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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

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

Question 6

An advantage of using the NuvaRing vaginal ring for contraception is:

1. It does not require fitting and is easy to insert.

2.It is inserted once a week, eliminating the need to remember to take a daily pill.

3.Patients get a level of estrogen and progestin equal to combined oral contraceptives.

4. It also provides protection against vaginal infections.

Question 7

Obese women may have increased risk of failure with which contraceptive method?

1. Combined oral contraceptives

2.Progestin-only oral contraceptive pill

3.Injectable progestin

4.Combined topical patch

Question 8

The mechanism of action of oral combined contraceptives that prevents pregnancy is:

1. Estrogen prevents the luteinizing hormone surge necessary for ovulation.

2. Progestins thicken cervical mucus and slow tubal motility.

3. Estrogen thins the endometrium making implantation difficult.

4.Progestin suppresses follicle stimulating hormone release.

Question 9

Oral emergency contraception (Plan B) is contraindicated in women who:

1.Had intercourse within the past 72 hours

2.May be pregnant

3.Are taking combined oral contraceptives

4.Are using a diaphragm

Question 10

Progesterone-only pills are recommended for women who:

1.Are breastfeeding

2.Have a history of migraine

3.Have a medical history that contradicts the use of estrogen

4. All of the above

Question 11

The advantage of vaginal estrogen preparations in the treatment of vulvovaginal atrophy and dryness is:

1.Ability to deliver higher doses of estrogen in a nonoral form

2. The vaginal cream formula provides moisture to the vaginal area.

3. Relief of symptoms without increasing cardiovascular risk

4. All of the above

Question 12

Re-evaluation of the Women’s Health Study has resulted in what changes in HRT implementation?

1. A combination of estrogen and progestin is no longer required in patients with an intact uterus.

2.Women with breast cancer survivorship over 10 years are no longer considered “at risk.”

3.HRT can be used in the first five years of menopause without major risk increase.

4. Low-dose estrogen can be used again in women over 65.

Question 13

“Menopause” is diagnosed when:

1. The patient has no menses for 12 months.

2. The patient has onset of vasomotor symptoms with irregular menses.

3.The patient has no bleeding cycle for six months.

4.Precise laboratory values are documented.

Question 14

Ongoing monitoring for women on ERT includes:

1.Lipid levels, repeated annually if abnormal

2.Annual health history and review of risk profile

3.Annual mammogram

4.All of the above

Question 15

Women with an intact uterus should be treated with HRT with both estrogen and progestin due to:

1.Increased risk for endometrial cancer if estrogen alone is used

2. Combination therapy providing the best relief of menopausal vasomotor symptoms

3. Reduced risk for colon cancer with combined therapy

4. Lower risk of developing blood clots with combined therapy

Question 16

Which of the following is not an indication for starting HRT?

1. Symptomatic hot flashes

2. Treatment or prevention of vaginal atrophy

3. Prevention of osteoporosis

4. Early surgical menopause

Question 17

All of the following are risks of exogenous hormones except:

1. Breast cancer

2. Uterine cancer

3. Increased cardiovascular problems

4.Vaginal atrophy

Question 18

What is the duration of selective estrogen receptor modifier (SERM) use for menopausal issues?

1. It matches the five year duration for estrogen products.

2. The bone health impact allows long-term use.

3. The increased risk of breast cancer encourages tapering as soon as possible.

4. The abnormal lipid profile contributes to an early termination as soon as hot flashes no longer occur.

Question 19

The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is:

1. Two years

2. Five years

3.10 years

4.15 years

Question 20

The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing:

1. Cardiovascular risk

2.Risk of stroke or other thromboembolic event

3.Risk of breast cancer

4.Vasomotor symptoms

Question 21

An adult female presents with genital warts on her labia. Patient-applied topical therapy for genital warts includes:

1. Podofilox 0.5% gel

2. Podophyllin 10% resin

3. Trichloroacetic acid

4. Any of the above

Question 22

A 24-year-old female patient is 32 weeks pregnant and has tested positive for syphilis. The best treatment for her would be:

1. IM ceftriaxone

2. IM benzathine penicillin G

3. Oral azithromycin

4. Any of the above

Question 23

A female patient presents with a complaint of vaginal discharge that when tested meets the criteria for bacterial vaginosis. Treatment of bacterial vaginosis in nonpregnant symptomatic women would be:

1.Metronidazole 500 mg PO b.i.d. x 7 days

2.Doxycycline 100 mg PO b.i.d. x 7 days

3.Intravaginal tinidazole daily x 5 days

4. Metronidazole 2 g PO x 1 dose

Question 24

An adult female patient presents to the clinic with vulvovaginal candidiasis. Appropriate treatment for her would be:

1.Over-the-counter (OTC) intravaginal clotrimazole

2. OTC intravaginal miconazole

3.Oral fluconazole one-time dose

4. Any of the above

Question 25

Treatment for suspected gonorrhea is:

1. Ceftriaxone 250 mg IM x 1

2. Ceftriaxone 2 g IM x 1

3.Ciprofloxacin 500 mg PO x 1

4.Doxycycline 100 mg bid x 7 days

Question 26

When treating suspected gonorrhea in a nonpregnant patient, the patient should be concurrently treated for chlamydia with:

1.Azithromycin 1 g PO x 1

2.Amoxicillin 500 mg PO x 1

3.Ciprofloxacin 500 mg PO x 1

4.Penicillin G 2.4 million units IM x 1

Question 27

The drug of choice for treatment of primary or secondary syphilis is:

1. Ceftriaxone intramuscular (IM)

2.Benzathine penicillin G IM

3. Oral azithromycin

4.Oral ciprofloxacin

Question 28

Follow-up testing after treatment of chancroid would be:

1. Syphilis and human immunodeficiency virus (HIV) testing at three-month intervals

2. Chancroid-specific antigen test every three months

3. Urine testing for Haemophilus ducreyi in 3 to 6 months for test of cure

4. Annual HIV testing if the patient engages in high-risk sexual behavior

Question 29

Besides prescribing antimicrobial therapy, patients with bacterial vaginosis require education regarding the fact that:

1. The most recent partners in the past 60 days should also be treated.

2. Alcohol should not be consumed during and for 72 hours after metronidazole therapy.

3. Condoms should be used during intercourse if intravaginal clindamycin cream is used.

4.Cotreatment for chlamydia is necessary.

Question 30

An adult female presents with a malodorous vaginal discharge and is confirmed to have a Trichomonas infection. Treatment for her would include:

1. Metronidazole 2 g PO x 1 dose

2. Topical intravaginal metronidazole daily x 7 days

3. Intravaginal clindamycin daily x 7 days

4. Azithromycin 2 g PO x 1 dose

Question 31

Monitoring for a healthy, nonpregnant adult patient being treated for a UTI is:

1. Symptom resolution in 48 hours

2. Follow-up urine culture at completion of therapy

3. Test of cure urinary analysis at completion of therapy

4.Follow-up urine culture two months after completion of therapy

Question 32

The treatment goals when treating urinary tract infection (UTI) include:

1. Eradication of the infecting organism

2. Relief of symptoms

3.Prevention of recurrence of the UTI

4.All of the above

Question 33

Lisa is a healthy nonpregnant adult woman who recently had a UTI. She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The  to give her would be:

1. Sixteen ounces per day of cranberry juice cocktail will prevent UTIs.

2.Cranberry juice will decrease UTIs.

3.There is no clear evidence that cranberry juice helps prevent UTIs.

4.Cranberry juice only works to prevent UTIs in children.

Question 34

Which of the following patients may be treated with a five day course of therapy for their UTI?

1. A 28-year-old pregnant woman

2. A six-year-old healthy female

3.A 24-year-old female

4.A 26-year-old female diabetic

Question 35

Maternal-to-child transmission of HIV infection during pregnancy may be prevented by:

1. Use of antiviral drugs such as zidovudine

2. Use of condoms during intercourse

3.Both 1 and 2

4.Neither 1 nor 2

Question 36

Which of the following holds true for the pharmacokinetics of women?

1. Gastric emptying is faster than that of men.

2.Organ blood flow is the same as that of men.

3.Evidence is strong concerning renal differences in elimination.

4.Medications that involve binding globulins are impacted by estrogen levels.

Question 37

Gender differences between men and women in pharmacokinetics include:

1.Women have more rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites

2. Women have a higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution

3. Women have increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations

4.Women have slower organ blood flow rates so drugs tend to take longer to be excreted

Question 38

Which of the following drug classes is associated with significant differences in metabolism based on gender?

