NR 565 - advanced pharmacology
midterm – Chamberlain quiz with correct
answers
12 CDC guidelines for prescribing opioids - CORRECT ANSWERS-Opioids are not first
line therapy
establish goals for pain and function
Discuss risks and benefits
Use immediate release opioids when starting
Use the lowest effective dose
Prescribe short durations for acute pain
Evaluate benefits and harms frequently
Use strategies to migrate risk
Review PDMP data
Use urine drug testing
Avoid concurrent opioid and benzo prescribing
Offer treatment for opioid use disorder
1st line treatment of osteoporosis - CORRECT ANSWERS-alendronate
A 41 year old patient comes into the clinic complaining of increased heart rate after
starting nitro patches for stable angina. What would an appropriate response be?
1. lets lower the dose and frequency of use
2. I will prescribe a BB to help with this
3. Next time this happens, lie down and practice deep breathing, this will bring your
heart rate down - CORRECT ANSWERS-2- I will prescribe a BB to help with this
A 55 year old male comes into the clinic with a gouty arthritis. He states that he has one
flareup a year. Your response is:
1. I will prescribe you glucocorticoids to help with inflammation
2. Lets start you on prophylactic therapy colchicine.
3. It will be helpful to take an NSAID to start with to help relive some inflammation. I'll
prescribe naproxen. - CORRECT ANSWERS-3- in patients with infrequent flareups,
being less than three per year, treatment of symptoms is all thats needed. NSAIDS are
the first line agent for relieving pain of an acute gout attack.
,A patient comes in stating that he tried NSAIDS to relieve a gouty attack but it hasnt
helped. He asks, "what are my options?" He further states that he has attacks every few
years but when he does NSAIDS do not help. Your response is:
1. I can prescribe a glucocorticoid (prednisone) and that will bring down the
inflammation and pain.
2. Have your tried increasing your dosage of NSAIDS and drink plenty of water?
3. Lets start by making some changes in your diet, can you tell me what you eat
regularly? - CORRECT ANSWERS-1
3- can also be correct but BEST answer
A patient with HF develops fibrotic changes, what should the provider do next? -
CORRECT ANSWERS-ensure that a patient is on an ARB (valsartan) as this inhibits
fibrosis (aldosterone antagonist)
A person who is depend on a pure opioid agonist should NEVER receive an opioid
agonist antagonist - CORRECT ANSWERS-true
ACE inhibitors MOA - CORRECT ANSWERS-Angiotensin Converting Enzyme Inhibitors
(ACE-I) prevent the conversion of angiotensin I to angiotensin II, which disrupts the
renin-angiotensin-aldosterone system (RAAS).
1. reduce levels of angiotensin II (through inhibition of ACE)
2. increasing levels of bradykinin (through inhibition of kinase 11)
End in -pril
adverse effects for bisphosphonates - CORRECT ANSWERS-osteonecrosis of the jaw
and hip fracture, Esophagitis
adverse effects of CCBs in elderly patients - CORRECT ANSWERS-gingival
hyperplasia (overgrowth of gum tissue) and chronic eczematous rash
adverse effects of colchicine - CORRECT ANSWERS-nausea, vomiting, diarrhea,
myelosuppression, myopathy, rhabdomyolysis
adverse effects of digoxin - CORRECT ANSWERS-GI- anorexia, nausea, vomiting
CNS- fatigue
Visual disturbances **(appearance of halos around dark objects)
dysrhythmias
Adverse effects of lasix (flurosemide) - CORRECT ANSWERS-ototoxicity
adverse effects of nitro - CORRECT ANSWERS-headache, hypotension, and
tachycardia (secondary to vasodilation)
Adverse effects of opioids - CORRECT ANSWERS-constipation
urinary retention
, orthostatic hypotension
emesis
neurotoxicity (delirium, agitation)
tolerance and physical dependence
respiratory depression
adverse effects of pregabalin - CORRECT ANSWERS-Sedation/drowsy, dizziness, and
ataxia, blurred vision, difficulty thinking
adverse effects of statins - CORRECT ANSWERS-rhabdomyolysis, hepatoxicity, new-
onset diabetes
After age one what happens to pharmacokinetic parameters, including drug sensitivity?
- CORRECT ANSWERS-mirror adult parameters
Alendronate patient education - CORRECT ANSWERS-minimize risk of esophagitis by
swallowing the pill whole with a full glass of water, then sit up for at least 30 min but 60
min preferred. intake of food prevents absorption, take this med 30 min prior to other
intake
Amiodarone should NOT be taken with what? - CORRECT ANSWERS-CYP3A4
inhibitors and grapefruit juice (levels can be increased)
An 82 year old male visits the clinic complaining that his pain medications "take forever"
to work after he takes his pill. What are possible reasons you can explain to him?
1.Perhaps we need to increase your dosage.
2.Sometimes as you get older, absorption may be slower resulting in a delayed
response.
3.As we get older the gastric acid decreases and may slow absorption. - CORRECT
ANSWERS-2&3
ARBS MOA - CORRECT ANSWERS-Block angiotensin II receptors on blood vessels in
heart and adrenals. Increases renal excretion of sodium and water. Cause dilation of
arterioles and veins.
