Carbamazepine (Tegretol) can sometimes show subtherapeutic range due to what?
Carbamazepine auto-induces metabolism, leading to lower levels despite good compliance
What are the black box warnings for Carbamazepine?
Dermatologic reactions
- Steven’s Johnson
- Toxic epidermal necrolysis
What lab test should be ordered for patients on Carbamazepine?
CBC every 3-4 months because it can cause decreased WBC, decreased platelets, and trouble with RBC
What kind of teaching needs to be done with families of patients who have seizure disorders?
Prevention is important, patient safety is important, Do NOT abruptly stop taking medication.
Ethosuximide (Zarontin), an anti-seizure medication can cause what?
Blood dyscrasias
Patients taking Topiramate need to be monitored for what electrolyte imbalance?
Decreased sodium bicarb leading to hyperchloremic metabolic acidosis
Topiramate treats seizures and what is one common side effect?
Normal side effect is weight loss, especially in higher dose patients
A child on Topiramate that wants to play sports should monitor what?
Don’t get overheated. Topiramate may affect his ability to sweat in the heat.
What should a pregnant patient be told about taking Valproate (Depakote)?
It is a known teratogen and category X medication. It should not be used in the first trimester, it may be restarted in second trimester.
What patient population should tricyclic antidepressants be used cautiously in?
Heart Disease patients
Phenelzine (Nardil) is a MAOI. What teaching needs to be done with this medication?
He should not use serotonergic drugs like Imitrex. Also, this class of medication interacts with yogurt, sour cream, soy sauce, etc.
Phenelzine (Nardil) may cause what if there is an interaction with known contraindicated foods?
Hypertensive crisis
What are the side effects of tricyclic antidepressants?
Anticholinergic type effects like dry mouth, sedation, constipation, increased appetite, blurred vision, tinnitus, euphoria, mania
How long does it take for SSRIs to take effect
2-6 weeks
SSRIs may cause what onset of action symptoms?
Nausea, but this will usually resolve in a week.
What is one thing you should not do with SSRIs?
Drink alcohol
What should happen when going off an SSRI?
Wean slowly, do not stop abruptly
What medications would a patient with depression and anxiety respond well to?
Buspar and an SSRI combined
Celexa (Citalopram)
Lexapro (Escitalopram)
Why should you combine an SSRI with Buspar?
Buspar augments the SSRI and is a good combo for anxiety and depression
What is a first line drug for mild to moderate generalized anxiety disorder?
Buspirone
How fast does Celexa start to demonstrate effects?
Improved appetitie and concentration in 1-2 weeks.
What is a major drug to treat bipolar disease?
Lithium
Blood levels need to be monitored with Lithium because why?
Lithium has a narrow therapeutic range so it is important to recognize toxicity
What are symptoms of lithium toxicity?
Drowsiness and Nausea
What dietary teaching needs to be done with patients taking lithium?
Salt intake needs to be consistent
What are the side effects of SSRIs (selective seratonin reuptake inhibitor)?
N/V, dizziness, light headedness, dry mouth, increased sweating, weight changes, agitation, sexual side effects.
What are the side effects of SNRIs (serotonin norepinephrine reuptake inhibitor)
Headache, somnolence, dizziness, insomnia, nervousness, dry mouth, constipation, abnormal ejaculation, anorexia/weight loss, elevated BP
What are the side effects of MAOIs?
Insomnia, anxiety, agitation, dizziness, headache, restlessness, hypotension, dry mouth, blurred vision, constipation
What Benzo has the greatest likelihood of dependence?
Xanax /alprazolam
What receptors do Benzos act on?
Enhances the neurotransmitter GABA (gamma-aminobutyric acid) receptors
What result do Benzos have on the body?
sedative
hypnotic
anxiolytic
anticonvulsant
muscle relaxer
What are long acting Benzos prescribed for?
Treatment of anxiety
What are short acting Benzos prescribed for?
Treatment of insomnia
What would be a good medication to prescribe for panic disorder?
Diazepam (Valium)
What is a anorexiant medication to treat obesity?
Phentermine
What is a precaution with Phentermine?
Anorexiants may cause tolerance and should only be used for 6 months
What medications or herbals should be avoided with Phentermine? Why?
SSRIs and St. Johns Wort…the combination may cause serotonin syndrome
Phentermine releases what two chemicals?
Epinephrine and norepinephrine
Epi and norepi causes what to break down?
Fat cells to break down stored fat
What are Signs and symptoms of seratonin syndrome?
Headache, agitation, mental confusion, hallucinations, coma
What are autonomic effects that you can get from seratonin syndrome?
Shivering, sweating, hyperthermia, vasoconstriction, tachycardia, nausea, diarrhea
What factors place a patient at risk for developing antimicrobial resistant organisms?
Inappropriate use of antibiotics
Children less than 2 years of age
Adults older than 65 yrs of age
Patients who do not finish their antibiotic regimen
What are appropriate antibiotics to prescribe to pregnant women and children?
PCN or Cephalosporins
(Amoxicillin, or Augmentin)
Which antibiotics inhibit cell wall synthesis?
Beta-lactam antibiotics
Vancomycin
Why is clavulanate added to Amoxicillin?
Clavulanate is a Beta-lactam inhibitor. This increases the spectrum of action and is effective at preventing amoxicillin-resistant bacteria that produce Beta-lactamase
What type of antibiotics should be avoided in children and pregnant women?
Tetracycline, fluoroquinolones
What is a normal side effect of amoxicillin?
Diarrhea and it is recommended to continue to take the medicine, drink lots of water, and take probiotics daily, eat yogurt
The American Heart Association recommedations for prophylaxis antibiotic use prior to dental care are…
- Prosthetic cardiac valve or prosthetic material used in valve repair
- Previous Endocarditis
- The following congenital diseases
I. Unrepaired cyanotic congenital heart disease including palliative shunts and conduits
II. Completely repaired congenital heart disease with prosthetic material device, whether placed surgically or with a catheter for 6 months following the procedure
III. Repaired congenital heart disease with residual effects at the site or adjacent to the site of a prosthetic patch or prosthetic device which inhibit endothelialization
IV. Cardiac transplantation recipients with cardiac valvular disease
What antibiotic is used for dental appointments?
Amoxicillin 2 gm for adults
50mg/kg in children
What should fluoroquinolones be reserved to treat?
Community acquired pneumonia in patients with comorbidities and Hospital acquired pneumonia
What is the black box warning for fluoroquinolones?
It may cause tendon ruptures. Specifically of the achilles tendon.
What medication can be affected with the use of fluoroquinolones?
Warfarin because fluoroquinolones displace the flora of the gut and displaces warfarin from albumin and interferes with metabolism by the P450 system.
Why are tetracyclines not recommended in pregnancy and in children less than 8 yrs of age?
They can cause staining of teeth, and cause problems with bone growth.
What population can tetracyclines like minocycline be used on? And patients who use it might develop what?
Adolescents. It may cause psuedotumor cerebri, drug-induced lupus and hepatitis, skin photosensitivity, tinnitus, fatty liver
Tetracycline should be avoided with what foods and medications?
Calcium ions
milk, yogurt, or other dairy products
Methotrexate
What drug interactions should be avoided when taking levaquin?
It is a fluoroquinolone, so do not take with coumadin or corticol steroid use.
Gentamycin is known to cause what?
