NSG 533 ADVANCED PHARMACOLOGY 5
TEST BANK 2026 COMPLETE QUESTIONS
WITH PRACTICE SOLUTION
◉ What are some drug-drug, drug-food interactions associated with
thyroid replacement. Answer: drug binding interactions, di-valent
cations, amiodarone, certain antibiotics
◉ RECOMMENDATION 13 Methimazole should be used in virtually
every patient who chooses antithyroid drug therapy for GD, except
during the first trimester of pregnancy when propylthiouracil is
preferred, in the treatment of thyroid storm (inhibition of peripheral
conversion), and in patients with minor reactions to methimazole
who refuse radioactive iodine therapy or surgeryDelayed onset.
Answer:
◉ Beta-blockers role in therapy?. Answer: So .. beta blockers are
used for Symptomatic relief of hyperthyroidism until more
definative therapy is instituted and thyroid levels retun to normal or
near normal..
Reduction of peripheral manifestations
Tachycardia, sweating, severe tremor, nervousness
Inhibition of peripheral conversion of thyroid hormones at higher
doses (propranolol ONLY)
,Small therapeutic effect in magnitude
thyrotoxicosis
◉ Why does amiodarone pose a unique concern to thyroid
disorders. Answer: "Amiodarone-normal thyroid autoregulation is
lost because of the relatively high iodine content" .. this fact can lead
to a situation where amiodarone can cauase BOTH hyper- and hypo-
thyroidism, depending on the patient, through several process
blocking thyroid peroxidase
blocking proteolysis of Tg and thyroid hormone
altering organification, etc
◉ What would you recommend if a patient is taking Nexium and
Plavix together?. Answer: As we have seen through our discussions,
there is a lot of information (including an FDA issued statement in
the package insert) describing the drug interaction and reduced
efficacy of clopidogrel if used with a PPI (primarily omeprazole) (or
in patients who are genetically slow CYP2C19 metabolizers);
however there is also evidence based information indicating the
interaction is not as significant as originally thought. Bottom line:
Despite pharmacokinetic evidence that omeprazole interferes with
clopidogrel metabolism, COGENT trial found addition of omeprazole
to clopidogrel reduced gastrointestinal events without increasing
cardiovascular events.
,◉ Note there is no significant difference in efficacy among the
H2RAs when given at equipotent dosesCimetidine is associated with
numerous clinically significant DIs
Dose reduction in renal and hepatic insufficiency and in the elderly
Duration of suppression ranges from 6-10 hours and varies with
dose
Note there is no significant difference in efficacy among the PPIs
when given at equipotent doses
Food may affect absorption. Given 30-60' before a meal. More
flexibility in term of dosing with newer agents (eg.
dexlansoprazole)Delayed onset: 3-4 days for full inhibition
Duration of action up to 24 hours due to covalent, irreversible
inhibition of proton pump. Answer:
◉ Patients with known osteoporosis can remain on PPI therapy.
Concern for hip fractures and osteoporosis should not affect the
decision to use PPI long-term except in patients with other risk
factors for hip fracture. Answer:
◉ Final thoughts on GERD:. Answer: ◦Therapy for GERD other than
acid suppression, including prokinetic therapy and/or baclofen,
should not be used in GERD patients without diagnostic evaluation.
◦For patients with partial response to once daily therapy with a PPI,
tailored therapy with adjustment of dose timing and/or twice daily
, dosing should be considered in patients with night-time symptoms,
variable schedules, and/or sleep
◦In patients with partial response to PPI therapy, increasing the
dose to twice daily therapy or switching to a different PPI may
provide additional symptom relief.
◦ Maintenance PPI therapy should be administered for GERD
patients who continue to have symptoms after the PPI is
discontinued, and in patients with complications including erosive
esophagitis and Barrett's esophagus
◦Histamine-receptor antagonists (H2RA) therapy can be used as a
maintenance option in patients without erosive disease if patients
experience heartburn relief. Bedtime H2RA therapy can be added to
daytime PPI therapy in selected patients with objective evidence of
night-time reflux if needed, but may be associated with the
development of tachyphylaxis after several weeks of usage
◉ Peptic ulcers (gastric and duodenal) are defects in the GI mucosa
that extend through the muscularis mucosa. Causal relationships
associate with H. Pylori infection, NSAIDs and SRMD.. Answer:
Therapy includes non-pharmacological interventions (similar to
GERD) and pharmacological with acid suppression (antacids,
H2RAs, PPIs) and/or mucosal protection (sucralfate, colloidal
bismuth, misoprostol), and if present, H Pylori eradication
Acid suppression - see treatment modalities under GERD (Duration
/ dosages may be different based on indication)
Mucosal protectionSucralfate - In acid environment it turns into a
viscous, sticky polymer that binds selectively to ulcers and erosions
TEST BANK 2026 COMPLETE QUESTIONS
WITH PRACTICE SOLUTION
◉ What are some drug-drug, drug-food interactions associated with
thyroid replacement. Answer: drug binding interactions, di-valent
cations, amiodarone, certain antibiotics
◉ RECOMMENDATION 13 Methimazole should be used in virtually
every patient who chooses antithyroid drug therapy for GD, except
during the first trimester of pregnancy when propylthiouracil is
preferred, in the treatment of thyroid storm (inhibition of peripheral
conversion), and in patients with minor reactions to methimazole
who refuse radioactive iodine therapy or surgeryDelayed onset.
