ADVANCED PHARMACOLOGY FINAL EXAM LATEST
REAL EXAM QUESTIONS AND CORRECT ANSWERS|
AGRADE
Anti-Viral Medications - ANSWER: powerpoint;
1. Describe the indications, contraindications, MOA, ADE, and monitoring of drugs
and drug classes discussed in this lesson (See Final Exam Drug List).
2. Provide an example of an antimicrobial that can have a loading dose. Explain the
purpose of loading dose.
3. Explain essential principles of antiretroviral therapy (ART) and monitoring
required.Links to an external site.
Links to an external site.4. Compare and contrast PrEP and PEP (monitoring,
indications).
5. Identify major causes for antiretroviral therapy (ART) resistance.
5. Describe the use of antiviral medications (i.e acyclovir, famciclovir, etc.) for
shingles or herpes virus and how you would select on antiviral medication over the
other, and monitoring prior to and during treatment.
6. Explain how Tamiflu (oseltamivir) works.
7. Application of indication, MOA, ADE, and monitoring of drug class and drugs (See
Test 3 Drug List) to answer clinical case scenarios
Herpes - ANSWER: herpes simplex and herpes zoster.
Herpes/Varicella/Zoster (HSV/VZV) medications, MOA, side effects, monitoring -
ANSWER: •famciclovir (Famvir)
•MOA: inhibits DNA polymerase, selectively inhibiting herpes viral DNA synthesis
and replication
•valacyclovir (Valtrex) & acyclovir (Zovirax)
•MOA: inhibits DNA polymerase; incorporates into viral DNA
•ADR: psychosis, encephalopathy, seizures, coma, hepatitis, neutropenia,
thrombocytopenia, jaundice, anaphylaxis, angioedema, Stevens-Johnson syndrome,
hallucination, delirium, ha, nausea, diarrhea, vomiting, fatigue
•Monitoring: Cr at baseline; acyclovir is most prescribed due to being cheapest, need
higher doses of acyclovir.; famciclovir works slightly different
Genital HSV First episode, suppressive therapy, episodic therapy - ANSWER: •First
Episode
•New acquired genital herpes can cause prolonged clinical illness w/ severe genital
ulcerations and neurlogic involvement
•All should be treated at the recommended dosage
•Acyclovir, valcyclovir or famciclovir
•Suppressive Therapy
•Reduces frequency of genital herpes recrurance by 70-80%
•Treatment w/valcyclovir (Valtrex) daily reduces risk of transmission in discordant
heterosexual couples
•Acyclovir (Zovirax), valcyclovir (Valtrex) or famciclovir (Famvir)
,•Episodic Therapy
•To be initiated at first sign
•Acyclovir, valvyclovir or famciclovir (Famvir); first episode at higher dosage. cdc
regimen recommendation is written alphabetically so not necessarily most
recommended. famciclvir is outside of abc order and is last because should be last
resort. no cream or ointment, need oral medications. suppressive therapy taken
every day; no monitoring for suppressive therapy just education annually; episodic
needs on hand and treats outbreaks
Oral herpes labialis treatment - ANSWER: •Famciclovir (Famvir) superior to acyclovir
or valacyclovir (Valtrex) for episodic treatment
•Suppressive treatment
• Valacyclovir (Valtex), Acyclovir (Zovirax)
•Cream
•docosanol cream (Abreava), acyclovir cream; fever blister. respond better to
famcyclovir than acyclovir; can use creams. famcyclovir is one time dose. acyclovir is
over five days dosing. can be anywere on skin; oral outside of mouth. creams only
used for mouth
HIV/AIDS - ANSWER: antiretroviral therapy; HAART; comanaged with infectious
disease; cdc guidelines; prophylaxis can be initiated in primary care. ensure can get
medications if displaced.
HIV/AIDS Goals of Treatment - ANSWER: 1.Achieve maximal suppression of plasma
viral load for as long as possible
2.Delay the development of medication resistance
3.Preserve CD4 T-cell numbers
4.Confer substantial clinical benefits, leading to reduction in morbidity and mortality
Rationale for ART Medication Selection - ANSWER: •ART
•Highly active antiretroviraly therapy (HAART) AKA combination antiretroviral
therapy (triple cocktail)(minimum)
•More than 30 U.S. Food and Drug Administration- approved ART drugs
•Treatment of HIV disease is a dynamic, rapidly changing arena.
