Final exam review

Final exam review ____ 14. Patients with allergic rhinitis may benefit from a prescription of: 1. Fluticasone (Flonase) 2. Cetirizine (Zyrtec) 3. OTC cromolyn nasal spray (Nasalcrom) 4. Any of the above ____ 18. Decongestants such as pseudoephedrine (Sudafed): 1. Are Schedule III drugs in all states 2. Should not be prescribed or recommended for children under 4 years of age 3. Are effective in treating the congestion children experience with the common cold 4. May cause drowsiness in patients of all ages What drug therapy could a provider select to administer to a client seeking treatment for rhinosinusitis? chloride channel activators nitrofurantoin antimotility agents amoxicillin Allergic Rhinitis – corticosteroids are used to e manage seasonal or perennial allergies; used intranasal 1-2 times daily; Decongestants are used for allergic rhinitis Second-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they: A. Are more effective than first-generation antihistamines B. Are less sedating than first-generation antihistamines C. Are prescription products and, therefore, are covered by insurance D. Can be taken with CNS sedatives, such as alcohol B. Are less sedating than first-generation antihistamines Patients with allergic rhinitis may benefit from a prescription of:  Fluticasone (Flonase)  Cetirizine (Zyrtec) contact:  OTC cromolyn nasal spray (Nasalcrom)  All of the above Nonpharmacological therapy includes increasing fluid intake, using nonmedicated cough drops, nasal saline spray/drops to decrease viscosity of nasal secretions, and rest. Anorexia is often associated with the common cold and fluids may need to be forced to maintain hydration. Infants who are congested cannot breathe and feed at the same time causing fluid intake to be inadequate. Nasal suctioning may be required to clear secretions. Oral decongestants are used for the temporary relief of nasal congestion from the common cold, sinus infections, and allergic rhinitis. They may be used to promote nasal or sinus drainage and are also indicated in the relief of eustachian tube congestion. Pseudoephedrine for those over 4 y/o Viral URI (the common cold) are self-limiting and require no treatment, the goal is relieving irritating symptoms, specifically nasal congestion. ANTIBIOTICS HAVE NO PLACE IN THE TREATMENT OF VIRAL URIs. They can cause antimicrobial resistances to secondary bacterial infections. Antihistamines have not been shown to change the course of the common cold. But many OTC medications contain antihistamines, most likely for their “drying out” effect. Decongestants are the mainstay treatment for the common cold (systemic or topical). Tylenol/Ibuprofen/ASA can be given for fever and malaise. Topical decongestants are safe for 3 consecutive days of use. Topical decongestants adverse effects – transient stinging, burning, sneezing, dryness, local irritation, rebound congestion with prolonged use. Topical decongestants can symptomatically relieve nasal congestion and relieve ear blockage and pressure pain. Topical decongestant adverse reactions – insomnia, dizziness, weakness, tremor, or irregular heartbeat. Topical decongestant meds – Afrin, phenylephrine, oxylmetazoline, Neo-Synephrine Theophylline – a bronchodilator that can affect the blood pressure Monitor decongestant use in cardiac patients as they can increase hypertension from the added vasoconstriction. A diabetic client with high blood pressure and a pacemaker is seeking relief from excess mucous production due to the common cold. Why would a provider not recommend decongestants to this client? The risk for contraindications is high. The risk for poor metabolism of the drug is high. The efficacy of the drug will be low due to the client’s other health conditions. The risk for urinary incontinence is high. Older adults are more likely to have adverse reactions from decongestants. Common complications for URIs – Sinusitis, otitis media, asthma exacerbation Echinacea is widely used in Europe, and increasing use in the US, for prevention of the common cold and flu and is considered an herbal remedy. How can a provider assess airflow limitation? By examining the natural expiratory volume and total volume of exhaled air and their difference By examining the forced expiratory volume and total volume of