final study guide

2008-12-17T15:53:00.000-08:00

- The time between when a drug response is observable and when there is no longer an observable drug effect is called the

B. duration of action.

- "Potency" refers to:

C. The dose required to achieve therapeutic effect.

- A drug that occupies a receptor but does not activate the receptor is an:

D. antagonist.

- Before marketing a new drug, the drug company asks the FDA to approve its choice of:

A. The trade name.

- Adverse reactions to drugs occur because:

A. No drug has only one receptor it binds to.

- Drug A can produce the same effects as Drug B at a lower dose of drug A. Drug A is:
A. more potent than Drug B.

- Most drug work by:

D. Binding to a specific receptor on the cell.

- Which of the following recent advances is most likely to influence future drug development and use?

B. Our knowledge of genetic differences between people.

- Nicotine induces P-450 enzymes in the liver. An AIDS patient taking a protease inhibitor drug which is metabolized by these enzymes would experience which of the following if they smoked?

D. Lower blood levels of the protease inhibitor

- You have a patient with Parkinson's disease, and you want to get more dopamine into the brain. Dopamine is a polar molecule. How can you accomplish this best?

C. Give a lipid soluble precurser to dopamine which can convert in the brain.

- The time between when a drug response is observable and when there is no longer an observable drug effect is called the

A. duration of action.

- Which of the following would be the most appropriate way to measure efficacy of a drug?

B. Asking clients if their symptoms were relieved after taking the drug.

- Once a drug's peak effect has been reached, further doses of the drug will increase efficacy.

B. false

- Recombinant technology is allowing us to:

B. Manufacture proteins in yeast cells.

- Nicotine induces P-450 enzymes in the liver. An AIDS patient taking a protease inhibitor drug which is metabolized by these enzymes would experience which of the following if they smoked?

D. Lower blood levels of the protease inhibitor

- You have a patient with Parkinson's disease, and you want to get more dopamine into the brain. Dopamine is a polar molecule. How can you accomplish this best?

A. Give a lipid soluble precurser to dopamine which can convert in the brain.

- In the US, controlled substances are

C. drugs whose use, distribution, and prescribing is determed by the Controlled Substances Act of 1970 and it ammendaments.

- Binding to plasma proteins can affect

D. distribution, metabolism and elimination

- Most drug metabolism occurs in the:

A. liver

- Which of the following is an adverse effect of subcutaneous administration of drugs?

4. pain, swelling or infection could occur.

- Which pregnancy category indicates that controlled studies in humans have not shown risk to the mother or fetus?

A. Category A

- According to the Drug Enforcement Agency, which drug class has the highest potential for abuse?

1. Schedule I

- After a drug is administered, it must get to the site where it exerts its action. This phase of pharmacokinetics is called

2. distribution

- An important advantage of administering a drug intravenously is that

3. the onset of action is faster than other routes.

- Which pregnancy category indicates that animal studies and clinical trials show a significant risk to the mother and/or fetus that clearly outweighs any benefit that might be derived?

4. Category X

- A teratogen is a drug that is likely to

1. cause birth defects

- A drug company is conducting a "Phase III" study on a new drug. Which activity will be occuring?'

C. The drug will be tested on patients who might benefit from it.

- Which property of drugs is determined by the degree that a drug can be absorbed and transported by the body to its active site?

A. bioavailability

- Drug K can be administered by mouth or parenterally (by injection in vein or tissue). However, the drug dose needed to produce therapeutic blood levels is three times higher when the drug is administered by mouth. Which of the following provides the best explanation for this phenomenon?

A. first-pass liver metabolism of oral dose

- Not all drugs in use today have been rated for safety in pregnancy. Of those that have been rated, which classification represents the greatest risk?

D. Category X

- Drugs may not be sold in the United States until they have been approved by:

A. The Food and Drug Administration

- Which of the following is recommended by the FDA to reduce medication errors?

B. Use of bar codes on patient name bands.

- When a drug is heavily plasma protein bound, the fraction of the drug that exerts the pharmacological effect is the

A. free drug

- Pharmacists are licensed to perform all of the following activities EXCEPT:

B. Prescribe which drug the patient needs.

- What activity takes place during "medication reconciliation"?

D. A list of the patient home medications is compared to what has been ordered in the hospital.

- One reason why most drugs have side effects is because

A. drugs bind to more than one receptor.

- Which of the following affects drug absorption from the site of administration?

C. solubility.

- Drug K can be administered by mouth or parenterally (by injection in vein or tissue). However, the drug dose needed to produce therapeutic blood levels is three times higher when the drug is administered by mouth. Which of the following provides the best explanation for this phenomenon?

A. first-pass liver metabolism of oral dose

- Not all drugs in use today have been rated for safety in pregnancy. Of those that have been rated, which classification represents the greatest risk?

D. Category X

- A drug that occupies a receptor but does not activate the receptor is an:

D. antagonist.

- Advanced practice nurses (Nurse Practitioner or Nurse Anesthetist)may perform all of the following activites EXCEPT:

B. Label and dispense the drug.

- Actions of glucocorticoids include:

C. supresses inflammation

-The mechanism of action of NSAIDS is to:

B. Inhibit the enzyme cyclooxygenase, preventing synthesis of prostaglandin and thromboxane.

- Azathioprine (Imuran) is used for:

C. Supressing inflammation in rheumatoid arthritis..

- A transplant patient receiving immunosupression with drugs such as corticosteroids with tacrolimus, mycophenolate or cyclosporine is at greatest risk for which adverse effect?

