NUR 635 MIDTERM EXAM: Pharmacology and Therapeutics for Nurse Practitioners, Exams of Nursing

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NUR 635 MIDTERM EXAM NEWEST 2024

ACTUAL EXAM ALL 120 QUESTIONS AND

CORRECT DETAILED ANSWERS WITH

ADDITIONAL EXTRA POINTS FOR REVIEW

ALREADY GRADED A+

What does the NP take into account concerning pharmacokinetics? - ANSWER>>Bioavailability What statement by the patient tells the RN they understand the education regarding heparin? - ANSWER>>I need to have my labs drawn in 2-3 days for thrombocytopenia which can occur on day 4 of therapy. **INR of 2-3 is appropriate **PT should be measured daily during the first 5 days, twice per week during the next 1 to 2 weeks, once a week for the next 1-2 months, and everhy 2 to 4 weeks thereafter. What educated statement by the patient tells the RN that the patient understands the use of warfarin? - ANSWER>>Avoid foods high in Vitamin-K What education should the NP include when educating patients on erythropoiesis- stimulating agents? - ANSWER>>They may cause tumors. The patient understands education regarding iron supplements when the patient states:

• ANSWER>>take on an empty stomach with orange juice. Vitamin-C helps absorb iron The NP knows that gliptins help diabetes because they: - ANSWER>>Gliptins act on the incretin system to increase insulin production indirectly Diabetics can benefit from GLP-1 agonists because they: - ANSWER>>Decrease gastric absorption by directly binding to a receptor in pancreatic beta cells

You have a patient with chronic renal failure who becomes anemic. The NP prepares the patient for: - ANSWER>>Treatment with epoetin alfa The NP believes the patient has adequate education regarding iron supplements when they verbalize: - ANSWER>>I need to have a CBC drawn in 4 weeks ACE Inhibitors help the patient with heart failure by doing all of the following EXCEPT: - ANSWER>>Increasing HR and preload ACE Inhibitors help patients with HF by: **Improve functional status and prolonging life. **Improve hemodynamics and prevent cardiac remodeling **Biggest side effects: cough and angioedema. Other: hypotension, hyperkalemia. **Do not give to patients with renal stenosis--> can cause renal failure A chronic pain patient calls for refills on regularly prescribed hydrocodone prescription. The appropriate action of the NP would be to: - ANSWER>>Schedule the patient for an in-person office visit What portion of the patient's history should be thoroughly assessed before prescribing Metronidazole (Flagyl) for a bacterial vaginosis: - ANSWER>>Social history of ETOH intake. **Worst hangover of your life! When being prescribed Lithium, the NP educates the patient that all of the following will need to be closely monitored throughout therapy except: - ANSWER>>Liver function. **While on lithium therapy, Renal and Thyroid function and Sodium levels need to be monitored!

You have a 32-week pregnant patient come in complaining of contractions. The NP educates the patient on the following: - ANSWER>>Treatment with a beta-2 agonist (Terbutaline?) The patient experiences hallucinations following atropine treatment for bradycardia. The NP will prescribe: - ANSWER>>Physostigmine (reversal agent that is used to treat antimuscarinic toxicity and reversible cholinergic medication) What condition would be appropriate for you to prescribe clonidine ER to an adolescent? - ANSWER>>Attention Deficit Hyperactivity Disorder (ADHD) When discontinuing baclofen, what adverse effects do you watch for? - ANSWER>>Hallucinations Lab work shows a decrease in creatinine clearance after the patient starts taking Memantine. The NP's appropriate course of action should be to: - ANSWER>>lower the dose of memantine. "renal dosing" The patient's caregiver needs more education when she verbalizes which of the following statements regarding rivastigmine transdermal patches: - ANSWER>>I need to change the patches every 72 hours (Rivastigmine patches are changed daily, not every 72 hours) After giving a patient a First generation Antipsychotic (FSA), the patient develops which adverse reaction that the NP must treat: - ANSWER>>Tardive Dyskinesia Treat with?? Tardive dyskinesia- twisting, writhing, worm-like movements of tongue and face US FDA approved valbenazine (Ingrezza) for the treatment, deutetrabenazine (Austedo) approved as well. Both are VMAT2 inhibitors, VMAT 2 recycles dopamine and returns to presynaptic vesicles.

