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up to nine drops a day at two hour intervals

Glenn has keratitis caused by herpes simplex. How often should he

apply his prescribed antiviral eye drops?

Sergio has had cataract surgery. What kind of eye drops
will he likely be given to reduce post-surgical

increasing aqueous humor outflow

Jalen has glaucoma and a miotic has been prescribed. The
physician explains to Jalen that miotics act by ____.

Cody openly and honestly discusses his history of addiction
with his surgeon prior to surgery and asks what pain
medications will have less potential for abuse. What
centrally acting synthetic analog of codeine might the
surgeon select?

Chiara has poorly controlled pain from diabetic neuropathy.
What serotonin norepinephrine reuptake inhibitor might be
given as an adjuvant?

Yes. Morphine does not have a ceiling to its analgesic

John wakes up in a hospital to find that he had been in an
accident that required major surgery to pin his legs back
together. He is told that he has a patient controlled
analgesia pump with morphine, which he recognizes as a
pure opiate agonist. Is he likely to be able to achieve good
pain control?

Landen has peripheral neuropathy from cancer
chemotherapy. After his pain is not well controlled with just
analgesics, his physician suggests the use of a tricyclic
antidepressant as an adjuvant. What drug might he be

It has fewer adverse effects than the salicylates.

Levi wonders why acetaminophen is used so frequently if it
has little anti-inflammatory effect. Why is this?

They decrease the rate of aqueous humor production.

Brent is taking a beta-adrenergic blocker to treat his

glaucoma. What action do beta-adrenergic blockers have?

Braxton accidentally splashed a caustic liquid in his eyes.
What topical medication might be prescribed to reduce
inflammation and prevent scar formation?

cardiac abnormalities
After hearing about another opioid-associated overdose
death, your friend wonders why nothing is being done
about this issue. You can inform your friend about the
market withdrawal of propoxyphene due to its association
with overdose deaths and ____.

Vonda is concerned about the safety of over-the-counter
medications for children. She knows that one particular
drug has been associated with liver toxicity and that the
manufacturers of this drug have voluntarily reduced the
concentration used in children's formulations. What is this

Yes. Use of these medications has been associated with

the occurrence of complex behaviors while asleep.
A celebrity with no history of substance abuse or bizarre
behavior is found driving in circles around a fountain at
three o'clock in the morning. His publicist releases a
statement attributing the behavior to a prescription
benzodiazepine sleep medication. Is this plausible?

Ashley has insomnia and her doctor gives her medication
to produce sleep. This type of medication is called a(n)

Systemic side effects are rare, but can include upper

respiratory infections.
You are providing medication education to Petra, who has
been prescribed a prostaglandin analog for the treatment
of glaucoma. What should you tell her about side effects?

Dependence is irrelevant for dying patients and should

not be a consideration.
Darlene's breast cancer has spread to her bones, causing
terrible, unrelenting pain. She meets with the palliative

care team to discuss pain control during the last weeks of

her life, and is concerned because she has heard that
doctors often withhold adequate doses of pain medication
for fear of dependence or abuse. What is their philosophy
likely to be?

2 to 3 days
Christian has an eye infection and an ophthalmic antibiotic
preparation has been prescribed. Assuming there is not
microbial resistance, how long should it take to see

reduction of intraocular pressure

May has been diagnosed with glaucoma and is told she will
be taking medications for the rest of her life. What is the
primary function of antiglaucoma drugs?

Yes. Because of her age, she may be more prone to side

effects like confusion.
Maggie, aged 77, occasionally takes diphenhydramine to
help her sleep. Is there any reason for concern?

No. Miotics are considered third-line therapy due to side

Julian has just been diagnosed with open-angle glaucoma
and medications are prescribed. Is he likely to have a
prescription for miotics?

Mackenzie has an eye inflammation commonly that is
called "pink" or "red" eye. She most likely has ____.

The medication may cause drowsiness and he should be

careful when engaging in hazardous activities.
Alfred is taking an alpha agonist to treat his glaucoma.
What is especially important for him to know?

You are reading the consent information for an eye exam
and see that you will be given eye drops that cause
cycloplegia. What is the most likely active substance in the
eye drops?

