1
NR
NR 566/ NR566 MIDTERM EXAM: (NEW 2025/ 2026 U
B B B B B B B B
PDATE) A DVANCED PHARMACOLOGY FOR CARE OF THE FA
B B B B B B B
MILY REVIEW| QUESTIONS & A NSWERS | GRADE A| 100%
B B B B B B B B
CORRECT (VERIFIED SOLUTIONS)- CHAMBERLAIN
B B B
1. Improvingbpatientbcompliancebwithbdiabetesbtreatmentb-
bANSb✓Nonadherencebtobthebtreatmentbregimen bmaybresultbinbincreased briskbforbcompli
cationsbandbreducedblifebexpectancy.bHealthcarebprovidersbshouldbbebawarebofbpotentialb
problemsbwithbnonadherence,bdiscussbthebimportancebofbadherencebatbeachbfollow-
upbvisit,bandbassistbpatientsbinbremovingbbarriersbtobadherencebsuchbasblackbofbsocialbsup
portbandbcostbofbthebtreatmentbregimen.bAbteambapproachbwithbthebpatientbasbanbactivebpa
rtnerbshouldbbebmaximized.bWaysbtobdealbwithbnonadherencebarebdiscussedbinbChapterb6
.bPatientbeducationbbookletsbarebavailablebfrombthebADA,bwhichbcanbbebaccessedbonbtheb
Internetbatbwww.diabetes.org.
2. Diabeticbmedicationsbtobavoidbwhenbtakingbdigoxinb-bANSb✓Metforminb-
bdigbmaybincreasebthebeffectbofbmetforminbleadingbtoblacticbacidosis.
3. Diabeticbmedicationsbwithbneedbforbrenalbdosebadjustmentb-bANSb✓Metformin
4. Diabeticbmedicationsbassociatedbwithbincreasedbriskbforbgenitalbmycoticbinfectionsb
-bANSb✓SelectivebSodiumbGlucosebCo-transporterb2b(SGLT-2)
5. Timebanticipatedbforbtotalbreversalbofbhyperthyroidbsymptomsbwithbmethimazoleb-
bANSb✓Abtreatmentbtypicallybrequiresb6btob12bmonthsbforbtotal breversal bofbhyperthyroidb
symptoms.
6. Routinebtestingbwithbdrugbtherapyb-bANSb✓TSHbandbfreebT4blevels
Everyb4btob8bweeksbuntilbeuthyroid
Duringbpregnancybevaluatebatb8bweeks'bandb6bmonths'bgestation
7. Recommendbdietarybiodinebintakeb-bANSb✓100-
150bmcg/daybforbnormalbthyroidbfunction
8. DrugsbthatbincreasebmetabolismbofbT4b-bANSb✓Carbamazepine,bPhenytoin
9. SymptomsbofbHyperthyroidismb-
bANSb✓increasedbCO,bdecreased bperipheral bvascularbresistance,btachycardiabatbrest,barr
hythmias,bdyspneabandbreducedbvitalbcapacity,bincreasedbappetitebwithbweightbloss,bdiarr
hea,bnausea,bvomiting,babdominalbpain,bsweating,bflushingbwarmbskin,bhairbloss,bnailsbgr
NR 566
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owbawaybfrombnailbbeds,boligo/amenorrhea,bimpotence/decreasedblibidobinbmen,brestles
sness,bshortbattentionbspan,bfatigue,binsomnia,bemotionalblability,benlargedbgland.
10. SymptomsbofbHypothyroidismb-
bANSb✓reducedbstrokebvolumebandbHR,bincreased bperipheralbresistancebtobmaintainbBP,
bbradycardia, bmacrocyticbanemiabassoc.bWithbB12bdeficiency,bdyspnea, bhypoventilation
,bCO2bretention,bdecreasedbappetite,bconstipation,bweightbgain,bfluidbretention,bdrybflaky
bskin,bdrybhair,bslow bwoundbhealing,bcoolbskin, bdecreasedblibido,bconfusion,bslowbspeech
,bmemorybloss,bclumsybmovements.
