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Pharm I Exam 1

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Sample test for practice for Simmons FNP Pharm I Exam 1
paigembrennan
Quiz by paigembrennan, updated more than 1 year ago
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Created by paigembrennan over 8 years ago
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Resource summary

Question 1

Question
The NP is reading the literature about a drug. The article reports that the drug is potent. The NP knows that this means that the drug:
Answer
  • Produces its effect at low doses
  • Produces strong effects at any dose
  • Requires high doses to produce its effects
  • Is very likely to cause adverse effects

Question 2

Question
Except for gene therapy, which statements are true about drug-receptor interactions? SELECT ALL THAT APPLY
Answer
  • Drugs can mimic the actions of endogenous molecules.
  • Receptors for drugs do not respond to hormones and neurotransmitters produced by the body.
  • The binding of a drug to its receptor is usually irreversible.
  • Drugs can block the actions of endogenous molecules.
  • Drugs can give the cell new functions.

Question 3

Question
Which assessment findings suggest hypersensitivity of the receptors when a patient suddenly stops taking atenolol (Tenormin), a beta 2 receptor antagonist that slows the heart rate?
Answer
  • BP 80/56 mmHg
  • Pulse 118 bpm
  • Respirations 26 breaths/min
  • Temperature 104 degrees F (40 degrees C)

Question 4

Question
A patient who has over dosed on methadone HCL (Metadol), an opiate, is brought to the emergency department unresponsive with severely depressed respirations. The patient receives intravenous naloxone HCL (Narcan), an opiod antagonist, with a dramatic improvement in the level of consciousness and respiratory rate and effort within minutes. Which is the priority action 45-60 minutes after the naloxone HCL is administered?
Answer
  • Assess for the return of pain because the effect of the naloxone HCL should be peaking.
  • Assess the need to administer another dose of naloxone HCL because the respiratory and CNS depression may return as the medication effect ends.
  • Prepare to administer the drug intramuscularly if the drug has not taken effect.
  • Prepare to counter act the effects of the opiod withdrawal.

Question 5

Question
When the therapeutic index of a drug is narrow, what should the NP expect?
Answer
  • Blood levels of the drug would be monitored throughout the therapy.
  • The drug would produce the desired effect at low doses.
  • The drug would produce many adverse effects at low doses.
  • The drug would only be used in an emergency.

Question 6

Question
Pharmacodynamics includes the study of how drugs work.
Answer
  • True
  • False

Question 7

Question
Phase 2 of the dose response relationship starts at the point when the therapeutic effect does not increase with the increasing dose.
Answer
  • True
  • False

Question 8

Question
Maximal efficacy is defined as the largest effect that a drug can produce.
Answer
  • True
  • False

Question 9

Question
Potency is defined as the dose of drug needed to get the desired effect.
Answer
  • True
  • False

Question 10

Question
Two drugs in the same therapeutic class with different recommended doses (2mg vs. 200mg) can have equal effects.
Answer
  • True
  • False

Question 11

Question
A drug that stimulates a family of receptors that are transcription factors does not reach a therapeutic effect until taken regularly for 2wks.
Answer
  • True
  • False

Question 12

Question
A drug that is selective for specific receptors will produce more unintended effects than a nonselective drug.
Answer
  • True
  • False

Question 13

Question
If a drug is selective for specific receptors it is safe.
Answer
  • True
  • False

Question 14

Question
Affinity is the strength of attraction between a drug and its receptor.
Answer
  • True
  • False

Question 15

Question
Drugs with high intrinsic activity cause an intense response.
Answer
  • True
  • False

Question 16

Question
An agonist blocks the stimulation of a receptor.
Answer
  • True
  • False

Question 17

Question
If a receptor is constantly bombarded by a drug, the cell can down-regulate and decrease the response to the drug.
Answer
  • True
  • False

Question 18

Question
If a patient suddenly stops taking an antagonist drug, he can have a hypersensitivity of the receptor and overstimulation.
Answer
  • True
  • False