exhaled air and their ratio By examining the relaxed state of the expiratory volume and last recorded volume of exhaled air and their sum By examining the elicited expiratory volume and limited volume of exhaled air and their quotient Albuterol, beta agonists, is generally considered the first-choice medication for treatment of asthma. Inhaled corticosteroids are recommended as first-line therapy for athletes who have persistent asthma to prevent worsening symptoms with exercise. How is first-line treatment for COPD the same as for asthma? Both diseases require maintenance therapies. Both diseases are treated based on the number of hospitalizations. Both diseases results from first- or second-hand smoking. Both diseases are first always treated with short-acting muscarinic antagonists (SAMAs). Mast cell stabilizer – cromolyn; works by inhibiting antigen-induced bronchospasm, blocks histamine release, stabilizes mast cells. Monoclonal antibody binds to free IgE and prevents them from responding to relevant allergens ____ 13. What is the desired mixed of T3 to T4 drug levels in newly diagnosed endocrine patients? 1. 99% of T3 and the rest is T4 to get rapid resolution. 2. Most needs to be T4 to mimic natural ratios of hormone. 3. The ratio is unimportant. 4. The mix needs to be 50-50 at first. ____ 3. After starting a patient with Grave’s disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every: 1. 1 to 2 weeks 2. 3 to 4 weeks 3. 2 to 3 months 4. 6 to 9 months ____ 7. Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored with TSH and free T4 levels every: 1. 2 weeks 2. 4 weeks 3. 2 months 4. 6 months TSH levels determine hpyo- or hyperthyroidism. Level is between 0.5-5.0 mU/I. Therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10. ____ 1. When methimazole is started for hyperthyroidism it may take ________ to see a total reversal of hyperthyroid symptoms. 1. 2 to 4 weeks 2. 1 to 2 months 3. 3 to 4 months 4. 6 to 12 months Hypothyroidism during pregnancy is safe to treat with thyroid replacement hormones, they are a Pregnancy Cat A drug, and may require higher doses due to increase metabolism. ____ 15. What happens to the typical hormone replacement dose when a woman becomes pregnant? 1. Most women need less medication. 2. Most women do not require a dose change. 3. The average woman needs more medication during pregnancy. 4. The average woman needs more medication only if carrying multiples. Which of the following is the mechanism of action of oral combined contraceptives that prevent pregnancy? A. Estrogen prevents the LH surge necessary for ovulation. B. Progestins thicken cervical mucous and slow tubal motility. C. Estrogen thins the endometrium, making implantation difficult. D. Progestin suppresses FSH release. Progesterone-only pills are recommended for women who: A. Are breastfeeding B. Have a history of migraine C. Have a medical history that contradicts the use of estrogen D. All of the above Trazodone can be used to treat insomnia but is not FDA approved and considered an Off-Label use. Melatonin, mugwort, valerian, passionflower, and chamomile are common herbal remedies for insomnia. Insomnia is one of the most frequently treated conditions with OTC medications. 3 Z-drugs for insomnia – Zolpidem, Zopiclone, Zaleplon – these are non-benzo Antacids can increase fluid retention. Treatment of Parkinson’s includes dopaminergics (amantadine, bromocriptine, levodopa, pramipexole, ropinirole). Pentoxifylline interacts with Histamine 2 blockers and GLP-1/amylin agonists; it is a vasodilator and anti-inflammatory  Rhinitis treatment  Nonpharmacological treatment for common cold  Treatment of URI’s  Topical decongestants  Decongestants related to ventilation  Decongestants related to hypertension  Side effects of respiratory medications  URI’s in the elderly  Prevention of the cold and flu  Antibiotic response related to common cold  Assessment of airflow  Treatments for asthma  First line medication for asthma  Mast cell stabilizers  Monoclonal antibodies related to asthma  Treatment for COPD  COPD non pharmacological vs pharmacological treatment  T3 and T4 levels  TSH lab values  Hormone replacement in pregnancy  Hypotensive agents  Vasodilating agents  Antilipemic agents  Statin effectiveness  Ezetimibe effectiveness  Niacin effectiveness  