NURS 615 Pharm Exam 3 Review Questions and answers

NURS 615 Pharm Exam 3 Review Questions and answers

• What is low dose colchicine- 1.2mg followed by 0.6mg one hour later or 1.8 milligrams total
• What patient education should you provide when prescribing colchicine?colchicine always causes seven

degree of diarrhea so make sure that people understand that

• What lab value should be monitored with gout? Check renal function test, BUN, Creatine
• what is the difference between high dose and low dose colchicine?

The difference between the two is low dose is as effective as high dose with a lower side effect profile.

• Identify the signs of hyperglycemia- polyuria, polydispia, and weight loss
• Identify symptoms of hypoglycemia-dizziness, confusion, diaphoresis and tachycardia
• identify the signs of ketoacidosis- fruity breath, rapid respirations, focal neurologic symptoms including

lethargy and obtundation which can develop and progress to coma in later stages.

• How does metformin work? Reduces gluconeogenesis in the liver, increases insulin mediated glucose

utilization in peripheral tissues lowering serum phreatic concentration thereby reducing substrate availability for gluconeogenesis. Also used to treat LDL and triglycerides in diabetics

• What diagnostic testing is required before and throughout therapy with metformin- a serum creatinine to

assess for impaired renal function.

• how is metformin processed in the body- Metformin is not metabolized. It is cleared from the body via

tubular secretion and excreted unchanged in the urine.

• What is the action of gliptin The first agent in the class, sitaglipin, was approved by the FDA in 2006

Inhibitors Dipeptidyl peptidase-4 (DPP4), or dpp-4 inhibitors or gliptins, are a class of oral hypoglycemics that block DPP-4 Glucagon increases blood glucose levels and dpp-4 inhibitors reduced glucagon blood glucose levels. dpp-4 inhibitors increase incretin levels and inhibit glucagon release which increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels

• How do GLP agonists work- They bind to glucagon-like peptide-1 receptor slowing gastric emptying,

increasing insulin secretion by pancreatic beta cells. Simultaneously the compound reduces the elevated glucagon secretion by inhibiting alpha cells of the pancreas. GLP-1 is normally secreted by L cells of the gastrointestinal mucosa response to a meal

• What are GLP agonist used to treat- Type 2 diabetes
• what is the benefit of using meglitinides- one of their advantages over older insulin secretagogues

such as sulfonylureas are meglitinides is that they have a lower risk of causing hypoglycemia.

• When should exenatide be administered- It should be administered 60 minutes before breakfast and

dinner.

• what is the mechanism of action of exenatide- Exenatide enhances glucose-dependent insulin secretion

by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion and slows gastric emptying although the mechanism of action is still under study

• What are the adverse effects of propylthiouracil or PTU- Side effects include fatal granulocytopenia

which usually the first sign is a fever and sore throat, vasculitis, a temporary alopecia, rash, aplastic anemia, and acute renal failure

• what is the mechanism of action of PTU- PTU inhibits the enzyme thyroperoxidase, which normally

acts in thyroid hormone synthesis by oxidizing the anion iodide (I−) to iodine (I0), facilitating iodine's addition to tyrosine residues on the hormone precursor thyroglobulin. This is one of the essential steps in the formation of thyroxine (T4).

• what are the side effects of levothyroxine? tachycardia and angina, more notably in the elderly
• which hormone is levothyroxine chemically identical to? T4
• Where is T4 secreted? by the follicular cells of the thyroid gland
• what is levothyroxine used to treat? thyroid hormone deficiency and occasionally to prevent

recurrence of thyroid cancer

• A patient develops toxic goiter. What's the recommended treatment Methimazole. used to treat

hyperthyroidism in patients with toxic adenoma or toxic goiter in preparation for more definitive therapy with radioiodine or surgery

• What are the adverse effects Methimazole? Methimazole is teratogenic and in the fetus can cause

aplasia cutis which is a congenital focal absence of the skin on the scalp.

