MSN-611-Advanced Pharmacology Across The Life Span

Correct Answer: A. Peptic ulcers caused by H. pylori need antibiotic therapy

Explanation:

A. Peptic ulcers caused by H. pylori need antibiotic therapy

Helicobacter pylori (H. pylori) infection is a common cause of peptic ulcers. The treatment for H. pylori-related ulcers typically involves a combination of antibiotics (to eradicate the bacteria) and proton pump inhibitors (PPIs) or H2 blockers (to reduce stomach acid).

Why the Other Options Are Incorrect:

B. The top cause of peptic ulcers is stress

While stress can exacerbate peptic ulcers, the most common cause is H. pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs), rather than stress alone. Stress may increase stomach acid production but is not considered the top cause.

C. Famotidine is more potent versus omeprazole

Famotidine is an H2 receptor antagonist, and omeprazole is a proton pump inhibitor (PPI). PPIs are generally more potent and effective at reducing stomach acid production compared to H2 blockers like famotidine. Therefore, omeprazole is typically considered more potent than famotidine.

D. Antacids are effective for long-term management of peptic ulcers

Antacids can temporarily neutralize stomach acid and provide symptom relief, but they are not effective for long-term management of peptic ulcers. Long-term treatment typically involves acid-reducing medications (e.g., PPIs or H2 blockers) and, if necessary, antibiotics for H. pylori infection.

Correct Answer: C. Fluoroquinolones

Explanation:

C. Fluoroquinolones

Fluoroquinolones, such as ciprofloxacin and levofloxacin, carry an FDA black box warning for the risk of tendonitis and tendon rupture. This serious adverse effect can occur during or even months after treatment and is more common in older adults, patients taking corticosteroids, and those with kidney, heart, or lung transplants. The mechanism is not completely understood, but fluoroquinolones are believed to interfere with collagen synthesis and tendon repair, leading to increased risk of injury, especially in the Achilles tendon.

Why the Other Options Are Incorrect:

A. Aminoglycosides

Aminoglycosides, such as gentamicin and tobramycin, are associated with nephrotoxicity and ototoxicity but do not carry a black box warning for tendon rupture.

B. Tetracyclines

Tetracyclines, like doxycycline, may cause photosensitivity and are contraindicated in children and pregnant women due to effects on bone and teeth, but they are not linked to tendon damage.

D. Cephalosporins

Cephalosporins are generally well tolerated and are not associated with tendonitis or tendon rupture. They do not have this black box warning.

Correct Answer: C. Hydralazine

Explanation:

Hydralazine is a medication that is safe to use in pregnancy, particularly for the management of hypertension and preeclampsia. It is a vasodilator that works by relaxing the smooth muscle in the blood vessels, which helps to lower blood pressure. It is commonly used in pregnant women with high blood pressure or hypertensive emergencies, such as preeclampsia, and has been found to have a favorable safety profile in pregnancy.

Why the Other Options Are Incorrect:

A. Warfarin

Warfarin is not safe during pregnancy. It is classified as a Category X drug, which means it is contraindicated in pregnancy due to its teratogenic effects. Warfarin can cross the placenta and cause birth defects and other complications such as bleeding. It is generally replaced with heparin or low-molecular-weight heparin (LMWH) for anticoagulation during pregnancy.

B. Lisinopril

Lisinopril is an ACE inhibitor and is not safe during pregnancy. It is classified as a Category D drug, meaning it has been shown to cause harm to the fetus, particularly in the second and third trimesters. It can cause renal failure, hypotension, and death in the fetus, as well as developmental issues. ACE inhibitors should be avoided in pregnant women, and alternative medications should be used to manage hypertension.

D. Methotrexate

Methotrexate is not safe during pregnancy and is classified as a Category X drug. It is a chemotherapy agent that inhibits cell division and can cause severe birth defects, spontaneous abortion, and fetal death. It is contraindicated in pregnancy and should be discontinued if pregnancy is planned or detected.

Correct Answer: B. Preexposure prophylaxis (PrEP)

Explanation:

B. Preexposure prophylaxis (PrEP)

Preexposure prophylaxis (PrEP), such as the combination of tenofovir and emtricitabine (Truvada or Descovy), is used to prevent HIV infection in individuals at high risk. Regular HIV testing—every 90 days (or 3 months)—is required to ensure the patient remains HIV-negative while on PrEP. If a person acquires HIV while taking PrEP and continues the medication without knowing their status, it could lead to resistance to the components of PrEP, which are also used in HIV treatment regimens. Therefore, strict adherence to routine HIV testing is essential for safety and efficacy.

Why the Other Options Are Incorrect:

A. NRTI/NNRTI

Nucleoside and non-nucleoside reverse transcriptase inhibitors (NRTIs and NNRTIs) are used to treat individuals already diagnosed with HIV. These medications do not require routine HIV testing every 90 days since the patient is already HIV-positive and under monitoring as part of their treatment plan.

C. Protease inhibitors

Protease inhibitors are also part of antiretroviral therapy (ART) for HIV-positive individuals. Like NRTIs/NNRTIs, they are used in those already diagnosed, not for prevention, and thus routine screening for HIV is not required in the same way as for PrEP.

