Pharmacology Final

Atropine is prescribed for a patient with gastrointestinal hypermotility. Which of the following conditions would warrant withholding the drug? a. narrow angle glaucoma, b. diarrhea, c. constipation, d. wide angle glaucoma

Anticholinergics are contraindicated for use in patients with narrow-angle glaucoma.

What two drugs prevent the development or extension of clots?

Anticoagulants and antiplatelets

What have been the drugs of choice for management of OAB over the last 30 years?

Antimuscarinics Mybetriq, Ditropan, Vesicare, Detrol

Potassium-sparing diuretics such as spironolactone are contraindicated for use in patients with ____ or _____.

Anuria Renal impairment

Beta 2 agonists are used to treat ______ but are contraindicated with ______.

Asthma (because they relax bronchial smooth muscles) Angina (because beta agonists increase HR and force and increase myocardial oxygen demand)

What drugs (2) selectively antagonize beta-1 adrenergic receptors? What drug non-selectively antagonizes beta-1 and beta-2 adrenergic receptors?

Atenolol Metoprolol Propanolol

Since it can penetrate CNS and stimulate central u-opioid receptors, diphenoxylate (when used for treatment of diarrhea) is combined with _____ to limit abuse potential.

Atropine (diphenoxylate + atropine = Lomotil)

Which of the following antihistamines are considered to be second-generation histamine1 (H1) antagonists? Check all that apply. Azelastine Fexofenadine Loratidine Diphenhydramine

Azelastine Fexofenadine Loratidine

______ is an alpha-blocker that is sensitive for prostate and bladder

Flomax

A patient is receiving fludrocortisone (Florinef Acetate). What condition does the health care provider expect to see in the patient's medical history? Adrenal insufficiency Pituitary insufficiency Excess adrenal function Excess pituitary function

Fludrocortisone is the drug of choice for chronic mineralocorticoid replacement where normal aldosterone synthesis is absent or impaired.

_____ is used to examine the eye to evaluate for foreign body or abrasion/injury

Fluorescein

Which federal agency controls the safety standards in the production of drugs, as well as regulates the approval and removal of products on the market? Drug Enforcement Agency (DEA) Food and Drug Administration (FDA) National Institutes of Health (NIH) United States Pharmacopeia (USP)

Food and Drug Administration (FDA)

What is the most appropriate approach to drug dosing with a corticosteroid when the patient doesn't have a life-threatening disease? Start high and taper down if tremendous adverse effects occur. Start low and increase gradually until symptoms are controlled. Always start high, and do not taper. Always start low, and do not taper.

For patients whose disease is not an immediate threat to life, the dosage of a corticosteroid should be low initially and then increased gradually until symptoms are under control.

How does Lasix work?

Inhibits loop of Henle and proximal and distal convoluted tubule sodium and chloride resorption.

When prescribing to an elderly patient the following is true: Higher doses of all medications are needed because of the decrease in renal function that naturally occurs as one ages. Lower doses of some medications are needed because of the decrease in renal function that naturally occurs as one ages. No change in medication dosages need to be considered despite the decrease in renal function that naturally occurs as one ages. Lower doses of all medications are needed because of the decrease in renal function that naturally occurs as one ages.

Lower doses of some medications are needed because of the decrease in renal function that naturally occurs as one ages.

Which of the following conditions would an expectorant drug such as guaifenesin treat effectively? Acute bronchitis Asthma Smoker's cough Emphysema

acute bronchitis Expectorants such as guaifenesin are most effective in managing symptoms associated with upper respiratory infections such as bronchitis, pharyngitis, and a number of others

The adverse effects of alkalinizing drugs are usually related to ______. Sodium bicarbonate (alka seltzer) causes ______ which manifests as hyperirritability, tetany or both.

Large dosages Metabolic alkalosis

Drug metabolism in humans usually results in a product that is: Less lipid soluble than the original drug. More likely to distribute intracellularly. More likely to be absorbed by the renal tubules. More lipid soluble than the original drug.

Less lipid soluble than the original drug.

A patient reports neglecting to systematically rotate insulin injection sites. Which of the following changes in the injected subcutaneous tissue could develop as a result of the patient's neglect? Saucer-like depression Lumps of fat Soreness or induration Red and intensely itchy skin

Lipohypertrophy, or fatty thickening of the lipid tissues, slows insulin absorption and is best prevented by rotation of injection sites. It is triggered by the insulin, which stimulates fat synthesis.

______ contains the opioid receptor agonists diphenoxylate, which stimulates enteric u-opioid receptors that ______ GI motility.

Lomotil Inhibit

What can be used along with an SSRI in order to alleviate sexual dysfunction?

Wellbutrin or BuSpar

Which of the following symptoms may be considered common adverse effects of taking bisphosphonate drugs? Esophagitis cough Headache Back pain

When taking a bisphosphonate drug, the patient may experience esophagitis within the first few months of therapy if the drug is taken incorrectly. Other adverse effects include gastrointestinal (GI) disturbance, diarrhea, and abdominal pain.

When is taking a nitrate contraindicated?

When taking sildenafil (Viagra).

Which of the following numbers could be the therapeutic index (TI) of a drug for which there is the greatest possibility of toxicity? 2 1 5 10

1 A drug's TI expresses the relative safety of a drug. TI relates the dose of a drug required to produce a desired effect to that producing an adverse or toxic response. Drugs with a high TI are said to be safe (i.e., to have a wide margin of safety). Those with a low TI are relatively unsafe and have the narrowest margin of safety, therefore the greatest possibility of toxicity.

In general, adrenergic agonists are used for the following:1) ______ BP in patients with severe hypoTN 2) reverse ______ ______ 3) minimize _____ at a superficial operative site

1) inc BP in patients with severe hypoTN 2) reverse anaphylactic shock 3) minimize bleeding at a superficial operative site (in conjunction with local anesthetics)

• Question 11 The following are appropriate indications for testosterone therapy. -: 1. Primary hypogonadism: due to diseases of the testes 2. Secondary hypogonadism: due to diseases of the hypothalamus and pituitary 3. Combined hypogonadism: due to both diseases of the testes and hypothalamus and pituitary 4. Weight loss management in perimenopausal women with difficulty losing weight. All of the Above 1, 2, and 3 1, 3, and 4

1, 2, and 3

A patient has begun taking fluoxetine (Prozac) for depression. When will the effects of the drug first be felt?

1-4 weeks Fluoxetine is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) group. Similarly to tricyclic antidepressants, the patient may not feel the drug effects for 1-4 weeks.

The patient is being initiated on a treatment regimen for atopic dermatitis. The health care provider should investigate the patient's family history to determine the presence of which additional condition?

40-65% of people with atopic dermatitis have asthma or hay fever.

How does omeprazole work?

PPI Suppresses gastric acid secretion by irreversibly binding with the proton pump system that controls hydrogen secretion from the parietal cells into the secretory canals

• Question 14 Absolute contraindications to combination oral contraceptives include all of the following EXCEPT: -: History of deep vein thrombosis or thromboembolic disorders Carcinoma of the endometrium or known or suspected breast carcinoma or estrogen-dependent neoplasms Myocardial infarction, coronary artery disease or cerebrovascular disease A previous history of smoking

A previous history of smoking

What may be required to administer otic medications for otitis externa?

A wick; used for Cipro HC Otic suspension

• Question 8 Which of the following people would be the best candidate for use of an intrauterine device (IUD)? -: A woman in a mutually monogamous, stable relationship A single woman who is actively dating A woman who cannot afford oral contraceptives A woman with a prior history of pelvic inflammatory disease

A woman in a mutually monogamous, stable relationship The IUD is most appropriate as a safe and effective contraceptive for the population of women who are in a mutually monogamous, stable relationship and who are not at high risk for infection.

• Question 15 Serious warning signs of problems associated with oral contraception are identified by the acronym ACHES, which means: -: A: anxiety C: chest pain, cough H: Hypertension E: Eye problems S: Severe leg pain A: achy leg pain C: chest pain, cough H: headache E: Eye problems S: Speech problems A: Acid reflux C: chest pain, cough H: Hypertension E: Eye problems S: Shortness of breath A: Abdominal pain C: chest pain, cough H: Headache E: Eye problems S: Severe leg pain

A: Severe abdominal pain C: Chest pain, cough, shortness of breath H: Severe headache, dizziness, weakness or numbness E: Eye problems, speech problems S: Severe leg pain Patients should be advised to notify you immediately for any of those symptoms

Why are beta 2 agonists useless for Raynaud's or other conditions with reduced skin blood flow?

Absence of beta 2 receptors in the cutaneous vascular bed

A patient is preparing to receive treatment with acarbose (Precose)- improves glycemic control in patients with diabetes. Which condition would contraindicate use of acarbose? COPD Narrow angle glaucoma Asthma Pregnancy

Acarbose is excreted in breast milk and should not be administered to nursing mothers. Acarbose is contraindicated for use in pregnancy.

What medications (3) inhibit angiotensin converting enzyme which interferes with conversion of angiotensin I to angiotensin II?

Accupril Altace (ramipril) Lisinopril

Which gland can be stimulated by corticotropin (adrenocorticotropic hormone [ACTH])? Thyroid Parathyroid Pituitary Adrenal

Adrenal- corticotropin and cosyntropin (Cortrosyn) are given diagnostically to stimulate synthesis of glucocorticoids, mineralocorticoids, and androgens by the adrenal cortex.

Which substance produces a response equal to or greater than the effects of an endogenous chemical in the body? Competitive inhibitor Noncompetitive inhibitor Antagonist Agonist

Agonist Agonists combine with receptors to initiate events; that is, they have intrinsic activity that is produced by two different mechanisms. Agonist I drugs bind to the same site as an endogenous substance (e.g., neurotransmitter) to produce a similar response. The response usually equals, or is greater than, that of the endogenous substance. Agonist II drugs bind to different extracellular sites, with no response produced solely in the presence of the agonist. However, an enhanced response is generated when an existing endogenous substance also binds to its site.

Which serious adverse effects of propylthiouracil (PTU) would have to be reported to the health care provider immediately? Increased urine output and thirst Dizziness and hallucinations Sore throat and fever Abdominal pain and constipation

Agranulocytosis is the most feared adverse reaction, although it occurs in 0.2% of patients. It usually develops within 90 days of starting therapy and is characterized by high fever, bacterial pharyngitis (sore throat), and an absolute granulocyte count below 250/mm3. These signs should be reported at once.