• What are the adverse effects of PTU? agranulocytosis anca positive vasculitis, hepatotoxicity, and

pancreatitis which is rare. 1 / 4

• What is the dosage schedule for alpha-glucosidase inhibitors? Acarbose- 50-100mg tablets po TID.

should be taken with the first bite of meals.

• in what population is alpha-glucosidase inhibitors contraindicated? in patients with inflammatory or

irritable bowel syndrome.

• What are the common side effects of alpha-glucosidase inhibitors

flatulence, diarrhea, and abdominal discomfort - almost always decrease if dosage is decreased.

• What is the mechanism of action of propylthiouracil? It works in the thyroid as well as peripherally. In

the thyroid PTU inhibits the thyroperoxidase which normally acts and thyroid hormone synthesis by oxidizing the iodide to iodine PTU also acts by inhibiting the enzyme 5-deiodinases which converts t4 to the active form t3.

• What are the contraindications for therapy with alpha-glucosidase inhibitors

Patients with irritable or inflammatory bowel syndrome is cannot take them second-degree to the flatulence that they can produce.

• What patient education is important relative the administration of levothyroxine

Take on an empty stomach approximately half an hour before meals as such thyroid replacement therapy is usually taken 30 minutes prior to eating in the morning

• What black box has the FDA issued regarding administration of TZDs (thiazolidinediones)?

bladder ca + water retention leading to edema in less than 5% of individuals, could lead to a decompensation + potentially unrecognized heart failure. Prescribed with caution. Pt education for water retention and weight gain especially in patients with decreased ventricular function.

• What symptoms may indicate that a patient is taking too much thyroid replacement hormone?

symptoms of hyperthyroidism, tachycardia, insomnia or nervousness

• What lab values will be used to monitor a patient on levothyroxine blood free thyroxine and TSH

35.how often are blood tests ordered for patients taking levothyroxine? done four to eight weeks after the start of treatment for a change in dose. Once the adequate replacement dose has been established the test can be repeated after six and then 12 months unless there is a change in symptoms 36.What is the onset of action peak of action and duration of action of Rapid acting insulin: Lispro(humalog)/Aspart (Novolog)/Glulisine (Apidra)? Onset 5 min, Peak 1 hr, Duration 4-5 hours 37.what is the onset of action, peak of action, and duration of Short acting insulin: Regular (humulin)?Onset 30-45 minutes, Peak 3-4 hours, Duration 4- 10 hours

• what is the onset of action, peak of action, and duration of intermediate action insulin (NPH)? Onset

60 to 90min, Peak 4-10 hours, Duration 12-24 hours

• what is the onset of action, peak of action, and duration of long acting insulin (Glargine/ Levemir or

detemir) Onset 2-4 hours, Peak (not documented), Duration up to 24 hours

• When changing from NPH to Glargine insulin, how will you adjust the patient's dose? The initial dose

of glargine is reduced by twenty percent to avoid hypoglycemia.

• Insulin glargine- long-acting basal insulin analog given once daily to help control blood sugar levels.

It consists of microcrystals that slowly releases insulin giving a long duration of action of 18 to 26 hours.Pharmacokinetic it resembles basal insulin secretion of a non-diabetic pancreatic beta cells.

• Insulin Glargine- Lantus
• What are the side effects of insulin therapy? hypoglycemia and hypokalemia
• What assessment should be made before prescribing in any antihypertensive agent

a thorough assessment of their liver and renal function. The real function especially for ace inhibitors and ACE receptor blockers which are primarily in the kidneys

• Why are ACE inhibitors the drug of choice and diabetic patients with hypertension

They reduce the adverse effects of diabetes on the kidneys. ACE inhibitors slow the onset of diabetic nephropathy in patients with microalbuminuria and type 1 diabetes

• What's the most common adverse effect of ACE inhibitors? A dry, hacking cough. That's the most

common reason to change treatment from an ace inhibitor to an ace receptor blocker.

