Sac State Fall 08 Nurs: 14 Pharmacology

Post 14 cancer/resp

2008-12-15T18:10:00.000-08:00

Good Luck everyone on the final, If you have anymore questions to add feel free to send them to me. Thanks to everyone for doing that throughout the semester we really appreciate that. Good Luck again and I'll see some of you on Thursday at 12:45 in Mendo 2007.

Which drug combination is INAPPROPRIATE for treating asthma?

A. Combivent, albuterol, and ipratropium
B. Beclomethasone and salmeterol
C. Cromolyn sodium, theophylline
D. fluticasone, levalbuterol

Which of the following drugs is the best choice for treating acute bronchospasm?

A. albuterol sulfate (PROVENTIL)
B. cromolyn sodium (INTAL)
C. ipratroprium bromide (ATROVENT)
D. zafirlukast (ACCOLATE)

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

A. ipratropium bromide (ATROVENT)
B. alpha-1 antritrypsin
C. theophylline
D. salmeterol (SERVENT)

The adverse effect characteristic of doxorubicin (ADRIAMYCIN) is

A. bladder irritation and bleeding.
B. cardiotoxicity.
C. hepatic fibrosis.
D. neurotoxicity.

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

A. decrease adverse effects.
B. increase efficacy.
C. reduce cost of therapy.
D. 1 and 2

Which approach would be useful in treating cancer?

A. Giving a drug that caused clotting in new tumor blood vessels.
B. Lowering the dose of methotrexate (MTX) so that hair loss did not occur.
C. Administering telomerase to a woman with lung cancer.
D. Administering Leucovorin instead of doxorubicin (ADRIAMYCIN).

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

A. Low platelet count and bleeding
B. Sodium retention and hypertension
C. Low white blood cell count and infection
D. Nausea and vomiting

Inhaled corticosteroids are used in the treatment of asthma because they

A. dilate the airways.
B. control infections.
C. decrease inflammation.
D. have a strong placebo effect.

Ipratropium bromide (ATROVENT) is a drug used to treat asthma. Which of the following drugs is most similar to Ipratropium bromide (ATROVENT) in terms of its mechanism of action?

A. atropine
B. albuterol (PROVENTIL)
C. theophylline.
D. neostigmine (PROSTIGMIN)

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

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.

The adverse effect characteristic of methotrexate (MTX) is

A. hypersensitivity.
B. cardiotoxicity.
C. hepatic fibrosis.
D. neurotoxicity.

Your patient needs to receive "colony stimulating factors". This is most likely because:

A. The bacteria suspected of causing the patient's infection is very difficult to grow, and thus has not been identified.
B. The patient needs to make more white blood cells.
C. It can carry chemotherapy drug molecules directly to the tumor cells.
D. It stimulates excretion of toxic metabolites of chemotherapy.

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

A. neurotoxicity.
B. Low platelet count and bleeding
C. Hair loss.
D. Nausea and vomiting

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

A. ipratropium bromide (ATROVENT).
B. cromolyn sodium (INTAL).
C. theophylline.
D. zileuton (ZYFLO).

What is the mechanism of action of the cancer drug methotrexate (MTX)?

A. Topoisomerase inhibition
B. Folate antagonism
C. Stimulate white blood cell production
D. Alpha adrenergic inhibition

More questions added 12/17, thanks again Lily!!

Here are the addtional questions that were not on the blog.
Which of the following drugs is the best drug for long term maintanence of asthma symptoms?

A. isoproterenol (MEDIHALER-ISO) by inhalation
B. Isoetharine (BRONKOMETER) by inhalation
C. salmeterol (SEREVENT) by inhalation
D. High dose oral prednisone

Match the statement to the appropriate drug.

Blocks leukotriene receptors zafirlukast (ACCOLATE)
Inhibits lipoxygenase zileuton (ZYFLO)
Inhibits inflammation Both of these drugs

Which approach would be useful in treating cancer?

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.

This drug is used to treat asthma and it works by stabilizing mast cells. This drug is

A. cromolyn sodium (INTAL).
B. ipratropium bromide (ATROVENT).
C. theophylline.
D. zileuton (ZYFLO).

According to the National Asthma Education Program, Cromolyn sodium (INTAL) should be used

A. as the first choice of therapy in children.
B. in combination with ipratropium bromide (ATROVENT).
C. only when inhaled coriticosteroids are not acceptable to the patient/family.
D. when the patient is allergic to aspirin.

Pre 14 resp/cancer

2008-12-10T23:55:00.000-08:00

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

A. Aspirin and other nonsteroidal anti-inflammatory drugs
B. COX2 inhibitors
C. Zafirlukast (ACCOLATE) and zileuton (ZYFLO)
D. Cromolyn sodium (INTAL) and albuterol (PROVENTIL)

Which of the following diseases is chracterized by persistent cough resulting in sputum production for more than 3 months for more than 2 years? Note: you may find the answer fastest in your lecture notes.

A. asthma
B. chronic bronchitis
C. emphysema

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

A. albuterol sodium (PROVENTIL)
B. cromolyn sodium (INTAL)
C. zafirlukast (ACCOLATE)
D. zileuton (ZYFLO)

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

A. zafirlukast (ACCOLATE)
B. metoprolol subcutaneoulsy
C. inhaled corticosteroids
D. methotrexate

Patients who receive traditional chemotherapy should be taught to

A. eat salty, crunchy foods such as potato chips to make up for salt loss.
B. continue having un-protected sex only if it is with one partner.
C. eat fresh, unpeeled fruit only if the neutrophil (WBC) count is acceptble.
D. avoid brushing or flossing teeth for 48 hours before chemotherapy.

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

A. cromolyn sodium (INTAL).
B. ipratropium bromide (ATROVENT).
C. albuterol (PROVENTIL).
D. zileuton (ZYFLO).

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.

A. asthma
B. chronic bronchitis
C. emphysema

Added 12/15, thanks Lily!!!!

Which of the following diseases is chracterized by hyper-reactive airways, reversible airflow obstruction, and increased mucus production? Note: you may find the answer fastest in your lecture notes.

A. asthma
B. chronic bronchitis
C. emphysema

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.
2. addition of tumor suppressor genes in unusual locations.
3. deletion of oncogenes.
4. absence of benign tumors.

Cancer cells are known to show abnormal features such as

1. increased cell stickiness.
2. lack of resoponse to growth control signals.
3. decreased rate of growth.
4. aggressive immune responsiveness.

Post 13 GI

2008-12-10T23:22:00.000-08:00

The patient is comatose following ingestion of an unknown poison. Staff in the Emergency Room will:

A. Induce vomiting with ondansetron (ZOFRAN)
B. Administer a universal poisoning antidote
C. Insert a stomach tube and give activated charcoal
D. Suppress symptoms with tricyclic antidepressants

Client teaching for someone taking over-the-counter antacids might include which statement?

A. Antacids interfere with absorption of many medicines, so take them at different times.
B. Although antacids are the mainstay of therapy for peptic ulcers, they must be taken frequently to be effective.
C. If gastrointestinal bleeding does not stop within 2 weeks, consult your practitioner.
D. If constipation results from magnesium antacids, try switching to aluminum antacids.

The obesity drug sibutramine (MERIDIA) works by:

A. Decreasing appetite by inhibiting reuptake of serotonin and norepinephrine
B. Blocking fat absorbtion from the gut
C. Blocking adrenergic receptors in the brain
D. Stimulating a craving for low-fat foods

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

A. Allow the solution to sit for 30 minutes before the patient drinks it
B. Minimize the amount of oral water taken (no more than 1/2 glass with the medication and no more than 2 glasses total for the day)
C. Assess for hypersensitivity to psyllium and GI obstruction, both of which are contraindications
D. Verify that the patient has a bowel movement within 30 minutes of administration.

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?

A. GAVISCON (aluminum hydroxide and magnesium carbonate)
B. MYLANTA (aluminum hydroxide, magnesium hydroxide and simethicone)
C. METAMUCIL (psyllium)
D. PHOSPHAJEL CAPS (aluminum phosphate)

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

A. Dissolve the tablet and put down the stomach tube.
B. None of the above. A patient with tubes into the stomach and intestine should not be receiving sucralfate.
C. Dissolve the tablet and put down the intestinal tube.
D. Give the tablet rectally.

The most effective drugs for treating gastric ulcers are:

A. Histamine stimulants
B. Aluminum Antacids
C. Anticholinergics
D. Antibiotics

Vitamin K has been ordered for your patient, most likely because of a problem with:

A. wound healing
B. bleeding
C. numbness and tingling in the extremeties
D. chronic infections

Lansoprazole is a Category B proton pump inhibitor, available in several forms. What precautions should you advise about/monitor for in patients taking this drug?

A. Get out of bed slowly.
B. Do not take if pregnant.
C. Do not crush delayed release beads inside the capsule.
D. Do not open capsule before swallowing.

Which of the following doctor's orders for nausea treatment should be questioned?

A. The patient has postoperative nausea without vomiting (yet). Orders are for prochlorperazine intravenously and ondansetron intravenously if that does not work.
B. The patient is vomiting postoperatively in the recovery room: Orders are to place topical scopolamine patch, and if ineffective give prochlorperazine intravenously.
C. The patient is a diabetic with nerve damage that slows down transit of food in the stomach (gastroparesis): Orders are to give metoclopramide intravenously.
D. The patient will receive chemotherapy in 30 minutes: Oders are to give dexamethasone and granisetron orally now.

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

A. A stimulant such as bisacodyl (DUCOLAX)
B. A prostaglandin such as misoprostol (CYTOTEC)
C. A proton pump inhibitor such as lansoprazole (PREVACID)
D. An opiate such as diphenoxylate and atropine (LOMOTIL)

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

A. Body mass index
B. Weight
C. Ability to swallow large pills
D. Blood pressure

A client selects cimetidine over-the-counter to treat symptoms of gastro-esophageal reflux disease. Which assessment is most important to make?

A. What other medications is the client taking? There are many drug-drug interactions with cimetidine.
B. What time and how is the drug being taken? It is best taken with food at bedtime.
C. What dose is being used? The recommended OTC dose should be doubled for active symptoms.
D. How long have the symptoms been going on? Cimetidine is only effective in the first 2 weeks of symptoms.

A patient should take pancrelipase:

A. On first awakening in the morning.
B. At bedtime.
C. With meals.
D. 3 hours after meals.

Added 12/15 Thanks Lily!!!!!

Which of the following is tried first in the treatment of gastroesophageal reflux disease?

A. A stimulant such as bisacodyl (DUCOLAX)
B. A prostaglandin such as misoprostol (CYTOTEC)
C. An opiate such as diphenoxylate and atropine (LOMOTIL)
D. An antacid such as MAALOX

The most important vitamins for an alcoholic to take are:

A. D and C
B. The B vitamins
C. Vitamin A and E
D. The fat soluble vitamins

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.
B. Lansoprozole in a hospitalized patient without a prior history of ulcer disease.
C. Metronidazole in a patient who just had open bowel surgery.
D. Metoclopramide in a diabetic patient with nausea from slow peristalsis.

Activated charcoal may be given in the emergency room to:

A. Prevent absorption of phosphate from the gut
B. Assist in the diagnosis of appendicitis
C. Bind and prevent absorption of ingested drugs and toxins
D. Treat nausea associated with intestinal blockage

Which of the following doctor's orders for nausea treatment should be questioned?

A. The patient will receive chemotherapy in 30 minutes: Oders are to give dexamethasone and granisetron orally now.
B. The patient is a diabetic with nerve damage that slows down transit of food in the stomach (gastroparesis): Orders are to give metoclopramide intravenously.
C. The patient has postoperative nausea without vomiting (yet). Orders are for prochlorperazine intravenously and ondansetron intravenously if that does not work.
D. The patient is vomiting postoperatively in the recovery room: Orders are to place topical scopolamine patch, and if ineffective give prochlorperazine intravenously.