A patient was started on antipsychotic therapy with fluphenazine (Prolixin) a week ago. During a follow-up visit, the patient states an inability to sit still and is observed to be restless and fidgeting in the chair. What is an accurate interpretation of this patient's behavior?

Akathisia. Akathisia is an extrapyramidal symptom that is one of the adverse effects of antipsychotic drug therapy. It is best described as a subjective experience of restlessness, which can lead to muscle quivering, and restless movements and behavior. It generally occurs within the first 2 weeks of treatment. It affects all age groups, but affects women twice as frequently as men

Which of the following medications would cause a health care provider to question the order if the patient was also receiving nadolol (Corgard)? Ipratropium (Atrovent) Zafirlukast (Accolate) Cromolyn (Intal) Albuterol (Ventolin)

Albuterol (Ventolin) Albuterol is a beta adrenergic agonist that should not be used in the presence of a beta adrenergic blocker such as nadolol; the effect of the beta agonist will be decreased.

30 yo female presents with c/o pink eye. She has a thick, ropy discharge and c/o very itchy eyes. She says she often gets this in the spring. Her past history is significant for asthma. On exam she has large conjunctival papillae under the upper eyelid. What is the likely diagnosis?

Allergic conjunctivitis

What medication inhibits calcium ion influx into vascular smooth muscle and myocardium?

Amlodipine CCBs. Decrease force of contraction and dilate arteries.

Lactulose reduces blood _____ levels in patients with leads to improved mental status.

Ammonia

You see a 30 lb 4 yo with acute otitis media. You want to prescribe Amoxicillin. The prescriber's reference recommends 90 mg/kg/day divided bid to tid. Which of the following is a correct dosage? Amoxil 400mg/tsp 2 tsp po tid Amoxil 400mg/tsp 1.5 tsp po bid Amoxil 250mg/tsp 1 tsp po daily Amoxil 125mg/tsp 1 tsp po bid

Amoxil 400mg/tsp 1.5 tsp po bid

The earliest signs of digoxin toxicity are _____, ______, _____.

Anorexia Nausea Diarrhea

What are corticosteroids used for?

Anti-inflammatory drugs

Ditropan is an ______ drug that is used to treat _____ incontinence.

Anticholinergic Urge

When are statins taken?

Bedtime fluvastatin, pravastatin, simvastatin

How does Lovenox (low molecular weight heparin) work?

Binds to antithrombin III and accelerates activity. Antithrombin III is a nonvitamin K-dependent protease that inhibits coagulation by lysing thrombin and factor Xa

Which statement regarding bioavailability is the most accurate? Bioavailability is 100% for oral preparations that are not metabolized in the liver. Bioavailability is calculated from the peak concentration of drug divided by the dose administered. Bioavailability is important because bioavailability determines which percentage of the administered dose reaches the systemic circulation. Bioavailability is equal to 1 (100%) only for drugs administered by a parenteral route.

Bioavailability is important because bioavailability determines which percentage of the administered dose reaches the systemic circulation. Oral bioavailability is calculated from the ration of the AUC after oral administration to the AUC after IV administration of the same dose. Many drugs given orally are incompletely absorbed or metabolized in the gut. They will have a bioavailability of less than 1.0 even if they are not metabolized in the liver.

Which of the following effects would be considered a therapeutic effect of a bisphosphonate drug? Alteration in the level of phosphorus in the bloodstream Reduction of the absorption of vitamin D in the gastrointestinal (GI) tract Inhibition of the absorption of calcium in the GI tract Prevention of bone resorption by inhibiting osteoclasts

Bisphosphonates bind to bone crystals to specifically inhibit the activity of osteoclasts, which in turn reduces bone resorption without affecting bone formation. However, since bone formation and resorption come together in the bone turnover process, bone formation does ultimately decrease.

What is the mechanism by which the selective serotonin reuptake inhibitor (SSRI) antidepressant drugs appear to work?

Blocking reuptake of serotonin. Antidepressant drugs appear to work by blocking presynaptic reuptake of serotonin and norepinephrine.

Opthalmic beta blockers can occasionally call systemic side effects such as:

Bradycardia, fatigue

The patient is scheduled to begin treatment with the disease-modifying antirheumatic drug methotrexate. In order to avoid a life-threatening adverse effect of the drug, the patient should receive a frequent assessment of: Heart rate Breath sounds Bowel sounds Mental status

Breath sounds Pulmonary fibrosis is an adverse effect of methotrexate and can be life threatening.

Nicotinic receptors do not include which of the following sites? a. bronchial smooth muscles b. ganglia c. skeletal neuromuscular junction d. adrenal medulla

Bronchial smooth muscles (contain muscarinic receptors)

The patient is experiencing irritability, muscle tension, and an inability to relax. What drug would the nurse expect to see ordered for the patient?

BuSpar (buspirone) This is the only drug approved for patients with Generalized Anxiety Disorder.

______ is a beta 1 blocker that also has nitric oxide potentiating vasodilatory effects.

Bystolic

What drugs (3) selectively antagonizes angiotensin II AT1 receptors?

Candesartan (Atacand), Losartan (Cozaar), Olmesartan (Benicar) ACEIs. Produce vasodilation by preventing formation of angiotensin II.

What drug selectively antagonizes alpha-1 adrenergic receptors, beta 1 and 2 adrenergic receptors (selective alpha and non-selective beta blocker)?

Carvedilol

___________ is the volume of fluid that is completely cleared of a drug in a given period of time. It is going to determine the steady state concentration of a drug. Many things can affect it including hepatic and/or renal function. Solubility Clearance Steady state Distribution

Clearance Clearance is the volume of fluid that is completely cleared of a drug in a given period of time. Clearance is going to determine the steady state concentration of a drug. Many things can affect clearance including hepatic and/or renal function. Clearance can also be affected by cardiac disease, and sometimes even respiratory disease. Clearance is usually increased with increased weight, so many drugs are dosed in mg/kg. Clearance can be affected by the presence of other drugs as well.

Combivent is an inhaler used in the treatment of COPD when a second medication is needed. What are the 2 classifications of medications in this inhaler? Combivent has an inhaled corticosteroid and a beta-agonist Combivent has an anticholinergic and an antihistamine Combivent has an inhaled corticosteroid and an anticholinergic Combivent has an anticholinergic and a beta-agonist

Combivent has an anticholinergic and a beta-agonist Combivent is an inhaled combination product that contains ipratropium bromide (short acting anticholinergic) 18 mcg and albuterol (short-acting beta-agonist) 90 mcg per inhalation. It is indicated in the treatment of COPD when a second aerosol bronchodilator is needed. It can be prescribed as 2 inhalations 4 times daily; max 12 inhalations per day

The patient is scheduled to begin treatment with sumatriptan (Imitrex). Before initiating treatment with the drug, the primary care provider should plan to screen the patient for evidence of which condition?

Coronary disease The most life-threatening adverse effects of triptans (constrict blood vessels in the brain) include myocardial infarction in patients with known coronary disease.

What reduces inflammation and controls pain when treating a patient with otic drops?

Corticosteroid such as dexamethasone

How much is LDL reduced by 20 mg of: - Crestor - Mevacor - Pravachol - Zocor

Crestor- 47-55% Mevacor- 24-27% Pravachol- 32% Zocor- 38%

What are the half-lives of: - Diazepam (Valium) - Triazolam - Alprazolam (Xanax)

D: 18-24 hours T: 2 hours A: 11 hours

In order to prescribe, dispense, or administer an controlled substance, the health care provider must register with the: FDA DEA NBA NIH

DEA

What is a common adverse effect of benzodiazepines (BZDs)?

Daytime sedation To one degree or another, BZDs rely on central nervous system (CNS) depression to relieve symptoms of anxiety. Adverse reactions common with BZDs include daytime sedation, ataxia, dizziness, and headaches.

How does secondary hypergastrinemia happen?

Decreased acid secretion (through use of a PPI) stimulates histamine release from enterochromaffin-like cells because of reduced negative feedback. Results in rebound gastric hyper acidity

Full activation of the sympathetic nervous system, as in the fight or flight reaction, may occur during maximal exercise. Which of the following effects is likely to occur? a. constipation, b. muscle weakness, c. bradycardia, d. decreased renal blood flow and constriction of renal vessels

Decreased renal blood flow, constriction of renal vessels

How do non-specific alpha 1 receptor blockers help BPH symptoms?

Decreases sympathetic tone and relaxes urethral strictures. -zosin

Which one of the following actions can minimize the risk of toxicity in neonates and infants, given the lower binding capacity of their albumin for penicillin? Decreasing the amount of drug given Increasing the amount of drug given Shortening the time interval between doses Making the time interval between doses irregular

Decreasing the amount of drug given The albumin in neonates and infants has a lower binding capacity for certain drugs (e.g., phenytoin, penicillin) compared with the binding capacity of mature albumin. Therefore more unbound drug is free to circulate and act. Thus it is possible that free drug levels will be high enough to produce adverse or toxic effects. To minimize the possibility of toxicity and to compensate for the shorter duration of drug action, it is often necessary to decrease the amount of the drug given and/or lengthen the time between doses.

Excessive or prolonged use of stimulant laxatives may lead to _______.

Dependence

The patient has been started on a treatment regimen for acute mania. As part of the teaching plan for the patient and the family regarding use of the medication, they should be taught to immediately report which symptoms to the primary care provider?

Deterioration of sleep patterns. It is often the first warning sign of an impending episode of mania or hypomania

A patient is receiving morphine sulfate. Which of the following effects cannot be attributed to the effects of the drug? Decreased peristalsis Diarrhea Delayed gastric emptying Common bile duct spasm

Diarrhea A common adverse effect of opioids is constipation, not diarrhea.

If you wanted to prescribe a benzodiazepine to treat anxiety and you wanted to prescribe a drug that could be taken once a day to increase compliance, which of the following would you choose? a. alprazolam, b. diazepam, c. triazolam, d. clonazepam

Diazepam Diazepam has a half-life of 18-24 hours and can be given once a day since considerable drug accumulation occurs and consequently there is a persistence of the drug and/or active metabolites throughout the day. Therefore, even if a patient were to miss a dose, or an entire day of drug, the blood levels would not fall precipitously.

What drugs (2) inhibits calcium ion influx into vascular smooth muscle and myocardium, relaxing smooth muscle, decreasing PVR, dilating coronary arteries and prolonging AV node refractory period?

Diltiazem (CCB) Nifedipine (CCB)

Which medication is the only drug available to treat sleep disorders during pregnancy?