Collin was given an opioid analgesic to help control the
pain from a broken nose, broken teeth, and facial

lacerations he suffered in a fall. He soon becomes

disoriented and violently sick to his stomach. What drug
might he be given to reverse the effects of the opioid?

Jeffrey has chronic dry eye that causes inflammation of his
eyes and discomfort. What topical preparation might be
prescribed to help relieve his symptoms?

Jose has angle-closure glaucoma and is about to have
surgery. What IV antiglaucoma medication might he be
given pre-operatively?

Lizzy has severe chronic pain following an automobile
accident and her pain specialist gives her a coanalgesic to
help control her pain. What class of drugs is often used as

Zara has a morphine pump to help post-surgical control
pain. What side effect occurs in more than 50% of patients
on morphine and often requires treatment?

Rachel is being treated for opioid addiction with a
medication that combines both a pure opioid agonist and a
partial opioid agonist. What is it?

seroronin receptor agonist

Felicity has poorly controlled migraines and the resulting
pain is not responsive to standard analgesic protocols. Her
physician suggests the use of sumatriptan when she has an
acute migraine. What is the mechanism of action for this

Franklin is taking an antipsychotic that acts by blocking
serotonin receptors and transiently blocking dopamine
receptors. What antipsychotic might he be taking?

coronary heart disease

Marsha is preparing a report on the health effects of
alcohol use. She has covered alcohol poisoning and
alcoholism. In her section on positive effects, Marsha

discusses the inverse association between alcohol

consumption and ____.

Jenny has severe depression characterized by extreme
fatigue, lethargy, and psychomotor retardation. Which
heterocyclic antidepressant would be most effective with
these symptoms?

Adrian's mother and father have personal and family
histories of drug addiction. Therefore, Adrian's mother asks
whether there are any nonstimulant medications that can
be used to treat his ADHD. What drug might be suggested?

Tom is a chronic alcoholic who is in recovery. What
medication might he be given that would decrease his
craving for alcohol?

Fifteen-year-old Adan has major depressive disorder. Which
antidepressant is recommended for treating major
depressive disorder in adolescents?

Jai has become psychologically dependent on marijuana.
What term is applicable when only psychological
dependence is involved?

Pauline is taking an antidepressant that is typically
reserved for refractory or atypical depression or those
associated with panic disorder or phobias. She is most
likely taking a(n) ____.

Lata is preparing a report on the abuse of ADHD
medications in school settings, and is particularly
interested in medications formulated in ways that reduce
the risk of abuse. What prodrug should she include?

Morris, 73 years of age, has been having severe anxiety
following the death of his wife. What benzodiazepine is

considered to be preferable for older adults because of its

relatively short half-life and inactive metabolites?

Jillian is taking an antidepressant that inhibits the reuptake
of both serotonin and norepinephrine. This medication is
most likely to be ____.

Andie is taking an antidepressant and has been told that
there are a number of foods and herbal preparations she
must avoid because of potentially dangerous side effects.
What type of antidepressant is she likely to be taking?

cardiovascular disease
Seven-year-old Grant's family and physician are
considering pharmacologic treatment of his ADHD with one
of the amphetamine/methylphenidate formulations.
Accordingly, it is particularly important that the physician
screen for personal and family history of ____.

Halle is taking an antipsychotic that may cause her to
experience extrapyramidal side effects because it blocks
dopamine receptors and unbalances cholinergic activities.
What antipsychotic might she be taking?

Make the appropriate referral.

Martina is providing medication education and, when she
mentions possible interactions of the medication with
alcohol, the patient acknowledges heavy alcohol binges
nearly every weekend. What should Martina do?

Maeve has Parkinson's with marked bradykinesia which has
not been well-controlled with medications typically
prescribed for mild Parkinson's. What medication might
help her?

Jim has been taking a carbidopa-levodopa agent for almost
two years and is experiencing wearing off. What
medication might be useful?


Jane has sensorimotor neurologic disorder characterized by

a distressing urge to move the legs, often accompanied by
a marked sense of discomfort in the legs. She likely has

Thelma has restless leg syndrome that has disrupted her
sleep and left her drowsy during the day. What medication
might be helpful?

