Final Exam: NR565/ NR 565 (Latest 2025 Update) Advanced Pharmacology Exam Review| Questions and Verified Answers -Chamberlain

Final Exam: NR565/ NR 565 (Latest 2025 Update) Advanced Pharmacology Exam Review| Questions and Verified Answers -Chamberlain 1. A patient has a TSH of .28, a free T4 of 3, and a free T3 over 650. What medication should she be started on? Answer: Methimazole, PTU, radioactive iodine. These labs indicate hyperthyroidism. Treatment for thyroid storm: K iodide or strong iodine solution to suppress thyroid release. Methimazole to suppress thyroid synthesis. 2. When is it appropriate to increase insulin needs? Answer: Pregnancy (after first trimester), stress, infection, weight loss, adolescent growth spurt. DECREASE for exercise and first trimester. 3. What is the TDD of a person that weighs 70kg? IF a person is eating a 50 carb meal, how much insulin will be needed based on the TDD from the above question? Answer: 42 TDD : 21 basal 21 bolus (Wt in kg x 0.6; 50% long acting and 50% rapid acting) 500 divided by (the TDD) 42 = 12. (carb to insulin ratio) then (meal carbs) 50 divided 12= 4.1 units with short acting insulin4. "As long as the short-acting insulin is drawn up first I can mix my insulin glargine with it." Answer: Of the long-acting medications, ONLY NPH the intermediate duration is suitable for mixing with the short action insulins. 5. A women who is taking Pioglitazone states, "I'm glad that this medication promotes weight loss." Answer: First this medication promotes increase in LDL levels, which increases cardiovascular risk. Also, she's a female so speak about exercise and weight bearing exercise d/t possible increased risk for fractures. 6. Glucocorticoid MOA Answer: Most effective in long-term control of airway inflammation 7. Cromolyn MOA Answer: Used as prophylaxis for mild to moderate asthma 8. Monoclonal Antibodies MOA Answer: Used for allergy-related asthma and Eosinophilic asthma. Omalizumab for allergy related and Ben ralizumab, mepliz, and resliz are for eosinophilic9. Leukotriene MOA Answer: Second-line therapy to reduce inflammation and bronchoconstriction 10. B2 adrenergic agonists MOA Answer: Can be used PRN, for EIB, COPD exacerbations, and maintenance therapy 11. methylxanthines MOA Answer: Maintenance therapy for chronic stable asthma (theophylline). P. 570. Use ONLY if B2 or anticholinergics are not appropriate. 12. anticholinergic MOA Answer: Approved for bronchospasm related to COPD 13. •What are some risk factors of fatal asthma attacks? Answer: Uncontrolled, hospitalized recently, triggers, 14. •Roflumilast (select all that apply) 1.Reduces inflammation 2.Not intended during pregnancy 3.Approved for asthma4.First-line drug for COPD Answer: Reduces inflammation, not intended for pregnancy, approved only for COPD, Second-line drug for COPD Uses for exacerbations prophylaxis in pts with severe COPD with a primary chronic bronchitis component. 15. What pt education can you provide a patient for ICS use? Answer: Rinse d/t oropharyngeal candidiasis and dysphonia (hoarseness, difficulty speaking). 16. What patient teaching can a provider give when prescribing a PPI? Answer: Hypomagnesia symptoms: muscle cramps, tremors, cramps, and palpitations. Check Mg levels periodically especially in the elderly. Get enough calcium and VIT D. call if having diarrhea (Cdiff) 17. What patient teaching can a provider give when prescribing an H2RA? Answer: Report lethargy, solmnolance, restlessness, confusion or hallucinations. (CNS effects). Teach about possible reduced libido, impotence, gynecomastia, pneumonia. P.594 Cimetidine interacts with CYP system so check with pt if they are taking warfarin, phenytoin, theophylline, lidocaine. 18. A patient presents with a complaint of reflux and constipation. He states that he drinks enough water, and admits he has gained 30lbs. He also states that he has been having "reflux" type symptoms. What are your next steps for education? Answer: Educate that weight gain can promote reflux symptoms, ask about any otc use such as antacids which may cause constipation. 