NR 566 Final Exam Questions with Verified Answers (Correct
Update)
Question 1: Not use:
Answer: heart disease dementia alzeheimers disease
Question 2: Additional Notes
Answer: o If phenytoin is administered in doses only slightly greater than those needed for therapeutic
effects, the liver's capacity to metabolize the drug will be overwhelmed,
Question 3: causing plasma levels of phenytoin to rise dramatically. This unusual relationship
between
A. As you can see, after plasma levels have reached the therapeutic range, small changes in
dosage produce large changes in plasma levels. As a result, small increases in dosage can cause
toxicity, and small decreases can cause 566 Final Exam Study Guide 4 therapeutic failure. This
relationship makes it difficult to establish and maintain a dosage that is both safe and effective.
For this reason, serum drug levels and trough levels are often used, along with assessments of
seizure control, to determine dosage. ▪ Examples: If a patient is taking phenytoin 300mg daily for
seizures and their serum concentration is 8mg/L and they experience a considerable increase in
seizure activity, their dose would only need to increase to 350mg daily. o When on medications
for Alzheimer's Disease (A
D. and symptoms increase, it is better to increase the AD medication than to add things like
herbal medications, vitamins, or NSAIDs
Answer: dosage and plasma levels is illustrated in Fig. 21.1A. As you can see, after plasma levels have
reached the therapeutic range, small changes in dosage produce large changes in plasma levels. As a
result, small increases in dosage can cause toxicity, and small decreases can cause 566 Final Exam
Study Guide 4 therapeutic failure. This relationship makes it difficult to establish and maintain a dosage
that is both safe and effective. For this reason, serum drug levels and trough levels are often used, along
with assessments of seizure control, to determine dosage. ▪ Examples: If a patient is taking phenytoin
300mg daily for seizures and their serum concentration is 8mg/L and they experience a considerable
increase in seizure activity, their dose would only need to increase to 350mg daily. o When on
medications for Alzheimer's Disease (AD) and symptoms increase, it is better to increase the AD
medication than to add things like herbal medications, vitamins, or NSAIDs
Question 4: Adverse Effect of Nonselective α1 Blockers
Answer: Alfuzosin (Uroxatral, Xatral) Doxazosin (Cardura, Cardura XL) Therapeutic Effects ▪ Time to
achieve ▪ Patient education/Provider response ▪ Assessment for therapeutic effect Hypotension, fainting,
dizziness, somnolence, and nasal congestion (from blocking α1 receptors on blood vessels) alfuzosin do
not combine with CYP3A4-such as erythromycin, itraconazole, nefazodone, and HIV protease
inhibitors (e.g., ritonavir)-can dramatically increase levels. doxazosin do not take if pregnant and do not
give to patients older than 65.
Page 1
, Question 5: Adverse Effect of Phosphodiesterase-5 Inhibitor
Answer: Tadalafil (Cialis) ▪Time to achieve ▪ Patient education/Provider response ▪ Assessment for
therapeutic effect
-Hypotension, priapism Variability in response can be a problem if diet and timing are not considered.
High-fat meals will delay absorption of avanafil, sildenafil, or vardenafil (but not tadalafil), thus
delaying onset of action. Timing is important: Avanafil should be taken approximately 15-30 min before
sexual activity. All other PDE-5 inhibitors should be taken about 1 h before sexual activity. Only
tadalafil is approved for daily dosing. Stress the importance of having an examination for development
of vision or hearing changes. Explain that prolonged priapism lasting longer than 4 h is a surgical
emergency; present to the local emergency department if this occurs. Evaluating Therapeutic Effects:
Evaluate patient satisfaction with therapy.
