NR 565 Midterm exam point – Download To Score An A+

NR 565 Midterm exam point – Download To Score An A+ Exam Week 1: • Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to: Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors • The National Standards of Culturally & Linguistically Appropriate Services are required to be implemented in all: Organizations that receive federal funds • Warfarin (coumadin) resistance may be seen in patients with VCORC1 mutation, leading to: Decreased response to warfarin Week 2: • what is phase 3 trials: who do they run it on (Human safety & efficacy studies). Phase III trials are controlled and uncontrolled clinical trials of a drug’s safety and efficacy in hospital and outpatient settings. Phase III studies gather precise information on the drug’s efficacy for specific indications, determine whether the drug produces a broader range of adverse effects than those exhibited in the small study populations of phases I and II studies, and identify the best way of administering and using the drug for the purpose intended • off label drugs who are they approved by FDA. Off-label prescribing is: Legal if there is scientific evidence for the use. Offlabel use includes use of an FDA-approved drug in a dose or route for which it was not approved or for a clinical indication other than the FDA-approved use. • The U.S. Food & Drug Administration regulates: The official labeling for all prescription & over-the-counter drugs • The ailment that generates the greatest over-the-counter annual drug sales is: Cough & colds Week 3: • There is a narrow margin between first appearance of adverse reaction to AChE inhibitors & serious toxic effects. Adverse reactions that require immediate action include: Fasciculations of voluntary muscles • Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia & block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs & so can be used to warn diabetics of possible decreased blood glucose? Diaphoresis • 60 year old male with TN beta-adrenergic antagonist, effect of the beta blocker do: reduce cardiac contractility, reduce HR and BP?? A 60-year old male is being treated for hypertension with a beta-adrenergic antagonist (beta-blocker). Which of the following is an expected cardiovascular effect of the beta-blocker class of drugs? Reduced cardiac contractility • HTN and BPH. Doxazosin. What are the drugs of choice for treating hypertension in older men with concomitant BPH? Alpha1-adrenergic antagonists (except alfuzosin, tamsulosin, and silodosin, which are not approved to treat HTN) are the drugs of choice for treating HTN in older men with concomitant BPH. What are they? Doxazosin orthostatic hypotension is one of the main concerns when initiating alpha-1 blocker • Define bioavailability? The percentage of the administered dosage that enter the blood stream. Pharmacokinetic factors that affect prescribing include: bioavailability Dose response curve answer choice • A patient with anxiety & depression may respond to: Buspirone (Buspar) & an SSRI combined o An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be: Buspirone (Buspar) • Dosage of Cymbalta and how do you adjust it: 40–60 mg/day, max 60 mg • What route is effected with firs-pass Metabolized first pass in the liver: PO, IV, IM. Drugs that have a significant first-pass effect: Are rapidly metabolized by the liver & may have little if any desired action. • When two or more medications are prescribed that are highly protein bound, what is the clinical outcome? Coumadin and protein binding. What happens when you give two drugs together increases level Warfarin is 98% bound to plasma proteins so even if the binding of a second drug to plasma proteins displaces even a small fraction of warfarin, it can have a dramatic increase in the effects of warfarin • Coumadin and NSAID interact. When prescribing NSAIDS, a complete drug history should be conducted as NSAIDs interact with these drugs: Warfarin (coumadin), an anticoagulant • Allergic Reaction that involved angioedema and what do you give. Epi? Patients should be monitored for indications of angioedema. Suspect angioedema in any patient who calls the next morning after taking the first dose and complains of voice changes or swollen lips or tongue. Stop the drug immediately. The symptoms recede as the drug is eliminated. Protection of the airway is rarely needed, but careful assessment of airway status is required. o A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which of the following statements is true about this adverse response? 