NRP507 Advanced Pharmacology
Week 1 Discussion
Drug Targets and Response
Identify the correct clinical application(s) for each question below using the following pharmacokinetic terms: “absorption,” “distribution,” “metabolism,” “excretion,” “half-life,” “steady-state.”
Answer the following questions in a minimum of 175-300 words:
Why is a Z pack of 5 days an adequate treatment for pneumonia?
Why does a patient starting on levothyroxine need to wait 4-6 weeks before repeating labs to check for therapeutic response to the drug?
What are the implications for a patient on Tegretol who is given a drug that is a CYP-450 inducer?
What are the implications for a patient on Coumadin who is given a drug that is a CYP-450 inhibitor?
Does a drug’s route of administration matter?
What are the implications for an 80-year-old individual with stage 4 chronic renal failure who needs to be prescribed an antibiotic for his pneumonia?
Which pharmacokinetic property is the least familiar to you?
NRP507 Advanced Pharmacology
Week 2 Discussion
Ominous Octet
The “Ominous Octet” phrase coined by Dr. Ralph DeFronzo refers to eight main core defects contributing to hyperglycemia, occurring with diabetes.
In a minimum of 175-300 words, provide seven main core defects contributing to hyperglycemia. One main core is already provided in the example below.
Include the following in your response:
Organ: The organ that is contributing to the hyperglycemia
Defect: A phrase to describe the defect
Drug Class: At least one drug class (not drug name)that works on the defect
Mechanism of Action: Explain the mechanism of action
Why is it important for an FNP to understand each defect?
Example
Organ: Pancreas
Defect: Decreased beta cell production
Drug Class: Sulfonylurea
Mechanism of Action: Stimulates release of insulin from beta cells
NRP507 Advanced Pharmacology
Week 3 Discussion
Hypertension
Answer the following questions in a minimum of 175-300 words:
A 42-year-old African American male presents with new onset hypertension 148/90. The FNP needs to initiate treatment. Review the most current EBP guidelines for HTN, and discuss what medication you would start him on and why. Justify your answers and cite appropriately. Consider your knowledge of pathophysiology in your decision-making. What nonpharmacological treatment plan would you recommend?
NRP507 Advanced Pharmacology
Week 4 Discussion
Prescribing Birth Control
The evidence-based practice (EBP) guidelines changed in 2012 to allow clinicians to prescribe birth control without performing a pap smear until a woman turns age 21. Explain briefly why this change was made. (Hint: related to HPV).
In a minimum of 175-300 words, discuss combination oral contraceptives (COC) and how they are a common choice employed. Ensure you:
Explain briefly the mechanism of action of COCs.
Identify the best candidate for COC.
Explain briefly 3 common side effects.
Discuss cautions and absolute contraindications to prescribing COCs.
Describe the significance of the acronym ACHES and how you as a clinician would communicate this very important information to your patients.
NRP507 Advanced Pharmacology
Week 5 Discussion
The Importance of Mechanism of Action for COPD and Asthma
Answer the following questions in a minimum of 175-300 words:
Which core defect of asthma does a SABA address?
Which core defect of asthma does an inhaled corticosteroid (ICS) or ICS/LABA address?
What is important for the patient to know? Why?
What is the difference in mechanism of action (MOA) of a short-acting beta agonist (SABA) vs. a long acting beta agonist (LABA) vs. a long-acting muscarinic antagonists (LAMA). Please explain.
Why would you never prescribe a LABA as monotherapy for a patient with asthma?
NRP507 Advanced Pharmacology
Week 6 Discussion
Prescribing for Depression
Answer the following questions in a minimum of 175-300 words:
What is the rationale for having a patient complete a tool for depression or anxiety before prescribing a drug?
You are prescribing a Selective Serotonin Reuptake Inhibitor (SSRI) for depression. Choose two of the following and discuss:
What are a few of the most common side effects of SSRI?
What dosing instructions would you share to help mitigate side effects?
What is a reasonable time frame to have your patient follow-up to assess their response?
What can they expect at this follow-up? Isremission a possibility?
When do you consider a referral?
NRP507 Advanced Pharmacology
Week 7 Discussion
Prescribing for Osteoporosis
The Bisphosphonates is the most common drug class used for osteoporosis treatment; there are four drugs in this class. Review the following scenario to answer the questions provided:
Scenario:
You have a 58-year-old Asian patient that had a Dual-Energy X-Ray Absorptiometry (DEXA):
T score of -3.5 (hip), T score of -2.8 (spine). She also drinks 3 cups of tea daily, smokes ½ pack cigarettes x 25 years, BMI 20, + FH osteoporosis (mother), low calcium in diet, does walk a lot in daily life, no fragility fractures, no history steroids, no other meds.
