2 2023-2024 NURS 5334 Pharm Study Guide Quiz 1 Latest Update Best Exam Solution Graded A+

2 2023-2024 NURS 5334 Pharm Study Guide Quiz 1 Latest Update Best Exam Solution Graded A+

2023/2024 NURS 5334Pharm StudyGuide Quiz 1Latest UpdateBest ExamSolution Graded A+
NURS 5334 PHARMMODULE 1•What are the BON rules and regulations for prescriptive authority forthe advance practice nurse?•Texas is very restricted•Describe the pharmacokinetic processes of absorption, distribution, metabolism and elimination and how differences in these areas affectdrug action.•Absorption•Drug’s movement from the site of administration into theblood.•Distribution•Drug’s movement from the blood into the interstitial spaceof tissues and from there into cells.•Metabolism•Biotransformation is the enzymatically mediated alteration ofdrug structure.•Elimination•Combination of metabolism and excretion•Discuss the impact of food on drug absorption, drug metabolism and ondrug toxicity and action—as well as the timing of drug administration.LIFESPAN•Hepatic metabolism and GFR increase during pregnancy, dosages ofsome drugs may need to be increased.•Rate of albumin to water decreases•Third trimester: Renal blood flow is doubled and renalexcretion is accelerated (drugs excreted rapidly)•Tone and mobility of bowel decrease•Prolongation of drug effects Total (½ life increases)Understand stages of development in pregnancy
•Conception: through week 2•Embryonic period: week 3-week 8a) Gross malformations can be produced by teratogens•Fetal period: week 9-delivery•Understand pregnancy labeling•3 categories nowa) Pregnancy, lactation, male & female reproductive potential•How do you decrease risk in the infant during breastfeeding?•Take meds immediately after breastfeeding, avoid drugs thathave long half-lives, choose drugs that tend to be excluded from milk, avoid drugs that are known to be hazardous.•How do pediatric patients differ in their response to medications?•Absorptiona) Oral?•Neonates: drug remain in the stomach longer which increases the levels, low acidity can affectthe absorption of acid labile drugsb) Parenteral?•Reponses are slow and erratic.•Infancy: absorption is more rapid than in neonates& adults•Best avoided in infantsc) Transdermal?•Greater skin permeability which increases topical drug absorption and increases the riskfor toxicity•Distributiona) Protein binding

1. Neonates: less protein-binding—increased availability of highly protein bound drugs such asphenytoin, diazepam, and phenobarbital. Reduceddosages needed in these highly bound drugs.b) Blood Brain Barrier1. Not fully developed at birth, drugs have easyaccess to the CNS, doses should be reduced.•Metabolisma) Hepatic function?1. Liver hasn’t reached full maturation—sensitiveto drugs eliminated by the CYP450. Liver’sability to metabolize drugs increases about onemonth after birth.b) T half life1. Decreased by as much as 48-72 hours•Excretiona) Renal?1. GFR is significantly reduced at birth, drugseliminated by the kidneys must be given in areduced dosage and longer dosing intervals.•What education needs to be given to parents?•What to do if child spits out medication or throws it up•Effective education: dosage size and timing, route, techniqueof administration, duration of treatment, how to store the drug, nature and time course of the desired response, nature and time course of adverse reactions.•Compare and contrast pharmacokinetics and pharmacodynamics of special populations—pediatrics, older
   adults and those that are pregnant.•Pediatrics—they have organ immaturity, elderly—they have organdegeneration, loss of nephrons, excretion of drug is decreased and you have to give this population a lower dose of medication. Medication can pass through milk of lactating females.•Analyze a drug interaction to determine an appropriate course of action.•Basic mechanism of drug-drug interactions through pharmacokineticinteractions are altered absorption, altered distribution, altered metabolism, and altered renal excretion.•Identify medications with a narrow therapeutic indexrequiring drug level monitoring.1.•Discuss the effect of ionization and pH on absorption.•Drugs that are weak acids are best absorbed in acidic environments. Acidic drugs accumulate on the alkaline side, basic drugs accumulateon the acidic side known as ion trapping. Ionization of the drugs is pH dependent, when the pH and the fluid on one side of the membrane differs from the pH on the other side, drug molecules tendto accumulate on the side where the pH most favors ionization.•Discuss factors affecting drug distribution.•Competition for protein binding and alteration of extracellular pH•Discuss barriers affecting drug distribution—such as placentalmembrane, blood brain barrier and volume of distribution.•Placental membrane: drugs are easily passed through the placentalmembrance•Blood brain barrier: the PGP pumps drugs back into the blood andthereby limits their access to the brain.•Volume of distribution:•Discuss the “first-pass effect”—what effect can this have on distribution
   of a drug?•Rapid hepatic inactivation of certain oral drugs. When drugs areabsorbed by the GI tract, they are carried directly to the liver through the hepatic portal vein
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+before entering the systemic circulation. If the capacity of the liver tometabolize the drug is extremely high, this drug can be completely inactivated on its first pass through the liver.•Discuss the significance of the Cytochrome P450 system on metabolism ofdrugs.•It is a group of 12 closely related enzyme families. CYP1, CYP2, CYP3 metabolize drugs. The other 9 families metabolize endogenous compounds (ex. Fatty acids, steroids).•Discuss the major hepatotoxic drugs and possible effects on drugmetabolism. 1.•List various routes of drug elimination—review normal renal function including glomerular filtration, passive tubular reabsorption and active tubular secretion; describe the implications on drug clearance and how elimination affects prescribing.1.•Discuss terms used to describe drug actions-agonist, partial agonist,antagonist.•Agonist: molecules that activate receptors•Partial agonist: Only has moderate intrinsic activity. Maximal effectthat a partial agonist can produce is lower than that of a full agonist.•Antagonist: Produce their effects by preventing receptor activation byendogenous regulatory molecules and drugs.•How do you convert pounds to KG?•Divide weight by 2.2•What is definition of polypharmacy? Is polypharmacy alwaysNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+inappropriate? What is Beer’s List?•Polypharmacy: 3 or more prescription drugs in conjunction-+with 3 or more dietary supplements.•No•List that identifies drugs with a high likelihood of causingadverse effects in the elderlyNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   ■RESryth5ro3m3yc4in PHARM STUDY GUIDE QUIZ 1 LATEST UPDATENURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+•What are pharmacodynamic and pharmacokinetic differences in geripatients?•Absorption?a) GI■Bacteriostatic:NU ECSTaTiC•Produce less acid and fewer parietal cells•Bioavailability decreased•Rate of absorption decreased•Distribution?a) Lean Body Mass•Drugs accumulate in adipose tissues becauselean muscle mass decreases by 20%b) Body Water•Decrease by 10-15%-drugs reach higherserum concentrationsc) Albumin•Lowered—leads to higher levels of free or unbounddrugs•Metabolism?a) Hepatic•Decreased with age—decreases drug clearanceb) T half life•Increases—alters drug-drug interactions•Excretion?a) Renal•Decreases—which decreases renal clearance of■C lindamycin BEST EXAM SOUTION GRADED A+■Sulfamethoxazole■T rimethoprim■a■T etracycline■i
