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advanced Pharm study guide for test 2
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Perguntas do quiz (81)
1What is the significance of bradykinin in the RAAS system
- Ait is a peptide needed for the release of aldosterone by the adrenal gland
- BIt is a peptide that causes blood vessels to constrict, raising blood pressure
- Cit causes contraction of non-vascular smooth muscle
- Dit is broken down by angiotensin converting enzyme causing vasodilation and mild dieresis
2the patient complains of a dry cough, what medication would be the most likely to have this finding?
- ACaptopril
- BLosartan
- CAmilodipine
- DNaproxen
3 angiotensin converting enzyme inhibitors (ACE inhibitors) work on what part of the RAAS system?
- Ablocks Renin from stimulating the release of Angiotensinogen
- Bblocks Angiotensinogen conversion to Angiotensin I
- CBlocks Angiotensin I conversion to Angiotensin II
- Dblocks Angiotensin II conversion to aldosterone
4what class of medications will reduce the adverse affects of Diabetes on the kidneys as well as decrease inappropriate remodeling of the heart
- Athiazide diuretics
- Bangiotensin receptor blockers (ARBs)
- CCalcium Channel Blockers (CCBs)
- Dangiotensin converting enzyme inhibitors (ACE inhibitors)
5What statement is true regarding ACE inhibitors?
- Athey are potassium wasting and must be monitored for hypokalema
- Bthey have little negative effect on lipids or sexual function
- CAfrican-Americans & low-renin hypertensives are extremely sensitive to monotherapy
- Dthey increase the effectiveness of NSAIDs
6What is considered the most serious ADR with ACE inhibitors?
- AAngioedema <1%
- B<1% neutropenia & agranulocytosis
- CHyperkalemia
- DProteinuria & glomerulonephritis
7Ace inhibitors and ARBs would be the drug of choice for which patient?
- A37yo Caucasian male with Hx of MI, and kidney failure
- B57yo Asian Female currently taking spironolactone
- C49yo caucasian female with Hx of DM, HF and MIx3
- D46yo African American male with Hx of DM, HTN and kidney stones
8which of the following statements is True about ACE inhibitors and ARBs used for the treatment of hypertension .
- AACEIs affect the myocardial oxygen demand but not the myocardial oxygen supply
- BACEIs affect the myocardial oxygen supply but not the myocardial oxygen demand
- CACEIs affect both the myocardial oxygen supply and the myocardial oxygen demand
- DACEIs and ARBs are contraindicated in treating heart failure related to CAD
9where are the primary sites of metabolism and excretion for ACEI's?
- Aall ACEIs are prodrugs and do not need to be metabolized, excretion is from the kidneys.
- BACEI's are metabolized in the avieoli of the lungs, excretion is primarily by GI tract with the capsule being whole but hollow
- Call ACEI's are prodrugs and converted to active metabolites in the liver, The kidney is the primary organ of excretion
- DACI's are prodrugs and converted to active metabolites in the liver, excretion is primarily by GI tract with the capsule being whole but hollow
10What are the contraindications for the use of ACEI's?
- AHypertensive Proteinuric Diabetes
- BBilateral renal artery stenosis
- CPostmyocardial Infarction
- DPregnancy
11what is the first goal of Hypertension management?
- AControlling isolated systolic hypertension (ISH)
- BPrevent the rise of BP with age
- Creduction in Cardio vascular risk
- DImprove control of HTN to below 140/90 mm Hg in adults and below 150/90 in those greater than age 60
12what statement is true with reguard to Dihydropyridines
- Agreater affinity for vascular ca+ channels than cardiac Ca+2 channels
- Bgreater affinity for cardiac Ca+2 channels than vascular ca+ channels
- CBlocks L-type calcium channels producing vasoconstriction
- DHas an intrinsic natriuretic effect requiring the use of a diuretic
13select all of the adverse drug reactions for Nondihydropyridines
- AReflex tachycardia
- BAnorexia
- CConstipation
- DBradycardia
14Most CCBs have short-acting forms with half-lives between 2 and 8 hours and sustained-release forms with half-lives of 12 to 24 hours what is the exception to this?
- ADigoxin, with a half life of 36-48 hours
- BCardizem, with a half life of 3-4 hours
- CAmlodipine, with a half-life of 30 to 50 hours
- Disradipine with a half life of 1.5-2 hours
15what is the main effect of digoxin
- Aopens the ATPase pump allowing free flow of Na+ and Ca+
- Binhibits the ATPase pump preventing Na+ from leaving the cell
- CBlocks L-type calcium channels producing vasodilation
- Dinhibits the ATPase pump preventing Ca+ from leaving the cell
16how is dosing for digoxin determined?
