NR 565 Week 1-4 Midterm Exam Actual Week 1-4
Midterm Exam Complete 1-100 Exam Questions
Proctored Via Examplify Chamberlain University With
Correct Answers | 100% Pass Guaranteed | Graded A+ |
Chronic or acute severe pain, cancer pain - - answerTherapeutic uses of fentanyl?
chronic pain, family history, other substance abuse, prescribed for long term use - - answerRisk factors
for opioid use disorder
opioids, benzos, alcohol, CNS depressants, anti-histamines, general anesthetics - - answerDrugs not safe
to take with opioids
agonist-antagonist - - answerBuprenorzhine and Naloxone
Naloxone is added to buprenorphine to decrease the likelihood of diversion and misuse of the
combination drug product - - answerBuprenorzhine and Naloxone benefit of combination
Non Opioid medications - NSAIDs, cox-2 inhibitors
Nonpharmacologic tx - heat/cold, yoga, physical therapy, exercise, healthy weight - - answerTreatment
of chronic pain- Example: How should something like osteoarthritis be treated?
decreased blood flow to liver
a. decreased liver mass
c. decrease in enzyme activity - - answerWhen prescribing medication we must understand that liver
function declines with age due to what cause?
,a. enlarged liver
b. decreased blood flow to liver
c. increased activity of the hepatic enzymes
decreased renal excretion - - answerWhat is the most important cause of adverse drug reactions? (older
age)
a. high drug dosages
b. lack of monitoring medications
c. decreased renal excretion
d. overprescribing/polypharmacy
2, 3, 4
changes in body composition associated with age due to an increase in body fat percentage and
decrease in lean muscle mass. There is also a decrease in total body water. Distribution can also be
impacted by decreased total body water and decreased cardiac output. Absorption can be impacted by
increase gastric pH, decreased absorption surface area decreased G.I. motility and decrease gastric
emptying. Metabolism can be impacted by de Cristo paddock blood flow, paddock mask, and activity of
hepatic enzymes. Excretion can be impacted by decreased renal blood flow, decrease GFR, decrees to
both secretion, and decrease number of nephrons - - answerDistribution of medication can be affected
in the elderly in what ways? SATA
1. decreased hormones
2. increased body fat
3. decreased lean mass
4. decreased albumin
2&3 - - answerAn 82 year old male visits the clinic complaining that his pain medications "take forever"
to work after he takes his pill. What are possible reasons you can explain to him?
1.Perhaps we need to increase your dosage.
2.Sometimes as you get older, absorption may be slower resulting in a delayed response.
3.As we get older the gastric acid decreases and may slow absorption.
Thiazide diuretics
,Ace Inhibitors
ARBS
CCB
BB - - answerOrder of HTN medications typically prescribed
ACE inhibitor and ARB - - answerWhich is best HTN medication for someone with diabetes
Avoid ACE and ARBs in patients who are pregnant or may become pregnant. Especially ARBs in the
second and third trimester. - - answerWhich medication to avoid in a patient who is pregnant or
breastfeeding?
labetalol, methyldopa, nifedipine - - answerMedications best for HTN for patient who is pregnant?
thiazide diuretics - - answerFor general population which HTN class is appropriate?
thiazide, CCB, BB - - answerFor African Americans which class of HTN medications is appropriate?
ACE Inhibitors or ARBS - - answerFor a chronic kidney disease, what is the best HTN medication class?
ACE inhibitors and ARBS - - answerWhat class of medications to avoid in African Americans?
blockade of sodium and chloride reabsorption
increases renal excretion of sodium, chloride, potassium, and water (hyponatremia, hypochloremia,
hypokalemia) - - answerThiazide diuretics MOA
Angiotensin Converting Enzyme Inhibitors (ACE-I) prevent the conversion of angiotensin I to angiotensin
II, which disrupts the renin-angiotensin-aldosterone system (RAAS).
1. reduce levels of angiotensin II (through inhibition of ACE)
2. increasing levels of bradykinin (through inhibition of kinase 11)
, End in -pril - - answerACE inhibitors MOA
Block angiotensin II receptors on blood vessels in heart and adrenals. Increases renal excretion of
sodium and water. Cause dilation of arterioles and veins.
End in -sartan - - answerARBS MOA
They work by preventing calcium from entering the cells of the heart and arteries. Calcium causes the
heart and arteries to squeeze (contract) more strongly. By blocking calcium, calcium channel blockers
allow blood vessels to relax and open.
blockade of peripheral arterioles cause dilation and reduces arterial pressure, arterioles of the heart
increases coronary perfusion, blockade of the SA node reduces heart rate, decreases AV node
conduction, myocardium decreases force of contraction - - answerCCB MOA
Carbamazepine lowers the effectiveness of Warfarin. This is because of the induction of drug-
metabolizing enzymes. There needs to be close monitoring for the Warfarin dose by checking the
prothrombin and INR. The dose may need to be adjusted to counterbalance the effect of adding or
removing the inducing agent - - answerPrescribing considerations when carbamazepine is prescribed
with warfarin
ensure that a patient is on an ARB (valsartan) as this inhibits fibrosis (aldosterone antagonist) - -
answerA patient with HF develops fibrotic changes, what should the provider do next?
ototoxicity - - answerAdverse effects of lasix (flurosemide)
aminoglycoside antibiotics, end in -cin - - answerWhat medication causes ototoxicity as well and should
not be prescribed with lasix?
potassium sparing diuretic (spironolactone) - - answerWhat medication might we consider prescribing
with a loop diuretic to prevent an electrolyte imbalance?
