Pharm Practice Quiz 4

All of these receptors are involved in nausea and vomiting. Dopamine receptors are involved in the chemoreceptor trigger zone (CTZ) in the brain, which is responsible for inducing vomiting. Acetylcholine receptors are involved in the transmission of signals from the CTZ to the vomiting center in the brainstem. Histamine receptors play a role in stimulating the CTZ and vomiting center. Serotonin receptors are involved in the activation of the vagus nerve, which triggers the vomiting reflex. Therefore, all of these receptors are involved in the process of nausea and vomiting.

PPIs should not be chewed or crushed to promote absorption. They should be taken whole, swallowed with water, and should not be broken, crushed, or chewed. This is because the enteric coating on PPIs is designed to protect the medication from stomach acid and ensure it is released in the small intestine where it can be absorbed properly.

Cimetidine is known to cause gynecomastia, which is the enlargement of breast tissue in males. This is because cimetidine has antiandrogenic effects, meaning it can interfere with the action of male hormones like testosterone. By blocking the effects of testosterone, cimetidine can disrupt the hormonal balance in the body, leading to the development of breast tissue in males.

Misoprostol is the correct answer because it is a prostaglandin analogue that helps prevent the formation of ulcers caused by non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs can cause irritation and damage to the stomach lining, leading to the development of ulcers. Misoprostol works by increasing the production of protective mucus in the stomach and reducing the secretion of stomach acid, thereby reducing the risk of NSAID-induced ulcers.

Phenytoin is metabolized by the liver through the enzyme CYP2C19, which is also responsible for metabolizing omeprazole. Therefore, taking omeprazole with phenytoin can inhibit the metabolism of phenytoin, leading to increased levels of phenytoin in the body. This can result in toxicity and potentially worsen seizures. Therefore, omeprazole should be avoided in patients taking phenytoin for seizures.

Lamivudine is not a 5-aminosalicylate because it belongs to a different class of drugs called nucleoside reverse transcriptase inhibitors. 5-aminosalicylates are a group of drugs commonly used to treat inflammatory bowel disease, and include sulfasalazine, mesalamine, and olsalazine. Lamivudine is used to treat HIV and hepatitis B infections.

The correct answer is "none of these are contraindications." This means that breast feeding, yeast hypersensitivity, and immunosuppression are not contraindications for hepatitis vaccines. In other words, individuals who are breastfeeding, have a hypersensitivity to yeast, or are immunosuppressed can still receive hepatitis vaccines without any issues or concerns.

A) opiate receptors
B) cholinergic receptors
C) dopamine
D - correct

The statement "these are all true" means that all of the given statements are correct. According to the statement, the treatment for IBD with corticosteroids is indeed at a dosage of 40-60mg daily. Additionally, the hydrocortisone enema is more effective than the foam or the suppository. Lastly, the foam provides greater systemic absorption than the enema. Therefore, all of the statements are true.

Parkinson's disease is not a contraindication for the use of azathioprine. Azathioprine is an immunosuppressive medication commonly used to prevent organ rejection after transplantation and to treat certain autoimmune diseases. It works by suppressing the immune system, which can be beneficial in certain conditions. However, it is contraindicated in pregnancy, active liver disease, and severe renal impairment due to potential risks and complications. Parkinson's disease, which is a neurodegenerative disorder affecting movement, does not have any known interactions or contraindications with azathioprine.

A) Immodium
B) Lomotil
C) Pepto Bismol
D) Kaopectate

Bismuth subsalicylate is primarily used for treating traveler's diarrhea. This condition is caused by consuming contaminated food or water while traveling, leading to symptoms such as diarrhea and abdominal pain. Bismuth subsalicylate helps to alleviate these symptoms by reducing inflammation in the intestines and slowing down bowel movements. It also has antimicrobial properties that can help kill the bacteria causing the diarrhea. Therefore, it is an effective treatment specifically for traveler's diarrhea.

Lactulose is not a bulk-forming laxative because it works as an osmotic laxative. It is a synthetic sugar that is not absorbed by the body and remains in the colon, where it draws water into the stool, softening it and increasing bowel movements. In contrast, bulk-forming laxatives such as psyllium, polycarbophil, and methylcellulose work by absorbing water in the intestines, forming a bulky gel-like substance that stimulates bowel movements.