Pre 13 GI

2008-12-04T00:04:00.000-08:00

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

A. Osmotically drawing water into the small intestine
B. Killing constipation causing gut bacteria
C. Lubricating and coating the surface of the feces
D. Increasing peristalsis via nerve stimulation in colon

Drug classes that are useful in treating gastric ulcers include:

A. H2 agonists
B. H1 blockers
C. Proton pump inhibitors
D. Bulk laxatives

Drug classes that are useful in treating gastric ulcers include:

A. Serotonin reuptake inhibitors
B. H1 blockers
C. Antibiotics
D. H2 agonists

Ranitidine may be preferred over cimetidine because:

A. Cimetidine is not available over the counter
B. Ranitidine has fewer drug interactions
C. Ranitidine penetrates into the brain better
D. Cimetidine is taken once daily

Sibutramine is approved for therapy lasting no longer than:

A. 2 weeks
B. 6 weeks
C. 3 months
D. 1 year

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?

A. Weight loss
B. Nausea or vomiting
C. Gastroesophageal reflux disease
D. Constipation

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 is taking docusate and biscodyl. What problem would these have been prescribed for?

A. Constipation
B. Gastroesophageal reflux disease
C. Weight loss
D. Irritable bowel syndrome

Pancrease should be taken:

A. With meals.
B. 60 minutes before each meal.
C. With grapefruit juice.
D. On an empty stomach.

Thanks Jose Rodriguez for the extra questions, we appreciate it!!!

Post 12 psych/seizure/abuse

2008-11-21T16:27:00.000-08:00

An herb thought to be useful in treating memory problems is:

A. Ginseng
B. St John's Wort
C. Ginkgo Biloba
D. Echinacea

A side effect common to most of the anticonvulsants is:

A. Hiccoughs
B. Sedation
C. Hypertension
D. Peripheral neuropathies (numbness and tingling in fingers and/or toes)

Fluoxetine (PROZAC) relieves depression by:

A. increasing the amount of serotonin in the synaptic cleft
B. blocking release of norepinephrine from the pre-synaptic nerve
C. increasing the metabolism of MAO (mono-amine oxidase)
D. depressing the metabolism of MAO

Carbamazepine is indicated for:

A. Bipolar disease
B. Febrile seizures in children
C. Depression
D. Partial seizures

Ethosuximide is indicated for:

A. Partial seizures
B. Tonic-clonic seizures
C. Absence seizures
D. Status epilepticus

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.
D. All of the above.

Mr. H is brought to the emergency room with chest pain, a rapid pounding heart beat and very high blood pressure. Since he is only 28, in excellent physical shape and has no history of heart disease, it surprises you when his tests show he had a heart attack. Which of the following drugs of abuse most likely could have contributed to the decreased oxygen delivery to his heart?

A. Alcohol
B. Cocaine
C. A hallucinogen such as LSD
D. Heroin

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:

A. Change to phenelzine
B. Suggest adding St. John's Wort herbal product
C. Change to amitriptyline
D. Increase the dose of paroxetine

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

A. carbamazepine, ethosuximide, lamotrigine
B. physostigmine, pyridostigmine
C. memantine
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?

A. 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.
B. The nurse administers risperidone to an elderly confused patient who tried to climb over the bedrail when the family has just agreed to leave one member at the bedside around the clock.
C. The doctor orders vicodin for a delirious patient who has pulled out 2 IV lines in the last hour.
D. A patient with a drug overdose is yelling obcenities in the emergency room and other patients are complaining. The nurse gives a dose of haloperidol.

The mechanism of action of the antiseizure drug valproic acid is most likely:

A. inhibition of acetylcholinesterase
B. stimulation of sodium channels
C. blocking serotonin reuptake
D. increase in GABA activity

Lamotrigine is indicated for:

A. Absence seizures
B. Insomnia
C. Tonic-clonic seizures
D. Status epilepticus

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

A. Folic acid, thiamine, and multivitamins will probably be ordered.
B. Delirium tremors (DTs) may develop and result in death if the patient is not treated with a drug such as lorazepam (ATIVAN).
C. Alcohol depletes liver fat so the patient will need a diet high in fat.
D. Prolonged night blindness from alcohol may have contributed to the accident.

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:

A. Switch to paroxetine
B. Increase the dose of sertraline
C. Add zolpidem for the next 6 weeks
D. Explain that more time is needed to see effect

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......

A. give atropine.
B. increase the donepezil dose.
C. give physostigimine.
D. discontinue the memantine.

Thanks Jose Rodriguez we really appreciate it!!!

The antipsychotic drug risperodone (RISPERDAL) works by:
A. Blocking H1 receptors in the brain
B. Antagonizing dopamine and serotonin receptors
C. Agonizing alpha-2 receptors
D. Stimulating release of gamma-aminobutyric acid (GABA) in the brain

Which of the following is an adverse effect of phenytoin (DILANTIN)?
A. addiction.
B. euphoria.
C. gum disease.
D. hair loss.

Zolpidem is indicated for:
A. Tonic-clonic seizures
B. Insomnia
C. Absence seizures
D. Bipolar disease

Thanks Lily (added 12/8)

An herb thought to be useful in treating anxiety and sleeping problems is:

A. Ginseng
B. Senna
C. Kava
D. Saw Palmetto

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

A. Drugs often deplete potassium. Keep diet high in potassium rich food.
B. The drugs may stimulate sexual appetite.
C. Dry mouth should be managed with ice chips or sugarless gum.
D. It is safe to use herbal supplements such as St. John's wort to enhance the antidepressant effect of the drugs.

The mechanism of action of phenytoin (DILANTIN)is

A. reducing sodium transport.
B. calcium channel blockade.
C. beta receptor blockade.
D. GABA inhibition.

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?

A. Amphetamines
B. Cocaine
C. A hallucinogen such as LSD
D. An opiate such as heroin

Pre 12 psych/seizure/abuse

2008-11-21T15:52:00.000-08:00

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

A. within about 30 minutes
B. after 2-4 hours, depending on the drug
C. within 24-48 hours
D. after a few weeks

Anticholinergic side effects from the antipsychotics occur because:

A. There are dopaminergic receptors in the autonomic nervous system
B. The drugs stimulate atropine release from the adrenals
C. MAO inhibitors potentiate release of norepinephrine
D. Tyramine metabolism is blocked

The drug zolpidem is useful in treating:

A. bipolar disease
B. anxiety
C. depression
D. insomnia

Diazepam (VALIUM) is used to treat:

A. Anxiety
B. Psychotic behavior
C. Depression
D. Postoperative pain

Under which of the following conditions should you hold (not administer) risperidone?

A. The patient admits to hallucinations.
B. The respiratory rate is high at 24.
C. The ordered dose is 100 mg orally.
D. The patient has a sulfa allergy.

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

A. within about 10 minutes
B. within about 1 hour
C. within 2-3 weeks
D. within 6-8 weeks

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

A. Drugs often deplete potassium. Keep diet high in potassium rich food.
B. The drugs may stimulate sexual appetite.
C. Dry mouth should be managed with ice chips or sugarless gum.
D. It is safe to use herbal supplements such as St. John's wort to enhance the antidepressant effect of the drugs.

Thanks Jose Rodriguez, we appreciate it!!!

Haloperidol (HALDOL) is used to treat:
A.Anxiety
B.Psychotic behavior
C.Postoperative pain
D.Depression

Valproate sodium (DEPAKENE) stimulates GABA receptors and is useful for treating:
A. Depression
B. Psychosis
C. Seizures
D. Obsessive Compulsive Disorder

Thanks Lily (added 12/8)

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)
B.The patient has a history of seizures after trauma to the head.
C.The blood pressure is high at 150/88.
D.The patient has a mild renal impairment.

Post 11 pain/ anesth

2008-11-16T12:37:00.000-08:00

What patient teaching should the nurse do regarding the use of the PCA (patient controlled analgesia) pump?

A. Your family or other visitors may push the button for you if you are asleep.
B. You should not worry about any side effects as this medication is given intraveneously.
C. Push the administration button prior to any activity likely to cause pain, such as walking or coughing.
D. Call the nurse when you need medication. Only the nurse should push the button.

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
B. Fentanyl patch, and an oral agonist-antagonist such as pentazocine (Talwin)
C. Meperidine (regular doses throughout day), acetaminophen or aspirin as needed
D. Tricyclic antidepressant and an anticonvulsant

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

A. Long term use is required, due to buildup of neurotoxic metabolites.
B. The patient has gall bladder disease, due to spasm of the Sphincter of Oddi.
C. The patient has a history of drug abuse, since these patients are not thought to have "true" pain.
D. The pain is nociceptive in nature.

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

A. Acetaminophen
B. Aspirin
C. Celebrex
D. Ibuprofen

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. Instruct the patient to increase the dose of VICODAN.
B. Instruct the patient to take 2 tabs of TYLENOL in between each VICODAN
dose.
C. Contact the MD/NP about adding ibuprofen.
D. Delay therapy for a few weeks until the patient has time to
heal.

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

A. Calcium
B. Diazepam (VALIUM)
C. Succinylcholine (ANECTINE)
D. Neostigmine (PROSTIGMIN) and atropine

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

A. Prevent reflex muscle spasm
B. Reduce pain
C. Decrease blood flow and thus risk of bleeding
D. Suppress autonomic nervous system reflexes

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)
B. Acetaminophen (TYLENOL)
C. Vecuronium (NORCURON)
D. All of the above

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

A. Vecuronium (NORCURON)
B. Lidocaine (XYLOCAINE)
C. Atropine
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?

A. Obtain labs to evaluate kidney function.
B. Ask the patient about pain level.
C. Get drug blood levels.
D. Check blood pressure and pulse.

A 3 year old had gastric surgery this morning and needs pain medicine. Which would be most appropriate?

A. Meperidine (DEMEROL) on a patient controlled analgesia (PCA)
pump
B. A fentanyl patch applied 12 hours after the end of surgery
C. Oral hydrocodone with acetaminophen (VICODAN) as needed
D. Small doses of intravenous morphine as needed

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

A. Diarrhea, abdominal cramps
B. Hypertension, tachycardia
C. Bleeding disorders
D. Dizziness, dry mouth, blurred vision

The inhalation agent isoflurane (FURANE) works by:

A. Preventing the breakdown of acetylcholine at the neuromuscular
junction
B. Increasing action of the neuroinhibitory transmitter gamma-aminobutyric acid
(GABA)
C. Inhibiting reuptake of serotonin by pre-synaptic cells in the
brain
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 skin for rash
B. Check blood pressure
C. Check date of last BM
D. Check respiratory rate

Gabapentin (NEUROTIN) has been ordered for your diabetic patient because:

A. Anxiety is common in diabetics
B. Neuropathic pain is common in diabetics
C. It suppresses vagal stimulation during anesthetic induction
D. It helps maintain blood sugar during the stress of surgery

The anesthetist added bupivacaine to the morphine epidural infusion in order to:

A. Work synergistically with morphine to reduce pain
B. Maintain blood pressure
C. Decrease urinary retention
D. Improve muscle strength in the legs

A diabetic patient has severe neuropathic pain which has been unresponsive to opioids. What would be most appropriate to try next?

A. Acetaminophen
B. The non-steroidal anti-inflammatory naproxen (ALEVE)
C. Gabapentin (NEURONTIN)
D. Methadone

Thanks Lily Sok for all your input, we appreciate it!!!

Pre 11 pain/ anesth

2008-11-16T12:13:00.000-08:00

Overdose on opioids is associated with which of the following?

A. Hypertension
B. Slow respiratory rate
C. Diarrhea
D. Frequent urination

The World Health Organization recommends which strategy for managing pain in a patient with cancer?

