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WorksheetsPharm Final (Part 1)
Total questions: 59
Worksheet time: 30mins
This drug phase (in a clinical trial) mainly evaluates the drug’s safety and helps determine a safe dosing range
Phase I
Phase II
Phase III
Phase IV
This drug schedule includes drugs that have high potential for abuse and can lead to severe psychological or physical dependence
Class I
Class II
Class III
Class IV
The study of what the body does to a drug from the moment it is administered until it is fully eliminated
Pharmacogenomics
Pharmacodynamics
Pharmacokinetics
Pharmacotherapeutics
Tthe study of the effects of a drug on the body and the mechanisms by which these effects occur.
Pharmacogenomics
Pharmacodynamics
Pharmacokinetics
Pharmacotherapeutics
What are the four main processes involved in pharmacokinetics
Metabolism
Absorption
Excretion
Dissolution
Distribution
High lipid solubility promotes extensive tissue penetration, including fat, leading to a large volume of distribution and potential tissue reservoirs.
True
False
What type of drug molecules generally require specific transport proteins or channels to cross the membrane?
Lipid-soluble
Water-soluble
Polarized
Non-polarized
Which of the following factors do NOT affect drug absorption?
Route of excretion
Rate of dissolution
Surface area
Lipid solubility
Which site of administration has the fastest absorption rate into systemic circulation?
Sublilngual
Enteral
Parenteral
Transdermal
Which of the following is NOT a factor affecting drug distribution?
Blood flow to tissues
Ability to enter cells
Ability to exit the vasculature
Renal blood flow
Membranes of the placenta are an absolute barrier to the passage of drugs.
TRUE
FALSE
What is the most common circulating plasma protein that can form reversible bonds drug molecules?
Globulin
Transferrin
Hemoglobin
Albumin
What is the fraction of an administered drug dose that reaches the body's systemic circulation in an active, unchanged form?
Half-life
Bioavailability
Active availability
Maximum effective dose
What part of pharmacokinetics is also called Biotransformation?
Absorption
Distribution
Metabolism
Excretion
Which of the following are NOT a result of metabolism
Prodrug inactivation
Drug inactivation
Increased therapeutic action
Increased renal excretion
To prevent inactivation, some drugs are administered parenterally
to avoid this effect:
Absorption
Biotransformation
Half-life
First-pass
Renal excretion involves 3 processes. Which of the following is NOT one of those processes?
Glomerular filtration
Passive tubular resorption
Active tubular resorption
Active secretion
Which of the following is the "Minimum Effective Concentration"?
A
B
C
D
What is the decreased responsiveness to a drug after repeated administration over time?
Addiction
Tolerance
Dependence
Withdrawal
Which of the following is a physiologic change during pregnancy that impacts drug response?
Increased blood volume
Decreased metabolism
Increased GI motility
Increased muscle mass
Which of the following should the nurse teach the pregnant patient about drug therapy during breast-feeding?
Drugs cannot be excreted in breast milk
Take drugs immediately after breast-feeding
Avoid drugs that are not known to be hazardous
Avoid drugs that have short half-lives
A malnourished patient has a serum protein level of 2.9 g/dL and is receiving warfarin (high protein binding). The nurse should anticipate what change in hemorrhage risk?
Increased
Decreased
No change
Unrelated to protein levels
A gene variant present in more than 1% of a population is termed a:
Mutation
Polymorphism
Allele
Haplotype
A patient is a CYP2D6 ultrarapid metabolizer (activity score >2.0) and needs Codeine for analgesia. The best recommendation is:
Use another opioid instead of Codeine
Administer decreased dose of Codeine
Administer increased dose of Codeine
Administer a non-opioid analgesic
Drug exposure during which developmental period most likely causes gross structural malformations?
Pre-implantation (1-2 weeks)
Embryonic period (3-8 weeks)
Fetal period (9 wees-delivery)
Post-delivery
In older adults, the most important cause of adverse drug reactions is:
Increased hepatic blood flow and metabolism
Reduced renal excretion leading to drug accumulation
Increased total body water increasing clearance of hydrophilic drugs
Increased serum albumin reducing free drug levels
Which statement correctly distinguishes an antibiotic from an antimicrobial?
