ADVANCED PHARMACOLOGY FINAL EXAM REVIEW DUE 21ST JUNE 2024/2025

ADVANCED PHARMACOLOGY FINAL EXAM REVIEW DUE 21ST JUNE 2024/2025 Why are nitrate-free periods every 24 hours necessary for the patient on nitroglycerin therapy? - CORRECT ANSWER-To inhibit the development of tolerance What does a low level of thyroid-stimulating hormone indicate? - CORRECT ANSWERHyperthroidism What would be the best option to treat a newly diagnosed patient with a low TSH level with? - CORRECT ANSWER-Propanolol (Inderal) Spironoaldactone (Aldactone) has what mechanism of action (MOA)? - CORRECT ANSWER-Aldosterone antagonist Heparin exerts its therapeutic action by what? - CORRECT ANSWER-Upregulating the activity of one of the body's natural anticoagulant molecules, antithrombin III What physiologic action happens when the offending drug is administered during an anaphylactic reaction. - CORRECT ANSWER-Mast cells liberate large doses of histamine. What are two systemic psoriasis medications? - CORRECT ANSWER-Photo-therapy and topical corticosteroids What is the first choice of drug therapy for the majority of patients with uncomplicated stage I hypertension? - CORRECT ANSWER-Thiazide diuretics What is the effect of cardiac glycosides? - CORRECT ANSWER-Digitalis glycosides have a negative chronotropic effect on the cardiac muscle cells. Amenorrhea is the most common side effect of which birth control medication? - CORRECT ANSWER-Medroxyprogesterone (Depo-Provera) What is an anti-hypertensive agent which competes with epinephrine for available betareceptor sites? - CORRECT ANSWER-Atenolol (Tenormin) What type of action does nitrates have on the body? - CORRECT ANSWER-Reduction in systemic venous tone. What is the recommended level of low-density lipoprotein cholesterol (LDL) for patients with known coronary artery disease? - CORRECT ANSWER-100mg/dl or less. What is the MOA of group IV anti-dysrhythmia drugs? - CORRECT ANSWERDepressing phase 4 depolarization and lengthening phases 1 and 2 repolarization. Which drug therapy should be used to lower the serum concentration of thyroid hormones and re-establish eumetabolic state in a patient with Graves' disease? - CORRECT ANSWER-Anti-thyroid drugs. Which type of diuretic would be used for a stage I hypertension in a patient with renal insufficiency? - CORRECT ANSWER-Loop diuretic. What drug should be considered as first-line therapy for a client with hypertension and heart failure? - CORRECT ANSWER-Enalapril (Vasotec) Which drug is considered safe for hypertension treatment during pregnancy? - CORRECT ANSWER-Methyldopa (Aldomet) What drug will reduce afterload because it is an alpha-adrenergic blocker? - CORRECT ANSWER-Prazosin (Minipress) What is an expected effect of the use of a beta-adrenergic blocker to control angina? - CORRECT ANSWER-Reduced force of cardiac contraction. What side effect should be monitored closely in the elderly when taking Metformin (Glucophage) for type 2 diabetes? - CORRECT ANSWER-Lactic acidosis. What is the primary role of cytochrome p-450 in the liver? - CORRECT ANSWERDeactivate and detoxify medications and other substances. What is a component of Vitamin K-dependent clotting factors? - CORRECT ANSWERProthrombin How are IV morphine and nitroglycerin beneficial in acute heart failure? - CORRECT ANSWER-Decrease preload. What is the purpose of administering a vasodilating drug to a patient in heart failure? - CORRECT ANSWER-Decrease afterload. What are some contrindications for HMG-co A reductase inhibitors (statins)? - CORRECT ANSWER-They cause myopathies, especially at higher doses or in combination with certain drugs. They should never be used in patients taking Warfarin (Coumadin). Which drug can reduce serum LDL the most in patients with hyperlipidemia? - CORRECT ANSWER-Lovastatin (Mevacor) Which drug is contrindicated in a patient with Myasthena Gravis? - CORRECT ANSWER-Procainamide (Pronestyl). What action is most effective in decreasing the risk of hyperkalemia associated with the start of angiotensin-converting enzyme inhibitor (ACEI) therapy? - CORRECT