A. Meperidine (DEMEROL) is the preferred drug for long term use.
Toxic metabolites with long term use.
B. Start with COX inhibitor such as acetaminophen. Add a weak opioid advancing
to stronger opioids as needed.
C. Start with a high-dose fentanyl patch, evaluating every hour until the pain
is controlled. Reduce dose of next patch applied if
possible.
D. Alternate a narcotic with doses of naltrexone to prevent
addicition.

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

A. The patient has a history of gastrointestinal bleeding.
B. The patient has a fever.
C. The patient is taking low doses to prevent a stroke.
D. The patient is elderly.

An example of a general anesthetic is:

A. Breathing in isoflurane
B. Injection of lidocaine into the skin
C. Injecting mepivacaine near a nerve
D. Giving a preoperative intravenous injection of atropine

Select the correct statement regarding pain management.

A. Mu and kappa receptors are limited in location to the sensory spinal cord
tracts.
B. Extreme care must be taken to avoid overdosing on narcotics as there is no
antidote.
C. At least 50 million people are diabled as a result of pain.
D. Neuropathic pain responds better to opioids than nociceptive pain
does.

A side effect of morphine, for which tolerance DOES NOT develop, is:

A. Hypertension
B. Sedation
C. Abdominal pain
D. Constipation

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

A. The potential for respiratory depression will increase the longer the
patient takes the medication.
B. Tolerence to the analgesic effect may develop but can be managed by a
decrease in dosage.
C. Do not crush the tablets as overdose could result.
D. Extra doses can be used to treat itching associated with
chemotherapy

An example of a local anesthetic is:

A. Injection of lidocaine into the skin
B. Breathing in isoflurane
C. A preoperative intravenous injection of atropine
D. Continuous intravenous infusion of propofol

Post 10 hormones/osteo

2008-11-16T11:49:00.000-08:00

M.K. is a 74 year old woman who has been taking thyroid hormones for 10 years. Which of the following effects of thyroid hormones would be the most dangerous for her?

A. cardiac stimulation
B. constipation
C. insomnia
D. muscle relaxation

F.H. is a 42 year old type 1 diabetic who has been receiving insulin for a long time. He needs a very high dose 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?

A. glucagon.
B. bromocriptine.
C. growth hormone.
D. metformin (GLUCOPHAGE).

Which of the following are adverse effects of metformin (GLUCOPHAGE)?

A. hypotension
B. headache
C. blurred vision
D. hyperglycemia

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

A. Increased blood glucose
B. Decreased white blood cell count
C. Increased serum sodium
D. Decreased serum potassium

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

A. within 5-10 minutes
B. in 6-12 hours
C. in 18-24 hours
D. after 2 weeks of therapy

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

A. It mimics the normal first phase insulin reaction.
B. It sensitizes cells to the action of insulin.
C. It decreases carbohydrate absorption from the gut.
D. It should be taken 30 minutes after eating.

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:

A. Large reduction in risk of breast cancer.
B. NO reduction in risk of heart attack and stroke.
C. Small reduction in risk of gall bladder disease.
D. Large increase in the risk of osteoporotic bone fractures.

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?

Student Response Correct Answer
A. Give 12 units Humalog insulin with sugar.
B. Give 12 units Humulin-R with sugar.
C. Give 12 units Humulin-N with sugar.
D. Give sugar.

LC is a 33 year old who has been taking oral contraceptives for the past 8 years. To assess her risk of having adverse effects from this medication, the most important question you should ask is:

A. "Are you allergic to eggs?"
B. "Do you smoke?"
C. "Has anyone in your family died of colon cancer?"
D. "Have any family members been diagnosed with osteoporosis?"

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

A. Take 240 mg sustained release Calan each morning.
B. Take 1 500 mg calcium carbonate in the morning on an empty
stomach.
C. Take 1 100 mg tablet of calcium citrate with each meal.
D. Take 2 500 mg tablets of calcium carbonate every evening with your
meal.

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

A. acetominophen
B. beta blockers
C. parasympathomimetic drugs
D. sympathomimetic drugs

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?

A. administer insulin
B. give him sugar
C. give him a high protein supplement
D. take his blood pressure and watch carefully

Match the drug to its MAJOR mechanism of aciton.

glipizide (GLUCOTROL) Replaces insulin
acarbose (PRECOSE) Increases insulin release
repaglinide (PRANDIN) Delays absorption of carbohydrate
NPH insulin

LC is a 33 year old who has been taking oral contraceptives for the past 8 years. To assess her risk of having adverse effects from this medication, the most important question you should ask is:

A. "Do you smoke?"
B. "Has anyone in your family died of colon cancer?"
C. "Are you allergic to eggs?"
D. "Have any family members been diagnosed with osteoporosis?"

Which of the following is the least expensive prevention for osteoporosis?

A. Flomax
B. Evista
C. Forteo
D. Calcium supplements with vitamin D

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

A. within 5-10 minutes
B. in 2-4 hours
C. in 8-12 hours
D. after 2 weeks of therapy

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

A. hypertension
B. headache
C. chest pain
D. muscle pain

Courtesy of Vanessa Kelly, Thanks!!!

LC is a 33 year old who has been taking oral contraceptives. She reports 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?

A. She is probably pregnant, and should pick up an over-the-counter kit to check before she takes any more BCPs.
B. These symptoms may eventually require a trip to the doctor, but they are not related to the BCPs.
C. She is showing signs of menopause and could probably safely stop taking the BCPs without getting pregnant.
D. She has probably developed a blood clot in her right leg (thrombophlebitis), and should go to the hospital to have it checked.

H.B. is a 48 year old male who is being treated for type 2 diabetes with oral agents. He reports his usual fasting blood glucose is 168, bedtime glucose is 180, and A1c is 10.2. Which of the following statements is true about H.B.?

A. He should stay on the same medications.
B. He needs additional medicine.
C. He needs lower doses of medicine.
D. His diabetes has resolved.

Your diabetic patient is to receive 8 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 145. What should you do?

A. Give 8 units Humalog and 2 units Humulin-R.
B. Give 10 units Humulin-R.
C. Give 8 units Humalog.
D. Give 12 units Humulin-N.

Pre 10 hormones/osteo

2008-11-06T18:12:00.000-08:00

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

A. hypertension
B. acne
C. decrease in breast size
D. pregnancy

Which of the following reflects adverse effects of oral contraceptives?

A. hypoglycemia
B. bronchospasm
C. blood clots
D. atrophy of secondary sex organs

Your cousin has complained of fatigue for some time. You notice she is gaining weight and that her skin has become very dry. She is cold all the time and is not as sharp mentally as she used to be. Her primary care provider says she has a thyroid problem that needs pharmacological support. Which of the following drugs should she take?

A. progesterone
B. a sympathomimetic drug
C. methimazole (TAPAZOLE)
D. levothyroxine (SYNTHROID)

K.R. is a 30 year old type 1 diabetic. He takes regular insulin four times a day. He is complaining that he is really hungry, feels weak, and has a headache. You notice that he is confused and his heart rate is increased and he is sweating. The most likely reason for these symptoms is

A. allergy.
B. hypoglycemia.
C. hyperglycemia.
D. lipodystrophy.

Production of thyroid hormones requires adequate dietary intake of

A. calcium.
B. vitamin B12.
C. iodine/iodide.
D. cholesterol

A patient should be told to take rosiglitizone:

1. 3x/day, 30 minutes after each meal.
2. Without regard to meals.
3. By injecting it into a different site each day.
4. 3x/day, 30 minutes before each meal.

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

A. weight loss
B. cough
C. fatigue
D. tachycardia

If you client received too much NPH insulin at 8am, you would anticipate a hypoglycemic reaction would occur

A. between 0800 (8 am) and 1400 (2pm)
B. between 1200 (noon) and 2000 (8 pm)
C. between 2000 (8 pm) and 2400 (midnight) that night
D. NPH does not usually cause hypoglycemia

A patient should be told to take insulin glargine:

A. 5-10 minutes before a meal.
B. Once a day at bedtime.
C. 30 minutes before a meal.
D. 60 minutes before the morning meal.

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)
B. 1500 (3pm)
C. 1800 (6 pm)
D. 2100 (9 pm)

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

A. T3 and T4
B. aldosterone.
C. calcitonin.
D. insulin.

Thanks Nazia Khan for the extra question, we really appreciate it!!!

Post 9 Dysrhy/CAD

2008-11-06T18:06:00.000-08:00

The mechanism of action of verapamil (CALAN) is

A. blocking calcium channels.
B. blocking sodium channels.
C. blocking the SNS.
D. blocking potassium channels

The major reason why beta blockers such as metoprolol are useful in the treatment of angina is because they

A. increase preload.
B. dilate coronary vessels.
C. decrease heart work.
D. reduce oxygen extraction.

A Class II antidysrhythmic such as the beta-blocker propranolol (INDERAL) is useful in treating dysrhythmia, however you should asess the patient for

A. bronchospasm.
B. an increase in blood pressure.
C. tachycardia.
D. a low potassium level.

The electrophysiological basis of automaticity is

B. slow leak of sodium into the cell.
C. rapid influx of potassium.
D. rapid influx of calcium.

Adenosine may be given by rapid intraveneous push to treat:

A. Heart failure
B. Bradycardia
C. Severe wheezing in asthmatics
D. Very rapid, regular heart rate

In general, antidysrhythmic drugs

A. Increase automaticity, speed conduction rates, and increase
refractoriness
B. Decrease automaticity, speed conduction rates, and decrease
refractoriness
C. Increase automaticity, slow conduction rates, and decrease
refractoriness
D. Decrease automaticity, slow conduction rates, and increase
refractoriness

A patient having chest pain at home would be instructed to:

A. Check their blood pressure and take an alpha-1 agonist.
B. Check their blood pressure and take a beta-blocker by mouth.
C. Apply a topical calcium channel agonist to the chest wall.
D. Put a nitroglycerine tablet under their tongue, and take an
aspirin.

Which 2 drugs should essentially all patients with suspected heart attack have within the first 24 hours?

A. prednisone and sotalol
B. clopidogrel and nitroglycerine
C. labetalol and aspirin
D. abciximab and dilitiazem

An elderly patient has premature ventricular contractions at a rate of 1-2 minute. This patient should receive:

A. amiodarone
B. atropine
C. digoxin
D. no drug therapy

This patient walked in complaining of lightheadedness. She was found to be in rapid atrial fibrillation, a rhythm she has been in on several different admissions. Most practitioners would treat this:

A. By trying to pharmacologically convert her out of the fibrillation with oral
amiodarone.
B. By trying to electrically convert her out of the rhythm with cardioversion
(shock).
C. By trying to pharmacologically convert her out of the fibrillation with
intraveneous amiodarone.
D. By slowing her ventricular rate down with verapamil, but leaving the atrium
fibrillating.

The major reason why calcium channel blockers such as verapamil (CALAN) are useful in the treatment of angina is because they

A. reduce oxygen extraction.
B. increase preload.
C. decrease heart work.
D. constrict plaque size.

All of the following are predictable adverse reactions of nitroglycerin EXCEPT

A. headache.
B. hypotension.
C. chest pain.
D. tachycardia.

The electrophysiological basis for repolarization is:

A. passive diffusion of calcium out of the cell
B. slow leak of sodium into the cell
C. active pumping of potassium out of the cell
D. rapid influx of calcium into the cell

Electrical procedures such as pacemakers, ablations and defibrillation has replaced the use of dysrhythmics in many situations because:

A. It eliminates problems with patients not being compliant with the
medications.
B. The procedures are covered under the 100,000 Lives Guidelines.
C. The procedures are more effective and have fewer adverse effects than the
medicines do.
D. They are less expensive for the patient than a lifetime supply of the
medication.

A patient receives alteplase after a heart attack. What is the most important side effect to watch for?

