2021 临床药学英语(南京医科大学)1466474446 最新满分章节测试答案

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本课程起止时间为:2021-12-03到2022-02-21
本篇答案更新状态:已完结

【作业】Clinical Pharmacy and Clincal Pharmacist 课后练习1

1、 问题:Evolving Therapeutic Strategies in Cancer Therapy-Induced Bone Loss: Examining Prostate CancerCase ApplicationJG is a 68-year-old African American male with prostate cancer, status post nerve-sparing radical prostatectomy. JG was diagnosed with localized prostate cancer 5 years ago. He is currently being admitted for severe (10/10) pain in his "upper leg" after a fall at home. He is a current smoker (1 pack per day) and drinks socially (10-12 beers on the weekends). He underwent a radical prostatectomy a month after diagnosis without any morbidity after surgery. He started to have more back pain about a year ago. A PET CT scan was performed and metastatic disease was noted in his liver at 4 different locations. For the past ten months ago, he has been treated with androgen deprivation therapy (ADT), consisting of a monthly subcutaneous injection of leuprolide 22.5 mg IM q3 months, along with bicalutamide 50 mg orally daily.Calcium and Vitamin D SupplementationADT can cause bone loss over time in prostate cancer patients. Risk assessments should be considered, along with appropriate considerations for lifestyle modifications and pharmacotherapy. Calcium and vitamin D supplementation should be considered to help decrease overall bone loss due to JG’s risk factors. As per the National Osteoporosis Foundation (NOF) Guidelines, patients aged 50 and older should take 1200-1500 mg of calcium and 800-1000 IU of vitamin D. Patients with malignancy and receiving concomitant therapies that may decrease bone mineral density (BMD) should be considered higher risk and should be placed on calcium and vitamin D at the NOF recommended doses. Adult patients younger than 50 years usually require 1000 mg of calcium and 600 IU of vitamin D. Patients need to choose an appropriate calcium salt. Calcium carbonate and calcium citrate can produce similar levels of calcium, but patients who are on acid suppression therapy may need to take the citrate salt.Pharmacologic TherapyOral bisphosphonates have mixed results in terms of efficacy in reducing cancer-related fractures. Thus, it may be beneficial to use these agents for prostate cancer patients if intravenous or subcutaneous routes are not an option. Alendronate 70 mg orally weekly and risedronate 2.5 mg orally daily have benefit in patients with prostate cancer, but the overall utility is not clear in reducing fractures overall. Patients receiving long-term ADT should consider these therapies if they can tolerate the potential for esophageal adverse effects and be able to remain upright for 30-60 minutes after dose administration.Intravenous bisphosphonates that may be used to decrease bone loss in prostate cancer include pamidronate 60 mg given intravenously and zoledronic acid 4 mg given intravenously over 15 minutes (administered every 3 months). Patients with lower concentrations of tumor markers may have a better response, but overall outcomes related to this decrease have not been demonstrated. With IV regimens, patients may have more muscle and joint pain immediately following infusion or injection. Renal function must be monitored, along with any complaints of jaw pain (to identify osteonecrosis of the jaw). Calcium monitoring should be considered in patients on parenteral bisphosphonate therapy and potentially on oral bisphosphonate therapy. Patients without any prior hypercalcemia from malignancy may potentially develop hypocalcaemia while being treated with parenteral bisphosphonate therapy.The RANK ligand inhibitor, denosumab, also has benefit for patients on ADT. It is given via a subcutaneous 60 mg injection given every 6 months. A potential benefit would be less frequent administration than that associated with bisphosphonate therapy and dosage adjustments in renal impairment would not be necessary. All of the pharmacological agents should be used in conjunction with calcium and vitamin D therapy. Patients should be monitored for low calcium levels, especially if they receive intravenous