Diphenhydramine If sleep disturbance has developed as part of an anxiety disorder and antianxiety drugs are used prior to delivery, the neonate will need to be thoroughly assessed for possible withdrawal symptoms, retardation, or physical anomalies.

Which of the four phases of pharmacokinetics is concerned with solubility? Absorption Distribution Biotransformation Elimination

Distribution Distribution of a drug once it has been absorbed depends on its solubility. Lipid-soluble drugs rapidly cross cellular membranes because of the highly permeable nature of capillary endothelial membranes. Drugs that are insoluble in lipids are limited in their ability to pass capillary endothelial membranes and therefore have a restricted distribution.

Which of the following is an implication of kidney changes in the older adult that the health care provider who is assessing drug response in this patient must take into consideration? Drug half-life is lengthened. Drug half-life is shortened. Drug elimination is faster. Toxic drug levels are less likely to occur.

Drug half-life is lengthened. Tubular secretory mechanisms and the ability to concentrate urine are diminished. In addition, cardiovascular disease, dehydration, and kidney disease commonly impair renal functioning. Thus the half-life of a drug may be increased by as much as 40%. Because drugs remain in the body longer, adverse and toxic effects are possible. Declines in renal function may be exaggerated by comorbid illness such as chronic hypertension and anemia, which have close associations with chronic kidney disease.

A patient is receiving methylphenidate (Ritalin) for the treatment of narcolepsy. What long-term effects should the health care provider expect to monitor in this patient?

Drug tolerance and dependence.

Which of the following anticholinergic effects may a patient experience when receiving brompheniramine (Dimetapp)? Dry mouth Enhanced vision Excessive tearing Increased voiding

Dry mouth The cholinergic blockade produced by first-generation histamine1 (H1) antagonists, such as brompheniramine, results in dry mouth, eyes, nasal passages, and throat.

_____ and _____ are oily or fatty substances used to keep the skin soft and prevent water evaporation. They lubricate _____ _____, thereby easing the removal of scales and reducing formation of ______ in intertriginous areas.

Emollients, lubricants psoriatic plaques fissures

What ACE inhibitor causes a non-productive cough that usually subsides several days after discontinuation of the drug? True or false: the cough is permanent even if the drug is discontinued.

Enalapril; false- the cough generally subsides several days after the drug is discontinued.

What medication is used in the treatment of anaphylaxis and why?

Epinephrine because it is a powerful antagonist that causes bronchodilation and vasoconstriction. Antihistamines and steroids can be used as adjunctive treatments.

Exenatide has its greatest effect on which of the following? Answers: Fasting blood sugar Post prandial blood glucose Equally for fasting and post prandial blood glucose DPP-IV action (Dipeptidyl Peptidase)

Exenatide, a GLP-1 mimetic (GLP-1 receptor agonist), is an agent for diabetes derived from exendin-4, a molecule found in the gila moster saliva. because this drug is able to stimulate the GLP-1 receptors in humans, it has similar effects to human GLP-1 such as lowering of glucose via glucose dependent beta cell stimulation, supression of glucogon release, delay of gastric emptying, and enhancing the satiery centers in the brain. Exenatide's half-life is 2.5 hours; therefore, it is a short acting agent whose primary role is in lowering post-prandial glucose. It has negligible effect of fasting glucose levels. Exenatide should be administered twice daily in relation with meals (breakfast and dinner). Exenatide does not have DPP-IV activity.

An inhibitor accelerates the activity of an isoenzyme and rushes the biotransformation of the substrate, pushing the substrate out, resulting in a possible loss of the therapeutic effects of the substrate. TRUE OR FALSE

FALSE

Half-life is the time it takes for the drug concentration to fall to 1/3 of the original concentration. TRUE OR FALSE

False

True or false: Warfarin is safe for use in pregnancy and lactation

False

• Question 20 Hormone therapy should be initiated in all women as they enter menopause, as it will reduce their risk for heart disease, osteoporosis, and breast cancer. -: True False

False

• Question 18 Oral contraceptives should always be started on a Sunday so as not to confuse the patient. -: True False

False Most experts now recommend that patients do the quick start method, beginning OCPs on the day of the visit. This decreases the chance of the patient conceiving between the time the pill was prescribed and the following Sunday. It also makes it easier to get refills, since many pharmacies are closed on Sundays.

Allopurinol (Zyloprim) should be started immediately in patients experiencing an acute gout attack. True False

False Allopurinol should not be started during an acute attack as it might prolong the attack or precipitate more attacks. NSAIDs are first-line treatment and colchicine (1.2 mg PO x1, then 0.6 mg PO x1 1 h later)is possible if the patient cannot take NSAIDs. Can continue allopurinol during an attack if already taking it.

True or false: Beta blockers are the best first line antihypertensive.

False- Not the first line therapy, especially for men (ED problems)

True or False: ACEIs can cause sodium retention.

False- can cause potassium retention

True or False: Pyridium is a phenazopyridine that is used for urinary analgesia in patients with bladder cancer.

False- used for UTIs

Which of the following terms describes the process by which the amount of active drug in the body is reduced after administration but before entering the systemnic circulation. Excretion First-order elimination First pass effect Metabolism Pharmacokinetics

First pass effect

Which one of the following effects is likely to accompany presystemic biotransformation of a drug? Decreased cardiac output First-pass effect in the liver Protein binding in the bloodstream Tissue binding in a body compartment

First-pass effect in the liver Drugs may be biotransformed, usually to inactive metabolites, before reaching the systemic circulation. Orally administered drugs are transformed in the gastrointestinal (GI) tract by acids, digestive enzymes, bacterial action, and enzymes in the cells of the intestinal walls. Venous blood from the GI tract (except the mouth and the rectum) passes through the liver via the portal system before entering systemic circulation. Therefore drugs that are highly cleared by the liver will undergo considerable biotransformation before entering systemic circulation. This phenomenon is known as the first-pass effect.

A patient self-administers 325 mg acetylsalicylic acid (aspirin) daily. Consider the following adverse effects, and select the one that could possibly occur as a result of salicylate therapy. Gastrointestinal (GI) distress Hepatotoxicity Skin tears Hypothermia

Gastrointestinal (GI) distress Nonsteroidal antiinflammatory drugs (NSAIDs) are generally well-tolerated; however, in a small percentage of patients, adverse GI events can occur.

A 19-year-old patient who is beginning drug therapy with phenytoin (Dilantin) is taught to visit the dentist regularly. Which effect associated with phenytoin use explains the health care provider's recommendation?

Gingival hyperplasia At risk when under the age of 23 and are taking more than 500 mg per day.

A 22 yo male college student with a history of asthma presents to your clinic with c/o cough, wheeze and SOB. He is afebrile, has diffuse expiratory wheezes, SaO2 94%, resps 24, P 98, BP 120/70. Exam is otherwise unremarkable. He ran out of his albuterol inhaler 3 days ago because he has been having to use it 6-8 times a day for the past 2 weeks. He has been waking up nightly with symptoms. He is not on any medications. How will you initially treat him? Give him a nebulizer treatment with beta agonist (albuterol) in the office and give him a dose of Prednisone 60mg po. Give him an injection of Rocephin and start him on azithromycin 500mg x 3 days. Start him on an inhaled corticosteroid Give him a prescription for a xopenex inhaler and tell him to fill it ASAP

Give him a nebulizer treatment with beta agonist (albuterol) in the office and give him a dose of Prednisone 60mg po.

Which of the following adverse effects may occur in a surgical patient receiving dexamethasone (Decadron) on an ongoing basis? Hyponatremia and hyperkalemia Hypotension and weight loss Increased muscle mass and somnolence Impaired wound healing and infection

Glucocorticoids act to interrupt inflammatory and immune responses.

Which adverse drug effect may occur in a patient receiving prednisone? Gastrointestinal (GI) irritation Hypoglycemia Dehydration Thickened skin

Glucocorticoids decrease the viscosity of gastric mucus, which normally protects the lining of the stomach from irritants. As a result, GI irritation can occur.

What class does Zantac belong to?

H2 blocker -azoles are PPIs

Which medications inhibit the action of histamine receptors thereby inhibiting gastric acid secretion and reducing total pepsin output?

H2RAs The resulting decrease in acid permits healing of ulcerated areas

What are the most common adverse effects of alpha agonists?

Headache, insomnia, restlessness, excitement, euphoria

• Question 9 A woman who has been using oral contraceptives for 2 years asks the health care provider how long she can continue to use this form of birth control. What response should the health care provider give? -: Healthy, nonsmoking women can use oral contraception until age 25. Healthy, nonsmoking women can use oral contraception until age 30. Healthy, nonsmoking women can use oral contraception until age 40. Healthy, nonsmoking women can use oral contraception until age 50.

Healthy, nonsmoking women can use oral contraception until age 50. Healthy, nonsmoking women can continue to use oral contraceptives without increased risk of cardiovascular disease until the age of 50 years. Oral contraceptives should not be used by women who smoke after age 35, owing to marked increase in risk for cardiovascular disease.

A patient with chronic respiratory disease has an order for salmeterol (Serevent), two puffs every 12 hours. Review the following possible adverse effects, and select the one that could occur following a dose of this drug. Pupil reaction Heart rate changes Deep tendon reflexes Level of consciousness

Heart rate changes Salmeterol xinafoate is a long-acting beta agonist commonly used in combination with an inhaled corticosteroid for long-term control of respiratory symptoms. Adverse effects include tachycardia and hypokalemia, and prolonged QT interval with overdose.

A diabetic patient is receiving methylprednisolone (Solu-Medrol). What medication changes can the health care provider anticipate that this patient may require? Answers: An increased dose of the corticosteroid A decreased dose of the corticosteroid An increased dose of the antidiabetic drug A decreased dose of the antidiabetic drug

High doses of glucocorticoids increase serum glucose levels. Therefore insulin and oral hypoglycemic drugs used for diabetes mellitus may appear ineffective. Increased dosages of the antidiabetic drugs may be required.

A patient with a history of seizure disorder exhibits ataxia and nystagmus. Which type of anticonvulsant drug will produce these adverse effects?

Hydantoins (anti-convulsants) Double vision can also be seen.

• Question 6 A patient is beginning to take a combination estrogen-progestin product as an oral contraceptive (OC). Which symptom(s), if verbalized, demonstrates that the patient has knowledge of the adverse effects associated with this drug? -: Total loss of menses Reduced breast size Hypotension Hypertension

Hypertension The estrogenic adverse effects from OCs include nausea, vomiting, breast tenderness and enlargement, hypertension and migraine headaches. Progestins can cause appetite increase, weight gain, fatigue, depression, and decreased libido.