Ototoxicity and hearing loss
Which medications interact with Linezolid?
Linezolid is a MAOI, so it should not be used with other MAOIs, pethidine, or demerol because of the risk of seratonin syndrome.
What are the food restrictions while taking linezolid?
Tyramine rich foods such as pork, aged cheese, alcohol, smoked or pickled foods.
What is the treatment for Lymes Disease?
Doxycycline 100mg PO BID x 21 days
What vitamin can prevent peripheral neuropathy from isoniazid?
Vitamin B 6 (Pyridoxine)
What should you monitor before prescribing valacyclovir?
Renal function. Patients should drink lots of water while on this medication.
Which medication would be appropriate for Influenza A?
Oseltamivir, if started within the first 48 hours
Name 3 things ta Rifampin is prescribed for?
TB, leprosy, legionella
What are the adverse effects for Isoniazid?
Hepatotoxicity and peripheral neuropathy
What are the main side effects of Doxycycline?
Mainly GI upset. Take with food. Can cause photosensitivity, Stephens Johnson syndrome, and toxic epidermal necrosis
What is the difference between oral and I.V. Vanco?
Oral is given for C-Diff as it goes right to the site of infection. I.V. vanco is given for MRSA infections and needs to be administered through a picc line or central line because it is toxic to veins.
What is the mechanism of action for Azithromycin?
It inhibits bacterial protein biosynthesis and prevents peptidyl transferase from adding to the growing peptide attached to the transfer RNA to the amino acid. It also inhibits ribosome ranslation.
Which class of antibiotics block bacterial protein production?
Bacteriostatic antibiotics: Tetracyclie, Sulfonamides, Macrolides, Clindamycin, Ethambutol, Nitrofuantoin, Novobiocin, tigecycline, oxazolidinone
What labs need to be monitored for long term antifungal therapy with ketoconazole?
AST, ALT, Phosphatase, bilirubin
What teaching should be done with Flagyl?
Do not consume alcohol in any form with this medication
Which antihelmintic is used to treat parasitic worms?
Mebendazole, and agromectin
and ivermectin to treat true parasites
What antifungal can be used topically?
Clotrimazole
What medication treats scabies and lice?
Ivermectin and permethrin cream
Rifampin is used to treat what?
TB
Side effects of rifampin?
Joint pain because it can precipitate gout and it is hepatotoxic.
IF patients are hypersensitive to Sulfa, what other medications will they be sensitive to?
Loop Diuretics, thiazide diuretics, and sulfonylureas
Sulfa antibiotics can cause what?
Stephen Johnsons Syndrome and toxic epidermal necrolysis
Nurs 615 pharm exam 2 questions and answers
Nurs 615 pharm exam 2 questions
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NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
1. Henry has recently started on carbamazepine to treat seizures. He comes
to see you and you note that while his carbamazepine levels had been in
the therapeutic range, they are now low. The possible cause for the low
carbamazepine levels include: Carbamazepine auto-induces metabolism,
leading to lower levels despite good compliance.
2. Carbamazepine has a Black Box Warning due to life-threatening:
Dermatologic reaction, including Steven’s Johnson and toxic epidermal
necrolysis
3. Long-term monitoring of patients who are taking carbamazepine
includes: Complete blood count every 3 to 4 months (can be a
decrease in WBC & platelets)
4. Six-year-old Felisha has recently been started on ethosuximide
(Zarontin) for seizures. She should be monitored for:
Blood dyscrasias, which are uncommon but possible
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
5. What should families be taught regarding seizure activity monitoring?
Prevention of seizures, patient safety, quality of life issues, reach
acceptable goals for treatment, & do not abruptly stop taking seizure meds
6. What electrolyte imbalance is associated with topiramate?
Decreased sodium bicarb leading to hyperchloremic metabolic acidosis
7. Lisa, who is overweight, recently started taking topiramate for seizures
and at her follow- up visit you note she has lost 4 kg. The appropriate
action would be:
Reassure her that this is a normal side effect of topiramate and continue to
monitor her weight.
8. Travis’s seizures are well controlled on topiramate and he wants to start
playing baseball. Education for Travis regarding his topiramate includes:
He should monitor his temperature and ability to sweat in the heat while
playing
9. Brandy is taking valproate (Depakote) for seizures and would like to get
pregnant. What advice would you give her?
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
Valproate is a known teratogen, but may be taken after the first trimester if
necessary. Keppra is a better drug to be on until the second trimester, then
she can go back to valproate.
10.What category is
valproate? Category X
11.The tricyclic antidepressants should be prescribed cautiously in
patients with: Heart disease
12.A 64-year-old male was prescribed phenelzine (Nardil) while in an acute
psychiatric unit for recalcitrant depression. The NP managing his primary
health care needs to understand the following regarding phenelzine and
other monoamine oxidase inhibitors (MAOIs):
He should not be prescribed any serotonergic drug such as sumatriptan
(Imitrex), MAOIs interact with many common foods, including yogurt, sour
cream, and soy sauce, and symptoms of hypertensive crisis (headache,
tachycardia, sweating) require immediate treatment
13.What are the precautions and contraindications for tricyclic
antidepressants? Side effects are similar to anticholinergic
activity such as dry mouth, sedation,
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
constipation, increased appetite, blurred vision, tinnitus, euphoria, and
mania. Caution in patients with cardiac disease (terminate ventricular
fibrillation, decrease cardiac contractility, increase collateral blood
circulation to ischemic heart muscles).
14.Marla is started on paroxetine (Paxil), a selective serotonin reuptake
inhibitor (SSRI), for depression. Education regarding her antidepressant
includes:
SSRIs may take 2 to 6 weeks before she will have maximum drug effects.
15.What “onset of action” symptoms should be reviewed with patients
who have been newly prescribed a selective serotonin reuptake
inhibitor?
They can feel a bit of nausea, but this resolves in a week.
16.Which of the following should not be taken with a selective
serotonin reuptake inhibitor?
Alcohol
17.Why is the consistency of taking paroxetine (Paxil) and never running out
of medication more important than with most other selective serotonin
reuptake inhibitors (SSRIs)?
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
It has a shorter half-life and withdrawal syndrome has a faster onset
without taper
18.Janet presents with depression associated with complaints of fatigue,
sleeping all the time, and lack of motivation. An appropriate initial
antidepressant for her would be: Duloxetine (Cymbalta)
19.A patient with anxiety and depression may
respond to: Buspirone (Buspar) and an SSRI
combined
20.When is buspirone (Buspar) and an SSRI combined?
Buspar is helpful in augmenting the SSRI and in treating patients with
agitated or anxious depression
21.An appropriate first-line drug to try for mild to moderate generalized
anxiety disorder would be:
Buspirone (Buspar)
22.Larry has been prescribed citalopram (Celexa) to treat his depression.
Education regarding how quickly selective serotonin reuptake inhibitor
(SSRI) antidepressants work would be:
Appetite and concentration improve in the first 1 to 2 weeks
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
23.An appropriate drug for the treatment of depression with
anxiety would be: Escitalopram (Lexapro)
24.One 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: Drowsiness and nausea
25.Simon is taking lithium for bipolar disorder. He should
be taught to: Eat a diet with consistent levels of salt
(sodium)
26.What are the side effects of tricyclic antidepressants?
Dry mouth, constipation, urinary hesitancy or retention, blurred vision,
sedation, orthostatic hypotension, weight gain, N/V, gynecomastia, and
changes in libido.