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+drugsANTIMICROBIALS1. Differentiate Bacteriostatic and Bactericidal.1. Bacteriostatic: can slow bacteria growth and do NOTcause cell death2. Baterialcidal: directly lethal to the bacteria2. What is the difference between broad spectrum and narrow spectrum?1. Broad spectrum: active against a wide variety ofmicrobes.2. Narrow spectrum: only active against a few species ofbacteria or micro-organisms3. Which is preferred?1. Narrow spectrum4. What are antibiotic classifications?1. Classifications by susceptible organisms2. Classified by mechanism of action5. What is empiric antibiotic use? Therapeutic use?1. Initiate treatment before you know what the results ofthe test– Treat with broad-spectrum antibiotic for initial treatment and once you get culture and drug sensitivity then you can use narrow spectrum antibiotic.6. Which antibiotics work by weakening the cell wall?NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+1. PenicillinsNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+7. Beta Lactam?1. Penicillins (penicillin G, Ampicillin, amoxicillin,pipercillin)2. Carbapenems (ztreonam, Imipenem, Meropenem,Ertapenem)3. Cephalosporins (Cefazolin, ceftriaxone, cefotetan)4. Vancomycin5. Lypoglycoproteins (telavancin)6. Monobactrams (aztreonam)7. Fosfomycin8. What are the medications that react with PCN?1. Aminoglycosides, bacteriostatic agents, and probenecid9. What organisms are susceptible to PCN?1. Gram-positive bacteria and gram-negative10. Beta lactams 1. Penicillins, cephalosporins and carbapenems (drugs thatend in-nem and -nam)b) Mechanism of action: weaken cell wall and promote bacterial lysis and death. Active only against bacteriathat is undergoing growth and cell division.c) allergy potential between penicillin and cephalosporinsd) Allergic ReactionMediated by•Immediate: 2-30 minutes after doseIgE•Accelerated: 1-72 hours after doseantibodiesNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+•Delayed: days to weeks•Treatment: epinephrine (IM orSubQ or IV), respiratory support.e) Drug-drug interactions: aminoglycosides,bacteriostatic agents, probenecidf) Penicillin G AKA Penicillin•Bactericidal to gram-positive and gram-negativebacteria.•Drug of choiceg) Ampicillin and Amoxicillin•Broad spectrum•Gram-negative bacillii. Haemophilus influenzaii. E. Coliiii. Salmonellaiv. Shigella•Adverse reactioni. Rashii. Diarrheah) Piperacillin•Extended-spectrum penicillin•Fights against: pseudomonas, enterbacter,proteus, bacteroides fragilis, klebsiella•Administered: parenterally via IVNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+•Adverse reaction: bleeding secondary todisrupting platelet aggregation.i) Penicillin combination (beta-lactamase inhibitors)•Ampicillin/sulbactam•Amoxicillin/clavulanate•Piperacillin/tazobactamj) Resistance issues with penicillin•Primarily against Staphylococcus aureusi. MRSA (sensitive)•Developed to resist penicillinase•Hepatotoxicity•Dose reduction in renal insufficiencyk) Nephrotoxicity•Kidney toxicity•Monitor renal function•Generations of cephalosporinsa) Mechanism of action: bind to penicillin-bindingproteins and disrupt cell wall synthesis, activateautolysis, damage cell wall.b) Most affective in cells undergoing active growth anddivision.c) Drug-drug interaction: probenecidd) Cefazolin & Ceftriaxone-do not give with alcohole) Cefotetan & Ceftriaxone (decreases vitamin Kmetabolism)-do not give with warfarinNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+f) Ceftriaxone-do not give with calciumg) Adverse effects: allergic reaction, bleeding,thrombophlebitis•1st:i. Destroyed by beta-lactamasesii. No CSFiii. Gram +iv. Narrow spectrumv. Used for prophylaxis, surgical prophylaxis•2n vi. Rarely used for active infectionsd•3rdi. Less sensitive to destructionii. No CSFiii. Less gram + more gram –iv. Rarely used for active infectionsv. Effective against H. Influenza,klebsiella, pneumococci, and staphylococcivi. Good for upper respiratory infections, otitismedia, bacterial sinusitisi. Highly resistantii. Enters CSF* (good treatment for meningitis)iii. Highly active against gram -iv. Preferred for severe infectionsNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+•4th•5thi. Highly resistantii. Enters CSFiii. Excellent gram – coverageiv. Commonly used to treat healthcare &hospital associated pneumonia(especially caused from pseudomonas)i. Used for infections associated with MRSAh) Thrombophlebitis with cephalosporins•Give by slow IV piggyback•Dilute drug (50-100 mL IV solution)•Carbapenems (Imipenem, meropenem, ertapenem,doripenem)a) Very broad antimicrobial spectrumb) Not effective against MRSAc) Imipenem1. Good for treating mixed infectionsii. staph aureusiii. gram – bacilli2. binds to PBP1 and PBP2d) Adverse effects1. GI: nausea and vomiting2. Skin rash and pruritus3. FeverNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+e) Drug-drug interaction: valproate (break throughseizures can occur)f) Administered only parenterally•Vancomycing) No beta-lactam ringh) Uses and coverage1. MRSA and C diff infections (IV)2. Oral is only used for c. diff (PO)3. Penicillin allergic patients for streptococcalendocarditis (rotten teeth that give a patientheart problems)i) Adverse Effects1. Thrombophlebitis2. Thrombocytopenia3. Red man syndromei. Hypotensionii. Histamine flushiii. Not an allergic reactionj) Nephrotoxicity and ototoxicity1. Monitor renal function•Lypoglycoproteinsk) Telavancin1. UsesNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+i. Gram + bacteriaii. Only given IViii. ONLY used in vancomycin-resistant infections2. Adverse Effectsi. Taste disturbanceii. Nauseaiii. Vomitingiv. Foamy urinev. Red man syndromevi. Prolong QT intervalvii. BLACK BOX WARNING: mortality increases in pts. With hospital-acquired orventilator-associated pneumonia and creatinine clearance <50.3. Drug-drug interactions: NSAIDS or ACE Inhibitors (damage kidneys), Clarithromycin,ketoconazole (cause prolonged QT interval)•Monobactramsl) Aztreonam1. Binds to PBP32. Narrow