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PHARM FINAL

what does an anticonvulsant drug do?
quickly stops the seizure a they time they are happening
What does an antiepileptic drug do?
it is a prophilactic that prvents future seizures from occurring
Cardopa enhances Levadopa by inhibiting…
it inhibits the conversion of Levodopa to dopamine in the periphery
The mechanism of action in an anti-epileptic drug.
they decrease the excitability of the brain cells consequently reducing the severity of the seizure
Certain bacteria have been building to produce enzymes that inactivate PCN to … in the body
Betalactimaces
What class of antibiotics is the primary therapy for topical placement and pt reported compromised skin integrety resulting in a high protential for infection
Sulfamerazine
Which of the following is the only brain structure that is under conscious control?
. Cerebral cortex
A loud noise would stimulate _____ fibers in the _____.
Excitatory, reticular formation
Someone who is unable to sense pain or temperature stimulation may have a problem in this region of the brain
Thalamus
The cerebrum contains _____ that consists of _____.
White matter, myelinated axons
All of the following are examples of information carried by afferent neurons except
Voluntary movement
Two types of medications that can be used to control people primarily having emotional or certain behavioral problems
Antianxiety and antidepressants
A person who has developed a speech problem as a result of head trauma probably has damaged what area of the brain?
Frontal lobe
Explain the relationship between GABA and the sedative-hypnotic drug agents.
. Sedative-hypnotic agents increase the GABA receptor-mediated chloride influx into nerves, inhibiting neuronal activity
Use the stages of the sleep cycle to select the stage that corresponds with the ability to dream
REM
Using the Physicians’ Desk Reference, you determine that a common adverse effect that an elderly patient may experience while taking zolpidem (Ambien) is:
Confusion and memory disturbances
Eszopiclone (Lunesta) is a hypnotic agent with a rapid onset of action, intermediate duration of action, and a half-life of 6 hours. Using half-life, at approximately what time would a dose administered to a patient at 8 a.m. be reduced to 50 percent?
2 p.m
. A patient informs you that she has been taking more phenobarbital than the doctor prescribed because she cannot sleep with the amount he prescribed. She also states that now if she doesn’t take the drug, she becomes very anxious, starts to have tremors, and begins to have unusual thoughts that she is being watched. Using your knowledge of the sedative-hypnotic drugs, how would you explain to this patient that she has developed a physical dependency on phenobarbital?
The anxiety, tremors, and paranoid behavior are signs of withdrawal, which occurs when the patient has taken larger than therapeutic dosages for more than 1 to 2 months.
Differentiate between the FDA pregnancy categories, and determine the proper category for the barbiturates.
Pregnancy Category D
A potentially fatal condition associated with antipsychotic use characterized by hyperthermia, muscular rigidity, and catatonia
Neuroleptic malignant syndrome
An important inhibitory neurotransmitter that keeps emotion and behavior under control is
GABA
Atypical antipsychotics differ from the other classes of antipsychotics because they:
. Have a greater impact on reducing serotonin activity over dopamine activity
Long term use of the typical antipsychotics, especially the phenothiazines, can result in this serious condition.
Tardive dyskinesia
Excessive blockade of dopamine D2 receptors will eventually result in
Extrapyramidal syndrome
A person taking an atypical antipsychotic medication could be expected to develop all of the following metabolic disorders EXCEPT:
Anemia
One main characteristic of the typical antipsychotics is their ability to
Block dopamine D2 receptors to a greater degree than serotonin 5HT2A receptors
Identify the type of depression in which there is a period of shock followed by a period of readjustment and resolve that life must go on.
Exogenous
Identify the type of depression that originates from within the individual and may not be able to be linked to specific causes
Major depressive disorder
. Explain how lithium works to decrease nerve conduction
The body uses lithium as if it were sodium. Na+ is normally required for conduction of nerve impulses; Li+ interferes with the nerve conduction, resulting in a decrease in the excitability of nerve tissue.
