NUR 635 Advanced Pharmacology Midterm Exam
COMPREHENSIVE questions answered, 2025 verified
graded A+ already passed!
· Some drugs or exogenous substances can induce CYP isozymes (less effect). Example.... - ---------
correct answer------St. John's wort (CYP3A4) and hormonal birth control
A benzodiazepine antagonist - ---------correct answer------flumazenil (Romazicon), a GABA receptor
antagonis
Absorption - ---------correct answer------absorption from the administration site either directly or
indirectly into the blood/plasma.
Absorption factors - ---------correct answer------· Gastrointestinal pH changes
· Gastric emptying
· Gastric/intestinal enzymes
· Bile acids & biliary function
· Gastrointestinal flora (type and quantity of bacteria)
· Food & nutrient interactions (most common interaction influencing GI drug absorption)
· Lipid solubility of the drug
Acute treatment of migraine headaches include - ---------correct answer------oral nonsteroidal anti-
inflammatory drugs (e.g., naproxen, ibuprofen), triptans (e.g., sumatriptan), opioids, and IM
dihydroergotamine
**Metoclopramide or prochlorperazine may be used in acute migraine attacks if nausea is presen
adverse reactions on warfarin - ---------correct answer-------bleeding (antidote is vitamin K)
-allergic reaction (rare)
Amlodipine is known to cause - ---------correct answer------most peripheral edema, especially pedal
edema
Angiotensin converting enzyme inhibitors: - ---------correct answer------lisinopril, captopril, enalapril,
ramipril, benazepril, fosinopril.
Angiotensin II receptor blocking agents: - ---------correct answer------valsartan, losartan, candesartan,
irbesartan.
Antiepileptics and migraines - ---------correct answer------(e.g., divalproex [Depakote, Depakene,
valproic acid]) reduces the intensity and number of migraine attacks; start with a low dose and
titrate upward slowly.
**Divalproex is not recommended for use during pregnancy (pregnancy category D).
,Atrial fibrillation symptoms - ---------correct answer------palpitations, fainting, breathless, chest pain,
dementia.
Atrial fibrillation treatment - ---------correct answer------anticoagulation, rate control, cardioversion,
ablation, surgery.
Benzodiazepines increase the risk of... - ---------correct answer------increase falls in the elderly and
other people unsteady on their feet
Beta adrenergic blocking agents: - ---------correct answer------propranolol, metoprolol, esmolol
(short-acting), atenolol.
Beta blockers and hypoglycemia - ---------correct answer------Beta blockers can mask the signs of
hypoglycemia except the diaphoresis that accompanies hypoglycemia.
Bile Acid Sequestrants - ---------correct answer------cholestyramine, colesevelam, colestipol
Bile acid sequestrants MOA - ---------correct answer------increase LDL catabolism, reduce cholesterol
absorption, but can cause an increase in VLDL production.
Bioavailability - ---------correct answer------A measure of the extent of drug absorption for a given
drug and route (from 0% to 100%)
Blood Factor Xa inhibitors: - ---------correct answer------apixaban (Eliquis), edoxaban (Savaysa),
rivaroxaban (Xarelto), fondaparinux (Arixtra).
Buspirone Pharmacokinetics - ---------correct answer------has a slow onset of action, should not be
used in acute anxiety states (e.g., panic disorder), and must be dosed twice daily (has a short T1/2).
Calcium channel blockers: - ---------correct answer------amlodipine, nicardipine, verapamil, felodipine,
nifedipine, diltiazem,
caution with anti seizure drugs that may have.... - ---------correct answer------increased metabolism
Cholesterol Absorpton Inhibitor: - ---------correct answer------ezetimibe (Zetia)
cholesterol and pregnancy - ---------correct answer------Statins are contraindicated in pregnancy
(Pregnancy Category X); use a bile acid sequestrant agent (Pregnancy Category B).
