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Pharm I Exam 1

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Sample test for practice for Simmons FNP Pharm I Exam 1
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Resumen del Recurso

Pregunta 1

Pregunta
The NP is reading the literature about a drug. The article reports that the drug is potent. The NP knows that this means that the drug:
Respuesta
  • Produces its effect at low doses
  • Produces strong effects at any dose
  • Requires high doses to produce its effects
  • Is very likely to cause adverse effects

Pregunta 2

Pregunta
Except for gene therapy, which statements are true about drug-receptor interactions? SELECT ALL THAT APPLY
Respuesta
  • Drugs can mimic the actions of endogenous molecules.
  • Receptors for drugs do not respond to hormones and neurotransmitters produced by the body.
  • The binding of a drug to its receptor is usually irreversible.
  • Drugs can block the actions of endogenous molecules.
  • Drugs can give the cell new functions.

Pregunta 3

Pregunta
Which assessment findings suggest hypersensitivity of the receptors when a patient suddenly stops taking atenolol (Tenormin), a beta 2 receptor antagonist that slows the heart rate?
Respuesta
  • BP 80/56 mmHg
  • Pulse 118 bpm
  • Respirations 26 breaths/min
  • Temperature 104 degrees F (40 degrees C)

Pregunta 4

Pregunta
A patient who has over dosed on methadone HCL (Metadol), an opiate, is brought to the emergency department unresponsive with severely depressed respirations. The patient receives intravenous naloxone HCL (Narcan), an opiod antagonist, with a dramatic improvement in the level of consciousness and respiratory rate and effort within minutes. Which is the priority action 45-60 minutes after the naloxone HCL is administered?
Respuesta
  • Assess for the return of pain because the effect of the naloxone HCL should be peaking.
  • Assess the need to administer another dose of naloxone HCL because the respiratory and CNS depression may return as the medication effect ends.
  • Prepare to administer the drug intramuscularly if the drug has not taken effect.
  • Prepare to counter act the effects of the opiod withdrawal.

Pregunta 5

Pregunta
When the therapeutic index of a drug is narrow, what should the NP expect?
Respuesta
  • Blood levels of the drug would be monitored throughout the therapy.
  • The drug would produce the desired effect at low doses.
  • The drug would produce many adverse effects at low doses.
  • The drug would only be used in an emergency.

Pregunta 6

Pregunta
Pharmacodynamics includes the study of how drugs work.
Respuesta
  • True
  • False

Pregunta 7

Pregunta
Phase 2 of the dose response relationship starts at the point when the therapeutic effect does not increase with the increasing dose.
Respuesta
  • True
  • False

Pregunta 8

Pregunta
Maximal efficacy is defined as the largest effect that a drug can produce.
Respuesta
  • True
  • False

Pregunta 9

Pregunta
Potency is defined as the dose of drug needed to get the desired effect.
Respuesta
  • True
  • False

Pregunta 10

Pregunta
Two drugs in the same therapeutic class with different recommended doses (2mg vs. 200mg) can have equal effects.
Respuesta
  • True
  • False

Pregunta 11

Pregunta
A drug that stimulates a family of receptors that are transcription factors does not reach a therapeutic effect until taken regularly for 2wks.
Respuesta
  • True
  • False

Pregunta 12

Pregunta
A drug that is selective for specific receptors will produce more unintended effects than a nonselective drug.
Respuesta
  • True
  • False

Pregunta 13

Pregunta
If a drug is selective for specific receptors it is safe.
Respuesta
  • True
  • False

Pregunta 14

Pregunta
Affinity is the strength of attraction between a drug and its receptor.
Respuesta
  • True
  • False

Pregunta 15

Pregunta
Drugs with high intrinsic activity cause an intense response.
Respuesta
  • True
  • False

Pregunta 16

Pregunta
An agonist blocks the stimulation of a receptor.
Respuesta
  • True
  • False

Pregunta 17

Pregunta
If a receptor is constantly bombarded by a drug, the cell can down-regulate and decrease the response to the drug.
Respuesta
  • True
  • False

Pregunta 18

Pregunta
If a patient suddenly stops taking an antagonist drug, he can have a hypersensitivity of the receptor and overstimulation.
Respuesta
  • True
  • False

