NR566 Advanced Pharmacology
Midterm 2026 – Full Exam with
Verified Answers
Bioavailability of bisphosphonate drugs and appropriate patient (client)
education --SOLUTION-- 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 --SOLUTION--
Etidronate has also been associated with fractures in patient (client)s with
Paget's disease when they are given high doses or when therapy lasted longer
than 6 months. These patient (client)s 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 patient (client)s 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 --
SOLUTION-- 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 --SOLUTION-- 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 patient (client)s 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 patient (client)s. 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 --SOLUTION--
Aromatase inhibitors Thyroid hormones
Glucocorticoid
s PPIs
SSRIs
Clinical signs and symptoms DM --SOLUTION--
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 --SOLUTION-- 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 --SOLUTION-- Acute symptoms of diabetes plus casual
plasma glucose concentration ≥200 mg/dL.
Midterm 2026 – Full Exam with
Verified Answers
Bioavailability of bisphosphonate drugs and appropriate patient (client)
education --SOLUTION-- 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 --SOLUTION--
Etidronate has also been associated with fractures in patient (client)s with
Paget's disease when they are given high doses or when therapy lasted longer
than 6 months. These patient (client)s 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 patient (client)s 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 --
SOLUTION-- 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 --SOLUTION-- 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 patient (client)s 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 patient (client)s. 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 --SOLUTION--
Aromatase inhibitors Thyroid hormones
Glucocorticoid
s PPIs
SSRIs
Clinical signs and symptoms DM --SOLUTION--
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 --SOLUTION-- 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 --SOLUTION-- Acute symptoms of diabetes plus casual
plasma glucose concentration ≥200 mg/dL.