spectrum3. Active against gram – bacteriai. Neisseria speciesii. H. InfluenzaNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+iii. Pseudomonasiv. Klebsiellav. Proteusvi. Serratiavii. Salmonellaviii. Shigella4. Highly resistant to beta lactamases•Fosfomycina) Single dose therapyb) UTI caused by E. Coli or enterococcus faecalisc) Mechanism of action1. Kills bacteria by partially preventing cross- linking of peptidoglycan strandsd) Adverseeffects1. Diarrhea2. Headache3. Vaginitis4. Nausea5. Abdominal pain6. Rhinitis7. Drowsiness8. Dizzinesse) Take with or without foodNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+f) Symptoms improve within 2-3 days after takingBACTERIOSTATIC INHIBITORS (suppress growth, do not kill)1. Tetracyclines (tetracycline, demeclocycline,doxycycline, minocycline)a) Broad spectrumb) Work against gram + and –c) Mostly used outpatientd) Extensive use = increased in bacterial resistancee) Uses1. Chylamydial infections and other STDs2. Helicobacter pylori (causes ulcers in the duodenal and gastric)3. Acne4. Skin infections5. Anthrax (doxycycline)6. Infectious disease7. PUD8. Periodontal disease9. RA 10.RMSF 11.Pneumonia 12.Lyme diseasef) Why can’t we give to children under 8 and pregnantwomen?NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+1. Can irreversibly stain teeth (4 months-8 years old)2. Impact skeletal development in babiesg) Photosensitivity3. Wear sunscreenh) Adverse effects1. Nausea, cramps, epigastric burning2. Create superinfections—c. diff3. Hepatotoxicity—IV formi) tetracycline with iron, vitamins, or calcium –bioavailability1. Impaired absorption of antibiotic2. If you want to take iron, vitamins, or calciumleave 2 hours in between tetracyclines2. Macrolides a) Broad spectrumb) Erythromycin1. High dose IV is cidal2. Low dose PO is static3. Food increases absorption4. Metabolized by CYP3A4 system5. Drug-drug interactions: theophylline, carbamazepine, warfarin, verapamil, diltiazem,HIV protease inhibitors, simvastatin ciproNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+6. Usesi. Alternative to PCN in allergic patientsii. Atypical infections1. Group A strep2. Corynebacterium diphtheriae3. Whooping cough4. Chlamydia and Mycoplasma(walking pneumonia)7. Side effectsi. GI difficulties most commonwith oral erythromycin1. N/V/D, abdominal cramping,hepatotoxicityii. Less side effects with newer macrolidesc) Azithromycin1. Cause QT prolongationsd) Clindamycin (Cleocin)1. Bacteriostatic2. BLACK BOX WARNING: Promote severec. diff in elderly patients3. Usesi. Anaerobic bacteria, gram – and +4. Used as alternate to penicillin5. Adverse effectsi. Hepatic toxicityNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ii. Blood dyscrasiasiii. Diarrheaiv. Hypersensitivity reactions3. Oxazolidiones (Zyvox or Linezolid)a) Used to treat VRE and MRSAb) Very expensivec) Limited use due to resistanced) Gram + bacteria, NO gram – bacteria1. Enterococcus2. MRSA3. Staphylococcus epidermidis4. Strep pneumoniae) Adverseeffects1. Diarrhea2. Nausea3. Vomiting4. Headache5. Myelosuppressionf) Drug-drug interactions1. MAOIs and Tedizolid4. Ketolides NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+a) Telithromycin1. Usesi. Strep pneumonia2. Adverse effectsi. Severe liver damageii. GI effectsiii. Visual disturbancesiv. Prolonged QT intervalv. BLACK BOX WARNING: muscleweakness and shouldn’t be used in myasthenia gravis due to respiratoryfailure.5. Streptogramins a) Dalfopristin1. Usesi. Vancomycin-resistant enterococcus2. Adverse effectsi. Hepatic toxicity3. Drug-drug interactions: CYP3A4 systemb) Chloramphenicol1. Usesi. Life threatening infections2. Adverse effectsi. Reversible bone marrow depressionii. Fatal aplastic anemia (BLACK BOXNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+WARNING)iii. Gray syndromeiv. GI effectsv. Peripheral neuropathy6. Tigecycline a) Broad spectrum bacteriab) Causes increased mortality (not used unless otherinfection isn’t responding to other agents)7. Retapamulin and mupirocina) Topical used for impetigo8. Mupirocina) Used in nostrils for MRSA for people who are carriers9. Aminoglycosides (gentamycin, tobramycin, amikacin)a) Uses and coverage1. Gram negative onlyi. Serious or life-threatening infections1. Alone or with other antibioticsii. Local treatment (ear/eye infection)2. Bactericidal3. Narrow spectrumb) Sensitive organismsNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+1. E. coli, Klebseilla pneumoniae, serratia marcescens, proteus mirabilis, pseudomonasaeruginosac) Peaks and troughs1. Daily dosingi. Peak levels need to be drawn 30 minutesafter IM injection or IV infusionii. Trough levels need to be drawn one hourbefore next dose—value should be closeto zero2. Divide dosingiii. Trough levels need to be drawn just beforethe next dose3. Peakiv. Measures the adequacy of dose (needs tobe high enough to kill bacteria)4. Troughv. If elevated=toxicity (love enough tominimize toxicity)d) Adverse effects1. Nephrotoxicity and ototoxicity2. Hypersensitivity reactions3. Blood dyscrasiase) Drug-drug interactions1. Neuromuscular blocking agentsNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+2. General anesthetics3. Cephalosporins, polymyxins, vancomycin, cyclosporine, aspirin (toxic to kidneys whenused in combination)f) Beneficial drug-drug interactions1. Penicillin2. Cephalosporins3. Vancomycing) Do not give to pt. with myasthenia gravis1. Reversal treatment of choice is calcium salth) Gentamycin1. Usesvi. Gram – bacilli2. Pseudomonas, e. coli, klebsiella,Serratia, proteus mirabilis3. Used where resistance is high inhospitals2. Adverse effectsvii. Nephrotoxicity, ototoxicity10. Sulfonamidesa) Broad spectrumb) Mechanism of action1. Suppress bacterial growth by inhibiting tetrahydrofolic acid (derivative of folic acid orfolate)NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+c) UsesNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+1. UTIs (main use)2. Gram negative3. Othersi. Nocardiosisii. Malariaiii. Ulcerative colitisiv. Toxoplasmosisv. Chlamydiad) Adverse effects1. Skin, skin, skini. Skin rashes & itchingii. Stevens-Johnson syndromeiii. Photosensitivity2. Hematologic effectsi. Hemolytic anemiaii. Kernicterus3. Renal damagee) Drug-drug interactions1. Phenytoin, glipizide, glyburide (inhibit hepaticmetabolism)2. Thiazide (Celebrex) diuretics and sulfides(cross- hypersensitivity)f) Resistance to sulfonamides1. Gonococci, meningococci, streptococci, shigellaeg) Topical sulfonamides (silver sulfadiazine andNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+mafenide)1. Used to suppress colonization in pt. with 2nd and3rd degree burns2. Mafenide application painfuli. Can cause acidosis3. Sulfadiazine application pain freei. Systemic absorption, be careful in pt.with sulfa allergies11. Trimethoprima) Uses1. Acute and uncomplicated UTIs2. E. coli, proteus, klebsiella, Enterobacter, and