Antibiotics are synthetic; antimicrobials are natural
Antibiotics are produced by microbes; antimicrobials include natural and synthetic agents
Antimicrobials only target bacteria; antibiotics target viruses and fungi
There is no difference; the terms are interchangeable
What is the ability of antibiotics to kill or inhibit harmful microorganisms without harming the host's cells?
Minimum therapeutic dose
Targeted gene therapy
Selective toxicity
Cell wall synthesis
Which drug class primarily increases cell membrane permeability?
Penicillins
Cephalosporins
Amphotericin B
Tetracyclines
What type of antibiotic spectrum is primarily active against gram-positive organisms with expanded coverage against select gram-negatives
Broad spectrum
Narrow spectrum
Extended-spectrum
Exclusive-spectrum
Why must patients complete the full prescribed antibiotic course?
To minimize adverse effects
To reduce drug cost
To ensure adequate exposure of normal flora
To prevent relapse and selection of resistant organisms
Which is a recognized misuse of antimicrobial drugs?
Treating bacterial infection based on culture and sensitivity
Using prophylaxis before high-risk surgery
Treating fever of unknown origin without evaluation
Adjusting dose for renal impairment
What is a group of enzymes produced by bacteria that break down beta-lactam antibiotics such as penicillins and cephalosporins?
Beta-lactamase inhibitors
Beta-lactamases
Transpeptidases
Transpetidase inhibitors
Which statement best describes the mechanism of action of penicillins?
Inhibit bacterial DNA gyrase and topoisomerase IV
Inhibit transpeptidases and activate autolysins, causing cell lysis
Bind to ribosomal 30S subunit causing misreading of mRNA
Increase bacterial cell membrane permeability directly
The most appropriate immediate nursing action when a patient develops wheezing and severe hypotension during IV penicillin infusion is:
Slow the infusion rate and observe
Discontinue the infusion and prepare to give epinephrine with airway/respiratory support
Give diphenhydramine and continue the infusion
Switch to oral penicillin
Which statement about amoxicillin (broad-spectrum, penicillinase sensitive) is correct?
It reliably treats S. aureus that produces beta-lactamases
Common adverse effects include rash and diarrhea
It must be given IV only
It is extensively metabolized by the liver
Which statement about imipenem (a carbapenem) is true?
It is reserved for mixed infections and is inactive against MRSA
It is primarily used orally due to good absorption
It is highly susceptible to beta-lactamases
It has a narrow spectrum limited to gram-positive cocci
Which statement best explains a key structural difference between gram-positive and gram-negative bacteria and its impact on beta-lactam antibiotic activity?
Gram-positive bacteria have an outer membrane that limits beta-lactam entry, making them less susceptible to penicillins.
Gram-negative bacteria have an outer membrane with porins that can restrict beta-lactam penetration to PBPs, reducing activity of some penicillins.
Gram-positive and gram-negative bacteria have identical peptidoglycan thickness; susceptibility differences are due only to efflux pumps.
Gram-negative bacteria lack penicillin-binding proteins (PBPs), so beta-lactams are ineffective.
Cephalosporins and alcohol can create a disulfiram reaction. What clinical manifestation would indicate this type of reaction is occurring?
shortness of breath
tachycardia
hypoxemia
hypertension
Which antibiotic is most strongly associated with causing C. difficile “superinfection”?
Clindamycin
Doxycycline
Azithromycin
Imipenem
For severe Clostridium difficile infection, which vancomycin route is appropriate and why?
IV, because oral absorption is excellent
Oral, because poor GI absorption keeps drug in the gut lumen
IM, because it achieves the highest stool levels
Topical, to avoid systemic toxicity
The dose-related nephrotoxicity of vancomycin is best monitored by:
Hemoglobin
Creatinine
Sodium
Liver transaminases
Red Man Syndrome” with vancomycin is primarily caused by:
Immune complex deposition after weeks of therapy
Renal accumulation of active metabolite
Direct myocardial toxicity prolonging QT
Rapid IV infusion causing histamine release
Which instruction helps maximize tetracycline absorption?