• Question 5 A patient who is receiving anticoagulant therapy is also being started on estrogen therapy. Which action may the health care provider need to take because of the interaction of these drugs? -: Increase the dose of the anticoagulant. Decrease the dose of the anticoagulant. Increase the dose of estrogen. Add ascorbic acid to the therapy.

Increase the dose of the anticoagulant. The action of clotting factors is increased by estrogen, thus diminishing the effects of oral anticoagulants. Thus the anticoagulant dose may have to be increased.

The patient has recently been diagnosed with Addison's disease. What patient teaching points should the health care provider emphasize about drug therapy for Addison's disease? Corticosteroids should be maintained at a steady level at all times. Corticosteroids are adjusted to meet changes in the patient's stress level. Corticosteroids are adjusted according to blood glucose measurements. Corticosteroids are adjusted according to blood pressure measurements.

Instruct patients regarding the need to temporarily increase drug dosages during times of stress.

Which effect on carbohydrate metabolism is unique to insulin's action? Decrease in glucose oxidation Increase in cellular uptake of glucose Decrease in glucose storage Increase in the rate of gluconeogenesis

Insulin influences carbohydrate metabolism by increasing glucose uptake, increasing glucose oxidation, and increasing glucose storage.

All of the following are true about the drug celecoxib (Celebrex) except: May be used daily for arthritic pain. Is safe to use in patients with allergy to sulfonamides Should be used cautiously in patients with heart disease because of risk for increased cardiovascular mortality in this group. Is the only remaining COX-2 on the market

Is safe to use in patients with allergy to sulfonamides

The mother of a pediatric patient asks the health care provider why her child should not be given aspirin. Which of the following statements represents the most accurate response by the health care provider? It could precipitate or worsen the potentially fatal Reye's syndrome. It could precipitate liver failure. It could cause deterioration of kidney function. It could lead to chronic nosebleeds.

It could precipitate or worsen the potentially fatal Reye's syndrome. Reye's syndrome is a rare but serious disorder that carries a mortality rate of 20% to 30%. Reye's syndrome is often the sequela of varicella and other viral infections. Salicylates may precipitate or worsen this disorder, but there is no unequivocal proof at this time that aspirin is a major factor.

The mother of a pediatric patient asks the health care provider why her child should not be given aspirin. Which of the following statements represents the most accurate response by the health care provider?The mother of a pediatric patient asks the health care provider why her child should not be given aspirin. Which of the following statements represents the most accurate response by the health care provider? It could precipitate or worsen the potentially fatal Reye's syndrome. It could precipitate liver failure. It could cause deterioration of kidney function. It could lead to chronic nosebleeds.

It could precipitate or worsen the potentially fatal Reye's syndrome. Serious condition that causes swelling in the liver and brain. Most often affects children and teenagers recovering from a viral infection. 20-30% mortality rate.

Prolia (denosumab) is a monoclonal antibody that binds to the receptor activator of nuclear factor-kappa B ligand (RANKL), a transmembrane or soluble protein essential for the formation, function, and survival of osteoclasts, the cells that are responsible for bone resorption. All of the following are true except: It is indicated for the prevention of fracture in postmenopausal women with osteoporosis & high fracture risk. It may not be given to patient that have hypocalcemia Usual dose is 60mg sub q once evey 6 months. All patients should also receive 10,000mg of calcium and 400 IU of vitamin D daily. It does not have the same concern as the biphosphonates for osteonecrosis of the jaw.

It does not have the same concern as the biphosphonates for osteonecrosis of the jaw.

A patient receiving nedocromil (Tilade) asks how this drug will help control a respiratory condition. Which of the following responses would be most appropriate for the health care provider to give the patient? It is a beta agonist that causes bronchodilation. It stabilizes mast cells to block reaction to allergens It is a corticosteroid that suppresses the immune response. It increases the diameter of the bronchioles.

It stabilizes mast cells to block reaction to allergens. Nedocromil stabilizes mast cells, whereby the activation and release of chemical mediators from eosinophils and epithelial cells are blocked.

The CYP 450 enzymes are proteins located in the endoplasmic reticulum of cells in the body. Around 15 of the CYP450 isoenzymes are involved in the biotransformation of drugs. Of these, 5 of them are responsible for 90-95% of drug biotransformation. The CYP IIIA4 subsystem is a type of one of the CYP450 enzymes. This particular subsystem is responsible for the largest percentage of biotransformation in this system. Where are most of the CYP450 isoenzymes (that are responsible for the largest percentage of drug biotransformation) located? spleen kidney liver skin

LIVER

The patient is being considered for treatment with the drug metformin (Glucophage). The health care provider recognizes that a contraindication to use of this drug with this patient would be his history of: Asthma Chronic bronchitis Renal disease Enlarged prostate

Metformin is contraindicated for use in patients with renal disease because of the tendency for the drug to accumulate.

Which type of headache is most commonly experienced by children?

Migraine headaches

Which of the following conditions can best be treated by the antiallergy drug cromolyn (Nalcrom)? Acute bronchospasm Acute asthma attack Status asthmaticus Mild persistent asthma

Mild persistent asthma Antiallergy drugs (previously known as mast cell stabilizers) are approved only for asthma prophylaxis; they allow for reduced dosages of corticosteroids and bronchodilators. These drugs are effective for patients with mild persistent asthma, including allergic asthma and asthma induced by exercise, cold air, and sulfur dioxide.

• Question 2 Which patient education points should the health care provider emphasize to the patient who is taking testosterone drugs? -:Add another gram of sodium to the daily diet. Monitor body weight on a regular basis. Drink an extra liter of fluid per day. Eat an extra banana or an orange 3 times a week.

Monitor body weight on a regular basis. Fluid retention can occur with testosterone replacement drugs. For this reason, the patient should be told to monitor weight on a regular basis.

A patient is taking Zocor 40 mg daily for dyslipidemia. The patient complains of leg weakness and pain. What would be the appropriate action to take?

Myopathy and rhabdomyolysis are not common with statin use, but they are known potential adverse reactions. Stop the Zocor and check the patient's CPK.

What does digoxin inhibit?

Na-K-ATPase pump; results in an increase in intracellular sodium which leads to pumping of sodium and calcium out of the cell

Which of the following adverse effects is most commonly associated with the use of intranasal cromolyn? Hypertension Burning of the eyes Heartburn Nasal burning and congestion

Nasal burning and congestion The most commonly reported adverse effects of intranasal cromolyn are sneezing, nasal burning, epistaxis, throat irritation, hoarseness, and an unpleasant bitter taste. The most serious adverse effect of cromolyn sodium is bronchospasm and coughing.

Which of the following is not a nasal corticosteroid? Omnaris Nasacort Veramyst Nasalcrom

Nasalcrom Nasalcrom is a mast cell stabilizer that can be used in the prevention and relief of nasal allergies. Nasacort, Veramyst, and Omnaris are all nasal steroid sprays that can be used to treat seasonal and perennial allergic rhinitis as well as prophylaxis of seasonal allergic rhinitis in patients of 12 years of age.

• Question 3 Which adverse drug effect associated with conjugated estrogen (Premarin) is the most common? -: Metallic taste in the mouth Nausea Tarry stools Constipation

Nausea Common minor adverse effects of estrogen pharmacotherapy include nausea, headache, midcycle bleeding, breast tenderness and enlargement, abdominal bloating, and increased vaginal discharge.

Suggest a treatment plan for a 25 year old female with migraines. She is experiencing uncomplicated migraines 2-3 times per week. No allergies. No co-morbidities. Suggest both preventative pharmacologic management as well an abortive medication.

Needs an abortive med: Excedrin, triptan- like imitrex (25-100 mg po x1), maxalt, etc. Also needs a preventative because she is having so many migraines. Can consider CCB, Beta-blocker (Toprol XL, 50-200 mg qd), antidepressant, some antiseizure meds (Topamax 50 mg po bid)

How often should phosphodiasterase inhibitors be used? Ex. Viagra, Cialis, Levitra (-afil)

No more than once per day

60 yo male with no chronic medical problems other than osteoarthritis in his knees comes to see you for knee pain. He is having pain when he wakes up that resolves in 10-15 minutes, but worsens again with activity, especially if he walks a distance or runs. He has normal labs, and a normal exam other than some crepitus in both knees. No swelling. Discuss the recommendations that you would make (OTC and/or prescription).

Non pharmacologic treatment should be emphasized. The patient should continue to exercise, but perhaps should run or walk shorter distances to prevent painful episodes. Rest, ice, compression and elevation should be used for pain. I would try him on Tylenol extra strength (OTC), 500 - 1000 mg every 4 - 6 hours by mouth, maximum 4000 mg (8 tablets) in 24 hours. If this didn't work, I would prescribe a COX-2 inhibiting NSAID (Celebrex 200 mg daily by mouth) to provide the minimum risk of GI side effects. If the drug was too expensive, we could do a 2 - 3 week trial of a non selective NSAID, probably naproxen 250 - 500 mg by mouth every 12 hours, maximum 1500 mg daily, then reassess for efficacy and side effects.

A patient who was taking oxycodone (Percocet) at home for relief of chronic back pain visits the emergency department on the weekend after the prescription for this drug expired and could not be refilled by the local pharmacist. The patient is complaining of back pain and muscle and joint pain, and also exhibits tremors and irritability. Which condition may the patient have? Acute back injury Pain-induced psychosis Opioid withdrawal Influenza

Opioid withdrawal Signs of opioid withdrawal peak at 36 to 72 hours after the last dose and include tactile hallucinations, irritability, sleeplessness, yawning, tremor, joint and muscle pain, anorexia, nausea, vomiting, diarrhea, dehydration, abdominal cramps, ketosis, weight loss, distorted vision and photophobia. They subside gradually over 2 to 5 weeks.

The health care provider teaches a patient beginning tricyclic antidepressant drug therapy about measures to minimize the most serious common adverse drug effects. What adverse reactions is considered the most serious?

Orthostatic hypotension Due in part, to blockade of alpha-1 receptors on blood vessels

What medications are used frequently by swimmers who have repeated ear infections?

