Regis NU641 Clinical Adv Pharmacology Final Exam 2023

Clonodine - Answer- Has several off-label uses including: alcohol and nicotine withdrawal and post therpautic neuralgia Guanfacine - Answer- hypertension drug that has also been approved to use for ADHD Ramelteon (Rozerem) - Answer- Insomnia med that does not have inverse risk for patients engaging in activities while somnolent with no memory of having taking pill Common mistakes practitioners make in treating anxiety disorders - Answer- General diagnosis and following up to see if treatment goals are being met Xanax - Answer- The benzodiazepine with the greatest likelihood of causing dependency s/t it has a short half-life Although a patient sees a neurologist for the management of her partial seizures, why is it important to know her medication regimen? - Answer- There are many drug-drug interactions with anticonvulsants Routine education for patient being treated with levetiracetam (Keppra) for seizures - Answer- To not abruptly discontinue Keppra due to risk for withdrawal seizures What advice you would give a woman who has been on Depakote for seizure and wants to get pregnant - Answer- Valproate is a known teratogen but may be taken after the first trimester if necessary Prior to starting antidepressants, the patient should have lab testing to rule out - Answer- hypothyroidism Cholinergic blockers are used to: - Answer- Counteract the ERS effects of phenothiazines Control tremors and relax smooth muscles in Parkinson's Disease Inhibit the muscarinic action of Ach on bladder muscle Memantine - Answer- A drug used to treat Alzheimer's disease but is not an anticholinergic Verapamil - Answer- Preventative therapy for cluster headache Minocycline (PO) - Answer- When prescribing for migraines, patient education includes: - Answer- Stress reduction and regular sleep are integral to migraine treatment Acetaminophen - Answer- Migraines in pregnancy may be safely treated with this When are migraines considered cured? - Answer- There is no known cure Nonpharmacologic Therapy for tension headache includes: - Answer- biofeedback, stress management, massage therapy Fluoxetine - Answer- First-line antidepressant for children with major depression between 8 to 17 years old SSRIs - Answer- Contains a black-box warning of suicidal ideation in pediatric and adolescent groups Stimulants (methylphenidate or amphetamine salts) - Answer- Are the most effective therapy and are generally first line of treatment of ADHD in children unless contraindications exist Hypercalcemia - Answer- Pt treated with more than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for An adolescent female calls the clinic with concerns that her acne is worse 2 weeks after starting topical tretinoin. What would be the appropriate care for her? - Answer- Reassure her that the worsening of acne is normal and it should improve with continued use Treatment for Tinea capitis - Answer- Oral griseofulvin or Biweekly shampoo with selenium sulfide or ketoconazole for 6 to 8 weeks Treatment for Tinea corporis and tinea pedis - Answer- Topical antifungals like miconazole applied twice daily for 4 weeks Treatment of Onychomycosis - Answer- Oral griseofulvin, ketoconazole, itraconazole, or terbinafine for several months; topical product is ciclopirox 8% (Penlac) Common treatments and counseling points for scabies - Answer- Common therapies: permethrin, ivermectin, crotamiton For permethrin, apply from the neck down, and leave the medication on for at least eight to 10 hours. Often, all household members and other close contacts should be treated. Bedding, clothing, and towels used by infested persons or their household, sexual, and close contacts (as defined above) anytime during the three days before treatment should be decontaminated by washing in hot water and drying in a hot dryer, by dry-cleaning, or by sealing in a plastic bag for at least 72 hours. Reduces Oral contraceptive efficacy - Answer- Concomitant use of hepatic enzyme inducers such as rifampin; barrier methods of contraception should be used as backup Long-term use of androgens requires specific laboratory monitoring of: - Answer- Calcium, testosterone, PSA, liver function, glucose, & lipids existing pregnancy - Answer- A contraindication to using the morning after (Plan B) contraceptive for emergency contraception (EC) To avoid breakthrough bleeding - Answer- When a hormonal contraceptive and a hormone replacement therapy drug are taken together, they should be taken at the same time each day A progestin-only type of contraceptive - Answer- Can cause irregular menstrual bleeding during the first month of use Effects of estrogen include - Answer- regulation of the menstrual cycle and maintaining normal skin structure and blood vessel integrity. Medroxyprogesterone injection - Answer- may cause an adverse effect of depression Older male patients using testosterone replacement therapy (TRT) - Answer- should have a digital prostate screening examination at 3 and 6 months after starting therapy Diarrhea - Answer- Is not a side effect of anticholinergic therapy for urinary incontinence antimicrobial efficacy - Answer- For an uncomplicated UTI in a child, reduced symptoms within 48 hours is a good indicator of Amoxicillin - Answer- A woman who is in her first trimester of pregnancy with a diagnosed urinary tract infection (UTI) is treated with Nitrofurantoin - Answer- Can be used to treat UTI in pregnant women if there is an amoxicillin resistance benzoyl alcohol - Answer- The only antifungal agent effective for head lice that is not neurotoxic Serotonin 5-HT3 receptor antagonists should be avoided in which of the patient populations? - Answer- Pregnant patients Treatment for preeclampsia - Answer- Bedrest (not strict bedrest), control of BP, seizure prophylaxis, and timely delivery Treatment algorithm for symptomatic bacterial vaginosis - Answer- First line - Flagyl (PO) Second line - Cream (Vaginal) Third line - Clindamycin Treatment for gonorrhea - Answer- Ceftriaxone (hepatic function) cefotaxime for those with hepatic impairment Treatment for Chlamydia - Answer- Amoxicillin, then nitrofurantoin Patient