End in -sartan
Are statins safe in pregnancy? - CORRECT ANSWERS-No
Assess someone for possible drug diversion? - CORRECT ANSWERS-Urine test at
least yearly
PDMP routinely
At what age can statins be prescribed? - CORRECT ANSWERS-avoid statin use in
children under the age of 10
midterm – Chamberlain quiz with correct
answers
12 CDC guidelines for prescribing opioids - CORRECT ANSWERS-Opioids are not first
line therapy
establish goals for pain and function
Discuss risks and benefits
Use immediate release opioids when starting
Use the lowest effective dose
Prescribe short durations for acute pain
Evaluate benefits and harms frequently
Use strategies to migrate risk
Review PDMP data
Use urine drug testing
Avoid concurrent opioid and benzo prescribing
Offer treatment for opioid use disorder
1st line treatment of osteoporosis - CORRECT ANSWERS-alendronate
A 41 year old patient comes into the clinic complaining of increased heart rate after
starting nitro patches for stable angina. What would an appropriate response be?
1. lets lower the dose and frequency of use
2. I will prescribe a BB to help with this
3. Next time this happens, lie down and practice deep breathing, this will bring your
heart rate down - CORRECT ANSWERS-2- I will prescribe a BB to help with this
A 55 year old male comes into the clinic with a gouty arthritis. He states that he has one
flareup a year. Your response is:
1. I will prescribe you glucocorticoids to help with inflammation
2. Lets start you on prophylactic therapy colchicine.
3. It will be helpful to take an NSAID to start with to help relive some inflammation. I'll
prescribe naproxen. - CORRECT ANSWERS-3- in patients with infrequent flareups,
being less than three per year, treatment of symptoms is all thats needed. NSAIDS are
the first line agent for relieving pain of an acute gout attack.
,A patient comes in stating that he tried NSAIDS to relieve a gouty attack but it hasnt
helped. He asks, "what are my options?" He further states that he has attacks every few
years but when he does NSAIDS do not help. Your response is:
1. I can prescribe a glucocorticoid (prednisone) and that will bring down the
inflammation and pain.
2. Have your tried increasing your dosage of NSAIDS and drink plenty of water?
3. Lets start by making some changes in your diet, can you tell me what you eat
regularly? - CORRECT ANSWERS-1
3- can also be correct but BEST answer
A patient with HF develops fibrotic changes, what should the provider do next? -
CORRECT ANSWERS-ensure that a patient is on an ARB (valsartan) as this inhibits
fibrosis (aldosterone antagonist)
A person who is depend on a pure opioid agonist should NEVER receive an opioid
agonist antagonist - CORRECT ANSWERS-true
ACE inhibitors MOA - CORRECT ANSWERS-Angiotensin Converting Enzyme Inhibitors
(ACE-I) prevent the conversion of angiotensin I to angiotensin II, which disrupts the
renin-angiotensin-aldosterone system (RAAS).
1. reduce levels of angiotensin II (through inhibition of ACE)
2. increasing levels of bradykinin (through inhibition of kinase 11)
End in -pril
adverse effects for bisphosphonates - CORRECT ANSWERS-osteonecrosis of the jaw
and hip fracture, Esophagitis
adverse effects of CCBs in elderly patients - CORRECT ANSWERS-gingival
hyperplasia (overgrowth of gum tissue) and chronic eczematous rash
adverse effects of colchicine - CORRECT ANSWERS-nausea, vomiting, diarrhea,
myelosuppression, myopathy, rhabdomyolysis
adverse effects of digoxin - CORRECT ANSWERS-GI- anorexia, nausea, vomiting
CNS- fatigue
Visual disturbances **(appearance of halos around dark objects)
dysrhythmias
Adverse effects of lasix (flurosemide) - CORRECT ANSWERS-ototoxicity
adverse effects of nitro - CORRECT ANSWERS-headache, hypotension, and
tachycardia (secondary to vasodilation)
Adverse effects of opioids - CORRECT ANSWERS-constipation
urinary retention
, orthostatic hypotension
emesis
neurotoxicity (delirium, agitation)
tolerance and physical dependence
respiratory depression
adverse effects of pregabalin - CORRECT ANSWERS-Sedation/drowsy, dizziness, and
ataxia, blurred vision, difficulty thinking
adverse effects of statins - CORRECT ANSWERS-rhabdomyolysis, hepatoxicity, new-
onset diabetes
After age one what happens to pharmacokinetic parameters, including drug sensitivity?
- CORRECT ANSWERS-mirror adult parameters
Alendronate patient education - CORRECT ANSWERS-minimize risk of esophagitis by
swallowing the pill whole with a full glass of water, then sit up for at least 30 min but 60
min preferred. intake of food prevents absorption, take this med 30 min prior to other
intake
Amiodarone should NOT be taken with what? - CORRECT ANSWERS-CYP3A4
inhibitors and grapefruit juice (levels can be increased)
An 82 year old male visits the clinic complaining that his pain medications "take forever"
to work after he takes his pill. What are possible reasons you can explain to him?
1.Perhaps we need to increase your dosage.
2.Sometimes as you get older, absorption may be slower resulting in a delayed
response.
3.As we get older the gastric acid decreases and may slow absorption. - CORRECT
ANSWERS-2&3
ARBS MOA - CORRECT ANSWERS-Block angiotensin II receptors on blood vessels in
heart and adrenals. Increases renal excretion of sodium and water. Cause dilation of
arterioles and veins.
End in -sartan
Are statins safe in pregnancy? - CORRECT ANSWERS-No
Assess someone for possible drug diversion? - CORRECT ANSWERS-Urine test at
least yearly
PDMP routinely
At what age can statins be prescribed? - CORRECT ANSWERS-avoid statin use in
children under the age of 10