- AThe principal tissue reservoir is skeletal muscle, Dosing should be based on lean muscle mass
- BThe principal tissue reservoir is adipose tissue, Dosing should be based on BMI%
- CThe principal tissue reservoir is the CNS and dosing should be based on CSF results
- Dthere is not a principal tissue reservoir, dosage is determined by weight in Kg.
17select the contraindications for the use of digoxen.
- ARenal Impairment
- BAV blocks or uncontrolled ventricular arrhythmias
- CAtrial Fibrillation
- Didiopathic hypertrophic subaortic stenosis (IHSS)
- EParoxysmal Supraventricular Tachycardia
18what finding would make you suspect CG Toxicity?
- Aserum levels of 4.5 ng/mL.
- Bthe patient presents with severe anorexia, nausea, vomiting, and diarrhea
- CST-T wave changes on the a 12-lead ECG
- Dpt presents with severe nausea, vomiting, and serum levels of 2.3 ng/mL.
19Arrhythmias are caused either by abnormal pacemaker activity or by abnormal impulse conduction, which is NOT an example of The major mechanisms by which antiarrhythmics act?
- Ablockade of Central Nervous System (CNS) effects on the heart
- Bprolongation of the effective refractory period
- Csodium channel blockade
- Dblockade of the calcium channel
20sodium channel blockers are what class of antiarrhythmic drugs?
- AClass I
- BClass II
- CClass III
- DClass IV
21Beta Blockers are what class of antiarrhythmic drugs?
- AClass I
- BClass II
- CClass III
- DClass IV
22Calcium Channel Blockers (CCB) are what class of antiarrhythmic drugs?
- AClass I
- BClass II
- CClass III
- DClass IV
23How are Antiarrhythmics metabolized.
- Aantiarrhythmics are already in their metabolized form after absorption and are deactivated by the liver.
- BAll antiarrhythmics are metabolized and excreated from the GI tract
- Call antiarrhythmics are prodrugs and do not need to be metabolized
- DAll antiarrhythmics are metabolized By the liver
24this drug class was introduced for the treatment of angina in the 19th century
- AACEs
- BCCBs
- Cnitrates
- DARBs
25what statement is true with reguard to Nitrates?
- Aby providing more nitric oxide (NO) to vascular endothelium and arterial smooth muscle, resulting in vasodilation.
- Bcause targeted relaxation of large veins resulting in decreased pre-load
- CArterial dilation is more common with lower doses and can result in a decrease in systemic arterial pressure
- DArterial dilation is more common with higher doses and can result in an increase in systemic arterial pressure
26in which of the following cases would you NOT give nitrates.
- A33yo female c/o migraine with HR111 bp 200/120
- B75yo male c/o chest pain that has not improved, HR 63 bp 110/65
- C45yo male car vs tree, c/o dizziness, chest pain and nausea. had MI 2 years ago. HR110 BP185/96
- D35yo female with weakness to one side of her body, difficulty speaking and pain in the jaw that radiates to her back
27which statement about Peripheral Vasodilators is FALSE?
- ASignificant clinical improvement of PVD can rarely be seen with monotherapy
- BPeripheral alpha1 antagonists and central alpha2 agonists can be used to treat resistant HTN and PVD.
- Cmonotherapy is recommended to show Significant clinical improvement of PVD without associated ADRs
- Dact by direct relaxation and dilation of arteriolar smooth muscle, thereby decreasing PVR
28when prescribing reductase inhibitors, what lab tests should also be performed?
- ACBC
- BAST/ALT
- CBUN/creatinine
- DLipid Panel
29what is the clinical indication for the use of Antilipidemics?
- Aincreased LDL, decreased HDL, high VLDL
- BHigh VLDL, increased HDL, Decreased LDL
- Cincreased HDL, increased LDL, low VLDL
- Ddecreased LDL, increased HDL, low VLDL
30The liver is the primary site of metabolism for most diuretics, which diuretic has nonhepatic and hepatic metabolism
- AFurosemide (Lasix)
- Bspironolactone (Aldactone)
- CAmiloride
- Dhydrochlorothiazide (HCTZ)
31if a patient is taking an aminoglycoside medication what Adverse drug reaction would you actively assess for?
- Aa white crystalline precipitate to form in the superficial portion of the cornea.
- Blocalized ocular toxicity
- Citching/swelling of the face/tongue/throat
- DIncreased Ocular Pressure in narrow-angle glaucoma
32if planning on using a combination of steroids and anti-infectives for ophthalmic Anti-Infective treatment in primary care what must be used to perform the assessment?