1. Swelling of the tongue or hoarseness are the most common symptoms. • to ace inhibitors. Patients who have angina, regardless of class, who are also diabetic, should be on: ACE inhibitors. o Angiotensin-converting enzyme(ACE) inhibitors treat hypertension because they: 1. Reduce sodium & water retention 2. Decrease vasoconstriction 3. Increase vasodilation 4. All of the above. o Ray has been diagnosed with hypertension & an angiotensin-converting enzyme inhibitor is determined to be needed. Prior to prescribing this drug, , the NP should assess for: Decreased renal function • Class of drugs certain meds were • Class 2 controlled substance, codeine, meperidine, opium, hydromorphone, oxycodone, oxymorphone, methadone, fentanyl) Stimulants (cocaine, amphetamine, methylphenidate) Depressants (pentobarbital, secobarbital) • difference between class 2 and 5 May be dispensed without a prescription unless regulated by the state o class 2 No refills permitted, No telephone orders unless true emergency and followed up by written prescription within 7 days. Drugs that are designated Schedule II by the U.S. Drug Enforcement Administration: May not be refilled; a new prescription must be written • What is a major barrier in fully understanding the racial differences in drug pharmacokinetics seen in American Indian or Alaskan Natives? more research is needed to identify further racial/ethnic differences in drug pharmacokinetics in this ethnic group. The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are: Largely unknown due to lack of studies of this population • What class of drug is clonidine? Alpha2 agonist, central acting adrenergic blocker. gradually taper the dose when discontinuing the medication over 4 days. dry mouth, insomnia being the most common adverse reaction • Brand of drugs for migraine to treat? Class? Triptans • zolmitriptan (Zomig). serotonin receptor agonist to treat migraine • first dose of any of the triptans under direct supervision to monitor for unrecognized coronary disease. The patient should receive the first dose in the clinic (or urgent care center) and be monitored for any adverse cardiovascular effects. • Nonpharmacologic therapy for tension headaches includes: 1. Biofeedback 2. Stress management 3. Massage therapy 4. All of the above • Stress management • Biofeedback • Regular exercise • Topical Heat/Cold packs • Massage therapy/relaxation • Acupuncture/herbal medication • Possible referral to psychiatrist or psychologist for possible contributing underlying anxiety • Migraine therapy usually supported by what therapy: abortive. Most patients with migraine need only abortive therapy for their headaches. • If migraine frequency is greater than twice a month and/or severely debilitating or if abortive agents are ineffective, the health-care provider should consider prescribing daily preventive therapy. • 4 drugs which one is pregnancy B? Sotalol and pindolol are listed as Pregnancy Category B. • Tetracycline questions? When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient: Not to take antacids while on these medications, as the antacid decreases absorption • What causes EPS effects how are the caused mechanism of action. EPSs manifest when dopamine receptor occupancy within the basal ganglia reaches approximately 80% as the dopamine-mediated inhibition of movement is now disinhibited • Carvedilol and labetalol taken together has to do with antipsychotic. Aytipcal Risperdone, Seroquel Use with antihypertensives may increase orthostasis. With Typical Haloperidol (Haldol) Increased effect of both drugs. • SSRI which benzo would you give for different scenarios. In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is: Alprazolam (Xanax). o When prescribing temazepam (Restoril) for insomnia, patient education includes: Temazepam should not be used more than three times a week for less than 3 months o An appropriate drug to initially treat panic disorder is: Diazepam (Valium) o For long-term treatment of anxiety, other classes of drugs should be considered first (e.g., buspirone or SSRIs); and if the benzodiazepine is necessary, then clonazepam is preferred due to its long half-life and daily dosing ability. o Clonazepam is preferred due to its long half-life and daily dosing schedule. • Wean off beta blockers: decrease dose by ½ for 4 days, Cardiovascular t life-threatening events from rapid withdrawal of a beta blocker: The dosage should be decreased by one-half every 4 days • Tegretol, which drug should you give with anticonvulsant. Carbamazepine has a Black-Box Warning regarding serious dermatological reactions, particularly among patients