NLN NE PHARM EXAM WITH VERIFIED SOLUTIONS 2024 ALREADY GRADED A+

Aminoglycosides -Use: Antibiotic -Examples: gentamycin, tobramycin, vancomycin, neomycin **Not all drugs ending in "-mycin" are aminoglycosides -IV or IM, only oral if for bowel prep -ADEs: Nephrotoxicity, ototoxicity, photosensitivity, superinfections, c-diff -Peak level: Draw 15-30 min after dose is completed -Trough level: Drawn within 30 min of giving next dose Blood administration -Start transfusion slow (2ml/min). Remain with the patient for first 15-30 min. If no signs of ADE, increase to desired rate -Largest gauge IV access as possible -Watch for acute rxn: allergic s/s - itching, rash, localized edema; febrile, septic, air embolism, circulatory overload -Delayed rxn: graft vs host, hemolytic, hepatitis Brainpower Read More Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:01 / 0:15 Full screen Treatment of diabetes in children (education) -wear bracelet or tag, teach how to give injection (90 degrees); 14-20 min sessions for children, 45-60 min for adults -Can start teaching children self management ~4-5 y/o, can given own insulin at 9 y/o supervised -Regular exercise is god, snack before and after -Carry glucose source at all times -simple sugar followed by complex CHO with protein source -After glucagon injection, turn child to side, risk for vomiting -Preferred DKA tx: insulin IV @ low dose -Run a mixture of insulin through the tubing before starting the drip because the insulin can chemically bind to plastic -Replace fluid over 24-48 hours HIV treatment inotropic medications -Positive inotropic meds increase cardiac contractility -examples: epinephrine, norepinephrine, dopamine -Negative inotropic meds decrease cardiac contractility, lower BP: examples -quinidine; betablockers (most end in 'olol") sulfonamides -Example: Bactrim -Anti-infective. -Bacteriostatic which action on bacteria results from interference with the functioning of enzyme systems necessary for normal metabolism, growth and multiplication -Treat: UTI, Chlamydia causing blindness, pneumonia, brain abscess, ulcerative colitis, active Crohn’s disease, rheumatoid arthritis -Side effects: Rash common; most are urticaria and maculopapular; GI symptoms; Bone marrow depression; Headache, dizziness, vertigo, ataxia, convulsion, depression -ADE/toxicity: Hepatotoxicity; Nephrotoxicity Stevens Johnson syndrome Do not use: known allergies to sulfa drugs; In polyuria, advanced renal or hepatic dysfunction; with intestinal and urinary blockage; asthma; -Take adequate amount to fluid ml/day to promote urinary output, at least 1500ml/d to prevent crystalluria/stone formation -May be taken after meals to prolong time in intestine. --Collect C&S prior to beginning therapy Thiazide diuretics -Examples: chlorothiazide (Hydrodiuril), hydrochlorothiazide (HCTZ, Diuril) -Name ends in ZIDE -non-potassium sparing diuretic. -Acts on distal tubes, blocks reabsorption of sodium, chloride and water. Leads to increased loss of Potassium. -Use for edema and mild to moderate hypertension -will see effect of within 1-4 wks -Side effects: Dizziness, vertigo, HA, weakness, dehydration, orthostatic hypotension; N/V, abdominal pain, diarrhea, constipation, frequent urination; dermatitis and rash; Electrolyte imbalance; impaired glucose tolerance -Adverse effects/toxicity: Renal failure, aplastic anemia, agranulocytosis, thrombocytopenia, anaphylactic reaction -Take early in the day to avoid nocturia -Take with food to avoid GI upset. -Thiazide is ineffective if creatinine clearance is <30ml/min -Eat foods high in potassium, restrict sodium, do not use salt substitute if taking potassium supplement -weigh self daily, report sudden weight gains or losses Avoid use with: Children; anuria Tricyclic Antidepressants -Examples: nortriptyline (Pamelor), amitriptyline (Elavil), doxepin (Sinequan), imipramine (Tofranil) -Most Tricyclics ends in INE -Initial mechanism of TCA takes 1-3 weeks to develop. -Maximum response is achieved in 6-8 wks -Has long half-life. -It is used to treat insomnia, attention deficit/hyperactivity and panic disorder -Side effects: orthostatic hypotension, sedation and anticholinergic effects -Adverse effects/toxicity: Most serious adverse effect is cardiac toxicity; in the absence of overdose or preexisting cardiac impairment, serious cardiotoxicity is rare; URINARY RETENTION IS URGENT; Overdose may cause convulsions -Take at nights, it causes sedation. -Do not