Take with milk to reduce GI upset
Take with iron supplements for better distribution
Avoid calcium, iron, magnesium, aluminum, and zinc; take 1 hour before or 2 hours after such products
Take with antacids to prevent chelation
Which tetracycline is preferred in patients with significant renal impairment?
Teteracycline
Demeclocycline
Doxycycline
None are safe in renal impairment
Which co-prescribed drug most increases the risk of erythromycin-associated QT prolongation and sudden cardiac death?
Verapamil
Amoxicillin
Ibuprofen
Furosemide
Which is a property of aminoglycosides?
Time-dependent killing with minimal post-antibiotic effect
Concentration-dependent killing with a significant post-antibiotic effect
Extensive hepatic metabolism with long half-life
High oral bioavailability and CSF penetration
Why are aminoglycosides typically administered parenterally for systemic infections?
They are rapidly metabolized in the stomach
They are poorly absorbed from the GI tract
Oral administration causes severe ototoxicity
Oral administration leads to excessive CSF levels
Which symptom most strongly suggests early aminoglycoside ototoxicity?
Photophobia
Metallic taste
Tinnitus with persistent headache
Polyuria and polydipsia
A patient is receiving once-daily IV gentamicin. When should the trough level be drawn?
Immediately after the loading dose
30 minutes after the end of the infusion
1 hour before the next scheduled dose
4 hours after the last dose, regardless of schedule
Co-administration of which agent can facilitate bacterial uptake of aminoglycosides?
A macrolide (e.g., azithromycin)
A cell-wall active beta-lactam antibiotic (e.g., penicillin)
A tetracycline (e.g., doxycycline)
A sulfonamide (Bactrim)
In which patient would you be most concerned about aminoglycoside-induced ototoxicity?
Patient with mild transaminitis
Patient taking a proton pump inhibitor
Patient with normal renal function
Patient with renal impairment
Trimethoprim-sulfamethoxazole’s (Bactrim) antimicrobial action is best described as:
Inhibits DNA gyrase and topoisomerase IV
Irreversibly binds the 50S ribosomal subunit
Sequential blockade of folic acid synthesis, disrupting DNA, RNA, and protein synthesis
Directly increases cell membrane permeability
Which patient should generally avoid TMP-SMX (Bactrim) due to increased risk of serious adverse effects?
30-year-old with penicillin allergy
24-year-old in the first trimester of pregnancy
40-year-old with well-controlled hypertension
12-year-old with otitis media
Which best describes the mechanism of action of fluoroquinolones such as ciprofloxacin?
Inhibit bacterial cell wall cross-linking
Bind ribosomes to inhibit protein synthesis
Inhibit bacterial DNA enzymes needed for replication and cell division
Disrupt folic acid synthesis in bacteria
Ciprofloxacin should be used with particular caution or avoided in which patient due to the risk of tendon rupture?
25-year-old with seasonal allergies
35-year-old pregnant woman
65-year-old kidney transplant recipient on glucocorticoids
40-year-old with controlled hypertension
A nurse is teaching a patient starting ciprofloxacin. Which statement indicates a need for further teaching?
“I will report any new pain or swelling in my Achilles tendon.”
“I should avoid taking my calcium supplement at the same time as this drug.”
“I can spend as much time in the sun as I want; this drug does not affect my skin.”
“I should report severe or persistent diarrhea to my provider.”
Which instruction is most important for a patient taking metronidazole (Flagyl)?
Avoid dairy products within 2 hours of taking the medication
Avoid alcohol during treatment and for 3 days after the last dose
Take the medication with antacids to prevent GI upset
Limit fluid intake to prevent darkened urine
A patient on metronidazole calls the clinic reporting flushing, rapid heartbeat, nausea, and vomiting after drinking wine. The nurse recognizes this as:
Allergic reaction
Disulfiram-like reaction
Stevens-Johnson syndrome
Normal side effect of therapy
