NR 565 Advanced Pharmacology Fundamentals
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Free NR 565 Advanced Pharmacology Fundamentals Questions
A patient comes into the clinic with complaints of bloating and abdominal pain for a few weeks. What are appropriate options for treatment?
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Test for H. Pylori
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Start patient on a bland diet
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Lifestyle modifications and Histamine Type-2 Receptor Antagonists
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Order endoscopy
Explanation
Correct Answer:
C. Lifestyle modifications and Histamine Type-2 Receptor Antagonists
Explanation of Correct Answer
For a patient presenting with bloating and abdominal discomfort lasting a few weeks without alarm features (such as weight loss, GI bleeding, or dysphagia), first-line management includes lifestyle modifications and empiric treatment with H2 receptor antagonists. These medications reduce gastric acid production and improve symptoms of dyspepsia. Testing for H. pylori or ordering endoscopy may be indicated if symptoms persist or worsen, but initial conservative management is appropriate in this case.
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.
What medication can impart a harmless black coloration to the tongue and stool?
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Lopermide
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Bismuth Subalicylate
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Ranitidine
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Clarithromycin
Explanation
Correct Answer:
B. Bismuth Subalicylate
Explanation of Correct Answer
Bismuth subsalicylate, commonly used for diarrhea and upset stomach, can cause a temporary and harmless black discoloration of the tongue and stool. This occurs due to the formation of bismuth sulfide when bismuth interacts with trace amounts of sulfur in saliva and the GI tract. The effect is benign and resolves once the medication is discontinued. Loperamide slows intestinal motility, ranitidine is an H2 blocker, and clarithromycin is an antibiotic, none of which cause this effect.
A 29-year-old woman with complaints of fatigue and weight gain presents for her annual physical exam. Her TSH is 13.5 mIU/L (normal 0.5-4.7 mIU/L). Which of the following agents is most appropriate to treat the TSH abnormality?
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Levothyroxine
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Liothyronine
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Liotrix
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Propylthiouracil
Explanation
Correct Answer:
A. Levothyroxine
Explanation of Correct Answer
An elevated TSH with fatigue and weight gain indicates primary hypothyroidism. Levothyroxine (synthetic T4) is the standard treatment because it is stable, predictable, and effectively converted to active T3 in the body. Liothyronine (T3) has a shorter half-life and more risk of side effects, while liotrix (T3/T4 mix) is not routinely used. Propylthiouracil is an antithyroid drug used for hyperthyroidism, not hypothyroidism. Therefore, levothyroxine is the most appropriate therapy.
What educating patients, how should we advise them to use nicotine gum?
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Drink a 8oz of water immediately before chewing nicotine gum.
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Remove dentures prior to chewing nicotine gum
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Use nicotine gum for one year to yield bet results.
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Chew nicotine gum slowly and intermittently for 30 minutes
Explanation
Correct Answer:
D. Chew nicotine gum slowly and intermittently for 30 minutes.
Explanation of Correct Answer
Patients should be taught the "chew and park" method when using nicotine gum. The gum is chewed slowly until a tingling or peppery taste develops, then "parked" between the cheek and gum to allow nicotine absorption through the oral mucosa. This process is repeated intermittently for about 30 minutes. Drinking water immediately before use can interfere with absorption, and dentures may complicate use but removal is not a standard instruction. Therapy duration varies by patient needs, not a fixed one-year period.
Which of the following symptoms indicates that a patient may need a lower dosage of levothyroxine?
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Bradycardia
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Cold intolerance
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Palpitations
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Weight gain
Explanation
Correct Answer:
C. Palpitations
Explanation of Correct Answer
Palpitations suggest that the levothyroxine dose may be too high, leading to symptoms of hyperthyroidism such as tachycardia, anxiety, heat intolerance, and weight loss. In this case, the dosage should be reduced to avoid complications like atrial fibrillation or osteoporosis. Bradycardia, cold intolerance, and weight gain are symptoms of under-treatment or hypothyroidism, which would indicate that the dose may need to be increased rather than decreased.
Extrapyramidal symptoms (EPS) have been associated with which of the following drugs?
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Metoclopramide
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Sucralfate
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Aprepitant
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Bisacodyl
Explanation
Correct Answer:
A. Metoclopramide
Explanation of Correct Answer
Metoclopramide is a dopamine receptor antagonist used as an antiemetic and prokinetic agent. By blocking dopamine receptors in the central nervous system, particularly in the basal ganglia, it can cause extrapyramidal symptoms (EPS), including dystonia, akathisia, parkinsonism, and tardive dyskinesia. These risks increase with long-term or high-dose use. Sucralfate is a mucosal protectant, aprepitant is a neurokinin-1 receptor antagonist, and bisacodyl is a stimulant laxative—none of which are associated with EPS.
Which of the following statements is not true regarding sulfonylureas?
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Sulonlyreas are safe to prescribe to pregnant and/or breast-feeding women
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Patients should be educated about signs and symptoms of hypoglycemia.
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Sulfonylureas cause a dose-dependent reduction in blood glucose.
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Sulfonylureas are indicated for only patients diagnosed with type 2 diabetes.
Explanation
Correct Answer:
A. Sulonlyreas are safe to prescribe to pregnant and/or breast-feeding women.
Explanation of Correct Answer
Sulfonylureas are not considered safe during pregnancy or breastfeeding because of the risk of neonatal hypoglycemia and potential drug transfer through breast milk. Insulin is the preferred treatment in pregnant or breastfeeding diabetic women. Sulfonylureas stimulate insulin release regardless of blood glucose, which can harm the infant if passed on. Therefore, the claim that they are safe in this population is false.
Which class of oral diabetes drugs is paired most appropriately with its primary mechanism of action?
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DPP-4 inhibitor: inhibits breakdown of complex carbohydrates
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SGLT2 inhibitor: increases urinary excretion of glucose
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Sulfonylurea: increases insulin sensitivity
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Thiazolidinedione: decreases hepatic gluconeogenesis
Explanation
Correct Answer:
B. SGLT2 inhibitor: increases urinary excretion of glucose
Explanation of Correct Answer
SGLT2 inhibitors work in the proximal renal tubules by blocking sodium-glucose transport proteins, reducing glucose reabsorption and promoting urinary glucose excretion. This lowers blood glucose independently of insulin. DPP-4 inhibitors prolong incretin activity rather than affecting carbohydrate breakdown. Sulfonylureas stimulate pancreatic insulin secretion, not sensitivity. Thiazolidinediones improve insulin sensitivity in muscle and adipose tissue, but they do not directly decrease hepatic gluconeogenesis. Thus, option B is the correct drug–mechanism match.
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.
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