B. Infection

- Drugs that interact with H1 receptors attach to which tissue?

1. Blood vessels and airways

- In addition to decreasing inflammation, NSAIDS are used to:

B. Reduce pain

- Azathioprine (Imuran) is used for:

B. Preventing rejection of transplanted organs.

- A relatively common adverse reaction to diphenhydramine (Benadryl) is:

A. Sedation

- Drugs that interact with H1 receptors attach to which tissue?

1. Blood vessels and airways

- When comparing antihistamines such as the classic diphenhydramine (BENADRYL) to the more recently marketed fexofenadine (ALLEGRA), you would say that fexofenadine is:

D. Less likely to cause dry mouth

- When systemic steroids are given for replacement (as in Addison's disease), doses are generally _____________ than when they are given for inflammation (such as in an acute asthma attack).

C. smaller and given for a longer period of time

- When ASPIRIN is used as an antiplatelet aggregator to prevent heart or brain attacks, the dose prescribed is:

B. 80-325 mg each day

- In rheumatoid arthritis, valdecoxib (BEXTRA) may be preferred over a traditional NSAID such as naproxen (ALEVE), because:

B. Once-a-day dosing is possible.

- Mr. Kim has had a kidney transplant and has been taking cyclosporin. His serum creatinine is going up. What is the best explanation of this?

D. Adverse drug reaction and transplant rejection must both be considered.

- Loratadine (CLARITIN) is an antihistamine useful in treating:

C. runny nose associated with allergies

- In the treatment of allergic rhinitis, nasal sprays of fluticasone are preferred over oral pills of prednisone because:

A. there are fewer side effects

- Naproxen (ALEVE) works by:

C. Inhibiting prostaglandin synthesis.

- Let's assume a patient's only supply of adrenocorticotropin (ACTH) is from the pituitary. In other words, they do not have and ACTH-secreting tumor. What would happen if dexamethasone was given for several days?

A. Blood levels of the body's natural glucocorticoid, (cortisol) would drop.

- Glucocorticoid preparations are available by which routes?

D. all of the above routes are available

- When comparing antihistamines such as the classic diphenhydramine (BENADRYL) to the more recently marketed fexofenadine (ALLEGRA), you would say that fexofenadine is:

D. Less likely to cause dry mouth

- Atheletes have been known to abuse steroids for body building purposes. The mechanism behind this is:

D. Glucocorticoids are not the type of steroids abused by athletes.

- When ASPIRIN is used to reduce fever in an adult, the usual dose is:

C. 650 mg as neeeded

- In rheumatoid arthritis, valdecoxib (BEXTRA) may be preferred over a traditional NSAID such as naproxen (ALEVE), because:

B. Once-a-day dosing is possible.

- Mr. Kim has had a kidney transplant and has been taking cyclosporin. His serum creatinine is going up. What is the best explanation of this?

D. Adverse drug reaction and transplant rejection must both be considered.

- Indications for H1 blockers include all of the following EXCEPT:

A. Asthma
B. Nasal allergies
C. Itching
D. Motion sickness
Score: 0/2

- In the treatment of allergic rhinitis, nasal sprays of fluticasone are preferred over oral pills of prednisone because:

B. there are fewer side effects

- Drugs used to treat allergies often act to block the effect of:

A. histamine

- If a patient had a tumor that was secreting adrenocorticotropin (ACTH), what would happen if dexamethasone was given for several days?

B. Blood levels of the body's natural glucocorticoid, (cortisol) would remain high.

- When glucocorticoid drugs have been given systemically in high dose for several weeks or more:

D. The dose should be tapered off slowly when the patient no longer needs the steroid.

- Examples of antibiotics in the cephalosporin class include:

C. cefazolin, cephalexin, ceftriaxone

- Match the drug to its main mechanism of action.
Penicillin

Sulfonamides

Aminoglycosides

Flouroquinolones

a. inhibit cell wall synthesis

b. antimetabolite, competition for folate

c. inhibit nucleic acid syntheisis

d. inhibit protein synthesis

(a, b, d, c)

- A patient who has been on antibiotics for several weeks now has an infection with fungus and a bacteria resistant to the antibiotic which was previously taken. This patient is said to have:

D. A super-infection.

- Resistance to antibiotics can be minimized by:

C. teaching patients to stop taking the antibiotic when the symptoms of infection resolve.

- What teaching is important for patients receiving a tetracyline antibiotic?

C. Avoid exposure to sun.

- Examples of antibiotics in the penicillin class include:

B. amoxicillin, nafcillin, pipercillin

- A "superinfection" refers to:

D. Overgrowth of undesired microbes when normal flora has been destroyed by antibiotic therapy.

- Patients who will be taking drugs to treat infection are instructed to take every dose as prescribed. The main reason for doing this is to:

C. Manage the infection without developing resistance to the drug.

- What teaching is important for patients receiving a tetracyline antibiotic?

A. Avoid exposure to sun.

- Ototoxicity (ear) and nephrotoxicity (kidney) are serious side effects of which of the following drug classes?

A. aminoglycosides

- Infections caused by beta-lactamase producing bacteria may be treated with:

B. An antibiotic that does not have a beta-lactam ring, such as vancomycin.

- Which of the following drug(s) is/are used in the treatment of tuberculosis?

