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NU 578 LATEST EXAM WITH
DETAILED QUESTIONS AND
VERIFIED ANSWERS
Question-succinylcholine - answer-only depolarizing nm blocker in clinical use Question-dantrolene - answer-treats malignant hyperthermia What test is used to diagnose hyperthyroidism? - answer-tsh. Small drops in t3 & t4 cause big increases in tsh Question-what happens when t3 & t4 fall? - answer-tsh increases Muscarinic agonists - answer-parasympathomimetic agents Question-muscarinic antagonists - answer-completely block actions of acetylcholine at muscarinic receptors Question-cholinesterase inhibitor - answer-enhance cholinergic action Question-cholinergic crisis - answer-sludge (salivation, lacrimation, urination, diaphoresis, gi, emesis) Question-neuromuscular blocking agents - answer-prevent acetylcholine from activating nicotinic receptors Question-how do you diagnose primary hypothyroidism? - answer-high tsh levels Question-what is the difference between primary and secondary hypothyroidism? - answer- normal or low-normal tsh levels + low t3 & t4 levels. Primary has high tsh levels.
Question-benefits of levothyroxine + liothyronine (t3) vs levothyroxine alone? - answer-none. Both work equally well. Question-when should pregnant women initially be screened for hypothyroidism? - answer-as soon as pregnancy is confirmed. Begin levothyroxine immediately Question-when can you expect to have to increase the levothyroxine dose during pregnancy? - answer-between weeks 4-8. Level off by week 16 and stays steady. Question-what is a strategy for managing t4 dose during pregnancy? - answer-empirically increase by 30% as soon as pregnancy is confirmed. Question-what causes creatinism in newborns? - answer-failure of thyroid to develop = congenital hypothyroidism. Question-5 week old comes in with large, tongue, potbelly, dwarfish looking. What is long term prognosis? - answer-hypothyroidism. Cretinism. Permanent mental retardation but no physical impairment. Question-how do you differentiate between transient & permanent hypothryoidism in infants? - answer-treat for 3 years then stop for 4 weeks. If tsh increases = permanent hypothyroidism = continue treatment. Question-#1 cause of hyperthyroidism - answer-graves' disease Question-preferred treatment for adults with hyperthyroidism? - answer-radioactive iodine Question-what is the treatment of choice in young patients with hyperthyroidism? - answer- methimazole or ptu
Question-ptu dose? - answer- 100 - 300 mg 3 times/day to start. Then switch to maintenance of 50 mg 3 times per day. Question-radioactive iodine - answer-hyperthyroidism: destroy thyroid tissue without causing complete gland destruction Question-who can't use radioactive iodine? - answer-patients younger than 30 - cancer, pregnant, breastfeeding Question-lugol's solution - answer-decreases iodine uptake by the thyroid, blocks thyroid hormone production, blocks release of thyroid hormone into blood Question-what is iodism? - answer-brassy taste, burning in mouth, sore teeth & gums, frontal ha, coryza. Fades when you stop iodine. Question-signs of lugol's od? - answer-swollen glottis and asyphxia. Give sodium thiosulfate Lavage to remove iodine Question-lugol's dose for hyperthyroidism? - answer- 2 - 6 drops 3 times per day for 10 days Mix with juice to kill bad taste Combined with ptu as a prep for thyroidectomy Started 10 days before surgery Question-lugol's dose for thyroid storm? - answer- 5 - 8 drops every 6 hours Question-propranolol for graves' disease? - answer- 80 - 120 mg po every 6 hours 2 - 4 mg iv every 4 hours
Question-pediatric levothyroxine dose - answer-< 3 monts old: 10-15 mcg/kg/d 3 - 6 months old: 8-10 mcg/kg/d 6 - 12 months old: 6-8 mcg/kg/d 1 - 5 years old: 5-6 mcg/kg/d 5 - 12 years old: 4-5 mcg/kg/d Question-average levothyroxine (t4) dose in adults: - answer-1.6 mcg/kg/do < 50: full replacement dose: 100-125 mcg/d
50: start at 25-50 mcg/d 50 with heart disease: start at 12.5-25 mcg/d Question-mydexema coma - answer-levothyroid 200-500 mcg iv. Can repeat in 24 hours at 100- 300 mcg. Question-drugs that reduce levothyroxine absorption? - answer-• h2 blockers
- prevacid
- malox, mylanta
- tums, os-cal
- iron supplements
- magnesium salts
- xenical Question-how should levothyroxine be taken with drugs that delay its absorption? - answer-wait 4 hours Question-how do you adjust levothyroxine if taking drugs that speed up its metabolism? - answer-may need to increase levothyroxine dose Question-drugs that speed up levothyroxine metabolism? - answer-• phenytoin
Question-ponv dose for aprepitant? - answer-40 mg po within 3 hours of anesthesia Question-what do you need to teach women taking apripitant? - answer-ocps won't work. Need another method. Question-what is the warfarin risk with apripitant? - answer-warfarin is less effective. Monitor bleeding times. Question-what good is lorazepam in vomiting? - answer-reduces anticipatory emesis. Question-how do phenothizaines prevent nv? - answer-block dopamine 2 receptors Question-what are the butyrophenones anti emetics? - answer-haldol & droperidol. Question-how does reglan block emesis? - answer-blocks dopamine receptors in ctz Question-what 2 cannabinoids suppress cinv? - answer-• dronabinol miranol & nabilone cesamet Question-which cannabinoid has the lowest stree value? - answer-dronabinol. Does not get you high & slow onset. Question-dronabinol dose? - answer-5 mg q 4-6 hours Question-nabilone dose? - answer- 1 - 2 mg twice a day Question-what are the 3 types of cinv? - answer-anticipitory, acute, delayed Question-what is the worst form of cinv? - answer-delayed. Cisplatin causes emesis 24-48 hours later and lasts 7 dyas.
