Pharm Exam 3

Question 1

What is the dose for colchicine?

Answer 1

1.2 mg (2 tablets) then 0.6 mg 1 hour later until symptoms subside

Question 2

What is the biggest side effect with colchicine?

Answer 2

diarrhea

Question 3

What lab values should be monitored with gout?

Answer 3

serum uric acid levels, CBC, renal and hepatic fx

Question 4

allopurinol, febuxostat, and probenecid are __________ drugs for gout, not rescue meds

Answer 4

Maintenance

Question 5

avoid _________ as it precipitates gout flares

Answer 5

alcohol

Question 6

report any signs of _________ or _________ when taking colchicine

Answer 6

neuropathy or myopathy

Question 7

What types of food should you avoid when taking colchicine?

Answer 7

oxalate rich foods; organ meats (liver, kidney), some fish such as sardines, trout
turkey, venison

Question 8

What patient teaching will you provide when prescribing febuxostat (Uloric)

Answer 8

symptoms will get worse before they get better. Can take NSAIDs up to 6 months to help

Question 9

These symptoms are all caused by what?
thinning of the skin, alopecia, acne, poor wound healing, myopathy, muscle wasting, osteoporosis, , skeletal fractures, peptic ulcer disease, HTN…

Answer 9

The use of corticosteroids for >6 months

Question 10

What is steroid psychosis?

Answer 10

Caused by overuse of corticosteroids and causes: delirium, agitation, insomnia, mood swings, severe depression

Question 11

Why is it important to taper the corticosteroid dose?

Answer 11

prevent adrenal insufficiency

avoid trigger of reoccurence of disease

Question 12

What are the black box warnings for NSAIDs

Answer 12

increase risk for cardiovascular events (MI, stroke) and increased risk for GI adverse effects such as bleeding, ulceration, perforation

Question 13

What are the recommendations in the treatment of pain?

Answer 13

First-choice: NSAIDs before opioids

Question 14

What is the MOA of ibuprofen?

Answer 14

COX-2 inhibitor

decreases prostaglandin synthesis

Question 15

What are the serious side effects associated with acetaminophen? /

Answer 15

acute toxicity –> liver failure

chronic toxicity –> renal failure

Question 16

These symptoms describe what? decreased LOC, hunger, diaphoresis, weakness, dizziness, tachycardia

Answer 16

hypoglycemia

Question 17

These symptoms describe what? Polyuria, polydipsia, polyphagia

Answer 17

Hyperglycemia

Question 18

These symptoms describe what? Drowsiness, dim vision, Kussmaul’s respiration, cherry red lips, abdominal pain, ketone-odor breath

Answer 18

Ketoacidosis

Question 19

What drug class is metformin?

Answer 19

Biguanide

Question 20

How does metformin work?

Answer 20

It increase peripheral glucose uptake, decreases hepatic glucose production, and decreases intestinal absorption of glucose. it also decreases glycogenolysis by the liver.

Question 21

What diagnostic testing is required before and throughout therapy with metformin?

Answer 21

renal function, liver function, CBC, serum electrolytes and ketones, BG

Question 22

dipeptidyl peptidasase-4 inhibitors (DPP-4): “_____”

Answer 22

gliptins

sitagliptin, saxagliptin, linagliptin, alogliptin

Question 23

How do gliptins work?

Answer 23

acts on the incretin hormone system to increase insulin production

Question 24

Glucagon-like peptide (GLP-1) agonists (albiglutide, dulaglutide, exenatide, liraglutide, lixisenatide) MOA:

Answer 24

directly binds to the GLP-1 receptor in the beta cell and acts as an incretin mimetic

Question 25

when should exenatide be administered? (GLP-1 Agonist)

Answer 25

60 minutes before a meal. Do not administer after a meal.

Question 26

What are the adverse effects of propylthiouracil?

Answer 26

agranulocytosis and possible aplastic anemia | can cause drug-induced hepatitis

Question 27

what is the BBW for propylthiouracil?

Answer 27

liver failure

Question 28

What two drugs are used to treat toxic goiter?

Answer 28

methimazole and propylthiouracil

Question 29

What are the doses of the two drugs used to treat toxic goiter?

Answer 29

methimazole: 60 mg/day TID | propylthiouracil 600-900 mg/day TID

Question 30

What signs should a patient report while taking propylthiouracil?

Answer 30

fever, sore throat, abnormal bleeding/bruising

Question 31

What is the MOA for alpha-glucosidase inhibitors?

Answer 31

block carbohydrates

Question 32

What is the dosage for alpha-glucosidase inhibitors? | (Acarbose, Miglitol) AND when should this be taken?

Answer 32

25 mg x4 weeks with first bite of meal | increased by 25 mg up to 75 mg/day

Question 33

If a patient is less than 60 kg, what dose of acarbose or miglitol should be prescribed?

Answer 33

50 mg TID

Question 34

Describe the pharmakodynamics of meglitinides

Answer 34

stimulate insulin secretion to lower postprandial BG levels

Question 35

what is the MOA of propylthiouracil?

Answer 35

blocks the conversion of T4 to T3 (INHIBITS THYROID HORMONES)

Question 36

What are the contraindications for taking alpha-glucosidase inhibitors?

Answer 36

bowel diseases such as IBS. These drugs produce gas.

Question 37

What patient education is important relative to the administration of levothyroxine?

Answer 37

should be taken 30 minutes before breakfast on an empty stomach. take in the morning to prevent insomnia.

Question 38

What is the BBW for the administration of thiazolidinediones (TZDs)

Answer 38

heart failure and bladder cancer

Question 39

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

Answer 39

symptoms of hyperthyroidism tachycardia, arrhthmias, angina, tremors, insomnia, irratabillity, V/D, Weight loss, menstrual irregularities, heat intolerance

Question 40

What is the MOA of metformin?

