Advanced Pharmacology Exam 1 Questions and Answers

Advanced Pharmacology Exam 1 Questions and Answers Describe the relevance of the Nurse Practice Act in any state for a nurse practitioner's practice, including prescriptive authority. -authority for NP practice defined by each state -Nurse practice acts are written by legislators (laws) and authorize Boards of Nursing to establish legal authority to define who may use the title of NP, the scope of practice for NPs, any practice restrictions, requirements to be credentialed within the state as NP, and disciplinary grounds for infractions In Tennessee, what body governs nurse practitioner prescriptive authority? Nurse Practice Act (Tennessee code annotated) In Tennessee, what is required for a nurse practitioner to use the title of advanced practice registered nurse (APRN), practice as an APRN, and prescribe medications? What is required to prescribe controlled substances? -Tennessee Nurse Practice Act is the law that regulates all nurses in TN. They require a state-level certification process for NPs to prescribe legend drugs. -DEA needed to prescribe controlled substances -you must renew RN and APRN each every two years what does LACE stand for regarding the APRN consensus model? L - Licensure (legal) A - Accreditation C - Certification E - Education state the steady state equation : steady state = (f value)(maintenance dose)(half-life) / (vd)(dosing interval) bacteriocidal : kill bacteria bacteriostatic: slows bacterial replication so an individual's immune system can kill it two ways antibiotics are classified: -how they kill (four methods) -spectrum ( + or -) gram positive antibiotics: -older antibiotics -more narrow spectrum later on with antibiotics : -we focused on having a broader spectrum with varying degrees of gram positive coverage -broader spectrum penicillin: -gram positive -cell wall inhibitor -bacteriocidal b-lactamase resistant penicillins: -oxacillin (Bactoril) -dicloxacillan penicillin is gram: positive bacitracin is gram: positive vancomycin is gram: positive amino pcs: mostly gram positive b-lactamase resistant pcns: mostly gram positive what are the two main beta lactams: -pcns -1 gen cephalosporins pen G is given for: syphilis pen v k is given for: GABHS aminopenicillins: -amoxicillan -am / CL (augmentin) -beta lactam resistant PCNs (oxacillin and dicloxacillin) 1st gen cephalosporins: -cephalexin (Keflex) -cefadroxil (Duricef) cephalosporins are what type of antibiotics? cell wall inhibitors 2nd gen cephalosporins: -ceftin -zinacef (IM/IV) -ceclor -lorabid -vantin 3rd gen cephalosporins: -cefitibuten -cefdinir -cefditoren -cefixime -ceftriaxone vancomycin is a: cell wall inhibitor fosfomycin is a : cell wall inhibitor topical bacitracin is a : cell wall inhibitor what are the cell wall inhibitors? -pcns -cephalosporins -vancomycin -fosfomycin -topical bacitracin protein synthesis inhibitors: -tetracyclines -macrolides -aminoglycosides -linezolid (Zyvox) - not a macrolide but PSI -topical mupirocin (bactroban) tetracyclines: -tetracycline (achromycin V, sumycin) -doxycycline (doryx, vibramycin) -minocycline (minocin, vectrin) macrolides: -erythromycin (emycin, EES) -clarithromycin (biaxin) -axithromycin (Zithromax, zmax) clindamycin: structurally similar to macorlides but not one aminoglycosdies: -gentamycin -neomycin -tobramycin -streptomycin tetracyclines are: bacteriostatic macrolides are: bacteriostatic aminoglycosides are: bactericidal dna gyrase inhibitors are: bacteriocidal dna gyrase inhibtors: -fluroquinolones -rifampin -metronidzaole (flagyl) folate antagonists: -sulfamethoxazole -trimethorprim -SMX / TMP (bacteriocidal in combination) (Bactrim, septra) folate antagonists are: bacteriostatic uncomplicated UTI in women: cystitis or pyelonephritis in adult women who are not pregnant and non-diabetic uncomplicated UTI in men: can be caused by anal intercourse (gram -), lack of circumcision complicated UTI: uti + comorbidities (dm, pregnancy, late diagnosis, chronic foley, suprapubic tube, obstruction secondary to stone, anatomic abnormalities, immunosuppression - these increase severity and risk of failure what antibiotic choice is appropriate for a 65 y/o man for a UTI? 1. Bactrim 2. cipro or levy for 7 days (nitrofurantoin contraindicated >65) nitrofurantoin is contraindicated in those: >65 antibiotic choice for a 22 y/o woman with UTI: 1. Bactrim for 3 days or nitrofurantoin 100 mg bid for 5 days 2. fosfomycin x 1 dose rationale (under 35 y, child bearing age so no cipro) antibiotic choice for 8 y/o girl with UTI: -always get urine culture -1. amoxicillin / clauv , cephalexin, Bactrim antibiotic choice for 27 y/o man with UTI: -check for STIs -bactrim, cipro or levy for 7 days How is the minimum inhibitory concentration (MIC) used by the NP to determine which antibiotic to choose to treat a UTI? lowest MIC in a sensitive antibiotic (+ price, route, A.D.R, & allergies) on the C&S can help determine which antibiotic is used first why is phenazopyridine (Pyridium) given for UTI? -decrease pain -decrease dysuria patient education with Pyridium: -take for 2-3 days (longer would mask sx) -turns bodily fluids red-orange -can stain clothes what role has bacterial resistance played in determining the antibiotic of choice for an adult patient with an uncomplicated UTI? -Bacterial resistance ( and klebsiella) has made beta lactams (cephalosporins and FQs) less effective for UTIs -TMP/SMX is becoming less effective for that produces beta lactamase what is the benchmark for E.coli resistance to TMP/SMX that is recommended as part of deciding whether to use that antibiotic for UTI? check local resistance rates >20% clinical presentation of primary syphilis: -painless genital lesion -indurated chancre sore -lymphadenopathy -very contagious how often should homosexual males be screened for syphilis and HIV? routinely every 3-12 months treatment for primary syphilis: -PCN benzathine (bicillan LA) 2.4 million units IM x 1 dose -others: azithromycin 2gm PO x1 -doxy 100 mg x 14 days -also: treat sexual partners -test for HIV what bacteria causes primary syphilis? treponema pallidum gram (-) what bug causes chancroid? Haemophilus ducreyi gram (-) sx of chancroid: -painful genital ulcer -softer, oozing pus -ragged edge -regional lymphadenopathy