Pregunta 19

Pregunta
The ED 50 is usually the recommended dose for the drug.
Respuesta
  • True
  • False

Pregunta 20

Pregunta
Absorption
Respuesta
  • Change in drug structure; makes drug more hydrophilic
  • Change in drug structure/movement out of the body
  • Movement of drug from blood into tissues/cells
  • Movement of drug into and out of the body; what body does to drug
  • Movement of drug into the blood
  • Movement of drug out of the body

Pregunta 21

Pregunta
Distribution
Respuesta
  • Change in drug structure; makes drug more hydrophilic
  • Change in drug structure/movement out of the body
  • Movement of drug from blood into tissues/cells
  • Movement of drug into and out of the body; what body does to drug
  • Movement of drug into the blood
  • Movement of drug out of the body

Pregunta 22

Pregunta
Elimination
Respuesta
  • Change in drug structure; makes drug more hydrophilic
  • Change in drug structure/movement out of the body
  • Movement of drug from blood into tissues/cells
  • Movement of drug into and out of the body; what body does to drug
  • Movement of drug into the blood
  • Movement of drug out of the body

Pregunta 23

Pregunta
Excretion
Respuesta
  • Change in drug structure; makes drug more hydrophilic
  • Change in drug structure/movement out of the body
  • Movement of drug from blood into tissues/cells
  • Movement of drug into and out of the body; what body does to drug
  • Movement of drug into the blood
  • Movement of drug out of the body

Pregunta 24

Pregunta
Metabolism
Respuesta
  • Change in drug structure; makes drug more hydrophilic
  • Change in drug structure/movement out of the body
  • Movement of drug from blood into tissues/cells
  • Movement of drug into and out of the body; what body does to drug
  • Movement of drug into the blood
  • Movement of drug out of the body

Pregunta 25

Pregunta
Pharmacokinetics
Respuesta
  • Change in drug structure; makes drug more hydrophilic
  • Change in drug structure/movement out of the body
  • Movement of drug from blood into tissues/cells
  • Movement of drug into and out of the body; what body does to drug
  • Movement of drug into the blood
  • Movement of drug out of the body

Pregunta 26

Pregunta
Which of the following labs would suggest to the NP that a patient may be at risk for drug toxicity secondary to impaired excretion?
Respuesta
  • AST 72 IU
  • INR 4.2
  • eGFR 30mL/min
  • WBC 13,000 mm3

Pregunta 27

Pregunta
What is the priority action to assist a patient in PACU to promote excretion of most anesthetics?
Respuesta
  • Encourage deep breathing
  • Maintain a patent IV line
  • Monitor urine output
  • Prevent constipation

Pregunta 28

Pregunta
Lanoxin (Digoxin) is a drug with a narrow therapeutic index. Which interventions would be critical for the NP to implement? SELECT ALL THAT APPLY.
Respuesta
  • Administer the medication only on a PRN basis.
  • Monitor the patient for therapeutic and toxic effects
  • Be diligent about the timing of drug administration
  • Monitor blood levels of the drug
  • Teach the patient that the drug takes several weeks to reach its peak effect

Pregunta 29

Pregunta
Grapefruit juice inhibits the CYP 450 system enzymes (CYP3A4 enzyme specifically) and inhibits p-glycoprotein in the intestines for days after ingestion. This especially affects calcium channel blockers, benzodiazepines, cyclosporine, and “statin” drugs. The NP would explain to the patient that ingesting grapefruit juice causes:
Respuesta
  • Excessive first-pass effect
  • Excess levels of drug in the blood
  • Lack of therapeutic drug effect
  • Rapid excretion of the drug

Pregunta 30

Pregunta
A patient receiving Vancomycin for a serious infection, has been ordered to have a peak and trough level drawn. When would the NP order these blood levels to be obtained?
Respuesta
  • Peak level 1.5-hours after infusion and trough level 30 minutes before the next dose.
  • Peak level 1.5-hours before infusion is started and trough level immediately after infusion of the drug is completed.
  • Peak level while the drug is infusing and trough level trough level immediately after infusion of the drug is completed.
  • Peak level while the drug is infusing and trough level 30 minutes before the next dose.

