PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED, Exams of Nursing

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PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS What is the most common reason for treatment failure in epilepsy - CORRECT ANSWERS Nonadherence Are Anticonvulsants ok to use during pregnancy - CORRECT ANSWERS NO What additional supplementation do women of childbearing age need when they are using anticonvulsant drugs - CORRECT ANSWERS 0.4 folic acid daily and during pregnancy Are anticonvulsants safe for lactation - CORRECT ANSWERS No; discontinue or stop breastfeeding What are the guidelines for discontinuing ADEs - CORRECT ANSWERS - Normal neurological exam and EEG - Seizure free for 2-4 years - Onset of seizure after age 2 before age 35 - Withdrawal should be done gradually * Relapse between 10-70% What are some of the theories behind migraines - CORRECT ANSWERS - Neurovascular mechanism: dysfunctions in neuronal and sensory processing - Triggers release of vasoactive neuropeptides - Dopamine stimulation What is the first line treatment for a mild to moderate migraine attack - CORRECT ANSWERS Combination acetaminophen + aspirin + caffeine (most consistent efficacy) What is your first line treatments for migraines when non-specific drugs are ineffective - CORRECT ANSWERS - Abortive Agents (Triptans drug class) - Serotonin Receptor Agonists MOA of triptans - CORRECT ANSWERS Stimulate serotonergic receptors that cause vasoconstriction and reduce swelling PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS What are some of the contraindications for Triptan Migraine Treatment? (* MOA - Vasoconstriction) - CORRECT ANSWERS - CV disease (Ischemic heart disease, Uncontrolled HTN, Stroke/TIA/PAD) - Ischemic bowel - Severe hepatic impairment - Hemiplegic and basilar migraine ADE for Triptans - CORRECT ANSWERS Mild - paresthesia, fatigue, somnolence, dizziness, flushing, nausea, dry mouth, chest tightness/pressure Serious - chest pain, coronary artery vasospasm, MI, arrythmia (VT, Vfib), TIA, seizure, HTN emergency) What are the Atypical Antidepressants? - CORRECT ANSWERS Bupropion (Wellbutrin), Mirtazapine (Remeron), and Trazodone What is the patho of Parkinsonism? - CORRECT ANSWERS imbalance between excitatory cholinergic neurons and greatly diminished numbers of inhibitory dopaminergic neurons What is the pharmacological goal for Parkinson's disease? - CORRECT ANSWERS to restore dopamine in the basal ganglia and antagonizing the excitatory effect of acetylcholine at the muscarinic receptors Which of these symptoms are improved with Anticholinergic (antimuscarinic) Agents in Parkinson's? - Tremor - Bradykinesia - Rigidity - CORRECT ANSWERS Tremor and Rigidity How do anticholinergics work? - CORRECT ANSWERS Block ACh from binding to receptor sites. What disease can Cogentin (benztropine) precipitate - CORRECT ANSWERS Narrow-angle glaucoma What are the cautions for Benztropine (cogentin) - CORRECT ANSWERS in elderly, BPH, urinary retention, liver, renal or GI or GU disease PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS 2) formation of numerous neurofibrillary tangles 3) loss of cortical neurons—particularly cholinergic neurons What is the aim of pharmacological therapy in Alzheimers - CORRECT ANSWERS • improving cholinergic transmission w/i the CNS OR • preventing excitotoxic actions resulting from over stimulation of NMDA-glutamate receptors What stage of Alzheimer's do you use Memantine (Namenda) - CORRECT ANSWERS Moderate to severe; NOT used in early stage Cholinesterase inhibitors MOA - CORRECT ANSWERS Block enzyme that degrades acetylcholine → results in more acetylcholine at the synaptic cleft → enhances cholinergic transmission What are the effects of a Cholinesterase Inhibitor - CORRECT ANSWERS • Diminishes s/s of dementia • Improves function and mildly slows progression of symptoms (not progression of disease) What is the indication to start a patient on a cholinesterase inhibitors - CORRECT ANSWERS Management of mild-moderate Alzheimer's dementia What are the recommend cholinesterase inhibitors for AD - CORRECT ANSWERS • Donepezil (Aricept), Rivastigmine (Exelon PO & transdermal patch), Galantamine (Razadyne) - indicated in mild to moderate • Donepezil also indicated in severe disease what fraction of patient's see results when taking a Cholinesterase inhibitors - CORRECT ANSWERS 1/3 = modest improvement in cognitive testing scores, function