1|Page
NR 566 MIDTERM EXAM (2 LATEST VERSIONS 2025) / NR566
MIDTERM EXAM REVIEW /LATEST ADVANCED PHARMACOLOGY
FOR CARE OF FAMILY|GRADED A+
Symptoms of Hyperthyroidism - Answer: increased CO, decreased peripheral
vascular resistance, tachycardia at rest, arrhythmias, dyspnea and reduced vital
capacity, increased appetite with weight loss, diarrhea, nausea, vomiting,
abdominal pain, sweating, flushing warm skin, hair loss, nails grow away from nail
beds, oligo/amenorrhea, impotence/decreased libido in men, restlessness, short
attention span, fatigue, insomnia, emotional lability, enlarged gland.
Symptoms of Hypothyroidism - Answer: reduced stroke volume and HR,
increased peripheral resistance to maintain BP, bradycardia, macrocytic anemia
assoc. With B12 deficiency, dyspnea, hypoventilation, CO2 retention, decreased
appetite, constipation, weight gain, fluid retention, dry flaky skin, dry hair, slow
wound healing, cool skin, decreased libido, confusion, slow speech, memory loss,
clumsy movements.
Hyperthyroid drugs with risk for hepatic toxicity - Answer: propylthiouracil
Bile acid sequestrants absorption and administration - Answer: affect LDL-C with
a modest increase in HDL-C. They are not commonly prescribed to treat
dyslipidemias in patients with diabetes. Not only do they increase TGs but they
may pose problems for patients with diabetic gastroparesis. The increase in TG is
especially of concern in diabetics because the pancreas is already under stress.
Levothyroxine administration instructions - Answer: Take first thing in the
morning at least 30, preferably one hour before eating. On an empty stomach with
only water. Achieve consistency in taking the med to avoid fluctuating thyroid
levels.
Differentiate between primary and secondary hypothyroidism - Answer: Primary
disorders include the following:
• Defective hormone synthesis resulting from autoimmune thyroiditis, endemic
iodine deficiency, or antithyroid drugs that were used to treat hyperthyroidism
• Congenital defects or loss of tissue after treatment for hyperthyroidism
Secondary causes of hypothyroidism, which are less common, include conditions
that cause either pituitary or hypothalamic failure. In secondary disorders, the TSH
,2|Page
response is inadequate so that the gland is normal or reduced in size, with both T3
and T4 synthesis equally reduced.
Differentiate between primary and secondary hyperthyroidism - Answer: Primary
is the term used when the pathology is within the thyroid gland. Secondary
hyperthyroidism is the term used when the thyroid gland is stimulated by excessive
TSH in circulation.
Precautions and testing for xanthine derivatives - Answer: Monitored closely for
signs of toxicity
When therapy is initiated, theophylline levels should be drawn frequently as the
dosage is titrated.
Signs of toxicity- serum theophylline level should be drawn
Once stabilized, monitoring should be done every 6 to 12 months
Mild intermittent asthma - Answer: Symptoms occur less often than twice a week
and the patient is asymptomatic between exacerbations; nighttime symptoms occur
less than twice a month; and peak expiratory flow (PEF) is greater than 80%
predicted. The use of short-acting beta2 agonists (SABA) should be less than twice
a week, unless used for exercise-induced bronchospasm (EIB).
Mild persistent asthma - Answer: Symptoms occur more often than twice a week
but less often than once a day and exacerbations may affect activity; nighttime
symptoms occur 3 to 4 times a month; and PEF is greater than 80% predicted.
Patients with mild persistent asthma may use their short-acting beta2 agonists more
than twice a week but not daily, and not more than once daily.
Moderate persistent asthma - Answer: The patient is having daily symptoms;
requires daily use of a beta2 agonist; exacerbations affect normal activity;
nighttime symptoms occur more often than once a week; and PEF is greater than
60% to less than 80%.
Severe persistent asthma - Answer: The patient has some degree of symptoms all
the time; extremely limited physical activity and frequent exacerbations; frequent
nighttime symptoms, often 7 days a week; and decreased lung function (PEF less
than 60% predicted). Table 30-1 outlines the classifications of asthma severity in
patients aged 12 years or older.
Risk factors for fatal asthma attacks - Answer: Previous severe exacerbations
requiring intubation or ICU.
, 3|Page
Two or more hospitalizations.
More than 3 ED visits in the past year.
Use of more than 2 SABA canisters per month.
