3 NURS 5334 Final Exam Study Guide Latest Version 2023-2024
NURS 5334Final ExamStudy GuideLatestVersion2023/2024
NURS 5334 Final Exam Study GuidePrescribing basics – –Prescribing is regulated by state BONProper RX – –Providers name and address, TelephoneDEAPt name/DOB/AddresName of Drug, strength, SIG(directions) with indication/Route and frequency, Quantity and signature.Drug Schedules: Most addictive to least – –1: Heroin,LSD, MJ2: hydrocodone, cocaine, Methamphetamine, methadone, oxycodone, meperidine, fentanyl, adderall, ritalin3: codeine, ketamine, testosterone4: xanax, valium, soma, ambient, tramadol5: antidiarrheal, antitussives, lomotil, lyricaPharmicodyamics – –The effects of drug on the body. Receptors are large molecules usually proteins, that interact and mediate the action of drugsagonist – –produce receptor stimulation and a conformational change every time they bind. Do not need all available receptors to produce a maximum responsePartial agonist – –drugs that have properties in b/w those of full agonist and antagonist. They bind to receptors but when they occupy the receptor sites, they stimulate only some of the receptors.antagonist – –drugs with affinity for a receptor but with no intrinsic activity. Affinity allows the antagonist to bind to receptors, but lack of intrinsic activity prevents the bound antagonist from causing receptor activation. The block action of drugs (ex. Narcan) Bioavailabity – –% of administered dosage of the drug that survives the first pass through the liver and reaches the blood streamhalf life – –Time required for the amount of a drug in the body to decline by 50%, drugs with shorter half lives must be administer frequently. 4.5-5.5 times the half life to get steady state and to be limited from the bodywhat the body does to the drug – –absorption, distribution, metabolism, excretion Distribution —movement of absorbed drug in bodily fluids throughout the body to target tissue. Properties affecting: lipid/water solubility, PH affects ionization of drug, protein binding, size of molecule (smaller molecules are more able to diffuse)Tissue: fat, bone, blood/brain barrier (only lipid soluble will pass), placental barrier (many drugscan pass)Protein binding – –unbound drug is free which is active, crosses membrane. Low plasma proteins result in more free drug. Competition: when 2 highly bound drugs are given it increases the level of both drugsMetabolism – –take place in the liver mostly. Chemical change of a drug structure to: Enhance excretion, inactivate the drug, increase therapeutic action, active a prodrug (inactive until metabolized in the body into the active compound, ex: levodopa), increase or decrease toxicity
CYP450 – –enzymes constitutes the most important of the phase I metabolizing enzymes (account for about 75% of drug metabolism in the liver)Phase 2: conjugation reaction occur leading to large increases in hydrophilicity of the substratesrendering them more readily excretableSubstrate – –an agent that is metabolized by an enzyme into a metabolite and product and eventually excretedInhibitors – –compete with other drugs for a particular enzyme affecting the metabolism (decreased) of the substrate and decreases the excretion of the substrate and increasing the circulating druginducer – –competes with other drugs for a particular enzyme affecting metabolism of the substrate (increases) decreasing the efficacy of the drugexcretion – –renal: passive glomerular filtration, active tubular secretion, tubular reabsorption, gi tract, lung, sweat and salivary, mammarygenomics – –study of the complete set of genetic information present in a cell, an organism, or speciespharmacogenetics – –the study of the influence of hereditary factors on the response of individual organisms to drugs, and the study of variations of DNA and RNA characteristics as related to drug responsePharmacogenetics tests – –Mentioned on drug labels can be classified as “test required,” “test recommended,” and “information only.” Currently, four drugs are required to have pharmacogenetics testing performed before they are prescribed: cetuximab, trastuzumab, maraviroc and dasatinibwafarin, carbamazepine, valproic acid and abacavir are recommended to tests prior to initial dosingCarbamazepine and Asisans – –Initiating carbamazepine therapy in these patients (allele HLA-B1502) are at high risk for developing Steven Johnson syndrome or toxic epidermal necrolysis (TEN)The ability of the anesthetic to penetrate the axon membrane is determined by 3 properties. What are they? – –Molecular size, Lipid solubility, degree of ionization at tissue pHWhy is epinephrine given with local anesthetics? – –Decreases local blood flow (decreased risk of bleeding)Delays systemic absorption of the anesthetic prolongs anesthesia reduces the risk of toxicityWhat is the most widely used local anesthetic? – –LidocaineWhat is a possible fatal reaction to benzocaine – –MethemoglobinemiaWhat is included in application guidelines for topical anesthetics – –avoid wrapping the site and heating the site, avoid application to open skinWhich medication will not cause rebound headaches from overuse? – –propranolol (preventative)What is the best option for menstural migraine? – –low dose estrogen about 3 days prior to mensesWhat food can trigger migraines? – –Hot dog d/t nitratesWhat medication is a Seratonin 1B1D receptor agonist? – –Sumatriptan Butterbur can help as prevention for migraine therapy. What side effect can occur? – –Liver damageWhat are the 3 main classes of opiod receptors? – –Mu kappa deltaWhich of the following will reserve he effects caused by opioid agonist? – –naloxone Which of the