NR 565 Advanced Pharmacology Fundamentals
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Free NR 565 Advanced Pharmacology Fundamentals Questions
What is the primary mechanism of action of decongestants?
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They suppress the cough reflex by acting on the medulla
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They shrink engorged mucous membranes to decrease nasal stuffiness.
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They thin and loosen mucus secretions to promote airway clearance
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They block histamine receptors to reduce allergic reactions
Explanation
Correct Answer:
B. They shrink engorged mucous membranes to decrease nasal stuffiness.
Explanation of Correct Answer
Decongestants work by stimulating alpha-adrenergic receptors in the nasal mucosa, causing vasoconstriction. This reduces blood flow to engorged mucous membranes, which decreases swelling and relieves nasal congestion. They do not suppress cough (antitussives), thin mucus (expectorants), or block histamine (antihistamines).
Of the following, which is not used to diagnose thyroid conditions?
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Calcitonin
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TSH
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Free T4
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Total T3
Explanation
Correct Answer:
A. Calcitonin
Explanation of Correct Answer
Calcitonin is produced by the thyroid gland but is not routinely used to diagnose common thyroid disorders such as hypothyroidism or hyperthyroidism. Instead, it is primarily measured when evaluating medullary thyroid carcinoma or C-cell hyperplasia. Standard thyroid function tests include thyroid-stimulating hormone (TSH), free thyroxine (Free T4), and triiodothyronine (Total T3), which provide direct information about thyroid hormone production and pituitary regulation. Therefore, calcitonin is not a typical diagnostic marker for thyroid conditions.
Which of the following drugs for diabetes is MOST likely to cause hypoglycemia?
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Glyburide
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Exenatide
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Rosiglitazone
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Saxagliptin
Explanation
Correct Answer:
A. Glyburide
Explanation of Correct Answer
Glyburide is a sulfonylurea that stimulates insulin release from pancreatic beta cells regardless of current blood glucose levels, making hypoglycemia a significant risk. This risk is particularly high in older adults and those with renal impairment. Exenatide (a GLP-1 agonist), rosiglitazone (a thiazolidinedione), and saxagliptin (a DPP-4 inhibitor) are much less likely to cause hypoglycemia because their mechanisms are either glucose-dependent or focused on improving insulin sensitivity rather than directly increasing insulin secretion.
Which medication can be abused due to its "morphine-like affect"?
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Prilosec
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Zofran
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Mylanta
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Lopermide
Explanation
Correct Answer:
D. Lopermide
Explanation of Correct Answer
Loperamide is an over-the-counter antidiarrheal that works by slowing intestinal motility through opioid receptor activity in the gut. At recommended doses, it does not produce central nervous system effects because it poorly crosses the blood–brain barrier. However, in very high doses, it can cross into the CNS and produce morphine-like euphoria, leading to its potential abuse. Prilosec (omeprazole), Zofran (ondansetron), and Mylanta (an antacid) do not have addictive or opioid-like properties.
Which medication is associated with decreased absorption of calcium, magnesium, and vitamin B12?
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Metronidazole
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Polyethylene glycol
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Metoclopramide
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Esomeprazole
Explanation
Correct Answer:
D. Esomeprazole
Explanation of Correct Answer
Esomeprazole, a proton pump inhibitor (PPI), reduces gastric acid secretion, which is essential for the absorption of several nutrients, including calcium, magnesium, and vitamin B12. Long-term use of PPIs is associated with deficiencies in these nutrients, increasing the risk of osteoporosis, hypomagnesemia, and anemia. Metronidazole is an antibiotic, polyethylene glycol is an osmotic laxative, and metoclopramide is a prokinetic agent—none of which impair nutrient absorption in the same way as PPIs.
Which of the following vaccines are live attenuated vaccines and contraindicated in patients with a low immune system?
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TDaP, Td, DT
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Zoster, Varicella, MMR
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HPV, IIV, IPV
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Hep A, Hep B, HiB
Explanation
Correct Answer:
B. Zoster, Varicella, MMR
Explanation of Correct Answer
Live attenuated vaccines contain weakened but still active forms of the virus, which can pose serious risks in immunocompromised patients. Zoster (live shingles vaccine), Varicella (chickenpox), and MMR (measles, mumps, rubella) fall into this category and are contraindicated in individuals with weakened immune systems. In contrast, TDaP, HPV, inactivated influenza vaccine (IIV), IPV, Hep A, Hep B, and Hib are inactivated or recombinant vaccines and are safe for immunocompromised patients.
After starting levothyroxine or changing the dose, when should thyroid function tests (TSH) be rechecked, and how often once the patient is stabilized?
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Recheck in 2 weeks, then every 3 months
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Recheck in 6–8 weeks, then every 12 months once stabilized
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Recheck in 6 months, then every 24 months
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Recheck in 12 weeks, then annually only if symptoms worsen
Explanation
Correct Answer:
B. Recheck in 6–8 weeks, then every 12 months once stabilized
Explanation of Correct Answer
Levothyroxine has a long half-life, and it takes several weeks for TSH levels to stabilize after starting or adjusting therapy. Therefore, TSH should be rechecked in 6–8 weeks to evaluate response and adjust the dose if needed. Once the correct dose is achieved and the patient remains euthyroid, TSH should be monitored annually. More frequent testing may be required if symptoms recur or medications affecting thyroid hormone metabolism are introduced.
A 33 year old woman previously diagnosed with hyperthyroidism noted have tachycardia. Which medication should the NP add to the patients regimen?
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atenolol
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levothyroxine
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lithium
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semaglutide
Explanation
Correct Answer:
A. atenolol
Explanation of Correct Answer
Atenolol, a beta-adrenergic blocker, is commonly prescribed to control the adrenergic symptoms of hyperthyroidism such as tachycardia, palpitations, tremors, and anxiety. While it does not treat the underlying thyroid hormone excess, it provides symptomatic relief until antithyroid medications, radioactive iodine, or surgery achieve long-term control. Beta-blockers are an essential adjunct in managing hyperthyroidism, especially when cardiovascular symptoms like tachycardia are present.
When should a TSH level be drawn after adjusting the dose of levothyroxine?
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after 24 months
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within 6-8 weeks
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at least once a year
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the following week
Explanation
Correct Answer:
B. within 6-8 weeks
Explanation of Correct Answer
TSH levels should be checked within 6–8 weeks after adjusting the dose of levothyroxine because thyroid hormone has a long half-life, and it takes several weeks for levels to stabilize and reflect the new steady state. Checking too early, such as within a week, would not provide accurate information. Once the patient is stable on a maintenance dose, TSH is typically monitored annually unless clinical symptoms or medication changes warrant earlier testing.
A pregnant woman comes in asking for GERD medication, what can you recommend?
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Misoprostol
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Sucralafate
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Esomeprazole
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Diet modifications only
Explanation
Correct Answer:
B. Sucralafate
Explanation of Correct Answer
Sucralfate is considered safe for use during pregnancy because it is minimally absorbed systemically and acts locally by coating the gastric mucosa, providing protection against acid. This makes it a suitable choice for GERD management when lifestyle and dietary modifications are not sufficient. Misoprostol is contraindicated in pregnancy due to its uterotonic effects, esomeprazole (a PPI) may be considered if symptoms are severe but is not first-line, and diet modifications alone may not provide adequate relief.
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