Week 3 Exam: NR565 / NR 565 (Latest 2026 / 2027) Advanced Pharmacology Fundamentals | Questions & Answers | 100% Correct | Grade A - Chamberlain

Week 3 Exam: NR565 / NR 565 (Latest 2026 / 2027) Advanced Pharmacology Fundamentals | Questions & Answers | 100% Correct | Grade A - Chamberlain Question: Order HTN medications are typically prescribed for non blacks Answer Thiazide ACEIs ARBS Question: Order HTN medications are typically prescribed blacks Answer thiazide CCB Question: Preferred antihypertensive drugs in patients with diabetes are Answer ACEIs, ARBs, CCBs, and diuretics (in low doses). Question: What drug classes should be used with caution for htn with ppl with diabetes? Answer Thiazides Furosemide β Blockers Thiazides and furosemide promote hyperglycemia, and β blockers suppress glycogenolysis and can mask signs of hypoglycemia. Question: why are ACEIs and ARBS used in diabetic nephropathy? Answer ACEIs and ARBs can slow the progression of renal damage and reduce albuminuria. Best approach or drug to use during pregnancy or someone wishing to become pregnant When drug therapy is initiated during pregnancy, methyldopa and labetalol are the traditional agents of choice. Question: What drug classes for htn are contraindicated for pregnacy? Answer ACEIs, ARBs, and DRIs are contraindicated owing to their potential for harm (fetal growth delay, congenital malformations, neonatal renal failure, neonatal death). Question: How is hypertension defined in pregnancy? Answer severe htn SBP 160 or DBP 110 (treatment) mild htn SBP 140 to 159 or DBP 90 to 109 (no treatment) Question: What category are ACEIs in pregnancy (A-D) Answer Category C during first trimester Category D during second and third trimester Question: What is the therapeutic action of a Thiazide diuretic? Answer Answer increase renal excretion of sodium, chloride, potassium and water Question: What is the therapeutic action of ACEIs? Answer reduce levels of angiotensin II through inhibition of ACE and increasing levels of bradykinin (through inhibition of kinase II) Question: What is the therapeutic action of ARBs? Answer -Blocks angiotensin II receptors on blood vessels, in the heart, and in the adrenals -Increases renal excretion of sodium and water Question: What is the therapeutic action of CCBs? Answer dihydropyridines act primarily on arterioles Question: Tell me about diuretics Answer Diuretics are medications that act on the kidneys to increase production of urine, therefore increasing elimination of water from the body. All diuretics decrease blood volume, venous pressure, and preload. Question: What is the function of thiazide diuretics? Answer Prevent Na+ reabsorption in the distal convoluted tubule of the kidney by blocking the thiazide sensitive Na+/Cl- symporter Question: What ending do ACEI's share? Answer PRIL -- captopril enalapril lisinopril What is a major side of effect of ACEI's? PRIL!!!!! Answer As a result of blocking ACE, bradykinins form and cause the dry cough but can later lead to life threatening angioedema. What other illness can ACEIs/ARBs be used for? Answer acute myocardial infarction (MI) in order to increase the perfusion of the heart to prevent further ischemic damage. heart failure ARBs share what ending? Answer SARTAN candesartan valsartan losartan What are two common adverse effects of ACEI's and ARBs? Answer hypotension hyperkalemia What do ACEIs increase that can cause cough and angioedema? Answer bradykinin levels What endings do CCBs share? (dihydropyridines) Answer PINE nifedipine nicardipine amlodipine nimodipine What are two examples of non-dihydropyridines CCBs Answer verpamil diltiazem Creates vasodilation by blocking voltage-gated calcium channels in both cardiac smooth muscles as well as in blood vessels. They preferentially exert their effects on arterial smooth muscle, and nifedipine is the prototype of this class. Answer Dihydropyridines CCB What drug class for HTN should be avoided in AAs Answer ACE inhibitors should be avoided by African American/Black and should take thiazides and/or CCBs. What statin medication causes issues for Asians? Answer Rosuvastatin reaches abnormally high levels in people of Asian heritage. At usual therapeutic doses, rosuvastatin levels in these people are about twice those in Whites. Accordingly, if rosuvastatin is used by Asians, dosage should be reduced due to lack of CYP3A4 Special condition for using ACEIs for HTN in AAs ACEIs should be used in African American patients who have _________________ & _____________ Also, ACEIs should be used in patients with _________________ _____________ , a condition for which ACEIs are superior to CCBs. 1. type 1 diabetes with proteinuria. 2. hypertensive nephrosclerosis, monotherapy with _________________ or _____________ is less effective in African Americans than in Caucasians for treating HTN β blockers or ACEIs Prescribing considerations when carbamazepine is prescribed with warfarin Carbamazepine induces hepatic drug-metabolizing enzymes and hence can increase the rate at which it and other drugs are inactivated. Accelerated inactivation of warfarin is of particular concern. Carbamazepine (Tegretol), used for epilepsy and bipolar disorder, can cause _____________________ in some patients— specifically patients of Asian ancestry who carry genes that code for an unusual _______________ __________ __________ known as HLA B*1502. 