medications are used to treat OIC? – –Naloxegol, methylinaltrexone, lubiprostoneTolerance is defined as – –increased does of a med needed to obtain the same responseWhich medication is used for opioid abuse? – –NaltrexoneEuphoria induced by morphine: – –An exaggerated sense of well-being caused by the activation of mu receptorsWhich medication is given nasally for migraines? – –ButorphanolWhich of the following describes the mechanism of NSAIDs? – –Inhibition of the cyclooxygenaseenzymeSecond generation COX 2 inhibitors: – –Suppress inflammation and cause less risk for gastric ulceration than COX 1, increase risk for heart diseaseWhich of the following medications should not be given with ASA? – –GlucocorticoidsWhich medication is given for acetaminophen overdose? – –AcetylcysteineWhat are non endocrine therapeutic uses for glucocorticoids? – –RA, SLE, IBS, Bursitis,OA, Gout, disorders of the eyeWhat is the danger of prolonged use of glucocorticoids? – –adrenal insufficiencyMethotrexate can cause fatal toxicities of: – –Bone marrow, liver, kidneys, lungs.Hemorrhagic enteritis and GI perforationJane is on etanercept for RA. The NP knows – –Jane should be checked for TB yearlyWhat is first line treatment for gout? – –Colchicine, indomethacinWhen would you initiate a Uriosuric Medication? – –more than 3 gout attacks per yearAntiinflammatories – –inhibition of COX 1: protects against MI and strokeinhibition COX 2: surpasses inflammation, pain and protects against colorectal cancer (less GI bleeding)first generation NSAIDS – –inhibit COX 1 and COX2: treatment is for relief of mild to moderate pain, relief of cramps r/t dysmenorrhea (risk GI bleed and renal impairment) generation 2 NSAIDS – –only suppresses COX2, decreased risk for GI bleeding but impose risk for increased heart diseaseAspirin – –Non-selective inhibitor of COX, therapeutic use analgesic, fever, mensural cramps, anti-inflammatory, Alzheimer disease. Risk for bleeding is too high. Increased secretion of acid and pepsin therefore ruins all the protective lining of the stomaching. Pt at risk: alcoholics, smoking, older people, or people who have had PUD. Risk of ASA is not advised in pt younger than 18 r/t Reyes syndrome, pregnancy because it cause ductus arteriosis, if given with Ibuprofen it can decrease effects of ASA. first generation non-ASA NSAIDS – –inhibit COX 1 and 2, given for RA and OA, no protection against MI or stroke. ex. Ibuprofen, alieve, diclophinac. Indicated for mild to moderate pain, antiinflammaroty and analgesic effects. risk of GI bleedCelebrex – –second generation non ASA nsaids, lower risk for GI but can still cause renal impairment. given for OA, RA, dysmenorrhea. S/E: abdominal pain, renal impairment, sulfa allergies. Drug interaction: warfarin, Decrease effects of furosemide, (increases)lithium, ACE inhibitors. Acetaminophen – –Analgesic and antipyretic. Hepatotoxicity risk. No more than 3 g in 24 hr period. for overdose: acetylesistine.Can blunt immune response of vaccinesglucocosteroids – –Risk for Cushings disease, diabetes, OA, risk for GI bleeds. If given over 7 days, needs to be tapered off unless on inhaled Corticorsteriods. Used in labor to mature lungs of infants.Therapeutic use: allergic condition, asthma and immune suppression.RA – –very different from OA. Autoimmune disease.Symmetrical morning stiffness that last for over an hour. Shortens life span of patients. Increases risk for CVD and stroke. When testing these patient, you want to do a full immunological test because it comes with other autoimmune diseases. First line treatment are NSAIDS and first line DMARD (methotrexate, minocycline) Gout – –Monoarticular arthritis, d/o r/t kidney don’t excrete enough uric acid. Only way to diagnosis is joint aspiration and look for the uric crystalsPrevention is bestGout preventions – –Migraines – –trial and error of medication and triggers. start with over the counter and move tomore aggressive over time. +2 a month, preventative medication is okay.Abortive medications: NSAIDS, ergoalcoloids (cause vasoconstriction), triptans (Seratonin 1b1d receptor agonist) Sumitriptan, cause vasoconstrictions, maximum dose is 200mg a day. can cause coronary vasospasmPreventative: Beta blockers, antiseizure medications (depikote and topimax), tricyclic antidepressants, Calcium Channel blockers, botox, vitamin b2/Co Q enzyme and butterbur. cluster headaches – –intensely painful headaches that affect one side of the head and may beassociated with tearing of the eyes and nasal congestion, occur in series, 5-15 minutesprophylaxis tx with regular HeadachesDepression tx – –SSRI, SNRI, Bupropion are first line treatments. Least side effects of any medicationsMild/moderate depression or anxiety are okay to treat but anything else needs to be referred to a psychiatric NP tricyclic antidepressants – –Weigh gain, drowsiness, and terrible anticholinergic effects. beers list, Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine.SSRIs – –Fluoxetine, paroxetine, sertraline, citalopram. effects don’t start for several weeks (4-6 weeks) can cause weight gain, vivid dreams, bruxism, bleeding disorders, ED/sexual dysfunction, hyponatriemia, most can cause n/v that might go away. need to taper off these meds. can be used for panic disorder, pms, anxiety, ptsd, post menopausal women SNRI – –serotonin norepinephrine reuptake inhibitors, opposite of SSRI (weight loss and increase in energy) Desvenlafaxine (Pristiq, Khedezla)Duloxetine (Cymbalta) ― also approved to treat anxiety and certain types of chronic painVenlafaxine (Effexor XR) ― also approved to treat anxiety and panic disorderS/E:NauseaDry mouthDizziness