education for HIV medications (How they need to take them) - Answer- Postmenopausal women with an intact uterus should not be prescribed - Answer- estrogen alone s/t risk of endometrial hyperplasia and endometrial cancer SERMs (selective estrogen receptor modulators) - Answer- Raloxifene - Prevention of osteoporosis in menopausal women; Invasive breast cancer risk reduction (females); Mimics estrogen beneficial bone sparing properties without affecting the uterus or breasts Treatment algorithm for dysmenorrhea - Answer- NSAIDs First line treatments for both types of pediatric diabetes (Type I & Type II) - Answer- Type I - Insulin Type II - (Not treated under 10 years old) Diet and exercise Treatment for constipation in pregnant patients - Answer- Fiber base product, Fluid, exercise, Metamucil, probiotics could be helpful Treatment for constipation in elderly patients - Answer- Lactulose or MiraLAX Autoimmune impact to beta cells in Type I DM - Answer- Destroys them and cause absolute dependence of insulin Levothyroxine (T4) - Answer- First line treatment of hypothyroidism in general patients Liothyronine (T3) - Answer- First line of treatment of hypothyroidism in CV patients the treatment goal for thyroid disorders - Answer- correcting hypermetabolic state Monitoring of Hyperthyroidism - Answer- TSH and T4 Levels to the patient reaches a stable euthyroid state this may take 6 to 8 weeks Long term hyperthyroidism - Answer- leads to increase CHF and increase in osteoporosis Treatment of hypoglycemia - Answer- 15g CHO from glucose tablets, 4 oz fruit juice, 8 oz of milk, half can of soda, or sugar wait 15 minutes 70mg give another 15g signs and symptoms of hypoglycemia - Answer- reduced cognition, tremors, diaphoresis, weakness, hunger, headache, irritability, seizure Two categories of monitoring that are needed for patients with DM - Answer- Blood glucose in target range and signs of complications such as DKA in Type I (acute) and chronic ones like nephropathy, retinopathy, peripheral and gastrointestinal neuropathies, HTN, CV disease and dyslipidemia. ACEIs are beneficial in DM patients - Answer- They increase the renal function by regulating the patient's blood pressure Glucophage (metformin) - Answer- First-line oral diabetic agent Glucophage (metformin) side effects - Answer- abdominal bloating, diarrhea, nausea, vomiting, and an unpleasant metallic taste; vitamin B 12 deficiency; headache the utility of protein restriction in ESRD patients - Answer- A modest benefit of slowing disease progression has been demonstrated by reducing the urinary protein excretion Gabapentin (Neurontin) - Answer- used for neuropathic pain ACE inhibitors ("PRIL" Captopril, Enalapril, Afosiopril) - Answer- cardiovascular drugs that should be prescribed in diabetic patients (Type II) Interactions with cholinergic blockers - Answer- Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action Pt is dx with depression and has been taking paroxetine (Paxil) PO daily x 2 weeks with no relief what should be done - Answer- Continue therapy Pt on dx with depression is on SSRI sertraline (Zoloft) 100mg PO daily for 2 years and want to stop taking it; what should be done - Answer- Slowly taper down the dose until off This is considered true after reexamination of the women's health study which has modified guidelines for the use of estrogen in menopause. - Answer- Supplemental for the first 5 years is considered to have a reasonable risk/benefit profile for selected groups of women. 17 yr old competitive runner presents with hip pain that began after falling which vary. Their only medical problem is severe acne for which they take isotretinoin (Accutane). What should the provider be concerned about? - Answer- They are at risk for bone injuries and need to be evaluated for fracture Pt wants oral contraceptives and has negative pregnancy test. What should the provider do? - Answer- Prescribe oral contraceptives and have her start them the same day as the visit with a back up method used for the next 7 days Patient education for cromolyn sodium (opticran) eye drops - Answer- They should not wear soft contacts Not an indication for starting hormone replacement therapy (HRT) - Answer- prevention of osteoporosis Intramuscular (IM) ceftriaxone - Answer- Treatment for adult gonococcal conjunctivitis 15 month old on Amoxicillin for 48 hours for AOM but still febrile with no change in tympanic membrane exam. What should the provider do next? - Answer- Change the ABX to Amoxicillin/Clavulanate Education for a parent with a child that has AOM - Answer- Providing adequate pain relief for at least the first 24 hours Amoxicillin/Clavulanate 500mg bid for 7 days - Answer- Current treatment for sinusitis in an adult who has a child in daycare Opthalmic Antiinfectives - Answer- Generally, there is little systemic absorption blurred vision - Answer- Common adverse drug reaction of ocular antihistamines Treatment for hyperthyroidism - Answer- Treat the base or cause; beta-blocker, antithyroid drugs, radioiodine therapy, thyroid removal Biophosphonates - Answer- treat or prevent osteoporosis by fostering bone reabsorption The goals of treatment when prescribing ART medication to patients with HIV includes - Answer- prevention of vertical transmission, improvement of quality of life, prolonging of survival An elderly person has been prescribed lactulose for the treatment of chronic constipation. Monitoring long-term treatment would include - Answer- Electrolytes, including potassium and chloride Bulk forming laxatives - Answer- Type of laxative for short or long term mild constipation Patient education for HIV medications - Answer- Take medications daily at the same time Protection for partner during sexual activities monitoring for DM patients at home - Answer- SMBG 3 to 6 times per day monitoring for DM patients in clinic - Answer- Hemoglobin A1C needs to 7% which monitors the pts BG average of the last 3 months Low potency steroids such as hydrocortisone - Answer- may be appropriate for mild dermatitis, especially in children High potency steroids - Answer- should never be used in children and should be used sparingly in adults