MN 553 FINAL EXAM ACTUAL QUESTIONS AND
SOLUTIONS GRADED A+
✔✔Commonly Used Pharmacoeconomic Research Methodologies - ✔✔**Cost-
minimization
Outcome: Outcome must be clinically identical in similar patient population
All social costs should be considered
EX: Adalat CC vs Procardia XL. Generic azathioprine vs brand-name azathioprine.
**Cost-effectiveness
Different clinical outcome
Justify the incremental cost increase for the therapeutic benefit from extra costs
associated with treatment
EX: antilymphocyte induction vs no induction.
**Cost-benefit
Expressing clinical outcome purely in monetary units
Assigns a dollar value to specific disease state
Unethical and should be avoided
Ex: 10 mm Hg reduction in blood pressure worth $100
✔✔Pharmacoeconomics - ✔✔Pharmacoeconomics is the study of the appropriate
utilization of drugs for the treatment of a specific disease. Pharmacoeconomic studies
characterize the improved outcomes while justifying additional drug expenditures.
Because the value and economics of many approved drugs are unknown at the time,
the true impact of new drug substitution on the cost and care of most patients with
complicated conditions is also unknown. In theory, if a therapeutically equivalent and
less expensive product is available, it should be substituted. This may substantially
affect the cost of drug therapy and overall health-care costs. Applying
pharmacoeconomics to prescribing practice involves understanding the impact of drug
costs on patients and making an educated prescribing decision to ensure the best
outcome.
✔✔Tetracycline Pharmacodynamics - ✔✔Tetracyclines are bacteriostatic; they inhibit or
retard the growth of bacteria but do not kill them. They retard bacterial growth by
inhibiting protein synthesis in sensitive bacteria and by preventing cell division and
replication. Like other antibiotics their effect on the body is indirect.
✔✔Tetracycline Absorption - ✔✔*Take tetracycline on an empty stomach or with foods
that are not high in calcium, aluminum, iron, or magnesium because the drug chelates
with these minerals, thereby decreasing absorption.
*When taken together (Tetracycline+quinolone antibiotic). Do not take antacids while on
these medications as the antacid decreases absorption.
✔✔Tetracycline Contraindications & Precautions - ✔✔Tetracycline is contraindicated in
patients with a known allergy to tetracyclines or to tartrazine (specific oral preparations
,contain tartrazine) and during pregnancy and lactation. Tetracycline should be used with
caution in children younger than 8 years and in patients with hepatic and renal
dysfunction.
✔✔Tetracycline Adverse Effects: - ✔✔N/V, diarrhea, abdominal or epigastric discomfort,
HA, dizziness, photosensitivity.
✔✔Tetracycline Drug Interactions: - ✔✔*The effectiveness of penicillin G decreases if it
is taken concurrently with tetracyclines. If this combination is used, the dosage of the
penicillin will have to be increased.
*Oral contraceptives may be less effective if taken with tetracycline. Patients taking oral
contraceptives should be advised to use an additional form of birth control while
receiving tetracycline.
*Tetracycline forms an insoluble chelate with aluminum, bismuth, calcium, iron,
magnesium, and zinc salts which are frequently an ingredient in anacids. This chelate
decrease the absorption of either tetracyclines or the salt.
✔✔Beta blockers - ✔✔Tx: HTN by reducing vascular smooth muscle tone. First drug
choice after MI.
other tx for angina, dysrhythmias class 2, heart failure, tachycardia, anxiety, tremor.
✔✔Action of Beta Blockers - ✔✔Decrease HR & contractility which decreases cardiac
output and decreases BP. Works by blocking sympathetic stimulation, epinephrine &
norepinephrine but doesn't block completely because you wouldn't have a pulse or a
BP.
✔✔Beta blocker action and anti-dysrhythmic drugs - ✔✔Slow HR & decrease
conduction through the AV node, often used if arterial dysrhythmias accompanied by
heart failure.
✔✔BB effect on whole body - ✔✔*Opposite of an adrenaline rush slows everything
down.
*Beta-1 receptors: Located primarily in the heart.
*Beta-2 receptors-Located in the smooth muscle of lungs, uterus, and other organs.
✔✔BB Precautions and Contraindications - ✔✔*Contraindicated for patients with
respiratory conditions that include a bronchospastic component.
*contraindicated for patients with AV block because their actions to decrease heart rate
and myocardial contractility result in an increased reduction in cardiac output and
worsened failure. Decreased cardiac output and the initial vasoconstrictive action of
these drugs may also worsen peripheral vascular diseases.