HeadacheExcessive sweatingOther possible side effects may include:TirednessConstipationInsomniaChanges in sexual function, such as reduced sexual desire, difficulty reaching orgasm or the inability to maintain an erection (erectile dysfunction)Loss of appetiteBrupropion (wellbutrin) – –stimulate, appetite suppressant, helps with sexual side effects of SSRIs, S/E: dry mouth, constipation and increase risk of seizure disorder St. John’s Wart (Hypericum perforatum) – –don’t want to give this to patients with SSRIs, a lot of drug reactions, dosed at 300mg TID, CYP450 inducerlithium – –Excretion is reduced with sodium levels are low. S/E: GI disturbances, n/v/d, ataxia, thirst, tremor, high urine output, death. Very narrow therapeutic indexBenzodiazepines – –drugs that lower anxiety and reduce stress: alprazolam, diazepam alcohol abuse – -nicotine abuse – –Prior to starting antidepressants, patients should have what lab testing to rule out – –hypothyroidismA 32 yo male is starting paroxetine for depression. He is complaining of not being able to obtainan erection. What can the NP do to help? – –add bupropionA 6 yo us being treated with ethosuximide. She should be monitored for: – –Blood dycrasias which are uncommon but possible.Sandy is taking lamotrigine for seizures and wants an rx for OCPs which can interact with lamotrigine and cause: – –reduced lamotrigine levels, requiring an increase in the dose of lamotrigineThe tricyclic antidepressants should be prescribed cautiously in patients with – –CADAtropine – –Cause pupil finalization in eye examBethanechol (Urecholine) – –GI/GU stimulation following surgery, parasympathomimetic Pyridostigmine (Mestinon) – –Category: Cholinergic, Anticholeristinase, Use: Myasthenia Gravis, Precautions: May cause cram,ps, increased peristalsisDoxazosin (Cardura) – –Hypertension, BPHAlbuterol – –Asthma inhalerScopolamine (Transderm Scop) – –Anticholinergic (drying effects)Used for motion sicknessCan cause sedation, anticholinergic effectsPhenylephrine – –Sudafed PE; sympathomimeticsPropranolol (Inderal) – –Beta adrenergic blocker for hypertensionDobutamine (Dobutrex) – –sympathomimetic Indication: short term management of heart failureAction: Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart.
Nursing Considerations:- Monitor hemodynamics: hypertension, ↑HR, PVCs- Skin reactions may occur with hypersensitivity- Beta blockers may negate therapeutic effects of dobutamine- Monitor cardiac output- Monitor peripheral pulses before, during, and after therapy- DO NOT confuse dobutamine with dopamineAcetylcholine binds to both _ and receptors – –nicotinic and MuscarinicNorepinephrine binds to both _ and receptors – –alpha and betaAtropine is considered to be the antidote to toxicity – –CholinergicSympathomimetic is the same as _ agonist – –adrenergicSympatholytic means the same as Anti- – –adrenegic Muscarinic antagonist means the same as anti- – –cholinergic cholinergic means the same as agonist and parasympathetic_ – –muscarinic and mimeticBradycardia, urinary urgency, bronchoconstriction, and pupillary constriction are the signs of toxicity – –cholinergicPupillary dilation, tachycardia, urinary retention and dry mouth are signs of muscarinic drugs such as atropine – –antagonistAn anticholinergic drug will acetylcholine availability to the tissue? – –increase Alpha 1 agonist___ BP, while alpha 1 antagonists BP? – –increase, decrease beta 1 receptor activation will lead to heart rate? Beta 1 blockade will Heart rate? – –increases/decreasebeta 2 receptor activation will lead to however, administering a noncardioselective beta blocker can lead to ? – –bronchodialiation/bronchoconstrictionAlpha 2 agonist such as clonidine will BP? – –lowerA inotrope will increase contractility; a chronotrope will decrease HR; while a dromotrope will decrease conduction via the AV node? – –positive, negative, negativeEpinephrine is used in many emergency situations, such , Cardiac___ and hypo_______ – –anaphylaxis, cardia arrest, hypotensionwhat “onset of actions symptoms” should be reviewed with patients who have been newly prescribed an SSRI? – –they can feel a bit of nausea but this resolves in about 1 weekJaycee has been on Escitalopram for a year and is willing to try tapering off the SSRI. What is the initial dosage adjustment when starting to taper off antidepressants? – –reduce the dose by 50% for 3-4 daysOne major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: – –GI problems, drowsiness and nausea, seizures and coma are serious problems.monitoring of a patient on gabapentin to treat seizures includes: – –Recording seizure frequency, duration and severity
Sam, aged 65, is started on L-dopa for his Parkinson’s disease (PD). He asks why this is necessary. You tell him: – –the primary goal of therapy is to replace depleted stores of dopamineA 55yo patient develops parkinson’s disease characterized by unilateral tremors only. The NP will refer the patient to a neurologist and should expect initial treatment to be – –Ropinirole (lesser symptoms need lighter drug)Inattention and sleep-wake cycle disturbance are hallmark symptoms of: – –delirium 3 typesof information needed for neuropharmacologic drugs: – –type or types of receptors throughwhich the drug acts.Normal response to the activation of those receptors (Agonist vs antagonist) What the drug in question does to receptor functioncholinergic receptors and adrenergic receptors are mediated each by? – –Cholinergic by acetylcholine and adrenergic by epinephrine and norepinephrinewhat are the subtypes of cholinergic and adrenergic receptors? – –cholinergic: nicotinic and muAdrenergic: Alpha1, alpha2, beta1, beta 2 and dopaminewhat