Otic drugs that contain antibacterial drugs + alcohol (as a drying agent)

Which of the following drugs inhibits the synthesis of thyroid hormones and reduces peripheral conversion of T4 to the more potent T3? Liotrix (Thyrolar) Levothyroxine (Synthroid) Methimazole (Tapazole) Propylthiouracil (PTU)

PTU blocks the synthesis of thyroid hormones and also reduces peripheral conversion of T4 to T3. By inhibiting the synthesis of thyroid hormones, PTU reduces the signs and symptoms of hyperthyroidism.

Omeprazole works at the ______ cells.

Parietal Drug is protonated and cyclizes, forming sulfenic acid which is then converted to sulfenamide which binds to proton pumps and inhibits pumping. Pumping is not restored until new pumps are synthesized.

Stool softeners such as docusate are used to prevent constipation in patients who should avoid straining at stool, including....

Patients who had an MI or who have had rectal surgery

The set of properties that characterizes the effects of a drug on the body is called: Distribution Permeation Pharmacodynamics Pharmacokinetics Protonation

Pharmacodynamics

Question 12 Which of the following are true regarding emergency contraception? -: Emergency contraception is teratogenic in patients that are already pregnant. Plan B is an estrogen only form of emergency contraception Plan A is the best form of emergency contraception Plan B is a progestin only form of emergency contraception

Plan B is a progestin only form of emergency contraception While Plan A is probably the better option- (plan ahead), Plan B is the marketed form of emergency contraception that is a progestin only drug.

Why should a women not be exposed to crushed finasteride (for BPH)?

Potential for teratogenic effects in a male fetus

The patient responds well to a couple of neb treatments in the office. His SaO2 rises to 97%, his breat sounds improve and his FEV1 improves. You decide to send him home with medications and close follow-up. Which of the following regimens would not be a reasonable choice? Prednisone 50 mg daily x 5 Prednisone 60mg daily x 5 day Prednisone 10mg daily x 10 days prednisone 20mg bid x 5 days

Prednisone 10mg daily x 10 days Prednisone can be administered as a "burst" in acute asthma exacerbations a 40-60mg daily or in divided doses x 3-10 days. If prescribed for more than 2 weeks it should be tapered off. The 10mg dose would be inadequate to be effective in an acute asthma exacerbation.

The primary care provider is considering adding methotrexate to the patient's treatment regimen. A preexisting condition that would contraindicate use of this drug with this patient is: Diabetes mellitus Cardiac arrhythmias Chronic obstructive pulmonary disease Pregnancy

Pregnancy Methotrexate is contraindicated for use during pregnancy. The teratogenic effects of the drug during the first trimester can be severe

A 46 yo woman with a history of asthma that has been well-controlled on a daily dose of moderate-dose ICS calls and asks for a refill on her albuterol inhaler. She has not had to use it in a long time and has lost hers and has been using her daughters albuterol inhaler since she recently got over an upper respiratory infection. She has gotten over the URI symptoms but has had more cough and wheezing than usual. What is the next step in management? Double her moderate dose ICS Prescribe an antibiotic Chest Xray Prescribe a short course of an oral corticosteroid and her own rescue inhaler

Prescribe a short course of an oral corticosteroid and her own rescue inhaler She likely had a viral infection that triggered an asthma exacerbation. She probably does not need antibiotics or a chest Xray. Of course she should be seen and evaluated. She will likely need a short course of an oral corticosteroid and a prescription for her own rescue med (albuterol inhaler).

Why is omeprazole enteric coated?

Prevent breakdown in stomach. Drug is released in alkaline pH of duodenum and absorbed into bloodstream.

Which of the following symptoms would indicate a patient's localized response to inflammation? Fever and headache Redness and swelling Anorexia and malaise Weakness and lethargy

Redness and swelling Redness, swelling, warmth, pain, and sometimes loss of function occur as local signs and symptoms of inflammation. Systemic manifestations include fever, headache, loss of appetite, lethargy or malaise, and weakness.

How many tabs of triptans should be written for?

Regarding Migraines- most insurance plans will only allow 9 or 10 pills a month. That being said, if they need that many, you don't have the migraines under control. Write for 10 tabs of a triptan. The preventative choices you all used were good. Beta blockers, CCBs, and some of the antiseizure meds were selected. A couple chose cyproheptadine which is an antihistamine. I haven't used that as a preventative but it wouldn't hurt to try it, especially if the patient has N&V with their migraines. Toprol XL 12.5-25 mg PO daily, double dose every 2 weeks, max 200 mg.

The health care provider is considering pain relief options for the patient. A condition that would not be an indication for use of an opioid analgesic is: Postoperative pain Traumatic injury Relief of abdominal pain from constipation Analgesia during labor and delivery

Relief of abdominal pain from constipation The primary use of an opioid analgesic is to prevent or relieve moderate to severe acute or chronic pain of various etiologies, including traumatic injuries, burns, biliary or renal colic, cancer-related pain and postoperative pain, and for analgesia during labor and delivery and diagnostic procedures. Constipation would be considered an adverse effect of opioid use.

Which body system is primarily responsible for drug elimination? Respiratory Gastrointestinal Renal Hepatic

Renal

_____ is an immune modulator that can increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with ketaroconjunctivitis sicca.

Restasis

QUESTION 15 - 5 points A 17 yo high school athlete presents with a large abscess on his thigh. You perform and I&D and drain a large amout of purulent exudate. What would you treat him with empirically? Write a prescription.

Rx: 160 TMP/800 SMX q12h x 10 days

QUESTION 14 - 5 points You see a 20 yo male college student that lives in a dorm with c/o cough and fever. He has crackles in the right lower lobe. You diagnose him with pneumonia. He has no known allergies and no chronic medical conditions. He has not had any other recent illnesses. Write a prescription for an antibiotic to treat him.

Rx: Azithromycin 500mg PO x 1 day, then 250mg PO x 4 days.

QUESTION 16 - 5 points You see a 24 yo that is 24 weeks pregnant. She c/o dysuria and frequency and you do a UA that shows TNTC WBCs, 5-10 RBCs, and many bacteria. She has no known allergies and has had an uncomplicated pregnancy until now. No chronic medical problems. Write a prescription to treat her UTI.

Rx: Cephalexin 500mg PO q6h x 10 days

QUESTION 18 - 5 points A 55 yo woman presents with classic UTI sxs. She has dysuria and frequency and had a normal exam. Urine is positive for leukocytes TNTC, RBC- 5-10, and many bacterial. She is allergic to sulfa drugs, write a prescription to treat her.

Rx: Cipro 500mg PO q12h x 7 days

QUESTION 17 - 5 points You see a 50 yo male with acute prostatitis. Write a prescription for an antibiotic to treat him.

Rx: Levaquin 500mg PO daily x 7days, Bactrim bid, Cipro 500 mg bid

QUESTION 19 - 5 points A patient presents with strep pharyngitis that is confirmed with a rapid strep screen. No allergies. How will you treat her? Write a prescription.

Rx: Zithromax 500mg PO on day 1, then 250mg PO daily x 4 days.

Write a prescription for an antidepressant for a 50 yo female with a history of depression and chronic pain related to fibromyalgia. She has been unsuccessfully treated with Celexa, Paxil, and Prozac in the past. She has Type II diabetes treated with metformin and glyburide, and hypertension controlled with Lisinopril. She has some problems with peripheral neuropathy.

SNRIs are great for people who have depression and coexisting pain problems. Cymbalta 60 mg po qd Effexor XR 75 mg po qd (inc by 75 mg q4-7 days) Can also consider a TCA

Select an antidepressant to treat a 30 yo male who has no allergies and is not on any other medications. He has never been on any antidepressants. He has no other co-morbidities.

SSRIs are typically the first line treatment in depression and anxiety. Lexapro 10mg/Celexa (take days), Zoloft 50 mg- can inc weekly by 25-50 mg, Prozac (takes weeks), Paxil 20-50 mg inc by 10 mg per week. Give 30 pills (b/c of co-pay). Follow up in 3 weeks.

A patient has been prescribed a beta agonist for acute asthma attacks. Which beta agonist should not be used for acute exacerbations of asthma? Salmeterol Albuterol Metaproterenol Pirbuterol

Salmeterol (Serevent) Deaths have been reported in patients who used salmeterol as a rescue drug, not understanding that it takes a minimum of 20 minutes for the drug to become effective.

A patient is receiving the ocular drug cromolyn (Crolom). What condition(s) would the health care provider expect to see in this patient's medical history?

Seasonal allergic conjunctivitis or vernal keratoconjunctivitis

Which of the following adverse effects are characteristic of centrally acting skeletal muscle relaxants? Sedation and drowsiness Weight gain and fever Irritability and restlessness Increased blood pressure and decreased pulse

Sedation and drowsiness Common adverse effects of centrally acting skeletal muscle relaxants are sedation, drowsiness, lightheadedness, ataxia, and dizziness.

What effects are characteristic of centrally acting skeletal muscle relaxants?

Sedation and drowsiness, lightheadedness, ataxia, dizziness

How would you classify his asthma? Mild persistent asthma Mild intermittent asthma Severe persistent asthma Moderate intermittent asthma

Severe persistent asthma

What is a common adverse effect that results from increased levels of serotonin in the synaptic cleft associated with taking an SSRI such as fluoxetine (Prozac)?

Sexual dysfunction Serotinergic 5HT2A postsynaptic receptors when stimulated by 5-HT (serotonin) release from presynaptic nerve terminals causing increased firing of post synaptic cells. Stimulation is responsible for depression; anxiety; sleep disorders; and decreased sexual function.

Name a metallic agent that is widely used in the treatment of burns.

Silver sulfadiazine

Sitagliptin is an agent for the treatment of diabetes that does which of the following? Enhances the expression of insulin receptors on the cell surface; thus, reducing insulin resistance. Stimulates insulin release by the beta cells in the pancreas in a glucose-dependent manner Inhibits the action of dipeptidyl peptidase-4; thus, increasing existing endogenous GLP-1 levels Stimulates gut L-cells to increase production of endogenous GLP-1

Sitagliptin is one of the newer drugs available for the treatment of diabetes which falls under the DPP-IV inhibitor category. In the US, saxagliptin is the only other available drug in this class. DPP-IV inhibitors block the action of dipeptidyl peptidase-IV, the enzyme responsible for degrading the native GLP-1. The drugs that enhance the expression of insulin receptors on the cell surface are the TZD's by increasing the activity of the PPAR genes. GLP-1 agonists (exenatide), stimulate insulin release by beta cells in a glucose-dependent manner. No agent exists that stimulates the L-cells to produce more GLP-1 as of yet.

