Nr 565 And Nr 565 Advanced Pharmacology Midterm
Latest Updated 2024
An 82 yo male visits the clinic complaining that his pain meds "take forever" to work after he takes his
pill. What are possible reasons you can explain to him as to why this may be happening.
A. Perhaps we need to increase your dose
B. Sometimes as you get older, absorption may be slower resulting in a delayed response
C. As we get older, the gastric acid decreases and may delay absorption - ANSWER-B. Sometimes as you
get older, absorption may be slower resulting in a delayed response
C. As we get older, the gastric acid decreases and may delay absorption
RA Characteristics
Onset
Affected population
Location
Joint stiffness duration
SxS - ANSWER-weeks-months
women>men
common hands, feet, & wrists
>60 min in AM
local & sys.
OA Characteristics
,Onset
Affected population
Location
Joint stiffness duration
SxS - ANSWER-years
men & Women equally
Hands & weight baring joints
<30min in AM
typically local
What might you expect to find in the synovial fluid of a pt with OA - ANSWER-Mild leukocytes
What might you expect to find in the synovial fluid of a pt with RA - ANSWER-Cloudy with leukocytes
Goals of Tx for RA - ANSWER-Sxs relief (pain, stiffness, inflammation,
maintaining joint fxn and ROM
minimize systemic involvement
delay progression
Typical pharm Txs for RA - ANSWER-NSAIDs, systemic steroids, antimalarials, antimetabolites, and
biologics
Baseline assessment data before starting DMARD - ANSWER-Liver, PG, serum creatinine, CBC with diff,
sxs of infxn (TB & hepatits), Hx & physical, renal status, & malignancies
,Significant baseline data for Sulfasalazine - ANSWER-CXR, pulmonary and neuro status
Significant baseline data for Leflunomide - ANSWER-CXR, BP & pulmonary status
Significant baseline data for Mehtotrexate - ANSWER-CXR, Pulmonary and GI status
Significant baseline data for hydroxychloroquine - ANSWER-Ophthalmologic & cardiac exam (ECG if
indicated)
Conventional DMARDs- examples - ANSWER-Methotrexate, hydroxychloroquine, sulfsalazine
Biologic DMARDS- examples - ANSWER-adalimumab, etanercept, golimumab
"-mab"s
MOA of methotrexate - ANSWER-folic acid antagonist ->inhibits lymphocyte proliferation
Within how many months of RA diagnosis should Methotrexate be started and why? - ANSWER-3
months of diagnosis
delay joint degeneration
What are therapeutic uses for morphine? - ANSWER-Pain, sedation, euphoria, resp depression, cough
suppression, suppression of GI motility, reduces anxiety
What are therapeutic uses for Fentanyl? - ANSWER-•Chronic pain (PATCHES), acute pain, cancer pain
, When should a patient be referred to a pain specialist? - ANSWER-120mme/day
What is MME and when to use it? - ANSWER-Morphine milligram equivalent
Potency of an opioid
ID opioid prescription burden of a single person
What is the PDMP and when to use it? - ANSWER-Prescription drug monitoring program
Used when prescribing controlled substances
How to assess someone for possible drug diversion - ANSWER-UA screen
PDMP routine use
Risk Factors for OUD? - ANSWER-Family hx of abuse
personal hx of abuse
cross tolerance
mental illness
When to prescribe Naloxone? - ANSWER-With every opioid prescription
When prescribing Medications, we must understand that the liver function declines with age d/t what?
A. Enlarged Liver
B. Decreased blood flow to liver
C. Increased activity of the hepatic enzymes - ANSWER-B. Decreased blood flow to liver
Latest Updated 2024
An 82 yo male visits the clinic complaining that his pain meds "take forever" to work after he takes his
pill. What are possible reasons you can explain to him as to why this may be happening.
A. Perhaps we need to increase your dose
B. Sometimes as you get older, absorption may be slower resulting in a delayed response
C. As we get older, the gastric acid decreases and may delay absorption - ANSWER-B. Sometimes as you
get older, absorption may be slower resulting in a delayed response
C. As we get older, the gastric acid decreases and may delay absorption
RA Characteristics
Onset
Affected population
Location
Joint stiffness duration
SxS - ANSWER-weeks-months
women>men
common hands, feet, & wrists
>60 min in AM
local & sys.
OA Characteristics
,Onset
Affected population
Location
Joint stiffness duration
SxS - ANSWER-years
men & Women equally
Hands & weight baring joints
<30min in AM
typically local
What might you expect to find in the synovial fluid of a pt with OA - ANSWER-Mild leukocytes
What might you expect to find in the synovial fluid of a pt with RA - ANSWER-Cloudy with leukocytes
Goals of Tx for RA - ANSWER-Sxs relief (pain, stiffness, inflammation,
maintaining joint fxn and ROM
minimize systemic involvement
delay progression
Typical pharm Txs for RA - ANSWER-NSAIDs, systemic steroids, antimalarials, antimetabolites, and
biologics
Baseline assessment data before starting DMARD - ANSWER-Liver, PG, serum creatinine, CBC with diff,
sxs of infxn (TB & hepatits), Hx & physical, renal status, & malignancies
,Significant baseline data for Sulfasalazine - ANSWER-CXR, pulmonary and neuro status
Significant baseline data for Leflunomide - ANSWER-CXR, BP & pulmonary status
Significant baseline data for Mehtotrexate - ANSWER-CXR, Pulmonary and GI status
Significant baseline data for hydroxychloroquine - ANSWER-Ophthalmologic & cardiac exam (ECG if
indicated)
Conventional DMARDs- examples - ANSWER-Methotrexate, hydroxychloroquine, sulfsalazine
Biologic DMARDS- examples - ANSWER-adalimumab, etanercept, golimumab
"-mab"s
MOA of methotrexate - ANSWER-folic acid antagonist ->inhibits lymphocyte proliferation
Within how many months of RA diagnosis should Methotrexate be started and why? - ANSWER-3
months of diagnosis
delay joint degeneration
What are therapeutic uses for morphine? - ANSWER-Pain, sedation, euphoria, resp depression, cough
suppression, suppression of GI motility, reduces anxiety
What are therapeutic uses for Fentanyl? - ANSWER-•Chronic pain (PATCHES), acute pain, cancer pain
, When should a patient be referred to a pain specialist? - ANSWER-120mme/day
What is MME and when to use it? - ANSWER-Morphine milligram equivalent
Potency of an opioid
ID opioid prescription burden of a single person
What is the PDMP and when to use it? - ANSWER-Prescription drug monitoring program
Used when prescribing controlled substances
How to assess someone for possible drug diversion - ANSWER-UA screen
PDMP routine use
Risk Factors for OUD? - ANSWER-Family hx of abuse
personal hx of abuse
cross tolerance
mental illness
When to prescribe Naloxone? - ANSWER-With every opioid prescription
When prescribing Medications, we must understand that the liver function declines with age d/t what?
A. Enlarged Liver
B. Decreased blood flow to liver
C. Increased activity of the hepatic enzymes - ANSWER-B. Decreased blood flow to liver