- AKeratometry
- Bretinoscope
- Copthalmoscope
- DTonometry device
33which of the following Ophthalmic Anti-Infectives has a high hypersensitivity rate?
- Aazithromycin
- Berythromycin
- Cpolymyxin B
- Dgentamicin
34what is important to remember when using Sulfacetamide
- Ait is incompatible with silver-containing preparations
- Bmust have tonometry available
- Cit has a high hypersensitivity rate
- Dmay cause localized ocular toxicity
35Children 3 months through 8 years are most likely to have what type of Bacterial conjunctivitis
select all that apply- Astaphylococcal
- Bstreptococcal
- CHaemophilus
- DStaphylococcus aureus
- EPseudomonas aeruginosa
36what is the treatment for Conjunctivitis-otitis syndrome
- Ahigh-dose amoxicillin
- Bparenteral antibiotics (ceftriaxone)
- Cophthalmic/otitc antibiotics
- Derythromycin ointment
37What symptoms would make you suspect herpes keratitis? if herpes keratitis is suspected what should be done next?
- Aintense redness of the eye, Watery/mucus discharge from the eye, fever blister on or near the eye; examination with woodslamp
- BSwelling of the lymph nodes in front of the ears, fever, slight Pinkness of the eye; referral to ophthalmologist
- Cburning, gritty sensation to the eye, lesion close to or on the eye, fever; referral to ophthalmologist
- DCrustiness around the eyelids upon waking in the morning, cough, fever; ocular assessment with ophthalmoscope
38while removing a cerumen impaction you notice that while irrigating, your patient suddenly develops nystagmus and states that they are suddenly dizzy. what is the likely cause of this?
- Airrigation was being performed too forcefully
- Bthe irrigation solution was not warmed
- Cirrigation solution has bypassed the ear drum and is interfering with the middle ear
- Dthe patient is having a seizure
39which statement is FALSE with reguard to Corticosteroids
- Ahave metabolic, anti-inflammatory, and growth-suppressing effects
- Bhigh levels of cortisol can cause decreased memory recall, anxiety and disturbed sleep patterns
- CGlucocorticoids decrease blood glucose concentration by stimulating glycogenesis in the liver
- DCorticosteroids can raise your risk of infections due to the wide range of effects on the immune system
40What determines systolic Blood pressure?
- Amean arterial pressure
- BTotal peripheral resistance
- Cend-diastolic volume (EDV) - end-systolic volume (ESV)
- DHR times stroke volume
41What determines diastolic blood pressure?
- ATotal peripheral resistance
- BCardiac output
- Cmean arterial pressure divided by ejection fraction
- Dend-diastolic volume (EDV) - end-systolic volume (ESV)
42select what factors will have a direct effect on systemic arterial pressure. select all that apply.
- Atotal peripheral resistance
- Bheart rate
- CStroke volume
- Dmean arterial pressure
43an increase in BP will send inhibitory impulses to the sympathetic vasomotor center in the brainstem resulting in what?
- Aexcitation of efferent nerves in the SNS results in decreased heart rate,
- BInhibition of efferent nerves in the SNS that innervate cardiac and vascular smooth muscle results in increased heart rate
- CInhibition of efferent nerves in the SNS that innervate cardiac and vascular smooth muscle results in vasodilation of peripheral arterioles
- Dexcitation of efferent nerves in the SNS that innervate cardiac and vascular smooth muscle
44changes in BP is sensed by ____ located in _____
- Abaroreceptors; aorta
- BMechanoreceptors; carotid arteries
- CNociceptors; arch of the aorta
- DMechanoreceptors; kidneys
45what are the ultimate goals of Angina therapy
- Ato treat anginal chest pain and return to normal activities
- Breduce the risks of stroke
- Creduce the risks of MI
- Dsmooth muscle and cardiac relaxation
46what statements are true about organic nitrates. select all that apply
- AReduces preload
- BIncreases afterload
- CInhibit platelet aggregation
- Dleads to the mediation of smooth muscle relaxation
47what makes Ranolazine unique for the treatment of angina?