endocrine effects - gynecomastia, menstrual irregularities, hirsutism, deepening of voice
Midterm Exam Complete 1-100 Exam Questions
Proctored Via Examplify Chamberlain University With
Correct Answers | 100% Pass Guaranteed | Graded A+ |
Chronic or acute severe pain, cancer pain - - answerTherapeutic uses of fentanyl?
chronic pain, family history, other substance abuse, prescribed for long term use - - answerRisk factors
for opioid use disorder
opioids, benzos, alcohol, CNS depressants, anti-histamines, general anesthetics - - answerDrugs not safe
to take with opioids
agonist-antagonist - - answerBuprenorzhine and Naloxone
Naloxone is added to buprenorphine to decrease the likelihood of diversion and misuse of the
combination drug product - - answerBuprenorzhine and Naloxone benefit of combination
Non Opioid medications - NSAIDs, cox-2 inhibitors
Nonpharmacologic tx - heat/cold, yoga, physical therapy, exercise, healthy weight - - answerTreatment
of chronic pain- Example: How should something like osteoarthritis be treated?
decreased blood flow to liver
a. decreased liver mass
c. decrease in enzyme activity - - answerWhen prescribing medication we must understand that liver
function declines with age due to what cause?
,a. enlarged liver
b. decreased blood flow to liver
c. increased activity of the hepatic enzymes
decreased renal excretion - - answerWhat is the most important cause of adverse drug reactions? (older
age)
a. high drug dosages
b. lack of monitoring medications
c. decreased renal excretion
d. overprescribing/polypharmacy
2, 3, 4
changes in body composition associated with age due to an increase in body fat percentage and
decrease in lean muscle mass. There is also a decrease in total body water. Distribution can also be
impacted by decreased total body water and decreased cardiac output. Absorption can be impacted by
increase gastric pH, decreased absorption surface area decreased G.I. motility and decrease gastric
emptying. Metabolism can be impacted by de Cristo paddock blood flow, paddock mask, and activity of
hepatic enzymes. Excretion can be impacted by decreased renal blood flow, decrease GFR, decrees to
both secretion, and decrease number of nephrons - - answerDistribution of medication can be affected
in the elderly in what ways? SATA
1. decreased hormones
2. increased body fat
3. decreased lean mass
4. decreased albumin
2&3 - - answerAn 82 year old male visits the clinic complaining that his pain medications "take forever"
to work after he takes his pill. What are possible reasons you can explain to him?
1.Perhaps we need to increase your dosage.
2.Sometimes as you get older, absorption may be slower resulting in a delayed response.
3.As we get older the gastric acid decreases and may slow absorption.
Thiazide diuretics
,Ace Inhibitors
ARBS
CCB
BB - - answerOrder of HTN medications typically prescribed
ACE inhibitor and ARB - - answerWhich is best HTN medication for someone with diabetes
Avoid ACE and ARBs in patients who are pregnant or may become pregnant. Especially ARBs in the
second and third trimester. - - answerWhich medication to avoid in a patient who is pregnant or
breastfeeding?
labetalol, methyldopa, nifedipine - - answerMedications best for HTN for patient who is pregnant?
thiazide diuretics - - answerFor general population which HTN class is appropriate?
thiazide, CCB, BB - - answerFor African Americans which class of HTN medications is appropriate?
ACE Inhibitors or ARBS - - answerFor a chronic kidney disease, what is the best HTN medication class?
ACE inhibitors and ARBS - - answerWhat class of medications to avoid in African Americans?
blockade of sodium and chloride reabsorption
increases renal excretion of sodium, chloride, potassium, and water (hyponatremia, hypochloremia,
hypokalemia) - - answerThiazide diuretics MOA
Angiotensin Converting Enzyme Inhibitors (ACE-I) prevent the conversion of angiotensin I to angiotensin
II, which disrupts the renin-angiotensin-aldosterone system (RAAS).
1. reduce levels of angiotensin II (through inhibition of ACE)
2. increasing levels of bradykinin (through inhibition of kinase 11)
, End in -pril - - answerACE inhibitors MOA
Block angiotensin II receptors on blood vessels in heart and adrenals. Increases renal excretion of
sodium and water. Cause dilation of arterioles and veins.
End in -sartan - - answerARBS MOA
They work by preventing calcium from entering the cells of the heart and arteries. Calcium causes the
heart and arteries to squeeze (contract) more strongly. By blocking calcium, calcium channel blockers
allow blood vessels to relax and open.
blockade of peripheral arterioles cause dilation and reduces arterial pressure, arterioles of the heart
increases coronary perfusion, blockade of the SA node reduces heart rate, decreases AV node
conduction, myocardium decreases force of contraction - - answerCCB MOA
Carbamazepine lowers the effectiveness of Warfarin. This is because of the induction of drug-
metabolizing enzymes. There needs to be close monitoring for the Warfarin dose by checking the
prothrombin and INR. The dose may need to be adjusted to counterbalance the effect of adding or
removing the inducing agent - - answerPrescribing considerations when carbamazepine is prescribed
with warfarin
ensure that a patient is on an ARB (valsartan) as this inhibits fibrosis (aldosterone antagonist) - -
answerA patient with HF develops fibrotic changes, what should the provider do next?
ototoxicity - - answerAdverse effects of lasix (flurosemide)
aminoglycoside antibiotics, end in -cin - - answerWhat medication causes ototoxicity as well and should
not be prescribed with lasix?
potassium sparing diuretic (spironolactone) - - answerWhat medication might we consider prescribing
with a loop diuretic to prevent an electrolyte imbalance?
endocrine effects - gynecomastia, menstrual irregularities, hirsutism, deepening of voice
