NURS 7430 Advanced Pharm Quizzes | Complete Solutions (Verified Answers)

NURS 7430 Advanced Pharm Quizzes | Complete Solutions (Verified Answers) If a patient has a true penicillin allergy (anaphylaxis) which of the following would be contraindicated? a. Zosyn b. Unasyn c. Augmentin d. Penicillin V e. All of the above Which of the following antibiotics should not be given to pregnant women? a. sulfonamide/ trimethoprim (Bactrim) b. Erythromycin c. Cephalexin (Keflex) d. Amoxicillin with clavulanic acid (Augmentin) Erythromycin, PCN and cephalosporins are not considered tetratrogenic but sulfamethozoles may cause congenital malformations such as neural tube defects. Which of the following concepts would not be involved in active transport of drugs? a. consumption of energy b. specific carrier c. could be saturable d. movement due to the concentration gradient d. movement due to the concentration gradient Passive diffusion is driven by concentration gradient. Active CARRIER transport requires energy and a specific carrier which can be saturated if too much medication is available What is the primary mechanism of action of Fluoroquinolones? a. Inhibiting RNA-dependant protein synthesis b. Affecting folic acid synthesis in bacteria c. Inhibiting bacterial cell wall synthesis d. Inhibiting DNA gyrase and topoisomerase e. Binding to bacteria ribosomes How do Azole antifungals primarily work? a. Inhibiting glucan synthesis b. Binding to sterols in the fungal cell wall c. Inhibiting fungal enzymes d. Inhibiting DNA gyrase and topoisomerase What is the mechanism of action of Cephalosporins? a. Inhibiting bacterial cell wall synthesis b. Inhibiting DNA gyrase and topoisomerase c. Affecting folic acid synthesis in bacteria d. Binding to bacteria ribosomes e. Inhibiting RNA-dependant protein synthesis Which of the following is an effect of antiviral drugs? Select all that apply. a. Antivirals block viral movement from the host cell into the blood. b. Antivirals interfere with virus synthesis or maturation. c. Antivirals kill extracellular viruses. d. Antivirals block cellular receptors so viruses can not bind with the host cell. Antivirals work by blocking the viruses ability to replicate in some fashion. Once a new virus has been created and released into circulation, antivirals aren't able to destroy them. If a person is given 2 medications and Medication A induces the CYP - 450 enzyme group that is responsible for metabolizing Medication B - How would you expect that to impact the drug levels for Medication B? a. decrease level of Medication B b. increase level of Medication B c. no impact on level of Medication B Which of the following is a saturable transport system? a. Water-soluble diffusion -- water based b. Passive diffusion -- concentration dependent c. Lipid-soluble diffusion -- fat based d. Facilitated diffusion -- carrier mediated Depends on a carrier protein and like active transport (that requires energy) can be saturated and may be inhibited by compounds that compete for the carrier. A patient presents with an overdose of alkaline Codeine. What drug can be given to trap the Codeine to prevent further metabolism; and, how will the pH of the urine be changed? a. NaHCO3; Decrease b. NH4Cl; Increase c. NH4Cl; Decrease d. NaHCO3; Increase Remember - like ionization promotes absorption and different ionization promotes excretion - so making the urine MORE acidic (decreasing the pH) will INCREASE the excretion of an alkaline drug. What are the characteristics of drugs that are excreted through passive diffusion out of the renal tubules? a. Non-Polar and lipophylic b. Non-Polar and hydrophobic c. Polar and hydrophyllic d. Polar and lipophylic Water is polar thus drugs that are polar and hydrophyllic (ie water soluble) are more easily excreted A drug if unchanged will diffuse out of the nephric lumen, back into systemic circulation do to differences in the concentration gradient. What is a Polymorphism of B-adrenergic receptor is an example of? a. Pharmacokinetic polymorphism b. Pharmacodynamic polymorphism c. Pharmacogenetics d. All of the Above Receptor based drug activity is what the drug does to the body thus changes in receptors is a pharmacodynamic issue. Most drugs are either weak acids or weak bases. a. True b. False Which of the following are special concerns when using antimicrobials in newborns and young children? a. Sulfonamides may displace bilirubin from its binding sites and lead