Midterm & Final Exams: NR 565 / NR565 |ALL EXAMS UPDATES STUDY BUNDLE WITH COMPLETE SOLUTIONS| Advanced Pharmacology Exam Reviews | Questions and Verified Answers (2023/ 2024 Updates)

NR565 / NR 565 Advanced Pharmacology
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1. The rash associated with scarlet fever typically occurs how long after th start of the
   symptomatic infection?
   A. 2 days
   B. 4 days
   C. 7 to 10 days
   D. 2 to 3 weeks
2. Treatment of scarlet fever in a 19-year-old woman with no allergy to penicillin can
   include all of the following except:
   A. penicillin
   B. cefdinir
   C. TMP-SMX
   D. cefpodoxime
3. An 18-year-old woman presents with a chief complaint of a 3-day history of “sore throat
   and swollen glands”. Her physical examination includes exudative pharyngitis, minimally
   tender anterior and posterior cervical lymphadenopathy, and maculopapular rash. She is
   diagnosed with infectious mononucleosis and was likely infected with the causative
   organism how many days ago?
   A. 5 to 10
   B. 20 to 30
   C. 30 to 50
   D. more than 100
4. The Epstein-Barr virus is primarily transmitted via:
   A. skin-to-skin contact
   B. contact with blood
   C. oropharyngeal secretions
   D. genital contact
5. Which of the following is most likely to be found in the laboratory data of a person with
   infectious mononucleosis?
   A. neutrophils with reactive forms
   B. lymphocytosis with atypical lymphocytes
   C. thrombocytosis

D. macrocytosis

6. You examine a 25-year-old man who has infectious mononucleosis with tonsillar
   hypertrophy, exudative pharyngitis, poor fluid intake due to difficulty swallowing,and a
   patent airway. You prescribe:
   A. amoxicillin
   B. prednisone
   C. ibuprofen
   D. acyclovir
7. In patients with infectious mononucleosis, which medication should be avoided because
   of a risk of rash development?
   A. acetaminophen
   B. sulfamethoxazole
   C. erythromycin
   D. amoxicillin
8. What percentage of patients with infectious mononucleosis have splenomegaly during the
   acute phase of the illness?
   A. at least 10%
   B. about 25%
   C. at least 50%
   D. nearly 100%
9. The size of a normal spleen is approximately:
   A. 1″ X 1″ X 3″
   B. 1″ X 3″ X 5″
   C. 2″ X 4″ X 6″
   D. 3″ X 5″ X 7″
10. Because of a risk for splenic rupture, persons who have recovered from infectious
    mononucleosis should wait how long before participating in collision or contact sports?
    A. at least 2 weeks
    B. at least 1 month
    C. at least 3 months
    D. at least 6 months
11. A 19-year-old man presents with a chief complaint of red, irritated right eye for the past
    48 hours with eyelids that were “stuck together” this morning when he awoke.
    Examination reveals injected palpebral and bulbar conjunctiva and reactive pupils; vision
    screen with the Snellen chart evaluation reveals 20/30 in the right eye (OD), left eye
    (OS), and both eyes (OU) and purulent eye discharge on the right. This presentation is
    most consistent with:
    A. suppurative conjunctivitis
    B. viral conjunctivitis
    C. allergic conjunctivitis

NR565 / NR565 Advanced Pharmacology
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1. Kasey fractured his ankle in two places and is asking for medication for his pain. The
   appropriate first-line medication would be:

• Acetaminophen with hydrocodone (Vicodin)

1. Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate
   (Ritalin). He and his parents should be educated about the side effects of
   methylphenidate, which are:

• Insomnia and decreased appetite

1. Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder
   (ADHD) includes:

• ADHD symptoms
• Routine height and weight checks
• Amount of methylphenidate being used

1. When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD
   the nurse practitioner will need to monitor:

• Blood pressure

1. Common mistakes practitioners make in treating anxiety disorders include:

• Thinking a partial response to medication is acceptable

1. An appropriate first-line drug to try for mild to moderate generalized anxiety disorder
   would be:

• Buspirone (Buspar)

1. An appropriate drug to initially treat panic disorder is:

• Diazepam (Valium)

1. Prior to starting antidepressants, patients should have laboratory testing to rule out:

• Hypothyroidism

1. David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression.
   David’s education regarding his medication would include:

• He may experience sexual dysfunction beginning a month after he starts therapy.

1. Jamison has been prescribed citalopram (Celexa) to treat his depression. Education
   regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work
   would be:

• Appetite and concentration improve in the first 1 to 2 weeks.