Lithium acts directly to stimulate norepinephrine and dopamine receptors, which stimulate the release of norepinephrine and dopamine from the nerve endings, and it inhibits the reuptake of these neurotransmitters back into the nerve endings, alleviating the symptoms
Dry mouth, tachycardia, hypertension, and insomnia
You have been asked to explain to a patient that while on MAOI therapy she must avoid foods that contain tyramine. The patient does not know what foods to avoid. You summarize the list of foods to avoid as:
Beer, wine, herring, and certain cheeses
The tricyclic antidepressants interact with many other types of drugs. Using the Physicians’ Desk Reference, you determine that the tricyclics will interfere with the antihistamine and anticholinergic drug agents, resulting in:
Dry mouth, constipation, urinary retention, and blurred vision
Differentiate between the FDA pregnancy categories and determine the proper category for lithium
Pregnancy Category D
The consumption of larger doses of a drug to prevent onset of psychological and physical withdrawal symptoms.
Drug dependency
A drug abuser experiences a psychotomimetic flashback experience after using marijuana. What other drug was probably abused in the past?
LSD
What physical characteristics would you expect to see from someone who habitually smokes marijuana?
Red eyes and increased heart rate
Which route of administration is not an effective way for a cocaine addict to take cocaine hydrochloride?
Inhalation, smoked as in a pipe
A patient presents to the emergency room with a temperature of 106 degrees Fahrenheit, confused and severely dehydrated. Upon placing a foley catheter in his bladder, 750 ml of urine drains out immediately. The most likely cause of the patients’ symptoms would be
Anticholinergic toxicity
Which of the following psychomotor stimulants is controlled by the drug enforcement agency and labeled as a schedule 1 drug
. LSD
One of the effects that occur with aging is a reduction in the amount of time spent in this stage of sleep:
. Stages 3 and 4 NREM
This drug class is often used for procedures requiring the patient to be able to maintain their vital signs within normal limits in addition to responding to the staff when used at therapeutic doses because it increases the NREM stage 2:
benzodiazepines
Which stage of sleep is important for physical restoration
. Stage 3 and 4 NREM
The main site of action of antipsychotic drugs is on neural pathways involving which portions of the brain:
cerebral cortex and limbic system
Which condition may develop after long-term antipsychotic therapy recognized as involuntary movements of the lips, jaw, tongue, and extremities
Tardive dyskinesia
Flumazenil (Romazicon) is used to reverse the depressant effects of
alprazolam (Xanax)
Extrapyramidal symptoms (EPS) are caused mainly by
blockage of dopamine receptors
The main pharmacologic effect of the SSRI’s is
increase levels of serotonin
Amphetamine and cocaine are potent CNS stimulants. Both increase the amount of _______ and ________ in the brain.
Norepinephrine and dopamine
Individuals who abuse alcohol frequently have nutritional deficiencies due to the intake of alcohol instead of food. These individuals can develop neurologic deficits due to the lack of:
. B vitamins
. The main pharmacologic effects of TCAs on neurotransmitter activity is:
only A and C
Which medication can be given as a depot treatment if the patient is non-compliant with their antipsychotics:
atypical antipsychotics
___________ is a skeletal muscle relaxant given during neuroleptic malignant syndrome to avoid skeletal muscle breakdown and subsequent renal failure:
Dantrolene
. Cholinergic nerve endings release which neurotransmitter
Acetylcholine
Benzodiazepines are a class of drugs widely used in the treatment of anxiety and when taken in excess can cause sedation and respiratory depression. If severe respiratory depression has occurred, giving this medication can reverse the effects of the benzodiazepine decreasing the severity of CNS depression.
flumazenil (Romazicon)
. A common side effect of antidepressants which can cause the patient to stop taking their medications is:
sexual dysfunction
. Which of the following is not a function of the spinal cord:
regulation of breathing
The “vital centers” are regulated by the:
medulla oblangata
Explain what is meant by: Barbiturates produce a dose dependent depression of the CNS.