•HIV medications are always used in combination to reduce the amount of HIV in the
blood
HIV/AIDS Principles of Therapy - ANSWER: §Ongoing HIV replication leads to immune
system damage and progression to AIDS
§Plasma HIV ribonucleic acid (RNA) and CD4 T-cell levels must be regularly measured
(every 3 to 6 months)
§Treatment decisions should be individualized based on the risk of disease
progression as indicated by plasma HIV RNA levels and CD4 measurements
§Goal of therapy should be the maximum achievable suppression of HIV replication
§Most effective way to achieve sustained suppression of HIV replication is the
combination of effective anti-HIV medications; want to initiated HAART as soon as
possible and don't ever want you to come off of it. adherence is very important.
, resistance can build up if people not compliant; can live normal life if compliant with
medication
Initiating ART Medications - ANSWER: §ART should be initiated in patients with
§AIDS-defining illness or CD4 count less than 350 cells/mm3
§HIV-associated nephropathy
§Co-infection with hepatitis B infection
§Pregnant women (antiretroviarl therapy during pregnancy can decrese risk of
transmission to baby)
§Patients with CD4 counts between 350 and 500 cells/mm3
§Potential benefits of early intervention must be weighed against the risks of early
therapy
ART regimen is determined by - ANSWER: §Comorbid conditions (look for mutations
and resistance. help determine what medications to initiate; infectious medicine
does this.)
§Convenience
§Gender and pretreatment CD4 T-cell count (nevirapine)
§Genotypic drug resistance testing
§HLA B*5701 testing if considering abacavir
§Patient adherence potential
§Potential adverse drug effects
§Potential drug interactions with other medications
§Pregnancy potential
HIV/AIDS Cost Considerations - ANSWER: •HIV medications are expensive
•Medication costs vary widely
•Patients may be eligible for state AIDS Drug Assistance Programs (ADAPs).
•Congress mandates funds be used for ADAPs
•Pharmaceutical companies have co-pays to provide financial assistance; post
exposure prophylaxis is over $3000
HIV/AIDS Medication Resistance - ANSWER: §Due to
§Poor patient adherence to the ART regimen
§Drug-drug or drug-food interactions
§Abnormal absorption, distribution, metabolism, or excretion of the medicine
§First sign of HIV resistance is detectable plasma viral RNA levels
§Phenotype assays are used to measure sensitivity to various antiretroviral agents;
can have higher fat distribution after starting haart which affects how medication is
able to work in body. infectious control monitors
ART Failure - ANSWER: •Defined as the failure to achieve or maintain suppression of
viral replication to less than 50 copies/mL
•May be either failure or virological rebound
•Causes
•Suboptimal adherence
•Toxicity
REAL EXAM QUESTIONS AND CORRECT ANSWERS|
AGRADE
Anti-Viral Medications - ANSWER: powerpoint;
1. Describe the indications, contraindications, MOA, ADE, and monitoring of drugs
and drug classes discussed in this lesson (See Final Exam Drug List).
2. Provide an example of an antimicrobial that can have a loading dose. Explain the
purpose of loading dose.
3. Explain essential principles of antiretroviral therapy (ART) and monitoring
required.Links to an external site.
Links to an external site.4. Compare and contrast PrEP and PEP (monitoring,
indications).
5. Identify major causes for antiretroviral therapy (ART) resistance.
5. Describe the use of antiviral medications (i.e acyclovir, famciclovir, etc.) for
shingles or herpes virus and how you would select on antiviral medication over the
other, and monitoring prior to and during treatment.
6. Explain how Tamiflu (oseltamivir) works.
7. Application of indication, MOA, ADE, and monitoring of drug class and drugs (See
Test 3 Drug List) to answer clinical case scenarios
Herpes - ANSWER: herpes simplex and herpes zoster.