19. zollinger-Ellison syndrome is due to a _______producing tumor. Treatment is long-term therapy of what medication class? Answer: gastrin.......PPI's 20. •A patient who takes NSAIDS almost daily for arthritic pain and refuses to try another medication is at risk for an NSAID-induced ulcer. The provider states, 1. I will put you on Misoprostol once daily 2. If you reduced the NSAID to 4 times a week, that should help prevent an ulcer 3. I will start you a PPI to prevent an ulcer 4. An H2RA will help prevent an ulcer. Answer: a PPI is the first-line choice, Misoprostol can cause diarrhea. 21. A young woman who was in a car accident 4 months ago takes NSAIDS for pain-related injuries. She has been dx with an ulcer and taking Misoprostol. She also has found out she is pregnant. What is the providers next steps? Answer: Switch her to a PPI d/t possible miscarriage. 22. A patient comes into the clinic with complaints of bloating and abdominal pain for a few weeks. What are appropriate options for treatment? 1.Test for H.Pylori 3. Start patient on a bland diet 2. Lifestyle modifications and H2RA 4. Order endoscopy Answer: Lifestyle mod H2RA23. A patient has tested positive for H.Pylori what are appropriate treatment options? 1.Start a PPI 2. Start antibiotic for 7 days 3.Start antacids to promote ulcer healing 4.Start antibiotic for 10-14 days Answer: start PPI, Start abx for 10-14. 24. •A pregnant woman comes in asking for GERD medication, what can you recommend? a. Misoprotol b. Sucralafate c. esomeprazole d. diet modifications only e. ranitidine Answer: sucralafate 25. Metoclopramide can be used for (select all that apply) 1.Nausea and vomiting 2.Diabetic gastroparesis 3.Gastroesophageal reflux Answer: all 26. •What TB medication is not safe for pregnancy? Answer: Ethambutol shows teratogenesis in animal studies and eye abnormalities in children. Rifabutin is the safest in pregnancy. 27. •What constitutes drug resistant TB? Answer: Resistant to isoniazide and Rifampin. 700 28. •IF a mother is taking isoniazid and rifampin, can she breastfeed? Answer: Yes, any other drug you would have to weigh benefit vs risk. 29. •What to assess if Psyllium does not work? Answer: Fecal impaction 30. Bulk-forming laxatives Answer: Work much like dietary fiber producing stool in 1-3 days 31. Stimulant Answer: •Stimulate intestinal motility 32. Osmotic Answer: High doses are used for bowel prep 33. Surfactant MOA Answer: . lowers surface tension which facilitates penetration of water into feces34. Black box warning associated with treatment for gastroparesis Answer: Reglan preferred treatment- tardive dyskinesa 35. patient teaching for metronidazole Answer: s/e of nausea and vomiting alcohol must be avoided should not be taken during pregnancy black box warning: associated with increased carcinogenic risk in mice and rats. unnecessary use is to be avoided. 36. What labs are used to diagnose hypo/hyper thyroid? Answer: TSH, T3, and T4. High TSH = hypo and low TSH = hyper. Opposites. 37. Timeframe for re-check of labs after starting levothyroxine Answer: 6-8 weeks (long half-life). Yearly after stable. 38. Signs and symptoms of hypothyroidism Answer: Dry hair, puffy face, goiter in the neck, slow heartbeat, weight gain, constipation, infertility, increased risk of miscarriages, irregular menstrual cycle, cold intolerance.39. Drug of choice for hypothyroidism Answer: Levothyroxine (Synthroid) 40. § Signs and symptoms of hyperthyroidism Answer: Hair loss, bulging eyes, goiter, rapid heartbeat, weight loss, diarrhea, menstrual periods loss often or longer. 41. Drug of choice for hyperthyroidism Answer: Methimazole (Tapazole) 42. Treatment of thyroid storm Answer: high doses of potassium iodide or strong iodine solution are given to suppress thyroid hormone release. Methimazole is given to suppress thyroid hormone synthesis. Beta blocker given to reduce HR. additional measures include sedation, cooling, and giving glucocorticoids and IV fluids. 43. Result of not treating hypothyroidism during pregnancy: Answer: Permanent neuro-psychological deficits in the child. Decrease IQ/neuropsychological function. First trimester. 44. Medication to treat symptoms of hyperthyroidism (notice this is treating symptoms and not the hyperthyroidism itself): Answer: Beta blockers (tachycardia) - propranolol/atenolol most popular.Non-radioactive iodine. ADJUNCTIVE THERAPY. 