Clinical uses for warfarin - ---------correct answer------Classic drug of choice for DVT and PE
· Start at 5 mg per day (7.5 mg/day if weight > 80 kg)
· Consider lower dose if > 75 years of age, multiple coexisting disorders, elevated liver enzymes,
changing thyroid status
-ASA
CYP450 - ---------correct answer------· CYP: a set of isozymes primarily found in the liver and GI tract
· Convert lipophilic drugs into more polar (and soluble) molecules
· Considerable genetic variability exists across race and gender
· Results in CYP450 polymorphisms which have a direct effect on drug metabolism.
,CYP450-related drug interactions can make predicting blood plasma levels/steady state levels
difficult.
Example.... - ---------correct answer------If a drug inhibits enzymatic activity, a substrate drug for that
enzyme system will have a greater concentration in the blood.
Distribution - ---------correct answer------reversibly/irreversibly movement of drug from the
bloodstream into the interstitial and intracellular fluid.
Distribution factors - ---------correct answer------· Membrane permeability: Cross membranes to site
of action
· Blood brain barrier reduces the speed of drug passage into and out of brain tissue
· Plasma protein binding: drugs bound to plasma proteins do not cross membranes (Note:
Malnutrition = âalbumin = á free drug = greater pharmacologic response)
· Aging cause a reduction in production of plasma proteins
· Lipophilicity of drug: lipophilic drugs concentrate in adipose tissue; remain in the body for a longer
period of time
Do loading doses altered for patient metabolism or elimination - ---------correct answer------No.
Loading doses are the same for every patient
dosing considerations for estrogen - ---------correct answer------Use the lowest estrogen dose as
possible for symptom control (which may take up to 12 weeks) and also consider the cost,
convenience and preferences of the patient.
dosing considerations for the elderly with depression - ---------correct answer------a low dose of an
antidepressant to reduce adverse effects.
drug interactions with sertraline and escitalopram - ---------correct answer------interact with cough
syrups containing dextromethorphan (-DM) and can cause serotonin syndrome.
Drug interactions with warfarin - ---------correct answer------1. Many drug-drug interactions
2. Antiplatelet drugs
3. Thrombolytic drugs
Drug reactions in elderly are related to - ---------correct answer------reduced renal function due to
age.
Adherence to pharmacotherapy is often decreased due to drug costs and increasing patient out-of-
pocket copayments.
Drugs most effective in alcohol withdrawal - ---------correct answer------lorazepam (Ativan) and
phenobarbital;
***if liver dysfunction is present, lorazepam is the preferred agent because of its different metabolic
pathway than other benzodiazepines.
, effectiveness of niacin - ---------correct answer------increases blood HDL-C levels approximately 30 to
50% (more than any other dyslipidemia agent).
effectiveness of statins - ---------correct answer------reduce LDL-cholesterol, with atorvastatin and
rosuvastatin reducing LDL-C over 50% of pretreatment LDL-C blood levels.
Elimination - ---------correct answer------how parent drug & its metabolites are eliminated from the
body
Example of the actions that can occur when a drug binds to a receptor - ---------correct answer-------
ion channel is opened or closed
-second messenger is activated (cAMP, cGMP, inositol phosphate, initiates a series of reactions
-normal cellular function is inhibited
-cellular function is "turned on"
Examples of diseases that can alter pharmacodynamics - ---------correct answer-------acid base status
-electrolyte imbalance
-altered intravascular volume
-tolerance
Examples of medications with loading doses - ---------correct answer------aminoglycosides
(gentamicin) or azithromycin, digoxin
Ezetimibe Combinations: - ---------correct answer------Liptruzet (atorvastatin/ezetimibe), Vytorin
(simvastatin/ezetimibe)
Ezetimibe MOA - ---------correct answer------inhibits cholesterol absorption from the gut, reducing
LDL levels
Fibrates MOA - ---------correct answer------increase VLDL clearance, reduce VLDL production,
(reducing TGs), but can increase LDL levels if TGs are high (i.e. over 400mg/dl).