A patient is preparing for a cortisone injection but is diabetic. What insulin would you choose to work the quickest to lower blood sugar? - ANSWER>>A rapid acting insulin: Lispro, Aspart, Glulisine How does metformin help to decrease blood sugar? - ANSWER>>By decreasing/inhibiting gluconeogenesis in the liver When educating a patient about Neutral Protamine Hagedorn (NPH) insulin, the NP includes the onset of action for this drug takes place: - ANSWER>> 1 - 1.5 hours (60- 90 minutes). A 68-year-old is coming in complaining of dizziness, confusion, sweating, and palpitations. The NP suspects: - ANSWER>>Hypoglycemia "Cold & Clammy, needs some candy" This type of insulin is injected 15 minutes prior to meals, is compatible with Neutral Protamine Hagedorn (NPH), and has a peak onset of one hour: - ANSWER>>Insulin Lispro When changing Neutral Protamine Hagedorn (NPH) Insulin to Insulin Glargine, the NP anticipates what to avoid hypoglycemia? - ANSWER>>Decrease the initial dose by 20% (Changing from an intermediate-acting insulin to a long-acting insulin) What lab is not concerning to the NP prior to prescribing Metformin? - ANSWER>>CBC (** Labs to check to include Urinary Analysis (UA), Liver function tests, or Renal function A 62-year-old patient presents with a history of myocardial infarction and is complaining of ringing in his ears. What does your work-up include? - ANSWER>>Assessing the patient for Aspirin toxicity. Aspirin causes tinnitus at toxic levels.

A patient I staking Plavix after diagnosis of a deep vein thrombosis. The NP believes the patient requires additional education when the patient tells her: - ANSWER>>"I love taking my medication with grapefruit juice" What does grapefruit juice do when taking Plavix? The patient is prescribed a low molecular weight heparin and becomes pregnant. The NP understands that: - ANSWER>>Factor Xa must be monitored closely. Why? The patient returns to the office 6 weeks after initiating therapeutic live changes (TLCs) and has lab work showing an LDL of 135. The NP's next step is to: - ANSWER>>Prescribe Lovastatin (**Know normal LDL/HDL: LDL below 130 mg/dL and HDL above 40 mg/dL) The patient with newly diagnosed pernicious anemia plan of care must include: - ANSWER>>The patient must have parenterally administered B12 (IM or IV) The patient demonstrates an understanding of pernicious anemia when they verbalize: - ANSWER>>"I need to have my blood drawn in 2 days to check for hypokalemia" Why? A patient comes in complaining that after walking, he experienced increased chest pain. What is the New York Heart Association classification? - ANSWER>>NYHA Class II "exertional/aggravated by fatty foods/big meals" NYHA Classes: NYHA I- Ordinary physical activity does not cause undue fatigue, dyspnea, or palpitations. NYHA II- Ordinary physical activity causes fatigue, dyspnea, palpitations, or angina. Angina with exertion NYHA III- Comfortable at rest. Less than ordinary physical activity causes fatigue, dyspnea, palpitations, or angina. NYHA IV- Symptoms occur at rest, any physical activity increases discomfort.