to neurotoxicity in infants less than 2 months old. b. Tetracyclines will only stain the baby teeth when given to children ages 4 - 7 years old. c. Since cross reactions are much more likely in children, cephalosporins should not be give to children who have had allergic reactions to penicillin. d. No adjustments for pediatric patients are necessary. What are the main differences between the early and later generations of cephalosporins? a. The later the generation, the better the gram positive coverage. b. The later the generation, the better the ability to penetrate the cerebral spinal fluid. c. The later the generation, the better the activity against beta lactamase producing bacteria. d. b and c Gram positive coverage is better with the earlier generation cephalosporins, but the later generations have better CSF penetration and better beta lactamase coverage. Of the generations of cephalosporins, which can claim the broadest spectrum of activity? a. First generation b. Second generation c. Third generation d. Fourth generation e. The generation is not associated with spectrum of activity. It deals more with the drug's pharmacokinetic properties. Which of the following best describes the spectrum of activity of penicillin (pcn)? a. PCN has the greatest activity against gram positive bacteria because it has difficulty penetrating the gram negative cell wall. b. PCN have the greatest activity against anaerobic bacteria because it targets the ribosomes common to anaerobic bacteria. c. PCN is bacteriostatic and therefore has a broad spectrum of activity against all types of bacteria. d. PCN has the greatest activity against gram negative bacteria because it interferes with folate synthesis which gram negative bacteria depends upon for replication. Which of the following is a third generation cephalosporin with a long half-life that allowing for once daily dosing in most patients? a. Cefuroxime b. Cefepime c. Cefoxitin d. Ceftazidime e. Ceftriaxone Which of the following antibiotics that require patients to refrain from alcohol ingestion during therapy? a. Penicillin V b. Metronidazole c. Clindamcyin d. Levofloxacin Which of the following macrolides has the least drug interactions? a. erythromycin (E.E.S) and clarithromycin (Biaxin) b. ciprofloxacin (Cipro) and levofloxacin (Levaquin) c. clarithromycin (Biaxin) and dirithromycin (Dynabac) d. azithromycin (Zithromax) and dirithromycin (Dynabac) Which of the following antibiotics have some or good activity against anaerobic bacteria? a. Clindamycin b. Metronidazole c. Imipenem d. Cefoxitin e. All of the above Which term describes the fraction of the drug that reaches systemic circulation? a. Permeation b. Biotransformation c. Bioavailability d. Excretion If a drug with a 2-hour half life is given with an initial dose of 8 mcg/ml, assuming first-order kinetics, how much drug will be left at 6 hours? a. 8 mg/m/ b. 4 mcg/ml c. 1 mcg. ml d. 0.5mcg/ml At 2 hours - 4 mg is left, At 4 hrs. - 2 mg is left At 2 hours - 1 mg is left Which of the following routes of administration has a bioavailability of about 80-100%, is usually very slow absorbing, and has prolonged duration of action? a. IV (intravenous) b. SQ (subcutaneous) c. Transdermal d. IM (intramuscular) Medication delivery through the transdermal route avoids the first pass effect thus increases bioavailability but has a slow onset of action and a prolonged effect. Fentynyl patches are a good example. Pharmacokinetics is the effect of the ____ and pharmacodynamics is the effect of the ____. a. Body on the drug; Drug on the body b. Drug on the body; Body on the drug c. Body on the drug; Drug on a drug d. Drug on a drug; Body on the drug KINETICS are what the body does with the drug - Dynamics is how the drug acts on the body! How does beta adrenergic blockers lower intraocular pressure? a. Contraction of the ciliary muscle b. Reducing the formation of aqueous humor by the ciliary body c. Increase the osmolarity of the blood and thus draws water from the vitreous humor d. Facilitating agueous humor outflow Maya is a 8 y/o girl who is diagnosed with Otitis Externa and prescribed Cortisporin Otic suspension drops for 7 days. Cortisporin Otic suspension is a mixture of polymyxin B sulfate, neomycin and hydrocortisone. What is the purpose of including the hydrocortisone in the mixture? a. Hydrocortisone Reduces swelling and promotes healing. b. Hydrocortisone moisturizes the ear canal, which promotes