1. The racial difference in drug pharmacokinetics seen in American Indian or Alaskan
   Natives are:

• Largely unknown due to lack of studies of this population

1. Pharmacokinetics among Asians are universal to all the Asian ethnic groups.
   A. True
   B. False
2. Alterations in drug metabolism among Asians may lead to:

• Slower metabolism of antidepressants, requiring lower doses

1. Asians from Eastern Asia are known to be fast acetylators. Fast acetylators:

• Require higher doses of drugs metabolized by acetylization to achieve efficacy

1. Hispanic native healers (curanderas):
   A. Are not heavily utilized by Hispanics who immigrate to the United States
   B. Use herbs and teas in their treatment of illness
   C. Provide unsafe advice to Hispanics and should not be trusted
   D. Need to be licensed in their home country in order to practice in the United States
2. Genetic polymorphisms account for differences in metabolism, including:

• Poor metabolizers, who lack a working enzyme
• Intermediate metabolizers, who have one working, wild-type allele and one mutant
  allele
• Extensive metabolizers, with two normally functioning alleles

1. Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:

• Increased dosages needed of drugs metabolized by 2D6, such as the selective
  serotonin reuptake inhibitors

1. Drugs that use CYP 3A4 isoenzymes for metabolism may:

• Induce the metabolism of another drug
• Inhibit the metabolism of another drug

1. Rifampin is a nonspecific CYP450 inducer that may:

• Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic
  failure

1. Inhibition of P-glycoprotein by a drug such as quinidine may lead to:

• Increased levels of a co-administered drug, such as digoxin, that requires Pglycoprotein for absorption and elimination

1. Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:

• Decreased response to warfarin

1. Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required
   prior to prescribing warfarin.
   A. True
   B. False
2. Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to
   prescribing:

• Cetuximab

1. Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502
   allele in patients with Asian ancestry prior to starting therapy due to:

• Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502
  allele

1. A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is
   inactivated by the body may lead to

• Increased adverse drug reactions, such as neutropenia

1. Patients who have a poor metabolism phenotype will have:

• Slowed metabolism of a prodrug into an active drug, leading to accumulation of
  prodrug

1. A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is
   critical to prescribing because:

• Distribution of drugs to target tissue may be affected.

1. Drugs that have a significant first-pass effect:

• Are rapidly metabolized by the liver and may have little if any desired action

1. The route of excretion of a volatile drug will likely be the:

• Lungs

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1. What is the significance of VCORC1 mutation?

• The significance of the VCORC1 mutation is that it is related to an
  individual exhibiting warfarin resistance since it plays a role in
  metabolizing the drug warfarin (Woo et al., 2016).
• This means that the individual is prone to an increased risk of bleeding
  which can lead to adverse outcomes for the individuals who exhibit this
  genetic mutation (Fereidouni et al., 2019).
• The VCORC1 mutation is responsible for producing a “subunit of the
  vitamin K epoxide reductase complex” (Woo et al., 2016).
• It is currently not required by the FDA to complete genetic testing prior
  to starting warfarin, but as practitioners we should encourage our
  patients to complete genetic testing so that we can accurately calculate the
  correct dosage for warfarin without creating significant adverse outcomes
  for these individuals.

1. Can you describe how new drugs are developed from the text?

• New drugs are developed by researches in a lab first by looking into
  disease processes and the medications that are used to help treat these
  disease processes.
• After looking at the medications to help treat disease better, researches
  look into how to make the medications be more effective with less toxicity
  or ‘side effects’. in order to do this, researchers start preclinical research.
• During this phase researchers look into whether the drug is going to kill
  people or cause serious harm to people. then they go into the clinical
  phase.
• The clinical phase is where they use the preclinical phase data and come
  up with human research subjects. These usually consist of two groups
  (one getting the new medication and one getting a ‘fake’ medication
  (placebo).
• Then this leads to step 4 the FDA drug review where they come up with
  labels, safety updates, etc. Then they move on to the post market
  monitoring where they actually pay attention to the way the medication is
  being used and what for. (US Food and Drug Administration, 2018)

1. Explain what it means if a drug is an antagonist?

• An antagonist according to our text is a drug that takes over a receptor
  without stimulating that receptor.
• We see the medication blocking the response of an agonist to that
  receptor. Such as seen in a beta-blocker keeping the adrenergic nerve
  activity from increasing the heart rate and therefore able to help decrease

the heart rate of the patient taking the medication. Antagonists can make
the agonist appear less potent.

• The effect of the antagonist depends on that of the affinity for the
  receptor and the blood levels noted in the patient (Woo RN PhD ARNP
  CPNP-PC CNL FAANP, Teri Moser et al., 2015).
• Another example would be naltrexone. This medication is used in patients
  that want to not relapse in heroin or opioid usage.
• The medication blocks the receptors for the opioids and does not allow
  the drugs to connect to the receptors.
• The problem with this is that it can cause an overdose if there is a relapse
  (Pharmacological Treatment | Medication Assisted Recovery, n.d.).