COX-2 inhibitors decrease production of the prostaglandin

that is good for the heart, but not the one that is harmful.
Lincoln has rheumatoid arthritis and a history of
gastrointestinal bleeds. What characteristic of COX-2
inhibitors is important for Lincoln?

a single first generation anticonvulsant

Zelina has just been diagnosed with generalized seizures
and the decision has been made to start treating her with
anticonvulsants. What is likely the first choice of

full glass of water, at least 30 minutes before her first

food of the day
Myra is taking a bisphosphonate for treatment of
osteoporosis. She should take the bisphosphonate with a

as adjuvants
Kristian has generalized epilepsy that is not as wellcontrolled in his opinion. He wonders if he should be
switched to a second-generation anticonvulsant. How are
second-generation anticonvulsants typically used in the
management of epilepsy?

should be used in strict accordance with label directions

The labels of non-selective NSAIDs must indicate that they

valproic acid
Kody takes a broad-spectrum anticonvulsant, which is likely
to be ____.

unprovoked seizures
Epilepsy is defined as the recurrence of ____.

antagonist effect on breast and uterine tissue

Marianne, 62 years of age, is discussing osteoporosis
prevention with her doctor, with concerns about the action
of estrogen replacement on breast and uterine tissue.
Marianne might be interested in selective estrogenreceptor modifiers (SERMs) because they have an estrogen

analgesics and sedatives

Ellis is having surgery and a neuromuscular blocking agent
has been administered. What else must also be

partial seizures
Clarissa is being treated with oxcarbazepine, a secondgeneration oral anticonvulsant indicated for the treatment
of ____.

Alex, 34 years of age, was recently diagnosed with
Parkinson's. What medication might he be prescribed as a
"levodopa-sparing" strategy?

dantrolene (D)
Delbert has cerebral palsy and experiences painful muscle
contractions. What peripherally-acting muscle relaxant may
help him?

Trevor has just been diagnosed with Parkinson's and his
doctor prescribes a single agent that alters dopamine
release and has anticholinergic effects. The efficacy of the
drug tends to wane rather quickly. What drug is it likely to

potentiation and increased risk of methotrexate toxicity

For years, the only medication Jayla has taken to help with
her severe knee pain is an NSAID. She has just been
diagnosed with cancer and is to be treated with, among
other agents, methotrexate. What is the potential
interaction between the methotrexate and the NSAID?

bone mineral density

Dina has osteoporosis. What factor is most effective in
determining her risk of fracture?

While helping her friend move into a third floor walk-up,
Elisabeth experiences painful muscle spasms in her back.
Her doctor prescribes a centrally acting muscle relaxant.
This medication is most likely ____.

Kassidy's seizures are well-controlled with carbamazepine.
However, what food should she avoid?

Rosetta has seizures that are characterized by an abrupt
loss of consciousness, falling, with extension of trunk and
extremities, followed by alternating contractions and
relaxation of the muscles. These are classified as ____.

Caitlin strained her back and her doctor prescribes a
centrally-acting muscle relaxant during the initial checkup.
After the pain subsides, her doctor is likely to prescribe

Even serious GI bleeds may be silent in the elderly and

have no warning signs.
Francesca attends doctor's appointments with her mother,
who is in her late 80s. Her mother is taking NSAIDs for
arthritis pain and Francesca asks what might indicate that
her mother was having a GI bleed as a result. What should
the doctor tell Francesca?

No, because carbamazepine is known to worsen absence

and myoclonic seizures.
Naya has absence seizures. Is carbamazepine likely to help

Prior to orthopedic surgery, Azalea meets with the
anesthesiologist who, when explaining the medications
that will be used, mentions that one will paralyze all of her
muscles, including her diaphragm. What agent has this

Dantrolene (T)
Tanya has multiple sclerosis and sometimes experiences
painful muscle spasms. What muscle relaxant is indicated
for the spasms associated with her condition?

Carla, 67 years of age, has a history of breast cancer and
thromboembolic disorders, and cannot take hormone
replacement or selective estrogen-receptor modifier
therapy to treat her osteoporosis. What hormonal agent
might be effective?

Concentrations in joint tissues are higher with the patch.

Cayden is using a diclofenac patch for pain from his recent
knee injury. How does the patch compare to oral

COX-2 inhibitors do not inhibit platelet aggregation.

