PC707 Final Safety Exam Questions With Verified Answers

Grapefruit Juice - Answer CYP450 inhibitor PCN contraindications - Answer hx type 1 PCN allergy caution in hx of cephalosporin allergy PCN can ___________ the effects of warfarin - Answer increase (increase bleeding risk) Tetracycline contraindications - Answer pregnancy lactation children under 8 they bind to the calcium in bones and teeth resulting in yellow or brown discoloration and hypoplasia of the tooth enamel may also occur. Tetracyclines may decrease the effectiveness of _______________ - Answer oral contraceptives • Tetracyclines have the potential to cause _________________ of the liver. - Answer fatty infiltration What foods can interfere with tetracyclines? - Answer chelation metals- Ca, Iron- medicine will be bound up and wont get good effects What precautions should someone take when on tetracyclines? - Answer Avoid long expsoure to sunlight and wear protective clothing tetracyclines can cause you to get sunburns more easily drink lots of water to prevent crystals forming in urine Tetracyclines may increase the activity of ________________ - Answer warfarin Are fluoroquinolones safe during pregnancy or lactation? - Answer No Are fluoroquinolones safe for children? - Answer No, not under age 18 If someone has underlying ___________ or ________________, you should use fluoroquinolones with caution. - Answer Use with caution in underlying CNS pathology and renal impairment. can cause seizures What is the black box warning for fluoroquinolones? - Answer risk for tendon rupture When taking levofloxacin (levaquin), a fluoroquinolone, what patients in particular have increased risk of tendon rupture? - Answer individuals over 60 years of age, those taking corticosteroids, and patients with organ transplants. Aside from tendon rupture, what are other potential side effects of levofloxacin (levaquin)? - Answer Potential side effects include non-reversible peripheral neuropathy, hepatotoxicity, hematologic disorders and seizures, anxiety, confusion, and depression. Fluoroquinolones can cause harm to which organ? For this reason, what precautions should prescribers take? - Answer Evaluate liver function before initiating fluoroquinolone (FQ) therapy, and avoid prescribing these antibiotics for patients at increased risk for hepatotoxicity. Fluoroquinolones can cause - Answer QT prolongation Are fluoroquinolones prone to drug-drug interactions? - Answer Yes increased warfarin effects increased tendon rupture with glucocorticoids increased risk for QT interval prolongation with antinarrythmics What should be avoided within 2hrs of taking fluoroquinolones? - Answer Ca, antacids, iron, magnesium, dairy, etc What do you most commonly see with Sulfa (sulfonamide) allergies? - Answer Rash (Type 4, t cell mediated)--> d/c the drug Fever + Rash: stop drug immediately, usually happens in 1-3 days if someone has HIV, they react more frequently to Sulfa drugs--> consult and be careful Are sulfonamides safe during pregnancy? - Answer Should be avoided in both the first and third trimesters unless no other reasonable alternative is available. The mechanism of action is inhibition of folate metabolism, which may lead to cardiovascular defects and oral cleft defects. In the third trimester, the sulfa compounds compete for bilirubinbinding sites on fetal and neonatal albumin resulting in hyperbilirubinemia and kernicterus. Sulfonamides and lactation - Answer contraindicated, can cause kernicterus Sulfonamides and infants - Answer contraindicated in infants under 2months Sulfonamides should be used with caution in what populations - Answer •people with blood dyscrasias people with renal impairment people with folate deficiency people with recent gout attack people with peptic ulcer disease serious side effects of sulfonamides - Answer hemolytic anemia, thrombocytopenia, convulsions, hepatic necrosis, renal failure Steven Johnson Adverse reactions with sulfonamides are more common in people who have - Answer HIV Patient teaching with sulfonamides - Answer Minimum of 8-10 glass of water daily to minimize crystallization Avoid prolonged exposure to sunlight, wear protective clothing and sunscreen. The hearing loss associated with sulfonamides is/is not reversible - Answer Hearing loss is reversible 24 hours to 2 weeks after med is discontinued What can happen if a patient takes Trimethoprim and sulfamethoxazole (TMP-SMX) and warfarin? - Answer The combination increases the INR an average of 1.76 times increasing the potential