What medication does a patient with Angina take to reduce morbidity and mortality? - ANSWER>>Aspirin You have a diabetic patient with angina. The NP understands that ALL diabetics should be on: - ANSWER>>ACE Inhibitors In addition to Aspirin, patients with angina who also have arrhythmias should be prescribed: - ANSWER>>Beta Blockers The NP understands that we give Nitro at 0800 and 1500 because: - ANSWER>>To prevent developing nitrate tolerance. It can develop within one day! A patient is prescribed Sildenafil (Viagra) for erectile dysfunction. What instructions are essential to give to the patient? - ANSWER>>Avoid taking nitroglycerin. Can cause severe hypotension Proscar is administered for BPH. What effect does this medication have? - ANSWER>>Decreases the size of the prostate gland. Promote regression of prostate epithelial tissues Your patient states he takes Viagra each morning with grapefruit juice. - ANSWER>>CYPA34 can suppress the metabolism of Viagra and therefore increase the levels of Viagra Insulin preparations are categorized by how fast they work and how long (duration) they work. What has the shortest onset and shortest duration? - ANSWER>>Humalog (Lispro), Novalog (Aspart), Apidra (Glulisine) **Know short duration rapid acting Lispro, Aspart & Gluulisine names! Know those are Rapid Regular and the 4th one is Inhalation with Regular insulin!

**More rapid than regular insulin (Except if Regular insulin is administered by inhalation) Onset 5-30 min Peak 0.5 to 3 hours Duration 3-4 hours If you are dividing into categories based on onset and duration, what insulin has short onset and duration? - ANSWER>>Neutral Protamine Hagedorn Insulin Know Rapid acting, short regular, NPH and long acting Tyler said this will make sense in the test question NPH is an intermediate duration insulin and is slow acting and provides glycemic control between meals Rapid acting: Lispro, Aspart, Gluulisine, + inhaled regular insulin (used on insulin pumps) Short acting: Regular insulin Intermediate acting: Isophane (NPH, Humulin N). **NPH is the ONLY one we can mix with short acting insulins! NPH is Cloudy. Clear before cloudy! Long duration: Insulin Glargine U-100 (Lantus), insulin detemir (Levemir) Ultralong: Insulin glargine- U-300 (Toujeo) 3x concentration compared to U-100. Duration in excess of 24 hours. Insulin degludec (Tresiba), analog persists up to 42 hours

Per Dr Tyler Lecture, KNOW THIS:

• Neutral Protamine Hagedorn NPH (intermediate duration)
• Glargine U-100 (long), Glargine U-300 ultra long Short duration rapid acting (Lispro, Aspart, Gluulisine) Short acting- Humulin or Regular insulin The nurse believes the patient has a firm understanding of her coumadin teaching when she verbalizes: - ANSWER>>I need a backup form of contraception. What is the drug of choice for Type II Diabetics? Metformin (Biguanides) How does metformin work? - ANSWER>>Decreases glycogenolysis Biggest SE: GI disturbances, lactic acidosis MOA: Inhibits glucose production in the liver (inhibits gluconeogenesis), reduce absorption in gut, sensitizes insulin receptors in target tissues (fat & skeletal muscles) Why do we recommend that patients take an aspirin per day? - ANSWER>>Prevent stroke, MI, PE. ASA works on platelets. Prevent clots, prevent thrombolytic events Side effects of taking too much ASA: - ANSWER>>tinnitus If you have an anemic patient taking epoetin, we monitor closely for: - ANSWER>>Hypertension too many RBC. Monitor BP Blackbox warning for eropoesis stimulating agents (ESA's): - ANSWER>>Risk for Tumors!

Patients diagnoses with angina have underlying ________. We prescribe what for these patients? - ANSWER>>Athersclerotic disease. Statin, ASA, Nitro If you have a patient who wants to self-donate blood, we prescribe: - ANSWER>>Epogen (Epoeitin) and Iron If prescribing iron for iron deficiency anemia, what lab do we order 1 week out? - ANSWER>>Reticulocyte count If prescribing iron replacement, what education do we give to patients about how to take it? - ANSWER>>Take it on an empty stomach and with vitamin C to help absorption. Take with OJ What does pernicious anemia mean? - ANSWER>>Pernicious means "death". They lack b If you lack B12 and we start administering B12, we do monitor for? - ANSWER>>Hypokalemia as this can happen in the first 2 days of taking B12. How long for NPH to take effect? - ANSWER>>60-90 min When diabetics start taking medication, warn them to monitor for: - ANSWER>>Hypoglycemia Beta-blockers and ETOH interact with insulin by: - ANSWER>>masking the signs of hypoglycemia What should we monitor/consider if we are prescribing Metformin? - ANSWER>>Avoid CT with contrast or we need to know their hydrations status and over hydrate patients. Know A1C. Know baseline kidney function.