bisphosphonates and denosumab.Non-pharmacologic TherapyPatients who consume more than three alcoholic drinks per day should decrease their intake or abstain from alcohol if they are at high risk for osteoporosis or have CTIBL. Patients who smoke should also consider smoking cessation. Pharmacists may contribute in helping patients stop smoking by educating about the various available smoking cessation therapies and programs, so this could be of benefit to patients on ADT. Other substances that should be minimized or eliminated include caffeine, dietary salt, and aluminum-containing dietary products or over the counter (OTC) medications (eg, antacids). Pharmacists can help screen patients for dietary and OTC products that may be contributing to modifiable risk factors for CTIBL. Medications such as anticoagulants, anticonvulants, barbiturates, cyclosporine, depo-medroxyprogesterone, glucocorticoids, and lithium can contribute to bone loss. Cancer patients receiving those medications, chemotherapy, aromatase inhibitors, or ADT are also at a considerably increased risk for bone loss and fractures. Other lifestyle issues include a sedentary lifestyle and avoidance of weight-bearing exercises.Considering that JG is being treated with ADT and is currently a smoker, consumes ethanol, and is older than age 65, he is at considerable risk for fracture. Recently, he was started on corticosteroids (prednisone 30 mg orally daily with food) by his primary care physician for some back and hip pain over the past 5 weeks. He also developed pain in his left leg, and upon evaluation in an emergency room, he was found to have deep vein thrombosis, and was initiated on enoxaparin 100 mg subcutaneously twice a day.His Eastern Cooperative Oncology Group (ECOG) performance is currently 1, which means that the patient can carry out most lighter activities but not strenuous ones. He notes that he drinks 5 cups of coffee per day and has told the pharmacist that he is not tolerating his oral bisphosphonate therapy and stopped taking it 4 months ago. The patient also has hypertension, hyperlipidemia, coronary artery disease (status post catheterization 2 years ago), and metastatic prostate cancer (status post prostate resection). He works as a mechanic. He follows a low-fat and low-salt diet and he has had a cardiac catheterization.His current medications are:Metoprolol 25 mg po dailyIsosorbide mononitrate 30 mg po qamAmlodipine 10 mg po dailyLisinopril 20 mg po dailyHydrochlorothiazide 25 mg po dailyPravastatin 20 mg po dailyAspirin 81 mg po dailyVitamin D 1000 units po dailyAlendronate 70 mg po weeklyNaproxen 250 mg po q8 hours prn (usually take 2 per day)Prednisone 30 mg po dailyPantoprazole 40 mg po dailyEnoxaparin 100 mg sq bidThe patient now is being worked up for cancer therapy induced bone loss. He has a DXA scan, which reveals a T-score of -2.6. His serum creatinine has increased from 0.8 mg/dL to 3.2 mg/dL.Pharmacists RolesPharmacists play a major role in helping with screening for CTIBL and appropriate medication use. Pharmacists can help recommend DXA screening if they encounter a cancer patient on chemotherapy, ADT, or an aromatase inhibitor. OTC recommendations can be pivotal in assisting patients in lessening their risk of fractures. Calcium and vitamin D use can be monitored and selection of appropriate calcium salts can help patients continue on a successful treatment plan. Patients who then start pharmacologic intervention require close follow-up. Pharmacists can help with monitoring or creating protocols to ensure close monitoring of serum creatinine for intravenous bisphosphonate use. Pharmacists can also ensure that serum calcium is monitored for all pharmacotherapy (ie, bisphosphonates, denosumab) implemented for patients at risk for CTIBL.Another important aspect of monitoring is adherence for oral agents. Patients may not be accustomed to taking a weekly oral agent. Patients must be educated about the appropriate administration of oral bisphophonates as well. In regard to parenteral agents used for CTIBL, adverse effects should also be monitored. Monitoring the scheduling in infusion centers can also help patients on a q3 month intravenous