B. rifampin and isoniazid

- Sharon is a 27-year-old pregnant female who was convinced by television advertising to seek prenatal care. Due to her history of IVDA, she took an HIV test that was positive. To protect her own health and avoid having an HIV positive baby, treatment should be:

D. zidovudine and 2 other HIV meds starting now and continuing through and after pregnancy

- Martha is a 70-year-old female who is brought from home to the emergency department by her daughter with a three-day history of "flu" and a one-day history of coughing purulent sputum. She has no co-morbidities except mild congestive heart failure. Her vital signs are: temp 38.1, pulse 100, respirations 26, BP130/80, 92% oxygen saturation on room air. Chemistries labs are normal. The WBC is 16,000 with left shift indicating new infection. Her chest X-ray shows an abnormal consolidation but no effusion. She is allergic to penicillin, which caused a rash.Should she receive drug treatment for an infection?

C. Yes, a fluroquinolone such as levofloxacin would be effective outpatient treatment.

- With therapeutic doses of ticarcillin, brain (CSF) concentrations of 15 mcg/ml are acheivable. You get a report from the laboratory that there is a bacteria in the patient's CSF that has an ticarcillin "MIC" of 128 mcg/ml. This means:

C. The bacteria is resistant to ticarcillin.

- Match the drug to its mechanism of action or target organism.
Rifampin

Trimethoprim

Cephalosporins

a. inhibit nucleic acid synthesis

b. interferes with folic acid metabolism

c. inhibits cell wall synthesis

( a, b, c)

- The main use of tetracyclines is in the treatment of:

A. Skin, lung and urinary tract infections.

- A patient insured by Aetna has an infection and is being considered for therapy with Zyvox (Linezolid). You know that:

B. Prior approval is required to have insurance pay for the Zyvox (Linezolid).

- While making a home visit to a patient, you want to verify that the patient understands his medications. The patient tells you he took his cefuroxime once a day for the first 3 days, then twice a day for 3 days and now he is up to three times a day. Which would be your best response?

B. May I see the directions on the bottle? That's a very unusual way to take an antibiotic.

- The antidote for warfarin sodium (COUMADIN)is

D. vitamin K.

- A patient has a thrombus in a vein and requires immediate anticoagulation. This best drug to use for this is:

D. Heparin (LIQUAEMIN).

-The effectiveness of a vaccine can be measured by:

A. Measuring the amount of antibody in the blood

- At 3 months old, which vaccinations should have been given?

C. diphtheria, tetanus, pertussis, haemophilus influenza, Hepatitis B, polio

- A predictable side effect of either heparin (LIQUAEMIN) or warfarin (COUMADIN)is:

C. bleeding.

- The antidote for warfarin sodium (COUMADIN)is

D. vitamin K.

- Warfarin (COUMADIN)is an anaticoagulant that reaches therapeutic levels in:

C. days.

- The effectiveness of a vaccine can be measured by:

B. Measuring the amount of antibody in the blood

- An infant who has received all scheduled immunization comes in for a 1 year check up. What new immunizations will be given?

C. Measles, Mumps, Rubella, Varicella

- The main side effect of all anticoagulants is:

A. bleeding.

- Which of the following is an example of active immunization?

A. An elderly patient receives an influenza vaccination every year which causes the person to produce antibodies against influenza virus.

- A 56 yo female (whose last pertussis vaccination was as a child), has a 3 yo child with whooping cough. She asks about spread of infection to herself and her 4 yo son who has received the following vaccinations: 1 MMR, 4 Hib, 3 hepB, 3 IPV and 4 DTaP. You should respond:

3. Your son should be ok, but watch for onset of persistant cough in yourself.

- A healthy, low-risk child who has received all scheduled immunization comes in for a 5 year old, preschool check up. What immunizations will be given?

D. Boosters for DTaP, IPV, varicella and MMR

- At the 2 month checkup, an infant should receive (along with other vaccines not listed):

B. Rotavirus

-One of your friends tells you that giving a child multiple vaccinations for different diseases at the same time increases the risk of harmful side effects and can overload the immune system. Your response to this friend should be:

D. There have been many studies showing vaccine efficacy when given in combination. Parents save time and money with fewer office visits, which might improve compliance. Kids prefer fewer trips to the clinic and fewer shots too.

- A patient complained of weakness on one side of the body and had trouble speaking. They are seen 30 minutes later in the ER. Brain scan confirms a non-hemorragic stoke. What drug would be the most likely choice in the Emergency Room to restore blood flow to the brain?

A. Tissue Plasminogen Activator (TPA)

- Your 65 year old patient has chronic atrial fibrillation of the heart and is at risk for throwing a blood clot to the brain. What drug would be the best choice to prevent blood clot development in this patient?

B. Coumadin (WARFARIN)

- Lab tests are done to monitor anticoagulant dosing. For which patient would you hold the coumadin?

D. The INR is 5 (normal is 1)

- One day after knee surgery, a patient is started on both heparin and coumadin. The rationale for doing this is:

A. Heparin works right away and provides anticoagulation until the coumadin starts working a few days later.

- Your 80 year old patient tells you he takes the herb ginko to "improve his aging memory". You are alert to the potential for drug interaction with which of his other medications?

D. warfarin (COUMADIN)

- Which of the following is an example of passive immunization?

C. An unborn baby receives antibodies from the mom across the placenta.

- Common side effects from vaccines include

A. slight fever and pain at the injection site.

- A healthy, low-risk child who has received all scheduled immunization comes in for a 5 year old, preschool check up. What immunizations will be given?

D. Boosters for DTaP, IPV, varicella and MMR

- A healthy 47 year old who lives with his healthy wife and works in a library, should receive which vaccination?

