NR 565 Advanced Pharmacology Fundamentals
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Free NR 565 Advanced Pharmacology Fundamentals Questions
A patient with severe asthma should be educated to use which of their asthma prescription medication first?
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Fermetoerol
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Levalbuterol
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Budesonide
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Roflumilast
Explanation
Correct Answer:
B. Levalbuterol
Explanation of Correct Answer
Levalbuterol is a short-acting beta-2 agonist (SABA) and serves as a rescue inhaler for acute asthma symptoms. Patients with severe asthma should be instructed to use their SABA first to achieve rapid bronchodilation and immediate relief of airway constriction. Maintenance therapies such as long-acting beta agonists (formoterol/fermoterol), inhaled corticosteroids (budesonide), or phosphodiesterase-4 inhibitors (roflumilast) are not used for quick symptom relief but for long-term control. SABAs remain first-line in acute management.
A patient presents with an A1C of 11.2%. Which medication should be considered at this time?
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Insulin
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Metformin
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Glipizide
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Sitagliptin
Explanation
Correct Answer:
A. Insulin
Explanation of Correct Answer
An A1C of 11.2% indicates severely uncontrolled diabetes, well above the recommended goal of <7%. At this level, oral agents alone are insufficient for rapid glycemic control. Insulin is the treatment of choice because it provides the most effective and immediate reduction in blood glucose, preventing complications such as hyperosmolar hyperglycemic state or diabetic ketoacidosis. Once glucose is stabilized, oral medications like metformin may be added for long-term management.
In what part of the body are SGLT-2 (sodium-glucose cotransporter 2) inhibitors active?
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Small intestine
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Pancreas
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Renal tubules
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Stomach
Explanation
SGLT-2 inhibitors act in the proximal renal tubules, where they block the reabsorption of glucose from the filtrate back into the bloodstream. By inhibiting this transporter, excess glucose is excreted in the urine, lowering blood glucose levels. This mechanism is independent of insulin secretion, making it effective even in patients with reduced beta-cell function. Their site of action in the kidneys also explains the associated risk of urinary tract and genital infections.
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.
A 26 year old asthmatic patient reports asthma symptoms that occur several times a day with nightly exacerbations. The patient is mostly like diagnosed with:
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Intermittent asthma
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Mild-persistant asthma
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Moderate-persistant asthma
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Severe asthma
Explanation
Correct Answer:
D. Severe asthma
Explanation of Correct Answer
Severe-persistent asthma is defined by symptoms occurring throughout the day, nightly awakenings, and severe limitations in daily activities. Patients often require multiple medications, including high-dose inhaled corticosteroids, long-acting beta agonists, and sometimes biologics. This patient’s report of several daily symptoms along with nightly exacerbations aligns with the diagnostic criteria for severe asthma, distinguishing it from moderate-persistent asthma where night symptoms occur more than once per week but not every night.
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
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Risk of tardive dyskinesia; discontinue after 12 weeks or if movement disorder develops
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Risk of agranulocytosis; discontinue if WBC count decreases
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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.
Patients with an increased risk for UTIs and genital infections or an active diagnosis, should avoid what drug class/es for treatment of Type II Diabetes?
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Thiazolidinediones (Glitazones)
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Biguanide.
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Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitors.
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All of the above.
Explanation
Explanation of Correct Answer
SGLT-2 inhibitors increase urinary glucose excretion by blocking glucose reabsorption in the proximal tubules. The elevated glucose in urine creates a favorable environment for bacterial and fungal growth, significantly raising the risk of urinary tract infections and genital mycotic infections. Therefore, patients with a history of recurrent or active UTIs and genital infections should avoid this class of drugs, as the side effects can worsen their condition and compromise safe diabetes management.
Proton pump inhibitors affect the absorption of all the following minerals/vitamins except
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calcium
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magnesium
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vitamin B12
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iron
Explanation
Correct Answer:
D. iron
Explanation of Correct Answer
Proton pump inhibitors (PPIs) reduce stomach acid, which impairs the absorption of calcium, magnesium, and vitamin B12 over time. This can contribute to osteoporosis, hypomagnesemia, and B12 deficiency in long-term users. Iron absorption, however, is largely unaffected by PPIs because it can still be absorbed through alternative pathways even in low-acid conditions. Therefore, iron absorption remains relatively stable, making it the exception among the listed nutrients.
Which of the following reactions occur during Phase 1 metabolism of drugs mediated by Cytochrome P450 enzymes?
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Conjugation, sulfation, acetylation
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Oxidation, reduction, hydrolysis
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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.
Which of the following agents for gastrointestinal problems is contraindicated in pregnancy?
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Calcium carbonate
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Famotidine
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Lansoprazole
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Misoprostol
Explanation
Correct Answer:
D. Misoprostol
Explanation of Correct Answer
Misoprostol is contraindicated in pregnancy because it is a prostaglandin E1 analog that stimulates uterine contractions, which can lead to miscarriage, preterm labor, or birth defects. It is sometimes used clinically to induce labor or as part of medical management of miscarriage, but not for routine gastrointestinal problems in pregnancy. Calcium carbonate, famotidine (an H2 blocker), and lansoprazole (a PPI) are generally considered safe options for managing GERD and other gastrointestinal symptoms during pregnancy.
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