45. Drug/Food/Supplement interactions with levothyroxine: Answer: Do not take antacids, Calcium or Iron, how to take it (morning 30-60 min b4 eat. 46. How to confirm a diagnosis of DM prior to beginning treatment: Answer: Fasting plasma glucose above 126. A random plasma glucose of over 200 plus symptoms of diabetes, an oral glucose tolerance test of two hours, plasma glucose of over 200, or a A1C higher than 6.5. 47. A1c general goals Answer: 7, patients that experience severe hypoglycemia/have a limited life expectancy may have an A1C goal of 8. 48. A1c older adults Answer: 8, those with multiple coexisting chronic illnesses, cognitive impairment, or functional dependence should have less stringent glycemic goals such as 8.0-8.5. 49. When should insulin be considered? Answer: For treatment of persistent hyperglycemia starting at a threshold of 180. Early introduction of insulin should be considered if there is evidence of ongoing weight loss, if symptoms of hyperglycemia are present, or whenA1C levels 10% or BGS 300 50. At what time interval should A1c be re-checked? How often should an A1C be monitored when stable or when unstable? Answer: Every 2-3 months and max of 4 times a year. If 7, every 6 months. At least two times a year if meeting goals and quarterly if meds have changed or not meeting goals. 51. Action of Insulin Answer: Anabolic, energy conservation, promotes cellular growth and division. 52. Pioglitazone contraindications: Answer: Heart failure (severe = no, mild = caution) and bladder cancer. Causes fluid retention. 53. GLP-1 (abbreviation and examples) Answer: Glucagonlike Peptide - Subcutaneous injections - Dulaglutide (Trulicity), Semaglutide (Ozempic), Liraglutide (Victoza).54. SGLT2i (abbreviation and examples) Answer: Sodium Glucose Cotransporter 2 Inhibitors - Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance). 55. DPP4-I (abbreviation and examples) Answer: Dipeptidyl Peptidase-4 Inhibitors - Sitagliptin, Saxagliptin, Linagliptin, Alogliptin. 56. TZD (abbreviation and examples) Answer: Thiazolidinediones - Rosiglitazone & Pioglitazone 57. Which drug class should be considered for diabetes prior to insulin? Answer: It is recommended that a GLP-1 be considered before starting insulin. Metformin first always unless contraindicated. 58. Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin Answer: Basal and bolus insulin replacement encompasses approximately 50% of the total daily insulin dose (TDD) Example: TDD = patient's weight in kg (80kg) x 0.6 units = 48 units. That means 24 units of the TDD is the basal insulin dose and the other 24 units is rapid-acting.59. How is total daily dose (TDD) of insulin calculated Answer: TDD is calculated by taking the total weight in kg and multiply by 0.6 units. 60. Know the carbohydrate-to insulin ratio when calculating basal insulin Answer: Mealtime dose is calculated using the 450 rule for regular insulin and 500 rule for rapid acting insulin then divide by TDD. The answer (rounded) = the ratio of 1:the # answer. That means that if the meal is 60g of carbs, 60 divided by the # in answer = # of units of rapidacting insulin. 61. GLP-1 MOA Answer: slows gastric emptying, stimulates glucose dependent insulin release, and suppresses glucagon release and reduces appetite 62. DPP-4i MOA Answer: Enhance the activity of incretins and thereby increase insulin release, reduce glucagon 63. TZD MOA Answer: Decreases insulin resistance and increase glucose uptake by muscle and adipose tissue64. Sulfonylureas MOA Answer: promote insulin secretion by the pancreas. 65. HYPOGLYCEMIA 66. SGLT2i MOA Answer: Kidney tubules. 67. Which diabetic medication(s) come with a concern of hypoglycemia? Answer: Insulin, meglitinides, sulfonylureas, amylin analogues 68. Acute symptoms of diabetes plus casual plasma glucose concentration greater than or equal to 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. · Diabetes mellitus · Pre-diabetes Answer: · Diabetes mellitus 69. Fasting plasma glucose greater than or equal to 126 mg/dL. *Fasting is defined as no caloric intake for at least 8 hours. · Pre-diabetes · Diabetes mellitus Answer: · Diabetes mellitus70. 