Solution and Answer Guide Essentials of Pharmacology for Health Professions, 9th Edition by Bruce Co

All Chapters 1-27 With Comprehensive Exam Part 1, Part 2: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 1: Consumer Safety and Drug Regulations

All Chapters 1-27 With Comprehensive Exam Part 1, Part 2 Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 1: Consumer Safety and Drug Regulations

Table of Contents Chapter Review Quiz Answers ................................................................................................... 1

Chapter Review Quiz Answers 1. The first major U.S. drug law was passed in the year _______ and was called the ___________________ Answer: 1906, Pure Food and Drug Act Feedback: The Pure Food and Drug Act is the first drug law passed in 1906 to ensure consumer safety.

2. USP stands for ______________________________________________________________________ Answer: United States Pharmacopeia Feedback: The United States Pharmacopeia is a reference that specifies the official U.S. standards for making individual drugs.

3. NF stands for ______________________________________________________________________ __ Answer: National Formulary Feedback: The National Formulary (NF) is another reference that specifies the official U.S. standards for making individual drugs. It has been combined with the United States Pharmacopeia (USP) into one reference book, the USP/NF 4. Which drug law established the USP and NF (which are now one)?

Answer: The Pure Food and Drug Act Feedback: The 1906 Pure Food and Drug Act established two references of officially approved drugs: the USP and NP, which were subsequently combined into one single reference source.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 1: Consumer Safety and Drug Regulations

5. The agency that requires you to keep a record of each controlled substance transaction is the __________ Answer: Drug Enforcement Agency Feedback: The Drug Enforcement Administration enforces security and accountability related to controlled substances. Anyone who dispenses, receives, sells, or destroys controlled substances must keep on hand special DEA forms, indicating the exact current inventory and a two-year inventory of every controlled substance transaction.

6. Schedule C-______________________________________________ has the lowest potential for abuse.

Answer: Schedule C-V has the lowest potential for abuse Feedback: The 1970 Controlled Substances Act classified abused and addicting drugs into five levels, or schedules, according to their medical value, harmfulness, and potential for abuse or addiction: C-I, C-II, C-III, C-IV, and C-V, with class C-1 being the highest potential for abuse, and C-V with the lowest potential for abuse.

7. How long must you keep an inventory record of each controlled substance transaction at your office? ___ Answer: Two years Feedback: The Drug Enforcement Administration enforces security and accountability related to controlled substances, including a two-year inventory of every controlled substance transaction (also see feedback to question 5).

8. Three responsibilities of the FDA include: _________________________________________________ Answer: Three responsibilities of the FDA may include any of the following:     

Oversee testing of all proposed new drugs before they are approved for marketing Investigate and remove unsafe drugs from the market Ensure proper labeling of drugs, foods, and cosmetics Review new drug applications and petitions for food additives Inspect plants where foods, drugs, medical devices, or cosmetics are made

Feedback: The increase in the number of drugs produced for marketing brought dangers to the public. The federal FDA was established to ensure that some basic standards would be followed. Its responsibilities include the five listed in the answers above.

9. What types of drugs are listed in the C-V schedule? __________________________________________ Answer: Drugs that have the lowest abuse potential among the five classes or schedules of controlled substance, and primarily consist of cough suppressants containing codeine and antidiarrheal preparations such as diphenoxylate Feedback: The 1970 Controlled Substances Act classified abused and addicting drugs into five levels, or schedules, according to their medical value, harmfulness, and potential for abuse or addiction: C-I, C-II, C-III, C-IV, and C-V, and drugs with the C-V classification have the lowest potential for abuse.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 1: Consumer Safety and Drug Regulations

10. What method is recommended for securing the controlled substances at your office? ________________.

Answer: The drugs should be kept inside a locked safety box, which is then placed within in a cupboard that is also locked.

Feedback: The Drug Enforcement Administration enforces security and accountability related to controlled substances, including that all controlled substances must be kept inside a locked safety box, which is then placed within in a cupboard that is also locked.

11. If a patient calls to request a refill of a Percocet (C-II) prescription, how would you reply? _____________ Answer: A refill for a C-II substance cannot be called into a pharmacy as a new prescription is required by law.

Feedback: The 1970 Controlled Substances Act set regulations as to which schedules prescriptions may be phoned in to the pharmacy. A refill for a C-II substance cannot be called into a pharmacy as a new prescription is required.

12. Dawn Vasquez has a rare disease that requires medication for only a small population of patients. Which act has allowed her drug to be produced even though it is not profitable to the pharmaceutical industry?

Answer: The Orphan Drug Act of 1983 Feedback: The 1983 Orphan Drug Act provides pharmaceutical companies financial incentives to develop medications for diseases that affect only a small number of people, so that orphan drugs that would otherwise be of low profitability would be available to patients with rare diseases.

13. A patient calls into the office asking for a new prescription for a narcotic medication that he has been taking for six months. You bring up his chart and notice that he has been requesting new prescriptions every 23 days, whereas the medication should last 30 days. Additionally, the patient also mentions that he feels that he is in need of a higher dose and gets agitated and irritable when you tell him that he will need an appointment.

What do you think of this? What should you do?

Answer: The medication taking behavior suggests a potential pattern of drug abuse.

Nevertheless, the most appropriate action should be to notify the patient’s physician so that s(he) can assess the real need of an increase in the dose and/or frequency of administration.

Feedback: The prescription fill record indicated that the patient is getting the narcotic more frequently that what is allowed by his physician for his medical condition. Given the high potential of narcotic abuse, such request needs to be addressed by the physician.

14. Each drug is given a ____________ number to identify the manufacturer, the drug, and the package size. a. FDA b. USP c. DEA d. NDC Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 1: Consumer Safety and Drug Regulations

Feedback: The National Drug Code (NDC) is a directory of numerical code that allows identification of a drug, as well as the package size and the manufacturer. This directory provides a list of all drugs manufactured for commercial distribution. The NDC is comprised of three parts: the first part is five numbers and identifies the manufacturer., the second part is four numbers and identifies the drug, and the third part is two digits that identifies the package size.

15. Drug standards insure consistency in all the areas EXCEPT a. strength b. purity c. quality d. size Answer: d Feedback: Drug standards assure consumers that the drug they take are of uniform strength, purity, and quality 16. The Federal Food, Drug, and Cosmetic Act of 1938 established which agency? a. NDC b. DEA c. FDA d. USP Answer: c Feedback: The Federal Food, Drug, and Cosmetic Act of 1938 established the Food and Drug Administration (FDA).

17. The earliest recorded use of drugs occurred during which civilization? a. Egyptian b. Roman c. Greek d. Aztec Answer: a Feedback: The first documented use of drug was in ancient Egypt.

18. Answer the questions concerning the following three drug labels: a. Which drug(s) requires a prescription?

Answer: Morphine Sulfate and Procardia (nifedipine) Feedback: Both Morphine and Procardia (nifedipine) require a prescription and cannot be purchased over the counter. b. Which drug(s) can be bought without a prescription?

Answer: Acetaminophen Feedback: Acetaminophen can be obtained over the counter from any pharmacy without a prescription. c. Which drug(s) requires a DEA number?

Answer: Morphine Sulfate

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 1: Consumer Safety and Drug Regulations

Feedback: Morphine is a controlled substance that requires not only a prescription but also that the ordering and dispensing, respectively, needs to be by a physician and a pharmacist that have a DEA number indicating their proper registration with the agency. [return to top]

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 2: Drug Names and References

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 2: Drug Names and References

Table of Contents Chapter Review Quiz Answers........................................................................................................... 2

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 2: Drug Names and References

Chapter Review Quiz Answers Match the definition with the term.

Definition 1. List of conditions for which a drug is meant to be used 2. Subcategories of drugs based on their effects on the body 3. Description of the cellular changes that occur as a result of a drug 4. Conditions for which a drug should not be given

Term Answer c. Indications f. Classifications e. Actions a. Contraindications

Refer to the following drug description to answer questions 5–8.

AZO Standard® (phenazopyridine HCl tablets, USP) Product of i-Health, a Division of DSM Description: AZO Standard (phenazopyridine HCl) is a urinary tract analgesic agent, chemically designated 2,6-pyridinediamine, 3-(phenylazo), monohydrochloride.

5. The generic name of the drug is _________________________________________________________ Answer: phenazopyridine HCl Feedback: The generic name of a drug is a common or general name assigned to the drug by the United States Adopted Name (USAN) council. It is different from the trade name by initial lowercase letter and never capitalized.

6. The chemical name of the drug is _______________________________________________________ Answer: 2,6-pyridinediamine, 3-(phenylazo), monohydrochloride Feedback: The chemical name of a drug describes the exact molecular formula of the drug and usually comprises of long, very difficult name to pronounce.

7. The trade name of the drug is __________________________________________________________ Answer: AZO Standard Feedback: The trade name of a drug is the name by which a pharmaceutical company identifies its product. It is copyrighted and used exclusively by that company and is different from the generic name by capitalized first letter. It is often shown on labels and references with the symbol ® (for “registered” trademark) after the name.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 2: Drug Names and References

8. What is indicated by the® symbol after the drug name? _______________________________________ Answer: A symbol associated with copyright or patent and refers to a name used exclusively by the drug company possessing that copyright or patent.

Feedback: The symbol ® means “registered” trademark, which is often associated with the trade name of a drug (also see feedback to question 7 above) 9. Explain when Tall Man Lettering should be used.____________________________________________ Answer: It is used to highlight the differences between look-alike and sound-alike drug.

Feedback: Tall Man Lettering is often used to highlight the differences between the two drugs. For example, Celexa would be written CeleXA, whereas Celebrex would be written CeleBREX. This ensures that the health care professional reads and recognizes the correct medication.

10. Explain the difference between these two medication orders: a. Give two Tylenol, PO. b. Give one Tylenol No. 2 PO. Answer: Although both medications are to be taken orally, the first order is for two Tylenol (acetaminophen) whereas the second order is a prescription for a controlled substance because it is for a single dose of a combination product consisting of acetaminophen and codeine.

Feedback: Tylenol is not the same as Tylenol in combination with different amount of codeine, and one such example is Tylenol No. 2.

11. An older adult male was found unconscious in his bedroom with several pink and blue pills beside his bed, but no labeled pill bottle can be found. He is rushed to the emergency department for treatment. What drug reference source will be most helpful in this situation?

Answer: Any of the following references are correct:    

AHFS Drug Information (American Health-System Formulary Service) Physicians’ Desk Reference (PDR) U.S. Pharmacopeia/Dispensing Information (USP/DI) Reliable professional websites such as

http://www.fda.gov http://www.pharmacist.com http://www.nlm.nih.gov/medlineplus

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 2: Drug Names and References

http://www.safemedication.com http://www.cdc.gov/vaccines/ http://www.usp.org Feedback: Although there are multiple choices of references available today, some examples of useful drug references as well as creditable websites are indicated above.

12. Place the following terms in the correct blank: OTC, controlled substance, legend drug, off-label a. a prescription is not needed Answer: OTC Feedback: OTC means over the counter and hence no prescription is required. b. term that means a prescription is required Answer: Legend drug Feedback: A legend drug is one that is determined unsafe for OTC purchase because of possible harmful side effects if taken indiscriminately. As a result, a prescription from a health care provider is necessary. c. potential for abuse Answer: Controlled substance Feedback: Controlled substances are abused and addicting drugs with different medical value, harmfulness, and potential for abuse or addiction. d. drug given for an unapproved use Answer: Off-label Feedback: Drugs approved by the Food and Drug Administration (FDA) have one or more official indications. On the other hands, a drug can be used off-label by some clinicians based on their own experience, and the use of such drugs for use unapproved by the FDA is known as off-label use. [return to top]

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 3: Sources and Bodily Effects of Drugs

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 3: Sources and Bodily Effects of Drugs

Table of Contents Chapter Review Quiz Answers........................................................................................................... 2

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 3: Sources and Bodily Effects of Drugs

Chapter Review Quiz Answers 1. Fill in the blanks for drug sources, examples, drug name, and classification Answer: Refer to the completed table that lists the answers.

Drug

Example

Drug Name

Classification

Animals

Thyroid gland of animals

Thyroid, USP

Hormone

DNA/genetic

Hepatitis B vaccine

Recombivax HB

Vaccine

Insulin

Humulin, Novolin

Anti-diabetic

Growth hormone

Nutropin

Hormone

Magnesium

Milk of Magnesia

Antacid, laxative

Zinc

Zinc oxide ointment

Sunscreen, skin protectant

Auranofin

Antiinflammatory

Cinchona bark

Quinidine

Anti-arrhythmic

Purple foxglove plant

Digitalis

Cardiotonic

Poppy plant (opium)

Morphine, Codeine

Analgesic, Analgesic, Antitussive

Meperidine

Demerol

Analgesic

Diphenoxylate

Lomotil

Antidiarrheal

Co-Trimoxazole

Bactrim, Septra

Antibacterial

Sources

engineered

Minerals

Gold

Plants

Synthetic

Feedback: There are different sources of drugs. Substances lacking in the human body can be replaced with similar substances obtained from the glands, organs, and tissues of animals. DNA and genetic engineering of drugs using recombinant DNA technology has allowed for the production of biologically active substances that are present in the body and that can be used to treat certain diseases. Minerals from the earth are another source and include examples such as iron, potassium, and

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 3: Sources and Bodily Effects of Drugs

silver. Plants were the primary sources of drugs used on the human body, and examples include bark, leaves, resin from trees. Synthetic (manufactured) sources involves synthetic sources to make drugs to market for human consumption.

2. Drugs that are distributed throughout the body have ___________________________________ effects.

Answer: systemic.

Feedback: Systemic effects are produced by a drug that reaches widespread areas of the body 3. Drugs whose action is limited to a specific location have ___________________________________ effects.

Answer: local.

Feedback: Local effects of a drug are limited to the area of the body where the drug is administered 4. As drugs pass through the body, they undergo four processes: Answer: Refer to the completed table that lists the answers.

Process

Definition of Process

Absorption

Passage through a membrane into the bloodstream

Distribution

Movement from bloodstream into tissues and body fluids

Metabolism

Physical and chemical alterations resulting in change in activity and solubility

Excretion

Eliminating of byproducts of drug metabolism from the body

Feedback: Within the body, drugs undergo several changes. From start to finish, the biological changes consist of four drug processes: absorption, distribution, metabolism, and excretion. The net result of these four biological processes determine the amount of drug in the body at a specific time after drug administration.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 3: Sources and Bodily Effects of Drugs

5. Factors that may affect the passage of drugs through the body: Answer: Refer to the completed table that lists the answers.

Process Absorption

Primary Site of Process Mucosal cells within mouth and along GI tract (stomach, small and large intestine).

Blood vessels in muscles, subcutaneous tissues, and dermis

Conditions Hampering Process Absorption may be slowed or impaired. For example, oral absorption of some antibiotics in the presence of cation (calcium from milk). Impaired blood flow to muscle if drug administered by intramuscularly injection

Distribution

Passage through cell membrane, capillaries. Systemic blood circulation

Reduction of cardiac output

Metabolism

Liver, small intestine

Medical conditions affecting ability of liver to perform drug biotransformation

Excretion

Kidney, lungs, large intestine

Medical conditions affecting ability of kidney, lungs or the large intestine to excrete parent drug and metabolites

Feedback: Many variables affect the rate and/or extent of drug passage through the body via these four biological processes. These include, but are not limited to, cell lining biological barrier at the level of absorption, distribution, metabolism, and excretion, as well as the rate and extent of blood flow to and from those barriers.

6. If circulation is poor, metabolism is faulty, or excretion is inadequate, drugs may build up in the system, leading to _______________ effects, causing poisonous, or ____________________, levels of the drug.

Answer: increased pharmacologic, toxic Feedback: Poor circulation will bring less blood and hence less drug to the two primary organs pf elimination, hence reducing overall drug elimination with resultant higher amount of drug (toxic levels) and increased pharmacologic effect.

7. Variables affecting the efficiency of drug action include _________, ________, _______, and ________.

Answer: age, gender, weight, and psychological state Feedback: Metabolism and excretion are slower in older adults.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 3: Sources and Bodily Effects of Drugs

Differences in fat per body mass and hormonal level can affect drug distribution and metabolism between male and female patients.

Many drug dosages are always calculated on the basis of the patient’s weight. In general, the bigger the person, the greater the dose should be.

A good example of psychological state as a variable affecting drug response is the placebo effect, which describes the phenomenon that the more positive the patient feels about the medication being taken, the more positive the physical response.

Match the term with the definition.

Term 8. Synergism

e.

9. Antagonism

f.

10. Potentiation

d.

11. Lethal dose 12. Toxic dose

b. c.

13. Maintenance dose

a.

14. Idiosyncrasy

h.

15. Tolerance

j.

16. Dependence

g.

17. Teratogenic

i.

Definition Answer Drugs working together for a better effect Drugs working against each other or counteracting each other’s effect One drug making the effect of another drug more powerful Amount of drug that can cause death Amount of drug that can cause dangerous side effects Amount of drug required to keep drug level steady Unusual response to a drug, other than expected effect Decreased response after repeated use of a drug, increased dosage required for effect Acquired need for a drug, with symptoms of withdrawal when discontinued Effects on a fetus from maternal use of a drug

18. An allergy or immune response to a drug is called ___________________________________________ Answer: hypersensitivity reaction Feedback: A hypersensitivity reaction is a type of adverse drug reaction associated with allergy and altered immune response. It can have a range of clinical manifestations that range from mild and manifest as hives or itchiness, or it can be extreme and become anaphylactic shock with severe loss of blood pressure.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 3: Sources and Bodily Effects of Drugs

19. Allergic reactions to drugs may be mild, with symptoms such as ________________________________ Answer: abdominal cramps, rash, urticaria Feedback: Allergic reactions can have a range of mild symptoms manifested as abdominal cramps, rash, urticaria.

20. Allergic reactions to drugs are more common in patients with __________________________________ Answer: other known allergies.

Feedback: Allergic reactions to drugs are likely to exist in patients with other known allergies. They can also develop after uneventful previous uses of a drug.

21. Severe allergic reaction with shock, laryngeal edema, and dyspnea is called _________________________ Answer: anaphylactic reaction Feedback: Severe, possibly fatal, allergic response to drug is known as anaphylactic reaction. The clinical manifestations can include itching, urticaria, shock, cyanosis, laryngeal edema, and dyspnea.

22. Treatment of severe anaphylactic reactions can include the following: _______, ________, and ______ Answer: epinephrine, fluids, cardiopulmonary resuscitation Feedback: Treatment includes cardiopulmonary resuscitation (CPR), if indicated and drugs as required: epinephrine, and fluids to raise blood pressure. Other drugs that could be administered, if indicated, include corticosteroid to reduce inflammation and the body’s immunological response, or antihistamine to reduce redness, itching, and edema.

23. What is the fastest acting route of administration? a. oral b. rectal c. transdermal d. intravenous Answer: d Feedback: The intravenous route put drug directly into the systemic circulation, without any delay in time secondary to movement of drug through biological membrane such as GI mucosa (oral and rectal), capillaries supplying the skin (transdermal).

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 3: Sources and Bodily Effects of Drugs

24. What is the most common and easiest route of administration? a. IV b. IM c. PO d. PR Answer: c Feedback: The oral route (po) is the most common drug administration route as it does not involve injection (intravenous or intramuscular) and specialized formulation such as suppository for rectal administration.

25. Which route is used when only a local effect is desired? a. topical b. transdermal c. oral d. otic Answer: d Feedback: Otic administration is for a local effect in the ear whereas topical, transdermal and topical administration produce systemic effects. [return to top]

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 4: Medication Preparations and Supplies

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 4: Medication Preparations and Supplies

Table of Contents Chapter Review Quiz Answers........................................................................................................... 2

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 4: Medication Preparations and Supplies

Chapter Review Quiz Answers Fill in the blanks.

1. a. Which route of administration is used most often? Why? _________________________________ Answer: oral route Feedback: Oral route, with its ease of use, no need of syringes (for intramuscular or subcutaneous) or special formulation such as suppository for rectal administration, makes this route the most commonly used means of drug administration. b. Which route is fastest? _____________________________________________________________ Answer: intravenous route Feedback: Intravenous route put drug directly into the systemic circulation, without any delay in time secondary to movement of drug through biological membrane such as GI mucosa (oral and rectal), capillaries supplying the skin (transdermal).

Complete with the appropriate drug form.

2. A tablet placed under the tongue: Answer: sublingual Feedback: sublingual administration refers to an oral dose placed under the tongue 3. A tablet placed in the cheek pouch: Answer: buccal Feedback: buccal administration refers to an oral dose placed in the cheek pouch 4. A tablet dissolved in the mouth for local action: Answer: lozenge Feedback: a lozenge is a tablet to be dissolved in the mouth for local action 5. A coated tablet that dissolves in the intestines instead of in the stomach: Answer: enteric-coated tablet Feedback: An enteric-coated tablet is a dosage form designed to dissolve in the intestines instead of in the stomach 6. A tablet or capsule that has delayed action over a longer period of time: Answer: sustained-release tablet or capsule

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 4: Medication Preparations and Supplies

Feedback: A sustained-release tablet or capsule is a dosage form designed to have delayed action over a longer period of time 7. A liquid drug form with an alcohol base: Answer: elixir Feedback: An elixir is a liquid dosage form with an alcohol base 8. A liquid medication that must be shaken before administration: Answer: suspension Feedback: A suspension is a liquid dosage form must be shaken before administration 9. Drugs given by the rectal route include: Answer: may include any of the following answers: antiemetics that prevent vomiting; antipyretics that reduces fever; laxatives; medications providing a local analgesic effect; sedatives Feedback: All of these drug groups could be administered via the rectal route to produce their respective pharmacologic effect 10. The parenteral route refers to any route other than the GI route. Name four parenteral routes Answer: injection; inhalation; topical; transdermal Feedback: All of these drug administration routes do not involve the GI tract and therefore are parenteral routes of administration.

Fill in the blanks.

11. Topical drug forms include those applied to the ___________________ and ______________________.

Answer: skin, mucosa Feedback: Topical drug forms include drugs for dermal (skin) application and drugs for mucosal application.

12. Medicine for injection is contained in two types of glass containers: a. With rubber stopper on top: ________________________________________________________ Answer: vial Feedback: A glass container sealed at the top by a rubber stopper to enhance the sterility of the contents is known as a vial.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 4: Medication Preparations and Supplies

b. All glass to be broken at the neck: ____________________________________________________ Answer: ampule Feedback: An ampule is a small glass container that holds a single dose of sterile solution for injection, and it must be broken at the neck to obtain the solution.

13. Needles are selected according to two measurements: ___________________ and __________________.

Answer: length, gauge Feedback: Needles for injections have two measurements: length and gauge.

Length varies from short (⅜ inch) to medium (1–1. inch) for standard injections.

Longer needles (2 to 5 inch) may be used for specialized forms of administration, e.g. intraosseous and intra-articular injections.

Gauge is a number that represents the diameter of the needle lumen or opening.

Needle gauges in common use vary from 16 (largest) to 31 (smallest).

14. The three most commonly used syringes for injections are ___________________, ________________, and ___________________.

Answer: insulin syringe, standard hypodermic syringe, tuberculin (TB) syringe Feedback: The three most common disposable syringes used for parenteral administration of drugs are 1) the insulin syringe used strictly for administering insulin to diabetics, 2) standard hypodermic syringe for either subcutaneous or IM injections,, and 3) the tuberculin syringe that is most commonly used for newborn and pediatric dosages and for skin test.

Labeling.

15. Label the parts of a syringe. a. Luer-Loc syringe hub b. plunger c. needle d. barrel e. rubber plunger tip 16. Which of the following are inhalation drug forms? (Select all that apply.) a. mist b. spray c. dry powder inhaler d. emulsion e. suspension Answer: a, b, c

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 4: Medication Preparations and Supplies

Feedback: For inhalation administration, a liquid drug is placed in a device that will create a fine mist or aerosol that contains tiny droplets of medication. A patient may also instill aerosol sprays into a respiratory tract with a device known as dry powder inhaler. Emulsion is usually for topical administration, and suspension is usually for oral administration.

17. Which of the following is an advantage of the transdermal patch? a. easy application b. inconsistent absorption c. effective for short periods of time d. no systemic effects Answer: a Feedback: The transdermal patch is easy to apply. It produces consistent blood level over a prolonged period of time.

18. Which statement is correct? a. IV drips are a way of administering large volumes of fluids b. IV push is a way of administering large volumes of fluids c. IVPB is a way of administering large volumes of fluids d. There is no way to administer large volumes of fluids via the IV route Answer: a Feedback: IV infusion or IV drip is used to administer large volumes of fluids. On the other hand, IV push is used to administer a small volume of drug. An IV piggyback (IVPB) is used for administration of a drug diluted in moderate volume (50–100 mL) of fluid for intermittent infusion at specified intervals.

19. Which of the following routes has the slowest absorption? a. intradermal b. intramuscular c. subcutaneous d. intravenous Answer: a Feedback: Intradermal provides the slowest absorption because of the lack of vascularity in the dermis.

20. Which angle is used to administer an intramuscular injection? a. 90 degrees b. 45 degrees c. 15 degrees d. 10 degrees Answer: a

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 4: Medication Preparations and Supplies

Feedback: For intramuscular injection, the needle is inserted at a 90-degree angle.

For subcutaneous injection, the needle is inserted at a 45-degree angle. For intradermal injection, the needle is inserted at a 10 to 15-degree angle. [return to top]

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6

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 5: Abbreviations and Systems of Measurement

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 5: Abbreviations and Systems of Measurement

Table of Contents Chapter Review Quiz Answers........................................................................................................... 2

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 5: Abbreviations and Systems of Measurement

Chapter Review Quiz Answers Interpret the following orders.

1. Keflex 250-mg cap PO q6h Answer: One Keflex 250-mg capsule by mouth every six hours 2. Neosporin ophth sol 2 gtt in OU tid Answer: Neosporin ophthalmic solution two drops in each eye three times daily 3. Feosol 65-mg tab bid pc c¯ orange juice: Answer: One Feosol 65-mg tablet two times a day, after meals and with orange juice 4. Diuril 500 mg PO qAM Answer: One Diuril 500 mg by mouth every morning 5. Dyazide 1 cap bid Answer: One Dyazide capsule twice a day 6. Demerol 50 mg IM q4h PRN for pain: Answer: Demerol 50 mg intramuscularly every four hours as needed for pain 7. Metamucil 1tsp mixed c¯ 8oz H2O bid pc Answer: Metamucil 1 teaspoon mixed with 8 ounces of water twice a day after meals 8. Dulcolax supp R PRN for constipation Answer: One Dulcolax suppository rectally as needed for constipation 9. Robitussin syr 1tsp q4h PRN for cough Answer: Robitussin syrup 1 teaspoon every four hours as needed for cough 10. Nitrostat 1 tab SL PRN for angina attack, may repeat q5min three times Answer: Nitrostat one tablet sublingually as needed for angina attack, may repeat every five minutes for three times 11. Phenergan supp 25 mg PRN q6h for nausea Answer: One Phenergan suppository 25 mg as necessary every six hours for nausea 12. Discontinue Phenergan 48 h post-op Answer: Discontinue Phenergan 48 h after surgery

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 5: Abbreviations and Systems of Measurement

13. Glipizide 5 mg PO daily c¯ breakfast Answer: One Glipizide 5 mg by mouth everyday with breakfast 14. Cefazolin 1 g IVPB q8h Answer: Cefazolin 1 g intravenously by IV piggyback every eight hours 15. Potassium chloride 20 mEq in NS 1L IV to run at 80 mL per hour Answer: Potassium chloride 20 milliequivalents in 1 L normal saline intravenously to run at 80 milliliters per hour 16. NPH Insulin 20 units subcu daily ac breakfast Answer: NPH Insulin 20 units subcutaneously every day before breakfast 17. Glyburide 2.5 mg daily c¯ breakfast Answer: One Glyburide 2.5 mg every day with breakfast 18. Gentamicin ophth sol 1 gtt q3h OD Answer: Gentamicin ophthalmic solution one drop in the right eye every three hours 19. Cefaclor suspension 20 mg/kg/day in two equal doses q12h Answer: Cefaclor suspension 20 mg per kilogram daily in two equal doses every 12 hours 20. Ambien 5 mg for sleep PRN, may repeat once PRN: Answer: Ambien 5 mg for sleep as needed, may repeat once every night 21. Which of the following is the oldest system of measurement for medication? a. household b. apothecary c. metric d. English Answer: b Feedback: The apothecary is the original system of weights and measures for writing medication orders.

22. Which of the following is true regarding telephone orders? a. Always read back and verify accuracy b. Anyone can accept a telephone order c. The physician does not need to sign the order later d. Under no circumstances can telephone orders be used

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 5: Abbreviations and Systems of Measurement

Answer: a Feedback: In an emergency, the physician may give a verbal order over the phone but they must sign the medication order afterwards. In addition, the institutional guidelines dictate who can take a telephone order.

23. Which of the following is not part of a medication order? a. date/time that the order was taken b. patient’s name c. medication name d. dosage and/or amount of medication e. which pharmacy to use Answer: e Feedback: A medication order does not specify which pharmacy a patient needs to use.

24. When teaching a patient to administer medications at home, which of the following would you instruct them to use to deliver 1 tsp of a liquid medication? a. a soup spoon b. a medication cup with marked lines c. a cup d. a measuring spoon for cooking Answer: b Feedback: The only measuring device that should be used to administer medication by mouth is a medication cup with marked lines. The other three choices are all household measurement and is not accurate for measuring dose amount of any medication.

Complete the following conversions and place the correct answer in the blank.

Answer: Refer to the table for the correct answers.

Conversion 25. 1,000 mg = 26. 75 mg = 27. 1 kg = 28. 150 lb = 29. 1 tsp = 30. 1 tbsp = 31. 100 kg = 32. 0.5 g = 33. 1 g = 34. 100 mcg =

Correct Answer 1g 0.075 g 2.2 lb 68.2 kg 1 teaspoon 1 tablespoon 220 lb 500 mg 1,000 mg 0.1 mg

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 5: Abbreviations and Systems of Measurement

35. A 6-month-old is brought to the pediatrician’s office by his mother for evaluation of a fever and fussiness. You obtain a set of vital signs and a weight of 17.6 pounds.

The physician determines that the child has otitis media (an ear infection). He orders the antibiotic cephalexin 15 mg/kg PO qid for 7 days. How many milligrams of medication should the patient receive per dose?

Answer: 120 mg Feedback: The patient weighs 17.6 lb which equals to 8 kg (17.6/2.2), so a single dose to be administered would be 15 x 8 = 120 mg. [return to top]

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5

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 6: Safe Dosage Calculations

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 6: Safe Dosage Calculations

Table of Contents Chapter Review Quiz Answers........................................................................................................... 2

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 6: Safe Dosage Calculations

Chapter Review Quiz Answers Section A Basic math review.

1. Match the following symbols with their meaning.

Symbols + = x /

Meaning Answer addition equals multiply divide

2. Multiply the following fractions: (22/3) x (32/5) a. 9 1/15 b. 54/8 c. 704/15 d. 10/3 Answer: c Feedback: Multiply the numerators (22 and 32) and the denominators (3 and 5).

3. Subtract the following decimals: 10.4 – 0.037 a. 10.363 b. 10.077 c. 10.437 d. 9.363 Answer: a Feedback: Subtract 0.037 from 10.4.

4. Which of the following is 8% written as a reduced fraction? a. 2/25 b. 8/100 c. 4/50 d. 8/1000 Answer: b Feedback: 8% = 0.08, so divide 8 by 100.

Section B The available dosages are listed with each drug. Choose the most appropriate available form to deliver the dosage ordered. Use only one form of each drug.

Indicate the amount and which drug form you should give for the following orders.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 6: Safe Dosage Calculations

Use the smallest number of tablets possible. Use either the basic calculation method or the ratio and proportion method and show your work!

1. atenolol (Tenormin) 75 mg. Available 50-mg and 100-mg scored tablets of Tenormin Answer: one and a half of 50 mg tablet Feedback: 1.5 (50 mg) = 75 mg.

2. buspirone (Buspar) 25 mg. Available 5-mg and 10-mg tablets of Buspar Answer: two and a half of 10 mg tablet Feedback: 2.5 (10) = 25 mg.