staphb) Adverse effects1. Hematologic2. Hyperkalemiac) Do not use in pregnancy or lactation12. Trimethoprim PLUS sulfamethoxazole (AKA Bactrim DS)a) Need to watch the plasma levelsb) Therapeutic uses1. UTI, otitis media, bronchitis, shigellosis, pneumocystis pneumonia, GI infectionc) Dosage in CHILDREN is based on trimethoprim and not sulfamethoxazole (not thecase in adults)NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+d) Adverse effects1. GI—nausea and vomiting2. Rash3. Hyperkalemia4. Steven-Johnson syndrome5. Blood dyscrasias6. Kernicterus7. Renal damage or crystal urea8. Birth defects in 1st trimesterDRUGS TO TREAT UTIs1. Uncomplicated UTIsa) Single dose therapy1. For uncomplicated, non pregnant femalesb) Conventional therapy1. For pregnant femalesc) Nitrofurantoin and Bactrim DSd) If there’s resistance: fluoroquinolones are usede) Fosomycin= single dose therapyf) Nitrofurantoin rapidly metabolized and concentrates in the bladder1. Used for acute cystitis, NOT pyleo2. Acute and uncomplicate Pyleoa) Mild and moderate infection treat at home1. First line: TMP, SMZ, Cipro and levofloxacinNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+for 10-14 days2. Second line: augmentin (amoxicillin clavulanate AKA cephalexin)b) Severe infection requires hospitalization and IVantibiotics then once controlled you start oral antibiotics3. Cipro, ceftrizxone, ceftazidime, ampicillin plusgentamicin, ampicillin/culbactam3. Complicated UTIsa) Need to do a C&S and treat with broad spectrum untilit comes back4. UTI relapsea) Long-term therapy: prophylactically low dose ofTMP/SMZ 3x weekly for 6 months or TMP at bedtime for 6 months or nitrofurantoin for 6 months5. Postcoital cystitisa) Take nitrofurantoin and void after intercourse6. Prostatitisa) Signs & Symptoms1. High fever, chills, malaise, myalgia, localized pain, dysuria, nocturia, urinary urgency, urinaryfrequencyb) CausesNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+1. E. coli, indwelling urethral catheters, urethral instrumentation, or transurethralprosthetic resectionc) Treatment1. 2-4 weeks of fluroquinolone or doxycycline7. UTI antisepticsa) Nitrofurantoin and methenamine1. Bacteriostatic2. High concentrations=bactericidal3. Usesi. Lower UTIii. Prophylaxisiii. Recurrent infections4. Not absorbed systemically (doesn’t workfor kidney infections)5. Adverse effectsi. GIii. Pulmonaryiii. Hematologic (agranulocytosis,leukopenia, thrombocytopenia,megaloblastic anemia)iv. Peripheral neuropathy (irreversible)v. Hepatotoxicityvi. Birth defects (DO NOT GIVE TOPREGNANT FEMALES)NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+6. Methenaminei. Uses1. Chronic lower UTIsii. Adverse effects1. Contraindicated in pt with renaland liver failureiii. Drug-drug interactions1. Urinary alkalinizers2. Sulfonamides8. Floroquinolones (cipro)a) Broad spectrumb) PO and IVc) Resistance in N. Gonorrhoeae1. Excellent oral absorption (PO)d) Cipro1. Uses (gram -)i. Anthraxii. Respiratory infectionsiii. UTIsiv. GI infectionsv. Bones, joints, soft tissue infecitons2. Adverse Effectsi. Cartilage damageNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+1. FDA black box warning: increaserisk of tendonitis and tendonrupture—not dose dependentii. Photosensitivity1. Wear sunscreeniii. Confusion in elderlyiv. N/V/Dv. Dizzinessvi. Headachesvii. Restlessnessviii. Occasionally seizuresix. Candida infections of pharynx & vaginax. C. diffxi. Increased risk for aortic dissection orruptured abdominal aortic aneurysm.3. Drug-drug interactionsi. Glucocorticoidsii. Antacids, magnesium, arm salts, zincsalts, sucralfate, milk, dairy products(absorption is reduced)iii. Theophylline, warfarin, tinidazole(causes elevations of these meds)4. Contraindicationsi. Don’t give to pregnant or lactatingwomen and children <18*NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+Quinolones interfere with warfarin so you must watch the PT/INR because it wouldbe high NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ii. Myasthenia gravis (causes muscle weakness)e) Ofloxacin, Moxifloxacin, Levofloxacin1. Usesi. Respiratory tractii. UTIiii. GI tractiv. Skin and soft tissuesf) Gemifloxacin1. Usesi. CAP and bacterial bronchitisg) Delafloxacin1. Usesi. Skin and skin structure infectionsh) Flagyl (metronidazole)1. Usesi. Bacteroides fragilisii. Fusobacteriumiii. Gardnerella vaginalisiv. Peptococcusv. peptostreptococcus2. Adverse effectsNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+i. Neurotoxicityii. Develop super infectionsiii. Increases carcinogenic risk in mice(BLACK BOX WARNING)3. Do not drink alcohol entire time taking and for48 hours afteri. Disulfuram-like reactioni) Daptomycin1. IV med given daily2. Creatinine clearance <30 med shouldn’t be given3. Usesi. MRSAii. Bloodstream infections caused by StaphAureusiii. Complex complicated skin infectionsj) Fidaxomicin1. Narrow spectrum2. Uses**i. Diarrhea associated with c. diffk) Polymyxin B and Bacitracin1. Topical agents2. Uses**i. Ears, eyes, and skinDRUGS TO TREAT STDSNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+1. Chylamida**l) Uncomplicated infections1. Azithromycin (1 gram)i. Preferred in a pregnancyii. Children >45 grams and under 8 years old2. Doxycycline (100mg PO twice daily for 7 days)i. Used in children over 8 years old3. Erythromycini. Preferred in infants for pneumoniae &conjunctivitisii. Pre-adolescents (child sexual abuse)2. <45 grams2. Lymphogranuloma venereuma) Strain of C. trachomatousb) Small erosion/papule and migrates to lymph nosedc) Doxycycline used as treatment, erythromycin as asubstitute3. Gonococcal infections**a) Cephalosporins (preferred treatment)1. Ceftriaxone 250mg once + azithromycin 1g POonce for urethritis, cervicitis, proctitis, pharyngitis, conjunctivitis2. Disseminated-ceftriaxone 1g IM or IV every24 hrs + azithromycin 1g onceb) Neonatal infectionNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+1. Ophthalmia can cause blindnessiii. Single dose of ceftriaxone IM or IV2. Preventioniv. 