bisphosphonate or on a q6 month denosumab injection.Although not very common, osteonecrosis of the jaw should be considered in any patient with persistent jaw pain or dental issues. The patient’s dentist should be aware that the patient is on an IV bisphosphonate or denosumab. Pharmacists can develop protocols or standard communications for patients who are on IV bisphosphonates or denosumab to help ensure compliance with monitoring for osteonecrosis of the jaw. Appropriate dosing of the intravenous bisphosphonates according to renal clearance capacity can be placed in a protocol and/or monitored by pharmacists. Pharmacists should be aware of CTIBL by recognizing risk factors and guiding patients towards appropriate lifestyle modifications and use of calcium, vitamin D, and pharmacologic agents.(1)、 [单选题]Which of the following regimens could be considered for prevention of ADT induced bone loss in this patient?A、Pamidronate 90 mg IV over 2 hours every 4 weeksB、Denosumab 120 mg SQ every 4 weeksC、Zoledronic acid 4 mg IV over 15 minutes q 3 monthsD、Denosumab 60 mg SQ q 6 monthsE、Risedronate 2.5 mg PO q dailyF、A, B, and EG、C, D, and E(2)、 [单选题]JG should be counseled on the following lifestyle changes:A、Increase total calcium intake (dietary plus supplements) to 1200-1500 mg per dayB、Increase vitamin D intake to 800-1000 units per dayC、Decrease alcohol intakeD、Increase weight-bearing exerciseE、All of the above(3)、 [单选题]Which form of calcium should be recommended to improve absorption due to concomitant proton pump inhibitor use?A、Calcium acetateB、Calcium carbonateC、Calcium citrateD、Chewable calcium(4)、 [单选题]What information now increases the risk of osteoporosis and bone loss for this patient?A、 Androgen deprivation therapyB、Corticosteroid useC、Coffee useD、Anticoagulant useE、All of the above(5)、 [单选题]What therapies could be considered for this patient?A、Denosumab 60 mg subcutaneously q6 monthsB、Zoledronic acid 4 mg intravenously q3 monthsC、Alendronate 70 mg po weeklyD、A or BE、All of the above(6)、 [单选题]At this point, a recommendation for an oral bisphosphonate is made to help with modifiable and non-modifiable risk factors. What would be appropriate recommendations for this patient at this time?A、Have serum creatinine monitored dailyB、Remain upright for 120 minutes after taking the bisphosphonateC、Remain upright for 30-60 minutes after taking the bisphosphonate, depending on the agent usedD、Eat just prior to taking the bisphosphonate(7)、 [单选题]Which of the following interventions can the pharmacist make?A、Change the oral bisphosphonate therapy by contacting the prescriberB、Add oral calcium and vitamin D to the patient’s therapyC、Change to subcutaneous denosumab for this patient by contacting the prescriberD、Counsel the patient about jaw pain and to notify dentist of bisphosphonate or denosumab therapy prior to undergoing dental proceduresE、All of the above(8)、 [单选题]What would be the next step for this patient?A、Start calcium 600 mg orally bidB、Start denosumab 60 mg every 6 months along with calcium and vitamin D supplementationC、Change his oral bisphosphonateD、Start zoledronic acid 4 mg IV q month with calcium and vitamin D supplementation(9)、 [单选题]What counseling points should be communicated to the patient?A、Continue taking your oral bisphosphonate with the denosumabB、Drink less fluids since the patient is no longer on an oral bisphosphonateC、Recommend a dental appointment for any jaw pain that persistsD、Exercise less, since the patient is currently on pharmacotherapy for CTIBL(10)、 [单选题]Pharmacists can have a major impact on preventing CTIBL by doing which of the following:A、Recommend that patients undergoing any chemotherapy begin treatment with a bisphosphonate or denosumabB、Refer at-risk patients to their physicians for DXA screening and treatment considerationC、Recommend that patients take calcium and vitamin D supplementation when D. prescribed bisphosphonates or denosumabD、Encourage treatment adherence and persistence since osteoporosis is usually a silent disease until fracture occursE、All of the aboveF、B, C, and D only
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Clinical Pharmacy and Clincal Pharmacist 课后测试1

