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Which of the following information is TRUE ABOUT anaerobic respiration? (Select All that apply)
 
a. Waste products are carbon dioxide and water.
b. It may produce between 36 and 38 ATP molecules.
c. In animals, including humans, the anaerobic cycle produces lactic acid, which causes muscle cramps.
d. The fermentation process in anaerobic respiration is roughly 5 percent as effective as what cells can do when they have access to oxygen.
e. In bacteria, it may produce nitrite, nitrogen gas, hydrogen sulfide, methane and acetic acid.



Which of the following information is TRUE ABOUT anaerobic respiration? (Select All that apply)
 
a. Waste products are carbon dioxide and water.
b. It may produce between 36 and 38 ATP molecules.
c. In animals, including humans, the anaerobic cycle produces lactic acid, which causes muscle cramps.
d. The fermentation process in anaerobic respiration is roughly 5 percent as effective as what cells can do when they have access to oxygen.
e. In bacteria, it may produce nitrite, nitrogen gas, hydrogen sulfide, methane and acetic acid.
 
Answer (c, d and e). "Anaerobic" means without oxygen, and respiration refers to the processes in a cell that convert biochemical energy, such as that found in glucose, into usable energy in the form of ATP. Waste products like carbon dioxide are also produced during this process.

The fermentation process in anaerobic respiration is roughly 5 percent as effective as what cells can do when they have access to oxygen. An aerobic cycle may produce between 36 and 38 ATP molecules, while anaerobic respiration only creates 2 ATP molecules.

Since muscles often run out of oxygen during extreme exertion, anaerobic respiration keeps them running. In animals, including humans, the anaerobic cycle produces lactic acid, which causes muscle cramps. In order for these cramps to stop, oxygen must find its way back into the muscle again so these cells can switch back to aerobic respiration and stop building up lactic acid.

Anaerobic respiration is also common in bacteria that live in environments without oxygen; depending on the bacteria, the products of their respiration include nitrite, nitrogen gas, hydrogen sulfide, methane and acetic acid.


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New York Law Mandate Electronic Prescribing Law.


Prescribers in the state of New York must issue electronic prescriptions directly to a pharmacy according to a new law. All prescriptions must be transmitted in electronic format, except for certain limited circumstances, effective March 27, 2016, under the Internet System for Tracking Over-Prescribing (I-STOP) Act. The regulations require prescribers and pharmacists to have a secure system for electronic transmission of the prescription from computer to computer in order to protect the confidentiality of patient information, notes the Office of the Professions (OP) advisory notice. For additional information on the electronic transmittal of prescriptions in New York, visit the OP section of the New York State Education Department website.
 
The New York Times states that New York is the first state to mandate electronic prescribing and enforce penalties, such as fines and imprisonment, for physicians who do not comply. The New York Times also notes that Minnesota has an electronic prescribing law but does not enforce or fine physicians for not complying with the mandate.


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Which of the following rating scales is commonly used to evaluate the severity of extrapyramidal symptoms (EPS)? (Select ALL that apply)
 
a. SAS
b. BARS
c. AIMS
d. ESRS
e. PDS


Which of the following rating scales is commonly used to evaluate the severity of extrapyramidal symptoms (EPS)? (Select ALL that apply)
 
a. SAS
b. BARS
c. AIMS
d. ESRS
e. PDS

Answer: (a,b,c,d). Extrapyramidal symptoms (EPS) are drug-induced movement disorders that include acute and tardive symptoms. These symptoms include dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), Parkinsonism (characteristic symptoms such as rigidity, bradykinesia, and tremor), and tardive dyskinesia (irregular, jerky movements). Since it is difficult to measure extrapyramidal symptoms, rating scales are commonly used to assess the severity of movement disorders. The Simpson-Angus Scale (SAS), Barnes Akathisia Rating Scale (BARS), Abnormal Involuntary Movement Scale (AIMS), and Extrapyramidal Symptom Rating Scale (ESRS) are rating scales frequently used for such assessment and are not weighted for diagnostic purposes.


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Poison Ivy rash is an example of:

a. Type I Hypersensitivity
b. Type II Hypersensitivity
c. Type III Hypersensitivity
d. Type IV Hypersensitivity
e. Type V Hypersensitivity


Poison Ivy rash is an example of:

a. Type I Hypersensitivity
b. Type II Hypersensitivity
c. Type III Hypersensitivity
d. Type IV Hypersensitivity
e. Type V Hypersensitivity

Answer: (d), Type 4 hypersensitivity is often called delayed type. Delayed hypersensitivity does not start to be noticeable until several hours to a full day after exposure to the antigen. It may last for over a week.
 
