NR 565 - ADVANCED PHARMACOLOGY MIDTERM EXAM QUESTIONS COMPLETE WITH 100% CORRECT ANSWERS

NR 565 - ADVANCED PHARMACOLOGY MIDTERM EXAM QUESTIONS COMPLETE WITH 100% CORRECT ANSWERS 1. A 28-year-old pregnant woman at 10 weeks gestation asks about taking a new medication for a chronic condition. What should the provider consider first? A) Drug metabolism is decreased during the second trimester B) The fetus is most vulnerable to drug effects during the first trimester C) Drug excretion is reduced during pregnancy D) The placenta provides complete protection to the fetus Answer: B The first trimester is when the fetus is undergoing rapid growth and organogenesis, making it most susceptible to adverse drug reactions with potential long-term consequences. During this period, drug exposure can cause structural birth defects. ________________________________________ 2. A 72-year-old patient with multiple comorbidities is prescribed a new medication. The provider checks the Beers Criteria before prescribing. What is the Beers Criteria? A) Guidelines for safe medication administration in pediatric patients B) Recommendations for medications that are potentially inappropriate for elderly patients C) Standards for drug testing in older adults D) Criteria for medication dosing in patients with liver disease Answer: B The Beers Criteria provides recommendations of medications that are potentially inappropriate for patients aged 65 and older. The prescriber ultimately makes the final decision about whether to use these medications. ________________________________________ 3. A patient is started on rifampin for tuberculosis. The provider notes that this medication will affect other drugs through which mechanism? A) Inhibition of gastric emptying B) Increased plasma protein binding C) Induction of CYP450 enzymes D) Inhibition of CYP450 enzymes Answer: C Rifampin is a CYP450 inducer that speeds up drug metabolism, causing drugs to be cleared faster and have lesser effects due to decreased blood levels. ________________________________________ 4. A patient taking warfarin is started on phenobarbital for seizure control. What effect would the provider expect on warfarin levels? A) Increased warfarin levels requiring dose reduction B) Decreased warfarin levels requiring dose increase C) No change in warfarin levels D) Increased risk of bleeding Answer: B Phenobarbital is a CYP450 inducer that speeds up metabolism. This will decrease warfarin levels, requiring a dose increase to maintain therapeutic effect. ________________________________________ 5. A patient is prescribed carbamazepine. Which of the following medications is a CYP450 inducer that could interact with carbamazepine? A) Ketoconazole B) Valproate C) Phenytoin D) Isoniazid Answer: C Phenytoin is a CYP450 inducer, along with barbiturates, St. John's wort, carbamazepine, rifampin, alcohol, and griseofulvin. The mnemonic "Bullshit Crap GPS INDUCES rage" can help remember these inducers. ________________________________________ 6. A patient is started on a medication that is a CYP450 inhibitor. What effect would this have on a concurrently administered drug that is metabolized by the same enzyme system? A) Decreased blood levels of the drug B) Increased blood levels of the drug C) Faster elimination of the drug D) No effect on drug levels Answer: B CYP450 inhibitors slow down metabolism, leading to increased blood levels of medications. This can result in toxicity and requires dose adjustments. ________________________________________ 7. A patient is prescribed ketoconazole for a fungal infection. The provider should monitor for increased levels of which concurrent medication? A) Warfarin B) Phenytoin C) Rifampin D) Carbamazepine Answer: A Ketoconazole is a CYP450 inhibitor (remember "VISA credit card debt INHIBITS spending on designers like CK to look GQ" - Valproate, Isoniazid, Sulfonamides, Amiodarone, Chloramphenicol, Ketoconazole, Grapefruit juice, Quinidine). It would increase levels of warfarin, increasing bleeding risk. ________________________________________ 8. Which of the following is NOT a CYP450 inhibitor? A) Valproate B) Grapefruit juice C) Amiodarone D) Phenobarbital Answer: D Phenobarbital is a CYP450 inducer, not an inhibitor. The CYP450 inhibitors include valproate, isoniazid, sulfonamides, amiodarone, chloramphenicol, ketoconazole, grapefruit juice, and quinidine. ________________________________________ 9. A pregnant woman in her third trimester has increased drug clearance. What physiological change is most responsible for this? A) Decreased hepatic metabolism B) Decreased glomerular filtration rate C) Increased glomerular filtration rate leading to increased drug excretion D) Decreased bowel motility Answer: C During pregnancy, the glomerular filtration rate increases, leading to increased drug excretion. Additionally, hepatic metabolism increases and bowel tone and motility decrease, which increases drug absorption. ________________________________________ 10. Which of the following medications is known to be teratogenic and should be avoided during pregnancy? A) Penicillin B) Acetaminophen C) Tetracycline D) Insulin Answer: C Tetracyclines are teratogenic antimicrobials. Other teratogenic medications include antiepileptic drugs, fluoroquinolones, large doses of vitamin A, some anticoagulants, and hormonal medications like diethylstilbestrol (DES). ________________________________________ 11. A pregnant woman requires an anticoagulant. Which medication should be avoided due to teratogenic risk? A) Heparin B) Low molecular weight heparin