1. life-threatening skin reactions 2. human leukocyte antigen (HLA) Why would you use nitro and a β blocker together? If pain occurs during the nitrate-free interval, it can be managed with sparing use of a short acting nitrate (e.g., sublingual nitroglycerin) or by adding a β blocker or CCB to the regimen. Beta Blockers share what ending? LOL !!!! Carvedilol Labetalol Metoprolol What is the risk of stopping Beta Blockers abruptly? Anginal pain or ventricular dysrhythmias may develop referred to as rebound excitation. The risk for rebound excitation can be minimized by withdrawing these drugs gradually (e.g., by tapering the dosage over a period of 1 to 2 weeks). If rebound excitation occurs, dosing should be temporarily resumed. What happens when you give a beta TWO blocker to someone with asthma? When bronchial beta 2 receptors are blocked bronchoconstriction occurs and the increase in airway resistance can be life threatening IF the must use one it should use an agent that is Beta 1 selective (metoprolol) Contraindications to thiazide diuretics advanced renal insufficiency Sulfa Allergy Pts w severe renal impairment and/or/cardiovascular issues History of gout/diabetes/hyperlipidemia beta blockers with nitro Beta Blockers suppress nitroglycerin induced tachycardia. They do so by preventing sympathetic activation of beta 1 adrenergic receptors on the heart. Monitoring needs for diuretics weight vitals blood glucose BUN & creatinine/kidney function electrolytes - sodium, potassium, calcium, magnesium Hypokalemia, hypomagnesemia, and hyponatremia are common. Thiazide diuretics can cause hypercalcemia; loop diuretics can cause hypocalcemia. What do you prescribe in response to fibrotic changes? ACEIs because ARBs do not increase levels of kinins, their effects on cardiac remodeling are less favorable than those of ACEIs. Effects of cardiac glycosides on HF (DIGOXIN) best known for their positive inotropic actions—that is, their ability to increase myocardial contractile force. By increasing contractile force, digoxin can increase cardiac output. In addition, it can alter the electrical activity of the heart and can favorably affect neurohormonal systems. What happens when quinidine and digoxin are combined? Quinidine is an antidysrhythmic drug that can cause plasma levels of digoxin to rise. Quinidine increases digoxin levels by (1) displacing digoxin from tissue binding sites and (2) reducing renal excretion of digoxin. By elevating levels of free digoxin, quinidine can promote digoxin toxicity. Accordingly, concurrent use of quinidine and digoxin should be avoided. What is the ASCVD risk score and when is it used? Under the 2018 ACC/AHA guidelines, ASCVD risk assessment is directed at determining the patient's absolute risk for developing clinical coronary disease over the next 10 years. The mode of intervention is then determined by the individual's degree of risk. The 2018 ACC/AHA cholesterol guideline defines high ASCVD risk as 20% or greater. Patients with existing clinical ASCVD are placed in a “very-high risk” category, despite their screening percentage. For all other people, 10-year risk must be calculated. The instrument employed most often is the Framingham Risk Prediction Score, which takes five factors into account: age, total cholesterol, HDL cholesterol, smoking status, and systolic blood pressure. At what age can statin drugs be prescribed? Lovastatin, simvastatin, pravastatin, and atorvastatin are approved for use in children. It is recommended to avoid statin use in children younger than 10 years. What is Ezetimibe (Zetia) and when should it be used? (non-statin) is a unique drug for reducing plasma cholesterol. Benefits derive from blocking cholesterol absorption. Ezetimibe is indicated as an adjunct to diet modification for reducing total cholesterol, LDL cholesterol, and apolipoprotein B in patients with primary hypercholesteremia. How would you treat high cholesterol if someone was concerned about or experiencing side effects from other medications? Which drug classification would be a good choice? The most effective agents are the HMG-CoA reductase inhibitors (e.g., atorvastatin [Lipitor]), usually referred to simply as statins. The most effective agents are the _________________ ______________ _____________(e.g., atorvastatin [Lipitor]), usually referred to simply as _______________ 1. HMG-CoA reductase inhibitors 2. statins. Therapeutic action of organic nitrates acute therapy of angina sustained therapy for angina Reduction of the frequency and intensity of anginal attacks. Name the prototype organic nitrate Nitroglycerin These agents relieve angina by causing vasodilation nitrates -- nitroglycerin Contraindications for ranolazine (antianginal agent) the drug is contraindicated for patients with preexisting QT prolongation and for those taking other drugs that can increase the QT interval. In addition, ranolazine is contraindicated for patients at risk for developing high levels of the drug—namely, patients with hepatic impairment or those taking drugs that inhibit CYP3A4. therapeutic effect of calcium channel blockers in stable angina they promote relaxation of peripheral arterioles; the resultant decrease in afterload reduces cardiac oxygen demand. Verapamil and diltiazem can produce modest additional reductions in oxygen demand by suppressing heart rate and contractility. Can cause