Pregunta 31

Pregunta
A patient has stopped taking levothyroxine (Synthroid) 3 days ago. The drug has a half-life of 7 days. The patient tells the NP that the drug must not have been necessary because he/the patient does not feel any different. Which of the following is the basis of the NP’s explanation for this phenomenon?
Respuesta
  • The patient’s dose was probably too high, so the drug is still working.
  • The patient could not have been taking the drug as prescribed.
  • The drug probably was not needed if the pt. has not experienced symptoms.
  • The drug’s previous doses have not been completely eliminated from the body.

Pregunta 32

Pregunta
The NP prescribes the following medications for a patient: glyburide (Diabeta) 10mg by mouth daily for diabetes and quinapril HCL (Accupril) 20mg by mouth daily for hypertension. The NP should advise Quinipril (ACEI) potentiates the action of glyburide (sulfonylureas) so the patient should be cautioned to monitor for signs and symptoms of hypoglycemia. The dose of the glyburide may need adjustment. In addition, the meds (specially the glyburide) should be administered with breakfast.
Respuesta
  • True
  • False

Pregunta 33

Pregunta
Which of the following is true for a drug that acts as a reversibly-binding partial agonist?
Respuesta
  • The effect of the drug cannot be overcome by an increase in the endogenous agonist.
  • The drug will have an effect on the Emax of the endogenous agonist.
  • The drug will have an effect on EC50 of the endogenous agonist.
  • The drug will effectively decrease the efficacy of the endogenous agonist.

Pregunta 34

Pregunta
Which of the following is most dependent on a drug's EC50?
Respuesta
  • Drug potency.
  • Drug efficacy.
  • Volume of Distribution.
  • Therapeutic Index.

Pregunta 35

Pregunta
In the following illustration, which drug is the most efficacious?
Image:
a70f21dd-8b8e-4683-915f-7d10d4e7f2cb (image/png)
Respuesta
  • A
  • B
  • A, C, & D are equally efficacious.
  • D

Pregunta 36

Pregunta
In the following illustration, if B is an endogenous agonist, A is most likely?
Image:
84e8befe-92a7-40c5-befa-b1db13a04074 (image/png)
Respuesta
  • A competitive inhibitor.
  • A noncompetitive inhibitor.
  • An allosteric potentiator.
  • It is impossible to tell based in the information in this graph.

Pregunta 37

Pregunta
In the follow graph, which of the following parameters is a comparison of ED50 to LD50?
Image:
ad701778-4164-46d1-802b-f7c972b1e1d0 (image/png)
Respuesta
  • Therapeutic Index
  • Standard Safety Margin
  • Therapeutic Window
  • None of the above

Pregunta 38

Pregunta
Which of the following is not a factor influencing drug membrane passage?
Respuesta
  • Molecular size
  • Lipid solubility
  • Volume of distribution
  • Degree of ionization
  • Concentration gradient

Pregunta 39

Pregunta
The fraction of drug reaching circulation following administration is known by which abbreviation?
Respuesta
  • LD
  • MD
  • F
  • Vd

Pregunta 40

Pregunta
Which of the following routes of absorption are in the correct order in terms of rate of absorption?
Respuesta
  • intravenous = subcutaneous > inhalational > intramuscular > oral
  • intravenous = inhalational > subcutaneous > intramuscular > oral
  • intravenous = inhalational > intramuscular > oral > subcutaneous
  • intravenous = inhalational > intramuscular > subcutaneous > oral

Pregunta 41

Pregunta
Which of the following is true regarding the graph below?
Image:
6e1824d0-92b8-48bc-ad58-694817cd41e6 (image/png)
Respuesta
  • Drug B has an availability equal to that of drug A.
  • Drug C has a rate equal to that of drug A.
  • The availability of B & C are dictated by their peak plasma concentration.
  • The difference in AUC between A and C dictate their relative availabilities.

