NR 567 ADVANCED PHARM MIDTERM EXAM
GUIDE ACTUAL EXAM COMPLETE 200 QUESTIONS
WITH DETAILED VERIFIED ANSWERS (100%
CORRECT ANSWERS) /ALREADY GRADED A+
What is the mechanism of action of thrombolytics like alteplase?
A. They inhibit platelet aggregation
B. They bind with plasminogen to form an active complex that converts plasminogen to
plasmin, which digests the fibrin meshwork of clots
C. They block the formation of thrombin
D. They inhibit vitamin K-dependent clotting factors
Correct Answer: B. They bind with plasminogen to form an active complex that converts
plasminogen to plasmin, which digests the fibrin meshwork of clots
Rationale: Thrombolytics like alteplase bind with plasminogen to form an active
complex that converts plasminogen to plasmin, which then digests the fibrin
meshwork of clots, leading to clot dissolution.
What is a major side effect of thrombolytics?
A. Hypertension
B. Bleeding, including the risk of intracranial hemorrhage
C. Bradycardia
D. Hyperglycemia
Correct Answer: B. Bleeding, including the risk of intracranial hemorrhage
Rationale: Bleeding, including the risk of intracranial hemorrhage, is a major side
effect of thrombolytics. This is the most significant adverse effect and requires
careful monitoring.
What are some contraindications for using thrombolytics? (Select all that apply)
A. Prior intracranial hemorrhage
B. Recent ischemic strokes
C. Severe uncontrolled hypertension
D. Active internal bleeding
,Correct Answer: A, B, C, D. Prior intracranial hemorrhage; Recent ischemic strokes;
Severe uncontrolled hypertension; Active internal bleeding
Rationale: Contraindications for thrombolytics include prior intracranial
hemorrhage, recent ischemic strokes, severe uncontrolled hypertension, recent
major surgery, and active internal bleeding. All of these increase the risk of serious
bleeding complications.
What laboratory parameters should be monitored when administering
thrombolytics?
A. CBC, PT/INR, and PTT
B. BMP and liver function tests
C. Cardiac enzymes and troponin
D. Blood glucose and hemoglobin A1c
Correct Answer: A. CBC, PT/INR, and PTT
Rationale: When administering thrombolytics, laboratory parameters to monitor
include CBC (complete blood count), PT/INR (prothrombin time/international
normalized ratio), and PTT (partial thromboplastin time) to assess bleeding risk
and coagulation status.
What is the recommended dosing for alteplase in acute myocardial infarction
(MI)?
A. 50 mg total: 10 mg IV bolus, 20 mg over 30 minutes, and 20 mg over 60 minutes
B. 100 mg total: 15 mg IV bolus, 50 mg over 30 minutes, and 35 mg over 60 minutes
C. 150 mg total: 20 mg IV bolus, 60 mg over 30 minutes, and 70 mg over 60 minutes
D. 100 mg total: 10 mg IV bolus, 40 mg over 30 minutes, and 50 mg over 60 minutes
Correct Answer: B. 100 mg total: 15 mg IV bolus, 50 mg over 30 minutes, and 35 mg
over 60 minutes
Rationale: The recommended dosing for alteplase in acute MI is 100 mg total: 15
mg IV bolus, followed by 50 mg infused over 30 minutes, and then 35 mg infused
over 60 minutes.
,What is the bioavailability of alteplase when administered IV?
A. 50%
B. 75%
C. 90%
D. 100%
Correct Answer: D. 100%
Rationale: Alteplase has 100% bioavailability when administered intravenously
because it is delivered directly into the systemic circulation, bypassing first-pass
metabolism.
How is alteplase metabolized?
A. Renal excretion
B. Rapid hepatic clearance, mainly by the liver through internalization and catabolism by
hepatic cells
C. Plasma esterase hydrolysis
D. Biliary excretion
Correct Answer: B. Rapid hepatic clearance, mainly by the liver through internalization
and catabolism by hepatic cells
Rationale: Alteplase is metabolized through rapid hepatic clearance, mainly by the
liver through internalization and catabolism by hepatic cells. This contributes to its
short half-life.
