NR 566 Midterm Exam Review 2021 Advanced Pharmacology
1. Myocardial oxygen supply
- Supply is reduced by the following:
o Hemodynamic factors such as increased resistance in coronary vessels,
hypotension, and decreased blood volume. ACE inhibitors, beta
blockers, directrenin inhibitors, and the dihydropyridine CCBs decrease
peripheral resistance through their vasodilatory actions.
o Cardiac factors such as decreases in diastolic filling time, increases in
heart rate,and valvular incompetence. Beta blockers and non-
dihydropyridine CCBs decrease heart rate. The beta blockers have the
further advantage of preventing the recurrence of MIs.
o Hematological factors such as the oxygen content of the blood, the
acid-basestatus of the blood, and anemia.
o Systemic disorders, such as shock, which reduce blood flow or the
availability ofoxygen.
2. Myocardial oxygen demand
- High systolic blood pressure, which increases the work the heart has to do to
move bloodfrom the left ventricle to the systemic circulation. One focus of
anginal management is control of blood pressure. ACE inhibitors, beta blockers,
direct renin inhibitors, and bothtypes of CCBs decrease blood pressure.
o Increased ventricular volume, which increases the work the heart has to
do because the left ventricle must move more blood. ACE inhibitors
reduce sodiumand water retention.
o Increased thickness of the myocardium (ventricular hypertrophy). The
same mechanism that facilitated growth of the vessel walls in
atherosclerosis also increases the thickness of the myocardium. ACE
inhibitors play a major role hereto decrease the remodeling. Beta blockers
can assist in prevention of ventricular hypertrophy but play a smaller
role.
o Increased heart rate resulting from exercise, stress, hyperthyroidism,
fever, anemia, hyperviscosity of the blood, or negative feedback
systems' response todecreased cardiac output. Beta blockers can assist
in decreasing heart rate resulting from conditions such as
hyperthyroidism and from negative feedbackpatterns secondary to
decreased cardiac output.
o Conditions that heighten the myocardium's contractile response. Beta
blockersand CCBs both have negative inotropic effects.
,3. Bioavailability of bisphosphonate drugs and appropriate patient education
- Histamine2 blocking agents double alendronate bioavailability, but the
impact is unknown. Aspirin may decrease the bioavailability of tiludronate
by up to 50% whentaken 2 hours after the tiludronate. Although
indomethacin increases the bioavailability of tiludronate by 2- to 4-fold, the
bioavailability is not significantly altered by diclofenac; therefore, each
NSAID must be considered individually.
4. Adverse effects associated with long-term use of bisphonates
- Etidronate has also been associated with fractures in patients with Paget's
disease when they are given high doses or when therapy lasted longer than
6 months. These patients must be carefully monitored with x-rays and
laboratory work to assess for these lesions. The development of a rare form
of subtrochanteric femur fracture in non-Paget's patients using
bisphosphonates is under close scrutiny and has contributed to movement
away from osteopenia prevention care to only osteoporosis therapy (FDA,
2010a).
5. Specifics about administration and education regarding pancreatic enzymes
- All doses are taken immediately before or with meals or snacks with a fatty
component. Fruit, hard candy, fruit juice like drinks, tea or coffee, or
popsicles do notrequire enzymes (CFF, 2009). Capsules may be opened and
sprinkled on food.
Capsules with enteric-coated beads should not be chewed. They may be
sprinkled onsoft acidic food that is not hot and that can be swallowed
without chewing, such as applesauce or gelatin. Swallow immediately
because the proteolytic enzymes may irritate the mucosa. Following with a
glass of water or juice or eating immediately after taking the drug helps to
ensure that the medication is swallowed and does not remain in contact with
the mouth and esophagus for long periods. Pancrelipase is destroyed by
acid. Proton pump inhibitors, sodium bicarbonate, or aluminum-based
antacids may be used with preparations without enteric coating to neutralize
gastric pH. Calcium- and magnesium-based antacids should not be used for
this purpose because they interfere with drug action. Enteric-coated beads
are designed to withstand the acid pH of the stomach. Enteric-coated
formulations should not be mixed with alkaline food or the coating will be
destroyed.
6. Common adverse effects with aromatase inhibitors
- Adverse effects for the drug class include various pain syndromes, vertigo,
insomnia resulting in daytime sleepiness and confusion, increased risk of
blood clots, and hair loss. A key concern is the loss of bone mass. Bone loss
can be significant when considering the concurrent osteoporotic risks of
postmenopause. Closer monitoring isrequired. All patients should be on
calcium and vitamin D supplementation. A relative leukopenia can occur,
but the incidence of viral and bacteria infections is not considered greater
than matched groups (about 10%). Hypertension occurs in 10% ofpatients. A
life-threatening increase in blood clotting can result in MI, stroke, or
, pulmonary embolus. Hot flashes can be intense.
