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advanced Pharm study guide for test 2

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study resource for ADV PHARMACOTHERAPEUTICS 20S-NURS-G820-W03 2nd test
Shawn Tredinnick
Quiz by Shawn Tredinnick, updated more than 1 year ago
Shawn Tredinnick
Created by Shawn Tredinnick about 4 years ago
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Resource summary

Question 1

Question
What is the significance of bradykinin in the RAAS system
Answer
  • it is a peptide needed for the release of aldosterone by the adrenal gland
  • It is a peptide that causes blood vessels to constrict, raising blood pressure
  • it causes contraction of non-vascular smooth muscle
  • it is broken down by angiotensin converting enzyme causing vasodilation and mild dieresis

Question 2

Question
the patient complains of a dry cough, what medication would be the most likely to have this finding?
Answer
  • Captopril
  • Losartan
  • Amilodipine
  • Naproxen

Question 3

Question
angiotensin converting enzyme inhibitors (ACE inhibitors) work on what part of the RAAS system?
Answer
  • blocks Renin from stimulating the release of Angiotensinogen
  • blocks Angiotensinogen conversion to Angiotensin I
  • Blocks Angiotensin I conversion to Angiotensin II
  • blocks Angiotensin II conversion to aldosterone

Question 4

Question
what class of medications will reduce the adverse affects of Diabetes on the kidneys as well as decrease inappropriate remodeling of the heart
Answer
  • thiazide diuretics
  • angiotensin receptor blockers (ARBs)
  • Calcium Channel Blockers (CCBs)
  • angiotensin converting enzyme inhibitors (ACE inhibitors)

Question 5

Question
What statement is true regarding ACE inhibitors?
Answer
  • they are potassium wasting and must be monitored for hypokalema
  • they have little negative effect on lipids or sexual function
  • African-Americans & low-renin hypertensives are extremely sensitive to monotherapy
  • they increase the effectiveness of NSAIDs

Question 6

Question
What is considered the most serious ADR with ACE inhibitors?
Answer
  • Angioedema <1%
  • <1% neutropenia & agranulocytosis
  • Hyperkalemia
  • Proteinuria & glomerulonephritis

Question 7

Question
Ace inhibitors and ARBs would be the drug of choice for which patient?
Answer
  • 37yo Caucasian male with Hx of MI, and kidney failure
  • 57yo Asian Female currently taking spironolactone
  • 49yo caucasian female with Hx of DM, HF and MIx3
  • 46yo African American male with Hx of DM, HTN and kidney stones

Question 8

Question
which of the following statements is True about ACE inhibitors and ARBs used for the treatment of hypertension .
Answer
  • ACEIs affect the myocardial oxygen demand but not the myocardial oxygen supply
  • ACEIs affect the myocardial oxygen supply but not the myocardial oxygen demand
  • ACEIs affect both the myocardial oxygen supply and the myocardial oxygen demand
  • ACEIs and ARBs are contraindicated in treating heart failure related to CAD

Question 9

Question
where are the primary sites of metabolism and excretion for ACEI's?
Answer
  • all ACEIs are prodrugs and do not need to be metabolized, excretion is from the kidneys.
  • ACEI's are metabolized in the avieoli of the lungs, excretion is primarily by GI tract with the capsule being whole but hollow
  • all ACEI's are prodrugs and converted to active metabolites in the liver, The kidney is the primary organ of excretion
  • ACI's are prodrugs and converted to active metabolites in the liver, excretion is primarily by GI tract with the capsule being whole but hollow

Question 10

Question
What are the contraindications for the use of ACEI's?
Answer
  • Hypertensive Proteinuric Diabetes
  • Bilateral renal artery stenosis
  • Postmyocardial Infarction
  • Pregnancy

Question 11

Question
what is the first goal of Hypertension management?
Answer
  • Controlling isolated systolic hypertension (ISH)
  • Prevent the rise of BP with age
  • reduction in Cardio vascular risk
  • Improve control of HTN to below 140/90 mm Hg in adults and below 150/90 in those greater than age 60