1. Beta blockers

2. Antibiotics

3.Serotonin reuptake inhibitors

4.Angiotensin-converting-enzyme (ACE) inhibitors

Question 39

The best way to use nonsteroidal anti-inflammatory drug (NSAIDs) for severe menstrual cramps is:

1. Take them for 2 to 3 days prior to the start of bleeding.

2.Take them 2 to 3 times a day during the first two days.

3. Take them every 2 to 3 hours.

4. They have not been found to be helpful at all.

Question 40

Dysmenorrhea is one of the most common gynecological complaints in young women. The first line of drug treatment for this disorder is:

1. Oral contraceptive pills

2. Caffeine

3.Nonsteroidal anti-inflammatory drug (NSAIDs)

4.Aspirin

Question 41

The metabolism of drugs in women is primarily impacted by:

1. Hepatic blow flow

2.Enzymes of the CYP450 system

3.The amount of gastric secretions

4. Whether they are pre- or postmenopausal

Question 42

Since 40% of bone accrual occurs during adolescence, building bone during this time is critical. Ways to improve bone accrual in adolescents include:

1. Use of bisphosphonates early if dual energy x-ray absorptiometry (DEXA) scans show limited bone accrual

2. Encouraging a daily dietary intake of 1,300 mg of calcium and 400 IU of vitamin D

3.Avoiding all birth control methods that include progesterone

4.Fostering the intake of iron mainly in green and leafy vegetables

Question 43

Treatment of PMDD that affects all or most of the symptoms includes:

1. Tryptophan up to 6 g/day

2. Vitamin E 200 to 400 mg/day

3. Evening primrose oil 500 mg/day

4.Fluoxetine 20 mg/day

Question 44

Hot flashes are often a concern during menopause. Which of the following may help in reducing them?

1. Drink one caffeinated liquid per day.

2.Take progesterone supplementation.

3.Exercise 20 to 40 minutes/day.

4. Increase intake of carrots, yams, and soy products.

Question 45

The goal of testosterone replacement therapy is:

1. Absence of all hypogonadism symptoms

2.Testosterone levels in the mid-normal range one week after an injection

3. Testosterone levels in the mid-normal range just prior to the next injection

4. Avoidance of high serum testosterone levels during therapy

Question 46

While on testosterone replacement, hemoglobin and hematocrit levels should be monitored. Levels suggestive of excessive erythrocytosis or abuse are:

1.Hemoglobin 14 g/dL or hematocrit 39%

2. Hemoglobin 11.5 g/dL or hematocrit 31%

3. Hemoglobin 13 g/dL or hematocrit 38%

4.Hemoglobin 17.5 g/dL or hematocrit 54%

Question 47

Male patients who should not be prescribed PDE-5 inhibitors include:

1.Diabetics

2.Those who have had an acute myocardial infarction in the past six months

3.Those who are deaf

4.Those who are under age 60 years of age

Question 48

When assessing a male for hypogonadism prior to prescribing testosterone replacement, serum testosterone levels are drawn:

1.Without regard to time of day

2.First thing in the morning

3.Late afternoon

4.In the evening

Question 49

Some research supports that testosterone replacement therapy may be indicated in which of the following diagnoses in men?

1.Age-related decrease in cognitive functioning

2.Metabolic syndrome

3.Decreased muscle mass in aging men

4.All of the above

Question 50

When prescribing phosphodiesterase type 5 (PDE-5) inhibitors such as sildenafil (Viagra) patients should be screened for use of:

1. Statins

2. Nitrates

3.Insulin

4. Opioids

 

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

Question 6

A patient presents with complaints of heartburn that is minimally relieved with Tums (calcium carbonate) and is diagnosed as gastroesophageal reflux disease (GERD). An appropriate on-demand therapy would be:

1. Omeprazole (Prilosec) twice a day

2. Ranitidine (Zantac) twice a day

3. Famotidine (Pepcid) once a day

4. Metoclopramide (Reglan) four times a day

Question 7

Bismuth subsalicylate (Pepto-Bismol) is a common over-the-counter (OTC) remedy for gastrointestinal complaints. Bismuth subsalicylate:

1. May lead to toxicity if taken with ibuprofen

2. Is contraindicated in children with flu-like illness

3.Has no antimicrobial effects against bacterial and viral enteropathogens

4.May cause stools to turn reddish color

Question 8

A 15-year-old patient presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is four pounds less than her last recorded weight. Besides intravenous (IV) fluids, the exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order?

