NR 565 - advanced pharmacology
midterm - Chamberlain
12 CDC guidelines for prescribing opioids - correct answer-Opioids are not first line therapy
establish goals for pain and function
Discuss risks and benefits
Use immediate release opioids when starting
Use the lowest effective dose
Prescribe short durations for acute pain
Evaluate benefits and harms frequently
Use strategies to migrate risk
Review PDMP data
Use urine drug testing
Avoid concurrent opioid and benzo prescribing
Offer treatment for opioid use disorder
1st line treatment of osteoporosis - correct answer-alendronate
A 41 year old patient comes into the clinic complaining of increased heart rate after starting
nitro patches for stable angina. What would an appropriate response be?
1. lets lower the dose and frequency of use
2. I will prescribe a BB to help with this
3. Next time this happens, lie down and practice deep breathing, this will bring your heart
rate down - correct answer-2- I will prescribe a BB to help with this
A 55 year old male comes into the clinic with a gouty arthritis. He states that he has one
flareup a year. Your response is:
1. I will prescribe you glucocorticoids to help with inflammation
2. Lets start you on prophylactic therapy colchicine.
3. It will be helpful to take an NSAID to start with to help relive some inflammation. I'll
prescribe naproxen. - correct answer-3- in patients with infrequent flareups, being less than
three per year, treatment of symptoms is all thats needed. NSAIDS are the first line agent for
relieving pain of an acute gout attack.
A patient comes in stating that he tried NSAIDS to relieve a gouty attack but it hasnt helped.
He asks, "what are my options?" He further states that he has attacks every few years but
when he does NSAIDS do not help. Your response is:
1. I can prescribe a glucocorticoid (prednisone) and that will bring down the inflammation
and pain.
2. Have your tried increasing your dosage of NSAIDS and drink plenty of water?
3. Lets start by making some changes in your diet, can you tell me what you eat regularly? -
correct answer-1
3- can also be correct but BEST answer
,A patient with HF develops fibrotic changes, what should the provider do next? - correct
answer-ensure that a patient is on an ARB (valsartan) as this inhibits fibrosis (aldosterone
antagonist)
A person who is depend on a pure opioid agonist should NEVER receive an opioid agonist
antagonist - correct answer-true
ACE inhibitors MOA - correct answer-Angiotensin Converting Enzyme Inhibitors (ACE-I)
prevent the conversion of angiotensin I to angiotensin II, which disrupts the
renin-angiotensin-aldosterone system (RAAS).
1. reduce levels of angiotensin II (through inhibition of ACE)
2. increasing levels of bradykinin (through inhibition of kinase 11)
End in -pril
adverse effects for bisphosphonates - correct answer-osteonecrosis of the jaw and hip
fracture, Esophagitis
adverse effects of CCBs in elderly patients - correct answer-gingival hyperplasia (overgrowth
of gum tissue) and chronic eczematous rash
adverse effects of pregabalin - correct answer-Sedation/drowsy, dizziness, and ataxia,
blurred vision, difficulty thinking
adverse effects of statins - correct answer-rhabdomyolysis, hepatoxicity, new-onset diabetes
, After age one what happens to pharmacokinetic parameters, including drug sensitivity? -
correct answer-mirror adult parameters
Alendronate patient education - correct answer-minimize risk of esophagitis by swallowing
the pill whole with a full glass of water, then sit up for at least 30 min but 60 min preferred.
intake of food prevents absorption, take this med 30 min prior to other intake
Amiodarone should NOT be taken with what? - correct answer-CYP3A4 inhibitors and
grapefruit juice (levels can be increased)
An 82 year old male visits the clinic complaining that his pain medications "take forever" to
work after he takes his pill. What are possible reasons you can explain to him?
1.Perhaps we need to increase your dosage.
2.Sometimes as you get older, absorption may be slower resulting in a delayed response.
3.As we get older the gastric acid decreases and may slow absorption. - correct answer-2&3
ARBS MOA - correct answer-Block angiotensin II receptors on blood vessels in heart and
adrenals. Increases renal excretion of sodium and water. Cause dilation of arterioles and
veins.
End in -sartan
Are statins safe in pregnancy? - correct answer-No
Assess someone for possible drug diversion? - correct answer-Urine test at least yearly
PDMP routinely
At what age can statins be prescribed? - correct answer-avoid statin use in children under
the age of 10
At what time of day should statins be given and why? - correct answer-evening- cholesterol
synthesis increases at night
Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score
What is it? - correct answer-ASCVD risk assessment is directed at determining the patient's
absolute risk of developing clinical coronary disease over the next 10 years. Defines high
risk as 7.5% or greater.
a calculation of your 10-year risk of having a cardiovascular problem, such as a heart attack
or stroke.
Baseline data for Methotrexate (DMARD) - correct answer-chest x-ray, emphasis on pulm
and GI status
Baseline diagnostics for DMARDS - correct answer-CBC with WBC differential
s/s of infection (TB and hepatitis)
malignancies
rule out pregnancy
ALT, AST, serum creatinine
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