NR 565 Midterm 2023 Exam with
Accurate Solutions
When prescribing Medications, we must understand that the liver function declines with
age d/t what?
A. Enlarged Liver
B. Decreased blood flow to liver
C. Increased activity of the hepatic enzymes - ANSWER-B. Decreased blood flow to
liver
An 82 yo male visits the clinic complaining that his pain meds "take forever" to work
after he takes his pill. What are possible reasons you can explain to him as to why this
may be happening.
A. Perhaps we need to increase your dose
B. Sometimes as you get older, absorption may be slower resulting in a delayed
response
C. As we get older, the gastric acid decreases and may delay absorption - ANSWER-B.
Sometimes as you get older, absorption may be slower resulting in a delayed response
C. As we get older, the gastric acid decreases and may delay absorption
RA Characteristics
Onset
Affected population
Location
Joint stiffness duration
SxS - ANSWER-weeks-months
women>men
common hands, feet, & wrists
>60 min in AM
local & sys.
OA Characteristics
Onset
Affected population
Location
Joint stiffness duration
SxS - ANSWER-years
men & Women equally
, Hands & weight baring joints
<30min in AM
typically local
What might you expect to find in the synovial fluid of a pt with OA - ANSWER-Mild
leukocytes
What might you expect to find in the synovial fluid of a pt with RA - ANSWER-Cloudy
with leukocytes
Goals of Tx for RA - ANSWER-Sxs relief (pain, stiffness, inflammation,
maintaining joint fxn and ROM
minimize systemic involvement
delay progression
Typical pharm Txs for RA - ANSWER-NSAIDs, systemic steroids, antimalarials,
antimetabolites, and biologics
What can a poor metabolism phenotype do to metabolism of drugs? - ANSWER-
Reduced or absent enzyme activity which can lead to slow processing of meds (low
effect) or increased risk of SEs.
How does poor metabolism affect a high or low therapeutic index? - ANSWER-Some Rx
need to be converted to active form for use -> low therapeutic effect
Some Rx need to be metabolized for clearance ->risk for OD
BB warning for opioids - ANSWER-Resp arrest
BB warning for Fentanyl - ANSWER-Fatal Resp Depression
BB warning for Methadone - ANSWER-QT prolongation
Fatal dysrhythmias (Torsades)
Resp Dep
BB warning for Codeine - ANSWER-10% codeine -> morphine in liver
Poss. Death in children
severe toxicity risk in BF infants
BB warning for Hydromorphone and Oxymorphone - ANSWER-HIGH ABUSE
POTENTIAL
Resp dep esp. when used with other sedatives i.e. alcohol
BB warning for Oxycodone - ANSWER-High abuse potential
Resp dep.
Accurate Solutions
When prescribing Medications, we must understand that the liver function declines with
age d/t what?
A. Enlarged Liver
B. Decreased blood flow to liver
C. Increased activity of the hepatic enzymes - ANSWER-B. Decreased blood flow to
liver
An 82 yo male visits the clinic complaining that his pain meds "take forever" to work
after he takes his pill. What are possible reasons you can explain to him as to why this
may be happening.
A. Perhaps we need to increase your dose
B. Sometimes as you get older, absorption may be slower resulting in a delayed
response
C. As we get older, the gastric acid decreases and may delay absorption - ANSWER-B.
Sometimes as you get older, absorption may be slower resulting in a delayed response
C. As we get older, the gastric acid decreases and may delay absorption
RA Characteristics
Onset
Affected population
Location
Joint stiffness duration
SxS - ANSWER-weeks-months
women>men
common hands, feet, & wrists
>60 min in AM
local & sys.
OA Characteristics
Onset
Affected population
Location
Joint stiffness duration
SxS - ANSWER-years
men & Women equally
, Hands & weight baring joints
<30min in AM
typically local
What might you expect to find in the synovial fluid of a pt with OA - ANSWER-Mild
leukocytes
What might you expect to find in the synovial fluid of a pt with RA - ANSWER-Cloudy
with leukocytes
Goals of Tx for RA - ANSWER-Sxs relief (pain, stiffness, inflammation,
maintaining joint fxn and ROM
minimize systemic involvement
delay progression
Typical pharm Txs for RA - ANSWER-NSAIDs, systemic steroids, antimalarials,
antimetabolites, and biologics
What can a poor metabolism phenotype do to metabolism of drugs? - ANSWER-
Reduced or absent enzyme activity which can lead to slow processing of meds (low
effect) or increased risk of SEs.
How does poor metabolism affect a high or low therapeutic index? - ANSWER-Some Rx
need to be converted to active form for use -> low therapeutic effect
Some Rx need to be metabolized for clearance ->risk for OD
BB warning for opioids - ANSWER-Resp arrest
BB warning for Fentanyl - ANSWER-Fatal Resp Depression
BB warning for Methadone - ANSWER-QT prolongation
Fatal dysrhythmias (Torsades)
Resp Dep
BB warning for Codeine - ANSWER-10% codeine -> morphine in liver
Poss. Death in children
severe toxicity risk in BF infants
BB warning for Hydromorphone and Oxymorphone - ANSWER-HIGH ABUSE
POTENTIAL
Resp dep esp. when used with other sedatives i.e. alcohol
BB warning for Oxycodone - ANSWER-High abuse potential
Resp dep.