A. bleeding
B. urinary retention
C. nausea
D. hearing loss

This slow rhythm has cuased the patinet's blood pressure to drop too low. While waiting for a pacemaker to be put in, you might give:

A. dilitiazem
B. amiodarone
C. atropine
D. metoprolol

An elderly patient who is taking a long acting form of nitroglycerin is at risk of falling because of

A. dizziness or fainting.
B. headaches.
C. increased preload.
D. slowing of the heart rate.
5.

Digoxin may be used to treat very rapid supraventricular heart rates such as those that may occur in atrial fibrillation because it

A. increases the rate of conduction through the atrioventricular node
B. decreases SNS stimulation of the heart and decreases AV conduction.
C. decreases PNS activity
D. increases potassium excretion.

The nurse notes tall peaked T waves on the EKG. What is the most important additional assessment data to collect?
EKGhyperkalemia.jpg

A. Pulse.
B. Blood pressure.
C. Serum potassium.
D. Serum sodium.

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

A. They cause hypertension and tachycardia.
B. They cause impotence and poor pregnancy outcomes.
C. They cause dysrhythmia
D. They increase automaticity, speed conduction rates, and increase refractoriness.

Mrs. Jones was admitted to CICU with a diagnosis of acute myocardial infarction (heart attack). Her hospital course was uneventful. When you prepare her for discharge, you would expect her to have prescriptions for

A. sildenafil if her heart rate is over 80
B. a statin if her LDL cholesterol is greater than 100
C. digoxin if her ejection fraction is over 60%
D. low molecular weight heparin if her aPTT is high

Pre 9 Dysrhy/CAD

2008-10-29T23:33:00.000-07:00

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

A. They increase automaticity, speed conduction rates, and increase
refractoriness.
B. They cause impotence and poor pregnancy outcomes.
C. They cause dysrhythmia.
D. They cause hypertension and tachycardia.

The electrophysiological basis of automaticity is

A. rapid influx of calcium.
B. inhibition of the sodium-potassium pump.
C. slow leak of sodium into the cell.
D. rapid influx of potassium.

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)
B. digoxin (LANOXIN)
C. epinephrine (ADRENALINE)
D. dobutamine (DOBUTREX)

Most antidysrhythmic drugs act by:

A. antagonism of receptors on the SA and AV node
B. promoting metabolism of normal neurotransmitters
C. creating retrograde electrical flow
D. blocking ion channels in myocardial cells

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 __________.

A. fast action potential.
B. muscle action potential
C. slow action potential
D. repolarization potential

All of the following decrease heart work and oxygen demand EXCEPT

A. decreasing contractility.
B. decreasing heart rate.
C. increasing duration of diastole.
D. increasing preload.

When looking at an electrical tracing of the heart, the passage of electricity through the atria is displayed as:

A. The QRS
B. The AV node
C. The QT interval
D. The P wave

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

A. beta blockers and aspirin
B. amiodarone and hydrocortisone
C. calcium channel blockers and acetaminophen
D. quinidine and lidocaine

An action potential characterized by a rapid influx of sodium through sodium channels in phase 0 and delayed repolarization secondary to calcium influx is an __________.

A. fast action potential
B. muscle action potential
C. slow action potential
D. repolarization potential
4.

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.
B. A prolonged ST segment.
C. A wide QRS.
D. An inverted P wave.
5.

Drugs useful in treating angina include:

1. Calcium channel blockers because they relax arterial smooth muscle and may slow heart rate.
2. Sodium channel blockers because they slow conduction within the heart.
3. Potassium channel blockers because they increase the refractory period.
4. Magnesium channel blockers because they reduce preload and afterload.

Post 8 HTN/ Lipids

2008-10-29T22:46:00.000-07:00

Before starting atorvastatin (LIPITOR), it is important to:

A. Document that the patient failed therapy with Niacin and one of the bile acid
sequestrants (Colestipol or Cholestyramine).
B. Be sure the patient is not pregnant.
C. Teach the patient how to do home blood sugar monitoring and be sure patient has
the equipment.
D. Document normal conductivity through heart with EKG.

Some antihypertensive drugs block both alpha and beta receptors. Why would this be a good thing for someone with hypertension?

A. it causes vasodilation
B. it decreases renin release
C. it increases cardiac output
D. 1, 2 only
E. 1,2,3

The mechanism of action of this drug is dilation of arterioles by a direct effect on vascular smooth muscle.

A. clonidine (CATAPRES)
B. captopril (CAPOTEN)
C. hydralazine (APRESOLINE)
D. atropine

Losartan (COZAAR) is an angiotensin II receptor antagonist which would be expected to have which side effect(s):

A. Hypokalemia (low potassium)
B. Pupil constriction
C. Dizziness
D. Dry mouth

Aldosterone alters blood pressure because it

A. causes potassium excretion.
B. dilates blood vessles.
C. causes sodium retention.
D. enhances renin release.

In acute head injury, the osmotic diuretic mannitol may be given to reduce brain swelling. What potential problem would you need to monitor for?

A. The mannitol prevents electrolytes from being excreted by the
kidney.
B. The blood pressure could drop quickly as fluid is pulled from cells into the
blood stream.
C. Urine output typically drops transiently during the first 4 hours.
D. Over time, if the mannitol diffuses into the brain, it would make the swelling
worse.

All of the following are adverse effects of furosemide (LASIX) EXCEPT

A. high blood potassium levels
B. low blood sodium and chloride levels
C. hypotension
D. hearing loss

Hyperlipidemia drug therapy for a person with existing coronary heart disease should begin when:

A. LDL cholesterol is greater than 100.
B. HDL cholesterol is elevated.
C. The patient has lost 10% of his/her body weight.
D. Blood pressure is under control.

R.J. is a 55 yo male with long standing hypertension who has been treated with Dyazide one capsule each day. On this clinic visit, a urine sample is positive for spilled protein. His BP is 136/82. You should:

A. Discontinue the Dyazide. After 1 week, start captopril 25 mg twice each
day.
B. No drug changes are required. He should have a low protein diet.
C. Increase the Dyazide dose to 2 capsule each day.
D. Add captopril 50 mg three times each day.

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.
B. Add losartan.
C. Increase the lasix.
D. Increase the lisinopril.

A patient crushed his sustained-release verapamil tablet before ingesting it. Which action would you most likely take?

A. Administer short acting verapamil to keep the heart rate down.
B. Check heart rate and administer a beta-blocker such as atenolol (TENORMIN) to
keep the heart rate down.
C. Check the serum creatinine and start dialysis.
D. Check the BP and give fluids and other medication as necessary to keep the BP
up.

P.J. is a 56 year old male who is taking an angiotensin receptor blocker for hypertension. You should teach him to

A. discontinue his medications if he develops a headache.
B. take his medication first thing in the morning to counteract the
sedation.
C. purchase his new prescription 3-4 days before his old prescription runs
out.
D. increase his salt intake to counteract the salt wasting associated with this
drug.

A drug that antagonizes aldosterone would be useful in treating hypertension because it would

A. cause potassium excretion.
B. enhance renin release.
C. block vasoconstriction
D. increase renal excretion of sodium.

Which assessment finding best reflects effective management of hypertension?

A. blood pressure 155/95
B. blood pressure reduced 10%
C. blood pressure less than 130/90
D. increased urinary output with edema reduction

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. losartan
C. cholestyramine
D. atorvastatin

John Doe is taking spironolactone (ALDACTONE). You should teach him to

A. take this medication in the evening to avoid sedation.
B. take potassium supplements as this drug lowers potassium levels in the blood.
C. take over the counter medications to reduce hair loss.
D. restrict water intake as this medication causes water retention.

.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. Discontinue the ACE inhibitor and add an Angiotensin Receptor Blocker.
2. Increase the ACEi dose.
3. Add a calcium channel blocker.
4. Discontinue the diuretic and add a beta blocker.

Thanks Lily Sok for the additional questions!

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?

A. Decrease the viscosity of the blood
B. Increase the viscosity of the blood
C. Decrease the radius of the vessel
D. Increase the radius of the vessel

Which of the following drugs is most likely to raise serum LDL cholesterol?

A. atorvastatin
B. hydrochlorothiazide
C. Niacin (Vitamin B3)
D. Cholestyramine

S.Q. is a 45 yo diabetic with mild renal disease (creatinine 1.7, normal is 0.6-1.2). She is taking valsartan 320 mg each day, hydrochlorothiazide 50 mg each day, and metoprolol 50 mg twice each day. She has tolerated these drugs without significant side effects. Today her BP is 138/94. You should:

A. Add lisinopril.
B. Increase the metoprolol.
C. Continue the medications as listed.
D. Reduce the valsartan dose.

Which of the following drugs blocks both alpha and beta receptors?

A. carvedilol (COREG)
B. clonidine (CATAPRES) Student Response
C. hydralazine (APRESOLINE) Student Response
D. propranolol (INDEROL) Student Response

All of the following are adverse effects of hydrochlorothiazide (ESIDRIX) EXCEPT

A. dizziness and faintness.
B. hypoglycemia. Student Response
C. high calcium levels.
D. paresthesia.

Diuretics are useful in treating hypertension becasue they

A. decrease preload.
B. increase vessel diameter.
C. block renin release.
D. block angiotensin converting enzyme.

The mechanism of action of furosemide (LASIX) is

A. antagonizing aldoseterone.
B. inhibiting sodium and chloride reabsorption in the loop of Henle.
C. increasing the osmolality of urine, thus increasing urinary output.
D. supressing renin release.

Pre 8 HTN/Lipids

2008-10-22T19:21:00.000-07:00

The diuretic furosemide (LASIX), causes:
A. Hypernatremia (high Na+ level in blood)
B. Hyperkalemia (high K+ level in blood)
C. Hypokalemia (low K+ level in blood)
D. Edema and hypertension

Enalapril (VASOTEC) is an example of an antihypertensive medicne from which class?
A. ACE inhibitor
B. Angiotensin II Receptor Antagonist
C. Vasodilator
D. Beta Blocker

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

A. start with one drug at the normal dose and increase the dose until it
works.
B. use the maximum dose of one drug and add a second drug at its maximum
dose.
C. use the maximum dose and add a small amount of an antagonist.
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)?
A. Blood sugar and Hemoglobin A1C
B. Potassium level
C. Total Cholesterol, HDL cholesterol, LDL cholesterol
D. Drug blood levels

A patient has a BP of 138/84. What condition would indicate a need to treat this patient with hypertensive medication?
1. Diabetes
2. High HDL cholesterol level
3. Age over 60 years.
4. Female gender.

Most patients with a blood pressure breater than 160/100 should be treated with:
1. A thiazide diuretic and one drug from another class.
2. Two beta blockers.
3. Lifestyle modification only.
4. A calcium channel blocker and an angiotensin receptor blocker.

All of the following drugs classes are used to treat hypertension EXCEPT
A. alpha-2 agonists
B. beta-2 agonists
C. vasodilators
D. calcium channel blockers

Enalapril (VASOTEC) treats hypertension by
A. Stimulating alpha1 receptors on blood vessels.
B. supressing renal excretion of sodium.
C. depressing contractility of the heart.
D. inhibiting angiotensin converting enzyme.

Additional Questions courtesy of Carissa Galvan, and Lily Sok, Thanks!!!

Teaching for a person taking an ACE inhibitor should include

A. report feelings of faintness to the health care provider.
B. if there is difficulty breathing or hoarsness, go to bed immediately.
C. monitor blood pressure at least once a year.
D. If you had angioedema from prior ACE inhibitor use, take a tylenol prior to taking your ACE inhibitor.

The serious, potentially life-threatening adverse of atorvastatin (LIPITOR), particularly if it is combined with a fibrate is

A. hyperglycemia
B. gastrointestinal bleeding.
C. chest pain.
D. skeletal muscle damage (rhabdomyolysis).

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?

