NR 565 Advanced Pharmacology Fundamentals
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Free NR 565 Advanced Pharmacology Fundamentals Questions
The correct drug classification of Ciclesonide is
-
Methylazanthine
-
Inhaled Corticosteroid
-
Short-acting Beta Agonist
-
Leukotriene Receptor Antagonist
Explanation
Correct Answer:
B. Inhaled Corticosteroid
Explanation of Correct Answer
Ciclesonide is an inhaled corticosteroid (ICS) used in the management of asthma. It works by reducing airway inflammation, decreasing mucus production, and improving overall lung function. As a prodrug, it is activated in the lungs, minimizing systemic side effects. ICS like ciclesonide are cornerstone therapies in asthma treatment, especially for patients with persistent symptoms, because they address the underlying inflammatory process rather than just providing bronchodilation.
During a physical assessment, a patient reports difficulty falling asleep, increased weightloss despite having an increased appetite, feeling increasingly anxious, and noticing their eyes bulging. Which diagnosis should the NP consider?
-
Hashimoto's Disease
-
Hypothyroidism
-
Hyperthyroidism
-
Addision's Disease
Explanation
Correct Answer:
C. Hyperthyroidism
Explanation of Correct Answer
Hyperthyroidism presents with symptoms of increased metabolism, including unintentional weight loss despite increased appetite, anxiety, and insomnia. Exophthalmos, or bulging eyes, is a hallmark sign of Graves’ disease, the most common cause of hyperthyroidism. These findings clearly distinguish hyperthyroidism from hypothyroidism, which causes fatigue, weight gain, and cold intolerance. Hashimoto’s disease typically leads to hypothyroidism, while Addison’s disease involves adrenal insufficiency with symptoms like hyperpigmentation, hypotension, and electrolyte disturbances.
A patient demonstrates correct understanding of nicotine patches if they state:
- "I can wear the same patch for up to a week. I just need to change sites with every new patch."
- "I should start with the smallest patch and progressively use larger patches over several weeks."
- "The patch can be placed directly hairy skin as long as it's clean. Just press down on the adhesive."
- "Severe and persistent itching and redness means I should stop wearing the patch and contact my provider."
Explanation
Explanation of Correct Answer
Nicotine patches should be applied once daily to clean, dry, hairless skin and rotated to avoid irritation. While mild redness is common, severe or persistent skin reactions indicate sensitivity or an allergic response and require provider consultation. Patches are not worn for a week straight, and therapy begins with higher doses that taper down, not the reverse. Placement on hairy skin reduces adhesion and absorption, so clean, hairless sites are recommended.
Cimetidine was the first histamine 2 receptor antagonist available but can produce adverse effects, especially in the older population. Of the adverse reactions listed below, which one is not an adverse effect of Cimetidine?
- Confusion
- Hallucinations
- Gynecomastia
- Rebound acid hypersecretion
Explanation
Correct Answer: D. Rebound acid hypersecretion
Explanation of Correct Answer
Cimetidine is known to cause central nervous system side effects such as confusion and hallucinations, particularly in older adults or those with renal impairment. It can also cause gynecomastia due to its anti-androgenic effects and interference with estrogen metabolism. However, rebound acid hypersecretion is not a typical adverse effect of H2 receptor antagonists like cimetidine; this is more commonly associated with long-term use of proton pump inhibitors (PPIs).
What is the FDA black box warning for the use of metoclopramide (Reglan)?
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Risk of gastrointestinal bleeding; discontinue after 6 months
-
Risk of tardive dyskinesia; discontinue after 12 weeks or if movement disorder develops
-
Risk of agranulocytosis; discontinue if WBC count decreases
-
Risk of lactic acidosis; discontinue if renal function worsens
Explanation
Correct Answer:
B. Risk of tardive dyskinesia; discontinue after 12 weeks or if movement disorder develops
Explanation of Correct Answer
Metoclopramide carries a black box warning for tardive dyskinesia, a serious and potentially irreversible movement disorder. The risk increases with duration of treatment and cumulative dose. Therapy should not exceed 12 weeks, and the medication should be stopped immediately if signs of involuntary movements develop. The other options describe risks linked to different drugs, not metoclopramide.
Which of the following vaccines are live attenuated vaccines and contraindicated in patients with a low immune system?
- TDaP, Td, DT
- Zoster, Varicella, MMR
- HPV, IIV, IPV
- 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.
The NP ordered a repeat fasting plasma glucose test for their patient, as the first test came back elevated. Which of the following repeat fasting plasma glucose value would confirm a diagnosis of diabetes?
-
98
-
148
-
122
-
55
Explanation
Correct Answer:
B. 148
Explanation of Correct Answer
A fasting plasma glucose level ≥126 mg/dL on two separate occasions confirms a diagnosis of diabetes mellitus. The value of 148 mg/dL exceeds this threshold, supporting the diagnosis when consistent with clinical findings. A value of 100–125 mg/dL is classified as impaired fasting glucose (prediabetes), while a normal fasting glucose is <100 mg/dL. Thus, a repeat result of 148 mg/dL confirms diabetes in this patient.
Which of the following reactions occur during Phase 1 metabolism of drugs mediated by Cytochrome P450 enzymes?
-
Conjugation, sulfation, acetylation
-
Oxidation, reduction, hydrolysis
-
Glucuronidation, methylation, conjugation
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Phosphorylation, glycosylation, acetylation
Explanation
Correct Answer:
B. Oxidation, reduction, hydrolysis
Explanation of Correct Answer
Phase 1 metabolism, largely catalyzed by cytochrome P450 enzymes, involves chemical modifications of drugs to increase their polarity and prepare them for further metabolism or excretion. The major reactions include oxidation, reduction, and hydrolysis. These processes often introduce or unmask a functional group, making the drug more suitable for Phase 2 conjugation. In contrast, conjugation reactions (such as glucuronidation, sulfation, or acetylation) occur in Phase 2 metabolism, not Phase 1.
Long acting beta agonists must be prescribed with which medication class?
- Glucocorticoids
- Short acting beta agonists
- Oral steroids
- Methylxanthines
Explanation
Correct Answer: A. Glucocorticoids
Explanation of Correct Answer
Long-acting beta agonists (LABAs) must always be prescribed in combination with inhaled glucocorticoids when managing asthma. LABAs provide prolonged bronchodilation but, when used alone, are associated with an increased risk of asthma-related deaths. Inhaled corticosteroids control the underlying airway inflammation, reducing this risk and improving overall disease management. Therefore, combination therapy ensures both immediate bronchodilation and long-term inflammation control, making it the standard of care for persistent asthma.
The NP ordered a repeat fasting plasma glucose test for their patient, as the first test came back elevated. Which of the following repeat fasting plasma glucose value would confirm a diagnosis of diabetes?
- 98
- 148
- 122
- 55
Explanation
A fasting plasma glucose level ≥126 mg/dL on two separate occasions confirms a diagnosis of diabetes mellitus. The value of 148 mg/dL exceeds this threshold, supporting the diagnosis when consistent with clinical findings. A value of 100–125 mg/dL is classified as impaired fasting glucose (prediabetes), while a normal fasting glucose is <100 mg/dL. Thus, a repeat result of 148 mg/dL confirms diabetes in this patient.
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