11. Hyperthyroidbdrugsbwithbriskbforbhepaticbtoxicityb-bANSb✓propylthiouracil
12. Bilebacidbsequestrantsbabsorptionbandbadministrationb-bANSb✓affectbLDL-
CbwithbabmodestbincreasebinbHDL-
C.bTheybarebnotbcommonlybprescribedbtobtreatbdyslipidemiasbinbpatientsbwithbdiabetes.b
NotbonlybdobtheybincreasebTGsbbutbtheybmaybposebproblemsbforbpatientsbwithbdiabeticbga
stroparesis.bThebincreasebinbTGbisbespeciallybofbconcernbinbdiabeticsbbecausebthebpancre
asbisbalreadybunderbstress.
13. Levothyroxinebadministrationbinstructionsb-
bANSb✓Takebfirst bthingbinbthebmorningbatbleast b30,bpreferablybonebhourbbeforebeating.bO
nbanbemptybstomachbwithbonlybwater.bAchievebconsistencybinbtakingbthebmedbtobavoidbfl
uctuatingbthyroidblevels.
14. Differentiatebbetweenbprimarybandbsecondarybhypothyroidismb-
bANSb✓Primarybdisordersbincludebthebfollowing:
•bDefectivebhormonebsynthesisbresultingbfrombautoimmunebthyroiditis,bendemicbiodinebdeficien
cy,borbantithyroidbdrugsbthatbwerebusedbtobtreatbhyperthyroidism
•bCongenitalbdefectsborblossbofbtissuebafterbtreatmentbforbhyperthyroidism
Secondarybcausesbofbhypothyroidism,bwhichbareblessbcommon,bincludebconditionsbthatbcausebeit
herbpituitaryborbhypothalamicbfailure.bInbsecondarybdisorders,bthebTSHbresponsebisbinadequatebs
obthatbthebglandbisbnormalborbreducedbinbsize,bwithbbothbT3bandbT4bsynthesisbequallybreduced.
15. Differentiatebbetweenbprimarybandbsecondarybhyperthyroidismb-
bANSb✓Primarybis bthebtermbusedbwhenbthebpathologybisbwithinbthebthyroidbgland.bSecon
darybhyperthyroidismbisbthebtermbusedbwhenbthebthyroidbglandbisbstimulatedbbybexcessiv
ebTSHbinbcirculation.
16. Precautionsbandbtestingbforbxanthinebderivativesb-
bANSb✓Monitored bcloselybforbsignsbofbtoxicity
Whenbtherapybisbinitiated,btheophyllineblevelsbshouldbbebdrawnbfrequentlybasbthebdosagebisbtitrat
ed.
Signsbofbtoxicity-bserumbtheophyllineblevelbshouldbbebdrawn
Oncebstabilized,bmonitoringbshouldbbebdonebeveryb6btob12bmonths
NR 566
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17. Mildbintermittentbasthmab-
bANSb✓Symptoms boccurblessboftenbthanbtwicebabweekbandbthebpatientbis basymptomaticbb
etweenbexacerbations;bnighttimebsymptomsboccurblessbthanbtwicebabmonth;bandbpeakbex
piratorybflowb(PEF)bisbgreaterbthanb80%bpredicted.bThebusebofbshort-
actingbbeta2bagonistsb(SABA)bshouldbbeblessbthanbtwicebabweek,bunlessbusedbforbexercis
e-inducedbbronchospasmb(EIB).
18. Mildbpersistentbasthmab-
bANSb✓Symptoms boccurbmoreboftenbthanbtwicebabweekbbutblessboftenbthanboncebabdayba
ndbexacerbationsbmaybaffectbactivity;bnighttimebsymptomsboccurb3btob4btimesbabmonth;ba
ndbPEFbisbgreaterbthanb80%bpredicted.bPatientsbwithbmildbpersistentbasthmabmaybusebthei
rbshort-
actingbbeta2bagonistsbmorebthanbtwicebabweekbbutbnotbdaily,bandbnotbmorebthanboncebdail
y.
