Pharmacology Ch 7/24/25

A nurse is caring for a patient who is receiving 4 mg of intravenous methylprednisolone. What equivalent dose of prednisone in milligrams would this patient receive at discharge?

5mg Based on equivalent dosing, a nurse recalls that 4 mg of intravenous methylprednisolone is equal in potency to prednisone 5 mg.

Which patients does a nurse determine cannot safely receive therapy with probenecid? A.) A 55-year-old patient on dialysis B.) A 71-year-old patient with heart failure C.) A 44-year-old with irritable bowel disease D.) A 66-year-old patient receiving mercaptopurine E.) A 59-year-old patient requiring liver transplantation

A.) A 55-year-old patient on dialysis Patients with renal dysfunction should not receive probenecid. The drug requires the kidney to be effective, rendering the drug ineffective in the setting of renal impairment. E.) A 59-year-old patient requiring liver transplantation Patients with severe liver impairment, such as those requiring a transplant, should not receive therapy with probenecid.

Which antigout therapies inhibit xanthine oxidase? A.) Allopurinol B.) Colchicine C.) Febuxostat D.) Lesinurad E.) Probenecid

A.) Allopurinol Allopurinol is a xanthine oxidase inhibitor that is useful in the prevention of gouty arthritis attacks. C.) Febuxostat Febuxostat is a xanthine oxidase inhibitor used in patients who require prophylactic therapy to reduce uric acid levels.

Which laboratory results would a nurse assess in a patient before initiation of ibuprofen for an extended period of time? A.) Platelet count B.) Renal function C.) Liver function tests D.) Thyroid function tests E.) Hemoglobin/hematocrit

A.) Platelet count Platelets should be assessed in the patient at baseline before nonsteroidal antiinflammatory drug (NSAID) initiation because there is a risk of thrombocytopenia and bleeding. B.) Renal function Renal function should be closely assessed and monitored in patients receiving ibuprofen, particularly long-term usage because of a risk for nephrotoxicity. C.) Liver function tests Liver function tests should be assessed at baseline and as warranted when a patient is chronically receiving ibuprofen. E.) Hemoglobin/hematocrit Hemoglobin/hematocrit should be assessed at baseline and throughout therapy with ibuprofen because of a risk for bleeding.

Which statements regarding the pharmacokinetics of glucocorticoids are accurate? A.) Rate of absorption varies depending on the glucocorticoid and route of administration. B.) Rapid absorption occurs when sodium phosphate and sodium succinate esters are given intramuscularly. C.) Glucocorticoids are minimally protein bound. D.) Glucocorticoids undergo hepatic metabolism to produce inactive metabolites. Glucocorticoids undergo biliary excretion.

A.) Rate of absorption varies depending on the glucocorticoid and route of administration. Glucocorticoid absorption greatly varies depending on both the glucocorticoid of reference and the route in which it is administered. B.) Rapid absorption occurs when sodium phosphate and sodium succinate esters are given intramuscularly. Rapid absorption occurs with two glucocorticoids esters - sodium phosphate and sodium succinate - when given intramuscularly. C.) Glucocorticoids undergo hepatic metabolism to produce inactive metabolites. They undergo hepatic metabolism, forming inactive metabolites.

Which parameters will a nurse ensure have been assessed before administering allopurinol to a patient newly prescribed the drug? A.) Uric acid levels B.) Kidney function C.) Bone mineral density D.) Complete blood count E.) Complete list of medications

A.) Uric acid levels Uric acid levels should be assessed at baseline before initiation of allopurinol because dosage adjustments will be made based on these levels. B.) Kidney function Kidney function assessment is critical before initiation with allopurinol because patients with severe kidney impairment cannot safely receive treatment. D.) Complete blood count Because bone marrow suppression may be part of a potentially fatal hypersensitivity syndrome, it is critical to determine baseline values, such as CBC, before allopurinol initiation. E.) Complete list of medications A complete list of prescription and over-the-counter medications is important to assess because there are significant drug-drug interactions that may occur with allopurinol.

Which statement accurately describes inflammation? Cyclooxygenase (COX)-1 is responsible for pain and inflammation once activated. Arachidonic acid is released upon injury to yield inflammation, swelling, and headache. Cyclooxygenase converts prostaglandins to arachidonic acid in the prostaglandin pathway. Lipoxygenase converts leukotrienes to arachidonic acid in the leukotriene pathway.

Arachidonic acid is released upon injury to yield inflammation, swelling, and headache.

Match the chemical class to the nonsteroidal antiinflammatory drug (NSAID) that belongs to the class. Aspirin Diclofenac sodium Piroxicam Naproxen --- Salicylate Acetic Acid Derivative Enolic Acid Derivative Propionic Acid Derivative Cyclooncyganase-2 Inhibitor

Aspirin - Salicylate Diclofenac sodium - Acetic Acid Derivative Piroxicam - Enolic Acid Derivative Naproxen - Propionic Acid Derivative

Which patient does a nurse identify cannot safely receive therapy with naproxen? A.) A 57-year-old patient with benign prostatic hyperplasia B.) A 59-year-old patient receiving dialysis three times weekly C.) A 67-year-old patient undergoing cataract surgery in 2 days D.) A 69-year-old patient with osteoporosis

B.) A 59-year-old patient receiving dialysis three times weekly Patients with severe renal dysfunction should avoid nonsteroidal antiinflammatory drugs (NSAIDs) if at all possible because of the effects they exert on the kidneys. Therefore a nurse would identify a patient on dialysis cannot safely receive therapy with naproxen.