Prior to starting Metformin, assess: - ANSWER>>Kidney function If giving iron, we check the reticulocyte after: - ANSWER>>1 week If giving iron, check: - ANSWER>>TIBC, Ferritin, H/H after 4 weeks (1 month of treatment) Two big reasons patients go into heart failure: - ANSWER>>Myocardial infarction and myocardial ischemia What can you not take with Metronidazole: - ANSWER>>ETOH causes worst hangover of your life Any drug prescribed that can cause hepatotoxicity, monitor: - ANSWER>>LFT's Why are NPs and PAs given the ability to prescribe autonomously? - ANSWER>>To increase access to care When is the most dangerous time to be exposed to a teratogen? - ANSWER>>First trimester If a women is breastfeeding and prescribed a potentially dangerous medication, what instructions should we provide to her? - ANSWER>>Take the medication right after nursing/pumping. Neostigmine is given for: - ANSWER>>Myasthenia gravis If treating myasthenia gravis and giving oral medication, what do we need to assess for? - ANSWER>>Ability to swallow safely

Big side effects with Parkinson's drugs: - ANSWER>>Extrapyramidal side effects (EPS), risky behavior, hallucinations, sleep attacks What type of medication does not cause sleep attacks when treating Dementia? - ANSWER>>Dopamine agonists Levodopa-Carbidopa can be combined with: - ANSWER>>Bromocriptine, which will allow you to decrease your doses of Levodopa-Carbidopa Why do CNS drugs cause sleepiness? - ANSWER>>They cross the BBB Baclofen is given for what type of disorders? - ANSWER>>Multiple Sclerosis, Spinal Cord injuries, Cerebral Palsy given for conditions with spasticity If Baclofen is abruptly withdrawn, it can cause: - ANSWER>>Hallucinations Rivastigmine is given for Alzheimer's patients and comes in a transdermal patch, which must be reapplied: - ANSWER>>daily Patients with frequent Migraines are given: - ANSWER>>Propranolol (don't give it to asthmatics) or Topamax A patient who is taking oxycodone states they don't think the medication is working anymore. What is happening and what should you do? - ANSWER>>They are developing a tolerance and you should change to something longer and stronger acting Why don't providers like to prescribe methadone? - ANSWER>>It has an exponential rise, builds up in your system, and you need to get an EKG once per year because it can cause QT prolongation and dangerous arrhythmias (torsade des pointed) Biggest side effect of First Generation Antipsychotics? - ANSWER>>Tardive dyskinesia

If you want to start a patient on an SSRI, but they are currently on a MAOI? - ANSWER>>Stop the MAOI for 2 weeks before starting the other. What do we give patients who are suffering from generalized panic disorder? - ANSWER>>Give an SSRI In preparing for hormone replacement therapy for a menopausal patient, the NP plans to prescribe: - ANSWER>>Transdermal patches because it has the least amount of side effects When prescribing oral contraceptives to teenage patients, when there is a concern for compliance, you will prescribe: - ANSWER>>Medroxyprogesterone acetate (Depo Provera) If a woman on an oral contraceptive, you will switch her to a: - ANSWER>>progesterone only OC to reduce the risk of clots. A patient is prescribed androgen therapy for: - ANSWER>>Hypogonadism Why is this concerning if a patient on androgen therapy begins gaining weight? - ANSWER>>you may be undertreating the patient and should check levels. How do you know if BPH treatment is effective? - ANSWER>>Easier urination Why is heparin prescribed simultaneously if you are starting a patient on coumadin? - ANSWER>>It takes a few days for Coumadin to build to therapeutic levels Patients with angina are prescribed: - ANSWER>>A long acting Nitro, Aspirin daily (prevents platelet aggregation and worsening of plaques in a atherosclerotic patient), a Beta blocker, Statin (increased cholesterol), and an ACE inhibitor (especially if diabetic)

