Maryville NURS 615 Pharm Midterm Exam 2025

Carbamazepine (Tegretol) can sometimes show sub therapeutic range due to what? - Carbamazepine auto-induces metabolism, leading to lower levels despite good compliance What are the black box warnings for Carbamazepine? - -Dermatologic reactions 1. Steven's Johnson 2. Toxic epidermal necrolysis What lab test should be ordered for patients on Carbamazepine? - -CBC every 3-4 months because it can cause decreased WBC, decreased platelets, and trouble with RBC What kind of teaching needs to be done with families of patients who have seizure disorders? - -Prevention is important, patient safety is important, Do NOT abruptly stop taking medication. Ethosuximide (Zarontin), an anti-seizure medication can cause what? - -Blood dyscrasias Patients taking Topiramate need to be monitored for what electrolyte imbalance? - Decreased sodium bicarb leading to hyperchloremic metabolic acidosis Topiramate treats seizures and what is one common side effect? - -Normal side effect is weight loss, especially in higher dose patients A child on Topiramate that wants to play sports should monitor what? - -Don't get overheated. Topiramate may affect his ability to sweat in the heat. What should a pregnant patient be told about taking Valproate (Depakote)? - -It is a known teratogen and category X medication. It should not be used in the first trimester, it may be restarted in second trimester. What patient population should tricyclic antidepressants be used cautiously in? - -Heart Disease patients Phenelzine (Nardil) is a MAOI. What teaching needs to be done with this medication? - He should not use serotonergic drugs like Imitrex. Also, this class of medication interacts with yogurt, sour cream, soy sauce, etc. Phenelzine (Nardil) may cause what if there is an interaction with known contraindicated foods? - -Hypertensive crisis NUR 615 NUR 615 What are the side effects of tricyclic antidepressants? - -Anticholinergic type effects like dry mouth, sedation, constipation, increased appetite, blurred vision, tinnitus, euphoria, mania How long does it take for SSRIs to take effect - -2-6 weeks SSRIs may cause what onset of action symptoms? - -Nausea, but this will usually resolve in a week. What is one thing you should not do with SSRIs? - -Drink alcohol What should happen when going off an SSRI? - -Wean slowly, do not stop abruptly What medications would a patient with depression and anxiety respond well to? - Buspar and an SSRI combined Celexa (Citalopram) Lexapro (Escitalopram) Why should you combine an SSRI with Buspar? - -Buspar augments the SSRI and is a good combo for anxiety and depression What is a first line drug for mild to moderate generalized anxiety disorder? - -Buspirone How fast does Celexa start to demonstrate effects? - -Improved appetitie and concentration in 1-2 weeks. What is a major drug to treat bipolar disease? - -Lithium Blood levels need to be monitored with Lithium because why? - -Lithium has a narrow therapeutic range so it is important to recognize toxicity What are symptoms of lithium toxicity? - -Drowsiness and Nausea What dietary teaching needs to be done with patients taking lithium? - -Salt intake needs to be consistent What are the side effects of SSRIs (selective seratonin reuptake inhibitor)? - -N/V, dizziness, light headedness, dry mouth, increased sweating, weight changes, agitation, sexual side effects. What are the side effects of SNRIs (serotonin norepinephrine reuptake inhibitor) - Headache, somnolence, dizziness, insomnia, nervousness, dry mouth, constipation, abnormal ejaculation, anorexia/weight loss, elevated BP NUR 615 NUR 615 What are the side effects of MAOIs? - -Insomnia, anxiety, agitation, dizziness, headache, restlessness, hypotension, dry mouth, blurred vision, constipation What Benzo has the greatest likelihood of dependence? - -Xanax /alprazolam What receptors do Benzos act on? - -Enhances the neurotransmitter GABA (gamma aminobutyric acid) receptors What result do Benzos have on the body? - - sedative hypnotic anxiolytic anticonvulsant muscle relaxer What are long acting Benzos prescribed for? - -Treatment of anxiety What are short acting Benzos prescribed for? - -Treatment of insomnia What would be a good medication to prescribe for panic disorder? - -Diazepam (Valium) What is a anorexiant medication to treat obesity? - -Phentermine What is a precaution with Phentermine? - -Anorexiants may cause tolerance and should only be used for 6 months What medications or herbals should be avoided with Phentermine? Why? - -SSRIs and St. Johns Wort...the combination may cause serotonin syndrome Phentermine releases what two chemicals? - -Epinephrine and norepinephrine Epi and norepi causes what to