PHARM WEEK 6. – 9 QUESTIONS WITH COMPLETE
SOLUTIONS
A 60-year-old patient asks the nurse about taking ginkgo to help
with memory. The patient has a history of arthritis, type 2
diabetes, thyroid disease, and hypertension. The patient is
currently taking NSAIDs (for arthritis), a ß-blocker for blood
pressure, oral antidiabetic medications, and thyroid replacement
hormone. What potential adverse effect from gingko would be
of most concern for this patient?
a)Stomach upset
b)Diarrhea
c)Bleeding
d)Drowsiness Correct Answers c)Bleeding: Potential adverse
effects of ginkgo include stomach or intestinal upset, headache,
bleeding, and allergic skin reaction. Potential drug interactions
include aspirin, NSAIDs, anticoagulants, and other drugs.
Ginkgo may interact with the NSAID and cause increased
bleeding.
A patient experiencing bronchospasms after running half a mile
has several inhalers they could use. Which one would be
appropriate for treatment at this time?
A. salbutamol
B. salmeterol xinafoate
C. formoterol fumarate
D. midodrine hydrochloride Correct Answers A. salbutamol
,A patient has two inhalers that are due to be taken at the same
time. One is a bronchodilator, the other is a corticosteroid.
Which inhaler should the patient take first?
a)The bronchodilator
b)The corticosteroid
c)It does not matter which one is taken first. Correct Answers
a)The bronchodilator
A patient is scheduled to have lunch at 1200 hours. The nurse
will administer pyridostigmine (Mestinon®) at what time for
optimal therapeutic effect?
a)1100 hours
b)1130 hours:
c)1200 hours
d)1230 hours Correct Answers b)1130 hours: The drug should
be taken 30 minutes before a meal for maximal therapeutic
effect.
A patient on a dobutamine drip reports that the intravenous line
"hurts." The nurse checks the insertion site and sees that the area
is swollen and cool. What will the nurse do first?
a)Slow the intravenous infusion.
b)Stop the intravenous infusion.
c)Inject the area with phentolamine.
d)Notify the physician health care provider. Correct Answers
b)Stop the intravenous infusion.
,a1 adrenergic receptor Correct Answers Located on
postsynaptic effector cells (the cell, muscle, or organ the nerve
stimulates)
a2 adrenergic receptor Correct Answers o Located on
presynaptic nerve terminals (the nerve that stimulates the
effector cells)
o Control the release of neurotransmitters
ACE Inhibitors : Captopril and lisinopril Correct Answers •
Captopril and lisinopril can be used if a patient has liver
dysfunction, unlike other ACE inhibitors that are prodrugs.
Captopril and lisinopril are not prodrugs.
ACE Inhibitors : Enalapril (Vasotec) Correct Answers • Only
ACE inhibitor available in both oral and parenteral preparations
• enalaprilat intravenous (IV) does not require cardiac
monitoring
• Oral enalapril sodium: prodrug
• Improves patient's chances of survival after an MI
• Reduces the incidence of HF
ACE Inhibitors: Adverse Effects Correct Answers Fatigue
Dizziness
Headache
Mood changes
Impaired taste
Possible hyperkalemia
Dry, nonproductive cough, which reverses when therapy is
stopped
Angioedema: rare but potentially fatal
, Note: First-dose hypotensive effect may occur
ACE Inhibitors: Indications Correct Answers • Hypertension
• HF (drug used either alone or in combination with diuretics or
other drugs)
• Slow progression of left ventricular hypertrophy after
myocardial infarction (MI) (cardioprotective)
• Renal protective effects in patients with diabetes
• Hypertension
• HF (drug used either alone or in combination with diuretics or
other drugs)
ACE Inhibitors: Mechanism of Action Correct Answers -Inhibit
ACE, which is responsible for converting angiotensin I (through
the action of renin) to angiotensin II
-Angiotensin II is a potent vasoconstrictor and causes
aldosterone secretion from the adrenal glands.
