Week 8 F inal Exam: NR565 / NR 565 (Latest 2026 / 2027) Advanced Pharmacology Fundamentals | Questions & Answers | 100% Correct | Grade A - Chamberlain

Week 8 F inal Exam: NR565 / NR 565 (Latest 2026 / 2027) Advanced Pharmacology Fundamentals | Questions & Answers | 100% Correct | Grade A - Chamberlain Qu estion: What labs are used to diagnose Thyroid disease? Answer TSH (0.3-6), Free T3 (230-620), total T3 (80-220),Total T4(4.5-12.5), & Free T4(0.9-2) *TSH & T4 preferred* Qu estion: What is the timeframe for re-check of labs after starting levothyroxine? Answer Check TSH 6-8 weeks after initiating therapy and afterdosage changes. Check TSH at least once a year afterserum TSH is stabilized. Qu estion: What are the signs and symptoms of hypothyroidism? Answer Pale, puffy, expressionless face, cold, dry skin, brittle hair, hair loss, heart rate and temp low, lethargy, fatigue, constipation, weight gain, intolerance to cold. Menstruation impairment, thyroid enlargement. Qu estion: What are the signs and symptoms of hyperthyroidism? Answer Heartbeat rapid and strong, dysrhythmias, angina, CNS stimulation-nervousness, insomnia, rapid thought process, rapid speech, skeletal muscles weaken and atrophy, metabolic rate raised, increased heat production, increased body temp, intolerance to heat, skin is warm and moist, appetite is increased, weight loss, exophthalmos. Qu estion: What are the Drug/Food/Supplement interactions that reduce levothyroxine absorption? Answer Histamine 2 (H2) receptor blockers, PPI, Sucralfate, Cholestyramine, Colestipol, Aluminum containing antacids, Calcium supplements (Tums, Os-Cal), Iron supplements, Magnesium salts, and Orlistat Qu estion: What are the drugs that accelerate levothyroxine metabolism? Answer Dilantin, carbamazepine (Tegretol, Carbatrol), rifampin (Rifadin), sertraline (Zoloft), and phenobarbital. *To maintain adequate levothyroxine levels, patients may need to increase their dosage* *The effects of warfarin are enhanced, dosage may need to be decreased. Also increases the risk for catecholamine-induced dysrhythmias.* *Can increase the requirements for insulin and digoxin.* Qu estion: What is the treatment of thyroid storm? Answer Treatment of thyroid storm- high doses of potassium iodide or strong iodine solution, methimazole suppresses hormone synthesis, Beta-blockers reduce heart rate, sedation, cooling, and giving glucocorticoids and IV fluids also help. Qu estion: What are the results for a pregnant woman treating hypothyroidism? Answer Untreated hypothyroid in pregnancy- causes permanent neuropsychological deficits in the child, congenital hypothyroidism, decreased IQ (mainly occurs during the 1st trimester and increases up to 50%). Qu estion: What medication is given to treat symptoms of hyperthyroidism? Answer Beta blockers to treat severe tachycardia. Qu estion: Etiology can be related to exogenous T4 ingestion, a concurrent non-thyroidal illness, or amiodarone-induced thyroid dysfunction. What is the diagnostic information the NP will receive? Answer TSH is low, free T4 is high and T3 is normal Qu estion: Possibility of a TSH producing pituitary tumor, which would need to be evaluated further with MRI. What is the diagnostic information the NP will receive? Answer Serum TSH is normal or elevated, and free T4 & T3 are elevated. Qu estion: Primary hyperthyroidism. However, other reasons for this thyroid function test abnormality could be exogenous T3 ingestion, or a functioning adenoma. Answer TSH is low, Free T4 is normal, and serum T3 is high. Qu estion: How to confirm a diagnosis of diabetes prior to beginning treatment? Answer FPG: greater than 126 Random plasma glucose: greater 200 with symptoms of diabetes. OGTT: 2 hour plasma glucose greater than 200 A1c: 6.5 or higher Qu estion: What is the A1c general goal? Answer Less than 7% Qu estion: What is the A1c goal for older adults Answer Less than 8% Qu estion: When should insulin be considered? Answer When should insulin be considered- in type 1 DM and in type 2 step 4 of the ADA guideline after a 3 drug combination is unsuccessful; or in patients with an A1c 10% or greater