Remember it is similar to anticholinergic side effects-“can’t see, can’t
pee, can’t spit, can’t shit.”
27.What are the side effects of SSRIs?
N/V, H/A, light-headedness, dizziness, dry mouth, increased sweating,
weight changes, exacerbation of anxiety, agitation, and sexual side effects.
Side effects are generally minor.
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28.What are the side effects of SNRIs? (serotonin and norepinephrine
reuptake inhibitor) H/A, somnolence, dizziness, insomnia, nervousness,
nausea, dry mouth, constipation, abnormal ejaculations,
anorexia/weight loss, and elevated BP at higher doses.
29.What are the side effects of MOIs?
Insomnia, anxiety, agitation are initial adverse reactions. Common side
effects include dizziness, H/A, restlessness, and hypotension. Also, dry
mouth, blurred vision, urinary retention and constipation
30.In choosing a benzodiazepam to treat anxiety the prescriber needs to
be aware of the possibilityofdependence.Thebenzodiazepamwith
the greatest likelihood of rapidly developing dependence is:
Alprazolam (Xanax)
31.What receptors do benzodiazepines act on?
Enhance the effect of the neurotransmitter gamma-aminobutyric acid
(GABA-A) receptors which results in a sedative hypnotic
anxiolytics/anticonvulsant/muscle relaxer properties.
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
32.Long-acting benzos are
prescribed for? Treatment of
anxiety
33.Short and intermediate-acting benzos are
prescribed for? Treatment of insomnia
34.An appropriate drug to initially treat panic
disorder is: Diazepam (Valium)
35.Bernadette, a 42-year-old female, requests a prescription for an
anorexiant to treat her obesity. A trial of phentermine is prescribed.
Prescribing precautions include:
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
Anorexiants may cause tolerance and should only be prescribed for 6
months
36.Before prescribing phentermine to Bernadette, a thorough drug history
should be taken including assessing for the use of serotonergic agents
such as selective serotonin reuptake inhibitors (SSRIs) and St John’s wort
due to:
The risk of serotonin syndrome
37.Outside the brain phentermine releases norepi & epi causing what to
break down? Fat cells to break down stored fat
38.When prescribing phentermine what should you assess for?
You must inquire if the patient is taking St. John’s Wort and or an SSRI as
these things can increase the risk of serotonin syndrome (H/A, agitation,
hyomania, mental confusion, hallucinations, & coma). Wait, there’s
more…you also get autonomic effects like shivering, sweating,
hyperthermia, vasoconstriction, tachycardia, nausea, diarrhea, and
somatic effects such as myoclonis, hyperreflexia, and tremor!
39.Factors that place a patient at risk of developing an antimicrobial-
resistant organism include:
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
Inappropriate use of antimicrobials
40.Infants and young children are at higher risk of developing antibiotic-
resistant infections due to:
The fact that children this age are more likely to be in daycare and
exposed to pathogens from other children
41.What must you instruct your patients do when taking an antibiotic?
Counsel your patients that they need to take the entire antibiotic course
for all of the days until the bottle is empty
42.There is often cross-sensitivity and cross-resistance between
penicillins and cephalosporins because:
Both drug classes contain a beta-lactam ring that is vulnerable to beta-
lactamase- producing organisms
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
43.Andy has been diagnosed with strep throat and needs a prescription for
an antibiotic. He says the last time he had penicillin he developed a red,
blotchy rash. An appropriate antibiotic to prescribe would be:
Azithromycin
44.Janis is a 25-year-old female who is 8 weeks pregnant and has a urinary
tract infection. What would be the appropriate antibiotic to prescribe
for her?
Amoxicillin (Trimox)
45.Which antibiotics inhibit bacterial cell wall synthesis?
These are the bactericidal antibiotics which inhibit the cell wall synthesis
and include the beta-lactam ABX and vancomycin
46.Why is clavulanate added to amoxicillin?
It is a combination of ABX consisting of amoxicillin trihydrate, a beta-
lactam ABX and potassium clavulanate, it’s a beta-lactamse inhibitor. This
combination results in an ABX with increased spectrum of action and
restored efficacy against amoxicillin-resistant bacteria that produce beta-
lactamase
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
47.What ABX are appropriate to prescribe to
children? Penicillins and cephalosporins are
generally regarded as safe
48.Which ABX class of drugs should be avoided in
children? Fluoroquinolones and tetracyclines are to be
avoided in childhood
49.Jaide is a 12-month-old child who is being treated with amoxicillin for
acute otitis media. Her parents call the clinic and say she has developed
diarrhea. The appropriate action would be to:
Advise the parents that some diarrhea is normal with amoxicillin and
recommend probiotics daily
50.Allison is a 13-year old child who comes to clinic with a 4-day history of
cough, low-grade fever, and rhinorrhea. When she blows her nose or
coughs the mucous is greenish- yellow. The appropriate antibiotic to
prescribe would be:
No ABX should be prescribed because this is a virus (mucous is greenish-
yellow)
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
51.Cindy was recently treated with clindamycin for an infection. She calls
the advice nurse because she is having frequent diarrhea that she thinks
may have blood in it. What would be the appropriate care for her?
Assess her for pseudomembranous colitis
52.MEMORIZE: the American College of Cardiology and the American
Heart Association’s guide to ABX prophylactic use for dental
appointments. See below…
53.According to the American College of Cardiology and the American
Heart Association, what are the guidelines related to prophylactic
antibiotics prior to a dental appointment?
a. Thisisaveryimportantquestion.Thiswillbeonyourexam.If
you go to the American Heart Association and look up the
guideline, I would memorize this because these questions can
be very tricky.
b. Antibiotic prophylaxis with dental procedures is reasonable only for
patients with
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
cardiac conditions associated with the highest risk of adverse
outcomes from endocarditis including:
i. Prosthetic cardiac valve or prosthetic material used in valve
repair
ii. Previous endocarditis
iii. Congenital heart disease only in the following categories:
1. Unrepaired cyanotic congenital heart disease including
those with palliative shunts and conduits
2. Completely repaired congenital heart disease with
prosthetic
material device, whether place by surgery or catheter
intervention during the six months after the procedure
3. Repaired congenital heart disease with residual effects
at the site
or adjacent to the site of a prosthetic patch or prosthetic
device, which inhibit endothelialization
4. Cardiac transplantation recipients with cardiac valvular
disease
c. Pay very close attention to those subtypes
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
d. The treatment used for a dental appointment is amoxicillin orally
two grams. In children it would be 50 milligrams per kilogram
e. Dental Procedures and Infective EndocarditisIn the past, patients
with nearly
every type of congenital heart defect needed to receive antibiotics
one hour before dental procedures or operations on the mouth,
throat, gastrointestinal genital, or urinary tract. However, in 2007 the
American Heart Association simplified its recommendations. Today,
antibiotics before dental procedures are only recommended for
patients with the highest risk of IE, those who have:
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
i. A prosthetic heart valve or who have had a heart valve
repaired with prosthetic material.
ii. A history of endocarditis.
iii. A heart transplant with abnormal heart valve function
iv. Certain congenital heart defects including:
1. Cyanotic congenital heart disease (birth defects with
oxygen levels lower than normal), that has not been
fully repaired, including children who have had a
surgical shunts and conduits.