How long does it take to build a tolerance to long-acting nitro? - ANSWER>>1 day. A patient must have at least 8-hrs nitro free per day, often occurs overnight when they are sleeping If a patient has atherosclerosis, plan to prescribe: - ANSWER>>Aspirin to prevent worsening platelet aggregation What patient education will you provide to a patient newly prescribed Plavix? - ANSWER>>Monitor for blood in the stool or emesis, bruising, petechiae, abdominal pain, uterine bleeding, back pain (retroperitoneal bleeding), or adrenal bleeding. **Other important teaching: Plavix has many interactions with OTC drugs!! Patient needs to report all OTC meds, herbal supplements, or vitamins A patient is discharged home on coumadin. When should labs be drawn? - ANSWER>>In 3-5 days after starting the medication. Future labs need to be drawn at least 12 hours after taking the last dose for monitoring. What do you monitor for in a patient recently started on Heparin? - ANSWER>>Thrombocytopenia which can occur 3-5 days out What patient teaching should you provide to a patient taking coumadin? - ANSWER>>Green leafy vegetables are high in vitamin K and can counteract coumadin. Grapefruit juice also interacts. Rispiridone and lithium treat: - ANSWER>>Bipolar disorder What is the black box warning for Carbamazepime (Tegretol)? - ANSWER>>Steven Johnson Syndrome and Toxic Epiderman Necrolysis (TENS). Aplastic anemia and agranulocytosis have also been reported.

**Carbemazapime is used in teh treatment to prevent manic episodes in BPD What is the blackbox warning related to antipsychotic drugs and older adults - ANSWER>>Elderly patients with dementia-related psychosis have an increased risk for death when treated with antipsychotic drugs How do combination oral contraceptives reduce fertility? - ANSWER>>By inhibiting ovulation **Estrogen in combo OC inhibit the relase of FSH from the pituitary (thereby inhibiting follicular maturation) **Progestin in combo OC acts in the hypothalamus and pituitary to supress midcycle LH surge, which normally triggers ovulation Patient education when taking oral contraceptives: - ANSWER>>Teach about the warning signs for thrombosis and thromboembolism. **leg tenderness, sudden chest pain, SOB, severe HA, sudden visual change. **Cigarettes increase the risk of serious CV side effects Acute treatment of migraines includes: - ANSWER>>Oral NSAIDs (eg naproxen, ibuprofen), triptans (eg sumatriptan), opioids, and IM dihydroergotamine

• Metoclopramide or prochlorperazine may be used in acute migraine attacks if nausea is present Preventative therapy should be consider in migraine management if: - ANSWER>>The patient experiences 2 migraine attacks in one month

**Preferred prophylactic drugs include propanolol (Except in asthmatics), divalproex and amitriptyline. Topiramate (Topamax) is also a preferred treatment **Divalproex is contraindicated in pregnancy and can cause neural tube defects. Also can cause potentially fatal pancreatitis and hepatitis Often prescribed with levodopa/carbidopa in the treatment of Parkinson's Disease - ANSWER>>Bromocriptine What medication may cause serious or possibly life-threatening sleep behaviors, such as sleep driving? - ANSWER>>Ambien Taking too much of this type of drug can make you "blind as a bat" or "mad as a hatter"

• ANSWER>>Anticholinergics, antimuscarinics Absorption, Distribution, Metabolism, excretion - ANSWER>>Pharmacokinetics Drugs used to relieve a myasthenic crisis - ANSWER>>Neostigmine, pyridostigmine This drug has a very narrow therapeutic index and high risk for toxicity, therefore levels should be monitored frequently - ANSWER>>Lithium The drug class that carries an increased risk of suicidality in children, adolescents, and young adults - ANSWER>>SSRIs/SNRIs The antidote for organophosphate poisoning - ANSWER>>Atropine This drug class double the rate of mortality in older adults with dementia - ANSWER>>Antipsychotics