Difficulty perceiving airway obstruction or worsening asthma.
Low socioeconomic status or inner-city residence.
Bioavailability of bisphosphonate drugs and appropriate patient education -
Answer: Histamine2 blocking agents double alendronate bioavailability, but the
impact is unknown. Aspirin may decrease the bioavailability of tiludronate by up to
50% when taken 2 hours after the tiludronate. Although indomethacin increases the
bioavailability of tiludronate by 2- to 4-fold, the bioavailability is not significantly
altered by diclofenac; therefore, each NSAID must be considered individually.
Adverse effects associated with long-term use of bisphonates - Answer: Etidronate
has also been associated with fractures in patients with Paget's disease when they
are given high doses or when therapy lasted longer than 6 months. These patients
must be carefully monitored with x-rays and laboratory work to assess for these
lesions. The development of a rare form of subtrochanteric femur fracture in non-
Paget's patients using bisphosphonates is under close scrutiny and has contributed
to movement away from osteopenia prevention care to only osteoporosis therapy
(FDA, 2010a).
Specifics about administration and education regarding pancreatic enzymes -
Answer: All doses are taken immediately before or with meals or snacks with a
fatty component. Fruit, hard candy, fruit juice like drinks, tea or coffee, or
popsicles do not require enzymes (CFF, 2009). Capsules may be opened and
sprinkled on food. Capsules with enteric-coated beads should not be chewed. They
may be sprinkled on soft acidic food that is not hot and that can be swallowed
without chewing, such as applesauce or gelatin. Swallow immediately because the
proteolytic enzymes may irritate the mucosa. Following with a glass of water or
juice or eating immediately after taking the drug helps to ensure that the
medication is swallowed and does not remain in contact with the mouth and
esophagus for long periods. Pancrelipase is destroyed by acid. Proton pump
inhibitors, sodium bicarbonate, or aluminum-based antacids may be used with
preparations without enteric coating to neutralize gastric pH. Calcium- and
magnesium-based antacids should not be used for this purpose because they
interfere with drug action. Enteric-coated beads are designed to withstand the acid
pH of the stomach. Enteric-coated formulations should not be mixed with alkaline
food or the coating will be destroyed.
NR 566 MIDTERM EXAM (2 LATEST VERSIONS 2025) / NR566
MIDTERM EXAM REVIEW /LATEST ADVANCED PHARMACOLOGY
FOR CARE OF FAMILY|GRADED A+
Symptoms of Hyperthyroidism - Answer: increased CO, decreased peripheral
vascular resistance, tachycardia at rest, arrhythmias, dyspnea and reduced vital
capacity, increased appetite with weight loss, diarrhea, nausea, vomiting,
abdominal pain, sweating, flushing warm skin, hair loss, nails grow away from nail
beds, oligo/amenorrhea, impotence/decreased libido in men, restlessness, short
attention span, fatigue, insomnia, emotional lability, enlarged gland.
Symptoms of Hypothyroidism - Answer: reduced stroke volume and HR,
increased peripheral resistance to maintain BP, bradycardia, macrocytic anemia
assoc. With B12 deficiency, dyspnea, hypoventilation, CO2 retention, decreased
appetite, constipation, weight gain, fluid retention, dry flaky skin, dry hair, slow
wound healing, cool skin, decreased libido, confusion, slow speech, memory loss,
clumsy movements.
Hyperthyroid drugs with risk for hepatic toxicity - Answer: propylthiouracil
Bile acid sequestrants absorption and administration - Answer: affect LDL-C with
a modest increase in HDL-C. They are not commonly prescribed to treat
dyslipidemias in patients with diabetes. Not only do they increase TGs but they
may pose problems for patients with diabetic gastroparesis. The increase in TG is
especially of concern in diabetics because the pancreas is already under stress.
Levothyroxine administration instructions - Answer: Take first thing in the
morning at least 30, preferably one hour before eating. On an empty stomach with
only water. Achieve consistency in taking the med to avoid fluctuating thyroid
levels.
Differentiate between primary and secondary hypothyroidism - Answer: Primary
disorders include the following:
• Defective hormone synthesis resulting from autoimmune thyroiditis, endemic
iodine deficiency, or antithyroid drugs that were used to treat hyperthyroidism
• Congenital defects or loss of tissue after treatment for hyperthyroidism
Secondary causes of hypothyroidism, which are less common, include conditions
that cause either pituitary or hypothalamic failure. In secondary disorders, the TSH
,2|Page
response is inadequate so that the gland is normal or reduced in size, with both T3
and T4 synthesis equally reduced.