D. Acyclovir

Acyclovir is an antiviral medication used primarily for herpes simplex virus and varicella-zoster virus. It has no role in HIV prevention or treatment, and it does not require HIV testing as part of its monitoring.

Correct Answer: A. Second generation antipsychotics have a reduced risk of causing EPS

Explanation:

Antipsychotic medications are commonly classified into two categories: first-generation antipsychotics (FGA) and second-generation antipsychotics (SGA). These classes have distinct profiles, particularly when it comes to side effects such as extrapyramidal symptoms (EPS) and metabolic syndrome.

A. Second generation antipsychotics have a reduced risk of causing EPS

This statement is correct. Second-generation antipsychotics (SGAs), also known as atypical antipsychotics, generally have a lower risk of causing extrapyramidal symptoms (EPS) compared to first-generation antipsychotics (FGAs). EPS includes symptoms such as tremors, rigidity, and bradykinesia, which are commonly seen with older, first-generation antipsychotics like haloperidol. Second-generation antipsychotics such as clozapine, olanzapine, and risperidone tend to cause fewer motor side effects, making them more favorable in terms of movement disorders.

Why the Other Options Are Incorrect:

B. First generation antipsychotics are more effective for negative symptoms

This statement is incorrect. First-generation antipsychotics (FGAs) are generally more effective at treating positive symptoms of schizophrenia, such as hallucinations and delusions, but are less effective in managing negative symptoms like social withdrawal, anhedonia, and flat affect. Second-generation antipsychotics (SGAs) are typically more effective for treating both positive and negative symptoms of schizophrenia. They work on a broader range of symptoms, making them a preferred option for many patients.

C. There are no differences between these two classes

This statement is incorrect. There are significant differences between first-generation (FGA) and second-generation antipsychotics (SGA). While both classes are used to treat schizophrenia and bipolar disorder, their side effect profiles and mechanisms of action differ. SGAs generally have a lower risk of EPS, but they may be associated with a higher risk of metabolic syndrome (e.g., weight gain, diabetes, dyslipidemia). In contrast, FGAs are more likely to cause EPS but have a lower risk of metabolic side effects.

D. First generation antipsychotics have an increased risk of causing metabolic syndrome

This statement is incorrect. While second-generation antipsychotics (SGAs) are more commonly associated with an increased risk of metabolic syndrome, including weight gain, diabetes, and dyslipidemia, first-generation antipsychotics (FGAs) are generally less likely to cause these metabolic side effects. SGAs such as clozapine and olanzapine are particularly notorious for their metabolic effects, whereas FGAs tend to be more associated with motor-related side effects like EPS.

Correct Answer: B. Decrease dose

Explanation:

The TSH (Thyroid Stimulating Hormone) level is used to evaluate thyroid function and guide the adjustment of levothyroxine, a synthetic form of thyroid hormone used to treat hypothyroidism. Typically, a normal TSH level ranges from 0.4 to 4.0 mU/L, but this can vary slightly depending on the lab.

A TSH level of 0.1 mU/L is considered subnormal and indicates that the patient’s thyroid hormone levels may be too high. This could suggest that the levothyroxine dose is too high, leading to a suppressed TSH, which is often a sign of over-treatment. Over-treatment with thyroid hormone can lead to symptoms of hyperthyroidism such as palpitations, weight loss, insomnia, and anxiety. In this case, the APRN would decrease the levothyroxine dose to bring the TSH level back within the appropriate range, which is generally between 0.4 and 4.0 mU/L, depending on the individual patient’s clinical status.

Why the Other Options Are Incorrect:

A. Increase dose

If the TSH level is low (0.1 mU/L), this indicates that the current dose of levothyroxine is too high, not too low. Increasing the dose would further suppress the TSH and may lead to hyperthyroidism, which is not recommended.

C. Recommend no change

With a TSH level of 0.1 mU/L, it is important to adjust the levothyroxine dose to avoid the potential complications of hyperthyroidism. In this case, recommending no change would not be appropriate since the patient is likely receiving too much thyroid hormone.

D. Add methimazole

Methimazole is used to treat hyperthyroidism by inhibiting thyroid hormone production. However, in this scenario, the patient is taking levothyroxine, which is for hypothyroidism. Adding methimazole is not appropriate since the patient’s low TSH suggests over-treatment with thyroid hormone, not hyperthyroidism. The appropriate action is to adjust the levothyroxine dose, not to add methimazole.

Correct Answer: B. RAAS is blocked by many antihypertensive medications

Explanation:

The Renin Angiotensin Aldosterone System (RAAS) plays a crucial role in regulating blood pressure, fluid balance, and electrolyte balance. It is activated by low blood pressure or low blood flow to the kidneys, which triggers the release of renin, leading to a cascade that eventually produces angiotensin II. Angiotensin II has potent vasoconstrictor effects, and it stimulates the release of aldosterone, which promotes sodium and water retention to increase blood volume and blood pressure. Many antihypertensive medications are designed to block different components of the RAAS pathway to lower blood pressure. These include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and aldosterone antagonists. These medications reduce the effects of angiotensin II and aldosterone, leading to vasodilation, reduced blood volume, and lowered blood pressure. Therefore, RAAS is blocked by many antihypertensive medications to treat conditions like hypertension and heart failure.

