NR565 / NR 565 Final Exam (Latest 2024 / 2025): Advanced Pharmacology Fundamentals – Chamberlain
Course
NR-565 Advanced Pharmacology Fundamentals
Final Exam
Primary hyperparathyroidism is usually caused by?
Correct Answer:
A parathyroid gland tumor and causes hypercalcemia
Secondary hyperparathyroidism is usually caused by?
Correct Answer:
CKD
Secondary hyperparathyroidism is what? Explain.
Correct Answer:
Increased PTH secretion due to hypocalcemia.
As PTH increases, it can lead to hypercalcemia
Increased levels of PTH causes what?
Correct Answer:
Hypercalcemia and hypophosphatemia
If a patient has hypercalcemia and hypophosphatemia, what kinds of
symptoms will these patients present with?
Correct Answer:
May be asymptomatic;
May also present with symptoms related to the neuromuscular changes that
include paresthesia and muscle cramps
Patients who have hypercalcemia will have what?
Correct Answer:
Low bone density (osteoporosis) that is most noted in the distal one third of
the radius; they can also have
Pathological fractures, kidney stones, ventricular hypertrophy, depression,
and gastric issues.
Hypomagnesemia does what?
Correct Answer:
Inhibits PTH secretion
What can hypomagnesemia be related to?
Correct Answer:
Malnutrition
Chronic alcoholism
Increased renal clearance that is caused by aminoglycoside antibiotics or
chemotherapy
Prolonged magnesium deficient parenteral nutritional therapy
What is associated with hypercortisolism?
Correct Answer:
Glucose intolerance
Cushing’s syndrome is characterized by what?
Correct Answer:
Fat deposits that have been described as “truncal or central obesity”
A moon face
Buffalo hump
An onset of an adrenal crisis can be signified by what?
Correct Answer:
Hypotension
What is Addisonian crisis? And how can it develop?
Correct Answer:
An adrenal crisis, causing hypotension that can progress to complete
vascular collapse and shock.
It can develop with undiagnosed disease, acute withdrawal of steroids, or
infections/ comorbid stressful events
Primary hypocortisolism is also known as what?
Correct Answer:
Adrenal insufficiency
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What is significant about the proximal convoluted tubule (PCT)?
It is where the least blood flow occurs, rhe most damage occurs in the PCT when ischemia happens
What enzyme is obtained from the kidney?
Erythropoieten
angiotensin converting enzyme (ACE) is made where? What does it do?
It is made in the lungs; to activate angiotensin 1 in the kidneys.
What is most important for the filtration process?
Blood hydrostatic pressure
What are the functions of the kidney?
Sodium/water removal, waste removal, hormone production
What is acute renal failure?
sudden loss of kidney function due to an illness, Injury, drug, Or toxin that stresses the kidneys. ARF can be reversible
What is chronic Renal failure?
A long slow process where the kidney looses its ability to function, it occurs in different stages
What is end stage renal disease?
Irreversible loss of kidney function
What are the types of ARF?
Prerenal, intravenal, post renal
What is the most common cause of ARF?
Pre renal
What happens when pre Renal is not treated?
It can turn into intrinsic/ intrarenal and damage inside
What is pre-renal failure?
When the damage is before the kidneys due to decreased blood flow from volume depletion or hypoperfusion
Give examples of volume depletion and hypoperfusion
Too many diuretics, vomiting and diarrhea, hemorrhage;
Decreased cardiac output due to hf and artheroschlerosis
Explain pathophysiology of pre renal failure
Decreased blood flow means decreased GFR, decreased GFR means decreased renal blood flow, then decreased GFR activates RAAS. Angiotensin secretes aldosterone which increases BP volume
If creatinine is elevated….
GFR is decreased
What is intra Renal failure?
Its the damage that has occurred inside the kidney due to:
->Glomerulonephritis
->Rhabdomylosis
->Contrast dye
->Drugs/meds
->HTN (uncontrolled HTN)
->DM
TUMOR LYSIS SYNDROME
What is the most common intra Renal failure?
Tubular
What is post-renal failure?
Obstruction located after the kidneys, most often a consequence from urinary obstruction
examples of post renal failure?
BPH,
Kidney stones
Bladder stones
Obstructed catheter
Tumors/ cancer ( bladder, ureters, prostate)
What is used to diagnose polynephritis? And complicated polynephritis?
Urine culture, urinalysis, signs and symptoms;
Urinary tract imaging and blood cultures (if patient is not doing well)
What can indicate polynephritis. In a urinalysis?
WBC casts indicate polynephritis but not always present in the UA
Renal calculi is what kind of acute Renal failure?
Post Renal failure
What are the goals of treatment for Renal calculi?
Pain management
Promote passage of the stone
Reduce the size of the stone
Prevent new stone formation
When is dialysis considered?
Stage 5 of CKD
CKD is associated with which conditions?
DM,
HTN,
SLE,
Intrinsic/ intra Renal kidney disease
CKD stages are based on what?
GFR and albuminuria
Signs of GERD in people over the age of 50:
Dysphagia
Odynophagia
Weight loss
N/V
Melena
Early satiety
How to prevent symptoms of a sliding hiatal hernia?
Eat small frequent meals
Do not lie down/prevent recumbent position after eating
Prevent tight clothes or abdominal supports
If obese, weight loss is recommended
Characteristic manifestations of a duodenal ulcer?
Intermittent epigastric pain,
Pain starts 30-2 hours after eating or empty stomach
Pain can occur in the middle of night and disappear in the AM
What is a peptic ulcer?