19. Moderatebpersistentbasthmab-
bANSb✓Thebpatientbisbhavingbdailybsymptoms;brequiresbdailybusebofbabbeta2bagonist;bexa
cerbationsbaffectbnormalbactivity;bnighttimebsymptomsboccurbmoreboftenbthanboncebabwe
ek;bandbPEFbisbgreaterbthanb60%btoblessbthanb80%.
20. Severebpersistentbasthmab-
bANSb✓Thebpatientbhasbsomebdegreebofbsymptoms ballbthebtime;bextremelyblimitedbphysi
calbactivitybandbfrequentbexacerbations;bfrequentbnighttimebsymptoms,boftenb7bdaysbabw
eek;bandbdecreasedblungbfunctionb(PEFblessbthanb60%bpredicted).bTableb30-
1boutlinesbthebclassificationsbofbasthmabseveritybinbpatientsbagedb12byearsborbolder.
21. Riskbfactorsbforbfatalbasthmabattacksb-
bANSb✓Previous bseverebexacerbationsbrequiringbintubationborbICU.
Twoborbmorebhospitalizations.
Morebthanb3bEDbvisitsbinbthebpastbyear.
Usebofbmorebthanb2bSABAbcanistersbperbmonth.
Difficultybperceivingbairwaybobstructionborbworseningbasthma.
Lowbsocioeconomicbstatusborbinner-citybresidence.
22. Asthmabstepbtherapyb-
bANSb✓ThebExpertbPanel bReportb3:bGuidelines b(NAEPP,b2007)brecommendsbabstepwis
ebapproachbtobthebpharmacologicalbmanagementbofbasthma.bManagementbcanbbeginbatbab
higherblevelbandbgraduallybstepbdownborbstartblowbandbmovebup,bdependingbonbthebpatien
t'sbstatusbwhenbbeginningbtreatment.
Stepb1:bSABAbPRN
Stepb2:bLowbdosebICS
Stepb3:bMediumbdosebICS
Stepb4:bMediumbdosebICSb+bLABAborbMontelukast
Stepb5:bHighbdosebICSb+bLABAborbMentelukast
NR 566
b
NR
NR 566/ NR566 MIDTERM EXAM: (NEW 2025/ 2026 U
B B B B B B B B
PDATE) A DVANCED PHARMACOLOGY FOR CARE OF THE FA
B B B B B B B
MILY REVIEW| QUESTIONS & A NSWERS | GRADE A| 100%
B B B B B B B B
CORRECT (VERIFIED SOLUTIONS)- CHAMBERLAIN
B B B
1. Improvingbpatientbcompliancebwithbdiabetesbtreatmentb-
bANSb✓Nonadherencebtobthebtreatmentbregimen bmaybresultbinbincreased briskbforbcompli
cationsbandbreducedblifebexpectancy.bHealthcarebprovidersbshouldbbebawarebofbpotentialb
problemsbwithbnonadherence,bdiscussbthebimportancebofbadherencebatbeachbfollow-
upbvisit,bandbassistbpatientsbinbremovingbbarriersbtobadherencebsuchbasblackbofbsocialbsup
portbandbcostbofbthebtreatmentbregimen.bAbteambapproachbwithbthebpatientbasbanbactivebpa
rtnerbshouldbbebmaximized.bWaysbtobdealbwithbnonadherencebarebdiscussedbinbChapterb6
.bPatientbeducationbbookletsbarebavailablebfrombthebADA,bwhichbcanbbebaccessedbonbtheb
Internetbatbwww.diabetes.org.
2. Diabeticbmedicationsbtobavoidbwhenbtakingbdigoxinb-bANSb✓Metforminb-
bdigbmaybincreasebthebeffectbofbmetforminbleadingbtoblacticbacidosis.
3. Diabeticbmedicationsbwithbneedbforbrenalbdosebadjustmentb-bANSb✓Metformin
4. Diabeticbmedicationsbassociatedbwithbincreasedbriskbforbgenitalbmycoticbinfectionsb
-bANSb✓SelectivebSodiumbGlucosebCo-transporterb2b(SGLT-2)
5. Timebanticipatedbforbtotalbreversalbofbhyperthyroidbsymptomsbwithbmethimazoleb-
bANSb✓Abtreatmentbtypicallybrequiresb6btob12bmonthsbforbtotal breversal bofbhyperthyroidb
symptoms.