2. A congenital heart defect that’s been completely
repaired with
prosthetic material or a device for the first six months
after the repair procedure.
3. Repaired congenital heart disease with residual defects,
such as
persisting leaks or abnormal flow at or adjacent to a
prosthetic patch or prosthetic devices
f. Key changes for patients with congenital heart defectsPreventive
antibiotics are
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
no longer recommended for any other congenital heart disease than
these:
i. Cyanotic congenital heart disease (birth defects with oxygen
levels lower than normal), that has not been fully repaired,
including children who have had a surgical shunts and
conduits.
ii. A congenital heart defect that’s been completely repaired with
prosthetic
material or a device for the first six months after the repair
procedure.
iii. Repaired congenital heart disease with residual defects, such
as persisting leaks or abnormal flow at or adjacent to a
prosthetic patch or prosthetic device.
g. Additionally, taking antibiotics just to prevent endocarditis is not
recommended
for patients who have procedures involving the reproductive, urinary
or gastrointestinal tracts.
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
54.Kristine had a small ventricle septal defect (VSD) repaired when she was 3
years old and has no residual cardiac problems. She is now 28 and is
requesting prophylactic antibiotics for an upcoming dental visit. The
appropriate antibiotic to prescribe according to current American College
of Cardiology and American Heart Association guidelines is: None, no
antibiotic is required for dental procedures
55.What patient teaching will you provide to a patient who is experiencing
non-infectious diarrhea related to ABX administration?
Patient will need to be assessed for C. dif colitis. Advise patient to
increase their probiotic intake with yogurt to repopulate the gut flora
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
56.To prevent further development of antibacterial resistance it is
recommended that fluoroquinolones be reserved for treatment of:
Community-acquired pneumonia in patients with comorbidities
57.Fluoroquinolones have a Black Box Warning regarding even months
after treatment.
Tendon rupture
58.Fluoroquinolones have been reported to enhance the effective of
and appropriate laboratory tests should be routinely monitored. It’s
postulated to affect gut flora, which displaces warfarin from albumin and
interfere with hepatic metabolism by inhibiting the cytochrome P450
enzyme system.
Warfarin
59.Tetracyclines should not be prescribed to children younger than 8
years due to: Adverse effects on bone growth
60.Tetracyclines such as minocycline are safe
to use in: Adolescents
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
61.Hanna is a 17-year-old female who is taking minocycline for acne. She
comes to the clinic complaining of a headache. What would be the plan of
care?
Evaluate her for pseudotremor cerebri
62.Valerie has been prescribed doxycycline for a chlamydia infection. She is
healthy and her only medication is an oral combined contraceptive.
Patricia’s education would include: Use a back-up method of birth control
(condom) until her next menses. Recent research has shown no
significant loss of effectiveness of oral contraceptives while using most
tetracycline ABX but most practitioners still encourage another barrier
method.
63.Adverse effects of tetracycline ABX use include:
Can stain developing teeth when taken by the mother during pregnancy
and can impair bone growth in children.
64.Interactions and precautions with tetracycline include:
Can be inactivated by calcium ions and are NOT to be taken with milk,
yogurt, or other dairy products. Can cause skin photosensitivity, drug-
induced lupus and hepatitis.
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
Tetracyclines can also cause microvassicular fatty liver, tinnitus, and can
interfere with methotrexate by displacing it from various protein binding
sites they can cause breathing complications such as anaphylactic shock
in some individuals.
65.What are the most common drug interactions with levofloxacin?
Potential tendon damage, black box warning (pregnancy), caution with
older population and cortical steroid use, and interaction with warfarin
66.A patient is administered gentamicin and complains of sudden hearing
loss. What should the NP do?
The NP should immediately instruct the patient to stop the medication as
there is a concern for ototoxicity
67.Which medications interact with linezolid (a weak MAO inhibitor)?
Should not be used with other MAOIs, tyramine rich foods such as pork,
aged cheese, alcohol, smoked or pickled foods, or serotonergic drugs
(all the good stuff). It should also not be given with pethidine or
meperidine (Demerol) under any circumstance d/t risk of serotonin
syndrome.
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
68.What is the treatment of Lyme
Disease? Doxycylcline 100 mg PO
q12 hrs x21 days
69.To prevent the development of peripheral neuropathy in patients
taking isoniazid for tuberculosis the patient is also prescribed:
Pyridoxine (vitamin B6)
70.Mary is an 82-year-old patient who has herpes zoster (shingles) and
would benefit from an antiviral such as valacyclovir. Prior to prescribing
valacyclovir she will need an assessment of:
Renal function
71.When prescribing acyclovir, patients should be educated regarding the:
Need to drink lots of fluids during treatment (need to flush the kidneys
as this class of drug can be nephrotoxic)
72.Michael has been diagnosed with type A influenza. Appropriate
prescribing of oseltamivir (Tamiflu) would include:
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
Starting oseltamivir within the first 48 hours of influenza symptoms
73.What is rifampin ABX prescribed
for? TB, leprosy, and legionella
among others
74.What are the adverse effects of isoniazid (INH)?
Used as the first line agent for the prevention and treatment of both
waiting and active TB. Adverse effects include hepatotoxicity and
peripheral neuropathy.
75.What are the main effects of doxycycline?
GI upset including anorexia, N/V, & diarrhea. Advise patient to
take with food todecrease GI irritation. Dermatologic side effects
include photosensitivity, rashes, Stevens-Johnson Syndrome
(serious), and toxic epidermal necrolysis.
76.What is the difference between oral Vanco and parenteral Vanco?
First of all, Vanco is a large hydrophilic molecule that partitions poorly
across the GI mucosa with a short half-life (usually admin 2xday). Oral is
given for the treatment of pseudomembranous colitis (c.diff) so it can
reach the site of infection, usually the colon. Parenteral Vanco is given for
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
the treatment of MRSA infections and due to its caustic properties it
should be administered through a PICC or central line.
77.What mechanism of action (MOA) of azithromycin?
Azithromycin is a macrolide which inhibits bacterial protein biosynthesis
preventing peptidyl transferase from adding to the growing peptide
attached to the transfer RNA to the next amino acid. It also inhibits
ribosomal translation.
78.Which class of antibiotics block bacterial protein production?
Bacteriostatic ABX limit growth of bacteria by interfering with bacterial
protein production, DNA replication, or other aspects of cellular bacterial
metabolism. This group includes tetracyclines, sulfonamides,
spectinomycin, trimethoprim, chloramphenicol, macrolides,
lincosamides, clindamycin, ethambutol, nitrofurantoin, novobiocin,
tigecycline, and oxazolidinone.
79.Monitoring for patients who are on long-term antifungal therapy with
ketoconazole includes:
AST, ALT, alkaline phosphatase, and bilirubin
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
80.When prescribing metronidazole (Flagyl) to treat bacterial vaginosis,
patient education would include:
Consuming alcohol in any form may cause a severe reaction
81.Every antibiotic drug class has resistant organisms that influence
prescribing decisions. T or F?
True
82.Identify which antihelmintic is used to treat intestinal
parasitic worms. Mebendazole and agromectin
83.Identify which antihelmintic is used to treat tissue parasites
(apparently there is a difference).
Mebendazole, albendazole or ivermectin
84.What antifungal medications can be used topically to treat
fungal infections? Clotrimazole (treatment for candidiasis)
85.What medication is used to treat scabies?