• What is the mechanism of ACE inhibitors? systematic process triggered by kidneys due to low blood

volume. begins w/ secretion of insulin from renal cortex. Once released renin cleaves off angiotensinogen

• form Angiotensin-I it is then catalyzed by angotensin converting enzyme in pulm vasculature to

angotensin 2 basil constrictor effects are > by ACE inhibition 2 / 4

• What is the mechanism of action of calcium channel blockers? Calcium channel blockers prevent or

reduce the opening of calcium channels reducing the effects.

• what effect do calcium channel blockers have on vascular smooth muscle? they reduce contraction the

arteries and causes an increase in arterial diameter a phenomenon called vasodilatations. Calcium channel blockers do not work on Venus smooth muscle

• what effect do calcium channel blocker have on cardiac muscles

by acting on cardiac muscles or the myocardium they reduce the force of the contraction of the heart

• What effect do calcium channel blockers have on the electrical activity of the heart?

by slowing down the conduction of electrical activity within the heart they slow down the heart rate; 52.reducing the aldosterone production by blocking the calcium signals on the adrenal cortex allows calcium channel blockers to decrease after load decreases which in turn decreases how hard the heart pumps decreasing oxygen requirements (helpful in treatment of angina pectoris).

53.what is the class of calcium channel blockers that affect arterial vascular smooth muscle ?dihydropyridines. What is the effect of dihydropyridines? lower blood pressure by causing vasodilation 54.which drugs are in the phenylalanine class of calcium channel blockers? Verapamil

• what is the effect of phenylalanine drugs? affect the cells of the heart and have a negative inotropic

and negative chronotropic effect

• what is a inotropic effect? how strong the heart muscle works
• where does propylthiouracil (PTU) work? PTU works both essentially in the thyroid as well as the

target tissues. that these enzymes only work in conjugated tyrosine molecules of t3 and t4 .

• what is a negative chronotropic effect. controls how quickly the heart beats.
• what is a benzothiazepine class of calcium channel blockers? Diltiazem
• What class does the following drugs belong to?:1) Nifedipine2) Amlodipine 3) Felodipine4)

Clevidipine5) Diltiazem6) dihydropyridine. Verapamil-.benzothiazepine. Diltiazem- phenylalanine 61.What are the adverse effects of dihydropyridine-type calcium channel blockers reflex tachycardia which can be detrimental for patients with the ischemic symptoms because the resulting increase in myocardial oxygen demand. work on the vasculature and do not work on the heart. can worsen proteinuria + increase edema in hands and feet.

• What are the adverse effects of statins rhabdomyolysis; you can also see an increased risk of diabetes

and increase the liver enzymes the blood due to liver damage. Other possible adverse effects include cognitive loss, neuropathy, pancreatic and other hepatic dysfunction and sexual dysfunction

• What patient education would you provide for client in which you have prescribed a statin

Instruct the patient to report any muscle weakness or tenderness and dark urine to the provider immediately

• What lipid disorders do bile acid sequestrants treat? cholestyramine or cholybar lowers plasma

cholesterol levels.

• what is the mechanism of action of bile acid sequestrants? bile acid sequestrants which binds bile in

the GI tract to prevent its reabsorption. removes bile acids from the body forming insoluble complexes with bile acids in the intestine then excreted in the feces. As a result of this loss of bile acids or plasma cholesterol is converted to bile acids in the liver to normalize levels.

• What would you recommend to a patient who is experiencing flushing with niacin therapy 300 mg of

aspirin 30 min before taking niacin

• How is amlodipine metabolized? It's metabolized in the liver to inactive metabolites vs cyp3a4;

grapefruit juice inhibits the cyp3a4 or 384 increasing the amount of amlodipine in the bloodstream.

69.what is amlodipine used for Amlodipine is a medication used to treat high blood pressure and prevent chest pain; it can also be used for heart failure.

