PHAR 6128 PPS II Final Exam - Chicago State University School of Pharmacy

Explanation:

Correct Answer: (E) All of the above medications have been reported to cause symptoms of heartburn

All three drug classes listed are well-documented causes of drug-induced heartburn and gastroesophageal reflux symptoms.

A. Bisphosphonates — Medications such as alendronate (Fosamax) are known to cause esophageal irritation, esophagitis, and heartburn, particularly if not taken with adequate water and in an upright position. Patients are instructed to remain upright for at least 30 minutes after taking bisphosphonates to minimize esophageal exposure.

B. Calcium channel blockers — Drugs such as amlodipine and nifedipine relax smooth muscle throughout the body, including the lower esophageal sphincter (LES). Relaxation of the LES allows gastric acid to reflux into the esophagus, causing heartburn symptoms.

C. Nonsteroidal anti-inflammatory drugs (NSAIDs) — NSAIDs such as ibuprofen and naproxen inhibit prostaglandin synthesis, which reduces the protective mucus lining of the gastrointestinal tract. This leads to increased gastric acid exposure, mucosal irritation, and heartburn.

Explanation:

Correct Answer: (A) Suggest increasing water intake and chewing sugarless gum

Increasing water intake helps manage cravings and oral fixation associated with quitting smoking, while chewing sugarless gum provides a substitute oral habit that can help reduce snacking and weight gain. These are practical, evidence-supported behavioral strategies that directly address the patient's concern.

Why Other Options are Incorrect:

B. Counsel the patient not to worry since most patients on average gain only 1 to 2 lbs — Dismissing the patient's concern is not effective counseling. Additionally, average weight gain after quitting tobacco is typically around 5 to 10 lbs, not 1 to 2 lbs, making this option factually inaccurate.

C. Encourage the patient to be proactive and start a diet before quitting — Starting a restrictive diet simultaneously with quitting tobacco can be overwhelming and may reduce the likelihood of successfully quitting. It is generally not recommended to make multiple major lifestyle changes at the same time.

D. Recommend the nicotine patch as that has been shown to reduce weight gain — While nicotine replacement therapy may delay weight gain, it is not specifically recommended primarily for weight management purposes, and its effect on long-term weight gain after quitting is limited.

Explanation:

Correct Answer: (C) Nonproductive cough

Codeine is an opioid-based antitussive that works by suppressing the cough reflex in the central nervous system. It is indicated for nonproductive (dry) coughs where there is no mucus to expel. Suppressing a nonproductive cough helps relieve discomfort without interfering with necessary airway clearance.

Why Other Options are Incorrect:

A. Productive "wet" cough — A productive cough serves the purpose of clearing mucus and secretions from the airways. Suppressing it with codeine would be counterproductive and potentially harmful, as it could lead to mucus accumulation and worsening infection.

B. Allergic Rhinitis — Codeine has no role in treating allergic rhinitis. This condition is managed with antihistamines, nasal corticosteroids, and decongestants.

D. Sore throat — Codeine is not indicated as a treatment for sore throat. Sore throats are typically managed with analgesics, antiseptic lozenges, or antibiotics when bacterial infection is present.

Explanation:

Correct Answer: (D) Pulling at the loose skin of a blister may result in the loss of viable skin and delay the healing process

The loose skin overlying a blister acts as a natural protective barrier for the healing tissue beneath. Removing or pulling at this skin exposes the raw underlying tissue to infection and mechanical damage, significantly delaying the healing process. Patients should be counseled to leave blisters intact whenever possible.

Why Other Options are Incorrect:

A. Pustules are a distinguishing symptom of bacterial skin infections — While pustules can be associated with bacterial infections, they are not exclusively so. Pustules can also occur in fungal infections, inflammatory conditions like acne, and other dermatological conditions.

B. Blistering is always a sign of a severe infection or skin condition — Blistering can occur in relatively mild conditions such as friction blisters from footwear or mild contact dermatitis. It is not always indicative of a severe condition.

C. Blistering is unlikely in tinea infections — Tinea pedis (athlete's foot), a common tinea infection, can actually present with blisters, particularly in its vesicular form. Blistering is therefore not unlikely in all tinea infections.

Explanation:

Correct Answer: (A) Prevents viral entry into host cells

Docosanol (Abreva) is an OTC antiviral agent used topically for the treatment of herpes labialis (cold sores) caused by Herpes Simplex Virus type 1 (HSV-1). Its unique mechanism of action involves integrating into the host cell plasma membrane and altering its composition, which prevents the fusion of the viral envelope with the host cell membrane. By blocking this fusion step, docosanol prevents viral entry into the host cell, thereby halting viral replication and reducing the duration and severity of cold sore outbreaks.