Marlee has heard that COX-2 inhibitors are less likely to
cause GI bleeds than are NSAIDs. What property of COX-2
inhibitors makes them less likely to cause GI bleeds?

progestin only
Sarah is breastfeeding her newborn son, and at her sixweek check up, asks her obstetrician about birth control.
What type of oral contraceptive can safely be used by
women who are breastfeeding?

To avoid hemorrhage
Nasir's acute flare-up of ulcerative colitis is being treated
with corticosteroids. Why are corticosteroids recommended
for only brief treatment of ulcerative colitis flare-ups?

endometrial cancer
Tess is post-menopausal and has an intact uterus. She is
very concerned about osteoporosis, as her mother had a
number of painful and debilitating osteoporosis-associated
fractures. What would she risk were she to take estrogenonly hormone replacement?

Magdalena is 27 weeks pregnant with twins and is showing
signs of labor. What medication might she be given to
manage her preterm labor?

4 weeks
Abigail just started taking oral contraceptives. How long
should she use backup contraception?

heart attack or stroke

In the United States, 70% of diabetics die from ____.

Ayla has a severe allergic reaction and is treated with
corticosteroids. What gland produces corticosteroids?

Maddy has Type 1 diabetes. What microvascular
complications might she experience?

Yes. Emergency contraception can be taken by women

with contraindications to oral contraceptives.
Suzette is in need of emergency contraception. She has
several contraindications to oral contraceptives. Can she
use emergency contraception?

adrenal (A)
Armen thinks of androgens as male hormones, so he is
surprised to hear that females also produce them. What
gland produces androgen in both women and men?

nitric oxide
The principal mediator in attaining and maintaining an
erection is ____.

Clara has been diagnosed with Type 2 diabetes and is
being started on an oral antidiabetic agent. What biguanide
might she be given?

Jimmy has Type 1 diabetes. What macrovascular
complications might he experience?

2 tablets of the progestin levonorgestrel

Kara is using Next Choice for emergency contraception.
What formulation is Next Choice?

Brayan has inadequate androgen production, but his
testicles are healthy and intact. The likely cause is a
malfunctioning ____.

stimulates sperm production

In males, follicle stimulating hormone ____.

Dina has AIDS and is experiencing profound weight loss
and cachexia. What hormonal medication might help her
with these issues?

nitric oxide (K)

Killian is experiencing difficulty maintaining erections,
although he is able to become aroused. What is the
principal mediator in attaining and maintaining an

decreased risk of hypoglycemia

Elisha has Type 1 diabetes and uses an analog insulin.
What is an advantage of analog insulin?

it is more rapidly absorbed

In her diabetes education class, Vickie learned that when
insulin is injected into the arms or thighs, ____.

It helps the body make T3, the bioactive form of thyroid

Martina is being treated for hypothyroidism with a
synthetic T4 replacement. What is the advantage of this

Josie has just been diagnosed with Type 1 diabetes.
Diabetes therapy with insulin focuses initially on controlling
fasting plasma glucose with the use of a long-acting insulin
analog such as ____.

cognitive disabilities
Routine newborn testing reveals that Kassandra has
congenital hypothyroidism. If congenital hypothyroidism is
untreated, Kassandra might develop ____.

Erika will be taking corticosteroids for a relatively long
period of time. In order to reduce the risk of suppressing
her adrenals and causing adrenal atrophy, what type of
corticosteroids are most effective?

Garrison has erectile disfunction (ED); angina, for which he
uses sublingual nitroglycerin; and benign prostatic

hyperplasia (BPH), for which he takes Flomax. What would

be a potential side effect if he were to use a PDE inhibitor?

dinoprostone intravaginal gel

Kara is 39 weeks pregnant and experiencing preeclampsia.
Her cervix has not yet ripened. What medication might she
be given to induce cervical ripening?

rapid-acting and of short duration

Rose has Type 1 diabetes and uses regular insulin. What
are the characteristics of regular insulin?

It decreases insulin resistance and improves sensitivity to

Phebian takes rosiglitazone for his Type 2 diabetes. How
does rosiglitazone act?