3. alprazolam (Xanax) 0.75 mg. Available 0.25-mg, 0.5-mg, and 1-mg tablets of Xanax Answer: one and a half of 0.5 mg tablet Feedback: 1.5 (0.5 mg) = 0.75 mg.

4. bumetanide (Bumex) 2 mg. Available 0.5-mg and 1-mg tablets of Bumex Answer: two of 1 mg tablet Feedback: 2 (1 mg) = 2 mg.

5. cimetidine (Tagamet) 200 mg. Available 300-mg and 400-mg tablets of Tagamet Answer: one half of 400 mg tablet Feedback: 0.5 (400 mg) = 200 mg.

6. furosemide (Lasix) 60 mg. Available 20-mg, 40-mg, and 80-mg tablets of Lasix Answer: one and a half of 40 mg tablet Feedback: 1.5 (40 mg) = 60 mg.

7. levothyroxine (Synthroid) 0.3 mg. Available 0.05-mg, 0.1-mg, and 0.15-mg tablets of Synthroid Answer: two of 0.15 mg table Feedback: 2 (0.15 mg) = 0.3 mg.

8. propranolol (Inderal) 15 mg. Available 10-mg, 20-mg, and 40-mg tablets of Inderal Answer: one and a half of 10 mg tablet Feedback: 1.5 (10 mg) = 15 mg.

9. prednisone 15 mg. Available 5-mg, 10-mg, and 20-mg tablets of prednisone Answer: one and a half of 10 mg tablet

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 6: Safe Dosage Calculations

Feedback: 1.5 (10 mg) = 15 mg.

10. sertraline (Zoloft) 75 mg. Available 50-mg and 100-mg tablets of Zoloft Answer: one and a half of 50 mg tablet Feedback: 1.5 (50 mg) = 75 mg.

Section B 1. The physician orders enoxaparin (Lovenox) 1 mg/kg subcu q12h. The patient weighs 176 lb. Enoxaparin is available as an injection 100 mg/ml. a. What is the patient’s weight in kilograms?

Answer: 80 kg Feedback: 176/2.2 = 80 b. What is the dose of Lovenox to be administered?

Answer: 80 mg/0.8 ml Feedback: 100 mg/ml = 80 mg/0.8 ml, since 100 mg/ml is the available strength so 0.8 ml = 80 mg ordered.

2. The medication order reads Demerol 60 mg IM. The narcotics drawer contains syringes labeled meperidine (Demerol) 75 mg/2 ml. a. How many milliliters would you administer?

Answer: 1.6 ml Feedback: (60/75) x 2, since 75 mg/2 ml is the available strength so 1.6 ml = 60 mg ordered. b. How many milliliters would you discard and mark as “wasted” on the narcotic record?

Answer: 0.4 ml Feedback: 2 ml (as available volume) minus 1.6 ml used 3. Lasix is available in 40-mg tablets. The order reads Lasix 60 mg PO qAM. How many tablets should you give?: Answer: one and a half tablet Feedback: one and a half of 40 mg tablet equals 60 mg ordered 4. Phenergan 12.5 mg IV is ordered. Available as 25 mg/ml injection. How many milliliters would you administer?

Answer: 0.5 ml

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 6: Safe Dosage Calculations

Feedback: 0.5 ml* 25 mg/ml equals 12.5 mg ordered 5. Acetaminophen elixir 650 mg PO is ordered. The container is labeled 325 mg/5 ml. a. How many milliliters would you administer? l Answer: 10 ml Feedback: (650/325) x 5, since 325 mg/5 ml is the available strength so 10 ml = 650 mg ordered b. How many teaspoons per dose?

Answer: 2 teaspoons Feedback: 1 teaspoonful = 5 ml 6. Morphine sulfate PO 30-mg liquid is ordered. Morphine oral solution is labeled 20 mg/ml. How many milliliters would you administer?

Answer: 1.5 ml Feedback: 30/20, since 20 mg/ml is the available strength so 1.5 ml = 30 mg ordered 7. The medication order reads heparin 5,000 units. Vials available in the medication cupboard are labeled heparin 10,000 units/mL. How many milliliters should you draw into the syringe?

Answer: 0.5 ml Feedback: 5,000/10,000, since 10,000 units/mL is the available strength so 0.5 ml = 5,000 units ordered 8. Digoxin elixir is available in 50 mcg/mL. The physician orders 125 mcg PO daily. How many milliliters should you give?

Answer: 2.5 milliliters Feedback: 125/50, as 50 mcg/mL is the available strength so 2.5 ml = 125 mcg ordered 9. The physician orders prednisone PO 7.5 mg daily. Prednisone is available in 5-mg and 10-mg scored tablets, which can be broken in half. Which strength tablet and how many tablets should you give?

Answer: One and a half of 5 mg tablet Feedback: 5 + 2.5 mg, as one and a half of 5 mg tablet = 7.5 mg ordered.

10. Amoxicillin suspension 750 mg PO q8h is ordered. Liquid medication available is 250 mg/5 ml. How many milliliters should you give??

Answer: 15 ml

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 6: Safe Dosage Calculations

Feedback: (750/250) x5, since 250 mg/5 ml is the available strength so 15 ml = 750 mg ordered 11. Calcium carbonate 1,000 mg PO daily is prescribed, to be given in divided doses bid.

Available tablets contain calcium 250 mg/tab. How many tablets should be taken each time?

Answer: Two 250 mg tablets Feedback: bid means twice daily, so 500 mg (two 250 mg) tablets each time.

12. Cheratussin AC contains 10 mg of codeine in each teaspoon (5 mL). If 2 tsp Cheratussin AC PO is prescribed q4h, how much codeine would be contained in each dose?

Answer: 20 mg Feedback: 2 tsp = two teaspoonfuls = 10 ml, hence equal to 20 mg dose ordered.

13. The physician orders ivermectin tablets for a 200-lb adult with scabies. The recommended dose is 0.2 mg/kg. Ivermectin is available as 3 mg tablet. How many tablets should be given for the dose?

Answer: six 3 mg tablet Feedback: 200 lb = 90.0 kg, so dose = 90,9 * 0.2 = 18.18 mg, hence six 3 mg tablet.

14. The physician orders cefaclor (Ceclor) suspension 200 mg PO q8h for a 44-lb child.

Ceclor suspension is available in 250 mg/5 ml. a. How many milliliters should be administered each time?

Answer: 4 ml Feedback: (200/250) x 5, as available strength is 250 mg/5 ml so 4 ml = 200 mg ordered b. The recommended dosage of Ceclor is 30 mg/kg/daily. How many milligrams would be appropriate for this child daily?

Answer: 600 mg Feedback: 30 mg/kg/daily = 30 x (44/2.2) = 600 as child weighs 44 lb (= 20 kg).

15. List five variables to consider in determining a child’s dose: __________, ___________, ___________, __________, and ___________.

Answer: Any five of the following are correct: age, gender, medical conditions, metabolic capacity, psychological conditions, weight Feedback: There are numerous formulas available for computing an approximate child’s dose based on

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 6: Safe Dosage Calculations

body surface area, weight, or age. Other dosing variables include gender, medical conditions, metabolic capacity, and psychological conditions.

16. List five factors that could lead to serious cumulative effects with medicines in older adults: __________, ___________, ___________, __________, and ___________.

Answer: Any five of the following are correct: impaired cardiac function, impaired circulation, impaired kidney function, impaired liver function, impaired pulmonary function, impairment of central nervous system neurotransmitter synthesis and/or function Feedback: Variables that could lead to serious cumulative effects with medicines in older adults include impaired cardiac function (reduced blood flow to organs of elimination), impaired circulation (reduced blood flow to organs of elimination), impaired kidney function, impaired liver function, impaired pulmonary function (for elimination of volatile compounds), and impairment of central nervous system neurotransmitter synthesis and/or function (enhanced pharmacologic effect) [return to top]

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7

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 7: Responsibilities and Principles of Drug Administration

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 7: Responsibilities and Principles of Drug Administration

Table of Contents Chapter Review Quiz Answers........................................................................................................... 2

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 7: Responsibilities and Principles of Drug Administration

Chapter Review Quiz Answers Complete the statements by filling in the blanks.

1. According to the Joint Commission, medication reconciliation consists of what five steps?

Answer:     

Develop list of current medications Develop list of medications to be prescribed Compare the two lists Make clinical decisions based on the comparison Communicate the new list to patient and caregivers

Feedback: Medication reconciliation is a method used to compare the medications a patient is taking to the medications ordered by the patient’s physician. According to the Joint Commission, medication reconciliation consists of the five steps listed above.

2. Before administering any medication, you should have the following three pieces of information about the patient: Answer: The following patient-specific information are needed: date of birth, all medical conditions, allergies, and all other concurrent medications.

Feedback: The above unique information about each patient ensure the proper drug is given to the right patient.

3. When preparing to administer medications, what three principles should be kept in mind?

Answer: The three principles are cleanliness, organization, and preparation area, good lighting with no distractions.

Feedback: When preparing to administer medications, several basic principles should always be kept in mind. These include 1) cleanliness: Always wash hands before handling medicines, and be sure the preparation area is clean and neat, 2) organization: Always be sure medications and supplies are in the appropriate area and in adequate supply, and 3) preparation area: Ensure this area is well lighted and away from distraction.

4. Patient education about medication should include the following four pieces of information:

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 7: Responsibilities and Principles of Drug Administration

Answer: Why medications are administered, how medications are to be administered, when medications are to be administered, potential side effects of as well as precautions and contraindications for the medications.

Feedback: By providing the about information, the patient would have a higher chance of understanding the purpose of the drug, how and when to safely take it, as well as what to expect of unwanted side effects of the drug.

5. When administering a controlled substance, documentation is necessary in what two places?

Answer: On the patient’s record of medication administration and on the special controlled substances administration record kept with the narcotics.

Feedback: Appropriate documentation is necessary for administering a controlled substance, which should include recorded on the patient’s record of medication administration (dose, time, route), as well as the recording of narcotics administered on the special controlled substances record kept with the narcotics.

6. Documentation of an injection given for pain should include the following five pieces of information: Answer: Right mediation and dosage form, right amount, right administration time, right administration route, right patient.

Feedback: The documentation should have above five pieces of information to ensure the right drug is given in the right amount at the right time via the right administration route to the right patient.

7. Name the Seven Rights of Medication Administration: Answer: Right mediation, right amount, right time, right route, right patient, right documentation, and right technique.

Feedback: The Seven Rights of Medication Administration is a guideline for safe and effective administration of medications, and include the above rights.

8. Medication errors must be reported immediately, and documentation includes recording the information in the following two areas: Answer: Patient’s record and an incident report Feedback: If a medication error is made, recording the information on the actual occurrence in the patient’s record as well as filing an incident report are legal requirements 9. Discuss a situation in which the health care professional would refuse to administer a medication.

Answer: A patient assessed to be abusing narcotics

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 7: Responsibilities and Principles of Drug Administration

Feedback: A narcotic is highly addictive and carries a high potential for abuse.

Therefore, a health care professional could refuse to administer a medication of there is suggestive evidence of narcotic abuse and would at least refer to the individual primary care provider.

10. Maria was reading Dr. Owens’s order and due to his poor handwriting, she was unsure of the spelling of the drug she was to administer. Maria should: a. not give the drug b. give the drug and watch for side effects c. question the physician d. change the drug to what she thinks it should be Answer: c Feedback: The nurse should call the physician and clarify the correct medication to be ordered and administered.

11. Maria’s patient asked her to leave his medication at his bedside in the hospital.

Maria should: a. tell him that is never allowed b. leave it if she trusts the patient c. leave it if it is ordered by the physician d. leave it with instructions to take only when needed Answer: a Feedback: A patient should not have free access to medication, which is to be administered as per physician’s order. [return to top]

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4

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 8: Administration by the Gastrointestinal Route

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 8: Administration by the Gastrointestinal Route

Table of Contents Chapter Review Quiz Answers........................................................................................................... 2

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 8: Administration by the Gastrointestinal Route

Chapter Review Quiz Answers 1. Name three advantages and three disadvantages of oral administration compared with administration by injection.

Answer: Answer may include any three of the following advantages and disadvantages: Advantages: a. Convenience b. Inexpensive c. Relative safety as some medications can be retrieved in case of error or overdose Disadvantages: a. b. c. d.

Slower onset of absorption and action Variable rate and extent of absorption Destruction of some drugs in the gastrointestinal tract Cannot be used in patients suffering from nausea or vomiting, or for unconscious patients, as well as patients who are on NPO order e. Should not be used for patients with difficulty swallowing (dysphagia),which might lead to aspiration (inhalation of a foreign substance or regurgitated gastric contents, which can cause severe lung damage).

Match the column on the left with the appropriate action on the right. Actions may be used more than once.

Definition 2. To facilitate swallowing 3. If NPO for laboratory tests 4. Patient vomits 15 min after 5. Most medications

6. Patient is allergic to penicillin 7. Most important medicine 8. Tablet cannot be swallowed 9. Sustained-release capsules 10. Dilantin ordered PO, patient NPO for surgery

Action Answer e. Elevate patient’s head and h. Administer with water f. Notify person in charge f. Notify person in charge a. Watch closely for drug reactions, e. Elevate patient’s head, and h. Administer with water a. Watch closely for drug reactions and f. Notify person in charge a. Watch closely for drug reactions and c. Administer first b. Crush tablet, mix with applesauce d. Usually cannot be opened f. Notify person in charge

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 8: Administration by the Gastrointestinal Route

Complete the following statements by filling in the blanks.

When pouring liquid medicine: 11. The bottle should be held ___.

Answer: with the label side upward Feedback: Doing so will prevent smearing of label while pouring the medicine from the bottle.

12. The medicine cup should be held ___.

Answer: at eye level and the thumbnail placed on the level to which medication will be poured Feedback: Doing so will ensure the right amount of drug measurement. Measuring should be to the bottom of the meniscus (curve in liquid).

13. The bottle cap should be placed ___.

Answer: upside down on the table Feedback: Doing so will minimize contamination of the solution.

14. If medication is in suspension, the bottle should first be ___.

Answer: shaken well Feedback: Doing so will ensure uniformity of drug amount to be delivered.

When administering medication by nasogastric tube: 15. Check tube placement first with which two tests: Answer: a. Verify that the tube is properly placed in the stomach b. Check that the tube is taped at the appropriate centimeter marking.

Feedback: Aspirate with a bulb or piston syringe for stomach contents and check the pH of the aspirated fluids. Gastric juice is acidic (pH of 0.9–1.5). If the aspirate does not meet these parameters or if there is any question, do not instill any liquids.

Instead, report to the person in charge. If the criteria are met, flush the tube with normal saline solution or with water.

Check the appropriate answer (answer True or False) When administering medication by PEG or nasogastric tube: 16. a. Medication should be pushed through the tube by pressure on the barrel of a syringe.

Answer: False

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 8: Administration by the Gastrointestinal Route

Feedback: One should never force fluids down a nasogastric tube, and medication should flow through the tube by gravity. b. Medication should flow through the tube by gravity.

Answer: True Feedback: One should never force fluids down a nasogastric tube, and medication should flow through the tube by gravity.

17. a. Medication should be cold.

Answer: False Feedback: When administering medication by PEG or nasogastric tube, the medication should be at room temperature. b. Medication should be at room temperature.

Answer: True Feedback: When administering medication by PEG or nasogastric tube, the medication should be at room temperature.

18. a. Patient’s head should be elevated.

Answer: True Feedback: When administering medication by PEG or nasogastric tube, the patient’s head should be elevated, for example, by elevating the head of the bed. b. Patient should be placed in the Trendelenburg position.

Answer: False Feedback: When administering medication by PEG or nasogastric tube, the patient’s head should be elevated, for example, by elevating the head of the bed.

19. Name four steps in the administration of a rectal suppository that are different from PO administration.

Answer: Any four of the followings    

Lower the head of the bed if necessary and position patient on the left side with the upper knee bent. Keep the patient covered, exposing only the rectal area.

Remove suppository from wrapper and lubricate the tapered end with a watersoluble lubricant.

Separate the patient’s buttocks gently with the nondominant hand so you can see the anus.

Ask the patient to take a deep breath. Insert the lubricated suppository gently into the rectum and push gently with gloved index finger until the suppository

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 8: Administration by the Gastrointestinal Route



has passed the internal sphincter. For infants, use the gloved little finger instead of the index finger.

Urge the patient to retain the suppository for at least 20 min. If patient is unable to cooperate, hold the buttocks together as required.

Feedback: All of the above steps are unique to rectal administration of drugs as a suppository 20. Medication documentation should include the following related to drug administration: Answer: Medication name, dosage, administration time, and signature or initials of person administering the medication. In addition, the documentation should record any adverse reaction to the medication as well as unusual circumstances associated with the administration (for example, medication withholding or refusal for any reason).

Feedback: Documentation of the above information would comply with the Seven Rights of Medication Administration: right medicine, right amount, right time, right route, right patient, right technique, and right documentation. In addition, the documentation should record any adverse reaction to the medication as well as unusual circumstances associated with the administration. [return to top]

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5

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 9: Administration by Parenteral and Other Routes

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 9: Administration by Parenteral and Other Routes

Table of Contents Chapter Review Quiz Answers........................................................................................................... 2

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 9: Administration by Parenteral and Other Routes

Chapter Review Quiz Answers Fill in the blanks.

1. Parenteral includes any routes other than the _______________________________________________ Answer: gastrointestinal tract Feedback: Parenteral routes include any administration sites that are not part of the gut.

2. Systemic effects are those affecting _______________________________________________________ Answer: the entire body Feedback: Systemic effects are produced by a drug that reaches widespread areas of the body.

3. The four parenteral routes with systemic effects include ______________________________________ Answer: any of the followings: transdermal, topical, inhalation, injections (intravenous, intramuscular, subcutaneous), and intra-peritoneal.

Feedback: Sublingual or buccal route is an enteral route and NOT a parenteral route.

Label the routes according to their action. Use R for rapid and S for slow. Match each route with the appropriate definition.

4.

5.

6.

7.

Route Sublingual Transcutaneous Inhalation Injection

Action R S R R

Route Definition Under the tongue Skin patch Nebulizer or IPPB Given with a needle

Answer c. d. b. a.

8. What precautions should be observed when applying transcutaneous systems?.

Answer: Wear gloves when applying the transcutaneous system. Do not touch the inside or edges of the patch Feedback: Wearing gloves eliminates the risk of drug absorption through the skin, which might cause undesirable side effects.

9. DPI refers to Answer: dry-powder inhaler

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 9: Administration by Parenteral and Other Routes

Feedback: Dry-powder inhaler is a medical delivery system that delivers medication by the inhalation route, Select the correct needle for the purpose. Needle size may be used for more than one purpose.

10. Subcutaneous injection Answer: b. 25 gauge, 5/8 inch Feedback: The size of the gauge is determined by the site of the injection. A 25 gauge needle is used for subcutaneous injections.

11. Intravenous injection Answer: c. 18 gauge Feedback: The size of the gauge is determined by the site of the injection and the viscosity of the solution as well, e.g., blood and oil require a thicker-gauge needle such as 18 gauge.

12. Allergy testing Answer: d. 27 gauge, 3/8 inch Feedback: A 27 gauge, 3/8 inch needle is typically used for allergy testing.

13. IM injection Answer: a. 21 gauge, 1. inch Feedback: The size of the gauge is determined by the site of the injection. A 21 gauge needle is used for IM injections.

14. What are the two purposes of the tuberculin syringe?

Answer:  

For intradermal injections of very small amounts of a substance (e.g., testing for tuberculosis or for allergies) For subcutaneous injections when a small amount (less than 1 mL) of medication is ordered (e.g., in pediatrics)

Feedback: The tuberculin syringe is calibrated in tenths of a milliliter and holds only a total of 1 ml. It is used for the above two injection purposes.

15. The insulin syringe is calibrated in ______, and 1 mL is equal to ______ in an insulin syringe.

Answer: units, 100 units

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 9: Administration by Parenteral and Other Routes

16. On a standard insulin syringe, each calibration represents Answer: 2 units On a Lo-Dose insulin syringe, each calibration represents Answer: 1 unit Match the injection with the proper technique.

Injection 17. Intramuscular 18. Subcutaneous 19. Intradermal

Proper technique Needle 90-degree angle, skin taut Needle 45-degree angle, skin pinched up Needle flat, bevel up, skin taut

Answer c a b

20. List the three sites for IM injections and when each is used.

Answer: Ventrogluteal site (above and to the outside of the buttock area, on the hip). Can be used for all patients.  Deltoid site (upper outer arm above the axilla). It is the recommended site for vaccines for adults and children between ages 1 and 18 years  Vastus lateralis (front of the thigh toward the outside of the leg). Located on the anterior lateral thigh, this site is the preferred site for infants, because these muscles are the most developed for children under the age of three.

21. Why is the Z-track method used? 

Answer: It is used for administering medications that are irritating or discoloring to the tissue, such as iron dextran, hydroxyzine, or cefazolin.

Feedback: The Z-track method prevents leakage of irritating and discoloring medications into the subcutaneous tissue.

Describe Z-track administration.

Answer: a. Draw up the medication and then add 0.3–0.5 mL of air to the syringe. Then replace the needle with a sterile one, 2 to 3 inches long. b. Stretch the skin as far as you can to the outer side and hold it there c. After cleansing the site, insert the needle with a dart-like motion, then inject the medication slowly. Wait 10 seconds before withdrawing the needle. d. Withdraw the needle and allow the skin to return to normal position. This seals off the needle track. e. Press firmly on injection site with a 2 × 2 gauze square. Do not massage the site because this could spread the medication to the subcutaneous tissue, causing irritation.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 9: Administration by Parenteral and Other Routes

f.

Advise the patient that walking will aid absorption and to avoid tight garments, such as girdles, that cause pressure on the site.

22. Define local effects. __________________________________________________________________ Answer: Drugs whose action is limited to a specific location Feedback: Local effects are pharmacological effect that is limited to one specific part (location) of the body, with very little, if any, effect on the rest of the body.

List four areas to administer medication for local effects Answer: a. Medications applied to the skin for skin conditions, sometimes referred as topical medications b. Medications applied to the mucous membranes to treat that specific tissue c. Medications instilled in the eyes for eye conditions d. Medications instilled in the ears for ear conditions 23. What are the two types of IV administration?

Answer: Continuous IV infusion, intermittent IV infusion (piggyback or bolus/push) Feedback: There are two types of IV administration: continuous IV infusion and intermittent IV infusion (piggyback or bolus/push). Both types require similar equipment—an IV catheter inserted in the vein and a bag of IV fluid, a small bag of medication (piggyback), or medication in a syringe.

24. List two examples of IV solutions in each of the categories: Isotonic solution types: Answer: Normal saline, lactated ringer’s, whole blood Feedback: There are three types of IV solutions which are classified based on the effect they have on the cell. Examples of Isotonic solution are normal saline, lactated ringer’s, whole blood.

Hypotonic solution types: Answer: Half-strength normal saline, dextrose 5% in water Feedback: There are three types of IV solutions which are classified based on the effect they have on the cell. Examples of hypotonic solution are half-strength normal saline, dextrose 5% in water.

Hypertonic solution types: Answer: Dextrose 5% in 0.9% saline, dextrose 5% in 0.45% saline, dextrose 5% in lactated Ringer’s

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301;Chapter 9: Administration by Parenteral and Other Routes

Feedback: There are three types of IV solutions which are classified based on the effect they have on the cell. Examples of hypertonic solution are dextrose 5% in 0.9% saline, dextrose 5% in 0.45% saline, dextrose 5% in lactated Ringer’s.

25. Which type of needle to you use to withdraw from an ampule? a. Filter b. 25 gauge c. non-coring d. intravenous Answer: a Feedback: If the medication is contained in an ampule, a filter needle is needed to withdraw fluid from an ampule.

26. Which of the following are considered other routes of administration that have mainly local effects? Select all that apply. a. ear medication b. eye medication c. sublingual d. intramuscular e. intravenous Answer: a, b Feedback: Medications for management of ear and eye disorders are usually administered topically. The other three routes of administration are for medications intended for systemic effects. [return to top]

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6

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 10: Poison Control

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 10: Poison Control

Table of Contents Chapter Review Quiz Answers........................................................................................................... 2

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 10: Poison Control

Chapter Review Quiz Answers Complete the statements by filling in the blanks.

1. Poisons can be taken into the body in four different ways: Answer: ingestion, inhalation, absorption through the skin, and via sting or snake bite.

Feedback: Even though the most common type of poisoning is by ingestion or swallowing, poisons can get into the body via inhalation and absorption through the skin, as well as resulting from a sting or snake bite.

2. In cases of poison ingestion, vomiting is to be avoided under the following five conditions: Answer: The following five answers:     

Ingestion of corrosive substances such as acids or alkalis Ingestion of volatile petroleum products such as gasoline, kerosene Ingestion of convulsant such as strychnine or iodine If patient is semiconscious, severely inebriated, in shock, convulsing, or has no gag reflex If patient is less than one year old

Feedback: Under the above conditions, vomiting could be injurious to the patient and should be avoided if possible.

3. Gastric lavage is contraindicated when a patient has ingested what type of substance?

Answer: It is contraindicated in patients who have ingested corrosives Feedback: It is contraindicated because of the danger of perforating the damaged tissue of the esophagus.

4. When is activated charcoal administered?

Answer: When it is necessary to reduce or minimize systemic absorption of the ingested poison or toxin Feedback: The therapeutic usefulness of activated charcoal is to reduce systemic absorption of the ingested poison. However, it should not be used when there is a specific antidote administered via the gastric route.

5. Why are gastric contents saved after emesis or gastric lavage?

Answer: It may be necessary for determination of the type of poison.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 10: Poison Control

Feedback: The personnel caring for poisoning victims should save the emesis from the poisoned victim send it to a laboratory for possible determination of the type of poison.

6. What is the treatment for poisons that contact skin or eyes?

Answer:   

External poisons should be flushed from the skin for 20 min or eyes for 30 min with continuous stream of water The patient should then be transported to an emergency care facility for further treatment as required Administration of an antidote may be needed if there is systemic absorption of specific poisons

Feedback: The above are the recommended procedure for management of external poisoning of skin or eyes.

7. What two groups of people are most at risk for poisoning?

Answer: Children and elderly Feedback: Poisonings are the leading cause of health emergencies for children across the nation. Another group at risk for poisoning is older adults as they usually take multiple medications and have decreased capacity to eliminate drug via the liver and the kidneys. Cognitive impairment is common in the elderly and contribute to increased misuse of medications.

8. Name four conditions that may lead to toxic medication reactions in older adults Answer:    

Lower metabolic capacity, reduced excretory function of the kidneys, impaired circulation Impaired cognitive function, hearing, vision Drug-drug interactions resulting from polypharmacy Concurrent medical conditions that lead to altered drug absorption, distribution, metabolism, and excretion

Feedback: Poisonings are common in older adults as they usually have decreased capacity to eliminate drug via the liver and the kidneys, and the presence of other medical conditions can also affect drug absorption, distribution, metabolism, and excretion in a negative way. They also take multiple medications which can lead to drug-drug interactions. Cognitive impairment is common in the elderly and contribute to increased misuse of medications.

9. What is the leading cause of poisoning deaths in children under 6 years of age?

Answer: Personal care products and/or cosmetics

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 10: Poison Control

Feedback: The most common sources for poisoning in children under age 6 are cosmetics and personal care products, likely reflecting their easy availability throughout the house.

10. What is the number of the National Poison Control Center?

Answer: 800-222-1222 11. In what scenarios is it appropriate to call 911 before poison control?

Answer: If the person involved is unconscious, has severe changes in vital signs, cognition, or behavior after ingesting a substance.

Feedback: Although poison control center is very helpful in providing information about poison exposure and what to do in such situations, patients should be educated that poison control center should not be the first phone call in a medical emergency, especially if affected individual is unconscious and/or has severe changes in vital signs, cognition, or behavior after exposure.

12. List 10 recommendations for patient education to prevent poisonings: Answer: Any 10 of the followings:           

 

Do not give or take medications in the dark Never leave medications on a bedside stand Always read the label before taking any medication or pouring any solution for ingestion Keep all medications, household chemicals, personal care products, cleaning supplies, and pesticides in a locked cupboard.

Never give or take any medication that is discolored, has strange odor, or is outdated Do not take medications in front of children Never tell children the medication you are giving them is candy Keep pocketbooks, purses, and pillboxes out of reach of children.

Do not allow children access to cosmetic products When preparing a baby’s formula, taste the ingredients Never transfer poisonous substances to unlabeled containers or to food containers such as milk or soda bottles or cereal. Keep in the original labeled container Never store poisonous substances in the same area with food Rinse out containers thoroughly before disposing of them

Feedback: Any of the above practice should be used to educate the public as they can contribute positively to minimizing the occurrence of poisoning in a household, especially for children and elderly. [return to top]

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4

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 11: Nutritional Concepts of Pharmacology

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 11: Nutritional Concepts of Pharmacology

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 11: Nutritional Concepts of Pharmacology

Case Study Answers Case Study A Water-Soluble Vitamins Jeanne Kim is a 37-year-old pregnant female. She is at her OB-GYN’s office for a 16week checkup.

1. The physician is reviewing Jeanne’s diet and inquires about her intake of folic acid.

She explains that a deficiency in folic acid during pregnancy can result in which condition in newborns? a. cerebral palsy b. cardiac malformations c. spina bifida d. seizures Answer: c Feedback: Deficiency in folic acid during pregnancy can result in result in spina bifida Newborns with folic acid deficiency have an increased risk of neural tube defects such as spina bifida. Other complications would include irritability, behavior disorders, as well as macrocytic and megaloblastic anemias 2. Which of the following foods is richest in folic acid? a. radishes b. black beans c. broccoli d. alfalfa sprouts Answer: c Feedback: Folic acid is found in leafy and green vegetables such as broccoli. Other rich sources of folic acid include avocados, beets, kidney beans, and organ meat.

3. Why is folic acid a necessary supplement for Jeanne? a. for the production of RBCs b. for fat metabolism c. for cell mitosis d. for the destruction of white blood cells (WBCs) Answer: c Feedback: Folic acid is important for proper cell mitosis in the developing fetus.

Folic acid is important for protein synthesis, production of RBCs, cell division (mitosis), normal growth and maintenance of all cells, it is also needed for pregnant

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 11: Nutritional Concepts of Pharmacology

women to prevent occurrence of neural tube defects such as spina bifida, in the newborn.

4. Which of the following is a sign that Jeanne might have a folic acid deficiency? a. weight gain b. muscle cramps c. pale sclera d. weight loss Answer: d Feedback: Weight loss is associated with folic acid deficiency Other than weight loss, other signs of deficiency include anemia, anorexia, weakness, fatigue, irritability and behavior disorders.

5. The physician cautions Jeanne about the amount of daily folic acid supplementation.

What should she recommend as the maximum amount of folic acid intake per day? a. 0.4 mg b. 0.8 mg c. 1.2 mg d. 5 mg Answer: a Feedback: The dietary reference intake for folic acid is 400 mcg or 0.4 mg per day.

The other answer choices exceed the dietary reference intake.

Case Study B Minerals Seventy-three-year-old Jose Velasquez has started taking a loop diuretic to reduce his elevated blood pressure.

1. While taking this specific high blood pressure medication, Jose is at risk for developing a deficiency in which mineral? a. potassium (K) b. chloride (Cl) c. calcium (Ca) d. iron (Fe) Answer: a Feedback: The patient is at risk of developing deficiency in potassium.

Hypokalemia is commonly associated with the use of thiazide diuretics, which are commonly used antihypertensive agents, as a result of loss of potassium from the kidney.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 11: Nutritional Concepts of Pharmacology

2. Which of the following may result from a deficiency of K? a. anorexia b. muscular weakness c. hypothermia d. constipation Answer: b Feedback: Muscle weakness is associated with low potassium.

One of the most common signs of potassium deficiency is muscular weakness, and one of the most common class of drug causing hypokalemia is diuretics.

3. The physician determines that Jose needs a potassium supplement but emphasizes that Jose should take the correct dose of K to avoid a potassium overdose. What is one symptom of K overdose? a. Hypokalemia b. shortness of breath c. urinary retention d. cardiac arrest Answer: d Feedback: Cardiac arrest can result from potassium overdose.