Question 19

Question
The ED 50 is usually the recommended dose for the drug.
Answer
  • True
  • False

Question 20

Question
Absorption
Answer
  • Change in drug structure; makes drug more hydrophilic
  • Change in drug structure/movement out of the body
  • Movement of drug from blood into tissues/cells
  • Movement of drug into and out of the body; what body does to drug
  • Movement of drug into the blood
  • Movement of drug out of the body

Question 21

Question
Distribution
Answer
  • Change in drug structure; makes drug more hydrophilic
  • Change in drug structure/movement out of the body
  • Movement of drug from blood into tissues/cells
  • Movement of drug into and out of the body; what body does to drug
  • Movement of drug into the blood
  • Movement of drug out of the body

Question 22

Question
Elimination
Answer
  • Change in drug structure; makes drug more hydrophilic
  • Change in drug structure/movement out of the body
  • Movement of drug from blood into tissues/cells
  • Movement of drug into and out of the body; what body does to drug
  • Movement of drug into the blood
  • Movement of drug out of the body

Question 23

Question
Excretion
Answer
  • Change in drug structure; makes drug more hydrophilic
  • Change in drug structure/movement out of the body
  • Movement of drug from blood into tissues/cells
  • Movement of drug into and out of the body; what body does to drug
  • Movement of drug into the blood
  • Movement of drug out of the body

Question 24

Question
Metabolism
Answer
  • Change in drug structure; makes drug more hydrophilic
  • Change in drug structure/movement out of the body
  • Movement of drug from blood into tissues/cells
  • Movement of drug into and out of the body; what body does to drug
  • Movement of drug into the blood
  • Movement of drug out of the body

Question 25

Question
Pharmacokinetics
Answer
  • Change in drug structure; makes drug more hydrophilic
  • Change in drug structure/movement out of the body
  • Movement of drug from blood into tissues/cells
  • Movement of drug into and out of the body; what body does to drug
  • Movement of drug into the blood
  • Movement of drug out of the body

Question 26

Question
Which of the following labs would suggest to the NP that a patient may be at risk for drug toxicity secondary to impaired excretion?
Answer
  • AST 72 IU
  • INR 4.2
  • eGFR 30mL/min
  • WBC 13,000 mm3

Question 27

Question
What is the priority action to assist a patient in PACU to promote excretion of most anesthetics?
Answer
  • Encourage deep breathing
  • Maintain a patent IV line
  • Monitor urine output
  • Prevent constipation

Question 28

Question
Lanoxin (Digoxin) is a drug with a narrow therapeutic index. Which interventions would be critical for the NP to implement? SELECT ALL THAT APPLY.
Answer
  • Administer the medication only on a PRN basis.
  • Monitor the patient for therapeutic and toxic effects
  • Be diligent about the timing of drug administration
  • Monitor blood levels of the drug
  • Teach the patient that the drug takes several weeks to reach its peak effect

Question 29

Question
Grapefruit juice inhibits the CYP 450 system enzymes (CYP3A4 enzyme specifically) and inhibits p-glycoprotein in the intestines for days after ingestion. This especially affects calcium channel blockers, benzodiazepines, cyclosporine, and “statin” drugs. The NP would explain to the patient that ingesting grapefruit juice causes:
Answer
  • Excessive first-pass effect
  • Excess levels of drug in the blood
  • Lack of therapeutic drug effect
  • Rapid excretion of the drug

Question 30

Question
A patient receiving Vancomycin for a serious infection, has been ordered to have a peak and trough level drawn. When would the NP order these blood levels to be obtained?
Answer
  • Peak level 1.5-hours after infusion and trough level 30 minutes before the next dose.
  • Peak level 1.5-hours before infusion is started and trough level immediately after infusion of the drug is completed.
  • Peak level while the drug is infusing and trough level trough level immediately after infusion of the drug is completed.
  • Peak level while the drug is infusing and trough level 30 minutes before the next dose.