• Question 7 A woman near menopausal age is considering estrogen replacement therapy. What effect does estrogen have on the process of osteoporosis? -: No apparent effect Replaces lost bone Stimulates new bone growth Slows postmenopausal bone loss

Slows postmenopausal bone loss Estrogen is a very effective treatment for the prevention of osteoporosis in women. It increases bone density, promotes calcium retention, reduces bone resorption, and slows postmenopausal bone loss.

What is the most common cause of lithium accumulation in patients adhering to the treatment regimen?

Sodium depletion and dehydration Reduces the volume of distribution of lithium and increases serum levels

Which of the following is a long-acting anticholinergic that is indicated for long-term maintenance treatment of bronchospasm due to COPD? Atrovent inhaler 2 puffs qid Advair 100/50 1 puff bid Spiriva 2 inhalations of one capsule once daily Symbicort 160/4.5 2 inhalations twice daily

Spiriva 2 inhalations of one capsule once daily Symbicort and Advair are both combinations of a long-acting beta-agonist and an inhaled corticosteroid. Atrovent is a short-acting anticholinergic. Spiriva is a long-acting anticholinergic indicated in COPD to treat bronchospasms.

What medication antagonizes aldosterone-specific mineralcorticoid receptors primarily in the distal convoluted tubule, decreasing sodium and water reabsorption and increasing K retention?

Spironolactone

A patient has been instructed to take benzonatate (Tessalon Perles) for nonproductive cough due to bronchial irritation. Which patient instruction should the health care provider give to this patient? Swallow the capsule whole. Chew the capsule as needed to prevent choking. Limit fluid intake when taking the drug. Increase intake of vitamin D while taking the drug.

Swallow the capsule whole. If the integrity of the capsule is lost, such as occurs with chewing, the drug could cause a local anesthetic effect and produce choking. Patients should be told to swallow the capsule whole.

A substrate is the drug that is metabolized by the isoenzyme. That drug will seek the particular enzyme to be biotransformed so that it can either reach the site that it needs to act in the body, or so that it can be eliminated. TRUE OR FALSE

TRUE

Most drugs are designed to be lipophilic (attracted to fat) to allow for absorption and so that they can penetrate the cell membranes. TRUE OR FALSE

TRUE Most drugs are designed to be lipophilic (attracted to fat) to allow for absorption and so that they can penetrate the cell membranes. In order to be excreted, these substances must be converted to a hydrophilic metabolite to allow for excretion. These reactions that convert the drugs from lipophilic to hydrophilic through the use of the CYP450 isoenzyme system is a phase I reaction. It is a common source of drug interactions.

The patient is experiencing a reduction in her dosage of a benzodiazepine after 10 years of heavy use. What adverse effect will result from such a reduction?

Tachycardia

What is a characteristic effect of an atropine overdose?

Tachycardia (bradycardia can be seen after small doses)

What are S/S of benzodiazepine withdrawal?

Tachycardia, fatigue, ataxia, blurry vision, hyperreflexia, depression, nausea

When are anticholinergic drugs most useful in treating patients with Parkinson's disease?

The patient is early in the course of the disease, with tremor but with little rigidity or bradykinesia. Anticholinergics are useful early in younger patients and can be used for middle-aged adults who have tremor but little rigidity or bradykinesia.

• Question 19 If a patient calls and tells you that she missed her pill yesterday (that she usually takes first thing in the morning), which is your best response? -: Throw that pack away and start a new pack the same day Use emergency contraception immediately, then start a new pack Take both yesterday's and today's pills, then continue taking that same pack Have her come in for an immediate pregnancy test and start Depo-Provera

Take both yesterday's and today's pills, then continue taking that same pack

A patient is undergoing thyroid replacement therapy with levothyroxine (Levothroid). At what time should the health care provider instruct the patient to take this drug? Immediately after breakfast or lunch Before breakfast on an empty stomach With the last meal of the day At bedtime on an empty stomach

Teach patients to take levothyroxine exactly as directed, on an empty stomach, and at the same time each day. Administration before breakfast is usually best.

Bismuth subsalicylate (Pepto-bismol) can decrease the absorption of which medications?

Tetracycline antibiotics

Which one of the following statements is an accurate description of a drug with a designation of "Food and Drug Administration (FDA) Pregnancy Category A"? The drug is not likely to cause fetal harm. The drug may or may not cause fetal harm. The drug may cause fetal harm, but it may be used if benefit outweighs risk. Use of the drug is contraindicated owing to prior demonstrated evidence of fetal harm.

The drug is not likely to cause fetal harm.

A patient is receiving hydromorphone (Dilaudid) as treatment for chronic pain. Which patient action would indicate a developing tolerance to the drug? The patient takes fewer doses during the day. The time frame between doses lengthens. The patient forgets to take a dose as scheduled. The patient takes a higher dose to obtain relief.

The patient takes a higher dose to obtain relief. Tolerance to opioids can develop quickly, depending on the dose and frequency of use. Tolerance is characterized by a shorter duration of pain relief, decrease in peak analgesic effect, and increase in the amount of the drug needed to relieve the pain.

• Question 1 A patient has been given a transdermal gel formulation of testosterone (AndroGel) for daily use. Which of the following patient teaching points, if implemented, would indicate that the patient has a correct understanding of the drug? -: The application site should not be covered to avoid transfer to clothing. The patient should shower immediately after application to rinse off residue. The gel should be applied to a clean dry area of the shoulder. Smoking should be avoided during use of the gel.

The gel should be applied to a clean dry area of the shoulder. AndroGel and Testim, the transdermal gel formulations of testosterone, are applied to clean, dry, intact skin of the shoulder, the upper arms, or the buttocks. Do not apply AndroGel to the scrotum, or Testim to the abdomen.

Which of the following statements best describes the process by which the plasma concentration of a drug declines with first-order kinetics? There is only 1 metabolic path for drug elimination The half-life is the same regardless of the plasma concentration. The rate of elimination is proportional to the rate of elimination at all times The drug is largely metabolized in the liver after oral administration and has low bioavailability The drug is distributed to only one compartment outside the vascular system

The half-life is the same regardless of the plasma concentration.

What criteria would the health care provider use to evaluate the efficacy of drug therapy for adrenal insufficiency? The patient's symptoms decrease, and no adverse drug effects are experienced. The patient's symptoms respond to maximal doses of the drug. The patient's symptoms decrease to a tolerable level. The patient's symptoms are eliminated completely.

The objective of treatment for adrenal insufficiency is to reduce patient symptoms to a tolerable level. Reasonable goals for drug therapy should be set in collaboration with the patient.

Which group of symptoms may be indicative of overdosage in a patient taking a thyroid replacement hormone? Bradycardia, somnolence, and ataxia Dry skin, tremors, and weight gain Tachycardia, insomnia, and nervousness Sneezing, coughing, and neck pain

The signs of thyroid hormone overdose mimic those of hyperthyroidism. They include tachycardia, chest pain, nervousness, insomnia, diaphoresis, tremors, and weight loss.

• Question 10 In treating an adult male patient that is concerned about hypogonadism, the following are true except: -: The diagnosis should be confirmed by both symptoms and laboratory findings confirming the diagnosis. Therapy should be individualized to each patient and the patient's goals and expectations of treatment should be ascertained. Treatment should be designed to ameliorate symptoms and minimize adverse effects of the drugs that are prescribed. The target testosterone levels should be aimed to achieve supraphysiologic peaks in order to achieve the best patient response.

The target testosterone levels should be aimed to achieve supraphysiologic peaks in order to achieve the best patient response.

The patient is experiencing amenorrhea as part of infertility. The health care provider is considering placing her on bromocriptine (Parlodel) as part of her treatment regimen. A contraindication to use of the drug with this patient would be her history of: Mental illness Cardiovascular disease Asthma Constipation

This drug holds a risk of first-dose phenomenon as evidenced by sudden cardiovascular collapse.

The patient is being treated with the drug pilocarpine (Pilocar). He complains of eye irritation. The most appropriate response of the health care provider is:

This is an expected adverse reaction to the medication. Pilocar is used to treat dry mouth and glaucoma.

A 52 yo man with type 2 DM comes to see you as a new patient. He has been on maximal doses of glipizide and metformin for 9 months and he states his blood sugars are increasing despite compliance with diet and medication. After a full evaluation, you start the patient on Actos and wait another 3 months. The patients FBS is now 187 and the Hb A1c has gone up from 8.5% to 10%. The patient assures you that he is compliant with medications and diet and states that he is walking 30 mins daily. What is the best next treatment to improve the patient's glycemic control? Answers: Start the patient on exenatide 5 mcg bid SQ Start the patient on pramlitide 60 mcg qAC SQ Start the patient on sitagliptin 100 mg QD Start the patient on insulin therapy

This patient has type 2 DM which is poorly controlled on a combination of 3 oral agents. As recommended by the AACE roadmap, patients on 2 or more oral agents who A1C is greater than 8.5% require insulin therapy to achieve glycemic goals. Insulin will reduce A1c by any required level and does not have a maximal dose. The addition of exenatide or sitagliptin will, at best, reduce A1c by 1% which will not get this patient to goal A1c. Pramlitide is only indicated in combination with insulin and would not be indicated for this patient when on 3 oral agents.

A 22 yo man presents to the clinic in a stupperous state. He has a bracelet that identifies him as having Type 1 DM. He has a fruity smell and is found too had a blood sugar of 569. Serum ketones are elevated, the serum pH is 7.06 and the patient has an anion gap of 25. What is the best form of treatment for this patient? Answers: IV insulin aspart bolus followed by insulin aspart q 3 hr subq Correct Regular insulin in IV drip using a scale ASQ regular insuling sliding scale SQ insuglarginnine once daily

This patient is presenting in severe ketoacidosis. The best form of treatment if IV insulin with regular insulin in a drip adjusted with a sliding scale. Alternatively, two rapid active insulines, aspart and lispor, have indications for IV use but neither has an advantage over regular

Which effect is associated with thyroid replacement hormones such as levothyroxine (Levothroid)? Increase in the metabolic rate of body tissues Inhibition of gluconeogenesis Decrease in utilization and mobilization of glycogen stores Inhibition of protein synthesis and cell growth

Thyroid hormones act to increase the metabolic rate of body tissues, promote gluconeogenesis, and increase the utilization and mobilization of glycogen stores. They also stimulate protein synthesis, cell growth, and differentiation, and aid in development of the central nervous system.

True or false: The action of warfarin is enhanced in the presence of fibrates?

