Week 6 Exam: NR565 / NR 565 (Latest 2026 / 2027) Advanced Pharmacology Fundamentals | Questions & Answers | 100% Correct | Grade A - Chamberlain

Week 6 Exam: NR565 / NR 565 (Latest 2026 / 2027) Advanced Pharmacology Fundamentals | Questions & Answers | 100% Correct | Grade A - Chamberlain Which of the following best describes asthma? A chronic inflammatory airway disorder with reversible airflow obstruction 3 multiple choice options Which of the following is most likely to trigger an asthma attack? Exercise or respiratory infection 3 multiple choice options What is the underlying pathological process in asthma? Inflammation leading to airway hyperresponsiveness 3 multiple choice options Which of the following symptoms is most characteristic of asthma? Chest tightness and wheezing, especially at night 3 multiple choice options What is the mechanism of action of ipratropium in the treatment of asthma or COPD? Inhibits muscarinic receptors to prevent bronchoconstriction 3 multiple choice options Ipratropium is primarily classified as which of the following? Short-acting muscarinic antagonist (SAMA) 3 multiple choice options Which of the following is a common side effect associated with inhaled ipratropium use? Dry mouth 3 multiple choice options In which patient population is ipratropium most commonly used as first-line therapy? Patients with COPD 3 multiple choice options Ipratropium may be used as adjunctive therapy in asthma primarily to: Provide additional bronchodilation when beta-agonists alone are insufficient 3 multiple choice options Omalizumab is classified as which type of medication? Monoclonal antibody 3 multiple choice options What is the primary mechanism of action of omalizumab in asthma treatment? Binds to IgE to prevent mast cell activation 3 multiple choice options Omalizumab is most appropriate for which type of asthma patient? A patient with moderate to severe allergic asthma not controlled by ICS 3 multiple choice options What is a serious adverse effect associated with omalizumab that requires post-injection monitoring that requires it to have a black box warning? Anaphylaxis 3 multiple choice options How is omalizumab typically administered? Subcutaneously or intravenously 3 multiple choice options What is the primary mechanism of action of bronchodilators in the treatment of asthma and COPD? Relaxing bronchial smooth muscle to relieve airway obstruction 3 multiple choice options Which of the following is considered a short-acting beta-2 agonist (SABA)? Albuterol 3 multiple choice options What is the primary therapeutic role of LABAs (long-acting beta-2 agonists)? Long-term control of asthma symptoms 3 multiple choice options Which of the following is a common adverse effect associated with beta-2 agonist bronchodilators? Tremors 3 multiple choice options What is the therapeutic benefit of bronchodilators in patients with COPD or asthma? Improving airflow and reducing shortness of breath 3 multiple choice options What is the primary mechanism of action of theophylline in asthma management? Inhibiting phosphodiesterase to increase cyclic AMP and cause bronchodilation 3 multiple choice options Which of the following is a major concern when using theophylline for asthma treatment? Potential toxicity due to narrow therapeutic index 3 multiple choice options What adverse effect is most commonly associated with high doses of theophylline? Tachycardia and arrhythmias 3 multiple choice options Why is serum level monitoring important in patients taking theophylline? To prevent toxicity and ensure therapeutic dosing 3 multiple choice options Which patient population is at higher risk for theophylline toxicity? Older adults 1 multiple choice option What is the primary therapeutic use of montelukast? Long-term treatment of asthma and prevention of exercise-induced bronchospasm 3 multiple choice options What is the mechanism of action of montelukast? Blocks leukotriene receptors to inhibit airway inflammation and bronchoconstriction 3 multiple choice options Which of the following is a common side effect of montelukast? Headache and gastrointestinal upset 3 multiple choice options Which uncommon but serious side effect has been reported with montelukast use? Neuropsychiatric effects such as mood changes 3 multiple choice options Montelukast is especially indicated for which type of asthma? Allergic asthma 3 multiple choice options What is the primary therapeutic use of inhaled glucocorticoids like beclomethasone in asthma? Long-term control of asthma symptoms by reducing airway inflammation 3 multiple choice options What is a common adverse effect of inhaled glucocorticoids? Oral candidiasis (thrush) 3 multiple choice options Which adverse effect is more commonly associated with systemic glucocorticoids such as prednisone? Weight gain and osteoporosis 3 multiple choice options What is a possible systemic adverse effect of long-term inhaled glucocorticoid use? Adrenal suppression 3 multiple choice options What is the mechanism of