Pregunta 42

Pregunta
Concerning drug receptor interactions, the constant Kd refers to: SELECT ALL THAT APPLY
Respuesta
  • maximal physiological effect
  • maximal binding
  • the drug concentration required to occupy 50% of receptors
  • drug concentration that results in half-maximal physiological response

Pregunta 43

Pregunta
Signal transduction involves G protein coupled receptor systems: SELECT ALL THAT APPLY
Respuesta
  • biogenic amines
  • peptide hormones
  • eicosanoids

Pregunta 44

Pregunta
Example(s) of second messenger effect(s): SELECT ALL THAT APPLY
Respuesta
  • increases in cAMP intracellular concentration
  • changes in intracellular calcium concentration
  • phosphoinositide effects

Pregunta 45

Pregunta
EC50 mainly reflects a drug's:
Respuesta
  • maximal effect
  • potency
  • lethality
  • ease of elimination
  • safety

Pregunta 46

Pregunta
Physiological processes mediated by the intracellular second messenger, cyclic AMP: SELECT ALL THAT APPLY
Respuesta
  • carbohydrate breakdown by the liver
  • decreased heart rate
  • increased contractility
  • smooth muscle relaxation
  • triglyceride breakdown

Pregunta 47

Pregunta
Drug effects are thought to be proportional to the number of occupied receptors
Respuesta
  • True
  • False

Pregunta 48

Pregunta
Nitric oxide mediates this effect on vascular smooth muscle:
Respuesta
  • smooth muscle relaxation
  • smooth muscle contraction
  • no effect

Pregunta 49

Pregunta
Receptors are usually:
Respuesta
  • lipids
  • proteins
  • DNA

Pregunta 50

Pregunta
Longer-lasting physiological response to drug:
Respuesta
  • increase in heart rate following epinephrine infusion
  • changes in gene product production following corticosteroid injection.

Pregunta 51

Pregunta
True statement(s) concerning competitive inhibition: SELECT ALL THAT APPLY
Respuesta
  • competitive in addition is based on reversible drug/antagonist binding at receptor sites
  • with competitive inhibition, the dose-effects curve the shifted to the left
  • with competitive inhibition, maximal drug effect cannot be obtained, even at high agonist concentrations

Pregunta 52

Pregunta
Example(s) of endogenous ligands that interact with membrane-integrated ion channels and affect(s) ion conductance. SELECT ALL THAT APPLY
Respuesta
  • acetylcholine
  • GABA
  • glutamate
  • aspartate
  • glycine

Pregunta 53

Pregunta
Example(s) of (a) receptor(s) which is/are enzyme(s): SELECT ALL THAT APPLY
Respuesta
  • dihydrofolate reductase
  • acetylcholinesterase
  • monoamine oxidase

Pregunta 54

Pregunta
Primary mechanism by which cAMP effects are terminated:
Respuesta
  • enzyme-catalyzed dephosphorylation
  • reuptake into presynaptic nerve terminals

Pregunta 55

Pregunta
An example of a receptor which is a structural protein.
Respuesta
  • Na/K ATPase
  • acetylcholinesterase
  • tubulin
  • DNA
  • phospholipase C

Pregunta 56

Pregunta
An example of an agent that exerts much of its effects through intracellular receptors that in complex form binds to DNA response elements:
Respuesta
  • acetylcholine
  • dopamine
  • corticosteroids
  • diltiazem
  • atropine

Pregunta 57

Pregunta
Factors that may cause variation in drug responsiveness:
Respuesta
  • changes in the number or function of receptors
  • tachyphylaxis
  • idiosyncratic drug responses
  • hypersensitivity reactions
  • all of the above

Pregunta 58

Pregunta
Major roles of receptors:
Respuesta
  • determine rate of drug elimination
  • determine drug action selectivity
  • provide a means of blocking drug action as well as mediating drug action
  • act as drug storage sites

Pregunta 59

Pregunta
Concerning oral administration -- disadvantages SELECT ALL THAT APPLY
Respuesta
  • least economical
  • drug taken orally may cause emesis
  • drug taken orally may be destroyed by gastric acidity
  • drug taken orally may be metabolized by gastrointestinal flora
  • drug taken orally may be inconsistently absorbed due to the presence of food

Pregunta 60

Pregunta
Factors That Can Affect Pharmacokinetics SELECT ALL THAT APPLY
Respuesta
  • Age
  • Hepatic or renal disease
  • Pregnancy
  • Drug interactions
  • Ethnicity
  • Metabolism
  • Nutritional status in patients
  • GI surgeries
  • Drug-drug interactions
  • Drug-food interactions