Question 31

Question
A patient has stopped taking levothyroxine (Synthroid) 3 days ago. The drug has a half-life of 7 days. The patient tells the NP that the drug must not have been necessary because he/the patient does not feel any different. Which of the following is the basis of the NP’s explanation for this phenomenon?
Answer
  • The patient’s dose was probably too high, so the drug is still working.
  • The patient could not have been taking the drug as prescribed.
  • The drug probably was not needed if the pt. has not experienced symptoms.
  • The drug’s previous doses have not been completely eliminated from the body.

Question 32

Question
The NP prescribes the following medications for a patient: glyburide (Diabeta) 10mg by mouth daily for diabetes and quinapril HCL (Accupril) 20mg by mouth daily for hypertension. The NP should advise Quinipril (ACEI) potentiates the action of glyburide (sulfonylureas) so the patient should be cautioned to monitor for signs and symptoms of hypoglycemia. The dose of the glyburide may need adjustment. In addition, the meds (specially the glyburide) should be administered with breakfast.
Answer
  • True
  • False

Question 33

Question
Which of the following is true for a drug that acts as a reversibly-binding partial agonist?
Answer
  • The effect of the drug cannot be overcome by an increase in the endogenous agonist.
  • The drug will have an effect on the Emax of the endogenous agonist.
  • The drug will have an effect on EC50 of the endogenous agonist.
  • The drug will effectively decrease the efficacy of the endogenous agonist.

Question 34

Question
Which of the following is most dependent on a drug's EC50?
Answer
  • Drug potency.
  • Drug efficacy.
  • Volume of Distribution.
  • Therapeutic Index.

Question 35

Question
In the following illustration, which drug is the most efficacious?
Image:
a70f21dd-8b8e-4683-915f-7d10d4e7f2cb (image/png)
Answer
  • A
  • B
  • A, C, & D are equally efficacious.
  • D

Question 36

Question
In the following illustration, if B is an endogenous agonist, A is most likely?
Image:
84e8befe-92a7-40c5-befa-b1db13a04074 (image/png)
Answer
  • A competitive inhibitor.
  • A noncompetitive inhibitor.
  • An allosteric potentiator.
  • It is impossible to tell based in the information in this graph.

Question 37

Question
In the follow graph, which of the following parameters is a comparison of ED50 to LD50?
Image:
ad701778-4164-46d1-802b-f7c972b1e1d0 (image/png)
Answer
  • Therapeutic Index
  • Standard Safety Margin
  • Therapeutic Window
  • None of the above

Question 38

Question
Which of the following is not a factor influencing drug membrane passage?
Answer
  • Molecular size
  • Lipid solubility
  • Volume of distribution
  • Degree of ionization
  • Concentration gradient

Question 39

Question
The fraction of drug reaching circulation following administration is known by which abbreviation?
Answer
  • LD
  • MD
  • F
  • Vd

Question 40

Question
Which of the following routes of absorption are in the correct order in terms of rate of absorption?
Answer
  • intravenous = subcutaneous > inhalational > intramuscular > oral
  • intravenous = inhalational > subcutaneous > intramuscular > oral
  • intravenous = inhalational > intramuscular > oral > subcutaneous
  • intravenous = inhalational > intramuscular > subcutaneous > oral

Question 41

Question
Which of the following is true regarding the graph below?
Image:
6e1824d0-92b8-48bc-ad58-694817cd41e6 (image/png)
Answer
  • Drug B has an availability equal to that of drug A.
  • Drug C has a rate equal to that of drug A.
  • The availability of B & C are dictated by their peak plasma concentration.
  • The difference in AUC between A and C dictate their relative availabilities.

