NR 566 Midterm/NR566 (Advanced Pharmacology for Care of the Family) Midterm Exam. Latest 2025 Detailed Update with Most Exam Questions and Answers/Already Graded A+

NR 566 Midterm/NR566 (Advanced Pharmacology for Care of the Family) Midterm Exam. Latest 2025 Detailed Update with Most Exam Questions and Answers/Already Graded A+ bioavailability of bisphosphonates - CORRECT ANS histamine 2 blocking, ranitidine agents double ALENDRONATE TILUDRONATE decreases 50 % by aspirin and is increased by INDOMENTHACIN *Consider each said individually Anastozole, letroxole, exemestane - CORRECT ANS aromatase inhibitors *hormone therapy to tx hormone receptor positive breast cancer. AE: vertigo, insomnia, sleepiness, confusion, LIFE THREATENING BLOOD CLOTTING, LOSS BONE MASS, *take Ca+ vit D supplementation *measure bone density GH (somatotropin) - CORRECT ANS *used in children with GH deficiency treats hypoglycemia Biophosphanates pt education - CORRECT ANS *empty stomach 8 oz water avoid anitacids/ alcohol ETIDRONATE increase in fx with pagets disease monitor labs and xrays drugs associated with bone loss that should be monitored - CORRECT ANS aromatase inhibitors, thyroid hormones, gluccocorticoid, PPI, SSRI Antidiabetic mediations to avoid in elderly - CORRECT ANS Sulfonylureas - hypoglycemia Glimpride Glyburide- most likely to cause hypo metformin *renal insuffiency HF Alpha-glycosidase inhibitors- not well tolerated Screening of Type 2 DM - CORRECT ANS 45 yrs old BMI 25 *test yearly 45 yrs old BMI WNL *q 3 yrs 45 yrs old VMI 25* test more frequent. Lispro, Aspart, Glulisine - CORRECT ANS rapid acting insulin 15 min peak 1 hr duration Regular insulin Regular U -500 - CORRECT ANS short acting insulin * used as bolus to correct hyperglycemia Regular insulin onset 30-60- peak 2-3 dura. 3-7 U-500 onset 30-45, peak 2-4, duration 8-24 hr Neutral Protamine Hagedorn (NPH) - CORRECT ANS NPH onset 30-60 peak 4-10 duration 10-16 Inhaled human insulin (afrezza) - CORRECT ANS most rapid less weight gain onset 12 min peak 1 hr duration 2-3 hrs Albuterol - CORRECT ANS -increases levels of digoxin -safe if children -first line therapy Etidronate (Didronel) - CORRECT ANS Bisphosphonates -90 day half life -preg cat B reduces bone reabsorption TX: low bone density, d/t cystic fibrosis, pagets disease (monitor xrays and labs), heterotropic ossification, hip replacement, spinal cord injury CI: entercolitis Alendeonate (fosamax) - CORRECT ANS Biphosphonates -10 yr. half life ( $cheapest) TX: osteoporosis men, postmenopausal women, gluccorticoids induced, pagets diseae Acarbose, miglitol, voglibose - CORRECT ANS Alpha Glucosidase inbitors -no weight gain -can give in combination with sulfonyureas -CI digoxin -reduce A1C Propythouracil PTU - CORRECT ANS TX hyperthyroidism -safe in pregnancy -risk for hepatic toxicity Hyperthyroidism cause s/s lab testing - CORRECT ANS -overactie thyroid gland r/t graves disease (mc) anterior pituitary disorder, plummers disease, amiodarone therapy -s/s: tachycardia, cardiac arrythmias, chest pain, tremors, nervousness, insomnia, irritability, diarrhea, vomiting, weight loss, menstural irregularites, heat intolerance -labs increase free T4 decrease TSH Hypothyroidism S/S - CORRECT ANS fatigue, memory impairment, depression, swollen face, decrease sv, hr, increase periph resistance, macrocytic anemia (ass. B12 def.) decrease appetite, weight gain, enlarged thyroid glad Diabetic meds that need renal adjustment - CORRECT ANS Metformin Diabetic medications with increased risk for