A. Hypokalemia (low K+ in blood)
B. Paradoxical hypertension
C. Liver failure
D. Cough and rash

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

1. Diabetes
2. High HDL cholesterol level
3. Age over 60 years.
4. Female gender.

Pre 7 ANS2/CHF

2008-10-22T18:05:00.000-07:00

Quiz 7 courtesy of Lily Sok, Jenny Lou, and Carissa Galvan. Thanks you very much ladies, we really appreciate it!!!

Beta-adrenergic blocking agents are used in the management of
A. asthma.
B. cirrhosis.
C. heart failure.
D. pneumonia.

Sympathomimetic drugs are likely to cause which of the following adverse effects?
A. bradycardia
B. tachycardia
C. hypertension
D. hyperglycemia
E. 1, 3, 4 only
F. 2, 3, 4 only

The adverse effects of beta blockers include
A. increased heart rate.
B. hypertension
C. bronchoconstriction.
D. urinary urgency.

A parasympathomimetic drug such as physostigmine (ANTILERIUM) is used to
1. decrease saliva production.
2. decrease motion sickness.
3. treat urinary retention.
4. counteract adverse effects of polocarpine.

Scopolamine may be used to treat motion sickness. Side effects of dry mouth, blurred vision and constipation result from
A. Inhibition of nicotinic receptors.
B. Stimulation of alpha receptors.
C. Inhibition of muscarinic receptors
D. Inhibition of dopamine recpetors

Drugs such as an alpha-1 agonist,that mimic the sympathetic nervous system would cause
A. pupil dilation.
B. decreased heart rate.
C. consriction of airways.
D. diarrhea.

The effects of sympathomimetic drugs include
A. decreased heart rate.
B. decreased blood sugar.
C. bronchoconstriction.
D. urinary retention.

Drug Y is an adrengeric receptor blocker. This means it
1. blocks acetylcholine receptors.
2. blocks nicotinic receptors.
3. simulates dopamine receptors.
4. blocks norepinephrine receptors.

More question courtesy of Corina Kendrick, Thanks!!!

Phenylephrine (NEOSYNEPHRINE)is an alpha-1 agonist. A predictable adverse effect of this drug is
A. hypertension.
B. Myasthenia Gravis.
C. sedation.
D. heart failure.

Which drug is administered parenterally in emergency situations, such as treating acute, liefe-threatening allergic reactions?
A. dobutamine (DOBUTREX)
B. dopamine (INTROPIN)
C. epinephrine (ADRENALIN)
D. norepinephrine (LEVOPHED

Phenylephrine (NEOSYNEPHRINE)is an alpha-1 agonist. This drug would be used to treat
A. hypertension.
B. Myasthenia Gravis.
C. nasal congestion.
D. heart failure.

Post 7 ANS2/CHF

2008-10-18T15:16:00.000-07:00

The mechanism of action of atropine is
A. activation of post-synaptic muscarinic receptors.
B. blockade of pre-synaptic alpha receptors.
C. antagonism of acetylcholine binding sites.
D. releasing norepinephrine from nerve endings.

Your patient has high blood pressure and you are considering giving him Beta-adrenergic blocking agents. Which of the following questions should you ask prior to ordering a beta blocker like propranolol (INDERAL)?
A. Do you have asthma?
B. Do you have food intolerances?
C. Do you have a family history of alcholism?
D. Are you allergic to penicillin?

Which of the following drugs would be effective in treating hypertension?
A. albuterol (PROVENTIL)
B. DOBUTamine (DOBUTREX)
C. phenylephrine (NEOSYNEPHRINE)
D. prazosin (MINIPRESS)

You are making a home visit for physical therapy on a patient with a history of hypertension. When you ask if there have been any changes since your last visit, the patient tells you that yesterday the doctor increased the prazosin (MINIPRESS) dose. This alerts you to check for:

A. Anaphylactic allergic reaction.
B. wheezing
C. Hypotension and dizziness when the patient stands up.
D. Muscle spasms and tremors

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:

A. Suppress the action of acetylcholine at muscarinic receptors thereby decreasing heart rate.
B. Activate alpha-2 receptors thereby decreasing SNS outflow from the central nervous system
C. Reduce afterload so the heart doesn't have to work so hard.
D. Stimulate alpha-1 receptors and keep the blood pressure up.

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?
A. atropine
B. physostigmin (ANTILERIUM)
C. bethanichol
D. pilocarpine

Pseudoephedrine is an alpha agonist added to many over the counter medications to treat:
A. diabetes
B. nasal congestion
C. insomnia
D. diarrhea

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.
B. increase increase preload.
C. increase heart work.

Drugs that improve morbidity and mortality in heart failure include:
A. Digoxin
B. Phenytoin (Dilantin)
C. Calcium channel blockers such as diltiazem (CARDIZEM)
D. The beta blocker carvedilol

A patient taking spironolactone (ALDACTONE) should be taught about adverse effects such as
A. alkalosis (high pH).
B. high potassium levels in the blood.
C. nausea.
D. constipation.

The mechanism of action of a direct acting beta agonist is
A. activation of post-synaptic receptors.
B. blockade of pre-synaptic receptors.
C. antagonism of acetylcholine binding sites.
D. releasing norepinephrine from nerve endings.

Beta-adrenergic blocking agents are used in the management of
A. asthma.
B. cirrhosis.
C. heart failure.
D. pneumonia.

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.
B. The fetus may undergo oxygen loss due to vasoconstriction associated with SNS activation.
C. The blood sugar may drop suddenly.
D. All of the above.

Propranolol (INDERAL) adverse effects include all of the following EXCEPT
A. bronchoconstriction.
B. hypertension.
C. impotence.
D. fatigue.

Drugs that improve morbidity and mortality in heart failure include:
A. Digoxin
B. Potassium supplements
C. Calcium channel blockers
D. ACE inhibitors

Patients who have NYHA class III heart failure should be taking
1. beta 2 adrenergics such as albuterol
2. non-selective beta blockers such as carvedilol.
3. peripheral alpha blockers such as prazocin
4. angiotensin converting enzymes such as angiotensin

Thanks Carissa for these additional questions!!

The mechanism of action of amphetamines is
A. interaction with post-synaptic receptors.
B. blockade of pre-ganglionic nicotinic receptors.
C. antagonism of acetylcholine binding sites.
D. releasing norepinephrine from nerve endings.

Which of the following drug classes produces the desired pharmacological effects by interacting with presynaptic receptors to reduce SNS outflow from the CNS?
A. alpha 1 agonists
B. alpha 2 agonists
C. beta 1 agonists
D. beta 2 agonists

Thanks Lily for the additional questions.

Drugs that improve morbidity and mortality in heart failure include:

A. Digoxin
B. Potassium supplements
C. ACE inhibitors Student Response
D. Calcium channel blockers

Atropine has which pharmacological property?
A. dilation of pupil
B. excessive sweating
C. decreased heart rate
D. increased GI motility

Post 6 ANS 1

2008-10-13T20:51:00.000-07:00

The antidote for atropine poisoning is

A. bethanechol (URECHOLINE)
B. phenytoin (DILANTIN)
C. physostigmine (ANTILIRIUM)
D. propranolol (INDERAL)

The antidote for overdose with a parasympathomimetic drug is:

A. atropine.
B. physostigmine (ANTILIRIUM).
C. edrophonium chloride (TENSILON)
D. propranolol (INDERAL)

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 given atropine. What side effects do you need to observe for?

A. Urinary retention
B. Diarrhea
C. Diaphoresis (sweating)
D. Heart block or other very slow heart rate

Extravasation of an alpha1 agonist (such as epinephrine) into the tissue surrounding a vein (or infused accidentally into an artery) can cause such severe vasoconstriction as to cut off blood supply and cause death of the tissue. What drug could be given to block this vasocontriction?

A. Phentolamine
B. Clonidine
C. Atenolol
D. Ephedra

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?

A. atropine
B. physostigmin (ANTILERIUM)
C. bethanichol
D. pilocarpine

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

A. insomnia
B. hypotension and dizziness.
C. diarrhea
D. bronchospasm

Atropine has which pharmacological property?

A. constriction of pupil
B. excessive sweating
C. increased blood sugar
D. constipation and decreased GI motility

Knowing herself to be prone to motion sickness, before her trip to the mountains, Dizzy Lizzy places a transdermal scopolamine patch behind her ear. The transdermal application will allow blockage of the muscarinic receptors in the pathway from the inner ear to the vomiting center of the brain. Although fairly selective for these receptors, there is some action at other muscarinic sites resulting in side effects of:

A. dry skin and mouth
B. diarrhea and uterine cramping
C. CNS stimulation: insomnia and seizures
D. bradycardia and urinary frequency

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

A. Constipation
B. Insomnia
C. Urinary frequency
D. Hypertension

A patient developed urinary retention after surgery. She was prescribed bethanechol (UROCHOLINE). Why is it important that nothing be obstructing the urethra?

A. The drug works by stimulating receptor sites on the urethra. Obstruction
prevents this stimulation.
B. Obstruction increases the risk of incontinence from this drug.
C. Skeletal muscles must first be in the relaxed state to allow this drug to
work.
D. Bladder contraction against an obstruction could cause backflow of urine
into the kidneys.

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
B. sympathomimetic/adrengergic
C. parasympatholytic
D. sympatholytic

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. What drug should be given?

A. The alpha-2 agonist clonidine.
B. The parasympathomimetic drug neostigmine.
C. The anticholinergic drug atopine.
D. The beta-2 agonist albuterol

Phenylephrine (NEOSYNEPHRINE)is an alpha-1 agonist. A predictable adverse effect of this drug is

A. hypertension.
B. Myasthenia Gravis.
C. sedation.
D. heart failure.

Which of the following drug classes produces the desired pharmacological effects by interacting with presynaptic receptors to reduce SNS outflow from the CNS?

A. alpha 1 agonists
B. alpha 2 agonists
C. beta 1 agonists
D. beta 2 agonists

Atropine has which pharmacological effect?

A. dilation of pupil
B. excessive sweating
C. decreased heart rate
D. increased GI motility

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

A. Hypertension
B. Diarrhea
C. Urinary retention
D. Cough

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

A. abdominal cramps, hypotension, excess salivation
B. Pupil dilation, tachycardia, constipation
C. Dry as a bone, red as a beet, blind as a bat, hot as a furnance, mad as a
hatter
D. Hypertension, tachycardia, increased urine output,
hyperglycemia

A patient receives atropine preoperatively. Why?

A. To prevent them from having to urinate during the surgery.
B. To decrease respiratory secretions and keep heart rate up.
C. To temporarily paralyze muscles so the patient holds still.
D. To prevent infection.

F. Ames presented with the following symptoms: dry skin, facial flushing, visual problems, elevated temperature, confusion, tachycardia, urinary retention, and constipation. Which of the following drugs should be administered?

A. phentolamine (REGITINE)
B. physostigmine (ANTILERIUM)
C. atropine
D. propranolol (INDEROL)
6.

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

A. drowsiness
B. hypertension
C. diarrhea
D. bronchospasm

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

A. Relax muscle spasm.
B. Raise the blood pressure.
C. Improve muscle strength.
D. Increase heart rate.

Pre 6 ANS 1

2008-10-06T20:43:00.000-07:00

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

A. ANS
B. Parasympathetic Nervous System
C. Sympathetic Nervous System
D. Somatic Nervous System

The neurotransmitter at adrenergic nerve endings is

A. acetylcholine.
B. norepinephrine.

The neurotransmitter at SNS ganglia is

A. acteylcholine.
B. dopamine.
C. norepinephrine.
D. substance P.

The recptor types occupied by norepinephrine include

A. alpha.
B. beta.
C. muscarinic.
D. nicotinic.
E. 1 and 2

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.
2. take her heart rate every hour for two days.
3. suck on ice chips to ensure hydration.
4. take a laxative for the next two days to prevent constipation.