1. Prochlorperazine (Compazine)

2. Meclizine (Antivert)

3. Promethazine (Phenergan)

4. Ondansetron (Zofran)

Question 9

A young adult will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler’s diarrhea. Advice includes following normal food and water precautions as well as taking:

1. Lopeb. ramide four times a day throughout the trip

2.Bismuth subsalicylate before each meal and at bedtime

3.Prescription diphenoxylate with atropine if she gets diarrhea

4.Calcium carbonate (Tums) four times a day for stomach upset

Question 10

When prescribing tacrolimus (Protopic) to treat atopic dermatitis patients should be informed that:

1. Tacrolimus is most effective if it is used continuously for four to six months.

2. Tacrolimus should be spread generously over the affected area.

3. The U.S. Food and Drug Administration (FDA) has issued a black box warning about the use of tacrolimus and the development of cancer in animals and humans.

4. The FDA recommends that patients be screened for cancer before prescribing tacrolimus.

Question 11

Instructions for the use of malathion (Ovide) for head lice include:

1.Use a blow dryer to dry the hair after applying.

2.Use malathion (Ovide) daily for a week until all lice are dead.

3.Rinse the malathion (Ovide) off and shampoo hair after 8 to 12 hours.

4. Use gloves to apply the malathion (Ovide).

Question 12

A patient is prescribed tazarotene for their psoriasis. Patient education regarding topical tazarotene includes:

1.That tazarotene is applied in a thin film to the psoriasis plaque lesions

2. To apply it liberally to all psoriatic lesions

3. To apply tazarotene to nonaffected areas to prevent breakout

4.That tazarotene may cause hypercalcemia if it is overused

Question 13

An adolescent female calls the clinic with concerns that her acne is worse one week after starting topical tretinoin. What would be the appropriate care for her?

1. Change her to a different topical acne medication as she is having an adverse reaction to the tretinoin.

2. Switch her to an oral antibiotic to treat her acne.

3. Advise her to apply an oil-based lotion to her face to soothe the redness.

4.Reassure her that the worsening of acne is normal and it should improve with continued use.

Question 14

First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be:

1. Over-the-counter (OTC) topical azole (clotrimazole, miconazole)

2. Oral terbinafine

3.Oral griseofulvin microsize

4. Nystatin cream or ointment

Question 15

When prescribing griseofulvin (Grifulvin V) to treat tinea capitis it is critical to instruct the patient or parent to:

1. Mix the griseofulvin with ice cream before administering.

2. Take the griseofulvin until the tinea clears, in approximately four to five weeks.

3. Shampoo with baby shampoo daily while taking the griseofulvin.

4.Take the griseofulvin with a high-fat food.

Question 16

A patient is a nasal methicillin-resistant staphylococcus aureus (MRSA) carrier. Treatment to eradicate nasal MRSA is mupirocin. Patient education regarding treating nasal MRSA includes:

1.Take the oral medication exactly as prescribed.

2. Insert one-half of the dose in each nostril twice a day.

3. Alternate treating one nare in the morning and the other in the evening.

4.Nasal MRSA eradication requires at least four weeks of therapy, with up to eight weeks needed in some patients.

Question 17

An adolescent has been prescribed isotretinoin (Accutane) by their dermatologist and is presenting to their primary care provider with symptoms of sadness and depression. The Beck Depression Inventory results indicate they have mild to moderate depression. What would be the best option at this point?

1. Prescribe a select serotonin reuptake inhibitor (SSRI) antidepressant.

2. Refer them to a mental health therapist.

3.Contact their dermatologist about discontinuing the isotretinoin.

4.Reassure them that mood swings are normal and schedule follow up in a week.

Question 18

When prescribing topical penciclovir (Denavir) for the treatment of herpes labialis (cold sores) patient education would include:

1. Spread penciclovir liberally all over lips and the area surrounding lips.

2. Penciclovir therapy is started at the first sign of a cold sore outbreak.

3. Skin irritation is normal with penciclovir and it should resolve.

4.Penciclovir should be used a minimum of two weeks to prevent recurrence.

Question 19

Instructions for applying a topical antibiotic or antiviral ointment include:

1.Apply thickly to the infected area, spreading the medication well past the borders of the infection.

2. If the rash worsens, apply a thicker layer of medication to settle down the infection.

3. Wash hands before and after application of topical antimicrobials.

4. Crusted lesions can be scrubbed off with a clean nail brush.

Question 20

When writing a prescription of permethrin 5% cream (Elimite) for scabies, patient education would include:

1.All members of the household and personal contacts should also be treated.