• what are the side effects of amlodipine? peripheral edema, dizziness and palpitations, and flushing;

common not dose-related: include fatigue, nausea, abdominal pain, and somnolence; and rare side effect include: blood disorders, impotence, depression, insomnia, tachycardia, gingival enlargement, hepatitis, and jaundice

• what is the action of amlodipine? By widening blood vessels, it lowers blood pressure 3 / 4

• What patient teaching will you provide when prescribing amiodarone any visual disturbances should

be reported immediately. pts. may have photosensitivity, so sunscreen is important. interstitial lung disease. hypo and hyperthyroidism may occur, and they should check blood pressure daily

• What are the drug interactions with digoxin? Digoxin has potentially serious interactions with

verapamil, amiodarone, erythromycin, and epinephrine as would be injected by a local with a local in the anesthetic. The digoxin level should be monitored while taking albuterol; need to monitor renal functions as it's excreted in the kidneys

• what is the most common indication for digoxin? are a fib and a flutter with that rapid ventricular

response although beta blockers and calcium channel blockers are a better first choice.

• what are the potential risks with using digoxin tentative evidence that digoxin may increase the risk of

death. High ventricular rate leads to insufficient diastolic filling time. By slowing down the conduction of the AV node and increasing its refractory period digoxin can reduce the ventricular rate.

• What's the purpose of thyroid panel with amiodarone? Induced abnormalities in thyroid function are

common. Amiodarone is structurally similar to thyroxine which contributes to the effects of amiodarone on thyroid function. TSH should be checked Q 6 mos or TSH should be checked Q 6 mos.

• Nitrate tolerance? occurs in pt taking nitrates around the clock or with long-acting forms prevented by

allowing a regular nitrate-free period to allow enzyme pathways to replenish. transdermal forms: remove patch at bedtime for 8 hrs, then apply new in morning

• How do you avoid nitrate tolerance? long-term nitrate therapy regimens should be tailored to provide a

10 to 12-hour nitrate-free interval level when possible

• Warfarin Sodium (Coumadin) Contraindications

Hemorrhage tendencies vitamin C or K deficiencies active peptic ulcer disease (GI bleed) Uncontrolled hypertension (promotes bleeding) Severe hepatic or renal disease (liver wont produce vitamin K and kidneys wont be able to clear it) Recent brain or spine surgery

• What classes of medications are used in the treatment of congestive heart failure?ACE inhibitors,

ARBs, BB, diuretics

• what type of drug is procainamide pharmaceutical anti arrhythmic agent used for medical treatment of

cardiac arrhythmias classified as a 1a

• what is procainamide used for used for both supraventricular and ventricular arrhythmias. For

example, it can be used to convert new onset a-fib though it is sub-optimal for this purpose. must have adequate serum concentration.

• how is procainamide dosed Because of its short half-life it must be dose every three to four hours

84.what are the side effects of procainamide may also lead to drug induced fever and other allergic responses. There is also a chance the systemic lupus erythematosus can occur, which at the same time leads to polyarthralgia, myalgia, and pleurisy—most of these side effects may occur due to the aestivation of procainamide.

• What are serious side effects associated with acetaminophen?

Acute overdoses of acetaminophen can cause potentially fatal liver damage. maximum recommended dose is 4 grams in 24 hours

• What is the mechanism of action for ibuprofen Ibuprofen is a non-selective inhibitor of

cyclooxygenase, its pharmacological effects are believed to be due to inhibition of cox-1 and 2 which decreases the synthesis of prostaglandins in mediating the inflammation pain fever and swelling 87.What are the recommendations in the treatment of pain? start with NSAIDS and work your way up from there.

• What are the black box warnings on NSAIDsincreased risk of serious cardiovascular thrombotic

events, MI and stroke. Pts with CAD or risk factors for CAD at higher risk. ALso increased risk of GI adverse events.

• What are the adverse effects of corticosteroids if administered for six months or more

osteoporosis it can also worsen diabetic control and patients should report any tarry black stools or abdominal pain.

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