genital mycotic infections - CORRECT ANS SGLT-2 selective sodium glucose co -transporter Diabetic meds to avoid when taking digoxin - CORRECT ANS metformin * dig increases effects leading to lactic acidosis Biguanides (Metformin) - CORRECT ANS -used in children 10 *INITAL DRUG OF CHOICE *insulin production is necessary for metformin to be productive. calculate appropriate daily dose of insulin - CORRECT ANS 0.3-0.5 units kg day DM diagnosis - CORRECT ANS 2 hr post load 200mg/dl fasting plasma glucose 126 HBA1C 6.5 A1C monitoring - CORRECT ANS 2x per year- meeting goals every 3 mo- not meeting goals goal A1c 7 or 6.5 Insulin Gargine Insulin determir Insulin degludec - CORRECT ANS Long acting: gargine and determir onset 60 min duration 24 hrs degludec 42 hrs. Metaproteronol - CORRECT ANS -nebulizer formula for infants Terbutaline - CORRECT ANS Off label inhibits uterine contractions Preg B Formoterol and Salmeterol - CORRECT ANS Black box not used as monotherapy -not used for acute exacerbations -*can worsen symptoms of asthma if pt is deteriorating -CI children 4 yrs. Drug interactions with Beta agonists - CORRECT ANS Tricyclic antidepressants and MAOIs potentiate effects on the vascular system Digoxin increase the risk arrhythmias (albuterol and levalbuterol beta agonist contraindications - CORRECT ANS Cardiac arrythmias, tachycardia, heart block, dig toxicity, angina, narrow angle glaucoma, organic brain damage, shock during anesthesia -diabetics cause hyperglycemia -phechormocytoma cause hypertension beta agonists clinical use - CORRECT ANS treat bronchospasm, associated with asthma, bronchitis, COPD. beta agonists side effects - CORRECT ANS Seziures, hypokalemia, angina, HTN, tachy, tremors, h/a, gi upset, inform provider if.. palpatations tachy, angina, tremors, dizziness, flushing, h/a Inhaled Anticholinergics - CORRECT ANS Muscarinic receptor blocker resulting in bronchodilation. Used to prevent bronchospasm, manage allergen or exercise-induced asthma, or COPD. Maximum effects may take up to 2 weeks, shake inhaler well before administration, when using two different inhaled medications, wait 5 minutes between, if administered via nebulizer, use within 1 hour of reconstitution. Ipatropium - CORRECT ANS (inhaled anticholinergics) * safe in kids if combined with albuterol =combivent -decreases rhinorrhea -minimally absorbed no major drug interactions Inhaled Anticholinergics ARDS - CORRECT ANS Cough, dry mouth Theophylline food interactions - CORRECT ANS Caffeine INH Isoniazide black box warning, risk factors - CORRECT ANS severs fatal hepatitis risk factors -50-65 yrs old -alcohol use -chronic ulcer disease -iv drug use -black and Hispanic women (postpartum) Prophylactic monotherapy for TB - CORRECT ANS INH single daily dose 9 mo Theophylline serum levels - CORRECT ANS keep levels below 20! -above 20 = nausea, vommiting, diarrhea, h/a, insomnia, irritability -above 35 = toxicity, hyperglycemia, hypotension, arrhythmias, tachy, seizures, brain damage, death Caffeine - CORRECT ANS xanthine derivative tx apnea of prematurity Theophylline treatment - CORRECT ANS Tx: bronchospams dt/ asthma, COPD, bronchitits Theophylline pharmacodynamics - CORRECT ANS mediated by selective inhibition of phosphodiesterase producing and increase in CAMP = bronchial smooth muscle and pulmonary vessel relaxation Inhaled corticosteroids contraindications - CORRECT ANS Cushings syndrome pregnancy herpes TB Nasal trama, ulcers Untreated respiratory infection Inhaled corticosteroids AE - CORRECT