Poison ivy rash is caused by an allergic reaction to an oily resin called urushiol (u-ROO-she-ol). This oil is in the leaves, stems and roots of poison ivy, poison oak and poison sumac. Urushiol, which is a hapten, when absorbed through the skin from a poison ivy plant, it (urushiol) undergoes oxidation in the skin cells to generate the actual hapten, a reactive molecule called a quinone, which then reacts with skin proteins to form hapten adducts.
 
T lymphocytes recognize the foreign substances, usually after the antigen is eaten, degraded, and presented (in pieces) by so-called antigen-presenting cells such as Langerhans cells in the skin, or macrophages. Urushiol metabolites (metabolite of Poison Ivy) are presented by this and other mechanisms. The T lymphocytes pour out inflammatory signal substances called cytokines. These call in armies of white blood cells called monocytes, which become macrophages. The macrophages become activated by the cytokines and attack everything in the vicinity, and can cause severe tissue damage.
 
Usually, the first exposure causes only sensitization, in which there is a proliferation of effector T-cells. After a subsequent, second exposure, the proliferated T-cells can become activated, generating an immune reaction that produces typical blisters of a poison ivy exposure.
 
 
In addition to poison ivy, a good example is the skin reaction to injected tuberculosis antigen. In fact, when tuberculosis bacteria infect the lung, it is the delayed hypersensitivity against them which destroys the lung. Unlike the other types, it is not antibody mediated but rather is a type of cell-mediated response.

Source: www.pharmacyexam.com


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Which of the following information about Lesinurad is/are TRUE? (Select All that apply).
 
a. Acute liver failure has reported with Lesinurad.
b. Lesinurad should be used in combination with a xanthine oxidase inhibitor.
c. The recommended dose is 200 mg once daily.
d. Lesinurad is a xanthine oxidase inhibitor.
e. Lesinurad is indicated for the treatment of hyperuricemia associated with gout.


Which of the following information about Lesinurad is/are TRUE? (Select All that apply).
 
a. Acute liver failure has reported with Lesinurad.
b. Lesinurad should be used in combination with a xanthine oxidase inhibitor.
c. The recommended dose is 200 mg once daily.
d. Lesinurad is a xanthine oxidase inhibitor.
e. Lesinurad is indicated for the treatment of hyperuricemia associated with gout.

Answer: (b,c,e). Zurampic (Lesinurad) is a URAT1 inhibitor. It is available as blue film-coated tablets for oral administration containing 200 mg Lesinurad. It should be used in combination with a xanthine oxidase inhibitor. Lesinurad reduces serum uric acid levels by inhibiting the function of transporter proteins involved in uric acid reabsorption in the kidney. It is indicated in combination with a xanthine oxidase inhibitor for the treatment of hyperuricemia associated with gout in patients who have not achieved target serum uric acid levels with a xanthine oxidase inhibitor alone.

Zurampic (Lesinurad) is not recommended for the treatment of asymptomatic hyperuricemia. Zurampic (Lesinurad) should not be used as monotherapy.

Zurampic (Lesinurad) tablets are for oral use and should be co-administered with a xanthine oxidase inhibitor, including allopurinol or febuxostat. Zurampic (Lesinurad) is recommended at 200 mg once daily. This is also the maximum daily dose. Zurampic (Lesinurad) should be taken by mouth, in the morning with food and water.

Zurampic (Lesinurad) causes an increase in renal uric acid excretion, which may lead to renal events including transient increases in serum creatinine, renal-related adverse reactions, and kidney stones. These renal events occurred more frequently in patients receiving Zurampic (Lesinurad) 400 mg, when used as monotherapy or in combination with a xanthine oxidase inhibitor. Kidney function is required to monitor.

Source: www.pharmacyexam.com


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Which of the following HMG-CoA inhibitors can be taken during any time of the day with or without food? (Select All that apply)

a. Atorvastatin
b. Pravastatin
c. Simvastatin
d. Pitavastatin
e. Rosuvastatin


Which of the following HMG-CoA inhibitors can be taken during any time of the day with or without food? (Select All that apply)

a. Atorvastatin
b. Pravastatin
c. Simvastatin
d. Pitavastatin
e. Rosuvastatin

Answer: (a,b,d,e).