. the higher the dose of barbiturates the greater the CNS depression
Treatment of comatose patients from barbiturate overdose includes:
supportive therapy
Which of the following organs does not see pharmacologic effects with the ingestion of alcohol:
lungs
Zolpidem (Ambien) is one of the most widely prescribed hypnotic drugs on the market. These drugs:
bind to the benzodiazepine receptor
For individuals whose main problem is falling asleep, which of the following may be the most helpful:
the shorter acting drug zaleplon (Sonata
The symptoms of alcohol intoxication often resemble all the following EXCEPT:
. stroke
Which of the following is unique to alcohol metabolism compared to other drugs:
. alcohol is metabolized at a constant rate
Which of the following drug classes, when stopped, will not have any physical symptoms of withdrawal:
anticholinergics
The alpha blocking actions of the tricyclic antidepressants may cause:
postural hypotension
One of the dangers of antidepressant drug treatment is the risk of:
patients attempting suicide by overdosing on their medications
Psychomotor stimulants are prescribed for all the following disorders EXCEPT:
Treatment of depression
Unoxygenated blood enters from the Inferior and Superior Vena Cava to the _______________ through the ____________________ to the _________________through the ___________________ to the ________________ ______ then in to the ______________. Oxygenated blood is then returned through the _________________ to the__________________ through the ______________ to the ______________ through the ____________________ to the ____________ where it is then distributed to the periphery
Right Atria, Tricuspid, Right Ventrical, Pulmonic Valve, Pulmonary artery, Lung. Pulmonary vein, Left Atria, Mitral Valve, Left Ventricle, Aortic valve, Aorta
What regulates the rate and force of contraction of the heart?
Autonomic nervous system
. Which term denotes the amount of blood that is ejected by the ventricles per minute:
cardiac output
A characteristic sign of left-sided heart failure is:
Pulmonary edema
Insufficient blood flow in coronary arteries to the heart is common in all of these conditions except:
Arrhythmias
. Identify the main therapeutic effect of the diuretic agents.
The main therapeutic effect produced by diuretics is the elimination of excess sodium and water by the kidneys
Explain the physiological changes that occur in the heart when there is a diagnosis of chronic heart failure.
Chronic heart failure leads to cardiac muscle undergoing hypertrophy, where the walls of the heart chambers increase in size and undergo structural remodeling in an attempt to generate more forceful contractions.
Describe the physiological effect of restricting sodium intake along with diuretic therapy for a patient with mild CHF.
Restriction of sodium intake along with diuretic therapy may decrease the edema, congestion, and reduced cardiac output that occurs with CHF.
Select the correct statement related to the renin-angiotensin-aldosterone (RAA) mechanism.
A drop in systemic blood pressure or a decrease in renal blood flow stimulates the release of renin from the kidneys. Renin initiates reactions that lead to the formation of angiotensin II. Angiotensin II causes vasoconstriction and the release of aldosterone (sodium retention) and ADH (water retention). These actions normally function to maintain normal blood pressure and blood volume.
Select the preferred beta-blockers used for the treatment of CHF.
. Metoprolol (Lopressor) and carvedilol (Coreg)
. Differentiate between preload and afterload, and select the correct statement.
Preload is the amount of blood returning to the heart (venous return). Afterload is the force (force of ventricular contraction) that the heart must generate in order to overcome vascular resistance (open the aortic valve) and eject blood out of the left ventricle.
The type of angina that is characterized by vasospasm is classified as:
Prinzmetal angina
Compare the routes of administration of the nitrates and determine the most common route of administration during attacks of angina.
. Sublingual
Use critical thinking to determine the correct nitrate drug that is used prophylactically to prevent the occurrence of anginal attacks.
. Nitroglycerin extended-release capsules
Use the adverse-effect profile of the nitrates to determine which of the following is not an adverse effect of this drug class.
Bradycardia
Alice is experiencing periods of angina, and she places a sublingual nitroglycerin tablet under her tongue as directed by her physician. After 5 minutes have passed, she is not feeling any relief. What step should be implemented next?
. Place another sublingual nitroglycerin tablet under her tongue.
Using the available treatment options for Prinzmetal angina, determine the preferred drug class for the treatment of variant or Prinzmetal angina.
Calcium channel blockers
The process of filtration in a nephron occurs in the:
Glomerulus
Diuretics can be used to manage all of these conditions except
Hypotension
Due to the potency of sodium and water removal by thiazide and thiazide-like diuretics, patients taking these diuretics may experience
Orthostatic hypotension
The buffering capacity of blood utilizes which ion to neutralize cellular waste products?