for serious bleeding events What antibiotics in particular can interact with warfarin? - Answer Erythromycin, fluconazole, ketoconazole, itraconazole, metronidazole, Trimethoprim and sulfamethoxazole (TMP-SMX) Trimethoprim-sulfamethazole (TMP-SMX) is associated with the serious adverse effect of___________________ - Answer hyperkalemia. The risk of hyperkalemia when taking Trimethoprim-sulfamethazole (TMP-SMX) is increased when: - Answer Taking TMP-SMX and angiotensin converting inhibitors or angiotensin receptor blockers concurrently increases the risk of hyperkalemia and sudden cardiac death . TMP-SMX is also more likely to increase hyperkalemia in elderly patients and in patients with kidney disease. sulfonamides are contraindicated for babies who - Answer have either hyperbilirubinemia or G6PD deficiency Can you give a cephalosporin to a PCN allergic patient? - Answer Yes, except with type 1 allergic reaction (anaphylaxis) There is a risk for _____toxicity with macrolids - Answer ototoxicity • Concomitant use of other ototoxic drugs increases risk for ototoxicity. Macrolids can prolong the ____________ - Answer • QT interval What macrolids have more drug to drug reactions? - Answer • Clarithromycin, erythromycin and telithromycin more drug to drug interactions because of common CYP pathway Caution should be taken with macrolides and people with ___________ disease - Answer liver Be careful when prescribing Nucleoside Analogues antivirals to people with ______________ - Answer renal failure systemic anti-fungals can have many _____________ reactions - Answer drug to drug If someone is on long term systemic antifungal treatment, you need to monitor ______________ - Answer liver fx b/c they can cause hepatotoxicity What serious side effect can systemic antifungals cause? - Answer • QT prolongation check for other QT prolonging drugs ________________ Are contraindicated with many of the azole antifungals - Answer statins What are contraindications for receiving a vaccine? - Answer There are actually very few true contraindications • Encephalopathy • True allergy -administering influenza vaccine to a person with an anaphylactic allergy to egg protein could cause serious illness in or death of the recipient. • Pregnancy- Live viruses If someone had any of these symptoms after receiving a vaccine, this would be considered a precaution for giving it again: - Answer • Temp greater than 105 within 48 hours of vaccine • Continuous crying greater than 3 hours • Convulsions If a person has anaphylaxis after eating gelatin, do not administer ________________, _______________, or _____________ vaccine. - Answer measles-mumps-rubella (MMR), MMR+varicella (MMRV), or varicella vaccine. A local reaction is not a contraindication. If someone is allergic to eggs, can they receive vaccines? - Answer If a person reports they have an allergy to egg, ask if they can eat lightly cooked eggs (e.g., scrambled eggs). If they can, trivalent influenza vaccine (TIV) may be administered. Yes if they have a serious systemic or anaphylactic reaction to eating eggs, but only if you are prepared to manage a severe allergic reaction In what populations should live vaccines be avoided? - Answer Live vaccines are not for pregnant women Consideration for immuno-supressed and not give to children less than one year in age drugs used to treat TB have many _________________ - Answer drug to drug interactions Rifampin interferes with _______________ - Answer oral contraceptives, use another method! When taking isoniazid, some clients should supplemental ________________ - Answer B6, helps to prevent neuropathy What cautions should be given to patients taking metronidazole? - Answer Clients taking metronidazole must be cautioned to avoid alcohol, including cough syrups or tinctures with alcohol, during treatment for 24-48 hours after the last dose can cause severe N/V What is the concern with oral metronidazole and breastfeeding? - Answer Metronidazole becomes concentrated in the breast milk and while no adverse effects to the infant have been found, the milk may become metallic in taste and may cause gastric upset for the infant If a high dose is prescribed to the breastfeeding woman, she should take it after a feeding session and may discard her breast milk for 12-24 hours after (pump and dump). use of metronidazole may also cause infant candida and diarrhea you should separate other meds from antacids by _______ hrs - Answer 2hrs Sodium bicarbonate antacids (Alka Seltzer) can cause - Answer fluid