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

A. ANS
B. Parasympathetic Nervous System
C. Sympathetic Nervous System
D. Somatic Nervous System

The neurotransmitter at cholinergic nerve endings is

A. acetylcholine.
B. norepinephrine.

The neurotransmitter at PNS ganglia is

A. acteylcholine.
B. dopamine.
C. norepinephrine.
D. substance P.

The recptor types occupied by acetylcholine include

A. alpha.
B. beta.
C. muscarinic.
D. nicotinic.
E. 3 and 4

Thanks Lily for the extra questions, we appreciate it!!!

Which of the following components of the nervous system is specifically responsible for vegitative, resting functions?

A. ANS
B. Parasympathetic Nervous System
C. Sympathetic Nervous System
D. Somatic Nervous System
5.

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

A. less SNS activity
B. more SNS activity
C. nothing would happen as there are other ways to break down norepinephrine.

The recptor types occupied by norepinephrine include

A. alpha.
B. beta.
C. muscarinic.
D. nicotinic.
E. 1 and 2

Post 5 Vac/Coag

2008-10-06T19:33:00.000-07:00

Common side effects from vaccines include

A. slight fever and pain at the injection site.
B. seizures.
C. generalized pain.
D. vomiting.

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)
B. Coumadin (WARFARIN)
C. Heparin
D. Atorvastatin (LIPITOR)

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.
B. Coumadin works right away and provides anticoagulation until the heparin starts working a few days later.
C. Coumadin will reduce the risk of bleeding from the heparin.
D. Heparin will reduce the risk of bleeding from the coumadin.

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

A. INR
B. aPTT
C. Hematocrit
D. Platelet

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?

A. digoxin
B. furosemide (LASIX)
C. potassium
D. warfarin (COUMADIN)

Which of the following is an example of passive immunization?

A. An elderly patient receives an influenza vaccination every year which causes the person to produce antibodies against influenza virus.
B. A child receives the inactivated polio vaccine instead of the live attenuated form.
C. An unborn baby receives antibodies from the mom across the placenta.
D. The World Health Organization uses oral polio vaccine rather than one that is injected with a needle.

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.
B. An infant receives respiratory syncytial virus intravenous immune globulin (RespiGam) every month during winter and spring.
C. An unborn baby receives antibodies from the mom across the placenta.
D. A person receives rabies immune globulin after being bitten by an infected animal.

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?

A. Boosters for DTaP, IPV, varicella and MMR
B. New immunization series for MMR and Varicella
C. New immunization series for H. Influenza, polio, and pneumococcal
D. Boosters for Hepatitis B and tetanus

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

A. pneumococcal pneumonia if not received within the last 5 years
B. zoster if antibody titer to chickenpox is low
C. influenza if not received within the within the last 10 years
D. tetanus toxoid if not received within the last 10 years

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:

A. You are correct, but only for infants. Very young children (<1 year) cannot make antibodies against more than one antigen at a time.
B. You are correct, but only for older children. Children 6-12 years of age understand the concept of getting a shot to prevent an infection. Psychologically, they do better with one shot for one disease for one visit.
C. You are correct but only for adolescents. It is not until puberty that vaccine boosters work better when separated from other vaccines by at least one month..
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.

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

A. The aPTT is 100 (normal is 25-40 seconds)
B. The INR is 1.8 (normal is 1)
C. The aPTT is 20 (normal is 25-40 seconds).
D. The INR is 0.8 (normal is 1)

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:

1. Your son should be ok, but watch for onset of persistant cough in yourself.
2. You and your son should both get boosters.
3. You and your 4 yo should be protected, but do wash your hands well after caring for your younger child.
4. You should be ok, but your 4 yo should receive pneumococcal conjugated vaccine.

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

A. Measles
B. Rotavirus
C. dTP
D. Hepatitis A

Thanks Lily for the additional questions!!!

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?

A. Tissue Plasminogen Activator (TPA)
B. Coumadin (WARFARIN)
C. Heparin
D. Aspirin
7.

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?

A. Tissue Plasminogen Activator (TPA)
B. Coumadin (WARFARIN)
C. Heparin
D. Atorvastatin (LIPITOR)
8.

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

A. The aPTT is 30 (normal is 25-40 seconds).
B. The aPTT is 60 (normal is 25-40 seconds)
C. The INR is 0.8 (normal is 1)
D. The INR is 5 (normal is 1)

An elderly person residing in a skilled nursing facility needs:

A. Tetanus and diptheria toxoids every 10 years.
B. Human Papilloma virus once at age 70.
C. Varicella if the titer of antibodies is high
D. Meningococcocal once at age 80

Pre 5 Vacc/Coag

2008-09-30T18:15:00.000-07:00

Courtesy of Sean Knight (Thanks!!) since I haven't done mine yet.

The antidote for heparin (LIQUAEMIN) is
A. aminocaproic acid (AMICAR).
B. acetylsalacylic acid (ASPIRIN).
C. protamine sulfate.
D. vitamin K.

Warfarin (COUMADIN)is an anaticoagulant that reaches therapeutic levels in:
A. minutes.
B. hours.
C. days.
D. weeks.

The effectiveness of a vaccine can be measured by:
A. Measuring the level of the vaccination in the blood.
B. Giving a small test booster dose of the vaccination.
C. Measuring the amount of antibody in the blood
D. Giving a large test booster dose of the vaccination

An infant who has received all scheduled immunization comes in for a 1 year check up. What new immunizations will be given?
A. Diptheria, Tetanus, Pertussis
B. Hepatitis A and B
C. Measles, Mumps, Rubella, Varicella
D. H. Influenza, polio, and pneumococcal

The main side effect of all anticoagulants is:
A. bleeding.
B. white blood cell clotting.
C. excessive red blood cell production.
D. activation of the clotting cascade.

Additional Questions from my quiz

A patient has a thrombus in a vein and requires immediate anticoagulation. This best drug to use for this is:
A. Warfarin (COUMADIN).
B. Protamine sulfate.
C. Vitamin K.
D. Heparin (LIQUAEMIN).

The antidote for warfarin sodium (COUMADIN)is
A. aminocaproic acid (AMICAR).
B. acetylsalacylic acid (ASPIRIN).
C. protamine sulfate.
D. vitamin K.

A patient has a thrombus in a vein and requires immediate anticoagulation. This best drug to use for this is:
A. Warfarin (COUMADIN).
B. Protamine sulfate.
C. Vitamin K.
D. Heparin (LIQUAEMIN).

At 3 months old, which vaccinations should have been given?
A. measles, mumps, rubella, haemophilus influenza
B. diphtheria, tetanus, pertussis, haemophilus influenza, Hepatitis B, polio
C. varicellar, haemolphilus influenza, measles, mumps
D. hepatitis A and B, diptheria, varicella

A predictable side effect of either heparin (LIQUAEMIN) or warfarin (COUMADIN)is:
A. bronchospasm.
B. hypertension.
C. bleeding.
D. fatigue.

Post 4 Infect

2008-09-28T18:44:00.000-07:00

Serious adverse reactions to the aminoglycoside antibiotics such as gentamicin are:

A. ringing in the ears and metallic taste in the mouth
B. kidney failure and loss of hearing
C. localized pain over the upper cheeks and eyes
D. liver failure

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

A. Use of a broad spectrum antibiotic such as amoxicillin.
B. An antibiotic with minimal oral absorbtion such as neomycin.
C. An antibiotic with a beta-lactam ring, such as penicillin.
D. An antibiotic prepared with an enzyme inhibitor such as clavulonate.

Drugs effective against tuberculosis include:

A. amphotericin B, fluconazole, nystatin
B. lamivudine, indinavir, zidovudine
C. vancomycin, amikacin, cefotaxime
D. rifabutin, ethambutol, isoniazid

Sue is a 19 year old sexually active female being seen in a family planning clinic for birth control. Her routine annual screening for chlamydia was positive despite being asymptomatic. She has no drug allergies. Should she be treated? With what drug(s), dose and for how long?

A. Yes, she should be treated with Zidovudine (x 7days) and Indinavir (x 7days) by mouth.
B. Yes, she should be treated with Mycostatin vaginal cream for 7 days.
C. Yes, she should be treated with Azithromycin (x 1 dose)
D. No, she does not need to be treated.

Robert is a 42-year-old prison guard whose annual TB skin test converted this year, with a 20-mm induration. He does not feel sick. Several of the inmates are receiving treatment for TB. What treatment if any should he receive?

A. 2 weeks of metronidazole
B. A single dose of streptomycin
C. 6-9 months of isoniazid
D. No treatment is needed.

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:

A. You could treat the infection with ticarcillin.
B. You could treat the infection with ticarcillin, but it would have to be high dose.
C. The bacteria is resistant to ticarcillin.
D. The patient is allergic to ticarcillin.

Match the drug to its main mechanism of action.

Penicillin
Sulfonamides
Aminoglycosides
Flouroquinolones

a. inhibit protein synthesis
b. inhibit cell wall synthesis
c. inhibit nucleic acid syntheisis
d. antimetabolite, competition for folate

The main use of metronidazole is in the treatment of:

A. Superficial skin infections.
B. Intestinal amebias and anaerobic infections
C. Viral infections of the throat.
D. Malaria.

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

A. Aetna will not permit their customers to have Zyvox.
B. Prior approval is required to have insurance pay for the Zyvox (Linezolid).
C. Aetna prefers this inexpensive, effective drug treatment for vancomycin and methicillin susceptible infections.
D. Aetna will only pay for this drug if the patient has been insured by Aetna for over 3 years.

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?

A. And were you able to tolerate the side effects alright building up to a therapeutic dose like that?
B. May I see the directions on the bottle? That's a very unusual way to take an antibiotic.
C. You must have had a previous allergy to that medicine. Are you having any rashes or difficulty breathing now?
D. Will you increase the dose again or stay at 3 tablets each day?

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

A. aminoglycosides
B. rifampins
C. penicillins
D. sulfonamides

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

A. azithromycin and ciprofloxacin
B. rifampin and isoniazid
C. phenazopyridine
D. echinacea

Michael is a 10-month-old seen in a primary care office with a 4-day history of runny nose. Yesterday he was rubbing his ear and was described by his mother as being "cranky". He looks sick and has a high fever 39.5). Tympanic membranes in his ears are red and swollen. He has not been treated for ear infections in the past and has no known allergies. Should he be treated? What medicine might be appropriate?

A. Yes, he should be hospitalized and treated with intravenous vancomycin for 14 days.
B. No, he does not require treatment. He probably has a viral irritation of the ear which will resolve on its own without treatment. Over-prescribing antibiotics lead to resistance.
C. Yes, he should be treated as an outpatient with ampicillin for 10 days.
D. Yes, he should be treated as an outpatient with oral vancomycin for 7 days.

You go to employee health after being stuck deep into your muscle with a needle containing blood from a patient with end-stage AIDS. Which of the following should happen?

A. You will be placed on broad spectrum antibiotics such as imipenem and taken to the operating room to have the wound thoroughly cleaned out.
B. It will be recommended that you take zidovudine, lamivudine and perhaps indinavir, starting within hours of the needlestick.
C. You will be offered zidovudine as single drug therapy.
D. Nystatin (MYCOSTATIN) will be applied topically to the wound after it has been thoroughly cleaned.

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

Rifampin
Trimethoprim
Cephalosporins

a. interferes with folic acid metabolism
b. inhibit nucleic acid synthesis
c. inhibits cell wall synthesis

The main use of tetracyclines is in the treatment of:

A. Skin, lung and urinary tract infections.
B. Infections in pregnant women and infants.
C. Viral infections of the throat.
D. Malaria.

