NURS 6203
Advanced
Pharmacology
COMPLETED EXAM
2024
,1. A 65-year-old man with a history of hypertension, diabetes, and chronic
kidney disease is prescribed lisinopril, a type of angiotensin-converting
enzyme (ACE) inhibitor, to lower his blood pressure. What is the main
mechanism of action of lisinopril and why is it beneficial for this patient?
a) It blocks the production of angiotensin II, a potent vasoconstrictor, and
reduces the workload on the heart and kidneys.
b) It inhibits the breakdown of bradykinin, a vasodilator, and enhances the
effects of nitric oxide and prostaglandins on the blood vessels.
c) It antagonizes the effects of angiotensin II on the angiotensin II type 1
(AT1) receptors, and prevents vasoconstriction, sodium retention, and
aldosterone secretion.
d) It stimulates the production of renin, a hormone that activates the renin-
angiotensin-aldosterone system (RAAS), and increases blood volume and
pressure.
*Answer: A. Rationale: Lisinopril is an ACE inhibitor that blocks the
conversion of angiotensin I to angiotensin II, which is a powerful
vasoconstrictor that increases blood pressure and causes damage to the
heart and kidneys. By lowering angiotensin II levels, lisinopril reduces the
workload on these organs and protects them from further deterioration.*
2. A 25-year-old woman with a history of asthma is experiencing an acute
exacerbation of her symptoms. She uses a metered-dose inhaler (MDI)
containing albuterol, a type of beta-2 adrenergic agonist, to relieve her
bronchospasm. What is the main pharmacodynamic effect of albuterol and
what are some possible adverse effects of this drug?
a) It activates the beta-2 receptors in the smooth muscle cells of the
bronchi, causing bronchodilation and increased airflow. Some possible
adverse effects are tachycardia, palpitations, tremors, and nervousness.
b) It inhibits the release of histamine and leukotrienes from the mast cells
in the airways, reducing inflammation and mucus secretion. Some
possible adverse effects are dry mouth, headache, drowsiness, and fatigue.
c) It blocks the muscarinic receptors in the parasympathetic nervous
system, preventing bronchoconstriction and mucus production. Some
possible adverse effects are blurred vision, urinary retention, constipation,
and confusion.
d) It stimulates the production of cyclic adenosine monophosphate
, (cAMP) in the epithelial cells of the airways, enhancing mucociliary
clearance and reducing airway resistance. Some possible adverse effects
are nausea, vomiting, diarrhea, and hypokalemia.
*Answer: A. Rationale: Albuterol is a beta-2 adrenergic agonist that
mimics the effects of epinephrine on the beta-2 receptors in the lungs. By
activating these receptors, albuterol causes relaxation of the bronchial
smooth muscle cells and dilation of the airways. This improves airflow
and oxygenation in patients with asthma. However, albuterol can also
activate beta-1 receptors in the heart, causing increased heart rate and
contractility. This can lead to cardiac arrhythmias, palpitations, chest pain,
and hypertension. Albuterol can also cause stimulation of the central
nervous system (CNS), resulting in tremors, anxiety, insomnia, and
nervousness.*
3. A 45-year-old man with a history of depression is prescribed
fluoxetine, a type of selective serotonin reuptake inhibitor (SSRI), to
improve his mood. What is the main pharmacokinetic property of
fluoxetine and what are some implications for its clinical use?
a) It has a long half-life of about 4 to 6 days, which means that it takes
several weeks to reach steady-state plasma levels and to achieve its full
therapeutic effect.
b) It has a high first-pass metabolism by the liver enzymes CYP2D6 and
CYP3A4, which means that it has a low bioavailability and requires a
high oral dose to be effective.
c) It has a low protein binding affinity of about 10%, which means that it
has a large volume of distribution and can cross the blood-brain barrier
easily.
d) It has a high potential for drug-drug interactions due to its inhibition of
CYP2D6 and CYP3A4 enzymes,
which means that it can increase the plasma levels and toxicity of other
drugs metabolized by these enzymes.
*Answer: D. Rationale: Fluoxetine is an SSRI that blocks the reuptake of
serotonin in the synaptic cleft, increasing the availability of serotonin for
binding to its receptors. This enhances the neurotransmission of serotonin
and improves the mood and cognition of patients with depression.