Question-antiemetic regimen for low risk chemotherapy drugs? - answer-1 drug: dexamethasone Question-high chemo drug antiemetic regimen? - answer-aprepitant + dexamethasone + ondasterone or palonosetron. Lorazepam for anticipitory. Question-why should pregnant women take unisom & b6? - answer-antiemetic of choice. Question-why can't a pregnant woman take methylprednisolone for emesis before 10 weeks gestation? - answer-cleft lip. Schedule i - answer-drugs in this schedule have no accepted medical use in the united states and have a high abuse potential. Examples are heroin, marijuana, lsd, peyote, etc. Question-schedule ii - answer-drugs in this schedule have a high abuse potential with severe psychic or physical dependence liability. Included are certain narcotic analgesics, stimulants, and depressant drugs. Examples are opium, morphine, codeine, hydromorphone, methadone, meperidine, oxycodone, anileridine, cocaine, amphetamine, methamphetamine, phenmetrazine, methylphenidate, amobarbital, pentobarbital, secobarbital, methaqualone, and phencyclidine. Question-schedule iii - answer-drugs in this schedule have an abuse potential less than those in schedules i and ii and include compounds containing limited quantities of certain narcotic analgesic drugs, and other drugs such as barbiturates, glutethimide, methyprylon, and chlorphentemine. Any suppository dosage form containing amobarbital, secobarbital, or pentobarbital is in this schedule.
Question-protein (albumin) binding - answer-prevents bound drug molecules from leaving the bloodstream Prolongs the distribution phase (increases half-life) Question-alpha-1 acid glycoprotein - answer-binds basic drugs Question-reservoir effect - answer- Question-blood-brain barrier (bbb) - answer-no intercellular pores between brain capillary endothelial membranes due to the presence of tight junctions between cells Question-to gain access to the brain from the capillaries, drugs must - answer-1) diffuse across cells (lipid-soluble, Nonionized form) Or
- or be actively transported by a carrier Question-placental barrier - answer-transfer of drugs is relatively slow with the Equilibration time between maternal blood and fetal tissues estimated at about 15 minutes for some drugs and almost an hour for other drugs. (virtually every drug used for therapeutic purposes can and does cross the placenta.) Question-drugs cross the placenta by - answer-diffusion (lipid-soluble, nonionized drugs Penetrate most rapidly.) Question-pharmacokinetic factors
Affecting distribution - answer-- competition for protein binding sites
- alteration of extracellular ph Question-metabolism - answer-chemical alteration of drug structure Question-metabolism - answer-usually produces a polar, water-soluble substance which is more easily excreted from the body. Question-lipid-soluble drugs - answer-not easily eliminated by the body's excretory mechanisms Question-sites of drug metabolism - answer-- liver (smooth er and hepatocytes)
- gut wall and mucosal surface
- plasma Question-phase i (nonsynthetic) metabolic reactions - answer-oxidation by the cytochrome p system which is a family of drug-metabolizing enzymes in the liver. Question-cytochrome p450 system (hepatic microsomal enzyme system) - answer-the major function of this enzyme system is to add an oxygen atom to the drug substrate. Drug + o2 --------> drug-oh Question-enzymes in the p450 system that metabilize drugs - answer-cyp1, cyp2, cyp Question-consequences of drug metabolism - answer-accelerated renal drug excretion Drug inactivation Increased therapeutic action Activation of prodrugs
(effects persist up to 3 days after last glass of juice!) Question-drugs affected by grapefruit juice - answer-- statins
- antihistamines
- calcium channel blockers
- psychiatric drugs
- immunosuppressants
- methadone
- viagra
- saquinavir (invirase)
- amiodarone (cordarone)