life-threatening QT prolongation and severe respiratory depression. -Because of the long half-life, it should be prescribed only by health care providers with special training in chronic pain management. Methadone black box warning maintenance consists of transferring the addict from the abused opioid to med. -By taking med, the addict avoids both withdrawal and the need to procure illegal drugs. -Maintenance dosing is done once a day. -Maintenance is most effective when done in conjunction with nondrug measures directed at altering patterns of drug use. Methadone maintenance therapy Unlike methadone, which is available only through certified opioid treatment programs, it can be prescribed and dispensed in general medical settings, such as primary care offices. -Prescribers must receive at least 8 hours of authorized training and must register with the Substance Abuse and Mental Health Services Administration. Buprenorphine Sublingual tablets, sublingual films, and buccal film, marketed as Suboxone, Zubsolv and Bunavail Buprenorphine w/Naloxone Delta-9-tetrahydrocannabinol (THC), an oily chemical with high lipid solubility. psychoactive substance in Cannabis Sativa Smoking - rapid, peak 10-20 minutes, approximately 60% absorbed -Oral - most inactivated; dose must be greater, peak 30mins-1 hour Marijuana Acts as a competitive antagonist at opioid receptors, thereby blocking opioid actions -Can reverse most effects of the opioid agonists, including respiratory depression, coma, and analgesia. -IM or subcutaneous Naloxone After a patient has undergone opioid detoxification, a pure opioid antagonist, can be used to discourage renewed opioid abuse. -Benefits derive from blocking euphoria and all other opioid-induced effects. By preventing pleasurable effects,it eliminates the reinforcing properties of opioid use. Naltrexone The oral formulation is dosed once a day. -The IM formulation, sold as Vivitrol, is dosed once a month. Naltrexone dosage If the dosage is sufficiently high, it can completely block access of strong opioids to µ-receptors and can thereby prevent opioid-induced euphoria. Buprenorphine Effects to which tolerance does develop include euphoria, respiratory depression, and nausea. - In contrast, little or no tolerance develops to constipation and miosis. Because tolerance to respiratory depression develops in parallel with tolerance to euphoria, respiratory depression does not increase because higher doses are taken to produce desired subjective effects. Opioid tolerance The time course of respiratory depression begins up to 90 minutes after PO ingestion. With prolonged use of opioids, tolerance develops to respiratory depression. - Certain patients, including the very young, older adults, and those with respiratory disease (e.g., asthma, emphysema), are especially sensitive to respiratory depression and hence must be monitored closely. -Opioid medications can cause respiratory arrest in both opioid-naïve and opioid-tolerant patients. Monitor for respiratory depression, especially during new-onset therapy or after escalation of dose. respiratory depression w/opioids Urinary hesitancy or retention is especially likely in patients with benign prostatic hypertrophy. Drugs with anticholinergic properties (e.g., tricyclic antidepressants, antihistamines) can exacerbate the problem. -Morphine can cause urinary hesitancy and urinary retention. urinary retention w/opioids Available in two formulations: (1) 50-mg tablets, for oral dosing; and (2) an ER suspension (380 mg/vial), marketed as Vivitrol, for IM dosing. -For oral therapy, a typical dosing schedule consists of 100 mg on Monday and Wednesday and 150 mg on Friday. -Alternatively, the drug can be administered daily in 50-mg doses. For IM dosing, the usual regimen is 380 mg once a month. Naltrexone dosing Indicated only for persistent severe pain in patients who are already opioid tolerant. Use in nontolerant patients can cause fatal respiratory depression. -The patch should not be used in children younger than 2 years or in anyone younger than 18 years who weighs less than 110 pounds. Fentanyl -Prolongs the QT interval and hence may pose a risk for potentially fatal dysrhythmia. -Torsades de pointes has developed in patients taking 65 to 400 mg/day. T Methadone Can increase the risk for congenital heart defects, spina bifida, and gastroschisis. opioids in pregnancy Can cause physical dependence in the fetus, resulting in withdrawal after delivery. opioids in infants Aspirin, as an adjuvant to opioids, should be avoided because of risk for Reye syndrome. opioids in children Can intensify responses to CNS depressants (e.g., alcohol, benzodiazepines) and therefore should not be combined with these drugs -Can precipitate a hypertensive crisis if combined with a monoamine oxidase inhibitor (MAOI). -SSRIs Tramadol interactions First step is to identify patients at risk for abuse by using a screening tool, such as NIDA Modified ASSIST -Become familiar with the state prescription drug monitoring program (PDMP -Urine drug test assessing opioid risk Promote constipation through actions in the CNS and gastrointestinal (GI) tract. Specifically, by activating µ receptors in the gut opioid-induced constipation Consists primarily of ventilatory support and giving an opioid antagonist. -Naloxone (Narcan) is the traditional antagonist of choic opioid overdose tx Actions