Hyperkalemia, or too much potassium in the body, can cause GI toxicities such as nausea, vomiting, diarrhea, bleeding, or abdominal pain. However, the most severe complication of potassium overdose is abnormal cardiac rhythm, potentially resulting in cardiac arrest.

4. While taking a potassium supplement, Jose experiences some GI distress. When should he take the K+ to minimize these GI side effects? a. with or after meals b. just before bed c. upon rising in the morning d. two hours prior to a meal Answer: a Feedback: The patient should take potassium supplementation with food.

One of the most common side effects of potassium supplement is GI distress and the easiest way of overcoming the GI distress with oral medication is to take it with food.

5. Which of the following will provide Jose with the best source of K? a. carrot salad b. broccoli rabe sauté

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 11: Nutritional Concepts of Pharmacology

c. fruit salad d. green beans Answer: a Feedback: Fruit is a rich source of potassium.

Natural sources of potassium include many types of fruit, for example, avocadoes, bananas, citrus fruits, potato skins, and tomatoes. [return to top]

Chapter Review Quiz 1. Antioxidants a. are safe to take in megadoses b. consist of proteins, carbohydrates, and fats c. are found only in synthetic products d. fight against the destructive effects of free radicals Answer: d Feedback: Antioxidants inhibit cell destruction in damaged or aging tissues caused by free radicals. Antioxidants can be either enzymes, vitamins, and minerals. There are both natural and synthetic antioxidants. Similar to medications, taking too much of antioxidants is not safe.

2. Free radical damage can be associated with a. stunted growth b. glaucoma c. heart disease d. grand mal seizure Answer: c Feedback: Although free radicals commonly cause several age-related diseases, they also attack cell membranes of the tissues lining the blood vessels, leading to cholesterol accumulation in the damaged arteries, development of plaque, atherosclerosis and heart disease.

3. Which of the following is an antioxidant vitamin? a. calcium b. beta carotene c. folate d. niacin Answer: b

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 11: Nutritional Concepts of Pharmacology

Feedback: Vitamin A, also known as retinol or beta carotene) are one of several vitamins that are considered antioxidants. The other examples are vitamin C and E. Niacin is vitamin B whereas calcium and folate are dietary supplements.

4. Which of the following is an antioxidant mineral? a. potassium b. sodium c. zinc d. iron Answer: c Feedback: In addition as a component of numerous enzymes, zinc is also an antioxidant. Sodium and potassium are minerals dissolved in body fluid (electrolytes) and iron is a mineral 5. Signs of a vitamin A deficiency may include which of the following? a. watery eyes b. night blindness c. weight gain d. accelerated growth Answer: b Feedback: Vitamin A is an important vitamin for proper visual function at night and its deficiency is associated with night blindness. Watery eyes, weight gain, and accelerated growth are not associated with caused by deficiency of this vitamin.

6. When buying dietary supplements, you should look for which term on the label a. natural b. FDA c. USP d. new discovery Answer: c Feedback: A United States Pharmacopoeia (USP) label assure consumer of product standard. Dietary supplement can be either natural or synthetic. Food and Drug Administration (FDA) does not regulate the marketing of dietary supplement.

7. Which of the following herbs can interact with anticoagulants to cause bleeding? a. cranberry and milk thistle b. garlic and ginkgo c. saw palmetto and glucosamine d. ginseng and echinacea Answer: b

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6

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 11: Nutritional Concepts of Pharmacology

Feedback: Both garlic and ginkgo has been reported to be associated with bleeding, which will then potentiate the pharmacologic effect of the anticoagulant warfarin, resulting in exaggerated bleeding risk. While the other herbs all have multiple biological effects, none of them interfere with the anticoagulant effect of warfarin.

8. Glucosamine a. is always combined with chondroitin b. has no known side effects c. can elevate cholesterol level d. counteracts thyroid medicine Answer: c Feedback: As herbal supplement, glucosamine use has been associated with several side effects including elevated cholesterol level.

9. Garlic a. lowers blood pressure and cholesterol level b. helps to control menopause symptoms c. alleviates symptoms of depression d. was banned by the FDA due to the danger of heart problems and stroke Answer: a Feedback: One of the purported usefulness of garlic is that it could be helpful to control blood pressure and cholesterol level, but it has no reported effect on depressive or menopause symptoms. Food and Drug Administration (FDA) does not regulate the marketing of dietary supplement.

10. Ginseng a. interacts with oral contraceptives b. has no known side effects c. causes liver damage d. may cause hypertension, mental changes, and nervousness Answer: d Feedback: Several of the reported side effects associated with use of ginseng include hypertension, mental changes, and nervousness. There are additional adverse effects, including nausea, vomiting, and diarrhea. It is also contraindicated in pregnancy. [return to top]

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7

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 12: Integumentary System Medications

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 12: Integumentary System Medications

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 12: Integumentary System Medications

Case Study Answers Case Study A Skin Medications Anne Marie Reingardt noticed patches of irritated skin on her elbows, knees, and scalp. During an appointment with a dermatologist she is diagnosed with psoriasis.

The physician prescribed a keratolytic agent for treatment of the psoriasis. She would benefit from the following information.

1. Keratolytic agents are used to control: a. Necrotic tissue b. Pruritus c. Scaling skin d. Fungal infections Answer: c Feedback: Keratolytic agents are used to loosen epithelial scales and therefore would be useful to control abnormal scaling of the skin but not necrotic tissue.

Pruritus should be managed with an antipruritic for relief from itching. Local antiinfectives are used to prevent and treat fungal infections.

2. A common side effect of a keratolytic agent is: a. Skin bruising b. Skin discoloration c. Glycosuria d. Severe skin irritation Answer: d Feedback: Side effects of keratolytic agents include irritation to the eyes or mucous membranes and not skin bruising nor discoloration. It also does not cause glycosuria.

3. Which instruction should Anne Marie receive about the keratolytic agent for her psoriasis? a. Treat irritated skin with the medication as needed b. Avoid contact with the eyes c. Discontinue use if the condition is no longer present or improves, even if midway through treatment d. Use on surrounding tissues to ensure adequate coverage Answer: b Feedback: Since keratolytic agents can cause irritation to the eyes or mucous membranes, the patient should avoid contact with the eyes when such agents are

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 12: Integumentary System Medications

used. Patient should also avoid contact with surrounding tissues when applied to manage warts, corns, or calluses.

4. Which of the following is an example of a keratolytic agent? a. Collagenase b. benzocaine c. salicylic acid d. Ammonium lactate Answer: c Feedback: Salicylic acid available in topical formulation is a common agent used as a keratolytic agent. Collagenase is an enzymatic agent. Benzocaine is a local anesthetic.

5. Keratolytic agents can also be used to treat: a. Allergic contact dermatitis b. Fungal infections c. Eczema d. Warts Answer: d Feedback: Other uses of keratolytic agents include management of warts, corns, or calluses. See feedback in Qs 3. Corticosteroids are used topically for allergic contact dermatitis. Antifungal agents are used for fungal infection. An emollient agent designed to soothe irritation is more suitable form eczema.

Case Study B Skin Medications Mary Hanson, a 64-year-old, is about to undergo a right total knee replacement. The nurse explains that an antiseptic will be used preoperatively. Ms. Hanson will find the following information helpful.

1. Antiseptics are substances that perform which of the following actions? a. They inhibit the growth of bacteria b. They assist with the chemical debridement of tissue c. They enhance the growth of healthy skin flora d. They inhibit the replication of a virus Answer: a Feedback: Antiseptics are substances that inhibit the growth of bacteria. They do not enhance the growth of healthy skin flora, cause chemical debridement of tissue, or have an anti-viral effect.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 12: Integumentary System Medications

2. The most preferred antiseptic for skin cleansing prior to surgery is: a. Povidone–iodine b. Terbinafine c. Mupirocin d. Chlorhexidine Answer: d Feedback: The two major antiseptics in use today are chlorhexidine and povidone– iodine. However, chlorhexidine is preferred because of lower rates of surgical site infections compared to povidone–iodin. Mupirocin is an antibiotic to treat infection and terbinafine is an antifungal agent for management of fungal infection.

3. Side effects of chlorhexidine can include: a. Petechiae b. Dermatitis c. Freckling of the skin d. Whitening of the skin Answer: b Feedback: Side effects reported for chlorhexidine include dermatitis and irritation, photosensitivity, and allergic reactions, especially in the genital area.

4. The nurse explains to Mary that she will need to perform the antiseptic scrub at home the night prior to the surgery. Mary should be instructed to: a. Leave the medication on her skin after application b. Apply the medication to her eyes and ears c. Rinse her skin thoroughly after use d. Apply the medication to all areas involving the dermis Answer: c Feedback: The patient should rinse thoroughly after applying antiseptic agent such as chlorhexidine so that the medication is not left on her skin. She should also avoid the antiseptic agents in the eyes or ears.

5. The best surgical scrub for a patient with an allergy to iodine is: a. Peridex b. Betadine c. Hibiclens d. Bactroban Answer: d Feedback: Although the two major antiseptics in use today are chlorhexidine and povidone–iodine, chlorhexidine (Hibiclens and Peridex) could cause allergic

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 12: Integumentary System Medications

reactions. Betadine contains povidone–iodine and would not be suitable in a patient with an allergy to iodine. [return to top]

Chapter Review Quiz 1. Which of the following is not true regarding the absorption of topical skin medications? a. If the skin is thick and callused, absorption will be slower b. If the skin is moist or warmer than normal, absorption will be faster c. If the skin is covered with plastic wrap, absorption will be faster d. If an ointment is used instead of a cream, absorption will be faster Answer: d Feedback: Oil-based preparations such as ointment and paste will take longer to be absorbed, in contrast to more water based preparations such as gels and creams, which are more rapidly absorbed. Other conditions associated with more rapid absorption include skin conditions that are not thick or callused, premoistened skin, warm skin, or plastic wrap applied to the application area.

2. Which category of topical skin preparation is used to protect the skin and soothe irritation? a. Antipruritic b. Keratolytic agent c. Enzymatic agent d. Emollient Answer: d Feedback: An emollient agent is designed to soothe irritation. On the other hand, antipruritic is for itching relief, a keratolytic agent loosens epithelial scales and therefore would be useful to control abnormal scaling of the skin. Enzymatic agents are used to promote removal of necrotic or fibrous tissue 3. Oral antiviral medications are most effective if started within how many hours of the onset of symptoms? a. 72 b. 96 c. 36 d. 48 Answer: d Feedback: Antivirals need to be started within 72 h of rash onset and actually are most effective if started within the first 48 h of onset of symptoms.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 12: Integumentary System Medications

4. Collagenase (Santyl) would be indicated to treat: a. Hives b. Scaly skin c. Necrotic tissue d. Psychiatric disorders Answer: c Feedback: Topical enzyme ointment such as Santyl are used for the chemical debridement (removal of dead or damaged tissue) of dermal ulcers and burns.

Collagenase should be used only on wounds associated with necrotic material.

5. Which action should a patient take after using a nystatin oral preparation? a. Spit out the excess b. Rinse the mouth c. Wipe off the excess d. Maintain NPO for at least 1h Answer: d Feedback: For treatment of candidiasis of the oral cavity, the entire dose of a nystatin oral suspension should be used to thoroughly coat inside the mouth, holding it for as long as possible (e.g., several minutes) before swallowing. In addition, the patient should remain NPO for at least an hour.

6. Which antipruritic would be most likely to cause a hypersensitivity reaction? a. Synalar b. benzocaine c. Cortaid d. Desitin Answer: b Feedback: Among the choices, benzocaine is a local anesthetic agent that has been reported to cause hypersensitivity reaction.

7. Which preparation is used to prevent an infant from developing diaper rash? a. Keratolytic b. Protectant c. Enzyme preparation d. Antipruritic Answer: b Feedback: A protectant agent is needed for the skin condition known as diaper rash. Enzyme preparation is used for the chemical debridement (removal of dead or damaged tissue) of dermal ulcers and burns. Antipruritic is used for management of itching. A keratolytic agent is useful to control abnormal scaling of the skin

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 12: Integumentary System Medications

8. A patient using a burn medication should be instructed to: a. Allow the burn to be open to air b. Disregard any signs of allergy c. Use the aseptic technique to prevent infection d. Use an enzymatic debriding agent to facilitate healing Answer: c Feedback: It is extremely important to have proper procedure to minimize any chance of infection in a burn patient. This include the use of aseptic technique to prevent infection associated with the damaged skin. The burn should obviously not be open to air and should be covered at all times with cream and sterile dressing.

The patient should be educated to watch for allergic reactions to two common medications used to treat burn: silver sulfadiazine (Silvadene) and mafenide (Sulfamylon). While enzymatic debriding agents can be used for the chemical debridement of dead tissue, it cannot facilitate healing.

9. Which of the following is an antibacterial cream used topically to treat impetigo? a. lindane b. Bactroban c. Mycostatin d. Monistat Answer: a Feedback: Bactroban is the only antibacterial agent among the answer choices.

Mycostatin and Monistat are both antifungal agents. Lindane is a neurotoxin that can be used to treat head lice.

10. Patients with mild acne would most likely be treated with: a. Benzoyl peroxide b. Tetracycline c. Systemic hormones d. Isotretinoin Answer: a Feedback: Patients with mild acne may choose from several nonprescription topical preparations such as benzoyl peroxide. Isotretinoin is for management of severe acne. Tetracycline is an antibiotic that can be used for acne. Systemic hormones should not be used for treatment of a topical skin condition. [return to top]

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7

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 13: Autonomic Nervous System Drugs

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 13: Autonomic Nervous System Drugs

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 13: Autonomic Nervous System Drugs

Case Study Answers Case Study A ANS Drugs Maria Sanchez is a 47-year-old woman who has a severe allergy to shrimp. While at a small social gathering with her husband, she inadvertently ingested some shrimp that was diced into pieces so small she did not notice them in her salad. She begins to experience signs of a severe reaction to the shrimp such as throat tightening and lip and eyelid swelling.

1. Which medication would be used as the first-line treatment for her symptoms? a. Levophed b. Neo-Synephrine c. Adrenalin d. Isuprel Answer: c Feedback: Adrenalin is the trade name for epinephrine, which is the drug of choice for patient with severe allergic reaction, such as those described in the case. Isuprel is the trade name for isoproterenol, which is useful for patients with heart block or ventricular arrhythmias. Levophed is the trade name for norepinephrine, which is useful for patients with hypotension. Neo-Synephrine is the trade name for phenylephrine, which is useful for patients with nasal congestion.

2. When a patient is given an adrenergic medication, which action does the medication have on the ANS? a. It mimics a sympathetic response b. It blocks a sympathetic response c. It mimics a parasympathetic response. d. It blocks a parasympathetic response Answer: a Feedback: Drugs that mimic the action of the sympathetic nervous system are known as sympathomimetic, which means they stimulate (and hence mimic) , and NOT block, a sympathetic response. On the other hand, drugs that mimic the action of the parasympathetic nervous system are known as parasympathomimetic drugs.

3. The EpiPen delivers an adrenergic medication, which has a primary effect of a. constriction of the pupils b. bronchodilation c. peripheral vasodilation d. cardiac relaxation Answer: b

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 13: Autonomic Nervous System Drugs

Feedback: EpiPen delivers epinephrine, which is a sympathomimetic agent that mimic or stimulate, the action of the sympathetic nervous system. Activation of the sympathetic nervous system will cause among different physiologic responses, bronchodilation, peripheral vasoconstriction, cardiac contraction, and dilation of the pupil.

4. A side effect that Maria may experience after the EpiPen injection is a. bradycardia b. palpitations c. migraine headache d. cardiac relaxation Answer: b Feedback: EpiPen delivers epinephrine, which is a sympathomimetic agent that mimic or stimulate, the action of the sympathetic nervous system. Activation of the sympathetic nervous system will cause tachycardia (increased heart rate or palpitation), bronchodilation, peripheral vasoconstriction, and cardiac muscle contraction.

5. Which part of the ANS helps the body to be ready for emergencies? a. parasympathetic b. parasympatholytic c. cholinergic d. sympathetic Answer: d Feedback: Activation of the sympathetic nervous system prepares a person for emergencies (the flight and fight syndrome), which means the sympathetic part of the ANS is involved. Parasympathetic, parasympatholytic, and cholinergic are terms that relate to the parasympathetic part of the ANS. Case Study B Cholinergic Blockers Jeb Cranshaw is enjoying a Caribbean cruise on his honeymoon. However, on the second day of the cruise, he starts to feel queasy and seasick. His nausea is so bad he tells his wife he wants to get off the ship at the next port. His wife suggests that he visit the ship’s clinic first for treatment.

1. Which type of drug will most likely be prescribed by the ship’s physician? a. beta-blocker b. antihistamine c. cholinergic d. anticholinergic

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 13: Autonomic Nervous System Drugs

Answer: d Feedback: Cholinergic blockers, or anticholinergics, are also known as parasympatholytics as they inhibit the action of the parasympathetic nervous system. A common formulation of anticholinergics is scopolamine transdermal patch to treat or prevent seasickness by decreasing gastric secretions and motility, as well as the occurrence of nausea and vomiting.

2. Scopolamine is prescribed for Mr. Cranshaw. This medication will most likely be delivered by which route? a. IM b. IV c. patch d. PO Answer: c Feedback: Scopolamine is commonly prescribed in the form of a transdermal patch (see feedback for question 1 above.

3. When educating Mr. Cranshaw about scopolamine, the ship’s physician will tell him that he may experience a. nausea b. dry mouth c. sweating d. slower heart rate Answer: b Feedback: By blocking the activation of the parasympathetic nervous system, scopolamine decreases body section, including those from the salivary gland and sweat gland, with the resultant sensation of dry mouth. Other anticholinergic effects include slowing down of GI motility, increased heart rate, and reduced secretions of the pharynx, bronchi, and GI tract.

4. Mr. Cranshaw’s wife is reading up on the general classification of the drug that he is taking and learns that one of these medications reduces the incidence of laryngospasm that can occur with general anesthesia. What is this medication? a. glycopyrrolate b. norepinephrine c. ephedrine d. atropine Answer: d Feedback: When used as preoperative medications, anticholinergics are useful to prevent cholinergic effects occurring during surgery, such as secretions of the

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 13: Autonomic Nervous System Drugs

mouth, hypotension, bradycardia, and laryngospasm associated with general anesthetics. Even though both glycopyrrolate and atropine are anticholinergic agents, atropine also has bronchodilating effect and is the only drug that can reduce the incidence of laryngospasm that can occur during general anesthesia. Both norepinephrine and ephedrine cause bronchoconstriction.

5. Mr. Cranshaw’s wife learns that which medication is often given preoperatively to reduce the secretions of the mouth and pharynx?? a. Robinul b. Isopto Homatropine c. Levophed d. Urecholine Answer: a Feedback: Robinul is the trade name for glycopyrrolate and is commonly used as preoperative medication to reduce the secretions of the mouth, pharynx, bronchi, and GI tract and reduce gastric activity, all of which would be beneficial during surgery (see feedback for question 4 above). Although Isopto Homatropine is an anticholinergic agent, it is primarily used to dilate the pupil of the eye. Urecholine is the trade name for bethanechol, which is a cholinergic agent. Levophed (norepinephrine) will activate the sympathetic nervous system. [return to top]

Chapter Review Quiz Match the type of drug (a. Adrenergic, b. Adrenergic blocker, c. Cholinergic, d.

Anticholinergic) with the action. Each type of drug may be used more than once Action 1. Increased muscle strength 2. Drying secretions 3. Increases blood pressure 4. Increases peristalsis 5. Lowers intraocular pressure 6. Antispasmodic 7. Bronchodilator 8. Lowers blood pressure 9. Constricts pupils 10. Antiarrhythmic

ANS Drugs Answer c. Cholinergic d. Anticholinergic a. Adrenergic c. Cholinergic c. Cholinergic d. Anticholinergic a. Adrenergic and d. Anticholinergic b. Adrenergic blocker c. Cholinergic b. Adrenergic blocker and d. Anticholinergic

Match the type of drug (a. Adrenergic, b. Adrenergic blocker, c. Cholinergic, d.

Anticholinergic) with possible side effects. Each type of drug may be used more than once.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 13: Autonomic Nervous System Drugs

Side effects 11. Bronchospasm 12. Hyperglycemia 13. Diarrhea 14. Flushing 15. Lethargy 16. Hypoglycemia 17. Constipation 18. Nervousness 19. Cognitive impairment

ANS Drugs Answer b. Adrenergic blocker, c. Cholinergic a. Adrenergic c. Cholinergic b. Adrenergic blocker c. Cholinergic b. Adrenergic blocker d. Anticholinergic a. Adrenergic d. Anticholinergic

20. A cholinergic drug should be used with extreme caution in a patient with a. benign prostatic hyperplasia (BPH) b. hepatic disease c. hypothyroidism d. renal disease Answer: a Feedback: Benign prostatic hyperplasia is a caution and even a contra-indication associated with the use of cholinergic agents, as they will stimulate cholinergic receptors on the smooth muscles of the urinary bladder, which is not desirable in a patient with enlarged prostate or benign prostatic hyperplasia. [return to top]

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6

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 14: Cardiovascular System Medications

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 14: Cardiovascular System Medications

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 14: Cardiovascular System Medications

Case Study Answers Case Study A Cardiovascular Drugs Isaac Doniego, a 77-year-old with heart failure, has been treated successfully with a combination of ACE inhibitors and diuretics. However, his symptoms worsened and became life threatening despite pharmacologic treatment, so he is hospitalized for evaluation and stabilization on a cardiac glycoside.

1. How will the cardiac glycoside act to lessen Isaac’s heart failure? a. by increasing his heart rate b. by increasing the force of cardiac contraction c. by increasing his oxygen utilization d. by suppressing possible cardiac arrhythmias Answer: b Feedback: Cardiac glycoside is a positive inotropic agent and hence increases the force of cardiac contraction.

A cardiac glycoside decreases a patient’s heart rate, does not change oxygen consumption or utilization. A cardiac glycoside also slows the ventricular rate in patients with atrial fibrillation. It does not suppress possible cardiac arrhythmias.

2. What type of cardiac glycoside is Isaac’s physician most likely to prescribe? a. synthetic adenosine b. lidocaine or a related drug c. digitalis product d. thiazide Answer: c Feedback: Digitalis products are cardiac glycosides that increase the force of cardiac contraction.

Both synthetic adenosine and lidocaine are antiarrhythmic drugs used for management of abnormalities in heart rate and/or cardiac conduction. Thiazide is a diuretic used to reduce edematous fluid in the body.

3. Isaac’s physician alerts him that cardiac glycosides should be avoided if he has which of the following conditions? a. hyperthyroidism b. hyperkalemia c. hypermagnesemia d. impaired renal function Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 14: Cardiovascular System Medications

Feedback: Digitalis products such as digoxin are primarily eliminated unchanged via the kidneys. Therefore, at least the dosage needs to be adjusted (lower dose and/or less frequent administration) to match the patient’s extent of renal impairment.

Hypokalemia, hypothyroidism, and hypomagnesemia all increases the risk of digitalis toxicity 4. Isaac should be advised to avoid certain medications because they can potentiate digoxin toxicity. Which of the following are in this category? a. cholestyramine, neomycin, and rifampin b. diuretics, calcium, and corticosteroids c. macrolides and antiarrhythmics d. adrenergics Answer: b Feedback: Thiazide and loop diuretics are commonly used in patients with cardiac failure and both can cause hypokalemia and potentiate digitalis toxicity (see feedback to question 3 above). Calcium increases the force of cardiac contraction and hence will add to the pharmacologic effect of digitalis. Corticosteroids use, especially long-term use, can cause sodium and water retention which indirectly counteract the beneficial effect of digitalis products in patients with heart failure.

All the other drugs mentioned as alternative answers are incorrect because they do not interact directly or indirectly with digitalis products.

5. If Isaac is experiencing digoxin toxicity, what should be administered as an antidote? a. There is no antidote; just discontinue digoxin b. Administer atropine c. Administer magnesium and calcium binders d. Administer digoxin-specific Fab fragments Answer: d Feedback: Digoxin-specific Fab fragments are specific antidote for patients with digoxin toxicity as they bind to digoxin molecules within the systemic circulation.

Atropine is used for patients with bradycardia. Magnesium and calcium binders will result in hypomagnesemia which enhance digitalis toxicity. Calcium binders do not reverse digitalis toxicity.

Case Study B Cardiovascular Drugs Dianna Whitfield, a 37-year-old African American woman, has been diagnosed with hypertension. Her physician discusses various options for pharmacologic treatment.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 14: Cardiovascular System Medications

1. Regardless of race or age, what class of drugs is most commonly prescribed as firstline therapy in patients with hypertension? a. thiazides b. beta-blockers c. ACE inhibitors d. calcium channel blockers Answer: a Feedback: Thiazide diuretics are usually the initial drug therapy for patients with hypertension, either as monotherapy of in combination with drugs from other classes of antihypertensive agents: ACE inhibitors, angiotensin receptor blockers, beta-blockers, or calcium channel blockers.

2. What antihypertensives are known to be more effective in African American individuals and older adults? a. thiazides b. angiotensin receptor blockers c. non-thiazide diuretics d. calcium channel blockers Answer: d Feedback: Based on literature data, calcium channel blockers are more effective in Blacks patients as well as older adults.

3. What antihypertensives are known to be less effective in African American individuals than in other groups? a. beta-adrenergic blockers b. antiadrenergics c. ACE inhibitors d. peripheral vasodilators Answer: c Feedback: In general, literature data indicate ACE inhibitors are more effective in younger and White populations and less effective in Black patients.

4. Dianna also has lupus. What class of antihypertensive should be avoided? a. beta-adrenergic blockers b. antiadrenergics c. ACE inhibitors d. thiazides Answer: d Feedback: One of the contraindications for using ACE inhibitors is collagen disease such as lupus-type syndrome and scleroderma.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 14: Cardiovascular System Medications

5. Suppose Dianna is pregnant and experiences preeclampsia. Under this circumstance, the antihypertensive of choice would likely be? a. chlorthalidone b. hydralazine c. losartan d. enalapril Answer: b Feedback: Drugs acting on the renin-angiotensin-aldosterone system (such as enalapril and losartan) are contra-indicated in pregnancy. Based on literature data, hydralazine is considered as the antihypertensive of choice during preeclampsia. [return to top]

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once Medications 1. Isosorbide 2. Zetia (= ezetimibe) 3. Lovenox (= enoxaparin) 4. Cardizem (= diltiazem) 5. Zocor (= simvastatin) 6. Plavix (clopidogrel) 7. Crestor (rosuvastatin) 8. Hydralazine 9. Quinidine 10. Procainamide

Conditions Answer c. Angina a. Elevated cholesterol d. Pulmonary emboli b. Angina, c. Hypertension, e. cardiac arrhythmia a. Elevated cholesterol f. Stroke prevention (platelet inhibitor) a. Elevated cholesterol b. Hypertension e. Cardiac arrhythmia e. Cardiac arrhythmia

11. About what percentage of adults in the United States are considered to have prehypertension? a. 27% b. 37% c. 47% d. 57% Answer: b Feedback: Literature data suggests that 37% of adults in the United States are considered to have prehypertension 12. Fibrillation refers to a. rapid heartbeat

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 14: Cardiovascular System Medications

b. irregular heartbeat c. slow heartbeat d. insufficient heartbeat Answer: b Feedback: Fibrillation means the heart is beating erratically or irregularly. Rapid heartbeat = tachycardia. Slow heartbeat = bradycardia. insufficient heartbeat = skipped heartbeat 13. Most drugs given to counteract arrhythmias have the potential for a. causing hypertensive crisis b. deranging calcium levels c. slowing the heart rate d. increasing glucose metabolism Answer: c Feedback: Most of the drugs given to counteract arrhythmias have the potential for lowering blood pressure and slowing heartbeat. Not all antiarrhythmic agents affect calcium. They do not change glucose metabolism.

14. Which of the following is especially important to monitor in patients receiving antiarrhythmic drugs? a. electrolytes b. glucose c. platelets d. lipids Answer: a Feedback: As the primary mechanism of action of most antiarrhythmic drugs is to interfere with movement of ions (e.g. potassium, sodium, and calcium) across cell membrane, electrolytes are the most important laboratory parameter to monitor in patients receiving antiarrhythmic drugs.

15. Which of the following has been widely accepted as the most effective treatment for patients with life-threatening ventricular tachycardia or fibrillation? a. insertion of an AICD b. amiodarone c. adenosine d. propranolol Answer: b Feedback: Based on literature data and clinical experience, amiodarone is the most effective antiarrhythmic agent for the treatment of refractory life-threatening

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 14: Cardiovascular System Medications

ventricular arrhythmias. Adenosine is primary used for arrhythmias within the atrioventricular node.

16. Inhibition of ACE lowers blood pressure by? a. decreasing cardiac output b. increasing cardiac output c. decreasing vasoconstriction d. increasing vasoconstriction Answer: c Feedback: The primary mechanism of action of ACE inhibitors is to decrease the production of angiotensin, a very potent vasoconstrictor. Therefore, the end result of ACE inhibition is vasodilation and lower blood pressure.

17. Side effects from beta-blockers are most common in a. patients of age 50 or younger b. patients receiving IV administration of the drug c. patients with preexisting arrhythmia d. patients who suffer from migraines Answer: b Feedback: Specific risk factors associated with adverse drug effects from the use of beta-blockers include patients over 60 years old and IV administration of the drug.

18. Which of the following beta-blockers is considered to be selective? a. metoprolol b. propranolol c. carvedilol d. labetalol Answer: a Feedback: Metoprolol is the only beta blockers among the given choices to be cardioselective, as it has a greater selectivity for the beta-1 receptors in the heart.

Propranolol blocks both beta-1 and beta-2 receptors. Both carvedilol and labetalol block alpha receptor in addition to beta receptors.

19. Coronary vasodilators are used for the a. treatment of hypotension b. reduction of intracranial pressure c. prevention of tachycardia and resulting syncope d. treatment of angina Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 14: Cardiovascular System Medications

Feedback: By increasing coronary blood flow, coronary vasodilators are primary used to restore balance between myocardial oxygen demand and supply, and is primarily used for treatment of angina. They do not have direct therapeutic usefulness for treatment of hypotension, reduction of intracranial pressure, or prevention of tachycardia and resulting syncope 20. What antilipemic agent class is most commonly used to treat hyperlipidemia? a. statins b. nicotinic acid derivatives c. bile acid sequestrants d. omega-3 fish oils Answer: a Feedback: By inhibiting the rate-limiting step of cholesterol synthesis, statins are the most effective and therefore the most commonly used to treat hyperlipidemia.

Both nicotinic acid derivatives and bile acid sequestrants are considered adjunctive therapy with statins. Omega-3 fish oils are primary sold over the counter to manage high triglyceride level.

21. Increased risk of new-onset diabetes mellitus is most associated with high doses of a. statins b. cardiac glycosides c. calcium channel blockers d. bile acid sequestrants Answer: None of the above Feedback: Statins and bile acid sequestrants do not affect glucose level. Among the drugs used to manage hyperlipidemia, niacin is the one associated with higher risk of hyperglycemia.

22. Which drug is least effective in reducing the mortality associated with heart failure? a. metoprolol succinate b. atenolol c. bisoprolol d. carvedilol Answer: b Feedback: Bisoprolol, carvedilol, and metoprolol are all approved by the Food and Drug Administration for management of patients with heart failure as they have clinical data showing positive impact on survival.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 14: Cardiovascular System Medications

23. What is one purpose of international normalized ratio (INR) monitoring? a. to monitor warfarin therapy b. to monitor kidney function for persons on antilipemics c. to determine the need for pharmacologic treatment of angina d. to determine the effectiveness of antihypertensives Answer: a Feedback: Warfarin is a narrow therapeutic index drug that requires monitoring of laboratory test to assess its efficacy as an anticoagulant. The specific test is prothrombin time, which is currently evaluated and reported as an international normalized ratio (INR).

24. How are low-molecular-weight heparins usually administered? a. orally b. sublingually c. subcutaneously d. as a skin patch Answer: c Feedback: Heparin and low-molecular-weight heparin products are not absorbed from the GI tract, and are usually administered by subcutaneously but can be given intravenously as well.

