NURS 251 Pharmacology Final Exam-with 100% verified solutions-2023-2024 ACCURATE, Exams of Nursing

Download NURS 251 Pharmacology Final Exam-with 100% verified solutions-2023-2024 ACCURATE and more Exams Nursing in PDF only on Docsity! 1 NURS 251 Pharmacology Final Exam-with 100% verified solutions-2023-2024 ACCURATE 1. Sublingual: When rapid effect is needed right away Subcutaneous: Destroy or inactivated in the GI Tract Intramuscular: Used for drugs with poor oral absorption Topical: For local effects on skin and eyes Pharmaceutics is the study of how various dosage forms influence the way in which the drug affects the body/ Administration of dosage form, dissolution of drug into body/ manipulating chemical compound. Pharmacokinetics is the study of what the body does to the drug, including absorption, distribution, metabolism, and excretion/ Absorption, distribution, metabolism, excretion. Pharmacodynamics is the study of what the drug does to the body/ Drug- receptor interaction. 2. The drug naltrexone is given to prevent relapse or cravings in individuals who use opioids. It binds to opioid receptors blocking endogenous agonist and other opioid drugs from binding and having an effect. Naltrexone is a/an Competitive agonist (binds to the same site of agonist) 3. Due to the many chronic diseases associated with aging the elderly can have decreased blood flow to the liver. With age, there can also be a decrease in liver enzymes, which can increase the duration of a drug in the patient’s systems. Which pharmacokinetic process is affected in this scenario? Metabolism (stored in the body)/ cytochrome P-450 enzymes/ liver/ Grapefruit and statins 4. When the combined effect of two drugs is greater than the sum of the individual effects it refers to Synergism: When the combined effect of two drugs is greater than the sum of 2 their individual effects 5 12. True or False. If the statement is false, explain why it is false. Calcium channel blockers work to treat angina by increasing the amount of nitric oxide in smooth muscle cells leading to vasodilation. False: Nitrates work to treat angina by increasing the amount of nitric oxide in smooth muscle cells leading to vasodilation/ Nitroglycerin (rapid acting and long acting), isosorbide dinitrate (rapid acting and long acting), and isosorbide mononitrate (long acting). False: Calcium channel blockers work to treat angina by inhibiting calcium to enter smooth muscle, decreasing their contractility, which leads to vasodilation/ verapamil, diltiazem, amlodipine, nifedipine, and nicardipine. 13. Alpha Agonist (Clonidine/ Doxazosin/ Metoprolol/)Decreases norepinephrine and renin Calcium Channel Blocker (Amlodipine/ Norvasc) Prevents smooth muscle contraction blocking calcuim ACE inhibitor (Lisinopril/ Prinivil) Prevents formation of Angiotensin II Diuretic (thiazide) (Hydrochlorothiazide) Works at the kidney Alpha Blocker (Carvedilol; both) Reduces stroke volume Vasodilator (Hydralazine) Directly causes peripheral vasodilation Direct Rein Inhibitor (Aliskiren/ Tekturna) Inhibits renin and decrease angiotensin I and II Angiotensin II receptor blocker Blocks binding of Angiotensin 14. A 75-year-old male residing in a nursing home came to the clinic at 7AM complaining of a “swollen tongue” and reporting a tingling sensation in his lips 6 and mouth. Finding nothing remarkable, the clinician reassured the patient and sent him back to his room. Five hours later, the patient was back complaining of difficulty swallowing, and it was noted that his tongue was quite swollen and protruding from his mouth. The clinician immediately called 911 to transfer the patient to the hospital. The patient’s medical history included the following pathologies and treatments: Disease Pharmaceutic al treatments Drug Class Bipolar affective disorder Lithium (125 mg/day) Antipsychotic Hypertension Felodipine (10 mg/day) Lisinopril (5 mg/day) CCB ACE-inhibitor Hyperlipidem ia Atorvastatin (80 mg/day) Statin Ischemic heart disease Clopidogrel (75 mg/day) Antiplatelet Osteoporosis Alendronate (70mg weekly) Bisphosphona te A. What is the potentially life-threatening adverse effect being experienced by the patient called? Angioedema B. What medication is mostly the cause of the adverse effect? Lisinopril/ ACEI 7 15. At Connie’s yearly physical, her physician discovered she had stage 2 hypertension. What would be the recommended treatment? Lifestyle changes, ACE inhibitor, and thiazide 16. Octreotide Severe watery diarrhea/ inhibits GH Propylthiouracil Hyperthyroidism/ thyroid hormone/ Methimazole Glucocorticoids Inflammation Vasopressin Used in emergency situations/ ADH Somatropin Growth hormone Ovaries Oral conception/ GnRH/ Lh/ FSH 17. If the statement is false, explain why it is false. Polyuria means