2 hour post-load plasma glucose in an oral glucose tolerance test greater than or equal to 200 mg/dL. The test uses a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. · Pre-diabetes · Diabetes mellitus Answer: · Diabetes mellitus 71. HgbA1c greater than or equal to 6.5% · Pre-diabetes · Diabetes mellitus Answer: · Diabetes mellitus 72. Fasting plasma glucose 100 to 125 mg/dL (IFG) or · Diabetes mellitus · Pre-diabetes Answer: · Pre-diabetes 73. Plasma glucose 140 to 199 mg/dL (IGT) 2 hours post-ingestion of standard glucose load (75 g) or · Diabetes mellitus · Pre-diabetes Answer: · Pre-diabetes 74. HgbA1c 5.7% to 6.4% · Diabetes mellitus · Pre-diabetes Answer: · Pre-diabetes 75. Methylxanthines (Theophylline) Who is at risk for toxicity and why? Answer: smokers require higher doses. Heart disease liver disease require lower doses. INITIAL doses are based on age and weight. P.569 low therapeutic range. Smoking causes increased clearance so if stop smoking levels will rise to toxic levels. 76. Step 1 therapy for asthma and COPD Answer: Manage with a SABA (albuterol) as needed. 77. Symptoms associated with intermittent asthma frequency Answer: 2 days/week or less 78. Symptoms associated with mild-persistent asthma frequency Answer: More than 2 days/week but less than daily 79. Symptoms associated with moderate-persistent asthma frequency Answer: Daily80. Symptoms associated with severe-persistent asthma frequency Answer: Several times a day 81. SABA drug class examples Answer: Albuterol (proair, ventolin, Proventil), levalbuterol (Xopenex). 82. LABA drug class examples Answer: Aclidinium bromide, arformoterol (brovana), formoterol, indacaterol, olodaterol, salemetrol. 83. ICS (Inhaled corticosteroids) drug class examples Answer: Beclomethasone dipropionate (QVAR), Budesonide (Pulmicort), Ciclesonide (Alvesco), Flunisolide (Aerospan), fluticasone propionate (Flovent), Mometasone furoate (asmanex). 84. SABA Benefits of use Answer: Used PRN for prophylaxis of exercise-induced bronchospasm and to relieve ongoing asthma attacks and COPD exacerbations. 85. Patient instructions for SABA Answer: Proper use/technique of inhaler.Consider spacer in difficulty with hand-breath coordination.Patients keep a record of symptom frequency, intensity, nighttime awakenings, effect on normal activity,and SABA use.Report CP or changes in rhythm.When two inhalations are needed, an interval of at least 1 minute should elapse between inhalations.Warn against exceeding recommended doses. 86. Why is it important to know the frequency a patient is using their SABA? Answer: SABA use is a marker of inadequate asthma control 87. LABA (long acting beta2-agonists) Answer: Should be taken on a fixed schedule, not PRN and always in combination with an inhaler glucocorticoid. 88. Examples of LABA Answer: Aclidinium bromide, arformoterol, formoterol, indacaterol, olodaterol, salmeterol. 89. Benefits of use - LABA Answer: Maintenance therapy. 90. Use in COPD - LABA Answer: May be used alone in patients with COPD. Drug therapy is minimal and limited to a small improvement in symptoms. 91. Inhaled ICS examples Answer: Beclomethasone dipropionate, Budesonide, Ciclesonide, Flunisolide, Fluticasone proprionate, Mometasone furonate. 92. Benefits of use - ICS Answer: Suppresses inflammation, reduce bronchial hyperreactivity and decrease airway mucus production. 93. At what point would an oral steroid be prescribed? Answer: Patients with moderate to severe persistent asthma or for management of acute exacerbations of asthma or COPD. Only prescribed when symptoms cannot be controlled with safer meds (inhaler glucocorticoids, inhaled B2 agonists). 94. When would roflumilast be indicated for a COPD patient? (PDE4 inhibitor) Answer: Severe cases of COPD with a primary component of chronic bronchitis. COPD exacerbations. 95. Smoking cessation - what works best? Answer: one drug and counseling work best together. Chantix most effective (cardiovascular risk). 96. Nicotine replacement s/e Answer: local irritation where the substance enters the body97. How does nicotine replacement work Answer: help with withdrawal cravings 98. Nicotine patch Answer: nonprescription, provides a steady level of nicotine; easy to use; unobtrusive 99. Nicotine gum Answer: unpleasant taste, requires good chewing technique, can't eat or drink, can damage dental work, hard with dentures Nonprescription; user controls doses 100. Nicotine nasal spray Answer: fasted nicotine delivery and highest nicotine levels that can be achieved, most irritating101. Wellbutrin/Bupropion are Answer: Nicotine free 102. Wellbutrin contrainidications Answer: history of seizure, anorexia, nervosa, cocaine use and alcohol withdraw. 