- caffeine Question-empty stomach - answer-administer at least 1 hour before or 2 hours after a meal Question-excretion - answer-removal of a drug from the body Question-glomerular filtration - answer-drugs are moved from blood into tubular urine Question-passive tubular reabsorption - answer-drugs that are lipid-soluble undergo passive reabsorption from the tubule back into the blood Question-active tubular secretion. - answer-large, charged drug molecules Added to the urine for excretion from the Body. Question-non-renal routes of excretion - answer-breast milk, bile, lungs, sweat, saliva
Question-factors that affect renal drug excretion - answer-ph-dependent ionization Competition for active tubular transport Age Question-p-glycoprotein - answer-transmembrane protein that transports drugs out of cells Pumps drugs out of organs for elimination and excretion Question-p-glycoprotein induction - answer-decreased absorption, fetal drug exposure, & brain/cns drug exposure Increased drug elimination Question-drugs to avoid in pregnancy - answer-- antiseizure drugs
- nitrofurantoin, sulfonamides, tetracyclines
- acei, arbs
- lithium
- nsaids
- warfarin
- oral hypoglycemics
- ptu, methimazole Question-pregnancy category a - answer-studies have shown no risk in first trimester, no evidence of risk in later trimesters Question-pregnancy category b - answer-animal studies have shown risk but human studies have no demonstrated risk in first trimester, no risk in later trimesters Question-pregnancy category c - answer-no studies have been done in women or animals
Receptor with be occupied by whichever molecule is in highest concentration Question-partial agonist - answer-a drug that binds to a receptor and causes a response that is less than that caused by a full agonist Can act as an agonist and an antagonist Question-therapeutic index - answer-ratio of ld50 to ed The higher the therapeutic index, the safer the drug Ld50 = dose that is lethal to 50% of population Ed50 = dose that produces therapeutic effect in 50% of population Question-pharmacogenomics - answer-the study of how genetic variations affect Individual responses to drugs Question-autonomic nervous system - answer-controls cardiac & smooth muscles, & glandular Secretion Question-sympathetic: - answer-"fight-or-flight" Regulates cardiovascular system Temperature Question-parasympathetic: - answer-"rest & digest" Slows hr Increased gastric secretion
Empty bladder & bowel Focus eyes Constrict pupils Contract bronchial smooth muscle Question-peripheral nervous system neurotransmitters - answer-acetylcholine, norepinephrine, epinephrine Question-cholinergic receptors - answer-receptors that mediate responses to acetylcholine Question-adrenergic receptors - answer-receptor sites for the sympathetic neurotransmitters norepinephrine and epinephrine Question-types of cholinergic receptors - answer-nicotinic and muscarinic Question-types of adrenergic receptors - answer-alpha 1, alpha 2, beta 1, beta 2 Question-αlpha 1 - answer-vasoconstriction ↓secretions Pupil dilation ↓gi motility Urinary retention Question-alpha 1 agonists uses - answer-vasoconstriction: Nasal decongestion Adjunct to anesthesia Increase bp Mydriasis:
Vasodilation Question-beta 2 agonist uses - answer-asthma Delay of preterm labor Question-adverse effects of beta 2 agonist - answer-hyperglycemia, tremor Question-dopamine - answer-increased hr Increased bp Question-treatment of anaphylaxis - answer-epinephrine! Activates alpha1, beta1 & beta 2 Vasoconstriction increases bp, reduces glottis edema Question-epinephrine - answer-vasoconstriction Bronchodilation, ↑ hr, ↑ glucose, ↑ lipolysis, Gi relaxation
- cardiac stimulant,
- anaphylaxis,
- combined w/local anesthetics Question-norepinephrine (levophed) - answer-↑ vasoconstriction so intense it causes a reflex ↓hr
Used for septic shock Question-dopamine (intropin) - answer-acts on dopamine --> beta1 --> and alpha1 (dose dependent receptor specificity) Low doses maintain good Renal blood flow, Higher doses increase bp ↑ cardiac contractility Used for shock Question-dobutamine (dobutrex) - answer-works on beta 1 receptors ↑hr, contractility Used for cardiac stimulation in hf Question-isoproterenol - answer-beta-selective adrenergic agonist Used for av heart block, cardiac arrest Question-phenylephrine (neosynephrine) - answer-works on alpha 1 receptors Vasoconstriction Used in cold meds Elevates bp Also used to dilate pupil