- AHave a negative chronotropic and inotropic effect and ↓ afterload, Decreases myocardial oxygen consumption, Increases myocardial perfusion
- Bdecreases peripheral vascular resistance and thereby MOD, as the heart has decreased afterload
- Ccause arterial smooth muscle relaxation, which results in peripheral vasodilation, decreased afterload,
- DHas antianginal and anti-ischemic effects that do not depend on reduction in heart rate or blood pressure
48what medication reduces platelet aggregation by inhibiting the synthesis of thromboxane A2
- AAspirin
- BNitroglycerin
- CNifedipide (Procardia)
- DDiltiazem (Cardizem)
49select what would be classified as class I according to the New York Heart Association and Canadian Cardiovascular Society
- AChest pain is present for the first few hours in the morning, in cold weather or after meals
- BAngina that occurs when walking 1-2 blocks on level ground, or by climbing 1 flight of stairs
- CAngina that occurs with strenuous, rapid exertion. Ordinary physical activity like walking upstairs does not cause angina
- DChest pain that occurs at rest
50select what would be classified as class II according to the New York Heart Association and Canadian Cardiovascular Society
- AChest pain is present for the first few hours in the morning, in cold weather or after meals
- BAngina that occurs when walking 1-2 blocks on level ground, or by climbing 1 flight of stairs
- CAngina that occurs with strenuous, rapid exertion. Ordinary physical activity like walking upstairs does not cause angina
- DChest pain that occurs at rest
51select what would be classified as class III according to the New York Heart Association and Canadian Cardiovascular Society
- AChest pain is present for the first few hours in the morning, in cold weather or after meals
- BChest pain that occurs at rest
- CAngina that occurs with strenuous, rapid exertion. Ordinary physical activity like walking upstairs does not cause angina
- DAngina that occurs when walking 1-2 blocks on level ground, or by climbing 1 flight of stairs
52select what would be classified as class IV according to the New York Heart Association and Canadian Cardiovascular Society
- AChest pain is present for the first few hours in the morning, in cold weather or after meals
- BChest pain that occurs at rest
- CAngina that occurs with strenuous, rapid exertion. Ordinary physical activity like walking upstairs does not cause angina
- DAngina that occurs when walking 1-2 blocks on level ground, or by climbing 1 flight of stairs
53What is considered to be the foundation of initial drug therapy for patients with angina ?
- AACEI and beta-adrenergic blockers
- BACEI and CCB
- CBB and CCB
- DNitrates and BB
54when diagnosing heart failure why might a chest x-ray be ordered?
- Ait can be used to identify and distinguish between systolic dysfunction and preserved systolic function.
- Bcan show Cephalization of the vascular supply
- Ccan show left-ventricular hypertrophy and axis deviation
- Dused to rule out pulmonary embolism
55select the types of heart failure. select all that apply
- Alow-output failure
- Bhigh-output failure
- CSystolic dysfunction
- DDiastolic dysfunction
56What is the most common BB used in heart failure?
- AAtenolol
- BLosartan
- Ccarvedilol
- Dclonidine
57how does Digoxin work?
- ADigoxin decreases contractility by decreasing intracellular calcium and inhibiting the sodium-potassium-ATPase pump
- BDigoxin increases heart rate by increasing intracellular calcium and inhibiting the sodium-potassium-ATPase pump
- CDigoxin increases contractility by increasing intracellular calcium and inhibiting the sodium-potassium-ATPase pump
- DDigoxin decreases heart rate by increasing intracellular calcium and inhibiting the sodium-potassium-ATPase pump
58Patients with left-ventricular dysfunction with current or prior symptoms of HF are classified as what stage according to ACC and AHA guidelines.
- AStage A
- BStage B
- CStage C
- Dstage D
59Which of the following is NOT one of the diagnostic criteria for DM?
- AA1C ≥6.5%
- BFPG ≥126 mg/dL
- Cplasma glucose ≥200 mg/dL
- Dclassic symptoms of hyperglycemia and a random plasma glucose ≥200 mg/dL
60What is true about DM type 1?
- ATypically diagnosed early in life
- Bthe bodies compensatory insulin production mechanisms reduce the onset of clinical symptoms for many years
- C90% to 95% of cases are diagnosed before the age of 30.
- DIf the disease progresses without treatment hypoglycemia, coma and death can occur.
61What are the treatment targets for Glycemic control in DM? select all that apply
- A2 hour postprandial plasma glucose less than 180 mg/dL
- BHemoglobin A1c less than 5%
- CRandom urine albumin/Cr less than 30mcg/mg
creatinine - DPreprandial plasma glucose 70 to 130 mg/dL
62What is the treatment target for blood pressure when treating DM?
- Aless than 130/80, 140/80 for patients with DM, hypertension
- Bless than 120/60, 130/80 for patients with DM, hypertension
- Cless than 140/80, 145/85 for patients with DM, hypertension
- Dless than 130/80, 150/90 for patients with DM, hypertension
63what are the treatment targets for lipid control when treating DM?