an increase in urine glucose. False: Polyuria means increased urination Glycosuria: increase in urine glucose Polydipsia: Excessive thirst Polyphagia: Excessive Hunger 18. Thomas, who is being treated for Type 2 diabetes with the maximum tolerated metformin dose, still has not reached his goal blood glucose values. What is an example of a second agent available as an injection that could be added to his regimen? Insulin or GLP1 agonist 19. Carla is a Type 2 diabetic, whose 8-year-old daughter was just diagnosed with Type 1 diabetes. You are explaining the daughter’s insulin treatments and how Carla will monitor her daughter’s blood glucose. Given that they both have diabetes, Carla asks you why her daughter can’t be treated with anti-diabetic pills. 10 27. Jose arrives at the doctor's office complaining of continued ear pain after treating his second ear infection this year with amoxicillin. He took the same exact medication and the same dose that worked that last time. This time the doctor prescribes a different medication called augmentin. What is the term that best describes why the doctor decided to prescribe a different antibiotic this time? Antibiotic resistance 28. Select the drug class that is bacteriostatic and works by preventing the bacteria from making folic acid, which is a vitamin that is necessary for DNA and RNA synthesis. Sulfonamides: Bacteriostatic- preventing the bacteria from making folic acid, which is a vitamin that is necessary for DNA and RNA synthesis/ trimethoprim/ Stevens-Johnson Syndrome Penicillins: Bactericidal/ Augmentin/ Beta- lactamase Inhibitor Cephalosporins: Bactericidal/ beta lactam Aminoglycosides: IM or IV/ Bactericidal/ negative/ Category D Tetracyclines: Category D 29. Based on your knowledge of antibiotic spectrums and keeping in mind antibiotic stewardship, which drug would be most appropriate for a simple Gram- positive infection in a patient who is also pregnant? Amoxicillin/ Aminopenicillins/ Ear infections, sinusitis, respiratory and skin infections, urinary tract infections Doxycycline/ Tetracyclines/ treat acne, skin infections respiratory, and GI tract infections. Amikacin/ Aminoglycosides/ serious Gram-negative infections resistant to other aminoglycosides. Tobramycin Gram-negative infections particularly pseudomonas aeruginosa. Ciprofloxacin/ Fluoroquinolones/ inhibit bacterial enzymes/ urinary tract infections, respiratory, abdominal, bone, and soft tissue infections. 11 30. Levofloxacin Fluoroquinolone Tobramycin Aminoglycoside Augmentin Penicillin Minocycline Tetracycline 31. True or False. If the statement is false, explain why it is false. HCl is the enzyme responsible for the catabolism (breaking down) of proteins into polypeptides. False: Pepsin is responsible for the catabolism of proteins HCI: breakdown food entering the stomach and are released via parietal cells 32. Denise comes to see her physician with complaints of an occasional burning sensation in her chest, especially prevalent after big meals. It is most noticeable if she eats something like pasta sauce or a fatty meal and bothers her most at night when she lies down to go to bed. The doctor tells her she is suffering from mild heartburn and thinks she would benefit from antacid as needed. Select the best medication for Denise. Calcium Carbonate: Antacid/ Aluminum hydroxide; magnesium hydroxide (Gaviscon, Maalox), Magnesium hydroxide (Milk of magnesia) Cimetidine: H2 receptor antagonist/ CNS effects such as confusion and disorientation/ Tagamet Omeprazole: PPI/ First line to treat H. Pylori/ Prilosec Clarithromycin: 33. Unfortunately, the PPI prescribed to treat Denise’s GERD did not resolve her symptoms. After further testing, it is discovered that she has a peptic ulcer caused 12 by H. Pylori. Her doctor decided to start her on triple therapy. Which antibiotic(s) would be appropriate for her treatment (select all that apply)? Amoxicillin Metronidazole Clarithromycin Tetracycline Triple therapy: two antibiotics in combination with bismuth salts (Pepto-Bismol or Kaopectate) Quadruple therapy: Adds PPIs (omeprazole/ Prilosec/ Asprin/ Nexium/ Protonix) Prostaglandins are only useful in the treatment or prevention of NSAID-induced ulcers. Misoprostol has not been shown to be effective at preventing ulcers in patients on chronic NSAID therapy. 34.34. Bulk- forming absorbs water into the Psylluim/ Metamucil/ Powder/ Fluid disturbance Saline Works by increasing osomotic pressure promotes peristalsis and evacuation. Magnesium hydroxide, magnesium sulfate/ Epsom salts/ oral liquid/ bowel prep for surgical procedures Hyperosomotic Increase fecal water Polyethylene glycol, lactulose, sorbitol, and glycerin/ Fleet/ Miralax/ suppository/ bowel prep for surgical procedures/ chronic constipation. Emollient Lowers the surface tension Docusatesalts and Mineral oil/ Colace/ Oral capsule/ rectal enema/ fleet/ Chronic constipation/ Fecal impactation. Stimulant Acts on the nerve within the intestines to cause Senna/ bisacodyl/ Ducolax/ oral or suppository and liquid/ cute constipation, bowel prep for surgical procedures. 