Question 12

Question
what statement is true with reguard to Dihydropyridines
Answer
  • greater affinity for vascular ca+ channels than cardiac Ca+2 channels
  • greater affinity for cardiac Ca+2 channels than vascular ca+ channels
  • Blocks L-type calcium channels producing vasoconstriction
  • Has an intrinsic natriuretic effect requiring the use of a diuretic

Question 13

Question
select all of the adverse drug reactions for Nondihydropyridines
Answer
  • Reflex tachycardia
  • Anorexia
  • Constipation
  • Bradycardia

Question 14

Question
Most 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?
Answer
  • Digoxin, with a half life of 36-48 hours
  • Cardizem, with a half life of 3-4 hours
  • Amlodipine, with a half-life of 30 to 50 hours
  • isradipine with a half life of 1.5-2 hours

Question 15

Question
what is the main effect of digoxin
Answer
  • opens the ATPase pump allowing free flow of Na+ and Ca+
  • inhibits the ATPase pump preventing Na+ from leaving the cell
  • Blocks L-type calcium channels producing vasodilation
  • inhibits the ATPase pump preventing Ca+ from leaving the cell

Question 16

Question
how is dosing for digoxin determined?
Answer
  • The principal tissue reservoir is skeletal muscle, Dosing should be based on lean muscle mass
  • The principal tissue reservoir is adipose tissue, Dosing should be based on BMI%
  • The principal tissue reservoir is the CNS and dosing should be based on CSF results
  • there is not a principal tissue reservoir, dosage is determined by weight in Kg.

Question 17

Question
select the contraindications for the use of digoxen.
Answer
  • Renal Impairment
  • AV blocks or uncontrolled ventricular arrhythmias
  • Atrial Fibrillation
  • idiopathic hypertrophic subaortic stenosis (IHSS)
  • Paroxysmal Supraventricular Tachycardia

Question 18

Question
what finding would make you suspect CG Toxicity?
Answer
  • serum levels of 4.5 ng/mL.
  • the patient presents with severe anorexia, nausea, vomiting, and diarrhea
  • ST-T wave changes on the a 12-lead ECG
  • pt presents with severe nausea, vomiting, and serum levels of 2.3 ng/mL.

Question 19

Question
Arrhythmias 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?
Answer
  • blockade of Central Nervous System (CNS) effects on the heart
  • prolongation of the effective refractory period
  • sodium channel blockade
  • blockade of the calcium channel

Question 20

Question
sodium channel blockers are what class of antiarrhythmic drugs?
Answer
  • Class I
  • Class II
  • Class III
  • Class IV

Question 21

Question
Beta Blockers are what class of antiarrhythmic drugs?
Answer
  • Class I
  • Class II
  • Class III
  • Class IV

Question 22

Question
Calcium Channel Blockers (CCB) are what class of antiarrhythmic drugs?
Answer
  • Class I
  • Class II
  • Class III
  • Class IV

Question 23

Question
How are Antiarrhythmics metabolized.
Answer
  • antiarrhythmics are already in their metabolized form after absorption and are deactivated by the liver.
  • All antiarrhythmics are metabolized and excreated from the GI tract
  • all antiarrhythmics are prodrugs and do not need to be metabolized
  • All antiarrhythmics are metabolized By the liver

Question 24

Question
this drug class was introduced for the treatment of angina in the 19th century
Answer
  • ACEs
  • CCBs
  • nitrates
  • ARBs

Question 25

Question
what statement is true with reguard to Nitrates?
Answer
  • by providing more nitric oxide (NO) to vascular endothelium and arterial smooth muscle, resulting in vasodilation.
  • cause targeted relaxation of large veins resulting in decreased pre-load
  • Arterial dilation is more common with lower doses and can result in a decrease in systemic arterial pressure
  • Arterial dilation is more common with higher doses and can result in an increase in systemic arterial pressure

Question 26

Question
in which of the following cases would you NOT give nitrates.
Answer
  • 33yo female c/o migraine with HR111 bp 200/120
  • 75yo male c/o chest pain that has not improved, HR 63 bp 110/65
  • 45yo male car vs tree, c/o dizziness, chest pain and nausea. had MI 2 years ago. HR110 BP185/96
  • 35yo female with weakness to one side of her body, difficulty speaking and pain in the jaw that radiates to her back