A patient insured by Medical has a fungal infection and is being considered for therapy with Sporanox (Itraconazole). You know that:

A. Patients on Medical cannot get Sporanox.
B. Prior approval is required to have Medical pay for the Sporanox.
C. Medical prefers this inexpensive, effective drug treatment for all fungal infections.
D. Sporanox is not effective against fungal infections.

Azithromycin can be useful for treating:

A. Some community-acquired pneumonias and sexually transmitted infections
B. Inflammatory pain in the joints not responsive to NSAIDS
C. Seizures in patients allergic to macrolides
D. Drug resistant strains of HIV

Additional Questions

You are splashed on your intact skin with normal looking, yellow urine from an HIV positive patient. Center for Disease Control Guidelines would advise you to:

A. Take a 4 week course of zidovudine, lamivudine, and indinavir.
B. Take a single dose of fluconazole (DIFLUCAN), and have an HIV test done.
C. Take a 6 month course of metronidazole (FLAGYL).
D. No prophylaxis will be offered.

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?

A. Yes, she should receive a single dose of oral vancomycin and followed up as an outpatient.
B. No treatment is needed. This pneumonia is probably caused by a virus, so she just needs some tike to get better.
C. Yes, she should be treated in the hospital with intravenous ampicillin for 2 weeks.
D. Yes, a fluroquinolone such as levofloxacin would be effective outpatient treatment.

Pre 4 Infect

2008-09-26T21:57:00.000-07:00

Examples of antibiotics in the cephalosporin class include:

A. azithromycin, clarithromycin, erythromycin
B. amoxicillin, nafcillin, pipercillin
C. cefazolin, cephalexin, ceftriaxone
D. amikacin, gentamicin, tobramycin

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

Rifampin a A inhibit nucleic acid synthesis
Trimethoprim c C interferes with folic acid metabolism
Cephalosporins b B inhibits cell wall synthesis

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:

A. Viralemia.
B. A super-infection.
C. Multimicrobial Supplantation Syndrome
D. Prophylactic propagation

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:

A. Decrease the possibility of acquiring an allergy to the drug.
B. Manage the infection without developing resistance to the drug.
C. Prevent the patient from saving left over drug to use in a future infection when it may not be the appropriate choice.
D. Limit costs associated with drug therapy.

What teaching is important for patients receiving a tetracyline antibiotic?

A. Take with food or milk.
B. Narrow spectrum, superinfection unlikely.
C. Avoid exposure to sun.
D. Safe to use in pregnancy.

General Feedback: Tetracylines are broad spectrum so superinfection risk is relatively high. They bind divalent cations, such as iron or calcium so should not be taken with milk or absorption could be decreased by up to 50%! If used during pregnancy or under 9yo, it binds to calcium in bones and discolors teeth permananetly. it does make skin more sensitive to burning.

Examples of antibiotics in the penicillin class include:

A. cefazolin, cephalexin, ceftriaxone
B. azithromycin, clarithromycin, erythromycin
C. amoxicillin, nafcillin, pipercillin
D. amikacin, gentamicin, tobramycin

Resistance to antibiotics can be minimized by:
A. early treatment of all viral infections.
B. limiting use of prophylactic antibiotics.
C. teaching patients to stop taking the antibiotic when the symptoms of infection resolve.
D. using broad spectrum antibiotics whenever possible

Match the drug to its main mechanism of action.

Penicillin a. inhibit nucleic acid syntheisis

Sulfonamides b. inhibit cell wall synthesis

Aminoglycosides c. antimetabolite, competition for folate

Flouroquinolones d. inhibit protein synthesis

A "superinfection" refers to:

A. An infection with a resistant organism.
B. The presence of several different organisms in an infected site.
C. Overgrowth of undesired microbes when normal flora has been destroyed by antibiotic therapy.
D. Infection with a fungus.

Post 3 Inflam

2008-09-26T21:49:00.000-07:00

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

A. Less expensive
B. Available by more routes of administration (oral, intravenous, topical)
C. More likely to cause sedation
D. Less likely to cause dry mouth

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

A. Glucocorticoids cause protein synthesis in exercising muscles.
B. Glucocorticoids inhibit insulin from carrying glucose into muscle cells.
C. Glucocorticoids stimulate the uptake of proteins from the GI tract.
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:

A. 80-325 mg each day
B. 80 mg as needed
C. 650 mg as neeeded
D. 4 grams as neeeded

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

A. COX-2 inhibitors are associated with a high rate of GI bleeding
B. Once-a-day dosing is possible.
C. It is less expensive.
D. It works in both women and men.

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

A. Sedation
B. Infection
C. Blood clots
D. Hypotension

General Feedback: Suppressing the immune system decreases the chance of rejecting the transplanted organ but also suppresses the ability to fight off infection.

Loratadine (CLARITIN) is an antihistamine useful in treating:

A. arthritis
B. ulcers
C. runny nose associated with allergies
D. headache associated with migraines

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

A. the cost is significantly lower
B. absorption is better
C. risk of addiction is lower
D. there are fewer side effects

General Feedback: Steroids have significant side effects and should be given locally, not systemically when possible.

Naproxen (ALEVE) works by:

A. Stimulating the release of leukotrines from white blood cells.
B. Blocking the enzyme lipo-oxygenase.
C. Inhibiting prostaglandin synthesis.
D. All of the above

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

A. The tumor would increase secretion of ACTH.
B. Blood levels of the body's natural glucocorticoid, (cortisol) would remain high.
C. Blood levels of the body's natural glucocorticoid, (cortisol) would drop.
D. The tumor would decrease secretion of ACTH.

General Feedback: When the body's only supply of ACTH is from the pituitary, giving a glucocorticosteroid like dexamethasone, creates a negative feedback loop so the pituitary puts out less ACTH and thus less cortisol is released from the adrenal gland. ACTH secreting tumors are not responsive to this negative feedback loop and keep secreting ACTH, thus keeping cortisol levels up.

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

A. The patient will probably have liver failure which will not resolve on discontinuation of the drug.
B. The patient will probably have liver failure which will resolve on discontinuation of the drug.
C. The patient will have a life-time dependency on the drugs.
D. The dose should be tapered off slowly when the patient no longer needs the steroid.

Newer generation antihistamines, such as fexofenadine (ALLEGRA), are less likely to enter __________ tissue than the older drugs such as the classic diphenhydramine (BENADRYL).

A. liver
B. renal
C. brain
D. fat

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).

A. larger and given for a longer period of time
B. larger and given for a shorter period of time
C. smaller and given for a longer period of time
D. smaller and given for a shorter period of time

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?

A. He is having an allergic reaction to the drug.
B. He is having a very common adverse reaction to the drug.
C. He is rejecting his transplanted kidney.
D. Adverse drug reaction and transplant rejection must both be considered.

A patient is to recieve ketorolac (TORADOL) for 3 days after surgery. This drug will act to:

A. Stimulate the release of leukotrines from white blood cells.
B. Block the enzyme lipo-oxygenase.
C. Inhibit prostaglandin synthesis.
D. All of the above

Glucocorticoid preparations are available by which routes?

A. Oral and intraveneous only
B. Topical and oral only
C. direct injection into a joint or lesion and inhaled only
D. all of the above routes are available

Additional Questions courtesy of Vanessa Kelly and Lily Sok, Thanks!!! (added 12/2)

Indications for H1 blockers include all of the following EXCEPT:

A. Asthma
B. Nasal allergies
C. Itching
D. Motion sickness

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 remain high.
B. The pituitary would be stimulated to secrete more ACTH.
C. The adrenal gland would be stimulated to secrete ACTH.
D. Blood levels of the body's natural glucocorticoid, (cortisol) would drop.

A patient with frequent bruising and fat deposits on the cheeks and shoulders, is being evaluated for Cushing's Syndrome. Dexamethasone is given for several days. What would be tested next?

1. Urine and or cortisol levels.
2. Fasting blood sugar.
3. Hemoglobin A1C
4. Platelets and cholesterol.

Pre 3 Inflam

2008-09-26T21:43:00.000-07:00

Actions of glucocorticoids include:

A. supresses inflammation
B. fight off infection
C. inhibit glucose production
D. stimulate adrenal secretions

In addition to decreasing inflammation, NSAIDS are used to:

A. Reduce pain
B. Proote blood clotting
C. Prevent allergies
D. Raise body temperature

Azathioprine (Imuran) is used for:

A. Boosting the immune response to vaccines.
B. Preventing rejection of transplanted organs.
C. Reducing inflammation associated with migraine headaches.
D. Preventing viral infections in patients who are immune suppressed.

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

A. Sedation
B. Infection
C. Blood clots
D. Hypotension

General Feedback: Suppressing the immune system decreases the chance of rejecting the transplanted organ but also suppresses the ability to fight off infection.

Drugs that interact with H1 receptors may be useful in:

1. Infection
2. Auto-immune disease
3. Hay fever
4. Gastric ulcer prevention

The mechanism of action of NSAIDS is to:

A. Bind reversibly to thromboxane, preventing release of acetylcholine from mast cells.
B. Inhibit the enzyme cyclooxygenase, preventing synthesis of prostaglandin and thromboxane.
C. Block glucocorticoid channels, stimulating the release of interleukin from white blood cells.
D. Stimulate release of iron stores from lymph cells, causing migration of white blood cells to inflammed tissue.

Azathioprine (Imuran) is used for:

A. Preventing viral infections in patients who are immune suppressed.
B. Preventing inflammation associated with sports injuries.
C. Supressing inflammation in rheumatoid arthritis..
D. Stimulating inflammation to treat migraine headaches.

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

A. Sedation
B. Infection
C. Gastric bleeding
D. Rash

General Feedback: Sedation and anticholinergic effects (constipation, dry mouth, blurred vision) are relatively common with diphenhydramine. Rash is less common.

Additional Questions courtesy of Vanessa Kelly and Lily Sok, Thanks!!! (added 12/2)

Adverse effects of glucocorticoids include:

A. Decreased blood sugar
B. Loss of fat tissue in the face and upper back
C. Mood and behavior changes
D. Decreased feeling in the fingers and toes.

Drugs that interact with H1 receptors attach to which tissue?

1. Blood vessels and airways
2. Stomach
3. White blood cells
4. Nerve cells

Azathioprine (Imuran) is used for:

A. Stimulating inflammation to treat migraine headaches.
B. Supressing inflammation in rheumatoid arthritis.
C. Preventing inflammation associated with sports injuries.
D. Preventing viral infections in patients who are immune suppressed.

Post 2 Gen 2

2008-09-26T21:36:00.000-07:00

The incidence and severity of adverse reactions caused by a drug determines which property of that drug?

A. efficacy
B. potency
C. purity
D. safety/toxicity

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

A. The drug will be tested on a third species of animal.
B. The drug will be tested on a second species of animal.
C. The drug will be tested on patients who might benefit from it.
D. The drug will be tested on a small group of human volunteers.

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

A. binding to plasma proteins.
B. liver function
C. solubility.
D. receptor specificity

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
B. hepatic enzyme induction resulting from oral route
C. differences in drug solubility between the oral and parenteral routes
D. differences in plasma protein binding between the oral and parenteral routes

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?

A. Schedule II
B. Schedule III
C. Category A
D. Category X

Drug X is an acidic drug that is largely un-ionized in acidic environments. Alkalinizing the urine would __________urinary elimination of this drug.

A. increase
B. decrease
C. have no effect on

Recently the FDA has reccommended the use of Tall man lettering, such as DOPamine rather than dopamine. The purpose of this is to

1. differentiate between trade name and generic name.
2. reduce drug name confusion that could cause errors.
3. designate that this is an OTC medication.

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

A. adjuvant.
B. affinitant.
C. agonist.
D. antagonist.

Select the true statement about drug allergies:

A. The bigger the first dose of the drug, the more likely you will see an allergic reaction.
B. Symptoms range from mild rash and swelling to airway constriction and shock.
C. It is the same as an idiosyncratic reaction.
D. All of the above.

