Nur 635 Advanced Pharmacology Mid-Term Exam (Correctly Answered With Rationales)

Statins lower cholesterol by: competitively inhibiting HMG-CoA reductase. {Ans: competitively inhibiting HMG-CoA reductase.}Patients receiving short-acting nitrates for the management of acute angina should be advised of the potential for: {Ans: headaches and postural hypertension Rationale: Patients who are receiving short-acting nitrates for acute angina should be advised of the high possibility for headaches and postural hypotension with each use. Nitroglycerin (Nitro-Dur) is a short-acting nitrate. The nitrates are primarily venodilators due to increased bio-availability to venous smooth muscle cells. Venodilation lowers preload (left ventricular end-diastolic pressure) and therefore reduces wall stress, resulting in a decrease in myocardial oxygen demand.}A patient with a prosthetic heart valve is taking warfarin therapy. The appropriate action prior to dental surgery is to: {Ans: hold warfarin 5 days prior to surgery and begin a low molecular weight heparin Rationale: The onset of anticoagulant action for oral warfarin is 24-72 hours with a half life elimination of 20-60 hours. Due to the long half-life elimination of warfarin and the high risk for thrombus development in a patient with a prosthetic heart valve, the warfarin should be stopped 5 days prior to surgery and the patient bridged to a low-molecular weight heparin (i.e. lovenox).