growth of the normal flora bacteria, which in turn eliminates the infecting organism. c. Hydrocortisone kills the bacteria, usually gram negative rods (Pseudomonas, Proteus) that usually cause Otitis Externia. d. Hydrocortisone works as a drying agent and promotes acidification of the cannal. Excessive use of sympathomimetic nasal sprays could lead to which of the following conditions? a. Increased sweating b. Higher blood glucose levels c. Rebound nasal congestion d. Urinary retention Rebound congestion is a constant nasal stuffiness (congestion) that develops from the overuse of nasal sprays (or drops or gels) that contain a decongestant medicine. This type of congestion occurs even when a person is not experiencing allergies or other cold-like symptoms. What is the therapeutic action of Adrenergic nasal decongestants? a. Dilate constricted arterioles in nasal mucosa and reduce airway resistance b. Inhibition of cyclooxygenase, there by blocking prostanoid and prostaglandin production. c. Constrict dilated arterioles in nasal mucosa and reduce airway resistance d. Direct stimulation of the beta-2 receptors resulting in bronchodilation. The mechanism by which decongestants produce their action is activation of post-junctional alpha-adrenergic receptors found on precapillary and post-capillary blood vessels of the nasal mucosa. Activation of these receptors by either direct binding of the sympathomimetic agent to the binding site of the receptor, or by the enhanced release of norepinephrine produces vasoconstriction. Such vasoconstriction decreases blood flow through the nasal mucosa and results in shrinkage of this tissue. Yasmin is a 28 y/o female kindergarten teacher. After presenting with an acutely red left eye, watery discharge, conjunctival swelling, and a tender preauricular node, she was diagnosed with conjunctivitis. She was prescribed a sulfonamide eye drops three timed daily. Which of the following adverse reaction should be addressed immediately? a. Itching, redness, and swelling b. Rash, angioedema or Stevens-Johnson syndrome c. Hematopoietic disturbances or crystalluria. d. Inhibition of CYP2C9 These are hypersensitivity reactions and the medication should be stopped and a healthcare provider contacted for instructions. Tobi is a 3 y/o male with a bulging red right TM. His mother reports a 3 day history of fevers up to 102. Fever and pain have been controlled with liquid Tylenol, however they continue to return after the medication wears off. Tobi's mother does not recall him every having ear problems before. Which of the following is appropriate treatment for the patients Acute Otitis Media? a. Levofloxacin for 10 days b. Amoxicillin (Amoxil) for 10 days c. Cefepime (Maxipime) for 10 days d. Erythromycin or trimethoprim/sulfamethoxazole for 10 days This is the ideal first choice medication Alejandro is a 35 y/o long haul truck driver, Spring has arrived and with it his allergy symptoms. He is having watery itchy eyes, runny nose and frequent bouts of sneezing. He states he needs something for these symptoms, but the 25 mg Benadryl tablets he has been taking are making him very sleepy and he can not drive feeling this way. Which of the following medications would be a good choice for management of his allergies? a. hydroxyzine b. promethazine c. diphenhydramine d. fexofenadine He should be cautioned that all antihistamines can be sedating and he should be careful when he is using the medication. If he is taking a once daily formulation, He might have a better response if he takes the medication at bedtime, the following day the medication will still be working but it should not have an extreme side-effect. This is a second generation, generally non-sedating anthistamine. What are the effects of H1 antihistamine on H1 receptors. Select all that apply. a. Increased hypotension, dizziness, and reflex tachycardia. b. Decreased cognitive and psycho-motor performance. c. Decreased neurotransmission in the CNS. d. Increased sedation and appetite. e. Decreases allergic inflammation, itching sneezing and rhinorrhea. Azelastine (eye and nasal applications), cromolyn (inhaled or nasal application) and loratadine (oral); what is the mode of action that is common to these medications? a. Leukotriene receptor antagonists which opposes the function of these inflammatory mediators. b. Mast cell stabilization and prevention of histamine release. c. Down regulation of corticosteroids to depress