7. Drugs associated risk for bone loss which should be monitored
- Aromatase inhibitors
- Thyroid hormones
- Glucocorticoids
- PPIs
- SSRIs
8. Clinical signs and symptoms DM
- Increased thirst
- Frequent urination
- Extreme hunger
- Unexplained weight loss
- Presence of ketones in the urine (ketones are a byproduct of the breakdown
of muscleand fat that happens when there's not enough available insulin)
- Fatigue
- Irritability
- Blurred vision
- Slow-healing sores
- Frequent infections, such as gums or skin infections and vaginal infections
9. Risk factors & associated complications of DM
- Complications: stroke, heart attack, peripheral artery disease, diabetic
retinopathy,cataracts, glaucoma, diabetic nephropathy, peripheral
neuropathy, diabetic foot.
- Risk factors: >45 years old, physical inactivity, 1st degree relative relative
with DM,high risk ethic group (african american, hispanic, native american,
asian american, and pacific islander), hx of gest DM, htn, HDL < 35,
triglycerides >250, polycystic ovarian syndrome, acanthosis nigricans, hx of
cardiovascular disease.
10. Diagnostic criteria of DM
- Acute symptoms of diabetes plus casual plasma glucose concentration ≥200
mg/dL.
- *Casual is defined as any time of day without regard to time since last
meal. The classic symptoms of diabetes are polyuria, polydipsia, and
unexplained weight loss.
- Fasting plasma glucose ≥126 mg/dL. * Fasting is defined as no caloric
intake for atleast 8 h.
- 2-h postload plasma glucose in an oral glucose tolerance test ≥200 mg/dL.
The test uses a glucose load containing the equivalent of 75 g anhydrous
glucose dissolved inwater.
- Hb A1c ≥6.5%.
- PRE-DIABETES:
o Fasting plasma glucose 100-125 mg/dL (IFG) or
o plasma glucose 140-199 mg/dL (IGT) 2 hr post-ingestion of standard
glucoseload (75 g) or
o Hb A1c 5.7%-6.4%
1. Myocardial oxygen supply
- Supply is reduced by the following:
o Hemodynamic factors such as increased resistance in coronary vessels,
hypotension, and decreased blood volume. ACE inhibitors, beta
blockers, directrenin inhibitors, and the dihydropyridine CCBs decrease
peripheral resistance through their vasodilatory actions.
o Cardiac factors such as decreases in diastolic filling time, increases in
heart rate,and valvular incompetence. Beta blockers and non-
dihydropyridine CCBs decrease heart rate. The beta blockers have the
further advantage of preventing the recurrence of MIs.
o Hematological factors such as the oxygen content of the blood, the
acid-basestatus of the blood, and anemia.
o Systemic disorders, such as shock, which reduce blood flow or the
availability ofoxygen.
2. Myocardial oxygen demand
- High systolic blood pressure, which increases the work the heart has to do to
move bloodfrom the left ventricle to the systemic circulation. One focus of
anginal management is control of blood pressure. ACE inhibitors, beta blockers,
direct renin inhibitors, and bothtypes of CCBs decrease blood pressure.
o Increased ventricular volume, which increases the work the heart has to
do because the left ventricle must move more blood. ACE inhibitors
reduce sodiumand water retention.
o Increased thickness of the myocardium (ventricular hypertrophy). The
same mechanism that facilitated growth of the vessel walls in
atherosclerosis also increases the thickness of the myocardium. ACE
inhibitors play a major role hereto decrease the remodeling. Beta blockers
can assist in prevention of ventricular hypertrophy but play a smaller
role.
o Increased heart rate resulting from exercise, stress, hyperthyroidism,
fever, anemia, hyperviscosity of the blood, or negative feedback
systems' response todecreased cardiac output. Beta blockers can assist
in decreasing heart rate resulting from conditions such as
hyperthyroidism and from negative feedbackpatterns secondary to
decreased cardiac output.
o Conditions that heighten the myocardium's contractile response. Beta
blockersand CCBs both have negative inotropic effects.
,3. Bioavailability of bisphosphonate drugs and appropriate patient education
- Histamine2 blocking agents double alendronate bioavailability, but the
impact is unknown. Aspirin may decrease the bioavailability of tiludronate
by up to 50% whentaken 2 hours after the tiludronate. Although
indomethacin increases the bioavailability of tiludronate by 2- to 4-fold, the
bioavailability is not significantly altered by diclofenac; therefore, each
NSAID must be considered individually.