are the functions of alpha1 receptors? – –Vasoconstriction, ejaculation and contraction of bladder neck and prostatewhat are the functions of alpha 2 receptors? – –minimal clinical significance what are the functions of Beta 1 receptors? – –Heart: increases heart rate, force of contraction, velocity of conduction in AV node. Kidney: renin releasewhat are the functions of beta 2 receptors? – –Bronchial dilation relaxation of uterine muscle vasodilation glycogenolysiswhat are the functions of Dopamine receptors? – –dilates renal blood vessels what are the functions of cholinergic drug receptors? – –Blocks the action of acetylcholine.Cholinesterase inhibitors prevent the breakdown of acetylcholineExamples of anticholinergic drugs – –bethanechol, atropine, oxybutynin, scopolamine, ipratropium bromideThey turn everything off and dry everythingSide effects of anticholinergics – –dry mouth, blurred vision, constipation, photophobia, urinary retention “I can’t see, can’t pee, can’t spit, can’t shit” understand alzheimer’s medications – -understand parkinsons medications – -Know psychiatric drugs (1st and 2nd line) for:depression anxiety bipolar OCD – –Sterling’s Law of the Heart – –the more the cardiac muscle is stretched, the stronger the contractionCalcium Channel Blockers – –agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent
or treat angina pectoris, some arrhythmias, and hypertension s/e: constipation, lower extremity edema, increased risk of heart block and gingival hyperplasiaKnow the stages of hypertension/heart failure – -bond williams classification – -Renin Inhibitors – –Aliskiren (Tekturna) binds tightly with renin and inhibits the cleavagecatalyzes the conversion of angiotensin i (inactive) to angiotensin II (highly active) ACE inhibitors – –contstricts renal blood vessels acts on the Kidney to promote retention of sodium and water and excretion of potassium”PRIL” Captopril, Enalapril, AfosioprilAntihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. Check BP before giving (hypotension)*Orthostatic HypotensionARBS – –block access of angiotensin II cause dilation of arterioles and veinsPrevent angiotensin II from inducing pathologic changes in cardiac structureReduce excretion of potassiumDecrease release of aldosteroneIncrease Renal excretion of sodium and water DO notinhibit Kinase IIdo not increase levels of bradykininAldosterone Antagonists – –selective blockade of aldosterone receptors in the kidney promotesexcretion of sodium and water and thereby reduces blood volume (spiralonlatome)Calcium Channel Blockers do what to the heart – –have exact same effect on heart as beta blockers. They suppress calcium influx and reduce force of contraction and slow heart rate and suppress conduction through the AV nodewhat are common side effects of CCBS are: – –constipation, LE edema, gingival hyperplasiawhat are the therapeutic uses for nifedipine? – –Migraines, angina, HTNbeta blockers _ the adverse cardiac effects of nifedipine but can the adverse cardiac effects of verapamil and diltiazem – –decrease; intensifyjohn is taking hydralazine for elevated BP. He comes in with arthralgia. What blood test might be elevated? – –ANAUntreated HTN can lead to what? – –angina, CHF, MI, kidney disease, strokeSYMPHATHOLYTICS are – –antiadrenergic drugs how is stage A CHF managed? – –Manage risks onlytrue or false: virtually all dysrhythmias can also cause dysrhythmias – –TRUEWhich medication is used to treat digoxin induced dysrhythmias? – –Phenytoin bill is taking amiodarone for his atrial fibrillation. What diagnostics will need to be done?
- –TSH and chest x ray every 6 monthsrecommended cholesterol screening is: – –every 5 years after 20Lucy is taking gemfibrozil and warfarin. You know how to check INR and expect that – –INR might be Elevated (gemfibrozil displaces warfarin from plasma protein)Bill has prinzmetal’s angina and it is wakening him at night. What will the NP prescribe? – –CCBHow do you prevent nitrate intolerance? – –Give smallest possible dose and have 8 free hours per day with long acting nitratesMary has been admitted with unstable angina. You know she will be treated with? – –ASAPlavixBeta blockerStatinACEWhat happens when clopidogrel is given with a PPI? – –the anti platelet effect is decreasedWhat role does O2 play in STEMI? – –Although oxygen is recommended and using it seems to make sense, the practice is not evidence basedWhat role does ASA play in STEMI? – –ASA caused a substantial reduction in mortality What role does morphine play in STEMI? – –in addition to relieving pain, morphine can improve hemodynamics by promoting ventilation, the drug reduces cardiac preload What role does Nitro play in STEMI? – –1. reduce preload and thereby reduce oxygen demand2. increase collateral blood flow in the ischemic region of the heart3. control hypertension caused by stemi-associated anxiety4. limit infract size and improve LV function however, despite these useful effects, nitroglycerindoes not reduce mortalityWhat role does BB play in STEMI? – –decreases myocardial oxygen demand; reduce cardiac pain, infract size, and short term mortality; recurrent ischemia and reinfarction are also decreasedWhich must heparin bind to in order to exert its anticoagulant effects? – –Antithrombin III- heparin binds to antithrombin III then inactivates thrombin and factor XaWhich one of the following drugs binds bile acids in the intestine, thus preventing their return to the liver via the enterohepatic circulation? – –cholestyramineA 58 yo female reports that she recently stopped taking her blood pressure meds because of swelling in her feet that began shortly after she started