103. Bupropion s/e Answer: serious neuropsychiatric effects 104. Recommended length of treatment for bupropion Answer: 12 weeks 105. What constitutes drug resistant TB Answer: Drug-resistant tuberculosis occurs when TB bacteria become resistant to the drugs used to treat the disease and includes multidrugresistant (MDR TB) and extensively drug-resistant (XDR TB). 106. Treatment of TB in a pregnant person, what all should be included? Answer: A 9-month regimen of isoniazid is recommended for pregnant women and should also receive pyridoxine supplements.107. Isoniazid (INH) Answer: a drug that can be used to prevent TB in people that have been exposed. 108. Rifabutin TB Answer: deemed the safest during pregnancy. 109. cold and cough meds actions (3) Answer: Decongestants decrease stuffiness. Antitussives suppress coughing. Expectorants help to clear out mucous. 110. examples of decongestants Answer: Beclomethasone dipropionate, budesonide, fluticasone, triamcinolone. 111. Which drug class has no significant drug interactions: cold and cough Answer: expectorants 112. H2 receptor antagonists examples Answer: Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), ranitidine (Zantac). 113. Which is most likely to interact due to CYP450 enzyme system? Answer: Cimetidine (Tagamet) 114. Proton Pump Inhibitors Answer: First-line therapy. Omeprazole (Prilosec), esomeprazole (nexium), pantoprazole (protonix) 115. Associated vitamin and/or mineral deficiencies with PPI Answer: Decreased absorption of calcium, magnesium, and vitamin B12. Short term use increases risk of what with PPI116. Answer: Community-acquired pneumonia (CAP, first few days), rebound GERD- use lowest does for shortest period of time and tapper. Can persist for several months after PPI dc, diarrhea (dose related) Cdiff 117. How to treat moderate to severe GERD Answer: Long-term maintenance therapy of PPI is recommended for severe. Moderate??? 118. What medication for GERD to avoid in older adults and why? Answer: Renal (famotidine aka Pepcid), Ranitidine and cimetidine due to risks for mental status changes, nizatidine (axid) heart and liver. 119. Treating GERD during pregnancy Answer: Some PPIs (esomeprazole) and H2 receptor antagonists (ranitidine) are safe for use in pregnancy. 120. Which cytoprotective agents would be used: Answer: Sucralfate - NOT misoprostol121. When to test for h. Pylori: Answer: If on treatment and not getting better. Consider testing before prescribing H2 receptor antagonists/PPIs. 122. How to treat h. Pylori Answer: Continue PPIs for 8-12 weeks, low-risk maybe no treatment, highrisk may require chronic acid suppression therapy. GI referral if no relief. 123. Lifestyle modifications to support ulcer healing Answer: Stop smoking, change in eating pattern (smaller meals and avoiding caffeine), avoid aspirin and NSAIDs, stop alcohol consumption, decrease stress and anxiety. 124. Which antidiarrheal contradicted in children during or after chickenpox Answer: Salicylate component of pepto 125. Patient teaching for ciprofloxacin for traveler's diarrhea: Neena is planning missionary work in a region with poor drinking water. She is given a prescription for ciprofloxacin to take with her. Which of the following instructions are most important to discuss with Neena? Answer: · Use the drug if symptoms develop and are severe or do not improve in a few days. 126. Which one associated with gray/black stools and black tongue Answer: Pepto - result from bismuth that make up pepto. · Constipation 127. Lifestyle modifications to suggest prior to treatment Answer: Increasing fiber and fluid in the diet, mild exercise. 128. Risks of laxatives during pregnancy Answer: Gastrointestinal stimulation can induce labor. 129. Preferred treatment during breastfeeding constipation Answer: senna 130. Psyllium Answer: bulk forming laxative and can cause fecal impaction or obstruction. 131. How psyllium works and what to assess for if it doesn't produce a bowel Answer: Absorb water, thereby softening and enlarging the fecal mass obstruction 132. Irritable Bowel Syndrome (IBS) Answer: A diary can be helpful to aid in diagnosis and treatment. Logging food and stressors that trigger symptoms, different for different people. Diagnosed by Rome IV criteria. 