True- drugs used to treat high cholesterol and high triglycerides gemfibrozil, fenfibrate

What is a cation-exchange resin (Kayexelate) used for?

To treat hyperkalemia. Exchanges sodium for hydrogen ions in the stomach and colon and then exchanges hydrogen for excess cations, such as potassium.

A patient reports feeling drowsy after taking a first-generation antihistamine. Which statement is the most appropriate response for the health care provider to give the patient? The drowsiness will probably worsen over time This effect can be reversed by taking a central nervous system (CNS) stimulant at the same time. The patient should not take any further doses of this drug. Tolerance to the drowsiness should develop within a few days or weeks.

Tolerance to the drowsiness should develop within a few days or weeks. Drowsiness is more common with first-generation histamine1 (H1) antagonists than with second-generation drugs and is characterized by slowed reaction times, diminished alertness, and drowsiness in 20% of patients. Impaired performance occurs whether or not the patient feels drowsy. This is particularly of concern in older adults, who are at high risk for falls. Fortunately, tolerance to the sedative effect of H1 antagonists often develops within a few days or weeks.

A mother brings her 5 yo in with complaints of several itchy patches on her daughter's leg. She has 3 erythematous, oval shaped patches with scalloped, scaly borders, and central clearing. You diagnose tinea corporis. Suggest a treatment plan.

Topical antifungals (-azoles and -allyamines): Clotrimazole 1% cream, bid/ Ketoconazole 2% cream daily for 2 weeks

A 14 yo female presents with complaint of an itchy rash on her abdomen just above the umbilicus. She has had the rash for about 3 months. It is red, has some vesicles and excoriations. It looks like a contact dermatitis. Her ROS and PE are otherwise normal.

Topical corticosteroid (Triamcinolone 0.1% ointment bid) and avoiding the allergen.

A patient is receiving levodopa (L-dopa) as part of treatment for Parkinson's disease. What symptom diminishment indicates that the drug is having a primary therapeutic effect?

Tremor and rigidity

An inhibitor blocks the activity of the isoenzyme so that the substrate cannot be biotransformed. This can result in limited substrate excretion, allowing for an increase in substrate levels, and possibly the risk of substrate toxicity. TRUE OR FALSE

True

Biphosphonates are non hormonal agents that have an extremely high affinity for bone. These drugs inhibit the activity of osteoclasts to normalize the rate of bone turnover resulting in an increase in bone mineral density. Selected Answer: True False

True

Colchicine 1.2 mg PO x1, then 0.6 mg PO 1h later x1 can be used for the treatment of an acute gout attack in patients that can not take NSAIDs or COX-2 inhibitors. True False

True

Cyclobenzaprine (Flexeril) is a muscle relaxant that is structurally related to TCAs (Tricyclic antidepressants). It acts in the CNS to reduce tonic somatic motor activity. It causes reserpine antagonism, norepinephrine potentiation, substantial anticholinergic effects, and sedation. True False

True

True or False: Nitric oxide activates guanylate cyclase which increases cyclic guanosine monophosphate (cGMP). cGMP causes vascular smooth muscle relaxation, which leads to vasodilation and increase blood flow. PDE5 is the enzyme that breaks down cGMP in the corpus cavernous. Inhibition of PDE5, with PDE5 inhibitors like sildenafil inhibit cGMP degradation, allowing for smooth muscle relaxation and increased blood flow into the penis, resulting in an erection.

True

True or False: Warfarin suppresses coagulation activity by interfering with the production of vitamin-K-dependent clotting factors (II, VII, IX, X).

True

True or false: Floxin otic drops are safe with perforated TMs

True

True or false: HCTZ works by inhibiting distal convoluted tubule sodium and chloride resorption.

True

• Question 16 The Mirena is an IUD that provides low levels of progestin as well as a mechanical protection against pregnancy. It is effective for 5 years and can actually also be used to help reduce heavy menstrual bleeding. It can be inserted in an office setting by health care providers that have had some specialized training. -: True False

True

• Question 17 The Nuvaring is a vaginal ring that delivers hormones that are packaged into the ring itself. The medications are slowly dissipated into the tissues after being inserted vaginally. The delivery system allows for lower doses of drugs because they avoid first- pass phenomenon. The ring is placed vaginally and it's specific placement is not of concern. The ring will find its place. -: True False

True

DMARDs, or disease modifying antirheumatic medications, have antiinflammatory effects that may slow disease progression and preserve joint function. True False

True Ex. Methotrexate, Adalimumab

A patient with which type of diabetes mellitus is most likely to experience insulin resistance Type I Type II Gestational Impaiered glucose tolerance

Type 2 diabetes is characterized by insulin resistance and relative insulin deficiency.

• Question 4 Which condition should contraindicate use of progestins? -: Advanced breast cancer Menopausal symptoms Endometriosis Undiagnosed vaginal bleeding

Undiagnosed vaginal bleeding Contraindications to the use of progestins include undiagnosed vaginal bleeding. Other contraindications include thromboembolic disorders, liver disease, breast or genital tract cancer, and cerebrovascular bleeding.

Antimuscarinics are contraindicated for use in patients with what?

Urinary or gastric retention

The health care provider is assessing a patient who is undergoing therapy with desmopressin (DDAVP). Which of the following electrolytes should be monitored closely while the patient is receiving the drug? Sodium Potassium Calcium Magnesium

Use desmopressin cautiously in patients with fluid and electrolyte imbalances because of the risk of hyponatremia.

A female patient receiving vasopressin (Pitressin) as treatment for diabetes insipidus complains of uterine cramping accompanied by diarrhea. Which response should the health care provider give? Answers: These symptoms are the result of a toxic dose of the drug. These symptoms are the result of oxytocic and smooth muscle effects of the drug. These symptoms are the result of onset of acute renal failure. These symptoms are the result of an idiosyncratic drug response.

Uterine cramping and diarrhea may occur because of the oxytocic and the stimulant effect of vasopressin on smooth muscle.

What are the adverse CV effects of alpha agonists?

Vasoconstriction, HTN, tachycardia, palpitations, arrythmias

Which of the following conditions would best be treated with vasopressin (Pitressin)? Heart failure Massive gastrointestinal bleed Angina pectoris Hypertension

Vasopressin (Pitressin) can be used as IV or intraarterial infusion in the emergency management of massive GI bleeding.

30 year old male presents with c/o urinary frequency, High BS WITH A1c of 8.8. No prior hostory of diabtes. He does hhave a chiari malformatiom that causes headaches, He sees his neurosurgeon twice yearly. He has had excessive thirst and has been awakening frequently at night to get a drink. He has also had extreme fatigue. His FBS in the office is 217, A1c 8.8. His renal function , LFTs, and CBC normal. How would you approach the management of this patient?

Very comprehensive initial management of this patient. Metformin BID is a good starting dose to allow for GI symptoms to become tolerable. Good inclusion of education also.I would prescribe Metformin Starting dose 500 mg tab BID PO w/ meals, Come back to the office 2 weeks later fo f/u, increase to 500 mg TID w/meal Work with him to help him set goals (for example lowering the A1C level to 8 within 6 months by exercising, following the diabetic diet and complying with the medication regimen) I would refer him to the diabetes educator nurse for carb count, BG monitoring and, overall diabetes teaching. I would also tell him to make an appointment with his neurosurgeon to see if his chiari malformation is worsening.

The patient with Stage 2 HTN will likely require a 2 drug combination to control BP. What drugs would be good first-line choices?

Zestoretic (lisinopril + HCTZ) 10/12.5 mg 1-2 tabs PO qd HCTZ can cause significant electrolyte imbalances without a lot of added anti-HTN benefit so use lower doses

QUESTION 12 The patient is being prescribed an antifungal medication after being diagnosed with oral thrush. Which drug would be an inappropriate selection for this patient? a. Amphotericin B b. Ketoconazole c. Itraconazole d. Fluconazole

a. Amphotericin B

QUESTION 10 - 1 point The patient is receiving dapsone (DDS) for treatment of a Brown Recluse Spider bite (off label use). While the patient is receiving dapsone, the primary care provider should plan to monitor the patient's: a. Complete blood count b. Potassium level c. Urine output d. Calcium level

a. Complete blood count

Which of the following indicate proper areas of instruction when the patient is receiving an antibiotic regimen? Select all that apply. a. Foods that interfere with antibiotic absorption b. Need for adequate hydration c. Avoidance of sun with macrolides d. Necessity for a form of birth control in addition to hormonal contraceptives e. Signs and symptoms to report to the primary health provider

a. Foods that interfere with antibiotic absorption b. Need for adequate hydration d. Necessity for a form of birth control in addition to hormonal contraceptives e. Signs and symptoms to report to the primary health provider

QUESTION 11 - 1 point Which of the following statements is accurate regarding the drug rifampin (Rifadin)? a. Orange discoloration of sweat, tears, urine, and feces will occur. b. It should always be taken with food or antacids. c. It should be taken as a double dose if a previous one is forgotten. d. It can be automatically stopped if symptoms are gone in 3 months.

a. Orange discoloration of sweat, tears, urine, and feces will occur.

QUESTION 4 - 1 point Which factor is the success of most vaccines in establishing an antigen-antibody response dependent upon? a. The humoral response of the immune system b. The age and weight of the patient c. Sufficient levels of circulating proteins d. Sufficient levels of circulating polysaccharides

a. The humoral response of the immune system

Volume contraction and loss of electrolytes with loop diuretics lead to (select all that apply): a. hypovolemia b. hypokalemia c. hypernatremia d. hyperuricemia e. hypoglycemia

a. hypovolemia b. hypokalemia d. hyperuricemia Also hyponatremia and hyperglycemia

A 60 yo woman with a long history of asthma returns for follow-up. She denies any complaints, but as you question her she admits to waking in the night to use her albuterol inhaler. She is compliant with her daily moderate-dose inhaled corticosteroid. No wheezing is heard on exam and her FEV1 is stable based on spirometry done in the office that day. What is the next step in management? Increase current inhaled corticosteroid to twice daily dosing add a long acting beta agonist add theophylline add a leukotriene receptor agonist

add a long acting beta agonist (-terol) Her night time symptoms indicate that she is not well controlled. Since she is on a moderate dose ICS, the next step would be to add a LABA which has been shown to be more effective than doubling the corticosteroid or switching to a high dose ICS. Leukotriene receptor antagonists (-lukast) and theophylline are next line drugs that can be considered if the LABA does not adequately control symptoms.