In infants, this is not fully developed and therefore infants are more sensitive to CNS drugs - ANSWER>>Blood Brain Barrier Time of development that fetus is at highest risk of teratogenicity from a drug - ANSWER>>First trimester Do not stop this class of drug abruptly due to an increased risk of cardiovascular events

• ANSWER>>Beta-blockers Agents that indirectly block the breakdown of acetylcholine and are often used in treatment of Alzheimer's Disease - ANSWER>>Cholinesterase inhibitors Adverse drug reaction that causes difficulty speaking and chewing and worm-like movements of the tongue - ANSWER>>Tardive Dyskinesia Receptor found in the lungs that causes bronchodilation when activated - ANSWER>>Beta 2 Receptors This drug has led to the death of children in ultrarapid metabolizers as 10% of the drug is converted to morphine - ANSWER>>Codeine Leading cause of acute liver failure in the U.S. - ANSWER>>Hepatotoxic drugs An autoimmune disease that attacks the nicotinic receptors in skeletal muscle - ANSWER>>Myasthenia Gravis An opioid antagonist that works to quickly reverse CNS and respiratory depression - ANSWER>>Naloxone (Narcan) How the drug affects the body - ANSWER>>Pharmacodynamics

Term for the amount of drug that reaches systemic circulation. Often affected by route of administration - ANSWER>>Bioavailability Symptoms for this syndrome include confusion, irritability, tachycardia, hypertension, diaphoresis, and is caused by having too much of this "happy" substance - ANSWER>>Serotonin Dopamine agonist often used in treatment of Parkinson's Disease that is least likely to cause sleep attacks - ANSWER>>Pramipexole Clonidine is often prescribed to children to treat this disorder - ANSWER>>ADHD Drug most effective in alcohol withdrawal - ANSWER>>Lorazepam (ativan) Drug used for anaphylactic reaction or cardiac arrest - ANSWER>>Epinephrine 1st line drugs for migraine prevention - ANSWER>>Beta Blockers Parasympatholytic used for unstable bradycardia - ANSWER>>Atropine Drug class used to treat ADHD - ANSWER>>Stimulants Drugs that have no medical use and high potential for abuse - ANSWER>>Schedule I controlled substances This drug is an antispasmodic muscle relaxant that must be tapered off due to risk of seizure or hallucinations if stopped abruptly - ANSWER>>Baclofen 3Muscle relaxant that is also a schedule IV controlled substance - ANSWER>>Carisoprodal (Soma)

1st line abortive drug class for mild to moderate headaches - ANSWER>>NSAIDs 1st line abortive drug for moderate to severe migraine headaches - ANSWER>>Sumatriptan (Imitrex) Used in the treatment of non-hypovolemic hypotension - ANSWER>>Norepinephrine or phenyleprine Drug used for acute management of seizures - ANSWER>>Lorazepam Used for treatment of beta-blocker overdose - ANSWER>>Glucagon Used in treatment of opioid use disorder. May cause QT prolongation. - ANSWER>>Methadone This opioid analgesic is used for treatment of post-op shivering or rigors - ANSWER>>Meperidine Antiseizure medication that carries Black Box warnings for severe skin reactions such as SJS - ANSWER>>Carbamazepine Drug class used to treat extra-pyramidal symptoms - ANSWER>>Anticholinergics Cause of menstrual-associated migraines - ANSWER>>Drops in estrogen levels Chronic use may cause amotivational syndrome or hyperemesis synrome - ANSWER>>Marijuana (THC) Deadly bacterial toxin used in prevention of chronic migraine headaches - ANSWER>>Botox (Botulinum toxin)

