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Contact Tutorial 1: Basic principles of

pharmacology
MCQ:

Drug classification and nomenclature:


1. The nurse researches a new drug ordered for a client. In order to understand the
drug’s mechanism of action, the nurse checks to determine which of the following?

a) The ingredients that are compounded in the drug


b) The pharmacological classification
c) The therapeutic action
d) The frequency of reported adverse effects

2. The nurse can predict the actions and adverse effects of other drugs in the same
pharmacologic class by understanding which of the following?

a) Prototype drug
b) Generic name of the drug
c) Brand name of the drug
d) Therapeutic classification

3. To find out which drugs treat hypertension, the nurse would look under which
classification?

a) Cardiac
b) Pharmacologic
c) Disease
d) Therapeutic

4. The trade name for a drug is usually selected to be short and easy to remember.
What is the reason the nurse does not use the trade name for a drug?

a) There are no trade names for combination drugs.


b) A drug can have more than one trade name.
c) The trade name will expire and no longer be used.
d) A company might change the trade name for a drug.

5) When a drug is ordered for a client, what is the nurse responsible for knowing and
understanding about the drug?

a) Name, intended use, special considerations, and adverse effects


b) Drug classification, contraindications, adverse effects, gender considerations, and
cost of therapy
c) Drug classification, contraindications, special considerations, and severity of
adverse effects
d) Name, intended use, effects, contraindications, special considerations, and
adverse effects
Adverse reactions:

Please answer question 6a and 6b based on the following scenario:

You are a new nurse who recently completed orientation on the medical/surgical
unit.
Your first patient of the day, Madam Lee, was prescribed ampicillin 1 g/100 mL to
infuse over 30 minutes to be administered 1 hour before a colonoscopy.
You review your medications in your mobile application and find that ampicillin is an
antibiotic and should not be administered to patients allergic to penicillin.
You review the patient’s history and see that the record reveals no known allergy.
But upon asking Madam Lee, she revealed an allergy to penicillin and shellfish.

6a) What questions would you specifically ask her with regards to her drug allergy to
penicillin? (you can choose more than one responses.)

I. What happens when she takes penicillin?


II. Is she willing to take this ampicilin?
III. Any family members have the same allergy?
IV. How severe is the drug reaction?

6b) Upon hearing your question(s), Madam Lee clearly states that she has nausea
and vomiting when she takes penicillin. How would you proceed with caring for this
patient? (you can choose more than one response.)

I. You would educate the patient about the differences between allergic reactions
and side effects
II. You would withhold the ampicillin and contact the prescriber.
III. You would administer the ampicillin.
IV. You would ensure that the patient has an anti-nausea medication prescribed to
her in anticipation of the side effects of ampicillin later.

7) A patient is prescribed a medication and is concerned it might have teratogenic


effects. Which response by the nurse is the most appropriate?

a) "Let me check the pregnancy risk category of the drug."


b) "Are you in your first trimester of pregnancy?"
c) "If your healthcare provider ordered the medication, it should be okay."
d) "You should avoid taking any medications while pregnant."
Drug interactions:

8) A patient has been started on drug A, a substrate of the cytochrome CYP3A4


(hepatic enzyme) in liver. The patient also takes drug B, an inducer of the CYP3A4.
What does the nurse recognize about drug A?

a) It will not be able to cross the blood—brain barrier (BBB).


b) It will be metabolized by the kidneys.
c) It might be inactivated at a faster rate than normal.
d) It might be excreted at a slower rate.

9) A patient receiving drug C, a substrate of the CYP2D6 enzyme, is started on drug


D, an inhibitor of the CYP2D6 enzyme. What should the nurse plan to do?

a) Monitor for signs of drug D toxicity.


b) Administer both drugs on an empty stomach.
c) Monitor for prolonged effects of the drug C.
d) Administer the medications at least 2 hours apart.

10) An older adult patient tells the nurse that she has been using several herbal
products recommended by a friend. Why would the nurse be concerned with this
statement, given the age of the patient?

a) The older adult patient may have difficulty reading labels and opening bottles and
confuse medications.
b) The older adult patient may have difficulty paying for additional medications and
stop using prescribed drugs.
c) The older adult patient may be more prone to allergic reactions from herbal
products.
d) The older adult patient may have other disease conditions that could increase the
risk for a drug reaction.