Question 6: Adverse Effect of Selective α1a Blockers
Answer: Silodosin (Rapaflo) Tamsulosin (Flomax) Abnormal ejaculation (ejaculation failure, reduced
ejaculate volume, retrograde ejaculation). have little or no effect on blood pressure, they are of no
benefit to men with hypertension but are preferred if reducing blood pressure would be a problem. Risk
of floppy-iris syndrome during cataract surgery that causes pain, delay recovery, and reduce the
hoped-for improvement in vision acuity. In severe cases, the syndrome can cause defects to the iris that
may lead to blindness. Men anticipating cataract surgery should postpone α blocker therapy until after
the procedure. Men already taking an α blocker should be sure to tell their ophthalmologist. can cause
hypotension if taken with organic nitrates (e.g., nitroglycerin), antihypertensive drugs, and PDE-5
inhibitors used for ED (e.g., sildenafil [Viagra]). tamsulosin can be used to to improve urinary
symptoms. silodosin do not combine with CYP3A4-such as erythromycin, itraconazole, nefazodone,
and HIV protease inhibitors (e.g., ritonavir)-can dramatically increase levels.
Question 7: Adverse Effect of α1a Blocker/5-α-Reductase Inhibitor
Answer: Tamsulosin/dutasteride (Jalyn) Therapeutic Effects ▪ Time to achieve ▪ Patient
education/Provider response ▪ Assessment for therapeutic effect Decreased libido and abnormal
ejaculation (ejaculation failure, reduced ejaculate volume, retrograde ejaculation)
Question 8: Adverse Effects of 5-α-Reductase Inhibitors
Answer: Dutasteride (avodart) Finasteride (proscar) Both decrease prostate size. both cause Decreased
ejaculate volume and libido. Teratogenic to the male fetus. Both drugs can reduce prostate size, although
several months are required for a noticeable effect. FInasteride-can cause increased likelihood of a
high-grade tumor. gynecomastia develops in some men. finasteride can be absorbed through the skin,
pregnant women should not handle tablets that have been broken or crushed. Men are also advised not to
donate blood if taking finasteride or until at least 1 month after stopping the drug to avoid the risk of
having a pregnant woman as the blood recipient. One should be aware that prostate shrinkage occurs
slowly-over a period of 6 to 12 months. Dutasteride-It can be absorbed through the skin, so pregnant
women should not handle the drug. Men should not donate blood while using dutasteride or for at least 6
months after stopping it to avoid transmission to women through administration of blood products.
Page 2
Update)
Question 1: Not use:
Answer: heart disease dementia alzeheimers disease
Question 2: Additional Notes
Answer: o If phenytoin is administered in doses only slightly greater than those needed for therapeutic
effects, the liver's capacity to metabolize the drug will be overwhelmed,
Question 3: causing plasma levels of phenytoin to rise dramatically. This unusual relationship
between
A. As you can see, after plasma levels have reached the therapeutic range, small changes in
dosage produce large changes in plasma levels. As a result, small increases in dosage can cause
toxicity, and small decreases can cause 566 Final Exam Study Guide 4 therapeutic failure. This
relationship makes it difficult to establish and maintain a dosage that is both safe and effective.
For this reason, serum drug levels and trough levels are often used, along with assessments of
seizure control, to determine dosage. ▪ Examples: If a patient is taking phenytoin 300mg daily for
seizures and their serum concentration is 8mg/L and they experience a considerable increase in
seizure activity, their dose would only need to increase to 350mg daily. o When on medications
for Alzheimer's Disease (A
D. and symptoms increase, it is better to increase the AD medication than to add things like
herbal medications, vitamins, or NSAIDs
Answer: dosage and plasma levels is illustrated in Fig. 21.1A. As you can see, after plasma levels have
reached the therapeutic range, small changes in dosage produce large changes in plasma levels. As a
result, small increases in dosage can cause toxicity, and small decreases can cause 566 Final Exam
Study Guide 4 therapeutic failure. This relationship makes it difficult to establish and maintain a dosage
that is both safe and effective. For this reason, serum drug levels and trough levels are often used, along
with assessments of seizure control, to determine dosage. ▪ Examples: If a patient is taking phenytoin
300mg daily for seizures and their serum concentration is 8mg/L and they experience a considerable
increase in seizure activity, their dose would only need to increase to 350mg daily. o When on
medications for Alzheimer's Disease (AD) and symptoms increase, it is better to increase the AD
medication than to add things like herbal medications, vitamins, or NSAIDs
Question 4: Adverse Effect of Nonselective α1 Blockers
Answer: Alfuzosin (Uroxatral, Xatral) Doxazosin (Cardura, Cardura XL) Therapeutic Effects ▪ Time to
achieve ▪ Patient education/Provider response ▪ Assessment for therapeutic effect Hypotension, fainting,
dizziness, somnolence, and nasal congestion (from blocking α1 receptors on blood vessels) alfuzosin do
not combine with CYP3A4-such as erythromycin, itraconazole, nefazodone, and HIV protease
inhibitors (e.g., ritonavir)-can dramatically increase levels. doxazosin do not take if pregnant and do not
give to patients older than 65.