B. tetanus toxoid if not received within the last 10 years

- An elderly person residing in a skilled nursing facility needs:

A. Tetanus and diptheria toxoids every 10 years.

- A patient complained of weakness on one side of the body and had trouble speaking. They are seen 30 minutes later in the ER. Brain scan confirms a non-hemorragic stoke. What drug would be the most likely choice in the Emergency Room to restore blood flow to the brain?

A. Tissue Plasminogen Activator (TPA)

- A 60 year old male has risk factors for a myocardial infarction (heart attack) because he smokes, has high blood pressure and has several family members who had heart attacks. What drug should be given to prevent a heart attack?

D. Aspirin

- A patient taking clopidogrel (Plavix) should have which lab test done to monitor for adverse effects?

D. Hematocrit

- Lab tests are done to monitor anticoagulant dosing. For which patient would you hold the heparin?

D. The aPTT is 100 (normal is 25-40 seconds)

- Which of the following components of the nervous system is specifically responsible for "fight or flight" responses?

C. Sympathetic Nervous System

- The neurotransmitter at adrenergic nerve endings is

B. norepinephrine.

- The neurotransmitter at PNS ganglia is

A. acteylcholine.

- The recptor types occupied by norepinephrine include
Student Response Correct Answer Feedback
A. alpha.
B. beta.

- Norepinephrine is inactivated by MAO and COMT. What do you expect would happen if you blocked these two enzymes?

B. more SNS activity

- Which of the following components of the nervous system has a short preganglionic fiber, and long post-ganglionic fiber?

C. Sympathetic Nervous System

- The neurotransmitter at adrenergic nerve endings is

B. norepinephrine.

- The neurotransmitter at PNS ganglia is

A. acteylcholine.

- Your patient is scheduled for a dilated eye exam. She is given atropine-like eye drops to dilate the pupils. You should teach her to

1. avoid driving and hazardous activities until she regains ability to focus.

- The mechanism of action of atropine is

C. antagonism of acetylcholine binding sites.

- Beta-adrenergic blocking agents are used in the management of

C. heart failure.

- Which of the following drugs would be effective in treating hypertension?

D. prazosin (MINIPRESS)

- A pregnant asthmatic patient leaves home for the birth clinic with the contractions are 10 minutes apart. She takes a dose of albuterol (PROVENTIL) before leaving home. What effect would you anticipate the albuterol would have?

A. Labor will be slowed as B-2 agonists relax the uterus and dilate the airways.

- The patient is in mild to moderate heart failure but is stable and is seen in the outpatient clinic. The heart rate is slightly elevated at 90. BP is normal at 110/70. The patient receives carvedilol (COREG) to:

C. Reduce afterload so the heart doesn't have to work so hard.

- Your patient came in with the following symptoms: fever, flushed dry skin, confusion, blurred vision, and constipation. If you suspect atropine overdose, what should you give this patient?

B. physostigmin (ANTILERIUM)

- Pseudoephedrine is an alpha agonist added to many over the counter medications to treat:

B. nasal congestion

- If a person has heart failure, the cardiac output is lower than is needed for adequate tissue blood flow. How would you improve cardiac output in a person who has lung congestion, jugular vein distention, tachycardia, and ankle edema?

A. decrease afterload.

- Drugs that improve morbidity and mortality in heart failure include:

A. ACE inhibitors

- A patient taking spironolactone (ALDACTONE) should be taught about adverse effects such as

C. nausea.

- The diuretic furosemide (LASIX), causes:

C. Hypokalemia (low K+ level in blood)

- Teaching for a person taking an ACE inhibitor should include

A. report feelings of faintness to the health care provider.

- The Angiotensin Converting Enzyme (ACE) Inhibitor, ekanioril (VASOTEC) is associated with which adverse reaction(s) in as many as 1/3 of those who take it?

B. Paradoxical hypertension

- What lab work should be done to monitor a patient's response to atorvastatin (LIPITOR)?
C. Total Cholesterol, HDL cholesterol, LDL cholesterol

- Most patients with a blood pressure breater than 160/100 should be treated with:

1. A thiazide diuretic and one drug from another class.

- The diuretic furosemide (LASIX), causes:

C. Hypokalemia (low K+ level in blood)

- Teaching for a person taking an ACE inhibitor should include

A. report feelings of faintness to the health care provider.

- Which is the best approach to treating hard to control hypertension?

D. start with a low dose of one drug and increase the dose slowly. It it is not effective change drugs or add a second drug at a low dose.

-What lab work should be done to monitor a patient's response to atorvastatin (LIPITOR)?

C. Total Cholesterol, HDL cholesterol, LDL cholesterol

- A patient has a BP of 138/84. What condition would indicate a need to treat this patient with hypertensive medication?

1. Diabetes

- Before starting atorvastatin (LIPITOR), it is important to:
B. Be sure the patient is not pregnant.

- The mechanism of action of this drug is dilation of arterioles by a direct effect on vascular smooth muscle.
C. hydralazine (APRESOLINE)

- Hypertension results from an increase in vascular resistance, and several factors contribute to this. Which of the following would be the MOST POWERFUL way to decrease blood pressure?

D. Increase the radius of the vessel

- Aldosterone alters blood pressure because it

C. causes sodium retention.

- Diuretics are useful in treating hypertension becasue they

A. decrease preload.

- Metoprolol is useful in treating hypertension because it

A. decreases cardiac work and output.
B. decreases renin release.

- A patient without other cardiac risks has triglycerides 300 mg/dl, HDLs 40 mg/dl and LDLs 150 mg/dl. Which drug (if any) should be given?