Pregunta 61

Pregunta
Factors That Affect Bioavailability: SELECT ALL THAT APPLY
Respuesta
  • How drug is transported across membranes
  • How drug is affected by
  • Shape of the medication
  • Gastric acid
  • Drug formulation: salt form, type of binders
  • Enzymes in GI tract

Pregunta 62

Pregunta
Factors affecting absorption: SELECT ALL THAT APPLY
Respuesta
  • Formulation
  • Mechanics of absorption
  • pH
  • Molecular size
  • Lipophilicity
  • 2nd messengers
  • Cellular environment
  • Ionization

Pregunta 63

Pregunta
Most drugs are strong acids (-) or bases (+)
Respuesta
  • True
  • False

Pregunta 64

Pregunta
Uncharged drugs are more lipid soluble
Respuesta
  • True
  • False

Pregunta 65

Pregunta
Ionized drug molecules more lipid soluble
Respuesta
  • True
  • False

Pregunta 66

Pregunta
You can create a non-ionized form of an acidic drug by placing it in an acidic environment
Respuesta
  • True
  • False

Pregunta 67

Pregunta
Drugs with low molecular weight pass through membrane pores more easily
Respuesta
  • True
  • False

Pregunta 68

Pregunta
Active transport is drug movement from area of higher concentration to lower concentration
Respuesta
  • True
  • False

Pregunta 69

Pregunta
Biotransformation reactions occur first with Phase I followed by Phase II.
Respuesta
  • True
  • False

Pregunta 70

Pregunta
CYP cytochromes are non-specific, so they could all act on the same drugs.
Respuesta
  • True
  • False

Pregunta 71

Pregunta
Biotransformation occurs: SELECT ALL THAT APPLY
Respuesta
  • liver
  • intestines
  • skin
  • lungs
  • kidney
  • brain
  • muscles
  • heart

Pregunta 72

Pregunta
During Phase II biotransformation, drugs can conjugate with which of the following:
Respuesta
  • glucoronic acid
  • sulphuric acid
  • acetic acid
  • amino acid
  • all of the above

Pregunta 73

Pregunta
Conjugation occurs during Phase I of biotransformation
Respuesta
  • True
  • False

Pregunta 74

Pregunta
Enzyme induction can cause potential toxicity
Respuesta
  • True
  • False

Pregunta 75

Pregunta
Only certain drugs are hepatotoxic
Respuesta
  • True
  • False

Pregunta 76

Pregunta
Alcoholism and fatty liver disease affect drug metabolism
Respuesta
  • True
  • False

Pregunta 77

Pregunta
Factors that affect drug metabolism: SELECT ALL THAT APPLY
Respuesta
  • Age
  • Comorbidities
  • Liver dysfunction
  • Gender

Pregunta 78

Pregunta
In an 18-month-old baby, these factors could affect biotransformation:
Respuesta
  • P-450 enzymes not fully developed
  • blood brain barrier not fully developed
  • intestinal enzymes not fully developed
  • renal system not fully developed
  • none of the above

Pregunta 79

Pregunta
A drug must be biotransformed to be excreted
Respuesta
  • True
  • False

Pregunta 80

Pregunta
Clearance is the sum of elimination from liver, kidneys, and GI tract.
Respuesta
  • True
  • False

Pregunta 81

Pregunta
All drugs are excreted by the kidneys.
Respuesta
  • True
  • False

Pregunta 82

Pregunta
After age [blank_start]50[blank_end] people lose [blank_start]10[blank_end] percent of kidney nephrons every decade.
Respuesta
  • 40
  • 50
  • 60
  • 70
  • 5
  • 7
  • 10
  • 15

Pregunta 83

Pregunta
You see a pt with HTN. You've given him a prescription for an antihypertensive BID. He returns in 30 days and his blood pressure is 150/85. He admits to noncompliance with BID dosing. You educate him about the importance of taking the medication as prescribed, because once daily is not enough to maintain adequate blood levels. This is an example of:
Respuesta
  • Dose of medication is too low and needs to be increased
  • Steady state
  • Increased renal clearance of medication

