NR 566 / NR566 Advanced Pharmacology
Care of the Family Midterm Exam |
Already graded A | Latest, 2020 / 2021|
Chamberlain College
- Mild intermittent asthma
- Symptoms occur less often than twice a week and the patient is asymptomatic
between exacerbations; nighttime symptoms occur less than twice a month; and peak
expiratory flow (PEF) is greater than 80% predicted. The use of short-acting beta2
agonists (SABA) should be less than twice a week, unless used for exercise-induced
bronchospasm (EIB).
- Mild persistent asthma
- Symptoms occur more often than twice a week but less often than once a day and
exacerbations may affect activity; nighttime symptoms occur 3 to 4 times a month;
and PEF is greater than 80% predicted. Patients with mild persistent asthma may use
their short-acting beta2 agonists more than twice a week but not daily, and not more
than once daily.
- Moderate persistent asthma
- The patient is having daily symptoms; requires daily use of a beta2 agonist;
exacerbations affect normal activity; nighttime symptoms occur more often than once
a week; and PEF is greater than 60% to less than 80%.
- Severe persistent asthma
- The patient has some degree of symptoms all the time; extremely limited physical
activity and frequent exacerbations; frequent nighttime symptoms, often 7 days a
week; and decreased lung function (PEF less than 60% predicted). Table 30-1
outlines the classifications of asthma severity in patients aged 12 years or older.
- Risk factors for fatal asthma attacks
- Previous severe exacerbations requiring intubation or ICU.
- Two or more hospitalizations.
- More than 3 ED visits in the past year.
- Use of more than 2 SABA canisters per month.
- Difficulty perceiving airway obstruction or worsening asthma.
- Low socioeconomic status or inner-city residence.
- Asthma step therapy
- The Expert Panel Report 3: Guidelines (NAEPP, 2007) recommends a stepwise
approach to the pharmacological management of asthma. Management can begin at a
higher level and gradually step down or start low and move up, depending on the
patient’s status when beginning treatment.
o Step 1: SABA PRN
o Step 2: Low dose ICS
o Step 3: Medium dose ICS
o Step 4: Medium dose ICS + LABA or Montelukast
o Step 5: High dose ICS + LABA or Mentelukast
o Step 6: High dose ICS + LABA or Montelukast + oral corticosteroids
- COPD therapy and goals of treatment
- Slow the disease process
- Maintain quality of life
- Medications
- Quit smoking
- Nutrition
- Infection protection
- Exercise -pulmonary rehabilitation improve function and quality of life
- Respiratory drug interactions with digoxin
- Albuterol can lower digoxin levels in body
- Patient education for treatment of asthma
- Basic facts about asthma.
- Medication skills.
- Self-monitoring skills.
- Specific to drug therapy.
- Reasons for the drug.
- Drugs as part of the total treatment regimen.
- Use of oral corticosteroids in the treatment of COPD
- Corticosteroids have nonspecific anti-inflammatory activity at multiple points in the
inflammatory process. Because of the cellular-level airway changes that define
COPD, corticosteroids’ effects are less dramatic in COPD than those seen in asthma.
Yet corticosteroids are key components in the management of stable COPD and
COPD exacerbations. - The use of daily inhaled corticosteroids (ICS) in the COPD patient has mixed results
in clinical studies. - inhaled corticosteroids do not modify the long-term decline in FEV1 seen in COPD,
but as both monotherapy and in combination with inhaled bronchodilators they
decrease exacerbations and improve health status in patients with symptomatic COPD - Therefore, the current ACP and GOLD guidelines recommend starting a patient on
moderate- to high-dose inhaled corticosteroids - Combination therapy of ICS and a long-acting beta agonist, such as Advair
(salmeterol/fluticasone), is more effective in decreasing exacerbations than either
agent alone
NR 566 / NR566 Advanced Pharmacology
Care of the Family Midterm Review Quiz
bank | LATEST, 2020/2021 |Q & A|
Chamberlain College
- Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs
and symptoms of hypoglycemia include:
A. “Fruity” breath odor and rapid respiration
B. Diarrhea, abdominal pain, weight loss, and hypertension
C. Dizziness, confusion, diaphoresis, and tachycardia
D. Easy bruising, palpitations, cardiac dysrhythmias, and coma - Nonselective beta blockers and alcohol create serious drug interactions with insulin
because they:
A. Increase blood glucose levels
B. Produce unexplained diaphoresis
C. Interfere with the ability of the body to metabolize glucose
D. Mask the signs and symptoms of altered glucose levels - Lispro is an insulin analogue produced by recombinant DNA technology. Which of the
following statements about this form of insulin is NOT true?