and behavior 1/3 = not able to tolerate medication d/t adverse effects What are the most common ADE for Cholinesterase Inhibitors - CORRECT ANSWERS GI upset, anorexia, muscle cramping What is the indication for an NMDA receptor Antagonist - CORRECT ANSWERS Moderate to severe Alzheimer's PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS What is the thinking behind using a NMDA receptor Antagonist for alzheimers (MOA) - CORRECT ANSWERS • Linked to learning and memory • Excessive stimulation leads to excitotoxicity • Glutamate is the major excitatory neurotransmitter • ? potentially neurotoxic in AD What is the only NMDA receptor antagonist? - CORRECT ANSWERS Memantine (Namenda) What is the MOA of Memantine (Namenda)? - CORRECT ANSWERS • Decreases activity of glutamate in synapse • Considered neuroprotective • Prevents the loss of neurons following ischemic and other brain injury What are some of the ADE for Memantine (Namenda) - CORRECT ANSWERS Constipation, Confusion, Dizziness, Headache, HTN *Reduce dose in severe renal impairment How long does a cholinesterase inhibitor stabilize a patient for - CORRECT ANSWERS 1 year What medications should you avoid when treating Alzheimers Dementia - CORRECT ANSWERS sedating or anticholinergic effects Is it ok to abruptly discontinue medications for AD? - CORRECT ANSWERS no, Abrupt discontinuation can lead to worsening cognition and behavior What is the goal of treatment for Epilepsy - CORRECT ANSWERS - complete elimination of seizures w/o ADE - optimal quality of life (QOL) What do you have to consider when prescribing drugs for epilepsy? - CORRECT ANSWERS - Efficacy vs ADE - Renal/Hepatic Disease PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS - Childbearing plans/age Do epilepsy drugs cure seizures - CORRECT ANSWERS NO they only suppress seizures What is the MOA of antiepileptic drugs - CORRECT ANSWERS - Increase the threshold of the CNS to convulsive stimuli or inhibit the spread of seizure activity - Blockade of voltage-gated channels (Na+ or Ca2+) enhancement of inhibitory impulses, or interference with excitatory glutamate transmission How are GABA Analogs metabolized & excreted in the body? - CORRECT ANSWERS NOT metabolized; Excreted in the urine How many drug interactions do GABA Analogs have? - CORRECT ANSWERS Minimal drug interactions MOA of Anticonvulsants (Phenytoin & Fosphenytoin) - CORRECT ANSWERS Prolongs effective refractory period, numerous physiologic effects→ sodium channels Zero order pharmacokinetics in Dilantin - CORRECT ANSWERS Small increase in daily dose - can produce large increase in plasma concentration, resulting in toxicity As you increase the drug, the rate of metabolism DOESNT go up What are the ADE of Phenytoin and Fosphenytoin - CORRECT ANSWERS - Gingival hyperplasia - Impaired cognition - Hirsutism - Vitamin D & Folic Acid deficiency - Osteomalacia - Hypothyroidism - Peripheral neuropathy - Rare: Stevens-Johnson syndrome, Toxic epidermal necrolysis PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS Is it ok to use ergots and triptans concurrently? - CORRECT ANSWERS NO, they must have at least 24 hours between the two drugs How many times can abortive agents be given in a week - CORRECT ANSWERS No more than twice Patient populations considerations with Abortive Agents - CORRECT ANSWERS - Geriatrics (might not be a migraine, consider intracranial lesion) - Children (safety & efficacy are not established) - Ergots are NOT safe in pregnancy What is the MOA of SSRIs - CORRECT ANSWERS block the reuptake of serotonin, leading to increased concentrations of the neurotransmitter What is the difference in Prozac and other SSRIs Halflife - CORRECT ANSWERS - most SSRIs half life of 15-75 hours - Prosac half life of 4-5 days and metabolic half life of 10 days - Can be given once weekly Common ADE for SSRI - CORRECT ANSWERS - Sexual dysfunction - Anxiety or Agitation - Sleep disturbances - Drug-Drug interaction - GI upset What is the Major concern when prescribing a patient SSRIs - CORRECT ANSWERS - SUICIDE - Seizures, Serotonin syndrome when used w/ MAOI or another serotonergic drug What can happen when you discontinue an SSRI - CORRECT ANSWERS - Serotonin-related discontinuation syndrome - headache, malaise, flu like crap, agitation, nervousness, sleep changes What is the black box warning for an SNRI - CORRECT ANSWERS SUICIDE PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS MOA for SNRI - CORRECT ANSWERS - Inhibits serotonin and norepinephrine reuptake * Not recommended in ESRD patients because it is metabolized in the liver Atypical Antidepressant MOA - CORRECT ANSWERS - Bupropion (Wellbutrin) - weak dopamine and norepinephrine reuptake inhibitor - Mirtazapine (Remeron) - enhances serotonin and norepinephrine neurotransmission - Trazodone - weak serotonin reuptake inhibitor Common ADE for Bupropion (Wellbutrin) - CORRECT ANSWERS - Dry mouth - Tremor - Lower seizure threshold - Sexual dysfunction *Relatively low risk of drug interactions Common ADE of Mirtazapine (Remeron) - CORRECT ANSWERS - Does NOT cause the antimuscarinic side effects of TCA or interfere with sexual function - Increased appetite and weight gain Black Box warning for atypical antidepressants - CORRECT ANSWERS SUICIDE MOA for TCA - CORRECT ANSWERS Black norepinephrine and serotonin reuptake into the neuron What are some other uses for TCA besides depression - CORRECT ANSWERS - Panic disorders - Migraine - Chronic or neuropathic pain What does it mean that a TCA is lipophilic - CORRECT ANSWERS That is can penetrate the BBB and into the rest of the CNS What disease class should you not use TCAs with - CORRECT ANSWERS Cardiovascular disease = lethal cardiac arrhythmias (VT, VF) and other serious cardiac effects PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS ADE for TCA - CORRECT ANSWERS Anticholinergic, α-blocking effects orthostatic hypotension, sedation, weight gain, arrhythmias, and seizures in overdose True or False MAOI and SSRIs need to be given together for both drugs to have efficacy? - CORRECT ANSWERS FALSE! - Would cause Serotonin syndrome; must have a wash out period of 2 weeks between the meds Why is the use of MAOI limited - CORRECT ANSWERS Complicated Dietary restrictions Pediactric considerations with antidepressants - CORRECT ANSWERS - TCA use in age 9+ - SSRI use of fluoxetine in age 8+ *BEWARE OF SUICIDE RISK! Benzodiazepine therapeutic uses - CORRECT ANSWERS Reduction of anxiety Anticonvulsant Sedation and hypnotic actions Muscle relaxant Anterograde amnesia What are the drugs of choice in terminating a grand mal epileptic seizure - CORRECT ANSWERS Diazepam and lorazepam Why should you not take benzos and drink alcohol - CORRECT ANSWERS CAN CAUSE DEATH FROM CNS DEPRESSION What is the antidote for benzodiazepines - CORRECT ANSWERS Flumazenil (Romazicon) What is the indication for use of Buspirone (buspar) - CORRECT ANSWERS Generalized Anxiety Disorder (GAD) how long does it take for buspar to work - CORRECT ANSWERS 1-2 weeks PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS What is a broad spectrum antibiotic? - CORRECT ANSWERS - A drug effective against a wide variety of microbial species * Increases risk for superinfections what are some procedures that you would give prophylaxis antibiotics for - CORRECT ANSWERS Joint replacements Guideline driven Mechanical valve and other anomalies Organ transport Immunosuppresion Pre-dental procedures (when they have a mechanical valve) What are some risks of combo antibiotic therapy - CORRECT ANSWERS Cost Polypharmacy = drug interactions Benefits of combo antibiotic therapy - CORRECT ANSWERS May delay emergency of resistance Multiple pathogens Synergy Enhanced drug uptake What is the MIC - CORRECT ANSWERS Minimum inhibitory concentration: smallest concentration of drug that visibly inhibits growth what is concentration-dependent killing - CORRECT ANSWERS - Efficacy increases as concentration increases - Allows for once daily dose to achieve efficacy - Ex. Aminoglycosides, Quinolones What is time dependent killing? - CORRECT ANSWERS -Amount of time the drug is above the MIC is critical for maximal bacterial kill -Beta-lactams act in this manner, macrolides, vancomycin PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS What is the principle behind the post antibiotic effect - CORRECT ANSWERS killing action continues after plasma levels decline → allow greater efficacy w/ single large dose rather than w/ multiple smaller doses What are the ways that a infection can develop resistances to antibiotics - CORRECT ANSWERS - Modification of the target site - Decreased accumulation (either uptake or increased efflux) - Enzymatic inactivation How do beta lactams and Vancomycin work - CORRECT ANSWERS Inhibitors of cell wall synthesis How do tetracyclines, Aminoglycosides, and Macrolides work - CORRECT ANSWERS Inhibit protein synthesis