Name Dose Timing Food
Pitavastatin Any time of the day With or without food
Simvastatin Evening N/A
Atorvastatin Any time of the day With or without food
Fluvastatin Evening With or without food
Pravastatin Any time of the day With or without food
Lovastatin Evening With food
Rosuvastatin Any time of the day With or without food


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Which of the following information is/are TRUE about preparing TPN formulation? (Select All that apply).
 
a. A lipid emulsion in a three-in-one admixture obscures the presence of calcium phosphate precipitates.
b. The solubility of the added calcium should be calculated from the volume at the time the calcium is added and should NOT be based upon the final volume.
c. If the amount of calcium or phosphate which must be added is likely to cause a precipitate, some or all of the calcium should be administered separately.
d. If a three-in-one admixture is medically necessary, then add the calcium before the lipid emulsion.
e. When adding calcium and phosphate to an admixture, the calcium should be added first.


Which of the following information is/are TRUE about preparing TPN formulation? (Select All that apply).
 
a. A lipid emulsion in a three-in-one admixture obscures the presence of calcium phosphate precipitates.
b. The solubility of the added calcium should be calculated from the volume at the time the calcium is added and should NOT be based upon the final volume.
c. If the amount of calcium or phosphate which must be added is likely to cause a precipitate, some or all of the calcium should be administered separately.
d. If a three-in-one admixture is medically necessary, then add the calcium before the lipid emulsion.
e. When adding calcium and phosphate to an admixture, the calcium should be added first.

Answer: (a,b,c,d). TPN solutions are made according to a variety of formulations and compounding protocols. Thus, there are possibilities of calcium phosphate precipitates and many other chemical incompatibilities. Precipitates could develop because of a number of factors such as: the concentration, pH, and phosphate content of the amino acid solutions; the calcium and phosphorous additives; the order of mixing; the mixing process; or the compounder. The presence of a lipid emulsion in the TPN admixture would obscure the presence of any precipitate.
 
Because of the potential for life threatening events, caution should be taken to ensure that precipitates have not formed in any parenteral nutrition admixtures.
 
1. The amounts of phosphorous and of calcium added to the admixture are critical. The solubility of the added calcium should be calculated from the volume at the time the calcium is added. It should not be based upon the final volume.
 
Some amino acid injections for TPN admixtures contain phosphate ions (as a phosphoric acid buffer). These phosphate ions and the volume at the time the phosphate is added should be considered when calculating the concentration of phosphate additives. Also, when adding calcium and phosphate to an admixture, the phosphate should be added first. 
 
2. The line should be flushed between the addition of any potentially incompatible components.
 
3. A lipid emulsion in a three-in-one admixture obscures the presence of a precipitate. Therefore, if a lipid emulsion is needed, either:

(1). use a two-in-one admixture with the lipid infused separately, or
(2). if a three-in-one admixture is medically necessary, then add the calcium before the lipid emulsion and according to the recommendations in number 1 above.
 
If the amount of calcium or phosphate which must be added is likely to cause a precipitate, some or all of the calcium should be administered separately. Such separate infusions must be properly diluted and slowly infused to avoid serious adverse events related to the calcium.

4. A filter should be used when infusing either central or peripheral parenteral nutrition admixtures. Standards of practice vary, but the following is suggested: a 1.2 micron air eliminating filter for lipid containing admixtures, and a 0.22 micron air eliminating filter for nonlipid containing admixtures.


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Which of the following information is/are TRUE about preparing TPN formulation? (Select All that apply).
 
a. A lipid emulsion in a three-in-one admixture obscures the presence of calcium phosphate precipitates.
b. The solubility of the added calcium should be calculated from the volume at the time the calcium is added and should NOT be based upon the final volume.
c. If the amount of calcium or phosphate which must be added is likely to cause a precipitate, some or all of the calcium should be administered separately.
d. If a three-in-one admixture is medically necessary, then add the calcium before the lipid emulsion.
e. When adding calcium and phosphate to an admixture, the calcium should be added first.


Which of the following information is/are TRUE about preparing TPN formulation? (Select All that apply).
 
a. A lipid emulsion in a three-in-one admixture obscures the presence of calcium phosphate precipitates.
b. The solubility of the added calcium should be calculated from the volume at the time the calcium is added and should NOT be based upon the final volume.
c. If the amount of calcium or phosphate which must be added is likely to cause a precipitate, some or all of the calcium should be administered separately.
d. If a three-in-one admixture is medically necessary, then add the calcium before the lipid emulsion.
e. When adding calcium and phosphate to an admixture, the calcium should be added first.