Pregunta 84

Pregunta
A patient is taking multiple doses of 100 mg of metoprolol. At what does of medication will the patient reach steady state? [blank_start]_____[blank_end] mg
Respuesta
  • 3.125

Pregunta 85

Pregunta
A patient is given a single dose of morphine for pain relief before leaving the hospital. Since he can't drive while under the influence, he wants to know how long until he can drive. The half-life if morphine is 2 hours. What is your answer?
Respuesta
  • 2 hours
  • 4 hours
  • 6 hours
  • 8 hours
  • 10 hours

Pregunta 86

Pregunta
What substances are excreted via the lungs?
Respuesta
  • Alcohol
  • Liquid
  • Gas
  • Volatile substance

Pregunta 87

Pregunta
Your pregnant patient develops a DVT. You place her on heparin. She mentions she doesn't like shots. Should you place her on warfarin instead to increase medication compliance?
Respuesta
  • Yes, drug compliance is very important. Because DVTs are so serious, increasing drug compliance is the primary concern.
  • No, heparin is better for the baby.

Pregunta 88

Pregunta
Until age 2, children have [blank_start]80[blank_end]% body water, in contrast to adults, who have [blank_start]60[blank_end]%.
Respuesta
  • 70
  • 75
  • 80
  • 85
  • 50
  • 55
  • 60
  • 65

Pregunta 89

Pregunta
Despite differences in body makeup, infants and children have consistent rates of absorption.
Respuesta
  • True
  • False

Pregunta 90

Pregunta
A laboratory is conducting a study to assess the safety, efficacy, and potency of a group of drugs before allowing the agents to proceed to clinical trials. The figure shows the dose-response curves for four different drugs from the same class of medications (Drugs A, B, C, & D). Which of the following is true regarding these medications?
Image:
a1db543b-821c-49fb-9bf3-89eacdf922da (image/png)
Respuesta
  • Drug A has greater efficacy than Drug D
  • Drug D has greater efficacy than Drug A
  • Drug A has greater potency than Drug D
  • Drug D has greater potency than Drug A
  • All four drugs (A,B,C,D) have equal potencies

Pregunta 91

Pregunta
An overweight patient comes to see you about heart palpitations and high blood pressure. You're trying to decide between a once-daily beta blocker and one given every 6 hours. You feel the once-daily is the best choice. Is this correct?
Respuesta
  • Yes, this is the best choice because once-daily will help with medication compliance.
  • No, this is not the best choice because your patient is overweight.

Pregunta 92

Pregunta
Characteristics of fat-soluble drugs: cell membrane potential [blank_start]_____[blank_end] pH [blank_start]_____[blank_end] molecular size [blank_start]_____[blank_end] Half-life [blank_start]_____[blank_end] Vd [blank_start]_____[blank_end] Ionization [blank_start]_____[blank_end] Absorption [blank_start]_____[blank_end] Route of administration [blank_start]_____[blank_end] Metabolized by [blank_start]_____[blank_end]
Respuesta
  • Cross cell membrane on their own
  • Use 2nd messengers to cross
  • Acidic
  • Basic
  • Small
  • Large
  • Short
  • Long
  • High Vd
  • Small Vd
  • Uncharged
  • Charged
  • Easily absorbed
  • Difficult to absorb
  • IV
  • PO
  • Does not matter as much
  • Kidneys
  • Liver

Pregunta 93

Pregunta
Characteristics of water-soluble drugs: cell membrane potential [blank_start]_____[blank_end] pH [blank_start]_____[blank_end] molecular size [blank_start]_____[blank_end] Half-life [blank_start]_____[blank_end] Vd [blank_start]_____[blank_end] Ionization [blank_start]_____[blank_end] Absorption [blank_start]_____[blank_end] Route of administration [blank_start]_____[blank_end] Metabolized by [blank_start]_____[blank_end]
Respuesta
  • Cross on their own
  • Use 2nd messengers
  • Acidic
  • Basic
  • Large
  • Small
  • Long
  • Short
  • High
  • Low
  • Charged
  • Uncharged
  • Difficult to absorb
  • Easily absorbed
  • PO
  • IV
  • It doesn't really matter
  • Kidneys
  • Liver
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