Pharmacology Midterm Exam Questions and Answers, Exams of Pharmacology

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Nr 565 Advanced Pharmacology Chamberlain

College of Nursing Midterm Exam Latest

Updated 2024- 2025 Correct Questions And

Answers Grade A

When prescribing Medications, we must understand that the liver function declines with age d/t what? A. Enlarged Liver B. Decreased blood flow to liver C. Increased activity of the hepatic enzymes - ANSWER B. Decreased blood flow to liver An 82 yo male visits the clinic complaining that his pain meds "take forever" to work after he takes his pill. What are possible reasons you can explain to him as to why this may be happening. A. Perhaps we need to increase your dose B. Sometimes as you get older, absorption may be slower resulting in a delayed response C. As we get older, the gastric acid decreases and may delay absorption - ANSWER B. Sometimes as you get older, absorption may be slower resulting in a delayed response C. As we get older, the gastric acid decreases and may delay absorption RA Characteristics Onset Affected population Location Joint stiffness duration SxS - ANSWER weeks-months women>men common hands, feet, & wrists

60 min in AM local & sys. OA Characteristics

Onset Affected population Location Joint stiffness duration SxS

• ANSWER years men & Women equally Hands & weight baring joints <30min in AM typically local What might you expect to find in the synovial fluid of a pt with OA - ANSWER Mild leukocytes What might you expect to find in the synovial fluid of a pt with RA - ANSWER Cloudy with leukocytes Goals of Tx for RA - ANSWER Sxs relief (pain, stiffness, inflammation, maintaining joint fxn and ROM minimize systemic involvement delay progression Typical pharm Txs for RA - ANSWER NSAIDs, systemic steroids, antimalarials, antimetabolites, and biologics Baseline assessment data before starting DMARD - ANSWER Liver, PG, serum creatinine, CBC with diff, sxs of infxn (TB & hepatits), Hx & physical, renal status, & malignancies Significant baseline data for Sulfasalazine - ANSWER CXR, pulmonary and neuro status Significant baseline data for Leflunomide - ANSWER CXR, BP & pulmonary status Significant baseline data for Mehtotrexate - ANSWER CXR, Pulmonary and GI status Significant baseline data for hydroxychloroquine - ANSWER Ophthalmologic & cardiac exam (ECG if indicated) Conventional DMARDs- examples - ANSWER Methotrexate, hydroxychloroquine, sulfsalazine Biologic DMARDS- examples - ANSWER adalimumab, etanercept, golimumab

What is the first-line treatment of osteoporosis? - ANSWER Bisphosphonates with calcium and vitamin D supplementation. Bisphophosphonates- examples - ANSWER Alendronate, ibandronate, risedronate zolendronic acid "- dronate" "-dron-" Pt education for bisphosphonates - ANSWER Swallow tab whole take with full glass of H2O remain upright for at least 30min (60min for ibandronate) Take medication on empty stomach Possible AEs of bisphosphonates - ANSWER Esophagitis, osteonecrosis of the jaw, & hip frx MOA of bisphosphonates - ANSWER Inhibits osteoclast bone resorption Black box warning for Raloxifene - ANSWER Increased risk for VTE Increased risk for death from stroke in PM women with Hx or risk of CAD Bisphosphonates' contraindications - ANSWER esophageal disorders CrCl < 30/ml/min inability to sit or stand for <30 min Active upper GI problems low Ca and vit D lvls What electrolyte imbalance are patients taking Denosumab at higher risk for? - ANSWER Ca & Mag What baseline data is needed before starting bisphosphonates, denosumab or raloxifene? - ANSWER DXA, Ca & Vit D lvls, PG status Denosumab: oral exam Raloxifene: mammogram Bisphosphonates: Creat & renal fxn