Answer the following questions in a minimum of 175-300 words:
Which one of the bisphosphonate drugs would you recommend for her?
When should she have her next follow-up DEXA?
Would you offer any other specific medication(s)? Why or why not?
What do you believe are two priorities for patient education?
NRP507 Advanced Pharmacology
Week 8 Discussion
Protein Pump Inhibitors and H2 Blockers
Answer the following questions in a minimum of 175-300 words:
What is the difference in mechanism of action between a PPI and an H2 blocker? Please explain.
Which one offers more blockade of hydrochloric acid?
Why do most of the PPIs need to be prescribed as dose before meals?
What are the implications for long-term use of these medications?
NRP507 Advanced Pharmacology
Week 3 Assignment
Patient Case Study: Diabetes Mellitus, Hypertension, Hyperlipidemia
This week you gained insight into diabetes, hypertension, and hyperlipidemia, and now it is time to apply your knowledge to complete a case study focused on a patient returning to review his labs.
As clinicians, it is essential to be aware of the two main evidence-based guidelines, the American Diabetes Association® (ADA) and the American Association of Clinical Endocrinologists® (AACE), to help you manage patients.
For this assignment, use the ADA evidence-based guidelines to answer the questions within the case study.
All rights reserved.
Case Study: Diabetes Mellitus,
Hypertension, Hyperlipidemia
Complete the case study by answering the questions associated with the scenario.
DOB: 2/14/72
George Garcia, a 48-year-old Hispanic male, presents for his 3-month follow-up type-2 diabetes mellitus (T2DM) lab review. He is a long-term patient in your practice. He works as an interstate truck driver, so he admits he doesn’t get a chance to exercise, eats a lot of fast food, and drinks 3 cups of coffee and 2 beers/day. He was diagnosed with T2DM 2 years ago and has maxed out on his metformin, refused to start a statin for “fearing the side effects” despite our discussions at each office visit. He has been taking his meds as prescribed and needs refills on everything. His blood pressure was suboptimal at his last visit 3 months ago and his lisinopril was increased from 20mg to 40mg, and he complains of constant throat clearing and an annoying dry cough. He complained of a mild cough in the past and always attributed it to allergies but states this is not allergies. He verbalizes he wishes he had some ideas on how he could make some health changes but finds it hard with his job. He feels sluggish and has decided he wants to try that medicine for cholesterol we discussed in the past.
ROS is negative except for his dry cough
The exam is normal except has frequent dry hacky cough during the visit
ASCVD 10-year risk assessment is >15%.
Eye exam: Current: no retinopathy
Foot exam: Current: sensation intact to monofilament
PMH: HTN, T2DM, Erectile dysfunction.
FH: Father: T2DM, MI
Mother: T2DM, obesity
Sisters x 2: Obesity
Meds:
metformin XR 1000mg 2 tab with dinner
lisinopril 40mg 1-tab daily
Viagra® 100mg 1-tab prn
Allergies: NKDA
VS: BP 142/90 P 82 R 20 BMI 28
CBC: Normal
Case Study DM_HTN_HLP
NRP/507 v5
Page 2 of 8
CMP: glucose: 116
GFR: 110
Creatinine: 0.9
BUN: 10
K: 4.0
LFTs: all normal urinary albumin-to-creatinine ratio normal
A1C: 7.5
Lipids: TC: 235
Trigs: 190
HDL: 32
LDL: 180
VLDL: 23
Part I: Hypertension (HTN)
Analysis of Blood Pressure Control
Using the most current ADA EBP guidelines, answer the following questions.
1. Using the information provided in the scenario, synthesize George’s overall social and medical history, clinical symptoms, and clinical assessment, and provide an analysis of his blood pressure control.
Plan of Care and Prescription Writing
2. Which medication would you use to treat him? Explain your rationale. Include the medication class, side effects, and any precautions or black box warnings in your explanation.
3. Using the Rx template provided, type the blood pressure prescription you have chosen to treat George’s blood pressure. Make sure to include all elements. Excellence in Health Care, LLC.
4. Outline 2 of the most common side effects of the medication you just prescribed, monitoring for appropriate follow-up labs and office visit, including time frames on both.
5. Discuss 5 specific, relevant, and realistic dietary interventions you would suggest to positively impact George’s blood pressure. One intervention needs to incorporate a complementary herb or supplement. Provide a rationale for each intervention using evidence-based support. (Use the National Institutes of Health Herbs at a Glance page to search for and locate evidence-based support for a complementary herb or supplement.)
Part II: Diabetes Mellitus (DM)
Using the most current ADA EBP guidelines, answer the following questions.
Analysis of Blood Sugar Control
1. Based on the information provided within the scenario, synthesize George’s overall social and medical history, clinical symptoms, and clinical assessment, and provide an analysis of whether his blood sugars are under control.