A) serotonin antagonists: ondansetron (Zofran), granisetron (Kytril), dolasetron
B) phenothiazines: prochlorperazine (Compazine), promethazine (Phenergan)
C) benzamides: metoclopramide (Reglan), trimethobenzamide (Tigan)
D) anticholinergics/antihistamines (second line treatment): diphenhydramine (Benadryl, meclizine (Antivert), dimenhydramine (Dramamine), scopolamine (Transderm-Scop)

Serotonin antagonists are indicated for severe nausea and vomiting. These medications work by blocking serotonin receptors in the brain, which helps to reduce the symptoms of nausea and vomiting. They are commonly used in the treatment of chemotherapy-induced nausea and vomiting, as well as post-operative nausea and vomiting. Benzodiazepines, dexamethasone, and phenothiazines may also be used in certain cases, but they are not specifically indicated for severe nausea and vomiting like serotonin antagonists are.

Inhibition of cox-1 contributes to the formation of ulcers. Cox-1 is an enzyme that is responsible for the production of prostaglandins, which help protect the stomach lining. When cox-1 is inhibited by NSAIDs, the production of prostaglandins is reduced, leading to a decrease in the protective mucus and an increase in stomach acid secretion. This imbalance can result in the erosion of the stomach lining and the formation of ulcers.

Sucralfate promotes mucosal defenses in PUD by reacting with hydrochloric acid in the stomach and binding to the surface of the ulcer. This forms a protective barrier that shields the ulcer from further damage and allows it to heal. By binding to the ulcer, sucralfate also helps to prevent further irritation and inflammation, promoting the overall healing process.

Uremic bleeding refers to excessive bleeding that occurs in patients with kidney failure. The treatment for uremic bleeding does not involve the use of calcium products. Calcium products are commonly used in the treatment of hyperphosphatemia, potassium imbalance, and osteodystrophy. However, in the case of uremic bleeding, other interventions such as blood transfusions, medications to promote clotting, and dialysis may be used instead.

Loperamide should be used cautiously in infectious diarrhea because it is an anti-diarrheal medication that works by slowing down the movement of the intestines. While this can provide relief from diarrhea symptoms, it can also potentially delay the elimination of infectious pathogens from the body. Therefore, caution should be exercised when using loperamide in infectious diarrhea to ensure that the underlying cause of the diarrhea is properly addressed and not masked by the medication.

Sorbitol is the correct answer because it is a drug that is metabolized in the GI tract, producing solutes that attract water osmotically. This increased water content in the intestines helps to facilitate propulsion and evacuation, making it an effective treatment for constipation. Milk of magnesia, prune juice, and ExLax are not metabolized in the same way and do not have the same osmotic effects in the GI tract.

The given statement is false because the correct statement is to calculate adjusted body weight if body weight is greater than 20% over ideal body weight, not 10%.

The vaccine Vaqta is incorrectly matched to the type of hepatitis it prevents. Vaqta is actually a vaccine that prevents hepatitis A, not hepatitis B.

Drugs larger than 500 daltons are not effectively removed by hemodialysis. Hemodialysis is a process that helps remove waste and excess fluids from the blood. It works by filtering the blood through a dialyzer, which allows small molecules to pass through while retaining larger ones. Since drugs larger than 500 daltons are too big to pass through the dialyzer, they cannot be effectively removed by hemodialysis.

Benzodiazepines are used for anticipatory nausea because they have anti-anxiety properties and can help reduce the feelings of nausea that can occur before a nauseating event, such as chemotherapy. These medications work by increasing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, which helps to calm the nervous system and reduce anxiety. By reducing anxiety, benzodiazepines can indirectly help to alleviate anticipatory nausea.

CCBs, or calcium channel blockers, are commonly used to treat acute tubular necrosis. However, one of the risks associated with their use is peripheral hypotension. CCBs work by relaxing the blood vessels, which can lead to a decrease in blood pressure. This can cause symptoms such as dizziness, lightheadedness, and fainting. Therefore, peripheral hypotension is a potential risk that should be considered when using CCBs for the treatment of acute tubular necrosis.

Butyrophenones are a class of antiemetic drugs that do not cause blurred vision. Unlike phenothiazines, cannabinoids, and antihistamines, butyrophenones do not have the side effect of blurred vision.