Page 1
, Question 5: Adverse Effect of Phosphodiesterase-5 Inhibitor
Answer: Tadalafil (Cialis) ▪Time to achieve ▪ Patient education/Provider response ▪ Assessment for
therapeutic effect
-Hypotension, priapism Variability in response can be a problem if diet and timing are not considered.
High-fat meals will delay absorption of avanafil, sildenafil, or vardenafil (but not tadalafil), thus
delaying onset of action. Timing is important: Avanafil should be taken approximately 15-30 min before
sexual activity. All other PDE-5 inhibitors should be taken about 1 h before sexual activity. Only
tadalafil is approved for daily dosing. Stress the importance of having an examination for development
of vision or hearing changes. Explain that prolonged priapism lasting longer than 4 h is a surgical
emergency; present to the local emergency department if this occurs. Evaluating Therapeutic Effects:
Evaluate patient satisfaction with therapy.
Question 6: Adverse Effect of Selective α1a Blockers
Answer: Silodosin (Rapaflo) Tamsulosin (Flomax) Abnormal ejaculation (ejaculation failure, reduced
ejaculate volume, retrograde ejaculation). have little or no effect on blood pressure, they are of no
benefit to men with hypertension but are preferred if reducing blood pressure would be a problem. Risk
of floppy-iris syndrome during cataract surgery that causes pain, delay recovery, and reduce the
hoped-for improvement in vision acuity. In severe cases, the syndrome can cause defects to the iris that
may lead to blindness. Men anticipating cataract surgery should postpone α blocker therapy until after
the procedure. Men already taking an α blocker should be sure to tell their ophthalmologist. can cause
hypotension if taken with organic nitrates (e.g., nitroglycerin), antihypertensive drugs, and PDE-5
inhibitors used for ED (e.g., sildenafil [Viagra]). tamsulosin can be used to to improve urinary
symptoms. silodosin do not combine with CYP3A4-such as erythromycin, itraconazole, nefazodone,
and HIV protease inhibitors (e.g., ritonavir)-can dramatically increase levels.
Question 7: Adverse Effect of α1a Blocker/5-α-Reductase Inhibitor
Answer: Tamsulosin/dutasteride (Jalyn) Therapeutic Effects ▪ Time to achieve ▪ Patient
education/Provider response ▪ Assessment for therapeutic effect Decreased libido and abnormal
ejaculation (ejaculation failure, reduced ejaculate volume, retrograde ejaculation)
Question 8: Adverse Effects of 5-α-Reductase Inhibitors
Answer: Dutasteride (avodart) Finasteride (proscar) Both decrease prostate size. both cause Decreased
ejaculate volume and libido. Teratogenic to the male fetus. Both drugs can reduce prostate size, although
several months are required for a noticeable effect. FInasteride-can cause increased likelihood of a
high-grade tumor. gynecomastia develops in some men. finasteride can be absorbed through the skin,
pregnant women should not handle tablets that have been broken or crushed. Men are also advised not to
donate blood if taking finasteride or until at least 1 month after stopping the drug to avoid the risk of
having a pregnant woman as the blood recipient. One should be aware that prostate shrinkage occurs
slowly-over a period of 6 to 12 months. Dutasteride-It can be absorbed through the skin, so pregnant
women should not handle the drug. Men should not donate blood while using dutasteride or for at least 6
months after stopping it to avoid transmission to women through administration of blood products.
Page 2
