ANCC ADULT NP BOARD EXAM PREP
WITH COMPLETE SOLUTIONS
Potent Inhibitors: CYP450 System - ANS -Macrolides (erythromycin,
clarithromycin, telithromycin)
Antifungals (ketoconazole, fluconazole, itraconazole)
Cimetidine (Tagamet)
Citalopram (Celexa)
Protease inhibitors (saquinavir, indinavir, nelfinavir)
Grapefruit juice
Narrow Therapeutic Index Drugs - ANS -■Warfarin sodium (Coumadin): monitor
INR.
■ Digoxin (Lanoxin): monitor digoxin level, EKG, electrolytes (potassium,
magnesium, calcium).
■ Theophylline: monitor blood levels.
■ Carbamezapine (Tegretol) and phenytoin (Dilantin): monitor blood levels.
■ Levothyroxine: monitor TSH.
■ Lithium: monitor blood levels, TSH (risk of HYPOthyroidism).
,Beers Criteria - ANS -Antipsychotics: Quetiapine, clozapine, and pimavanserin may
be used with caution.
Rivaroxaban and dabigatran: Higher bleeding risk than warfarin and other direct
oral anticoagulants.
Tramadol: Risk of hyponatremia from syndrome of inappropriate antidiuretic
hormone secretion.
Opioids: Do not combine with benzodiazepines or gabapentinoids, as they
increase the risk of severe respiratory depression.
s/sx of digoxin toxicity - ANS -Initial symptoms are GI (nausea/vomiting),
hyperkalemia, and bradydysrhythmias (atrioventricular [AV] blocks) or
tachydysrhythmias (ventricular tachycardia/fibrillation or atrial tachycardia with
2:1 block). Others include confusion and visual changes (yellowish-green-tinged
color vision).
Digoxin therapeutic range - ANS -0.5-2 mg
Warfarin INR range issues - ANS -Consistently Stable INR
Check every 2 to 4 weeks up to every 12 weeks.
Single Out-of-Range INR
If patient has stable INR and has a single out-of-range INR ≤0.5 below or above
therapeutic INR (2-3), experts suggest continuing current warfarin dose; retest
INR within 1 to 2 weeks.
INR <5 With No Significant Bleeding Risk
Omit one dose and/or reduce maintenance dose slightly; recheck INR.
, DOACs: Antidotes - ANS -idarucizumab and andexanet alfa: reverse the
anticoagulant effects of dabigatran and FXa inhibitors, respectively. Fresh frozen
plasma and prothrombin complex concentrate can also be used for rapid reversa
2017 ACC/AHA stages of hypertension - ANS -Normal BP: Systolic <120 mmHg and
diastolic <80 mmHg
Elevated BP: Systolic 120 to 129 mmHg and diastolic <80 mmHg
Stage 1: Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
Stage 2: Systolic ≥140 mmHg or diastolic ≥90 mmHg
Thiazide diuretics contraindication - ANS -Sulfa allergy
(Caution with gout, diabetes)
Also loop diuretics contraindicated with sulfa allergy
Patients with both ____, and ______ receive an extra benefit from thiazides. -
ANS -hypertension, osteoporosis
Potassium sparing diuretics black box warning - ANS -Hyperkalemia, which can be
fatal; higher risk with renal impairment, diabetes, elderly, severely ill
With severe__________ disease, all ACEIs, ARBs, and aliskiren are contraindicated
because of high risk of hyperkalemia. - ANS -renal /CKD
Loop Diuretics Adverse Effects - ANS -Electrolytes (hypokalemia, hyponatremia,
hypomagnesemia, and low levels of chlorine)
Hypovolemia and hypotension (dizziness, lightheadedness)
WITH COMPLETE SOLUTIONS
Potent Inhibitors: CYP450 System - ANS -Macrolides (erythromycin,
clarithromycin, telithromycin)
Antifungals (ketoconazole, fluconazole, itraconazole)
Cimetidine (Tagamet)
Citalopram (Celexa)
Protease inhibitors (saquinavir, indinavir, nelfinavir)
Grapefruit juice
Narrow Therapeutic Index Drugs - ANS -■Warfarin sodium (Coumadin): monitor
INR.
■ Digoxin (Lanoxin): monitor digoxin level, EKG, electrolytes (potassium,
magnesium, calcium).
■ Theophylline: monitor blood levels.
■ Carbamezapine (Tegretol) and phenytoin (Dilantin): monitor blood levels.
■ Levothyroxine: monitor TSH.
■ Lithium: monitor blood levels, TSH (risk of HYPOthyroidism).
,Beers Criteria - ANS -Antipsychotics: Quetiapine, clozapine, and pimavanserin may
be used with caution.
Rivaroxaban and dabigatran: Higher bleeding risk than warfarin and other direct
oral anticoagulants.
Tramadol: Risk of hyponatremia from syndrome of inappropriate antidiuretic
hormone secretion.
Opioids: Do not combine with benzodiazepines or gabapentinoids, as they
increase the risk of severe respiratory depression.
s/sx of digoxin toxicity - ANS -Initial symptoms are GI (nausea/vomiting),
hyperkalemia, and bradydysrhythmias (atrioventricular [AV] blocks) or
tachydysrhythmias (ventricular tachycardia/fibrillation or atrial tachycardia with
2:1 block). Others include confusion and visual changes (yellowish-green-tinged
color vision).
Digoxin therapeutic range - ANS -0.5-2 mg
Warfarin INR range issues - ANS -Consistently Stable INR
Check every 2 to 4 weeks up to every 12 weeks.
Single Out-of-Range INR
If patient has stable INR and has a single out-of-range INR ≤0.5 below or above
therapeutic INR (2-3), experts suggest continuing current warfarin dose; retest
INR within 1 to 2 weeks.
INR <5 With No Significant Bleeding Risk
Omit one dose and/or reduce maintenance dose slightly; recheck INR.
, DOACs: Antidotes - ANS -idarucizumab and andexanet alfa: reverse the
anticoagulant effects of dabigatran and FXa inhibitors, respectively. Fresh frozen
plasma and prothrombin complex concentrate can also be used for rapid reversa
2017 ACC/AHA stages of hypertension - ANS -Normal BP: Systolic <120 mmHg and
diastolic <80 mmHg
Elevated BP: Systolic 120 to 129 mmHg and diastolic <80 mmHg
Stage 1: Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
Stage 2: Systolic ≥140 mmHg or diastolic ≥90 mmHg
Thiazide diuretics contraindication - ANS -Sulfa allergy
(Caution with gout, diabetes)
Also loop diuretics contraindicated with sulfa allergy
Patients with both ____, and ______ receive an extra benefit from thiazides. -
ANS -hypertension, osteoporosis
Potassium sparing diuretics black box warning - ANS -Hyperkalemia, which can be
fatal; higher risk with renal impairment, diabetes, elderly, severely ill
With severe__________ disease, all ACEIs, ARBs, and aliskiren are contraindicated
because of high risk of hyperkalemia. - ANS -renal /CKD
Loop Diuretics Adverse Effects - ANS -Electrolytes (hypokalemia, hyponatremia,
hypomagnesemia, and low levels of chlorine)
Hypovolemia and hypotension (dizziness, lightheadedness)
