NU641 Week 3 Quiz Exam Questions and Answers: Pharmacology for Healthcare Professionals, Exams of Nursing

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NU641 Week 3 Quiz Exam Questions and

Answers

Alpha 1 adrenergic receptor stimulation causes...(2)

• Vasoconstriction
• Increased blood pressure Alpha 1 adrenergic receptor blockade results in...(2)
• Vasodilation
• Reduced blood pressure Only alpha 1 adrenergic receptor blocking drugs used to treat hypertension
• Prazosin
• Alfuzin What can occur with the first dose of an alpha 1 receptor blocking agent? Orthostatic hypotension Beta adrenergic blocking drugs (5)
• Propanolol
• Metoprolol
• Esmolol (short acting)
• Atenolol
• Nadolol Beta 1 adrenergic stimulation results in (3)
• Increased heart rate
• Increased blood pressure
• Increased cardiac output Beta 1 adrenergic blockade results in (3)
• Reduced heart rate
• Reduced BP
• Reduced cardiac output Beta blocking agents include... nonselective agents (e.g. propranolol) that block beta 2 receptors in the lungs Selective blockers block... beta 1 receptors in the heart and vasculature Carvedilol (Coreg) (2)

• Not used in hypertensive emergencies
• Alpha and beta receptor blocker First line therapy for hypertension includes (3)
• ACEIs
• Angiotensin receptor blockers (ARBs)
• CCB Are beta blockers considered first line therapy in hypertension? No because of increased morbidity and mortality Abrupt withdrawal of beta blocker therapy Can be life threatening especially in patients with CAD, angina, and migraine headaches Diuretics are often... Second add on agent used with first line drug if not selected as first line therapy to treat hypertension Beta blockers are useful in treating hypertension with... coexisting CKD Dihydropyridine (DHP) calcium channel blockers (5)
• Amlodipine
• Nicardipine
• Isradipine
• Felodipine
• Nifedipine Non-DHP Calcium Channel Blockers (2)
• Diltiazem
• Verapamil How do CCBs work? Reduce amount of intracellular calcium, which reduces vascular rigidity and lowers BP The latest Hypertension Guideline Management algorithm recommends what for black individuals with normal renal function? CCBs CCB are useful in hypertensive patients with underlying angina or diabetes Adverse effects of CCBs (5)
• First degree AV block
• Dizziness
• Headache
• Constipation
• Peripheral edema DHP CCB adverse effects (2)

• Gingival hyperplasia
• Peripheral edema Amlodipine adverse effects
• Causes the most peripheral edema, especially pedal (hand edema also possible) ACEI examples (6)
• Lisinopril
• Captopril
• Enalapril
• Ramipril
• Benazepril
• Fosinopril ACEIs work by (3)
• Reducing myocardial oxygen demand
• Increasing myocardial oxygen supply
• Produce vasodilation What reduces MOD? (4)
• Beta blockers
• CCBs
• Nitrates
• ACEIs Drug of choice in treating hypertension in patients with diabetes and why (3)
• ACEIs
• Decreases production of angiotensin II (potent vasoconstrictor)
• Improves both renal hemodynamics and insulin sensitivity ACEI adverse effects (3)
• Cough
• Hyperkalemia
• Angioedema What should be assessed before using ACEIs? Renal function ARB examples (4)
• Valsartan
• Losartan
• Candesartan
• Irbesartan ARBs work by Blocking angiotensin II receptors, reducing their stimulation by angiotensin I

In hypertensive emergencies use...(3)