retention Sodium bicarbonate antacids (Alka Seltzer) contain - Answer aspirin Sodium bicarbonate antacids (Alka Seltzer) are not recommended for people with - Answer HTN, fluid retention, CHF, pregnancy (contraindicated) Do not prescribe magnesium for someone with - Answer renal insufficiency Aluminum hydroxide can decrease ___________ absorbtion - Answer warfarin What precautions do you need to take when taking cimetidine? - Answer MANY DRUG TO DRUG INTERACTIONS Cimetidine (Tagamet) may reduce the hepatic metabolism of warfarin-type anticoagulants, phenytoin, propranolol, nifedipine, chlordiazepoxide, diazepam, certain tricyclic antidepressants, lidocaine, theophylline, and metronidazole, thereby delaying elimination and increasing blood levels of these drugs. avoid in pregnancy PPIs can impact absorption of ______________ - Answer iron, protein, vitamin B12, calcium increased risk of fractures possibly an increase risk of gastric malignancy Misoprostol (Cytotec) is contraindicated: - Answer in pregnancy, unless being used for induction or cervical ripening (off label) Before prescribing a GI cocktail, you need to be sure that - Answer your patient isn't having a heart attack Warfarin interactions with medications for gastric acid secretion - Answer Aluminum hydroxide (antacid) can decrease absorption of warfarin Cimetidine (tagamet, H2RA) can increase effects of warfarin long term use of PPIs can increase the risk for - Answer hip fx, community acquired pneumonia, C. Diff infection, Kidney disease, hypocalcemia, and hypomagnesemia Bismuth subsalicylate (Pepto-Bismol) is contraindicated for - Answer pregnancy and lactation as well as in children less than 12 years of age due to salicylate Bismuth subsalicylate (Pepto-Bismol) can cause - Answer stools to appear black hairy tongue when a patient presents with concerns about blood in the stool ask first about their recent use of Pepto-Bismol. What is the black box warning for Reglan (metoclopramide hydrochloride)? - Answer irreversible TARDIVE DYSKINESIA Don't prescribe for more than 12 weeks Is reglan (metoclopramide hydrochloride) safe in pregnancy? - Answer While it is pregnancy category B, it can cross the placenta and cause extrapyramidal signs in the newborn Is reglan (metoclopramide) safe for pediatrics? - Answer No, due to TD and extrapyramidal effects reglan (metoclopramide) can increase a postpartum mother's risk for - Answer postpartum depression also: TD, tiredness, nausea, headache, diarrhea, dry mouth, breast discomfort, vertigo, restless legs, intestinal gas, hair loss and anxiety All laxatives are contraindicated in patients with - Answer undiagnosed abdominal pain, nausea, vomiting, or suspected bowel obstruction What are the FDA warnings for Oral sodium phosphate (OSP) products (Visicol and OsmoPrep available by prescription) and Fleets Phosph-soda? - Answer They can cause acute phosphate nephropathy greatest risk: individuals > 55 yrs of age, dehydrated, history of kidney problems, delayed bowel emptying, active colitis or those taking diuretics, ACE inhibitors, ARBs and possibly NSAIDs. More than 1 dose in 24hrs can cause harm to kidneys, heart and possibly death bulk forming agents should be avoided in patients with: - Answer narrow esophageal lumen Frequent use of mineral oil can lead to: - Answer deficiencies of A, D, E and K due to decreased absorption of fat soluble vitamins How should constipation be managed for pregnant women? - Answer Start with lifestyle and dietary changes then try bulk forming laxatives and glycerin suppositories (stool softeners) stimulant laxatives are _____________ in pregnancy - Answer contraindicated Castor oil (ricinoleic acid) is pregnancy category - Answer X What is the first line treatment for children with impaction? - Answer PEG (polyethylene glycol) with or without electrolytes cautions and contraindications for antihistamines and anticholinergics - Answer must be used cautiously in patients with glaucoma, seizure disorder, BPH, and cardiovascular disease contraindicated in severe liver disease. Promethazine (a phenothiazine) black box warning - Answer has been known to cause fatal respiratory depression in children, contraindicated in children under 2 phenothiazines SE - Answer extrapyramidal side effects, tardive dyskinesia suppress cough, which can lead to silent pneumonia contraindications of phenothiazines - Answer parkinsons disease children under 2 glaucoma, bone marrow depression, severe cardiovascular or hepatic disease caution with respiratory impairment