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NUR 635 PHARM FINAL EXAM 202 5 | NUR 635
PRINCIPLES OF PHARM FINAL EXAM 202 5 / WITH
CORRECT DETAILED ANSWERS/ALREADY GRADED A+
While rational drug selection is based on the individual patient the aspect of rational drug selection addressing disease-specific informationby a national medical or nursing organization is
A. a guideline.
B. cost.
C. availability.
D. patient hepatic and renal function.
- ANSWER- A. a guideline Drugs that alter synaptic transmission are much more selective than those that alter axonal conduction, why is this?
- ANSWER- a drug thataffects the axonal conduction - non-selective effect. Drugs that alter synaptic transmission - very selective because of the differences in synapses and their specific neurotransmitters What is phenytoin used for?
- ANSWER- Seizures What should you monitor for with phenytoin?
- ANSWER- Delayedhypersensitivity - even 1 month later What is carbamazepine used for?
- ANSWER- Seizures What may cause carbamazepine levels to drop despite no other change?What to do? - ANSWER- Autometabolization of drug. Increase dose. What is the black box warning for carbamazepine?
- ANSWER- Steven-Johnson Syndrome & TENS Monitoring for carbamazepine, and how often?
- ANSWER- CBC, 3 - 4 times a year What population is most at risk for Steven-Johnson syndrome & TENSwhen taking carbamazepine?
- ANSWER- Asian patients Main class of medication for depression?
- ANSWER- Selectiveserotonin reuptake inhibitors (SSRIs) What to watch for with SSRIs? - ANSWER- Other medications that cancause serotonin syndrome What is lamictal used for?
- ANSWER- Seizures Patient on lamictal has fever, rash, swollen lymph nodes. What are we concerned for?
- ANSWER- Hypersensitivity in lamictal can lead to MODS
What do medications need in order to be effective:
- ANSWER-Albumin (binding to) If a patient has a toxic drug level, but normal albumin, what could be happening?
- ANSWER- Other drugs competing for albumin What does "Sig" mean on a prescription?
- ANSWER- Directions topharmacist What items are necessary on a prescription?
- ANSWER- Drug, dose,route, frequency, quantity, refills Abbreviations to not use - ANSWER- QD What drug may cause grey teeth? - ANSWER- Tetracyclines Pt reports no improvement in seizures after treatment for a few weeks.What next - ANSWER- Assess drug levels for therapeutic index If patient on phenytoin wants birth control?
- ANSWER- Not oralcontraceptives! IUD better Patient on teratogen med wants to get pregnant. When should they stop?
- ANSWER- Before getting pregnant, beware first trimester
Pregnant pt has been taking daily aspirin. Concern for what? - ANSWER- Premature close of PFO Pain treatment for shingles? - ANSWER- Lidocaine after lesions heal How does reglan help with GERD? - ANSWER- Increases esophagealtone Who should not take calcium carbonate antacids? - ANSWER- Pt withkidney stones Pt on minocycline with HA. Pt has what? - ANSWER- PseudotumorCerebri Why do we rotate off phentermine? - ANSWER- Pt will developtolerance Education on flagyl? - ANSWER- Avoid alcohol - severe reaction What is minocycline? - ANSWER- Tetracycline for acne Minocycline can be given safely to? - ANSWER- Adolescents (nopregnancy or liver fx) New dx of GERD. First therapy? How often? - ANSWER- H2 blocker - BID Paxil side effects to educate? - ANSWER- Sexual dysfunction, canresolve on its own What medication for pregnant UTI? - ANSWER- Amoxicillin Theophylline, NV/HA after starting. What do? - ANSWER- See if itresolves in a couple of days
Why should older patients take 2nd gen antihistamines rather than 1st? - ANSWER- CNS effects & urinary retention Genital herpes outbreak, what med? - ANSWER- Acyclovir UTI, med, how long? - ANSWER- Bactrim, 3 days MRSA skin infection. What med? - ANSWER- Bactrim Patient has pheochromocytoma. What med to avoid? - ANSWER- Albuterol - hypertensive crisis How to taper medication? - ANSWER- Decrease by 50% every 3 - 4 days What is methylnaltrexone? - ANSWER- Treats opioid associatedconstipation SSRI, wants something for weight loss. Why not phentermine? - ANSWER- Serotonin syndrome Sprained ankle with soft tissue swelling, what med? - ANSWER-NSAID Neuropathic pain, med? - ANSWER- Gabapentin
Adverse drug reaction of haldol? - ANSWER- Extrapyramidalsymptoms. When to take dimenhydrinate? - ANSWER- 15 min prior to trip Antifungal therapy long term puts you at risk for? - ANSWER- livertoxicity Giving pt eye drops, education? - ANSWER- don't wear contacts, wash hands in between handling Who should avoid ophthalmic beta blockers? - ANSWER- Pts on betablockers What bronchodilator is safe on beta blocker? - ANSWER- Ipratropium How to antacids work? - ANSWER- increases our pH Lithium education? - ANSWER- sodium can influence your lithiumlevels. So intake should be consistent. PPIs long term, monitor for?