Vinnie is a convicted sex offender who has decided to
attempt management of his sexual urges
pharmacologically. What hormonal medication might be
helpful to him?

pituitary (W)
Three-year-old Wiley is small for his age; testing reveals
that he has very low levels of human growth hormone.
What gland produces human growth hormone?

Davina is rushed to the hospital shortly after she begins to
experience symptoms of what is diagnosed as an ischemic
stroke. What agent can be administered that will dissolve
the clot?

verapamil and diltiazem

Mariam takes a calcium channel blocker as an
antiarrhythmic. What are the only two calcium channel
blockers with significant antiarrhythmic activity?

erythropoiesis-stimulating agents
Bhu is undergoing rigorous chemotherapy for cancer and
has become anemic. What type of medication will increase
her body's production of red blood cells?

nonnarcotic antitussive

Kristopher is taking medicine that contains

dextromethorphan. What type of agent is

Adenosine is less likely to cause hypotension.

Huey is given adenosine to convert his PSVT. What
advantage does adenosine have over diltiazem?

Darren has asthma and sometimes needs a rescue inhaler.
What is he likely to use?

Edward has COPD and uses oxygen. What adverse effect
does he risk if an excessively high concentration is used?

The heart muscle enlarges.

Velma is taking digoxin for heart failure. What is a result of
untreated heart failure?

Mateo takes an antiarrhythmic that acts by inhibiting
adrenergic nerve receptors. He is most likely taking ____.

They constrict blood vessels in the respiratory tract.

Jaqueline uses an over-the-counter decongestant. What is
the mechanism of action of decongestants?

rescue medications
Short-acting beta agonists are ____.

Her asthma control is deteriorating.

Sixteen-year-old Elyza has asthma and has been using her
rescue inhaler more frequently. What does this indicate?

cigarette smoking
The primary cause of COPD is ____.

fibric acid derivatives

Cian, who is diabetic, has been found to have extremely
high triglycerides. What category of antilipemic agents will
both lower her triglycerides and improve her glucose

asparagus and cabbage

Dawson, who is on warfarin therapy, is surprised to learn

that he must try to keep his intake of foods high in vitamin
K consistent, as they can alter the effectiveness of his
therapy. What are some foods that are high in vitamin K?

It reduces hepatic synthesis of triglycerides.

Jake takes nicotinic acid for the treatment of diabetic
dyslipidemia. How does nicotinic acid act?

What antiarrythmic agent has local anesthetic effects,
direct stabilizing action on myocardial membranes, and
beta-adrenergic blocking properties?

Karly is taking a nonnarcotic antitussive that has both
central and peripheral actions. What might she be taking?

What antiarrythmic agent acts by slowing AV nodal
conduction and is also used in the treatment of
hypertension and angina?

chronic bronchitis
Yuri has inflammation of bronchial tubes, which leads to
chronic mucus production and a wet cough. What disease
does he have?

Clay has COPD and is not responsive to inhaled
bronchodilators. What medication might be used?

Nayeli has just been diagnosed with high cholesterol. What
category of antilipemics is considered to be the first choice
for monotherapy of high cholesterol?

an arrhythmia
Bernice is being treated with adenosine. She likely has ____.

She will not feel tingling when she places it under her
Tegan uses sublingual nitroglycerin for angina and has
been warned to store it in a glass container with a tightly
fitting screw top away from heat, because it is so sensitive

to environmental conditions. How can she tell if, despite

her efforts, the medication has lost its potency?

metered dose inhaler

Iona uses an inhaler that delivers her medication through
the compression of a valve. What kind of inhaler does she

No. The thickening of bronchial secretions may result in

further airway obstruction.
Bartholomew has a cold with a cough and runny nose. He
has an antihistamine that worked wonderfully with his
spring allergies. Should he use this for his cold?

propafenone (A)
Abdul is taken to the emergency room and is treated with a
medication that is especially useful in converting and
maintaining atrial fibrillation to sinus rhythm. What is this
drug likely to be?

The only clinical drug currently used in the cardiac
glycoside family is ____.

Pearl, who has asthma, uses a beta2 agonist as a
maintenance medication. What medication might she be

rebound congestion
Jean's doctor suggests that she use a decongestant but
cautions her to limit her use to just a few days. What might
prolonged use cause?
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