treatment. Which of the following is most likely to cause peripheral edema? – –Felodipine (CCB)Jack is taking Colesevelam. The NP tells him to: – –He needs to increase fluid and fiber A 54 yo male is noted to have hyperlipidemia, and is prescribed atorvastatin. This drug reduces plasma cholesterol by which processes? – –Inhibiting cholesterol biosynthesis A 42 yo woman is noted to have type 2 Diabetes. She has HTN with BP 150/94. The UA shows mild albuminuria. Which of the following drugs would be the best choice to treat HTN? – –EnalaprilBrad has HTN and is found to have enlarged prostate on exam. His BP has been running in the 150/90 range. Which of the following meds would offer treatment for both? – –terazosinWhich best describes the action of ACE inhibitors on the failing heart? – –Reduces preloadWhich of the following is the most accurate statement regarding digoxin? – –Increases vagal tone and decreases AV node conduction
Which of the following is a limiting adverse effect of ACE inhibitors? – –hyperkalemiaWhich of the following medications can be used to treat gestational diabetes? – –Metformin and insulinWhat is the 4 step approach in the treatment of DM type 2? – –Step 1: lifestyle +metforminstep 2: continue step 1 and add second drug step 3: step up to 3 drugs (including metformin) step 4: more complex insulin regimenJohn comes in with random glucose of 250? Does he need any further testing? – –NO Jane has type 1 diabetes and is taking a beta blocker. what does she need to be aware of? – –Beta blockers impair glycogenolysis and glycogenolysis is a means which the body can respond to and counteract a fall in blood glucoseGina is taking canagliflozin for her diabetes. The NP tells her this may increase her risk for? – –UTIsSGLT-2 inhibitors cannot be given if GFR <35. t or f? – –FALSE: can be given with GFR less than 35opitmally at what interval should the TSH be reassessed after a levothyroxine dosage is adjusted? – –6-8 weekswhich of the following can induce thyroid dysfunction? – –AmiodaroneIrma is an 80 yo with CAD. She has an elevated TSH with a low free T4. She weighs 80kg. What dosage of levothyroxine are you going to initiate? – –12.5-25 mcgStacy is 30 yo that has elevated TSH and low free T4. She weight is 100lbs. What does of levothyroxine will you give her? – –75 mcgJane is in her first trimester of pregnancy and has symptomatic hyperthyroidism. What is the endocrinologist going to prescribe? – –PropylthiouracilMary is postmenopausal is having severe vasomotor symptoms. She has a uterus. She would like to start on hormones. The NP – –Will start her on estrogen and progesteroneJulie is wanting to start OCPs but would like to discontinue in 1 year to try for pregnancy. The NP will prescribe: – –Beyaz due to having added folic acidA patient just call you and she missed a pill. She is on a 28 day cycle. you tell her: – –take the pillas soon as possible and continue the pack. Use another form of contraception for 7 daysLisa has migraines with aura. You are discussing contraception. You recommend: – –Mirena IUDOne of the main reasons women stop progestin only pills: – –break through bleeding Sally is post menopausal ands been having frequent UTIs. The NP: – –recommend vaginal estrace 1gm vaginally weeklyDavid is prescribed sildenafil for ED. Side effects can be? – –Ischemic optic neuropathy, hearing loss and priapismWhat are possible side effects of testosterone? – –Disorders of the liver, prostate cancer, edema, abuse potential, elevated LDL and decreased HDLWhat is the MOA of alpha adrenergic agents? – –Blockade of alpha 1 receptors and relaxes smooth muscle in the bladder neckHigh FBG levels: – –NPH dose needs to be increasedhyperglycemia after breakfast – –not enough SA insulin or too many carbs or calories at the meal
hypoglycemia before lunch – –intermediate acting insulin is peaking before lunch is eaten or patient not eating enough breakfasthypoglycemia in the afernoon – –its from the peak and tail of the intermediate acting insulinhyperglycemia in the afternoon – –intermediate acting insulin needs to be increased or die of lunch is too largehyperglycemia after evening meal – –short acing insulin needs to be increased hypoglycemia overnight (2-3 am) – –afternoon NPH is peaking and causing low BS, patient needs less intermediate acting insulinJohn is a type 1 diabetic and is on insulin glargine at HS and insulin lisper ac each meal. He is having his wisdom teeth removed. How should he manage his insulin? – –continue the glargine and take lisper only as a supplementWhich of the following should be used with caution in a person with a sulfa allergy? – –glycerideand pioglitazoneWhat is the most common adverse effect noted with alpha-glucosidase inhibitor use? – –GI upsetwhat of the following should be monitored with a TZD? – –ALT-liver toxicityThe meglitinides are particularly helpful adjuncts in type 2 diabetes to minimize risk of: – –postprandial hyperglycemiaYou are prescribing levothyroxine to an elderly 82 yo. Which of the following should you keep in mind?? – –the levothyroxine dose needed by the elderly is 75% less of what is needed by a young adultMethimazole is primarily excreted by: – –urineIn patients taking anti-thyroid drugs should avoid which of the following? – –Seafood Vitamin C – –An important substance needed for proper repair of the skin and tissues; promotes the production of collagen in the skins dermal tissues; aids in and promotes the skins healing process.Found in citrus fruits and vegetables. Antioxidant property and can help with iron as wellNiacin – –Vitamin B3; deficiency can lead to dermatitis, which causes scaling and cracking of theskin, GI and central nervous system disturbances (ataxia)large dose can be used to treat low HDL- s/e of flushing (combative with ASA)Riboflavin (B2) – –essential for carbohydrate fat and protein metabolism. Necessary for tissue maintenance. And healthy eyes and good for MIGRAINE headaches and can take up to 3 months (400mg Daily)Thiamin – –Vitamin B1 needed in energy production.Alcoholism is the most common cause of deficiencyParadoxine (B6) – –coenzyme in AA metabolim, isoiazide interferes with B6 metabolism; deficiency is rare in US except in alcoholicsProtein and starchy vegatables