What is the initial elimination half-life of alteplase?
A. About 5 minutes
B. About 15 minutes
C. About 30 minutes
D. About 60 minutes
Correct Answer: A. About 5 minutes
Rationale: The initial elimination half-life of alteplase is about 5 minutes,
representing its rapid plasma clearance phase. The terminal elimination half-life is
about 35-50 minutes.
, What is the terminal elimination half-life of alteplase?
A. About 5-10 minutes
B. About 15-25 minutes
C. About 35-50 minutes
D. About 60-90 minutes
Correct Answer: C. About 35-50 minutes
Rationale: The terminal elimination half-life of alteplase is about 35-50
minutes, representing the slower elimination phase after the initial rapid
clearance.
What is the mechanism of action of statins like lovastatin?
A. They inhibit cholesterol absorption in the intestine
B. They inhibit HMG-CoA reductase in the liver, reducing cholesterol synthesis and
lowering LDL cholesterol levels
C. They increase HDL cholesterol production
D. They bind bile acids in the intestine
Correct Answer: B. They inhibit HMG-CoA reductase in the liver, reducing cholesterol
synthesis and lowering LDL cholesterol levels
Rationale: Statins like lovastatin inhibit HMG-CoA reductase, the rate-limiting
enzyme in cholesterol synthesis in the liver. This reduces cholesterol synthesis and
lowers LDL cholesterol levels.
What are the medications used in acute pulmonary embolism?
A. Heparin and alteplase (Activase)
B. Aspirin and clopidogrel
C. Warfarin and enoxaparin
D. Heparin and aspirin
Correct Answer: A. Heparin and alteplase (Activase)
Rationale: Heparin and alteplase (Activase) are the medications used in acute
pulmonary embolism. Heparin provides anticoagulation while alteplase provides
thrombolytic activity.
GUIDE ACTUAL EXAM COMPLETE 200 QUESTIONS
WITH DETAILED VERIFIED ANSWERS (100%
CORRECT ANSWERS) /ALREADY GRADED A+
What is the mechanism of action of thrombolytics like alteplase?
A. They inhibit platelet aggregation
B. They bind with plasminogen to form an active complex that converts plasminogen to
plasmin, which digests the fibrin meshwork of clots
C. They block the formation of thrombin
D. They inhibit vitamin K-dependent clotting factors
Correct Answer: B. They bind with plasminogen to form an active complex that converts
plasminogen to plasmin, which digests the fibrin meshwork of clots
Rationale: Thrombolytics like alteplase bind with plasminogen to form an active
complex that converts plasminogen to plasmin, which then digests the fibrin
meshwork of clots, leading to clot dissolution.
What is a major side effect of thrombolytics?
A. Hypertension
B. Bleeding, including the risk of intracranial hemorrhage
C. Bradycardia
D. Hyperglycemia
Correct Answer: B. Bleeding, including the risk of intracranial hemorrhage
Rationale: Bleeding, including the risk of intracranial hemorrhage, is a major side
effect of thrombolytics. This is the most significant adverse effect and requires
careful monitoring.
What are some contraindications for using thrombolytics? (Select all that apply)
A. Prior intracranial hemorrhage
B. Recent ischemic strokes
C. Severe uncontrolled hypertension
D. Active internal bleeding
,Correct Answer: A, B, C, D. Prior intracranial hemorrhage; Recent ischemic strokes;
Severe uncontrolled hypertension; Active internal bleeding
Rationale: Contraindications for thrombolytics include prior intracranial
hemorrhage, recent ischemic strokes, severe uncontrolled hypertension, recent
major surgery, and active internal bleeding. All of these increase the risk of serious
bleeding complications.
What laboratory parameters should be monitored when administering
thrombolytics?