- ANSWER- Osteoporosis, check calcium.Anemia. Antibiotic education
- ANSWER- Finish course of therapy. Drink lotsof water. How quickly should you see improvement in pneumonia withantibiotics?
- ANSWER- 48 - 72 hours Long term lactulose for constipation, what do you monitor? - ANSWER- Potassium and chloride
New onset of mild-mod anxiety, first treatment? - ANSWER- buspar Levaquin blackbox warning - ANSWER- tendon rupture Decongestant to older patients, what route? - ANSWER- Nasal, no systemic side effects Child with acute otitis media, how to treat pain? - ANSWER- Lidocaineeardrops Azithromycin - how to dose? - ANSWER- Titrating z pack Otitis externa, how to treat? - ANSWER- Cipro and hydrocortisone drop Contraindications to antibiotic ear drops? - ANSWER- Ruptured tympanic membrane Pt with acute otitis media with conjunctivitis? - ANSWER- High dose amoxicillin Why do we worry about st johns wort? - ANSWER- Interacts with many medications, accelerates metabolism of drugs Why does topamax help you lose weight? - ANSWER- Gives sensationof fullness Severe alcoholic with bad withdrawal? - ANSWER- Thiamine andbanana bag.
Pt malnourished, infected mouth, sores. Suspect? - ANSWER- Scurvy Pt has flushing, what could they be taking? - ANSWER- May be takingniacin How to treat elevated ammonia? - ANSWER- Lactulose Biggest side effect of hydrocodone - constipation, how to treat? - ANSWER- Senna, docusate, miralax Step 1 management of asthma? - ANSWER- short acting alpha 2 Guaifenesin - how does it work? - ANSWER- thins secretions, easier tocough up How to treat afrin overuse? - ANSWER- Nasal steroids while weaning Alendronate education? - ANSWER- 30 min before meal, lots of water Increase pain with paget's disease, what treatment? - ANSWER- Calcitonin salmon What is paget's disease? - ANSWER- Abnormal bone reabsorption More than 3 gout flare ups in past year? - ANSWER- Allopurinol What is probenecid used for? - ANSWER- Chronic gout New diagnosis of rheumatoid arthritis, what med? - ANSWER- Methotrexate
Why do we not treat onychomycosis? - ANSWER- Liver toxic Community acquired with comorbidities - outpatient? - ANSWER-Rocephin + azithromycin How to treat PUD peptic ulcer disease? - ANSWER- PPI +clarithromycin + amoxicillin Mild intermittent asthma - ANSWER- SABA 1st step of asthma - ANSWER- albuterol 2nd step of asthma - ANSWER- give SABAs How do you know you need to bump up asthma tier plan? - ANSWER-Rescue inhaler more than 2x week or more than 1x day. Why should a pt never run out of paxil? - ANSWER- Short half life.Will withdraw really quick Pt with new onset depression. What to check first? - ANSWER- Checkthyroid labs The amino acid found in dairy products, Fish and eggs is tyrosine. The amino acid from which tyrosine is made is: - ANSWER- Phenylalanine
If a 100-mg drug is administered and has a half-life of 6 hours, the percentage of the drug that will be in the system 18 hours later is: - ANSWER- 12.5% The intention of pharmacologic blockade of synaptic nicotinic acetylcholine receptor at the neuromuscular junction is often used to: - ANSWER- Paralyze muscles in the patient who is intubated Which of the following is considered an inhibitory neurotransmitter? - ANSWER- Glycine Activation of alpha-1 receptors does NOT: - ANSWER- inhibit insulinrelease Which of the following enzymes does NOT affect the first-pass effect ofan orally administered drug? - ANSWER- salivary enzymes Fick's Law of Diffusion describes drug mobility as the: - ANSWER- passive diffusion of non-ionized drugs down a concentration gradientfrom an area of high concentration to low concentration The process whereby a drug's activity is altered in order to prepare it for excretion is known as: - ANSWER- biotransformation Distribution of a drug is determined by the: - ANSWER- reversibletransfer of drug from one location to amount of drug entering circulation. The primary site of drug metabolism is the: - ANSWER- liver
