N5334 FINAL EXAM QUESTIONS AND CORRECT RATIONALES
Prescribing cbasics Prescribing cis cregulated cby cstate cBON
Proper cRX Providers cname cand caddress, cTelephone
DEA
Pt cname/DOB/Addres
Name cof cDrug, cstrength, cSIG(directions) cwith cindication/Route cand cfrequency, cQuantity cand csignature.
Drug cSchedules: cMost caddictive cto cleast 1: cHeroin,LSD, cMJ
2: chydrocodone, ccocaine, cMethamphetamine, cmethadone, coxycodone, cmeperidine, cfentanyl, cadderall, critalin
3: ccodeine, cketamine, ctestosterone
4: cxanax, cvalium, csoma, cambient, ctramadol
5: cantidiarrheal, cantitussives, clomotil, clyrica
Pharmicodyamics The ceffects cof cdrug con cthe cbody. cReceptors care clarge cmolecules cusually cproteins, cthat cinteract cand cmediate cthe
caction cof cdrugs
agonist produce creceptor cstimulation cand ca cconformational cchange cevery ctime cthey cbind. cDo cnot cneed call cavailable creceptors cto cproduce
ca cmaximum cresponse
Partial cagonistdrugs cthat chave cproperties cin cb/w cthose cof cfull cagonist cand cantagonist. cThey cbind cto creceptors cbut cwhen cthey coccupy cthe
creceptor csites, cthey cstimulate conly csome cof cthe creceptors.
antagonist drugs cwith caffinity cfor ca creceptor cbut cwith cno cintrinsic cactivity. cAffinity callows cthe cantagonist cto cbind cto creceptors, cbut
clack cof cintrinsic cactivity cprevents cthe cbound cantagonist cfrom ccausing creceptor cactivation. cThe cblock caction cof cdrugs c(ex. cNarcan)
Bioavailabity % cof cadministered cdosage cof cthe cdrug cthat csurvives cthe cfirst cpass cthrough cthe cliver cand creaches cthe cblood cstream
half clife Time crequired cfor cthe camount cof ca cdrug cin cthe cbody cto cdecline cby c50%, cdrugs cwith cshorter chalf clives cmust cbe
cadminister cfrequently. c4.5-5.5 ctimes cthe chalf clife cto cget csteady cstate cand cto cbe climited cfrom cthe cbody
what cthe cbody cdoes cto cthe cdrug absorption, cdistribution, cmetabolism, cexcretion
Distribution movement cof cabsorbed cdrug cin cbodily cfluids cthroughout cthe cbody cto ctarget ctissue. cProperties caffecting: clipid/water
csolubility, cPH caffects cionization cof cdrug, cprotein cbinding, csize cof cmolecule c(smaller cmolecules care cmore cable cto cdiffuse)
Tissue: cfat, cbone, cblood/brain cbarrier c(only clipid csoluble cwill cpass), cplacental cbarrier c(many cdrugs ccan cpass)
Protein cbinding unbound cdrug cis cfree cwhich cis cactive, ccrosses cmembrane. cLow cplasma cproteins cresult cin cmore cfree cdrug.
cCompetition: cwhen c2 chighly cbound cdrugs care cgiven cit cincreases cthe clevel cof cboth cdrugs
Metabolism take cplace cin cthe cliver cmostly. cChemical cchange cof ca cdrug cstructure cto: c
Enhance cexcretion, cinactivate cthe cdrug, cincrease ctherapeutic caction, cactive ca cprodrug c(inactive cuntil cmetabolized cin cthe cbody cinto cthe
cactive ccompound, cex: clevodopa), cincrease cor cdecrease ctoxicity
CYP450 enzymes cconstitutes cthe cmost cimportant cof cthe cphase cI cmetabolizing cenzymes c(account cfor cabout c75% cof cdrug cmetabolism
cin cthe cliver)
Phase c2: cconjugation creaction coccur cleading cto clarge cincreases cin chydrophilicity cof cthe csubstrates crendering cthem cmore creadily
cexcretable
Substrate an cagent cthat cis cmetabolized cby can cenzyme cinto ca cmetabolite cand cproduct cand ceventually cexcreted
Inhibitors compete cwith cother cdrugs cfor ca cparticular cenzyme caffecting cthe cmetabolism c(decreased) cof cthe csubstrate cand cdecreases cthe
cexcretion cof cthe csubstrate cand cincreasing cthe ccirculating cdrug
inducer competes cwith cother cdrugs cfor ca cparticular cenzyme caffecting cmetabolism cof cthe csubstrate c(increases) cdecreasing cthe
cefficacy cof cthe cdrug
excretion renal: cpassive cglomerular cfiltration, cactive ctubular csecretion, ctubular creabsorption, cgi ctract, clung, csweat cand csalivary,
cmammary
, genomics study cof cthe ccomplete cset cof cgenetic cinformation cpresent cin ca ccell, can corganism, cor cspecies
pharmacogenetics the cstudy cof cthe cinfluence cof chereditary cfactors con cthe cresponse cof cindividual corganisms cto cdrugs, cand cthe cstudy
cof cvariations cof cDNA cand cRNA ccharacteristics cas crelated cto cdrug cresponse
Pharmacogenetics ctests Mentioned con cdrug clabels ccan cbe cclassified cas c"test crequired," c"test crecommended," cand c"information conly."