Bicarbonate
. _____ is a diuretic that also has a beneficial effect for people with open-angle glaucoma, since _____ is associated with ocular fluid formation.
Acetazolamide, carbonic anhydrase
Spironolactone produces its potassium-sparing diuretic effect by being an aldosterone receptor:
. Antagonist that inhibits sodium and potassium exchange
. Explain the role of the kidneys in the development of hypertension.
Activation of the RAA mechanism causes vasoconstriction, and sodium and water retention, which leads to an increase in blood pressure.
Using the adverse-effects profile of the diuretic drug agents, select the true statement related to the thiazide and loop diuretics.
The thiazide and loop diuretics interfere with the renal excretion of uric acid.
Select the statement that is not consistent with the pharmacologic effect or adverse-effects profile of the vasodilator hydralazine (Apresoline).
. The main adverse effects are nausea, headache, hypertension, and reflex bradycardia.
. Select the primary indication for the use of minoxidil (Loniten).
Minoxidil is indicated for patients who do not respond to triple therapy with other drug combinations
Select the correct statement related to the mechanism of action of aliskiren (Tekturna).
Aliskiren inhibits the enzymatic activity of renin and decreases the conversion of angiotensinogen to angiotensin I, thereby reducing the formation of angiotensin II.
Which medication given during a hypertensive crisis/emergency metabolizes to thiocyanate resulting in toxicity if the patient’s renal function is inadequate for excretion:
Nitroprusside
The presence of _____ can occur from overactive clotting activity in the body that is not properly regulated.
Thromboembolisms
. What are the two groups in which heparin can be classified?
Standard heparin and low-molecular-weight heparin
The preferred anticoagulant during pregnancy is:
. Heparin
A patient experiencing hemorrhaging after receiving heparin should be given:
Protamine sulfate
. Why would a patient currently experiencing thromboembolisms be given warfarin?
To prevent secondary thromboembolic complications
Patients on the oral anticoagulant therapy, Warfarin, should be monitored by which tests?
Protime (PT) or INR
. Why is an unstable plaque more dangerous?
Thrombus formation that can block blood flow
. Endogenous cholesterol synthesis takes place in the _____ and _____.
. Liver and small intestines
Which of the following is not a useful purpose for cholesterol in the body?
Building blocks for amino acids
What is the first line of defense when treating hyperlipidemia?
Diet control
Which of the following activities would not result in an elevation of HDL levels?
Cholesterol is endogenously produced at night
Rhabdomyolysis is a serious side effect that may be experienced by patients on statin medications because
Myoglobin molecules can disrupt blood flow to kidneys and cause renal failure
The irreversible process by which aspirin inactivates cyclooxygenase production is:
Platelets lack a nucleus and can’t produce more cyclooxygenase.
The formation of _____ practically guarantees the clotting cascade to proceed.
Thromboplastin
The primary reason heparin cannot be administered orally is that:
The mucopolysaccharide is destroyed by gastric acid in the stomach
Which medications mechanism of action works by converting plasminogen to plasmin?
Alteplase
Which lipoprotein is produced in the intestines for the transport of exogenous cholesterol and triglycerides?
Chylomicrons
What region of the heart is responsible for cardiac muscle contraction?
Myocardium
A disease in which the aging process leads to fibrosis and narrowing of the arteries is:
Arteriosclerosis
What condition occurs when there is insufficient blood in the coronary arteries which can be reversed if therapy is initiated immediately?
Angina pectoris
. A decrease in blood flow to the myocardium will immediately result in:
Ischemia
The parasympathetic nervous system has _____ effect on myocardial contraction
. Very little
. Differentiate between the classes of drugs available to treat angina, and select the drug that can be used in combination with the nitrates for patients who require more than one drug to control angina.
. Beta-adrenergic blockers
Distinguish between the adverse effects of the beta-adrenergic blockers and those of the calcium channel blockers, and select the statement that does not correspond with an adverse effect that would result from an overdosage of the calcium channel blocker verapamil.