1. What the terms efficacy and bioavailability mean?

• According to Woo & Robinson (2016), efficacy in medicine means the
  power of producing the maximum effect of a drug (Woo & Robinson,
  2016, p. 14).
• When thinking about efficacy and medication, an example may include
  hypertension medication and how it lowers blood pressure but can also
  have an effect on other mechanisms in the body such as heart rate or
  kidney function.
• Patients who are prescribed new medication should be monitored closely
  on how it may affect the patient’s outcome. It also states that drugs with

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1. gastroesophageal reflux disease (GERD)

• common disorder characterized by heartburn and acid regurgitation.

1. Major groups of GERD

• erosive esophagitis and
• non-erosive reflux disease (NERD).

1. Drug of choice for GERD

• Proton Pump Inhibitors;

1. Cimetidine use for GERD

• drug of choice for relieving symptoms.; does little to hasten healing.

1. Proton Pump Inhibitor MOA

• irreversibly blocking hydrogen and the amount of HCl produced by the stomach

1. Proton Pump Inhibitor Prototype Drug

• Omeprazole

1. PPI AE

• Pneumonia,
• FX,
• Rebound Acid Hypersecretion,
• Hypomagnesemia

1. PPI Monitoring

• Magnesium (Hypomagnesimia)

1. PPI Drug Interaction

• Clopidogrel (Plavix)

1. Antidiarrheal drugs fall into two major groups

• (1) specific antidiarrheal drugs: Treat the underlying causative agent
• (2) nonspecific antidiarrheal drugs: Treat the symptom but do not treat the agent

1. Opioids (antidiarrheals)

• most effective antidiarrheal agents;
• activating opioid receptors in the GI tract,
• these drugs decrease intestinal motility and thus slow down intestinal transit,
  which allows more time for absorption of fluid and electrolytes.

1. diphenoxylate (Lomotil, others) and loperamide (Imodium, others)

• most frequently employed opioids for diarrhea

1. Diphenoxylate (Lomotil)

• Opioid Antidiarrheal; Formulated w/ atropine to discourage abuse

1. Diphenoxylate (Lomotil) MOA
2. Loperamide (Imodium)

• Opioid Antidiarrheal; Meperidine analog

1. Loperamide (Imodium) MOA

• treat diarrhea and reduce the volume of discharge from ileostomies.
• Benefits derive from suppressing bowel motility and from suppressing fluid
  secretion into the intestinal lumen.

1. Bismuth subsalicylate (Pepto-Bismol)

• -popular over-the-counter medication that can be used for upset stomach,
  diarrhea, heartburn, and general indigestion.
• -antibacterial and antisecretory properties; used to treat traveler’s diarrhea

1. Bismuth subsalicylate (Pepto-Bismol) Contraindication

• contraindicated in children or teenagers during or after recovery from chickenpox
  or flu-like illness due to the risk of Reye’s syndrome and in individuals with
  aspirin hypersensitivity.

1. Bismuth subsalicylate (Pepto-Bismol) AE

• gray/black stools and
• black tongue from the bismuth.

1. Traveler’s diarrhea

• Escherichia coli

1. Traveler’s Diarrhea Treatment

• -Ciprofloxacin for adults.
• -Azithromycin (Zithromax) is preferred for children and for pregnant women).
• -Rifaximin (Xifaxan) may also be used provided the patient is not pregnant or
  febrile and that stools are not bloody.

1. Metoclopramide MOA

• A prokinetic agent:
  (1) suppresses emesis (by blocking receptors for dopamine and serotonin in
  the CTZ)
  (2) it increases upper GI motility (by enhancing the actions of
  acetylcholine).

1. Prokinetic Agent

• Metoclopramide; Drugs that increase the tone and motility of the GI tract.
  Indications include gastroesophageal reflux disease (GERD), CINV, and diabetic
  gastroparesis.

1. Metoclopramide (Reglan) PO Dose Use

• 1) diabetic gastroparesis
• 2) suppression of gastroesophageal reflux.

1. Metoclopramide (Reglan) IV Dose Use

• 1) suppression of postoperative nausea and vomiting,
• 2) suppression of CINV,
• 3) facilitation of small bowel intubation
• 4) facilitation of radiologic examination of the GI tract.

1. Metoclopramide (Reglan) AE

• High-dose therapy: sedation and diarrhea are common
• Long-term high-dose therapy: irreversible tardive dyskinesia, characterized by
  repetitive, involuntary movements of the arms, legs, and facial muscles.

1. Metoclopramide contraindication

• Contraindication in patients with GI obstruction, perforation, or hemorrhage.

