Unit 5 MN553 Pharm Exam with complete solutions

Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for: Question options: Excessive sedation Tachycardia and angina Weight gain Cold intolerance - ANSWER Tachycardi ...

Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for: Question options: Excessive sedation Tachycardia and angina Weight gain Cold intolerance - ANSWER Tachycardia and angina Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report: Question options: Tinnitus and decreased salivation Fever and sore throat Hypocalcemia and osteoporosis Laryngeal edema and difficulty swallowing - ANSWER Fever and sore throat Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it: Question options: Substitutes for insulin usually secreted by the pancreas Decreases glycogenolysis by the liver Increases the release of insulin from beta cells Decreases peripheral glucose utilization - ANSWER Decreases glycogenolysis by the liver Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include: Question options: "Fruity" breath odor and rapid respiration Diarrhea, abdominal pain, weight loss, and hypertension Dizziness, confusion, diaphoresis, and tachycardia Easy bruising, palpitations, cardiac dysrhythmias, and coma - ANSWER Dizziness, confusion, diaphoresis, and tachycardia Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they: Question options: Increase endogenous insulin secretion Have a significant risk for hypoglycemia Address the insulin resistance found in type 2 diabetics Improve insulin binding to receptors - ANSWER Have a significant risk for hypoglycemia Treatment with insulin for type 1 diabetics: Question options: Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight Divides the total doses into three injections based on meal size Uses a total daily dose of insulin glargine given once daily with no other insulin required Is based on the level of blood glucose - ANSWER Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight The American Heart Association states that people with diabetes have a 2- to 4-fold increase in the risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include: Question options: Glycemic targets between 7% and 7.5% Use of insulin in type 2 diabetics Control of hypertension and hyperlipidemia Stopping smoking - ANSWER Glycemic targets between 7% and 7.5% Drugs used to treat diabetic peripheral neuropathy include: Question options: Metoclopramide Cholinergic agonists Cardioselective beta blockers Gabapentin - ANSWER Gabapentin The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing: Question options: Cardiovascular risk Risk of stroke or other thromboembolic event Breast cancer Vasomotor symptoms - ANSWER Vasomotor symptoms Inadequate vitamin D intake can contribute to the development of osteoporosis by: Question options: Increasing calcitonin production Increasing calcium absorption from the intestine Altering calcium metabolism Stimulating bone formation - ANSWER Inadequate vitamin D intake can contribute to the development of osteoporosis by: Question options: Increasing calcitonin production Increasing calcium absorption from the intestine Altering calcium metabolism Stimulating bone formation The drug recommended as primary prevention of osteoporosis in men over age 70 years is: Question options: Alendronate (Fosamax) Ibandronate (Boniva) Calcium carbonate Raloxifene (Evista) - ANSWER Alendronate (Fosamax) In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for: Question options: A calcium channel blocker A beta blocker Liothyronine An alpha blocker - ANSWER A beta blocker When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in: Question options: 2 weeks 4 weeks 2 months 6 months - ANSWER 4 weeks Treatment of a patient with hypothyroidism and cardiovascular disease consists of: Question options: Levothyroxine Liothyronine Liotrix Methimazole - ANSWER Levothyroxine Men who use transdermal testosterone gel (AndroGel) should be advised to avoid: Question options: Washing their hands after applying the gel Wearing occlusive clothing while using the gel Exposure to estrogens while using the gel Skin-to-skin contact with pregnant women while using the gel - ANSWER Skin-to-skin contact with pregnant women while using the gel A 22-year-old woman receives a prescription for oral contraceptives. Education for this patient includes: Question options: Counseling regarding decreasing or not smoking while taking oral contraceptives Advising a monthly pregnancy test for the first 3 months she is taking the contraceptive Advising that she may miss two pills in a row and not be concerned about pregnancy Recommending that her next follow-up visit is in 1 year for a refill and annual exam - ANSWER Counseling regarding decreasing or not smoking while taking oral contraceptives A 56-year-old woman is complaining of vaginal dryness and dyspareunia. To treat her symptoms with the lowest adverse effects she should be prescribed: Question options: Low-dose oral estrogen A low-dose estrogen/progesterone combination A vaginal estradiol ring Vaginal progesterone cream - ANSWER A vaginal estradiol ring Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be: Question options: Recommend she return to the clinic at the start of her next menses to get a Depo Provera shot. Prescribe oral combined contraceptives and recommend she start them at the beginning of her next period and use a back-up method for the first 7 days. Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first 7 days. Discuss the advantages of using the topical birth control patch and recommend she consider using the patch. - ANSWER Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first 7 days. Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects? Question options: Increased migraine headaches Increased risk of developing blood clots Irregular vaginal bleeding for the first few months Increased risk for hypercalcemia - ANSWER Irregular vaginal bleeding for the first few months Oral emergency contraception (Plan B) is contraindicated in women who: Question options: Had intercourse within the past 72 hours May be pregnant Are taking combined oral contraceptives Are using a diaphragm - ANSWER May be pregnant When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research? Question options: Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins. Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime. - ANSWER Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins. Prior to prescribing metformin, the provider should: Question options: Draw a serum creatinine to assess renal function Try the patient on insulin Tell the patient to increase iodine intake Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions - ANSWER Draw a serum creatinine to assess renal function Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset and duration of action? Question options: Levemir Glulisine Glargine Detemir - ANSWER Glulisine The drugs recommended for older adults with type 2 diabetes include: Question options: Second-generation sulfonylureas Metformin Pioglitazone Third-generation sulfonylureas - ANSWER Third-generation sulfonylureas Women with an intact uterus should be treated with both estrogen and progestin due to: Question options: Increased risk for endometrial cancer if estrogen alone is used Combination therapy provides the best relief of menopausal vasomotor symptoms Reduced risk for colon cancer with combined therapy Lower risk of developing blood clots with combined therapy - ANSWER Increased risk for endometrial cancer if estrogen alone is used Bisphosphonate administration education includes: Question options: Taking it on a full stomach Requiring sitting erect for at least 30 minutes afterward Drinking it with orange juice Taking it with H2 blockers or proton pump inhibitors (PPI) to protect the stomach - ANSWER Requiring sitting erect for at least 30 minutes afterward Long-term use of androgens requires specific laboratory monitoring of: Question options: Glucose, calcium, testosterone, and thyroid function Calcium, testosterone, PSA, and liver function Calcium, testosterone, PSA, liver function, glucose, and lipids CBC, testosterone, PSA, and thyroid level - ANSWER Calcium, testosterone, PSA, liver function, glucose, and lipids Patients taking hormonal contraceptives and hormone replacement therapy need to take the drug daily at the same time to prevent: Question options: Nausea Breakthrough bleeding Breast tenderness Pregnancy - ANSWER Breakthrough bleeding The mechanism of action of oral combined contraceptives that prevents pregnancy is: Question options: Estrogen prevents the luteinizing hormone surge necessary for ovulation. Progestins thicken cervical mucus and slow tubal motility. Estrogen thins the endometrium making implantation difficult. Progestin suppresses follicle stimulating hormone release. - ANSWER Progestins thicken cervical mucus and slow tubal motility. When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include: Question options: They should feel symptomatic improvement in 1 to 2 weeks. Drug adverse effects such as lethargy and dry skin may occur. It may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory testing. Because of its short half-life, levothyroxine doses should not be missed. - ANSWER It may take 4 to 8 weeks to get to euthyroid symptomatically and by labor