Increased myocardial contraction
Use mechanism of antihypertensive action to determine the treatment options when the desired effect is blocking of the beta-1 receptors in the heart to decrease cardiac output and blood pressure;
Atenolol (Tenormin), metoprolol (Lopressor), and nadolol (Corgard)
Select the preferred treatment for hypertension for patients with cardiac arrhythmias or ischemic heart disease.
Calcium channel blockers or beta-blockers
Which of the following would be the first line treatment for someone who has been admitted with an active GI bleed with an INR of 6?
Vitamin K
Patients receiving the anticoagulant therapy, Heparin, should be monitored by which test?
. Heparin Xa level
All of the following electrolytes play an important role in cardiac function EXCEPT:
. glucose
Lasix would be the drug of choice to treat an acute CHF exacerbation. Lasix will increase urine output in the patient and decrease the workload of which chamber of the heart:
left ventricle
The drug that is classified as an arterial vasodilator and that also has a direct effect to decrease heart rate and cardiac contractility is:
Diltiazem
. ____________ dilatation decreases _____________ which decreases the workload of the heart, thereby decreasing oxygen consumption:
venous; preload
All of the following are true EXCEPT:
tubular reabsorption of water is diuresis
The drug of choice for causing a decrease in preload is:
nitrates
The opioids used to suppress coughing include all of the following except:
Loperamide
One advantage of administering an opioid analgesic over an NSAID drug for post-operative pain would
Reduce risk of bleeding
. Opioid overdose results in respiratory depression because
The suppressed medulla cannot respond to CO2 stimulation
What can a patient do to prevent recurring pain and psychological factors associated with discomfort
Adhere to a prescribed schedule
Which of these groups of medications can play an adjunct role in pain management?
Antiepileptic drugs and tricyclic antidepressants
The specific class of opioid receptor in the CNS responsible for respiratory depression is:
Mu2
Which one of these drugs would produce a synergistic depression with an opioid drug?
Alprazolam
Identify the drug agent that irreversibly inhibits the aggregation of platelets necessary for blood clot
Aspirin
Using the preferred drug therapy for the treatment of acute gout attacks, select the true statement
For the treatment of acute gout attacks, relief of pain, and interruption of the inflammatory process, colchicine and specific NSAIDs (indomethacin, naproxen) and sodium thiosalicylate are indicated.
. Use the side-effects profile of the salicylates to select the false statement related to their use.
Salicylates stimulate prostaglandin synthesis
Use the administration guidelines for the nonsteroidal antiinflammatory drugs to select the NSAID that is commercially available for parenteral administration to induce closure of the atrial opening in premature infants with patent ductus arteriosis.
Ibuprofen and indomethacin
Select the statement that best explains why some patients develop nausea and vomiting after taking aspirin.
Salicylates stimulate the medullary center known as the chemoreceptor trigger zone. This zone directly excites the vomiting center so that emesis may occur.
Differentiate between acetaminophen and the NSAIDs, and select the true statement related to their use.
. Acetaminophen is recommended for use in patients who experience GI upset from aspirin or nonsteroidal antiinflammatory drugs (NSAIDs); however, it is not interchangeable with these products for chronic therapy of inflammatory conditions such as osteoarthritis.
Select the statement that best explains why acetaminophen is effective in the treatment of headache pains but not effective in the treatment of muscle aches and inflammation
Acetaminophen is effective against the pain of headache because it inhibits prostaglandin synthesis within the CNS but does not significantly inhibit the synthesis of prostaglandins in peripheral systems, which accounts for the lack of antiinflammatory activity.
Select the correct statement about the enzymes referred to as cyclooxygenase (COX).
Cyclooxygenase makes various prostaglandins needed from arachidonic acid.
Select the correct statement related to the uricosuric drug agent probenecid
Probenecid causes GI disturbances, so it is recommended that it be taken with milk, meals, or antacids.
Select the statement that best describes the mechanism of action of colchicine.
Colchicine specifically alters the ability of the phagocytes to attack uric acid crystals. As a result, the pH of the joint fluid does not fall.