action of inhaled glucocorticoids in asthma? Reduce production of inflammatory mediators and airway hyperresponsiveness 3 multiple choice options Which serious adverse effect is highlighted by the black box warning for monoclonal antibodies like omalizumab used in asthma treatment? Anaphylaxis 3 multiple choice options Which of the following is NOT part of a regular asthma control assessment? C) Blood pressure monitoring 3 multiple choice options A patient with asthma uses their rescue inhaler 3 days per week, experiences nighttime awakenings twice per month, and has symptoms 4 days per week. How would their asthma control be classified? Not well controlled 3 multiple choice options For a patient with well-controlled asthma, what is the recommended follow-up timeframe? Reevaluate in 1-6 months 3 multiple choice options What is the recommended management step for a patient with very poorly controlled asthma? Step up therapy by 1-2 steps and consider systemic glucocorticoids 3 multiple choice options Which of the following is a primary cause of Chronic Obstructive Pulmonary Disease (COPD)? Smoking 3 multiple choice options COPD includes which of the following conditions? Chronic bronchitis and emphysema 3 multiple choice options Which of the following is a common symptom of COPD? Chronic cough with sputum production 3 multiple choice options What characterizes airflow limitation in COPD? It is partially reversible but mostly progressive 3 multiple choice options What is the primary goal of COPD management? Reduce symptoms and improve exercise tolerance 3 multiple choice options Which of the following is a secondary goal in managing COPD? Managing exacerbations and improving quality of life 3 multiple choice options Which of the following is considered a cornerstone of COPD treatment? Smoking cessation and bronchodilators 3 multiple choice options In severe COPD cases, which medication class may be added to the treatment regimen? PDE4 inhibitors and oxygen therapy 3 multiple choice options What is the primary therapeutic use of roflumilast in COPD management? To reduce exacerbations in severe COPD patients with chronic bronchitis 3 multiple choice options What is the mechanism of action of roflumilast? Inhibiting phosphodiesterase-4, increasing cAMP and decreasing airway inflammation 3 multiple choice options Which of the following is a common adverse effect of roflumilast? Nausea, vomiting, diarrhea, and headache 3 multiple choice options Tiotropium works primarily by: Blocking muscarinic receptors to prevent acetylcholine-induced bronchoconstriction 3 multiple choice options Which of the following is a common adverse effect associated with tiotropium? Dry mouth and constipation 3 multiple choice options Tiotropium may cause which cardiovascular side effects? Tachycardia and palpitations 1 multiple choice option What is the primary goal of tuberculosis (TB) treatment? To eliminate the TB bacteria, prevent relapse, and prevent drug resistance 3 multiple choice options Why is combination therapy used in the treatment of tuberculosis? To reduce the risk of drug resistance and prevent relapse 3 multiple choice options Which of the following drugs are included in the intensive phase of standard TB treatment? Rifampin, ethambutol, isoniazid, pyrazinamide 3 multiple choice options How long does the continuation phase of standard drug-sensitive TB treatment typically last? 18 weeks 3 multiple choice options What defines multidrug-resistant TB (MDR-TB)? Resistance to both isoniazid and rifampin 3 multiple choice options What is the duration of treatment typically required for drug-resistant tuberculosis? At least 24 months 3 multiple choice options How is treatment efficacy in TB monitored? Monthly sputum tests, chest x-rays, and symptom evaluation 3 multiple choice options What is a serious adverse effect associated with aminoglycosides such as streptomycin and amikacin? Ototoxicity 3 multiple choice options Aminoglycosides carry a black box warning for which of the following? Permanent hearing loss and kidney damage 3 multiple choice options What is a risk when aminoglycosides are used concurrently with other nephrotoxic agents? Increased renal impairment 3 multiple choice options What is the primary use of aminoglycosides like streptomycin in TB treatment? MDR-TB (Multidrug-resistant tuberculosis) 3 multiple choice options What is the most significant adverse effect of ethambutol? Optic neuritis 3 multiple choice options Why is ethambutol generally not recommended for children under 8 years old? Difficulty in monitoring for vision changes 3 multiple choice options What mechanism of action makes ethambutol effective in TB treatment? Inhibits arabinosyl transferase to impair cell wall synthesis 3 multiple choice options Which symptom would warrant immediate discontinuation of ethambutol? Visual changes 3 multiple choice options Which of the following best defines extensively drug-resistant tuberculosis (XDR-TB)? Resistance to isoniazid, rifampin, a