lOMoARcPSD|45010774
FNPExam Study Guide
Advanced Nurse Practice in Obstetric Health Care (Walden University)
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Pharmacology
Concepts
Pharmacokinetics: movement of drugs through body
Pharmacodynamics: physiologic and biochemical effects of drugs
Pharmacogenomics: study of how genes affect response to meds
Half-life: amount of time it takes for drug concentration to decrease 50%
First-Pass Effect: oral drug enters portal circulation - in liver, CYP450 metabolizes
drug, then it is released to body; can bypass first-pass effect via IV,
gels/creams/patches, buccal
o
When asked about drug interactions, think of these:
- Macrolides
PC
- Antifungals
- Cimetidine
- Citalopram
- Protease inhibitors
- Grapefruit juice
yN
- interacts with statins, erythromycin, CCBs, antivirals, amiodarone,
benzos, cisapride, carbamazepine, buspirone
Safety Issues with Common Meds
m
Drug Safety Issue
H2 antagonists e.g. Mental status changes w/ kidney disease
ranitidine, Avoid if creatinine clearance < 50 mL/min
om
famotidine
PPIs e.g. Risk of fractures, PNA, CDiff, hypomagnesemia, B12 and iron
omeprazole, malabsorption, atrophic gastritis, kidney disease
pantoprazole Interactions: warfarin, diazepam, carbamazepine,
M
phenytoin, ketoconazole
Warfarin Interacts with “G” herbs - garlic, ginger, ginkgo, ginseng
D/C 7 days before surgery
Thiazolidinediones black box: exacerbate CHF, do not use if NYHA Class III or IV
e.g. pioglitazone HF
Contraindications: MI, stroke, bladder CA, T1DM, eye/liver
1
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problems
Atypical High risk of weight gain, metabolic syndrome, T2DM -
antipsychotics e.g. monitor weight every 3 months
risperdal, zyprexa, black box: higher mortality in elderly
seroquel Monitor TSH, lipids, A1C, weight/BMI
Bisphosphonates erosive esophagitis - take with 8oz glass water, do not lie
e.g. alendronate, down 30 min
risedronate Contraindications: GERD, PUD, CKD, esophageal stricture
o
Statins Do not give with grapefruit juice
Simvistatin - highest risk of rhabdomyolysis
PC
Systemic cataracts, osteoporosis, skin changes, emotional lability,
glucocorticoids weight gain, high BP
Phenytoin (Dilantin) early toxicity signs: nystagmus, unsteady gait
severe: slurring, lethargy, confusion, coma
yN
Digoxin
- Not 1st-line anymore for HF
- narrow therapeutic index (-0.5 - 2.0 ng/mL)
- Life threatening effects: severe bradycardia, heart block, vtach, vfib
m
- s/s of OD: N/V, hyperkalemia, brady or tachy, yellowish/green tinged
vision/halos
Warfarin
om
- Therapy for a-fib is is an INR of 2.0 – 3.0
- Goal for those with synthetic heart valve is 2.5-3.5
- Vitamin K rich foods decrease INR (vitK is a blood clotter and blocks effects of
warfarin
Learn how to manage elevated INR: (higher INR, thinner the blood, longer it takes to
M
clot)
- INR 4.0 – 4.99: Skip next dose and/or reduce the maintenance dose slightly.
Check INR once or twice a week when adjusting dose. Do not give Vit K
- INR 5.0 – 9.0: Hold one or two doses; with or without administration of low
– dose vitamin K (1 to 2.5mg). Monitor INR every 2 to 3 days until it is stable.
Decrease the warfarin maintenance dose.