Ivermectin and permethrin cream (can also treat lice)
86.What is pyrazinamide used to treat?
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
TB and the most common side effect is joint pain. Can precipitate gout
flares by decreasing renal excretion of uric acid. Most dangerous side effect
is hepatotoxicity.
87.If a patient is allergic to sulfonamide antibiotics, he or she will most
likely have cross- sensitivity to:
Loop diuretics, sulfonylureas, and thiazide diuretics
88.Sulfa ABX when used in large doses has the potential to cause?
Strong allergic reactions including Stevens-Johnson syndrome and toxic
epidermal necrolysis
NURS 615 -Pharm Exam 2-Super Duper Exam
2 Q&A
NURS 615 Pharm Exam 2 Mega
Review Study Guide latest
NURS 615 Pharm Exam 2 Mega Review Study Guide
Law-Ham Pharm Exam 2 Review
**Know every drug that is on the PowerPoint – have a one-line mechanism of action on a table for each drug and
understand it, as well as how and where it works
Carbamazepine (Tegretol) – is an anticonvulsant = thought to affect Na+ channels to slow spread of
abnormal activity
•SE = decreases body’s production of blood cells, rare reports of aplastic anemia and agranulocytosis, can
cause Steven Johnson Syndrome and Toxic Epidermal Necrolysis
•Should get a CBC Q3-4 months (watch for WBC count in particular)
•Carbamazepine is a strong inducer of hepatic enzymes/metabolism and can lead to lower levels
•Do NOT stop taking abruptly, has a shorter half-life w/repeated uses
Topiramate (Topamax) – is for tx of epilepsy, seizures, migraine prophylaxis
•Blocks sodium channels or potentiate GABA
•Peaks 2 hours after oral admin, mostly eliminated via urine
•Can cause ↓ Na bicarb levels which can lead to hyperchloremic metabolic acidosis
•Serum bicarbonate should be monitored at baseline and periodically
•Can cause ocular syndrome (acute myopia and glaucoma) – should inform provider immediately if pt
experiences eye pain or blurred vision
•Rare side effect is oligohidrosis (↓sweating) and hyperthermia
•Can increase the risk of suicidal behavior/ideation, cause weight reduction
•Should NOT be discontinued abruptly
•Is a pregnancy category D and can increase risk of cleft lip/palate in infants
Levetiracetam (Keppra) – antiepileptic, does NOT affect GABA, does inhibit burst firing and spread of
seizure activity
•Mostly cleared through renal system, is not extensively metabolized
•Absolute contraindication is sensitivity to the drug
•At increased risk for suicidal thoughts and depression, behavioral changes, somnolence, fatigue,
dizziness, muscle coordination difficulties
•Potential for withdrawal seizures if keppra is stopped abruptly
•Safer med for seizures in children and pregnancy
Valproate (Depakote)– is an anticonvulsant, for tx of bipolar disorder and mania also
•Blocks GABA uptake into presynaptic neurons
•SE = GI distress, heartburn, CNS depressant
•Is a pregnancy category X, known teratogen, may only be taken after the 1st trimester if necessary, bur
should recommend switching to different anticonvulsant like Keppra
NURS 615 Pharm Exam 2 Mega Review Study Guide
Ethosuximide (Zarontin) – tx for seizures
NURS 615 Pharm Exam 2 Mega Review Study Guide
•Should be monitored for blood dyscrasia (an abnormal condition or dx of the blood)
Antiepileptics block transmission, raise the seizure threshold, so that the patient will not peak over the seizure threshold
and have a seizure.
Anticonvulsants in terms of monitoring (most common side effects, most serious side effects) – know that they are all
monitored with blood work for their levels so that is a similarity amongst them
•Carbamazepine – CBC – Causes agranulocytosis so be watching the white count in particular
although there is other bone marrow suppression as well
•What do you monitor? – TSH because the med can affect the thyroid
•Never want anyone to d/c suddenly, must be weaned off
•Talk to patients about safety – driving limitations, may have to report patient to DMV if they are
having active seizures
•Oral health can be affected by anti-seizure meds and extra trips to the dentist may be required
Neurotransmitters
•GABA – calming
•Acetylcholine – muscle action, thought and learning
***If a specific drug is listed on the PowerPoint, know all about it.
•All these drugs are listed on the PowerPoint
•Seizure
oTopiramate – topamax
oCarbamazepine – Tegretol
oValproate – Depakote
oLevetiracetam – Keppra
•MAOI
o Phenelzine – Nardil
•Anxiolytics
Phentermine (Adipex-P) – used for obesity, stimulating satiety centers
•Should only be used short-term (6 months or less)
•DO NOT mix w/ SSRIs or St. John’s Wart (Serotonin Syndrome), or w/ MAOIs (HTN crisis)
Lithium— tx of choice for manic-depressive (bipolar) illness, ↓ severity/frequency of mania
▪Replaces Na+ during depolarization in neurons = stops transmission of electrical impulses
▪Inversely proportional to Na+ — ↓Na+ = ↑Lithium ↑Na+ = ↓Lithium
▪Lithium Toxicity can occur = drowsiness, nausea, course tremors, diarrhea, confusion, stupor
▪NOT to be used in renal pts, children under 12, or pregnant women
▪Pt education = avoid dehydration, eat a diet with consistent Na+ levels
NURS 615 Pharm Exam 2 Mega Review Study Guide
Antidepressants – SSRIs (fluoxetine, paroxetine, sertraline, citalopram, escitalopram)
NURS 615 Pharm Exam 2 Mega Review Study Guide
•SSRI blocks the reuptake of serotonin which keeps it present in the synapse for longer, so you get more
effect from it
•All of the antidepressants, whether a drug family or specific drug, you need to know and understand that drug
and mechanism of action
•Common side effects of SSRIs – weight gain, sometimes weight loss, anticholinergic effects like dry mouth
and constipation, nausea, vomiting, sexual side effects – diminished, delayed or absent orgasm, premature
ejaculation, decreased libido
•Nausea can occur when first starting SSRI, but will resolve in a week or so
•With citalopram, appetite and concentration improve in the first 1-2 weeks, works quickly
•Interacts w/ MAOIs
•SSRIs – serotonin syndrome – HA, hallucinations, shivering, agitation, sweating, high body temperature,
tremor, hyperreflexia, dilated pupils, nausea, diarrhea
•DO NOT stop abruptly or miss doses = serotonin withdrawal – can see this in shorter acting SSRI’s when people
forget to take them (paroxetine is the shortest acting), sertraline and citalopram can also happen but not as
quickly as paroxetine.
•Serotonin withdrawal syndrome – tremulous, paresthesia’s, nausea, vomiting, sweating
SNRIs
•Effect and block the reabsorption of norepinephrine – norepi effects specifically the sympathetic nervous
system and also has serotonergic effects
•Sevilla, Cymbalta, etc. names of drugs
•An initial tx for depression w/ symptoms of fatigue, sleeping all the time, and lack of motivation
•Side effects – headaches, nausea, somnolence, dry mouth, anticholinergic things, palpitations, hypertension,
and hyperhidrosis (excessive sweating).