An ulceration or break in the protective mucosal lining of The lower esophagus, stomach, OR duodenum
Where is a peptic ulcer least likely to occur?
In the large intestine
What is the standard first line treatment for major deppresive disorder?
SSRI’S
Selection of an anti depressant includes?
Symptoms, age, s/e, safety, cost
What is an example of a determining prognosis of ARF?
Kidneys responding well to a diuretic, indicates that kidneys are functioning well
What is the most significant risk factor of CKD?
DM
Once stage 4 of CKD is reached, what happens next?
Progression to stage 5, dialysis, OR kidney transplant
What are the Symptoms of hiatal hernias?
Often asymptomatic until later in life
hiatal hernias are associated with…
Other GI disorders, but primarily GERD
What are the key features of social Anxiety?
Fear and avoidance of social situations.
Examples of positive schizophrenia symptoms?
Hallucinations,
delusions,
formal thought disorder,
bizarre behavior
Examples of negative symptoms of schizophrenia?
Flat affect,
Alogia
Anhedonia
Attention deficits
Apathy
What are cognitive symptoms of schizophrenia?
Inability to perform daily tasks that require attention and planning
Hypothyroidism is The ….
Most common disorder of thyroid function
Hypothyroidism is most Common in who?
Women and the elderly
TSH is released by what?
anterior pituitary gland
What are the two categories of opthalmopathy associated with graves disease?
Functional abnormalities and infiltrative changes
What are the two most distinguishing factors of graves disease?
pretibial myxedema and exophthalmos
What is used to treat Hyperthyroidism?
methimazole,
Propylthiouracil
Radioactive iodine
Surgery
What is the goal of using radioactive iodine for hyperthyroidism?
To destroy overactive thyroid tissue
Radiative iodine therapy for hyperthyroidism does what?
Destroys thyroid cells causing death. It is only absorbed by thyroid tissue
What is the treatment of choice for hypothyroidism?
Levothyroxine (Synthroid)
What are some environmental factors that are associated with type one diabetes?
Viral infections (particularly enteroviruses)
Coxsackievirus
H Pylori
Exposure to cows milk proteins
Lack of vitamin D
What is the diagnostic criteria for DM?
Hemoglobin A1c equal or greater than 6.5%
What is the action of insulin?
Glucose uptake mostly in the liver, muscle, adipose tissue
autonomic neuropathy is what?
A complication of diabetes
Gastrointestinal Symptoms of autonomic neuropathy includes?
Decreased esophageal motility
Gastroparesis
Delayed gastric emptying
Primary hyperparathyroidism is usually caused by?
A parathyroid gland tumor and causes hypercalcemia
Secondary hyperparathyroidism is usually caused by?
CKD
Secondary hyperparathyroidism is what? Explain.
Increased PTH secretion due to hypocalcemia.
As PTH increases , it can lead to hypercalcemia
Increased levels of PTH causes what?
Hypercalcemia and hypophosphatemia
If a patient has hypercalcemia and hypophosphatemia, what kinds of symptoms will these patients present with?
May be asymptomatic;
May also present with symptoms related to the neuromuscular changes that include paresthesia and muscle cramps
Patients who have hypercalcemia will have what?
Low bone density (osteoporosis) that is most noted in the distal one third of the radius; they can also have
Pathological fractures, kidney stones, ventricular hypertrophy, depression, and gastric issues.
Hypomagnesemia does what?
Inhibits PTH secretion
What can hypomagnesemia be related to?
Malnutrition
Chronic alcoholism
Increased renal clearance that is caused by aminoglycoside antibiotics or chemotherapy
Prolonged magnesium deficient parenteral nutritional therapy
What is associated with hypercortisolism?
Glucose intolerance
Cushings syndrome is characterized by what ?
Fat deposits that have been described as “truncal or central obesity”
A moon face
Buffalo hump
An onset of an adrenal crisis can be signified by what?
Hypotension
What is addisonian crisis? And how can it develop?
An adrenal crisis, causing hypotension that can progress to complete vascular collapse and shock.
It can develop with undiagnosed disease, acute withdrawal of steroids, or infections/ comorbid stressful events
Primary hypocorticolism is also known as what?
Adrenal insufficiency
What lab work indicates hypocorticolism?
Serum and urine cortisol levels are decreased and ACTH levels are increased
When prescribing cortisol what should NP keep in mind?
With stressors such as surgery traumas or infections, additional cortisol must be administered to make up for it / compensate
Alzheimer’s is a result of what?
Reduced hippo campus size
Parkinson’s disease symptoms include
Bradykinesia with shuffling gait, resting tremors, rigidity, postural Disturbances, dysarthria and dysphasia
Rise factors of multiple sclerosis includes?
Smoking, vitamin D deficiency, EBV
Why do febrile seizures occur?
Neurons get excited by the decrease Co 2 levels caused by hyperventilation during febrile state
Bells palsy is associated with what cranial nerve?
Cranial nerve VII ( 7)
Bells palsy results in what symptoms?
Asymmetry of the face with inability to close the eye, smile, or frown on the affected side.
Trigeminal neuralgia is associated with what cranial nerve?
Cranial nerve V (5)
It is a very painful severe sharp stabbing pain that can worsen with chewing
Melanoma is what?
Most aggressive type of skin cancer; the thickness of the lesion impacts prognosis
Why does glucose intolerance occurs?
Cortisol induced insulin resistance and increased gluconeogenesis and glycogen storage by The liver.
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