NUR 635 Pharm Final Exam Questions and Answers (Already GRADED A)

While rational drug selection is based on the individual patient the aspect of rational drug selection addressing disease-specific information by a national medical or nursing organization is A. a guideline. B. cost. C. availability. D. patient hepatic and renal function. A. a guideline Drugs that alter synaptic transmission are much more selective than those that alter axonal conduction, why is this? a drug that affects the axonal conduction - non-selective effect. Drugs that alter synaptic transmission - very selective because of the differences in synapses and their specific neurotransmitters What is phenytoin used for? Seizures What should you monitor for with phenytoin? Delayed hypersensitivity - even 1 month later What is carbamazepine used for? Seizures What may cause carbamazepine levels to drop despite no other change? What to do? Autometabolization of drug. Increase dose. What is the black box warning for carbamazepine? Steven-Johnson Syndrome & TENS Monitoring for carbamazepine, and how often? CBC, 3-4 times a year What population is most at risk for Steven-Johnson syndrome & TENS when taking carbamazepine? Asian patients Main class of medication for depression? Selective serotonin reuptake inhibitors (SSRIs) What to watch for with SSRIs? Other medications that can cause serotonin syndrome What is lamictal used for? Seizures Patient on lamictal has fever, rash, swollen lymph nodes. What are we concerned for? Hypersensitivity in lamictal can lead to MODS Patient on lamictal wants birth control. What do we need to change? Increase lamictal dose. When will pt notice improvement after starting an SSRI? 4 weeks later 1st line medication for moderate generalized anxiety Buspar (SNRI) 1st line med for classic migraines Triptans 2nd line treatment for classic migraines Prophylactic - propranolol Why is important that NPs have the authority to prescribe? Increase access to healthcare What must be done if a drug has a narrow therapeutic index? Frequent serum level monitoring Why would 10mg percocet or 10mg oxy work better than the other? Differences in pill filler composition What do medications need in order to be effective: Albumin (binding to) If a patient has a toxic drug level, but normal albumin, what could be happening? Other drugs competing for albumin What does "Sig" mean on a prescription? Directions to pharmacist What items are necessary on a prescription? Drug, dose, route, frequency, quantity, refills Abbreviations to not use QD What drug may cause grey teeth? Tetracyclines Pt reports no improvement in seizures after treatment for a few weeks. What next Assess drug levels for therapeutic index If patient on phenytoin wants birth control? Not oral contraceptives! IUD better Patient on teratogen med wants to get pregnant. When should they stop? Before getting pregnant, beware first trimester Pregnant pt has been taking daily aspirin. Concern for what? Premature close of PFO Pain treatment for shingles? Lidocaine after lesions heal How does reglan help with GERD? Increases esophageal tone Who should not take calcium carbonate antacids? Pt with kidney stones Pt on minocycline with HA. Pt has what? Pseudotumor Cerebri Why do we rotate off phentermine? Pt will develop tolerance Education on flagyl? Avoid alcohol - severe reaction What is minocycline? Tetracycline for acne Minocycline can be given safely to? Adolescents (no pregnancy or liver fx) New dx of GERD. First therapy? How often? H2 blocker - BID Paxil side effects to educate? Sexual dysfunction, can resolve on its own What medication for pregnant UTI? Amoxicillin Theophylline, NV/HA after starting. What do? See if it resolves in a couple of days ICS and beta agonist. Which first? Beta first, then ICS SSRI Paxil, how long til it works? 2-6 weeks Pt high risk for osteoporosis. Education? Vit D/Calcium + weight bearing exercise Pt started on antibiotics. Bloody diarrhea. Pt has? C. diff Asthma patient, education on worsening symptoms? Call provider, use rescue inhaler more Patient with panic disorder? valium Adverse effects of singular? Aggression, anxiety, suicidal ideation Depression with anxiety, what med? Lexapro What to check before starting pt on acyclovir? Renal function How long til improvement on Celexa? 