TCAs (amitriptyline, nortriptyline, imipramine, trimipramine)
•Effect brain chemicals
oSerotonin – 5ht
oNoradrenaline/norepinephrine
oActs on Histamine and Acetylcholine
•This group of medications has the highest anticholinergic effects – the highest amount of dry mouth
and constipation
•People who have BPH, glaucoma, urinary problems should not take this medication due to the degree of
anticholinergic effect
•Should be prescribed cautiously in patients with heart disease
•Can behave like class 1 antiarrhythmics = terminate Vfib, ↓ heart contractility, increase collateral blood flow
to ischemic heart muscles
•SE = anticholinergic, sedating, increased appetite, tinnitus, nausea, as well as cardiac conduction disorders
including a prolonged QT interval with this drug – a baseline EKG is imperative before starting on this medication.
Tardive dyskinesia (movement), neuroleptic malignant syndrome
•If you ever put someone on this for their depression, understand that in the first few weeks they can
have increased suicidal ideation
•An overdose of TCAs is fatal; whereas, with the SSRIs it isn’t
NURS 615 Pharm Exam 2 Mega Review Study Guide
Buspirone (full agonist, serotonin) but can also be an antagonist
•Full agonist for the presynaptic 5ht1 receptorDocument continues below
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Psychiatric/Mental Health Nursing (NURS 404)(NURS 404)
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NURS 615 Pharm Exam 2 Mega Review Study Guide
•If someone has too much serotonin, it will act as an antagonist
•Or if they do not have enough serotonin, it will act as an agonist in the post synaptic
•Structure similar to clozapine which is an atypical antipsychotic
•Pt with anxiety and depression may respond to buspirone and an SSRI combined
•Is an appropriate first-line drug for mild to moderate generalized anxiety disorder
•Works well for anxiety and has a synergistic effect with SSRI for someone who has a resistant type of
depression that needs an extra boost
•Will compete for metabolism site w/ antipsychotics (Haldol)
MAOI Inhibitors
•Phenelzine (Nardil)
•Parmate
•Marplan
•Not used often and are not popular due to the amount of adverse effects
•MAO – irreversibly inactivates the enzymes that metabolize NE, serotonin, and dopamine therefore increasing
bioavailability of each so you get a longer serotonin, norepi effect such as more energy as well as a better
mood)
•Adverse effects: tardive dyskinesia
•Do not mix with other substances (other MAOI’s)
•Do NOT eat foods containing tyramine (aged cheese/meats, alcohol) as these can cause symptoms of HTN
crisis (increased BP, tachycardia, HA, dizziness, sweating, tremors) which requires immediate tx
•Do not mix well with other things so they need to be two weeks separated from anything else (assuming this is
specifically referring to other antidepressants)
•When starting new antidepressant, wean patient off this medication. Pt must be off of this medication at
least two weeks before starting another antidepressant
Benzodiazepines – binds to GABA receptors to inhibit the neurotransmitter release
•Alprazolam, Chlordiazepoxide, Clonazepam, Diazepam, Lorazepam
•Effect/binds to GABA receptors – which is sedating, acts as anticonvulsant, muscle relaxant, helps with
alcohol withdrawal
•Tend to be very habituating – be aware of this and limit prescribing, CNS depressant
•If you have to put a patient on a benzo, try to choose something that is longer acting so that patient does
not need to redose constantly. Longer acting benzo example is klonopin
•Short and intermediate acting benzos to tx insomnia, long-acting benzos to tx anxiety
•An appropriate drug to initially tx panic disorder is diazepam (Valium)
•CAUTION IN PRESCRIBING, alprazolam (Xanax) has greatest likelihood of rapid dependence
Insomnia Meds
•Familiarize yourself with what it means to utilize sleep hygiene and be sure your clients are using that.
•Meds should only be for short term or occasional use because you want the patient to develop their own
sleep patterns and not become dependent upon a pill to go to sleep at night.
•Ambien – non-benzo type of sleep aid – works within the GABA receptors but non-benzo – considered to work at
a benzo booster site.
•Temazepam – benzodiazepine sleep aid – has same side effects as other
benzos Anti-infective
NURS 615 Pharm Exam 2 Mega Review Study Guide
•Antibiotics is a broad term for a lot of things including antibacterial, antifungals, antiprotozoal, anthelmintic,
and antiviral
NURS 615 Pharm Exam 2 Mega Review Study Guide
•Classified as gram positive or gram negative
oGram positive bacteria have no capsule – have a thick peptidoglycan wall which stains purple
oGram negative bacteria have a capsule that protects the cell peptidoglycan wall from staining so it
will show as pink
•Also classified by shape – i.e. flagellated, spirilla, cocci
•Classified by oxygen use
oAnaerobes – cannot grow in the presence of oxygen
oAerotolerant – most bacteria that cause humans to be sick. They can survive for 72 hours in the
presence of oxygen, even though they may not usually, and they may not grow in oxygen
oMost human flora is anaerobic deep within our bodies.
•Anti-infective work in the following ways
oCell walls – an
oFolic Acid metabolism –
oProtein synthesis inhibitors at 30s and 50s ribosomal subunit
o****MUST KNOW EACH ANTIBIOTICS FAMILIES MECHANISM OF ACTION*****
•Bacteriostatic vs bactericidal
oBacteriostatic – stop bacteria from reproducing but do not kill it = utilized in people who have an
intact immune system that is able to go in and kill the bacteria as long as it is not reproducing
oBactericidal – wipes out the bacteria = the bad and the good which is where C. Diff and other
things come from
•What effects antibiotic efficacy?
oPeople’s immune function – people with poor immune function may need bactericidal or higher levels
of antibiotics
▪Diabetic
▪Steroids
▪Chemotherapy
▪Asplenia (absence of normal spleen function)
▪Hx. Of previous infections
▪Elderly
▪Foreign bodies – catheters, artificial joints, valves, and shunts = may need to be removed
if possible, in order for patient to be properly treated
▪Autoimmune disease – autoimmune drugs lower ability to fight infection
oAlteration in Distribution
▪Not high enough albumin level
▪Overweight
▪Underweight – emaciated or cachectic (physical wasting)
▪Renal function decreased
▪Anything that can affect kinetics needs to be thought about in relation to antibiotic efficacy
•Bacteria cause resistance by
oBreaking down beta lactam ring
oOr breaking down whatever the drug is consisting of and inactivating it
oPenicillin has things added to prevent the bacteria from breaking down the beta lactam ring
oReduce bacterial efflux pumps or change the influx of it so it cannot work as well
oAlter the binding site so the medicine cannot exert its action
•Every antibiotic drug class has resistant organisms that influence prescribing decisions
•Common resistant organisms
oMRSA
NURS 615 Pharm Exam 2 Mega Review Study Guide
▪Community acquired
•Acquired from locker rooms, jails, prisons, gymnasiums, livestock handlers who
handle animals who handle antibiotics
NURS 615 Pharm Exam 2 Mega Review Study Guide
•Outpatient treatment options can be trimethoprim sulfa or doxycycline
▪Hospital acquired – much more difficult to treat
•Requires extensive antibiotics that we do not use often such as vancomycin,
linezolid, daptomycin, maybe even imipenem’s and combinations of these things
▪These occur in sicker patients who already have some bacterial resistance issues
oVRE (Vancomycin-Resistant Enterococci)
▪Natural enterococcus in GI tract and female genital tract
▪In weakened immune systems it can cause infection
▪Treatment is with penicillin-cephalosporin combos, aminoglycosides
▪Very difficult to treat
•Who is affected by antibiotic resistance?
oDaycares – children are more likely to be exposed to pathogens from other children
oReview the slide and be familiar
•Mentioned being familiar with drugs on the slides again – understand broad vs. narrow spectrum, bactericidal
vs. bacteriostatic, common indications for use, concern or contraindications, interactions
Both PCNs and Cephalosporins contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms =
why there is often cross-sensitivity and cross-resistance btw the two.