Answer:
◉ Beta-blockers role in therapy?. Answer: So .. beta blockers are
used for Symptomatic relief of hyperthyroidism until more
definative therapy is instituted and thyroid levels retun to normal or
near normal..
Reduction of peripheral manifestations
Tachycardia, sweating, severe tremor, nervousness
Inhibition of peripheral conversion of thyroid hormones at higher
doses (propranolol ONLY)
,Small therapeutic effect in magnitude
thyrotoxicosis
◉ Why does amiodarone pose a unique concern to thyroid
disorders. Answer: "Amiodarone-normal thyroid autoregulation is
lost because of the relatively high iodine content" .. this fact can lead
to a situation where amiodarone can cauase BOTH hyper- and hypo-
thyroidism, depending on the patient, through several process
blocking thyroid peroxidase
blocking proteolysis of Tg and thyroid hormone
altering organification, etc
◉ What would you recommend if a patient is taking Nexium and
Plavix together?. Answer: As we have seen through our discussions,
there is a lot of information (including an FDA issued statement in
the package insert) describing the drug interaction and reduced
efficacy of clopidogrel if used with a PPI (primarily omeprazole) (or
in patients who are genetically slow CYP2C19 metabolizers);
however there is also evidence based information indicating the
interaction is not as significant as originally thought. Bottom line:
Despite pharmacokinetic evidence that omeprazole interferes with
clopidogrel metabolism, COGENT trial found addition of omeprazole
to clopidogrel reduced gastrointestinal events without increasing
cardiovascular events.
,◉ Note there is no significant difference in efficacy among the
H2RAs when given at equipotent dosesCimetidine is associated with
numerous clinically significant DIs
Dose reduction in renal and hepatic insufficiency and in the elderly
Duration of suppression ranges from 6-10 hours and varies with
dose
Note there is no significant difference in efficacy among the PPIs
when given at equipotent doses
Food may affect absorption. Given 30-60' before a meal. More
flexibility in term of dosing with newer agents (eg.
dexlansoprazole)Delayed onset: 3-4 days for full inhibition
Duration of action up to 24 hours due to covalent, irreversible
inhibition of proton pump. Answer:
◉ Patients with known osteoporosis can remain on PPI therapy.
Concern for hip fractures and osteoporosis should not affect the
decision to use PPI long-term except in patients with other risk
factors for hip fracture. Answer:
◉ Final thoughts on GERD:. Answer: ◦Therapy for GERD other than
acid suppression, including prokinetic therapy and/or baclofen,
should not be used in GERD patients without diagnostic evaluation.
◦For patients with partial response to once daily therapy with a PPI,
tailored therapy with adjustment of dose timing and/or twice daily
, dosing should be considered in patients with night-time symptoms,
variable schedules, and/or sleep
◦In patients with partial response to PPI therapy, increasing the
dose to twice daily therapy or switching to a different PPI may
provide additional symptom relief.
◦ Maintenance PPI therapy should be administered for GERD
patients who continue to have symptoms after the PPI is
discontinued, and in patients with complications including erosive
esophagitis and Barrett's esophagus
◦Histamine-receptor antagonists (H2RA) therapy can be used as a
maintenance option in patients without erosive disease if patients
experience heartburn relief. Bedtime H2RA therapy can be added to
daytime PPI therapy in selected patients with objective evidence of
night-time reflux if needed, but may be associated with the
development of tachyphylaxis after several weeks of usage
◉ Peptic ulcers (gastric and duodenal) are defects in the GI mucosa
that extend through the muscularis mucosa. Causal relationships
associate with H. Pylori infection, NSAIDs and SRMD.. Answer:
Therapy includes non-pharmacological interventions (similar to
GERD) and pharmacological with acid suppression (antacids,
H2RAs, PPIs) and/or mucosal protection (sucralfate, colloidal
bismuth, misoprostol), and if present, H Pylori eradication
Acid suppression - see treatment modalities under GERD (Duration
/ dosages may be different based on indication)
Mucosal protectionSucralfate - In acid environment it turns into a
viscous, sticky polymer that binds selectively to ulcers and erosions