take with MAO it will cause hypertensive crisis from excessive adrenergic stimulation of the heart and blood vessels, -monitor orthostatic BP of pt. in hospital -Use with caution: Glaucoma; Elderly; constipation; prostatic hyperplasia, as they are more sensitive to anticholinergic effect -Avoid use with: hypersensitivity, MI, Cardiovascular disease Hepatitis -inflammation of liver caused by virus, bacteria or exposure to meds or hepatotoxins -Stages of viral hepatitis: (1)Pre-icteric -precedes appearance of jaundice, may have flulike symptoms (2)Icteric -appearance of jaundice, elevated bilirubin, dark or tea colored urine, clay-colored stools (3)Post-icteric -convalescent stage; jaundice improves; color of urine and stool returns to normal Hepatitis A -Cause: enterovirus -At risk: Young children; Institutionalized people; Health care personnel -Transmission: fecal-oral; ingestion of food or liquids contaminated with the virus.; person by person contact -Incubation: 3-5 wks -Infectious: usually 2 wks. before the onset of jaundice and 1 wk. after onset of jaundice. -s/s: May have no symptoms initially -Complications: Fulminant hepatitis, death Hepatitis B -At risk: IV drug users; People on Hemodialysis; Health care personnel -Transmission: blood and body fluids, contaminated needles/parenteral, sexual activity -Incubation: 6-24 weeks -S/D: progression of symptom sis more insidious and prolonged than Hep A virus; Initially may be asymptomatic; 1 week-2 months of Prodromal symptoms: fatigue, anorexia, transient fever, abdominal discomfort, N/V, HA. -Then expanding to Hepatic S/S: photophobia, angioedema, rash, vasculitis, jaundice in Icteric phase -Complication: Cirrhosis, Fulminant hepatitis Hepatitis C -At risk: IV drug users, People receiving frequent transfusions, Healthcare personnel -Transmission: Same as Hep B; Blood and body fluids -Incubation period: 5-10 weeks -s/s: similar to HBV but often less severe. -Complications: chronic liver disease; Cirrhosis. Hepatitis D -Cause: Occurs only with Hepatitis B and only causes problems with an acute Hep B infection -At risk: common in Middle east, south Africa and Mediterranean -Transmission: same as Hepatitis B -Incubation period:7-8weeks -Hep D along with Hep B causes superinfection and worsening of condition and rapid progression of cirrhosis -Complications: As per Hep B Hepatitis E -Cause: waterborne virus -At risk: Travel to areas where sewage disposal is inadequate and/or people bathe in contaminated rivers -At higher risk with higher mortality: women in third trimester of pregnancy -Transmission: Same as Hep A -Incubation:2-9 weeks -Complications: Maternal and fetal demise Acetylsalicylic acid (Aspirin) -Non-narcotic analgesic; Antipyretic; Anti platelet -Blocks pain impulse in peripheral and some CNS; antipyretic result; inhibit platelet aggregation; Treat: TIA, Post MI, Stroke, angina -Side effects: Increases coagulation times, Reye’s syndrome (encephalopathy and fatty liver); GI bleed; tinnitus; liver toxicity (dark urine, clay stool, itching, yellowing sclera and skin); visual changes -Labs: Monitor coagulation studies -Teaching: Take with full glass of water, milk for food to prevent stomach upset; Do not crush enteric coated; given daily (81-325 mg) for cardiac prophylaxis post MI, stents, strokes, etc. -Do not use with: children under 12 and/or children or teenagers with chicken pox or flu like symptoms (because of risk of Reye’s syndrome); pregnancy in 3rdtrimester; and vitamin K deficiency Activated charcoal (Actidose) -Uses: Treat poison and overdose following oral ingestion; Binds to poison and prevent its absorption by the GI tract and then eliminates in the feces -Administer within 60 minutes of ingestion. -Give once or twice depending on the level of toxin. -May come pre-mixed with water (12.5-25 grams) -Side effects: Vomiting with rapid administration, pulmonary aspiration -Binding is irreversible so cathartic such as sorbitol may be added as well -It allows certain drugs/toxins to be drawn out of the blood and bind to charcoal in the intestine a kind of “gut dialysis” -Stools will be black -Charcoal does not change the stomach pH. -Do not administer with Ingestion of: caustic alkali agent; high viscosity petroleum products; OR when: convulsions are occurring; cardiac dysrhythmias are present; or there is emesis of blood -Implement antidote supportive care and prevent aspiration are if gastric lavage is not to be performed.