Question 27

Question
which statement about Peripheral Vasodilators is FALSE?
Answer
  • Significant clinical improvement of PVD can rarely be seen with monotherapy
  • Peripheral alpha1 antagonists and central alpha2 agonists can be used to treat resistant HTN and PVD.
  • monotherapy is recommended to show Significant clinical improvement of PVD without associated ADRs
  • act by direct relaxation and dilation of arteriolar smooth muscle, thereby decreasing PVR

Question 28

Question
when prescribing reductase inhibitors, what lab tests should also be performed?
Answer
  • CBC
  • AST/ALT
  • BUN/creatinine
  • Lipid Panel

Question 29

Question
what is the clinical indication for the use of Antilipidemics?
Answer
  • increased LDL, decreased HDL, high VLDL
  • High VLDL, increased HDL, Decreased LDL
  • increased HDL, increased LDL, low VLDL
  • decreased LDL, increased HDL, low VLDL

Question 30

Question
The liver is the primary site of metabolism for most diuretics, which diuretic has nonhepatic and hepatic metabolism
Answer
  • Furosemide (Lasix)
  • spironolactone (Aldactone)
  • Amiloride
  • hydrochlorothiazide (HCTZ)

Question 31

Question
if a patient is taking an aminoglycoside medication what Adverse drug reaction would you actively assess for?
Answer
  • a white crystalline precipitate to form in the superficial portion of the cornea.
  • localized ocular toxicity
  • itching/swelling of the face/tongue/throat
  • Increased Ocular Pressure in narrow-angle glaucoma

Question 32

Question
if 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?
Answer
  • Keratometry
  • retinoscope
  • opthalmoscope
  • Tonometry device

Question 33

Question
which of the following Ophthalmic Anti-Infectives has a high hypersensitivity rate?
Answer
  • azithromycin
  • erythromycin
  • polymyxin B
  • gentamicin

Question 34

Question
what is important to remember when using Sulfacetamide
Answer
  • it is incompatible with silver-containing preparations
  • must have tonometry available
  • it has a high hypersensitivity rate
  • may cause localized ocular toxicity

Question 35

Question
Children 3 months through 8 years are most likely to have what type of Bacterial conjunctivitis select all that apply
Answer
  • staphylococcal
  • strepto­coccal
  • Haemophilus
  • Staphylococcus aureus
  • Pseudomonas aeruginosa

Question 36

Question
what is the treatment for Conjunctivitis-otitis syndrome
Answer
  • high-dose amoxicillin
  • parenteral antibiotics (ceftriaxone)
  • ophthalmic/otitc antibiotics
  • erythromycin ointment

Question 37

Question
What symptoms would make you suspect herpes keratitis? if herpes keratitis is suspected what should be done next?
Answer
  • intense redness of the eye, Watery/mucus discharge from the eye, fever blister on or near the eye; examination with woodslamp
  • Swelling of the lymph nodes in front of the ears, fever, slight Pinkness of the eye; referral to ophthalmologist
  • burning, gritty sensation to the eye, lesion close to or on the eye, fever; referral to ophthalmologist
  • Crustiness around the eyelids upon waking in the morning, cough, fever; ocular assessment with ophthalmoscope

Question 38

Question
while 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?
Answer
  • irrigation was being performed too forcefully
  • the irrigation solution was not warmed
  • irrigation solution has bypassed the ear drum and is interfering with the middle ear
  • the patient is having a seizure

Question 39

Question
which statement is FALSE with reguard to Corticosteroids
Answer
  • have metabolic, anti-inflammatory, and growth-suppressing effects
  • high levels of cortisol can cause decreased memory recall, anxiety and disturbed sleep patterns
  • Glucocorticoids decrease blood glucose concentration by stimulating glycogenesis in the liver
  • Corticosteroids can raise your risk of infections due to the wide range of effects on the immune system