Plan of Care and Prescription Writing
2. Which medication changes would you make to treat him and explain your rationale? Include the medication class, side effects, and any precautions or black box warnings in your explanation.
3. Using the Rx templates, type the prescription(s) you have chosen to treat George’s blood sugar.
4. Outline your follow-up plan for labs and office visit, including time frames on both. List each lab and provide rationale.
5. Discuss 5 lifestyle interventions and explain specifically how they can impact George’s glycemic control.
Part III: Hyperlipidemia (HLP)
Analysis of Lipid Control
Using the most current ADA EBP guidelines, answer the following questions.
1. Based on the information provided within the scenario, synthesize George’s overall social and medical history, clinical symptoms, and clinical assessment, and provide an analysis of whether his lipids are under control.
2. Differentiate the mechanism of action between a hydrophilic statin and a lipophilic statin and provide an example of each. How is this information helpful to you as a clinician and specifically in treating George?
Plan of Care and Prescription Writing
3. Which medication would you use to treat George? Explain your rationale including the medication class, side effects, any precautions, or black box warnings in your explanation.
4. Using the Rx template, type the prescription you have chosen to treat George’s abnormal lipids.
Excellence in Health Care, LLC.
Monitoring, Follow-up, and Patient Education
5. Outline monitoring for appropriate follow-up labs and office visit, including time frames on both.
6. Patient education is always essential and important. In this case, what imperative piece of information regarding a potential side effect of this lipid medication would you impart to George?
NRP507 Advanced Pharmacology
Week 5 Assignment
Patient Case Study: Asthma
Based on the knowledge you have gained up to this point, it is time to apply your skills to determine the proper treatment plan for a patient presenting with asthma exacerbation.
CASE STUDY:
Asthma
Complete the case study by answering the questions associated with the scenario.
DOB: 2/3/1984
Nancy Smith, a 35-year-old female, presents with an asthma exacerbation. She was diagnosed with asthma at age 20 and
has been only using an albuterol inhaler p.r.n. (when necessary). She has been seen in urgent care a few times over the past year (most recently 4 months ago) and was given a prescription for an inhaled steroid (this one she never filled), albuterol inhaler, and oral steroids. Her asthma symptoms flared again 2 weeks ago, and she has been using her albuterol 3-4 times/day. She reports that she is very short of breath when climbing stairs or when walking to the mailbox. She has had nighttime coughing spells every day during the past week and has had to prop herself up on pillows to breathe. She indicates that she has had similar previous flares in the past and she “just wants more albuterol and steroid pills.”
Meds:
Proair HFA
Claritin prn
Spirometry: FEV1: 58%
FEV1/FVC ratio: 69%
Pulse ox: 93% on RA
Analysis of Asthma Stage
Refer to the most current UpToDate® evidence based guidelines (EBG) for asthma located in the University Library to answer the following questions:
1. Synthesize the patient’s overall social and medical history, clinical symptoms, and clinical assessment to classify her asthma using EBG. Which of the 4 categories (intermittent, persistent mild, persistent – moderate, persistent – severe) does she fall under? Explain your justification.
2. From a pathophysiological perspective, what is the danger with her current treatment plan execution regarding her SABA use? Explain your answer.
Plan of Care and Prescription Writing
1. What is your evidence-based medication treatment plan? Please do NOT use the Alternative treatment plan listed in the guidelines for this case study. Based on your analysis, write a minimum of 3 prescriptions the patient will need using the templates provided. One prescription needs to include a steroid burst.
Excellence in Health Care, LLC.
DEA #
Name Date
DOB
Rx:
Sig:
Qty:
RF:
Signature
Dispense as Written Substitution Permissible
Excellence in Health Care, LLC.
DEA #
Name Date
DOB
Rx:
Sig:
Qty:
RF:
Signature
Dispense as Written Substitution Permissible
Excellence in Health Care, LLC.
DEA #
Name Date
DOB
Rx:
Sig:
Qty:
RF:
Signature
Dispense as Written Substitution Permissible
Mechanism of Action, Monitoring, and Patient Education
1. Explain the mechanism of action of each medication you are prescribing and how it addresses the patient’s asthma exacerbation. When would you see her back for a follow-up appointment?
2. Outline appropriate monitoring for drug side effects, laboratory monitoring with rationale, and follow-up.
3. Discuss the specific, realistic patient education you would provide and how you would tailor your information to Nancy to facilitate treatment adherence and understanding.