cCurrently, cfour cdrugs care crequired cto chave cpharmacogenetics ctesting cperformed cbefore cthey care cprescribed: ccetuximab, ctrastuzumab,
cmaraviroc cand cdasatinib
wafarin, ccarbamazepine, cvalproic cacid cand cabacavir care crecommended cto ctests cprior cto cinitial cdosing
Carbamazepine cand cAsisans Initiating ccarbamazepine ctherapy cin cthese cpatients c(allele cHLA-B*1502) care cat chigh crisk cfor cdeveloping
cSteven cJohnson csyndrome cor ctoxic cepidermal cnecrolysis c(TEN)
The cability cof cthe canesthetic cto cpenetrate cthe caxon cmembrane cis cdetermined cby c3 cproperties. cWhat care cthey? Molecular csize, cLipid
csolubility, cdegree cof cionization cat ctissue cpH
Why cis cepinephrine cgiven cwith clocal canesthetics? Decreases clocal cblood cflow c(decreased crisk cof cbleeding)
Delays csystemic cabsorption cof cthe canesthetic
prolongs canesthesia
reduces cthe crisk cof ctoxicity
What cis cthe cmost cwidely cused clocal canesthetic? Lidocaine
What cis ca cpossible cfatal creaction cto cbenzocaine Methemoglobinemia
What cis cincluded cin capplication cguidelines cfor ctopical canesthetics avoid cwrapping cthe csite cand cheating cthe csite, cavoid capplication cto
copen cskin
Which cmedication cwill cnot ccause crebound cheadaches cfrom coveruse? propranolol c(preventative)
What cis cthe cbest coption cfor cmenstural cmigraine? low cdose cestrogen cabout c3 cdays cprior cto cmenses
What cfood ccan ctrigger cmigraines? Hot cdog cd/t cnitrates
What cmedication cis ca cSeratonin c1B1D creceptor cagonist? Sumatriptan
Butterbur ccan chelp cas cprevention cfor cmigraine ctherapy. cWhat cside ceffect ccan coccur? Liver cdamage
What care cthe c3 cmain cclasses cof copiod creceptors? Mu ckappa cdelta
Which cof cthe cfollowing cwill creserve che ceffects ccaused cby copioid cagonist? naloxone
Which cof cthe cmedications care cused cto ctreat cOIC? Naloxegol, cmethylinaltrexone, clubiprostone
Tolerance cis cdefined cas increased cdoes cof ca cmed cneeded cto cobtain cthe csame cresponse
Which cmedication cis cused cfor copioid cabuse? Naltrexone
Euphoria cinduced cby cmorphine: An cexaggerated csense cof cwell-being ccaused cby cthe cactivation cof cmu creceptors
Which cmedication cis cgiven cnasally cfor cmigraines? Butorphanol
Which cof cthe cfollowing cdescribes cthe cmechanism cof cNSAIDs? Inhibition cof cthe ccyclo-oxygenase cenzyme
Second cgeneration cCOX c2 cinhibitors: Suppress cinflammation cand ccause cless crisk cfor cgastric culceration cthan cCOX c1, cincrease crisk
cfor cheart cdisease
Which cof cthe cfollowing cmedications cshould cnot cbe cgiven cwith cASA? Glucocorticoids
Which cmedication cis cgiven cfor cacetaminophen coverdose? Acetylcysteine
What care cnon cendocrine ctherapeutic cuses cfor cglucocorticoids? RA, cSLE, cIBS, cBursitis, cOA, cGout, cdisorders cof cthe ceye
What cis cthe cdanger cof cprolonged cuse cof cglucocorticoids? adrenal cinsufficiency
Methotrexate ccan ccause cfatal ctoxicities cof: Bone cmarrow, cliver, ckidneys, clungs.
