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Pharmacology NURS 251 Final Exam
1.Sublingual: When rapid effect is needed right away Subcutaneous: Destroy or inactivated in the GI Tract Intramuscular: Used for drugs with poor oral absorption Topical : For local effects on skin and eyes Pharmaceutics is the study of how various dosage forms influence the way in which the drug affects the body/ Administration of dosage form, dissolution of drug into body/ manipulating chemical compound. Pharmacokinetics is the study of what the body does to the drug, including absorption, distribution, metabolism, and excretion/ Absorption, distribution, metabolism, excretion. Pharmacodynamics is the study of what the drug does to the body/ Drug- receptor interaction.
2. The drug naltrexone is given to prevent relapse or cravings in individuals who use
opioids. It binds to opioid receptors blocking endogenous agonist and other opioid drugs from binding and having an effect. Naltrexone is a/an Competitive agonist (binds to the same site of agonist)
3. Due to the many chronic diseases associated with aging the elderly can have
decreased blood flow to the liver. With age, there can also be a decrease in liver enzymes, which can increase the duration of a drug in the patient’s systems. Which pharmacokinetic process is affected in this scenario? Metabolism (stored in the body)/ cytochrome P-450 enzymes/ liver/ Grapefruit and statins
4. When the combined effect of two drugs is greater than the sum of the
individual effects it refers to Synergism: When the combined effect of two drugs is greater than the sum of their individual effects
5. True or false. Schedule I drugs have a low abuse potential and are accepted
medical use False via having a high abuse potential and no accepted medical use
6. Michael is a 2 year old male with a history of a liver cirrhosis problem caused by
biliary atresia. While on a family vacation, Michael developed a fever, and his parents found children’s Motrin as the only antipyretic option at eh hotel convenience shop. Is this an appropriate for Michael? Explain why or why not.
12. True or False. If the statement is false, explain why it is false. Calcium channel
blockers work to treat angina by increasing the amount of nitric oxide in smooth muscle cells leading to vasodilation. False: Nitrates work to treat angina by increasing the amount of nitric oxide in smooth muscle cells leading to vasodilation/ Nitroglycerin (rapid acting and long acting), isosorbide dinitrate (rapid acting and long acting), and isosorbide mononitrate (long acting). False: Calcium channel blockers work to treat angina by inhibiting calcium to enter smooth muscle, decreasing their contractility, which leads to vasodilation/ verapamil, diltiazem, amlodipine, nifedipine, and nicardipine.
Alpha Agonist (Clonidine/ Doxazosin/ Metoprolol/) Decreases norepinephrine and renin Calcium Channel Blocker (Amlodipine/ Norvasc) Prevents smooth muscle contraction blocking calcuim ACE inhibitor (Lisinopril/ Prinivil) Prevents formation of Angiotensin II Diuretic (thiazide) (Hydrochlorothiazide) Works at the kidney Alpha Blocker (Carvedilol; both) Reduces stroke volume Vasodilator (Hydralazine) Directly causes peripheral vasodilation Direct Rein Inhibitor (Aliskiren/ Tekturna) Inhibits renin and decrease angiotensin I and II Angiotensin II receptor blocker Blocks binding of Angiotensin
14. A 75-year-old male residing in a nursing home came to the clinic at 7AM
complaining of a “swollen tongue” and reporting a tingling sensation in his lips
15. At Connie’s yearly physical, her physician discovered she had stage 2
hypertension. What would be the recommended treatment? Lifestyle changes, ACE inhibitor, and thiazide
16. Octreotide Severe watery diarrhea/ inhibits GH
Propylthiouracil Hyperthyroidism/ thyroid hormone/ Methimazole Glucocorticoids Inflammation Vasopressin Used in emergency situations/ ADH Somatropin Growth hormone Ovaries Oral conception/ GnRH/ Lh/ FSH
17. If the statement is false, explain why it is false. Polyuria means an increase in
urine glucose. False: Polyuria means increased urination Glycosuria: increase in urine glucose Polydipsia: Excessive thirst Polyphagia: Excessive Hunger
18. Thomas, who is being treated for Type 2 diabetes with the maximum tolerated
metformin dose, still has not reached his goal blood glucose values. What is an example of a second agent available as an injection that could be added to his regimen? Insulin or GLP1 agonist
19. Carla is a Type 2 diabetic, whose 8-year-old daughter was just diagnosed with
Type 1 diabetes. You are explaining the daughter’s insulin treatments and how Carla will monitor her daughter’s blood glucose. Given that they both have diabetes, Carla asks you why her daughter can’t be treated with anti-diabetic pills.
(A) Explain the difference between type 1 and type 2 diabetes that changes
treatment The difference is type 2 is caused by both insulin resistance and insulin deficiency but can still independently produce insulin, while type one is just insulin deficency.