NRP507 Advanced Pharmacology
Week 6 Assignment
Patient Case Study: Migraine
Assignment Content
Karen Myers a 35-year old, who was recently promoted to CEO of a marketing company, presents to the FNP for c/o increasing migraines. She does not have a migraine today but has a past medical history (PMH) of migraines since her early 20s and was able to manage them effectively with OTC Excedrin® Migraine, however, it is no longer effective. Her job requires her to be “at the top of her game,” and she expresses frustration since she has missed work a few times over the past month due to the migraines when she had to retreat to her dark, quiet bedroom and try to sleep it off. She describes a scintillating scotoma aura she has always experienced with her migraines. The evolution of her migraines has not changed, and she describes it as always unilateral, starting in her occipital scalp and migrating retro-orbitally.
ROS: GI: c/o mild nausea with migraines but has never vomited, Neuro: See HPI; Denies red flags. -- PMH: Migraines -- Meds: Excedrin Migraine prn -- Allergies: NKDA -- VS: 124/74, P 72, R 16 -- BMI 24
Question 1Which of the following is most appropriate to prescribe first line for Karen?
Tramadol 50 mg tab, sig: 2 tabs at the onset of her migraine and repeat every 4 hours until migraine resolved
Propranolol hydrochloride LA 80 mg cap, sig: 1 cap daily
Rizatriptan 5-10 mg tab, sig: 1 tab at onset of migraine; may repeat dose every 2 hours x2
Magnesium 400 mg tab, sig: 1 tab daily
Question 2
The mechanism of action of serotonin receptor agonists is:
Vasodilation by inhibiting the release of vasoactive peptides and blocking pain pathways in the brainstem, thereby inhibiting dural nociception.
Inhibition of prostaglandin synthesis and have a central analgesic mechanism of action
Modulation of neurotransmitters and appears to affect the central serotonin receptor function
Inhibition of vasospasm of the cerebral arteries and preventing cerebral hypoxia during migraine attacks
Question 3
In a follow-up 3 weeks later, Karen reports success with using the triptan prescribed. She expressed concern over side effects she experienced shortly after taking a dose. Which of the following concerns you the most?
Warming sensation
Drowsiness
Chest tightness
Transient visual loss
Question 4
Which of the following is an unlikely risk factor contributing to Karen’s increased migraine frequency?
Work stress
Jet lag
Dark chocolate and aspartame
Acupuncture
Question 5
You determine Karen is overusing her abortive migraine treatment and want to initiate a prophylactic medication (in addition to abortive treatment). Which of the following medications is most favorable considering the concerns she verbalized above?
Topiramate
Verapamil
Amitriptyline
Candesartan
Botulinum toxin
NRP507 Advanced Pharmacology
Week 7 Assignment
Patient Case Study: Musculoskeletal/Pain
Assignment Content
This week you explored both the musculoskeletal system and pain management. In this assignment, focus on developing the proper treatment plans for two patients presenting with severe pain related to gout and osteoarthritis.
Gout
Read the following scenario to answer questions 1-3:
Marco Aquino, a 41-year-old male from the Philippines, presents with severe pain in his right first MTP joint that started 2 days ago. He suspects it is his “gout flaring up” again because of overindulging in seafood and beer, which he admits. He describes similar episodes of severe pain in the same toe over the past couple of years to the degree he couldn’t walk. He didn’t see a provider but achieved resolution of the pain after a few weeks of ice, rest, and taking an herbal medication from the Philippines. He works as a forklift driver and can’t miss work. He is asking what he can take to achieve more rapid relief of his symptoms. He takes no other medications and has no known allergies. His labs are all normal.
Question 1
All of the following are appropriate medication options to prescribe for George’s acute gout attack except for which of the following?
Indomethacin
Prednisone
Colchicine
Probenecid
Question 2
Marco has agreed to take allopurinol, a xanthine oxidase inhibitor daily. Educating Marco about titration of the medication to a therapeutic dose is important. The goal is to treat to a serum uric acid level of what?
The “normal” uric acid level outlined by the laboratory conducting the testing
Less than 6mg/dL
Less than 8mg/dL
There is no specific uric acid level treatment goal; only need to achieve resolution of symptoms.
Question 3
Which of the following labs is the least important to monitor while Marco is on anti-gout medications?
Liver function
Renal function
CBC
Uric acid
Question 4
Which of the following is the most appropriate treatment for Tracie at this point?
Scheduled dosing of acetaminophen in combination with topical capsaicin
Scheduled dosing of oral NSAIDs with mild opioid for breakthrough pain
Topical NSAID pain relief with mild opioid for breakthrough pain
PRN dosing of acetaminophen
Question 5
Tracie asks about alternative treatments. All of the following are true except:
Systematic reviews done on glucosamine revealed a significant reduction in knee pain.
Topical NSAID pain reliever is generally considered a safer alternative to oral therapy; however, it still requires liver function monitoring.
Beneficial interventions include stretching, yoga, acupuncture, weight reduction, and gradual conditioning of major muscle groups.