Qu estion: At what time interval should A1c be re-checked? Answer Every 3 months until A1c is less than 7% and then every 6 months thereafter. Qu estion: What is the action of Insulin? Answer Anabolic promotes energy conservation and storage of glycogen, cell growth and division, and transport of glucose, amino acids, nucleotides, and potassium. Additionally, it stimulates the synthesis of complex organic molecules. Qu estion: What is contraindicated for patients taking a Thiazolidinediones particularly Pioglitazone? Answer Patients with severe HF and used with caution in patients with mild HF or symptoms of HF. Patients with bladder cancer or history of bladder cancer. Pioglitazone can increase the risk for fractures in women only. Can cause ovulation in premenopausal women resulting in unintended pregnancy. Qu estion: What is the MOA for GLP-1? Answer Glucagon-like Peptide-1 receptor agonists: Lowers blood glucose by slowing gastric emptying, stimulating glucose-dependent insulins release, suppressing postprandial glucagon release, and reducing appetite. What is the MOA for TZD? Answer Thiazolidinediones: Decrease insulin resistance which increase glucose uptake by muscle and adipose tissue. Decreases glucose production by the liver. What is the MOA for DPP4-I? Answer Dipeptidyl Peptidase-4 Inhibitors: Enhance the activity of incretins by inhibiting their breakdown by DPP-4, which increases insulin release, reduces glucagon release, and decreases hepatic glucose production. What is the MOA for SGLT2i? Answer Sodium-Glucose Cotransporter 2 Inhibitors: Increases glucose excretion by the kidneys by inhibiting SGLT-2 in the tubules, decreases glucose levels and weight loss by caloric loss through urine. Which drug class should be considered for diabetes prior to insulin? Answer GLP-1 should be considered. Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin. Answer TDD = 0.6 units/kg/day What is the carbohydrate to insulin ratio when calculating basal insulin? Answer Use the 450 rule. 450/TDD Simple calculation: Patient weighs 184 pounds which = 80kg To calculate the TDD of insulin: 0.6 x 80 = 48 units 50% is basal insulin dose. In this example, 24 units of glargine (Lantus). 50% rapid-acting bolus/mealtime insulin = 24 units. The mealtime carbohydrate-to-insulin does is calculated using 450 rule for regular and 500 rule for rapid-acting insulin. Divide 500/TDD = 10.4 (round to 10). The carb-to-insulin ratio is 1:10. If the meal is 60 grams of carbs, then 60/10 = 6 units of rapid-acting insulin for carb exchange. Which medications come with a concern of hypogylcemia? Answer Second-generation Sulfonylureas like; Glimepiride, Glipizide, Glyburide. Thiazolidinediones: Pioglitazone (Actos), Rosiglitazone (Avandia). Hypoglycemia only in the presence of excessive insulin. GLP-1: Exenatide (Byetta) & the extended release, Liraglutide, Dulaglutide (Trulicity), Lixisenatide (Adlyxin). The MOA of Sulfonylureas Answer Stimulates beta cells of the pancreas to secrete more insulin. Diabetic drug classifications: Answer SGLT2 inhibitors. (-flozin) DPP-4. (-gliptin) GLP-1 Agonists (-tide) TZDs. (-zone) Sulfonyleureas. (-ide) GLP-1 Agonists: Answer These subcutaneous injections cause an increase in insulin production and inhibit postprandial glucagon release and increase satiety. GLP-1 drugs can be helpful in obese patients as they stimulate weight loss and suppression of appetite without causing hypoglycemia. SGLT2 inhibitors Answer Sodium-glucose cotransporter-2 inhibitors (SGLT2) block glucose reabsorption by the kidneys in the proximal nephron and increase the release of glucose in urine. SGLT2 agents are effective in all stages of type 2 DM with no concerns for hypoglycemia. Due to SGLT2 actions on the kidneys, there is a risk for volume depletion and hypotension and can lead to diabetic ketoacidosis. DPP-4 inhibitors Answer Dipeptidyl peptidase-4 inhibitors (DPP-4i) inhibit DPP-4 activity and increase active incretin concentrations which result in increased insulin secretion and decreased glucagon. Risk of hypoglycemia is not related to these actions. DPP-4i agents may cause