0.5% erythromycin ophthalmic ointment@ birth required by lawc) Preadolescent1. Weight >45kg: treatment same as adults2. Weight <45kg: single dose of ceftiaxon forvaginitis, cervicitis, urethritis, pharyngitis,proctitis3. Systemic is IM or IV ceftriaxone daily for 7 days4. Nongonococcal urethritisa) Diagnosis: presence of polymorphonuclearleukocytes and negative culture for gonorrheab) Azithromycin or doxycycline1. Alternatives: erythromycin, levofloxacin orofloxacin, metronidazole, tinidazole for trichomonas.c) Pelvic inflammatory disease1. Cause: gonorrhea or chlamydia2. Causes infertility3. Broad coverage and combo therapy is requiredi. Inpatient: IV cefoxitin or cefotetan and doxycycline followed by oral doxycyclineii. Outpatient: ceftriaxone or cefoxitin andNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+doxycycline, used with/withoutmetronidazoled) Acute epididymitis (pain in back and testes)1. Treat according to the organism2. Ceftriaxone plus doxycycline or ofloxacin3. Levofloxacin is added if pt. has anal intercoursee) Non-sexually transmitted disease(urinary tract instrumentation)1. Ofloxacinf) Syphilis**1. Primary: chancre, red, hard, protruding, andpainless sore2. Secondary: 2 weeks after chancre heals3. Tertiary: 5-40 years after initial infection4. Highly responsive to Penicillin Gg) Bacterial vaginosis (fishy odor, pH <4.5)**1. Non-pregnant womeni. Metronidazole or clindamycin cream2. Pregnant womeni. Only oral clindamycin and metronidazoleh) Trichimoniasis**1. Metronidazole 2g PO once or Tinidazole 4g POoncei) Chancroid1. Painful ragged ulcer at site of inoculationNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+2. Swollen lymph nodesNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+3. Azithromycin, ceftriaxone, cipro, erythromycinbasej) Herpes simplex virus**1. Acyclovir, famciclovir, valacycloviri. Can be taken every day for suppressive therapy or can preserve it and take themwhen there’s an active outbreakii. Vancyclovir 500mg taken daily candecrease transmission by 50%iii. Infants exposed at birth should betreated with acyclovirANTIFUNGALS 5. Amphotericin B (broad spectrum, given IV)a) Uses1. Some protozoa2. Systemic mycosesb) Mechanism of action1. Binds to ergosterol in the fungal cell membrane and increases permeability andthe cell leaks intracellular cations reducesviability. Bacteria not affected.2. Fungicidal or fungistaticc) Adverse effects1. Infusion reactionsNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+i. Phlebitis2. Renaldamagecauses hypoka lemia (may need potassi um and monitorcreatinine)3. Fever,chills, rigors, nausea, headache.4. Hematologic effects: bone marrow suppression and normochromic normocytic anemia (monitorh&h)d) Drug-drug reactions1. Hydrocortisone-high incidence of phlebitis2. Aminogylcosides-nephrotoxic3. Cyclosporins-nephrotoxic4. NSAIDS-nephrotoxice) BLACK BOX WARNING1. Highly toxic, only used in the setting of lifethreatening infections.6. Azoles (Itraconazole, fluconazole, voriconazole, ketoconazole, Posaconazole, isavuconazonium)a) Uses (orally)1. Systemic mycosesb) Mechanism of Action1. Inhibits the synthesis of the ergosterol and disrupts the fungal cell membrane . Inhibitsfungal cytochrome p450c) Adverse effects1. Liver damage (monitor liver enzymes)NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+2. GI effects (N/V/D)d) Drug-Drug interactions (inhibit p450 drugmetabolism)1. Dofetilide (antiarrhythmic)2. Warfarin3. Cyclosporin4. Lovastatin5. Simvastatin6. PPIs (inhibit absorption)7. Cola (enhances absorption)e) BLACK BOX WARNING1. Decrease in ventricular ejection fraction—shouldnot be used in patients with heart failure or ventricular dysfunction7. Echinocandinsa) Caspofungin, Micafungin, Anidulafungin1. Usesi. IV therapy of invasive aspergillus not responsive to amphotericin B, itraconazole,and candida infections2. Adverse effectsi. Feverii. Phlebitis3. Drug-drug interactionsi. Drugs that induce cytochrome P450 mayNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+decrease levelsii. Decreases levels of tacrolimusiii. Combining with cyclosporine can increaserisk for liver injury8. Pyrimidine Analogb) Flucytosine1. Usesi. Serious infections from candida andcryptococcus neoformans2. Adverse effectsi. Half life prolonged in patients in renal impairment (BLACK BOX WARNING)ii. Bone marrow suppressioniii. Neutropenia or thrombocytopeniaiv. Rarely fatal agranulocytosisv. Hepatotoxicity3. Drug-drug interactionsi. ??9. Which drugs treat?a) Tinea pedis1. Terbinafine (topical)2. Butenafine (topical)3. Ciclopirox (topical)NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+b) Tinea corporis1. Terbinafine (topical)2. Butenafine (topical)3. Ciclopirox (topical)c) Tinea cruris1. Terbinafine (topical)2. Butenafine (topical)3. Ciclopirox (topical)d) Tinea capitis1. Fluconazole2. Terbinafine3. Itraconazole4. Butenafinee) Vulvovaginalcandidiasis1. Topical antifungals2. 1 dose of fluconazole 150mgf) Onychomycosis1. Terbinafine (topical) and itraconazoleTUBERCULOSIS DRUGS1. Two species of bacteriaa) Tubercular bacillib)2. When is treatment consideredNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+effective? a)3. How are drugs chosen for treatment?a) Initial drug selection is empiric based on patterns of drug resistance in the community and immunocompetence of the patient. Once culture sputum results come back, regimen should be adjustedaccordingly.4. What are first line drugs? Second line?a) 1st line: Isoniazid, Rifampin, Pyrazinamide, Ethambutol,Rifapentine, and Rifabutinb) 2nd line: Cycloserine, Ethionamide, Capreomycin, Para- aminosalicylic acid,aminoglycosides, quinolones.5. What is the induction phase of treatment? ContinuationPhase?a) Induction phase: eliminate actively dividingextracellular tubercle bacillib) Continuation phase: eliminate persistent intracellularorganisms6. Define multidrug resistant TB. Define extensively resistantTB.a) Multidrug resistant: TB resistant to both isoniazid andrifampin, the two most effective drugs for TBb) Extensively resistant: TB that is resistant to not only isoniazid and rifampin but to all fluoroquinolones and atNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+least one of the injectable second-line anti-TB drugs.7. IsoniazidNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+a) Adverse effects1. Peripheral neuropathies2. Hepatotoxic—can cause anemia3. Cross blood brain barrier—cause optic neuritis,seizures, dizziness, ataxia, psychological disturbances.b) Drug-drug interactions1. Can raise levels of phenytoin,carbamazepine, diazepam, and triazolambecause it’s a strong inhibitor of CYP2C19,CYP2C9, CYP2E18. Rifampina) Adverse effects1. Hepatotoxic2. Discoloration of bodily fluids3. GI disturbancesb) Drug-drug interactions1. Oral contraceptives (decreases effectiveness)2. Warfarin3. Hepatotoxic drugs4. Drugs used to treat HIV9. Pyrazinamidea) Adverse effects1. Hepatotoxic2. Non-gouty polyarthralgia3. HyperuricemiaNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+4. GI disturbances5. Photosensitivity10. Ethambutola) Adverse effects1. Optic neuritis2. Hyperuricemia3. Dermatitis4. GI upset5. Peripheral neuropathy6. Renal damage7. Thrombocytopenia11. Levofloxacin and Moxifloxacin (quinolones)a) Adverse effects1. Look at “fluoroquinolones”b) Drug-drug interactions1. Look at “fluoroquinolones”12. Capreomycin (injectable)a) Adverse effects1. Renal damage2. Eighth cranial nerve damage3. Hearing loss4. TinnitusNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+5. Disturbed balance13. Amikacin (injectable)a) Adverse effects1. Nephrotoxic2. Eighth cranial nerve damage (BLACK BOXWARNING)14. Para-aminosalicylic acida) Adverse effects1. GI disturbances: N/V/D2. Salt loading3. Allergic