Answer 40

increases insulin sensitivity, decreases hepatic glucose production, and decreases intestinal absorption of glucose

Question 41

What lab values will be used to monitor a patient who is on levothyroxine?

Answer 41

TSH and free T4

Question 42

Two rapid acting insulins:

Answer 42

aspart and glulisine

Question 43

two short-acting insulins

Answer 43

regular insulin and R U-500

Question 44

What is the intermediate insulin?

Answer 44

NPH

Question 45

Name three long-acting insulins

Answer 45

glargine, detemir, degludec

Question 46

When changing from NPH insulin, how will you adjust the patient's dose?

Answer 46

Add total daily dose then decrease by 20% and make adjustments by the patient's response

Question 47

What are the side effects of insulin therapy?

Answer 47

hypoglycemia, hypokalemia, weight gain

Question 48

What assessment should be made before prescribing anti-hypertensive agents?

Answer 48

baseline BP and pulse, diet, sodium intake, electrolytes (especially potassium d/t diuretic therapy) weight and other fluid status indicators

Question 49

What should you monitor when prescribing ACE-I, ARBs, and DRI (direct rennin inhibitors)

Answer 49

RENAL FUNCTION and potassium levels

Question 50

Why are ACE inhibitors the drug of choice in a diabetic patients with HTN?

Answer 50

They delay progression of diabetic neuropathy

Question 51

What is the MOA for ACE-I

Answer 51

decreased production of both angiotensin II and aldosterone

Question 52

What is the most common adverse effect of an ACE inhibitor?

Answer 52

dry, hacking cough

Question 53

What is the MOA for ARBS

Answer 53

block angiotensin II receptors | do not produce dry, hacking cough

Question 54

What is the MOA for CCB?

Answer 54

Block calcium channels resulting in decrease in trans-membrane calcium and prolonged vascular smooth muscle relaxation

Question 55

What are the two types of CCBs?

Answer 55

dihydropyridine type "PINE" or non-dihydropyridine type (verapamil)

Question 56

side effects of CCB?

Answer 56

dizziness, hypotension, tachycardia, increase proteinuria which causes edema

Question 57

What are the adverse effects of statins?

Answer 57

risk of myopathy and the resulting rhabdomyolysis

Question 58

What patient education will you provide for patients taking statins?

Answer 58

report any muscle weakness avoid alcohol do not take if pregnant

Question 59

What lipid disorders do fibric acid derivatives treat?

Answer 59

hypertriglyceridemia

Question 60

What disorders do bile acid sequestrants treat?

Answer 60

hyperlipidemia

Question 61

What is the MOA for fibric acid derivatives?

Answer 61

promotes secretion of LDL which is then cleared by a receptor-mediated mechanism (so lower overall LDL)

Question 62

What is the MOA for bile acid sequestrants?

Answer 62

reduce plasma low-density lipoprotein (LDL) by interrupting the enterohepatic circulation of bile acids, with consequent diversion of hepatic cholesterol toward the synthesis of new bile acids

Question 63

What would you recommend to a patient who is experiencing flushing while taking niacin?

Answer 63

gradually increase the dose over a few weeks | pre-treat with ASA 30 minutes before, and take the extended release form (Niaspan)

Question 64

What type of drug is amlodipine?

Answer 64

dihydropyridine CCB

Question 65

How is amlodipine metabolized?

Answer 65

CYP3A4 system in the liver | avoid grapefruit

Question 66

What are the side effects of amlodipine?

Answer 66

dizziness, hypotensin, edema (which can exacerbate HF)

Question 67

What patient teaching will you provide when taking amiodorone?

Answer 67

take as prescribed. Don't double doses, it has a very long half life. Abrupt withdrawal can cause life-threatening arrythmias, MI, or stroke. Can also cause pulmonary toxicity. Change positions slowly d/t hypotension

Question 68

What are the drug interactions with digoxin?

Answer 68

any drug that cause hypokalemia, hypercalcemia, or hypomagnesemia

Question 69

What is the purpose of a thyroid panel while taking amiodarone?

Answer 69

amiodarone (structurally similar to thyoxine) inhibits the thyroid gland and results in inflammation causing either hyperthyroidiism or hypothyroidism

Question 70

What is nitrate intolerance?

Answer 70

continuous exposure to nitates cause them to lose effect. Need to be free for 10-12 hours before regaining their effects.

Question 71

What are the contraindications to warfarin?

Answer 71

any type of bleeding issues or pregnancy

Question 72

What classes of medication are used in the treatment of HF?

Answer 72

ACE inhibitors are the first-line of treatment

Question 73

What are the adverse effects of procanimide (anti-arrhythmic agent) and what patient teaching will you provide?

Answer 73

hypotension--change positions slowly take caution while driving d/t sedative effects report fever, chills, sore throat, or unusual bleeding (agranulocytosis)

Question 74

What lab monitoring will be completed for a patient taking statins?

Answer 74

cholesterol, liver fx

Question 75

3 contraindications for ACE-I and ARBs?

Answer 75

bilateral renal artery stenosis angioedema pregnancy

Question 76

What patient education will be provided when taking thiazolidiediones (TZDs)

Answer 76

don't use with patients with bladder CA or HF | may need to increase BC dose or choose alternative treatment for BC

Question 77

What is the daily maximum dose of APAP?

Answer 77

4 gm/day

Question 78

Can schedule 2 drugs be refilled?

Answer 78

NO

Question 79

Can schedule 3 drugs be refilled?

Answer 79

prescription must be rewritten after 6 months or 5 refills (narcotics with codeine, stimulants, depressants