ANS Xerostoma horseness tounge and mouth irritation flushing dysgeusia (altered taste) dysmenorrhea (fluticason, momentasone) Step therapy 1) Mild intermittent asthma - CORRECT ANS symptoms: 2x per wk night symp 2x per month PEF 80 TX SABA PRN 2x per week oral systemic oral corticosteroids 1 per year step therapy 2) MPA (mild persistant asthma) - CORRECT ANS symptoms 2x per wk. not everyday night symptoms 3-4x per month PEF 80 TX: Low dose ICS children 4 have more than 2 exacerbations in six months = systemic steroids 3) Asthma step therapy Moderate persistent asthma - CORRECT ANS daily symptoms daily night time symptoms every wk. PEF 60 80 TX: medium dose ICS 4) Asthma step therapy Sever persistent asthma - CORRECT ANS pt has some degree of symptoms all the time limited physical activity frequent exacerbations at night PEF 60 TX medium dose ICS +LABA or Montelukast Risk factors for fatal asthma attacks - CORRECT ANS 2 or more hospitalizations 3 ed visits per year use of 2 SABA canisters per mo worsening asthma difficulty with airway low socioeconomic inner city residence Step 5 asthma therapy tx - CORRECT ANS high dose inhaled corticosteroids, plus long acting beta agonist Step 6 asthma therapy tx - CORRECT ANS high dose inhaled corticosteroids, plus long acting beta agonist + oral corticosteroids -refer to asthma specialist Treatment for immunocompromised pt with CAP - CORRECT ANS Respiratory fluroquinolon ( Levaquin, moxifloxin, gemifloxin) COPD therapy and goals of treatment - CORRECT ANS -slow disease process -quit smoking -nutrition and infection protection TX Beta Agonists 1st line Anticholinergic drugs Methylxamines (Theophylline) Use of corticosteroids in treatment of COPD and Asthma - CORRECT ANS Asthma: ICS long term control COPD TX Beta Agonists 1st line Anticholinergic drugs Methylxamines (Theophylline) Beclomethasone HFA - CORRECT ANS Inhaled corticosteroid Pnuemonia: common bacterial pathogens - CORRECT ANS Streptococcus pneumonaie, also -H influenza -S aureaus pneumonia treatment - CORRECT ANS healthy nor risk factors or drug resistance MACROLIDE ( azithro, clarithro, erythro,) or Doxycycline Comorbitities Respiratory furoquinolone (moxifloxacin, gemifloxacin levofloxacin) or Beta lactam + Macrolide (amoxicillin or amoxicillin clavunate) Radiologic findings during pneumonia treatment - CORRECT ANS chest x ray- not a good indication of recovery. *lobar consolidation of chest x ray Treatment of pneumonia in pregnancy - CORRECT ANS risk factors *prior lung diseas, anemia, illicit drug use. TX: Macrolides Erythromycin preg cat B Azithro preg cat B Clarythromycin preg cat C Tx of chlamydia pneumonia - CORRECT ANS Erythromycin (EryPed) 50mg/kg daily 14 days Azithromycin (Zithromax) 20 mg/kg/day 3 days Nicotine gum - CORRECT ANS *Nicotine released during chewing CI TMJ, PUD 25 cigarettes per day 4 mg per hour 25 cig per day 2 mg per hr -do not consume acidic foods (coffee soft drinks juice) 15 min b4 or after chewing transdermal nicotine patch - CORRECT ANS steady dose nicotine 10 cigs/day: 14 mg patch 10 cigs/day: 21 mg patch Nicotine Lozenge commit - CORRECT ANS 2-4 mg OTC dont chew or swallow wk 1-6 take 1-2 hrs 9 per day max 20 wk 7-9 take 2-4 hrs wk 10-12 take 4-8 hrs Nicotine inhaler - CORRECT ANS 10mg nicotine inhaled for 20 min 6x per day 3-6 wks side effects: coughing, mouth and throat irritation, dyspepsia Nicotine nasal spray - CORRECT ANS *3 months max use to prevent addiction 1-2 sprays in each nostril per hr not to exceed 5 doses. 