Why the Other Options Are Incorrect:

A. RAAS agonists are used to treat cardiomyopathies

RAAS agonists (substances that stimulate the RAAS system) are not used to treat cardiomyopathies. In fact, RAAS inhibition is often a key part of managing heart failure and other heart conditions. Overactivation of RAAS can worsen heart failure and contribute to cardiomyopathy, so medications that block this system are commonly used, not agonists.

C. RAAS only functions in response to hypertension

This statement is incorrect. The RAAS system does not only function in response to hypertension. It is primarily activated in response to low blood pressure, low blood volume, or low sodium levels, not just hypertension. RAAS also plays a role in maintaining overall circulatory homeostasis and fluid balance.

D. This system functions to protect the liver from hypertension

The RAAS system is not specifically aimed at protecting the liver from hypertension. Its primary function is to regulate blood pressure and fluid balance, but it is not involved in protecting the liver. It does, however, affect various organs through its blood pressure-raising effects, but liver protection is not one of its key roles.

Correct Answer: A. Inhaled corticosteroids (ICS)

Explanation:

Inhaled corticosteroids (ICS) are considered the first-line therapy for the long-term management of asthma. ICS medications work by reducing inflammation in the airways, which helps to prevent asthma symptoms, reduce the frequency of exacerbations, and improve overall lung function. ICS are highly effective in controlling asthma when used regularly, and they address the underlying inflammation that causes asthma symptoms. Common examples of ICS include fluticasone, budesonide, and beclometasone.

Why the Other Options Are Incorrect:

B. Angiotensin receptor - neprilysin inhibitor (ARNI)

Angiotensin receptor-neprilysin inhibitors (ARNI), such as sacubitril/valsartan, are primarily used in the treatment of heart failure and are not used for asthma management. They work by inhibiting the breakdown of certain peptides that regulate blood pressure and fluid balance, which has no direct role in managing asthma.

C. Theophylline

Theophylline is a methylxanthine medication that can be used for asthma management, but it is generally considered a second-line or add-on therapy due to its side effects and narrow therapeutic index. It has fallen out of favor as the preferred treatment for long-term asthma control due to the availability of inhaled corticosteroids (ICS), which are more effective and safer.

D. Long-acting beta agonist (LABA)

Long-acting beta agonists (LABAs), such as salmeterol and formoterol, are used to help control asthma symptoms by relaxing the smooth muscles of the airways. However, LABAs are generally used as an add-on therapy to ICS in asthma management, not as a first-line treatment. Monotherapy with LABAs for asthma is not recommended due to the increased risk of severe asthma exacerbations and death when used without an ICS.

Correct Answer: D. Alpha pressors

Explanation:

In the treatment of chronic heart failure (CHF), the goal is to improve heart function, manage symptoms, and prevent further complications. The appropriate medication classes for heart failure generally include beta blockers, diuretics, and ACE inhibitors (ACEI) or angiotensin II receptor blockers (ARBs).

Why the Other Options Are Correct:

A. Beta blockers

Beta blockers are a cornerstone in the management of chronic heart failure. They work by blocking beta-adrenergic receptors, which helps reduce the heart rate and the workload on the heart. Beta blockers, such as carvedilol, metoprolol, and bisoprolol, have been shown to reduce morbidity and mortality in patients with heart failure by improving heart function, preventing arrhythmias, and reducing hospitalizations.

B. Diuretics

Diuretics, such as furosemide or spironolactone, are used in the treatment of chronic heart failure to reduce fluid retention, which is a common symptom of the condition. Diuretics help relieve symptoms such as edema, pulmonary congestion, and shortness of breath by promoting the excretion of sodium and water through the kidneys, thus reducing the overall fluid burden on the heart.

C. ACEI/ARB

Angiotensin-converting enzyme inhibitors (ACEIs), such as enalapril or lisinopril, and angiotensin II receptor blockers (ARBs), such as losartan or valsartan, are commonly used in heart failure to block the effects of the renin-angiotensin-aldosterone system (RAAS). These drugs help reduce blood pressure, prevent cardiac remodeling, and improve survival. ACEIs and ARBs are foundational in the treatment of heart failure with reduced ejection fraction (HFrEF).

Why the Correct Answer is Incorrect:

D. Alpha pressors

Alpha pressors, such as phenylephrine or norepinephrine, are vasoconstrictors that work by stimulating alpha-adrenergic receptors to increase blood pressure. These medications are typically used in acute settings for shock or severe hypotension, not in the management of chronic heart failure. In fact, alpha pressors would not be appropriate for chronic heart failure because they increase afterload (the resistance the heart has to pump against), which can worsen the condition by increasing the workload on an already struggling heart. Chronic heart failure treatment focuses on reducing workload and improving heart efficiency, not increasing it.