PCNs and Cephalosporins are generally regarded as safe to prescribe to children, but Fluoroquinolones and Tetracyclines
are to AVOIDED in childhood.
The beta-lactam ABX (PCNs and Cephalosporins) and Vancomycin inhibit bacterial cell wall synthesis.
Penicillins
•Bactericidal
•Inhibit cell wall synthesis
•Usually used for strep throat and upper respiratory types of things – otitis media
•Some pneumonias – amox-clavulanate used for this as it is a beta-lactamase inhibitor which increases its
efficacy against amoxicillin-resistant bacteria – **Augmentin
•Maybe meningitis
•Valve infections
•Blood infections
•Abdominal
•Sensitive infections – bacteria that are sensitive to it
•SAFEST DRUG for pregnancy (UTI) and pediatrics – AUGMENTIN/AMOXICILLIN
•Amoxicillin – risk for anaphylaxis – cross sensitivity with cephalosporin risk up to 25%
oIf you cannot find something other than a cephalosporin to treat somebody with allergic reactions to
penicillin’s, go with a higher generation cephalosporin. Higher generations have a little bit less
crossover with penicillin
oSome anaphylactic risk comes from previous exposure with mold spores
•Remember that penicillin’s and cephalosporins can give you diarrhea, continue tx but recommend
probiotics daily and yogurt helps
o Kaopectate and some other things can be used after verifying that this is not a c. diff or bacterial
overgrowth type of diarrhea
Cephalosporins
NURS 615 Pharm Exam 2 Mega Review Study Guide
•Note that the first generation usually has gram positive coverage
•By the time you get to the fifth generation, there is a lot of gram-negative activity
NURS 615 Pharm Exam 2 Mega Review Study Guide
•If you are wanting gram negative activity, do not choose cephalexin or cefazolin, you need to go to a
different drug group altogether or something in a higher generation
•Widely distributed
•Renally excreted as is penicillin – if you have a patient that does not have a renal system that is working well,
you may need to adjust your dosing and monitor the renal functions
•Generally a pretty safe drug
•Same adverse effects of penicillins; however, very uncomfortable at injection site
o Rocephin – often mixed with lidocaine to ease discomfort
•Mechanisms of resistance – also add a beta lactamase inhibitor type of medication to it
oHas other mechanism of resistance such as
▪Making bacterial cell wall impermeable to the antibiotic
▪Effecting the upregulation and the pumping in of the antibiotic
•If a client with strep pharyngitis is allergic to penicillin or cephalosporins then what do you use?
o Macrolides – erythromycin or azithromycin – do not risk allergic reaction
Vancomycin
•Very toxic to the ear and the kidney
•Has gram positive coverage – particularly effective in IV form for staph aureus or MRSA infection
•Bactericidal – widely distributed and renally excreted – watch the kidneys
•Does not absorb well in GI tract so mostly given IV unless somebody has C. diff in which case we can give it
PO because it will work topically
•Can cause phlebitis at IV site as well as nephro and ototoxicity
•Red Man syndrome if infused too rapidly – histamine type release and patient feels flushed, fever, chills,
tachycardia, pruritis, paresthesia’s – does not mean this is an allergic response, means we need to slow it
down
Bacteriostatic ABX limit bacterial growth by interfering w/bacterial protein production, DNA replication = Tetracyclines,
Sulfonamides, Spectinomycin, Trimethoprim, Chloramphenicol, Macrolides, Lincosamides, Clindamycin,
Ethambutol, Nitrofurantoin, Oxazolidinone.
Tetracyclines
•Doxycylcine 100 mg PO Q12H or BID for 14-28 days depending
•If pt is on doxycycline for a chlamydia infection, recommend she use a back-up method of birth control
(condom) since this med can ↓ effectiveness of oral contraception
•Doxycycline can cause anorexia, N/V, diarrhea = should take w/food
•Tetracyclines such as Minocycline are safe to use in adolescents for the tx of acne
•If pt taking Minocycline complains of a HA, evaluate for pseudotremor cerebri
•Do not give to children less than age 8 because it effects bone growth as well as causing stained teeth
•Adverse effects = photosensitivity, lupus/hepatitis, fatty liver, tinnitus, SJS (serious), TEN
•Can be inactivated by calcium ions, DO NOT give with an antacids or dairy (yogurt, milk) because that
decreases the absorption
•Bacteriostatic
Macrolides, Azalides
•Bacteriostatic as a general rule, inhibits bacterial protein biosynthesis (peptidyl transferase), binds to the P site
of the 50S ribosome subunit
NURS 615 Pharm Exam 2 Mega Review Study Guide
•Vary in excretion – stool and urine
•Cover some of the unusual or uncommon respiratory problems such as mycoplasma pneumonia,
chlamydia pneumonia, Bordetella pertussis
NURS 615 Pharm Exam 2 Mega Review Study Guide
•There is a molecule with a macrolide ring on this drug
•Have been around a really long time so we are starting to appreciate problems with resistance now
•Azithromycin for sinus infection is not really used much more because of problems with resistance – gets to
the ears and throat better as they are deeper in the body
•Azithromycin is a good abx for strep throat especially if pt has developed a rash/rxn to PCN
•Besides causing significant GI upset, can cause acute hepatitis, rash, prolonged QT and malignant arrhythmias
– serious side effects that need to be monitoring
•Given for upper and lower respiratory infections, uncomplicated skin infections
•STIs
Lincosamides
•Clindamycin – relative of erythromycin – binds like they do to the bacterial 50s ribosomes
•Bacteriostatic for certain bugs
•Works deep within the body
•Bactericidal for certain bugs
•If a bacteria is resistant to macrolides, it will be resistant to clindamycin as well
•If pt begins to have frequent diarrhea w/blood in it, assess pt for pseudomembranous colitis
•Adverse effects: nausea, vomiting, diarrhea – can cause c. diff diarrhea, metallic taste in mouth, dizziness,
vertigo, hypotension, arrhythmias –if patient is having bad c. diff diarrhea from this med, that could be
the reason the patient offloads their metabolism and has arrythmias
Oxazolidinones
•Linezolid –
oBacteriostatic although can be cidal against a few gram positives
oUtilized for the big bads – pneumonias and more complicated infections, VREs – not first drug of choice
oSHOULD NEVER BE USED within two weeks or concurrently with maoi d.t drug interactions
ocauses BONE MARROW SUPPRESSION – MONITOR CBC can cause lactic acidosis so be concerned
with acid base balances, optic and peripheral neuropathies
▪Especially if used greater than 28 days
oHeadache and nausea also ADRs
oOriginally developed as an MAOI, indirect acting sympathomimetic – giving an SSRI with this would
cause serotonin syndrome and also interactions with tyramine rich foods (aged cheese, wines, etc.)