Use of nicotine products leads to sympathetic stimulation. As a result, one can conclude that:
Heart rate will increase
Match the drug preparation verenicline with the correct trade name:
Chantix
When differentiating between ganglionic stimulants and ganglionic blockers, you determine that ganglionic stimulants:
Have little clinical use
Differentiating between the adverse effects of Nicorette and Nicoderm, you determine that use of Nicorette can result in all of the following adverse effects except:
Drowsiness
When integrating a smoking cessation treatment with the Nicotrol inhaler, it should be used with caution because:
Use of the inhaler may cause minor breathing difficulties
The major toxicity associated with neuromuscular blocker overdose is:
Respiratory muscle paralysis
What is the drug of choice for treating malignant hyperthermia?
Dantrolene
. Which type of skeletal muscle relaxant can be considered a cholinergic receptor antagonist?
Nondepolarizing
Some patients may have a genetic predisposition to developing malignant hyperthermia when taking an inhalation anesthetic with which type of skeletal muscle relaxant?
Succinylcholine
Prolonged use of which centrally acting skeletal muscle relaxant can lead to dependency?
A. Baclofen
Diazepam
Dantrolene relaxes muscle by inhibiting the release of which ion from the sarcoplasmic reticulum?
Calcium
Discontinuation of intrathecal baclofen therapy should be gradual in order to prevent:
Rebound spasticity
A patient with breathing problems has been given a muscle relaxant and begins to experience bronchospasms, which may lead to an asthmatic attack. This can be attributed to the release of:
Histamine
One way to overcome the effects of a rapidly metabolized skeletal muscle relaxant and maintain paralysis is to administer the medication by:
Baclofen
Which medication can potentiate the effects of succinylcholine due to shifting the levels of potassium in the body?
Diuretics
Identify the most commonly used local anesthetic technique
Infiltration anesthesia
Match lidocaine, a local anesthetic, to a condition it is used to treat
Cardiac arrhythmias
Explain why local anesthetics are valuable as a treatment for pain management.
Local anesthetics block sensory nerves at low doses that do not inhibit motor nerve function
. Explain the reason why local anesthetics that are given by injection occasionally contain epinephrine
Epinephrine counteracts the vasodilation that occurs with local anesthetic use
Why are local anesthetic agents that contain epinephrine contraindicated for use in the areas of the fingers, toes, ears, nose, or penis?
Epinephrine in these areas may lead to ischemia and gangrene
Using the Physicians’ Desk Reference available in the office, you determine that the amide local anesthetics have a moderate to long duration of action and that the drug group that falls into this category includes:
Lidocaine, bupivacaine, and mepivacaine
Injection of local anesthetics is used for surgical, suturing, and obstetrical procedures. Using your knowledge of this drug class, what product should be used to relieve the pain of postherpetic neuralgia?
Lidoderm 5% transdermal patch
Injections of anesthetic agents must be administered slowly, and the patient must be monitored for vital signs. Select the signs to look for that could indicate central nervous system toxicity.
Dizziness, blurred vision, and slurred speech
Select the statement that best explains potency of a local anesthetic
. Potency is the ability to produce a nerve block at a relatively low dose.
When differentiating between local and general anesthetics, general anesthetics:
Cause total loss of consciousness
Identify the neurotransmitter found at the autonomic ganglia that stimulates the nicotinic-neural
Acetylcholine
Nicorette gum has been classified as Pregnancy Category:
D
A patient who recently started on a smoking cessation treatment plan is complaining of throat irritation. Using what you have learned about the smoking cessation products, you determine that this adverse effect is due to his use of:
Nicotrol Inhaler
A patient complains of weakness, dizziness, and feelings of faintness when standing up. Using your knowledge of ganglionic stimulants and blockers, you determine from the patient’s medication profile that the drug that is probably causing these adverse effects is:
Mecamylamine (Inversine
Implementing a treatment plan that includes mecamylamine (Inversine) is indicative of a diagnosis of:
Severe hypertension
. Implementing a treatment plan that includes ganglionic blocking drugs and vasodilators could lead to a drug interaction that could result in:
Additive vasodilating effects
Select the main effect of the ganglionic blockers on the gastrointestinal system.