133. Nonspecific drugs to treat IBS Answer: Antispasmodics (Hyoscyamine and dicyclomine), bulkforming agents (psyllium and polycarbophil), antidiarrheals (loperamide), and tricyclic antidepressants (TCAs). 134. How to treat gastroparesis: Answer: Prokinetic drug is best 135. Black box warning associated with treatment (prokinetic drug) Answer: Risk of developing tardive dyskinesia136. Patient teaching needed with Metronidazole Answer: Tardive dyskinesia risk increases with length of treatment, treatment should not exceed 12 weeks, immediately discontinue with signs of movement disorder including repetitive involuntary movements of arms, legs, and facial muscles. Older adults are especially vulnerable. Never used during first trimester of pregnancy 137. The parent of a child with cerebral palsy reports that the child has pebble-like stools most of the time and seems uncomfortable if several days have passed between stools. Which of the following medications should be recommended to alleviate the child's constipation? · Magnesium citrate · Methylcellulose · Bisacodyl suppositories · Polyethylene glycol Answer: · Polyethylene glycol 138. Sodium phosphate is a routine order for bowel cleansing before a colonoscopy. The patient's lab tests report an elevated creatinine clearance and blood urea nitrogen. What is the best course of action for this patient? · Prescribe polyethylene glycol and electrolytes (PEG-ELS) instead · Suggest that the patient reduce the dietary sodium intake · Reduce the amount of fluid given with the laxative to prevent fluid retention · Prescribe a laxative suppository instead Answer: · Prescribe polyethylene glycol and electrolytes (PEG-ELS) instead139. An older adult patient takes an opioid analgesic after a right-hip open reduction internal fixation (ORIF). Which of the following medications should be prescribed to prevent constipation? · GoLYTELY · Docusate sodium · Glycerin suppositories · Polyethylene glycol Answer: · Docusate sodium 140. A patient reports taking an oral bisacodyl laxative for several years. Which of the following instructions should be given to guide the discontinuation of the laxative? · Withdraw from the laxative slowly to avoid a rebound constipation effect. · Stop taking the oral laxative and use a suppository until normal motility resumes. · Stop taking the laxative immediately and expect no stool for several days. · Switch to a bulk-forming laxative, such as methylcellulose. Answer: · Stop taking the laxative immediately and expect no stool for several days. 141. A patient who has been taking senna for several days reports that her urine is yellowish brown. Which of the following responses is the most appropriate response? · It indicates that renal failure has occurred. · It is caused by dehydration, which is a laxative side effect. · It is an expected, harmless effect of senna. · It is a sign of toxicity; this drug must be discontinued. Answer: · It is an expected, harmless effect of senna. 142. DTaP Answer: Five doses: #1: 2 months #2: 4 months #3: 6 months #4: between 15 and 18 months #5: between 4 and 6 years Booster every 10 years thereafter starting at age 11 years 143. Who should receive the Tdap vaccine? Answer: A booster shot with Tdap is recommended for all children 1118 years old. every 10 years after that. 144. True contraindication for DTaP or Tdap vaccine: Answer: • A shocklike state • Fever (105°F or higher) occurring within 48 hours of vaccination and not attributable to another identifiable cause • Persistent, inconsolable crying lasting 3 or more hours and occurring within 48 hours of vaccination • Seizures (with or without fever) occurring within 3 days of vaccination history of anaphylactic reaction or encephalopathy within 7 days of vaccine 145. Varicella Vaccine Contraindications Answer: Pregnancy, certain cancers (leukemia, lymphomas, hypersensitivity to neomycin or gelatin, immunocompromised. Concern for Reye syndrome in children.146. Hepatitis B virus (HBV) vaccine Contraindications Answer: Soreness at injection site and mild to moderate fever. Prior anaphylactic reaction to the vaccine itself or baker's yeast. 147. Attenuated vaccine Answer: Composed of live microbes that have been weakened or rendered completely avirulent. 