Black Cohosh uses – –menopause vasomotor symptoms; not to be given with selective estrogenmodulatorsCo Q 10 – –Co Q-10 deficiency (statins), antioxidant, hypertension, heart failure, migraine prevention, Parkinson’scranberry juice – –helps prevent UTIs, may increase INR in patients taking warfarin Feverfew uses – –Bolded: Prevention of migrainesS/e: platelet agreggationsExtras: Rheumatoid arthritis flaxseed – –small brown seed of the flax plant; used in baking, cereals, or other foods. Valued in nutrition as a source of fatty acids, lignans, and fiber.Helps to lower LDLGarlic – –Decreases cholesterol and blood pressureSuppresses platelet aggregations.Taken Raw 1-2 cloves daily with elisionGinger Root* – –Primary use to treat vertigo and N/V associated with Motion sickness. Helps patients with arthritis, lower blood sugar. At high dosages, possible interference with cardiac, antidiabetic, or anticoagulant drugsGinko (Ginko biloba)* – –help increase pain free walking in patient with peripheral arterial diseaseGlucosamine* – –Made from shellfish. Can cause increased risk of bleeding and bronchospasm. a substance produced naturally in the body; often used as a supplement to maintain cartilage inthe jointsanyone over the age of 6 should get the flu vaccine: true or false. – –Trueout of the shingles (shingreks) it’s a recombinate vaccine given in 2 dose. Started at the age of 50 but definitely by age l65. – –can get flu like symptoms and very sore after injectionsA good history of herb and supplement use in critical before prescribing because approximately _% of patients in the us are using herbal products? – –38% A potential harmful effect on patients who take some herbal medication is? – –lead poisoningWhat black cohosh used for? – –Treating symptoms of menopauseHerbs and supplements are regulated by the US food and Drug administration. True or False – –FalseWhen melatonin is used for sleep, the recommendation is that the patient : – –Take it no more than 3 nights a weekWhy is Comfey on the danger list? – –it can cause veno-occlussive disease.The role of the NP in use of Herbal medication is to: – –Educate patient and guide them to the appropriate source of careThe standard dose of St. John’s Wort for the treatment of mild depression is: – –300 mg three times dailyPts taking st. john’s wort need to be instructed on which of the following drug reactions. Check all that apply – –MAOI, SSRIs, OTC cough and cold medications Ginseng, chichis taken to assist with memory my potentiate: – –InsulinAttenuated vaccines are also known as : – –Live vaccinesLive attenuated influenza vaccine (FluMist) may be administered to: – –All patients over 6 monthsThe reason that 2 MMR vaccines at least a month apart are recommended is: – –Only 95% of the patients are fully immunized for measles after the first vaccine, with 99% having immunity after 2 doses of MMRThe MMR vaccine is not recommended for pregnant women because – –there is a risk of the fetus developing congenital rubella syndromeThe rotovirus vaccine: – –Is a live vaccine that replicates in the small intestine, providing active immunity against rotovirus. Should not be administered to infants who are or may be potentially immunocompromised. Is not given to an infant who has a febrile illnessTrue contraindications to DTAP or TDAP vaccine include: – –Anaphylactic reaction with a previous doseHepatitis B immune globulin is administered to provide passive immunity to: – –Infants born to HBsAg-positive mothersTHe recognition phase of the immune response is: – –when a mature lymphocyte encounters itsmatching antigenThe activation phase of the immune response is: – –the lymphocyte undergoes proliferation and differentiationThe elimination phase of the immune response is – –elimination of the antigenT or F: there is a link between MMR and autism – –FALSEWhat are the HPV vaccines? – –Gaurdasil, Gardasil 9 and Cervarix.Gardasil protects against what: – –Cervical, vulvar, and vaginal in female as well as anal cancer and genital warts in females and malesCervarix protects against what: – –cervical cancer only but last longer than gardasil Selective estrogen receptor modulators – –mimic estrogen without targeting breast and uterusBisphosphonates – –Fosamax: inhibit bone resorption used in osteoporosis. AE: dysphagia, esophageal ulcer. Nursing: take 1st thing in the morning w/o food, 8oz of water, remain upright for 30mins after taking, if dose missed-skipVitamin D metabolism – –skin photoconversion or reabsorbed in gut -> 1st hydroxylation in liver-> 2nd hydroxylation in kidney’s proximal tubule (alpha-1-hydroxylase)Jade is a nasal methicillin resistant staphylococcus aureus (MRSA) carrier. Treatment to eradicated nasal MRSA is muprocin. Patient education regarding treating nasal MRSA includes: – –Insert one-hand of the dose in each nostril twice a dayWhen prescribing griseofulvin to treat tine capitis it is critical to instruct the patient’s parents to: – –Griseofulvin is best absorbed injested with a high fat foodFirst line therapy for treating topical fungal injections such as