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Advanced Pharmacology NSG 533 Latest Update 2024 Actual Exam Questions and Correct Detailed Answers (Verified Answers) Graded A+
What medications / foods can contribute to GERD? - Correct Answer - -
Medications: anticholinergics, barbiturates, dopamine, estrogen, opioids,
progesterone, theophylline, nitrates
-Foods: cirrus fruits/juices, coffee, tomatoes, spicy food, carbonated drinks
Fried/fatty foods, garlic, onions, chocolate
What is the most effective PPI or H2RA within each of these classes? - Correct Answer - -PPI- bismuth quadruple therapy combined with proton pump inhibitors -H2RA- Famotidine 80mg
Other products such as antacids are also available. What are some of these and what is their place in therapy? - Correct Answer - -Reflux symptoms <2 times a week (infrequent) -Effective for immediate relief -Magnesium/Aluminum Hydroxide (Maalox)- can cause constipation -Alginic Acid
Why would antibiotics be used for PUD caused by H Pylori? What is a typical regimen and duration of therapy? What patient specific factors should be considered and how should treatment be monitored? - Correct Answer -
Considerations before regimen choice: 1 / 4
pg. 2 -penicillin allergy -previous exposure to macrolide antibiotics
Strongest Recommendation:
-Bismuth Quadruple Therapy 10-14 days *Do not drink alcohol w/ metronidazole* -Salvage regimen should be different than first regimen
Who would be a candidate for prophylaxis of NSAID induced ulcer and what agents are appropriate? What if the patient is on cardio-protective (low dose) aspirin? What if an NSAID induced ulcer does develop. How should it be treated? -
Correct Answer - Candidate:
-Candidates: Chronic Said Use, Hex ulcers, Zollinger-Ellison
Prevention Treatment- PPI, standard doses (most effective & best tolerated), Misoprostol (better than H2RA's, No Pregnancy)
What if an NSAID induced ulcer does develop. How should it be treated? - Correct Answer - Ulcer Treatment- -PPI (most effective) -H2RA (Famotidine 40mg daily) -Sucralfate (binding paste, requires multiple doses, adverse med reactions, abdominal side effects)
which beta blockers are contraindicated in asthma - Correct Answer - nadolol, propranolol, timolol, sotalol symptoms of uncontrolled asthma - Correct Answer - at least three of the
following: 2 / 4
pg. 3 -daytime asthma more than 2x a week -nighttime awakening -reliever therapy more than 2x a week -activity intolerance
treatment of asthma symptoms less than 2x a month - Correct Answer - as needed low dose ICS-formoterol or as needed low dose ICS with SABA
treatment of asthma symptoms more than 2x a month - Correct Answer - daily low dose ICS and as needed SABA or as needed low dose ICS-formoterol
treatment of asthma symptoms most days of the week - Correct Answer - daily low dose ICS-formoterol and as needed SABA or daily medium dose ICS and SABA
treatment of daily asthma symptoms (severe asthma) - Correct Answer - daily medium dose ICS-formoterol with reliever therapy OR daily high dose ICS with reliever therapy
What agents are used to treat hypothyroid disease? What makes the medications different and what do the guidelines recommend for use - Correct Answer -
Recommendation 22.1: Patients with hypothyroidism should be treated with
Levothyroxine monotherapy. Grade Other forms of thyroid replacement may be associated with necessary cost, lack of therapeutic rationale, increase adverse effects and allergenicity (animal-based products)
Starting therapy Normal adult dose: 1.6 mcg/kg/day (~100-125 mcg/day) based
on IBW (LBW)Titration by 25-50 mcg every 4-6 weeks until TSH normalizes EXCEPTIONS include elderly, chronically ill patients or history of cardiovascular disease. Initially 12.5-25 mcg/day, then titrate to maintenance dose until TSH 3 / 4
pg. 4 normalizes Expect higher requirements during pregnancy Thyroid hormone demand Increases in TBGDestruction of T4 by placental deiodinases
How is treatment monitored and how should results be interpreted as far as therapy changes (the relationship between TSH and T3-4) - Correct Answer - Monitoring should be every 6-8 weeks after starting or dose/product change. If TSH is not in target range (0.5-2.5 mIU/L) alter dose in 10% to 20% increments.levothyroxine has a T 1/2 of 6-10 days (and NTI. see below). How does this relate to the fact that after initiating or changing a doe or changing a product (IE brand to generic, generic to brand or one generic brand to another), TSH should be checked in about 6 weeks
Why are thyroid replacement drugs considered to have a narrow therapeutic index (NTI) and what does that mean clinically? - Correct Answer - The therapeutic index (TI) is the range of doses at which a medication is effective without unacceptable adverse events. Drugs with a narrow TI (NTIs) have a narrow window between their effective doses and those at which they produce adverse toxic effects. Oral Bioavailability: (erratic) 40-80%brand vs generic Highly protein bound (99%) Half-life Euthyroid = 6-7 days Hypothyroid = 9-10 days Steady State: @ 6 weeks or 4-5 t1/2 's ... this is the bases for monitoring @ six weeks from start or changes!Consider changes such as brand to generic, different generics manufactures, different pharmacies, etc Any such change will require repeat lab monitoring @ ~
- weeks to confirm the same clinical response
What are some drug-drug, drug-food interactions associated with thyroid replacement - Correct Answer - drug binding interactions, di-valent cations, amiodarone, certain antibiotics
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