the stress response, immune response, and inflammation. d. Stabilization of anticholinergic activity on smooth muscle. Tatiana a 25 y/o woman has been treated with propranolol for 4 months and has been titrated up to the maximum dose; yet, she has not had any change in the frequency or severity of her migraine headaches. She also complains of difficulty sleeping sometimes. What would be the best course of action? a. Stop her propranolol and start her on a calcium channel blocker. b. Taper her off the propranolol slowly and then switch her to a tricyclic antidepressant. c. Continue treatment for another 2 - 3 months to see if headaches improve. d. Change her to another beta blocker medication. "Triptan" drugs (ie, sumatriptan) are used in the treatment of migraine headaches, what is their mechanism of action? a. Triptans are dopamine receptors antagonists b. Triptans inactivate an enzyme that degrades dopamine c. Triptans inhibit uptake and degration of serotonin d. Triptans are serotonin receptor agonists Please, choose the medications used for migraine prophylaxis. Select all that apply. a. Calcium channel blockers b. Tricyclic antidepressants c. Opioids d. Beta-blockers Beta-blockers are the drug of choice for migraine prophylaxis According to the LATEST evidence, which of the following is accurate regarding migraine prophylaxis and treatment in children and adolescents? a. Intranasal sumatriptan (Imitrex) is the only triptan proven to be effective for migraine treatment in children and adolescents. b. Anticonvulsants are the safest and most effective for prevention of migraine in children and adolescents. c. NSAIDs are ineffective in treating migraines in children and adolescents. d. Only propranolol has been proven effective for migraine prevention in children and adolescents. Which of the following are possible side effects of Timolol maleate/ hemihydrate (Timoptic) used to treat glaucoma? Select all that apply. a. Blurred vision b. Eye ache c. Darkening of the iris d. Thickening of the eye lashes e. Corneal anesthesia Topical carbonic anhydrase inhibitors are used in the treatment of glaucoma to: a. increase production of aqueous humor b. decrease aqueous outflow c. facilitate aqueous outflow d. decrease production of aqueous humor Which of the following are benefits of sunscreens? Select all that apply. a. Protection against sunburn. b. Prevention of photoaging of the skin. c. Protection against photosensitivity reactions to certain drugs. d. Decrease the risk of actinic keratoses, squamous cell carcinoma and melanoma. e. Provide absolute protection against basal cell carcinoma. Think tricyclic antidepressants, phenothiazines, sulfonamides, & sulfonylureas Rosacea is managed through antibacterial and anti-inflammatory effects. Which of the following medications are used to treat Rosacea by exerting an anti-inflammatory and/or immunosuppressive effects? a. Doxycycline tablet or capsule and Metronidazole cream, gel or lotion b. Oxymetazoline cream and Retapamulin ointment c. Amoxicillin and Erythromycin tablets d. Brimonidine gel and Hydroquinone gel Doxycycline is indicated for its anti-inflammatory effect and Metronidazole has anti-inflammatory and immunosuppressive effects. Which therapy strategies are preferred for treatment of mild to moderate psoriasis? a. Methotrexate, UVA or UVB exposure and keratolytic agents such as coal tar and salicylic agents b. Retinoids, gentamicin and hydroquinone c. Retinoids, vitamin D, keratolytic agents, and corticosteroids d. Topical antibiotics, topical steroids and ã-tocopherol The majority of patients with mild to moderate psoriasis can be managed with retinoids, vitamin D, keratolytic agents, and corticosteroids. Selection C includes appropriate therapies for severe cases including the phototherapy. Selections B and D are incorrect, antibiotics and hydroquinone (a lightening agent) and vitamin E (ã-tocopherol) are not indicated. Tierra is a 28 y/o female who states she does not know what she got into, but has had similar reactions in the past. She has vesiculation and inflammation on both forearms and is tentatively diagnosed with Contact Dermatitis. An antihistamine for itching and a low strength topical steroid is suggested to reduce inflammation. Which of the following is an appropriate treatment? a. Hydrocortisone acetate 2.5% ointment b. Desoximetasone 0.05% ointment c. Triamcinolone acetonide 0.1% ointment d. Clobetasol propionate 0.05% cream