Question 42

Question
Concerning drug receptor interactions, the constant Kd refers to: SELECT ALL THAT APPLY
Answer
  • maximal physiological effect
  • maximal binding
  • the drug concentration required to occupy 50% of receptors
  • drug concentration that results in half-maximal physiological response

Question 43

Question
Signal transduction involves G protein coupled receptor systems: SELECT ALL THAT APPLY
Answer
  • biogenic amines
  • peptide hormones
  • eicosanoids

Question 44

Question
Example(s) of second messenger effect(s): SELECT ALL THAT APPLY
Answer
  • increases in cAMP intracellular concentration
  • changes in intracellular calcium concentration
  • phosphoinositide effects

Question 45

Question
EC50 mainly reflects a drug's:
Answer
  • maximal effect
  • potency
  • lethality
  • ease of elimination
  • safety

Question 46

Question
Physiological processes mediated by the intracellular second messenger, cyclic AMP: SELECT ALL THAT APPLY
Answer
  • carbohydrate breakdown by the liver
  • decreased heart rate
  • increased contractility
  • smooth muscle relaxation
  • triglyceride breakdown

Question 47

Question
Drug effects are thought to be proportional to the number of occupied receptors
Answer
  • True
  • False

Question 48

Question
Nitric oxide mediates this effect on vascular smooth muscle:
Answer
  • smooth muscle relaxation
  • smooth muscle contraction
  • no effect

Question 49

Question
Receptors are usually:
Answer
  • lipids
  • proteins
  • DNA

Question 50

Question
Longer-lasting physiological response to drug:
Answer
  • increase in heart rate following epinephrine infusion
  • changes in gene product production following corticosteroid injection.

Question 51

Question
True statement(s) concerning competitive inhibition: SELECT ALL THAT APPLY
Answer
  • competitive in addition is based on reversible drug/antagonist binding at receptor sites
  • with competitive inhibition, the dose-effects curve the shifted to the left
  • with competitive inhibition, maximal drug effect cannot be obtained, even at high agonist concentrations

Question 52

Question
Example(s) of endogenous ligands that interact with membrane-integrated ion channels and affect(s) ion conductance. SELECT ALL THAT APPLY
Answer
  • acetylcholine
  • GABA
  • glutamate
  • aspartate
  • glycine

Question 53

Question
Example(s) of (a) receptor(s) which is/are enzyme(s): SELECT ALL THAT APPLY
Answer
  • dihydrofolate reductase
  • acetylcholinesterase
  • monoamine oxidase

Question 54

Question
Primary mechanism by which cAMP effects are terminated:
Answer
  • enzyme-catalyzed dephosphorylation
  • reuptake into presynaptic nerve terminals

Question 55

Question
An example of a receptor which is a structural protein.
Answer
  • Na/K ATPase
  • acetylcholinesterase
  • tubulin
  • DNA
  • phospholipase C

Question 56

Question
An example of an agent that exerts much of its effects through intracellular receptors that in complex form binds to DNA response elements:
Answer
  • acetylcholine
  • dopamine
  • corticosteroids
  • diltiazem
  • atropine

Question 57

Question
Factors that may cause variation in drug responsiveness:
Answer
  • changes in the number or function of receptors
  • tachyphylaxis
  • idiosyncratic drug responses
  • hypersensitivity reactions
  • all of the above

Question 58

Question
Major roles of receptors:
Answer
  • determine rate of drug elimination
  • determine drug action selectivity
  • provide a means of blocking drug action as well as mediating drug action
  • act as drug storage sites

Question 59

Question
Concerning oral administration -- disadvantages SELECT ALL THAT APPLY
Answer
  • least economical
  • drug taken orally may cause emesis
  • drug taken orally may be destroyed by gastric acidity
  • drug taken orally may be metabolized by gastrointestinal flora
  • drug taken orally may be inconsistently absorbed due to the presence of food