reactions4. Hepatotoxicity5. Goiter15. Ethionamidea) Adverse effects1. GI disturbances: N/V/D2. Hepatotoxicity3. Peripheral neuropathy4. CNS effects: convulsions, mental disturbance5. Allergic reactions6. Hypoglycemia16. Cycloserinea) Adverse effects1. Anxiety2. DepressionNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+3. Confusion4. Hallucinations5. Paranoia6. Hyperreflexia7. Seizures8. Peripheral neuropathy9. Hepatotoxicity10. Folate deficiency17. Bedaquiline [Sirturo]a) Adverse effects1. BLACK BOX WARNING: prolonged QT18. Treatmenta) What is treatment for drug sensitive TB1. Two phasesi. Initial phase (8 weeks)1. Eliminate actively dividing extracellular tubercle bacilli.2. Isoniazid, rifampin, pyrazinamide, ethambutolii. Continuation phase (18 weeks)1. Eliminate persistent intracellularorganisms2. Isoniazid and rifampinNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+b) Multi drug resistant?1. Isoniazid resistanti. Treated for 6 months with 3 drugs1. Rifampin, ethambutol, pyrazinamide2. Rifampin resistanti. Treated for 18-24 months with 3 drugs1. Isoniazid, ethambutol, pyrazinamidec) Extensively drug resistant?1. Treatment is prolonged to at least 24 months2. Use 2nd and 3rd line drug—less effective3. Initial therapy can consist of 5,6,7 drugsi. Isoniazid, rifampin, pyrazinamide, ethambutol, amikacin or capreomycin, levofloxacin, cycloserine, ethionamide orPAS.4. Last resorti. Infected tissue removed by surgeryd) Patients with TB and HIV?1. Rifabutin can be used but it can accelerate the metabolism of protease inhibitors and NNRTIs but not as much as rifampin.e) Latent TB?1. Treated with one or two drugs2. TB must be ruled out3. Isoniazid alone daily or twice weekly for nineNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+months or isoniazid daily or twice weekly for 6months4. Rifampin alone daily for 4 months, isoniazid plus rifapentines taken weeklyfor three monthsf) How do you promote treatment adherence?1. Directly observed therapyi. Administration of each dose is done infront of representative of the health department2. Intermittent dosing (2-3 times a week)g) How do you evaluate?1. Three primary modesi. Bacteriologic evaluation of sputum1. Evaluated monthly until 2consecutives are negativeii. Chest radiographs1. Done in pt with negativepretreatment sputum test2. Repeat every 2 months after initial txiii. Clinical evaluation1. Fever, malaise, anorexia, cough must be evaluated at every clinicvisit2. Should be markedly decreasedNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+within 2 weeksNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ANTHELMINTICS1. What are the antihemintics drugs?a) Drugs of choice1. Mebendazole, albendazole, pyrantel pamoate,praziquantel, diethylcarbamazine, ivermectin.2. Anthelmintic drugs are generally devoid of serious adverse effects3. Important to match drug with infesting worm4. Many worm infestations are both asymptomatic and self-limited, hence drug therapy can be optionalANTIVIRALS FOR NON HIV1. Acyclovira) Uses1. 1st choice for herpes simplex virus or varicellazoster virusb) Adverse effects1. IVi. Phlebitisii. Nephrotoxicityiii. Neurotoxicity2. Orali. GI effectsii. VertigoNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+2. Valacyclovira) Uses1. Herpes zoster, genital herpes, herpes labialis,cold sores, varicella, chicken poxb) Adverse effects1. Hematologic affects: thrombocytopenia, aplasticanemia2. Neurologic: psychosis, encephalopathy, seizures3. GI affects3. Famciclovira) Uses1. Genital HSV, herpes zoster, orolabial HSVb) Adverse effects1. Blood dyscrasiasi. Neutropeniaii. Thrombocytopenia2. Stevens Johnson Syndrome3. CNS—hallucinations, deliriumc) Drug-drug interactions1. Live varicella & zoster vaccine4. Ganciclovira) UsesNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+1. Herpes simplex viruses, CMV virus (prevention and tx in immunocompromised pt—transplant pt, HIV, and those receiving immunosuppressingdrugs)b) Adverse effects1. Granulocytopenia2. Thrombocytopenia3. Reproductive toxicity4. Teratogenic and carcinogenic effects5. Nausea, fever, rash, anemia, liver dysfunction,confusion, other CNS symptoms5. Valganciclovira) Uses1. CMV, retinitis, prevention of CMV disease inhigh-risk organ transplant recipientsb) Adverse effects1. Blood dyscrasiasi. Bone marrow suppressionii. Granulocytopeniaiii. Anemiaiv. Thrombocytopenia2. N/V/D3. Potential mutagenesis and carcinogenesis6. Cidofovira) UsesNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+1. CMV retinitis in patients with AIDSb) Adverse effects1. Nephrotoxicity2. Neutropenia3. Ocular disordersLOCAL ANESTHESIA1. What is MOA of local anesthetics?a. Suppress pain by blocking sodium channels and impulses, conduction along the axons and the selectivity of the anesthetic effects, only neurons located near the side of administration are affected and they suppress pain without generalized depression ofthe CNS2. What 3 properties determines the ability of anesthetic to penetrate axonmembrane?a. Molecular size, lipid solubility, degree of ionization at the tissue pH3. Why are vasoconstrictors used in conjunction with local anesthetics?a. Delays the systemic absorption and prolongs anesthesia andreduces the risk of toxicity4. What blood dyscrasia can occur from benzocaine?a. Methemoglobinemia-hgb is modified so it cant release O2 into the tissues and if enough hgb is converted to methemoglobin, death canresult.5. What are application guidelines for topical anesthetics to prevent systemicreactions?NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+a. Apply the smallest amount needed, avoid application to large areas, avoid broken or irritated skin, avoid strenuous exercise, wrapping thesite and heating the site.VIRAL HEPATITIS DRUGS & FLUa. What are the medications used in the treatment of hepatitis?i. Hep C1. Pegylated interferon alfa combined withribavirina. Interferon alfa: only given subQi. Conventional vs. long actingii. Adverse effects: flu-like, neuropsychiatric effects, depression,fatigue, thyroid dysfunction, heart damage, bone marrow suppression, neutropenia, thrombocytopeniab. Ribavirini. Used in combo with interferon alfaii. Aerosol form to treat children withRSViii. Adverse effects: flu-like, severedepression, hemolytic anemia, birthdefects (do not give to pregnantwomen)NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+2. DAAsa. NS3/4A protease inhibitorb. NS5A inhibitorc. NS5B nucleoside polymerase inhibitorsd. NS5B non-nucleoside polymerase inhibitorsi. Tamifluii. Relenzaiii. Rapivabiv. Xofluzaii. Hep B1. Interferon alpha2. Peginterferon alpha3. Lamivudine4. Adefovir5. Entecavir6. Telbivudine7. Tenofovirb. What are the medications used in treatment of flu?ANTIVIRAL DRUGS FOR HIV INFECTIONSa. What are the 5 classes of antivirals used in treatment ofHIV? What is MOA for each?i. Reverse transcriptase inhibitors1. Inhibits the