Decrease intestinal secretions
Integrating a cholinergic drug into the existing treatment plan of a patient already taking a ganglionic blocking drug could result in a drug interaction characterized by:
Antagonism of anticholinergic effects, especially on the GI and urinary tracts
Selection of the ganglionic blockers for the treatment of severe hypertension in males can lead to:
Impotence
The antidote given for depolarizing muscle blocker toxicity is:
None available
Two types of receptors that can be manipulated to reduce spasticity are:
Alpha-2 adrenergic and GABA
Which of the following would be observed from a low dose of a nondepolarizing muscle relaxant used to promote a neuromuscular blockade?
Relaxation of facial muscles
A medication that results in spinal hyperpolarization would belong to which class of skeletal muscle relaxants?
. Centrally acting
Cocaine was the first local anesthetic to be discovered. Explain the reason why cocaine can’t be used by injection
Injected cocaine produces vasoconstriction
Explain how local anesthetics affect cardiac function.
Local anesthetics depress the function of the cardiac conduction system.
Implementing the use of potent local anesthetics can lead to adverse effects on the central nervous system. These effects can lead to nervousness, excitation, tremors, and convulsions. The probable cause of these effects is:
. Stimulation of the cerebral cortex
Overdose of local anesthetics can lead to CNS excitation. What treatment would you use to reverse the effects of the local anesthetics?
Barbiturates and diazepam (Valium)
When differentiating between injectable bupivacaine, which is available as a 0.25% to 0.75% solution with a duration of action of 2 to 4 hours, and injectable procaine, which is available as a 1% to 2% solution with a duration of action of 15 minutes to 1 hour, the choice of agent used for injection around the spinal cord is primarily determined by the:
Duration of action required
Because of the contraindications of use of the amide local anesthetics, patients who have any form of liver disease should be monitored for
. Accumulation of the amide metabolites
Two naturally occurring opiates derived from the poppy plant are:
Morphine and codeine
Mu receptors have _____ ion channels which will be _____, thereby decreasing the release of neurotransmitters associated with pain.
Ca, blocked
Oral formulations of opioid drugs should never be _____ in order to avoid _____.
Chewed, an enhanced effect leading to side effects
Identify the chemicals that stimulate peripheral nerve endings and carry pain impulses to the CNS.
Bradykinin
What type of antibody is produced the first time a person is sensitized by tree pollen?
IgE
Why shouldn’t oral cromolyn dosage forms be taken with fruit juice or milk?
Absorption of drug will be compromised
The effects of histamine on the vasculature are that it:
Promotes vasodilation of the blood vessels and capillaries
A person allergic to chocolate may develop a migraine headache because:
Histamine dilates cerebral blood vessels that will stimulate nearby pain receptors.
What occurs in an allergic reaction when histamine binds to receptors on sensory nerve endings?
Itch-specific fibers are stimulated, causing itching and pain
Nonselective interactions of first-generation antihistamines include:
. Relief of allergy symptoms and sedation
Antihistaminics can be used in cold remedies because of the anticholinergic properties responsible for:
. Drying nasal secretions
What role do H1-receptors play in the bronchioles for patients with asthma?
Contraction of bronchiolar smooth muscle and making breathing difficult
) Why would Dr. Smith not prescribe an antihistamine for his patient with asthma?
Antihistamines are not therapeutically useful in the treatment of asthma
Advantages of newer-generation antihistaminics over first-generation antihistaminics are
Increased selectivity for peripheral H1-receptors and less sedation
Explain the mechanism of action of the anticholinergic drug agents used to treat asthma
By blocking the actions of acetylcholine, anticholinergic drugs produce
Explain the reason why theophylline may be contraindicated in patients with existing cardiovascular disease.
Theophylline may cause excessive cardiac stimulation
Summarize the preferred therapy for the relief of moderate or persistent asthma.
Daily treatment with low-to-moderate-dose inhaled antiinflammatory corticosteroids and inhaled selective beta-2 adrenergic bronchodilators.
Summarize the role that the autonomic nervous system plays in the development of asthma.
Parasympathetic activation through the release of acetylcholine produces bronchoconstriction and increased secretion of mucus.