To elicit an effective bioavailability response, drugs with a high affinityfor a receptor site need to be delivered: - ANSWER- In lower doses The ion that is most critical in the release of the neurotransmitter fromthe presynaptic neuron is: - ANSWER- Calcium Therapeutic indices of a drug should be determined from a serum sample obtained during: - ANSWER- At steady state of the drug Pharmacodynamic interactions that occur when two drugs act on distinct receptors is known as: - ANSWER- heterodynamic competitors Neurotransmitters are considered: - ANSWER- chemical substances After a drug is metabolized by the liver and enters the bile, it is mostlikely to be: - ANSWER- fecally excreted The relationship between an effect of a drug and the amount of druggiven is known as: - ANSWER- dose-response curve In preparation for an action potential, synthesis of the transmitter occurs during the: - ANSWER- presynaptic preparation
- ANSWER- decreasing the amount of drug that is actually increasing the amount of drug that is absorbed delivered into general circulation after passing through the gastrointestinal system prior to through the gastrointestinal system and the liver The protein-bound part of a drug is: - ANSWER- Inactive and acts as areservoir A chemical synapse differs from an electrical synapse in that the signal transmission: - ANSWER- requires a neurotransmitter
In the pharmacokinetics of a drug, the rate of metabolism: - ANSWER-varies widely among patients The process by which cells ingest extracellular fluid and its contents, including protein-bound medications, is known as: - ANSWER- pinocytosis Drugs that accumulate in tissues: - ANSWER- keep blood levels of drugfrom decreasing rapidly The translocation of a drug from one side of the biological barrier to another is NOT completed through the process of: - ANSWER- laxation The most common method by which drugs are chemically altered withinthe liver is: - ANSWER- oxidation Which of the following is NOT included in the neuron structure? - ANSWER- Riboflavin The term that describes the movement of a drug among parts of the bodyis: - ANSWER- distribution Pharmacokinetics is:
- ANSWER- The effect the body has on the drug The correct sequence of the movement of a drug through the body is: - ANSWER- absorption, distribution, metabolism, excretion When one drug displaces another drug from the binding sites on proteins, causing an increase in the amount of "free" drug, this is knownas: - ANSWER-
Which of the following actions triggers a rise in membrane or action potential of a cell? - ANSWER- Opening of the voltage gated sodiumions The process by which the body breaks down and converts a medicationinto active chemical substances is known as: - ANSWER- metabolism The ratio of minimum effective concentration (MEC) to minimum toxic concentration (MTC) of a drug is the: - ANSWER- therapeutic window The scientific study of origin, composition, mode of action, therapeuticuse and toxicology is known as: - ANSWER- pharmacology Which of the following is a neurotransmitter within the parasympathetic nervous system? - ANSWER- acetylcholine When two medications are taken at the same time, causing them tochelate, this is known as a(n): - ANSWER- absorption interaction The term NOT associated with the pharmacokinetics of a drug is: - ANSWER- Pharmacodynamics Electrical synapse differs from chemical synapse in that signaltransmission - ANSWER- can occur in both directions
The intentional pharmacologic blockade of synaptic nicotinic acetylcholine receptor at the neuromuscular junction is often used to: - ANSWER- Paralyze muscles in a patient who is intubated