25. What is an advantage of the new oral anticoagulants? a. slow onset for long-term therapy b. fewer food and drug interactions c. ability to monitor with standard laboratory equipment d. availability of numerous reversal agents Answer: b Feedback: The commonly used warfarin is a narrow therapeutic index drug and its effectiveness can be significantly affected by the amount of dietary intake of vitamin K (warfarin is a vitamin K antagonist) and drug-drug interactions. Both of these limitations have been significantly reduced with the newer oral anticoagulants [return to top]

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 15: Urinary System Drugs

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 15: Urinary System Drugs

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 15: Urinary System Drugs

Case Study Answers Case Study A Urinary System Drugs Ernesto Poligio, a 68-year-old, is admitted to the hospital with shortness of breath, swollen ankles, and fatigue. His diagnosis is pulmonary edema.

1. Ernesto’s physician prescribes a loop diuretic, which acts directly on what part of the kidney? a. nephrons b. Bowman’s capsule c. renal pelvis d. loop of Henle Answer: d Feedback: In patients with heart failure, a loop diuretic is usually used for management of congestive symptoms such as pulmonary edema. The loop diuretics inhibit water reabsorption at the ascending loop of Henle.

2. The primary action of loop diuretics is to a. increase the excretion of water, sodium, chloride, and potassium b. inhibit H2O reabsorption back into the bloodstream c. reduce peripheral vascular resistance d. decrease fluid retention by promoting the excretion of uric acid Answer: b Feedback: A loop diuretic eliminates edematous fluid by decreasing urinary reabsorption of sodium and chloride, and thereby inhibiting water reabsorption, at the ascending loop of Henle of the nephron.

They do not reduce fluid retention by promoting the excretion of uric acid. The primary mechanism of thiazide diuretic as an antihypertensive agent is to reduce peripheral vascular resistance.

3. A potential side effect of a loop diuretic is a. hypokalemia b. hypertension c. hyperkalemia d. renal colic Answer: a Feedback: The most common and important side effect of a loop diuretic is hypokalemia, as a result of increased urinary excretion of potassium at the ascending loop of Henle of the nephron.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 15: Urinary System Drugs

It does not cause hyperkalemia or renal colic. Although loop diuretic is not commonly used as an antihypertensive agent, reducing fluid volume would likely result in decreased blood pressure.

4. The nurse is preparing Mr. Ernesto for discharge and instructs him on how to take his daily medication. One important point to include is to a. get 4 h of sunshine a day b. take medications at bedtime c. avoid eating bananas d. rise slowly from a reclining position Answer: d Feedback: The diuretic reduces blood volume and therefore could potentially cause orthostatic hypotension if the patient rises from a supine or reclining position too fast.

The patient should not take the medication at night because of the need to get up to urinate, especially with the risk of orthostatic hypotension mentioned above. The patient should eat bananas as that is a source of potassium and hypokalemia is a common side effect of a loop diuretic. The loop diuretic does not cause photosensitivity.

5. The nurse also makes sure that she reviews potential interactions with other medications and advises Mr. Ernesto to avoid a. NSAIDs b. diphenhydramine c. digoxin d. anticonvulsants Answer: c Feedback: Hypokalemia is a common side effect of a loop diuretic, and therefore the patient should avoid digoxin as much as possible because hypokalemia enhances digoxin toxicity.

Case Study B Urinary System Drugs Betty Weinstein is visiting her OB/GYN for her 6-week postpartum checkup. She complains of burning, pain, and discomfort upon urination. Her physician prescribes a urinary analgesic to help relieve these symptoms.

1. The physician explains to Betty that urinary analgesics are given for a short time to alleviate symptoms associated with a. incontinence b. nocturia

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 15: Urinary System Drugs

c. cystitis d. prostatic hyperplasia Answer: c Feedback: Urinary analgesics such as phenazopyridine are used for a short time to relieve burning, pain, discomfort, and urgency associated with cystitis (bladder inflammation). Urinary incontinence and nocturia are common complaints in patients with prostatic hyperplasia.

2. After giving Betty the prescription, the physician explains that the medication phenazopyridine can change the color of Betty’s urine. What color might her urine be on this medication? a. deep yellow b. pink-tinged c. pale yellow d. orange-red Answer: d Feedback: Phenazopyridine produces a characteristic discoloration of bodily fluids, including orange-red urine, which may stain fabric; causes discoloration of contact lenses.

3. The physician also educates Betty on possible side effects of phenazopyridine, which include a. vertigo b. fatigue c. palpitations d. nasal congestion Answer: a Feedback: A side effect of phenazopyridine is vertigo. Other common side effects include headache and GI disturbances.

4. Prior to prescribing the medication, the physician reviews Betty’s chart to make sure she does not have a cautionary condition. Patients with what condition would need to avoid phenazopyridine? a. cardiovascular disease b. BPH c. impaired kidney function d. asthma Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 15: Urinary System Drugs

Feedback: One of the precautions for using phenazopyridine is impaired kidney function. Depending on the extent or severity of the impairment, phenazopyridine needs to be used with caution or avoided.

5. The physician also prescribes an antibiotic to be taken along with the phenazopyridine. Because of this, she explains to Betty that she should only take phenazopyridine for how many days? a. 2 b. 4 c. 6 d. 8 Answer: a Feedback: Phenazopyridine is used for a short time to relieve burning, pain, discomfort, and urgency associated with cystitis (bladder inflammation). It should not be taken for more than 2 days. [return to top]

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once Medications 1. Proscar (= finasteride) 2. probenecid 3. Hydrochlorothiazide 4. Ditropan XL (= oxybutynin) 5. Allopurinol 6. Lasix (furosemide) 7. Cardura (doxazosin) 8. Detrol (tolterodine) 9. Demadex (torsemide) 10. Microzid (hydrochlorothiazide)

Conditions Answer c. Benign prostatic hyperplasia (BPH) b. Gout e. Edema d. Incontinence b. Gout a. Congestive heart failure, e. Edema c. Benign prostatic hyperplasia (BPH) d. Incontinence a. Congestive heart failure, e. Edema e. Edema

11. Which medication is used prophylactically at low doses to prevent recurrent attacks of gout? a. Naprosyn b. ibuprofen c. indomethacin d. colchicine Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 15: Urinary System Drugs

Feedback: Naprosyn, ibuprofen, and indomethacin are all non-steroidal antiinflammatory drugs. Only colchicine is used to treat gout.

12. What type of intake is suggested for a patient on probenecid to prevent kidney stones and renal colic? a. low sodium b. large volume of fluids c. low potassium d. acidic fluids Answer: b Feedback: Kidney stones and renal colic could occur in a patient taking probenecid if he or she does not take adequate amount of fluids.

13. Which instruction should be given to a patient taking allopurinol? a. Eat purine-rich foods b. Avoid alcohol c. Take medication with meals d. Expect a slight rash Answer: c Feedback: Patients taking allopurinol should avoid alcohol to minimize increases in serum urate concentrations.

14. In treating BPH, a patient taking Flomax might experience which side effect? a. hypertension b. dizziness c. palpitations d. hyperglycemia Answer: b Feedback: Flomax is the trade name for tamsulosin, an alpha-1 receptor blocker that blocks such receptors in smooth muscle of the bladder neck and prostate, causing them to relax. Its use is associated with orthostatic hypotension, dizziness, headache. Tamsulosin specifically does not cause palpitations 15. What is a symptom or condition that is characterized by having to urinate more than eight times in 24 h? a. nocturia b. frequency c. urgency d. incontinence Answer: b

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 15: Urinary System Drugs

Feedback: Urinary frequency is defined as having to urinate more than eight times in 24 hours whereas urinary urgency means the sudden need to urinate.

16. Which of the following is the most uncommon medication used to treat a UTI? Macrobid a. phenazopyridine b. Bactrim DS c. oxybutynin Answer: d Feedback: Oxybutynin is an antispasmodic used to decrease bladder tone and suppress bladder, resulting in decreased incontinence contractions in patients with neurogenic bladder. Macrobid is the trade name for nitrofurantoin, a urinary tract anti-infective agent. Bactrim DS is a combination antibiotic commonly used to treat UTI, and phenazopyridine is a urinary analgesic.

17. In which area of the renal system do loop diuretics primarily function? a. loop of Henle b. collecting duct c. distal tubule d. proximal tubule Answer: a Feedback: The loop diuretics inhibit water reabsorption at the ascending loop of Henle.

Thiazide diuretic works at the distal tubule. Potassium sparing diuretics work at the collecting duct, and acetazolamide works at the proximal tubule.

18. Which diuretic would be considered potassium sparing? a. hydrochlorothiazide b. furosemide c. spironolactone d. bumetanide Answer: c Feedback: Thiazide diuretic such as hydrochlorothiazide and loop diuretics such as furosemide and bumetanide cause hypokalemia.

19. Using the renal system as an example, what is true regarding the flow of water across a permeable barrier? a. Water will flow in the direction that contains less sodium b. Water will flow in the direction that contains a hypotonic solution c. Water flow is not affected by sodium concentration d. Water will flow in the direction that contains a hypertonic solution

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 15: Urinary System Drugs

Answer: d Feedback: When two solutions are separated by a permeable barrier, water will cross the permeable barrier in the direction of the higher salt (electrolyte) concentration. So, water will flow in the direction that contains more sodium, or in another word, water will flow in the direction of a hypertonic. Solution.

20. Patients with gout can be initiated on allopurinol therapy during an active gout attack. a. True b. False Answer: b Feedback: If xanthine oxidase inhibitor such as allopurinol is initiated during an acute gout attack, it can make the attack worse [return to top]

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Chapter 16: Gastrointestinal Drugs

Solution and Answer Guide Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Chapter 16: Gastrointestinal Drugs

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Chapter 16: Gastrointestinal Drugs

Case Study Answers Case Study A Gastrointestinal Drugs Derek Washington, a 42-year-old, has called his physician’s office to discuss an issue with the nurse. He has had diarrhea for the past 24 h and would like a recommendation for a medication to relieve this condition. He does not have a fever, abdominal pain, cramping, or other symptoms.

1. The advice nurse suggests that Derek take some Pepto-Bismol, following the medication’s label dosages. Which side effect may occur if he takes an amount over the recommended dosage a. dehydration b. dehydration c. hypoglycemia d. black discoloration of the tongue and stool Answer: d Feedback: The anti-diarrheal agent Pepto-Bismol can cause discoloration of the tongue and stool (black).

Pepto-Bismol is usually relatively safe. However, the most common side effects are constipation and discoloration of the tongue and stool, typically black in color.

2. The advice nurse also checks with Derek to see what other medications he is currently taking. The nurse explains that Derek should be cautious with which of the following when taking Pepto-Bismol a. iron b. docusate sodium c. warfarin d. ibuprofen Answer: c Feedback: Pepto-Bismol can increase the pharmacologic response to warfarin Pepto-Bismol contains bismuth subsalicylate. The antiplatelet effect of salicylate derivative can cause bleeding, therefore, enhancing the pharmacologic response to warfarin, and result in increased bleeding.

3. Which type of diet will the nurse recommend for Derek while he is taking PeptoBismol? a. a full-liquid diet b. a diet high in roughage c. a bland diet

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Chapter 16: Gastrointestinal Drugs

d. a diet that avoids foods with natural pectin Answer: c Feedback: Patients treated with bismuth subsalicylate should eat a bland diet Patients treated with bismuth subsalicylate should eat a diet of bland nature, as well as foods containing natural pectin but exclude roughage (which in general aids passage of substance through the gut). They should also ensure adequate fluid.

4. The nurse also inquires about Derek’s history of allergies to medication. PeptoBismol should be avoided in patients who are allergic to which drug? a. penicillin b. salicylates c. naproxen sodium d. glucocorticoids Answer: b Feedback: Pepto-Bismol should be avoided in patients with history of allergy to salicylate.

Pepto-Bismol contains bismuth subsalicylate. Therefore, patients who are allergic to salicylate should avoid the product.

5. The nurse recommends that Derek take Pepto-Bismol for no longer than? a. 48 h b. 72 h c. 96 h d. 1 week Answer: a Feedback: Patients should not self-medicate with Pepto-Bismol for longer than 48 hours.

Pepto-Bismol contains bismuth subsalicylate. Therefore, they should not be taking the product for longer than 48 h to avoid potential salicylate toxicity.

Case Study B Gastrointestinal Drugs Helen Hoffmann is taking a bus trip to New York City with a group of friends. She is anxious about the trip because she often experiences motion sickness, so she consults with her physician. In the past she has experienced nausea and vomiting on long road trips and while on boats.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Chapter 16: Gastrointestinal Drugs

1. Helen’s physician suggests a medication to help prevent nausea and vomiting.

Which medication will she be most likely to recommend? a. diphenhydramine b. meclizine c. promethazine d. prochlorperazine Answer: b Feedback: Meclizine is effective in the prevention of nausea and vomiting, Motion sickness is mediated by activation of cholinergic and histamine receptors.

The antihistamine meclizine is effective in preventing nausea and vomiting, and/or vertigo associated with motion sickness, such as a cruise or riding in a car or bus. It causes less drowsiness than the other antihistamine diphenhydramine.

Promethazine and prochlorperazine are dopamine receptor antagonists.

2. After further discussion, the physician thinks that Helen would experience less motion sickness with a Transderm-Scop patch. To which area of the body is this patch applied? a. on the inner wrist b. on the upper arm c. behind the ear d. on the anterior abdomen Answer: c Feedback: Transderm-Scop patch is applied behind the ear.

Transderm-Scop contains the anticholinergic agent scopolamine. For greatest effectiveness in preventing motion sickness, scopolamine is applied as TransdermScop patch behind the ear, preferably at 4 hours before anticipated exposure to motion stimulus.

3. How many hours prior to her bus trip should Helen apply the Transderm-Scop patch to prevent motion sickness? a. 1 h b. 2 h c. 4 h d. 8 h Answer: c Feedback: Transderm-Scop patch should be applied at 4 hours before anticipated exposure to motion stimulus.

For maximum effectiveness to prevent motion sickness, the Transderm-Scop patch should be applied at 4 hour before anticipated exposure to motion stimulus.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Chapter 16: Gastrointestinal Drugs

4. The physician discusses other options for motion sickness treatment as well. Which medication can be given by IM injection to a patient who already has motion sickness? a. dimenhydrinate b. diphenhydramine c. Nexium d. meclizine Answer: a Feedback: Dimenhydrinate is available as an injectable product for intramuscular administration.

For treatment of motion sickness that has already developed, both dimenhydrinate and scopolamine are effective when given as an intramuscular injection 5. Which additional instruction regarding the Transderm-Scop patch should the physician give to Helen prior to her bus trip? a. The patch will be effective for 24 h b. The patch may cause excitability 4 c. Do not cut the patch prior to application d. The patch will work only for motion sickness caused by bus travel Answer: c Feedback: Transderm-Scop patch should not be cut in any way prior to application.

The Transderm-Scop patch is a special formulation designed to release scopolamine at a constant rate over a specific time period. Cutting the patch would destroy that formulation characteristic. When applied to the inner ear, the patch is effective for 72 hours for patients who suffer from motion sickness related to car or bus travel as well as cruise or boat. It can cause drowsiness but not excitation [return to top]

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once Medications 1.

2.

3.

4.

5.

6.

Nexium (= esomeprazole) Linzess (= linaclotide) Rowasa (= mesalamine) calcium carbonate Prevacid (= lansoprazole Transderm-Scop (scopolamine)

Conditions Answer c. heartburn g. Inflammatory bowel disease g. Inflammatory bowel disease a. Diarrhea c. heartburn h. Motion sickness

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Chapter 16: Gastrointestinal Drugs

7. Dulcolax (= bisacodyl) 8. simethicone 9. Imodium (= loperamice) 10. Phenergan (= promethazine)

f. Constipation b. Flatulence a. Diarrhea e. Nausea and vomiting

11. With antacids, which of the following applies to administration? a. before meals b. 2 h from other medications c. with Tagamet d. with milk Answer: b Feedback: Antacid should be taken separately by 2 hours from other drug administrations.

Antacids can affect absorption of other concurrently administered drugs, and therefore needs to be taken separately by 2 hours from other drug administrations, including Tagamet. Antacids will complex with calcium within the milk.

12. What is a frequent side effect of calcium carbonate antacids? a. diarrhea b. fluid retention c. constipation d. palpitations Answer: c Feedback: Calcium can cause constipation.

Use of calcium-containing antacids such as calcium carbonate is associated with constipation. On the other hand, magnesium- containing antacids cause diarrhea.

Fluid retention and palpitations are not common side effects of antacids.

13. A patient taking an antispasmodic may experience which side effect?? a. urinary retention s b. diarrhea c. restlessness d. excitability Answer: a Feedback: Antispasmodics have anticholinergic properties. Therefore, their use is associated with anticholinergic side effects such as dry mouth, blurred vision, palpitation, constipation, and urinary retention. Diarrhea is associated with drugs having cholinergic activities. Restlessness and excitability are not common side effects of antispasmodics.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Chapter 16: Gastrointestinal Drugs

14. Clostridium difficile infection is primarily caused by a. yeast overgrowth in the colon b. intermittent use of H2 blocker therapy c. eradication of native intestinal flora by antibiotics or another source d. prolonged use of probiotics Answer: c Feedback: Clostridium difficile infection is a bacterial infection resulting from elimination or disruption of normal intestinal flora associated with antibiotic.

15. When a patient complains of constipation, what is the first action that should be taken? a. administer an osmotic laxative b. obtain an abdominal X-ray c. administer a bisacodyl tablet with milk d. identify the cause of the constipation Answer: d Feedback: The first step in managing constipation is identify and treat the underlying cause. Most of the time fluid therapy should be instituted before using any laxative (for example, osmotic laxative, Bisacodyl), as their use could lead to laxative abuse.

16. An interaction of an antiemetic drug with another category of drug can result in a potentiation of a sedative effect. What is the second category of drug? a. antiarrythmics b. antidopaminergics c. muscle relaxant d. antacids Answer: c Feedback: Among the choices provided, only muscle relaxants have been associated with sedation. Therefore, their concurrent use could potentiate the sedative effect of the antiemetic drug.

17. For patients who experience constipation directly resulting from opioid use, a new medication that may help them is a. Movantik b. Scopalamine c. Amitiza d. Dulcolax Answer: a

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Chapter 16: Gastrointestinal Drugs

Feedback: Movantik is the trade name for naloxegol, a peripheral opioid receptor antagonist that opposes the effect of opioids in the gut.

Opioid stimulate peripheral opioid receptor, resulting in constipation. Therefore, the use of a peripheral opioid receptor antagonist such as naloxegol would reverse the constipating effect. Scopalamine is primary used for motion sickness and vertigo. Dulcolax is a stool softener useful for managing constipation but has less direct pharmacologic effect on opioid-associated constipation. Amitiza is the trade name for lubiprostone, a calcium channel activator that helps manage constipation in and also has less direct pharmacologic effect on reversing opioid-associated constipation.

18. For patients who experience IBD that presents with severe constipation, which of the following medications can be considered? a. Linzess b. pantoprazole c. Amitiza d. bisacodyl Answer: a Feedback: Linzess is the trade name of linaclotide, which is indicated for treating irritable bowel syndrome (IBD) with severe constipation. Pantoprazole is proton pump inhibitor for managing patient with peptic ulcer disease. Amitiza is the trade name for lubiprostone, a calcium channel activate that help manage constipation.

Bisacodyl is a stimulant laxative that produces strong peristaltic activity and usually reserved when rapid, thorough emptying the bowel (e.g. before sigmoidoscopic examination) is necessary/ 19. Which of the following statements is true? a. PPIs have a longer duration of action than H2 antagonists because they bind reversibly b. PPIs have a longer duration of action than H2 antagonists because they bind irreversibly c. H2 antagonists have a longer duration of action than PPIs because they bind reversibly d. H2 antagonists have a longer duration of action than PPIs because they bind irreversibly Answer: b Feedback: PPIs have a longer duration of action than H2 antagonists because they bind irreversibly to the proton pump, and serves as the gate keeper to prevent gastric acid secretion. The antagonistic action of H2 antagonists are reversible.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Chapter 16: Gastrointestinal Drugs

20. Which of the following is not a use for misoprostol? a. prevent NSAID-induced ulcers b. terminate pregnancy c. induce early labor in pregnant women d. taken in combination with ibuprofen to protect the stomach (Duexis) Answer: d Feedback: Misoprostol is commonly used during pregnancy to induce labor or terminate pregnancy. It also protect the GI mucosa from the irritant effect of certain drugs, such as NSAIDs. Prophylactically, it is approved to prevent NSAID-induced ulcers. Duexis is the trade name for a combination product comprising of ibuprofen and He blocker and not misoprostol. [return to top]

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 17: Respiratory System Drugs and Antihistamines

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 17: Respiratory System Drugs and Antihistamines

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 17: Respiratory System Drugs and Antihistamines

Case Study Answers Case Study A Respiratory Medications Thirty-four-year-old Rohan Jackson has had asthma for 4 years. During his annual physical, he explains that he uses his rescue inhaler more than once a day every day of the week. The physician performs a physical exam with a focus on Rohan’s respiratory system and reviews his plan of care, including his medications.

1. The physician decides to start Rohan on a new medication, montelukast. She explains that this medication works by a. controlling the inflammatory process caused by leukotrienes b. producing an antihistamine effect c. suppressing the cough associated with asthma d. liquefying pulmonary secretions and thus promoting increased air flow Answer: a Feedback: Montelukast is a leukotriene receptor antagonist and “oppose” the effect of the inflammatory mediator leukotrienes, thereby helping to prevent asthma symptoms and acute attacks. Unlike antihistamine, it does not oppose the biological effect of histamine. It also does not affect cough or pulmonary secretions.

2. When starting montelukast, Rohan should be prepared for which potential side effect? a. flushing of face and hands b. dry cough c. headache d. tinnitus Answer: c Feedback: Headache is a minor side effect associated with some medications.

However, it occurs at a much higher incidence with the leukotriene receptor antagonists and thus patients receiving this class of agent need to be educated about this side effect.

3. One advantage of montelukast over other asthma medications is that it a. can be used as monotherapy or as an add-on therapy b. has no drug interactions c. can be taken during pregnancy and breast-feeding d. can be used as a rescue drug Answer: a

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 17: Respiratory System Drugs and Antihistamines

Feedback: The leukotriene receptor antagonist can be used as monotherapy or as add-on therapy in patients whose persistent mild to moderate asthma and with insufficient control with inhaled corticosteroids. They do have the potential of drug interactions with other medications, although the incidence is less with montelukast. Although montelukast can be used in children as young as 2 years old, caution should be exercised with its use during pregnancy or lactation. It is primarily used for asthma prophylaxis and should not be used as a rescue drug.

4. Montelukast belongs to which category of drugs? a. asthma rescue b. asthma curative c. asthma prophylaxis d. asthma acute exacerbation Answer: c Feedback: Montelukast is used for asthma prophylaxis and should not be used as a rescue drug or for controlling acute exacerbation. It is also not curative for the medical condition.

5. What is a side effect of montelukast that Rohan should promptly report to his physician? a. throat irritation b. suicidal ideation c. fatigue d. double vision Answer: b Feedback: Among the side effects of montelukast, the most concerning would be the development of behavior or mood changes, sleep disturbances, and suicidal ideation. These signs and symptoms, should be reported to the physician as soon as possible.

Case Study B Respiratory Medications During a visit to an urgent care clinic, 38-year-old Mariella Sanchez is diagnosed with a severe sinus infection. The nurse practitioner prescribes an antibiotic and an oral decongestant.

1. A decongestant’s primary action in opening nasal passages is to a. reduce nasal irritation b. anesthetize receptors in nasal passages c. thicken bronchial secretions d. constrict blood vessels in the respiratory tract

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 17: Respiratory System Drugs and Antihistamines

Answer: d Feedback: Decongestants such as phenylephrine and pseudo-ephedrine are adrenergic drugs and as such cause vasoconstriction within the respiratory tract, resulting in the shrinkage of swollen mucous membranes and helping to open nasal airway passages.

2. A potential systemic side effect of a decongestant is a. bradycardia b. hypertension c. sedation d. hypotension Answer: b Feedback: Decongestants such as phenylephrine and pseudo-ephedrine are adrenergic drugs and as such will cause effect that mimics activation of sympathetic system. Therefore, increased blood pressure and heart rate would be expected effect of these adrenergic drugs.

3. Prior to prescribing the decongestant, the nurse practitioner carefully reviews Mariella’s chart because decongestants are contraindicated in individuals with a. pregnancy b. depression c. asthma d. multiple sclerosis Answer: a Feedback: Adrenergic drugs such as phenylephrine and pseudo-ephedrine should be at least used with caution during pregnancy or lactation.

4. To avoid the potential complications of rebound congestion, Mariella is cautioned to take the oral decongestant for no more than? a. 3 days b. 7 days c. 10 days d. 30 days Answer: b Feedback: Adrenergic drugs such as phenylephrine and pseudo-ephedrine should be on a short-term basis (3 days for nasal or 7 days for oral) to avoid the occurrence of rebound congestion.

5. When Mariella goes to the pharmacy, how will she be able to purchase the decongestant pseudoephedrine? a. OTC

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 17: Respiratory System Drugs and Antihistamines

b. by prescription only c. from the pharmacist behind the counter d. only in combination with an antihistamine Answer: c Feedback: Psuedoephedrine can now be sold only in limited quantities under special conditions (behind the counter) by pharmacies. This action, as enacted by the Combat Methamphetamine Epidemic Act of 2005, is to attempt limiting its sale in large quantities. [return to top]

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once Medications 1. Allegra (= fexofenadine) 2. Commit (= nicotine) 3. guaifenesin 4. Xopenex (= levalbuterol) 5. Spiriva (= tiotropium) 6. Tessalon (benzonatate) 7. cromolyn sodium 8. Accolate (= zafirlukast) 9. Zyban (= bupropion) 10. Nexafed (= Pseudoephedrine)

Conditions Answer e. Allergies f. Smoking cessation h. Congestion c. Asthma (adrenergic) a. Bronchospasm (anticholinergic) g. Bronchitis (unproductive cough) d. Asthma (prophylactic) d. Asthma (prophylactic) f. Smoking cessation h. Congestion

11. Which of following is not a consideration or concern when using oxygen therapy? hypoventilation a. danger of fire b. blindness (in premature infants) c. can only be administered via nasal cannula Answer: d Feedback: Oxygen may be administered by endotracheal intubation, nasal cannula, various masks, tents, or hoods. On the other hand, side effects of oxygen therapy include, but are not limited to hypoventilation (particularly with COPD; may cause CO2 retention and acidosis), blindness (in premature infants), and danger of fire when used (even though oxygen by itself is not flammable but it does support combustion.)

12. What is the first-line therapy for noninfectious rhinitis?

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 17: Respiratory System Drugs and Antihistamines

a. b. c. d.

nasal corticosteroids oral corticosteroids aqueous preparations aerosol preparations

Answer: a Feedback: Nasal corticosteroids are increasingly considered first-line therapy for most noninfectious rhinitis and should be started before symptoms occur and taken regularly throughout the period of exposure. Aerosol corticosteroid preparations seem to be more irritating (burning, sneezing) to the nasal mucosa. Aqueous preparations may drip into the throat, resulting in reduced deposition of drug in the nasal mucosa.

13. A potential side effect of inhaled corticosteroids is? a. staining of teeth b. throat irritation c. canker sores d. excessive salivation Answer: b Feedback: Although corticosteroids administered by inhalation have fewer systemic side effects than oral and parenteral administration such as intravenously, they do cause dry mouth and throat irritation, as well as increased chance of infection such as fungal infection within the oral cavity.

14. When educating a patient prior to initiating an inhaled corticosteroid, which instruction is most important? a. Expect an increased susceptibility to influenza. b. Use only half of one dose if experiencing dry mouth. c. Exhale immediately after inhaling the dose. d. Rinse your mouth with water or mouthwash after administration.

Answer: d Feedback: To reduce the possibility of fungal infection, patients should be counseled to rinse their mouth out with water after use and to not swallow medication. The rinsing could also minimize irritation of the esophageal passage.

15. What is an appropriate instruction for patients taking second-generation antihistamines? a. Take OTC medications as needed—no restrictions. b. Take laxatives in conjunction with the antihistamine to avoid constipation. c. Use caution when driving or operating machinery. d. Expect palpitations that will resolve over time.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 17: Respiratory System Drugs and Antihistamines

Answer: c Feedback: Although the second-generation antihistamines cause little or no sedation, they are not completely sedation-free. Therefore, patients should use caution with driving or operating machinery until they know how these drugs affect them.

16. How should bronchodilators be administered in conjunction with corticosteroids? a. administer the bronchodilator immediately before the corticosteroid b. administer the corticosteroid immediately before the bronchodilator c. administer the medications 4 h apart d. administer the medications 2 h apart Answer: a Feedback: Since inhaled corticosteroids are not used as acute bronchospasm treatment, the bronchodilator should be administered first to open the airway for adequate delivery of the corticosteroids.

17. A mucolytic is contraindicated in patients a. with pharyngitis b. with swollen lymph nodes c. taking oral steroids d. with a depressed gag reflex Answer: d Feedback: A mucolytic is contraindicated in patients with a depressed gag reflex as the resultant liquefied pulmonary secretions could occlude the airway if the patient is unable to adequately clear the secretions.

18. What cough medication is frequently used for cough because it does not depress respirations? a. dextromethorphan b. codeine c. guaifenesin d. mometasone Answer: a Feedback: Cough suppressants are divided into narcotic preparations such as codeine and hydrocodone and non-narcotic preparations such as dextromethorphan. Dextromethorphan is used more frequently by patients because it does not depress respirations, does not cause dependence, and has few side effects than narcotic cough preparations.

19. What side effect is most likely to occur with large doses of antitussives? a. urinary retention

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 17: Respiratory System Drugs and Antihistamines

b. constipation c. respiratory depression d. nausea Answer: c Feedback: Respiratory depression is most likely to occur with large doses of narcotic antitussives. See answer and feedback to question 18 as well.

20. Antitussives frequently contain controlled substances that are not available OTC. Which of the following medicines does not contain a controlled substance and is available OTC? a. Hyromet b. Delsym c. Tussionex d. Cheratussin AC Answer: b Feedback: Delsym is the trade name for dextromethorphan, a non-narcotic antitussive and not a controlled substance. Hydromet is the trade name for hydrocodone with homatropine. Tussionex is the trade name for hydrocodone with chlorpheniramine, and Cheratussin AC is the trade name for codeine with guaifenesin. Both codeine and hydrocodone are narcotic antitussives.

21. Cough and cold medications containing antihistamines are appropriate only when the cause of the cough is a. asthma b. allergic rhinitis c. emphysema d. smoking Answer: b Feedback: Combination of cough and cold formulations should be used only if the corresponding symptom is present. Therefore, such combination formulations containing antihistamines should be used when the cause of the cough is allergic rhinitis.

22. Nicorette would be an appropriate treatment for an individual with which condition? a. arrhythmia b. dentures c. pregnancy d. a smoker with COPD Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 17: Respiratory System Drugs and Antihistamines

Feedback: Nicotine replacement products such as Nicorette enable the smoker to focus on breaking the social habits of nicotine and participating in a behavior modification program for smoking cessation without battling the withdrawal symptoms at the same time. Side effects of Nicorette include cardiac irritability, dental problems that might be exacerbated by chewing gum, e.g. wearing dentures, and should be used at least cautiously during pregnancy.

23. Individuals taking first-generation antihistamines can expect anticholinergic side effects such as a. hypertension b. drying of secretions c. tearing of the eyes d. bradycardia Answer: b Feedback: One of the anticholinergic side effects of drugs with anticholinergic properties (such as the first generation antihistamines) is drying of body secretions, especially of the eyes, ears, nose, and throat, as well as producing the sensation of dry mouth. Other examples of anticholinergic side effects include tachycardia and hypotension.

24. If a patient currently using nicotine patches to quit smoking asks if he can use anything for breakthrough cravings, which of the following would be the appropriate response? a. b. c. d.

Yes, you can use nicotine gum, lozenges, or an inhaler for cravings.

Yes there is, but only if you are having cravings more than 10 times per day.

For safety reasons, you should never use two nicotine products concurrently.

No there isn’t, because although you can use two nicotine products at the same time, it would be a waste of money to use both.