Discussion:

1. State at least 3 sources of drug information that can be used to help you obtain
specific information about drugs. Briefly discuss some of the pros and cons with
regards to the drug information sources that you have identified.
2. When referring to a drug information source concerning a particular drug, you will
likely encounter the following terms. What does each of the following inform you
about the drug?
a) Classification:
b) Therapeutic use/indication:
c) Mechanism of action:
d) Adverse reactions (common & life threatening ones):
e) Contraindication:
f) Antidote (if any):
Contact Tutorial 2: Antimicrobial Drugs

1. The nurse is teaching a nursing student about the mechanism by which


antimicrobial agents achieve selective toxicity. Which statement by the student
indicates a need for further teaching?
a) “Some agents disrupt the bacterial cell wall.”
b) “Some agents act to interfere with bacterial protein synthesis.”
c) “Some agents cause phagocytosis of bacterial cells.”
d) “Some agents weaken the cell wall, causing cell wall lysis.”

2. A microbe acquires antibiotic resistance by which means?


a) Development of medication resistance in the host.
b) Overriding of the minimum bactericidal concentration.
c) Transfer of DNA coding from microbes to the host.
d) Transfer of DNA coding to other bacteria.

3. Which is the example of the improper use of antibiotic therapy?


a) Using surgical drainage as an adjunct to antibiotic therapy
b) Treating a viral infection
c) Basing treatment on sensitivity reports
d) Treating fever in an immunodeficient patient

4. A patient has acquired an infection while in the hospital. The nurse identifies this
type of infection as what?
a) Superinfection
b) Suprainfection
c) Nosocomial infection
d) Resistant infection

5. Which statement about superinfections does the nurse identify as true?


a) Superinfections are more common in patients treated with narrow-spectrum drugs.
b) Superinfection is defined as a new infection that appears during the course of
treatment for a primary infection.
c) Superinfections are caused by viruses.
d) Superinfections are easy to treat.

6. A patient is prescribed an antibiotic to treat a urinary tract infection. What


statement by the patient indicates a need for further teaching?
a) “I can stop the medication as soon as the symptoms have disappeared.”
b) “I will drink more fluids to help clear up the infection.”
c) “I will stop the medication and contact the doctor if I develop a rash.”
d) “I should report vaginal itching or discharge.”
7. Which of the following statements is INCORRECT for patients taking antibiotics?

a) Patients may experience mild diarrhoea.


b) Patients should still take the full course even if they show signs of allergy to the
drug.
c) Patients should report any previous allergies or adverse effects before starting
treatment.
d) Patients should take the full course even when the infection appears to have
resolved before the antibiotics are finished.

8. A patient has a localized skin infection, which is most likely caused by a gram-
positive cocci. Until the culture and sensitivity results are available, the nurse will
expect the provider to order a ____-spectrum ____ agent.
a) broad; systemic
b) broad; topical
c) narrow; systemic
d) narrow; topical

9. An older adult patient with chronic obstructive pulmonary disease (COPD)


develops bronchitis. The patient has a temperature of 39.5°C. The nurse will expect
the provider to:
a) obtain a sputum culture and wait for the results before prescribing an antibiotic.
b) order empiric antibiotics while waiting for sputum culture results.
c) treat symptomatically, because antibiotics are usually ineffective against
bronchitis.
d) treat the patient with more than one antibiotic without obtaining cultures.

10. Which patient should receive prophylactic antibiotic therapy?


a) A healthy patient who is to have his teeth cleaned.
b) A patient who is scheduled for a hysterectomy.
c) A well toddler with fever and runny nose.
d) A elderly patient with pneumonia.

11. The nurse identifies which host factor as the most important when choosing an
antimicrobial drug?
a) Age
b) Competent immune function
c) Genetic heritage
d) Previous medication reactions

12. Which patient would most likely need intravenous antibiotic therapy to treat a
urinary tract infection?
a) A patient with an uncomplicated urinary tract infection caused by Escherichia coli
b) A patient with pyelonephritis with symptoms of high fever, chills, and severe flank
pain
c) A patient with acute cystitis who complains of dysuria, frequency, and urgency
d) A patient with acute bacterial prostatitis with a mild fever, chills, and nocturia
13. Thirty minutes after receiving an intramuscular (IM) injection of penicillin G, a
patient reports itching and redness at the injection site. Which action should the
nurse take first?
a) Elevate the lower legs.
b) Place an ice pack on the site.
c) Make sure the patient stays calm.
d) Prepare subcutaneous adrenaline for administration.