HIV replication by suppressingsynthesis of the viral DNA.NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ii. Non nucleoside reverse transfer inhibitors1. Bind to the active center of reverse transcriptase and cause direct inhibitioniii. Protease inhibitors1. Reduce viral load to an undetectable leveliv. Integrase strand transfer inhibitors1. Treat those infected with HIV-1v. Fusion inhibitors1. Blocks entry of the HIV into the CD4 T cellsvi. CCR5 antagonists1. Used for those infected with CCR5-tropic HIV-1strainb. Know major side effects and drug interactions with eachi. Reverse transcriptase inhibitors (zidovudine)1. Adverse effectsa. Hematologic toxicity, lactic acidosis,myopathyii. Non nucleoside reverse transfer inhibitors(efavirenz, nevirapine, delavirdine, etravirine, rilpirvirine)iii. Protease inhibitors (lopinavir, ritonavir, indinavir, squinavir, nelfinavir, fosamprenavir, atazanavir, tipranavir, darunavir)1. Adverse effectsNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+a. Hyperglycemia, fat redistribution, hyperlipidemia, increased bleeding in ptwith hemophilia, reduce bone density, elevation of serum transaminase2. Drug-drug interactionsiv. Integrase strand transfer inhibitors (raltegravir)1. Adverse effectsa. Insomnia, headache, rare hypersensitivityv. Fusion inhibitors (enfuvirtide AKA fuzeon)1. Adverse effectsa. Injection site reactions, ammonia,hypersensitivity reactionsvi. CCR5 antagonists (maraviroc)1. Adverse effectsa. Hepatic toxicity, myocardial ischemia, orthostatic hypotension, immune reconstitution syndrome, increased risk for infection, potential risk for malignancy, upper respiratory infections,cough.c. What are laboratory tests used to guide treatment of HIV?i. Plasma HIV RNA or viral load assaysd. What causes resistance in treatment of HIV?i. Nonadherence to treatmente. Which medications can be used in pregnancy?NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+i. Same medications can be used in pregnancy that is used in non- pregnancy, just transmission occurs andlowers the maternal viral load.f. When is tenofovir/emtricitabine (Truvada) indicated?i. It is an HIV prophylaxisii. Those considered high risk for HIV acquisition, those ptthat have sexual partners with known HIV infection, sexually active with people who belong to the social networks with a high HIV population, or one or more ofthe following: don’t use condoms, have STI, engage in sex for money, men in prisons.NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+DRUGS FOR HEADACHES1. What is pathophysiology of migraine?a. Neurovascular disorder that involves the dilation and inflammation ofintracranial blood vessels. Vasodilation causes the pain.2. What foods can trigger migraines?a. Aged cheeses, wine, cured meats, hot dogs, lunch meat, chocolate, Chinese food, canned soups, diet sodas, artificial sweeteners, yellowfood coloring.3. What drug classes are abortive medications?a. NSAIDs/aspirinb. Opioid analgesics: butorphanol and meperidinec. Serotonin 1B/1D receptor agonists: triptand. Ergot alkaloids4. What drug classes are preventive? What can happen with all preventivemedications have if taken too frequently?a. Beta blockers, antiepileptic drug, tricyclic antidepressants,calcium channel blockers, botulism toxin, ACE inhibitors,Angiotensin 2 receptor blockers.b. Chronic headache5. What are some herbal meds effective with migraines? What are their sideeffects?a. riboflavin B2 and coenzyme Q-10b. Side effects: GI, liver damage and cancer6. What is treatment for menstrual migraine?NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+a. Tricyclic antidepressants, estrogen gel and patchesHEADACHES1. NSAIDs: First line2. Seratonin 1B1D Receptor Agonists/Triptansa. What is MOA?NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+i. Binds to receptors on the intracranial blood vessels and causes vasoconstriction, diminishes perivascularinflammationb. Side effects?i. Chest symptoms: heavy arms or chest pressureii. Teratogeniciii. Vertigo, malaise, fatigue, tingling sensation, bad taste withintranasal formc. Drug/drug interactions?i. Ergot alkaloids, sumatriptan and all other triptansd. What is Treximet?i. Combination of Sumatriptan & Naproxen3. Ergot Alkaloidsa. What is MOA?i. Works by agonist activity at subtypes of serotonin receptors and specifically the 5HT1B and 5HT1D receptors. Suppresses the release of CGRP, to block inflammation associated with the trigeminal vascular system.b. Side effects?i. N/Vii. Overdose: causes ischemia secondary to constriction of the peripheral arteries. Extremities become cold, pale and numb.Muscle pain and then gangrene sets in.iii. Teratogenicc. Drug/drug interactions?NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+i. Drugs that are CYP3A4 inhibitorsii. Triptansiii. SSRIs4. What are primary treatments for cluster HA?a. Prophylaxisb. Glucocorticoids, verapamil, lithium5. What are primary treatments for tension HA?a. Acetaminophen, NSAIDs (aspirin, ibuprofen, naproxen), butalbitalOPIOIDS1. What are 3 main classes of opioid receptors?a. Mu receptorsb. Kappa receptorsc. Delta receptors2. What are 3 classifications of drugs that act as opioid receptors?a. Agonistb. Partial agonistc. AntagonistNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+3.4. Strong opioid agonista. Morphinei. What are therapeutic uses?1. Relieve pain without affecting any other senses,no loss of consciousnessii. Side effects? BB warning?1. Respiratory depression (BLACK BOX WARNING)2. Constipation, orthostatic hypotension, urinary retention and hesitancy, N/V, euphoria, sedation,drowsiness, neurotoxic, delirium, agitation, myoclonus, hyperalgesia, renal impairment, pre-existing cognitive impairment.iii. What is tolerance? Cross tolerance? Dependence?1. Tolerance: increased doses are needed to obtain the sameNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+response.2. Cross tolerance: tolerance to another opioid agonists will develop, but there’s no tolerance to the miosis orconstipation.3. Dependence: abstinence syndrome with abrupt discontinuation, occurs about 10 hours after the lastdose.a. Initial: yawning, rhinorrhea, sweatingb. Progess: violent sneezing, weakness, n/v/d, bone& muscle pain, muscle spasms and kicking movement.iv. What are the medications available to treat opioid inducedconstipation (OIC)?1. Naloxegol, methylnaltrexone, lubiprostonev. What is the reversal drug? Naloxenevi. Drug designed to discourage abuse? Naltrexoneb. Others: fentanyl5. Mod-strong opioid agonista. Codeine: Class II alone, III with acetaminophen, V as coughsuppressantb. Oxycodonec. Hydrocodoned. Tapentadol6. Opioid agonist antagonista. PentazocineNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+b. Nalbuphinec. Butorphanold. Buprenorphine Prolongs QT7. Dosing guidelinesNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+a. Define physical