You have a patient who is 78 years old with a BMI of 30 who is taking Lisinopril for his blood pressure

Question 1 I acknowledge that I will not use any external resources including the textbook or work collaboratively to complete this timed exam.

 

Yes

 

 No

 

Question 2You have a patient who is 78 years old with a BMI of 30 who is taking Lisinopril for his blood pressure. When thinking about risks in prescribing for this patient you understand which of the following to be impactful in terms of pharmacokinetics for this patient?

 

Increased BMI

 

 Increased small bowel surface area

 

 Increased gastric emptying

 

 Decrease in gastric PH

 

Question 3When considering topical medication in the infant, what normal physiologic findings can contribute to drug toxicity?

 

The skin is less hydrated than the adult

 

 They have a larger body surface area to mass ratio.

 

 They have increased blood flow to skeletal muscle.

 

 They have thicker skin than the adult patient.

 

 Question 4You are caring for a patient that is on Lithium to control his mood disorder. When prescribing this medication, you know it is most important to consider which of the following for patient outcomes?

 

Dose form

 

 Therapeutic index

 

 Extraction ratio

 

 Administration rate

 

 Question 5The desired response to antimicrobial therapy within the first 24 to 48 hours includes:

 

Increased nasal secretion.

 

 Increased sputum production.

 

 White blood cell count begins to normalize.

 

 Spike in temperature.

 

 Question 6You are getting ready to give your pregnant patient a prescription for Diflucan to treat her vaginal yeast infection. You get an alert on your screen with a black box warning that states relative contraindication in this population. What do you understand this to indicate?

 

This is a contraindication in this patient population and should not be given.

 

 This benefit outweighs the risk, and the medication should be given.

 

 An alternative medication of the same class should be prescribed for safety .

 

 None of the above.

 

Question 7Penicillinase -resistant penicillin’s are an important tool for the clinician in treating antibiotic resistant infections. Which of the following is a drug in that class?

 

Dicloxacillin

 

 Amoxicillin

 

 Penicillin V potassium

 

 Penicillin G

 

Question 8A mother has called because her 4-year-old has a fever of 102.2 F. She thinks it could be an ear infection based on the child’s symptoms and complaints of ear pain. With your understanding of bioavailability of drugs, you advize mom to give which medication?

 

Ibuprofen chewable tablets

 

 Ibuprofen liquid

 

 Ibuprofen tablets

 

 Tylenol chewable tablets.

 

Question 9Anthelmintic agents act in what areas?

 

Systemically and locally

 

 Systemically

 

 Locally

 

 Topically

 

Question 10You are prescribing a medication to a patient with impaired liver function. Given what you know about first pass effect, what form of administration would you avoid?

 

Oral

 

 Topical

 

 Inhalation

 

 Parenteral

 

Question 11At what age will the isoenzyme activities reach a level of function equivalent to an adult?

 

 6 months

 

 1-2 years

 

 3-4 years

 

 5-7 years

 

 Question 12Systemic fungal infections include histoplasmosis, coccidioidomycosis, cryptococcosis, blastomycosis and sporotrichosis. This is most often contracted through which method?

 

Topical

 

 Inhalation

 

 Oral

 

 Nosocomial transmission

 

 Question 13Polyenes have what mechanism of action against fungal infections?

 

 Bind to sterols in the fungal cell

 

 Bind to protein in the fungal cell

 

 Bind to host cell wall to prevent fungal infection

 

 Bind to host cell protein to prevent fungal infection

 

Question 14 Enterobiasis is caused by a small threadlike pinworm. The treatment of choice in this condition is which of the following?

 

 Ivermectin

 

 Two doses of Pyrantel

 

 Single dose of albendazole

 

 No medication is needed just supportive care

 

Question 15You are evaluating a 84 year old patient for hyperlipidemia. You are considering prescribing Lipitor. When considering this, what should you evaluate for safe prescribing?

 

Modification of Diet in Renal Disease

 

 Cockcroft-Gault formula

 

 The patient’s serum creatinine rounded up to 1 mg/dl

 

 All of the above

 

Question 16What is considered to be the primary determinant of drug pharmacokinetics and pharmacodynamics?

 

Genetics

 

 Absorption

 

 Binding affinity

 

 Dosing form

 

Question 17Protein binding drugs tend to have what impact on the neonate and infant?

 

Be reduced in the body

 

 Be increased in the body

 

 Have the same plasma concentration as an adult

 

 Have a decreased steady state

 

Question 18Drug concentration is significant in patient care and medical management. This is best assessed when a drug has reached a steady state. What is your understanding of steady state of a drug?

 

It is the balance between absorption and elimination.

 

 It is the balance between the peak and trough.

 

 It is the balance between binding affinity and volume distribution.

 

 It is the balance between extraction ratio and administration rate.

 

Question 19A patient is taking a drug with a high binding affinity for albumin. Another drug that has a higher protein bound affinity is added to the patient’s medication regime. What would be a possible outcome to monitor for?

 

The first drug may achieve toxic levels in the body.

 

 The second drug may achieve toxic levels in the body.

 

 Both drugs will achieve toxic levels in the body.

 

 Both drugs will work effectively.

 

Question 20You are caring for a patient with hypertension. You recently prescribed Metoprolol 25 mg tablets.  The patient has come back to see you today and complains of constipation after starting this drug. What type of adverse reaction is this classified as?

 

Type A

 

 Type B

 

 Type C

 

 Type D

 

Question 21A number of demographic variables are associated with differences in in drug metabolism. Which of the following is not considered one of those differences?

 

Males metabolize more efficiently than females.

 

 Older adults metabolize drugs less efficiently than younger adults.

 

 Females metabolize more efficiently than males.

 

 Poor metabolizers may experience exaggerated side effects.

 

Question 22You are caring for a patient that is newly diagnosed with HIV. You understand what next step to be most important in determining a treatment regimen?

 

Testing for concomitant infections.

 

 Testing for viral genotypic/phenotypic resistance.

 

 Assessing the patient’s age.

 

 Assessing the patient’s ability to pay for the medications.

 

 Question 23In the geriatric population doses of some drugs will need to be adjusted. This is often the result of poor renal function. We would understand this to be an alteration of which of the following?

 

Absorption

 

 Distribution

 

 Metabolism

 

 Elimination

 

Question 24Glomerular filtration rate changes over time. In the infant it is normally between 20-30 mL/min. Given this what is the best approach in initial dosing for drugs that are mainly excreted by glomerular filtration?

 

Increasing the usual dose

 

 Decreasing dosage intervals

 

 Decreasing the usual dose

 

 No change is needed

 

Question 25You are caring for a patient that has tested positive for TB. You are explaining the treatment plan for this patient. What is the expected treatment duration that you should educate the patient on?

 

10 days

 

 2 weeks

 

 3-6 months

 

 8-9 months

 

 Question 26Viruses use the host cell to make new viral particles to infect more cells. Given this, what must an antiviral drug do to create specificity of drug action?

 

Differentiate between the cell functions of the host and the virus

 

 Differentiate between the cell wall and the virus wall

 

 Differentiate between the cell type and the virus type

 

 Differentiate between the cell protein of the virus and the host cell

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