148. Live virus vaccine Answer: Composed of living microbes that have been weakened or rendered completely avirulent. 149. Toxoid vaccine Answer: A bacterial toxin changed to a nontoxic form. Administration causes the receipt's immune system to manufacture antibodies. DTAP, TETANUS 150. immunity - What are they and how is each one achieved? Answer: Immunity is achieved through the occurrence of antibodies to a specific disease. 151. Herd (Community) immunity: Answer: The resistance to an infectious organism because a large group of people is immune to the infectious organism through vaccine. 152. Active immunity: Answer: The immune system produces antibodies in response to an antigen by the vaccine, or by the infection itself. 153. Passive immunity Answer: The immunity that occurs naturally. 154. Definition of vaccine Answer: A preparation containing whole or fractioned microorganisms. Administration causes recipient's immune system to manufacture antibodies directed against the microbe from which the vaccine was made. 155. Post exposure prophylaxis for suspected rabies bite Answer: Post exposure prophylaxis (PEP) consists of a dose of human rabies immune globulin (HRIG) and rabies vaccine given on the day of the rabies exposure, and then a dose of vaccine given again on days 3, 7, and 14. 156. Patient teaching and assessments for post vaccine side effects: Answer: Local reactions (discomfort, swelling, erythema at the injection site), fever, rare is anaphylaxis, acute encephalopathy, and vaccineassociated paralytic poliomyelitis. 157. Who can receive attenuated influenza vaccine (FluMist)? Answer: individuals 2yo an d less than 50. non pregnant, and those who are not immunocompromised 158. Measles, mumps, and rubella virus vaccine (MMR) Measles, mumps, and rubella, and varicella virus vaccine (MMRV)Varicella virus vaccine Influenza vaccine Rotavirus vaccine · Recombinant protein solution · Live virus · Toxoids · Bacterial polysaccharide conjugated to protein Answer: · Live virus 159. Diphtheria and tetanus and acellular pertussis vaccine (DTaP) Diphtheria and tetanus and acellular pertussis adsorbed, hepatitis B (recombinant), and inactivated poliovirus vaccine Tetanus and diphtheria · Bacterial polysaccharide conjugated to protein · Recombinant protein solution · DNA-free virus-like particles · Toxoids Answer: · Toxoids 160. Poliovirus vaccine, inactivated (IPV, Salk vaccine) Hepatitis A vaccine (HepA) Hepatitis B vaccine (HepB) Influenza vaccine · Bacterial polysaccharide conjugated to protein · Inactive viral antigen · Recombinant protein solution · Toxoids Answer: · Inactive viral antigen 161. Human papillomavirus vaccine· Recombinant protein solution · DNA-free virus-like particles · Inactive viral antigen · Bacterial polysaccharide conjugated to protein Answer: · DNA-free virus-like particles 162. Haemophilus influenzae type b (Hib) vaccine Pneumococcal vaccine (PCV13) Pneumococcal polysaccharide vaccine (PPSV) Meningococcal vaccine (MCV4) · Inactive viral antigen · Toxoids · Bacterial polysaccharide conjugated to protein · Live virus Answer: · Bacterial polysaccharide conjugated to protein 163. Meningococcal subgroup B vaccine Live virus Inactive viral antigen DNA-free virus-like particles Recombinant protein solution Answer: Recombinant protein solution 164. A patient is has just been prescribed levothyroxine. The NP put in a lab order to check TSH levels in:1. 1.4-6 weeks 2. one week 3. 6-8 weeks 4. once a year Answer: 6-8 weeks165. A patient comes into the clinic complaining of sore throat and fever. She has recently started Methimazole in the last 4 weeks. What does this suggest? Answer: Agranulocytosis. Must check CBC and LFTS for infection. Labs may not always catch in time since it progresses rapidly. MONITOR LFTS WITH METHIMAZOLE 166. A newly pregnant mother shows understanding of Hypothyroidism in pregnant women by stating(Select all that apply) 1. I can keep my current dose of levothyroxine 2. I know that if I don't take my medicine it can cause permanent damage to my baby 3. I will need to increase my dose of medicine for a short-time 4. My baby will start to make her own thyroid hormones in week 3 Answer: 2. I know that if I don't take my medicine it can cause permanent damage to my baby 3. I will need to increase my dose of medicine for a short-time 167. What is the role of Radioactive Iodine and what is a possible adverse effect? Answer: TO destroy thyroid tissue with those with hyperthyroidism. And/or have not responded to therapy. 