-: 1. Depo causes strong progestational effects on the endometrium so irregular bleeding and or spotting is fairly common during the early months of use. Unpredictable bleeding, and/or amenorrhea is common and expected with continual use. 2. Median time to conception after the last Depo injection is 10 months, with a range of 4-31 months. A patient who desires a more rapid return to fertility should choose a different method of contraception. 3. Average weight gain with depo after 1 year is over 5 lbs. After 2 years it is over 8 lbs. It causes an increase appetite. all of the above 1 only 3 only 2 and 3

all of the above

Which of the following insulin preparations can be used in an insulin pump? Novolog 70/30 Humalog 75/25 Lantus Apidra

apidra

QUESTION 24 - 1 point Which treatment would be appropriate for gonococcal conjuncitivitis? a. Erythromycin ophthalmic ointment 1/2 inch ribbon tid to both eyes x 7 days b. Rocephin 1000mg IM x 1 c. Zithromycin 500mg on day one followed by 250mg days 2-5 d. gentamycin ophthalmic drops 2 drops to each eye q 4 hrs while awake x 7 days

b

QUESTION 6 - 1 point A known contraindication to receiving a second dose of a pertussis-containing vaccine is: a. Chest pain b. Encephalopathy c. Altered mental status d. Shortness of breath

b. Encephalopathy

The primary care provider is considering adding a cephalosporin to the patient's medication regimen. Before initiating this therapy, the provider should determine if the patient has experienced an anaphylactic reaction to: a. Sulfonamides b. Penicillins c. Tetracyclines d. Aminoglycosides

b. Penicillins

QUESTION 2 - 1 point Which of the following antibiotics would not likely be given to a 4-year-old child who requires antibiotic therapy, because of its effect on developing teeth? a. Penicillin b. Tetracycline c. Cephalosporin d. Beta-lactamase

b. Tetracycline

QUESTION 9 - 1 point The patient who has been taking isoniazid (INH) for 2 months complains about numbness, paresthesias, and tingling in the extremities. Which of the following interpretations of these symptoms is appropriate for this patient? a. The patient is experiencing hypercalcemia. b. The patient is experiencing peripheral neuritis c. The patient is experiencing small blood vessel spasm. d. The patient is experiencing impaired arterial circulation.

b. The patient is experiencing peripheral neuritis

QUESTION 7 - 1 point A patient is receiving mebendazole (Vermox) as treatment for hookworm. Which of the following routes of drug elimination is applicable to this drug? a. Liver b. Feces c. Urine d. Lungs

b. feces

QUESTION 20 - 1 points Eric is an 18 yo swimmer on the college swim team. He presents to your office with c/o right ear pain. On exam he has an edematous auditory canal with yellow exudates. He c/o pain with tragal or pinnal movement. TMs are normal. What is the likely diagnosis? a. otitis media b. otitis externa c. malignant otitis d. inner ear infection

b. otitis externa

Which of the following antiemetics is a phenothiazine? a. dramamine b. phenergan c. reglan d. zofran

b. phenergen - Zofran- selective 5HT3 receptor antagonist - Reglan- anti-dopaminergic - Dramamine- antihistamine

QUESTION 25 - 1 point A 9 yo male presents with c/o bilateral eye redness, started in the right eye. c/o itching, yellow discharge, and his eyelids were stuck together this morning. He was sent home from school because of it. He is allergic to sulfa drugs. Which of the following should be avoided in this patient? a. erythromycin ophthalmic ointment, apply to affected eye qid b. sulfacetamide ophthalmic 2 drops affected eye every 3 hrs x 7 days c. azithromycin ophthalmic drops 1 drop affected eye bid x 1 day then once daily x 4 days d. Patanol 1 gtt in each eye bid x 10 days

b. sulfacetamide ophthalmic 2 drops affected eye every 3 hrs x 7 days

QUESTION 8 - 1 point The patient has been prescribed chloroquine for treatment of malarial symptoms. Before initiating treatment, the primary care provider should plan to screen the patient for evidence of: a. Hearing deficit b. Change in mental status c. Ocular disease d. Osteoporosis

c. Ocular disease

GI motility is decreased by blocking ______ receptors: a. adrenergic b. anti-adrenergic c. muscarinic d. All of the above

c. muscarinic

Pyridium is not safe for use in patients with: a. chronic renal disease b. liver disease c. glomerulonephritis d. All of the above

d. All of the above

QUESTION 21 Eric is an 18 yo swimmer on the college swim team. He presents to your office with c/o right ear pain. On exam he has an edematous auditory canal with yellow exudates. He c/o pain with tragal or pinnal movement. TMs are normal. What is the likely diagnosis? Which of the following treatments is/are appropriate considerations in treating Eric? a. ciprofloxacin/dexamethasone otic 4 drops into the affected ear twice daily for 7-10 days b. Cortisporin otic drops 4 drops in affected ear qid x 7-10 days c. Ofloxacin otic 10 drops into the affected ear once daily x 7 days d. All of the above

d. All of the above

Stimulant laxatives are contraindicated for use in patients with which conditions? a. abdominal pain of unknown cause (esp when associated with fever) b. rectal fissures c. ulcerated hemorrhoids d. All of the above

d. All of the above

The most of common adverse effects to beta blockers usually happen when therapy is begun and include: a. Hypotension b. Bradycardia c. Bronchospasm d. All of the above

d. All of the above

QUESTION 23 - 1 point 24 yo male presents with red eyes with severe, purulent discharge, eye matting, and preauricular adenopathy and eyelid swelling. It started about 2 days ago. His ROS is negative other than some mild dysuria and penile discharge that he noticed a few days ago as well. Which of the following is the likely diagnosis? a. Allergic conjunctivitis b. Viral conjunctivitis c. Simple bacterial conjunctivitis d. Gonoccocal conjunctivitis

d. Gonoccocal conjunctivitis

QUESTION 13 A health care provider reads in the medical record that a patient is receiving valacyclovir (Valtrex). Review the following viral infections, and select the one that the health care provider expects to see in the patient's history. a. Cytomegalovirus (CMV) retinitis b. Human immunodeficiency virus (HIV) c. Respiratory syncytial virus (RSV) d. Herpes genitalis

d. Herpes genitalis

QUESTION 5 - 1 point Consider the following types of immunizations, and choose the one that a health care provider should refuse to administer to a patient diagnosed with acquired immune deficiency syndrome (AIDS). a. Sera b. Toxoid c. Antitoxin d. Live attenuated viral vaccine

d. Live attenuated viral vaccine

Sodium polystyrene sulfonate resin (Kayexelate) causes all of the following adverse reactions except: a. gastric irritation b. anorexia c. nausea/vomiting d. diarrhea e. constipation f. fecal impaction (esp in older adults)

d. diarrhea (It can occasionally cause diarrhea but only occasionally)

QUESTION 22 - 1 points Which of the following is an aminoglycoside antibiotic that frequently causes sensitization, particularly if applied to eczematous dermatoses? a. Mupirocin b. Silvadene c. Nystatin d. neomycin

d. neomycin

All of the following are functions of the SNS, except: a. fight or flight response for life's stressors b. management of CV system c. regulation of body temperature d. shunting of blood from the heart, blood vessels and lungs to the GI tract, kidneys and skin

d. shunting of blood from the heart, blood vessels and lungs to the GI tract, kidneys and skin

Prescriptive authority for nurse practitioners is: determined by legislation that vary by state. granted by the federal government as outlined in the Affordable Health Care for America Act completely autonomous in all 50 states only regulated by state medical boards

determined by legislation that vary by state.

A 65 yo man who has smoked a pack per day for 45 years presents with shortness of breath that has been progressively worsening with activities. He has a chronic cough and fatigue and reports that he has frequent problems with "bronchitis". Exam reveals a well developed, well nourished 65 yo male. He appears mildly dyspneic. BBS are diminished throughout with expiratory wheezing. O2 sst is 92%. BP 160/90, P 92, R 24, T 98.6. ROS and physical Exam are otherwise normal. What is the differential diagnosis? What are the short- term interventions? Chronic management?

differential diagnosis: GERD, sinusitis, asthma, COPD, ACE inhibitor side effect, postnasal drip, pneumonia interventions: spirometry to get FEV1 and FEV2 measurements and stage his COPD, albuterol/ipratropium nebulizer to treat wheezes (DuoNeb 0.5 mg/2.5 mg/3ml (1 vial) inhaled via nebulizer x 1), short course of steroids (Prednisone 50 mg tabs: take 1 by mouth daily x 5 days, administer 5 tabs, no refills) chronic management: anticholinergic + LABA + PRN beta 2 agonist, smoking cessation, exercise as tolerated, pulmonary rehabilitation, annual flu shot, pneumococcal immunization prescriptions: Atrovent HFA 17mcg/spray MDI, 2 puffs inhaled 4 times per day (anticholinergic) Servent diskus 50 mcg/actuation DPI 1 puff inhaled every 12 hours (LABA) Ventolin HFA 90 mcg/spray MDI 2 puffs inhaled every 4 -6 hours as needed for wheezing or shortness of breath (SABA) Could also add an ICS (Pulmicort, Flovent)- if stage II or IV or if above doesn't work to control symptoms

Acetaminophen has strong anti-inflammatory properties that make it an excellent choice for treatment of osteoarthritis. true false

false Acetaminophen does not inhibit peripheral prostaglandin synthesis so it has either weak or absent anti-inflammatory and platelet inhibiting effects.

Adverse effects commonly associated with cholinergic miotics such as pilocarpine include:

irritation, conjunctivitis, and blepharitis

The following can all be considered as long-term control medications in the treatment of asthma except: Inhaled corticosteroids (beclomethasone, fluticasone) levalbuterol (Xopenex) Long-acting beta agonists (salmeterol, formoterol) Leukotriene antagonists (singulair)

levalbuterol (Xopenex) Xopenex is a short-acting beta agonist that can be used in the acute treatment of bronchospasm. Long-acting beta agonists like salmeterol can be used in combination with an inhaled corticosteroid in patients that are not adequately controlled on other asthma-controller medications or whose disease warrents initiation of 2 maintenance therapies. Singulair is a leukotriene receptor antagonist that can be used in the control of asthma, but not for acute exacerbations. Inhaled corticosteroids are considered first line as an asthma preventative.

Acetaminophen reduces fever through direct action in the hypothalamic heat-regulating center, thereby lowering the set point to normal. It does this by inhibiting the action of pyrogenic cytokines on heat-regulating centers. This action increases dissipation of body heat via vasodilation and sweating. true false

true