severe and disabling joint pain that can occur at any point in time during treatment. Additionally, DPP-4i drugs may cause angioedema and acute pancreatitis. TZDs Answer Thiazolidinediones (TZD) enhance insulin sensitivity in muscle tissue and reduce glucagon production in the liver. These medications should be taken daily with breakfast and can be combined with other diabetic agents. TZD should be avoided in patients with congestive heart failure (CHF) as it causes water retention and edema, which aggravates CHF. Sulfonylureas Answer Sulfonylureas stimulate beta cells of the pancreas to secrete more insulin. Sulfonylureas have a long half-life and are not commonly utilized due to a high risk of severe hypoglycemia. They also cause photosensitivity; therefore, patient education is needed regarding sunscreen. Sulfonylureas should be avoided in patients with impaired hepatic or renal function. ___________________ decreases glucose production by the liver & increase tissue response to insulin. Answer Metformin ______________ & _______________ promote insulin secretion by the pancreas. Answer Sulfonylureas & Meglitinides __________ decreases insulin resistance & thereby increase glucose uptake by muscle & adipose tissue & decrease glucose production by the liver. Answer TZDs ________________________ enhance the activity of incretins & thereby increase insulin release, decrease glucagon release, & decrease glucose production by the liver. Answer Dipeptidyl Peptidase - 4 (DPP-4) Inhibitors ___________________ increase glucose excretion vial the urine by inhibiting SGLT-2 in the kidney tubules, decrease glucose levels & inducting weight loss by caloric loss through urine. Answer Sodium-Glucose Cotransporter 2 (SGLT-2) ______________ lower blood glucose by slowing gastric emptying, stimulating glucose dependent insulin release, suppressing postprandial glucagon release, & decrease appetite. Answer Glucagon-like Peptide-1 (GLP-1) Who should receive Tdap vaccination? Answer Adults in close contact with infants healthcare workers Contraindication for Tdap vaccine Severe allergic reaction to previous dose, or hx of encephalopathy within 7 days of vaccine Varicella vaccine contraindications Hx of anaphylaxis with previous dose, allergy to gelatin or neomycin Hepatitis B vaccine contraindications Previous rxn to vaccine, allergy to yeast and neomycin Examples of attenuated vaccines measles, mumps, rubella, chickenpox, yellow fever, rotavirus examples of live vaccines MMR, varicella, rotavirus, influenza examples of toxoid vaccines Diphtheria, tetanus, pertussis, Examples of inactive viral antigen vaccine Poliovirus (SALK), Hep A, Hep B, influenza What are the types of immunity? active, passive, and herd Define vaccine suspension of organisms or fractions of organisms that induce immunity Post exposure prophylaxis for Rabies human rabies immunoglobulin + human diploid cell vaccine on days 0,3,7,14 Patient teaching after vaccination Redness and swelling can occur at site, mild fever or fatigue Who can receive attenuated influenza vaccine (Flumist) individuals 2yo an d less than 50. non pregnant, and those who are not immunocompromised Pantoprazole dosing 40 - 80 mg ORAL or IV Qday Metronidazole (Flagyl) dosing 250 mg 4x day or 500mg BID for 7-14 days Ondansetron (Zofran) dosing -8/24mg po 30 minutes prior to chemo initiation -8/16 mg po Q12h for 1/2 days after chemo administration -TOP 200 Albuterol Sulfate (inhalation) dosage 2 inhalations What labs are used to diagnose thyroid disease TSH T3 T4 When should you recheck labs after starting levothyroxine 6-8 weeks until euthyroid state signs and symptoms of hypothyroidism Thin, dry hair Thick, brittle nails constipation bradycardia Goiter PeriOrbital edema cold intolerance weight gain signs and symptoms hyperthyroidism 1. heat intolerance (high heat production) 2. weight loss, increased appetite 3. hyperactivity 4. diarrhea 5. high reflexes 6. pretibial myxedema (Graves) 7. warm moist skin; fine hair 8. chest pain, palpitations, arrhythmias, increased β-adrenergic receptors Treatment of thyroid storm - Propylthiouracil (preferred) or methimazole - iodine-potassium solutions - glucocorticoids - beta blockers Result of not treating hypothyroidism during pregnancy Permanent neuro-psychological deficits in the child. Decrease IQ/neuropsychological function. First trimester. Treatment of hyperthyroidism - Radioactive iodine (I131) works by destroying the thyroid gland - Surgery to remove all or part of the thyroid gland - Lifelong thyroid hormone replacement will be needed Levothyroxine interactions anticoagulants antacids sucralfate turnips, cabbage, strawberries, peaches, spinach, peas, radishes how to diagnose diabetes Elevation of blood glucose, as determined by one of three tests: 1) Random blood glucose concentration higher than 200 mg/dL 2) Fasting glucose concentration of 126 mg/dL on more than one occasion 3) Abnormal oral glucose tolerance test A1C goal for diabetics 7% per ADA standards A1C goal for older adults 7-8% When treating diabetes when should insulin be considered A1C greater than 10% How often should A1C be rechecked Every 3-4 months What is the action of insulin Transporting glucose through the cell membrane therefore lowering blood glucose Pioglitazone (Actos) contraindications Type 1 diabetes Diabetic ketoacidosis Hypersensitivity Clinical evidence of active liver disease Active bladder cancer Diabetic drug classifications GLP-1 TZD DPP-4i Sulfonylureas SGLT2i Which drug class should be considered for diabetes prior to insulin It is recommended that a GLP-1 be considered before starting insulin. Metformin first always unless contraindicated. Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin Basal and bolus insulin replacement encompasses approximately 50% of the total daily insulin dose (TDD) Example: TDD = patient's weight in kg (80kg) x 0.6 units = 48 units. That means 24 units of the TDD is the basal insulin dose and the other 24 units is rapid-acting. Carbohydrate to insulin ratio when calculating basal insulin 500 divided by TDD Which diabetic medications come with concern of hypoglycemia Insulin, meglitinides, sulfonylureas, amylin analogues Who is at risk for Methylxanthines toxicity Older Adults taking anticholinergics and beta agonists Smokers Step 1 therapy for asthma and COPD Manage with a SABA (albuterol) as needed. Asthma Step 1: Intermittent SABA PRN Asthma Step 2: Mild Persistent -General Symptoms 2 times/week BUT 1 time/day; exacerbations may affect activity -Night Symptoms 2 times/month -Lung Function: FEV1 or PEF ≥80% predicted. PEF variability 20-30% Asthma Step 3: Moderate Persistent -General Symptoms: Daily symptoms. Daily use of inhaled SABA. Exacerbations ≥2 times/week; may last days. -Night symptoms 1 time/week -Lung Function: FEV1 or PEF 60% to 80% predicted. PEF variability 30% Asthma Step 4: Severe Persistent -General Symptoms: Continued symptoms. Limited physical activity. Frequent exacerbations. -Night Symptoms: Frequent -Lung Function: FEV1 or PEF 60% predicted. PEF variability 30% SABAs albuterol, levalbuterol, terbutaline Benefits of SABA Short acting relief of bronchospasm Relieves asthma attacks SABA patient teaching Advise patients to use albuterol first if using other inhalation medications and allow 5 min to elapse before administering other inhalant medications unless otherwise directed. Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth and clean the mouthpiece with water at least once a week. Instruct patient to notify health care professional if there is no response to the usual dose or if contents of one canister are used in less than 2 wk. Asthma and treatment regimen should be re evaluated and corticosteroids should be considered. Need for increased use to treat symptoms indicates decrease in asthma control and need to re-evaluate patient's therapy. Importance of knowing how often to use SABA Can be deadly if misuse LABAs Salmeterol Formoterol Oldaterol Benefits to a LABA are? Less frequent dosing and nocturnal protection LABA use in COPD Usually first line in combination with LAMA Examples of inhaled corticosteroids beclomethasone, budesonide, fluticasone Benefits of inhaled corticosteroids Decrease eosinophils/mast cells/T-lymphocytes