Question 60

Question
Factors That Can Affect Pharmacokinetics SELECT ALL THAT APPLY
Answer
  • Age
  • Hepatic or renal disease
  • Pregnancy
  • Drug interactions
  • Ethnicity
  • Metabolism
  • Nutritional status in patients
  • GI surgeries
  • Drug-drug interactions
  • Drug-food interactions

Question 61

Question
Factors That Affect Bioavailability: SELECT ALL THAT APPLY
Answer
  • How drug is transported across membranes
  • How drug is affected by
  • Shape of the medication
  • Gastric acid
  • Drug formulation: salt form, type of binders
  • Enzymes in GI tract

Question 62

Question
Factors affecting absorption: SELECT ALL THAT APPLY
Answer
  • Formulation
  • Mechanics of absorption
  • pH
  • Molecular size
  • Lipophilicity
  • 2nd messengers
  • Cellular environment
  • Ionization

Question 63

Question
Most drugs are strong acids (-) or bases (+)
Answer
  • True
  • False

Question 64

Question
Uncharged drugs are more lipid soluble
Answer
  • True
  • False

Question 65

Question
Ionized drug molecules more lipid soluble
Answer
  • True
  • False

Question 66

Question
You can create a non-ionized form of an acidic drug by placing it in an acidic environment
Answer
  • True
  • False

Question 67

Question
Drugs with low molecular weight pass through membrane pores more easily
Answer
  • True
  • False

Question 68

Question
Active transport is drug movement from area of higher concentration to lower concentration
Answer
  • True
  • False

Question 69

Question
Biotransformation reactions occur first with Phase I followed by Phase II.
Answer
  • True
  • False

Question 70

Question
CYP cytochromes are non-specific, so they could all act on the same drugs.
Answer
  • True
  • False

Question 71

Question
Biotransformation occurs: SELECT ALL THAT APPLY
Answer
  • liver
  • intestines
  • skin
  • lungs
  • kidney
  • brain
  • muscles
  • heart

Question 72

Question
During Phase II biotransformation, drugs can conjugate with which of the following:
Answer
  • glucoronic acid
  • sulphuric acid
  • acetic acid
  • amino acid
  • all of the above

Question 73

Question
Conjugation occurs during Phase I of biotransformation
Answer
  • True
  • False

Question 74

Question
Enzyme induction can cause potential toxicity
Answer
  • True
  • False

Question 75

Question
Only certain drugs are hepatotoxic
Answer
  • True
  • False

Question 76

Question
Alcoholism and fatty liver disease affect drug metabolism
Answer
  • True
  • False

Question 77

Question
Factors that affect drug metabolism: SELECT ALL THAT APPLY
Answer
  • Age
  • Comorbidities
  • Liver dysfunction
  • Gender

Question 78

Question
In an 18-month-old baby, these factors could affect biotransformation:
Answer
  • P-450 enzymes not fully developed
  • blood brain barrier not fully developed
  • intestinal enzymes not fully developed
  • renal system not fully developed
  • none of the above

Question 79

Question
A drug must be biotransformed to be excreted
Answer
  • True
  • False

Question 80

Question
Clearance is the sum of elimination from liver, kidneys, and GI tract.
Answer
  • True
  • False

Question 81

Question
All drugs are excreted by the kidneys.
Answer
  • True
  • False

Question 82

Question
After age [blank_start]50[blank_end] people lose [blank_start]10[blank_end] percent of kidney nephrons every decade.
Answer
  • 40
  • 50
  • 60
  • 70
  • 5
  • 7
  • 10
  • 15

Question 83

Question
You see a pt with HTN. You've given him a prescription for an antihypertensive BID. He returns in 30 days and his blood pressure is 150/85. He admits to noncompliance with BID dosing. You educate him about the importance of taking the medication as prescribed, because once daily is not enough to maintain adequate blood levels. This is an example of:
Answer
  • Dose of medication is too low and needs to be increased
  • Steady state
  • Increased renal clearance of medication

Question 84

Question
A patient is taking multiple doses of 100 mg of metoprolol. At what does of medication will the patient reach steady state? [blank_start]_____[blank_end] mg
Answer
  • 3.125