14. Which statement about allergic reactions to penicillin does the nurse identify as
true?
a) Anaphylactic reactions occur more frequently with penicillins than with any other
drug.
b) If patient is allergic to one penicillin, he can be given another penicillin.
c) Benadryl is the drug of choice for anaphylaxis due to penicillin allergy.
d) Patients allergic to penicillin are also allergic to vancomycin.

15. A patient with a history of a severe anaphylactic reaction to penicillin has an


order to receive cephalosporin. What should the nurse do?
a) Administer the cephalosporin as ordered.
b) Contact the healthcare provider for a different antibiotic.
c) Administer a test dose of cephalosporin to determine reactivity.
d) Have an adrenaline dose available when administering the cephalosporin.

16. A patient is given IV vancomycin turned red with itchiness and flushing on the
face, neck, and shoulders). What is the explanation?
a) This is due to rapid intravenous administration.
b) This is due to slow intravenous administration.
c) This is due to overdosage of Vancomycin.
d) This has nothing to do with IV vancomycin.

17. The nurse is caring for a patient receiving intravenous gentamicin for a severe
bacterial infection. Which assessment finding by the nurse indicates the patient is
experiencing an adverse effect of gentamycin therapy?
a) Blurred vision
b) Hand tremors
c) Urinary frequency
d) Tinnitus

18. A patient is prescribed doxycycline. If the patient complains of gastric irritation,


what should the nurse do?
a) Instruct the patient to take the medication with milk.
b) Tell the patient to take an antacid with the medication.
c) Give the patient food, such as crackers or toast, with the medication.
d) Have the patient stop the medication immediately and contact the healthcare
provider.
19. Fluoroquinolones should be discontinued immediately if what happens?
a) Nausea, vomiting, or diarrhea is experienced.
b) Dizziness, headache, or confusion occurs.
c) Tendon pain or inflammation develops.
d) Theophylline is prescribed for asthma.

20. A patient who was taking sulfonamides develops Stevens-Johnson syndrome.


Upon assessment, the nurse expects to find what?
a) Hypotension
b) Bronchospasm
c) Temperature of 35.5C
d) Widespread skin lesions.
Tutorial: ANS drugs
MCQ:

1. The health care provider prescribes adrenaline for a patient who was stung by
several wasps 30 minutes ago and is experiencing an allergic reaction. The nurse
knows that the primary purpose of this medication for this patient is to:

a) Stop the systemic release of histamine produced by the mast cells.


b) Counteract the formation of antibodies in response to an invading antigen.
c) Increase the number of white blood cells produced to fight the primary invader.
d) Increase a declining blood pressure and dilate constricting bronchi associated with
anaphylaxis.

2) A client is prescribed salbutamol (Ventolin) by inhalation for asthma. The patient


asks the nurse how the medication can help. The nurse's response should be based
on the fact that it is a

a) Nonselective adrenergic agonist


b) Selective beta2 agonist
c) Selective alpha1 agonist
d) Selective beta1 agonist

3) A patient is started on a new drug, a selective beta1-agonist medication. The


nurse would explain that this medication performs which action?

a) Increases cardiac output.


b) decrease cardiac output.
c) Relaxes bronchial smooth muscle.
d) Constricts blood vessels.

4) To avoid the first-dose phenomenon, the nurse knows that the initial dose of
prazosin should be:

a) Very low and given at bedtime.


b) Doubled and given before breakfast.
c) The usual dose and given before breakfast.
d) The usual dose and given immediately after breakfast.