Why Other Options are Incorrect:

B. Inhibits viral DNA polymerase — Inhibition of viral DNA polymerase is the mechanism of antiviral agents such as acyclovir, valacyclovir, and famciclovir. These drugs work intracellularly after viral entry, which is fundamentally different from docosanol's mechanism of preventing entry altogether.

C. Destroys viral RNA — Docosanol does not destroy viral RNA. Additionally, herpesviruses are DNA viruses, not RNA viruses, making this mechanism doubly incorrect in the context of HSV treatment.

D. Enhances immune response — Docosanol does not function as an immunomodulator or immune stimulant. It acts directly on the host cell membrane as a physical barrier to viral fusion and entry, not through immunological pathways.

Explanation:

Correct Answer: (A) True

Open-ended questions are a foundational communication technique in Motivational Interviewing (MI). Unlike closed-ended questions that can be answered with a simple yes or no, open-ended questions invite patients to share their thoughts, feelings, concerns, and experiences in their own words. This approach encourages the patient to take the lead in the conversation, facilitates a deeper therapeutic dialogue, and prevents the provider from making assumptions or premature judgments about the patient's readiness, values, or motivations for change. Open-ended questions are one of the four core communication skills in MI, summarized by the acronym OARS — Open-ended questions, Affirmations, Reflective listening, and Summaries.

Explanation:

Correct Answer: (A) True

H2RAs such as famotidine work by blocking histamine receptors on stomach parietal cells, producing acid suppression that begins relatively quickly, typically within 30 to 60 minutes. However, their duration of acid suppression is shorter compared to PPIs. PPIs such as omeprazole irreversibly inhibit the proton pump and, while they have a slower onset requiring consistent daily dosing to reach full effect, they provide longer-lasting and more profound acid suppression over a 24-hour period.

Why Other Options are Incorrect:

B. False — This is incorrect. The pharmacokinetic and pharmacodynamic profiles of H2RAs and PPIs are well established in clinical literature, confirming that H2RAs do have a faster onset but shorter duration compared to PPIs.

Explanation:

Correct Answer: (C) Pain, anxiety, secretions, nausea

Pain, anxiety, secretions (such as excessive respiratory secretions), and nausea are among the most common and clinically significant symptoms encountered in hospice patients that pharmacists actively help manage through medication optimization. Pain management (using opioids, adjuvant analgesics), anxiolytic therapy (using benzodiazepines), antisecretory agents (such as hyoscine/scopolamine for death rattle), and antiemetics are all core components of the pharmacist's role in hospice medication management and symptom control.

Why Other Options are Incorrect:

A. Muscle spasms, chills, teeth chattering — While muscle spasms may occasionally occur in hospice patients, chills and teeth chattering are not primary or commonly managed hospice symptoms and do not represent the central focus of pharmacist-driven symptom management in this setting.

B. Incontinence, dizziness, infection, skin discoloration — While incontinence and dizziness may occur in hospice patients, infection treatment is generally not a hospice priority (comfort over cure), and skin discoloration is not a pharmacologically managed symptom by pharmacists in this setting.

D. Itching, dry skin, congestion, sneezing — Pruritus can occur in hospice patients, particularly in liver or renal failure, but dry skin, congestion, and sneezing are not the primary focus of pharmacist-managed hospice symptom control.

E. Dysgeusia, sweating, blurry vision, hair loss — These symptoms are more typically associated with medication side effects or chemotherapy toxicity rather than the core symptoms that pharmacists focus on managing in hospice care.

Explanation:

Correct Answer: (B) Using open-ended questions

The four foundational principles of Motivational Interviewing as defined by Miller and Rollnick are Express Empathy, Develop Discrepancy, Roll with Resistance, and Support Self-Efficacy. A fifth principle sometimes included is Avoid Argumentation. While using open-ended questions is an important communication skill and technique within the practice of MI (part of the OARS framework — Open-ended questions, Affirmations, Reflective listening, Summaries), it is a communication technique or skill, not one of the core foundational principles of Motivational Interviewing.

Why Other Options are Incorrect:

A. Express empathy — This is a core MI principle. It involves using reflective listening to demonstrate understanding and acceptance of the patient's perspective without judgment, creating a safe and collaborative therapeutic relationship.

C. Avoid argumentation — This is a recognized MI principle. Direct confrontation and argumentation increase patient defensiveness and resistance, so MI practitioners are trained to avoid arguing and instead guide the patient gently toward self-reflection.

D. Roll with resistance — This is a core MI principle. Rather than confronting or challenging patient resistance, the MI practitioner acknowledges it, reframes it, and uses it as an opportunity to explore the patient's ambivalence about change.

E. Develop discrepancy — This is a core MI principle. It involves helping the patient recognize the gap between their current behavior and their stated values or goals, creating the cognitive dissonance that motivates change.