Question 40

Question
What determines systolic Blood pressure?
Answer
  • mean arterial pressure
  • Total peripheral resistance
  • end-diastolic volume (EDV) - end-systolic volume (ESV)
  • HR times stroke volume

Question 41

Question
What determines diastolic blood pressure?
Answer
  • Total peripheral resistance
  • Cardiac output
  • mean arterial pressure divided by ejection fraction
  • end-diastolic volume (EDV) - end-systolic volume (ESV)

Question 42

Question
select what factors will have a direct effect on systemic arterial pressure. select all that apply.
Answer
  • total peripheral resistance
  • heart rate
  • Stroke volume
  • mean arterial pressure

Question 43

Question
an increase in BP will send inhibitory impulses to the sympathetic vasomotor center in the brainstem resulting in what?
Answer
  • excitation of efferent nerves in the SNS results in decreased heart rate,
  • Inhibition of efferent nerves in the SNS that innervate cardiac and vascular smooth muscle results in increased heart rate
  • Inhibition of efferent nerves in the SNS that innervate cardiac and vascular smooth muscle results in vasodilation of peripheral arterioles
  • excitation of efferent nerves in the SNS that innervate cardiac and vascular smooth muscle

Question 44

Question
changes in BP is sensed by ____ located in _____
Answer
  • baroreceptors; aorta
  • Mechanoreceptors; carotid arteries
  • Nociceptors; arch of the aorta
  • Mechanoreceptors; kidneys

Question 45

Question
what are the ultimate goals of Angina therapy
Answer
  • to treat anginal chest pain and return to normal activities
  • reduce the risks of stroke
  • reduce the risks of MI
  • smooth muscle and cardiac relaxation

Question 46

Question
what statements are true about organic nitrates. select all that apply
Answer
  • Reduces preload
  • Increases afterload
  • Inhibit platelet aggregation
  • leads to the mediation of smooth muscle relaxation

Question 47

Question
what makes Ranolazine unique for the treatment of angina?
Answer
  • Have a negative chronotropic and inotropic effect and ↓ afterload, Decreases myocardial oxygen consumption, Increases myocardial perfusion
  • decreases peripheral vascular resistance and thereby MOD, as the heart has decreased afterload
  • cause arterial smooth muscle relaxation, which results in peripheral vasodilation, decreased afterload,
  • Has antianginal and anti-ischemic effects that do not depend on reduction in heart rate or blood pressure

Question 48

Question
what medication reduces platelet aggregation by inhibiting the synthesis of thromboxane A2
Answer
  • Aspirin
  • Nitroglycerin
  • Nifedipide (Procardia)
  • Diltiazem (Cardizem)

Question 49

Question
select what would be classified as class I according to the New York Heart Association and Canadian Cardiovascular Society
Answer
  • Chest pain is present for the first few hours in the morning, in cold weather or after meals
  • Angina that occurs when walking 1-2 blocks on level ground, or by climbing 1 flight of stairs
  • Angina that occurs with strenuous, rapid exertion. Ordinary physical activity like walking upstairs does not cause angina
  • Chest pain that occurs at rest

Question 50

Question
select what would be classified as class II according to the New York Heart Association and Canadian Cardiovascular Society
Answer
  • Chest pain is present for the first few hours in the morning, in cold weather or after meals
  • Angina that occurs when walking 1-2 blocks on level ground, or by climbing 1 flight of stairs
  • Angina that occurs with strenuous, rapid exertion. Ordinary physical activity like walking upstairs does not cause angina
  • Chest pain that occurs at rest

Question 51

Question
select what would be classified as class III according to the New York Heart Association and Canadian Cardiovascular Society
Answer
  • Chest pain is present for the first few hours in the morning, in cold weather or after meals
  • Chest pain that occurs at rest
  • Angina that occurs with strenuous, rapid exertion. Ordinary physical activity like walking upstairs does not cause angina
  • Angina that occurs when walking 1-2 blocks on level ground, or by climbing 1 flight of stairs