A. Optimal time of preprandial injection is 15 minutes.
B. Duration of action is increased when the dose is increased.
C. It is compatible with neutral protamine Hagedorn insulin.
D. It has no pronounced peak. - The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH)
insulin to insulin glargine to improve glycemia control throughout the day. If this is done:
A. The initial dose of glargine is reduced by 20% to avoid hypoglycemia.
B. The initial dose of glargine is 2 to 10 units per day.
C. Patients who have been on high doses of NPH will need tests for insulin antibodies.
D. Obese patients may require more than 100 units per day. - When blood glucose levels are difficult to control in type 2 diabetes some form of insulin
may be added to the treatment regimen to control blood glucose and limit complication
risks. Which of the following statements is accurate based on research?
A. Premixed insulin analogues are better at lowering HbA1C and have less risk for
hypoglycemia.
B. Premixed insulin analogues and the newer premixed insulins are associated with more
weight gain than the oral antidiabetic agents.
C. Newer premixed insulins are better at lowering HbA1C and postprandial glucose
levels than long-acting insulins.
D. Patients who are not controlled on oral agents and have postprandial hyperglycemia can
have neutral protamine Hagedorn insulin added at bedtime.
- Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because
it:
A. Substitutes for insulin usually secreted by the pancreas
B. Decreases glycogenolysis by the liver
C. Increases the release of insulin from beta cells
D. Decreases peripheral glucose utilization - Prior to prescribing metformin, the provider should:
A. Draw a serum creatinine to assess renal function
B. Try the patient on insulin
C. Tell the patient to increase iodine intake
D. Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions - The action of “gliptins” is different from other antidiabetic agents because they:
A. Have a low risk for hypoglycemia
B. Are not associated with weight gain
C. Close ATP-dependent potassium channels in the beta cell
D. Act on the incretin system to indirectly increase insulin production - Sitagliptin has been approved for:
A. Monotherapy in once-daily doses
B. Combination therapy with metformin
C. Both 1 and 2
D. Neither 1 nor 2 - GLP-1 agonists:
A. Directly bind to a receptor in the pancreatic beta cell
B. Have been approved for monotherapy
C. Speed gastric emptying to decrease appetite
D. Can be given orally once daily - Avoid concurrent administration of exenatide with which of the following drugs?
A. Digoxin
B. Warfarin
C. Lovastatin
D. All of the above
- Administration of exenatide is by subcutaneous injection:
A. 30 minutes prior to the morning meal
B. 60 minutes prior to the morning and evening meal
C. 15 minutes after the evening meal
D. 60 minutes before each meal daily - Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism
with propylthiouracil. Patients should be taught to report:
A. Tinnitus and decreased salivation
B. Fever and sore throat
C. Hypocalcemia and osteoporosis
D. Laryngeal edema and difficulty swallowing - Elderly patients who are started on levothyroxine for thyroid replacement should be
monitored for:
A. Excessive sedation
B. Tachycardia and angina
C. Weight gain
D. Cold intolerance - Which of the following is not an indication that growth hormone supplements should be
discontinued?
A. Imaging indication of epiphyseal closure
B. Growth curve increases have plateaued
C. Complaints of mild bone pain
D. Achievement of anticipated height goals - Besides osteoporosis, IV bisphosphonates are also indicated for:
A. Paget’s Disease
B. Early osteopenia
C. Renal cancer
D. Early closure of cranial sutures - What is the role of calcium supplements when patients take bisphosphonates?
A. They must be restricted to allow the medication to work.
B. They must be taken in sufficient amounts to provide foundational elements for bone
growth.
C. They must be taken at the same time as the bisphosphonates.
D. They only work with bisphosphonates if daily intake is restricted.
NR 566 / NR566 Advanced Pharmacology Care of the Family
Midterm Exam Review
- TB screening test? Next step if +?
- PPD
- >15mm, >10mm if prison, healthcare, nursing home, DM, ETOH, chronically
ill, >5mm for AIDS, immune suppressed - If + PPD –> do CXR.
