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A collection of questions and answers related to a pharmacology midterm exam. It covers various topics, including drug interactions, adverse drug reactions, and treatment options for conditions like rheumatoid arthritis, gout, and osteoporosis. Useful for students studying pharmacology and provides insights into common exam questions and their answers.
Typology: Exams
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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
"-mab"s MOA of methotrexate - ANSWER folic acid antagonist - >inhibits lymphocyte proliferation Within how many months of RA diagnosis should Methotrexate be started and why? - ANSWER 3 months of diagnosis delay joint degeneration What routine monitoring is needed for Methotrexate? - ANSWER Periodic liver & renal fxn What blood level do we expect to see elevated in a patient with gout? - ANSWER Uric acid First line Tx for gout - ANSWER Corticosteroids, NSAIDs, or Colchicine What is the typical treatment regimen for chronic gout? - ANSWER Allopurinol, Febuxostat, low dose Colchicine (prophylaxis) MOA of febuxostat - ANSWER inhibits xanthine oxidase - >decreased production of uric acid Is allopurinol safe to use with patient who have renal dysfunction? - ANSWER Yes; Rx of choice for pts with renal dysfxn or who overproduce uric acid What is the initial dosage of colchicine for acute gout? - ANSWER 0.6mg TID on 1st day OR 1.2mg x 1 - > 0.6mgx1 in 1 hour; on subsequent days, 1-2/day until flare resolution What is required to diagnose Osteoporosis? - ANSWER DXA scan T score of - 2.5 or lower T score of - 1 to - 2.5 PLUS one of the following: 10yr prob. of hip Frx of 3% or more OR 10 yr prob of osteoperosis r/t frx of 20% or more What is the most common fracture seen in Severe Osteoporosis? - ANSWER Hip & Vertebrae
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
Schedule 3 drugs (description) - ANSWER low-mod dependence potential less than class 1&2 but more than 4 Schedule 3 drugs - ANSWER Rx with <90mg of codeine(Tylenol and codeine) Ketamine Anabolic steroids Testosterone Schedule 4 drugs (Description) - ANSWER low dependence & abuse potential Schedule 4 drugs - ANSWER Xanax Ativan Soma Darvocet Valium Tramadol An 82 year old male visits the clinic complaining that his pain medications "take forever" to work after he takes his pill. What are possible reasons you can explain to him? A. Perhaps we need to increase your dosage. 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 slow 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 slow absorption. Distribution of medication can be affected in the elderly in what ways? A. Decreased hormones B. Increased body fat C. Decreased lean mass D. Decreased albumin - ANSWER B. Increased body fat C. Decreased lean mass D. Decreased albumin When prescribing medications, we must understand that liver function declines with age due to what cause? A. Enlarged liver B. Decreased blood flow to liver C. Increased activity of the hepatic enzymes - ANSWER B. Decreased blood flow to liver
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
severe thrombocytopenia or uncontrollable bleeding lumbar puncture regional anesthesia eye, brain, or spinal surgery, CAUTION: hemophilia, increased capillary permeability, dissecting aneurysm, GA ulcers, hypertension, women anticipating abortion What patient population needs a lower dose of warfarin? - ANSWER Elderly, renal, and hepatic What BP medications are okay to use during pregnancy? - ANSWER Labetalol, nifedipine Statins can have potentiating AE from which inhibitor? - ANSWER 3A4: Can increase levels of lovastatin and simvastatin Furosemide can have a drug-drug interaction with what medications? - ANSWER Digoxin-increases risk of toxicity and dysrhythmias Gentamycin- ototoxicity What are some medications for treatment of angina? - ANSWER Nitrates-decrease O demand and dilating veins->decreased preload Beta-blockers decrease O2 demand by decreasing HR and contractility CCB- arterial dilation (decreased afterload) decreases HR and contractility Ranolazine- POSSIBILY by helping myocardium generate energy more efficiently Contraindications for ranolazine? - ANSWER Existing QT prolongation or taking Rx that increase QT. Hepatic impairment or 3A4 inhibition A 41 year old patient comes into the clinic complaining of increased heart rate after starting Nitro patches for stable angina. What would an appropriate response be? A. Lets lower the dose and frequency of use B. I will prescribe a beta blocker to help with this C. Next time this happens, lie down and practice deep breathing, this will bring your heart rate down. - ANSWER B. I will prescribe a beta blocker to help with this Role of aldosterone? - ANSWER Retention of Na and excretion of K and H leading to increased volume. Promotes remodeling and fibrosis through SNS activation and decreasing uptake of NE
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
Complications of untreated gout? - ANSWER Erosion Irreversible joint dmg Renal dmg topn Allopurinol can cause what condition when taken long-term? - ANSWER Hypersensitivity syndrome- rash fever eosinophellia, liver & kidney fxn SCAR Pt Education of Alendronate? - ANSWER Swallow tab whole with glass of H2O, Remain upright for at least 30-60 min Take on empty stomach Take in AM before anything else is consumed Denosumab adverse effects? - ANSWER Hypocalcemia infxns skin reactions osteonecrosis of jaw Match the med with the appropriate description: Ibandronate Alendronate Raloxifene A. 1st-line treatment of Osteoporosis B. Do not take with calcium, magnesium, or iron C. DVT, PE, and risk of stroke - ANSWER Ibandronate- B Alendronate- A Raloxifene- C Baseline data for ALL DMARDS? - ANSWER Complete Hx and physical Baseline diagnostics for ALL DMARDS? - ANSWER CBC with diff WBC sxs of infxn assess for TB, hepatitis, malignancies, PG, ALT, AST, and serum Creat. DMARDS Pt Teaching - ANSWER Risk for infxn
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)