Advanced Pharmacology Final Exam Review 2021/2022 with complete solution

Why are nitrate-free periods every 24 hours necessary for the patient on nitroglycerin therapy? Correct answer- To inhibit the development of tolerance What does a low level of thyroid-stimulating hormone indicate? Correct answer- Hyperthroidism What would be the best option to treat a newly diagnosed patient with a low TSH level with? Correct answer- Propanolol (Inderal) Spironoaldactone (Aldactone) has what mechanism of action (MOA)? Correct answer- Aldosterone antagonist Heparin exerts its therapeutic action by what? Correct answer- Upregulating the activity of one of the body's natural anticoagulant molecules, antithrombin III What physiologic action happens when the offending drug is administered during an anaphylactic reaction. Correct answer- Mast cells liberate large doses of histamine. What are two systemic psoriasis medications? Correct answer- Photo-therapy and topical corticosteroids What is the first choice of drug therapy for the majority of patients with uncomplicated stage I hypertension? Correct answer- Thiazide diuretics What is the effect of cardiac glycosides? Correct answer- Digitalis glycosides have a negative chronotropic effect on the cardiac muscle cells. Amenorrhea is the most common side effect of which birth control medication? Correct answer- Medroxyprogesterone (Depo-Provera) What is an anti-hypertensive agent which competes with epinephrine for available beta- receptor sites? Correct answer- Atenolol (Tenormin) What type of action does nitrates have on the body? Correct answer- Reduction in systemic venous tone. What is the recommended level of low-density lipoprotein cholesterol (LDL) for patients with known coronary artery disease? Correct answer- 100mg/dl or less. What is the MOA of group IV anti-dysrhythmia drugs? Correct answer- Depressing phase 4 depolarization and lengthening phases 1 and 2 repolarization. Which drug therapy should be used to lower the serum concentration of thyroid hormones and re-establish eumetabolic state in a patient with Graves' disease? Correct answer- Anti-thyroid drugs. Which type of diuretic would be used for a stage I hypertension in a patient with renal insufficiency? Correct answer- Loop diuretic. What drug should be considered as first-line therapy for a client with hypertension and heart failure? Correct answer- Enalapril (Vasotec) Which drug is considered safe for hypertension treatment during pregnancy? Correct answer- Methyldopa (Aldomet) What drug will reduce afterload because it is an alpha-adrenergic blocker? Correct answer- Prazosin (Minipress) What is an expected effect of the use of a beta-adrenergic blocker to control angina? Correct answer- Reduced force of cardiac contraction. What side effect should be monitored closely in the elderly when taking Metformin (Glucophage) for type 2 diabetes? Correct answer- Lactic acidosis. What is the primary role of cytochrome p-450 in the liver? Correct answer- Deactivate and detoxify medications and other substances. What is a component of Vitamin K-dependent clotting factors? Correct answer- Prothrombin How are IV morphine and nitroglycerin beneficial in acute heart failure? Correct answer- Decrease preload. What is the purpose of administering a vasodilating drug to a patient in heart failure? Correct answer- Decrease afterload. What are some contrindications for HMG-co A reductase inhibitors (statins)? Correct answer- They cause myopathies, especially at higher doses or in combination with certain drugs. They should never be used in patients taking Warfarin (Coumadin). Which drug can reduce serum LDL the most in patients with hyperlipidemia? Correct answer- Lovastatin (Mevacor) Which drug is contrindicated in a patient with Myasthena Gravis? Correct answer- Procainamide (Pronestyl). What action is most effective in decreasing the risk of hyperkalemia associated with the start of angiotensin-converting enzyme inhibitor (ACEI) therapy? Correct answer- Making sure that the patient is well hydrated. What factor influences plasma protein drug binding and distribution of that drug? Correct answer- The amount of albumin available in the blood stream. What does the half-life of a medication determine? Correct answer- How often the drug is to be administered. What important information should be given to a patient who is taking Metoprolol (Lopressor) for angina and hypertension? Correct answer- The drug should not be taken with milk or dairy products. Which medications should be avoided for patients with a sulfa allergy? Correct answer- Sulfamethoxazole/Trimethoprim (Bactrim) and Celecoxib (Celebrex). What should be taken into consideration when prescribing fat-soluable drugs in the elderly? Correct answer- They are associated with increased duration of drug action. Which hypolipidemic class of drugs does not have to have liver function studies? Correct answer- Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) FYI: I actually just looked this up because it didn't seem right...From the FDA: "The good news—no more periodic blood tests for liver function. The warnings—taking a statin may increase the odds of developing type 2 diabetes or suffering reversible memory loss or problems thinking. The FDA warned that one statin, lovastatin, shouldn't be taken with some antibiotics, anti-fungal agents, or medications used to treat AIDS." What is the MOA of cardiac glycosides? Correct answer- Increase the force of cardiac contraction. What age-related changes place the elderly at risk for an exaggerated response to Warfarin (Coumadin) and Heparin? Correct answer- Protein binding changes and decrease in clotting factors. Along with diet, what drug is used to treat hypertriglyceridemia? Correct answer- Gemfibrozil (Lopid). What drug is the best choice of treatment for a newly diagnosed patient with type 2 diabetes only having postprandial glucose elevation? Correct answer- Meglitinide (Prandin). Which medication is considered the safest for a diabetic patient if hypoglycemia is a major concern? Correct answer- Metformin (Glucophage). What drug is an absolute contraindication if the patient is a smoker and taking medications for type 2 diabetes? Correct answer- Birth control. How should an oral glucocorticoid be taken? Correct answer- With food. The normal starting dose of levothyroxine is 50-100mcg per day for primary hypothroidism. What is the most appropriate starting dose in a 71-year old female patient? Correct answer- 25mcg per day. What drug class should be avoided in patients with a diagnosis of osteopenia or osteoporosis? Correct answer- Clucocorticoids like Prednisone. What thyroid drug blocks thyroid hormone production and release? Correct answer- L- thyroxine (Levothyroid). What drug class exacerbates hyperglycemia? Correct answer- Corticosteroids like Prednisone (Deltasone). What drug would you add for a patient who has been taking a sulfonylurea medication like Glipizide (Glucotrol) for type 2 diabetes when there is poor glucose control? Correct answer- Add Metformin (Glucophage) to the sulfonylurea. Which drug class may predispose an insulin dependent patient to hypoglycemia? Correct answer- A selective beta-adrenergic blocker like Nadolol (Corgard). What side effects may an elderly patient who has just been placed on a calcium channel blocker for treatment of hypertension and angina except to watch for? Correct answer- Constipation, peripheral edema, and decreased heart rate. What might be a probable cause of a decreased digoxin level of 0.5mg/ml in a 70-year old with previously stable levels be a result of? Correct answer- Antacid use. What drug used in the treatment of congestive heart failure is NOT associated with decreased mortality? Correct answer- Digoxin (Lanoxin). A patient complains of "puffy feet" shortly after beginning a new medication three months ago. There is no underlying physiological cause for this condition. What medication is most likely causing the problem? Correct answer- Amlodipine (Norvasc). What drugs affect the action of Warfarin (Coumadin)? Correct answer- Alcohol, NSAIDs, and oral antifungals. What drug has a beneficial effect on benign prostate hypertrophy that may be used to treat simultaneous hypertension? Correct answer- Doxazosin (Cardura). What anithypertensive agent is safe during pregnancy? Correct answer- Methyldopa (Aldomet). A patient is taking the ACEI Enalapril (Vasotec) for the last four months for the treatment of congestive heart failure, and is complaining of a nonproductive cough. What should the NP advise the patient regarding this side effect? Correct answer- The cough should subside 1-4 days after discontinuing the drug. Which medication classification has been found to be most helpful in managing the problems associated with congestive heart failure? Correct answer- ACE inhibitors like Trandolapril (Mavik). What potentially serious side effect should a NP monitor or suspect in a patient who has begun taking Lovastatin (Mevacor) approximately three weeks ago, and who now presents complaining of generalized muscle aches. Correct answer- Rhabdomyolysis. What drug is a dihydropyridine calcium channel blocker? Correct answer- Amlodipine (Norvasc). A 75-year old patient is taking Timolol Maleate (Timpotic) for chronic open angle glaucoma and is well controlled. What side effect might you watch for if Propanolol (Inderal) is added? Correct answer- Bradycardia. What is the preferred lab test to evaluate coagulation status in a 76-year old female who is taking Warfarin (Coumadin) for chronic atrial fibrillation, and who is being managed outpatient? Correct answer- International normalization ratio (INR). Which drug class is the only one proven to decrease cardiovascular mortality in hypertensive patients? Correct answer- Beta-adrenergic blockers like Metoprolol (Toprol). What is the most common adverse side effect of drugs taken to lower