Neostigmine is a medication used to treat what disorder/disease? - ANSWER>>Myasthenia Gravis Myasthenia Gravis is an autoimmune disorder that may cause what symptom? - ANSWER>>Difficulty swallowing True or false: in order for a medication to affect the CNS, it must be able to cross the blood brain barrier? - ANSWER>>TRUE A major goal in treating Parkinson's Disease is to restore what in the brain? - ANSWER>>Dopamine Common side effects of dopaminergics? - ANSWER>>Sleep attacks, hallucinations, confusion Which medication is appropriate in the treatment of acute psychosis? - ANSWER>>Haloperidol After being treated with a first-generation antipsychotic, the patient develops difficulty speaking and chewing likely due to which adverse reaction? - ANSWER>>Tardive Dyskinesia Which medication can help manage daily panic attacks? - ANSWER>>SSRIs Cholinesterase inhibitors are used in the treatment of what condition? - ANSWER>>Alzheimer's Disease True or false: anticonvulsants are only used to treat seizure disorders? - ANSWER>>FALSE

This antiseizure medication is also used for prophylactic treatment of migraines: - ANSWER>>Topiramate This anti-seizure medication is also an anti-arrhythmic: - ANSWER>>Phenytoin (Dilantin) Which antiseizure medication has a Black Box warning for blood dyscrasias and serious dermatologic reactions? - ANSWER>>Carbamazepine (Tegetrol) Which agent should you try first to treat an early onset migraine? - ANSWER>>NSAIDs Hallucinations may occur if this medication is stopped abruptly? - ANSWER>>baclofen Sedative hypnotics are often used for insomnia. A common agent used is: - ANSWER>>zolpidem Atomoxetine (staterra), clonidine and guanfacine are used in the treatment of which disorder? - ANSWER>>ADHD Initial intervention for infrequent migraine headaches includes: - ANSWER>>headache diary Which medications cause QT prolongation? - ANSWER>>amiodorone, methadone, tricyclic depressants A contraindication for a triptan includes: - ANSWER>>hypertension, MAOI, CAD Your friend breaks out in hives and has wheezing after eating PB, what do you do? - ANSWER>>Epinephrine IM (epi-pen) Beta blockers have been used for: - ANSWER>>post MI, HTN, HF

What drug route allows for 100% bioavailability? - ANSWER>>Intravenous Chronic renal failure will affect what element of pharmacokinetics? - ANSWER>>excretion TRUE OR FALSE: Andrenergic antagonists or alpha blockers cause vasoconstriction? - ANSWER>>false Symptoms of BPH include: - ANSWER>>urinary hesitation common side effect of ACE inhibitors: - ANSWER>>cough TRUE OR FALSE: angina pain is caused by cardiac ischemia? - ANSWER>>true All patients with angina should receive this medication to reduce mortality? - ANSWER>>Aspirin Lifestyle modifications to reduce cardiac risk include: - ANSWER>>stop smoking, daily exercise, weight loss (at least 10 pounds) a patient with heart failure that has anginal pain with walking and slight limitation of activity is what class? - ANSWER>>II A patient is taking HCTZ (hydrochlorothiazide) for HTN. What lab is most important to monitor? - ANSWER>>potassium (K) TRUE OR FALSE: one primary mechanism that worsens heart failure is cardiac remodeling? - ANSWER>>TRUE

Which class of medication is indicated in patients post MI to precent cardiac remodeling? - ANSWER>>ACE inhibitors TRUE OR FALSE: when treating hyperlipidemia, calculating ASCVD risk will help to determine treatment? - ANSWER>>TRUE Which class of medication is contraindicated in patients with liver failure? - ANSWER>>HMG-CoA inhibitors (statins) Which anticoagulant has the quickest onset of action? - ANSWER>>heparin Patients receiving heparin are at risk for what adverse reaction? - ANSWER>>thrombocytopenia Why would heparin and warfarin be given together? - ANSWER>>warfarin has a delayed effect All of the following could increase a patient's ability to bleed: - ANSWER>>herbal supplements, aspirin, TPA Factor Xa levels may be monitored for patient's on this medication? - ANSWER>>low molecular weight heparin Which blood pressure medication can be taken during pregnancy? - ANSWER>>beta blockers after a hip replacement, what drug is often used to prevent DVT? - ANSWER>>enoxaparin A patient started on warfarin for A-fib should be taught that... - ANSWER>>the INR should be between 2- 3