A. fenofibrate

- B.B. is a 29 yo male with HTN. He takes Hydrochlorothiazide 50 mg and lisinopril 40 mg each day. Current BP is 164/98. You should:

1. Add a calcium channel blocker.

- P.P. is a 52 yo diabetic AA female who just had a stroke. She has had long term HTN. Current meds are: lisinopril 20 mg each day, labetalol 400 mg twice a day, lasix 20 mg twice each day. Current labs include sodium 138 (normal 135-145) and potassium 3.5 (normal 3.5-5). Her BP is 210/118 and her pulse is 75. You should:

A. Increase the labetalol.

C. Increase the lisinopril.

- In general, antidysrhythmic drugs

D. Decrease automaticity, slow conduction rates, and increase refractoriness

- The electrophysiological basis of automaticity is

D. slow leak of sodium into the cell.

- One strategy for treating angina is to reduce heart work. Which of the following drugs would be used to reduce heart work?

A. diltiazem (CARDIZEM)

- If it took extra long for electricity to get from the atrium to the ventricle, what would you see on the EKG?

A. A prolonged PR interval.

- Which of the following should be given in the immediate time period after a heart attack?

D. beta blockers and aspirin

- Which of the following generalized statements about antidysrhythmic drugs is true?

B. They cause dysrhythmia.

- An action potential characterized by a slow leak of ions into the cell, that has a phase 0, phase 3, and phase 4, is an __________.

C. slow action potential

- All of the following decrease heart work and oxygen demand EXCEPT

D. increasing preload.

- If it took extra long for electricity to get from the atrium to the ventricle, what would you see on the EKG?

B. A prolonged PR interval.

- Which of the following should be given in the immediate time period after a heart attack?

C. beta blockers and aspirin

- Which of the following is an adverse effect of the oral contraceptives?

A. hypertension

- Which of the following would be expected in a patient who needed a higher dose of thyroid hormone replacement?

A. fatigue

- If your client took regular insulin at 0700 (7am) but forgot to eat, what time would a hypoglycemic reaction be most likely to occur?

A. 0900 (9am)

- Inadequate dietary intake of iodide/iodine would result in defective production of

D. T3 and T4

- A patient should be told to take rosiglitizone:

2. Without regard to meals.

- Which of the following is an adverse effect of the oral contraceptives?

A. hypertension

- Which of the following would be expected in a patient who needed a higher dose of thyroid hormone replacement?

A. fatigue

- If your client took regular insulin at 0700 (7am) but forgot to eat, what time would a hypoglycemic reaction be most likely to occur?

A. 0900 (9am)

- Inadequate dietary intake of iodide/iodine would result in defective production of

B. T3 and T4

- A patient should be told to take rosiglitizone:

4. Without regard to meals.

- What patient teaching should the patient receive regarding the use of the PCA (patient controlled analgesia) pump?

A. Push the administration button prior to any activity likely to cause pain, such as walking or coughing

- A 57 year old with severe pain from terminal cancer needs pain medicine. Which would be most appropriate?
A. Acetaminophen, sustained release morphine in regular doses and short acting oral morphine as needed for pain uncontrolled with above meds

- Meperidine (DEMEROL) use is NOT recommended for pain when:

A. Long term use is required, due to buildup of neurotoxic metabolites.

- The American Pain Society published Practice Guidelines in 2002 for managing arthritis. For mild pain, the drug of choice is:

A. Acetaminophen

- You are visiting a patient at home for therapy after orthopedic surgery. The patient is taking VICODAN but says even at the maximum prescribed dose, the pain is not bearable, and he refuses physical therapy. Your best action is to:

A. Contact the MD/NP about increasing the strength of the VICODAN.

- An adult patient with life threatening airway spasms from tetanus receives vecuronium (NORCURON) for several weeks. What drug(s) should the patient receive simultaneously?

B. Diazepam (VALIUM)

- Before sticking the large needle through the skin, the surgeon infiltrated the skin with lidocaine in order to:

B. Reduce pain

- A patient with multiple sclerosis has muscle spasms which are making it difficult for her to work with her physical therapist. A drug which could be used to help this problem is:

A. Baclofen (LIORESOL)

- The inhalation agent isoflurane (FURANE) works by:

B. Increasing action of the neuroinhibitory transmitter gamma-aminobutyric acid (GABA)
D. Depressing impulse transmission in the brain

- A patient with cancer has been taking sustained release morphine around-the-clock for several months. What is the best measure of adverse reactions that you would anticipate at this time?

A. Check date of last BM

- What patient teaching should the patient receive regarding the use of the PCA (patient controlled analgesia) pump?

C. Push the administration button prior to any activity likely to cause pain, such as walking or coughing.

- A 57 year old with severe pain from terminal cancer needs pain medicine. Which would be most appropriate?
A. Acetaminophen, sustained release morphine in regular doses and short acting oral morphine as needed for pain uncontrolled with above meds

- Meperidine (DEMEROL) use is NOT recommended for pain when:

A. Long term use is required, due to buildup of neurotoxic metabolites.

- The American Pain Society published Practice Guidelines in 2002 for managing arthritis. For mild pain, the drug of choice is:

A. Acetaminophen

- You are visiting a patient at home for therapy after orthopedic surgery. The patient is taking VICODAN but says even at the maximum prescribed dose, the pain is not bearable, and he refuses physical therapy. Your best action is to:

A. Contact the MD/NP about increasing the strength of the VICODAN.

- An adult patient with life threatening airway spasms from tetanus receives vecuronium (NORCURON) for several weeks. What drug(s) should the patient receive simultaneously?

