NURS 531 PHARMACOTHERAPEUTICS NOTES/ DOWNLOAD TO SCORE AN A.

EXAM 1 Notes 1. More drugs metabolized by CYP3A4 greater than any other P450 enzyme = increased drug-drug interaction 2. Factors that regulate Css (serum conc), with this ADME is same to check maintenance dose = increase drug increase Css plasma levels 3. Induction of CYP450 Enzyme increased # of enzymes, increased intrinsic? activity increased rate of metabolism = increase metabolic rate decrease amount of purest? drug 4. IV drug 1st order kinetic Q 3hrs. 9 hrs later Cp (plasma conc) = 3mcg/L. What was initial Cp of drug? = 9 hrs = 3 (t1/2 - half life) x 2=6; 6 x2=12 (2nd half life); 12x2=24 (1st half life) 5. Drug A 80% plasma protein bound w/ very low therapeutic index, Drug B 99% plasma protein = the risk of ADReaction will be more/increased w/ Drug A. So lower the % the higher the ADR risk 6. Basic (alkalinic) Drug Z pKa (pH) 8.0. not metabolized, undergoes renal elimination = True statement - acidification of urine will increase renal elimination/excretion of Drug Z 7. Presence of good slows reabsorption of Antibiotic Tab = a &b (decreases rate of absorption of Antibiotic; Takes longer to reach Therapeutic plasma levels of Antibiotics 8. BEST measure of Total amount of oral drug in plasma over time = AUC (area under the curve) 9. 10mg “LOWOUCH” IV for pain f=0.2, PO amount needed = 10/0.2= 50mg ****PO amt always IV amt for same drug 10. Renal clearance of 4 days: 0.90, 0.03, 0.62, 0.18, shortest t1/2(half life) = 0.90 L/hr/kg 11. EXAM 2 Notes Module/Exam 2 Weeks 4-6 ANS Quiz NURS 531 Pharm Endocrine/Autonomics: · stion 1 0.2 out of 0.2 points Among the regimens listed below using various insulin preparations delivered subcutaneously by injection but not by pump, which would be the most logical? Selected Answer: b. Glargine to provide basal insulin coverage and aspart given before each meal. Answers: a. Lispro to provide basal insulin coverage and detimir given before each meal. b. Glargine to provide basal insulin coverage and aspart given before each meal. c. Detemir to provide basal insulin coverage and NPH insulin before each meal. d. Lispro or glargine injected every 3 hours and NPH given at bedtime. · Question 2 0.2 out of 0.2 points Mr. P self-medicates with an aluminum hydroxide antacid before every meal to reduce symptoms of hyperacidity. However he tends to overeat and drink. As a result, he ends up taking a couple of aspirin every day. Which of the following is likely to be TRUE with regard to Mr. P’s self-medication with these over-the-counter medications? Selected Answer: c. Mr. P. will experience reduced therapeutic effects from the antacid because he is not taking it at the optimal time. Answers: a. More aspirin will be absorbed in the presence of the antacid. b. Mr P. is likely to experience diarrhea. c. Mr. P. will experience reduced therapeutic effects from the antacid because he is not taking it at the optimal time. d. Mr. P. sometimes takes other types of antacids because one antacid is the same as another with regard to adverse effects. · Question 3 0.2 out of 0.2 points Which of the following statement(s) is/are TRUE about treatment of erectile dysfunction with a phosphodiesterase type 5 inhibitors? (Hint:You may choose more than one answer.) b. Phosphodiesterase type 5 inhibitors decrease the degradation of cyclicGMP. c. Among the phosphodiesterase type 5 inhibitors, tadalafil has the longest half-life. d. Use of phosphodiesterase type 5 inhibitors can result in visual disturbances and hypotension because these inhibitors are not absolutely selective for the phosphodiesterase type 5 isoform. Answers: a. Phosphodiesterase type 5 inhibitors stimulate nitric oxide synthase. b. Phosphodiesterase type 5 inhibitors decrease the degradation of cyclicGMP. c. Among the phosphodiesterase type 5 inhibitors, tadalafil has the longest half-life. d. Use of phosphodiesterase type 5 inhibitors can result in visual disturbances and hypotension because these inhibitors are not absolutely selective for the phosphodiesterase type 5 isoform. e. Only sildenafil can be taken with an organic nitrate. · Question 4 0.2 out of 0.2 points Anna is an APN is treating a 58 year-old postmenopausal patient for severe osteoporosis. Consider the following and select one answer. e. All of the above actions are incorrect. Answers: a. Anna prescribes 2 drugs. She prescribes alendronate and raloxifene because the mechanism of alendronate is anabolic and the mechanism of raloxifene is anti-resorptive. b. Anna suggests that her patient should eat a large meal before taking alendronate to reduce potential gastrointestinal side effects of the drug. c. Anna orders liver function test for 6 months and 12 months after initiating therapy to treat osteoporosis because bisphosphonates are metabolized in the liver where they form a reactive metabolite that can injure liver cells. d. Because bisphosphonates can cause hypercalcemia, Anna suggests that her patient should refrain from drinking milk or eating foods like yogurt