What is not true about epoetin alfa? - ANSWER>>treats patients with pernicious anemia Pernicious anemia is due to deficiency of - ANSWER>>B12 Lab monitoring for iron deficiency anemia include the following - ANSWER>>reticulocyte count in 1 week, TIBC in 4 weeks, Hgb/Hct/ferritin in 4 weeks Which class of antidiabetic medication is contraindicated in CKD stage 4, 5 - ANSWER>>metformin A pregnant diabetic woman wants to know if she should continue her diabetes medication, you tell her - ANSWER>>she will be switched to insulin during pregnancy metformin helps to control blood glucose levels by - ANSWER>>decreasing glycogenolysis by the liver, reduces glucose absorption in the gut, increasing skeletal muscles uptake of glucose When starting a basal insulin, which class of medication should you reduce or d/c? - ANSWER>>sulfonylurea TRUE OR FALSE: beta-blockers can mask effect of hypoglycemia - ANSWER>>TRUE TRUE OR FALSE: alcohol can mask the signs and symptoms of hypoglycemia - ANSWER>>TRUE Signs and symptoms of hypoglycemia include: - ANSWER>>confusion, tachycardia, diaphoresis A diabetic patient has developed hypertension, which class of medication should be started? - ANSWER>>ACE inhibitor

Levothyroxine should be taken at what time of day? - ANSWER>>first thing in the morning, 30 minutes prior to eating How would you know effectiveness of levothyroxine - ANSWER>>Decrease in TSH levels Which form of estrogen has the least side effects? - ANSWER>>transdermal a post-menopausal woman is being seen for HRT, what questions should you ask? - ANSWER>>Do you smoke cigarettes? Hx of DVT/PE? Hx of hysterectomy? Your male patient on testosterone has had a 7 pound weight gain and needs early refill on testosterone, you suspect? - ANSWER>>he is using more than prescribed What should you avoid while taking the antibiotic metronidazole (Flagyl) to avoid adverse effects? - ANSWER>>Alcohol What medication class can be used to treat BPH? - ANSWER>>Alpha blockers Why would we recommend for a patient to take an aspirin daily? - ANSWER>>Stroke, MI, PE prevention What is a big side effect of too much aspirin? - ANSWER>>Bleeding What should you monitor closely for an anemic patient getting epoetin? - ANSWER>>Blood pressure (HTN) What is the black box warning for epoietis-stimulating agents (ESAs) - ANSWER>>They can cause tumors

If a patient is diagnosed with angina, what medications should they take? - ANSWER>>aspirin, statins, nitro If you have someone who wants to self-donate, what would we prescribe to them to stimulate red blood cells? - ANSWER>>Epoetin WITH iron If prescribing iron, what labs do we want to get and how long out should we get them? - ANSWER>>Reticulocyte count within 1 week TIBC, H&H, ferritin - 4 weeks What education should we provide to someone needing iron replacement? - ANSWER>>Take on an empty stomach with orange juice (vit. C helps with absorption) and it can cause GI upset In a patient with pernicious anemia receiving Vit B12, what should we monitor? - ANSWER>>Potassium (hypokalemia can occur within first two days) How long does it take NPH to take effect? - ANSWER>>60-90 minutes What is the biggest side effect to monitor for when treating diabetics with insulin or oral agents? - ANSWER>>Hypoglycemia (tachycardia, diaphoresis) Why can beta blockers and alcohol not be taken together? - ANSWER>>Masks signs of hypoglycemia If we are switching a patient from NPH to glargine, what do we need to do with the glargine dosing? - ANSWER>>Decrease by 20% to prevent hypoglycemia What to monitor when starting metformin? - ANSWER>>Renal function tests