Sulfonamides
•Sulfamethoxazole – often utilized with trimethoprim (Bactrim)
•Silver sulfadiazine – cream used in burns
•Bacteriostatic, highly protein bound and well distributed
•Effect folic acid so never use in somebody who has a folic acid deficit
•If pt has sulfonamide allergy, then they are cross-sensitive to loop/thiazide diuretics and sulfonylureas
•Excreted via the kidneys so make sure this is prescribed in somebody with good kidney function
•Used to treat E. coli UTIs and occasionally strep pneumonia and pyrogens – used to be used for c. trachomatous
•Adverse effects – folate deficiency because it disrupts folic acid synthesis. Can also cause SJS or TEN so systemic
reaction can occur (esp. w/large doses). Glossitis, stomatitis, hepatitis – can cause transient jaundice, CNS
effects
– can suppress bone marrow, renal impairment
NURS 615 Pharm Exam 2 Mega Review Study Guide
•Contraindicated in people that are folate deficient or G6PD deficient (condition causing RBCs to break down
in response to certain meds, infections, stressors)
NURS 615 Pharm Exam 2 Mega Review Study Guide
o People with G6PD deficiency are missing an enzyme needed for cellular processes – what happens is that
you give a sulfonamide and the persons RBCs will hemolyze and they will develop an anemia and so forth
•Avoid in lactation and infants under 2 months because they are G6PD deficient just by being too new, also
avoid in sulfa allergies
Macrobids
•Nitrofurantoin (Macrodantin)
•Used for urinary tract infections, also works well with kidney infections (basically goes directly to the kidneys)
so it would be contraindicated in somebody with kidney disease
•Renally excreted
•Crosses the placenta
•Same effect as sulfa in terms of g6pd though
Fluoroquinolones
•One of the latest and greatest medications
•End in floxacin
•Bactericidal working on the bacterial DNA replication
•Work very well on inner anaerobe type of bacteria that live deep within us – Haemophilus,
enterococcus, pseudomonas
•Save for the ‘big bads’ – pneumonias, things that could really hurt us, things that are resistant to all other types
of medications
•Fluoroquinolones should be reserved for tx of community-acquired PNA in pts w/ comorbidities
•Can go where many other antibiotics cannot
•Avoid antacids, dairy, and iron within a few hours of taking this medication
•Understand that it does concentrate in the prostate and the kidneys – it is a good prostatitis medication for
this reason
•Is renally excreted – alter dose and monitor functions with patients that have renal disease
•Not recommended in pregnancy or children under 18
o Damage to cartilage – black box warning for tendon rupture even months after tx– elderly are the most
susceptible
•Can prolong the QT interval
oKnow the patient’s cardiac status
oKnow other medications that patient is on that also prolong the QT
•Know drug to drug interactions with fluoroquinolones
oWhat does fluoroquinolones and warfarin do? Enhances the effect of warfarin
oWhat does fluoroquinolones and NSAIDs do?
Aminoglycosides
•Gentamicin
•Amikacin
•Tobramycin
•Neomycin
•Things mostly systemically given – eye drops and ear drops most frequent
oPoor GI absorption so IV drug
oRenally excreted and concentrates in the kidneys as well as the inner ear which is why the issue with
NURS 615 Pharm Exam 2 Mega Review Study Guide
gentamicin and ototoxicity and hearing loss
oAlso can cause renal problems (nephrotoxicity) so monitoring of hearing and renal functions
incredibly necessary
NURS 615 Pharm Exam 2 Mega Review Study Guide
•Topically administered medications have different side effects
Metronidazole (Flagyl)
•Bacterial vaginosis, h. pylori, diverticulitis, etc. used for
•Great for anaerobic coverage – things found deep within the body
•Bactericidal
•Works on nucleic acid synthesis
•Can be IV or PO
•Metabolized in the liver
•**Biggest take away from this is to tell patients they can have nothing with alcohol (not even cough
medicine) because they will vomit profusely (disulfiram like reaction) – tachycardia, nausea, vomiting
Antimycobacterial and meds (TB)
•Know what TB looks like – clinical manifestations – weight loss, night sweats, hemoptysis, fatigue
•Rifampin used to tx TB, leprosy, and legionella
•Isoniazid (INH) – used as 1st line agent for prevention and tx of both waiting and active TB
•Rifampin – causes red orange secretions and urine if someone is wearing contacts, they should be taken
out because this med will ruin their contacts
o Often see this given to people exposed to meningococcus as a preventative
•Isoniazid – peripheral neuritis or neuropathy can occur so recommend Pyridoxine (vitamin B6) be taken while
on INH
•Pyrazinamide – increases uric acid (Gout flare-ups) but can also decrease liver functions and cause someone to
become hepatotoxic (most dangerous side effect)
•Ethambutol – can cause optic neuritis leading to visual problems such as green red color blindness, tell pt
to report these symptoms immediately as it can be permanent
Lyme disease medications – Doxycycline 100 mg Q12H for 21 days
A pt with a small ventricle septal defect (VSD) that was repaired some years ago with no residual cardiac problems DOES
NOT need ABX before dental procedures.
A pt who is experiencing non-infectious diarrhea related to ABX administration will need to be assessed for C. diff colitis,
so advise pt to increase probiotic intake w/yogurt to repopulate the gut flora.
If a child comes to the clinic with a cough, low-grade fever, rhinorrhea, and the mucous is greenish-yellow then NO ABX
should be prescribed because this is a virus.
Antivirals
•Make sure you know what the names are for influenza drugs and simplex and zoster drugs
•Influenza – oseltamivir (Tamiflu) or zanamivir (Relenza) – start within 48 hours of influenza symptoms in order
to successfully treat
o Prophylactic treatment will occur in places such as nursing homes to prevent death
•Acyclovir, famciclovir, valacyclovir – antivirals of choice for herpes simplex 1 and 2 as well as zoster
oStart as soon as symptoms begin – numbness or tingling feeling
oDrink lots of fluids when taking acyclovir (to help prevent nephrotoxicity)
•Zoster
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oFor herpes zoster (shingles) – asses renal function prior to taking valacyclovir
NURS 615 Pharm Exam 2 Mega Review Study Guide
oUnilateral rash along nerve root – will also be put on gabapentin or possible tricyclic to help with
the pain
oPeople who are on antivirals for any length of time need monitoring for their liver function
Antifungals
•Organized according to polyenes, azoles, allyamines
•Can be systemic or topical depending on the infection
•Some require system – example is griseofulvin for ringworm (often seen on client’s head)
•Ketonazole – can cause hepatoxicity (need to monitor AST/ALT, alkaline phosphatase, and bilirubin)
•Amphotericin B is systemic and for serious type of fungal infection
•Candidiasis – topical tx (clotrimazole) = yeast, thrush, commonly used things are nystatin, mycostatin,
itraconazole, fluconazole (big treatment for oral, oropharyngeal, or esophageal yeast, as well as vaginal
yeast infection).
•Take note that these drugs can be hepatotoxic (need baseline LFTs) and nephrotoxic so good follow up
is required for use
Antihelminetics
•Lice and scabies = use permethrin cream and Ivermectin
•Mebendazole and agromectin used to tx intestinal parasitic worms
•Elimite cream – apply from head to toe, leave on for 8 hours before rinsing off
How do we know what we use?
•Lexicomp – expensive program but most hospitals have this
•Uptodate online – also expensive for individuals – most practices have one or the other
•Harriet lane is a good book – also online and is a good reference for pediatrics
•Consult infectious disease society of America
•American college of physicians
•Sanford guide – can place as download on phone