fluoroquinolone, and at least one injectable second-line drug 3 multiple choice options What is the approximate mortality rate for patients with XDR-TB? 40-60% 3 multiple choice options Why is XDR-TB more difficult to treat than drug-sensitive TB? It requires longer treatment with less effective and more toxic drugs 3 multiple choice options What is the mechanism of action of isoniazid? Inhibits mycolic acid synthesis, essential for mycobacterial cell walls 3 multiple choice options Which of the following is true about isoniazid's activity against tuberculosis? It is bactericidal to actively dividing TB bacteria and bacteriostatic to dormant bacilli 3 multiple choice options Isoniazid is known to interact with which of the following due to its inhibition of cytochrome P450 enzymes? Phenytoin 3 multiple choice options What should be monitored closely when isoniazid is used with phenytoin? Phenytoin plasma levels 3 multiple choice options What is an appropriate therapeutic use of isoniazid? Used for both active and latent TB infections 3 multiple choice options Pyrazinamide is most effective during which phase of TB treatment? First two months of therapy 3 multiple choice options Which of the following is the most significant adverse effect of pyrazinamide? Hepatotoxicity 3 multiple choice options What adverse effect of pyrazinamide may lead to joint pain in patients? Hyperuricemia 3 multiple choice options A patient taking pyrazinamide develops sensitivity to sunlight. This side effect is best described as: Photosensitivity 3 multiple choice options What is the mechanism of action of rifampin? Inhibits bacterial RNA polymerase 3 multiple choice options A patient on rifampin reports red-orange urine and tears. What should the nurse tell the patient? This is a harmless and expected side effect 3 multiple choice options Which of the following is a serious drug interaction associated with rifampin? Hepatic 3 multiple choice options What is a key advantage of rifabutin over rifampin in TB treatment? It has a lower risk of hepatotoxicity 3 multiple choice options A patient taking rifabutin reports blurred vision and eye pain. What is the appropriate action? Discontinue the medication and report to the provider(due to risk of uveitis) 3 multiple choice options Which of the following adverse effects is shared by both rifampin and rifabutin? Discoloration of body fluids 3 multiple choice options 4. In TB and HIV coinfection, why is rifabutin often preferred over rifampin? Rifabutin has fewer interactions with antiretroviral drugs 3 multiple choice options What is the primary challenge in treating patients with TB and HIV coinfection? Significant drug interactions between TB and HIV medications 3 multiple choice options Which class of HIV drugs most commonly interacts with rifampin? Protease inhibitors and NNRTIs Methylxanthines Who is at risk for toxicity and why? Older patients are at much higher risk for toxicity when taking methylxanthines. Systemic anticholinergics are included in Beers Criteria for Potentially Inappropriate Use in Older Adults; they should not be substituted for inhaled anticholinergics These drugs are contraindicated for patients with untreated seizure disorders or peptic ulcer disease. Use with caution in patients with heart disease (can exacerbate dysrhythmias), liver dysfunction (increased risk for toxicity), peptic ulcer disease (can exacerbate condition), or seizure disorders (can exacerbate seizures). Asthma & COPD Step 1 therapy Complete this sentence: Manage with a ______ as needed. SABA symptoms associated with mild persistent asthma Symptoms: More than 2 d/wk but less than daily nighttime awakenings: 3–4 times/month SABA use= more than 2 days/week but less than daily AND no more than 1 time on any day. Effect on activity= minimal activity limitation. Risk for exacerbations requiring systemic glucocorticoids= 2 or more times/6 months OR wheezing lasting more than 1 day 4 or more times/year (2 or more times/year for 5 y.o. & up). symptoms associated with moderate persistent asthma Symptoms: Daily nighttime awakenings: 3-4 times/month More than once/week but less than nightly SABA use= daily. Effect on activity= some activity limitation. Risk for exacerbations requiring systemic glucocorticoids= increased frequency & intensity of exacerbations or wheezing. symptoms associated with severe persistent asthma symptoms: several times daily nighttime awakenings: often nightly SABA use= several times a day Effect on activity= severe activity limitation. Risk for exacerbations requiring systemic glucocorticoids= even greater increased frequency & intensity of exacerbations or wheezing. symptoms associated with intermittent asthma symptoms: 2d/wk or less nighttime awakenings: 2 times/month or less effect on activity: none SABA use= 2 days/week or less. Risk for exacerbations requiring systemic glucocorticoids= 0-1 time/year. What are some examples of a SABA? albuterol, levalbuterol benefits of SABA Rescue inhaler, all asthma