1、 问题:What would you recommend to this patient at this time?
选项：
A:Fulvestrant （氟维司群） alone
B:Fulvestrant + PI3K/AKT/mTOR inhibitor in a clinical trial
C:pan-ErbB receptor inhibitor in a clinical trial
D:Chemotherapy
答案: 【Fulvestrant + PI3K/AKT/mTOR inhibitor in a clinical trial】

2、 问题:Why do we need to learn Clinical Pharmacy English?
选项：
A:Increase international medical and pharmacy knowledge
B:Improve global health awareness and cross-cultural communication ability
C:Broaden students’ international vision and cultivate students’ global competence
D:Lay foundation for follow-up scientific research
答案: 【Increase international medical and pharmacy knowledge;
Improve global health awareness and cross-cultural communication ability;
Broaden students’ international vision and cultivate students’ global competence;
Lay foundation for follow-up scientific research】

Drug Evaluation 课后测试2

1、 问题:2. Which one is faster, the normal rate of impulse initiation or the SA node?
选项：
A:impulse initiation
B:the SA node
C:AV node
D:same
答案: 【the SA node】

2、 问题:                                                                                HeartThe heart acts as a pump and maintains circulation of the blood by alternate concentration and relaxation of cardiac muscle (the myocardium). It generally contracts at a rate of 70 to 75 beats/minute in a healthy 70-kg person at rest. The normal heart rhythm, known as sinus rhythm, originates in specialized cardiac cells, called pacemaker cells, in the sino-atrial (SA) or sinus node and has been defined as a sinus node rate of 60 to 100 beats/minute. Each heart beat or contraction is initiated by generation of an action potential in the SA node; the electrical impulse spreads over both atria, causing them to contract, and on to the atrioventricular (AV) node. From the AV node it spreads through the bundle of His and down the Purkinje fibers to the ventricles, causing them to contract. It is the movement of ions across the cardiac cell membrane that generates the action potential. The electrical changes involved can be recorded on an electrocardiogram (ECG). Other cardiac cells that are located outside the sinus node are also capable of initiating impulses. These cells, termed ectopic pacemakers, can be found in the atriovertricular junction and in the His-Purkinje system. The normal rate of impulse initiation by these ectopic pacemakers is less than that of the sinus node and therefore they do not normally initiate the heart beat. However, they may become dominant in certain circumstances such as: if the intrinsic rate of the ectopic pacemaker rises above that of the sinus node; if the sinus node rate falls below that of the ectopic pacemaker; or when a normal sinus node impulse is prevented from being conducted through the heart (heart block) leaving the ectopic pacemaker to fire at its own intrinsic rate.A cardiac arrhythmia can be defined in simple terms as any abnormally of rate, regularity, or site of origin of the cardiac impulse or as a disturbance in conduction that causes an abnormal sequence of activation. Symptoms depend on the arrhythmia but may include fatigue, dyspnoea, dizziness, and syncope; sudden death may occur. Palpitation is a term used to describe an unacceptable awareness of the beating heart by the patient. This may occur normally in circumstances such as emotion, exercise, or stress or may occur in association with arrhythmias. Clinically, arrhythmias may be classified by presumed site of origin, namely as supraventricular arrhythmias (including atrial arrhythmias and atrioventricular junctional arrhythmias) or as ventricular arrhythmias. Classification can also be based on rate as either bradyarrhythmias (slow) or tachyarrhythmias (fast).Bradyarrhythmias are caused by sinus node dysfunction, which either depresses impulse generation or disturbs the conduction of impulses from the sinus node to the atria. Atrioventricular block indicates disturbance of conduction of the atrial impulse to the ventricles. In first-degree block the impulse is delayed. It is usually asymptomatic but may progress to second- or third-degree block. In second-degree block the impulse is blocked intermittently and in third-degree block there is a complete block. Atrioventricular dissociation indicates a condition in which ventricular activity is faster than, and independent of, the atrial activity. Bradyarrhythmias may be treated with either atropine or isoprenaline, although cardiac pacing is the treatment of choice.For tachyarrhythmias a classification or diagnosis based on the precise mechanism of the arrhythmia would also be desirable but this is not always clear. In many of the clinically relevant arrhythmias, however, the mechanism is one of re-entry. Re-entry occurs when the initial impulse does not die out but continues to propagate and reactivate the heart.Questions1. Only the SA node can initiate the heart beat, true or false, why?
选项：
A:正确
B:错误
答案: 【错误】