-Block ACE, thus preventing the formation of angiotensin II
-Prevent the breakdown of the vasodilating substance bradykinin
-Result in decreased SVR (afterload), vasodilation, and therefore
decreased BP
Adrenergic Blockers Correct Answers • Bind to adrenergic
receptors but inhibit or block stimulation of the sympathetic
nervous system (SNS)
Adrenergic Drug Characteristics Correct Answers Mimic the
effects of SNS neurotransmitters (catecholamines)
- norepinephrine
- epinephrine
- dopamine
SOLUTIONS
A 60-year-old patient asks the nurse about taking ginkgo to help
with memory. The patient has a history of arthritis, type 2
diabetes, thyroid disease, and hypertension. The patient is
currently taking NSAIDs (for arthritis), a ß-blocker for blood
pressure, oral antidiabetic medications, and thyroid replacement
hormone. What potential adverse effect from gingko would be
of most concern for this patient?
a)Stomach upset
b)Diarrhea
c)Bleeding
d)Drowsiness Correct Answers c)Bleeding: Potential adverse
effects of ginkgo include stomach or intestinal upset, headache,
bleeding, and allergic skin reaction. Potential drug interactions
include aspirin, NSAIDs, anticoagulants, and other drugs.
Ginkgo may interact with the NSAID and cause increased
bleeding.
A patient experiencing bronchospasms after running half a mile
has several inhalers they could use. Which one would be
appropriate for treatment at this time?
A. salbutamol
B. salmeterol xinafoate
C. formoterol fumarate
D. midodrine hydrochloride Correct Answers A. salbutamol
,A patient has two inhalers that are due to be taken at the same
time. One is a bronchodilator, the other is a corticosteroid.
Which inhaler should the patient take first?
a)The bronchodilator
b)The corticosteroid
c)It does not matter which one is taken first. Correct Answers
a)The bronchodilator
A patient is scheduled to have lunch at 1200 hours. The nurse
will administer pyridostigmine (Mestinon®) at what time for
optimal therapeutic effect?
a)1100 hours
b)1130 hours:
c)1200 hours
d)1230 hours Correct Answers b)1130 hours: The drug should
be taken 30 minutes before a meal for maximal therapeutic
effect.
A patient on a dobutamine drip reports that the intravenous line
"hurts." The nurse checks the insertion site and sees that the area
is swollen and cool. What will the nurse do first?
a)Slow the intravenous infusion.
b)Stop the intravenous infusion.
c)Inject the area with phentolamine.
d)Notify the physician health care provider. Correct Answers
b)Stop the intravenous infusion.
,a1 adrenergic receptor Correct Answers Located on
postsynaptic effector cells (the cell, muscle, or organ the nerve
stimulates)
a2 adrenergic receptor Correct Answers o Located on
presynaptic nerve terminals (the nerve that stimulates the
effector cells)
o Control the release of neurotransmitters
ACE Inhibitors : Captopril and lisinopril Correct Answers •
Captopril and lisinopril can be used if a patient has liver
dysfunction, unlike other ACE inhibitors that are prodrugs.
Captopril and lisinopril are not prodrugs.
ACE Inhibitors : Enalapril (Vasotec) Correct Answers • Only
ACE inhibitor available in both oral and parenteral preparations
• enalaprilat intravenous (IV) does not require cardiac
monitoring
• Oral enalapril sodium: prodrug
• Improves patient's chances of survival after an MI
• Reduces the incidence of HF
ACE Inhibitors: Adverse Effects Correct Answers Fatigue
Dizziness
Headache
Mood changes
Impaired taste
Possible hyperkalemia
Dry, nonproductive cough, which reverses when therapy is
stopped
Angioedema: rare but potentially fatal
, Note: First-dose hypotensive effect may occur
ACE Inhibitors: Indications Correct Answers • Hypertension
• HF (drug used either alone or in combination with diuretics or
other drugs)
• Slow progression of left ventricular hypertrophy after
myocardial infarction (MI) (cardioprotective)
• Renal protective effects in patients with diabetes
• Hypertension
• HF (drug used either alone or in combination with diuretics or
other drugs)
ACE Inhibitors: Mechanism of Action Correct Answers -Inhibit
ACE, which is responsible for converting angiotensin I (through
the action of renin) to angiotensin II
-Angiotensin II is a potent vasoconstrictor and causes
aldosterone secretion from the adrenal glands.
-Block ACE, thus preventing the formation of angiotensin II
-Prevent the breakdown of the vasodilating substance bradykinin
-Result in decreased SVR (afterload), vasodilation, and therefore
decreased BP
Adrenergic Blockers Correct Answers • Bind to adrenergic
receptors but inhibit or block stimulation of the sympathetic
nervous system (SNS)
Adrenergic Drug Characteristics Correct Answers Mimic the
effects of SNS neurotransmitters (catecholamines)
- norepinephrine
- epinephrine
- dopamine