6. Routinebtestingbwithbdrugbtherapyb-bANSb✓TSHbandbfreebT4blevels
Everyb4btob8bweeksbuntilbeuthyroid
Duringbpregnancybevaluatebatb8bweeks'bandb6bmonths'bgestation
7. Recommendbdietarybiodinebintakeb-bANSb✓100-
150bmcg/daybforbnormalbthyroidbfunction
8. DrugsbthatbincreasebmetabolismbofbT4b-bANSb✓Carbamazepine,bPhenytoin
9. SymptomsbofbHyperthyroidismb-
bANSb✓increasedbCO,bdecreased bperipheral bvascularbresistance,btachycardiabatbrest,barr
hythmias,bdyspneabandbreducedbvitalbcapacity,bincreasedbappetitebwithbweightbloss,bdiarr
hea,bnausea,bvomiting,babdominalbpain,bsweating,bflushingbwarmbskin,bhairbloss,bnailsbgr
NR 566
b
, 2
NR
owbawaybfrombnailbbeds,boligo/amenorrhea,bimpotence/decreasedblibidobinbmen,brestles
sness,bshortbattentionbspan,bfatigue,binsomnia,bemotionalblability,benlargedbgland.
10. SymptomsbofbHypothyroidismb-
bANSb✓reducedbstrokebvolumebandbHR,bincreased bperipheralbresistancebtobmaintainbBP,
bbradycardia, bmacrocyticbanemiabassoc.bWithbB12bdeficiency,bdyspnea, bhypoventilation
,bCO2bretention,bdecreasedbappetite,bconstipation,bweightbgain,bfluidbretention,bdrybflaky
bskin,bdrybhair,bslow bwoundbhealing,bcoolbskin, bdecreasedblibido,bconfusion,bslowbspeech
,bmemorybloss,bclumsybmovements.
11. Hyperthyroidbdrugsbwithbriskbforbhepaticbtoxicityb-bANSb✓propylthiouracil
12. Bilebacidbsequestrantsbabsorptionbandbadministrationb-bANSb✓affectbLDL-
CbwithbabmodestbincreasebinbHDL-
C.bTheybarebnotbcommonlybprescribedbtobtreatbdyslipidemiasbinbpatientsbwithbdiabetes.b
NotbonlybdobtheybincreasebTGsbbutbtheybmaybposebproblemsbforbpatientsbwithbdiabeticbga
stroparesis.bThebincreasebinbTGbisbespeciallybofbconcernbinbdiabeticsbbecausebthebpancre
asbisbalreadybunderbstress.
13. Levothyroxinebadministrationbinstructionsb-
bANSb✓Takebfirst bthingbinbthebmorningbatbleast b30,bpreferablybonebhourbbeforebeating.bO
nbanbemptybstomachbwithbonlybwater.bAchievebconsistencybinbtakingbthebmedbtobavoidbfl
uctuatingbthyroidblevels.
14. Differentiatebbetweenbprimarybandbsecondarybhypothyroidismb-
bANSb✓Primarybdisordersbincludebthebfollowing:
•bDefectivebhormonebsynthesisbresultingbfrombautoimmunebthyroiditis,bendemicbiodinebdeficien
cy,borbantithyroidbdrugsbthatbwerebusedbtobtreatbhyperthyroidism
•bCongenitalbdefectsborblossbofbtissuebafterbtreatmentbforbhyperthyroidism
Secondarybcausesbofbhypothyroidism,bwhichbareblessbcommon,bincludebconditionsbthatbcausebeit
herbpituitaryborbhypothalamicbfailure.bInbsecondarybdisorders,bthebTSHbresponsebisbinadequatebs
obthatbthebglandbisbnormalborbreducedbinbsize,bwithbbothbT3bandbT4bsynthesisbequallybreduced.