3、 问题: Brady arrhythmias are caused by AV node dysfunction, true or false? 
选项：
A:正确
B:错误
答案: 【错误】

4、 问题:Kate’s doctor told her that she might has a first-degree atrioventricular block and suggested her to take further examination. However, Mary does not feel any uncomfortable. Should she take the doctor’s advice?
选项：
A:正确
B:错误
答案: 【正确】

【作业】Drug Evaluation 课后练习2

1、 问题:谈一谈本章学习的感受
评分规则: 【 内容不限
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Pharmacotherapy 课后测试3

1、 问题:                                                                        HypertensionHypertension, particularly essential or primary hypertension, is widespread and although usually asymptomatic, is a major risk factor for stroke and to some extent ischemic heart disease. Control of hypertension is therefore a major aspect of cardiovascular risk reduction. National and international guidelines on management have been published.Definitions: The term blood pressure generally means arterial blood pressure, the pressure of the blood on artery walls. It is usually measured indirectly in the brachial artery just above the elbow using an appropriately calibrated sphygmomanometer and is expressed in mmHg. Two measurements are made: systolic or maximum blood pressure (achieved during ventricular contraction of the heart) and diastolic or minimum blood pressure (achieved during ventricular        dilatation). Hypertension means a higher than “normal” blood pressure; it has been defined as the level of blood pressure above which intervention has been shown to reduce the associated cardiovascular risk. Many factors influence blood pressure, resulting in a bell-shaped distribution curve in the general population, and in consequence it is difficult to define an absolute norm. Normal adult blood pressure has been arbitrarily defined as a systolic pressure below 130 mmHg together with a diastolic pressure below 85 mmHg (i.e. below 130/85 mmHg), but more recent studies have suggested that optimal blood pressure, in terms of cardiovascular risk, may be lower than this. US guidelines now define normal blood pressure as below 120/80 mmHg, while European and British guidelines classify this as optimal. Blood pressure of 130~139/85~89 mmHg are regarded as high normal or are included in the classification of prehypertension. Although hypertension was formerly defined in terms of diastolic blood pressure alone, it is now recognized that systolic pressure is also important in determining risk, and current guidelines give equal emphasis to both.Blood pressure above 140 mmHg systolic, and/or 90 mmHg diastolic is generally considered to represent hypertension. Although classifications of mild, moderate, and severe hypertension have been widely used, these terms may be misleading since absolute cardiovascular risk is more important in determining the need for treatment and depends on other factors in addition to blood pressure. Most guidelines therefore use a grading system to classify hypertension, as follows:grade 1: 140~159/90~99 mmHg;grade 2:160~179/100~109 mmHg;grade 3:≥180/≥ 110 mmHg.In the US guidelines, stage 1 hypertension corresponds to grade 1, whereas stage 2 includes both grades 2 and 3.When systolic and diastolic pressures fall into different categories the higher values is used for classification purposes. Classification and subsequent treatment decisions should be based on blood pressure measurements taken on several occasions over a period that varies according to the severity of hypertension. Ambulatory blood pressure monitoring may be used in some cases. However, readings tend to be lower with ambulatory monitoring than with conventional measurement and normal and abnormal values are not yet clearly established, although recommendations have been made.In malignant or accelerated hypertension rapidly progressing severe hypertension is associated with retinopathy and often renal impairment.Isolated systolic hypertension occurs mainly in the elderly and has been defined as systolic pressure of 140 mmHg or more and diastolic pressure under 90 mmHg.1.What’s the shape of blood pressure distribution? 
选项：
A:Bell-shaped
B:arrow-shaped
C:heart-shaped
D:linear
答案: 【Bell-shaped】

2、 问题:If the systolic pressure is 144 and the diastolic pressure is 105, which grade does hypertension correspond to?
选项：
A:Grade 1
B:Grade 2
C:Grade 3
D: He is normal
答案: 【Grade 2】

3、 问题:Which one usually has a larger reading, ambulatory monitoring or conventional measurement?
选项：
A:Ambulatory monitoring
B:Conventional measurement
C:Same
D:Can’t compare
答案: 【Conventional measurement】