patients should have a SABA, they are for prophylaxis of exercise induced bronchospasms and to relieve ongoing asthma attacks and COPD exacerbations Patient instructions for a SABA How to use the inhaler (have patients demonstrate), use a spacer for those with difficulty with hand-breath coordination, patients with asthma should assess peak expiratory flow daily and compare with personal best and keep record, patients using meter dose inhalers or dry powder inhalers should have at least 1 minute intervals between inhalers if using more than one, report chest pain associated with changes in HR or rhythm, do not exceed recommended dosages (Provider should be notified if symptoms require more frequent use of SABA) Why is it important to know the frequency a patient is using their SABA? If patients are using it more frequently due to symptoms, the provider should be notified so medication changes can take place and the NP can provide adequate asthma relief examples of LABAs Salmeterol, formoterol, oldaterol, Arformoterol Benefits of use of LABA (for long term control) LABAs are for patients who experience frequent attacks and dosing is done on a fixed, NOT PRN, schedule. For asthma, they must be combined with a glucocorticoid because they are not a first line therapy in asthma (FDA recommends a LABA and glucocorticoid are both contained in the same inhaler to prevent a LABA asthma-associated death - LABA monotherapy in asthma is contraindicated) use of LABAs in COPD LABAs are preferred over SABAs for patients with stable COPD. LABA can increase the risk for severe asthma attacks and asthma related death; however, this is not a concern for those with COPD Examples of ICS (inhaled corticosteroids) Beclomethasone dipropionate, Budesonide, Ciclesonide, Flunisolide, Fluticasone propionate, Mometasone furoate Benefits of ICS Most effective drugs available for long-term control of airway inflammation. By reducing inflammation, they reduce bronchial hyper-reactivity and decrease airway mucus production in both asthma and COPD. They do not alter the course of the conditions, but they provide significant long-term control and management of symptoms At what point would an oral steroid be prescribed? Oral glucocorticoids may be required for patients with moderate to severe persistent asthma or for management of acute exacerbations of asthma or COPD. Because of their potential for toxicity, these drugs are prescribed only when symptoms cannot be controlled with safer medications (inhaled glucocorticoids, inhaled β2 agonists). Because the risk for toxicity increases with duration of use, treatment should be as brief as possible. When would roflumilast be indicated for a COPD patient? In patients with severe, chronic COPD, the risk for exacerbations may be reduced with roflumilast should be used in combination with a LAMA, a LABA, or an inhaled glucocorticoid. it is used for exacerbation prophylaxis in patients with severe COPD with a primary chronic bronchitis component and a history of frequent exacerbations. How does nicotine replacement work? NRT allows smokers to substitute a pharmaceutical source of nicotine for the nicotine in cigarettes—and then gradually withdraw the replacement nicotine. Five FDA-approved formulations are available: chewing gum, lozenges, transdermal patches, a nasal spray, and an inhaler patient education for NRT patches Nicotine patches are applied once a day to clean, dry, nonhairy skin of the upper body or upper arm. The site should be changed daily and not reused for at least 1 week. NicoDerm CQ patches are left in place for 24 hours and then immediately replaced with a fresh one. Most patients begin with a large patch and then use progressively smaller patches over several weeks. Certain patients (those with cardiovascular disease, those who weigh less than 100 pounds, and those who smoke less than one-half pack of cigarettes a day) should begin with a smaller patch. Patients who experience severe, persistent local reactions (e.g., severe erythema, itching, edema) should discontinue the patch and contact a medical provider. patient education for NRT gum The gum must be chewed to release the nicotine. After release, nicotine is absorbed across the oral mucosa into the systemic circulation. Patients should be advised to chew the gum slowly and intermittently for approximately 30 minutes. Rapid chewing can release too much nicotine at one time, resulting in effects similar to those of excessive smoking (e.g., nausea, throat irritation, hiccups). Because foods and beverages can reduce nicotine absorption, patients should not eat or drink while chewing or for 15 minutes before chewing After 3 months without cigarettes, patients should discontinue nicotine use. Withdrawal should be done gradually. Use of nicotine gum beyond 6 months is not recommended. patient education for NRT nasal spray Many patients continued to use the spray, being unwilling or unable to give it up. Nonetheless, because the spray delivers nicotine without