Texas Woman's University Dallas Pharm Exam 1 SP26
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Free Texas Woman's University Dallas Pharm Exam 1 SP26 Questions
A client with COPD is prescribed a daily scheduled maintenance drug by inhalation that decreases mucus production and airway resistance. Which drug will the nurse teach the client about?
- Montelukast
- Ipratropium
- Acetylcysteine
- Albuterol
Explanation
Correct Answer: B) Ipratropium
Ipratropium is an inhaled anticholinergic bronchodilator used as a daily maintenance medication in COPD. It works by blocking muscarinic receptors in the airways, which reduces mucus secretion and causes bronchodilation by decreasing airway resistance — making it the correct match for the description given. Montelukast is a leukotriene receptor antagonist used for asthma, not COPD maintenance. Acetylcysteine is a mucolytic that breaks down mucus but is not a bronchodilator and is not a standard daily maintenance inhaler for COPD. Albuterol is a short-acting beta-2 agonist used for acute relief of bronchospasm, not as a scheduled daily maintenance drug.
The client needs to quickly reach therapeutic serum drug levels of a new medication. The nurse anticipates which will be ordered?
- Trough
- Maintenance dose
- Loading dose
- Creatinine clearance
Explanation
Correct Answer: C) Loading dose
A loading dose is a larger-than-usual initial dose given at the start of therapy to rapidly achieve therapeutic drug concentrations in the bloodstream. This is particularly useful for medications where it would take too long to reach therapeutic levels through standard dosing alone.
Once the therapeutic level is established, a maintenance dose is then used to keep the drug at a steady therapeutic concentration. A trough is the lowest serum drug concentration measured just before the next dose and is used for drug monitoring, not for rapidly achieving drug levels.
Creatinine clearance is a measure of kidney function used to guide dosing adjustments, not to accelerate drug levels.
A client is receiving an inhaled anesthetic for anesthesia during surgery. The client's body temperature starts to rise, followed by sweating. The nurse recognizes these as early symptoms of which potentially fatal reaction to inhaled anesthetics?
- Malignant hyperthermia
- Red man syndrome
- Local Anesthetic Systemic Toxicity (LAST)
- Stevens-Johnson Syndrome
Explanation
Correct Answer: A) Malignant hyperthermia
Malignant hyperthermia (MH) is a rare but life-threatening pharmacogenetic reaction triggered by exposure to volatile inhaled anesthetic agents (such as halothane, sevoflurane, or desflurane) and succinylcholine. It is caused by a genetic defect in the ryanodine receptor of skeletal muscle, leading to uncontrolled release of calcium from the sarcoplasmic reticulum. This causes sustained, uncontrolled skeletal muscle contractions resulting in a dramatic rise in body temperature (often exceeding 40°C), profuse sweating, muscle rigidity, tachycardia, and severe metabolic acidosis. Early recognition is critical — the treatment is immediate discontinuation of the triggering agent and administration of dantrolene sodium, the only specific antidote for malignant hyperthermia.
Which symptoms are associated with an anaphylactic reaction?
- Slow heart rate
- Hives and swelling
- Bleeding
- Skin necrosis
Explanation
Correct Answer: B) Hives and swelling
Anaphylaxis is a severe, life-threatening systemic allergic reaction triggered by IgE-mediated hypersensitivity. The hallmark symptoms include hives (urticaria), angioedema (swelling), bronchospasm, hypotension, and tachycardia — not a slow heart rate.
The massive release of histamine and other inflammatory mediators causes widespread vasodilation, increased vascular permeability, and smooth muscle contraction, leading to these classic manifestations.
A slow heart rate (bradycardia) is not characteristic of anaphylaxis — tachycardia is expected due to compensatory response to hypotension. Bleeding and skin necrosis are not features of anaphylaxis and are associated with other conditions such as coagulopathies or severe infections like meningococcemia.
A client presents to the emergency department with an acute gout flare. The big toe is inflamed, and crystallization is present. Which medication will decrease the inflammation?
- Morphine sulfate
- Allopurinol
- Colchicine
- Acetaminophen
Explanation
Correct Answer: C) Colchicine
Colchicine is the drug of choice for treating acute gout flares because it works by inhibiting the migration of neutrophils to the affected joint, thereby reducing the inflammatory response triggered by uric acid crystal deposition. It directly targets the mechanism of gout-related inflammation. Allopurinol is used for long-term prevention of gout by reducing uric acid production, but it is not used during an acute flare as it can actually worsen the attack if initiated at this time. Morphine sulfate is an opioid analgesic that addresses pain but does not treat the underlying inflammation. Acetaminophen provides mild pain relief but has no anti-inflammatory properties and does not address the crystallization-driven inflammatory process in gout.
