PC 707 Final Safety Exam Questions & Answers Correct 100%

IgE mediated allergic reaction that happens after the 2nd exposure to the antigen? - Answer Type I Immediate hypersensitivity Delayed Allergic reaction involving T cell in the skin? - Answer Type IV Reaction Primary treatment for a Type 1 Allergic response? - Answer Epinephrine Adjunctive treatment for a Type 1 Allergic response - Answer ‣ H1 Blockers ‣ Corticosteroids help prevent bi phasic reactions ‣ Bronchodilators provide some relief- One of the most Severe forms of a Type IV allergic reactions. - Answer ‣ Stevens Johnson Syndrome ‣ Toxic epidermal necrolysis When considering a drug "re challenge" after reaction what are crucial factors the APRN must consider? - Answer ‣ What drug the patient reacted to ‣ The severity of the reaction (never again in Type I or severe type IV) *most important* What Black Box Warning does Carbamazepine & Lamictal carry? - Answer Potential life-threatening dermatologic reaction, including Steven's Johnson and Toxic Epidermal Necrolysis What Black Box Warning does Promethazine (Phenergan) antiemetic carry? - Answer Potential for life threatening respiratory depression in children. What Black Box Warning do Fluoroquinolones carry? - Answer Potential for tendon rupture What Black Box Warning does SSRIs carry? - Answer Potential increased risk of suicide in teens. What Black Box Warning does opioids carry? - Answer Combining opioids & benzodiazepines can cause extreme sleepiness, slowed breathing & death Insulin/Sulfonaureas adverse effect - Answer Hypoglycemia! Tricyclic Antidepressants - Answer Very risky for overdose Nitrofurantoin (Macrobid) adverse effect - Answer Pulmonary Toxicity (rare ) Proton Pump Inhibitors Increases the risks for - Answer ‣ Upon starting: Community acquired pneumonia ‣ Over time more likely to get infections like TB ‣ Over time possible increased potential for fractures Bisphosphonates potential risk - Answer osteonecrosis of the jaw As we age, our kidneys become smaller & there is a decrease in renal blood flow. Why is this a prescribing consideration? - Answer Decreased renal clearance of drugs As we age, our liver become smaller, has decreased blood flow & first pass metabolism decreases. Why is this a prescribing consideration? - Answer Decreased liver size also means decreased production of CYP 450 enzymes! So if you need to select a drug for the elderly, try to select drugs that use Phase 2 metabolism (not affected by age) Phase I is affected & involves the CYPs. AS we age, there is a decrease in total body water by 10-15%! Why is this a concern when prescribing for the elderly? - Answer Decrease in total body water results in decreased distribution of water soluble medications & causes increased serum levels of drugs. Why are the elderly at higher risk of Torsades de Points? - Answer Elderly tend to be on more drugs, so more of a chance to have multiple QT prolongation drugs. Additional risk of TdP with low potassium, *low magnesium* & bradycardia- more common in the elderly. Afib more likely What are the concerns with anticholinergic drugs & the elderly? - Answer In the elderly Anticholinergic drugs can cause: ‣ Memory impairment, ‣ confusion, ‣ falls, ‣ hallucinations, ‣ tachycardia & ‣ acute angle glaucoma What class of drugs do you have to assess & monitor for Rhabdomyolysis? - Answer Statins Rhabdomyolysis S&S - Answer ‣ muscle complaints do not involve joints, ‣ involve large muscle groups proximal to trunk, commonly legs, low back & ‣ are symmetrical. What to do if pt on statins c/o muscle pains s&s of rhabdomyolisis? - Answer ‣ stop for 2-4 weeks, ‣ address the possibility of rhabdomyolysis by evaluating CK & creatinine & performing urinalysis for myoglobinuria ‣ If not Rhabdo- consider restarting lower does ‣ (look for d2d cyp issues). ‣ If Rhabdo- no more statins ever. NSAIDS & clotting - Answer NSAIDS interfere with clotting & promote bleeding NSAIDS & GI bleed - Answer strip stomach lining & increase chance of GI bleed NSAIDs & HTN - Answer cause fluid retention- & can worsen HTN, CHF, Edema, & cause repeat MIs