What are the first-line options for hypertension? - ANSWER TZD, ACEI, ARB What are first-line antihypertensives for African Americans? - ANSWER TZD or CBB What antihypertensive classes are recommended for patients with CKD or HF? - ANSWER ACEI or ARB Women who have hypertension and osteoporosis should be prescribed which antihypertensive medication? - ANSWER TZD What should we monitor for when a patient is prescribed an ACEI and K+ sparing diuretic? - ANSWER Hyperkalemia What are some potential side effects of Statins? - ANSWER Myopathy Myalgia (check CPK) GI upset What should patients avoid taking with simvastatin or lovastatin? - ANSWER Grapefruit Macrolides Schedule 1 drugs (description) - ANSWER No acceptable medical use High abuse & dependance potential Schedule 1 drugs - ANSWER Heroin LSD Cannabis MDMA Peyote Schedule 2 drugs (description) - ANSWER High dependence & abuse potential. considered dangerous BUT have purpose Schedule 2 drugs - ANSWER Rx with <15mg of hydrocodone (vicodin) cocaine Meth methadone hydromorphone oxy fentanyl Adderall Ritalin

What is the most important cause of Adverse Drug Reactions? A. High drug dosages B. Lack of monitoring of medications C. Decreased renal excretion D. Overprescribing/Polypharmacy - ANSWER C. Decreased renal excretion What can a poor metabolism phenotype do to metabolism of drugs? - ANSWER Reduced or absent enzyme activity which can lead to slow processing of meds (low effect) or increased risk of SEs. How does poor metabolism affect a high or low therapeutic index? - ANSWER Some Rx need to be converted to active form for use - > low therapeutic effect Some Rx need to be metabolized for clearance - >risk for OD BB warning for opioids - ANSWER Resp arrest BB warning for Fentanyl - ANSWER Fatal Resp Depression BB warning for Methadone - ANSWER QT prolongation Fatal dysrhythmias (Torsades) Resp Dep BB warning for Codeine - ANSWER 10% codeine - > morphine in liver Poss. Death in children severe toxicity risk in BF infants BB warning for Hydromorphone and Oxymorphone - ANSWER HIGH ABUSE POTENTIAL Resp dep esp. when used with other sedatives i.e. alcohol BB warning for Oxycodone - ANSWER High abuse potential Resp dep. What are therapeutic uses for morphine? - ANSWER Pain, sedation, euphoria, resp depression, cough suppression, suppression of GI motility, reduces anxiety What are therapeutic uses for Fentanyl? - ANSWER •Chronic pain (PATCHES), acute pain, cancer pain

When should a patient be referred to a pain specialist? - ANSWER 120mme/day What is MME and when to use it? - ANSWER Morphine milligram equivalent Potency of an opioid ID opioid prescription burden of a single person What is the PDMP and when to use it? - ANSWER Prescription drug monitoring program Used when prescribing controlled substances How to assess someone for possible drug diversion - ANSWER UA screen PDMP routine use Risk Factors for OUD? - ANSWER Family hx of abuse personal hx of abuse cross tolerance mental illness When to prescribe Naloxone? - ANSWER With every opioid prescription Drugs not safe to take with opioids? - ANSWER Opioids, alcohol, antihistamines, CNS depressants, or general anesthetics Provider Responsibilities when Prescribing opioids? - ANSWER 12 CDC guidelines 12 CDC guidelines when prescribing opioids - ANSWER 1. Opioids are NOT 1st line

2. est. goals for pain & Fxn
3. discuss risks and benefits
4. Use IR to start
5. lowest effective dose
6. prescribe short durations for acute pain
7. eval. benefits and harm frequently
8. Use strats to mitigate risk
9. Review PDMP data
10. us UA testing
11. avoid concurrent opioid and Benzo prescribing
12. offer tx for OUD In what patient population are statins contraindicated? - ANSWER Pregnant women pts with viral or ROH hepatitis CAUTION: pts taking fenofibrates or zetia In what patient population is Warfarin contraindicated? - ANSWER PG or lactating