The 100,000 lives campaign suggested that nationwide implementation of 6 interventions could save 100,000 lives each year. Which is one of these interventions?

A. Patients should be advised to not bring a list of their home medicine when they are admitted to a hospital.
B. When a patient is on a mechanical ventilator, medicine to prevent peptic ulcers should be avoided.
C. We should give a beta-blocker drug early on and at discharge for patients with heart attacks.
D. Aspirin and other platelet inhibitors should never be given in chest pain until you are sure the patient did not have a heart attack.

General Feedback: The 100,000 lives campaign called for research based interventions (among other things) to deploy rapid response teams, give aspirin right away for heart attack, clean skin with chlorhexidine before starting central intravenous lines, keep glucose normal after surgery, reconciliate medications, and prevent pneumonia for patients on ventilators.

A teratogen is a drug that is likely to

1. cause birth defects
2. have a high abuse potential.
3. require a prescription.
4. be illegal.

A drug company is conducting a "Phase I Clinical Trial" study on a new drug. Which activity will be occuring?

A. The drug will be chemically tested in test tubes.
B. The drug will be tested in non-human animals.
C. The drug will be tested in a small number of healthy volunteers.
D. The drug will be tested in a small number of patients who might benefit from the drug.

For the breastfed infant, factors which enhance drug excretion into breast milk include:

A. Drug has a high molecular weight
B. Drug is not fat soluble
C. Drug is in the ionized form
D. Maternal drug level is high

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

A. The Food and Drug Administration
B. The National Institute of Drugs
C. The American Association of Pharmacists
D. The Center for Drug Control

What activity takes place during "medication reconciliation"?

A. Before approving a drug name, comparisons are made with other drug names to be sure nothing is similar.
B. Double checks are made on labeling of the drug before it is released to patients or those who will administer them.
C. Before administering the drug, double checks are made that it is the right drug, dose, time, route, and patient.
D. A list of the patient home medications is compared to what has been ordered in the hospital.

Additional questions courtesy of Vanessa Kelly, Thanks!!(added on 10/3)

One reason why most drugs have side effects is because
A. drugs bind to more than one receptor.
B. drugs cannot bind to the desired receptor.
C. drugs are pure.
D. the drug is not given in high enough doses.

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
B. efficacy
C. purity
D. safety/toxicity

S. Henry has been taking digoxin for many years. Knowing that digoxin is highly plasma protein bound, what do you predict will occur if you give him a second drug that also binds plasma proteins?

A. the potential for digoxin toxicity will increase
B. the potential for digoxin toxicity will decrease
C. the potential for toxicity of the second drug will decrease
D. nothing should happen

Binding to plasma proteins can affect

A. drug distribution.
B. drug metabolism.
C. drug elimination.
D. distribution, metabolism and elimination

In pregnancy:

A. Most drugs reach the fetus, some cause adverse effects.
B. Few drugs are able to cross the placenta, but the ones that do are almost always very toxic to the baby.

Which of the following would best apply to the term, drug interactions (as opposed to contraindications, precautions, and adverse reactions)?

A. Every drug has some side effects that many patients may experience when taking the drug.
B. One drug may counteract or enhance the effect of another drug the patient is taking.
C. Specific drugs should not be used under certain conditions, such as when a patient is pregnant.
D. The risk of complications is increased if the drug is given to a patient with an organ impairment, such as a kidney.

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

A. Use of bar codes on patient name bands.
B. Placing medications at the patient's bedside for self-administration.
C. Asking patient care technicians to administer drugs.
D. Using only trade name drugs in hospital pharmacies.

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

A. free drug
B. protein bound drug
C. both the free and protein bound drug
D. metabolized drug fragments

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

A. Prescribe which drug the patient needs.
B. Label and dispense the drug.
C. Teach the patient about the drug.
D. Analyze potential interactions with other drugs the patient is taking.

Pre 2 Gen 2

2008-09-26T21:30:00.000-07:00

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

1. Schedule I
2. Schedule II
3. Schedule III
4. Schedule IV

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

1. absorption
2. distribution
3. metabolism
4. excretion

After a drug is administered, it goes to the site of action. Soon after this, the blood level of the drug begins to decline. This decline in blood levels best represents

1. absorption
2. distribution
3. metabolism
4. allergy

If a rapid onset of action is important, which route of administration would you choose?

1. transcutaneous
2. inhaled
3. intravenous
4. oral

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

A. Category A
B. Category C
C. Category D
D. Category X

In the US, controlled substances are

A. drugs whose use, distribution, and prescribing is determed by the Controlled Substances Act of 1970 and it ammendaments.
B. not intended for human use.
C. usually sold over the counter in low doses.
D. restricted because of risk in pregnancy.

When two or more drugs are given together and the result is smaller than you would have seen if the drugs had been given alone, you have a drug interaction known as:

A. potentiation
B. synergy
C. summation
D. antagonism

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

1. little of the drug is absorbed by this route.
2. drug metabolism is slower.
3. drug distribution is usually a problem.
4. pain, swelling or infection could occur.

Additional Question courtesy of Vanessa Kelly, THanks!!! (added 10/3)

In the US, controlled substances are

A. not intended for human use.
B. usually sold over the counter in low doses.
C. restricted because of risk in pregnancy.
D. drugs whose use, distribution, and prescribing is determed by the Controlled Substances Act of 1970 and it ammendaments.

An important disadvantage of administering a drug intravenously is that

1. the potential for infection is higher than for oral administration.
2. drug metabolism is slower.
3. drug abosrption is less complete.
4. drug absorption is erratic.

Most drug metabolism occurs in the:

A. liver
B. kidney
C. intestines
D. gall bladder

An important disadvantage of administering a drug intravenously is that

1. the potential for infection is higher than for oral administration.
2. drug metabolism is slower.
3. drug abosrption is less complete.
4. drug absorption is erratic.

Which pregnancy category indicates that either risks found in animal studies were not validated in human studies, or there were no risks found in animal studies?

A. Category A
B. Category B
C. Category C
D. Category X

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

A. The Food and Drug Administration
B. The National Institute of Drugs
C. The American Association of Pharmacists
D. The Center for Drug Control

An important advantage of administering a drug intravenously is that

1. you can control the duration of action.
2. there are fewer adverse effects.
3. the onset of action is faster than other routes.
4. first pass metabolism is enhanced.

Which pregnancy category indicates that there is evidence of human fetal risk but that use of the drug might still be acceptable if the woman is very ill and there are not safer, effective drug choices.

1. Category A
2. Category C
3. Category D
4. Category X

Post 1 Gen 1

2008-09-26T21:24:00.001-07:00

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

	Student Response
A.	onset of action.
B.	threshold action.
C.	elimination threshold
D.	duration of action.

This term refers to how much of a drug must be given to see a desired response.

	Student Response
A.	duration of action
B.	efficacy
C.	peak effect
D.	potency

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

	Student Response
A.	adjuvant.
B.	affinitant.
C.	agonist.
D.	antagonist.

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

	Student Response
A.	The trade name.
B.	The generic name.
C.	The chemical name.
D.	The code name.

Adverse reactions to drugs occur because:

	Student Response
A.	No drug has only one receptor it binds to.
B.	They are too pure.
C.	Metabolizing enzymes systems are poisoned.
D.	Several drugs can bind to the same cellular site.

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

	Student Response
A.	more potent than Drug B.
B.	more efficacious than Drug B.
C.	more absorbable than Drug B.
D.	less likely to cause hypersensitivity responses than drug B.

Most drug work by:

	Student Response
A.	Changing the electrical charge surrounding a cell.
B.	Preventing other chemicals from attaching to plasma proteins.
C.	Being taken up into a metabolic pathway instead of an amino acid.
D.	Binding to a specific receptor on the cell.

General Feedback:

This accounts for the selectivity we see in drugs, acting on some cells and not on others. The binding may activate or inhibit an enzyme, alter cell permeability, or alter the production of a cellular protein.

Recombinant technology is allowing us to:

	Student Response
A.	Manufacture proteins in yeast cells.
B.	Insert new genes into a patient, whose own genes don't work well.
C.	Fuse medicines so patients have fewer pills to take.
D.	Design a drug that fits better with a receptor.

General Feedback:

Hepatitis vaccine is a good example. The DNA that codes for the portion of the hepatitis virus to which we make an immune reponse is inserted in a yeast cell. When the yeast makes protein from it's DNA it makes many copies of the hepatitis protein, which we can inject as a vaccine.

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?

	Student Response
A.	Decreased elimination of the protease inhibitor
B.	Higher blood levels of the protease inhibitor
C.	Lower blood levels of the protease inhibitor
D.	Increased distribution 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?

	Student Response
A.	Give lower doses of dopamine to decrease the diffusion gradient into the brain.
B.	Give a water soluble preparation of dopamine which will cross the blood-brain barrier.
C.	Give higher doses of dopamine to increase the diffusion gradient into the brain.
D.	Give a lipid soluble precurser to dopamine which can convert in the brain.

General Feedback:

Charged (polar or water soluble) molecules cannot cross the blood brain barrier. The Parkinson's patient takes levadopa (a lipid soluble precurser to dopamine). After it diffuses across the blood brain barrier, it coverts to dopamine. (You could get into trouble by converting all that dopamine out in the periphery as the blood pressure would sky rocket. Add a peripheral conversion inhibitor (carbidopa) to prevent this. Sinemet is the typical drug taken. It is a combination of levadopa and carbidopa.

The time between when a drug is administered and when there are observable effects is called the

	Student Response
A.	duration of action.
B.	onset of action.
C.	peak effect.
D.	threshold dose.

A drug that occupies and "turns on" a receptor is an:

	Student Response
A.	adjuvant.
B.	affinitant.
C.	antagonist.
D.	agonist.

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

	Student Response
A.	more potent than Drug B.
B.	more efficacious than Drug B.
C.	more absorbable than Drug B.
D.	less likely to cause hypersensitivity responses than drug B.

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

	Student Response	Correct Answer	Feedback
A.	true
B.	false

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

	Student Response
A.	The discovery of substances secreted by microbes to kill other microbes.
B.	Our ability to alter the natural biological rhythm.
C.	Our knowledge of genetic differences between people.
D.	Our ability to isolate a chemical out of a plant.

General Feedback:

We have been able to isolate compounds out of plants for hundreds of years. Consider getting morphine from opium and digitalis form foxglove. The first antibiotics were discovered in the early 20th century and most/all microbes known to man have already been sceeened for potential new antibiotics. Chronopharmacolgy is a relatively new field but we do not have the ability to alter biological rhythms in a systematic way that could be exploited for drug therapy. In 2000 with the completion of the human genome project our knowledge of genetics is enabling us to customize drug therapy. This is anticipated to really change the way drugs are developed and used.

You have a patient with meningitis, an inflammation of the brain covering. How can you get antibiotics to cross the blood brain barrier?

	Student Response
A.	Use antibiotics that are not metabolized by the liver.
B.	Administer the antibiotics subcutaneously so there is a prolonged duration of action.
C.	Give large water soluble antibiotics.
D.	They can already cross because inflammation opens pores.

General Feedback:

Inflammation opens the tight juction between endothelial cells in the brain allowing the antibiotics to enter.

Thanks Lily for the extra questions!!

"Potency" refers to:

A. The severity of side effects.
B. The dose required to achieve therapeutic effect.
C. How quickly the drug will work.
D. Whether the drug will work.
6.

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

A. Analyzing chemically the ingredients of the drug for impurities.
B. Asking clients if their symptoms were relieved after taking the drug.
C. Observing clients for harmful side effects while being treated with the drug.
D. Testing blood samples for concentration of the drug after the drug has been given.