B. Diazepam (VALIUM)

- Before sticking the large needle through the skin, the surgeon infiltrated the skin with lidocaine in order to:

B. Reduce pain

- Cyclobenzaprine (FLEXERIL) is a muscle relaxant with significant anticholinergic properties. What would you predict for side effects?

D. Dizziness, dry mouth, blurred vision

- A common intravenous agent used in anesthesia for induction and/or maintenance is:

D. Propofol (DIPRIVAN)

- A post-operative patient is taking 2 hydrocodone with acetaminophen tablets every 6 hours. How would you best measure efficacy of this medication?

D. Ask the patient about pain level.

- If a depressed patient starts taking an antidepressant drug, effectiveness should be seen:

D. after a few weeks

- Which of the following should patients and/or their caregivers be told when they start taking antidepressant drugs?

C. Dry mouth should be managed with ice chips or sugarless gum.

- The drug zolpidem is useful in treating:

B. insomnia

- Diazepam (VALIUM) is used to treat:

A. Anxiety

- Under what conditions would you hold (not administer) Dilantin?

B. The lab tells you the phenytoin blood level is 25 mcg/ml. (Normal 0; Therapeutic 10-20 mcg/ml)

- If an anxious patient starts taking a benzodiazepine orally, effectiveness should be seen:

B. within about 1 hour

- Which of the following should patients and/or their caregivers be told when they start taking antidepressant drugs?

C. Dry mouth should be managed with ice chips or sugarless gum.

- Valproate sodium (DEPAKENE) stimulates GABA receptors and is useful for treating:

A. Seizures

- Haloperidol (HALDOL) is used to treat:

C. Psychotic behavior

- Under what conditions would you hold (not administer) Dilantin?

A. The lab tells you the phenytoin blood level is 25 mcg/ml. (Normal 0; Therapeutic 10-20 mcg/ml)

- An herb thought to be useful in treating depression is:

B. St John's Wort

- A side effect common to most of the anticonvulsants is:

B. Sedation

- The mechanism of action of phenytoin (DILANTIN)is

C. reducing sodium transport.

- Ethosuximide is indicated for:

C. Absence seizures

- Carbamazepine is indicated for:

A. Bipolar disease

- An alcoholic who was driving drunk is admitted to the hospital after an auto accident. Which statement is FALSE?

C. Alcohol depletes liver fat so the patient will need a diet high in fat.

- Ms. J is brought to the emergency room in a semi-comatose state. She has a low blood pressure and is breathing slowly. Her pupils are pinpoint. These signs and symptoms are most consistent with a drug overdose on which of the following?

D. An opiate such as heroin

- A patient with a 3 week history of fatigue, sadness, irritability, boredom and difficulty paying attention in school seeks medical attention for insomnia. Sertraline 50 mg/day is furnished but 2 days later the patient states the symptoms have not improved. The best course of action is to:

D. Explain that more time is needed to see effect

- Which of the following are/is a cholinesterase inhibitor(s), appropriate for the treatment of symptoms of Alzheimer's disease?

D. donepezil, galatamine, rivastigimine

- When evaluating care provided by hospitals, the Joint Commission may review whether chemical restraints are used appropriately, in the treatment of patients, or inappropriately, to "police" irritating behavior. Which of the following is an appropriate use of chemical restraints?

D. A patient is agitated and restless, writhing around in bed which is causing the dressings to be torn off a wound. The nurse gives a dose of midazolam

- Lamotrigine is indicated for:

B. Tonic-clonic seizures

- Carbamazepine is indicated for:

A. Partial seizures
D. Bipolar disease

- Severe alcohol withdrawal:

A. May not be manifested until several days after alcohol ingestion has stopped.
B. Includes signs and symptoms of hallucinations, agitation, sweating, rapid heart rate.
C. Is treated aggressively with benzodiazepines or the patient could die.

- Mr. B is brought in by ambulance with a drug overdose. He was found outdoors after a relatively cold night. He is in a coma, blood pressure is low, and his body temperature is low. Which drug would you suspect he overdosed on?

A. Alcohol

- A patient seeks medical attention for depression and receives a prescription for paroxetine 20 mg/day. 3 weeks later the patient states the symptoms have not improved. The best course of action is to:

D. Increase the dose of paroxetine

- A patient receiving donepezil and memantine comes to the hospital with nausea and vomiting. You note he swallows frequently and drools clear saliva. His skin is wet with sweat. BP is low at 80/50 and heart rate is low at 50. You should treat shock and......

C. give atropine.

- Saline laxatives, such as milk of magnesia, work by:

C. Osmotically drawing water into the small intestine

- Drug classes that are useful in treating gastric ulcers include:

A. Antibiotics

- Ranitidine may be preferred over cimetidine because:

B. Ranitidine has fewer drug interactions

- Pancrease should be taken:
A. With meals.

-Many times you can develop almost a complete list of patient problems and potential problems just by looking at the list of medications the patient takes. Your patient can have either ondansetron or metoclopramide as needed. What problem would these have been prescribed for?

B. Nausea or vomiting

- Sibutramine is approved for therapy lasting no longer than:

D. 1 year

- The patient is comatose following ingestion of an unknown poison. Staff in the Emergency Room will:
C. Insert a stomach tube and give activated charcoal

- If antacids have been unsuccessful in treating gastroesophageal reflux disease (GERD), which drug would be tried next?