Injection options include steroids, hyaluronate, and viscous solutions.
Question 6
Tracie returns 1 year later and she indicates her daily pain is now 7/10 despite using acetaminophen, NSAIDS, topical medications, physical therapy, massage, ice, and rest. She is currently using ibuprofen 800mg TID with food, capsaicin topical to her knee, and adds acetaminophen prn. The pain interferes with her quality of life and sleep. She plans to have a total knee replacement done, but her surgery is scheduled 2 months out. She is requesting stronger pain medicine until she can get her surgery done. According to the World Health Organization "pain ladder," which is the most appropriate medication to add for Tracie?
Ketoprofen
Oxycodone
Tramadol
MS Contin®
NRP507 Advanced Pharmacology
Week 1 Quiz
Question 1
Steady state is:
1. The point on the drug concentration curve when absorption exceeds excretion
2. When the amount of drug in the body remains constant
3. When the amount of drug in the body stays below the minimum toxic concentration
4. All of the above
Question 2
The time required for the amount of drug in the body to decrease by 50% is called:
1.Steady state
2. Half-life
3. Phase II metabolism
4. Reduced bioavailability time
Question 3
Pharmacokinetic factors that affect prescribing include:
1. Therapeutic index
2. Minimum effective concentration
3. Bioavailability
4. Ease of titration
Question 4
Under new U.S. Food and Drug Administration labeling, pregnancy categories have been:
1.Strengthened with a new coding such as C+ or C- to discern when a drug is more or less toxic to the fetus
2. Changed to incorporate a pregnancy risk summary and clinical considerations on the drug label
3. Eliminated, and replaced with a link to the National Library of Medicine TOXNET Web site for in-depth information regarding pregnancy concerns
4. Clarified to include information such as safe dosages in each trimester of pregnancy
Question 5
Precautions that should be taken when prescribing controlled substances include:
1. Faxing the prescription for a Schedule II drug directly to the pharmacy
2.Using tamper-proof paper for all prescriptions written for controlled drugs
3.Keeping any pre-signed prescription pads in a locked drawer in the clinic
4.Using only numbers to indicate the amount of drug to be prescribed
Question 6
Phase IV clinical trials in the United States are also known as:
1.Human bioavailability trials
2. Postmarketing research
3. Human safety and efficacy studies
4. The last stage of animal trials before the human trials begin
Question 7
A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:
1. Ensure the patient will not have increased adverse drug reactions to the tamoxifen
2. Identify potential drug–drug interactions that may occur with tamoxifen
3. Reduce the likelihood of therapeutic failure with tamoxifen treatment
4. Identify poor metabolizers of tamoxifen
Question 8
Inhibition of P-glycoprotein by a drug such as quinidine may lead to:
1. Decreased therapeutic levels of quinidine
2. Increased therapeutic levels of quinidine
3. Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination
4. Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination
Question 9
Infants and young children are at higher risk of developing antibiotic-resistant infections due to:
1.Developmental differences in pharmacokinetics of the antibiotics in children
2.The fact that children this age are more likely to be in daycare and exposed to pathogens from other children
3. Parents of young children insisting on preventive antibiotics so they don’t miss work when their child is sick
4. Immunosuppression from the multiple vaccines they receive in the first two years of life
Question 10
When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would include:
1.Metronidazole is safe in the first trimester of pregnancy.
2. Consuming alcohol in any form may cause a severe reaction.
3.Sexual partners need concurrent therapy.
4.Headaches are a sign of a serious adverse reaction and need immediate evaluation.
NRP507 Advanced Pharmacology
Week 2 Quiz
1.Question 1
Attenuated vaccines are also known as:
1.Killed vaccines
2.Booster vaccines
3.Inactivated vaccines
4. Live vaccines
Question 2
Recombinant influenza vaccine (Flucelvax, Flublok) may be administered annually to:
1. Patients with an egg allergy
2. Pregnant adolescent patients
3. Patients age six weeks or older
4. Patients with acute febrile illness
Question 3
Anemia due to chronic renal failure is treated with:
1. Epoetin alfa (Epogen)
2. Ferrous sulfate
3. Vitamin B12
4. Hydroxyurea
Question 4
A patient has just had her pregnancy confirmed and is asking about how to ensure a healthy baby. What is the folic acid requirement during pregnancy?
1. 40 mcg/day
2.200 mcg/day
3.600 mcg/day
4.2 g/day
Question 5
Hyperthyroid patients require which specialty consultation even when asymptomatic for that organ system?
1. Hepatology
2. Pulmonary
3. Ophthalmology
4. Rheumatology
Question 6
Why are “natural” thyroid products not readily prescribed for most patients?