Answer: a Feedback: The most effective method of using nicotine replacement products is for patients to use one long-acting nicotine replacement method (e.g., patch) and one “rescue” nicotine replacement method (e.g., gum) for breakthrough cravings.

25. Which of the following can be used to treat an acute bronchospasm? a. SABAs b. LABAs c. inhaled corticosteroids d. cholinergics Answer: a

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 17: Respiratory System Drugs and Antihistamines

Feedback: The only effective agent in treating acute bronchospasm is a short-acting beta-2 agonists (SABA) which open up the airway. Long-acting beta-2 agonists (LABA) and inhaled corticosteroids are both used for prophylaxis. A cholinergic agent actually stimulates the muscarinic receptor on the bronchioles, resulting in bronchoconstriction. [return to top]

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10

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 18: Eye and Ear Medications

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 18: Eye and Ear Medications

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 18: Eye and Ear Medications

Case Study Answers Case Study A Eye Medications Leena Shah is a 62-year-old female who has been experiencing a gradual loss of vision. She has recently been diagnosed with chronic (open-angle) glaucoma.

1. The ophthalmologist explains to Leena that glaucoma is a condition that results from a. bleeding into the aqueous humor space b. obstruction of the outflow of the aqueous humor c. hyperpigmentation of the aqueous humor d. dehydration of the aqueous humor Answer: b Feedback: Glaucoma is caused by excessive intraocular pressure due to obstruction of the outflow of aqueous humor.

2. The primary action of drugs for glaucoma is to a. increase intraocular pressure b. decrease intraocular pressure c. decrease external ocular pressure d. increase external ocular pressure Answer: b Feedback: Since glaucoma is caused by excessive intraocular pressure, the primary action of drugs for glaucoma is to decrease intraocular pressure.

3. The physician is preparing to write Leena a prescription for glaucoma treatment.

She explains that the treatment will a. be short term (1–3 months) b. be intermittent c. continue for 6–12 months d. continue for her lifetime Answer: d Feedback: The patient has chronic (open-angle) glaucoma and the vision damage cannot be reversed. Therefore, she would need to continue glaucoma treatment for her lifetime.

4. The physician determines that the best medication to treat Leena is a carbonic anhydrase inhibitor, which acts by a. decreasing the formation of aqueous humor b. increasing blood flow to the aqueous humor space

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 18: Eye and Ear Medications

c. reducing aqueous humor inflammation d. decreasing blood flow to the aqueous humor space Answer: a Feedback: A carbonic anhydrase inhibitor reduce the formation of aqueous humor and hence would help in reducing the intraocular pressure.

5. Leena’s physician starts her on acetazolamide at a low dose but explains that she may need to increase her dose. If her dose is increased, Leena may experience which side effect? a. hyperactivity b. urinary tract infection c. taste alteration d. urinary retention Answer: c Feedback: Some of the dose-related side effects of carbonic anhydrase inhibitor include thirst, taste alteration, and frequent urination.

Case Study B Eye Medications Pia Ramirez is a 33-year-old female tennis player. She has been hit in the eye with a tennis ball and is experiencing severe pain.

1. Which medication would most likely be given to Pia to act as a local ophthalmic anesthetic a. tetracaine b. atropine c. cyclopentolate d. phenylephrine Answer: a Feedback: Tetracaine is a local ophthalmic anesthetic and is usually applied topically to the eye for painful injury, removal of foreign bodies, or before minor surgical and diagnostic procedures.

2. The physician applies a local ophthalmic anesthetic. What side effect may Pia experience? a. twitching of the eyelid b. anaphylaxis c. flushing of the eye’s blood vessels d. profound itching Answer: b

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3

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 18: Eye and Ear Medications

Feedback: Side effects of local anesthetics may include hypersensitivity (transient stinging) reactions such as anaphylaxis in those allergic to local anesthetics with the ester functional group in their chemical structure.

3. After being administered Alcaine, the nurse should instruct Pia to a. store the medication at room temperature b. remain upright for 2 h c. massage the eye every 4 h d. wear an eye patch Answer: d Feedback: Alcaine is the trade name for proparacaine, and Pia should be instructed to wear an eye patch after administration of the local ophthalmic anesthetic, since she will experience a loss of the blink reflex. She should also avoid touching or rubbing the eye until the anesthesia has worn off, and store product in refrigerator.

4. What will the nurse instruct Pia to do after self-administering eye drops? a. blink rapidly b. pull down her lower eye lid to let the excess medication drain out c. apply pressure to her eyelid d. close the eye gently so as not to squeeze the medication out Answer: d Feedback: To ensure maximal effect from the eye drop, Pia should close the eye gently so as not to squeeze the medication out, and use a tissue to gently blot extra medication coming out of the eye.

5. Pia is cautioned to follow up with her physician if the pain continues. This is because prolonged use of an ophthalmic anesthetic can cause which complication a. retinal detachment b. cataract formation c. corneal erosion d. conjunctival bleeding Answer: c Feedback: Local ophthalmic anesthetic is intended for short-term use to minimize side effects. Prolonged use also could result in corneal erosions, delayed wound healing, and keratitis. [return to top]

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 18: Eye and Ear Medications

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once Medications 1. Cosopt (= timolol 0.5% with dorzolamide 2%) 2. Acular (= ketorolac) 3. tetracaine 4. atropine 5. prednisolone 6. pilocarpine 7. Timoptic (= timolol) 8. Diamox Sequels (= acetazolamide) 9. Travatan Z (= travoprost) 10. phenylephrine

Conditions Answer b. Glaucoma d. Postoperative inflammation e. Eye injury pain a. To dilate pupils d. Postoperative inflammation b. Glaucoma b. Glaucoma b. Glaucoma b. Glaucoma a. To dilate pupils

11. The purpose of an ophthalmic decongestant medication is a. to block histamine receptors b. blood vessel vasoconstriction c. to block the tear duct d. blood vessel vasodilation Answer: b Feedback: Ophthalmic decongestant causes vasoconstriction of blood vessels, and provide relief from minor eye irritation and redness.

12. What is the best form of ophthalmic medication for adults? a. gel b. ointment c. drops d. medicated patch Answer: c Feedback: Ophthalmic drops are preferred in adults and administration during the day.

13. When administering more than one ophthalmic medication at a time, the minimum amount of time desired between the medications is a. 5 min b. 15 min c. 30 min d. 1 h

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 18: Eye and Ear Medications

Answer: a Feedback: Patient should be instructed that if they need to use two different ophthalmic medications, then they need to wait for 5 min after the first medication before putting another ophthalmic medication into the same eye.

14. Which category of drug may exacerbate glaucoma? a. anticoagulant b. anti-inflammatory c. antihypertensive d. anticholinergic Answer: d Feedback: Several groups of drugs, including potent corticosteroids, anticholinergics, and antihistamines, can exacerbate glaucoma.

15. Which medication is used at the end of an eye exam to constrict the pupil? a. timolol b. atropine c. pilocarpine d. brimondidine Answer: c Feedback: Pilocarpine is used after ophthalmic examinations in glaucoma patients to constrict the pupil and counteract the mydriatic (pupil-dilating) effects of other medications.

16. What should patients using OTC ear drops for pain relief be told? a. Only use the drops for short-term relief until you can be seen by a doctor. b. Use the drops for as long as it takes to resolve the pain. c. OTC otic drops can resolve a minor ear infection. d. There is no specific patient counseling.

Answer: a Feedback: Patients using OTC homeopathic ear drops should be instructed to use them only as temporary relief until they can be seen by a doctor.

17. Patients who have earwax build-up should be instructed to a. do nothing it will resolve on its own b. attempt to remove it with a cotton swab c. use an antibiotic drop from a past ear infection d. use Debrox OTC Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 18: Eye and Ear Medications

Feedback: Earwax build-up usually occur from the patient attempting to remove the earwax with a cotton swab or other object that results in the earwax being pushed deeper into the ear canal. On the other hand, an OTC medication such as Debrox (carbamide peroxide) can be used to soften, loosen, and remove the excessive earwax.

18. You can use otic drops in the eyes, but you cannot use ophthalmic drops in the ears. a. True b. False Answer: b Feedback: It is common practice to substitute an ophthalmic preparation (of the same active ingredient and concentration) if the pharmacy does not have the otic preparation in stock or it is not commercially available, if the otic preparation is not covered under the patient’s insurance, or if the patient does not have insurance (ophthalmic preparations are generally less expensive). In these cases, the patient should be counseled that even though the bottle is labelled “ophthalmic,” it is intended for “otic” use.

On the other hand, although patients can use ophthalmic drops in the ears, they cannot use otic drops in the eyes. This is because all ophthalmic drops must be formulated with a pH that is acceptable for use in the eyes (around 7.4), whereas otic drops are not pH balanced or buffered. If an otic preparation were to be used in the eye, extreme burning and irritation would occur. [return to top]

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 19: Central Nervous System Drugs: Analgesics, Sedatives, and Hypnotics

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 19: Central Nervous System Drugs: Analgesics, Sedatives, and Hypnotics

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 19: Central Nervous System Drugs: Analgesics, Sedatives, and Hypnotics

Case Study Answers Case Study A Analgesics Seventy-two-year-old Maureen O’Malley is in the recovery room after just having undergone a right total hip replacement for severe arthritis. In addition to arthritis, she has a history of stomach/duodenal ulcers, high cholesterol, and gout.

1. The recovery room nurse will administer which category of medication first to relieve Maureen’s pain? a. hypnotic b. sedative c. analgesic d. anti-inflammatory Answer: c Feedback: Analgesics are medications given to relieve pain in patients 2. After administering an opioid analgesic, the nurse should observe Maureen for which side effect? a. constipation b. respiratory depression c. abdominal pain d. hypoglycemia Answer: b Feedback: While opioid analgesic can cause different side effects, the most dangerous is respiratory depression, although the risk can be reduced with appropriate titration of the opioid analgesic dose.

3. The best method to assess Maureen’s response to the analgesic is to observe a. her facial expression b. her respiratory rate c. the rating of her pain on a pain scale d. the ability to open her eyes Answer: c Feedback: Health care professionals can assess a patient’s pain by asking the patient to describe the pain and its location, and assess a patient’s pain by assessing the pain’s severity with a validated pain assessment scale either based on a range of 1–10, or use symbolic facial expressions to show level of pain.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 19: Central Nervous System Drugs: Analgesics, Sedatives, and Hypnotics

4. Due to her history, which nonopioid analgesic should be avoided in Maureen? a. NSAIDs b. lidocaine patch c. acetaminophen d. muscle relaxants Answer: d Feedback: Muscle relaxants can cause CNS depression and thus potentiate the effect of opioid analgesic.

5. The nurse administering an opioid to Maureen will use extreme caution if she has a history of a. arthritis b. allergy to penicillin c. COPD d. cataracts Answer: c Feedback: Due to its propensity to cause respiratory depression, opioid analgesics should be administered with extreme caution if patient has a history of COPD or asthma.

Case Study B Hypnotics Sanjay Rudip is 43 years old and has been experiencing insomnia for the past 6 weeks. At his annual physical, Sanjay reports to his physician that he saw a commercial for Lunesta (eszopiclone) and wants to know if this medication is right for him. Sanjay’s medical history includes mild cluster headaches that are relieved with acetaminophen. Sanjay works as a computer technician and spends most of his day seated in front of screens. Usually when he comes home he takes a 1-h nap and then drinks a coffee afterward so he can have energy to play with his young children. He generally showers before bedtime and reads a book for 15–30 min before turning off the light. He states he generally takes a long time to fall asleep and wakes up four to five times each night.

1. The physician explains to Sanjay that hypnotic medications should not be used for extended amounts of time except under close medical supervision. What is the primary reason for this? a. loss of functioning due to an inability to stay awake during the day b. an increase in REM sleep as a withdrawal symptom c. risk of cardiac arrest d. physical and psychological dependence

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 19: Central Nervous System Drugs: Analgesics, Sedatives, and Hypnotics

Answer: d Feedback: Hypnotic medications should not be used for extended time period without close medical supervision because of the potential for psychological and physical dependence. In addition, these medications depress the rapid eye movement (REM), or dream phase of sleep, and withdrawal after prolonged use can result in a severe rebound effect with occurrence of nightmares and hallucinations.

2. Eszopiclone falls into which category of sedatives or hypnotics? a. nonbenzodiazepine b. benzodiazepine c. melatonic receptor agonist d. antihistamine Answer: a Feedback: Eszopiclone is classified as a nonbenzodiazepine sedatives or hypnotics and has a rapid onset of effect.

3. The physician informs Sanjay that before starting hypnotics, there are nonpharmacological ways to help with insomnia. Based on Sanjay’s daily habits, what should he change to help promote healthy sleep? a. He should not read before bed. b. He should only shower in the morning. c. He should try to avoid daytime naps and caffeine intake late in the day. d. He should not change anything; nonpharmacological methods are not effective when used alone, but need to be combined with a hypnotic.

Answer: c Feedback: Non-drug interventions to combat insomnia include exercising during the day; avoiding daytime naps; avoiding heavy meals and stimulant-type medications near bedtime; and taking advantage of warm milk, back rubs, soft music, relaxation techniques, and other calming influences.

4. The physician warns Sanjay that when taking a hypnotic, he may develop tolerance.

What does this mean? a. The body will release its own analgesia. b. A larger dose will be required over time to achieve the same effect. c. Sanjay will experience a lower pain threshold in the future. d. Relief from pain will be as a result of a suggestion without the actual administration of a medication.

Answer: b

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 19: Central Nervous System Drugs: Analgesics, Sedatives, and Hypnotics

Feedback: Drug tolerance is a pharmacological phenomenon that develops with some medications and requires a higher dose to achieve the same pharmacological effect associated with the previous lower dose.

5. Sanjay returns a month later stating the nonpharmacological methods have helped him fall asleep more easily but not stay asleep. What should the physician ask Sanjay about his sleep hygiene routine? a. Do you drink water before going to bed? b. Do you have vivid dreams that wake you up? c. Do you sleep with a humidifier near your bed? d. Do you drink alcohol before bedtime?

Answer: d Feedback: In addition to the non-pharmacological means identified in feedback to question #3 in this patient case, patients should also avoid caffeine and alcohol use near bedtime. [return to top]

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once 1.

2.

3.

4.

Medications amitripytline Vicodin (hydrocodone/acetaminophen) Imitrex (Sumatriptan) Methadone

5. Belsomra (suvorexant) 6. Duragesic (Fentanyl) 7. dronabinol 8. codeine 9. Narcan 10. Tegretol

Conditions Answer d. Tricyclic antidepressant (adjuvant) e. Opioid analgesic with acetaminophen h. Antimigraine (triptan) i. Opioid analgesic and narcotic withdrawal c. Orexin antagonist j. Transdermal analgesic for chronic pain f. Nonopioid analgesic (cannabinoid) a. Antitussive b. Opioid antagonist g. Anticonvulsant (adjuvant analgesic)

11. Which medication is used to treat opiate-induced respiratory depression? a. butorphanol b. naloxone c. ethadone d. oxycodone

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 19: Central Nervous System Drugs: Analgesics, Sedatives, and Hypnotics

Answer: b Feedback: The opioid antagonist naloxone is a “reversal agent” used in the treatment of opioid overdoses and in the operating room, delivery room, and newborn nursery for opiate-induced respiratory depression.

12. Nonopioid analgesics like topical lidocaine (in some strengths), acetaminophen, and NSAIDs are commonly obtained by which method? a. from a pharmacist b. over the counter c. with a prescription d. from a mail-order company Answer: c Feedback: Most nonopioid analgesics, including topical lidocaine (in some strengths), acetaminophen, and NSAIDs, are available without a prescription as over-the-counter medications.

13. What is a convenient aspect of topical lidocaine patches? a. They dissolve in water, so they are safe to flush down the toilet. b. They have a special adhesive that can be applied to both hairless and hairy areas. c. They can be cut to the shape and size needed. d. They do not expire Answer: c Feedback: Lidocaine patches can be cut into smaller custom-sized pieces and make it very convenient to cover exactly the area that they need to be treated.

14. Which group of medications would be useful in treating pain described as “sharp,” “shooting,” “shock-like,” or “lightning-like”? a. anticonvulsants like gabapentin b. opioids like oxycodone c. hypnotics like zolpidem d. tricyclic antidepressants like amitriptyline Answer: a Feedback: Anticonvulsants such as carbamazepine and gabapentin are commonly used for the management of nerve pain associated with neuralgia, herpes zoster (shingles), and cancer. Such therapy is implemented when the 15. Which of the following is not true for ramelteon and drugs in the same class? a. They activate the melatonin receptors. b. They should be taken within 30 min of going to bed with a high-fat meal or snack.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 19: Central Nervous System Drugs: Analgesics, Sedatives, and Hypnotics

c. They are contraindicated with fluvoxamine. d. They are controlled substances.

Answer: d Feedback: Ramelteon and drugs in the same class are prescription medications but are not controlled substances. [return to top]

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 20: Psychotropic Medications, Alcohol, Drug Abuse, and Withdrawal Treatment

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 20: Psychotropic Medications, Alcohol, Drug Abuse, and Withdrawal Treatment

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 20: Psychotropic Medications, Alcohol, Drug Abuse, and Withdrawal Treatment

Case Study Answers Case Study A Psychotropic Drugs Kevin McClellan is a 19-year-old college student who, by his roommate’s accounts, has been displaying “odd” behavior. The roommate convinces Kevin to visit the student health center with him and reports to the nurse that Kevin has had periods of “wild activity” alternating with periods of staying in bed for days at a time. The most recent example is that Kevin went to a high-end clothing store and maxed out his parent’s credit card, then shortly thereafter didn’t show up to any social events or classes for multiple days. The nurse reviews Kevin’s records and finds that he has a history of bipolar disorder.

1. What is the drug of choice to treat patients with bipolar disorder? a. Buspirone b. Chlorpromazine c. Alprazolam d. Lithium Answer: d Feedback: Lithium salts are approved for the treatment of mania and the treatment and prophylaxis of bipolar disorder. It is the only mood stabilizer that has lowered the suicide rate in bipolar patients.

2. Patients on lithium should be monitored for correct dosing by which method? a. Observation of patient’s behavior b. Serum lithium levels c. Patient reporting of his or her own behavior d. EKG every 3 months Answer: b Feedback: The therapeutic response and toxicity of lithium are related to the amount of lithium in the body. Therefore, serum lithium levels must be monitored in lithium-treated patients..

3. Side effects of lithium can include: a. Hypotension b. Hypertension c. Weight loss d. Hyperthyroidism Answer: a

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 20: Psychotropic Medications, Alcohol, Drug Abuse, and Withdrawal Treatment

Feedback: Some of the side effects of lithium include cardiac arrhythmias and hypotension, weight gain, and hypothyroidism.

4. While reviewing Kevin’s chart, the nurse notes that he had visited the health center during the prior school year with complaints of photophobia. This indicates which complication? a. Retinal detachment b. Potential seizure activity c. Lithium toxicity d. Dehydration Answer: c Feedback: Signs of lithium toxicity can include drowsiness, confusion, blurred vision, photophobia, as well as tremors, muscle weakness, seizures, coma, and cardiovascular collapse.

5. All patients should be cautioned when taking lithium with which category of medications? a. Anticholesterol b. Angiotensin-converting enzyme (ACE) inhibitors c. Anticoagulants d. Sulfonylureas Answer: b Feedback: Another reason to monitoring lithium concentrations is its high potential of interaction with other drugs, including CNS drugs, most antidepressants, diuretics, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, and sodium salts.

Case Study B Psychotropic Drugs Jose Aquilar is a 33-year-old marine who has just completed a 6-month tour of duty in Afghanistan. He was honorably discharged for health reasons after his unit was ambushed and many of the soldiers in his unit did not make it. He has been home for over 4 weeks and is experiencing signs of posttraumatic stress disorder. He is on no medications and has no allergies to medication.

1. Jose has asked his personal physician for a medication to help him cope as he assimilates back into his daily life. What type of drug would the physician be most likely to prescribe to Jose for short-term use? a. Antipsychotic b. Anxiolytic c. Tranquilizer d. Antimanic

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 20: Psychotropic Medications, Alcohol, Drug Abuse, and Withdrawal Treatment

Answer: b Feedback: Posttraumatic stress disorder is an example of anxiety disorders, and an anxiolytic agent would be helpful in its management.

2. The physician warns Jose that when taking a minor anxiolytic, he may develop drug dependence. What does this likely mean for Jose? a. He will need larger doses over time to achieve the same effect. b. He will associate the drug with incidents from his tour of duty. c. He will find it difficult to make it through the day without the drug. d. He will rely on the drug during any emotional conflict.

Answer: a Feedback: The pharmacological phenomenon of tolerance means that patients who experience tolerance over time would need a higher dose to achieve the same therapeutic effect.

3. The physician also explains that sudden withdrawal after prolonged use of an anxiolytic may result in which symptom? a. Development of tics and other TDs b. Somnolence, lethargy, and depression c. Seizures, agitation, psychosis, insomnia, and gastric distress d. Blurred vision and dry eyes and mouth Answer: c Feedback: One of the pharmacological consequences of prolonged use of an anxiolytic is that sudden withdrawal, either due to missed dose or discontinuation, might result in occurrence of seizures, agitation, psychosis, insomnia, and gastric distress.

4. Side effects of benzodiazepines may include: a. Akathisia b. Neuritis c. Dystonia d. Ataxia Answer: d Feedback: Side effects of benzodiazepines are many and may include ataxia and tremor, drowsiness, lethargy, and headache.

5. Physicians should use extreme caution when prescribing a benzodiazepine to a patient with a history of all of the following EXCEPT: a. Suicidal tendencies b. History of substance abuse c. Pregnancy and lactation d. Type II diabetes

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 20: Psychotropic Medications, Alcohol, Drug Abuse, and Withdrawal Treatment

Answer: a Feedback: History of substance abuse, suicidal tendencies, pregnancy and lactation are all patient-related conditions that require extreme caution when prescribing a benzodiazepine. [return to top]

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once Medications 1. Xanax (= alprazolam) 2. lithium 3. Risperdal (= risperidone) 4. amitriptyline 5. Prozac (= olanzapine) 6. Adderall (= amphetamine) 7. Buspar (= buspirone) 8. Zyprexa (= ziprasidone) 9. Ativan (= lorazepam) 10. Wellbutrin (= bupropion)

Conditions Answer b. Anxiolytic e. Antimanic a. Antipsychotic c. Antidepressant a. Antipsychotic d. CNS stimulant b. Anxiolytic a. Antipsychotic b. Anxiolytic c. Antidepressant

11. Close monitoring of a pediatric patient taking a CNS stimulant for ADHD is necessary to assess for: a. Temporary suppression of growth pattern b. Alopecia c. Weight gain d. Hypotension Answer: a Feedback: Prolonged administration of CNS stimulants to children with ADHD has been reported to cause at least a temporary suppression of normal weight and/or height patterns in some patients. Therefore, close monitoring is required. Growth rebound has been observed after discontinuation, and attainment of normal adult weight and height does not appear to be compromised.

12. A side effect of a selective norepinephrine reuptake inhibitor (SNRI) for ADHD is: a. Growth retardation b. Insomnia c. Increased potential for abuse d. Increased risk of suicidal tendencies in children and adolescents Answer: d

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5

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 20: Psychotropic Medications, Alcohol, Drug Abuse, and Withdrawal Treatment

Feedback: Among the side effects of selective norepinephrine reuptake inhibitor, the one of most concern would be the increased risk of suicidal tendencies in children and adolescents.

13. With depression, there may be a shortage of what substance in the brain? a. Glucose b. Dopamine c. Potassium d. Monoamine oxidase Answer: b Feedback: Neurotransmitters are substances such as dopamine, serotonin, or norepinephrine are substances that travel across the synapse (contact point between two neurons) to transmit messages between nerve cells. In depression, there may be a shortage of some of these neurotransmitters..

14. A common side effect of a tricyclic is: a. Weight loss b. Urinary frequency c. Mouth dryness d. Diarrhea Answer: c Feedback: Anticholinergic activity of a tricyclic antidepressant is responsible for many of its side effects. One of the anticholinergic effects is dry mouth.

15. MAOIs can interact with some drugs as well as food and herbal supplements. These interactions can cause which side effect? a. Hypoglycemia b. Hypertensive crisis c. Seizures d. Hyponatremia Answer: b Feedback: The biggest concern from drug interactions with MAOIs is hypertensive crisis, which can be fatal. MAOIs administration should only occur at least two weeks after discontinuance of these interacting drugs.

16. Tardive dyskinesia is characterized by which of the following? a. Muscle laxity b. Spasticity c. Tremors d. Involuntary, repetitive, and purposeless movements Answer: d

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6

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 20: Psychotropic Medications, Alcohol, Drug Abuse, and Withdrawal Treatment

Feedback: Tardive dyskinesia (involuntary, repetitive, and purposeless body movements) is one of the extrapyramidal side effects commonly associated with dopamine depletion within the brain.

17. What is not a treatment for acute or chronic alcoholism?

Vitamin B1 (thiamine) IV, IM, or PO; multiple vitamins; and folic acid a. Bupropion (Wellbutrin) b. Naltrexone (ReVia) c. Disulfiram (Antabuse) Answer: d Feedback: Disulfiram is used as part of a behavioral modification therapy for patients suffering from acute or chronic alcoholism.

18. A serious side effect of cocaine is: a. Paranoia b. Cardiac/respiratory failure c. Flashbacks d. Panic attacks Answer: b Feedback: Cocaine is an illegal drug that is highly addictive, causing dependence after even short-term use. Serious side effects of cocaine are many and include hypertension, chest pain, tachycardia, cardiac arrhythmias, stroke, and cardiac/respiratory failure.

19. The drug nicknamed the date-rape drug because of its ability to induce amnesia is called: a. Rohypnol b. Lysergic acid c. Fluticasone d. Phencyclidine Answer: a Feedback: Flunitrazepam (Rohypnol) is a potent benzodiazepine that is not approved for use in the USA. On the other hand, It has been used here as a recreational drug and is also referred to as the date-rape drug because of its ability to induce amnesia, preventing the victim from recalling specific events while under the influence of the drug.

20. Jared, a health care provider, suspects that another health care provider is abusing drugs. What is the first step that Jared should take? a. Give the individual the benefit of the doubt and remain quiet. b. Report any observed drug use to the proper person in authority.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 20: Psychotropic Medications, Alcohol, Drug Abuse, and Withdrawal Treatment

c. Confront the individual and threaten to tell a person in authority. d. Provide the individual with an 800 number for drug treatment and counseling.

Answer: b Feedback: It is the responsibility of all medical personnel to not only recognize drug abuse but also to report any observed drug abuse to the proper person in authority. [return to top]

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8

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 21: Musculoskeletal and AntiInflammatory Drugs

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 21: Musculoskeletal and Anti-Inflammatory Drugs

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 21: Musculoskeletal and AntiInflammatory Drugs

Case Study Answers Case Study A Musculoskeletal Drugs Tavin Brown pulled a muscle in his back while helping his daughter move into her college dorm. He is now experiencing severe back spasms.

1. Tavin visits his primary care physician, who prescribes cyclobenzaprine, a skeletal muscle relaxant. He cautions Tavin that he might experience which side effect? a. Hypertension b. Euphoria c. Palpitations d. Insomnia Answer: b Feedback: Side effects of skeletal muscle relaxants such as cyclobenzaprine include CNS depressant effects. In addition, at high doses all muscle relaxants can exhibit euphoric effects.

2. Tavin’s physician also explains that this medication should be taken for which time frame? a. Intermittently as needed b. Short term c. Minimum of 6 months d. 1 year Answer: b Feedback: As a result of the dose-related euphoric effects which could lead to abuse, cyclobenzaprine should be used for short term only..

3. The physician reviews Tavin’s past medical history to determine if he has a condition that would require caution. What is an example of this type of condition? a. Past history of muscle strain b. Cataracts c. Impaired kidney function d. Past history of appendicitis Answer: c Feedback: Cautions or contraindications for skeletal muscle relaxants apply to different patient-related condition, including pregnancy or lactation, history of drug abuse, and impaired kidney function.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 21: Musculoskeletal and AntiInflammatory Drugs

4. After prescribing the medication to Tavin, the physician cautions him to be careful in taking other medications with this muscle relaxant. What is one category of medication that may cause a potentiated effect? a. Antiemetics b. Anticoagulants c. Anticholinergics d. Antihistamines Answer: c Feedback: Cyclobenzaprine is structurally similar to amitriptyline and possesses potent anticholinergic effects. Therefore, Interactions with potentiation of side effects occur with anticholinergics.

5. Tavin has been taking cyclobenzaprine for 2 days. He has experienced some relief from his back spasms, but now is complaining of a dry mouth. What action would the physician take after hearing about this symptom? a. Advise him to discontinue the medication immediately. b. Advise him to take an antihistamine, as he might be experiencing an allergic reaction. c. Explain that this is a common side effect. d. Inquire if he is experiencing urinary urgency.

Answer: c Feedback: Dry mouth is a sensation associated with the anticholinergic effect of cyclobenzaprine. It is usually of no major concern and is temporary in duration.

Case Study B Anti-Inflammatory Drugs Nahal Reddy has been experiencing pain in her right knee. After examination of the knee, her nurse practitioner (NP) recommends taking an NSAID. 1. The NP explains that the medication’s action is to reduce inflammation by: a. Increasing the synthesis of prostaglandins b. Inhibiting the synthesis of prostaglandins c. Reducing white blood cells in the affected joint d. Increasing blood flow to the affected joint Answer: b Feedback: NSAIDs inhibit the synthesis of prostaglandins, substances that produces much of the inflammation and pain of rheumatic conditions, sprains, and menstrual cramps.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 21: Musculoskeletal and AntiInflammatory Drugs

2. Which age group is particularly susceptible to side effects from NSAIDs? a. Young children b. Young adults c. Postmenopausal women d. Older adults Answer: d Feedback: Older adults or debilitated patients do not tolerate ulceration or bleeding commonly associated with use of NSAIDs, especially with prolonged therapy.

3. A frequent side effect of NSAIDs is: a. Diarrhea b. Urinary frequency c. Hypotension d. GI ulceration and bleeding Answer: d Feedback: GI ulceration and bleeding are common side effect associated with large doses and/or long-term use of NSAIDs. 4. In an effort to reduce the potential side effects while taking NSAIDs, the NP suggests that Nahal: a. Take the medication with a small sip of water b. Take the medication with meals c. Avoid enteric-coated capsules d. Take the medication on an empty stomach Answer: b Feedback: There are several means of reducing the GI upset associated with NSAIDs, and they include taking the medication with meals or milk, using entericcoated, timed-release capsules or buffered formulation of the medication.

5. Nahal expresses concern about taking medication, including the NSAID. What would be the most appropriate explanation from the NP regarding NSAIDs and the risk of cardiovascular disease? a. NSAIDs are not safe for heart patients. b. NSAIDs have a greater GI risk than cardiovascular risk. c. NSAIDs have no risk. d. NSAIDs can increase the risk of adverse events for individuals with a history of cardiovascular disease.

Answer: d Feedback: Both traditional NSAIDs and the COX-2 inhibitors can increase the risk of recurrent myocardial infarction or death in patients who have a history of or who

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 21: Musculoskeletal and AntiInflammatory Drugs

are at high risk for cardiovascular disease. Therefore, the benefits and risks in terms of pain relief and cardiovascular and GI safety must be weighed carefully for each individual. [return to top]

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once 1.

2.

3.

4.

5.

6.

7.

8.

9.

Medications Dantrolene Arthrotec (=diclofenac and misoprostol) Mobic (= meloxicam) Actonel (= Risedronic acid) Voltaren (= diclofenac) Flexeril (= cyclobenzaprine) Nabumetone (= buspirone) Evista (= raloxifene) Celebrex (= celecoxib)

Conditions Answer c. Muscle relaxant for multiple sclerosis a. Combination NSAID e. Partially selective NSAID b. Osteoporosis therapy f. Nonselective NSAID d. Muscle relaxant for acute muscle strain e. Partially selective NSAID b. Osteoporosis therapy g. COX-2 inhibitor

10. Patients with which respiratory condition may manifest a sensitivity to aspirin and other NSAIDs? a. Allergies b. Frequent upper respiratory infections c. Cystic fibrosis d. Asthma Answer: d Feedback: Patients with asthma may manifest sensitivity to aspirin and other NSAIDs. This is because the synthesis of prostaglandins are shut down, resulting in more production of leukotriene which cause broncho-constriction.