*Beta blockers may precipitate or exacerbate type 2 diabetes. Because of their effects
on carbohydrate metabolism and their ability to mask the common symptoms of
hypoglycemia, beta blockers must be used cautiously in patients with diabetes.
, *Propranolol and metoprolol are excreted in breast milk and the manufacturer
recommends using caution when administering to nursing mothers.
✔✔BB Adverse Effects - ✔✔Cardiovascular reactions: Bradycardia, CHF w/concomitant
pulmonary edema, hypotension.
CNS/psych reactions: fatigue, weakness, dizziness, depression, drowsiness, insomnia,
nightmares, mental status changes are more common in those drugs that have higher
CNS penetration & in older adults.
Endocrine reactions: Alterations in carbohydrate metabolism resulting in hyperglycemia,
hypoglycemia, or unstable diabetes are discussed in the Precautions and
Contraindications section.
GI: dry mouth, anorexia, N/V, flatulence & constipation.
Genitourinary reactions: One of the most likely reasons for nonadherence to a treatment
regimen that includes beta blockers is the risk for impotence and decreased libido. This
side effect may resolve with continued use of the medication.
Respiratory Reactions
Bronchospasm and dyspnea are discussed in the Precautions and Contraindications
section. Nasal stuffiness may also occur.
✔✔Gabapentin - ✔✔Therapeutic Uses: anticonvulsant; painful neuropathy.
Indication: adjunctive therapy for partial seizures with or without secondary
generalization in adults, post herpetic neuralgia, RLS.
Mechanism of action: used in conjunction w/other anticonvulsants to control certain
types of seizures in patients with epilepsy. Effective in controlling painful neuropathies.
Pregnancy C category.
Contraindications: hypersensitivity to gabapentin; suicidal ideations; lactation.
Gabapentin adverse effects:
Drowsiness, fatigue, dizziness, weight gain, nystagmus, ataxia, may cause leukopenia
✔✔Gabpentin Interactions - ✔✔Kidney disease
Mental/mood problems (such as depression, thoughts of suicide)
Use/abuse of drugs/alcohol
Breathing problems
Products that may interact with this drug include:
Orlistat
SOLUTIONS GRADED A+
✔✔Commonly Used Pharmacoeconomic Research Methodologies - ✔✔**Cost-
minimization
Outcome: Outcome must be clinically identical in similar patient population
All social costs should be considered
EX: Adalat CC vs Procardia XL. Generic azathioprine vs brand-name azathioprine.
**Cost-effectiveness
Different clinical outcome
Justify the incremental cost increase for the therapeutic benefit from extra costs
associated with treatment
EX: antilymphocyte induction vs no induction.
**Cost-benefit
Expressing clinical outcome purely in monetary units
Assigns a dollar value to specific disease state
Unethical and should be avoided
Ex: 10 mm Hg reduction in blood pressure worth $100
✔✔Pharmacoeconomics - ✔✔Pharmacoeconomics is the study of the appropriate
utilization of drugs for the treatment of a specific disease. Pharmacoeconomic studies
characterize the improved outcomes while justifying additional drug expenditures.
Because the value and economics of many approved drugs are unknown at the time,
the true impact of new drug substitution on the cost and care of most patients with
complicated conditions is also unknown. In theory, if a therapeutically equivalent and
less expensive product is available, it should be substituted. This may substantially
affect the cost of drug therapy and overall health-care costs. Applying
pharmacoeconomics to prescribing practice involves understanding the impact of drug
costs on patients and making an educated prescribing decision to ensure the best
outcome.
✔✔Tetracycline Pharmacodynamics - ✔✔Tetracyclines are bacteriostatic; they inhibit or
retard the growth of bacteria but do not kill them. They retard bacterial growth by
inhibiting protein synthesis in sensitive bacteria and by preventing cell division and
replication. Like other antibiotics their effect on the body is indirect.
✔✔Tetracycline Absorption - ✔✔*Take tetracycline on an empty stomach or with foods
that are not high in calcium, aluminum, iron, or magnesium because the drug chelates
with these minerals, thereby decreasing absorption.
*When taken together (Tetracycline+quinolone antibiotic). Do not take antacids while on
these medications as the antacid decreases absorption.
