesis of the peptidoglycan layer of bacterial cell walls
16 / 16 acute bacterial rhino sinusitis. She returns com- plaining of no change in symptoms. You recommend switching her treatment to:: Levofloxacin.
168. A 46-year-old man who is currently smoking 1 PPD and has a 30 pack-year cigarette smoking history
with penicillin allergy presents with acute bacterial rhino sinusitis. Three weeks ago, he was treated with a macrolide for "bron- chitis." You know prescribe:: Levofloxacin.
169. A 26-year-old woman presents with uncomplicated UTI. She is otherwise healthy, has not received any
systemic antimicrobials in the past year, does not have a sulfa allergy, and is not taking any medications other than Ortho-Cy- clen (ethinyl estradiol and nor estimate) for birth control. Her last menstrual period began 10 days ago. The local E. coli resistance rate to TMP/SMX is about 10%. The preferred therapy for this patient is:: Trimethoprim-sulfamethoxazole.
170. All of the following antimicrobials would be expected to exhibit in vitro ac- tivity against beta-
lactamase-producing Moraxella catarrhalis except:: Amoxi- cillin.
171. A 13-year-old boy presents with acute bacterial rhino sinusitis. He has a beta-lactam allergy and had
taken clarithromycin 2 months ago for a "bad cold." You recommend treatment with:: Levofloxacin.
172. Risk factors for developing fluoroquinolone-associated tendinitis and tendon rupture include all of
the following except:: Recent use of a systemic beta-lactam antimicrobial
