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NR 565 Midterm 2024 exam questionsWhen prescribing Medications, we must understand that the liver function declines with age d/t
what?
A. Enlarged Liver
B. Decreased blood flow to liver
C. Increased activity of the hepatic enzymes - B. Decreased blood flow to liver
An 82 yo male visits the clinic complaining that his pain meds "take forever" to work after he
takes his pill. What are possible reasons you can explain to him as to why this may be
happening.
A. Perhaps we need to increase your dose
B. Sometimes as you get older, absorption may be slower resulting in a delayed response
C. As we get older, the gastric acid decreases and may delay absorption - B. Sometimes as you
get older, absorption may be slower resulting in a delayed response
C. As we get older, the gastric acid decreases and may delay absorption
RA Characteristics
Onset
Affected population
Location
Joint stiffness duration
SxS - weeks-months
women>men
common hands, feet, & wrists
>60 min in AM
local & sys.
OA Characteristics
Onset
Affected population
Location
Joint stiffness duration
SxS - years
men & Women equally
Hands & weight baring joints
<30min in AM
typically local
, What might you expect to find in the synovial fluid of a pt with OA - Mild leukocytes
What might you expect to find in the synovial fluid of a pt with RA - Cloudy with leukocytes
Goals of Tx for RA - Sxs relief (pain, stiffness, inflammation,
maintaining joint fxn and ROM
minimize systemic involvement
delay progression
Typical pharm Txs for RA - NSAIDs, systemic steroids, antimalarials, antimetabolites, and
biologics
Baseline assessment data before starting DMARD - Liver, PG, serum creatinine, CBC with diff,
sxs of infxn (TB & hepatits), Hx & physical, renal status, & malignancies
Significant baseline data for Sulfasalazine - CXR, pulmonary and neuro status
Significant baseline data for Leflunomide - CXR, BP & pulmonary status
Significant baseline data for Mehtotrexate - CXR, Pulmonary and GI status
Significant baseline data for hydroxychloroquine - Ophthalmologic & cardiac exam (ECG if
indicated)
Conventional DMARDs- examples - Methotrexate, hydroxychloroquine, sulfsalazine
Biologic DMARDS- examples - adalimumab, etanercept, golimumab
"-mab"s
MOA of methotrexate - folic acid antagonist ->inhibits lymphocyte proliferation
Within how many months of RA diagnosis should Methotrexate be started and why? - 3 months
of diagnosis
delay joint degeneration
What routine monitoring is needed for Methotrexate? - Periodic liver & renal fxn
What blood level do we expect to see elevated in a patient with gout? - Uric acid
First line Tx for gout - Corticosteroids, NSAIDs, or Colchicine
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