1. Misoprostol (Cytotec)

• an analog of prostaglandin E1. In the United States, the drug’s only approved GI
  indication is prevention of gastric ulcers caused by long-term therapy with
  NSAIDs.

1. Misoprostol (Cytotec) Contraindication

• contraindicated during pregnancy due to risk for partial or complete expulsion of
  the developing fetus.

1. Peptic Ulcer Disease Step 2 Therapy

• H. pylori testing & Treatment with PPIs

1. H. pylori

• gram-negative bacillus that can colonize the stomach and duodenum; most
  common cause of gastric and duodenal ulcers

1. H. Pylori Treatment

• PPI plus antibiotics

1. H. pylori triple therapy

• Amoxicillin,
• Clarithromycin or
• Metronidazole, PPI (omeprazole)

1. H. pylori quadruple therapy

• PPI,
• bismuth,
• metronidazole,

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1. What adjunctive therapy can we prescribe to control symptoms of hyperthyroidism?

• Beta blocker

1. Typically at what interval should thyroid levels be checked?

• 6-8 weeks

1. Why doesn’t the FDA recommend using PTU as a 1st line treatment for hyperthyroidism?

• Risk for liver toxicity

1. What should be included in patient teaching for Levothyroxine?

• Take in the morning at least 30-60 minutes before eating

1. What drug class can interfere with the assessment and monitoring of DM?

• Beta Blockers

1. What is the role of beta cells in DM?

• The cells responsible for insulin synthesis & release into the blood stream

1. What is the A1C goal for someone with DM?

• Less than 7

1. What A1C is indicative of DM?

• >6.5

1. What is diagnosis criteria for diabetes?

• Fasting BG >= 126 or random BG >= 200 plus symptoms or OGTT >= 200

1. What medication is safe for use in pregnancy?

• H2 receptor antagonists
• Book says “Pregnant women – Some PPIs (esomeprazole) and H2 receptor
  antagonists (ranitidine) are safe for use in pregnancy.

1. We treat peptic ulcers with all of the following except?

• Ondansetron, diphenoxylate

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1. Typical Antipsychotics

• A class of older drugs to treat schizophrenia and related psychotic disorders
  primarily by reducing excess levels of dopamine in the brain
• do not give to elderly, neuroleptic malignang syndrome with high fever,
  increased HR, diaphoresis, rigidity, coma, many EPS
• do not stop suddenly, do not drive with it, wear sunscreen, monitor gait
• chlorpromazine, thioridazine, fluphenazine, fluphenazine decanoate,
  perphenazine, trifluoperazine, haloperidol, loxapine

1. atypical antipsychotics

• Antipsychotics that do not have significant side effects common to older
  antipsychotics
• agranulocytosis is deadly s/e, has EPS but less than others, no alcohol
• Olanzapine (obesity), Clozapine (agranulocytosis), Respiradone (increase
  prolactin)

1. Dopaminergics

• Treat parkinsons by enhancing dopamine
• do not give to schizophrenic patients
• levodopa (sinemet)
• stand up slowly, inhibited by protein

1. Benzodiazepines

• The most common group of antianxiety drugs, increases GABA and
  decreases neuronal excitation
• do not mix with cns depressive agents
• Valium, xanax, ativan

1. Serotonergic anxiolytics

• Enhances serotonin to relieve anxiety
• No CNS depression, no anticonvulsant properties, very mild SE
• Buspirone, ipsapirone, gepirone

1. Barbiturates

• drugs that depress the activity of the central nervous system, reducing
  anxiety but impairing memory and judgment, treat epilepsy, seizures,
  insomnia
• do not suddenly discontinue, CNS depression does occur, decreases many
  other medications such as beta blockers
• pentobarbital, -barbital etc

1. sedative-hypnotics

• Drugs that can act in the body either as sedatives or as hypnotics, depress the
  CNS

1. Benzodiazepine hypnotics

• Diazepam, Midazolam, Zolazepam
• Potentiates the inhibitory action of GABA. Activation of the receptor causes
  an influx of Cl- ion movement into the neuron and hyperpolarization and
  inhibition of membrane depolarization
• Addicting

1. Nonbenzodiazepine hypnotics

• Zolpidem, Zaleplon, exZopiclone. “ALL ZZZs put you to sleep.”
• MOA: act via BZ1 subtype of GABA receptor. Effects reversed by
  flumazemnil
• Use: insomnia
• SE: ataxia, headaches, confusion. Short duration. Decreased depdence risnk
  like bneozs and only modest daf-after pscyhomoter depression

1. mood stabilizers

• drugs used to control mood swings in patients with bipolar mood disorders

1. Lithium

• Inhibits IP3 second messenger cascade, mood stabilizer for bipolar
• therapeutic range 0.6 to 1.5
• causes congenital malformations