Fibrates: - ---------correct answer------bezafibrate, fenofibrate, fenofibric acid, gemfibrozil
COMPREHENSIVE questions answered, 2025 verified
graded A+ already passed!
· Some drugs or exogenous substances can induce CYP isozymes (less effect). Example.... - ---------
correct answer------St. John's wort (CYP3A4) and hormonal birth control
A benzodiazepine antagonist - ---------correct answer------flumazenil (Romazicon), a GABA receptor
antagonis
Absorption - ---------correct answer------absorption from the administration site either directly or
indirectly into the blood/plasma.
Absorption factors - ---------correct answer------· Gastrointestinal pH changes
· Gastric emptying
· Gastric/intestinal enzymes
· Bile acids & biliary function
· Gastrointestinal flora (type and quantity of bacteria)
· Food & nutrient interactions (most common interaction influencing GI drug absorption)
· Lipid solubility of the drug
Acute treatment of migraine headaches include - ---------correct answer------oral nonsteroidal anti-
inflammatory drugs (e.g., naproxen, ibuprofen), triptans (e.g., sumatriptan), opioids, and IM
dihydroergotamine
**Metoclopramide or prochlorperazine may be used in acute migraine attacks if nausea is presen
adverse reactions on warfarin - ---------correct answer-------bleeding (antidote is vitamin K)
-allergic reaction (rare)
Amlodipine is known to cause - ---------correct answer------most peripheral edema, especially pedal
edema
Angiotensin converting enzyme inhibitors: - ---------correct answer------lisinopril, captopril, enalapril,
ramipril, benazepril, fosinopril.
Angiotensin II receptor blocking agents: - ---------correct answer------valsartan, losartan, candesartan,
irbesartan.
Antiepileptics and migraines - ---------correct answer------(e.g., divalproex [Depakote, Depakene,
valproic acid]) reduces the intensity and number of migraine attacks; start with a low dose and
titrate upward slowly.
**Divalproex is not recommended for use during pregnancy (pregnancy category D).
,Atrial fibrillation symptoms - ---------correct answer------palpitations, fainting, breathless, chest pain,
dementia.
Atrial fibrillation treatment - ---------correct answer------anticoagulation, rate control, cardioversion,
ablation, surgery.
Benzodiazepines increase the risk of... - ---------correct answer------increase falls in the elderly and
other people unsteady on their feet
Beta adrenergic blocking agents: - ---------correct answer------propranolol, metoprolol, esmolol
(short-acting), atenolol.
Beta blockers and hypoglycemia - ---------correct answer------Beta blockers can mask the signs of
hypoglycemia except the diaphoresis that accompanies hypoglycemia.
Bile Acid Sequestrants - ---------correct answer------cholestyramine, colesevelam, colestipol
Bile acid sequestrants MOA - ---------correct answer------increase LDL catabolism, reduce cholesterol
absorption, but can cause an increase in VLDL production.
Bioavailability - ---------correct answer------A measure of the extent of drug absorption for a given
drug and route (from 0% to 100%)
Blood Factor Xa inhibitors: - ---------correct answer------apixaban (Eliquis), edoxaban (Savaysa),
rivaroxaban (Xarelto), fondaparinux (Arixtra).
Buspirone Pharmacokinetics - ---------correct answer------has a slow onset of action, should not be
used in acute anxiety states (e.g., panic disorder), and must be dosed twice daily (has a short T1/2).
Calcium channel blockers: - ---------correct answer------amlodipine, nicardipine, verapamil, felodipine,
nifedipine, diltiazem,
caution with anti seizure drugs that may have.... - ---------correct answer------increased metabolism
Cholesterol Absorpton Inhibitor: - ---------correct answer------ezetimibe (Zetia)
cholesterol and pregnancy - ---------correct answer------Statins are contraindicated in pregnancy
(Pregnancy Category X); use a bile acid sequestrant agent (Pregnancy Category B).