C. A proton pump inhibitor such as lansoprazole (PREVACID)

- Before starting an herbal weight loss product containing ephedra, it is most important to check the patient's:

C. Blood pressure

- When administering psyllium and bran (METAMUCIL) to treat constipation, it is important to:

A. Assess for hypersensitivity to psyllium and GI obstruction, both of which are contraindications

- Which of the following combination products would be most likely to treat heartburn (acid indigestion) associated with excessive gas, without side effects of either constipation or diarrhea?

B. MYLANTA (aluminum hydroxide, magnesium hydroxide and simethicone)

- A patient has one medium sized tube into the stomach and one small tube into the small intestine. To give sucralfate to this patient:

B. Dissolve the tablet and put down the stomach tube. correct, it is an acid activated drug

- The most effective drugs for treating gastric ulcers are:

B. Antibiotics

- The most important vitamins for an alcoholic to take are:

B. The B vitamins

- A patient should take pancrelipase:

C. With meals.

- MD orders should be questioned if the drug ordered would be dangerous for the patient to receive, if the patient needs a drug which is not ordered and when multiple drugs are ordered for the same condition when combination therapy is not called for. Which drug order should be questioned?

A. No prescription for a stool softner in a patient on morphine for cancer.

- The obesity drug sibutramine (MERIDIA) works by:

A. Decreasing appetite by inhibiting reuptake of serotonin and norepinephrine

- When administering psyllium and bran (METAMUCIL) to treat constipation, it is important to:
C. Assess for hypersensitivity to psyllium and GI obstruction, both of which are contraindications

- Which of the following is a beta2 adrenergic agent used to treat asthma?

C. albuterol (PROVENTIL).

- Which of the following diseases is chracterized by abnormal enlargement of gas exchange airways with destruction of alveolar walls? Note: you may find the answer fastest in your lecture notes.

B. chronic bronchitis
C. emphysema

- Which of the following drugs causes bronchodilation and is classified as a bronchodilator?

A. albuterol sodium (PROVENTIL) 100%

- Cancer is known to be a result of changes in DNA that predispose a person to cancer. One DNA change that is involved with more than 40 different kinds of cancer is

1. deletion or mutation of tumor suppressor genes. 100%

-Patients who receive traditional chemotherapy should be taught to

A. eat fresh, unpeeled fruit only if the neutrophil (WBC) count is acceptble. 100%

- A relatively new treatment for asthma is the use of leukotriene antagonists/inhibitors. Examples from this drug class include:

C. Zafirlukast (ACCOLATE) and zileuton (ZYFLO) 100%

- Which of the following drugs is the best drug for long term maintanence of asthma symptoms?

C. inhaled corticosteroids 100%

- Overdose on opioids is associated with which of the following?

B. Slow respiratory rate

- The world health organization recommends which strategy for managing pain in a patient with cancer?

B. Start with COX inhibitor such as acetaminophen. Add a weak opioid advancing to stronger opioids as needed.

- Many people interchange aspirin and acetaminophen (TYLENOL) for treating problems such as headahces. Under which of the the following circumstances is aspirin favored over acetaminophen?

C. The patient is taking low doses to prevent a stroke.

- An example of general anesthetic is:

A. Breathing in isoflurane

- Select the correct statement regarding pain management.

B. At least 50 million people are diabled as a result of pain.

- What information must be taught to the care giver of a patient who will be receiving tablets of sustained release opioid?

C. Do not crush the tablets as overdose could result.

- An example of a local anesthetic is:

C. A preoperative intravenous injection of atropine.

- Which of the following drugs would INCREASE the cardiovascular adverse effects of thyroid hormones?

D. sympathomimetic drugs

- F.H. is a 42 year old type 1 diabetic who has been receiving insulin for a long time. He needs a very high does of insulin to maintain his blood glucose within the target range. Which of the following drugs might be added to his medications to help control his blood glucose?

D. metformin (GLUCOPHAGE)

- Which of the following are adverse effects of glipizide (GLUCOTROL)?

B. headache

- Which of the following would you predict as an effect of insulin administration?

D. Decreased serum potassium

- After subcutaneous administration of regular insulin, the peak effect is seen:

B. In 2-4 hours

- For many years, women have been prescribed estrogen with or without progesterone at menopause to reduce hotflashes and protect the bones and blood vessels. In 2002 the Women's Health Initiative published findings (JAMA 2002 Jul 17;288(3):366-8) substantiated by other reviews (JAMA 2002 Aug 21;288(7):872-81) that showed the effect of postmenopausal hormone replacement therapy (HRT) to include:

B. NO reduction in the risk of heart attack and stroke.

- A patient is to receive 12 units of regular insulin AND sliding scale insulin as follows: for BS (blood sugar) less than 80: give sugar, for BS 81-140: give no insulin, for BS 141-200 give 2 units regular insulin, for BS 201-250 give 4 units regular insulin, for BS 251-300 give 6 units regular insulin, for BS 301-350 give 8 units regular insulin. For BS over 350 give 10 units regular insulin. This morning the blood sugar was 40. What should you do?

D. Give sugar

- LC is a 33 year old who has been taking oral contraceptives. She reposts a recent weight gain and says her right foot is so swollen she can barely get her shoe on. Her left foot is normal. What is the significance of these complaints?

D. She has probably developed a blod clot in her right leg (thrombophlebitis), and should go to the hospital to have it checked.

- When teaching an elderly client how to take calcium supplements to prevent osteoporosis, your best statement would be:

C. Take 2 500mg tablets of calcium carbonate every evening with your meal.

- H.W. is a 56 year old male who has type 2 diabetes. He is taking glipizide (GLUCOTROL) and acarbose (PRECOSE). He shows evidence of hypoglycemia. How should this be treated?