) Compare the expectorant and the mucolytic agent, and select the product that is available over the counter without a prescription for the relief of an unproductive cough.
Mucinex
A patient complains of hoarseness and changes in his voice. Using your knowledge of steroids and leukotriene inhibitors, you advise the patient that the best way to avoid these adverse effects is to:
Rinse his mouth with water after inhaling the medication to reduce the amount of steroid that remains in his mouth and throat.
Use the mechanism of action of the corticosteroids to determine the physiologic action that results from their administration
Corticosteroids inhibit the release of inflammatory mediators from the mast cells.
Compare the mucolytic and expectorant drug agents, and determine the primary mechanism of action of the mucolytic agents
Increase in liquification of the bronchial mucus
Use the adverse-effect profile of the systemic steroids to determine the statement that is true regarding the use of these steroids in the treatment of asthma.
Systemic steroid use leads to increased susceptibility to infection
Using the onset of action as the primary factor, determine the preferred therapy for the treatment of the sudden onset of asthma symptoms.
. Albuterol
Differentiate between the chemical mediators that are formed and released from injured tissue, mast cells, and leukocytes in the respiratory tract, and select the function of histamine as it relates to asthma.
Histamine causes bronchoconstriction, increased vascular permeability that contributes to mucosal edema, and infiltration of leukocytes.
Select the primary reason why the preferred route of administration for the corticosteroids in the treatment of chronic asthma and COPD is oral inhalation with metered-dose inhalers.
. The advantage of inhalation is that lower dosages of steroid are delivered directly into the respiratory tract, therefore limiting systemic absorption and the adverse effects associated with steroid use
Receptors found on parietal cells that increase secretion of HCl when activated
Histamine
Gastric juices are released during the gastric phase from
. Distention of the stomach when food enters
Which of the following is not a common cause of peptic ulcers?
Overproduction of inhibitory enzyme to stop acid secretion
Which medications can actually promote the formation of ulcers by interfering with mucus production or secretion?
. NSAIDs and steroids
To completely stop acid secretion between meals would put a person at increased risk of
GI infections
Symptoms of chronic erosion of mucosal lining and perforation would include
Presence of blood in stool or vomit
In treating an H. pylori peptic ulcer, triple therapy refers to using
Two antibiotics and a proton pump inhibitor
One way to directly block the secretion of acid and pepsin in the stomach would be to
Administer an H2 blocker
Omeprazole (Prilosec) works by
. Inhibiting a hydrogen-potassium pump in parietal cells
Select the statement that best explains why increased dietary fiber is a major component in the management of constipation.
Fiber increases stool bulk and fluid content and decreases transit time, resulting in an increase in the frequency of defecation
The production of the hormone erythropoietin in the formation of red blood cells is regulated by the
. Kidney cells
An example of a therapeutic use for a hormone for a condition other than hormone insufficiency would be
Administering cortisol to a patient after an organ transplant
Compare the mineralocorticoids and glucocorticoids, and select the true statement about these hormones.
The main effect of the mineralocorticoid hormones is to regulate the fluid balance of the body.
Which clinical condition has shown an improvement with HRT?
Osteoporosis
Select the true statement related to the body’s response to calcium levels of more than 10.5 mg/dL.
When the plasma calcium level reaches 10.5 mg/dL, calcitonin is secreted. It lowers the circulating calcium level by antagonizing the effect of PTH on bone.
When teaching a patient who is taking biphosphonates, you would tell them all the
following EXCEPT
lie down for 30 minutes after taking
Teaching an individual who is going to be on long-term steroids would include all the following EXCEPT:
steroids increase the ability of the immune system to fight off infection
This hormone is released in response to pregnancy. Performing a blood test would show high levels
HCG
Naturally occurring female hormones are contained in soy, spearmint, and tofu. These
hormones are called:
Naturally occurring female hormones are contained in soy, spearmint, and tofu. These
hormones are called:
You would teach a woman who uses any type of birth control all of the following EXCEPT
a discharge with intrauterine devices is not uncommon
Why would Dr. Smith not prescribe an antihistamine for his patient with asthma?
Antihistamines are not therapeutically useful in the treatment of asthma

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