11. A patient taking an NSAID who develops ringing in the ears should be instructed to take which action? a. Discontinue the drug. b. Go immediately to the emergency department. c. Make an appointment with an audiologist. d. Reduce the dosage by half.

Answer: a Feedback: The patient should discontinue the drug and report to the physician about the ringing in the ears.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 21: Musculoskeletal and AntiInflammatory Drugs

12. The mechanism of action of bisphosphonates is to: a. Increase bone development b. Increase bone resorption c. Inhibit bone resorption d. Increase calcium deposition into the bone Answer: b Feedback: Bisphosphonates are nonhormonal agents that act directly to inhibit bone reabsorption, thereby increasing bone mineral density at the spine and hip, as well as decreasing the incidence of first and future fractures.

13. Which of the following is a selective estrogen receptor modifier? a. Alendronate b. Raloxifene c. Teriparatide d. Calcitonin-salmon Answer: b Feedback: Raloxifene is a selective estrogen receptor modifier with estrogen agonist activity on bone and lipids, and estrogen antagonist activity on breast and uterine tissue. These properties result in increased bone mineral density, decreased bone reabsorption, and reduced fracture risk without promoting breast or endometrial cancer.

14. What is a key point to review with a patient taking a bisphosphonate? a. Taking NSAIDs for discomfort b. Avoiding weight-bearing exercise c. Increasing caffeine consumption d. Sitting upright for 30–60 min after taking the drug Answer: d Feedback: Patients need to be educated about not lying down or eating or drinking anything else for at least 30–60 min. This cautionary step will help prevent reflux and avoid esophageal irritation.

15. Combining salicylates and alcohol increases the risk for: a. Anemia b. The possibility of GI bleed c. Reye’s syndrome d. The possibility of accelerated clotting time Answer: b Feedback: Interactions of NSAIDs, especially salicylates, are many, and include alcohol, which potentiates the possibility of GI bleeding.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 21: Musculoskeletal and AntiInflammatory Drugs

16. Unless otherwise directed by a physician, what is the maximum number of days that an OTC NSAID should be taken? a. 3 b. 7 c. 10 d. 14 Answer: c Feedback: The FDA has issued a warning regarding the over-the-counter nonselective NSAIDs: They should be used in strict accordance with label directions.

Therefore, self-treatment with an over-the-counter NSAID should not exceed 10 days, unless directed by a physician.

17. The muscle relaxant dantrolene is used to treat: a. Amyotrophic lateral sclerosis (ALS) b. Rheumatic disorders c. Post stroke contractures d. Spasticity associated with cerebral palsy Answer: d Feedback: Dantrolene is used in patients with multiple sclerosis and cerebral palsy.

By causing a direct effect on skeletal muscles, it is effective in the management of spasticity resulting from upper motor neuron disorders such as these two neurological disorders. On the other hand, it is ineffective for amyotrophic lateral sclerosis, and is also not used for those with trauma or rheumatic disorders.

18. Suppose NSAIDs are suggested as a treatment for a lengthy time period. How will they most likely be prescribed? a. Variable doses on consecutive days b. Alternate day dosing c. A dose as low as possible for effectiveness d. A 3-day drug holiday once a month Answer: c Feedback: NSAIDs can be given for lengthy time periods in maintenance doses as low as possible for effectiveness.

19. Which drug category may potentiate the possibility of bleeding when taking NSAIDs? a. Multivitamins. b. Antianxiety drugs c. Antihistamines d. Anticoagulants Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 21: Musculoskeletal and AntiInflammatory Drugs

Feedback: Since NSAIDs can cause bleeding, then they will interact with drugs that affect the clotting system, such as anticoagulants, resulting in potentiation of pharmacologic effects and increased bleeding risk.

20. Which medication for osteoporosis would be a poor choice in a patient who has stage III renal failure? a. Calcium and vitamin D supplementation b. Actonel c. Prolia d. Reclast Answer: d Feedback: zoledronic acid is the generic name for Reclast, and is the most potent bisphosphonate. However, before its use, patients should be checked for having proper renal function, and it should be monitored frequently. [return to top]

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8

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 22: Anticonvulsants, Antiparkinsonian Drugs, and Agents for Alzheimer’s Disease

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 22: Anticonvulsants, Antiparkinsonian Drugs, and Agents for Alzheimer’s Disease

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 22: Anticonvulsants, Antiparkinsonian Drugs, and Agents for Alzheimer’s Disease

Case Study Answers Case Study A Anticonvulsant Drugs While standing in line with a friend at a local coffee shop, 22-year-old Danielle Miller abruptly loses consciousness and falls to the ground. For the next 2 min, she experiences alternating contraction and relaxation of her extremities. Her friend instructs the coffee shop cashier to call 911 to report that a customer is having a seizure.

1. What type of seizure is Danielle experiencing? a. Atypical b. Generalized c. Febrile d. Partial Answer: b Feedback: Generalized seizures include tonic-clonic (formerly called grand mal) and absence (formerly called petit mal) seizures. Tonic-clonic seizures are characterized by an abrupt loss of consciousness and falling, with tonic extension of trunk and extremities (tonic phase), followed by alternating contraction and relaxation of the muscles (clonic phase).

2. After Danielle is treated in the ER and seen by a neurologist, she is prescribed carbamazepine. The nurse explains that she might experience what side effect from the drug? a. Hypernatremia b. Gingivitis c. Ataxia d. Headache Answer: c Feedback: Side effects of carbamazepine can include: ataxia, syncope (fainting), visual difficulties, and hyponatremia.

3. The nurse also cautions Danielle that carbamazepine has multiple interactions with other substances. Which of the following should Danielle avoid because it can potentiate the effect of carbamazepine? a. Rifampin b. Phenobarbital c. Green tea d. Grapefruit juice Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 22: Anticonvulsants, Antiparkinsonian Drugs, and Agents for Alzheimer’s Disease

Feedback: Carbamazepine interact with multiple drugs. In addition, grapefruit juice potentiates its action and can increase the risk of serious adverse. Therefore, this combination should be avoided.

4. Which category of drug can increase the levels of carbamazepine? a. Calcium channel blockers b. Antidiarrheals c. Anticoagulants d. Antacids Answer: a Feedback: Calcium channel blockers, cimetidine, macrolide antibiotics, azole antifungals, certain antipsychotics, protease inhibitors, valproic acid, and isoniazid can all increase levels of carbamazepine.

5. Danielle is concerned about her quality of daily life while taking carbamazepine.

What can the nurse explain as an advantage of taking carbamazepine for seizure control? a. No liver or kidney complications b. Minimal sedation and cognitive effects c. No cardiac complications d. Can be taken while pregnant Answer: b Feedback: As an anti-convulsant, carbamazepine has the advantage of minimal sedation and adverse cognitive effects.

Case Study B Anti-Parkinsonian Drugs Mitchell Grange is at the neurologist’s office to receive the results of recent testing after his complaints of muscle tremors, rigidity, and slow movement.

1. The physician explains that Mitchell has Parkinson’s disease (PD), a chronic neurological disease characterized by: a. Akathesia b. Tardive dyskinesia c. Myocutaneous tightening d. Bradykinesia Answer: d Feedback: Parkinson’s disease is a chronic neurological disorder characterized by fine, slowly spreading muscle tremors; rigidity; and generalized slowness of movement called bradykinesia.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 22: Anticonvulsants, Antiparkinsonian Drugs, and Agents for Alzheimer’s Disease

2. The neurologist prescribes an antiparkinsonian drug, Sinemet, and instructs Mitchell on which of the following? a. The drug may cause increased wakefulness. b. Expect to see the benefits of the drug in 3 to 5 days c. Take the drug with a small nonprotein snack to lessen GI distress. d. Stop taking the drug immediately if feeling side effects.

Answer: c Feedback: Sinemet is a combination of levodopa and carbidopa. It is recommended as an initial drug treatment for patients with bradykinesia uncontrolled by other anti-Parkinsonian drugs. The patient should be instructed that GI disturbances might occur with drug administration, and taking with food would help to minimize the distress. However, it is important to minimize the protein load in order to avoid competition for transport across the GI tract.

3. The physician also explains to Mitchell that caution should be exercised when he gets up to walk. This is because Sinemet can cause which side effect? a. Seizures b. Hypotension c. Blurred vision d. Muscular weakness Answer: b Feedback: Hypotension, dizziness, and syncope can occur as side effects to Sinemet. Therefore, it is important for patients to exercise when getting up from a supine or sitting position.

4. An abrupt discontinuation of Sinemet can lead to which complication? a. Myocardial infarction b. Severe shortness of breath c. Hypoglycemia d. Neuroleptic malignant syndrome Answer: d Feedback: Abrupt discontinuation of Sinemet could lead to neuroleptic malignant syndrome characterized by delirium, rigid muscles, fever, and autonomic nervous system dysfunction.

5. An interaction of Sinemet may occur with: a. Antihypertensives b. Multivitamins c. Antidepressants d. Foods high in carbohydrates

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 22: Anticonvulsants, Antiparkinsonian Drugs, and Agents for Alzheimer’s Disease

Answer: a Feedback: Since Sinemet can cause hypotension, it could interact with antihypertensive agents and may potentiate hypotensive effect. [return to top]

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once Medications 1. Aricept (= rasagiline) 2. entacapone 3. Neurontin (= gabapentin) 4. Lamictal (= lamotrigine) 5. Zarontin (= ethosuximide) 6. amantadine 7. Depakote (= valproic acid) 8. Cogentin (= ) 9. Topamax (= topiramate) 10. Razadyne (= galantamine)

Conditions Answer e. Alzheimer’s disease c. Parkinson’s disease a. Seizures a. Seizures b. absence seizure d. Extrapyramidal reactions a. Seizures d. Extrapyramidal reactions a. Seizures e. Alzheimer’s disease

11. A common side effect of phenytoin is: a. Hypertension b. Muscle cramps c. Sedation d. Dehydration Answer: c Feedback: Some of the side effects of phenytoin include sedation, ataxia, dizziness, and headache.

12. Health care professionals should closely monitor patients receiving anticonvulsants for which condition? a. Hyperactivity b. Mania c. Insomnia d. Suicidal ideation Answer: d Feedback: The FDA has indicated the increased risk of suicidal ideation and behavior in patients receiving anticonvulsants for treating epilepsy, psychiatric disorders, or other conditions such as migraine and neuropathic pain.

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5

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 22: Anticonvulsants, Antiparkinsonian Drugs, and Agents for Alzheimer’s Disease

13. Which of the following can interact with carbamazepine (Tegretol), potentiating the risk of side effects? a. Dairy products b. Grapefruit juice c. Aspirin d. Iron Answer: b Feedback: Multiple drug interactions can occur with carbamazepine, one of which is with grapefruit juice, which can potentiate its action and can increase the risk of serious adverse effects.

14. Anticholinergics used to treat younger patients with PD may cause which side effect? a. Drooling b. Night sweats c. Dry mouth d. Bradycardia Answer: c Feedback: Dry mouth is a common manifestation of anticholinergic effects 15. Caution should be used when administering memantine to patients with Alzheimer’s disease because there is an increased risk of: a. Diabetic ketoacidosis b. Falls c. Nausea and vomiting d. Decreased gag reflex Answer: b Feedback: Side effects of memantine are dose-related and include confusion, cerebrovascular disorder, falls, and agitation.

16. Patients taking any anticonvulsant medication should be instructed to: a. Take the medication with food b. Expect slurred speech with the first dose c. Omit a dose if experiencing nausea d. Perform vigorous dental hygiene Answer: d Feedback: Patients should be instructed to ensure careful oral hygiene until gum tenderness subsides with continued treatment. This is especially true with phenytoin.

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6

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 22: Anticonvulsants, Antiparkinsonian Drugs, and Agents for Alzheimer’s Disease

17. Most children who experience febrile seizures do not require anticonvulsant drug therapy. a. True b. False Answer: a Feedback: In most cases, febrile seizures signify a serious underlying acute infection such as sepsis or bacterial meningitis. Resolving the underlying condition is therefore generally sufficient treatment.

18. Which of the following is not a first line therapy for restless leg syndrome (RLS)? a. Pramipexole (Mirapex) b. Ropinirole (Requip) c. Rotigotine (Neupro patch) d. Gabapentin (Neurotin) Answer: d Feedback: The dopamine agonists pramipexole, ropinirole, and rotigotine are also FDA approved for RLS treatment. [return to top]

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7

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 23: Endocrine System Drugs

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 23: Endocrine System Drugs

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 23: Endocrine System Drugs

Case Study Answers Case Study A Endocrine System Drugs After weeding in her garden, Marie Kilcline experiences a severe allergic reaction to poison ivy. She presents to her physician with a rash on her face, arms, and legs.

1. The physician prescribes a corticosteroid. How will this category of medication be most beneficial to Marie? a. As an antipruritic b. As an antineoplastic c. As an antidiabetic d. As an anti-inflammatory Answer: d Feedback: The anti-inflammatory effects of corticosteroid counteracts the symptoms (depending on severity of the reaction: for example, rash, hives, or anaphylaxis) that are encountered in allergic reactions, for example, to insect bites, poison plants, chemicals, or other medications.

2. The physician explains that side effects of the corticosteroid may include: a. Hypotension b. Hypoglycemia c. Increased susceptibility to infection d. Flushing of the hands and face Answer: c Feedback: As a result of its extensive physiologic effects on the body, side effects of corticosteroids used for longer than very brief periods can be quite serious. One of these effects is delayed wound healing and increased susceptibility to infection.

3. Prior to handing Marie her prescription, the physician reviews her medication history. He knows this is essential because of possible interactions with corticosteroids. Which drug may cause an interaction resulting in reduced effectiveness of the corticosteroid? a. Estrogen b. Salicylates c. Diuretics d. Phenytoin Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 23: Endocrine System Drugs

Feedback: As a result of its extensive physiologic effects on the body, there is very high potential for corticosteroids to interact with other drugs, including phenytoin which reduces its effectiveness, and estrogen which potentiate its effectiveness.

4. When Marie picks up her corticosteroid medication at the pharmacy, she reads the label on the side of the bottle containing instructions on when to take her medication. Which of the following is most likely to be on this label? a. Take 1 h before meals. b. Avoid taking with milk. c. Take 1 h after meals. d. Take 2 h after meals.

Answer: c Feedback: Patients taking corticosteroids should be instructed to take oral corticosteroids with or as soon as possible after meals or with milk to decrease gastric irritation.

5. Marie will be taking her medication for a prescribed amount of time. What will be the best method to discontinue her corticosteroid? a. Slowly taper the dosage b. Stop the medication abruptly c. Reduce the dose in alternating weeks d. Administer an IV bolus and then discontinue the medication Answer: a Feedback: Prolonged administration of corticosteroids can cause suppression of the pituitary gland with adrenocortical atrophy, in which the body no longer produces its own hormones. To minimize this effect, withdrawal of corticosteroids, especially after long-term therapy, should always be gradual with step-down (i.e., tapering) dosage to allow the body’s normal hormone production and regulation to return.

Case Study B Antidiabetic Agents Forty-eight-year-old Marcus Wales has been diagnosed with new onset of type 2 diabetes. His physician orders a low-fat, low-calorie diet. In addition to dietary changes, the physician would like to start him on metformin and another oral hypoglycemic drug.

1. The physician starts him on glyburide, a sulfonylurea medication. He explains to Marcus that sulfonylureas work by: a. Blocking glucose uptake into the cell b. Increasing insulin production from the pancreas

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3

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 23: Endocrine System Drugs

c. Decreasing glucagon secretion d. Promoting urinary excretion of excess glucose Answer: b Feedback: The sulfonylureas increase insulin production from the pancreas and improves peripheral insulin activity.

2. The physician explains to Marcus that one of the side effects of a sulfonylurea medication is: a. Insomnia b. Orthostatic hypotension c. Excessive urination d. Fatigue Answer: d Feedback: The most common side effect of sulfonylurea is hypoglycemia, and one of the hypoglycemic signs and symptoms is fatigue.

3. Prior to prescribing the medication, the physician reviews Marcus’s medical history.

This is because sulfonylureas must be used with extreme caution in individuals who: a. Are obese b. Are asthmatic c. Have impaired kidney and liver function d. Have peripheral vascular disease Answer: c Feedback: One of the cautions or contraindications for using sulfonylureas is impaired kidney and liver functions.

4. The physician cautions Marcus to call him prior to taking any other medication because of possible interactions. Which drug can potentiate the hypoglycemic effect of a sulfonylurea? a. Quinolones b. Penicillins c. Antacids d. Rifampin Answer: a Feedback: One of the many medications that can potentiate the hypoglycemic effect of a sulfonylurea are anti-infective agents, including miconazole, fluconazole, quinolones, and sulfonamides.

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4

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 23: Endocrine System Drugs

5. What drug causes an interaction with sulfonylureas, resulting in an antagonistic action in which a larger dose may be required? a. MAOIs b. Testosterone c. Corticosteroids d. Narcotic analgesics Answer: c Feedback: One of the many side effects of corticosteroids is hyperglycemia, and therefore its use can antagonize the hypoglycemic effect of a sulfonylurea. [return to top]

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once Medications 1. Glucophage 2. prednisone 3. Humulin R 4. Synthroid 5. Avandia 6. Tapazole 7. Isophane 8. Prandin 9. Lantus 10. Humalog

Conditions Answer c. Oral antidiabetic agent d. Corticosteroid f. Insulin—short acting a. Thyroid agent c. Oral antidiabetic agent b. Antithyroid g. Insulin—intermediate acting c. Oral antidiabetic agent h. Insulin—long acting e. Insulin—rapid acting

11. The biguanide that decreases hepatic glucose production and enhances insulin uptake is which of the following? a. Glucophage b. Starlix c. Synthroid d. Cortrosyn Answer: a Feedback: The biguanide metformin (trade name Glucophage) decreases hepatic glucose production and enhances insulin uptake in muscle tissue.

12. NTIs means are characterized by which of the following? a. Very high doses are needed to show effects. b. They have a small range at which they are safe and effective. c. They are administered with a narrow-gauged needle. d. They do not require laboratory monitoring upon initialization.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 23: Endocrine System Drugs

Answer: b Feedback: NTI means narrow therapeutic index and medications with narrow therapeutic index usually have a small range at which they are safe and effective.

13. A patient who is on a thyroid medication should be monitored for which potential side effect? a. Hyperglycemia b. Hypotension c. Muscle twitching d. Shortness of breath Answer: a Feedback: One of the cautions or contraindications for thyroid hormones is diabetes so close monitoring of blood glucose is required for detection of hyperglycemia.

14. Thyroid medication should be taken: a. At bedtime with a sip of water b. On an empty stomach 30–60 min prior to breakfast c. 30–60 min after breakfast d. With breakfast Answer: b Feedback: Patients treated with thyroid medication should be instructed to take it on empty stomach 30–60 min prior to breakfast.

15. Insulin is administered parenterally because: a. It is easier to monitor dosage b. It is destroyed in the GI tract c. Insulin pills are difficult to swallow d. Parenteral dosing is tolerated better Answer: b Feedback: Insulin must be administered parenterally because it is destroyed in the GI tract.

16. To prevent a medication error, an insulin dose in a syringe: a. Should be color-coded for specific doses b. Should be drawn up with the nondominant hand for a better visualization of the dose c. Should be verified only by a pharmacist d. Should be verified by another clinician Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 23: Endocrine System Drugs

Feedback: To prevent a medication error, an insulin dose should always have a clinician compare the insulin in the syringe with the dosage ordered.

17. What best describes the onset and duration of action of regular insulin? a. Delayed onset and short duration b. Extended onset and long duration c. Rapid onset and short duration d. Ultra-rapid onset and very short duration Answer: c Feedback: Regular insulin is rapid acting (onset of 30 to 60 min) and has a short duration of action (6 to 10 hours).

18. The peak of rapid-acting insulins falls under which time frame post-injection? a. 1–2 h b. 1–5 h c. 6–12 h d. 12–24 h Answer: b Feedback: In addition to rapid onset and short duration of action (see question 18), the use of regular insulin is associated with a peal effect within 1 to 5 hours after administration.

19. What is one of the most likely symptoms of hyperglycemia? a. Weight gain b. Excitability c. Excessive thirst d. Urinary retention Answer: c Feedback: Symptoms of hyperglycemia are many and may include dehydration and excessive thirst.

20. Which of the following may potentiate the hypoglycemic effect of insulin? a. NSAIDs b. Corticosteroids c. Antidepressants d. Alcohol Answer: d Feedback: In addition to oral hypoglycemic agents, another commonly used substance that can potentiate the hypoglycemic effect of insulin is alcohol.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 23: Endocrine System Drugs

21. Which preparation of insulin is used to correct elevated blood glucose? a. Lispro b. Regular c. isophane (NPH) d. Glargine Answer: a Feedback: The most effective insulin preparation to correct elevated blood glucose is one with rapid onset of action such as Lispro (10 to 30 min).

22. Illness, increased stress, or trauma may have what effect on a prescribed dose of insulin? a. Less insulin may be required. b. The dose will need to be divided. c. More insulin may be required. d. No change in dosage will be required.

Answer: c Feedback: Patient-specific conditions such as illness, increased stress, or trauma are all associated with an increased need of insulin amount .

23. Which of the following is the main type of side effect observed with SGLT2 inhibitors? a. Urinary b. Respiratory c. Dermal d. Gastric Answer: a Feedback: Vaginal yeast infections and urinary tract infections, as well as increased desire to urinate, are common side effect observed with SGLT2 inhibitors.

24. In what scenario would steroid tapering be most important when discontinuing corticosteroid therapy? a. When oral therapy exceeds 14 consecutive days at a dose of 20 mg of prednisone (or equivalent) per day or more b. When topical therapy is used daily for 30 days or more c. When inhaled therapy is used at a dose of 50 mcg for 14 days or more d. When a single oral dose of 50 mg is administered Answer: a

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8

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 23: Endocrine System Drugs

Feedback: Steroid tapering is important to avoid adrenocortical insufficiency and adrenocortical atrophy. This is especially important with patients whose therapy exceeds 14 consecutive days at a dose of 20 mg of prednisone (or equivalent) per day or more 25. Thyroid replacement therapy, like levothyroxine, should be taken when? a. In the evening on an empty stomach before bedtime with other night-time medications. b. In the morning with the first meal of the day. c. Anytime, as long as it is taken at the same time each day with food. d. First thing in the morning on an empty stomach.

Answer: d Feedback: Patients treated with thyroid replacement therapy such as levothyroxine should be instructed to take it on empty stomach 30–60 min prior to breakfast. [return to top]

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9

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 24: Reproductive System Drugs

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 24: Reproductive System Drugs

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 24: Reproductive System Drugs

Case Study Answers Case Study A Reproductive System Drugs Allison Cavanaugh is a 24-year-old female who has been experiencing painful and heavy-flow menses. At a recent visit to her gynecologist, she was diagnosed with endometriosis.

1. The physician writes a prescription for an oral contraceptive containing estrogen and progestin and explains that this might help Allison’s condition by: a. Increasing the frequency of ovulation b. Increasing the amount or thickness of cervical mucus c. Decreasing the amount of pituitary hormones released d. Creating a thin, atrophic endometrium not conducive to sustaining a fertilized ovum Answer: d Feedback: Oral contraceptive containing estrogen and progestin helps in this case by creating a thin, atrophic endometrium not conducive to sustaining a fertilized ovum.

2. The physician explains that Allison might experience some minor side effects that should resolve after a few months of use. Which of the following is one of these possible side effects? a. Constipation b. Weight gain c. Painful joints d. Pelvic pain Answer: b Feedback: Minor side effects of contraceptives include weight gain, should resolve after a few months of use.

3. Prior to writing the prescription for the contraceptive, the physician reviews Allison’s medical history. This is important because contraceptives are contraindicated in patients with a history of: a. Asthma b. Thrombophlebitis c. Peanut allergy d. Breast augmentation Answer: b

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 24: Reproductive System Drugs

Feedback: One of the cautions or contraindications for estrogen products is history or presence of thrombophlebitis or thromboembolic disorder.

4. The nurse instructs Allison on how to take the contraceptive. Which of the following instructions is most likely to be included in her teaching plan? a. Use a backup contraceptive for 3 months. b. Take the oral contraceptive at the same time each day. c. Note that oral contraceptives protect against HIV. d. Take a drug holiday after taking the contraceptive for 6 months.

Answer: b Feedback: The patient should be instructed to use backup contraception for the first month on oral contraceptives and for the first 2 weeks with Depo-Provera. They should also take the contraceptive at the same time every day.

5. What symptom would be most important for Allison to report to her physician after starting the oral contraceptive? a. Chest pain b. Urinary frequency c. Breast tenderness d. Rash on chest Answer: a Feedback: The patient should report the following symptoms to the health care professional when using oral contraceptives: chest pain. shortness of breath, severe headache, dizziness, weakness, numbness, eye problems, breast lumps, or severe leg pains in the calf or thigh.

Case Study B Reproductive System Drugs Katrina Oosterlund is in her 31st week of pregnancy and has developed hypertension, 3+ edema in her ankles, and proteinuria. The obstetric (OB) physician is concerned that she may develop new-onset grand mal seizures related to eclampsia. She is admitted to the hospital and started on IV magnesium sulfate.

1. Katrina is reluctant to start on the IV because she is concerned about the drug magnesium sulfate. The physician explains that the medication is necessary for her condition and will produce an anticonvulsant effect by: a. Peripheral vasoconstriction b. An increase in circulatory volume c. Depressing the CNS and thereby causing cerebral vasodilation d. The induction of bradycardia and a subsequent reduction in blood pressure Answer: c

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 24: Reproductive System Drugs

Feedback: Magnesium sulfate acts by depressing the central nervous system, blocking neuromuscular transmission, and causing cerebral vasodilation, resulting in anticonvulsant effects.

2. The nurse notes a physician order for an antidote in case of an overdose of magnesium sulfate. The drug she will have on hand in case of an overdose is: a. Calcium carbonate b. Glucagon c. Calcium gluconate d. Carboprost Answer: c Feedback: Serious side effects of magnesium sulfate include circulatory collapse, cardiac depression, and cardiac arrest. Therefore, calcium gluconate would be the antidote in case of an overdose of magnesium sulfate.

3. Extreme caution should be exercised when administering magnesium sulfate because of its potential effects on the neonate. This includes the potential for: a. Hypotension b. Increased risk of seizure c. Respiratory depression d. Hypertension Answer: c Feedback: In addition to the adverse side effects on the cardiovascular system, other side effects of magnesium sulfate include pulmonary edema and fatal respiratory paralysis.

4. What is one of the serious side effects of magnesium sulfate? a. Hypertension b. Flaccid paralysis c. Status asthmaticus d. Severe dehydration Answer: b Feedback: In addition to the adverse side effects on the cardiovascular and pulmonary systems, other side effects of magnesium sulfate include flaccid paralysis and CNS depression.

5. While Katrina is receiving IV magnesium sulfate, she will be monitored closely for: a. Vital signs and reflexes b. Blood glucose levels c. Hematocrit and hemoglobin d. Creatinine clearance

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 24: Reproductive System Drugs

Answer: a Feedback: Since magnesium sulfate possesses adverse cardiovascular and pulmonary effects as well as flaccid paralysis and CNS depression, it is important to monitor vital signs and reflexes. [return to top]

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once 1.

2.

3.

4.

5.

6.

7.

8.

9.

Medications Premarin Megace Depo-Testosterone Danocrine Covaryx terbutaline Cialis Levitra Pitocin

Conditions Answer b. Menopausal symptoms i. Cachexia of AIDS e. Hypogonadism a. Endometriosis b. Menopausal symptoms h. Preterm labor d. Erectile dysfunction d. Erectile dysfunction f. Uterine inertia in labor

10. What possible side effect should a patient taking tadalafil report to a physician? a. Insomnia b. Vision abnormalities c. Constipation d. Tingling in the feet Answer: b Feedback: Some of the side effects of PDE inhibitors such as sildenafil, vardenafil, and avanafil include headache, flushing, vision abnormalities, and dizziness.

11. Which category of drugs has serious interactions with PDE inhibitors? a. Nitrates b. Anti-inflammatories c. Muscle relaxants d. Hypoglycemic agents Answer: a Feedback: Nitrates are vasodilators and PDE inhibitors potentiate their hypotensive effects.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 24: Reproductive System Drugs

12. Women with a uterus should not use estrogen-alone therapy because it puts them at risk for which of the following? a. Blood clots b. Uterine cancer c. Stroke d. Osteoporosis Answer: Feedback: Estrogen monotherapy is associated with an increased risk of endometrial carcinoma (a type of uterine cancer) in women with an intact uterus.

13. Estrogen therapy (i.e., estrogen alone) has been associated with an increased risk of endometrial cancer. On the other hand, estrogen combined with which agent reduces this risk? a. Testosterone b. Androgens c. Progestin d. Progesterone agonist Answer: Feedback: 14. A contraceptive preparation containing two sequences of progestin doses and less than 50 mcg of estrogen is called: a. Monophasic b. Biphasic c. Triphasic d. Four-phasic Answer: b Feedback: Estrogen–progestin oral contraceptives are available in several formulations and variable amount of estrogen and progestin. A biphasic preparation contains two sequences of progestin doses and less than 50 mcg estrogen.

15. Dinoprostone intravaginal gel or vaginal insert is indicated for: a. Premature labor b. Therapeutic abortion c. Induction of labor d. Cervical ripening Answer: d Feedback: Prostaglandins are released as a natural part of the cervical ripening process. Dinoprostone is a prostaglandin E2 analog.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 24: Reproductive System Drugs

16. Oxytocin should be avoided for patients with a history of: a. Miscarriage b. Diabetes mellitus c. Endometriosis d. Placenta previa Answer: d Feedback: Some of the cautions or contraindications for oxytocin use include placenta previa, prolapsed cord, and multiparity, and prolonged use in patients with eclampsia.

17. A side effect of methylergonovine, given for the treatment of postpartum hemorrhage, can include: a. Fever b. Nausea and vomiting c. Urinary retention d. Peripheral vasodilation Answer: b Feedback: Side effects of methylergonovine occur most commonly when administered IV undiluted or too rapidly, or in conjunction with regional anesthesia or vasoconstrictors (since methylergonovine is a semisynthetic ergot alkaloid by itself) and can include: nausea and vomiting, as well as numbness and coldness of extremities with overdose.

18. A drug used primarily for pulmonary disorders but that can also be used for the management of preterm labor is: a. Oxytocin b. Carboprost c. Terbutaline d. Misoprostol Answer: c Feedback: Terbutaline is a beta-2 receptor agonist used as a bronchodilator for management of pulmonary disorders such as asthma and COPD. It ca also be used with careful monitoring in the management of preterm labor.

19. Maternal side effects of terbutaline include: a. Hyperglycemia b. Hypoglycemia c. Hyperthyroidism d. Hyperkalemia Answer: a

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7

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 24: Reproductive System Drugs

Feedback: Maternal complications of using terbutaline include metabolic abnormalities such as hyperglycemia and hypokalemia.

20. Fetal side effects of terbutaline include: a. Hypercalcemia b. Hypobilirubinemia c. Tachycardia d. Intra-abdominal bleeding Answer: c Feedback Fetal complications of using terbutaline include tachycardia, hypotension, hyperbilirubinemia, and hypoglycemia.

21. Extreme caution is required with the administration of oxytocin, along with constant fetal and maternal monitoring, to prevent which side effect? a. Cervical stricture b. Maternal desaturation c. Maternal seizures d. Uterine rupture Answer: d Feedback: Oxytocin stimulates the uterus to contract, thus inducing childbirth. Side effects of oxytocin are dose related and can be serious. Therefore, constant maternal and fetal monitoring are required to prevent dangerous side effects such as risk of uterine rupture. [return to top]

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8

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 25: Anti-Infective Drugs

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 25: Anti-Infective Drugs

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 25: Anti-Infective Drugs

Case Study Answers Case Study A Anti-Infective Drugs Thirty-seven-year-old Constantine Karoulis suffered a torn Achilles tendon while playing flag football with some friends. He underwent an Achilles tendon repair, and 10 days postoperatively, he noticed swelling, redness, and warmth around the incision and yellow discharge seeping from it.