4. Adverse effects associated with long-term use of bisphonates
- Etidronate has also been associated with fractures in patients with Paget's
disease when they are given high doses or when therapy lasted longer than
6 months. These patients must be carefully monitored with x-rays and
laboratory work to assess for these lesions. The development of a rare form
of subtrochanteric femur fracture in non-Paget's patients using
bisphosphonates is under close scrutiny and has contributed to movement
away from osteopenia prevention care to only osteoporosis therapy (FDA,
2010a).
5. Specifics about administration and education regarding pancreatic enzymes
- All doses are taken immediately before or with meals or snacks with a fatty
component. Fruit, hard candy, fruit juice like drinks, tea or coffee, or
popsicles do notrequire enzymes (CFF, 2009). Capsules may be opened and
sprinkled on food.
Capsules with enteric-coated beads should not be chewed. They may be
sprinkled onsoft acidic food that is not hot and that can be swallowed
without chewing, such as applesauce or gelatin. Swallow immediately
because the proteolytic enzymes may irritate the mucosa. Following with a
glass of water or juice or eating immediately after taking the drug helps to
ensure that the medication is swallowed and does not remain in contact with
the mouth and esophagus for long periods. Pancrelipase is destroyed by
acid. Proton pump inhibitors, sodium bicarbonate, or aluminum-based
antacids may be used with preparations without enteric coating to neutralize
gastric pH. Calcium- and magnesium-based antacids should not be used for
this purpose because they interfere with drug action. Enteric-coated beads
are designed to withstand the acid pH of the stomach. Enteric-coated
formulations should not be mixed with alkaline food or the coating will be
destroyed.
6. Common adverse effects with aromatase inhibitors
- Adverse effects for the drug class include various pain syndromes, vertigo,
insomnia resulting in daytime sleepiness and confusion, increased risk of
blood clots, and hair loss. A key concern is the loss of bone mass. Bone loss
can be significant when considering the concurrent osteoporotic risks of
postmenopause. Closer monitoring isrequired. All patients should be on
calcium and vitamin D supplementation. A relative leukopenia can occur,
but the incidence of viral and bacteria infections is not considered greater
than matched groups (about 10%). Hypertension occurs in 10% ofpatients. A
life-threatening increase in blood clotting can result in MI, stroke, or
, pulmonary embolus. Hot flashes can be intense.
7. Drugs associated risk for bone loss which should be monitored
- Aromatase inhibitors
- Thyroid hormones
- Glucocorticoids
- PPIs
- SSRIs
8. Clinical signs and symptoms DM
- Increased thirst
- Frequent urination
- Extreme hunger
- Unexplained weight loss
- Presence of ketones in the urine (ketones are a byproduct of the breakdown
of muscleand fat that happens when there's not enough available insulin)
- Fatigue
- Irritability
- Blurred vision
- Slow-healing sores
- Frequent infections, such as gums or skin infections and vaginal infections
9. Risk factors & associated complications of DM
- Complications: stroke, heart attack, peripheral artery disease, diabetic
retinopathy,cataracts, glaucoma, diabetic nephropathy, peripheral
neuropathy, diabetic foot.
- Risk factors: >45 years old, physical inactivity, 1st degree relative relative
with DM,high risk ethic group (african american, hispanic, native american,
asian american, and pacific islander), hx of gest DM, htn, HDL < 35,
triglycerides >250, polycystic ovarian syndrome, acanthosis nigricans, hx of
cardiovascular disease.
10. Diagnostic criteria of DM
- Acute symptoms of diabetes plus casual plasma glucose concentration ≥200
mg/dL.
- *Casual is defined as any time of day without regard to time since last
meal. The classic symptoms of diabetes are polyuria, polydipsia, and
unexplained weight loss.
- Fasting plasma glucose ≥126 mg/dL. * Fasting is defined as no caloric
intake for atleast 8 h.
- 2-h postload plasma glucose in an oral glucose tolerance test ≥200 mg/dL.
The test uses a glucose load containing the equivalent of 75 g anhydrous
glucose dissolved inwater.
- Hb A1c ≥6.5%.
- PRE-DIABETES:
o Fasting plasma glucose 100-125 mg/dL (IFG) or
o plasma glucose 140-199 mg/dL (IGT) 2 hr post-ingestion of standard
glucoseload (75 g) or
o Hb A1c 5.7%-6.4%
