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Week 14. Rx = prescription

Rx, Latin: recipe, to take, prescription.

Below are three archetypal pharmacology test questions for your reading pleasure (yeah!), so that you might also experience the exquisite pain that is the biweekly proctored pharm exam.

Type I. The Lab-Values-From-Hell Question.
A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105° F. The patient’s skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer:
a. iodine-131 (131I).
b. propylthiouracil (PTU).
c. intravenous levothyroxine.
d. methimazole (Tapazole).
Answer: Besides levothyroxine, these are actually all great things that might help a patient with hyperthyroidism, but as the patient is experiencing a thyroid storm in the ER, pick the drug that will act the fastest, which is PTU.

Type II. The "Which Patient Will Die First?" Question.
The nurse working on a high acuity medical-surgical unit is prioritizing care for four patients who were just admitted. Which patient should the nurse assess first?
a. The NPO patient with a blood glucose of 80 who just received 20 units of 70/30 Novolin insulin
b. The patient with a pulse of 58 who is about to receive digoxin (Lanoxin)
c. The patient with a blood pressure of 136/92 with complaints of a headache
d. The patient with a mild allergy to penicillin who is receiving an infusion of cefazolin (Ancef)
Answer: NPO = nothing per oral, so if the patient isn't eating and just got a nice insulin shot, you can expect the patient's blood glucose to bottom out and something quite bad, like disorientation, seizures, or coma might ensue. The other patients also need intervention, but hopefully the digoxin won't feed itself to the patient with a low heart rate, the headache isn't indicative of a hypertensive crisis, and a mild allergy to penicillin doesn't confer cross sensitivity to cephalosporins, or if it does, the reaction will be mild also.

Type III. The "You're in Med School, Aren't You?" aka "What Will the Doctor Order?" Question.
A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone (Flovent HFA) 110 mcg twice daily and has used 2 puffs of albuterol (Proventil HFA), 90 mcg/puff, every 4 hours for 2 days. The nurse expects the doctor to order which drugs?
a. Four puffs of albuterol, oxygen, and intravenous theophylline
b. Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg
c. Intramuscular glucocorticoids and salmeterol by metered-dose inhaler
d. Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen
Answer: You are expected to know everything. That is all. c.


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