Which corticosteroid is the treatment of choice for a patient with Addison disease? A.) Betamethasone B.) Fludrocortisone C.) Prednisone D.) Triamcinolone

B.) Fludrocortisone Fludrocortisone is a mineralocorticoid, which is the treatment of choice in patients requiring mineralocorticoid replacement such as in Addison disease.

A nurse is caring for a patient (a documented overproducer of uric acid) who was recently prescribed lesinurad 200 mg PO daily for management of gout. In addition to lesinurad, the patient is also receiving colchicine for gout and amlodipine for hypertension. Which rationale explains why the nurse would call the health care provider before administering lesinurad? A.) Lesinurad interacts with colchicine, and they cannot be given together. B.) Lesinurad must be administered with allopurinol or febuxostat. C.) Lesinurad may worsen this patient's hypertension, even when receiving antihypertensive therapy. D.) Lesinurad should not be given to patients who are documented overproducers of uric acid because it is not effective.

B.) Lesinurad must be administered with allopurinol or febuxostat. The nurse would call the health care provider before administering lesinurad because this drug must be given with a xanthine oxidase inhibitor such as febuxostat or allopurinol. It cannot be given as monotherapy. The patient is not currently receiving a xanthine oxidase inhibitor.

A nurse is providing care to a patient with gout who presents with a fever, rash, eosinophilia, kidney failure, and pancytopenia. Which antigout drug would the nurse suspect has led to this patient's clinical manifestations? A.) Lesinurad B.) Colchicine C.) Allopurinol D.) Probenecid

C.) Allopurinol Allopurinol is the likely culprit. This drug is associated with a potentially fatal hypersensitivity syndrome that may be characterized by a rash, fever, eosinophilia, end-organ disease, and bone marrow toxicity, which accurately describes this patient's clinical manifestations.

Which antigout drugs are associated with an increased risk for stroke and myocardial infarction? A.) Allopurinol B.) Colchicine C.) Febuxostat D.) Lesinurad E.) Probenecid

C.) Febuxostat Febuxostat is associated with an increased risk for cardiovascular events like stroke and myocardial infarction. D.) Lesinurad Although a causal relationship has not been established, lesinurad is associated with an increased risk for stroke and myocardial infarction.

Which statement accurately describes corticosteroids? A.) The adrenal medulla secretes corticosteroids. B.) There are two types of corticosteroids - epinephrine and norepinephrine. C.) Glucocorticoids affect carbohydrate metabolism, and mineralocorticoids regulate electrolytes. D.) Corticosteroid levels are regulated by the hypothalamic-pituitary-adrenal axis with use of a positive feedback mechanism.

C.) Glucocorticoids affect carbohydrate metabolism, and mineralocorticoids regulate electrolytes. It is accurate that glucocorticoids affect carbohydrate metabolism and mineralocorticoids are responsible for electrolyte regulation.

Which statement accurately describes the pharmacokinetics of probenecid? A.) After oral administration, probenecid is partially absorbed in the gastrointestinal tract. B.) Probenecid is minimally protein bound. C.) Probenecid undergoes glucuronide conjugation and oxidation. D.) Probenecid undergoes biliary excretion.

C.) Probenecid undergoes glucuronide conjugation and oxidation. The drug undergoes metabolism-involved glucuronide conjugation and oxidation.

Which rationale accurately describes a nurse's concern for the initiation of meloxicam, a nonsteroidal antiinflammatory drug (NSAID), in a patient taking lisinopril and metformin concurrently? A.) The combination of metformin and meloxicam may lead to hyperglycemia. B.) The combination of metformin and meloxicam may lead to hypoglycemia. C.) The combination of lisinopril and meloxicam may lead to reduced antihypertensive effects, increasing the patient's blood pressure. D.) The combination of lisinopril and meloxicam may lead to increased antihypertensive effects, decreasing the patient's blood pressure.

C.) The combination of lisinopril and meloxicam may lead to reduced antihypertensive effects, increasing the patient's blood pressure.

Which effect would a nurse be concerned with for a patient who is receiving ibuprofen in addition to alendronate, a bisphosphonate? A.) Nephrotoxicity B.) Worsening of blood pressure C.) Increased drug levels of alendronate D.) Increased risk for gastrointestinal bleeding

D.) Increased risk for gastrointestinal bleeding Bisphosphonates like alendronate are associated with an increased risk of bleeding. This is increased when given with ibuprofen.

Which statement accurately describes the pharmacokinetics of lesinurad? A.) The absolute bioavailability of lesinurad is 50%. B.) Lesinurad is minimally protein bound (<25%). C.) Lesinurad undergoes oxidation and is metabolized by CYP3A4. D.) Lesinurad is excreted in both urine and feces.

D.) Lesinurad is excreted in both urine and feces. This statement is true. Lesinurad is excreted in urine (63%) and feces (32%).

Which manifestations are considered cardinal signs of inflammation? Crepitus (popping/clicking) Edema Erythema Heat Pain

Edema Erythema Heat Pain

Which statements accurately describe what occurs in the body of patients with gout? When crystals deposit, symptoms of inflammation may result. Deposits of calcium oxalate lead to a feeling of small, sharp needles in the tissues. Gout may be caused by overproduction of uric acid, decreased uric acid excretion, or both. Hyperuricemia is too much uric acid in the blood, which can lead to formation of uric acid crystals. Uric acid is formed when the body converts purines to hypoxanthine, which then converts to xanthine and finally the end product of uric acid.

When crystals deposit, symptoms of inflammation may result. Gout may be caused by overproduction of uric acid, decreased uric acid excretion, or both. Hyperuricemia is too much uric acid in the blood, which can lead to formation of uric acid crystals. Uric acid is formed when the body converts purines to hypoxanthine, which then converts to xanthine and finally the end product of uric acid.