Nokea
Upregulation or hypersensitization may lead to:
- A. Increased response to a drug
- B. Decreased response to a drug
- C. An exaggerated response if the drug is withdrawn
- D. Refractoriness or complete lack of response
Correct Answer: C
Rationale: Choice C is correct because upregulation (more receptors) or hypersensitization from chronic antagonist use can cause an exaggerated rebound response if withdrawn, as seen with beta blockers. Choice A is incorrect as increased response occurs during use, not withdrawal. Choice B is wrong because decreased response isn't typical of upregulation. Choice D is incorrect since refractoriness relates to agonists, not this scenario.
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The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the:
- A. Minimum adverse effect level
- B. Peak of action
- C. Onset of action
- D. Therapeutic range
Correct Answer: C
Rationale: Choice C is correct because the onset of action is when a drug first shows a therapeutic effect on the concentration curve, marking the start of its clinical impact. Choice A is incorrect as ‘minimum adverse effect level' isn't a standard term; it confuses with toxicity thresholds. Choice B is wrong because peak of action is the maximum effect, not the first sign. Choice D is incorrect since therapeutic range is the concentration window for efficacy, not a specific time point.
Pharmacokinetic changes in the elderly that affect drug dosing include:
- A. Decreased renal function
- B. Increased liver metabolism
- C. Decreased body fat
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because decreased renal function in the elderly slows drug excretion, requiring dose adjustments to prevent accumulation, per geriatric pharmacology. Choice B is incorrect as liver metabolism decreases, not increases. Choice C is wrong because body fat increases, not decreases. Choice D is incorrect since only A is accurate.
A 4-month-old infant has a viral illness with high fever and cough. The infant's parent asks the NP about what to give the infant to help with symptoms. The NP should prescribe which of the following?
- A. Aspirin to treat the fever
- B. Acetaminophen as needed
- C. Dextromethorphan for coughing
- D. An antibiotic to prevent increased infection
Correct Answer: B
Rationale: The correct answer is B because acetaminophen is safe for infants to reduce fever. Choice A is incorrect (aspirin risks Reye’s syndrome). Choice C is wrong (dextromethorphan risks respiratory depression). Choice D is inaccurate (antibiotics don’t treat viral illness).
An example of a first-dose reaction that may occur includes:
- A. Orthostatic hypotension that does not occur with repeated doses
- B. Purple glove syndrome with phenytoin use
- C. Hemolytic anemia from ceftriaxone use
- D. Contact dermatitis from neomycin use
Correct Answer: A
Rationale: Choice A is correct because orthostatic hypotension can occur with a first dose of drugs like antihypertensives, subsiding as the body adjusts, a classic first-dose reaction. Choice B is incorrect as purple glove syndrome is a rare phenytoin effect, not first-dose specific. Choice C is wrong because hemolytic anemia is a type II reaction, not first-dose. Choice D is incorrect since contact dermatitis is a delayed, not first-dose, reaction.
The elderly are at high risk of ADRs due to:
- A. Having greater muscle mass than younger adults, leading to higher volume of distribution
- B. The extensive studies that have been conducted on drug safety in this age group
- C. The blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effect
- D. Age-related decrease in renal function
Correct Answer: D
Rationale: Choice D is correct because an age-related decline in renal function slows drug excretion, increasing ADR risk as drugs accumulate. Choice A is incorrect as muscle mass decreases with age, not increases. Choice B is wrong because studies are often limited in the elderly, not extensive. Choice C is incorrect since the blood-brain barrier's permeability doesn't typically lessen, and higher doses aren't standard.