• Nitroprusside
• Labetalol
• Nicardipine Hydralazine reduces... Afterload (systemic vascular resistance) Atropine is (2)
• Anticholinergic drug
• Used to increase heart rate Diuretics that have a potential to cross-react with sulfa allergies (2)
• Loop diuretics
• Thiazide diuretics Relieves heart failure symptoms but does not reduce mortality Furosemide (Lasix) How do loop diuretics work? Block reabsorption of Na & Cl in ascending loop of Henle in the kidney Loop diuretics can cause (2)
• Diuretic resistance
• Hypokalemia Potassium sparing diuretics examples (3)
• Spironolactone
• Triamterene
• Amiloride Antihypertensive drugs used in pregnancy (3)
• Labetalol
• Methyldopa
• Nifedipine Bile Acid Sequestrants examples
• Cholestyramine
• Colesevelam
• Colestipol Fibrate examples (4)
• Benzafibrate
• Fenofibrate
• Fenofibric acid
• Gemfibrozil HMG-CoA reductase inhibitor (statins) examples (7)

• atorvastatin
• fluvastatin
• lovastatin
• pitavastatin
• pravastatin
• rosuvastatin
• simvastatin Statin combination examples
• Caduet (atorvastatin/amlodipine)
• Liptruzet (atorvastatin/ezetimibe)
• Vytorin (simvastatin/ezetimibe) Omega-3 fatty acid examples (3)
• icosapent ethyl (Vascepa)
• omega-3 ethyl esters (Lovaza)
• omega=3carboxylic acids (Epanova) Proprotein Convertase Subtilusin/Kexin Type 9 (PCSK-9) Inhibitor examples (2)
• alirocumab (Praluent)
• evolocumab (Repatha) Cholesterol absorption inhibitor example Ezetimibe (Zetia) Ezetimibe Combination example (2)
• Liptruzet (atorvastatin/ezetimibe)
• Vytorin (simvastatin/ezetimibe) Oligonucleotide inhibitor of ApoB-100 Synthesis example mipomersen (Kynamro) Nicotinic acid examples (3)
• immediate-release niacin
• slow-release niacin (Slo-Niacin)
• extended-release niacin (Niaspan) Natural Products with Some Activity vs. Cholesterol (4)
• alpha-linoleic acid
• red yeast rice
• garlic (limited)
• krill (for elevated TGs) No activity vs cholesterol Nicotinamide First step in dyslipidemia therapy

Lifestyle changes After instituting lifestyle changes for 3 months... assess patient's risk factors to determine appropriate therapy Bile Acid Sequestrants work by (3)

• Increasing LDL catabolism
• Reducing cholesterol absorption
• Can cause an increase in VLDL production Fibrates work by (4)
• Increasing VLDL clearance
• Reducing VLDL production
• Reducing TGs
• Can increase LDL if TGs are high (over 400) Current guidelines state that a fibrate should be used if...(2)
• LDL and TG levels are elevated & a statin is not tolerated
• Niacin no longer recommended because outcomes data are not favorable Niacin use with diabetes May cause an increase in BG Statins work by (4)
• Increasing LDL breakdown
• Decreasing LDL production
• Moderately reduce TGs
• Modestly increase HDL Ezetimibe (Zetia) works by (2)
• Inhibiting cholesterol absorption from the gut
• Reducing LDL levels First line pharmacotherapy for dyslipidemia Statin When are statins dosed? Bedtime for maximal effect on LDL Evaluate what before statin use? Muscle function Statin adverse effects (3)
• Muscle cramping
• Muscle aches
• Rhabdomyolysis Use what for dyslipidemia in pregnancy? Bile acid sequestrant

Statins may increase Fasting BG, but this is not a contraindication to their use Why are PCSK9 inhibitors not used routinely? (2)

• High cost
• Lack of long-term outcome and safety data When should PCSK9 inhibitors be used? As an add-on therapy to statins in treating familial dyslipidemia Triglycerides are most effectively reduced by (4)
• Niacin
• Fibrates
• Omega-3 fatty acids
• Slightly by statin drugs Niacin works by (2)
• Reducing VLDL and LDL synthesis
• Increasing HDL production Bempedoic acid (2)
• ATP citrate lyase inhibitor
• First in its class Bempedoic acid use (2)
• Taken with maximally tolerated statin
• Lowers LDL-C an additional 16.5% beyond that of the statin Bempedoic acid adverse effects (8)
• Hyperuricemia (causes gout)
• Tendon rupture
• Upper respiratory tract infection
• Bronchitis
• Back pain
• Abdominal pain
• Muscle spasms
• Elevated liver enzymes Agents used in angina (5)
• Beta blockers
• ACEIs
• ARBs
• Nitrates
• CCBs Initial drugs for angina (2)