Hemorrhagic centeritis cand cGI cperforation
Jane cis con cetanercept cfor cRA. cThe cNP cknows Jane cshould cbe cchecked cfor cTB cyearly
What cis cfirst cline ctreatment cfor cgout? Colchicine, cindomethacin
When cwould cyou cinitiate ca cUriosuric cMedication? more cthan c3 cgout cattacks cper cyear
Prescribing cbasics Prescribing cis cregulated cby cstate cBON
Proper cRX Providers cname cand caddress, cTelephone
DEA
Pt cname/DOB/Addres
Name cof cDrug, cstrength, cSIG(directions) cwith cindication/Route cand cfrequency, cQuantity cand csignature.
Drug cSchedules: cMost caddictive cto cleast 1: cHeroin,LSD, cMJ
2: chydrocodone, ccocaine, cMethamphetamine, cmethadone, coxycodone, cmeperidine, cfentanyl, cadderall, critalin
3: ccodeine, cketamine, ctestosterone
4: cxanax, cvalium, csoma, cambient, ctramadol
5: cantidiarrheal, cantitussives, clomotil, clyrica
Pharmicodyamics The ceffects cof cdrug con cthe cbody. cReceptors care clarge cmolecules cusually cproteins, cthat cinteract cand cmediate cthe
caction cof cdrugs
agonist produce creceptor cstimulation cand ca cconformational cchange cevery ctime cthey cbind. cDo cnot cneed call cavailable creceptors cto cproduce
ca cmaximum cresponse
Partial cagonistdrugs cthat chave cproperties cin cb/w cthose cof cfull cagonist cand cantagonist. cThey cbind cto creceptors cbut cwhen cthey coccupy cthe
creceptor csites, cthey cstimulate conly csome cof cthe creceptors.
antagonist drugs cwith caffinity cfor ca creceptor cbut cwith cno cintrinsic cactivity. cAffinity callows cthe cantagonist cto cbind cto creceptors, cbut
clack cof cintrinsic cactivity cprevents cthe cbound cantagonist cfrom ccausing creceptor cactivation. cThe cblock caction cof cdrugs c(ex. cNarcan)
Bioavailabity % cof cadministered cdosage cof cthe cdrug cthat csurvives cthe cfirst cpass cthrough cthe cliver cand creaches cthe cblood cstream
half clife Time crequired cfor cthe camount cof ca cdrug cin cthe cbody cto cdecline cby c50%, cdrugs cwith cshorter chalf clives cmust cbe
cadminister cfrequently. c4.5-5.5 ctimes cthe chalf clife cto cget csteady cstate cand cto cbe climited cfrom cthe cbody
what cthe cbody cdoes cto cthe cdrug absorption, cdistribution, cmetabolism, cexcretion
Distribution movement cof cabsorbed cdrug cin cbodily cfluids cthroughout cthe cbody cto ctarget ctissue. cProperties caffecting: clipid/water
csolubility, cPH caffects cionization cof cdrug, cprotein cbinding, csize cof cmolecule c(smaller cmolecules care cmore cable cto cdiffuse)
Tissue: cfat, cbone, cblood/brain cbarrier c(only clipid csoluble cwill cpass), cplacental cbarrier c(many cdrugs ccan cpass)
Protein cbinding unbound cdrug cis cfree cwhich cis cactive, ccrosses cmembrane. cLow cplasma cproteins cresult cin cmore cfree cdrug.
cCompetition: cwhen c2 chighly cbound cdrugs care cgiven cit cincreases cthe clevel cof cboth cdrugs
Metabolism take cplace cin cthe cliver cmostly. cChemical cchange cof ca cdrug cstructure cto: c
Enhance cexcretion, cinactivate cthe cdrug, cincrease ctherapeutic caction, cactive ca cprodrug c(inactive cuntil cmetabolized cin cthe cbody cinto cthe
cactive ccompound, cex: clevodopa), cincrease cor cdecrease ctoxicity
CYP450 enzymes cconstitutes cthe cmost cimportant cof cthe cphase cI cmetabolizing cenzymes c(account cfor cabout c75% cof cdrug cmetabolism
cin cthe cliver)
Phase c2: cconjugation creaction coccur cleading cto clarge cincreases cin chydrophilicity cof cthe csubstrates crendering cthem cmore creadily
cexcretable
Substrate an cagent cthat cis cmetabolized cby can cenzyme cinto ca cmetabolite cand cproduct cand ceventually cexcreted
Inhibitors compete cwith cother cdrugs cfor ca cparticular cenzyme caffecting cthe cmetabolism c(decreased) cof cthe csubstrate cand cdecreases cthe
cexcretion cof cthe csubstrate cand cincreasing cthe ccirculating cdrug
inducer competes cwith cother cdrugs cfor ca cparticular cenzyme caffecting cmetabolism cof cthe csubstrate c(increases) cdecreasing cthe
cefficacy cof cthe cdrug
excretion renal: cpassive cglomerular cfiltration, cactive ctubular csecretion, ctubular creabsorption, cgi ctract, clung, csweat cand csalivary,
cmammary
, genomics study cof cthe ccomplete cset cof cgenetic cinformation cpresent cin ca ccell, can corganism, cor cspecies
pharmacogenetics the cstudy cof cthe cinfluence cof chereditary cfactors con cthe cresponse cof cindividual corganisms cto cdrugs, cand cthe cstudy
cof cvariations cof cDNA cand cRNA ccharacteristics cas crelated cto cdrug cresponse
Pharmacogenetics ctests Mentioned con cdrug clabels ccan cbe cclassified cas c"test crequired," c"test crecommended," cand c"information conly."
