NSG 6005 FINAL STUDY GUIDE

FINAL STUDY GUIDE PREVIOUS EXAM INFO Guanfacine- used to treat HTN or ADHD, non stimulant. Alpha 2 adrenergic agonist. Antiarrhythmics start on p. 322 Class I: sodium channel blockers Class Ia: lengthens action potential (quinidine, procainamide [requires freq. dosing], disopyramide) Class Ib: shortens action potential (lidocaine, phenytoin) treats ventricular arrhythmias Class Ic: minimal or no effect on action potential; severe ventricular tachycardias- where no other drugs have worked Class II: beta blockers (propranolol, metoprolol, atenolol)- indirectly reduces slope by blocking chronotropic impact of norepinephrine Atenolol has longer half-life than metoprolol Class III: agents that lengthen action potential (potassium channel blockers) – (amiodarone, bretyllium) effective in treating re-entry problems, inhibits v-fib due to myocardial ischemia, improves contractility Class IV: Calcium channel blockers (verapamil, diltiazem, bepridil) & (amlodipine, felodipine) 2 types of CCB: type I- non-hydropyridines-affect conduction through AV node, have neg chronotropic effect (verapamil, diltiazem) type II: hydorphyridines-do not affect conduction through AV node (nifedipine, amlodipine, felodipine) Class IA & IC -what is similar? LidocaineAmiodaraone effective against supraventricular rhythms BPH & HTN med Doxazosin- used to treat BPH & HTN Mexiletine- only available orally Valerian has no adverse reactions when used at the recommended level; however, overdosage at 2.5 g or more can cause cardiac disturbance, excitability, headache, insomnia, and nausea. It can potentiate alcohol and other CNS depressants if taken in large amounts. (p. 139) Ayurvedic medicine- Although all three doshas exist together, often plants and people are classified by the one that is most dominant in them, referred to as the person’s “Prakruti,” and specific to them as an individual. (p. 132) Glaucoma meds: Longer eyelashes-lanasoprost or bimatoprost – prostaglandin drugs Glaucoma med cause blurriness after instilled into eyes for few minutes Procainamide-short acting; need dose reduction in CHF and renal impairment (p. 325) VLDL- synthesized in the liver (p. 1130) Drugs that inhibit VLDL synthesis in the liver (niacin, fibric acid derivatives) also reduce LDLs via the endogenous pathway (p.1130). Cholesterol meds: -acted on sterols? Inhibitor Hmgcoa- statins Bile from liver-bile sequestrins Cost benefit analysis Cardiotonic Digoxin with renal failure- contradicted in renal impairment; Digoxin can also be problematic when treating older adults and patients with renal insufficiency. Renal function may decrease during heart failure treatment and the drug may not be adequately excreted, allowing it to increase to toxic levels. Digoxin levels should be closely monitored in these patients. (p. 1072) Because digoxin is excreted essentially unchanged by the kidneys, severe renal impairment effectively contraindicates its use. (p. 318) Treatment with hepatitis C- antiviral meds, NS5A inhibitors TacrineTimololThe nurse concludes that a client newly diagnosed with glaucoma knows the purpose for the prescribed timolol (Timoptic) blocker when the clients makes which statement: - REDUCE INTRAOCCULAR PRESSURE Cromolyn-allergic David presents to clinic with symptoms of allergic conjunctivitis. He is prescribed cromolyn sodium (Opticrom) eyedrops. The education regarding using cromolyn eyedrops includes which one of the following tips - he should not wear his soft contacts while using the cromolyn eyedrops. PNA & hypothyroidism- what med don’t give?? -epi inhaler Which class antiarrhythmic meds treat SVT or VT? HSV med- answer to do with applying to oral lesion at the first sign of outbreak Protozoal infection- which type of med antifungal, antimalarial or antiviral plus one other I can’t remember Erectile dysfunction- sildenafil or something It must be noted that phosphodiesterase-5 inhibitors (sildenafil, Viagra; vardenafil, Levitra; tadalafil, Cialis) used to treat erectile dysfunction, when taken in combination with nitrates used for chest pain, can cause severe vasodilation resulting in hypotension and syncope. (p. 892) Patients with Wolff–Parkinson–White (WPW) syndrome can have ventricular responses that are dangerously rapid. Drugs commonly used to control ventricular response such as diltiazem, verapamil, and digoxin are ineffective in this situation and can facilitate conduction through the accessory pathway, increasing the risk for ventricular fibrillation (p. 315) Final exam pharm 1. Lauren is a 13 year old child who comes to the clinic with a 4 day history of cough, low grade fever, and rhinorrhea. When she blows her nose or coughs the mucous is greenish yellow. The appropriate antibiotic to prescribe would be - None 2. Pong-tai is a 12month old child who is