1. The prescriber would use what to determine the appropriate antibiotic therapy? a. culture and sensitivity test b. serum creatinine test c. empiric evidence test d. CBC with differential test Answer: a Feedback: Performing culture and sensitivity testing of the organism collected from the site of infection is the most appropriate way of selecting the right antibiotic for the infection.

2. If Constantine requires aminoglycosides, why are they most often administered either by IV or IM injection? a. Medications cause GI distress when given orally b. A therapeutic dose cannot be reached when administered orally c. Pills are difficult for the patient to swallow d. The medication is poorly absorbed from the GI tract Answer: d Feedback: Aminoglycosides are poorly absorbed from the GI tract and have to be administered parenterally.

3. What method is used to determine optimal dosing for the aminoglycoside (gentamicin) that has been ordered for Constantine? a. repeat C&S of wound drainage b. serum peak and trough levels c. 24-h urine analysis d. CBC with differential Answer: c Feedback: In general, the aminoglycoside is considered a drug with a narrow therapeutic index, and monitoring the peak and trough concentration of the drug have been recommended to ensure maximizing efficacy and minimizing toxicity.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 25: Anti-Infective Drugs

4. Constantine was prescribed gentamicin. What side effect can gentamicin IV cause? a. syncope b. nephrotoxicity c. polyuria d. lower extremity cramping Answer: b Feedback: The most worrisome toxicity of gentamicin is nephrotoxicity, and monitoring of the trough concentration of the drug is commonly performed to minimize its occurrence.

5. Constantine is taken back to the operating room (OR) for a wound debridement, and gentamicin is ordered again for his wound infection. Postoperatively, an interaction may occur between gentamicin and which category of drug? a. antiemetics b. anti-inflammatories c. analgesics d. muscle relaxants Answer: d Feedback: A rare but dangerous side effect of aminoglycoside is neuromuscular blockade, including respiratory paralysis. Therefore, an interaction may occur between gentamicin and muscle relaxants.

Case Study B UTI Infection Lillian Westcott is diagnosed with a UTI after complaining of burning upon urination.

Her physician is preparing to write her a prescription for nitrofurantoin.

1. Prior to prescribing nitrofurantoin, the physician reviews Lillian’s medical history because this medication should be used with caution in patients with a. diabetes b. renal impairment c. hypertension d. COPD Answer: b Feedback: If a patient has renal impairment, nitrofurantoin would accumulate in the body, resulting in dose-related toxicity, especially pulmonary fibrosis.

2. A common side effect of nitrofurantoin is a. tinnitus b. numbness of hands

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 25: Anti-Infective Drugs

c. abdominal pain d. brown-colored urine Answer: d Feedback: Brown coloration of urine is a commonly reported side effect of nitrofurantoin but is normally harmless.

3. The physician reviews Lillian’s current medications because nitrofurantoin can interact with a certain drug that decreases its effectiveness. Which drug is this? a. probenecid b. warfarin c. an antacid containing magnesium d. ibuprofen Answer: a Feedback: Nitrofurantoin is primarily used for UTI. Probenecid competes with nitrofurantoin for excretion into the renal tubule of the kidney, resulting in systemic accumulation of nitrofurantoin and elevated toxicity.

4. Which of the following should the nurse make sure to include in Lillian’s instructions for nitrofurantoin? a. Urine may become discolored. b. Take the medication with an antacid. c. Stop taking the medication when symptoms disappear. d. Take the medication with water.

Answer: a Feedback: Brown coloration of urine is a commonly reported side effect of nitrofurantoin but is normally harmless.

5. The duration of drug therapy using nitrofurantoin for a UTI is how many days? a. 3 b. 7 c. 10 d. 14 Answer: b Feedback: The typical duration of nitrofurantoin therapy for a UTI is 7 days. [return to top]

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4

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 25: Anti-Infective Drugs

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once 1.

2.

3.

4.

5.

6.

7.

Medications nitrofurantoin (Macrodantin) nystatin fluconazole (Diflucan) linezolid (Zyvox) ethambutol valacyclovir erythromycin

Conditions Answer c. Urinary tract infections f. Fungus f. Fungus b. MRSA and VRE d. Tuberculosis f. Fungus e. Acne

8. What is the best method for preventing the spread of infection? a. Bleach patient care areas daily b. Have patients wear a mask. c. Observe routine handwashing. d. Require masks and gloves for all health care personnel.

Answer: c Feedback: Effective strategies to minimize anti-infective resistance and prevent the spread of infection include better patient and physician education on appropriate anti-infective use, accurate diagnosis, and targeted treatment of infections. In addition, strict adherence to preventive measures such as routine handwashing and alcohol wiping between patient visits along with rapid isolation of patients with resistant infections is also extremely important.

9. An over-response of the body to a specific substance is called a. hyperimmunity b. superinfection c. direct toxicity d. allergic hypersensitivity Answer: a Feedback: Activation of the immune response is a body defense mechanism to counteract infection, and over-response is associated with a state of hyperimmunity.

10. A sudden onset of dyspnea, chest congestion, shock, and collapse is called a. anaphylaxis b. nephrotoxicity c. dyscrasia d. prophylaxis

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 25: Anti-Infective Drugs

Answer: a Feedback: Anaphylaxis is a potentially fatal reaction to some antibiotics such as a penicillin, and is usually accompanied by a sudden onset of dyspnea, chest congestion, shock, and collapse.

11. When administering an anti-infective drug to an older patient, which of the following may be indicated for safe treatment? a. more frequent dosing b. an increased dose c. a lower dose d. once-a-day dosing Answer: c Feedback: In general the elderly patients have a lower capacity to eliminate drug and therefore a lower dose is highly recommended for this patient population.

12. The best treatment for herpes zoster (shingles) will start within how many hours of the onset of the blister-like rash? a. 24 b. 24-72 c. 48 d. 96 Answer: b Feedback: Herpes zoster (shingles) is best treated within 24–72 h of onset of rash or intense pain on the skin of one side of the trunk or head. Delayed treatment with an antiviral medication can lead to complications.

13. The physician orders an antibiotic to be given to a patient before surgery. What is this type of dosing called?: a. antiseptic b. predetermined c. prophylactic d. proactive Answer: c Feedback: Ordering an antibiotic to be given to a patient before surgery is common and such practice is known as prophylaxis.

14. Caution needs to be exercised when prescribing a cephalosporin to a patient with which known allergy? a. seafood b. penicillin c. latex d. peanuts

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 25: Anti-Infective Drugs

Answer: b Feedback: There is an up to 10% cross-reactivity rate between penicillin and cephalosporin with respect to penicillin allergy and caution needs to be exercised when prescribing a cephalosporin to a patient with known penicillin allergy.

15. Which medication category may cause discolored teeth in young children? a. tetracyclines b. cephalosporins c. aminoglycosides d. carbapenems Answer: a Feedback: The use of tetracycline in children is well known to cause discolored teeth, and this group f antibiotic should be avoided in children unless no other antibiotic is available for treating an infection.

16. What medication is used to treat oral cavity candidiasis? a. nystatin b. rifampin c. isoniazid d. amphotericin B Answer: a Feedback: Among the answer choices, nystatin is an antifungal agent that had been used in the past for treatment of oral cavity candidiasis.

17. A patient receiving zanamivir might experience which side effect? a. phlebitis b. airway irritation c. nausea d. rash Answer: b Feedback: Oseltamivir and zanamivir are antiviral agents for management of influenza infection. Zanamivir is given via inhalation and its main side effect is airway irritation.

18. The drug of choice for treating methicillin-resistant Staphylococcus aureus is a. metronidazole b. ciprofloxacin c. vancomycin d. doxycycline Answer: c

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 25: Anti-Infective Drugs

Feedback: Vancomycin is one of a small number of drugs effective against methicillin-resistant Staphylococcus aureus (MRSA). However, emergent resistance from MRSA does occur with vancomycin. Therefore, sensitivity testing is definitely needed in patients with MRSA infection.

19. A patient taking an antiretroviral should be instructed that a. OTC drugs are permitted in conjunction with an antiretroviral as long as dosing instructions on the antiretroviral’s label are followed b. the drug should be taken in an upright position with a full glass of water c. the drug reduces the risk of HIV transmission to other individuals d. the medication may be stopped abruptly Answer: b Feedback: Patients taking antiretrovirals should be instructed to take the drug in an upright position with full glass of water.

20. What side effect might protease inhibitors cause? a. exacerbation of existing diabetes b. constipation c. dehydration d. urinary tract infection Answer: a Feedback: The use of protease inhibitors have been reported to cause hyperglycemia, new-onset diabetes mellitus, diabetic ketoacidosis, and exacerbation of existing diabetes 21. The single best way to reduce the spread of the influenza virus is what? a. the annual flu vaccine b. mask wearing and physical distancing c. handwashing d. avoiding public transportation Answer: c Feedback: As in preventing the spread of antibiotic resistance, the single best way to reduce the spread of the influenza virus is handwashing.

22. Antibiotic-resistant bacteria can form as a result of all of the following EXCEPT a. taking an antibiotic for a shorter duration than prescribed b. overprescribing of an antibiotic or antibiotic class c. using an antibiotic for an incorrect infection d. using a combination of antibiotics rather than a single antibiotic.

Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 25: Anti-Infective Drugs

Feedback: Taking an antibiotic for an inappropriate duration, antibiotic overprescribing, and using an antibiotic for an incorrect infection all contribute to the emergence of antibiotic-resistant bacteria.

23. The best preventive action a person can take to avoid the shingles rash is a. receiving one dose of Shingrix b. receiving two doses of Shingrix c. prophylactically taking acyclovir 400 mg daily d. increasing exercise and improving the diet Answer: b Feedback: Shingrix is an inactive vaccine administered intramuscularly in a twodose series for the prevention of shingles. [return to top]

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9

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 26: Antineoplastic Drugs

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 26: Antineoplastic Drugs

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 26: Antineoplastic Drugs

Case Study Answers Case Study A Antineoplastic Drugs The oncology infusion clinic’s first patient of the day is Herman Johnson, a 72-yearold male with a new diagnosis of metastatic colon cancer. The oncologist has ordered a medication from a category of drugs as a first-line treatment that will not eradicate the cancer but will stop or slow the growth of cancer.

1. This category of drug is called a(n): a. Colony stimulating factor b. Vaccine c. Angiogenesis inhibitor d. Signal transduction inhibitor Answer: c Feedback: Angiogenesis inhibitors prevent the formation of new blood vessels that tumors need to grow and invade nearby tissue, thereby stopping the growth and spread of cancerous cells. However, they cannot eradicate the cancer.

2. Upon receiving his first dose, the nurse informs Mr. Johnson that he can expect which symptom(s)? a. Fever and chills b. Hot flashes c. Decreased platelet count d. Blood in his stools Answer: a Feedback: Fever and chills are common side effects after the first infusion of monoclonal antibodies, a class of agents that also include the angiogenesis inhibitors.

3. Prior to a first dose, the nurse will administer which medication to minimize a potentially severe reaction? a. Morphine sulfate b. Motrin c. Mylanta d. Benadryl Answer: d Feedback: Severe reactions to monoclonal antibodies can be minimized by premedicating with acetaminophen, diphenhydramine (Benadryl), and/or meperidine (Demerol).

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 26: Antineoplastic Drugs

4. During an infusion of Avastin, the nurse will be watching out for which possible side effect that may necessitate stopping the infusion? a. Nausea b. Bronchospasm c. Metallic taste in the mouth d. Headache Answer: b Feedback: Severe reactions to monoclonal antibodies are clinically manifested as angioedema, hypotension, dyspnea, and bronchospasm 5. In the next several weeks, Mr. Johnson will be monitored for which side effect? a. Hypotension b. Low WBCs c. Constipation d. Excessive bruising Answer: c Feedback: Once the patient can tolerate the acute side effects, then the long-term immunosuppressive effect of anticancer drugs need to be monitored, including monitoring of red and white blood cell counts, as well as platelet counts.

Case Study B Antineoplastic Drugs During 39-year-old Geneva Moyet’s annual physical, a physician palpates a swollen thyroid gland. A CT scan and biopsy determine that she has thyroid cancer. The physician refers her to an oncologist, who indicates that she should be treated with radioactive sodium iodide, a radioisotope.

1. By which route will this specific radioisotope be administered? a. IM injection b. Seed placement c. Orally d. Intravenously Answer: c Feedback: Radioactive sodium iodine is administered orally to treat thyroid cancer, as the radioactive iodine will be taken up naturally by the thyroid gland.

2. What is a distinct advantage of radioimmunotherapy? a. It is usually given one time. b. It has no side effects. c. It is given once a month. d. No extra precautions need to be taken post-treatment.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 26: Antineoplastic Drugs

Answer: a Feedback: Radioimmunotherapy consists of monoclonal antibodies with radioisotopes attached to them so that the cancerous tissue/organ that the targeted antibody binds to can also be irradiated. The distinct advantage of radioimmunotherapy is that it is usually given one time.

3. Which of the following is the primary side effect of radioimmunotherapy? a. Diarrhea b. Nausea c. Fever d. Decreased blood count Answer: d Feedback: Unfortunately, there is no anticancer therapy that specifically only destroy the cancerous cells without any effect on normal cells, including the bone marrow. Therefore, the primary side effect of radioimmunotherapy is decreased blood count that usually occurs within 4 to 6 weeks after treatment.

4. What should the nurse wear when handling patient excreta after radioimmunotherapy? a. Gloves only b. Gown and gloves c. Cap, gown, and gloves d. Cap, gown, gloves, and booties Answer: a Feedback: Gloves should be worn when handling IVs with antineoplastic agents, as they could cause extreme tissue damage and necrosis if infiltration into surrounding tissues occurs. This is especially antitumor antibiotics and vinca alkaloids.

5. Suppose that Geneva develops a low blood count. What category of drug would be given to her to stimulate bone marrow production of RBCs, WBCs, and platelets? a. Colony-stimulating factor b. Hormone modifiers c. Biological therapy (interferons) d. Antitumor antibiotics Answer: a Feedback: Colony-stimulating factor such as erythropoietin allow bone marrow stem cells to divide and develop into red blood cells, WBCs, and platelets. Using colony-stimulating factor to stimulate blood cell production provide the option of increasing the doses of antineoplastics without increasing the risk of infection or the need for transfusions.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 26: Antineoplastic Drugs

[return to top]

Chapter Review Quiz Match the medication in the first column with the condition in the second column that it is used to treat. Conditions may be used more than once Medications 1. Palliative 2. Cytotoxic 3. Antineoplastic 4. Monoclonal antibodies 5. Proliferating 6. Exogenous antibodies 7. Refractory 8. Immunosuppressive 9. Endogenous antibodies 10. Clone

Conditions Answer f. Alleviation of symptoms i. Destructive to cells j. Counteracts malignant cell growth g. Engineered in a laboratory h. Reproducing rapidly g. Engineered in a laboratory b. Unresponsive to treatment e. Decreases antibody production c. Within the cell d. Produce a copy

11. Alkylating agents such as cisplatin and cyclophosphamide work by which method of action? a. They prevent growth by damaging the DNA needed for reproduction. b. They assist in bone marrow depression. c. They block cell mitosis. d. They bind to estrogen receptors.

Answer: a Feedback: Alkylating agents prevent cell growth by damaging DNA needed for reproduction. As such, they can also cause long-term damage to the bone marrow, which is the most important adverse effect of this class of medication.

12. A tumor that is classified as benign is: a. Destructive to other cells b. Noncancerous c. Cancerous d. Resistant to radiation Answer: b Feedback: A benign tumor is non-cancerous and is different from a malignant tumor which is cancerous.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 26: Antineoplastic Drugs

13. A common side effect of an antimetabolite is: a. Numbness and tingling b. Phototoxicity c. Nausea and vomiting d. Visual disturbances Answer: c Feedback: Antimetabolites work by interfering with DNA synthesis, repair, and cellular replication and have the greatest impact on highly proliferating cells.

However, this also means that other highly proliferative cells, including those lining the GI tract are significantly affected, resulting in severe nausea and vomiting.

14. Which drug is used to treat cerebral edema associated with brain tumors? a. Leucovorin b. Anastrozole c. Letrozole d. Dexamethasone Answer: d Feedback: Dexamethasone, with its anti-inflammatory effects, is used to treat cerebral edema associated with brain tumors.

15. Which antitumor antibiotic is known to be cardiotoxic and should not be used in patients with congestive heart failure unless no other options are possible? a. Mitomycin b. Daunorubicin c. Adriamycin d. Bleomycin Answer: c Feedback: Doxorubicin (Adriamycin) is the antineoplastic agent that is mostly associated with dose-related cardiotoxicity. [return to top]

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6

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 27: Age-Related Medication Issues

Solution and Answer Guide Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 27: Age-Related Medication Issues

Table of Contents Case Study Answers ............................................................................................................................ 2 Chapter Review Quiz ........................................................................................................................... 5

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1

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 27: Age-Related Medication Issues

Case Study Answers Case Study A Drugs and Older Adults Kita Wong is concerned that her 78-year-old mother, SuLyn, is not taking her medications correctly. SuLyn is on phenytoin, theophylline, digoxin, and a benzodiazepine.

1. What is the most likely age-related effect for SuLyn of the medications she takes every day? a. High risk for periodic severe hypoglycemia b. Frequent changes in the dose and schedule of her medications c. Slowed clearance of drugs from her system, resulting in potentially cumulative effects d. Increased clearance of drugs, resulting in the need for higher doses of the medication Answer: c Feedback: All of these drugs rely significantly on either the liver or the kidneys for elimination from the body. Elderly at the very least have physiologic decline in liver and kidney functions and most have some degree of hepatic and renal impairment, hence the elderly usually have overall slower clearance of medication from their bodies.

2. How do benzodiazepines affect older adults as opposed to younger adults? a. Older adults have a decreased sensitivity to the drug. b. Older adults have largely the same reaction to the drug as young adults. c. Older adults require an increased dosage of the drug. d. Older adults have an increased sensitivity to the drug.

Answer: d Feedback: In addition to slower clearance of medications, elderly patients also have increased sensitivity to medications, including the benzodiazepine.

3. What is the best method for monitoring SuLyn’s phenytoin therapy? a. 24-h urine check b. Patient reports of seizure activity c. Serum phenytoin level d. EEG Answer: b

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 27: Age-Related Medication Issues

Feedback: The efficacy and toxicities of phenytoin are related to the dose and concentration of the drug. Therefore, serum phenytoin level is usually monitored in patient receiving the drug.

4. Consider that water accounts for only 45% of an older adult’s body weight. How will this most likely affect SuLyn’s physiological response to theophylline? a. SuLyn may need a larger dose b. SuLyn’s vital signs may be critically affected c. SuLyn’s response will not be affected by this d. SuLyn may need a smaller dose Answer: d Feedback: The older adult has less body water. Therefore, drugs that are water soluble, such as digoxin, ethanol, lithium, and theophylline may become concentrated and cause adverse reactions. As such, the theophylline dose in this patient would need to be lower.

5. SuLyn has just been diagnosed with reduced renal function. What category of drugs may be particularly dangerous for her? a. Aminoglycosides b. Antihistamines c. Salicylates d. Calcium channel blockers Answer: a Feedback: Aminoglycosides are significantly eliminated by the kidneys. Therefore, the reduced renal function means an increased likelihood of aminoglycosides toxicity if the dose is not adjusted to match the patient’s decreased renal function.

Case Study B Drugs and Older Adults A visiting nurse is referred to Walter Jacobsen, an 89-year-old male living independently in a small apartment. During her intake interview, the nurse asks Walter about his medical history and his current medications. He reports his history to the nurse and then retrieves a large brown paper bag from the kitchen with numerous medications, explaining that he takes all of the medications in the bag.

1. Polypharmacy is the use of medication and is more specifically defined as: a. Applying to prescription drugs only b. Taking two drugs at a time c. Taking one drug for at least 14 days d. The use of multiple drugs, either OTC or prescription Answer: d

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3

Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 27: Age-Related Medication Issues

Feedback: Polypharmacy, or the use of multiple drugs (prescription and OTC medications) in an individual, is the most common reason the elderly suffer from adverse drug effects.

2. The nurse should instruct Walter, at a minimum, to keep a list of which medications? a. Only prescription drugs b. Prescription drugs and OTC drugs. c. Prescription drugs, OTC drugs, and vitamins d. Prescription drugs, OTC drugs, vitamins, and herbal or mineral supplements Answer: b Feedback: As discussed in feedback to #1, the patient should at least have a list of all prescription and OTC medications that he is taking.

3. The nurse decides to set up a system for Walter. What method will be most beneficial for Walter to help him take the correct pills on the correct days? a. A note on his bathroom mirror b. A daily pillbox organizer c. A mailed reminder card from his primary care physician d. A monthly phone call reminder from the local pharmacy Answer: b Feedback: The easiest and most direct way for the patient to take his multiple medications would be using a daily pillbox organizer to help him remember when to take which medication.

4. The nurse decides to give Walter further instructions regarding his medications.

Which item should she include in her teaching plan? a. In case of a missed dose, take two pills at the next scheduled dose. b. Memorize the purpose of each medication. c. Keep an updated list of all medications, including dose and frequency, in your wallet. d. Always request a generic medication when filling a prescription.

Answer: c Feedback: The nurse should tell the patient to keep an updated list of all medications, including dose and frequency, in his wallet, or in a place that is readily available at all times.

5. When the nurse is reviewing Walter’s medications, she is following a moral, ethical, and legal responsibility when she:: a. Questions an inappropriate medication and/or dose b. Disregards Walter’s concerns about a particular medication c. Discards pills that Walter did not take d. Changes the dose of a medication to better address his symptoms

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 27: Age-Related Medication Issues

Answer: a Feedback: The dangerous issue of polypharmacy in the elderly patients means that healthcare professionals, including nurses, should question an inappropriate medication and/or dose. [return to top]

Chapter Review Quiz Choose the correct answer. Please note that some questions require you to refer to the updated Beer’s criteria for PIM use in older adults.

1. The aging process is: a. The same in individuals in similar decades of life b. Very individualized c. Different based upon ethnicity d. Slowed in males versus females Answer: b Feedback: The change in drug disposition and effects is highly dependent on the individual’s altered function of eliminating organs as well as the level of changes in drug sensitivity.

2. As an individual age, the gastric pH: a. Stays at the same level b. Fluctuates over time c. Increases d. Decreases Answer: c Feedback: The elderly patients usually have lower production of gastric acid, therefore, resulting in a higher gastric pH. 3. You are educating an older adult who is taking a quinolone antibiotic in conjunction with an antacid. When should the patient be instructed to take the quinolone? a. Take with the antacid. b. Take 1h prior to the antacid. c. Take 1h post antacid. d. Do not take within 2 h of antacid.

Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 27: Age-Related Medication Issues

Feedback: The use of antacids usually resulting in reducing the absorption of concurrently administered medications. Therefore, it is usually advisable for its administration to be separated from other drugs by at least two hours.

4. Cumulative effects of drugs in older adults can be because of: a. Increased GI motility b. Higher metabolism c. Inadequate absorption d. Improved renal function Answer: c Feedback: Cumulative effects of drugs in older adults can result from inadequate absorption secondary to slowed gastrointestinal motility, reduced fluid intake, and/or relative (lack of stomach acid.

5. What is an example of an antipsychotic drug that produces significant anticholinergic effects in older adults?? a. amitriptyline b. benztropine c. chlorpromazine d. diphenhydramine Answer: c Feedback: Chlorpromazine is a first generation antipsychotic agent with significant anticholinergic effects.

6. Which of these is an appropriate medication to treat arthritis pain for older adults? a. Indocin b. Ketorolac c. Acetaminophen d. Talwin Answer: c Feedback: Acetaminophen should be considered to be used for pain, if possible, at least part of the time that the patient needs analgesics for pain control.

7. Which of these is an appropriate medication to treat allergies in older adults? a. Benadryl b. Claritin c. Chlor-Trimeton d. Vistaril Answer: b

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 27: Age-Related Medication Issues

Feedback: The use of non-sedating antihistamines such as Claritin is better than other drugs with anticholinergic effects, including sedation.

8. Which of these is an appropriate pain medication for older adults after surgery? a. Morphine b. Indocin c. Demerol d. Talwin Answer: b Feedback: Indocin has much less adverse effects on the central nervous system compared to the other opioid-like analgesics.

9. When starting an older adult patient on a new drug, which is the best method of dosing? a. Allow the patient to titrate the dose to the desired effect b. Start with a high dose and then reduce to the desired effect c. Start with a moderate dose for the least risk with the most effectiveness d. Start at the lowest effective dose and increase slowly to avoid adverse effects Answer: d Feedback: The concept of start low and go slow is especially important for drug dosing in the elderly. Doing so will have a higher likelihood of obtaining the desirable efficacy and minimizing toxicity.

10. Which category of drugs is most likely to cause dizziness or motor impairment, increase the risk of falls, and impact sexual functioning in older adults? a. Anticoagulants b. Antihypertensives c. Anti-infectives. d. Antidiabetics Answer: b Feedback: Many CNS-acting and antihypertensive drugs cause dizziness or motor impairment, which increase the risk of falls. In addition, the elderly also has impaired baro-reflex compensatory mechanism, which potentiate the orthostatic effect of antihypertensive agents, resulting in postural hypotension and making them at additional risk of fall. Both classes of drugs can also impair sexual functioning, reducing the quality of life for some older adults.

11. Which of these cardiac drugs is least appropriate for older adults? a. Norpace b. Vasotec c. Procardia XL d. Hydralazine

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 27: Age-Related Medication Issues

Answer: a Feedback: Norpace is the trade name for disopyramide, an antiarrhythmic drug with significant anticholinergic effect, which is usually undesirable in elderly patients because most of them already have a cholinergic deficit with aging.

12. Which one of these is an appropriate antidepressant to treat older adults with no history of seizure disorder? a. Prozac b. Amitriptyline c. Doxepin d. Wellbutrin Answer: a Feedback: Generally, it is believed that the SSRI class of antidepressants has a lower risk for inducing seizures, as shown by an incidence of only 0.1 percent for paroxetine (Paxil). Another SSRI is fluoxetine (Prozac).

13. Which organ’s function decreases with age, resulting in a decline of creatinine clearance? a. Liver b. Kidney c. Small intestine d. Large intestine Answer: b Feedback: Creatinine from muscle mass Is excreted by the kidney, so creatinine clearance will decline with impaired kidney function.

14. Which two categories of drug therapy are responsible for more than two-thirds of drug-related hospitalizations in older adult patients? a. Antidiabetic/antithrombotic b. Antihypertensive/anticoagulants c. Antidiabetic/antihypertensive d. Antidepressant/antihypertensive Answer: d Feedback: Many CNS-acting, including antidepressants, and antihypertensive drugs can cause postural hypotension. This coupled with impaired baroreflex with aging, usually contribute to fall, fracture, and hospitalization in the elderly patients.

15. Older adults are very sensitive to drug actions and are more likely to have adverse reactions to anticholinergics. What is a potential side effect of an anticholinergic? a. Drooling b. Constipation

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Solution and Answer Guide: Colbert, Essentials of Pharmacology, 9e, © 2023, 9780357618301; Chapter 27: Age-Related Medication Issues

c. Urinary frequency d. Diarrhea Answer: b Feedback: Some of the well-known anticholinergic effects are blurred vision, dry mouth, tachycardia, constipation, and urinary retention.

16. Which of the following is not an alternative formulation used for younger patients who have trouble swallowing?? a. Liquids b. Chewable tablet c. Sprinkle capsule d. Orally disintegrating tablet Answer: c Feedback: Any easily dissolvable formulations of oral dosage forms would be easier on patients who have trouble swallowing. Orally disintegrating tablets can be dissolved or dispersed in a glass of water. Therefore, the chewable tablets is not an alternative formulation.

17. Younger patients have a higher water content compared to adults, which requires dosing adjustments with certain drugs. a. True b. False Answer: a Feedback: Drugs that are primarily water soluble would have different distribution space in younger patients who have a higher water content than adults. Therefore, their dosage would needs to be adjusted.

18. What is the term for when a medication has the opposite effect on a patient or group of patients (like young children) compared to the average adult? a. Symbiotic reaction b. Paradoxical effect c. ADME process d. Syncope Answer: b Feedback: A possible term to describe an unexpected opposite effect of a medication is paradoxical effect. [return to top]

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

Solution and Answer Guide Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1 Choose one correct answer and mark the appropriate letter.

1. Drug standards regulate which factors in drug preparation? a. strength, quality, purity b. fillers, color, taste c. color, taste, quality d. quality, fillers, taste Answer: a Feedback: The strength, quality, and purity are standards for making any drug and these drug standards are specified in the United States Pharmacopeia/National Formulary.

2. The Pure Food and Drug Act a. requires warning labels on certain medications b. sets limitations on prescription use c. establishes consumer protection d. was passed in 1976 Answer: c Feedback: The Pure Food and Drug Act is the first drug law passed in 1906 to ensure consumer safety.

3. The Food and Drug Administration regulates a. prescriber registration b. creation of drug schedules c. prescription labeling d. establishment of drug regulations Answer: d Feedback: The Food and Drug Administration was established in accordance to the 1938 Federal Food, Drug, and Cosmetic Act, which provide many drug regulations to ensure consumer safety. Some examples of these regulatory authorities include approval of all new medications, ensuring accurate labeling of active and inactive ingredients and precaution warning to ensure proper use of drugs.

4. Controlled substances include a. Digoxin and Tylenol b. Benadryl and Cardizem c. Ampicillin and Ibuprofen d. Valium and Marijuana

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

Answer: d Feedback: Controlled substances are those that have a high potential of developing dependence and abuse, and typically these drugs affect the central nervous system.

Examples include the benzodiazepine valium (diazepam) and psychoactive substance such as cocaine and marijuana.

5. Controlled drugs a. are listed by schedule b. have no limitations on refills c. do not cause dependence d. are available over the counter Answer: a Feedback: Because of their high potential of dependence and abuse, controlled substances are highly regulated and classified into different schedules. These schedules have different restrictions of use that are based on the extent of dependence and abuse potential.

6. A good source of drug information is a. news magazines b. your colleagues c. social networks d. PDR Answer: d Feedback: A good source of drug information that is also objective is the Physician Desk Reference.

7. The generic name of a drug is a. assigned by the drug company b. written in capital letters c. the common name d. the same as the trade name is a common name Answer: c Feedback: The generic name of a drug is a common name assigned by the United States Adopted Name council, and is different from the trade name by having an initial lowercase letter and is never capitalized.

8. The term OTC refers to drugs that a. are often controlled b. require a prescription c. are sold over the counter d. are officially certified

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

Answer: c Feedback: The term OTC refers to over the counter, which means that are drugs that can be obtained without a prescription.

9. Two conditions commonly listed as contraindications for drug administration are a. obesity and glaucoma b. hypersensitivity and pregnancy c. psychosis and seizures d. glaucoma and anemia Answer: b Feedback: There are very few objective information about the safety of drugs in pregnant women as well as about the extent and incidence of hypersensitivity reaction to drug. Hence they are commonly listed as contraindications for drug administration.

10. Before giving a new drug, you must know a. its absorption rate b. the distribution process it will follow c. its excretion rate d. its indication for use and side effects Answer: d Feedback: For proper therapeutic and safe use of any drug, its indication for use and side effects need to be made known to the patient.

11. An antibiotic with photosensitivity listed as a side effect could cause a. deafness b. sunburn c. blindness d. kidney damage Answer: b Feedback: The prefix “photo” related to light or sunlight, so an antibiotic with photosensitivity listed as a side effect could cause sunburn.

12. The initial high dose to quickly elevate drug levels is the a. loading dose b. maintenance dose c. maximum dose d. therapeutic dose Answer: a

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

Feedback: The loading dose will rapidly fill up the patient by providing an elevated drug level.

13. An accumulation of a normal drug dosage can best be explained by what pharmacokinetic change? a. increase in metabolism b. increase in excretion c. decrease in metabolism d. decrease in absorption Answer: c Feedback: When the metabolic rate is decreased, drug will not be eliminated from the body effectively and hence will accumulate even when a normal drug dosage is administered.