2. Infants should have permethrin applied from the neck down.

3. The permethrin is washed off after 10 to 20 minutes.

4. Permethrin is flammable and to avoid open flame while the medication is applied.

Question 21

A patient who used clotrimazole (Lotrimin AF) for athlete’s foot developed a red, itchy rash consistent with a hypersensitivity reaction. They now have athlete’s foot again. What would be a good choice of antifungal?

1. Miconazole (Micatin) powder

2. Ketoconazole (Nizoral) cream

3. Terbinafine (Lamisil) cream

4. Griseofulvin (Grifulvin V) suspension

Question 22

A child presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. Their parents have limited finances and request the least expensive treatment. Which medication would be the best choice for treatment?

1. Mupirocin (Bactroban)

2. Bacitracin and polymyxin B (generic double antibiotic ointment)

3.Retapamulin (Altabax)

4.Oral cephalexin (Keflex)

Question 23

A 6-month-old infant with severe eczema would benefit from topical corticosteroid therapy. Instructions for using topical corticosteroids in children include:

1.Apply liberally to all areas with eczema.

2. Double the frequency of application when the eczema is severe.

3. Apply sparingly to eczema areas.

4. Cover the eczema area with an occlusive dressing after applying a corticosteroid.

Question 24

An adult male has male pattern baldness on the vertex of his head and has been using Rogaine for two months. He asks how effective minoxidil (Rogaine) is. Minoxidil:

1. Provides a permanent solution to male pattern baldness if used for at least four months

2. Will show results after four months of twice-a-day use

3. May not work for his type of baldness

4. Works better if he also uses hydrocortisone cream daily on his scalp

Question 25

When choosing a topical corticosteroid cream to treat diaper dermatitis, the ideal medication would be:

1.Intermediate potency corticosteroid ointment (Kenalog)

2.A combination of a corticosteroid and an antifungal (Lotrisone)

3. A low-potency corticosteroid cream applied sparingly (hydrocortisone 1%)

4.A high-potency corticosteroid cream (Diprolene AF)

Question 26

Mild acne may be initially treated with:

1.Topical combined antibiotic

2. Minocycline

3. Topical retinoid

4.Over-the-counter (OTC) benzoyl peroxide

Question 27

The most cost-effective treatment for two or three impetigo lesions on the face is:

1. Mupirocin ointment

2. Retapamulin (Altabax) ointment

3.Topical clindamycin solution

4.Oral amoxicillin/clavulanate (Augmentin)

Question 28

A young adult female has severe cystic acne and is requesting treatment with Accutane. The appropriate treatment for her would be:

1.Order a pregnancy test and if it is negative prescribe the isotretinoin (Accutane).

2. Prescribe Accutane after educating her on the adverse effects.

3. Recommend she try oral antibiotics (minocycline).

4.Refer her to a dermatologist for treatment.

Question 29

A patient has been diagnosed with scabies. Education would include:

1. She should leave the scabies treatment cream on for an hour and then wash it off.

2. Scabies may need to be retreated in a week after initial treatment.

3. All members of the household and close personal contacts should be treated.

4. Malathion is flammable and she should take care until the solution dries.

Question 30

An adolescent football player presents to the clinic with athlete’s foot. Patients with tinea pedis may be treated with:

1. OTC miconazole cream for four weeks

2. Oral ketoconazole for six weeks

3.Mupirocin ointment for two weeks

4.Nystatin cream for two weeks

Question 31

Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with:

1. Topical antipruritics

2. Oral corticosteroids for 2 to 3 weeks

3. Thickly applied topical intermediate-dose corticosteroids

4. Isolation of the patient to prevent spread of the dermatitis

Question 32

Topical immunomodulators such as pimecrolimus (Elidel) or tacrolimus (Protopic) are used for:

1. Short-term or intermittent treatment of atopic dermatitis

2.Topical treatment of fungal infections (Candida)

3.Chronic, inflammatory seborrheic dermatitis

4.Recalcitrant nodular acne

Question 33

Long-term treatment of moderate atopic dermatitis includes:

1. Topical corticosteroids and emollients

2. Topical corticosteroids alone

3.Topical antipruritics

4.Oral corticosteroids for exacerbations of atopic dermatitis

Question 34

A child has classic tinea capitis. Treatment for tinea on the scalp is:

1. Miconazole cream thoroughly rubbed in for four weeks

2. Oral griseofulvin for 6 to 8 weeks

3. Ketoconazole shampoo daily for six weeks

4. Ciclopirox cream daily for four weeks

Question 35

Appropriate initial treatment for psoriasis would be:

1. An immunomodulator (Protopic or Elidel)

2. Wet soaks with Burow’s or Domeboro solution

3. Intermittent therapy with intermediate potency topical corticosteroids

4.Anthralin (Drithocreme)

Question 36

An adolescent presents to the clinic with moderate acne. They have been using OTC benzoyl peroxide at home with minimal improvement. A topical antibiotic (clindamycin) and a topical retinoid adapalene (Differin) are prescribed. Education would include:

1. He should see an improvement in his acne within the first two weeks of treatment.

2. If there is no response in a week, double the daily application of adapalene (Differin).

3. He may see an initial worsening of his acne that will improve in 6 to 8 weeks.

4. Adapalene may cause bleaching of clothing.

Question 37

Long-term use of PPIs may lead to:

1.Hip fractures in at-risk persons

2.Vitamin B6 deficiency

3.Liver cancer

4.All of the above

Question 38

An acceptable first-line treatment for peptic ulcer disease with positive Helicobacter pylori (H. pylori) test is:

1.Histamine-2 receptor antagonists for 4 to 8 weeks

2.PPI bid for 12 weeks until healing is complete

3.PPI bid plus clarithromycin plus amoxicillin for 14 days

4.PPI bid and levofloxacin for 14 days

Question 39

Gastroesophageal reflux disease (GERD) may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone:

1.Calcium carbonate

2.Estrogen

3.Furosemide

4.Metoclopramide

Question 40

The next step in treatment when a patient has been on PPIs twice daily for 12 weeks and not improving is:

1.Add a prokinetic (metoclopramide).

2.Refer the patient for endoscopy.

3.Switch to another PPI.

4.Add a cytoprotective drug.

Question 41

If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the next step would be:

1.A PPI b.i.d. plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days

2.To test H. pylori for resistance to common treatment regimens

3.A PPI plus clarithromycin plus amoxicillin for 14 days

4.A PPI and levofloxacin for 14 days

Question 42

Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of:

1.Antimicrobial resistance

2.An ineffective antacid

3.Overuse of PPIs

4.All of the above

Question 43

Lifestyle changes are the first step in treatment of GERD. Food or drink that may aggravate GERD include:

1. Eggs

2. Caffeine

3.Chocolate

4.Soda pop

Question 44

After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is:

1.Testing for H. pylori eradication with a serum enzyme-linked immunosorbent assay (ELISA) test

2.Endoscopy by a specialist

3.A PPI for 8 to 12 weeks until healing is complete

4.All of the above

Question 45

A patient with mild GERD is started on _______ first.

1.Antacids

2.Histamine-2 receptor antagonists

3.Prokinetics

4.Proton pump inhibitors (PPIs)

Question 46

Antacids treat GERD by:

1.Increasing lower esophageal tone

2.Increasing gastric pH

3.Inhibiting gastric acid secretion

4.Increasing serum calcium level

Question 47

If a patient with GERD who is taking a PPI daily is not improving, the plan of care would be:

1.Prokinetic (metoclopramide) for 8 to 12 weeks

2.PPI (omeprazole) twice a day for 4 to 8 weeks

3.Histamine-2 receptor antagonist (ranitidine) for 4 to 8 weeks

4.Cytoprotective drug (misoprostol) for 4 to 8 weeks

Question 48

Infants with reflux are initially treated with:

1.Histamine-2 receptor antagonist (ranitidine)

2.PPI (omeprazole)

3.Antireflux maneuvers (such as elevating the head of the bed)

4.Prokinetic (metoclopramide)

Question 49

If a patient with symptoms of GERD states that he has been self-treating at home with over-the-counter (OTC) ranitidine daily, the appropriate treatment would be:

1.Prokinetic (metoclopramide) for 4 to 8 weeks

2.PPI (omeprazole) for 12 weeks

3.Histamine-2 receptor antagonist (ranitidine) for 4 to 8 weeks

4.Cytoprotective drug (misoprostol) for two weeks

Question 50

Metoclopramide improves GERD symptoms by:

1. Reducing acid secretion

2.Increasing gastric pH

3.Increasing lower esophageal tone

4.Decreasing lower esophageal tone

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