Inhibit transcription of inflammatory genes in airway epithelium Reduce endothelial cell leak Upregulate B2 receptor production Reduce airway epithelial subbasement membrane thickening Steroid use in asthma Short course of oral when asthma attack occurs usually prednisone When would roflumilast be indicated for a COPD patient? (PDE4 inhibitor) Severe cases of COPD with a primary component of chronic bronchitis. COPD exacerbations. How does nicotine work? when it gets into the brain, it attaches to acetylcholine receptors and mimics the actions acetylcholine. It also activates areas of the brain that are involved in producing feelings and pleasure and reward. Nicotine Replacement Therapy (NRT) a form of medicine that delivers small amounts of nicotine to the body to help a person quit using tobacco Nicotine replacement education inhalers should not be used by clients with asthma, with the gum and loengers no eating or drinking 15 minutes prior to using and during, with the patch take off at night because can cause nightmares or sleep disturbances and teach patient not to use other nicotine products while using patch due to the stimulation of the CNS, the lozenges need to slowly dissolve for effectiveness and no more then 5 in a 6 hrs period Wellbutrin Contraindications caution in patients with a history of seizures, anorexia nervosa, cocaine use, and alcohol withdrawal and bupropion. SR should not be given with MAOI inhibitors Bupropion (Wellbutrin) length of treatment 7-12 weeks Drug resistant TB resistant to at least one first-line anti-TB drug Treatment of TB in pregnancy 2 mos: INH, RIF, EMB 7 mos: INH, RIF Isoniazid (INH) -antiTB - take daily for 6-12 months and most likely with other meds too -worked if 3 neg. sputum cultures, no temp. - Liver toxicity (hepato) check liver fxn - Don't take with alcohol (liver fxn remember?) - Take on empty stomach Examples of decongestants Phenylephrine Pseudoephedrine Which drug class has no significant drug interactions Expectorants Examples of H2 receptor antagonists Cimetidine Ranitidine Famotidine Nizatidine Which H2RA has the most drug interactions? Cimetidine PPI associated with what deficiency Calcium Magnesium B12 Short term use of PPI increases risk of Community Acquired PNA How to treat moderate to severe GERD Long-term maintenance therapy of PPI is recommended for severe. Moderate??? GERD treatment in older adults Avoid long term PPI due to associated bone fracture and vitamin and mineral deficiency Which cytoprotective agents can be given in pregnancy Carafate When to test for H. pylori If on treatment and not getting better. Consider testing before prescribing H2 receptor antagonists/PPIs. how to treat H. pylori 2 antibiotics, PPI, pepto. MOC. AOC Lifestyle modification to support ulcer healing 5-6 small meals a day, stop smoking, avoid NSAIDs Which antidiarrheal agent should not be used in children during or after chickenpox Pepto-Bismol (Bismuth Subsalycitate) Traveler's diarrhea E. coli Traveler's Diarrhea Treatment Cipro Ciproflaxin (Cipro) teaching in Travelers Diarrhea Only start if symptoms are progressive and not getting better with pepto What drug is associated with gray/black stool and black tongue Pepto-Bismol (Bismouth Subsalicylate) constipation lifestyle changes regular exercise increase fluids!!! bowel habit training Increase fiber Risks of laxatives during pregnancy Gastrointestinal stimulation can induce labor. Constipation treatment in pregnancy Lifestyle -Try fiber (psyllium, methyl cellulose) with adequate fluids first -docusate and PEG are used to prevent and treat Constipation treatment in breastfeeding Senna How does psyllium work? absorbs H2O into GI tract to increase bulk of stool What happens when psyllium doesn't produce bowel movements Can result in fecal impaction and obstruction Abd pain should be assessed with no BM Why is a diary important in treatment and diagnosis of IBS Can identify triggers how to treat gastroparesis Prokinetic drug is best Reglan black box warning reglan tardive dyskinesia Metronidazole education -avoid ETOH during and 2 days after -take on empty stomach -dry mouth