5) A patient who is taking an adrenergic-blocker for hypertension reports being dizzy


when first getting out of bed in the morning. The nurse should advise the patient to:

a) Move slowly from the recumbent to the upright position.


b) Drink a full glass of water before rising to increase vascular circulatory volume.
c) Avoid sleeping in a prone position.
d) Stop taking the medication.
6) A patient is started on bisoprolol. Which is the most important action to be
included in the plan of care for this patient related to this medication?

a) Monitor apical pulse and blood pressure


b) Elevate the head of the bed during meals
c) Take the medication after meals
d) Consume foods high in potassium

7) Atenolol has been ordered for a patient with hypertension. Because of adverse
effects related to this drug, the nurse would carefully monitor for which adverse
effect?

a) Bronchodilation
b)Tachycardia
c) Edema
d) Bradycardia

8) Muscarinic agonist (cholinergic drugs) are most often indicated in which situation?

a) Preventing excess salivation and sweating


b) Treating a client with bradycardia
c) Lowering intraocular pressure in patients with glaucoma
d) Inhibiting muscular contractions in the bladder

9) Which side effect from an anticholinergic agent such as atropine is unexpected?

a) Dry mouth
b) Diarrhea
c) Urinary retention
d) Dilated pupils

10) All the following findings may be expected in a patient who received a muscarinic
antagonist (anticholinergics), EXCEPT

a) Dilated pupils
b) Increased heart rate
c) Hypoactive bowel sounds
d) Excessive salivation
Discussion:

During an after dinner stroll along the Clementi canal, a swarm of bees suddenly
appeared and stung Mr Lee several times in the face, arms and legs. He became
very pale and weak, complained of difficulty in breathing and chest tightness. He was
rushed immediately to the nearest Accident & Emergency department at a nearby
hospital.

Physical examination:
At presentation, breathing was found to be shallow and extremely laboured. He was
cyanotic. BP (90/70) with a rapid and weak pulse that was difficult to palpate. His
skin was cool and clammy. He also appeared to be dazed and confused.
Auscultation of chest – tachycardia (120 beats/min) and harsh bronchial sounds.

Diagnosis:
Type 1 hypersensitivity reaction (anaphylaxis)

Treatment:
Patient was administered intravenous injection of adrenaline. In addition, salbutamol
was administered to relieve his breathing. He was also placed on iv fluids to expand
his fluid volume.

1) Which adrenergic receptors control the smooth muscle tone of the bronchi?
2) What are the effects of adrenaline on the cardiorespiratory system?
3) Why is adrenaline the drug of choice in treatment of anaphylactic shock?
4) What is the rationale for the use of salbutamol?
Contact tutorial 4: Cardiovascular and Renal
drugs:
1. Frusemide has following side effects
a) hypoNatremia, hypoKalemia
b) hyperNatremia, hyperKalemia
c) hyperNatremia, hypoKalemia
d) hypoNatremia, hyperKalemia

2. Thiazide diuretic has the following side effects


a) hearing loss
b) hyperkalemia
c) hyperuricemia
d) hypernatremia

3. Stimulate RAAS system will cause


a) Na retention, K retention
b) Na excretion, K excretion
c) Na retention, K excretion
d) Na excretion, K retention

4. _____________has special benefit for DM with hypertension


a) ACEI/ARB
b) Hydrochlorothiazide
c) beta blocker
d) frusemide

5. ACEI will cause the following, EXCEPT


a) vasoconstriction
b) dry cough
c) vasodilation
d) increase Na excretion

6. __________ has special benefit for chronic heart failure with hypertension
a) digoxin or telmisartan
b) verapamil or metoprolol
c) enalapril or diltiazem
d) atenolol or losartan

7. First drug of choice for 50-year-old male with acute pulmonary oedema
a) frusemide
b) hydrochlorothiazide
c) bisoprolol
d) amlodipine

8. Which one is angiotensin II receptor antagonist?


a) hydrochlorothiazide
b) valsartan
c) nifedipine
d) methyldopa
9. 32yo patient, with preeclampsia at 34 weeks of pregnancy. Which antihypertensive drug is
best for her?
a) valsartan
b) ramipril
c) methyldopa
d) perindopril

10. Sympatholytic drugs include


a) metoprolol
b) ARB
c) ACE inhibitor
d) calcium channel blocker

11. Which of the following is NOT used for acute heart failure?
a) frusemide
b) nitroglycerin
c) morphine
d) verapamil

12. Which of the following can cause reflex tachycardia, flushing, dizziness, lower limb
oedema?
a) ramipril
b) amlodipine
c) hydrochlorothiazide
d) spironolactone

13. Role of angiotensin converting enzyme inhibitors in heart failure are


a) Reduce both preload and afterload
b) Increase both preload and afterload
c) Reduce preload and increase afterload
d) Increase preload and reduce afterload

14. Potential benefit of nitroglycerin in heart failure is


a) reduce venous return
b) reduce heart rate
c) reduce water retention
d) reduce effects of sympathetic activation