ANSWER-Making sure that the patient is well hydrated. What factor influences plasma protein drug binding and distribution of that drug? - CORRECT ANSWER-The amount of albumin available in the blood stream. What does the half-life of a medication determine? - CORRECT ANSWER-How often the drug is to be administered. What important information should be given to a patient who is taking Metoprolol (Lopressor) for angina and hypertension? - CORRECT ANSWER-The drug should not be taken with milk or dairy products. Which medications should be avoided for patients with a sulfa allergy? - CORRECT ANSWER-Sulfamethoxazole/Trimethoprim (Bactrim) and Celecoxib (Celebrex). What should be taken into consideration when prescribing fat-soluable drugs in the elderly? - CORRECT ANSWER-They are associated with increased duration of drug action. Which hypolipidemic class of drugs does not have to have liver function studies? - CORRECT ANSWER-Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) FYI: I actually just looked this up because it didn't seem right...From the FDA: "The good news—no more periodic blood tests for liver function. The warnings—taking a statin may increase the odds of developing type 2 diabetes or suffering reversible memory loss or problems thinking. The FDA warned that one statin, lovastatin, shouldn't be taken with some antibiotics, anti-fungal agents, or medications used to treat AIDS." What is the MOA of cardiac glycosides? - CORRECT ANSWER-Increase the force of cardiac contraction. What age-related changes place the elderly at risk for an exaggerated response to Warfarin (Coumadin) and Heparin? - CORRECT ANSWER-Protein binding changes and decrease in clotting factors. Along with diet, what drug is used to treat hypertriglyceridemia? - CORRECT ANSWERGemfibrozil (Lopid). What drug is the best choice of treatment for a newly diagnosed patient with type 2 diabetes only having postprandial glucose elevation? - CORRECT ANSWERMeglitinide (Prandin). Which medication is considered the safest for a diabetic patient if hypoglycemia is a major concern? - CORRECT ANSWER-Metformin (Glucophage). What drug is an absolute contraindication if the patient is a smoker and taking medications for type 2 diabetes? - CORRECT ANSWER-Birth control. How should an oral glucocorticoid be taken? - CORRECT ANSWER-With food. The normal starting dose of levothyroxine is 50-100mcg per day for primary hypothroidism. What is the most appropriate starting dose in a 71-year old female patient? - CORRECT ANSWER-25mcg per day. What drug class should be avoided in patients with a diagnosis of osteopenia or osteoporosis? - CORRECT ANSWER-Clucocorticoids like Prednisone. What thyroid drug blocks thyroid hormone production and release? - CORRECT ANSWER-L-thyroxine (Levothyroid). What drug class exacerbates hyperglycemia? - CORRECT ANSWER-Corticosteroids like Prednisone (Deltasone). What drug would you add for a patient who has been taking a sulfonylurea medication like Glipizide (Glucotrol) for type 2 diabetes when there is poor glucose control? - CORRECT ANSWER-Add Metformin (Glucophage) to the sulfonylurea. Which drug class may predispose an insulin dependent patient to hypoglycemia? - CORRECT ANSWER-A selective beta-adrenergic blocker like Nadolol (Corgard). What side effects may an elderly patient who has just been placed on a calcium channel blocker for treatment of hypertension and angina except to watch for? - CORRECT ANSWER-Constipation, peripheral edema, and decreased heart rate. What might be a probable cause of a decreased digoxin level of 0.5mg/ml in a 70-year old with previously stable levels be a result of? - CORRECT ANSWER-Antacid use. What drug used in the treatment of congestive heart failure is NOT associated with decreased mortality? - CORRECT ANSWER-Digoxin (Lanoxin). A patient complains of "puffy feet" shortly after beginning a new medication three months ago. There is no underlying physiological cause for this condition. What medication is most likely causing the problem? - CORRECT ANSWER-Amlodipine (Norvasc).