A. CBC, PT/INR, and PTT
B. BMP and liver function tests
C. Cardiac enzymes and troponin
D. Blood glucose and hemoglobin A1c
Correct Answer: A. CBC, PT/INR, and PTT
Rationale: When administering thrombolytics, laboratory parameters to monitor
include CBC (complete blood count), PT/INR (prothrombin time/international
normalized ratio), and PTT (partial thromboplastin time) to assess bleeding risk
and coagulation status.
What is the recommended dosing for alteplase in acute myocardial infarction
(MI)?
A. 50 mg total: 10 mg IV bolus, 20 mg over 30 minutes, and 20 mg over 60 minutes
B. 100 mg total: 15 mg IV bolus, 50 mg over 30 minutes, and 35 mg over 60 minutes
C. 150 mg total: 20 mg IV bolus, 60 mg over 30 minutes, and 70 mg over 60 minutes
D. 100 mg total: 10 mg IV bolus, 40 mg over 30 minutes, and 50 mg over 60 minutes
Correct Answer: B. 100 mg total: 15 mg IV bolus, 50 mg over 30 minutes, and 35 mg
over 60 minutes
Rationale: The recommended dosing for alteplase in acute MI is 100 mg total: 15
mg IV bolus, followed by 50 mg infused over 30 minutes, and then 35 mg infused
over 60 minutes.
,What is the bioavailability of alteplase when administered IV?
A. 50%
B. 75%
C. 90%
D. 100%
Correct Answer: D. 100%
Rationale: Alteplase has 100% bioavailability when administered intravenously
because it is delivered directly into the systemic circulation, bypassing first-pass
metabolism.
How is alteplase metabolized?
A. Renal excretion
B. Rapid hepatic clearance, mainly by the liver through internalization and catabolism by
hepatic cells
C. Plasma esterase hydrolysis
D. Biliary excretion
Correct Answer: B. Rapid hepatic clearance, mainly by the liver through internalization
and catabolism by hepatic cells
Rationale: Alteplase is metabolized through rapid hepatic clearance, mainly by the
liver through internalization and catabolism by hepatic cells. This contributes to its
short half-life.
What is the initial elimination half-life of alteplase?
A. About 5 minutes
B. About 15 minutes
C. About 30 minutes
D. About 60 minutes
Correct Answer: A. About 5 minutes
Rationale: The initial elimination half-life of alteplase is about 5 minutes,
representing its rapid plasma clearance phase. The terminal elimination half-life is
about 35-50 minutes.
, What is the terminal elimination half-life of alteplase?
A. About 5-10 minutes
B. About 15-25 minutes
C. About 35-50 minutes
D. About 60-90 minutes
Correct Answer: C. About 35-50 minutes
Rationale: The terminal elimination half-life of alteplase is about 35-50
minutes, representing the slower elimination phase after the initial rapid
clearance.
What is the mechanism of action of statins like lovastatin?
A. They inhibit cholesterol absorption in the intestine
B. They inhibit HMG-CoA reductase in the liver, reducing cholesterol synthesis and
lowering LDL cholesterol levels
C. They increase HDL cholesterol production
D. They bind bile acids in the intestine
Correct Answer: B. They inhibit HMG-CoA reductase in the liver, reducing cholesterol
synthesis and lowering LDL cholesterol levels
Rationale: Statins like lovastatin inhibit HMG-CoA reductase, the rate-limiting
enzyme in cholesterol synthesis in the liver. This reduces cholesterol synthesis and
lowers LDL cholesterol levels.
What are the medications used in acute pulmonary embolism?
A. Heparin and alteplase (Activase)
B. Aspirin and clopidogrel
C. Warfarin and enoxaparin
D. Heparin and aspirin
Correct Answer: A. Heparin and alteplase (Activase)
Rationale: Heparin and alteplase (Activase) are the medications used in acute
pulmonary embolism. Heparin provides anticoagulation while alteplase provides
thrombolytic activity.