How do fluoroquinoles work - CORRECT ANSWERS Inhibit nucleic acid function or synthesis How do sulfonamides and trimethoprimamples work - CORRECT ANSWERS Inhibit metabolism What are some antibiotics that are ok do use during pregnancy and lactation - CORRECT ANSWERS Cephalosporins, Clindamycin, Erthromycin What are the beta-lactam antibiotics? - CORRECT ANSWERS Penicillin, Cephalosporins, Carbapenems, Monobactams Are beta lactams bactericidal or bacteriostatic? - CORRECT ANSWERS bactericidal How do infections resist the beta-lactams - CORRECT ANSWERS Inactivation of the agent via bacterial enzyme How do infections resist the macrolides - CORRECT ANSWERS active efflux What is a major ADE for beta lactams - CORRECT ANSWERS Hypersensitivity - anaphylacis PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS Why are tetracyclines contraindicated in pregnancy/lactation - CORRECT ANSWERS Binds to calcium and can cause tooth enamel dysplasia and irregularities in bone growth What is the difference between 1st and 2nd generation penicillins - CORRECT ANSWERS - first generation is very narrow spectrum +gram - second has increased activity against gram- How does the spectrum of coverage by penicillins change from generation 1 to generation 4 - CORRECT ANSWERS Goes from mostly gram+ coverage to mostly gram- coverage What antibiotics have cross allergy to the beta-lactams? - CORRECT ANSWERS Cephalosporins What type of gram antibiotics do the 1-4th generations of cephalosporins cover - CORRECT ANSWERS Starts over with good gram+ coverage then swings towards more gram- coverage What makes the 5th generation of cephalosporins different the generations 1-4 - CORRECT ANSWERS Equally covers both gram+ and - What type of infection is vancomycin effective against - CORRECT ANSWERS it is narrow spectrum for GRAM + only How does vancomycin work - CORRECT ANSWERS inhibits cell wall synthesis How do infections resist vancomycin - CORRECT ANSWERS Alteration of the binding site Red man syndrome cause and s/s - CORRECT ANSWERS - Seen with use of Vancomycin (related to rate of infusion) Flushing, Rash, pruritis * Can premedicate with Benadryl - S/S - flushing, rash, and pruritis What can cause a high incidence of Ototoxicity with use of Vancomycin - CORRECT ANSWERS Concomittant use of ototoxic or hephrotoxic drug (Aminoglycoside) PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS Does metronidazole cover aerobic or anaerobic - CORRECT ANSWERS Anaerobic What happens if you drink alcohol and take flagyl - CORRECT ANSWERS You get sick as shit (vomiting) Which antibiotics have good CSF penetration - CORRECT ANSWERS Metronidazole Clinical use for Mupirocin - CORRECT ANSWERS - Impetigo and on some streptococci species - Administer intranasally to eliminate staph carriage states Clinical use for Nitrofurantoin - CORRECT ANSWERS Uncomplicated UTI What are the three ways drugs act on fungi - CORRECT ANSWERS - Alter cell membrane permeability - Block nucleic acid synthesis - Disrupt micro tubule functions Amphotericin B MOA - CORRECT ANSWERS -Binds ergosterol (unique to fungi); forms membrane pores that allow leakage of electrolytes. -Amphotericin "tears" holes in the fungal membrane by forming pores What is the toxicity related to Amphotericin B - CORRECT ANSWERS Renal - can prevent with IV hydration MOA of azole antifungals - CORRECT ANSWERS inhibit conversion of lanosterol to ergosterol which causes damaging of cell membrane and increased permeability resulting in cell lysis and death ADE for Azole Antifungales - CORRECT ANSWERS GI Rash QTC prolongation Hepatotoxicity PHARMACOLOGY TEST 3 EXAM QUESTIONS AND ANSWERS 2023/2024 ALL ANSWERS 100% CORRECT VERIFIED BEST GRADED A+ FOR SUCCESS Echinocandins MOA - CORRECT ANSWERS Inhibit cell wall synthesis by inhibiting synthesis of β- glucan. What happens if you drink while taking Griseofulvin - CORRECT ANSWERS YOU GET SICK AS SHIT (increase the effects of alcohol; tachycardia, flushing, increased sweating, or redness of the face) MOA of oseltamivir and zanamivir - CORRECT ANSWERS Inhibit influenza neuraminidase > prevent release of progeny virus What is the time window to administer Anti-influenza drugs - CORRECT ANSWERS 24-72 hours Difference in dose of tamiflu for prevention/ treatment - CORRECT ANSWERS Prevention - 75mg QD x 10 days Treatment - 75mg BID x 5 days What is the contraindication with Zanamivir? - CORRECT ANSWERS Patients with airway disease (ex. asthma)