b/c can suppress the cough reflex, can cause silent pneumonia Prochlorperazine (Compazine) should be avoided in children under the age of ________ because - Answer under age of 5 due to risk of extrapyramidal reactions cannabinoids lower - Answer the seizure threshold Timing of sucralfate when taking other drugs - Answer separate by 2hrs, can decrease absorption of other drugs Ondansetron may increase the risk for - Answer prolonged QT Who should avoid taking bismuth subsalicylate? - Answer pregnancy, young children, GI issues, cardiac issues Thiazide Diuretics Side Effects - Answer Hyperglycemia (careful with DM), may alter glycemic control Hyperuricemia (careful with gout) Hypertriglyceridemia & hypercholesteremia (monitor lipids) Hypokalemia (can increase the risk for cardiac arrhythmias) Hyponatremia Hypomagnesemia Thiazide diuretics are contraindicated if someone has - Answer Significant renal impairment Pre-existing hypokalemia potentially with sulfa allergy What deficiencies should you monitor for when someone is on thiazide diuretics? - Answer hyponatremia (Sodium) hypokalemia (Potassium) hypomagnesemia (Magnesium) increasing uric acid levels increasing calcium levels What are the major SE of ACE inhibitors? - Answer ACEI cough Hyperkalemia Renal Fx deterioration Angioedema If someone is on ACEI and their kidney fx is worsening... - Answer monitor closely and consider reducing or discontinuing the drug. Do not give ACEI or ARBs to people with - Answer bilateral renal stenosis. This can cause renal failure in these patients b/c the patient already has limited blood flow to the kidneys and blocking the RAAS makes that worse How can ACEI impact K? - Answer Can raise K and cause hyperkalemia monitor K levels and be aware if they are taking any other K raising drugs, like spironalactone Do not prescribe ACEI and ______________ together - Answer ARBs Can ACE inhibitors or ARBs be prescribed in pregnancy? - Answer No ARB side effects - Answer Hyperkalemia Angioedema Renal fx deterioration Dizziness Fatigue Upper respiratory tract infections gastrointestinal issues (upset stomach and diarrhea) ARBs should be discontinued if - Answer progressive and/or significant deterioration in renal function Should you give ACEI or ARB with moderate to severe kidney disease? - Answer No Side effects of CCBs - Answer Heart block or bradycardia (depresses cardiac muscles and AV node) Reflex tachycardia (risk with dihydropyridines) Ankle edema (considered benign, due to vasodilation, more common in women) Headaches (due to vasodilation) Mood changes flushing dizziness When are CCBs contraindicated? - Answer 2nd and 3rd-degree heart blocks Severe bradycardia (non-DHPs) caution with HF b/c can worsen HF Do not combine CCBs with - Answer beta blockers can increase the risk of bradycardia and heart block. What are the major SE with loop diuretics? - Answer Hypokalemia (increases risk of arrhythmias) Hyponatremia Hypomagnesemia loop diuretics are contraindicated with - Answer anuria Aldosterone receptor antagonist SE - Answer Gynecomastia Hyperkalemia Vomiting, diarrhea, stomach cramps Post-menopausal bleeding Erectile dysfunction Aldosterone receptor antagonist contraindications - Answer Hyperkalemia (K+> 5.5mEg/L) Renal insufficiency (serum cr > 2.0 mg/dl in men or 1.8 mg/dl in women) To decrease risk for hyperkalemia, Avoid with potassium supplements or other potassium sparing diuretics or severe renal dysfunction. When should alpha-1 blockers be given and why? - Answer At bedtime, this can help with first dose phenomenon which can cause dizziness, faintness, palpitations, or syncope. Prescribe BBLs with caution in which populations? - Answer Asthma, COPD, chronic bronchitis, & emphysema DM as may potentiate hypoglycemia or mask symptoms Myasthenia gravis BBL contraindications - Answer 2nd or 3rd degree heart block Severe bradycardia (<45 bpm) What should you keep in mind when discontinuing BBLs? - Answer Wean slowly when discontinuing due to the risk of rebound HTN Why arent BBLs ideal for patients with DM2? - Answer can raise blood sugar Beta blockers and dyslipidemia - Answer increase triglycerides and cholesterol, decrease HDL Should beta blockers be taken in pregnancy or lactation - Answer not ideal, Cat C or D and can cause fetal abormalities, PTL are present in breastmilk BBL SE - Answer bradycardia CHF with pulmonary edema hypotension fatigue weakness dizziness hyperglycemia GI issues (N/V, gas, constipation, diarrhea) impotence and decreased libido bronchospasm dyspnea