Question 52

Question
select what would be classified as class IV according to the New York Heart Association and Canadian Cardiovascular Society
Answer
  • Chest pain is present for the first few hours in the morning, in cold weather or after meals
  • Chest pain that occurs at rest
  • Angina that occurs with strenuous, rapid exertion. Ordinary physical activity like walking upstairs does not cause angina
  • Angina that occurs when walking 1-2 blocks on level ground, or by climbing 1 flight of stairs

Question 53

Question
What is considered to be the foundation of initial drug therapy for patients with angina ?
Answer
  • ACEI and beta-adrenergic blockers
  • ACEI and CCB
  • BB and CCB
  • Nitrates and BB

Question 54

Question
when diagnosing heart failure why might a chest x-ray be ordered?
Answer
  • it can be used to identify and distinguish between systolic dysfunction and preserved systolic function.
  • can show Cephalization of the vascular supply
  • can show left-ventricular hypertrophy and axis deviation
  • used to rule out pulmonary embolism

Question 55

Question
select the types of heart failure. select all that apply
Answer
  • low-output failure
  • high-output failure
  • Systolic dysfunction
  • Diastolic dysfunction

Question 56

Question
What is the most common BB used in heart failure?
Answer
  • Atenolol
  • Losartan
  • carvedilol
  • clonidine

Question 57

Question
how does Digoxin work?
Answer
  • Digoxin decreases contractility by decreasing intracellular calcium and inhibiting the sodium-potassium-ATPase pump
  • Digoxin increases heart rate by increasing intracellular calcium and inhibiting the sodium-potassium-ATPase pump
  • Digoxin increases contractility by increasing intracellular calcium and inhibiting the sodium-potassium-ATPase pump
  • Digoxin decreases heart rate by increasing intracellular calcium and inhibiting the sodium-potassium-ATPase pump

Question 58

Question
Patients with left-ventricular dysfunction with current or prior symptoms of HF are classified as what stage according to ACC and AHA guidelines.
Answer
  • Stage A
  • Stage B
  • Stage C
  • stage D

Question 59

Question
Which of the following is NOT one of the diagnostic criteria for DM?
Answer
  • A1C ≥6.5%
  • FPG ≥126 mg/dL
  • plasma glucose ≥200 mg/dL
  • classic symptoms of hyperglycemia and a random plasma glucose ≥200 mg/dL

Question 60

Question
What is true about DM type 1?
Answer
  • Typically diagnosed early in life
  • the bodies compensatory insulin production mechanisms reduce the onset of clinical symptoms for many years
  • 90% to 95% of cases are diagnosed before the age of 30.
  • If the disease progresses without treatment hypoglycemia, coma and death can occur.

Question 61

Question
What are the treatment targets for Glycemic control in DM? select all that apply
Answer
  • 2 hour postprandial plasma glucose less than 180 mg/dL
  • Hemoglobin A1c less than 5%
  • Random urine albumin/Cr less than 30mcg/mg creatinine
  • Preprandial plasma glucose 70 to 130 mg/dL

Question 62

Question
What is the treatment target for blood pressure when treating DM?
Answer
  • less than 130/80, 140/80 for patients with DM, hypertension
  • less than 120/60, 130/80 for patients with DM, hypertension
  • less than 140/80, 145/85 for patients with DM, hypertension
  • less than 130/80, 150/90 for patients with DM, hypertension

Question 63

Question
what are the treatment targets for lipid control when treating DM?
Answer
  • HDL >100mg/dl, LDL <50mg/dl, triglicerides less than 150mg/dl
  • HDL >150mg/dl, LDL <100mg/dl, triglicerides less than 50mg/dl
  • HDL >50mg/dl, LDL <100mg/dl, triglicerides less than 150mg/dl
  • HDL >100mg/dl, LDL <150mg/dl, triglicerides less than 50mg/dl

Question 64

Question
what factors effect the treatment plan and drug selection process when treating DM? Select all that apply
Answer
  • individual patient variables (race, weight, pregnant etc.)
  • current AHA guidelines
  • Desiered gylcemic target
  • type of diabetes
  • severity of the hyper/hypo glycemia