H2 antagonists are the first line treatment for chronic mild to moderate GERD. These medications work by blocking the histamine receptors in the stomach, which reduces the production of stomach acid. By reducing the amount of acid in the stomach, H2 antagonists help to relieve the symptoms of GERD such as heartburn and acid reflux. They are effective in managing the symptoms of GERD and are generally well-tolerated by patients.

Azathioprine is the correct answer because it takes effect in the same amount of time as 6-mercaptopurine and works by the same mechanism of action (MOA) since 6-mercaptopurine is an active metabolite of azathioprine. This means that azathioprine is converted into 6-mercaptopurine in the body, which then exerts its therapeutic effects.

Monoclonal antibodies work by reducing the infiltration of inflammatory cells and TNF (tumor necrosis factor). This means that they can help to decrease inflammation in the body by preventing the movement of immune cells to the site of inflammation and by blocking the action of TNF, which is a pro-inflammatory cytokine. By doing so, monoclonal antibodies can help to alleviate symptoms and manage conditions associated with excessive inflammation, such as autoimmune diseases.

Recumbent patients refers to individuals who are lying down or in a reclined position. The use of lubricant laxatives in recumbent patients can be contraindicated because it may lead to aspiration pneumonia. When lying down, there is a higher risk of the laxative entering the lungs instead of the digestive tract, causing inflammation and infection. Therefore, caution should be exercised when considering the use of lubricant laxatives in recumbent patients to avoid potential complications.

Metoclopramide is known to increase the tone of the lower esophageal sphincter (LES). The LES is a muscular ring that separates the esophagus from the stomach and helps to prevent stomach acid from flowing back into the esophagus, which is a common problem in gastroesophageal reflux disease (GERD). By increasing the tone of the LES, metoclopramide can help to reduce the frequency and severity of acid reflux episodes in patients with GERD.

A non-selective beta blocker is a treatment for esophageal varices associated with cirrhosis. These medications help to reduce the pressure in the portal vein, which is often elevated in patients with cirrhosis and can lead to the development of esophageal varices. By reducing the pressure, non-selective beta blockers can help to prevent bleeding from these varices and decrease the risk of complications. Lactulose is used to treat hepatic encephalopathy, not esophageal varices. Calcium channel blockers and mannitol are not typically used in the treatment of esophageal varices associated with cirrhosis.

The correct answer is "none of the above." This means that all of the first-line antiemetics listed in the question (phenothiazines, serotonin (5-HT3) antagonists, butyrophenones, and benzamides) can cause extrapyramidal symptoms. Extrapyramidal symptoms are movement disorders that can include muscle stiffness, tremors, and involuntary movements.

A platelet count of 52,000 is not an indication to decrease the interferon dose by 50% in chronic hepatitis. Platelets are important for blood clotting, and a low platelet count can increase the risk of bleeding. However, it is not directly related to interferon dosage adjustment in chronic hepatitis. The other options, such as serious mood changes, daily nausea with occasional vomiting, and fatigue, are more commonly associated with interferon therapy and may warrant a decrease in dosage.

Genotype 1 is the least likely to respond to interferon among the given options. This is because genotype 1 is known to have a lower response rate to interferon-based therapies compared to genotypes 2 and 3. Interferon is a type of antiviral medication used to treat hepatitis C, but its effectiveness can vary depending on the specific genotype of the virus. Genotype 1 is generally considered more difficult to treat and may require alternative or combination therapies for better response rates.

Lactated ringers is not an IV colloid. IV colloids are solutions that contain large molecules, such as proteins or starches, which help to increase blood volume. Albumin and blood are examples of IV colloids, as they contain proteins. Dextrose, on the other hand, is a type of sugar and is not considered an IV colloid. Lactated ringers, also known as Ringer's lactate solution, is a type of intravenous fluid that contains electrolytes and is used to replace fluids and electrolytes in the body. It does not contain large molecules like proteins or starches, which are characteristic of IV colloids.

The correct answer is 3-6 months. 6-mercaptopurine is a medication used to treat certain types of cancer and autoimmune diseases. It is a slow-acting drug that takes time to build up in the body and start producing noticeable effects. The timeframe of 3-6 months is a general estimate for when patients may start experiencing the therapeutic benefits of this medication.