1-2 weeks Step down approach for GERD, what do they start on? PPIs Known G63D deficiency, what antibiotic can you not prescribe? Sulfas Chantix - pt education? Psych side effects, dreams, suicide ideation Why should older patients take 2nd gen antihistamines rather than 1st? CNS effects & urinary retention Genital herpes outbreak, what med? Acyclovir UTI, med, how long? Bactrim, 3 days MRSA skin infection. What med? Bactrim Patient has pheochromocytoma. What med to avoid? Albuterol - hypertensive crisis How to taper medication? Decrease by 50% every 3-4 days What is methylnaltrexone? Treats opioid associated constipation SSRI, wants something for weight loss. Why not phentermine? Serotonin syndrome Sprained ankle with soft tissue swelling, what med? NSAID Neuropathic pain, med? Gabapentin Adverse drug reaction of haldol? Extrapyramidal symptoms. When to take dimenhydrinate? 15 min prior to trip Antifungal therapy long term puts you at risk for? liver toxicity Giving pt eye drops, education? don't wear contacts, wash hands in between handling Who should avoid ophthalmic beta blockers? Pts on beta blockers What bronchodilator is safe on beta blocker? Ipratropium How to antacids work? increases our pH Lithium education? sodium can influence your lithium levels. So intake should be consistent. PPIs long term, monitor for? Osteoporosis, check calcium. Anemia. Antibiotic education? Finish course of therapy. Drink lots of water. How quickly should you see improvement in pneumonia with antibiotics? 48-72 hours Long term lactulose for constipation, what do you monitor? Potassium and chloride Patient started on ICS. Education? rinse mouth after every use Patient with PUD has Hpylori. 1st treatment? PPI + amoxicillin + clarithromycin What medication can aggravate GERD by affecting esophageal tone? Estrogen Why do long acting beta agonists have blackbox warning? Can be accidently taken instead of albuterol for acute asthma attack Allergy to PCN. What else can they not receive? Why? Cephalosporins, both vulnerable to beta lactamase producing organisms Gonorrhea in a 20yo female with oral contraceptives. Education? Need back up until next menses How to treat eye gonorrhea? Ceftriaxone, eye drops Who is most at risk for a fatal asthma attack? Previous hx of intubation What can help with peripheral neuropathy? B6 When can you prescribe tamiflu? can only give in first 24 hrs of symptoms Treating depression, pt feels only partial improvement. What next? change drug or increase dose New onset of mild-mod anxiety, first treatment? buspar Levaquin blackbox warning tendon rupture Decongestant to older patients, what route? Nasal, no systemic side effects Child with acute otitis media, how to treat pain? Lidocaine eardrops Azithromycin - how to dose? Titrating z pack Otitis externa, how to treat? Cipro and hydrocortisone drop Contraindications to antibiotic ear drops? Ruptured tympanic membrane Pt with acute otitis media with conjunctivitis? High dose amoxicillin Why do we worry about st johns wort? Interacts with many medications, accelerates metabolism of drugs Why does topamax help you lose weight? Gives sensation of fullness Severe alcoholic with bad withdrawal? Thiamine and banana bag. Pt malnourished, infected mouth, sores. Suspect? Scurvy Pt has flushing, what could they be taking? May be taking niacin How to treat elevated ammonia? Lactulose Biggest side effect of hydrocodone - constipation, how to treat? Senna, docusate, miralax Step 1 management of asthma? short acting alpha 2 Guaifenesin - how does it work? thins secretions, easier to cough up How to treat afrin overuse? Nasal steroids while weaning Alendronate education? 30 min before meal, lots of water Increase pain with paget's disease, what treatment? Calcitonin salmon What is paget's disease? Abnormal bone reabsorption More than 3 gout flare ups in past year? Allopurinol What is probenecid used for? Chronic gout New diagnosis of rheumatoid arthritis, what med? Methotrexate Which vaccines don't we need at age 11? Hep B, PCV23 Education on flexeril (cyclobenzaprine)? CNS depression, urinary retention, blurred vision Pilocarpine - what does it do? Drains fluid from the eye to treat glaucoma Why do we no longer prescribe demerol? Many side effects Patient on hydrocodone, not as effective. Why? Developed a tolerance (increase dose) How to dose pancreatic enzymes? Units of lipase Who needs pancreatic enzymes? Cystic fibrosis, gastric bypass How to titrate pancreatic enzymes? Based off poop color (steatorrhea) Soft tissue only mrsa? sulfamethoxazole/trimethoprim (Bactrim) More invasive MRSA, med? cephalexin (Keflex) Why do we not treat onychomycosis? Liver toxic Community acquired with comorbidities - outpatient? Rocephin + azithromycin How to treat PUD peptic ulcer disease? PPI + clarithromycin + amoxicillin Mild intermittent asthma SABA 1st step of asthma albuterol 2nd step of asthma give SABAs How do you know you need to bump up asthma tier plan? Rescue inhaler more than 2x week or more than 1x day. Why should a pt never run out of paxil? Short half life. Will withdraw really quick Pt with new onset depression. What to check first? Check thyroid labs