Question 65

Question
For the treatment of type 2 DM what is the first-line therapy for most patients?
Answer
  • Insulin
  • Thiazolidinediones (TZDs)
  • Metformin
  • Glipizide

Question 66

Question
Insulin with and onset of 5-30min, peak 0.5-3h and duration of 3-4h describes what type of insulin?
Answer
  • Rapid-Acting (RAI)
  • Short-acting Insulin
  • Intermediate-Acting (IAI)
  • Long-Acting (LAI)

Question 67

Question
Insulin with and onset of 30-60min, peak 2-4h and duration of 3-7h describes what type of insulin?
Answer
  • Rapid-Acting (RAI)
  • Short-acting Insulin
  • Intermediate-Acting (IAI)
  • Long-Acting (LAI)

Question 68

Question
Insulin with and onset of 1-2h, peak 4-10h and duration of 10-16h describes what type of insulin?
Answer
  • Rapid-Acting (RAI)
  • Short-acting Insulin
  • Intermediate-Acting (IAI)
  • Long-Acting (LAI)

Question 69

Question
Insulin with and onset of 1-2h, no peak, and duration of 20-24h describes what type of insulin?
Answer
  • Rapid-Acting (RAI)
  • Short-acting Insulin
  • Intermediate-Acting (IAI)
  • Long-Acting (LAI)

Question 70

Question
Generally, what percentage of daily insulin is given as an intermediate or long-acting form of insulin?
Answer
  • 0-25%
  • 25-50%
  • 50-75%
  • 75-100%

Question 71

Question
a 1 Unit bolus of insulin will typically lower glucose by approximately
Answer
  • 10-20mg/dl
  • 60-90mg/dl
  • 20-60mg/dl
  • 10-40mg/dl

Question 72

Question
Each 15 gm Carbohydrate serving raises BG by approximately
Answer
  • 15mg/dl
  • 25mg/dl
  • 50mg/dl
  • 70mg/dl

Question 73

Question
what percentage of beta cells must be lost before hyperglycemia occurs?
Answer
  • 50-60%
  • 60-70%
  • 70-80%
  • 80-90%
  • 90-100%

Question 74

Question
what statement is true about Insulin
Answer
  • alcohol use, increases hyperglycemia
  • Beta blockers mask hypoglycemic symptoms
  • Short-acting Insulin onset of action is 1 to 1.5 hours, and its duration is 12 to 24 hours
  • Rapid-Acting (RAI) duration of action is 4 to 6 hours

Question 75

Question
what is the preferred injection site that absorbs 50% more than other sites
Answer
  • Inhalation method
  • Abdominal site
  • upper outer area of the arm
  • front and outer sides of the thighs

Question 76

Question
what insulin's are pregnancy category C? select all that apply
Answer
  • Aspart
  • Humulin R
  • glargine
  • glulisine

Question 77

Question
What is important to consider if your patient has Hyperthyroidism and is taking insulin?
Answer
  • delays insulin breakdown, and may require less insulin units
  • they have improved insulin sensitivity, will require less insulin
  • increases renal clearance, requiring more insulin than baseline
  • insulin can potentiate effects of antidiuretic hormone

Question 78

Question
what is the indication for the use of Sulfonylureas when treating DM?
Answer
  • Excessive production of glucose by the liver
  • rapid intestinal glucose dumping
  • Insufficient production of endogenous insulin
  • Decreased tissue insensitivity to insulin

Question 79

Question
what patient would you NOT prescribe Metformin (Glucophage) for the treatment of type 2 DM?
Answer
  • 20yo female who had ambulatory surgery 3 days ago
  • 11yo male with HTN
  • 9yo female HTN and HF
  • 18yo male who is currently taking a sulfonylurea

Question 80

Question
your 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?
Answer
  • a piece of hard candy held between the cheek
  • 15gm CHO
  • sugar packets
  • Lactose

Question 81

Question
what DM medication should not be used with ACEIs due to the increased risk of angioedemia
Answer
  • Thiazolidinediones
  • Alpha-Glucosidase Inhibitors
  • Biguanides
  • Dipeptidyl Peptidase-4
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