Which of the following statements are true regarding cetirizine and diphenhydramine? Select all that apply.
- Diphenhydramine has a longer half-life than cetirizine
- Both cetirizine and diphenhydramine can be used to treat seasonal allergies
- The primary side effect of diphenhydramine is sedation
- Both medications should be taken early to block histamine receptors before allergen exposure
- Cetirizine readily crosses the blood-brain barrier causing significant sedation
Explanation
Correct Answers: B) Both cetirizine and diphenhydramine can be used to treat seasonal allergies, C) The primary side effect of diphenhydramine is sedation, and D) Both medications should be taken early to block histamine receptors before allergen exposure
Both cetirizine and diphenhydramine are H1 antihistamines effective for treating seasonal allergies by blocking histamine receptors and reducing symptoms such as sneezing, itching, and runny nose. Since antihistamines are more effective at preventing histamine from binding than displacing it once already bound, both medications should be taken early and proactively before allergen exposure for maximum effectiveness.
Diphenhydramine is a first-generation antihistamine that readily crosses the blood-brain barrier, making sedation its most prominent and well-known side effect — which is why it is also used as a sleep aid.
A client reports taking ergotamine for treatment of migraine headaches. The nurse recognizes that this drug has which warning associated with it?
- Avoid use with CYP3A4 inhibitors
- May cause respiratory depression when taken with benzodiazepines
- May cause liver damage when taken with acetaminophen
- Avoid use with NSAIDs
Explanation
Correct Answer: A) Avoid use with CYP3A4 inhibitors
Ergotamine is metabolized by the CYP3A4 enzyme in the liver. When CYP3A4 inhibitors (such as certain antifungals, macrolide antibiotics, or HIV protease inhibitors) are taken concurrently, the metabolism of ergotamine is significantly slowed, causing dangerous accumulation of the drug in the bloodstream. This can lead to ergotism — a serious condition characterized by severe vasoconstriction, peripheral ischemia, and potentially gangrene. This drug interaction carries a Black Box Warning. The other options describe warnings associated with different drug classes and are not specific to ergotamine.
Which of the following headache treatment options has Black Box Warnings for cardiovascular risk and for gastrointestinal bleeding risk?
- Ergotamine tartrate
- Acetaminophen, aspirin, caffeine
- Sumatriptan
- Sumatriptan and naproxen
Explanation
Correct Answer: D) Sumatriptan and naproxen
The combination product of sumatriptan and naproxen (Treximet) carries Black Box Warnings for both cardiovascular risk and gastrointestinal bleeding risk. Naproxen is an NSAID that carries a Black Box Warning for increased risk of serious cardiovascular thrombotic events and GI bleeding, ulceration, and perforation. Sumatriptan is a triptan that carries cardiovascular warnings due to its vasoconstrictive properties. Together, this combination product carries both warnings. Ergotamine tartrate carries warnings related to vasospasm and ergotism. Acetaminophen, aspirin, and caffeine combination carries a warning for liver damage with acetaminophen overuse. Sumatriptan alone does not carry a GI bleeding warning.
A client has been started on an antihypertensive medication. Ideally, a client will be able to maintain a constant serum drug level of this medication. This is referred to as the __________.
- Steady state
- Minimum effective concentration
- Toxic concentration
- Half-life
Explanation
Correct Answer: A) Steady state
Steady state refers to the condition in which the rate of drug administration equals the rate of drug elimination, resulting in a constant and stable serum drug concentration over time. For antihypertensive medications, maintaining steady state is the therapeutic goal because it ensures consistent blood pressure control without dangerous peaks or drops.
It is typically reached after approximately 4 to 5 half-lives of consistent dosing. Minimum effective concentration is the lowest drug level needed to produce a therapeutic effect. Toxic concentration is the drug level at which harmful effects begin to occur.
Half-life is the time required for the drug concentration to decrease by 50% and is used to determine dosing intervals, not the state of constant drug levels.
A client has been receiving bupivacaine for localized pain relief. The client begins to report a metallic taste and is becoming increasingly agitated. Which can be used to treat this condition?
- 2% lipid solution
- Acetylcysteine
- 20% lipid solution
- Propofol
Explanation
Correct Answer: C) 20% lipid solution
The symptoms described — metallic taste and agitation following bupivacaine administration — are classic early signs of Local Anesthetic Systemic Toxicity (LAST). This occurs when local anesthetics like bupivacaine enter the systemic circulation, causing CNS and cardiovascular toxicity. The first-line treatment for LAST is 20% intravenous lipid emulsion (Intralipid). It works by acting as a "lipid sink," binding the lipid-soluble anesthetic and drawing it away from cardiac and neural tissues. A 2% lipid solution is not the correct concentration — the standard rescue dose requires the 20% formulation.
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