Herpes/Varicella/Zoster (HSV/VZV) medications, MOA, side effects, monitoring -
ANSWER: •famciclovir (Famvir)
•MOA: inhibits DNA polymerase, selectively inhibiting herpes viral DNA synthesis
and replication
•valacyclovir (Valtrex) & acyclovir (Zovirax)
•MOA: inhibits DNA polymerase; incorporates into viral DNA
•ADR: psychosis, encephalopathy, seizures, coma, hepatitis, neutropenia,
thrombocytopenia, jaundice, anaphylaxis, angioedema, Stevens-Johnson syndrome,
hallucination, delirium, ha, nausea, diarrhea, vomiting, fatigue
•Monitoring: Cr at baseline; acyclovir is most prescribed due to being cheapest, need
higher doses of acyclovir.; famciclovir works slightly different
Genital HSV First episode, suppressive therapy, episodic therapy - ANSWER: •First
Episode
•New acquired genital herpes can cause prolonged clinical illness w/ severe genital
ulcerations and neurlogic involvement
•All should be treated at the recommended dosage
•Acyclovir, valcyclovir or famciclovir
•Suppressive Therapy
•Reduces frequency of genital herpes recrurance by 70-80%
•Treatment w/valcyclovir (Valtrex) daily reduces risk of transmission in discordant
heterosexual couples
•Acyclovir (Zovirax), valcyclovir (Valtrex) or famciclovir (Famvir)
,•Episodic Therapy
•To be initiated at first sign
•Acyclovir, valvyclovir or famciclovir (Famvir); first episode at higher dosage. cdc
regimen recommendation is written alphabetically so not necessarily most
recommended. famciclvir is outside of abc order and is last because should be last
resort. no cream or ointment, need oral medications. suppressive therapy taken
every day; no monitoring for suppressive therapy just education annually; episodic
needs on hand and treats outbreaks
Oral herpes labialis treatment - ANSWER: •Famciclovir (Famvir) superior to acyclovir
or valacyclovir (Valtrex) for episodic treatment
•Suppressive treatment
• Valacyclovir (Valtex), Acyclovir (Zovirax)
•Cream
•docosanol cream (Abreava), acyclovir cream; fever blister. respond better to
famcyclovir than acyclovir; can use creams. famcyclovir is one time dose. acyclovir is
over five days dosing. can be anywere on skin; oral outside of mouth. creams only
used for mouth
HIV/AIDS - ANSWER: antiretroviral therapy; HAART; comanaged with infectious
disease; cdc guidelines; prophylaxis can be initiated in primary care. ensure can get
medications if displaced.
HIV/AIDS Goals of Treatment - ANSWER: 1.Achieve maximal suppression of plasma
viral load for as long as possible
2.Delay the development of medication resistance
3.Preserve CD4 T-cell numbers
4.Confer substantial clinical benefits, leading to reduction in morbidity and mortality
Rationale for ART Medication Selection - ANSWER: •ART
•Highly active antiretroviraly therapy (HAART) AKA combination antiretroviral
therapy (triple cocktail)(minimum)
•More than 30 U.S. Food and Drug Administration- approved ART drugs
•Treatment of HIV disease is a dynamic, rapidly changing arena.
•HIV medications are always used in combination to reduce the amount of HIV in the
blood
HIV/AIDS Principles of Therapy - ANSWER: §Ongoing HIV replication leads to immune
system damage and progression to AIDS
§Plasma HIV ribonucleic acid (RNA) and CD4 T-cell levels must be regularly measured
(every 3 to 6 months)
§Treatment decisions should be individualized based on the risk of disease
progression as indicated by plasma HIV RNA levels and CD4 measurements
§Goal of therapy should be the maximum achievable suppression of HIV replication
§Most effective way to achieve sustained suppression of HIV replication is the
combination of effective anti-HIV medications; want to initiated HAART as soon as
possible and don't ever want you to come off of it. adherence is very important.
, resistance can build up if people not compliant; can live normal life if compliant with
medication
Initiating ART Medications - ANSWER: §ART should be initiated in patients with
§AIDS-defining illness or CD4 count less than 350 cells/mm3
§HIV-associated nephropathy
§Co-infection with hepatitis B infection
§Pregnant women (antiretroviarl therapy during pregnancy can decrese risk of
transmission to baby)
§Patients with CD4 counts between 350 and 500 cells/mm3
§Potential benefits of early intervention must be weighed against the risks of early
therapy
ART regimen is determined by - ANSWER: §Comorbid conditions (look for mutations
and resistance. help determine what medications to initiate; infectious medicine
does this.)
§Convenience
§Gender and pretreatment CD4 T-cell count (nevirapine)
§Genotypic drug resistance testing
§HLA B*5701 testing if considering abacavir
§Patient adherence potential
§Potential adverse drug effects
§Potential drug interactions with other medications
§Pregnancy potential
HIV/AIDS Cost Considerations - ANSWER: •HIV medications are expensive
•Medication costs vary widely
•Patients may be eligible for state AIDS Drug Assistance Programs (ADAPs).
•Congress mandates funds be used for ADAPs
•Pharmaceutical companies have co-pays to provide financial assistance; post
exposure prophylaxis is over $3000
HIV/AIDS Medication Resistance - ANSWER: §Due to
§Poor patient adherence to the ART regimen
§Drug-drug or drug-food interactions
§Abnormal absorption, distribution, metabolism, or excretion of the medicine
§First sign of HIV resistance is detectable plasma viral RNA levels
§Phenotype assays are used to measure sensitivity to various antiretroviral agents;
can have higher fat distribution after starting haart which affects how medication is
able to work in body. infectious control monitors
ART Failure - ANSWER: •Defined as the failure to achieve or maintain suppression of
viral replication to less than 50 copies/mL
•May be either failure or virological rebound
•Causes
•Suboptimal adherence
•Toxicity