- For treatment of existing osteoporosis, the dose of alendronate
- 10 mg/day or 70 mg/week
- Initial dosage for bone less prevention alendronate and risedronate
- 5 mg/day or 35 mg/week
- For treatment of existing osteoporosis, the dose of risedronate
- 75 mg for 2 consecutive days or 150 mg once a month
- Alendronate (Fosamax)
- Therapy with 10 mg daily can increase bone density by up to 10% after 3
years and can decrease vertebral and hip fractures by 50%
- Testosterone replacement therapy
- risk of prostate cancer
- Testosterone replacement therapy
- Erythrocytosis is a risk; Hgb and Hct levels checked, expect increase first 6
mths, unless Hgb level higher than 17.5 g/dL, Hct higher than 54%, or both
suggests overtreatment or occasionally abuse. IM happens more than
transdermal. If the Hct is greater than 54%, therapy is stopped until the Hct
decreases to a safe level. The patient should also be evaluated for hypoxia
and sleep apnea. Restarting therapy at a reduced dose usually solves
problems.
- Adults with vitamin B12 deficiency that is not pernicious anemia
- 1,000 mcg of oral cobalamin are given until normal B12 levels are achieved—
usually 6 to 12 weeks. In seriously ill patients, both vitamin B12 and folic
acid may need to be administered.
- Who cannot get TRT
NR 566 / NR566 Advanced Pharmacology Care of the Family
Final Exam Review
- Chlamydia first line treatment
- doxycycline 100 mg orally twice daily for 7 day
- Uncomplicated gonococcal first line treatment
- weight <150kg- single IM dose ceftriaxone 500mg
- weight >150kg- single IM dose ceftriaxone 1g
- bacterial vaginosis treatment
- metronidazole 500 mg orally twice daily for 7 days
- metronidazole 0.75% gel, 5 grams intravaginally once a day for 5 days
- or clindamycin 2% cream, 5 grams intravaginally at bedtime for 7 days
- women treatment of trichomoniasis
- metronidazole 500 mg twice daily for 7 days
- men treatment of trichomoniasis
- single dose of 2 grams of oral metronidazole
- Syphilis treatment
- benzathine penicillin G given as 2.4 million units once as a single
intramuscular dose
- HSV Treatment for first episode
- oral Acyclovir 400mg tid x7-10 days
- or oral valacyclovir bid x7-10 days
- HSV treatment for recurrent episodes
- Acyclovir 800 mg BID x 5 days
- -Famciclovir 1 gram BID x 1 day
- -Valacyclovir 1 grams once daily x 5 day
- A 17-year-old male has a presumptive diagnosis of gonococcal urethritis based on a
Gram’s stain of a urethral discharge specimen that shows multiple gram-negative
intracellular diplococci. Nucleic acid amplification testing (NAAT) for Neisseria
gonorrhoeae and Chlamydia trachomatis are sent. He denies any history of drug allergies.
- Ceftriaxone 500 mg intramuscularly in a single dose plus oral doxycycline
100 mg twice daily for 7 days
- Osteoporosis
- lone bone mass and increased bone fragility
- most common disorder of calcium metabolism
- osteoporosis
- how does hormone therapy decrease osteoporosis
- it reduces postmenopausal bone loss
- What warning comes on hormone therapy
Midterm Exam: NR566/ NR 566 (New
2023/ 2024 Update) Advanced
Pharmacology Care of the Family Exam
Review| Questions and Verified Answers –
Chamberlain
Q Organic sunscreen needs what ingredient to be effective
✓ Answer: Avobenzone
Q 1st line for mild to moderate acne
✓ Answer: Topical antibiotics/retinoids- Benzoyl peroxide
Q 1st line for severe acne
✓ Answer: Oral therapy- Isotretinoin
Q Which treatment would be selected over another for acne?
✓ Answer: Treatment depends on severity of acne.
Q Salicylic acid education
✓ Answer: Salicylate toxicity is not a concern when applied only to the face;
however, if acne is extensive and the drug is applied to the trunk, back, and other
locations, salicylate toxicity may occur. Monitoring for signs and symptoms of
salicylism (e.g., hyperpnea, tinnitus, nausea and vomiting, and mental status
changes) is indicated. Peeling and drying are adverse effects, not desired effects,
of salicylic acid. Tinnitus is a symptom of systemic toxicity that requires
immediate attention.