✔✔Tetracycline Contraindications & Precautions - ✔✔Tetracycline is contraindicated in
patients with a known allergy to tetracyclines or to tartrazine (specific oral preparations
,contain tartrazine) and during pregnancy and lactation. Tetracycline should be used with
caution in children younger than 8 years and in patients with hepatic and renal
dysfunction.
✔✔Tetracycline Adverse Effects: - ✔✔N/V, diarrhea, abdominal or epigastric discomfort,
HA, dizziness, photosensitivity.
✔✔Tetracycline Drug Interactions: - ✔✔*The effectiveness of penicillin G decreases if it
is taken concurrently with tetracyclines. If this combination is used, the dosage of the
penicillin will have to be increased.
*Oral contraceptives may be less effective if taken with tetracycline. Patients taking oral
contraceptives should be advised to use an additional form of birth control while
receiving tetracycline.
*Tetracycline forms an insoluble chelate with aluminum, bismuth, calcium, iron,
magnesium, and zinc salts which are frequently an ingredient in anacids. This chelate
decrease the absorption of either tetracyclines or the salt.
✔✔Beta blockers - ✔✔Tx: HTN by reducing vascular smooth muscle tone. First drug
choice after MI.
other tx for angina, dysrhythmias class 2, heart failure, tachycardia, anxiety, tremor.
✔✔Action of Beta Blockers - ✔✔Decrease HR & contractility which decreases cardiac
output and decreases BP. Works by blocking sympathetic stimulation, epinephrine &
norepinephrine but doesn't block completely because you wouldn't have a pulse or a
BP.
✔✔Beta blocker action and anti-dysrhythmic drugs - ✔✔Slow HR & decrease
conduction through the AV node, often used if arterial dysrhythmias accompanied by
heart failure.
✔✔BB effect on whole body - ✔✔*Opposite of an adrenaline rush slows everything
down.
*Beta-1 receptors: Located primarily in the heart.
*Beta-2 receptors-Located in the smooth muscle of lungs, uterus, and other organs.
✔✔BB Precautions and Contraindications - ✔✔*Contraindicated for patients with
respiratory conditions that include a bronchospastic component.
*contraindicated for patients with AV block because their actions to decrease heart rate
and myocardial contractility result in an increased reduction in cardiac output and
worsened failure. Decreased cardiac output and the initial vasoconstrictive action of
these drugs may also worsen peripheral vascular diseases.
*Beta blockers may precipitate or exacerbate type 2 diabetes. Because of their effects
on carbohydrate metabolism and their ability to mask the common symptoms of
hypoglycemia, beta blockers must be used cautiously in patients with diabetes.
, *Propranolol and metoprolol are excreted in breast milk and the manufacturer
recommends using caution when administering to nursing mothers.
✔✔BB Adverse Effects - ✔✔Cardiovascular reactions: Bradycardia, CHF w/concomitant
pulmonary edema, hypotension.
CNS/psych reactions: fatigue, weakness, dizziness, depression, drowsiness, insomnia,
nightmares, mental status changes are more common in those drugs that have higher
CNS penetration & in older adults.
Endocrine reactions: Alterations in carbohydrate metabolism resulting in hyperglycemia,
hypoglycemia, or unstable diabetes are discussed in the Precautions and
Contraindications section.
GI: dry mouth, anorexia, N/V, flatulence & constipation.
Genitourinary reactions: One of the most likely reasons for nonadherence to a treatment
regimen that includes beta blockers is the risk for impotence and decreased libido. This
side effect may resolve with continued use of the medication.
Respiratory Reactions
Bronchospasm and dyspnea are discussed in the Precautions and Contraindications
section. Nasal stuffiness may also occur.
✔✔Gabapentin - ✔✔Therapeutic Uses: anticonvulsant; painful neuropathy.
Indication: adjunctive therapy for partial seizures with or without secondary
generalization in adults, post herpetic neuralgia, RLS.
Mechanism of action: used in conjunction w/other anticonvulsants to control certain
types of seizures in patients with epilepsy. Effective in controlling painful neuropathies.
Pregnancy C category.
Contraindications: hypersensitivity to gabapentin; suicidal ideations; lactation.
Gabapentin adverse effects:
Drowsiness, fatigue, dizziness, weight gain, nystagmus, ataxia, may cause leukopenia
✔✔Gabpentin Interactions - ✔✔Kidney disease
Mental/mood problems (such as depression, thoughts of suicide)
Use/abuse of drugs/alcohol
Breathing problems
Products that may interact with this drug include:
Orlistat
