MSN Pharmacology for Advanced Practice 2 — Questions and Answers
Question 1: Which adverse effect is most associated with long-term corticosteroid use that an MSN-prepared NP should monitor?
- Hypoglycemia and weight loss
- Hyperglycemia, osteoporosis, adrenal suppression, and immunosuppression (Correct answer)
- Bradycardia and hyponatremia
- Thrombocytopenia and bleeding
Correct answer: Hyperglycemia, osteoporosis, adrenal suppression, and immunosuppression
Chronic corticosteroid use causes hyperglycemia, bone density loss, HPA axis suppression, and increased infection risk through multiple mechanisms.
Question 2: A patient on metformin is scheduled for a contrast CT scan. What pharmacological precaution is required?
- Increase the metformin dose before the procedure
- Hold metformin before and 48 hours after contrast administration due to risk of lactic acidosis (Correct answer)
- Switch to insulin permanently
- No precaution is needed with modern contrast agents
Correct answer: Hold metformin before and 48 hours after contrast administration due to risk of lactic acidosis
Contrast-induced nephropathy can impair metformin clearance, leading to accumulation and risk of lactic acidosis; guidelines recommend holding metformin around contrast use.
Question 3: Which mechanism explains why selective serotonin reuptake inhibitors (SSRIs) require 2–4 weeks to produce antidepressant effects?
- Slow hepatic metabolism delaying peak plasma levels
- Neuroadaptive changes in autoreceptor sensitivity and synaptic remodeling take weeks to develop (Correct answer)
- Blood-brain barrier takes weeks to allow drug entry
- The drug must accumulate in fat stores before becoming active
Correct answer: Neuroadaptive changes in autoreceptor sensitivity and synaptic remodeling take weeks to develop
While SSRIs inhibit the serotonin transporter immediately, antidepressant response requires downregulation of presynaptic autoreceptors and neuroplastic changes that develop over weeks.
Question 4: Aminoglycoside antibiotics are dosed using once-daily extended interval strategies primarily to maximize which pharmacodynamic property?
- Time-dependent killing (T>MIC)
- Concentration-dependent killing and post-antibiotic effect (Correct answer)
- Minimum inhibitory concentration at trough
- Bioavailability-dependent bacteriostatic effect
Correct answer: Concentration-dependent killing and post-antibiotic effect
Aminoglycosides exhibit concentration-dependent killing; high peak concentrations optimize bactericidal activity, while the post-antibiotic effect allows the trough to be low, reducing nephrotoxicity.
Question 5: Which immunosuppressant used post-transplant inhibits calcineurin, thereby preventing T-cell cytokine production?
- Mycophenolate mofetil
- Azathioprine
- Cyclosporine and tacrolimus (Correct answer)
- Sirolimus (rapamycin)
Correct answer: Cyclosporine and tacrolimus
Cyclosporine and tacrolimus both inhibit calcineurin, preventing dephosphorylation of NFAT and subsequent IL-2 transcription needed for T-cell activation.
Question 6: A pregnant patient requires anticoagulation. Which agent is safe to use throughout pregnancy?
- Warfarin — safe in all trimesters
- Unfractionated or low-molecular-weight heparin — does not cross the placenta (Correct answer)
- Rivaroxaban — FDA Category B
- Dabigatran — safest option in first trimester
Correct answer: Unfractionated or low-molecular-weight heparin — does not cross the placenta
Heparins do not cross the placenta due to their large molecular size and negative charge, making them the preferred anticoagulants throughout pregnancy.
MSN Pharmacology for Advanced Practice 2
Which adverse effect is most associated with long-term corticosteroid use that an MSN-prepared NP should monitor?