D. Give him sugar

- After subcutaneous administration of NPH insulin, the peak effect is seen:

B. in 6-12 hours

- Which of the following statements about Repaglinide (PRANDIN)is true?

A. It mimics the normal first phase insulin reaction.

- Beta-adrenergic blocking agents are used in management of

C. heart failure

- Sympathomimetic drugs are likely to cause which of the following adverse effects?

B. tachycardia

C. hypertension

D. hyperglycemia

- The effects of sympathomimetic drugs include

C. bronchoconstriction

- A parasympathomimetric drug such as physostigmine (ANTILERIUM) is used to

3. Treat urinary retention

- Scopolamine may be used to treat motion sickness. Side effects of dry mouth, blurred vision and constipation result from

C. Inhibition of muscarinic receptors

- Atropine has which pharmacological effect?

D. constipation and decreased GI motility

- K. Samuels was admitted to the emergency department with the following symptoms: excessive saliva production, copious tear production, frequent urination, diarrhea, anxiety, and hypotension. K. Samuels' symptoms are characteristic of _____ drug overdose.

A. parasympathomimetic/cholinergic

- Mr. Jones is a 75 year old man who was admitted to the hospital because he fainted at home. His heart rate was only 40 and his BP was low. He is give atropine. What side effects do you need to observe for?

A. Urinary retention

- Phenylephrine (NEOSYNEPHRINE) is an alpha-1 agonist. This drug would be used to treat

C. Nasal congestion

- Your patient came in with the following symptoms: fever, flushed dry skin, confusion, blurred vision, and constipation. If you suspect atropine overdose, what should you give this patient?

B. physostigmin (ANTILERIUM)

- Which of the following is a predictable adverse effect of clonidine (CATAPRES), an alpha-2 agonist?

A. drowsiness

- Atropine has which pharmacological effects?

A. dilation of pupil

- Edrophonium (Tensilon) is a short-acting AchE inhibitor used to diagnose myasthenia gravis. In a patient with MG, this drug should:

D. Improve muscle strength

- For many years, patients with psychosis were treated with phenothiazines like chlorproMAZINE (Thorazine). Trouble side effects included anticholinergic problems such as:

A. Constipation

- A patient developed urinary retention after surgery. She was prescribed bethanechol (UROCHOLINE). Adverse effects of this drug include:

A. Abdominal cramps, hypotension, excess salivation

Which drug combination is INAPPROPRIATE for treating asthma?

	Student Response	Correct Answer	Feedback
A.	Combivent, albuterol, and ipratropium

2.

Which of the following drugs is the best drug for long term maintanence of asthma symptoms?

	Student Response	Correct Answer	Feedback
A.	isoproterenol (MEDIHALER-ISO) by inhalation
B.	Isoetharine (BRONKOMETER) by inhalation
C.	salmeterol (SEREVENT) by inhalation		an inhaled, long acting B2 agonist is one of the most important drugs to use in long-term asthma therapy
D.	High dose oral prednisone

Score:

2/2

3.

Which of the following drugs is the best drug for treating nighttime asthma symptoms?

	Student Response	Correct Answer	Feedback
A.	ipratropium bromide (ATROVENT)
B.	alpha-1 antritrypsin
C.	theophylline
D.	salmeterol (SERVENT)

Score:

0/2

4.

The adverse effect characteristic of cyclophosphamide (CYTOXAN)is

	Student Response	Correct Answer	Feedback
A.	bladder irritation and bleeding.
B.	kidney fibrosis.
C.	muscle necrosis.
D.	neurotoxicity.

Score:

2/2

5.

Combinations of anti-cancer drugs are often given in order to

	Student Response	Correct Answer	Feedback
A.	decrease adverse effects.
B.	increase efficacy.
C.	reduce cost of therapy.
D.	1 and 2

Score:

2/2

6.

Which approach would be useful in treating cancer?

	Student Response	Correct Answer	Feedback
A.	Administering estrogen to a woman with estrogen receptor positive breast cancer.
B.	Administering an anti-angiogenesis drug such as Thalidomine to a man with a cancerous tumor too large for surgical removal.
C.	Administering telomerase to a woman with liver cancer.
D.	Lowering the dose of methotrexate (MTX) to reduce nausea.

Score:

2/2

7.

COMMON adverse reactions to chemotherapy include all of the following EXCEPT:

	Student Response	Correct Answer	Feedback
A.	neurotoxicity.
B.	Low platelet count and bleeding
C.	Hair loss.
D.	Nausea and vomiting

Score:

0/2

8.

Inhaled corticosteroids are used in the treatment of asthma because they

	Student Response	Correct Answer	Feedback
A.	dilate the airways.
B.	control infections.
C.	decrease inflammation.
D.	have a strong placebo effect.

Score:

0/2

9.

This anticholinergic agent is used to treat asthma and it works by blocking muscarinic receptors. This drug is

	Student Response	Correct Answer	Feedback
A.	ipratropium bromide (ATROVENT).
B.	cromolyn sodium (INTAL).
C.	theophylline.
D.	zileuton (ZYFLO).

Score:

2/2

10.

Mitotic inhibitors such as vincristine (ONCOVIN) are used in cancer treatment because they:

	Student Response	Correct Answer	Feedback
A.	Substitute for a structure necessary for building a strand of DNA.
B.	Cause cross-linking between strands of DNA, thus preventing cell division.
C.	Block transcription of new DNA or RNA.
D.	Block cell division in metaphase.

nurs14 final

final study guide

2.

3.

4.

5.

6.

7.

8.

9.

10.