However, fluoxetine also inhibits the activity of CYP2D6 and CYP3A4
enzymes, which are responsible for the metabolism of many drugs, such
Advanced
Pharmacology
COMPLETED EXAM
2024
,1. A 65-year-old man with a history of hypertension, diabetes, and chronic
kidney disease is prescribed lisinopril, a type of angiotensin-converting
enzyme (ACE) inhibitor, to lower his blood pressure. What is the main
mechanism of action of lisinopril and why is it beneficial for this patient?
a) It blocks the production of angiotensin II, a potent vasoconstrictor, and
reduces the workload on the heart and kidneys.
b) It inhibits the breakdown of bradykinin, a vasodilator, and enhances the
effects of nitric oxide and prostaglandins on the blood vessels.
c) It antagonizes the effects of angiotensin II on the angiotensin II type 1
(AT1) receptors, and prevents vasoconstriction, sodium retention, and
aldosterone secretion.
d) It stimulates the production of renin, a hormone that activates the renin-
angiotensin-aldosterone system (RAAS), and increases blood volume and
pressure.
*Answer: A. Rationale: Lisinopril is an ACE inhibitor that blocks the
conversion of angiotensin I to angiotensin II, which is a powerful
vasoconstrictor that increases blood pressure and causes damage to the
heart and kidneys. By lowering angiotensin II levels, lisinopril reduces the
workload on these organs and protects them from further deterioration.*
2. A 25-year-old woman with a history of asthma is experiencing an acute
exacerbation of her symptoms. She uses a metered-dose inhaler (MDI)
containing albuterol, a type of beta-2 adrenergic agonist, to relieve her
bronchospasm. What is the main pharmacodynamic effect of albuterol and
what are some possible adverse effects of this drug?
a) It activates the beta-2 receptors in the smooth muscle cells of the
bronchi, causing bronchodilation and increased airflow. Some possible
adverse effects are tachycardia, palpitations, tremors, and nervousness.
b) It inhibits the release of histamine and leukotrienes from the mast cells
in the airways, reducing inflammation and mucus secretion. Some
possible adverse effects are dry mouth, headache, drowsiness, and fatigue.
c) It blocks the muscarinic receptors in the parasympathetic nervous
system, preventing bronchoconstriction and mucus production. Some
possible adverse effects are blurred vision, urinary retention, constipation,
and confusion.
d) It stimulates the production of cyclic adenosine monophosphate
, (cAMP) in the epithelial cells of the airways, enhancing mucociliary
clearance and reducing airway resistance. Some possible adverse effects
are nausea, vomiting, diarrhea, and hypokalemia.
*Answer: A. Rationale: Albuterol is a beta-2 adrenergic agonist that
mimics the effects of epinephrine on the beta-2 receptors in the lungs. By
activating these receptors, albuterol causes relaxation of the bronchial
smooth muscle cells and dilation of the airways. This improves airflow
and oxygenation in patients with asthma. However, albuterol can also
activate beta-1 receptors in the heart, causing increased heart rate and
contractility. This can lead to cardiac arrhythmias, palpitations, chest pain,
and hypertension. Albuterol can also cause stimulation of the central
nervous system (CNS), resulting in tremors, anxiety, insomnia, and
nervousness.*
3. A 45-year-old man with a history of depression is prescribed
fluoxetine, a type of selective serotonin reuptake inhibitor (SSRI), to
improve his mood. What is the main pharmacokinetic property of
fluoxetine and what are some implications for its clinical use?
a) It has a long half-life of about 4 to 6 days, which means that it takes
several weeks to reach steady-state plasma levels and to achieve its full
therapeutic effect.
b) It has a high first-pass metabolism by the liver enzymes CYP2D6 and
CYP3A4, which means that it has a low bioavailability and requires a
high oral dose to be effective.
c) It has a low protein binding affinity of about 10%, which means that it
has a large volume of distribution and can cross the blood-brain barrier
easily.
d) It has a high potential for drug-drug interactions due to its inhibition of
CYP2D6 and CYP3A4 enzymes,
which means that it can increase the plasma levels and toxicity of other
drugs metabolized by these enzymes.
*Answer: D. Rationale: Fluoxetine is an SSRI that blocks the reuptake of
serotonin in the synaptic cleft, increasing the availability of serotonin for
binding to its receptors. This enhances the neurotransmission of serotonin
and improves the mood and cognition of patients with depression.
However, fluoxetine also inhibits the activity of CYP2D6 and CYP3A4
enzymes, which are responsible for the metabolism of many drugs, such