Question 85

Question
A patient is given a single dose of morphine for pain relief before leaving the hospital. Since he can't drive while under the influence, he wants to know how long until he can drive. The half-life if morphine is 2 hours. What is your answer?
Answer
  • 2 hours
  • 4 hours
  • 6 hours
  • 8 hours
  • 10 hours

Question 86

Question
What substances are excreted via the lungs?
Answer
  • Alcohol
  • Liquid
  • Gas
  • Volatile substance

Question 87

Question
Your pregnant patient develops a DVT. You place her on heparin. She mentions she doesn't like shots. Should you place her on warfarin instead to increase medication compliance?
Answer
  • Yes, drug compliance is very important. Because DVTs are so serious, increasing drug compliance is the primary concern.
  • No, heparin is better for the baby.

Question 88

Question
Until age 2, children have [blank_start]80[blank_end]% body water, in contrast to adults, who have [blank_start]60[blank_end]%.
Answer
  • 70
  • 75
  • 80
  • 85
  • 50
  • 55
  • 60
  • 65

Question 89

Question
Despite differences in body makeup, infants and children have consistent rates of absorption.
Answer
  • True
  • False

Question 90

Question
A laboratory is conducting a study to assess the safety, efficacy, and potency of a group of drugs before allowing the agents to proceed to clinical trials. The figure shows the dose-response curves for four different drugs from the same class of medications (Drugs A, B, C, & D). Which of the following is true regarding these medications?
Image:
a1db543b-821c-49fb-9bf3-89eacdf922da (image/png)
Answer
  • Drug A has greater efficacy than Drug D
  • Drug D has greater efficacy than Drug A
  • Drug A has greater potency than Drug D
  • Drug D has greater potency than Drug A
  • All four drugs (A,B,C,D) have equal potencies

Question 91

Question
An overweight patient comes to see you about heart palpitations and high blood pressure. You're trying to decide between a once-daily beta blocker and one given every 6 hours. You feel the once-daily is the best choice. Is this correct?
Answer
  • Yes, this is the best choice because once-daily will help with medication compliance.
  • No, this is not the best choice because your patient is overweight.

Question 92

Question
Characteristics of fat-soluble drugs: cell membrane potential [blank_start]_____[blank_end] pH [blank_start]_____[blank_end] molecular size [blank_start]_____[blank_end] Half-life [blank_start]_____[blank_end] Vd [blank_start]_____[blank_end] Ionization [blank_start]_____[blank_end] Absorption [blank_start]_____[blank_end] Route of administration [blank_start]_____[blank_end] Metabolized by [blank_start]_____[blank_end]
Answer
  • Cross cell membrane on their own
  • Use 2nd messengers to cross
  • Acidic
  • Basic
  • Small
  • Large
  • Short
  • Long
  • High Vd
  • Small Vd
  • Uncharged
  • Charged
  • Easily absorbed
  • Difficult to absorb
  • IV
  • PO
  • Does not matter as much
  • Kidneys
  • Liver

Question 93

Question
Characteristics of water-soluble drugs: cell membrane potential [blank_start]_____[blank_end] pH [blank_start]_____[blank_end] molecular size [blank_start]_____[blank_end] Half-life [blank_start]_____[blank_end] Vd [blank_start]_____[blank_end] Ionization [blank_start]_____[blank_end] Absorption [blank_start]_____[blank_end] Route of administration [blank_start]_____[blank_end] Metabolized by [blank_start]_____[blank_end]
Answer
  • Cross on their own
  • Use 2nd messengers
  • Acidic
  • Basic
  • Large
  • Small
  • Long
  • Short
  • High
  • Low
  • Charged
  • Uncharged
  • Difficult to absorb
  • Easily absorbed
  • PO
  • IV
  • It doesn't really matter
  • Kidneys
  • Liver
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