(B) Why Carla currently does not need the same treatment plan as her daughter.
By way of Carla being type 2 her insulin receptors numbers are reduced and she needs drugs to sensitize her cells or lower the blood glucose, while her daughter’s type 1 completely lacks insulin and will need insulin replacement therapy.
20. A diabetic patient who injects insulin once daily is taking which class of
insulin? Long acting: 1 over 24 hr period / Lantus, Levemir Intermediate- acting: Twice daily/ Insulin isophane suspension Short- acting: 30 minutes prior to meal/ Humlin R/ Novolin R Rapid- acting: At meal time 15 minutes prior/ Humalog/ Novolog/ Apidra
21. Narrowing of the bronchioles caused by unknown factors or precipitated by factors
like respiratory infections, stress, or cold weather is referred to as: Intrinsic asthma: Emphysema : air spaces within the bronchioles enlarge as a result of the destruction of the alveolar walls. Chronic bronchitis : inflammation or irritation on the lower respiratory tract, specifically the bronchi. Allergic asthma : outside factors such as allergens
Albuterol Inhalation/ short acting Beta Agonist/ Beta2 adrenergic agonist
27. Jose arrives at the doctor's office complaining of continued ear pain after treating
his second ear infection this year with amoxicillin. He took the same exact medication and the same dose that worked that last time. This time the doctor prescribes a different medication called augmentin. What is the term that best describes why the doctor decided to prescribe a different antibiotic this time? Antibiotic resistance
28. Select the drug class that is bacteriostatic and works by preventing the bacteria
from making folic acid, which is a vitamin that is necessary for DNA and RNA synthesis. Sulfonamides: Bacteriostatic- preventing the bacteria from making folic acid, which is a vitamin that is necessary for DNA and RNA synthesis/ trimethoprim/ Stevens-Johnson Syndrome Penicillins: Bactericidal/ Augmentin/ Beta- lactamase Inhibitor Cephalosporins: Bactericidal/ beta lactam Aminoglycosides: IM or IV/ Bactericidal/ negative/ Category D Tetracyclines: Category D
29. Based on your knowledge of antibiotic spectrums and keeping in mind antibiotic
stewardship, which drug would be most appropriate for a simple Gram- positive infection in a patient who is also pregnant? Amoxicillin/ Aminopenicillins/ Ear infections, sinusitis, respiratory and skin infections, urinary tract infections Doxycycline / Tetracyclines/ treat acne, skin infections respiratory, and GI tract infections. Amikacin/ Aminoglycosides/ serious Gram-negative infections resistant to other aminoglycosides. Tobramycin Gram-negative infections particularly pseudomonas aeruginosa. Ciprofloxacin/ Fluoroquinolones/ inhibit bacterial enzymes/ urinary tract infections, respiratory, abdominal, bone, and soft tissue infections.
Levofloxacin Fluoroquinolone Tobramycin Aminoglycoside Augmentin Penicillin Minocycline Tetracycline
31. True or False. If the statement is false, explain why it is false. HCl is the
enzyme responsible for the catabolism (breaking down) of proteins into polypeptides. False: Pepsin is responsible for the catabolism of proteins HCI: breakdown food entering the stomach and are released via parietal cells
32. Denise comes to see her physician with complaints of an occasional burning
sensation in her chest, especially prevalent after big meals. It is most noticeable if she eats something like pasta sauce or a fatty meal and bothers her most at night when she lies down to go to bed. The doctor tells her she is suffering from mild heartburn and thinks she would benefit from antacid as needed. Select the best medication for Denise. Calcium Carbonate: Antacid/ Aluminum hydroxide; magnesium hydroxide (Gaviscon, Maalox), Magnesium hydroxide (Milk of magnesia) Cimetidine: H2 receptor antagonist/ CNS effects such as confusion and disorientation/ Tagamet Omeprazole: PPI/ First line to treat H. Pylori/ Prilosec Clarithromycin:
33. Unfortunately, the PPI prescribed to treat Denise’s GERD did not resolve her
symptoms. After further testing, it is discovered that she has a peptic ulcer caused
peristalsis Absorbent / Bismuth subsalicylate / Charcoal/ Act by coating the wall of the GI tract. They bind the causative substance to their adsorbent surface for elimination from the body. Opiates / Diphenoxylate with atropine (Lomotil), loperamide (Imodium )/ acting on smooth muscle cells in the GI tract inhibiting motility and excessive GI propulsion. This results in a decrease in the number of stools and their water content. Probiotic/ lactobacillus acidophilus / replenishing bacteria that may have been destroyed by antibiotics. This helps restore the normal flora and suppresses the growth of diarrhea causing bacteria Anticholinergic/Atropine/ hyoscyamine/ slowing peristalsis by reducing the contractions and smooth muscle tone in the GI tract.