15. Which adverse effect of antihypertensive is of most concern to elderly patients?


a) restlessness
b) hypotension
c) constipation
d) dry mouth

16. Your patient develops an irritating dry cough after recently given a new antihypertensive
drug.
a) advise patient to see his/her doctor for review
b) advise patient to reduce dose
c) advise patient to take it before going to bed
d) advise patient to take drug on alternative days
17. Which of the following will have positive effect if taking with spironolactone?
a) valsartan
b) perindopril
c) potassium supplement
d) frusemide

18. Patient A takes aminoglycoside antibiotic for pneumonia & frusemide for fluid overload.
you monitor for
a) hepatotoxicity
b) cardiac arrhythmia
c) ototoxicity
d) pulmonary fibrosis

19. All of the following work by inhibit platelet aggregation, EXCEPT?


a) unfractionated heparin
b) clopidogrel
c) aspirin
d) dipyridamole

20. Which of the following drug is indicated for outpatient secondary prevention of stroke or
myocardial infarction?
a) alteplase
b) aspirin
c) unfractionated heparin
d) glycoprotein IIb/IIIa inhibitor

21. Which of the following CANNOT be administered as outpatient?


a) unfractionated heparin
b) low molecular weight heparin
c) dabigatran
d) warfarin

22. Which of the following drug is mainstay anticoagulant for thromboembolism prophylaxis
in mechanical heart valves
a) rivaroxaban
b) dabigatran
c) warfarin
d) clopidogrel

23. Which of the following regarding warfarin is CORRECT?


a) warfarin activity can be increased or decreased by a lot of drugs and food.
b) therapeutic level of warfarin is monitored by aPTT.
c) it is used for emergency anticoagulation.
d) it can be reversed by protamine sulfate.

24. If a patient (on warfarin for atrial fibrillation) has target INR of 2-3, what should be done if
current INR is 3.9?
a) Assess for bleeding, increase warfarin dose then recheck INR
b) Assess for thrombosis, increase warfarin dose, then recheck INR
c) Assess for thrombosis, reduce warfarin dose, then recheck INR
d) Assess for bleeding, reduce warfarin dose then recheck INR
Contact tutorial 5: Respiratory drugs tutorial:
1. A patient is receiving treatment for asthma with salbutamol (Ventolin). The nurse teaches
the patient that while serious adverse effects are uncommon, the following may occur. Which
of the following is NOT an adverse effect of salbutamol?

a) tachycardia
b) sedation
c) tremor
d) angina

2. A patient with asthma has a prescription for two inhalers, salbutamol (Ventolin) and
beclomethasone (beclotide). How should the nurse instruct this patient on the proper use of
the inhalers?

a) Use the albuterol inhaler, and use the beclomethasone only if symptoms are not relieved.
b) Use the beclomethasone inhaler, and use the albuterol only if symptoms are not relieved.
c) Use the albuterol inhaler, wait 5–10 minutes, then use the beclomethasone inhaler.
d) Use the beclomethasone inhaler, wait 5–10 minutes, then use the albuterol inhaler.

3. A patient has been using a fluticasone (Flixotide) inhaler as a component of his asthma
therapy. He returns to his health care provider’s office complaining of a sore mouth. On
inspection, the nurse notices white patches in the patient’s mouth. What is a possible
explanation for these findings?

a) The patient has been consuming hot beverages after the use of the inhaler.
b) The patient has limited his fluid intake, resulting in dry mouth.
c) The residue of the inhaler propellant is coating the inside of the mouth.
d) The patient has developed thrush as a result of the fluticasone.

4. A patient who received a prescription for montelukast (Singulair) returns to his provider’s
office after three days, complaining that “the drug is not working.” She reports mild but
continued dyspnea and has had to maintain consistent use of her bronchodilator inhaler,
salbutamol (Ventolin). What does the nurse suspect is the cause of the failure of the
montelukast?

a) The patient is not taking the drug correctly.


b) The patient is not responding to the drug and will need to be switched to another
formulation.
c) The drug has not had sufficient time of use to have full effects.
d) The salbutamol inhaler is interacting with the montelukast.