Answer: (a,b,c,d). TPN solutions are made according to a variety of formulations and compounding protocols. Thus, there are possibilities of calcium phosphate precipitates and many other chemical incompatibilities. Precipitates could develop because of a number of factors such as: the concentration, pH, and phosphate content of the amino acid solutions; the calcium and phosphorous additives; the order of mixing; the mixing process; or the compounder. The presence of a lipid emulsion in the TPN admixture would obscure the presence of any precipitate.
 
Because of the potential for life threatening events, caution should be taken to ensure that precipitates have not formed in any parenteral nutrition admixtures.
 
1. The amounts of phosphorous and of calcium added to the admixture are critical. The solubility of the added calcium should be calculated from the volume at the time the calcium is added. It should not be based upon the final volume.
 
Some amino acid injections for TPN admixtures contain phosphate ions (as a phosphoric acid buffer). These phosphate ions and the volume at the time the phosphate is added should be considered when calculating the concentration of phosphate additives. Also, when adding calcium and phosphate to an admixture, the phosphate should be added first. 
 
2. The line should be flushed between the addition of any potentially incompatible components.
 
3. A lipid emulsion in a three-in-one admixture obscures the presence of a precipitate. Therefore, if a lipid emulsion is needed, either:

(1). use a two-in-one admixture with the lipid infused separately, or
(2). if a three-in-one admixture is medically necessary, then add the calcium before the lipid emulsion and according to the recommendations in number 1 above.
 
If the amount of calcium or phosphate which must be added is likely to cause a precipitate, some or all of the calcium should be administered separately. Such separate infusions must be properly diluted and slowly infused to avoid serious adverse events related to the calcium.

4. A filter should be used when infusing either central or peripheral parenteral nutrition admixtures. Standards of practice vary, but the following is suggested: a 1.2 micron air eliminating filter for lipid containing admixtures, and a 0.22 micron air eliminating filter for nonlipid containing admixtures.


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Prescribing authority shall be allowed, under the medical direction of a supervising physician, for:
 
I. Advanced registered nurse practitioners.
II. Clinical nurse specialists  
III. Certified nurse-midwives.

a. I only
b. I and II only
c. II and III only
d. All


Prescribing authority shall be allowed, under the medical direction of a supervising physician, for:
 
I. Advanced registered nurse practitioners.
II. Clinical nurse specialists  
III. Certified nurse-midwives.
 
a. I only
b. I and II only
c. II and III only
d. All

Answer: All, [Title 59 Oklahoma Pharmacy Act Chapter 8 Section 353.1a]. 
 
Prescribing authority shall be allowed, under the medical direction of a supervising physician, for an advanced practice nurse recognized by the Oklahoma Board of Nursing in one of the following categories: advanced registered nurse practitioners, clinical nurse specialists, or certified nurse-midwives.
 
The advanced practice nurse may write or sign, or transmit by word of mouth, telephone or other means of communication an order, for drugs or medical supplies that is intended to be filled, compounded, or dispensed by a pharmacist.
 
The supervising physician and the advanced practice nurse shall be identified at the time of origination of the prescription and the name of the advanced practice nurse shall be printed on the prescription label.

 


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According to Oklahoma State Pharmacy Law, every registered pharmacist or assistant pharmacist shall, within ten (10) days after discontinuing or changing his or her place of practice, remove his or her certificate and notify the Executive Director of the Board of his or her new place of practice.

True or False


According to Oklahoma State Pharmacy Law, every registered pharmacist or assistant pharmacist shall, within ten (10) days after discontinuing or changing his or her place of practice, remove his or her certificate and notify the Executive Director of the Board of his or her new place of practice.
 
Answer: True, [Title 59 Oklahoma Pharmacy Act Chapter 8 Section 353.12(A)].
 
Every person upon receiving a certificate of licensure pursuant to the Oklahoma Pharmacy Act, or who has heretofore received a certificate of licensure in this state, shall keep such certificate conspicuously displayed in the pharmacy where such pharmacist is actively engaged in the practice of pharmacy or in such a location as is otherwise prescribed by the State Board of Pharmacy.
 
The current receipt for licensure shall be attached to the lower left corner of the original certificate.
 
According to Oklahoma State Pharmacy Law, every registered pharmacist or assistant pharmacist shall, within ten (10) days after discontinuing or changing his or her place of practice, remove his or her certificate and notify the Executive Director of the Board of his or her new place of practice.