Fibrate effectiveness  Similarities of clonidine and guanfacine  Hypertension medication in pregnancy  How do Beta1 blockers affect the heart  Beta-adrenergic blockers related to heart failure  Commonalities of prazosin, terazosin, doxazosin  Amlodipine vs Nifedipine  Calcium channel antagonists of DHP vs. NDHP  Cautions when using NDHP  Hypertension treatment  Use of calcium containing antacids  Antacids related to fluid retention  Strep throat related to treatment and diarrhea  IBS related to diarrhea  Diarrhea related to travel  IBS treatment  Inflammatory bowel disease treatment  Tx of Alzheimer’s Disease  Tx of Parkinson’s Disease  Tx of Major Depression  Tx for anxiety  Tx for insomnia  Tx for PTSD  Z-drugs for insomnia  Clinical judgement in prescribing  Reducing costs of medications  Managed care organizations r/t health improvement  Managed care organizations r/t quality of life  Managed care organizations r/t to dollars per life-year saved  Managed care organizations r/t concrete monetary end-point  Managed care organizations r/t comparing drug benefits  Cost effectiveness in prescribing  Copays from state to state  Review of drugs recently placed on the market  Vital signs related to prescribing  Pentoxifylline  First vs second generation antihistamines  Naproxen related to Rheumatoid arthritis  Medications for muscle spasms  Prevention of osteoporosis  Alendronate  Treatment of acute pain  Pain related to different ages  Acute vs chronic pain  Diarrhea post hospitalization  Antidiarrheal medications related to stool changes  Activated charcoal  Antibiotics related to antacids  Probiotics  Bismuth subsalicylate therapy  Laser trabeculoplasty  Antiglaucoma agents related to kidney stones  Uses for ketotifen  Treatment of Type II DM  Tx hypothyroidism  Tx of partial seizures  Tx of narcolepsy  Tx of ADHD  Tx Schizophrenia  Tx Bipolar disorder  Penicillin and Cephalosporin cross sensitivity  Tx for strep throat  UTI treatment in pregnancy  Side effects of amoxicillin  Cephalosporins related to bacterial bronchitis  Penicillin allergies  Doxycycline use/avoidance in children 1) An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone? A. Beta blockers B. Diuretics C. Nondihydropyridine calcium channel blockers D. Angiotensin II receptor blockers 2) Adam has type I diabetes and plays tennis for his university. He exhibits knowledge deficit about his insulin and his diagnosis. He should be taught that: A. He should increase his increase his carbohydrate intake during times of exercise intake during times of exercise. B. Each brand of insulin is equal in bioavailability, so buy the least expensive. C. Alcohol produces hypoglycemia and can help control his diabetes when taken in small amounts. D. If he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes. 3) Age is a factor in different responses to pain. Which of the following age-related statements about pain is not true? A. Preterm and newborn infants do not yet have functional pain pathways. B. Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter neuronal organization in the child. C. Increases in pain threshold in older adults may be related to peripheral neuropathies and changes in skin thickness. D. Decreases in pain tolerance are evident in older adults. 4) Alterations in drug metabolism among Asians may lead to: A. Slower metabolism of antidepressants, requiring lower doses B. Faster metabolism of neuroleptics, requiring higher doses C. Altered metabolism of omeprazole, requiring higher doses D. Slower metabolism of alcohol, requiring higher doses 5) Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following except: A. Notify your healthcare provider immediately if you have visual change. B. Monitor your own blood pressure and pulse daily. C. Take a hot shower or bath if you feel dizzy. D. Use a sunscreen on exposed body surfaces. 6) Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to: A. Reduce the chance of tardive dyskinesia. B. Potentiate the effects of the drug. C. Reduce the tolerance that tends to occur. D. Increase CNS depression. 7) An appropriate drug for the treatment of depression with anxiety would be: A. Alprazolam (Xanax) B. Escitalopram (Lexapro) C. Buspirone (Buspar) D. Amitriptyline (Elavil) 8) Cara is taking levetiracetam (Keppra) to treat seizures. Routine e