CAM/Herbal Supplements:
Ginger
2
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, lOMoARcPSD|45010774
- For nausea, dyspepsia, constipation
- Think about pregnant women that eat ginger candies for nausea
Ginseng
- Overall increases physical and mental health, lowers cholesterol
St. John’s Wort
- Depression, anxiety, sleep disorder
- Think John is an old anxious and depressed man who can’t sleep
Echinacea
- Helps with common cold
- Think “ech”, like feeling “ech” during a cold
o
Ginkgo Biloba
- Memory and concentration
PC
- Think “Biloba” is an old grandma
Kava Kava
- Relaxation
- Think it’s kind of like “woooosah” but “kaavaaa”
Garlic
yN
- Improve digestion, energy levels
Evening Primrose and Black Cohosh
- Improve menstrual discomfort
- Think Primrose and Cohosh are flowers, and flowers associated with women
m
Antibiotics
Gram-Positive and Gram-Negative Organisms
om
4 Common Gram-Positive Bugs To Know
- Staphylococcus
- Streptococcus
- Enterococcus
- C. diff
M
- (The coccs & c.diff)
If not one of these … then it’s gram negative:
- N. gonorrhoeae
- N. meningitidis
- E. coli, Shigella, Campylobacter, Salmonella
- Pasteurella
- Rickettsia, Borrelia
- Proteus, Pseudomonas, Legionella, others
3
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FNPExam Study Guide
Advanced Nurse Practice in Obstetric Health Care (Walden University)
Scan to open on Studocu
Studocu is not sponsored or endorsed by any college or university
Downloaded by Splash Spashnet ()
, lOMoARcPSD|45010774
Pharmacology
Concepts
Pharmacokinetics: movement of drugs through body
Pharmacodynamics: physiologic and biochemical effects of drugs
Pharmacogenomics: study of how genes affect response to meds
Half-life: amount of time it takes for drug concentration to decrease 50%
First-Pass Effect: oral drug enters portal circulation - in liver, CYP450 metabolizes
drug, then it is released to body; can bypass first-pass effect via IV,
gels/creams/patches, buccal
o
When asked about drug interactions, think of these:
- Macrolides
PC
- Antifungals
- Cimetidine
- Citalopram
- Protease inhibitors
- Grapefruit juice
yN
- interacts with statins, erythromycin, CCBs, antivirals, amiodarone,
benzos, cisapride, carbamazepine, buspirone
Safety Issues with Common Meds
m
Drug Safety Issue
H2 antagonists e.g. Mental status changes w/ kidney disease
ranitidine, Avoid if creatinine clearance < 50 mL/min
om
famotidine
PPIs e.g. Risk of fractures, PNA, CDiff, hypomagnesemia, B12 and iron
omeprazole, malabsorption, atrophic gastritis, kidney disease
pantoprazole Interactions: warfarin, diazepam, carbamazepine,
M
phenytoin, ketoconazole
Warfarin Interacts with “G” herbs - garlic, ginger, ginkgo, ginseng
D/C 7 days before surgery
Thiazolidinediones black box: exacerbate CHF, do not use if NYHA Class III or IV
e.g. pioglitazone HF
Contraindications: MI, stroke, bladder CA, T1DM, eye/liver
1
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, lOMoARcPSD|45010774
problems
Atypical High risk of weight gain, metabolic syndrome, T2DM -
antipsychotics e.g. monitor weight every 3 months
risperdal, zyprexa, black box: higher mortality in elderly
seroquel Monitor TSH, lipids, A1C, weight/BMI
Bisphosphonates erosive esophagitis - take with 8oz glass water, do not lie
e.g. alendronate, down 30 min
risedronate Contraindications: GERD, PUD, CKD, esophageal stricture
o
Statins Do not give with grapefruit juice
Simvistatin - highest risk of rhabdomyolysis
PC
Systemic cataracts, osteoporosis, skin changes, emotional lability,
glucocorticoids weight gain, high BP
Phenytoin (Dilantin) early toxicity signs: nystagmus, unsteady gait
severe: slurring, lethargy, confusion, coma
yN
Digoxin
- Not 1st-line anymore for HF
- narrow therapeutic index (-0.5 - 2.0 ng/mL)
- Life threatening effects: severe bradycardia, heart block, vtach, vfib
m
- s/s of OD: N/V, hyperkalemia, brady or tachy, yellowish/green tinged
vision/halos
Warfarin
om
- Therapy for a-fib is is an INR of 2.0 – 3.0
- Goal for those with synthetic heart valve is 2.5-3.5
- Vitamin K rich foods decrease INR (vitK is a blood clotter and blocks effects of
warfarin
Learn how to manage elevated INR: (higher INR, thinner the blood, longer it takes to
M
clot)
- INR 4.0 – 4.99: Skip next dose and/or reduce the maintenance dose slightly.
Check INR once or twice a week when adjusting dose. Do not give Vit K
- INR 5.0 – 9.0: Hold one or two doses; with or without administration of low
– dose vitamin K (1 to 2.5mg). Monitor INR every 2 to 3 days until it is stable.
Decrease the warfarin maintenance dose.
CAM/Herbal Supplements:
Ginger
2
Downloaded by Splash Spashnet ()
, lOMoARcPSD|45010774
- For nausea, dyspepsia, constipation
- Think about pregnant women that eat ginger candies for nausea
Ginseng
- Overall increases physical and mental health, lowers cholesterol
St. John’s Wort
- Depression, anxiety, sleep disorder
- Think John is an old anxious and depressed man who can’t sleep
Echinacea
- Helps with common cold
- Think “ech”, like feeling “ech” during a cold
o
Ginkgo Biloba
- Memory and concentration
PC
- Think “Biloba” is an old grandma
Kava Kava
- Relaxation
- Think it’s kind of like “woooosah” but “kaavaaa”
Garlic
yN
- Improve digestion, energy levels
Evening Primrose and Black Cohosh
- Improve menstrual discomfort
- Think Primrose and Cohosh are flowers, and flowers associated with women
m
Antibiotics
Gram-Positive and Gram-Negative Organisms
om
4 Common Gram-Positive Bugs To Know
- Staphylococcus
- Streptococcus
- Enterococcus
- C. diff
M
- (The coccs & c.diff)
If not one of these … then it’s gram negative:
- N. gonorrhoeae
- N. meningitidis
- E. coli, Shigella, Campylobacter, Salmonella
- Pasteurella
- Rickettsia, Borrelia
- Proteus, Pseudomonas, Legionella, others
3
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