the additional hazards in cigarettes, using the spray is clearly preferable to smoking but not ideal for long-term use. Adverse effects are mild and temporary. At first, most users experience rhinitis, sneezing, coughing, watering eyes, and nasal and throat irritation. Fortunately, these effects abate in a few days. Nicotine nasal spray should be avoided by patients with sinus problems, allergies, or asthma. Contraindications to Wellbutrin (for depression) Bupropion SR should not be given in conjunction with Wellbutrin (bupropion) or monoamine oxidase inhibitors. Use with caution in patients with history of seizure, anorexia nervosa, cocaine use, and alcohol withdrawal. Recommended length of treatment for Bupropion (smoking cessation) Decrease use after 7-12 weeks 150 mg PO daily × 3 days, 150 mg PO twice daily × 7-12 weeks Begin 1-2 weeks before smoking cessation What constitutes drug resistant TB? MDR-TB is defined as TB that is resistant to both isoniazid and rifampin, our two most effective antituberculosis (anti-TB) drugs. XDR-TB, a severe form of MDR-TB, is defined as TB that is resistant not only to isoniazid and rifampin but also to all fluoroquinolones (e.g., moxifloxacin) and at least one of the injectable second-line anti-TB drugs (amikacin, or capreomycin). Treatment of TB in a pregnant person, what all should be included? Rifabutin is deemed the safest during pregnancy. The CDC reports that the benefit justifies the risk for isoniazid, rifampin, and pyrazinamide. The CDC does not recommend rifapentine due to insufficient data in pregnant women. Ethambutol has caused teratogenesis in animal studies and there have been reports of eye abnormalities in children; therefore ethambutol should be given only if the benefits are judged to be greater than the risks. Examples of decongestant Phenylephrine (Neo-synephrine) ï Pseudoephedrine (Sudafed) ï Naphazoline (Privine) ï Oxymetazoline (Afrin, Dristan) ï Tetrahydrozoline (Tyzine) ï Xylometazoline (Otrivin) Which drug class has no significant drug interactions Expectorants have no known significant interactions with other medications?????????????? Isoniazid (INH) is a drug that can be used to prevent TB in people that have been exposed. Primary agent for treatment and prophylaxis of TB. This drug has early bactericidal activity and is superior to alternative drugs with regard to efficacy, toxicity, ease of use, patient acceptance, and affordability. asthma treatment photo Once a diagnosis of COPD is established, disease severity is assessed according to the Global Initiative Obstructive Lung Disease (GOLD) grading system. The grading system is based on which of the following criteria? Select all that apply. COPD-related hospitalizations symptoms the number of exacerbations spirometry results number of falls in the last 12 months COPD-related hospitalizations (Correct answer) symptoms (Correct answer) the number of exacerbations (Correct answer) spirometry results (Correct answer) number of falls in the last 12 months Pharmacological therapy in the treatment of stable COPD is outlined in the GOLD criteria. During periods of exacerbation, the majority of mild to moderate cases can be managed with bronchodilator therapy which may include one or more of the following. Select all that apply. phosphodiesterase-4 inhibitors long-acting B2 agonists (LABA) inhaled corticosteroids antibiotics long-acting antimuscarinic agents (LAMA) systemic corticosteroids phosphodiesterase-4 inhibitors long-acting B2 agonists (LABA) (Correct answer) inhaled corticosteroids (Correct answer) antibiotics (Correct answer) long-acting antimuscarinic agents (LAMA) (Correct answer) systemic corticosteroids (Correct answer) Jeanie is requesting a different medication regimen to alleviate her shortness of breath. Select an alternative medication for Jeanie that is from the same drug class as Spiriva. Select all that apply. Revefenacin Ipratropium bromide Formoterol Terbutaline Umeclidinium bromide Glycopyrronium bromide Revefenacin (Correct answer) Ipratropium bromide (Correct answer) Formoterol Terbutaline Umeclidinium bromide (Correct answer) Glycopyrronium bromide (Correct answer) Select an alternative medication for Jeanie that is from the same drug class as Symbicort. Select all that apply. Arfomoterol Formoterol/beclomethasone Formoterol/mometasone Erdosteine Tiotropium Arfomoterol Formoterol/beclomethasone (Correct answer) Formoterol/mometasone (Correct answer) Erdosteine Tiotropium COPD is classified as a chronic disease. Which of the following prevention strategies will help reduce the likelihood of exacerbations and improve Jeanie's overall quality of life: vaccinations including pneumonia and flu vaccines pulmonary rehabilitation physical activity smoking cessation nutritional counseling and support vaccinations including pneumonia and flu vaccines (Correct answer) pulmonary rehabilitation (Correct answer) physical activity (Correct answer) smoking cessation nutritional counseling and support (Correct answer)