35. Which anti-nausea medication would you NOT want to recommend for a
patient who is also taking risperidone for their bipolar disorder? Prochlorperazine/ Antidopaminergic/ EPS/ Block dopamine receptors in the CTZ of the brain. Scopolamine / Anticholinergics Ondansetron / Serotonin Blocker/ Category B/ cancer chemotherapy and radiation therapy. Metoclopramide / Prokinetics/ stimulating peristalsis through ACh receptors in the GI tract/ Block Dopamine Dimenhydrinate / Antihistamines/ H1 receptors/ meclizine/ block H1 receptors which prevents ACh from binding to the receptors in the vestibular nuclei Aprepitant / Neurokinin antagonists/ Inhibit substance-P neurokinin receptors/ increase the concentration of corticosteroid
36. Michael is in need of a medication to treat his knee pain post-surgery. The doctor
thinks that he needs to be on an opioid; however, he has a history of abuse. What medication could be given in the case of an overdose? Explain your answer with the mechanism of action. Naloxone is an opioid antagonist that competes at the same receptor sites as opioids and can reverse effects such as respiratory depression via opioid overdose
37. Joanna suffers from fibromyalgia pain. Which medication class would not be an
appropriate treatment option? Antiepileptics Tricyclic antidepressants Opioids SNRIs
38. Select the anxiety medication below that is at the highest risk of abuse.
Lorazepam/ Benzodiazepine/ Oral, IM, IV / Schedule VI Buspirone Escitalopram/ SSRI Quetiapine/ Antipsychotic
39. Amitriptyline Corrects the imbalance of serotonin and norepinephrine
in the nerve endings of the CNS/ Tricyclic Antidepressants / Elavil Fluoxetine Blocks the reuptake of serotonin/ SSRI / Quetiapine Blocks dopamine receptors in the brain Venlafaxine Blocks the reuptake of reuptake of both serotonin and norepinephrine/ SNRI
43. Jamie has been diagnosed with Multiple Sclerosis. She would prefer a
medication that she can give to herself instead of having to go to an infusion center on a monthly basis. Which medication below would be the most appropriate option? Inferon Beta- 1a (Rebif); MS 3 subcutaneous injections Etanercept (Enbril): RH / Recombinant DNA-derived TNF-blocking drug Natalisumab (Tysabri): MS inhibits the leukocyte adhesion that the alpha4 protein subunits are involved Abatacept (Orencia): RH/ selective co-stimulation modulator Adalimumab (Humira) Acts on tumor necrosis factor (TNF), which is a naturally occurring cytokine involved in the normal inflammatory and immune response/ Crohn’s disease, ulcerative colitis, plaque psoriasis, and psoriatic arthritis. Bevacizumab (Avastin) Cancer/ Binding to and inhibiting vascular endothelial growth factor, which is a protein that promotes the development of new blood vessels in both tumor and normal body tissues/ colon cancer, rectal cancer, non- small-cell lung cancer, and malignant glioblastoma.
44. Which drug classes make up the most common combination therapy for the
initial treatment of HIV? Highly active anti-retrovirals: Combination of two nucleoside-analogue reverse transcriptase (NRTIs) and one nonnucleoside reverse transcriptase inhibitor (NNRTI), or one protease inhibitor. IMPORTANCE OF DRUG ADHERENCE: By way of HIV having no current cure and being a retrovirus (e.g able to replicate and spread quickly and easily) it is important to take the medicine to help control the virus and increase effectiveness and avoid or at least delay the development of drug resistance.
45. Lucille was previously treated with interferon and ribavirin for her chronic
hepatitis C virus. She did not tolerate the regimen well and it did not cure her hepatitis C. Explain why she could or could not try a medication regimen like Ombitasvir/paritaprevir/ritonavir with dasabuvir. She can if she is without cirrihosis as ribavirin helps to enhance the immune system with the goal of the body then being able to fight off the virus, while the newer treatments available interferes with the proteins that help the virus grow and spread. As they can be taken in combination and have shown both efficacy and tolerability. What’s more the ribavirin can be taken away via intolerability and treatment could still be used to see results.
46. Write the following directions in a sig code format. Take 1 tablet by mouth
every 6 hours as needed 1 tab po q6h prn
47. You need to determine the dose for a 96-pound patient. The medication is dosed
10 mg /kg. What would be the dose in mg? (NOTE: The Canvas calculator is on the top left-hand side of the page, and is a blue rectangular icon.) 436 mg
48. The recommended dosing range for amoxicillin is 25-45mg/kg per day divided into
2 doses given every 12 hours. Select the appropriate dose based on the stock bottle and the 5-ml measuring device shown below for a 35-pound child. (250mg/5ml) 5 ml every 12 hours 16 X 45 X 5 X 2/ 250/ 4= 7. 16 X 25 X 5 X 2/ 250/ 4= 4 middle is 5