5. Which of the following drugs is most immediately helpful in treating a severe acute asthma
attack?

a) Beclomethasone
b) Montelukast
c) Salbutamol
d) Salmeterol
6. The nurse is assisting a patient to master the use of a steroid inhaler. The patient says, "I
don't think I should be using steroids. I heard steroids are bad for health." The nurse's
response should be based on which statement?

a) The steroid preparations used to treat airway problems have no adverse effect at all.
b) Steroids can be very risky, but the risk is necessary in this patient's case.
c) Inhaled steroids are very useful in managing reactive airways, with a fairly good safety
profile.
d) Inhaled steroid use is usually short term, so any risk to the patient is minimal.

7. A patient is learning metered-dose inhaler technique. The patient says, "I don't understand
why I have to use this thing. Can't I just take pills?" The nurse responds that the inhalation
route:

a) is easier to master than is oral therapy.


b) is less expensive than is oral therapy.
c) is more likely to lead to termination of the disease process than are pills.
d) delivers the medication directly to the site, resulting in lower doses and fewer systemic
side effects.

8. A patient with degenerative arthritis is provided with a spacer along with a corticosteroid
metered-dose inhaler. The nurse recognizes that the spacer MOST likely assists this patient
to:

a) compensate for decreased dexterity.


b) use a larger dose of the steroid.
c) progress with weaning from the steroid drug.
d) avoid thrush infections.

9. A patient in acute respiratory distress is receiving a nebulizer salbutamol treatment. The


family member is annoyed because patient already has a salbutamol metered-dose inhaler
(MDI). The nurse's response to the family's concern is based on the knowledge that:

a) nebulized therapy is more cost effective in the inpatient setting.


b) suspension of the medication in liquid and delivery over a longer period increase the
bronchodilator's effectiveness.
c) the nebulized form of the drug will have fewer negative effects on this distressed patient.
d) the patient who is dyspneic and distressed is unlikely to be able to use a MDI effectively.

10) A patient with limited strength in the hands is being prepared for discharge with a dry
powder inhaler (DPI). The discharge nurse teaches the patient that an advantage of this
inhaler is that:

a) the patient can activate the inhaler with less pressure than is needed for a metered-dose
inhaler.
b) this inhaler has no dose limits.
c) the patient can increase the effectiveness of the powder by instilling it into a small
nebulizer.
d) the patient can activate the inhaler simply by inhaling.
11) Over the course of treatment for chronic asthma, a patient develops an allergy to the
propellants in rapid-acting metered-dose inhalers (MDIs). What option would the prescriber
expect to be used to address this problem after discharge?

a) Oral medication of the same class as the metered-dose inhaler


b) Nebulizer treatments
c) A concentrated-dose metered-dose inhaler
d) A dry powder inhaler (DPI)

12) The nurse is caring for an orthopedic surgical patient with mild intermittent asthma.
During the second postoperative day, the patient has an asthma attack while eating lunch.
The nurse expects the healthcare provider to give an order for:

a) a long acting beta2 agonist inhaler


b) a short-acting beta2 agonist inhaler.
c) an oral corticosteroid.
d) theophylline.

13) The nurse helps a patient establish goals to control asthma with medications. The nurse
emphasizes that the preferred drugs for long-term control of asthma are:

a) inhaled corticosteroids.
b) inhaled beta2 agonists.
c) anticholinergics.
d) systemic corticosteroids.

14) The nurse explains to a client that drugs that activate beta2-adrenergic receptors:

a) relax bronchiolar smooth muscle.


b) result in airway diameter narrowing.
c) increase labored breathing
d) decrease production of viscous secretions.

15) A patient with asthma is prescribed salbutamol, 2 puffs 3 times a day. The nurse should
teach the patient to do what?

a) Rinse the mouth after taking the prescribed dose.


b) Take an extra dose if breathing is compromised.
c) Wait 1 minute between puffs from the inhaler.
d) Take adequate amounts of calcium and vitamin D.

16) A patient with asthma is prescribed inhaled fluticasone. What should the nurse do?

a) Take the patient’s pulse before administering the medication.


b) Teach the patient to use a spacer to prevent a fungal infection.
c) Instruct the patient to use this drug to treat an acute attack.
d) Encourage the patient to avoid weight-bearing activity.

17) Which of the following is NOT a serious adverse effect of long-term oral glucocorticoid
therapy?

a) Adrenal suppression
b) Osteoporosis
c) Hypoglycemia
d) Peptic ulcer disease

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