NR 566 MIDTERM REVIEW EXAM
QUESTIONS AND ANSWERS GRADED
A+
Bioavailability of bisphosphonate drugs and appropriate patient education - Correct
answer-Histamine2 blocking agents double alendronate bioavailability, but the
impact is unknown. Aspirin may decrease the bioavailability of tiludronate by up to
50% when taken 2 hours after the tiludronate. Although indomethacin increases the
bioavailability of tiludronate by 2- to 4-fold, the bioavailability is not significantly
altered by diclofenac; therefore, each NSAID must be considered individually.
Adverse effects associated with long-term use of bisphonates - Correct answer-
Etidronate has also been associated with fractures in patients with Paget's disease
when they are given high doses or when therapy lasted longer than 6 months.
These patients must be carefully monitored with x-rays and laboratory work to
assess for these lesions. The development of a rare form of subtrochanteric femur
fracture in non-Paget's patients using bisphosphonates is under close scrutiny and
has contributed to movement away from osteopenia prevention care to only
osteoporosis therapy (FDA, 2010a).
,Specifics about administration and education regarding pancreatic enzymes -
Correct answer-All doses are taken immediately before or with meals or snacks
with a fatty component. Fruit, hard candy, fruit juice like drinks, tea or coffee, or
popsicles do not require enzymes (CFF, 2009). Capsules may be opened and
sprinkled on food. Capsules with enteric-coated beads should not be chewed. They
may be sprinkled on soft acidic food that is not hot and that can be swallowed
without chewing, such as applesauce or gelatin. Swallow immediately because the
proteolytic enzymes may irritate the mucosa. Following with a glass of water or
juice or eating immediately after taking the drug helps to ensure that the
medication is swallowed and does not remain in contact with the mouth and
esophagus for long periods. Pancrelipase is destroyed by acid. Proton pump
inhibitors, sodium bicarbonate, or aluminum-based antacids may be used with
preparations without enteric coating to neutralize gastric pH. Calcium- and
magnesium-based antacids should not be used for this purpose because they
interfere with drug action. Enteric-coated beads are designed to withstand the acid
pH of the stomach. Enteric-coated formulations should not be mixed with alkaline
food or the coating will be destroyed.
Common adverse effects with aromatase inhibitors - Correct answer-Adverse
effects for the drug class include various pain syndromes, vertigo, insomnia
resulting in daytime sleepiness and confusion, increased risk of blood clots, and
,hair loss. A key concern is the loss of bone mass. Bone loss can be significant
when considering the concurrent osteoporotic risks of postmenopause. Closer
monitoring is required. All patients should be on calcium and vitamin D
supplementation. A relative leukopenia can occur, but the incidence of viral and
bacteria infections is not considered greater than matched groups (about 10%).
Hypertension occurs in 10% of patients. A life-threatening increase in blood
clotting can result in MI, stroke, or pulmonary embolus. Hot flashes can be intense.
Drugs associated risk for bone loss which should be monitored - Correct answer-
Aromatase inhibitors
Thyroid hormones
Glucocorticoids
PPIs
SSRIs
Clinical signs and symptoms DM - Correct answer-Increased thirst
Frequent urination
Extreme hunger
Unexplained weight loss
, Presence of ketones in the urine (ketones are a byproduct of the breakdown of
muscle and fat that happens when there's not enough available insulin)
Fatigue
Irritability
Blurred vision
Slow-healing sores
Frequent infections, such as gums or skin infections and vaginal infections
Risk factors & associated complications of DM - Correct answer-Complications:
stroke, heart attack, peripheral artery disease, diabetic retinopathy, cataracts,
glaucoma, diabetic nephropathy, peripheral neuropathy, diabetic foot.
Risk factors: >45 years old, physical inactivity, 1st degree relative relative with
DM, high risk ethic group (african american, hispanic, native american, asian
american, and pacific islander), hx of gest DM, htn, HDL < 35, triglycerides >250,
polycystic ovarian syndrome, acanthosis nigricans, hx of cardiovascular disease.
Diagnostic criteria of DM - Correct answer-Acute symptoms of diabetes plus
casual plasma glucose concentration ≥200 mg/dL.