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NSAIDs are not a cause of obstructive nephropathy. Obstructive nephropathy refers to a condition where there is a blockage in the urinary system, leading to impaired kidney function. High doses of methotrexate, tumor lysis syndrome, and IV phosphate and calcium given together can all potentially cause obstructive nephropathy. However, NSAIDs are not known to cause this condition. NSAIDs are commonly used for pain relief and reducing inflammation, but they do not typically cause blockages in the urinary system.

The statement "microorganisms are not proven to be associated with disease progression in IBD" suggests that there is no conclusive evidence to support a direct link between microorganisms and the progression of Inflammatory Bowel Disease (IBD). This implies that the role of microorganisms in IBD is not well-established or understood.

Fatigue severe enough to require bed rest is an indication to discontinue interferon because it suggests a significant level of exhaustion and weakness. This level of fatigue may be a sign of severe side effects or complications from the interferon treatment. It is important to discontinue the medication in order to prevent further deterioration of the patient's health and to explore alternative treatment options.

Mannitol is a diuretic drug that is commonly used to treat acute tubular necrosis. It works by increasing urine production, which helps to remove excess fluid from the body. However, one of the potential side effects of mannitol is volume overload, which means that it can cause an excessive buildup of fluid in the body. This is because mannitol can increase the volume of fluid within the bloodstream, leading to an increased risk of fluid overload. Therefore, mannitol carries the risk of volume overload in patients with acute tubular necrosis.

Entecavir (Baraclude) is the correct answer because it is a nucleoside analog reverse transcriptase inhibitor (NRTI) that is primarily used to treat chronic hepatitis B virus (HBV) infection. While lamivudine (Epivir) and adefovir (Hepsera) are also NRTIs, they are commonly used in the treatment of HIV infection, unlike entecavir. Therefore, entecavir does not have any activity against HIV, unlike the other two nucleosides.

Combination therapy for genotype 2 or 3 HCV typically involves the use of direct-acting antiviral medications. The recommended treatment duration for these genotypes is typically 12 weeks. However, in cases where there is a high chance of achieving a good response (around 80%), the treatment duration can be shortened to 24 weeks. This allows for effective eradication of the virus and reduces the risk of relapse. Therefore, 24 weeks is the correct answer for achieving an 80% response rate with combination therapy for genotype 2 or 3 HCV.

Calcitriol is not a treatment for symptomatic potassium imbalance associated with chronic renal failure. Calcitriol is a form of vitamin D that is used to treat low levels of calcium in the blood. It helps the body absorb calcium from the intestines and promotes bone growth. It does not have a direct effect on potassium levels. Other options like calcium gluconate, insulin/dextrose, and kayexalate are commonly used to treat high potassium levels in patients with chronic renal failure.

Budesonide is released in the terminal ileum for diseases affecting the ileum or ascending colon. It has low systemic bioavailability, meaning that it is not easily absorbed into the bloodstream and therefore has limited effects on the rest of the body. This makes it a suitable treatment option for localized conditions in the ileum or ascending colon, as it can target the affected area without causing widespread side effects. Prednisone, hydrocortisone, and azathioprine, on the other hand, have higher systemic bioavailability and can have more widespread effects throughout the body.

Progressive multifocal leukoencephalopathy (PML) is a rare and often fatal viral infection of the brain caused by the JC virus. Natalizumab is a medication used to treat multiple sclerosis and Crohn's disease, but it has been associated with an increased risk of developing PML. The drug works by blocking certain immune cells from entering the brain, which can allow the JC virus to replicate and cause damage. Therefore, natalizumab is the correct answer as it is directly associated with the development of PML caused by the JC virus.

The treatment for acute viral hepatitis is supportive care. This involves managing the symptoms and providing relief to the patient. Supportive care may include rest, proper nutrition, hydration, and medication to alleviate symptoms such as nausea, fatigue, and pain. While liver transplant, interferons, and nucleoside analogs may be used in certain cases or for specific types of viral hepatitis, they are not the standard treatment for all cases of acute viral hepatitis. Therefore, the correct answer is supportive care.

A) 10 days
B) 2 weeks
C) 10 days
D) 7 days

Chronic interstitial nephritis is associated with lithium. This is because long-term use of lithium, a medication commonly used to treat bipolar disorder, has been known to cause chronic interstitial nephritis. This condition involves inflammation and scarring of the kidney's tubules and can lead to impaired kidney function. Other medications such as NSAIDs, sulfa drugs, and amphotericin B are not typically associated with chronic interstitial nephritis.