• ACEIs
• Beta blockers Rarely used together in angina ACEIs and ARBs, this combination has not reduced mortality CCBs amlodipine or felodipine can be used to treat angina if... ACEIs and beta blockers are contraindicated First line agent for heart failure ACEI, has improved life expectancy Second line treatment added for heart failure Beta blockers Digoxin (Lanoxin) works by (2)
• Increasing cardiac force of contraction
• Improves cardiac function Initial dose of digoxin Given as a loading dose to attain steady state quickly because digoxin has long half life (33 to 40 hours) Digoxin blood levels that can increase mortality

1ng/ml

Digoxin may increase... cardiac mortality in women Digoxin is only used when... ACEIs, beta blockers, and diuretics have not improved function Digitalis toxicity

• toxic drug effects from administration of digoxin
• Occurs in as many as 25% of patients Antidote to digitalis toxicity Digibind Diuretics and heart failure (2)
• Can be used early when goal is controlling BP
• Used in all stages of heart failure Drug of choice in early mild HF Thiazide diuretics Furosemide and heart failure Relieves heart failure symptoms but does not reduce mortality Loop diuretics and HF More effective in stage C Milrinone and HF Phosphodiestrase inhibitor for acute HF

Nitroglycerin spray May be most cost effective for patients with occasional need Nitrates are contraindicated with... PDE-5 inhibitors like sildenafil and vardenafil Nitrates and the elderly May be less effective if they have dyslipidemia because of calcified plaque in the coronary arteries Amiodarone can cause Thyroid and pulmonary toxicity Treating stage A heart failure (3)

• ACEI (drugs of choice)
• ARBs are useful but more expensive
• Diuretics Treating stage B heart failure (3)
• ACEI for all patients, ARBs for those intolerant of ACEI
• Beta blockers for most patients
• Diuretics Stage C heart failure treatment (3)
• ACEIs & Beta-blockers for all patients
• Diuretics - loop diuretics (e.g., furosemide), digoxin
• Potassium Sparing Diuretics (e.g., spironolactone) Stage D heart failure treatment (4)
• Stage C treatments plus
• Inotropes (e.g., dobutamine)
• Diuretics
• Ventricular assist device, transplantation, hospice Atrial fibrillation symptoms (5)
• Palpitations
• Fainting
• Breathless
• Chest pain
• Dementia Atrial fibrillation treatment (5)
• Anticoagulant
• Rate control
• Cardioversion
• Ablation
• Surgery

Enoxaparin (Lovenox) (2)

• Low molecular weight heparin
• Inhibits factor Xa indirectly by activating antithrombin III Heparins work by Producing rapid anticoagulation by binding with antithrombin III and inhibits factors IXa, Xa, XIIa, and XIII. Warfarin (Coumadin) works by (2)
• Inhibiting vitamin-K dependent blood factors II, VII, IX, and X
• Takes several days for its anticoagulant effect Dabigatran (Pradaxa) Blood factor IIa inhibitor (direct thrombin inhibitor) Idarucizumab (Praxbind) reversal agent for dabigatran (Pradaxa) Blood factor Xa inhibitors (4)
• apixaban (Eliquis)
• edoxaban (Savaysa)
• rivaroxaban (Xarelto)
• fondaparinux (Arixtra) Eptifibatide (Integrilin) (2)
• Antiplatelet
• Binds to GPIIb/IIIa receptor sites on platelets Antiplatelet drugs (5)
• clopidogrel (Plavix)
• aspirin
• prasugrel (Effient)
• ticagrelor (Brilinta)
• dipyridamole (Persantine) Copidogrel (Plavix) (3)
• Prodrug
• Must be activated by hepatic CYP2C19 metabolism
• Individuals who are poor metabolizers may not form the active metabolite, result being reduced anti platelet response