low-density lipoprotein (LDL) cholesterol, such as a bile acid sequestrant like Questran and Ezetimibe (Zetia)? Correct answer- Gastrointestional symptoms. What medications are most appropriate for efectively managing a patient with moderate persistent asthma? Correct answer- An inhaled steroid (Fluticasone) and a long-acting bronchodilator (Advair). What medication class should be avoided in patients with bronchitis due to the fact it might worsen the symptoms of congestion. Correct answer- Antihistamines like Benadryl. Which antibiotic is most effective in treating community acquired pneumonia (CAP) in a young adult without co-morbid conditions? Correct answer- Azthromycin (Zithromax). What drug combination would be most effective to keeping a 20-year old patient with mild persistent asthma symptom free? Correct answer- A short-acting bronchodilator prn like Albuterol (Proventil) and an inhaled corticosteroid). What drug should be avoided in a patient who is taking Theophylline twice daily for bronchospastic disease, and who presents today with thick, discolored, tenacioius sputum, and mild shortness of breath, and fever? Correct answer- Prednisone (Deltasone). What is the optimal time to start antiviral therapy, such as Oseltamivir Phosphate (Tamiflu), in select patients with influenza? Correct answer- Within 48 hours of developing symptoms. What is the most important teaching point for a patient taking Salmeterol (Serevent) for asthma? Correct answer- It is not effective during an acute asthma attack. Which medication is most effective for patients with chronic emphysema? Correct answer- Apratropium (Atrovent). What is the most appropriate treatment of exercise induced asthma? Correct answer- An inhaled short-acting beta-agonist like Albuterol (Proventil). What is the treatment of choice for recurrent herpes simplex virus type 2 infection? Correct answer- Oral acyclovir. What is the most appropriate treatment for a patient with a history of rheumatic fever and resultant valvular disease who is about to undergo a dental procedure, and who has no known drug allergies? Correct answer- Amoxicillin (Amoxil). What antimicrobial agent would be appropriate to prescribe in a 65-year old patient who presents with a past medical history of coronary artery disease, a 101F temperature, and tachypnea of 24 breaths per minute. Chest X-ray confirms a left lower lobe pneumonia. Correct answer- Levofloxacin (Levaquin). What is the most appropriate intervention for an 8-yr old sent home from school with mucopululent discharge from his eye and suspected bacterial conjunctivitis? Correct answer- Bacitracin/polymyxin (Polysporin) opthalmic solution for 7-10 days. Which class of drugs should NOT be used to treat COPD? Correct answer- Leukotriene inhibitors, such as Zafirlukast (Aaccolate). How do antiprostaglandin drugs cause stomach mucosal injury? Correct answer- They alter the thickness of the protective mucosal layer. What do gastric parietal cells produce? Correct answer- Hydrochloric acid. How do Diphenoxylate (Lomotil) and Loperamide (Imodium) help relieve diarrhea? Correct answer- They decrease the motility of the ileum and colon, slowing the transit time and promoting more water absorption. Can antacids cause diarrhea? Correct answer- Yes, antacids containing magnesium, which decrease bowel transit time, may cause diarrhea. Most often seen in renal insufficiency. Which medication does NOT increase the incidence of constipation in an older adult? Correct answer- Warfarin (Coumadin). Which laxative is safe for long-term use? Correct answer- Methycellulose (Citrucel). Which medication given for nausea and vomiting works by affecting the chemoreceptor trigger zone, thereby stimulating uppergastrointestinal motility and increasing lower esophagealsphincter pressure? Correct answer- Antidopaminergic agents such as Prochlorperazine (Compazine). Which drug class is most likely to produce the most rapid relief for a patient who is having heartburn symptoms? Correct answer- Antacids like Calcium Carbonate (Tums). Which H2RA is most likely to cause drug interactions with Phenytoin (Dilantin) and Theophylline (Bronkodyl)? Correct answer- Cimetidine (Tagamet). Which pharmacologic intervention should you consider when treating a middle-aged man with recurrent gastric ulcers? Correct answer- Antimocrobial therapy to treat an underlying H-pylori. Which OTC supplement commonly taken by the elderly exacerbates constipation? Correct answer- Calcium. What direction would you give when prescribing Sucralfate (Carafate)? Correct answer- The drug must be taken on an empty stomach. What drug should be limited when the patient has a NSAID induced peptic ulcer? Correct answer- Misiprostol (Cytotec). A patient presents with a history of GERD and many other medical conditions. What medication would you encourage her to avoid? Correct answer- NSAIDs. What drug can exacerbate the symptoms of GERD? Correct answer- Verapamil (Calan).