Q Isotretinoin patient education
✓ Answer: Avoid driving, protect from sun, frequent blood tests, discontinue
tetracycline, alcohol should be avoided, contraindicated in pregnancy-defects in
developing fetus, cannot donate blood, avoid supplements containing vitamin A,
avoid waxing and laser therapy, notify of depression.
Q When to prescribe an intranasal glucocorticoid
✓ Answer: Prevention and treatment of seasonal and perineal rhinitis.
Q Moderate to severe symptoms treatment
✓ Answer: · Combination therapy
~ Intranasal glucocorticoids
Q Select the treatment agent that corresponds to the symptom(s). Intermittent sneezing,
nasal itching, and rhinorrhea
✓ Answer: · Intranasal antihistamine
~ Oral antihistamine
Q Select the treatment agent that corresponds to the symptom(s).
Nasal congestion is dominant complaint
✓ Answer: · Oral decongestant
Q Select the treatment agent that corresponds to the symptom(s).
Mild symptoms
✓ Answer: · Oral antihistamine
Q Which of the following symptoms of CNS stimulation occur with the use of oral
sympathomimetics? Select all that apply.
✓ Answer: · restlessness
~ anxiety
~ insomnia
~ irritability
Midterm Exam: NR566/ NR 566 Advanced
Pharmacology Care of the Family Exam |
Questions and Verified Answers (2023/
2024 New Update)- Chamberlain
- Budesonide risks of use in children
✓ Answer: risk for delayed growth - Ketoconazole and omeprazole concurrently- what does the patient need to know
✓ Answer: decrease absorption of ketoconazole and reduce effectiveness - Which weight loss drug(s) are associated with a suicide risk in children, adolescents, and
young adults?
✓ Answer: Naltrexone and bupropion (contrave) - Which weight loss drugs are DEA scheduled drugs?
✓ Answer: Diethylpropion
✓ Locaserin
✓ Phentermine/topiramate (Phentermine is scheduled, not topiramate)
✓ Phendimetrazine - At what BMI level should bariatric surgery be considered?
✓ Answer: BMI 35 or more - Topiramate -Therapeutic effect
✓ Answer: induces sense of satiety (Sense of satisfaction- don’t feel hungry) - How to discontinue phentermine and/or topiramate
✓ Answer: if the person has not lost 5% of weight loss by 6 months then d/c
medication
✓ tolerance can develop n 6-12 weeks - Which of the following would be contraindicated to prescribing phentermine/topiramate?
✓ Answer: glaucoma, hyperthyroidism, hypertension - Orlistat patient education (orlistat acts in the GI tract to reduce absorption of fat)
✓ Answer: may cause hypothyroidism in patients taking levothyroxine (two drugs
should be administered 4 hours apart)
✓ take vitamins A, D, E, and K
✓ stools often fatty or oily and fecal incontinence can occur (bulk forming laxative)
✓ taken with food
✓ vitamin k deficency can occur and compound effects of warfarin, so coagulation
must be monitored
✓ taking more of the meds in a day won’t help weight loss
✓ not for patients with malabsorption issues or cholestasis - Liraglutide- Baseline data needed
✓ Answer: Ha1C, lipids, renal function - Ongoing monitoring/assessment needs – Liraglutide
✓ Answer: assess for s/s of cholecystitis, pancreatitis, depression, and suicidal
thoughts
✓ do not give to someone with thyroid cancer or history of thyroid cancer - Loarcaserin- Baseline data needed
✓ Answer: baseline assessment to rule out valvular disorders and pulmonary
hypertension - Ongoing monitoring/assessment needs – Loarcaserin
✓ Answer: CBC w/ differential for s/s of blood dyscrasias - Naltrexone/bupropion (contrave)- Baseline data needed
✓ Answer: blood glucose, liver function, renal functions, and mental status - Ongoing monitoring/assessment needs – Contrave (Naltrexone/bupropion)
✓ Answer: periodic assessments for blood glucose, liver and renal function, s/s of
depression, anxiety, panic attacks, or suicidal ideation, and mania
✓ think naltrexone (opioid antagonist) so pain medicine will not work for them - Phentermine baseline data needed
✓ Answer: cardiac assessment