Differentiate between primary and secondary hyperthyroidism - Answer: Primary
is the term used when the pathology is within the thyroid gland. Secondary
hyperthyroidism is the term used when the thyroid gland is stimulated by excessive
TSH in circulation.
Precautions and testing for xanthine derivatives - Answer: Monitored closely for
signs of toxicity
When therapy is initiated, theophylline levels should be drawn frequently as the
dosage is titrated.
Signs of toxicity- serum theophylline level should be drawn
Once stabilized, monitoring should be done every 6 to 12 months
Mild intermittent asthma - Answer: Symptoms occur less often than twice a week
and the patient is asymptomatic between exacerbations; nighttime symptoms occur
less than twice a month; and peak expiratory flow (PEF) is greater than 80%
predicted. The use of short-acting beta2 agonists (SABA) should be less than twice
a week, unless used for exercise-induced bronchospasm (EIB).
Mild persistent asthma - Answer: Symptoms occur more often than twice a week
but less often than once a day and exacerbations may affect activity; nighttime
symptoms occur 3 to 4 times a month; and PEF is greater than 80% predicted.
Patients with mild persistent asthma may use their short-acting beta2 agonists more
than twice a week but not daily, and not more than once daily.
Moderate persistent asthma - Answer: The patient is having daily symptoms;
requires daily use of a beta2 agonist; exacerbations affect normal activity;
nighttime symptoms occur more often than once a week; and PEF is greater than
60% to less than 80%.
Severe persistent asthma - Answer: The patient has some degree of symptoms all
the time; extremely limited physical activity and frequent exacerbations; frequent
nighttime symptoms, often 7 days a week; and decreased lung function (PEF less
than 60% predicted). Table 30-1 outlines the classifications of asthma severity in
patients aged 12 years or older.
Risk factors for fatal asthma attacks - Answer: Previous severe exacerbations
requiring intubation or ICU.
, 3|Page
Two or more hospitalizations.
More than 3 ED visits in the past year.
Use of more than 2 SABA canisters per month.
Difficulty perceiving airway obstruction or worsening asthma.
Low socioeconomic status or inner-city residence.
Bioavailability of bisphosphonate drugs and appropriate patient education -
Answer: Histamine2 blocking agents double alendronate bioavailability, but the
impact is unknown. Aspirin may decrease the bioavailability of tiludronate by up to
50% when taken 2 hours after the tiludronate. Although indomethacin increases the
bioavailability of tiludronate by 2- to 4-fold, the bioavailability is not significantly
altered by diclofenac; therefore, each NSAID must be considered individually.
Adverse effects associated with long-term use of bisphonates - Answer: Etidronate
has also been associated with fractures in patients with Paget's disease when they
are given high doses or when therapy lasted longer than 6 months. These patients
must be carefully monitored with x-rays and laboratory work to assess for these
lesions. The development of a rare form of subtrochanteric femur fracture in non-
Paget's patients using bisphosphonates is under close scrutiny and has contributed
to movement away from osteopenia prevention care to only osteoporosis therapy
(FDA, 2010a).
Specifics about administration and education regarding pancreatic enzymes -
Answer: All doses are taken immediately before or with meals or snacks with a
fatty component. Fruit, hard candy, fruit juice like drinks, tea or coffee, or
popsicles do not require enzymes (CFF, 2009). Capsules may be opened and
sprinkled on food. Capsules with enteric-coated beads should not be chewed. They
may be sprinkled on soft acidic food that is not hot and that can be swallowed
without chewing, such as applesauce or gelatin. Swallow immediately because the
proteolytic enzymes may irritate the mucosa. Following with a glass of water or
juice or eating immediately after taking the drug helps to ensure that the
medication is swallowed and does not remain in contact with the mouth and
esophagus for long periods. Pancrelipase is destroyed by acid. Proton pump
inhibitors, sodium bicarbonate, or aluminum-based antacids may be used with
preparations without enteric coating to neutralize gastric pH. Calcium- and
magnesium-based antacids should not be used for this purpose because they
interfere with drug action. Enteric-coated beads are designed to withstand the acid
pH of the stomach. Enteric-coated formulations should not be mixed with alkaline
food or the coating will be destroyed.