1. There is no reliability for the amount of hormone per dose.
2. There is higher incidence of allergic reactions.
3. There is a more reliable dose of triiodothyronine (T3) to T4 per batch lot of preparation.
4. All of the above
Question 7
Treatment with insulin for type 1 diabetics:
1.Starts with a total daily dose of 0.2 to 0.4 units per kilogram of body weight
2.Divides the total doses into three injections based on meal size
3. Uses a total daily dose of insulin glargine given once daily with no other insulin required
4. Is based on the level of blood glucose
Question 8
Routine screening of asymptomatic adults for diabetes is appropriate for:
1. Individuals who are older than 45 and have a body mass index (BMI) of less than 25 kg/m2
2. Native Americans, African Americans, and Hispanics
3. Persons with high-density lipoprotein (HDL) cholesterol greater than 100 mg/dL
4. Persons with prediabetes confirmed on at least two occasions
Question 9
Ethnic groups differ in their risk for and presentation of diabetes. Hispanics:
1. Have a high incidence of obesity, elevated triglycerides, and hypertension
2. Do best with drugs that foster weight loss, such as metformin
3. Both 1 and 2
4. Neither 1 nor 2
Question 10
Establishing glycemic targets is the first step in treatment of both types of diabetes. For type 1 diabetes:
1.Tight control/intensive therapy can be given to adults who are willing to test their blood glucose at least twice daily.
2. Tight control is acceptable for older adults if they are without complications.
3. Plasma glucose levels are the same for children as adults.
4.Conventional therapy has a fasting plasma glucose target between 120 and 150 mg/dL.
NRP507 Advanced Pharmacology
Week 3 Quiz
1.Question 1
What physical assessment is required prior to initiating a new hypertensive patient on an ACE?
1. Distal pulse intensity
2.Carotid bruits
3.Pulse deficit
4.Renal bruits
Question 2
Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct.
1.Administration to older adults because of reduced renal function
2. Digoxin given with aldosterone antagonist diuretics because of decreased potassium levels
3. Taking an antacid for gastroesophageal reflux disease because it increases the absorption of digoxin
4. Doses between 0.25 and 0.5 mg/day
Question 3
Beta blockers are especially helpful for patients with exertional angina who also have:
1.Arrhythmias
2.Hypothyroidism
3. Hyperlipidemia
4.Atherosclerosis
Question 4
Medications are typically started for angina patients when:
1.The first permanent electrocardiographic (ECG) changes occur
2. Class I or II symptoms begin
3.The events trigger a trip to the emergency department
4.Troponin levels become altered
Question 5
Class I recommendations for stage A HF include:
1. Aerobic exercise within tolerance levels to prevent the development of HF
2.Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention
3.Beta blockers for all patients regardless of cardiac history
4. Treatment of thyroid disorders, especially if they are associated with tachyarrhythmias
Question 6
ACE inhibitors are a foundational medication in HF. Which group of patients cannot take them safely?
1. Elderly patients with reduced renal clearance
2.Pregnant women
3. Women under age 30
4.1 and 2
Question 7
The most recent treatment guidelines strongly recommend dosing primarily based on:
1. Family history
2. Personal CV risk
3.Specific lipid levels
4.Twenty-year risk of CV event
Question 8
When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment?
1. Total LDL
2. Fasting high-density lipoprotein (HDL)
3. Coronary artery disease risk level
4.Fasting total cholesterol
Question 9
Potassium excess risk is highest with which combination of medications:
1. Aldactone and a beta blocker
2. An ACE and a loop diuretic
3. An ARB and an aldosterone antagonist
4. A direct renin inhibitor and a thiazide
Question 10
Lack of adherence to blood pressure management is very common. Reasons for this lack of adherence include:
1. Lifestyle changes are difficult to achieve and maintain.
2. Adverse drug reactions .
3. Costs of drugs and monitoring with laboratory tests can be expensive.
4.All of the above
NRP507 Advanced Pharmacology
Week 4 Quiz
Question 1
Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be:
1. Recommend she return to the clinic at the start of her next menses to get a Depo- Provera shot.
2. Prescribe oral combined contraceptives and recommend she start them at the beginning of her next period and use a back-up method for the first seven days.
3. Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first seven days.
4. Discuss the advantages of using the topical birth control patch and recommend she consider using it.
Question 2
Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects?