tine corporis or tine pedis would be: – –OTC topical azalea (clotrimazole, miconazole)Erika has been prescribed isotretinoin by her dermatologist and is presenting to you with symptoms of sadness and depression. A beck’s Depression Scale indicates she has mild to moderate depression. What would you do at this point? – –Contact her dermatologist about discounting the isotretinoin David is a 26 year old competitive runner who presents with a complaint of pain in his hip since he fell running. Isotretinoin is the only medication he is taking. he is for severe acne. What should you be concerned for? – –He is at risk for bone injuries and needs to be evaluated for fractureJose has had eczema for many years and reports that he thinks his corticosteroid cream is not working as well as it previously was. He may be building a tolerance to the steroids. Treatment options include: – –Recommend an interrupted or cyclic schedule of applicationTopical diphenhydramine is available OTC to treat itching. patients or parents should be instructed regarding the use of topical diphenhydramine that: – –Topical diphenhydramine should not be used in children younger than 2When prescribing permethrin 5% cream for scabies, patient education should include: – –all members of the household and person contacts should also be treatedTopical immunomodulators such as pimecrolimus or tacrolimus are used for: – –Short term or intermittent treatment of atopic dermatitis S/E of medication is risk of cancerThe goal of therapy when prescribing HRT include: – –reducing vasomotor symptomsThe optimal maximum time for HRT or ERT is: – –5 yearsAngela is an african american female who has heard that women of african descent do not need to worry about osteoporosis. What education would you provide about her risk? – –Black women are at risk of developing osteoporosis due to their lower calcium intake as a groupDrugs that increase the risk of osteoporosis include: – –Carbamazepine, Glucocorticoids, levothyroxineSERMs (selective estrogen receptor modulators) treat osteoporosis by selectively: – –Selectively acting on the estrogen receptors in the boneThe ongoing monitoring for patients over 65 taking alendronate or any other bisphophonate is: – –Annual renal function evaluationWhat is the established frequency of repeating DEXA imaging after starting bisphosphonates? – –There is no evidence-based time line for monitoring after the first 2 yearsIV forms of bisphosphonates are used for all the following except:1. Severe gastric irritation with oral forms2. Known cancer mets into the bone3. Persons with advancing renal dysfunction4. Progression of bone loss on oral formulations – –1. Severe gastric irritation with oral forms2. Known cancer mets into the bone4. Progression of bone loss on oral formulationsBoth UVA and UVB rays promote damage to DNA and can cause premalignant actinic keratoses,basal cell, squamous cell and melanoma. – –True SPF is an index of projection against UVB and UVA radiation – –False only UVB Tacrolimus and pimecrolimus are used for atopic dermatitis. What do both carry potential for: – –Both can cause skin cancer and lymphomaFinasteride is an oral drug with what indications: – –Androgenic alopecia and BPHJohnny has impetigo. You order: – –mupirocin ointmentWhat are the 3 ways anti ulcer drugs work? – –Eradicate H. Pylori (antibiotics)Reduce gastric acidity (antisecretory agents, misoprostol)Enhance mucosa defenses (Sucralate, misoprostol)Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide:1. Can be given to patients of all ages, including infants and children, for viral gastroenteritis2. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea3. Is the treatment of choice for the diarrhea associated with E. coli 01574. May be used in pregnancy and by lactating women – –Sloes gastric motility and reduces fluidand electrolyte loss from diarrheabismuth subsalicylate is a common OTC remedy for GI complaints. Bismuth subsalicylate: – –May lead to toxicity if taken with ASA. Has antimicrobial effects against bacterial and viral enteropathogens. Is Contraindicated in children with flu-like illness Hannah will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler’s diarrhea. Advice includes following normal food and water precautions as well as taking:1. Loperamide four times a day throughout the trip2. Bismuth subsalicylate with each meal and at bedtime3. A prescription for diphenoxylate with atropine to use if she gets diarrhea4. None of the above – –2. Bismuth subsalicylate with each meal and at bedtimeJosie is a 5yr old presenting with 48hr n/v/d. unable to keep fluids down and wt is 4 lbs less than last recorded wt. besides IV fluids, her exam warrants use of anti nausea med. which is appropriate – –OndansetronPatients on chronic long-term PPI therapy require monitoring for: – –Iron deficiency anemia (CBC), Vitamin B12, Calcium deficiency (also at risk for PNA)GERD may be aggrevated by the following medication that effects lower esophageal sphincter (LES) tone – –EstrogenLifestyle changes are the first step in treatment of GERD. Food or drinks that might aggravate GERD include: – –CaffeineMetoclopramide (reglan) improves GERD symptoms by: – –increasing lower esophageal toneAntacids treat GERD by: – –Increasing gastric PHWhen treating patients using the “step-down” approach the patient with GERD is taken off of first – –PPIsif a patient with GERD taking a PPI daily is not improving, The next step would be: – –PPI twice a day for 8-12 weeksinfants with reflux are initially tx with – –anti reflux maneuvers elevate head of bed An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: – –PPI twice daily plus clarithromycin plus amoxicillin for 14 days