dependence, abuse, addiction.i. Physical dependence: abstinence syndrome will occur if thedependent producing drug is abruptly withdrawn and its notequated with addiction.ii. Abuse: drug use that is inconsistent with medical or social normsiii. Addiction: continued use of psychoactive substance despite physical, psychological, or socialharmb. Identify patients at risk with screening toolsi. NIDA toolii. State prescription drug monitoring programiii. Obtain urine drug testc. What is prescription drug monitoring program (PDMP)?i. Database that contains information regarding all scheduled medications prescribed to a patient, who prescribed them, andthe amount prescribed.d. What is REMS?i. Risk evaluation and mitigation strategy. Designed to reduceopioid related injuries and death.OPIOID ANTAGONISTS1. Naloxenea. What is onset of SubQ injection?i. 2-5 minutesb. T1/2 life?i. 2 hoursNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+2. Naltrexone-used for Alcohol and opioid abusea. Pt has to be rendered free from opioid use because it doesn’t preventcravings3. Methylnaltrexone, lubiprostone, naloxegol-Used for Opioid InducedConstipation4. Alvimopan- is indicated to accelerate the time to upper and lowergastrointestinal recovery following surgeries that include partial bowel resection with primary anastomosisNONOPIOID CENTRALLY ACTING ANAGESICS1. Tramadola. Suicide riskb. Seizure risk2. Clonidine (used for hypertension and relief of severe pain)3. Ziconotide (intrathecal administration)4. Dexmedetomidine – used for patients on mechanical ventilationANTIINFLAMMATORIES1. Cyclooxygenase Inhibitorsa. NSAIDsb. Acetaminophen2. Differentiate Cox 1 and Cox 2 drugsa. Cox 1: located in all the tissues and do important things such as, protects gastric mucosa, supports renal function, promotes plateletaggregation.NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+i. Protect against MI and strokeNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+b. Cox 2: mediates inflammation and sensitizes receptors topainful stimuli, mediates fever, contributes to perception ofpain, promotes vasodilation, contributes to colon cancer.i. Risk for MI and stroke3. ASAa. Drug interactions?i. Anticoagulants (warfarin and heparin)ii. Glucocorticoidsiii. Alcoholiv. Ibuprofenv. ACE inhibitors and ARBsb. Side effects?i. Ulceration and bleeding of GIii. Reversible impairment of kidneysiii. Edemaiv. Toxic levels—tinnitus, sweating, headache, dizzinessv. Children <18 years old—Reye syndrome4. Non ASA first generation NSAIDs –indications RA, OAa. Ibuprofen, Naproxenb. SAFETY ALERT: All first-generation NSAIDs are associated with an increased risk of GI bleeding that can lead to hospitalization or death5. 2nd Generation NSAIDs-indications RA, OAa. Celecoxib, Meloxicani. What are drug/drug interactionsNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+1. Warfarin (increases anticoagulant effect)2. ACE inhibitors (decrease antihypertensive effects)3. Lithium (increase levels)4. Fluconazole (increases celecoxib levels)Both first and second generation pose the risk for heart disease, renalfunction, and GI bleed though Cox 2 pose less risk for GI6. Acetaminophena. No anti-inflammatory actionb. What are side effects?i. Steven Johnson syndromeii. Acute generalized pustulosisiii. Toxic epidermal necrolysisiv. Hepatic toxicityv. Hepatic necrosisvi. N/V/D, sweatingc. Drug/drug?i. Alcohol (increase risk to liver)ii. Warfarin (increase risk of bleeding)d. Vaccines?i. Tylenol can blunt the immune responsee. What is treatment for overdose?i. Acetylcysteine or MucomystNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+GLUCOCORTICOIDS1. What are therapeutic uses?a. Help mature lungs in a fetusb. Suppress immune response in inflammationc. Rheumatoid arthritis, systemic lupus, erythematosus, synovitis, osteoarthritis, gouty arthritis, allergic conditions, asthma, skin diseases (stigmas, psoriasis, mycosis, fungoides, seborrheic dermatitis, contact dermatitis, exfoliative dermatitis), neoplasms,suppression of allograft rejections.2. What are metabolic effects?a. Protein synthesis is suppressed and fat deposits are mobilized and sodium retention and potassium excretion, inhibits the intestinal absorption of calcium and anti-inflammatory and immunosuppressant effects.3. What are adverse effects?a. Adrenal insufficiency, osteoporosis, pneumocystis pneumonia, hyperglycemia, glycosuria, proximal myopathies in the proximalmuscles of the arms and legs.4. Drug/drug interactions?a. Diuretics (loss of potassium)b. NSAIDs (risk of GI bleed)c. Insulin and oral hypoglycemicsd. Vaccines5. How should these drugs be tapered?NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+a. Taper the dosage to 50% of the physiologic value, monitorfor signs of insufficiencyRA1. Chronic systemic inflammation including the synovial membranes ofmultiple joints2. Shortens lifespan and increases risk of CV and stroke3. Goal of treatmenta. Reduce inflammation and pain while preserving function andpreventing deformity4. First line treatment:a. NSAIDs with DMARD5. DMARDsa. Traditionali. Methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, minocycline, Penicillamine,Azathioprine, Cyclosporine6. Biological response modifiersa. Non-TNFi. Abatacept, rituximab, anakinra, tocilizumabb. Anti-TNFi. Infliximab, adalimumab, etanercept, certolizumab, golimumab7. Oral JAK inhibitorsa. Tofacitinib, RuxolitinibAll of these drugs suppress immune systemNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+COMMONLY USED NSAIDsDMARDS/TRADITIONAL1. Methotrexatea. Adverse reactions?i. Hepatic fibrosis, bone marrow suppression, GI ulceration,pneumonitis (BLACK BOX)b. Bone Marrow?i. SuppressionNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+2. Sulfasalazinea. GI side effects3.GOUT1. Causea. Excessive production of uric acidb. Impaired renal excretion of uric acid2. Flare up < 3 times per yearNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+ NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+a. NSAIDs first lineb. Glucocorticoids: Second or if intolerant to NSAIDs3. Flare up > 3 times per yeara. Uricosurics4. Colchicinea. No longer first lineb. Treats acute gouty attackc. Reduces incidences of attackd. Aborts an impending attacke. Adverse effects?i. GIii. Myelosuppressioniii. Leukopeniaiv. Granulocytopeniav. Thrombocytopeniavi. Pancytopeniavii. rhabdomyolysisf. Drug/drug?i. Statinsii. P-glycoprotein inhibitorsiii. Inhibitors of the CYP3A45. Inhibits uric acid formationa. Allopurinol-drug of choiceb. Febuxostatc. ProbenecidNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+
   NURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+6. Converts uric acid to allantoin, a compound readily excreted by the kidneya. Pegloticase- IV for those that have not responded to other therapyNURS 5334 PHARM STUDY GUIDE QUIZ 1 LATEST UPDATE BEST EXAM SOUTION GRADED A+