NR 565 - advanced pharmacology midterm
- Chamberlain
12 CDC prescription guidelines for opioids - ANS-Opioids are not the first line of treatment. set
objectives for pain and function. Discuss risks and benefits
Use immediate release opioids when starting
Use the lowest effective dose
Short-term treatment for acute pain Regularly weigh the benefits and drawbacks. Use
strategies to migrate risk
Review PDMP data
Use urine drug testing
Avoid prescribing benzos and opioids simultaneously. Offer treatment for opioid use disorder
ANS-alendronate is the treatment of choice for osteoporosis. A 41 year old patient comes into
the clinic complaining of increased heart rate after starting nitro patches for stable angina. What
would an appropriate response be?
1. lets lower the dose and frequency of use
2. I will prescribe a BB to help with this
3. Next time this happens, lie down and practice deep breathing, this will bring your heart rate
down - ANS-2- I will prescribe a BB to help with this
A 55 year old male comes into the clinic with a gouty arthritis. He states that he has one
flareup a year. Your response is:
1. I will prescribe you glucocorticoids to help with inflammation
2. Lets start you on prophylactic therapy colchicine.
3. It will be helpful to take an NSAID to start with to help relive some inflammation. I'll
prescribe naproxen. - ANS-3- in patients with infrequent flareups, being less than three per year,
treatment of symptoms is all thats needed. NSAIDS are the first line agent for relieving pain of
an acute gout attack.
A patient comes in stating that he tried NSAIDS to relieve a gouty attack but it hasnt helped.
"What are my options?" he inquires. He further states that he has attacks every few years but
when he does NSAIDS do not help. Your response is:
1. I can prescribe a glucocorticoid (prednisone) and that will bring down the inflammation and
pain.
2. Have your tried increasing your dosage of NSAIDS and drink plenty of water?
3. Lets start by making some changes in your diet, can you tell me what you eat regularly? -
ANS-1
3- can also be correct but BEST answer
A patient with HF develops fibrotic changes, what should the provider do next? - ANS-ensure
that a patient is on an ARB (valsartan) as this inhibits fibrosis (aldosterone antagonist)
, A person who is depend on a pure opioid agonist should NEVER receive an opioid agonist
antagonist - ANS-true
ACE inhibitors MOA - ANS-Angiotensin Converting Enzyme Inhibitors (ACE-I) prevent the
conversion of angiotensin I to angiotensin II, which disrupts the renin-angiotensin-aldosterone
system (RAAS).
1. reduce levels of angiotensin II (through inhibition of ACE)
2. increasing levels of bradykinin (through inhibition of kinase 11)
End in -pril
adverse effects for bisphosphonates - ANS-osteonecrosis of the jaw and hip fracture,
Esophagitis
adverse effects of CCBs in elderly patients - ANS-gingival hyperplasia (overgrowth of gum
tissue) and chronic eczematous rash
adverse effects of colchicine - ANS-nausea, vomiting, diarrhea, myelosuppression, myopathy,
rhabdomyolysis
adverse effects of digoxin - ANS-GI- anorexia, nausea, vomiting
CNS- fatigue
**Distractions to the visual field (the appearance of halos around dark objects) dysrhythmias
Adverse effects of lasix (flurosemide) - ANS-ototoxicity
adverse effects of nitro - ANS-headache, hypotension, and tachycardia (secondary to
vasodilation)
Adverse effects of opioids - ANS-constipation
urinary retention
orthostatic hypotension
emesis
neurotoxicity (agitation and delirium) tolerance and dependence on one's body respiratory
impairment adverse effects of pregabalin include ANS-sedation (drowsiness), ataxia (dizziness),
blurred vision, and difficulty thinking. adverse effects of statins - ANS-rhabdomyolysis,
hepatoxicity, new-onset diabetes
After age one what happens to pharmacokinetic parameters, including drug sensitivity? -
ANS-mirror adult parameters
Alendronate patient education - ANS-minimize risk of esophagitis by swallowing the pill whole
with a full glass of water, then sit up for at least 30 min but 60 min preferred. intake of food
prevents absorption, take this med 30 min prior to other intake
ANS-CYP3A4 inhibitors and grapefruit juice (where levels can rise) should NOT be taken with
amiodarone. An 82 year old male visits the clinic complaining that his pain medications "take
forever" to work after he takes his pill. What are possible reasons you can explain to him?
1. Perhaps we need to increase your dosage.
2. Absorption may sometimes slow down as you get older, which can lead to a delayed
response. 3. As we get older the gastric acid decreases and may slow absorption. - ANS-2&3
ARBS MOA - ANS-Block angiotensin II receptors on blood vessels in heart and adrenals.
increases sodium and water excretion from the kidneys. Cause dilation of arterioles and veins.