of Asian ethnicity. (Stevens–Johnson syndrome and toxic epidermal necrolysis) and the risk of developing aplastic anemia and agranulocytosis. o Patients of Asian ethnicity should be screened for the presence of the HLA-B*1502 genetic variant prior to starting carbamazepine. o Tell the patient that administration with food may increase absorption, and because carbamazepine can be sedating, care should be exercised in situations in which mental and physical alertness is required for safety o Do not give during or within 14 d of MAOI use (phenelzine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate), and selegiline (Emsam) • Charlie is a 65-year-old male who has been diagnosed with hypertension & benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it: Relaxes smooth muscle in the bladder neck • Positive and negative effects: what drug? Aytipcal antipshycotics address both the positive and negative symptoms of schizophrenia.- aripiprazole (Abilify), asenapine (Saphris), clozapine (Clozaril), iloperidone (Fanapt), lurasidone (Latuda), olanzapine (Zyprexa), paliperidone (Invega), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon). • SSRI and side effects: weight gain. What “onset of action” symptoms should be reviewed with patients who have been newly prescribed a selective serotonin reuptake inhibitor: They can feel a bit of nausea, but this resolves in a week. o Most common are nausea and sometimes vomiting, headache, light-headedness, dizziness, dry mouth, increased sweating, weight gain or loss, exacerbation of anxiety, and agitation. o Symptoms of serotonin syndrome are nausea, diarrhea, chills, sweating, hyperthermia, hypertension, myoclonic jerking, tremor, agitation, ataxia, disorientation, confusion, and delirium. • Gabapentin. Giving it with something else. Gabapentin is a good choice to prescribe as an anticonvulsant in conjunction with oral contraceptives. o New onset seizure what med would you start her on in relation to birth control. ▪ the overall risk of malformations in children exposed to phenytoin during pregnancy is 10%. Pregnant women who take phenytoin can decrease the risks to the fetus by taking 400 international units (IU) of folic acid per day. ▪ Oral estrogen-containing contraceptives decrease lamotrigine levels by approximately 50%. If the patient is already taking lamotrigine and an oral contraceptive is started, the lamotrigine dose is increased 50 mg/d weekly. The lamotrigine dose may need to be twice the normal dose. ▪ Anticonvulsants in general are associated with fetal defects, but the succinimides (ethosuximide (Zarontin) and methsuximide (Celontin) absence seizures., with careful monitoring of plasma levels, appear to be safe for use during pregnancy and are Pregnancy Category C. Succinimides may decrease the effectiveness of oral contraceptives; thus, the patient should be advised to use a backup birth control method. ▪ Keppra does not interact with oral contraceptives o Beta blockers are one of the first-line choices for migraine preventive therapy. Propranolol (Inderal) and timolol (Blocadren) are the only beta blockers that have been FDA approved for migraine preventive therapy ***Muscarinic antagonist: Miochol mech of action to dilate the eye • By inhibiting CYP isozymes, there is the potential to increase therapeutic plasma concentrations, with potential increase in adverse effects, of ~50 commonly prescribed drugs and classes of drugs. • Quetiapine and aripiprazole can be used as adjunct therapy in patients also being treated for major depressive disorder. • What dosing of propranolol has been proven effective in reducing the incidence of migraine headaches? Answer: Propranolol in doses of 20 to 80 mg 3 or 4 times daily. dose is not obtained in 4 to 6 weeks, the drug should be gradually withdrawn • Question: What should be the first consideration in selecting the most appropriate beta blocker? Answer: In selecting the most appropriate beta blocker, first consideration is usually given to β1 selectivity ("cardio-selectivity) • What is the dosing schedule of donepezil? How is increased? What is the maximum dose? When should higher doses be used? The recommended starting dose of donepezil is 5 mg daily at bedtime. Doses are increased at 4- to 6-week intervals to reduce adverse reactions. The maximum dose is 10 mg daily. The higher dose should be used if tolerated because it is more efficacious, especially for severe disease o Kenneth is taking warfarin & is asking about what he can take for minor aches & pains. The best recommendation is: Acetaminophen, not to exceed 4 grams per dayp