in heart Promotes vascular fibrosis decreasing arterial compliance and disrupting baroreceptor reflex How to mitigate adverse effects of aldosterone? - ANSWER Antagonist (eperlonone)- block receptors - >increased retention of K and increased excretion of Na and H A patient with HF develops fibrotic changes, what should the provider do next? - ANSWER Prescribe an ARB- inhibits fibrosis HTN Guidelines according to Rosenthal and Burchum - ANSWER Diuretics, Beta blocker, RAAS inhibitor (ACEI, ARB, aldosterone agonist), CCB For the general population what class of HTN medication is appropriate? - ANSWER Thiazide diuretics For a CKD patient, what class of HTN is appropriate? - ANSWER ACEI or ARB For the African American patient, what class of HTN medication is appropriate? - ANSWER Diuretics->CCB, & A/B blockers When are ACEI contraindicated - ANSWER 2nd & 3rd trimester PG Bilateral renal artery stenosis When are CCBs contraindicated? - ANSWER HTN, sick sinus syndrome, 2nd or 3rd degree heart block When are Beta Blockers contraindicated? - ANSWER Bradycardia, AV heart block CAUTION: Pts with HF, asthma, bronchospasm, DM, hx of severe allergic Rxns What clinical tools are used to treat hyperlipidemia? - ANSWER Lifestyle changes, DASH diet, increase dietary soluble fiber, exercise, wt loss, smoking cessation A 55 year old male comes into the clinic with a gouty arthritis. He states that he has one flareup a year. Your response is: A. I will prescribe you glucocorticoids to help with inflammation B. Lets start you on a prophylactic therapy of colchicine. C. It will be helpful to take an NSAID to start with to help relieve some inflammation. Ill prescribe Naproxen. - ANSWER C. It will be helpful to take an NSAID to start with to help relieve some inflammation. Ill prescribe Naproxen.

A patient comes in stating that he tried NSAIDS to relieve a gouty attack but it just hasn't helped. He asks, "what are my options?" He further states that he has attacks every few years but when he does NSADIS "never help." Your response is: A. I can prescribe a glucocorticoid (Prednisone) and that will bring down the inflammation/pain. B. Have you tried increasing your dosage of NSAIDS and drink plenty of water? C. Lets start by making some changes in your diet, can you tell me what you eat regularly? - ANSWER A. I can prescribe a glucocorticoid (Prednisone) and that will bring down the inflammation/pain. Colchicine is considered for long-term treatment if a person has _____ or more gouty attacks per year. - ANSWER 3 (greater than 2) Colchicine should not be taken with what medications? - ANSWER Statins, PGP inhibitors, 3A4 inhibitors Match the adverse affect to the proper medication Colchicine Allopurinol Probenecid A. Take with food to minimize GI side effects and drink 2.5-3L of water to prevent uric acid crystal formation in kidneys B. Nausea, vomiting, diarrhea, myelosuppression, and Myopathy C. SCAR can develop, generally well tolerated with minimal GI and neurologic effects - ANSWER Colchicine-B Allopurinol-C Probenecid-A What should be co-administered with febuxostat? - ANSWER NSAID or Colchicine for up to 6 mo after starting Initiation of Allopurinol can elicit an acute gouty attack. What can be taken in conjunction to prevent that? - ANSWER Colchicine & NSAIDs (low dose) Adverse Effects of Colchicine? - ANSWER GI myelosuppression or injury to proliferating cells (leukopenia, granulocytopenia, thrombocytopenia, and pancytopenia Myopathy or Rhabdo (long term tx) CAUTION: Statins Lesinurad should be combined with what other gout medication? - ANSWER Allopurinol- decreases uric acid levels in blood when Allopurinol alone did not work

avoid close contact with communicable dz seek medical attention for signs of infxn, bruising, bleeding, pallor, fatigue, fever, sxs of HF (SOB, orthopnea, fatigue, edema)