40 sprays per day. SE: nasopharyngeal ocular mucosa irritation Buproprion (Zyban) - CORRECT ANS Antidepressant tx smoking cessation start 1-2 weeks b4 quit date pt can quit cold turkey on quit day if pt has not quit by week 7 d/c treatment Bupropion CI - CORRECT ANS Seizure disorder, anorexia, bulimia, 14 days MAOI, brain tumor, brain surgery, closed head injury Varenicline (Chantix) - CORRECT ANS Smoking cessation ARDS: Nausea, neuropsychiatric symptoms: agitation, depressed mood, suicidal ideation, actual suicidal behavior. -start 1 wk before the quit date Nicotine toxicity - CORRECT ANS H/a, n/v, Contraindications for smoking cessation therapy - CORRECT ANS hypersensitivity, following an MI, life threatening arrhythmia, angina pectoris. TB treatment - CORRECT ANS RIPE (rifampin, isoniazid, pyrazinamide, ethambutol) 2 months 4 drug therapy 4 months INH, RIF *Streptomycin(preg cat D) is used in place of Ethambutol if child is too young for a vision screening. TB rational drug selection for pregnancy and children - CORRECT ANS Pregnancy INH & RIF (EMB included unless resistance to INH is unlikely) Pyridoxine (vit B 6) added to regimen to decrease incidence of peripheral neuropathy associated with INH. Children INH and RIF are used for asymptomatic 6-9 mo. Criteria for resistant TB - CORRECT ANS Levofloxacin Cycloserine (seromycine and a fluroquinolone) Prophylactic treatment of TB for high risk patient - CORRECT ANS skin test 10mm or more INH and RIF 12 dose regimen 3 months once weekly ICS & LABA combinations - CORRECT ANS (Advar )Fluticasone ICS + Salmetrerol LABA (Airduo Repi click) Fluticasone ICS + salmeterol LABA (Breoellipta) Fluticasone ICS + Vilanterol (LABA) (Dulera- Momentasone ICS + formoterol (LABA) (Symbicort) Budesonide (ICS) + formoterol (LABA) Beclomethaxone diproponate (qvar) - CORRECT ANS Inhaled corticosteroid Budesonide - CORRECT ANS ICS tx children 6 mo Flunisolide - CORRECT ANS ICS tx children 6 mometasone furonate - CORRECT ANS ICS children 12 Fluticasone - CORRECT ANS ICS caution in children 4 Ciclesonide - CORRECT ANS ICS safe but not effective in children 12 6 ACEI - CORRECT ANS break down bradykinin (AE cough) works on the RASS system reduces angiotensin II and aldosterone *Does not affect CO *prevents diabetic neuropathy *improves insulin sensitivity *renoprotective for individuals with proteinuria CATOPRIL - CORRECT ANS ACEI -prototype -2-3 x day dosing -short-acting -tx htn DI diuretics AE: RASH d/c drug ENALIPRIL - CORRECT ANS tx htn children 1 mo-16 years AE photosensitivity Quinapril - CORRECT ANS ACEI AE photosensitivity ACI ards - CORRECT ANS Cough (bradykinin) Angioedema ENAPIPRIL, AUINAPRIN , RAMIPRIL- (photosensitivity) CI pregnancy ACEI drug interactions - CORRECT ANS ACEI, lithium, K+ sparing diuretics ARBS pharmacodynamics - CORRECT ANS block AT II receptor and aldesterone *do not affect cardiac output, *do not prevent diabetic neuopathy- supress rate of progression. Losartan - CORRECT ANS ARBS -prototye DI: K+ supplementation, K+ sparing diuretics Irbesartan - CORRECT ANS ARB tx: htn, diabetic neuropathy in type II (not taking insulin) children 6-12 Valsartan - CORRECT ANS ARB CI children6 AE photosensitivity ARBs CI - CORRECT ANS bilateral renal artery stenosis angioedema pregnancy hyperkalemia *check serum K+ Caution with impaired renal function Caution hypovolemia, hyponatremia ARBs ARDs - CORRECT ANS hypotension dizziness h/a fatigue tachyphylaxis -short term drug tolerance Hypertension treatment - CORRECT ANS ACEI, ARBs, diuretic first line meds ARBs