End in -sartan
Are statins safe in pregnancy? - ANS-No
, Assess a person for potential drug diversion? - An ANS-Urine test every year at the very least
PDMP routinely
At what age can statins be prescribed? - ANS-avoid statin use in children under the age of 10
Why should statins be taken at night when cholesterol synthesis is higher at night? - ANS Risk
Score for Atherosclerotic Cardiovascular Disease (ASCVD) What is it? - ANS-ASCVD risk
assessment is directed at determining the patient's absolute risk of developing clinical coronary
disease over the next 10 years. defines high risk as a rate of 7.5% or higher. a calculation of
your 10-year risk of having a cardiovascular problem, such as a heart attack or stroke.
Baseline data for Methotrexate (DMARD) - ANS-chest x-ray, emphasis on pulm and GI status
Baseline diagnostics for DMARDS - ANS-CBC with WBC differential
s/s of infection (TB and hepatitis)
malignancies
rule out pregnancy
ALT, AST, serum creatinine
comprehensive history and physical exam
assess risk for immunocompetence and liver and renal status
Behaviors that should predict controlled substance addiction - ANS-reinforcing properties of
drugs - pleasurable (euphoria) or reduce unpleasant experience (reduce anxiety and stress
physical dependence
physiological dependence (dependence on drugs on well-being) social factors (peer pressure)
drug availability (Drugs in hospitals - reason for nurses or pharmacist abuse)
vulnerability of individual
impulsive
low tolerance for frustration
rebellious against social norms
depressive, anxiety, and anti-social personality disorders
abuse other drugs
Beta-blockers use with nitroglycerin - ANS-Beta Blockers suppress nitroglycerin induced
tachycardia. They do so by preventing sympathetic activation of beta 1 adrenergic receptors on
the heart.
Nitroglycerin lowers BP by reducing venous return and dilating arterioles. the lowered BP
activates the baroreceptor reflex causing reflex tachycardia. Which will increase cardiac
demand and negate the therapeutic effects of nitroglycerin. Txt with beta blocker can suppress
the heart and slow the rate.
no digoxin - increase contractility of heart
black box warning for amiodarone - ANS-lung damage - resemble HF and pneumonia
Black box warning for hydrocodone - ANS-products that contain Tylenol are associated with
hepatotoxicity
methadone's black box warning: ANS-prolong QT interval, fatal dysrhythmias black box
warning for mexiletine - ANS-increased risk for mortality when used to treat non-life threatening
arrhythmias
Black box warning for quinidine - ANS-increase mortality in patients with a-flutter and a-fib
black box warning for Raloxifene - ANS-risk for venous thromboembolic events (DVT, PE,
stroke)
- Chamberlain
12 CDC prescription guidelines for opioids - ANS-Opioids are not the first line of treatment. set
objectives for pain and function. Discuss risks and benefits
Use immediate release opioids when starting
Use the lowest effective dose
Short-term treatment for acute pain Regularly weigh the benefits and drawbacks. Use
strategies to migrate risk
Review PDMP data
Use urine drug testing
Avoid prescribing benzos and opioids simultaneously. Offer treatment for opioid use disorder
ANS-alendronate is the treatment of choice for osteoporosis. A 41 year old patient comes into
the clinic complaining of increased heart rate after starting nitro patches for stable angina. What
would an appropriate response be?
1. lets lower the dose and frequency of use
2. I will prescribe a BB to help with this
3. Next time this happens, lie down and practice deep breathing, this will bring your heart rate
down - ANS-2- I will prescribe a BB to help with this
A 55 year old male comes into the clinic with a gouty arthritis. He states that he has one
flareup a year. Your response is:
1. I will prescribe you glucocorticoids to help with inflammation
2. Lets start you on prophylactic therapy colchicine.
3. It will be helpful to take an NSAID to start with to help relive some inflammation. I'll
prescribe naproxen. - ANS-3- in patients with infrequent flareups, being less than three per year,
treatment of symptoms is all thats needed. NSAIDS are the first line agent for relieving pain of
an acute gout attack.
A patient comes in stating that he tried NSAIDS to relieve a gouty attack but it hasnt helped.
"What are my options?" he inquires. He further states that he has attacks every few years but
when he does NSAIDS do not help. Your response is:
1. I can prescribe a glucocorticoid (prednisone) and that will bring down the inflammation and
pain.
2. Have your tried increasing your dosage of NSAIDS and drink plenty of water?
3. Lets start by making some changes in your diet, can you tell me what you eat regularly? -
ANS-1
3- can also be correct but BEST answer
A patient with HF develops fibrotic changes, what should the provider do next? - ANS-ensure
that a patient is on an ARB (valsartan) as this inhibits fibrosis (aldosterone antagonist)
, A person who is depend on a pure opioid agonist should NEVER receive an opioid agonist
antagonist - ANS-true
ACE inhibitors MOA - ANS-Angiotensin Converting Enzyme Inhibitors (ACE-I) prevent the
conversion of angiotensin I to angiotensin II, which disrupts the renin-angiotensin-aldosterone
system (RAAS).