15 40. Joelle is now being treated with olanzapine instead of chlorpromazine for her schizophrenia. It was chosen in part because it has less of a chance of EPS. What should be monitored for now that she is on an atypical antipsychotic? Metabolic Syndrome (will also accept lipids, glucose, weight) Atypical antipsychotics have been shown to have other adverse effects related to their unwanted effect on the endocrine system. Insulin resistance, weight gain, and changes in lipids have all been shown to occur. 41. True or False. If the statement is false, explain why it is false. Providers may define what they consider to be a specialty medication for reimbursement and contracting purposes. False, by way of payers determining the specialty medication status 42. MS: Damage to the myelin coating around the nerve fibers in the CNS causes the nerve signals to be disrupted Cancer A disease process that involves the development and proliferation of abnormal calls Hepatitis C Recent treatment advancements HIV Typically present with acute clinical illness that varies in presentation followed by a longer clinical latency Crohn’s Disease Inflammatory bowel disease caused by inflammation in the digestive tract which can lead to symptoms such as abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition Rheumatoid Arthritis Autoimmune disorder that causes inflammation and tissue damage in the joints 16 43. Jamie has been diagnosed with Multiple Sclerosis. She would prefer a medication that she can give to herself instead of having to go to an infusion center on a monthly basis. Which medication below would be the most appropriate option? Inferon Beta- 1a (Rebif); MS 3 subcutaneous injections Etanercept (Enbril): RH/ Recombinant DNA-derived TNF-blocking drug Natalisumab (Tysabri): MS inhibits the leukocyte adhesion that the alpha4 protein subunits are involved Abatacept (Orencia): RH/ selective co-stimulation modulator Adalimumab (Humira) Acts on tumor necrosis factor (TNF), which is a naturally occurring cytokine involved in the normal inflammatory and immune response/ Crohn’s disease, ulcerative colitis, plaque psoriasis, and psoriatic arthritis. Bevacizumab (Avastin) Cancer/ Binding to and inhibiting vascular endothelial growth factor, which is a protein that promotes the development of new blood vessels in both tumor and normal body tissues/ colon cancer, rectal cancer, non- small-cell lung cancer, and malignant glioblastoma. 44. Which drug classes make up the most common combination therapy for the initial treatment of HIV? Highly active anti-retrovirals: Combination of two nucleoside-analogue reverse transcriptase (NRTIs) and one nonnucleoside reverse transcriptase inhibitor (NNRTI), or one protease inhibitor. IMPORTANCE OF DRUG ADHERENCE: By way of HIV having no current cure and being a retrovirus (e.g able to replicate and spread quickly and easily) it is important to take the medicine to help control the virus and increase effectiveness and avoid or at least delay the development of drug resistance. 17 45. Lucille was previously treated with interferon and ribavirin for her chronic hepatitis C virus. She did not tolerate the regimen well and it did not cure her hepatitis C. Explain why she could or could not try a medication regimen like Ombitasvir/paritaprevir/ritonavir with dasabuvir. She can if she is without cirrihosis as ribavirin helps to enhance the immune system with the goal of the body then being able to fight off the virus, while the newer treatments available interferes with the proteins that help the virus grow and spread. As they can be taken in combination and have shown both efficacy and tolerability. What’s more the ribavirin can be taken away via intolerability and treatment could still be used to see results. 46. Write the following directions in a sig code format. Take 1 tablet by mouth every 6 hours as needed 1 tab po q6h prn 47. You need to determine the dose for a 96-pound patient. The medication is dosed 10mg/kg. What would be the dose in mg? (NOTE: The Canvas calculator is on the top left-hand side of the page, and is a blue rectangular icon.) 436mg 48. The recommended dosing range for amoxicillin is 25-45mg/kg per day divided into 2 doses given every 12 hours. Select the appropriate dose based on the stock bottle and the 5-ml measuring device shown below for a 35-pound child. (250mg/5ml) 5 ml every 12 hours 16 X 45 X 5 X 2/ 250/ 4= 7.2 16 X 25 X 5 X 2/ 250/ 4= 4 middle is 5