15. Differentiatebbetweenbprimarybandbsecondarybhyperthyroidismb-
bANSb✓Primarybis bthebtermbusedbwhenbthebpathologybisbwithinbthebthyroidbgland.bSecon
darybhyperthyroidismbisbthebtermbusedbwhenbthebthyroidbglandbisbstimulatedbbybexcessiv
ebTSHbinbcirculation.
16. Precautionsbandbtestingbforbxanthinebderivativesb-
bANSb✓Monitored bcloselybforbsignsbofbtoxicity
Whenbtherapybisbinitiated,btheophyllineblevelsbshouldbbebdrawnbfrequentlybasbthebdosagebisbtitrat
ed.
Signsbofbtoxicity-bserumbtheophyllineblevelbshouldbbebdrawn
Oncebstabilized,bmonitoringbshouldbbebdonebeveryb6btob12bmonths
NR 566
b
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NR
17. Mildbintermittentbasthmab-
bANSb✓Symptoms boccurblessboftenbthanbtwicebabweekbandbthebpatientbis basymptomaticbb
etweenbexacerbations;bnighttimebsymptomsboccurblessbthanbtwicebabmonth;bandbpeakbex
piratorybflowb(PEF)bisbgreaterbthanb80%bpredicted.bThebusebofbshort-
actingbbeta2bagonistsb(SABA)bshouldbbeblessbthanbtwicebabweek,bunlessbusedbforbexercis
e-inducedbbronchospasmb(EIB).
18. Mildbpersistentbasthmab-
bANSb✓Symptoms boccurbmoreboftenbthanbtwicebabweekbbutblessboftenbthanboncebabdayba
ndbexacerbationsbmaybaffectbactivity;bnighttimebsymptomsboccurb3btob4btimesbabmonth;ba
ndbPEFbisbgreaterbthanb80%bpredicted.bPatientsbwithbmildbpersistentbasthmabmaybusebthei
rbshort-
actingbbeta2bagonistsbmorebthanbtwicebabweekbbutbnotbdaily,bandbnotbmorebthanboncebdail
y.
19. Moderatebpersistentbasthmab-
bANSb✓Thebpatientbisbhavingbdailybsymptoms;brequiresbdailybusebofbabbeta2bagonist;bexa
cerbationsbaffectbnormalbactivity;bnighttimebsymptomsboccurbmoreboftenbthanboncebabwe
ek;bandbPEFbisbgreaterbthanb60%btoblessbthanb80%.
20. Severebpersistentbasthmab-
bANSb✓Thebpatientbhasbsomebdegreebofbsymptoms ballbthebtime;bextremelyblimitedbphysi
calbactivitybandbfrequentbexacerbations;bfrequentbnighttimebsymptoms,boftenb7bdaysbabw
eek;bandbdecreasedblungbfunctionb(PEFblessbthanb60%bpredicted).bTableb30-
1boutlinesbthebclassificationsbofbasthmabseveritybinbpatientsbagedb12byearsborbolder.
21. Riskbfactorsbforbfatalbasthmabattacksb-
bANSb✓Previous bseverebexacerbationsbrequiringbintubationborbICU.
Twoborbmorebhospitalizations.
Morebthanb3bEDbvisitsbinbthebpastbyear.
Usebofbmorebthanb2bSABAbcanistersbperbmonth.
Difficultybperceivingbairwaybobstructionborbworseningbasthma.
Lowbsocioeconomicbstatusborbinner-citybresidence.
22. Asthmabstepbtherapyb-
bANSb✓ThebExpertbPanel bReportb3:bGuidelines b(NAEPP,b2007)brecommendsbabstepwis
ebapproachbtobthebpharmacologicalbmanagementbofbasthma.bManagementbcanbbeginbatbab
higherblevelbandbgraduallybstepbdownborbstartblowbandbmovebup,bdependingbonbthebpatien
t'sbstatusbwhenbbeginningbtreatment.
Stepb1:bSABAbPRN
Stepb2:bLowbdosebICS
Stepb3:bMediumbdosebICS
Stepb4:bMediumbdosebICSb+bLABAborbMontelukast
Stepb5:bHighbdosebICSb+bLABAborbMentelukast
NR 566
b