1. reduce levels of angiotensin II (through inhibition of ACE)
2. increasing levels of bradykinin (through inhibition of kinase 11)
End in -pril
adverse effects for bisphosphonates - ANS-osteonecrosis of the jaw and hip fracture,
Esophagitis
adverse effects of CCBs in elderly patients - ANS-gingival hyperplasia (overgrowth of gum
tissue) and chronic eczematous rash
adverse effects of colchicine - ANS-nausea, vomiting, diarrhea, myelosuppression, myopathy,
rhabdomyolysis
adverse effects of digoxin - ANS-GI- anorexia, nausea, vomiting
CNS- fatigue
**Distractions to the visual field (the appearance of halos around dark objects) dysrhythmias
Adverse effects of lasix (flurosemide) - ANS-ototoxicity
adverse effects of nitro - ANS-headache, hypotension, and tachycardia (secondary to
vasodilation)
Adverse effects of opioids - ANS-constipation
urinary retention
orthostatic hypotension
emesis
neurotoxicity (agitation and delirium) tolerance and dependence on one's body respiratory
impairment adverse effects of pregabalin include ANS-sedation (drowsiness), ataxia (dizziness),
blurred vision, and difficulty thinking. adverse effects of statins - ANS-rhabdomyolysis,
hepatoxicity, new-onset diabetes
After age one what happens to pharmacokinetic parameters, including drug sensitivity? -
ANS-mirror adult parameters
Alendronate patient education - ANS-minimize risk of esophagitis by swallowing the pill whole
with a full glass of water, then sit up for at least 30 min but 60 min preferred. intake of food
prevents absorption, take this med 30 min prior to other intake
ANS-CYP3A4 inhibitors and grapefruit juice (where levels can rise) should NOT be taken with
amiodarone. An 82 year old male visits the clinic complaining that his pain medications "take
forever" to work after he takes his pill. What are possible reasons you can explain to him?
1. Perhaps we need to increase your dosage.
2. Absorption may sometimes slow down as you get older, which can lead to a delayed
response. 3. As we get older the gastric acid decreases and may slow absorption. - ANS-2&3
ARBS MOA - ANS-Block angiotensin II receptors on blood vessels in heart and adrenals.
increases sodium and water excretion from the kidneys. Cause dilation of arterioles and veins.
End in -sartan
Are statins safe in pregnancy? - ANS-No
, Assess a person for potential drug diversion? - An ANS-Urine test every year at the very least
PDMP routinely
At what age can statins be prescribed? - ANS-avoid statin use in children under the age of 10
Why should statins be taken at night when cholesterol synthesis is higher at night? - ANS Risk
Score for Atherosclerotic Cardiovascular Disease (ASCVD) What is it? - ANS-ASCVD risk
assessment is directed at determining the patient's absolute risk of developing clinical coronary
disease over the next 10 years. defines high risk as a rate of 7.5% or higher. a calculation of
your 10-year risk of having a cardiovascular problem, such as a heart attack or stroke.
Baseline data for Methotrexate (DMARD) - ANS-chest x-ray, emphasis on pulm and GI status
Baseline diagnostics for DMARDS - ANS-CBC with WBC differential
s/s of infection (TB and hepatitis)
malignancies
rule out pregnancy
ALT, AST, serum creatinine
comprehensive history and physical exam
assess risk for immunocompetence and liver and renal status
Behaviors that should predict controlled substance addiction - ANS-reinforcing properties of
drugs - pleasurable (euphoria) or reduce unpleasant experience (reduce anxiety and stress
physical dependence
physiological dependence (dependence on drugs on well-being) social factors (peer pressure)
drug availability (Drugs in hospitals - reason for nurses or pharmacist abuse)
vulnerability of individual
impulsive
low tolerance for frustration
rebellious against social norms
depressive, anxiety, and anti-social personality disorders
abuse other drugs
Beta-blockers use with nitroglycerin - ANS-Beta Blockers suppress nitroglycerin induced
tachycardia. They do so by preventing sympathetic activation of beta 1 adrenergic receptors on
the heart.
Nitroglycerin lowers BP by reducing venous return and dilating arterioles. the lowered BP
activates the baroreceptor reflex causing reflex tachycardia. Which will increase cardiac
demand and negate the therapeutic effects of nitroglycerin. Txt with beta blocker can suppress
the heart and slow the rate.
no digoxin - increase contractility of heart
black box warning for amiodarone - ANS-lung damage - resemble HF and pneumonia
Black box warning for hydrocodone - ANS-products that contain Tylenol are associated with
hepatotoxicity
methadone's black box warning: ANS-prolong QT interval, fatal dysrhythmias black box
warning for mexiletine - ANS-increased risk for mortality when used to treat non-life threatening
arrhythmias
Black box warning for quinidine - ANS-increase mortality in patients with a-flutter and a-fib
black box warning for Raloxifene - ANS-risk for venous thromboembolic events (DVT, PE,
stroke)