1. Increased migraine headaches
2. Increased risk of developing blood clots
3. Irregular vaginal bleeding for the first few months
4. Increased risk for hypercalcemia
Question 3
A contraindication to the use of combined contraceptives is:
1. Adolescence (not approved for this age)
2. A history of clotting disorder
3. Recent pregnancy
4. Being overweight
Question 4
Adverse effects of depot medroxyprogesterone acetate (DMPA) (Depo-Provera) include:
1. Decrease in bone mineral density with longer-term use
2. Increase in migraines
3. Increased risk for venous thromboembolism (VTE)
4. Increased risk of cardiovascular events
Question 5
Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of:
1. Hemoglobin
2.Serum calcium
3.White blood count
4. Serum potassium
NRP507 Advanced Pharmacology
Week 5 Quiz
Question 1
Medications used in the management of chronic obstructive pulmonary disease (COPD) include:
1. Inhaled beta 2 agonists
2. Inhaled anticholinergics (ipratropium)
3. Inhaled corticosteroids
4. All of the above
Question 2
Asthma exacerbations at home are managed by the patient by:
1. Increasing frequency of beta 2 agonists and contacting their provider
2. Tripling inhaled corticosteroid dose
3. Inhaled beta 2 agonists every 20 minutes for two hours
4.Starting montelukast (Singulair
Question 3
Treatment for mild-intermittent asthma is:
1. Daily inhaled medium-dose corticosteroids
2. Short-acting beta 2 agonists (albuterol) as needed
3. Long-acting beta 2 agonists every morning as a preventative measure
4. Montelukast (Singulair) daily
Question 4
Education for patients who use an inhaled beta agonist and an inhaled corticosteroid includes:
1. Use the inhaled corticosteroid first, followed by the inhaled beta agonist.
2. Use the inhaled beta agonist first, followed by the inhaled corticosteroid.
3. Increase fluid intake to 3 L per day.
4. Avoid use of aspirin or ibuprofen while using inhaled medications.
Question 5
If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be:
1. Intravenous (IV) or intramuscular (IM)
2. IV or IM ceftriaxone
3. IV amoxicillin
4. IV ciprofloxacin
Question 6
A four-year-old patient has suspected bacterial pneumonia. He has a temperature of 102°F, oxygen saturation level of 95%, and is taking fluids adequately. What would be appropriate initial treatment for his pneumonia?
1. Ceftriaxone
2.Azithromycin
3. Cephalexin
4. Levofloxacin
Question 7
Drug resistant tuberculosis (TB) is defined as TB that is resistant to at least:
1. Fluoroquinolones
2.Rifampin and isoniazid
3.Amoxicillin
4.Ceftriaxone
Question 8
The principles of drug therapy for the treatment of TB include:
1. Patients are treated with a drug that M. tuberculosis is sensitive to.
2. Drugs need to be taken on a regular basis for a sufficient amount of time.
3. Treatment continues until the patient’s PPD is negative.
4. All of the above
Question 9
A 3-year-old patient presents with a URI. Treatment for their URI would include:
1.Amoxicillin
2. Diphenhydramine
3.Pseudoephedrine
4.Nasal saline spray
Question 10
Treatment for sinusitis in an adult who has a child in daycare is:
1.Azithromycin 500 mg a day for five days
2.Amoxicillin-clavulanate 500 mg bid for seven days
3. Ciprofloxacin 500 mg bid for five days
4. Cephalexin 500 mg qid for five days
NRP507 Advanced Pharmacology
Week 6 Quiz
Question 1
Which of the following medications prevents the seizures and delirium tremens associated with alcohol withdrawal?
1. Clonidine
2. Lorazepam
3.Ethanol supplementation
4.Barbiturates
Question 2
The first-line medication(s) for alcohol withdrawal is/are:
1. Valproates
2. Benzodiazepines
3.Carbamazepine
4.Clonidine
Question 3
Why is taking paroxetine (Paxil) consistently and never running out of medication more important with this drug than with most other SSRIs?
1. It has a shorter half-life and withdrawal syndrome has a faster onset without taper.
2. It has the longest half-life and the withdrawal syndrome has a faster onset.
3. It is quasi-addictive in the dopaminergic reward system.
4. It is the most activating of SSRI medications and a sudden stop to taking it will cause the person to have sudden deep sadness.
Question 4
What “onset of action” symptoms should be reviewed with patients who have been newly prescribed an SSRI?
1. They will have insomnia for a week.
2. They may feel a bit of nausea, but this will resolve in a week.
3.They will have an “onset seizure” but this is considered normal.
4. They will no longer dream.
Question 5
First-line therapy for an adult with ADHD is:
1.Methylphenidate
2.Atomoxetine
3.Clonidine
4.Behavioral therapy
Question 6
After an adult is started on stimulants for ADHD the following should be monitored:
1. Height and weight for increased body mass index (BMI)
2.Blood pressure for hypotension
3. Refill pattern for diversion
4. All of the above
Question 7
A 54-year-old female has a history of migraines that do not respond well to over-the-counter (OTC) migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be:
1.Prescribe the rizatriptan, but only give her four tablets with no refills to monitor the use.
2. Prescribe rizatriptan and arrange to have her observed in the clinic or urgent care with the first dose.
3.Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital).