QUESTIONS AND ANSWERS GRADED
A+
Bioavailability of bisphosphonate drugs and appropriate patient education - Correct
answer-Histamine2 blocking agents double alendronate bioavailability, but the
impact is unknown. Aspirin may decrease the bioavailability of tiludronate by up to
50% when taken 2 hours after the tiludronate. Although indomethacin increases the
bioavailability of tiludronate by 2- to 4-fold, the bioavailability is not significantly
altered by diclofenac; therefore, each NSAID must be considered individually.
Adverse effects associated with long-term use of bisphonates - Correct answer-
Etidronate has also been associated with fractures in patients with Paget's disease
when they are given high doses or when therapy lasted longer than 6 months.
These patients must be carefully monitored with x-rays and laboratory work to
assess for these lesions. The development of a rare form of subtrochanteric femur
fracture in non-Paget's patients using bisphosphonates is under close scrutiny and
has contributed to movement away from osteopenia prevention care to only
osteoporosis therapy (FDA, 2010a).
,Specifics about administration and education regarding pancreatic enzymes -
Correct answer-All doses are taken immediately before or with meals or snacks
with a fatty component. Fruit, hard candy, fruit juice like drinks, tea or coffee, or
popsicles do not require enzymes (CFF, 2009). Capsules may be opened and
sprinkled on food. Capsules with enteric-coated beads should not be chewed. They
may be sprinkled on soft acidic food that is not hot and that can be swallowed
without chewing, such as applesauce or gelatin. Swallow immediately because the
proteolytic enzymes may irritate the mucosa. Following with a glass of water or
juice or eating immediately after taking the drug helps to ensure that the
medication is swallowed and does not remain in contact with the mouth and
esophagus for long periods. Pancrelipase is destroyed by acid. Proton pump
inhibitors, sodium bicarbonate, or aluminum-based antacids may be used with
preparations without enteric coating to neutralize gastric pH. Calcium- and
magnesium-based antacids should not be used for this purpose because they
interfere with drug action. Enteric-coated beads are designed to withstand the acid
pH of the stomach. Enteric-coated formulations should not be mixed with alkaline
food or the coating will be destroyed.
Common adverse effects with aromatase inhibitors - Correct answer-Adverse
effects for the drug class include various pain syndromes, vertigo, insomnia
resulting in daytime sleepiness and confusion, increased risk of blood clots, and
,hair loss. A key concern is the loss of bone mass. Bone loss can be significant
when considering the concurrent osteoporotic risks of postmenopause. Closer
monitoring is required. All patients should be on calcium and vitamin D
supplementation. A relative leukopenia can occur, but the incidence of viral and
bacteria infections is not considered greater than matched groups (about 10%).
Hypertension occurs in 10% of patients. A life-threatening increase in blood
clotting can result in MI, stroke, or pulmonary embolus. Hot flashes can be intense.
Drugs associated risk for bone loss which should be monitored - Correct answer-
Aromatase inhibitors
Thyroid hormones
Glucocorticoids
PPIs
SSRIs
Clinical signs and symptoms DM - Correct answer-Increased thirst
Frequent urination
Extreme hunger
Unexplained weight loss
, Presence of ketones in the urine (ketones are a byproduct of the breakdown of
muscle and fat that happens when there's not enough available insulin)
Fatigue
Irritability
Blurred vision
Slow-healing sores
Frequent infections, such as gums or skin infections and vaginal infections
Risk factors & associated complications of DM - Correct answer-Complications:
stroke, heart attack, peripheral artery disease, diabetic retinopathy, cataracts,
glaucoma, diabetic nephropathy, peripheral neuropathy, diabetic foot.
Risk factors: >45 years old, physical inactivity, 1st degree relative relative with
DM, high risk ethic group (african american, hispanic, native american, asian
american, and pacific islander), hx of gest DM, htn, HDL < 35, triglycerides >250,
polycystic ovarian syndrome, acanthosis nigricans, hx of cardiovascular disease.
Diagnostic criteria of DM - Correct answer-Acute symptoms of diabetes plus
casual plasma glucose concentration ≥200 mg/dL.
