Midterm Exam: NR 565 / NR565 Advanced
Pharmacology Exam Review | Weeks 1-4
Covered| Questions and Verified Answers
(2023/ 2024)
Q: An 82-year-old male visits the clinic complaining that his pain meds “Take forever” to work
after he takes his pill. What are possible reasons you can explain to him?
- Perhaps we need to increase your dose.
- Sometimes as you get older, absorption may be slower resulting in a delayed response.
- As we get older the gastric acid decreases making it harder to break up the med, causing a
slower absorption.
Answer:
-Sometimes as you get older, absorption may be slower resulting in a delayed response.
- As we get older the gastric acid decreases making it harder to break up the med, causing a
slower absorption.
Q: Distribution of medication can be affected in the elderly in what ways?
- Decrease hormones
- Increased body fat
- Decreased lean mass
- Decreased Albumen
Answer: - Increased body fat
- Decreased lean mass
- Decreased Albumen (less protein binding sites available- mostly seen in malnour- ished)
Q: When prescribing medications, we must understand that liver function declines with age due
to what cause? - enlarged liver
- decreased blood flow to liver
- increased activity of the hepatic enzymes
Answer:
- decreased blood flow to liver
(Liver usually shrinks, enzyme activity usually decreases)
Q: What is the most important cause of adverse drug reactions? - High drug dosages
- Lack of monitoring of meds
- Decreased renal excretion
- Overprescribing/Polypharmacy
Answer:
Q: Overprescribing/Polypharmacy
Q: How does poor metabolism affect a high or low therapeutic index?
Answer:
results in low efficacy or toxicity
Q: Plavix
If Plavix is not converted to its active form what adverse effects can occur?
Answer:
–
Clot formation leading to stroke
Q: Black Box (BB) warning for opioids?
Answer:
Resp depression
Q: Black Box (BB) warning for Fentanyl?
Answer:
Fatal resp depression (fent is 100x stronger than morphine)
Q: Black Box (BB) warning for Methadone?
Answer:
Prolonged QT- typically has an
EKG ordered with it
Q: Black Box (BB) warning for Codeine?
Answer:
10% of the drug can be converted to morphine by the liver- concerns for breastfeeding mothers.
Q: Black Box (BB) warning for Hydromorphone and Oxymorphone?
Answer:
Resp depression
-High abuse potential
Q: Black Box (BB) warning for Oxycodone?
Answer:
Resp depression
-High abuse potential
Q: What are the therapeutic uses for morphine?
Answer:
Pain control for palliative, cancer, labor, post-op patients.
Q: What are the therapeutic uses for Fentanyl?
Answer:
Anesthesia and breakthrough, sometimes used for opioid tolerant patients.
Q: When should a patient be referred to a pain specialist?
Answer:
Chronic pain patients who reach an MME of 120 or greater
Q: What is MME and when to use it?
Answer:
Morphine Milligram Equivalents
- It is a way to calculate how much pain meds someone is getting based on the type of med they
are getting, helps safely prescribe.
-Typically used when there is a dosage change or when trying to establish a dosage.
Q: At what MME would you prescribe naloxone?
Answer:
At 50 MME
Q: Risk factors for OUD?
Answer:
-Family history of abuse
-History of depression
-History of anxiety
-History of S. I.
-Poor social history