of these drugs at µ and κ receptors -Pentazocine is the prototype agonist-antagonist Designated µ, κ, and δ. From a pharmacologic perspective, µ receptors are the most important because opioid analgesics act primarily by activating µ receptors, although they also produce weak activation of κ receptors opioid receptors Three families of peptides—enkephalins, endorphins, and dynorphins—that have opioid-like properties. -Endogenous opioid peptides are found in the central nervous system (CNS) and in peripheral tissues. opioid peptides Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it: Relaxes smooth muscle in the bladder neck To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should do all of the following EXCEPT: 1. Take the dose at bedtime 2. Sit up slowly and dangle their feet before standing 3. Monitor their blood pressure and skip a dose if the pressure is less than 120/80 4. Weigh daily and report weight gain of greater than 2 pounds in one day 3. Monitor their blood pressure and skip a dose if the pressure is less than 120/80 John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should: Not miss a dose or stop taking the drug because of potential rebound hypertension Clonidine has several off-label uses, including: 1. Alcohol and nicotine withdrawal 2.Post-herpetic neuralgia 3. Both 1 and 2 4. Neither 1 nor 2 3. Both 1 and 2 Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by: Reducing vascular smooth muscle tone Which of the following adverse effects are less likely in a beta1-selective blocker? Impaired insulin release Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work and find a CrCl of 25 ml/min. What action should you take related to his nadolol? Extend the dosage interval. Beta blockers are the drugs of choice for exertional angina because they: Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance Adherence to beta blocker therapy may be affected by their: Effects on the male genitalia, which may produce impotence Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the: Left ventricular dysfunction is diagnosed Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with: Angina Coronary artery disease To prevent life-threatening events from rapid withdrawal of a beta blocker: The dosage should be decreased by one-half every 4 days. Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia and block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose? Diaphoresis Combined alpha-beta antagonists are used to reduce the progression of heart failure because they: Vasodilate the peripheral vasculature Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes? Histamine 2 blockers Quinolones Serotonin re-uptake inhibitors Alpha-beta blockers are especially effective to treat hypertension for which ethnic group? African American Bethanechol: Increases detrusor muscle tone to empty the bladder Clinical dosing of Bethanechol: Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory clinical response is achieved Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects? Diphenhydramine Anticholinesterase inhibitors are used to treat: Myasthenia gravis Which of the following drugs used to treat Alzheimer's disease is not an anticholinergic? Memantine Taking which drug with food maximizes it bioavailability? Rivastigmine Which of the following drugs should be used only when clearly needed in pregnant and breastfeeding women? Pyridostigmine There is a narrow margin between first appearance of adverse reaction to AChE inhibitors and serious toxic effects. Adverse reactions that require immediate action include: Fasciculations of voluntary muscles Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily? Donepezil Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine? Vasodilation and decreased heart rate Nicotine gum products are: Bound to exchange resins so the nicotine is only released during chewing Nicotine replacement therapy (NRT): Delays healing of esophagitis and peptic ulcers Success rates for smoking cessation using NRT: Vary from 40% to 50% at 12 months Cholinergic blockers are used to: Counteract the extrapyramidal symptoms (EPS) effects of phenothiazines Control tremors and relax smooth muscle in Parkinson's disease Inhibit the muscarinic action of ACh on bladder muscle Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions? Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action. Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness. The patient is taught to: Swallow the tablet 1 hour before traveling where motion sickness is possible. You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when standing abruptly. The best option for this patient is: Discontinue the tamsulosin and start doxazosin. You are treating a patient with a diagnosis of Alzheimer's disease. The patient's wife mentions difficulty with transportation to the clinic. Which medication is the best choice? Donepezil A patient presents with a complaint of dark stools and epigastric pain described as gnawing and burning. Which of the medications is the most likely cause? Bethanechol Your patient calls for an appointment before going on vacation. Which medication should you ensure he has an adequate supply of before leaving to avoid life-threatening complications? Carvedilol Activation of central alpha2 receptors results in inhibition of cardioacceleration and ______________ centers in the brain. Vasoconstriction