and ice cream. e. All of the above actions are incorrect. · Question 5 0.2 out of 0.2 points Match the mechanism of action with the drug o Question Correct Match Selected Match Glyburide e. Stimulates insulin secretion by binding to beta-cell sulfonylurea receptor e. Stimulates insulin secretion by binding to beta-cell sulfonylurea receptor Pioglitazone a. Act as a PPAR-gamma agonists to reduce insulin resistance a. Act as a PPAR-gamma agonists to reduce insulin resistance Metformin d. Delays glucose absorption from gut, reduces gluconeogenesis, reduces glycogenolysis, facilitates insulin-mediated glucose utilization d. Delays glucose absorption from gut, reduces gluconeogenesis, reduces glycogenolysis, facilitates insulin-mediated glucose utilization Exenatide b. Synthetic GLP-1 mimetic - enhances glucosedependent insulin secretion, suppresses inappropriately elevated serum glucose concentrations, and delays gastric emptying b. Synthetic GLP-1 mimetic - enhances glucosedependent insulin secretion, suppresses inappropriately elevated serum glucose concentrations, and delays gastric emptying Acarbose c. Delays the absorption of glucose from the intestines by inhibiting glucosidase in the wall of the intestines c. Delays the absorption of glucose from the intestines by inhibiting glucosidase in the wall of the intestines o o All Answer Choices a. Act as a PPAR-gamma agonists to reduce insulin resistance b. Synthetic GLP-1 mimetic - enhances glucose-dependent insulin secretion, suppresses inappropriately elevated serum glucose concentrations, and delays gastric emptying c. Delays the absorption of glucose from the intestines by inhibiting glucosidase in the wall of the intestines d. Delays glucose absorption from gut, reduces gluconeogenesis, reduces glycogenolysis, facilitates insulin-mediated glucose utilization e. Stimulates insulin secretion by binding to beta-cell sulfonylurea receptor · Question 6 0.2 out of 0.2 points Which of the following statements are TRUE about histamine2-receptor antagonists in the treatment of hyperactivity and uncomplicated gastroesophageal reflux disease (GERD)? Selected Answer: c. For optimal response, H2 antagonists should be taken in the evening. Answers: a. Blocking the H2 receptor blocks the final common pathway of acid production in parietal cells. b. H2 receptor antagonists protect the stomach lining by increasing mucus production. c. For optimal response, H2 antagonists should be taken in the evening. d. Among the H2 antagonists, cimetidine has the least number of adverse effects. · Question 7 0.2 out of 0.2 points Which of the following statements is TRUE with regard the ideal anti-muscarinic drug to treating overactive bladder (OAB)? Selected Answer: d. The ideal anti-muscarinic drug would be highly selective for the M3 receptor and would not cross the blood brain barrier. Answers: a. The ideal anti-muscarinic drug would be highly selective for the M2 receptor subtype. b. The ideal anti-muscarinic drug would be a tertiary amine. c. The ideal drug already exists. Current anti-muscarinics on the market are very effective. d. The ideal anti-muscarinic drug would be highly selective for the M3 receptor and would not cross the blood brain barrier. · Question 8 0.2 out of 0.2 points Methimazole and propylthiouracil (PTU) are two drugs that are used to treat patients with Grave’s disease. What extra mechanism of action of PTU (compared to methimazole) explains the beneficial effects of PTU on patients who are experiencing severe hyperthyroidism or thyroid storm? Selected Answer: c. Only PTU inhibits conversion of T4 to T3 in periphery Answers: a. Only PTU inhibits peroxidase (oxidation of iodide to iodine) b. Only PTU inhibits coupling of iodine to tyrosine c. Only PTU inhibits conversion of T4 to T3 in periphery · Question 9 0.2 out of 0.2 points RANKL (receptor activator of nuclear factor KappaB ligand) is a cell-attached ligand that is important in regulating bone remodeling. Which of the following statement is TRUE about drugs used to treat osteoporosis by decreasing RANKL action? Selected Answers: a. Osteoblasts-associated RANKL binds to the RANK receptor on osteoclasts. Answers: a. Osteoblasts-associated RANKL binds to the RANK receptor on osteoclasts. b. Bisphosphonates act as a transcription factor to increase the expression of RANKL. c. r-OPG (recombinant osterprotegrin) and denosumab bind to RANK and inhibit maturation of osteoclasts and thereby inhibit degradation of bone. d. Based on the mechanism of action of denosumab, a predicted effect of this drug would be an increase in serum calcium · Question 10 0.2 out of 0.2 points Your patient is complaining that she has frequent spotting or break through bleeding since she started an oral contraceptive (OC). A common reason for this occurrence is related to: Selected Answer: taking an OC pill at different times. Answers: having multiple sexual partners. taking an OC pill at different times. the clinical and therapeutic efficacy of the drug. taking an OC pill with food