Clinical uses for warfarin - ---------correct answer------Classic drug of choice for DVT and PE
· Start at 5 mg per day (7.5 mg/day if weight > 80 kg)
· Consider lower dose if > 75 years of age, multiple coexisting disorders, elevated liver enzymes,
changing thyroid status
-ASA
CYP450 - ---------correct answer------· CYP: a set of isozymes primarily found in the liver and GI tract
· Convert lipophilic drugs into more polar (and soluble) molecules
· Considerable genetic variability exists across race and gender
· Results in CYP450 polymorphisms which have a direct effect on drug metabolism.
,CYP450-related drug interactions can make predicting blood plasma levels/steady state levels
difficult.
Example.... - ---------correct answer------If a drug inhibits enzymatic activity, a substrate drug for that
enzyme system will have a greater concentration in the blood.
Distribution - ---------correct answer------reversibly/irreversibly movement of drug from the
bloodstream into the interstitial and intracellular fluid.
Distribution factors - ---------correct answer------· Membrane permeability: Cross membranes to site
of action
· Blood brain barrier reduces the speed of drug passage into and out of brain tissue
· Plasma protein binding: drugs bound to plasma proteins do not cross membranes (Note:
Malnutrition = âalbumin = á free drug = greater pharmacologic response)
· Aging cause a reduction in production of plasma proteins
· Lipophilicity of drug: lipophilic drugs concentrate in adipose tissue; remain in the body for a longer
period of time
Do loading doses altered for patient metabolism or elimination - ---------correct answer------No.
Loading doses are the same for every patient
dosing considerations for estrogen - ---------correct answer------Use the lowest estrogen dose as
possible for symptom control (which may take up to 12 weeks) and also consider the cost,
convenience and preferences of the patient.
dosing considerations for the elderly with depression - ---------correct answer------a low dose of an
antidepressant to reduce adverse effects.
drug interactions with sertraline and escitalopram - ---------correct answer------interact with cough
syrups containing dextromethorphan (-DM) and can cause serotonin syndrome.
Drug interactions with warfarin - ---------correct answer------1. Many drug-drug interactions
2. Antiplatelet drugs
3. Thrombolytic drugs
Drug reactions in elderly are related to - ---------correct answer------reduced renal function due to
age.
Adherence to pharmacotherapy is often decreased due to drug costs and increasing patient out-of-
pocket copayments.
Drugs most effective in alcohol withdrawal - ---------correct answer------lorazepam (Ativan) and
phenobarbital;
***if liver dysfunction is present, lorazepam is the preferred agent because of its different metabolic
pathway than other benzodiazepines.
, effectiveness of niacin - ---------correct answer------increases blood HDL-C levels approximately 30 to
50% (more than any other dyslipidemia agent).
effectiveness of statins - ---------correct answer------reduce LDL-cholesterol, with atorvastatin and
rosuvastatin reducing LDL-C over 50% of pretreatment LDL-C blood levels.
Elimination - ---------correct answer------how parent drug & its metabolites are eliminated from the
body
Example of the actions that can occur when a drug binds to a receptor - ---------correct answer-------
ion channel is opened or closed
-second messenger is activated (cAMP, cGMP, inositol phosphate, initiates a series of reactions
-normal cellular function is inhibited
-cellular function is "turned on"
Examples of diseases that can alter pharmacodynamics - ---------correct answer-------acid base status
-electrolyte imbalance
-altered intravascular volume
-tolerance
Examples of medications with loading doses - ---------correct answer------aminoglycosides
(gentamicin) or azithromycin, digoxin
Ezetimibe Combinations: - ---------correct answer------Liptruzet (atorvastatin/ezetimibe), Vytorin
(simvastatin/ezetimibe)
Ezetimibe MOA - ---------correct answer------inhibits cholesterol absorption from the gut, reducing
LDL levels
Fibrates MOA - ---------correct answer------increase VLDL clearance, reduce VLDL production,
(reducing TGs), but can increase LDL levels if TGs are high (i.e. over 400mg/dl).
Fibrates: - ---------correct answer------bezafibrate, fenofibrate, fenofibric acid, gemfibrozil