Treatment failure in patients with PUD associated with H. Pylori may be because of: – –antimicrobial resistancePernicious anemia is treated with: – –Vitamin B12 (Cobalamin)Premature infants require iron supplementation with – –2mg/kg per day until 12 monthAdults get about 325 TIDBreastfed infants should receive iron supplementation of: – –1 mg/kg/dayEducation of patients prescribed iron would include: – –increase fluid and fiber to treat constipationwhat is folic acid requirement in pregnancy? – –800mcg/daypatient being treated for folate deficiency require monitoring of: – –H & H at 1 week and then 8weeksbefore beginning IM vitamin B12 therapy, which laboratory values should be obtained? —Reticulocyte count, H &H, Iron and Vitamin B12 countAnemia due to chronic renal failure is treated with: – –Epoetin AlfaOral decongestants should be discouraged in patients with – –cardiovascular disease a 19 year old asthmatic is admitted to the ED is severe bronchospasm. The NP should order: – –a nebulizer beta 2 agonistRegarding the use of long-acting beta 2 agonists (LABAs) which of the following is NOT true? – –LABAs can be used as mono therapy to relieve bronchospasm in asthma The antitussive dextromethorphan suppresses the cough reflex by: – –direct action on the cough centerYour new 10-year-old patient has asthma, and you decide to treat her with a β2 agonist. In considering the possible drug effects in this patient, you would note that β2 stimulants frequently cause(A) Direct stimulation of renin release(B) Hypoglycemia(C) Increased cGMP (cyclic guanine monophosphate) in mast cells(D) Skeletal muscle tremor (E) Vasodilation in the skin – –Increased pulse ratetiotropium bromide is an inhaled anticholinergic – –used for the treatment of COPD Christy has exercised-induced and mild persistent asthma and is prescribed 2 puffs of albuterol 15 minutes before exercised and as needed for wheezing. One puff per day of beclomethasone is also prescribed. Education regarding her inhalers includes: – –Beclomethasone needs to be used every day to treat her asthmaMontelukast may be prescribed for: – –A 2 year old child with moderate persistent asthma (no less)a common adverse reaction when using codeine-based antitussives is: – –ConstipationWhich medication is most likely to cause bronchoconstriction in an asthma patient? – –Carvedilol b/c it’s nonselectiveHow do H1 and H2 receptors differ? – –H2 play a role in secretion of gastric acid, H1 receptors play a role in vasodilation and bronchoconstrictionwhat are the adverse effects of H1 antagonist? – –Dry mouth, constipation, fatigue, confusion, hallucinations in children
What is the advantage of using a second generation H1 antagonist rather than a first generation H1 antagonist? – –They are virtually void of all anticholinergic actions Which of thefollowing are second generation H1 antagonists? – –cetirizine, fexofenadine, levocetirizine, loratadinesusie has been on prednisone 60 mg for 10 days for COPD exacerbation. Does she need a steroid taper? – –Yes, 50, 40, 30, 20, 10, 5 stop-each dose for about 3 days Fluticasone can possibly cause: – –epistaxis, slowing of linear growthtessalon (benzonatate) works by – –decreasing the sensitivity of the respiratory tract stretch receptorsMary brings in her 2 year old who has a cold. The NP – –OTC cold remedies should be avoided inchildren under 4What are 2 major pharm classes in treatment of COPD? – –Anti-inflammatory agentsBronchodilators Anticholinergicskathy’s 8 year old has been diagnosed with moderate persistent asthma. What do you tell her about ICS use? – –Inhaled steroids can slow growth in children but do not decrease adult height.What are rules of 2 in asthma treatment? – –Asthma is poorly controlled if:-rescue inhaler is used more than 2 times weekly-night time symptoms more than 2 times per month-has had 2 bursts of oral steroids in last yearIpratropium works by: – –blocking muscarinic receptors in the bronchitiotropium is: – –a long acting inhaled anticholinergic agent approved for maintenance therapy of bronchospasm associated with COPDWhat FEV1/FVC ration is diagnostic of COPD? – –70 of lessWhat are the 6 steps in asthma therapy? – –SABA always used PRN1. no daily med needed2. low dose ICS3. Low dose ICS + laba or medium dose ICG4. medium dose ICS +laba5. high dose ICS + Laba6. High dose ICS+laba+oral GlucocoritoidIf cromolyn is used for exercised induced asthma, it should be administered: – –15 minutes before exerciseIn a patient currently on SABA and SAAC with FEV1 of 50% and increasing exacerbations. What needs to be added? – –An ICS and LABAWhat drugs are first line treatment for Primary Open angle glaucoma? – –1. beta adrenergic blocking agents 2. alpha 2 adrenergic agonist3. prostaglandins analogsBeta blockers decrease IOP by – –decreasing aqueous humor production which drug isused in emergency treatment of acute angle-closure glaucoma? – –PilocarpineHow is dry age related macular degeneration treated? – –treated with zinc, antioxidants and multiple vitaminsWhat are 3 most causative organisms of AOM? – –Strep pneumonia, H. flu and M.
CatarrhalisWhat is considered recurrent otitis media? – –3 or more times in 6 months Antibiotics should be used for otitis media with effusion? – –NO!What are 2 top causative organisms of acute otitis externa? – –Pseudomonas aeruginosa and Staph aureusfungal causes are aspergillum and candidaWhich otic solution should be ordered for pseudomonas external OM? – –Ciprofloxacin how would you treat fungal EOM? – –Acidifying drops, clotrimazole 1% if acidifying drops ineffective,itraconazole or diflucan PO if drops ineffective