14. Patient characteristics affect the processing of drugs in the body. Two of these characteristics are a. hair color and gender b. skin color and mental status c. ethnicity and age d. weight and age Answer: c Feedback: The metabolic rate that process drug elimination in an individual can be affected by age and ethnicity.

15. Drug toxicity from cumulative effects may result from a. intracranial pressure b. glaucoma c. kidney malfunction d. high blood pressure Answer: c Feedback: When the excretion rate of a drug is decreased as a result of kidney dysfunction, drug will not be eliminated from the body effectively and hence will accumulate to a higher than expected level, producing toxicity.

16. Idiosyncrasy means a. an opposite effect from that expected b. an allergic response to a drug c. a unique, unusual, and unexpected response to a drug d. having an effect from a drug as the result of suggestion Answer: c

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

Feedback: Idiosyncrasy means unexpected effect that is not related to the known pharmacological profile of the drug.

17. The route of administration most often used is a. topical b. sublingual c. injection d. oral Answer: d Feedback: Because of its convenience, the oral route is the most often used administration route for medication.

18. A form of parenteral administration is a. nasogastric tube b. injection c. oral d. rectal Answer: b Feedback: Parenteral means drug administration route that is not associated with the gut.

19. A type of medication that can be crushed and mixed with food to facilitate administration is a. time-release capsule b. lozenge c. capsule d. enteric-coated tablet Answer: c Feedback: Special oral unit dosage form other than capsule and tablet should not be crushed, as doing so will destroy the unique formulation characteristic.

20. Topical administration includes which of the following? a. nebulizer b. cream c. sublingual d. inhalation Answer: b Feedback: Cream and ointment are typical topical drug formulation applied to the skin.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

21. The most rapid form of administration is a. PO b. IV c. IM d. subcu Answer: b Feedback:. The intravenous (IV) route directly put the medication into the systemic circulation and is the most rapid form of administration.

22. The least accurate system for measuring medication is a. metric b. apothecary c. household d. standard Answer: c Feedback: Although the household system is more familiar to the layperson, it is the least accurate system for measuring medication.

23. The most frequently used system for measuring medicine is a. apothecary b. metric c. household d. standard Answer: b Feedback: The metric system is the current system of measurement and is the most frequently used way for measuring medicine.

24. Medication orders must contain a. patient’s address b. alternate drugs c. physician’s address d. drug name, dosage, and route Answer: d Feedback: For proper administration of a drug, the medication order must contain the drug name, dosage, and route.

25. The prescription blank for a controlled substance must contain a. name of the drug company b. physician’s DEA number c. physician’s address d. lot number of the drug

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

Answer: b Feedback: To minimize the potential of abuse, the prescription blank for a controlled substance must contain the DEA number, which is unique to each prescriber.

26. The least accurate type of equipment for measuring medicine is a a. medicine cup b. calibrated utensil c. tablespoon d. syringe Answer: c Feedback: Common household items such as a tablespoon is the least accurate type of equipment for measuring medicine.

27. Responsibilities of the health care professional in drug administration include a. assessing and evaluating patients b. checking the order for accuracy c. reporting adverse patient outcomes d. all the above Answer: d Feedback: For proper and safe use of the drug, a health care professional must assess and evaluate the patient, check order accuracy, and report any adverse patient outcomes related to the administration of the drug.

28. After administering medication, you should a. inform the patient’s family b. document drugs administered c. complete additional treatments ordered d. administer drugs to the next patient Answer: b Feedback: The proper and responsible way for a healthcare professional to do after drug administration is to document the drug administration event.

29. The most helpful patient information to know when administering medication is a. patient’s residence b. patient’s disabilities c. patient’s health history, including allergies d. patient’s occupation Answer: c

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

Feedback: In order to properly assess the safe use of a drug for a patient, the healthcare professional should check the patient’s health history, including allergies.

30. If a medication error is made, once the patient is cared for you should a. immediately report the error to the physician b. file an incident report c. note the error on the patient record d. apologize to the patient Answer: c Feedback: After the occurrence of the medication error, the patient should be cared for first, then the error should be noted on the patient record.

31. Before giving any medicine, it is essential to review the Rights of Medication Administration, including a. right medication and right amount b. right physician and DEA number c. right drug company d. right drug lot Answer: a Feedback: To minimize medication error, the rights of medication administration requires that the right medication is given in the right amount.

32. Documentation of a controlled drug given PRN for pain requires a. review of pharmacy delivery record b. re-evaluation of effectiveness c. note of the trade name d. review of the physician’s comments Answer: b Feedback: Since the medication is ordered on an as needed basis, the intended effectiveness of the medication should be evaluated. This is especially true for a controlled substance with a high dependence and abuse potential.

33. Administration by the gastrointestinal route includes which of the following? a. PEG tube b. oral inhaler c. transdermal patch d. eye drops Answer: d Feedback: Administration by the gastrointestinal route includes any of the anatomic regions of the GI tract, such as the PEG tube.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

34. An advantage of the oral route over other routes is that it a. absorbs the most quickly b. is the best route to treat emergencies c. is economical, with few equipment costs d. can be used for all patients all the time Answer: c Feedback: The oral route is convenient and costs the least with respect to drug administration.

35. If a medication is ordered PO and the patient is NPO, you should a. give the medication by injection b. give the medication rectally c. omit the medication and note on the chart d. consult the person in charge Answer: d Feedback: If a medication is ordered PO and the patient is NPO, then the person in charge needs to be notified.

36. Oral medications are usually best administered with a. fruit juice b. milk c. water d. hot tea Answer: c Feedback: Unless there is a special reason related to the drug, oral medications are usually best administered with water 37. When preparing the proper dosage of cough syrup, you should a. shake the bottle b. dilute with liquid c. hold the bottle with the label side down d. hold the medicine cup at eye level.

Answer: d Feedback: For proper measuring the right amount of cough syrup, the medicine cup should be held at eye level.

38. When administering a rectal suppository, you should a. assist the patient to self-administer b. provide privacy and use disposable gloves c. turn the patient onto the right side d. warm the suppository under warm water

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

Answer: b Feedback: The healthcare professional should provide privacy and use disposable gloves, as well as position the patient onto the left side with the upper knee bent.

39. The parenteral route least likely to be used for systemic effects is a. transdermal b. topical c. sublingual d. inhalation Answer: b Feedback: Topical application of medication is intended to produce a local, and not systemic effect.

40. The route with the slowest action is a. transcutaneous b. inhalation c. sublingual d. injection Answer: a Feedback: Transcutaneous route of administration is intended for slow release of medication from its vehicle and hence provide the slowest onset of pharmacologic effect.

41. After instilling eye drops, you should a. rub the eyelid vigorously b. press on the inner canthus c. close the eyelid quickly d. discard the eyedropper Answer: b Feedback: Proper technique for instillation of eye medications include pressing gently on the inner canthus following administration, thus minimizing systemic absorption.

42. For intradermal injection, you should a. use a tuberculin syringe b. use a 21-gauge, 1-inch needle c. pinch the skin d. inject 1–3 mL of solution Answer: a

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

Feedback: The appropriate supplies for administering medication via intradermal injection are tuberculin syringe; 27-gauge, 3/8-inch needle.

43. Which of the following is not true for intramuscular injections? a. pinch the skin b. administer at a 45-degree angle of needle c. use a 1ó-inch needle for most patients d. always administer Z-track for medications that are irritating to tissue Answer: b Feedback: For intramuscular injections, the needle is at a 90-degree angle.

44. Which of the following IM injection sites is most commonly used for immunizations? a. dorso gluteal b. vastus lateralis c. ventrogluteal d. deltoid Answer: d Feedback: The recommended site for vaccine administration is the deltoid.

45. Before administering medication via NG tube, you should verify placement by a. injecting 10 mL water b. attaching NG to suction c. having an X-ray of the abdomen taken d. checking the pH of gastric aspirate Answer: d Feedback: The health professional should verify tube placement by checking the pH of gastric aspirate.

46. If a 2-year-old accidentally swallows several children’s aspirin tablets, you should a. administer ipecac b. give activated charcoal c. call Poison Control d. give 8 oz of milk Answer: c Feedback: The proper step to be taken in this case should be calling the Poison Center, which will determine the appropriate step to be taken next.

47. If there is doubt about the type of poison ingested by an individual, toxicology tests will be done on body fluids, including a. tears and saliva b. blood and urine

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

c. stool and emesis d. emesis and tears Answer: b Feedback: Body fluids such as blood and urine should be tested to determine the type of poison ingested, so that proper management steps can be instituted.

48. The groups at greatest at risk of accidental poisoning are a. young children and older adults b. adolescents and healthy adults c. healthy adults and adults with disabilities d. adolescents and dementia patients Answer: a Feedback: From a toxicology perspective, the patient groups most susceptible to accidental poisoning are the young children and the elderly.

49. Prevention is the key to preventing harm and death from poisoning. Key to prevention is a. legislation b. oversight c. regulation d. public education Answer: d Feedback: The most effective way to prevent accidental poisoning and its associated health consequences is educating the public.

50. Which of the following is the IV route used for? a. correct body fluid imbalances b. administer blood c. administer medications d. all of the above Answer: d Feedback: The intravenous route can be used for administering blood, medications, as well as fluids and electrolytes.

51. How many types of IV administration are there? a. one b. two c. three d. four Answer: b

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

Feedback: There are two types of IV administration: continuous IV infusion and intermittent IV infusion (piggyback or bolus/push).

52. Which of the following is an isotonic fluid? a. lactated Ringers b. ½ NSS c. D5W d. D5LR Answer: a Feedback: Lactated Ringer’s (LR) is an example of isotonic fluid.

53. A self-administered inhalational device that utilizes a propellant to deliver the medication is a(an) a. DPI b. SVN c. MDI d. PEG Answer: c Feedback: A metered dose inhaler (MDI) is a device commonly used by asthmatic patients to self-administer medications for their medical condition.

54. Who discovered penicillin? a. Alexander Fleming b. Oswald Schmeideberg c. Alfred Einhorn d. Watson and Crick Answer: a Feedback: Alexander Fleming is best known for his discovery of penicillin.

55. Why is Tall Man Lettering used? a. It looks appealing to customers. b. It highlights differences in sound-alike medications. c. It adds confusion. d. It helps patients spell the drug names.

Answer: b Feedback: The Tall Man Lettering is used to highlights differences in sound-alike medications.

Calculate the correct dosage for administration in the following problems. Label your answers. Remember that syringes are not marked in fractions; therefore, when

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 1

computing dosages for administration, you must convert all fractions to decimals and round off to one decimal place.

56. You are to give 7,500 units of heparin subcu. How many milliliters should you give?

Answer: 1.5 ml Feedback: The heparin is available as an injection 5,000 units/ml. Therefore, the amount to be given is 7,500/5,000 = 1.5 ml.

57. You are to give 10 mL of guaifenesin cough syrup with codeine. How much codeine would the patient receive in each prescribed dose?

Answer: 200 mg Feedback: The cough syrup is available as 100 mg guaifenesin and 100 mg of codeine /5 ml. Therefore, 10 ml of the cough syrup will contain 200 mg of codeine.

58. The medicine bottle label states that the strength of each tablet in the bottle is 0.25 mg. The physician has ordered that the patient is to receive 0.5 mg. How many tablets should you give?

Answer: two tablets Feedback: Each tablet contains 0.25 mg of the active ingredient, so two tablets would need to be given for the patient to receive the prescribed dose of 0.5 mg.

59. The physician has ordered 50 mg of meperidine to be given. How many milliliters should you give?

Answer: 0.5 ml Feedback: The meperidine is available as an injection 100 mg/ml. Therefore, the amount to be given is 50 mg/100 mg = 0.5 ml.

60. To convert pounds to kilograms (kg), you would divide the number of pounds by what number?

Answer: 2.2 Feedback: 1 kg = 2.2 lbs, therefore, we need to divide the number of pounds by 2.2

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

Solution and Answer Guide Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2 Choose one correct answer and mark the appropriate letter.

1. Vitamin C aids in the absorption of a. protein b. iron c. fat d. zinc Answer: b Feedback: Vitamin C improves the absorption of micronutrients, especially iron.

2. What is one side effect of taking an iron preparation? a. blood-tinged stools b. brown stools c. white stools d. black stools Answer: d Feedback: In addition to causing constipation, iron can cause black-colored stool.

3. Which vaccine is recommended for all persons over the age of 50 years? a. Pneumovax 23 b. Adacel c. Prevnar 13 d. Shingrix Answer: d Feedback: When an individual turns 50 years old, he or she should take the shingle vaccine (Shingrix).

4. Which side effect may occur after prolonged use of a corticosteroid cream? a. hyperglycemia b. epidermal thinning with frequent skin tears c. immunodeficiency disorders d. systemic viral infection Answer: c Feedback: Prolonged use of corticosteroid could suppress the immune system and hence has the potential to cause immunodeficiency disorders.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

5. Which type of preparation is used topically to soothe the skin and seal out wetness from diaper rash? a. keratolytics b. antipruritics c. protectants d. enzymatics Answer: c Feedback: A protectant is a type of medication applied topically for soothing the skin and can help seal out wetness from diaper rash.

6. A yeast infection of the tongue is medically known as a. tinea pedis b. varicella zoster c. tinea coporis d. candidiasis Answer: d Feedback: A fungal infection occurring within the mouth or on the tongue is known as oral candidiasis.

7. A common topical antifungal medication used for athlete’s foot would be a. clotrimazole b. betamethasone c. mupirocin d. povidone–iodine Answer: a Feedback: Clotrimazole is an azole antifungal agent and used commonly for treating athlete’s foot.

8. Drugs that mimic the action of the sympathetic nervous system are known as a. adrenergics b. cardiogenics c. adrenergic blockers d. cholinergics Answer: a Feedback: A pharmacologic agent that activate the sympathetic nervous system or mimic the activation of the sympathetic nervous system is known as an adrenergic agent.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

9. Adrenergics should be used with caution in patients with a. hypotension b. angina c. asthma d. diabetes Answer: b Feedback: Since an adrenergic agent will increase heart rate, it should be used with caution in patients with angina, as increasing the heart rate will increase the myocardial oxygen demand imposed on the heart and precipitate an anginal episode.

10. Cholinergic blockers would most likely cause which of the following side effects? a. hypotension b. photosensitivity c. dry mouth and constipation d. enhanced vision Answer: c Feedback: Adverse side effects of cholinergic blockers or anticholinergic agents include dry mouth and constipation.

11. What would be the best food choice for an individual undergoing treatment with an antineoplastic? a. spaghetti and meatballs b. orange juice c. mashed potatoes d. peppered steak Answer: c Feedback: One common side effect of antineoplastic agent is mucositis. Therefore, food that requires minimal chewing would be the most desirable.

12. A clinician is reviewing an order sheet for a patient with breast cancer. Herceptin is ordered to be given orally. The clinician knows that this is an error and that instead the drug should be administered by which route? a. intrathecal b. intravenous c. topical d. intramuscular injection Answer: b Feedback: Herceptin is a monoclonal antibody that needs to be administered parenterally, and the most common route of administration is intravenous.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

13. Plant alkaloids can be fatal if administered by which route? a. intrathecal b. intravenous c. oral d. intraosseous Answer: a Feedback: Plant alkaloids have significant neurotoxicity. If given by the intrathecal route, it can cause fatality.

14. The main indication for the use of a diuretic is to a. reduce bladder spasm b. promote excretion of uric acid c. reduce urinary frequency d. reduce the circulating fluid volume Answer: d Feedback: By reducing the circulating fluid volume, the diuretics can be used to lower blood pressure and relieve congestive symptoms in patients with heart failure.

15. Which of the following is common side effect of all the antineoplastic agents discussed? a. photosensitivity b. cardiotoxicity c. GI effects such as nausea and vomiting d. extravasation Answer: c Feedback: All neoplastic agents exert their pharmacologic effects on both tumor cells and normal cells, especially those that have a high turnover rate such as the cells ining the GI tract. As such, regardless of their route of drug administration, they all cause nausea and vomiting.

16. What condition is medical marijuana not used to treat (in states that allow it)? a. end-of-life situations where palliative care is a priority (pain) b. PTSD/depression c. anxiety d. dizziness Answer: b Feedback: Medical marijuana is used as an analgesic for certain types of cancerrelated pain, for prevention of chemotherapy-induced nausea and vomiting. It has also been used as an appetite stimulant in cachexia associated with AIDS or cancer.

It also possesses properties of a euphoriant, sedative and hallucinogen.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

17. UTIs are commonly treated with a. antibiotics and Pyridium b. steroids and fluids c. antibiotics and ibuprofen d. nothing; uncomplicated UTIs self-resolve Answer: c Feedback: For urinary tract infection (UTI), antibiotics and ibuprofen are used to eliminate the bacteria and manage the pain, respectively.

18. Long-term use of agents that reduce gastric acid can possibly result in a deficiency of which vitamin? a. vitamin D b. vitamin E c. vitamin C d. vitamin B12 Answer: d Feedback: Proper absorption of vitamin B12 requires an acidic environment, and long-term use of agents to reduce gastric acid will increase the gastric pH and produce an alkali environment.

19. The drug mesalamine produces an anti-inflammatory effect in which section of the gastrointestinal tract? a. stomach b. colon c. esophagus d. duodenum Answer: b Feedback: Mesalamine produces symptomatic relief for patients who have inflammatory conditions within the colon.

20. What instruction should be given with a prescription for esomeprazole (Nexium) and other PPI’s? a. Take 2 h after a meal. b. Take on an empty stomach. c. Take with water only d. Take with meals Answer: b Feedback: These agents should be taken on an empty stomach.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

21. What is the drug of choice for infective endocarditis prophylaxis? a. penicillin b. cefaclor c. amikacin d. amoxicillin Answer: d Feedback:. According to clinical guidelines, amoxicillin is the drug of choice for infective endocarditis prophylaxis.

22. What is a potential hypersensitivity reaction caused by vancomycin? a. red rash of the face and upper torso b. lactic acidosis c. flushing of hands d. elevated CPK Answer: a Feedback: Vancomycin might cause a hypersensitivity reaction called red man syndrome, with characteristic red rash of the face and upper torso.

23. Amphotericin B is administered by which route? a. oral b. intravenous c. intramuscular d. transdermal Answer: b Feedback: Amphotericin is not absorbed orally and needs to be administered by intravenous infusion.

24. What is the primary function of mydriatic eye preparations? a. pupil constriction b. pupil dilation c. corneal anti-inflammatory d. retinal anesthetic Answer: b Feedback: Mydriatics make the pupil of the eye dilate.

25. Patients being treated with an anti-infective ophthalmic preparation should be instructed to a. avoid eye makeup b. wear contact lenses for not more than 12 h a day c. instil into the upper eyelid area d. use drops only until symptoms begin to improve

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

Answer: a Feedback: Patients should be instructed not using eye makeup or not wearing contact lenses while treating eye infections, and instill the eye drop into the lower conjunctival sac.

26. Which is a key guideline in educating a patient with an eye infection? a. consider an eye patch as an effective alternative to an antibiotic for treatment b. engage in careful handwashing to prevent the spread of infection c. gently massage the upper eyelid after instillation of eye drops d. when using more than one drop instill both drops at the same time Answer: b Feedback: To manage an eye infection, it is important for the patient the importance of careful handwashing to prevent the spread of infection to the other eye or another patient.

27. Large doses of acetaminophen can cause which side effect? a. gastric ulcer b. petechiae c. liver toxicity d. splenic swelling Answer: c Feedback: Although acetaminophen in general is very safe, ingesting a large amount can cause liver toxicity.

28. Opioids can tend to cause tolerance, which is a. when the drug is stopped, withdrawal symptoms occur b. when the person has a physical need to take the drug c. when the drug is not tolerated in the body and side effects occur d. when a larger dose of the drug is needed to achieve the same effect Answer: d Feedback: Tolerance is a pharmacological phenomenon in which a larger dose of the drug is needed to achieve the same effect, and is very common with opioid use.

29. Why may a lidocaine patch be of benefit to a patient experiencing postherpetic neuralgia? a. It acts peripherally with little CNS action. b. It produces an anesthetic effect. c. It acts as a CNS depressant. d. It produces an anti-inflammatory effect.

Answer: b

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

Feedback: Lidocaine is an anesthetic that produces a beneficial therapeutic effect for a patient experiencing postherpetic neuralgia.

30. What is the preferred first-step intervention in treating insomnia? a. barbiturates b. benzodiazepines c. nondrug therapies d. nonbenzodiazepines Answer: c Feedback: Before starting pharmacological treatment, patients should be encouraged to use nondrug interventions to combat insomnia.

31. What is a possible side effect of an overdose of a tricyclic antidepressant? a. hypertension b. mania c. hyperglycemia d. tachyarrhythmias Answer: d Feedback: The major toxicity of tricyclic antidepressants occur in the heart, which include arrhythmias.

32. Which antidepressant can be useful in a patient with severe depression characterized by extreme fatigue, lethargy, and psychomotor retardation? a. mirtazapine b. bupropion c. imipramine d. trazodone Answer: b Feedback: Bupropion is considered an activating antidepressant and can be useful in cases of severe depression characterized by extreme fatigue, lethargy, and psychomotor retardation.

33. Which vital sign should be monitored continuously when administering midazolam (or any benzodiazepine to a patient? a. blood pressure b. pulse c. temperature d. respiratory rate Answer: d

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

Feedback: Midazolam is a benzodiazepine that has a respiratory depressant effect.

Therefore, the respiratory rate should be monitored.

34. What is first-line therapy for children with ADHD? a. stimulants such as Adderall or Ritalin b. antidepressants such as Celexa or Zoloft c. nonpharmacological therapy d. all of the above Answer: c Feedback: The first-line therapy for children with ADHD should be with nonpharmacological therapy.

35. The use of skeletal muscle relaxants is of greatest concern, and should be avoided, in which population? a. young children b. older adults c. pregnant or breast-feeding women d. individuals with bone cancer Answer: c Feedback: The use of skeletal muscle relaxants is of greatest concern, and should be avoided, in pregnant or breast-feeding women.

36. Individuals with a sulfonamide hypersensitivity should follow which guideline when taking celecoxib (Celebrex)? a. take only three doses b. take for one month c. avoid taking the drug d. wait 2 h after aspirin ingestion Answer: c Feedback: Patients with sulfonamide hypersensitivity should not take Celebrex.

37. What is the IV drug of choice to treat status epilepticus? a. diazepam b. lorazepam c. valproic acid d. fosphenytoin Answer: b Feedback: The treatment of choice is IV lorazepam l.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

38. A patient taking entacapone (Comtan) may need assistance with getting out of bed due to which possible side effect? a. muscular stiffness b. peripheral neuropathy c. orthostatic hypotension d. tachycardia Answer: c.

Feedback: Side effects of entacapone include orthostatic hypotension.

39. Which anticonvulsant is considered “broad-spectrum” and is useful for the management of many seizure types? a. phenytoin b. oxcarbamazepine c. valproic acid d. clonazepam Answer: c Feedback: Valproic acid is considered a broad-spectrum anticonvulsant useful for the management of many seizure types, including generalized tonic-clonic, absence, and myoclonic seizures.

40. Corticosteroids can be used to treat all of the following EXCEPT a. allergic reactions b. respiratory disorders c. malignancies d. headaches Answer: c Feedback: Corticosteroids can be used to manage allergic reactions, respiratory disorders such as asthma. A new use for corticosteroids in migraine therapy is to treat drug-overuse headache.

41. A patient taking thyroid replacement medication (like levothyroxine) should be instructed to take it a. anytime during the day b. only when they are having symptoms c. on an empty stomach in the morning d. before bed with a snack Answer: c Feedback: Patient should be instructed to take levothyroxine on an empty stomach.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

42. An overdosage of thyroid replacement medication (like levothyroxine) is manifested in which of the following ophthalmic conditions? a. drooping eyelids b. bulging eyeballs c. dilated pupils d. reddened conjunctive Answer: b Feedback: Overdose with thyroid replacement therapy could result in hyperthyroidism with many associated signs and symptoms, one of which is an abnormal protrusion of the eyeball.

43. Which oral medication for diabetes is considered first-line therapy? a. metformin b. Januvia c. Lantus d. Victoza Answer: a Feedback: Based on current guideline, metformin is considered first-line oral agent for diabetes.

44. Which of the following is a long-acting insulin? a. Novolog b. Novolin N c. Levemir d. Apidra Answer: c Feedback: Levemir is a long-acting insulin analog.

45. Insulin should be injected a. in the largest muscle every time b. in various muscles with the patient rotating sites c. subcutaneously with the patient rotating sites d. subcutaneously in the back of the arm only Answer: c Feedback: Insulin is administered subcutaneously and the site of injection should be rotated with each administration to minimize skin reaction.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

46. If a diabetic patient is hypoglycemic, what is a reasonable choice for acute treatment? a. 4 oz of orange juice b. sugar-free candy c. a small portion of red meat d. 8 oz of diet soda Answer: a Feedback: Sugar or glucose needs to be administered if a patient is hypoglycemic, and orange juice is a good source of sugar.

47. What hormone is responsible for the changes in the uterine endometrium during the second half of the menstrual cycle in preparation for implantation of the fertilized ovum? a. estrogen b. progesterone c. gonadotropin-releasing hormone d. testosterone Answer: b Feedback: The physiological role of progesterone is to prepare the implantation of the fertilized ovum 48. What is one side effect of continuous progestin? a. breast size reduction b. weight loss c. constipation d. amenorrhea Answer: d Feedback: Menstrual irregularity and amenorrhea, breakthrough bleeding, and spotting are common side effects of continuous progestin.

49. Postcoital contraception should be taken within how many hours of unprotected sex? a. 48 h b. 24 h c. 96 h d. 72 h Answer: Feedback: Postcoital contraceptiomust be administered within 72 h of unprotected intercourse and is more effective the sooner it is taken after having unprotected sex..

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

50. Which of the following is critical to monitor prior to administering digoxin? a. blood pressure b. radial pulse rate c. apical heart rate d. respiratory rate Answer: c Feedback: Potential bradycardia caused by digoxin should be monitored with apical heart rate.

51. Digoxin taken in conjunction with what type of medications can increase the chance of arrhythmias? a. antacids b. macrolides c. benzodiazepines d. diuretics Answer: d Feedback: Most diuretics can cause hypokalemia, which enhance the toxicity of digoxin and increase the chance of arrhythmias.

52. Which antiarrhythmic may cause tachycardia? a. procainamide b. adenosine c. verapamil d. metoprolol Answer: a Feedback: Procainamide is among the medications known as pro-arrhythmics that actually could cause arrhythmia.

53. Which medication could be used to replace an ACE inhibitor when a patient has problems with a dry cough as a side effect? a. losartan b. metoprolol c. digoxin d. atorvastatin Answer: a Feedback: Losartan has similar pharmacological mechanism of action as the ACE inhibitor but does not cause dry cough, which is commonly associated with the use of an ACE inhibitor.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

54. The most effective and most commonly used antilipemic medications are called a. bile acid sequestrates b. statins c. nicotinic acids d. fibrates Answer: b Feedback: The statins group is the most effective antilipemic medications and first line agents in treating high cholesterol.

55. Warfarin is monitored with what laboratory method? a. complete blood work with differential b. LH levels c. TSH levels d. INR Answer: d Feedback: The efficacy and toxicity of warfarin is monitored with the international normalized ratio (INR) test.

56. Clopidogrel should not be taken with which of the following medications? a. OTC Zantac b. OTC aspirin c. OTC Prilosec d. OTC Pepcid Answer: c Feedback: A proton pump inhibitor such as OTC Prilosec will prevent the conversion of clopidogrel to its active metabolite and prevents its therapeutic effect.

57. In patients with COPD, what precaution should be taken when administering oxygen? a. avoid smoking when in use b. always use the highest concentration tolerable c. only use a nasal cannula to delivery it d. use for no more than 1 h continuously Answer: a Feedback: Oxygen is not flammable but does support combustion. Smoking, matches, cleaning aerosols, and electrical equipment that may spark are not allowed in rooms where oxygen is in use..

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

58. What is the preferred route of administration of bronchodilators to minimize systemic adverse effects? a. oral b. injection c. sublingual d. inhalation Answer: d Feedback: When properly utilized, the inhalational route results in the least amount of systemic drug absorption.

59. Which antitussive has the greatest effectiveness? a. codeine b. hydrocodone c. benzonatate d. dextromethorphan Answer: b Feedback: Hydrocodone has slightly greater antitussive activity than codeine, both of which have higher efficacy than dextromethorphan and benzonatate.

60. What is one side effect of nicotine replacement products? a. diarrhea b. thickened secretions c. hyperglycemia d. nausea and vomiting Answer: d Feedback: Chewing nicotine replacement products too quickly may cause lightheadedness, nausea, heartburn, vomiting, and throat and mouth irritation) 61. Why should older adults avoid taking over-the-counter (OTC) antacids for longer than 2 weeks without medical supervision? a. OTC antacids may mask GI bleed. b. OTC antacids may cause C. difficile infection. c. OTC antacids may cause excessive flatulence. d. OTC antacids may cause urinary incontinence.

Answer: a Feedback: Elderly patients should avoid taking over-the-counter (OTC) antacids for longer than 2 weeks without medical supervision because of the danger of masking symptoms of GI bleeding or GI malignancy.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

62. Constipation is a concern for older adults. Which is a suggested first-line laxative for this population? a. calcium carbonate b. bismuth sulfate c. magnesium citrate d. sennosides Answer: a Feedback: Magnesium citrate by itself can cause diarrhea, therefore, its judicious use is useful in managing constipation.

63. What is the key strategy to avoiding problems when taking NSAIDs? a. take on an empty stomach b. take in conjunction with Tylenol c. take the lowest effective dose for the shortest time period with food or milk d. take for no more than 28 days continuously Answer: c Feedback: The key to avoiding problems with NSAIDs is to use the lowest effective dose for the shortest period of time.

64. What is one potential side effect of a calcium carbonate antacid? a. mild diuresis b. constipation c. diarrhea d. nausea Answer: b Feedback: Side effects of calcium-containing antacids include constipation.

65. Due to various reasons, older adult patients tend to a. take medications exactly as prescribed b. be nonadherent to one or more medications c. go to one pharmacy and one doctor for all their health care needs d. be on few medications Answer: b Feedback: The elderly are usually prescribed too many medications, which could lead to them being nonadherent to one or more medications.

66. Which treatment for gout is reserved for those who have failed other therapy and is administered IV? a. Allopurinol b. Uloric

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

c. Colcrys d. Krystexxa Answer: d Feedback: Pegloticase (Krystexxa) is a newer class of gout treatment and is reserved for patients who are resistant to other therapies and is given via IV infusion every 2 weeks.

67. The combination medication Duexis (famotidine and ibuprofen) is supplied in combination form for what reason? a. To increase patient adherence b. To decrease cost of medication c. Because ibuprofen and other NSAIDs can cause stomach ulcers, the famotidine (H2 blocker) acts as a protectant. d. Because famotidine and other H2 blockers can cause stomach ulcers, the ibuprofen (NSAID) acts as a protectant.

Answer: Feedback: A new combination medication, Duexis (famotidine and ibuprofen), is approved for the treatment of arthritis and rheumatoid arthritis. This is primarily due to the fact that ibuprofen can cause stomach ulcers, the famotidine acts as a protectant.

68. When taking SSRIs or tricyclic antidepressants, within which time frame should patients expect to see symptom relief? a. 2–6 weeks b. 1–2 days c. 1–3 years d. 30–60 minutes Answer: a Feedback: The therapeutic effect of antidepressants is generally not seen until 2-6 weeks after initiation of therapy.

69. Which of the following is the correct representation for insulin concentration? a. U-500 means there are 500 units of insulin per 10 mL b. U-100 means there are 100 units of insulin per 1 mL c. U-200 means there are 100 units of insulin per 2 mL d. U-100 means there are 100 units of insulin per 100 mL Answer: b Feedback: The correct representation is 100 units of insulin per 1 mL.

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Solution and Answer Guide: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Comprehensive Exam For Part 2

70. What is a paradoxical effect in terms of how medication affects certain patients? a. when a medication has the opposite effect on a person than intended b. when a medication is not as potent as intended c. when a medication is stronger for a certain patient than for others d. when a medication does not work for certain patients Answer: a Feedback: The phenomenon of paradoxical effect means that an opposite pharmacologic effect results.

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