- AHDL >100mg/dl, LDL <50mg/dl, triglicerides less than 150mg/dl
- BHDL >150mg/dl, LDL <100mg/dl, triglicerides less than 50mg/dl
- CHDL >50mg/dl, LDL <100mg/dl, triglicerides less than 150mg/dl
- DHDL >100mg/dl, LDL <150mg/dl, triglicerides less than 50mg/dl
64what factors effect the treatment plan and drug selection process when treating DM? Select all that apply
- Aindividual patient variables (race, weight, pregnant etc.)
- Bcurrent AHA guidelines
- CDesiered gylcemic target
- Dtype of diabetes
- Eseverity of the hyper/hypo glycemia
65For the treatment of type 2 DM what is the first-line therapy for most patients?
- AInsulin
- BThiazolidinediones (TZDs)
- CMetformin
- DGlipizide
66Insulin with and onset of 5-30min, peak 0.5-3h and duration of 3-4h describes what type of insulin?
- ARapid-Acting (RAI)
- BShort-acting Insulin
- CIntermediate-Acting (IAI)
- DLong-Acting (LAI)
67Insulin with and onset of 30-60min, peak 2-4h and duration of 3-7h describes what type of insulin?
- ARapid-Acting (RAI)
- BShort-acting Insulin
- CIntermediate-Acting (IAI)
- DLong-Acting (LAI)
68Insulin with and onset of 1-2h, peak 4-10h and duration of 10-16h describes what type of insulin?
- ARapid-Acting (RAI)
- BShort-acting Insulin
- CIntermediate-Acting (IAI)
- DLong-Acting (LAI)
69Insulin with and onset of 1-2h, no peak, and duration of 20-24h describes what type of insulin?
- ARapid-Acting (RAI)
- BShort-acting Insulin
- CIntermediate-Acting (IAI)
- DLong-Acting (LAI)
70Generally, what percentage of daily insulin is given as an intermediate or long-acting form of insulin?
- A0-25%
- B25-50%
- C50-75%
- D75-100%
71a 1 Unit bolus of insulin will typically lower glucose by approximately
- A10-20mg/dl
- B60-90mg/dl
- C20-60mg/dl
- D10-40mg/dl
72Each 15 gm Carbohydrate serving raises BG by approximately
- A15mg/dl
- B25mg/dl
- C50mg/dl
- D70mg/dl
73what percentage of beta cells must be lost before hyperglycemia occurs?
- A50-60%
- B60-70%
- C70-80%
- D80-90%
- E90-100%
74what statement is true about Insulin
- Aalcohol use, increases hyperglycemia
- BBeta blockers mask hypoglycemic symptoms
- CShort-acting Insulin onset of action is 1 to 1.5 hours, and its duration is 12 to 24 hours
- DRapid-Acting (RAI) duration of action is 4 to 6 hours
75what is the preferred injection site that absorbs 50% more than other sites
- AInhalation method
- BAbdominal site
- Cupper outer area of the arm
- Dfront and outer sides of the thighs
76what insulin's are pregnancy category C? select all that apply
- AAspart
- BHumulin R
- Cglargine
- Dglulisine
77What is important to consider if your patient has Hyperthyroidism and is taking insulin?
- Adelays insulin breakdown, and may require less insulin units
- Bthey have improved insulin sensitivity, will require less insulin
- Cincreases renal clearance, requiring more insulin than baseline
- Dinsulin can potentiate effects of antidiuretic hormone
78what is the indication for the use of Sulfonylureas when treating DM?
- AExcessive production of glucose by the liver
- Brapid intestinal glucose dumping
- CInsufficient production of endogenous insulin
- DDecreased tissue insensitivity to insulin
79what patient would you NOT prescribe Metformin (Glucophage) for the treatment of type 2 DM?
- A20yo female who had ambulatory surgery 3 days ago
- B11yo male with HTN
- C9yo female HTN and HF
- D18yo male who is currently taking a sulfonylurea
80your patient who is taking metformin and an alpha-glucosidase inhibitor to treat their DM presents with unsteady gait, generalized confusion and elevated anxiety CBG is 50mg/dl. what would you give to correct this?
- Aa piece of hard candy held between the cheek
- B15gm CHO
- Csugar packets
- DLactose
81what DM medication should not be used with ACEIs due to the increased risk of angioedemia
- AThiazolidinediones
- BAlpha-Glucosidase Inhibitors
- CBiguanides
- DDipeptidyl Peptidase-4
Informações
- Descrição
- study resource for ADV PHARMACOTHERAPEUTICS 20S-NURS-G820-W03 2nd test
- Autor
- Shawn Tredinnick
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- English
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