168. Beta blockers in diabetes Answer: Can mask the signs/symptoms of hypoglycemia 169. A1C target in children/adolescents Answer: 7% 170. Insulin dose calculations Answer: 1: calculate TDD by using 0.6units/kg/day 2: calculate mealtime carbohydrate-to-insulin dose by dividing 500 (for rapid acting) or 450 (for regular insulin) by TDD 3: round your number 4: now you have your carbohydrate-to-insulin ratio such as 1:10 Example: if meal is 60g of carbs, 60g divided by 10 is the # of units of insulin 171. A patient receives his first lab results showing an AIC of 7.2%. What is the diagnosis? Answer: Repeat for confirmation 172. A random glucose of ________ is considered diabetic? Answer: A random plasma glucose of over 200 173. A person with diabetes has recurrent severe hypoglycemia events. What should his A1C goal be? Answer: Less stringent A1C goals (such as 8% [64 mmol/mol]) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the goal is difficult to achieve despite DS174. When is it okay for a patient to have an A1C goal of 6.5%? Answer: When there are no hypoglycemic events and the patient can handle it. 175. A person comes in with an A1C of 10% and a fasting glucose of 300, what are the next steps for the provider? Answer: Combination injectable therapy immediately. IF 9% can start at step 2 with dual therapy. P400 176. Biguanide (metformin) Answer: Decreases glucose production by the liver 177. Who should not take metformin? Answer: Severe metabolic acidosis can occur with accumulation of metformin. Highest risk occurs in diabetic patients with significant renal impairment. liver disease, severe infection, or a history of lactic acidosis contraindicated for people with failing hearts 178. Sulfonylureas should not be used during __________ or with _______ or _______ impairment. Answer: Not used during pregnancy; liver or renal impairment 179. What is the TDD of a person that weighs 70kg?If a person is eating a 50 carb meal, how much insulin will be needed based on the TDD from the above question? Answer: TDD = 42 500/42 = 12 rounded 50/12 = 4 units of insulin 180. A patients states that she will take her Insulin lispro 30-60 minutes before a meal. Answer: Lispro onset is 15-30 mins 181. Mixing insulins Answer: When a mixture is prepared, the short-acting insulin should be drawn into the syringe first to avoid contaminating the stock vial of the short-acting insulin with NPH insulin. 182. Canagliflozin s/e Answer: female genital fungal infections, urinary tract infections, and increased urination. 183. A patient taking Sitagliptin reports abdominal pain with vomiting. What are your next steps? Answer: Concern for pancreatitis184. Lifespan considerations formethylxanthines Answer: •Rates of metabolism are affected by age. For nonsmoking adults half-life is about 8 hours. Smoking can accelerate it.Half-life in kids is 4hrs 185. LABA MOA Answer: A sympathomimetic drug that activates B2 adrenergic receptors. This promotes broncho dilation and thus relieving bronchospasm. Has limited role in suppressing histamine release in the lung. 186. A patient wakes up at night a few times a week, has been using his SABA daily, and has been experiencing symptoms daily, and states he cannot make it up flight of stairs without trouble breathing. What is his severity of his asthma symptoms and what step should be considered? Answer: Moderate persistent asthmaStep 3- not well controlled, SABA PRN, low dose IGC and LABA OR medium dose IGC 187. What are some benefits of using ICS? Answer: very effective, safer than systemic, usually minor adverse reactions 188. tdap Answer: A booster shot with Tdap is currently recommended for all children 11 to 18 years old. Boosters with Td are given every 10 years thereafter. 189. Varicella contraindications Answer: pregnant, weakened immune, HIV/AIDS with T-cell 200, cancer, high-dose steroids 190. Hep B contraindication Answer: Baker's yeast 191. Live vaccine contraindications Answer: Immunocompromised children are at special risk from live vaccines, and therefore should be avoided. pregnancy.