4.Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan.
Question 8
A 24-year-old patient has had migraines for 10 years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling her naratriptan, education would include:
1.Naratriptan will interact with antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and St. John’s Wort, and she should inform any providers she sees that she has migraines.
2. Continue to monitor her headaches, and if the migraines are consistently happening around her menses there is preventive therapy available.
3.Pregnancy is contraindicated when taking a triptan.
4.All of the above
Question 9
Nicotine replacement therapy should not be used in which patients?
1.Pregnant women
2.Patients with worsening angina pectoris
3.Patients who have just suffered an acute myocardial infarction
4.All of the above
Question 10
The most appropriate smoking cessation prescription for pregnant women is:
1. A nicotine replacement patch at the lowest dose available
2.Bupropion (Zyban)
3. Varenicline (Chantix)
4. Nonpharmacologic measures
NRP507 Advanced Pharmacology
Week 7 Quiz
Question 1
Selective estrogen receptor modifiers (SERMs) treat osteoporosis by selectively:
1. Inhibiting magnesium resorption in the kidneys
2.Increasing calcium absorption from the gastrointestinal (GI) tract
3. Acting on the bone to inhibit osteoblast activity
4. Acting on the estrogen receptors in the bone
Question 2
Inadequate vitamin D intake can contribute to the development of osteoporosis by:
1. Increasing calcitonin production
2. Increasing calcium absorption from the intestine
3.Altering calcium metabolism
4. Stimulating bone formation
Question 3
How do bisphosphonates treat osteoporosis?
1. By selectively activating estrogen pathways in the bone
2. By reducing bone resorption by inhibiting parathyroid hormone (PTH)
3.By reducing bone resorption and inhibiting osteoclastic activity
4. By increasing PTH production
Question 4
Drugs that increase the risk of osteoporosis include:
1. Oral combined contraceptives
2. Carbamazepines
3.Calcium channel blockers
4.High doses of vitamin D
Question 5
Besides osteoporosis, intravenous (IV) bisphosphonates are also indicated for:
1.Paget’s disease
2. Early osteopenia
3. Renal cancer
4. Early closure of cranial sutures
Question 6
Patients need to be questioned about all pain sites because:
1. Patients tend to report the most severe or important in their perception.
2. Pain tolerance generally decreases with repeated exposure.
3. The reported pain site is usually the most important to treat.
4. Pain may be referred from a different site to the one reported.
Question 7
Which of the following statements is true about age and pain?
1.Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children.
2.Among the NSAIDs, indomethacin is the preferred drug because of a lower adverse effect profile than other NSAIDs.
3.Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.
4.Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.
Question 8
Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs?
1. All opiates are scheduled drugs, which require a Drug Enforcement Administration (DEA) license to prescribe.
2. Opiates stimulate only ? receptors for the control of pain.
3. Most of the adverse effects of opiates are related to ? receptor stimulation.
4.Naloxone is an antagonist to opiates.
Question 9
One of the main drug classes used to treat acute pain is nonsteroidal anti-inflammatory drug (NSAIDs). They are used because:
1. They have less risk for liver damage than acetaminophen.
2. Inflammation is a common cause of acute pain.
3. They have minimal gastrointestinal (GI) irritation.
4. Regulation of blood flow to the kidneys is not affected by these drugs.
Question 10
Narcotics are exogenous opiates. They act by:
1. Inhibiting pain transmission in the spinal cord
2. Attaching to receptors in the afferent neuron to inhibit the release of substance P
3. Blocking neurotransmitters in the midbrain
4. Increasing beta-lipoprotein excretion from the pituitary gland
NRP507 Advanced Pharmacology
Week 8 Final Quiz
Question 1
Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for:
1. Iron deficiency anemia, vitamin B12 and calcium deficiency
2.Folate and magnesium deficiency
3.Elevated uric acid levels leading to gout
4. Hypokalemia and hypocalcemia
Question 2
Patients taking antacids should be educated regarding these drugs, including letting them know that:
1.They may cause constipation or diarrhea.
2. Many are high in sodium.
3. They should separate antacids from other medications by one hour.
4. All of the above
Question 3
A patient has diarrhea and is wondering if they can take loperamide (Imodium). Loperamide:
1.Can be given to patients of all ages, including infants and children, for viral gastroenteritis
2. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea
3. Is the treatment of choice for the diarrhea associated with E. coli 0157
4. May be used in pregnancy and by lactating women
Question 4
Methylnaltrexone is used to treat constipation in:
1.Patients with functional constipation
2.Patients with irritable bowel syndrome-associated constipation
3. Children with encopresis
4.Patients with opioid-associated constipation
Question 5
Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first?
1.Patients with kidney stones
2. Pregnant patients
3. Patients with heartburn
4.Postmenopausal women