break down? - -Fat cells to break down stored fat What are Signs and symptoms of seratonin syndrome? - -Headache, agitation, mental confusion, hallucinations, coma What are autonomic effects that you can get from seratonin syndrome? - -Shivering, sweating, hyperthermia, vasoconstriction, tachycardia, nausea, diarrhea What factors place a patient at risk for developing antimicrobial resistant organisms? - Inappropriate use of antibiotics Children less than 2 years of age Adults older than 65 years of age Patients who do not finish their antibiotic regimen NUR 615 NUR 615 What are appropriate antibiotics to prescribe to pregnant women and children? - -PCN or Cephalosporins (Amoxicillin, or Augmentin) Which antibiotics inhibit cell wall synthesis? - -Beta-lactam antibiotics Vancomycin Why is clavulanate added to Amoxicillin? - -Clavulanate is a Beta-lactam inhibitor. This increases the spectrum of action and is effective at preventing amoxicillin-resistant bacteria that produce Beta-lactamase What type of antibiotics should be avoided in children and pregnant women? - Tetracycline, fluoroquinolones What is a normal side effect of amoxicillin? - -Diarrhea and it is recommended to continue to take the medicine, drink lots of water, and take probiotics daily, eat yogurt The American Heart Association recommedations for prophylaxis antibiotic use prior to dental care are... - -1. Prosthetic cardiac valve or prosthetic material used in valve repair 2. Previous Endocarditis 3. The following congenital diseases I. Unrepaired cyanotic congenital heart disease including palliative shunts and conduits II. Completely repaired congenital heart disease with prosthetic material device, whether placed surgically or with a catheter for 6 months following the procedure III. Repaired congenital heart disease with residual effects at the site or adjacent to the site of a prosthetic patch or prosthetic device which inhibit endothelialization IV. Cardiac transplantation recipients with cardiac valvular disease What antibiotic is used for dental appointments? - -Amoxicillin 2 gm for adults 50mg/kg in children What should fluoroquinolones be reserved to treat? - -Community acquired pneumonia in patients with comorbidities and Hospital acquired pneumonia What is the black box warning for fluoroquinolones? - -It may cause tendon ruptures. Specifically of the achilles tendon. What medication can be affected with the use of fluoroquinolones? - -Warfarin because fluoroquinolones displace the flora of the gut and displaces warfarin from albumin and interferes with metabolism by the P450 system. Why are tetracyclines not recommended in pregnancy and in children less than 8 yrs of age? - -They can cause staining of teeth, and cause problems with bone growth. NUR 615 NUR 615 What population can tetracyclines like minocycline be used on? And patients who use it might develop what? - -Adolescents. It may cause psuedotumor cerebri, drug-induced lupus and hepatitis, skin photosensitivity, tinnitus, fatty liver Tetracycline should be avoided with what foods and medications? - -Calcium ions milk, yogurt, or other dairy products Methotrexate What drug interactions should be avoided when taking levaquin? - -It is a fluoroquinolone, so do not take with coumadin or corticol steroid use. Gentamycin is known to cause what? - -Ototoxicity and hearing loss Which medications interact with Linezolid? - -Linezolid is a MAOI, so it should not be used with other MAOIs, pethidine, or demerol because of the risk of seratonin syndrome. What are the food restrictions while taking linezolid? - -Tyramine rich foods such as pork, aged cheese, alcohol, smoked or pickled foods. What is the treatment for Lymes Disease? - -Doxycycline 100mg PO BID x 21 days What vitamin can prevent peripheral neuropathy from isoniazid? - -Vitamin B 6 (Pyridoxine) What should you monitor before prescribing valacyclovir? - -Renal function. Patients should drink lots of water while on this medication. Which medication would be appropriate for Influenza A? - -Oseltamivir, if started within the first 48 hours Name 3 things ta Rifampin is prescribed for? - -TB, leprosy, legionella What are the adverse effects for Isoniazid? - -Hepatotoxicity and peripheral neuropathy What are the main side effects of Doxycycline? - -Mainly GI upset. Take with food. Can cause photosensitivity, Stephens Johnson syndrome, and toxic epidermal necrosis What is the difference between oral and I.V. Vanco? - -Oral is given for C-Diff as it goes right to the site of infection. I.V. vanco is given for MRSA infections and needs to be administered through a picc line or central line because it is toxic to veins. What is the mechanism of action for Azithromycin? - -It inhib