cCurrently, cfour cdrugs care crequired cto chave cpharmacogenetics ctesting cperformed cbefore cthey care cprescribed: ccetuximab, ctrastuzumab,
cmaraviroc cand cdasatinib
wafarin, ccarbamazepine, cvalproic cacid cand cabacavir care crecommended cto ctests cprior cto cinitial cdosing
Carbamazepine cand cAsisans Initiating ccarbamazepine ctherapy cin cthese cpatients c(allele cHLA-B*1502) care cat chigh crisk cfor cdeveloping
cSteven cJohnson csyndrome cor ctoxic cepidermal cnecrolysis c(TEN)
The cability cof cthe canesthetic cto cpenetrate cthe caxon cmembrane cis cdetermined cby c3 cproperties. cWhat care cthey? Molecular csize, cLipid
csolubility, cdegree cof cionization cat ctissue cpH
Why cis cepinephrine cgiven cwith clocal canesthetics? Decreases clocal cblood cflow c(decreased crisk cof cbleeding)
Delays csystemic cabsorption cof cthe canesthetic
prolongs canesthesia
reduces cthe crisk cof ctoxicity
What cis cthe cmost cwidely cused clocal canesthetic? Lidocaine
What cis ca cpossible cfatal creaction cto cbenzocaine Methemoglobinemia
What cis cincluded cin capplication cguidelines cfor ctopical canesthetics avoid cwrapping cthe csite cand cheating cthe csite, cavoid capplication cto
copen cskin
Which cmedication cwill cnot ccause crebound cheadaches cfrom coveruse? propranolol c(preventative)
What cis cthe cbest coption cfor cmenstural cmigraine? low cdose cestrogen cabout c3 cdays cprior cto cmenses
What cfood ccan ctrigger cmigraines? Hot cdog cd/t cnitrates
What cmedication cis ca cSeratonin c1B1D creceptor cagonist? Sumatriptan
Butterbur ccan chelp cas cprevention cfor cmigraine ctherapy. cWhat cside ceffect ccan coccur? Liver cdamage
What care cthe c3 cmain cclasses cof copiod creceptors? Mu ckappa cdelta
Which cof cthe cfollowing cwill creserve che ceffects ccaused cby copioid cagonist? naloxone
Which cof cthe cmedications care cused cto ctreat cOIC? Naloxegol, cmethylinaltrexone, clubiprostone
Tolerance cis cdefined cas increased cdoes cof ca cmed cneeded cto cobtain cthe csame cresponse
Which cmedication cis cused cfor copioid cabuse? Naltrexone
Euphoria cinduced cby cmorphine: An cexaggerated csense cof cwell-being ccaused cby cthe cactivation cof cmu creceptors
Which cmedication cis cgiven cnasally cfor cmigraines? Butorphanol
Which cof cthe cfollowing cdescribes cthe cmechanism cof cNSAIDs? Inhibition cof cthe ccyclo-oxygenase cenzyme
Second cgeneration cCOX c2 cinhibitors: Suppress cinflammation cand ccause cless crisk cfor cgastric culceration cthan cCOX c1, cincrease crisk
cfor cheart cdisease
Which cof cthe cfollowing cmedications cshould cnot cbe cgiven cwith cASA? Glucocorticoids
Which cmedication cis cgiven cfor cacetaminophen coverdose? Acetylcysteine
What care cnon cendocrine ctherapeutic cuses cfor cglucocorticoids? RA, cSLE, cIBS, cBursitis, cOA, cGout, cdisorders cof cthe ceye
What cis cthe cdanger cof cprolonged cuse cof cglucocorticoids? adrenal cinsufficiency
Methotrexate ccan ccause cfatal ctoxicities cof: Bone cmarrow, cliver, ckidneys, clungs.
Hemorrhagic centeritis cand cGI cperforation
Jane cis con cetanercept cfor cRA. cThe cNP cknows Jane cshould cbe cchecked cfor cTB cyearly
What cis cfirst cline ctreatment cfor cgout? Colchicine, cindomethacin
When cwould cyou cinitiate ca cUriosuric cMedication? more cthan c3 cgout cattacks cper cyear