being treated with amoxicillin for acute otitis media. His parents call the clinic and say he has developed diarrhea. The appropriate action would be to - Advise the parents that some diarrhea is normal with amoxicillin and recommend probiotics daily 3. There is often a cross sensitivity and cross resistance between pcn and cephalosporins because - Both drug classes contain a beta lactam ring that is vulnerable to beta lactamase producing organisms 4. Sara is a 25 year old female who is 8 weeks pregnant and has a uti. What would be the appropriate antibiotic to prescribe - Amoxicillin 5. Jonathon has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had pcn he developed a red blotchy rash. An appropriate antibiotic to prescribe would be - Azithromycin 6. Treatment for herpes simplex 1 - Acyclovir 7. A girl is prescribed fluconazole after being treated with an antibiotic for uti. What is the purpose of the fluconazole - Yeast infection 8. What do glaucoma eye drop timilol, lantoprost have in common - -decrease intraocular pressure 9. What antibiotic is used to treat MRSA - Vanc 10. What medication to avoid for someone with open angle glaucoma and kidney stones - Acetylcholine 11. What medications to avoid with closed angle glaucoma - Acetazolamide - Topiramate - 12. Otitis media - amoxicillin 13. ADR of isoniazid 14. What analysis would a managed care organization use to improve health outcomes 15. What analysis would be used if a managed care organization wanted to compare two drugs with different benefits 16. You are prescribing drugs using step therapies to cut costs what drug would you prescribe - Generic 17. Which analysis is expressed in terms of life years 18. What do 1A's treat? - Atrial/ventricular tach (quinodine, procainamide) 19. Mexiletine - Only available orally 20. 1b (lidocaine, mexiletine, phenytoin) - Blocks sodium channels - Tx ventricular arrythmias 21. 1c (propadenone) - Na blocker & BB - Treats WPW, AFIB 22. Class 2 (BB’S) - Tx: Supraventricular 23. Class 3 (amio, sotalol) - Prolonged action potential 24. Class 4 (verapamil, diltiazem) - Tx: svt 25. I. Sodium channel blockers- 1A, 1B, 1C II. β-adrenergic antagonists III. Potassium channel blockers and relatives IV. Calcium channel blockers 26. Nurse practitioner prescriptive authority is regulated by: 1. The National Council of State Boards of Nursing 2. The U.S. Drug Enforcement Administration 3. The State Board of Nursing for each state 4. The State Board of Pharmacy 30. Clinical judgment in prescribing includes: 1. Factoring in the cost to the patient of the medication prescribed 2. Always prescribing the newest medication available for the disease process 3. Handing out drug samples to poor patients 4. Prescribing all generic medications to cut costs 31. Nurse practitioner practice may thrive under health-care reform because of: 1. The demonstrated ability of nurse practitioners to control costs and improve patient outcomes 2. The fact that nurse practitioners will be able to practice independently 3. The fact that nurse practitioners will have full reimbursement under health-care reform 4. The ability to shift accountability for Medicaid to the state level 32. . According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to: 1. The belief among African Americans that prayer is more powerful than drugs 2. Poor compliance on the part of the African American patient 3. The genetic predisposition for illness found among African Americans 4. Discrimination, cultural barriers, and lack of access to health care 33. The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are: 1. Increased CYP 2D6 activity, leading to rapid metabolism of some drugs 2. Largely unknown due to lack of studies of this population 3. Rapid metabolism of alcohol, leading to increased tolerance 4. Decreased elimination of opioids, leading to increased risk for addiction 34. Hispanic native healers (curanderas): 1. Are not heavily utilized by Hispanics who immigrate to the United States 2. Use herbs and teas in their treatment of illness 3. Provide unsafe advice to Hispanics and should not be trusted 4. Need to be licensed in their home country in order to practice in the United States 35. Pharmacoeconomics is: 1. The study of the part of the U.S. economy devoted to drug use 2. The study of the impact of prescription drug costs on the overall economy 3. The analysis of the costs and consequences of any health-care-related treatment or service 4. The analysis of the clinical efficacy of the drug 36. Indirect costs associated with drug therapy include: 1. The cost of diagnostic tests to monitor therapeutic levels 2. Health-care provider time to prescribe and educate the patient 3. Child-care expenses incurred while receiving therapy 4. Loss of wages while undergoing drug therapy 37. The intangible costs of drug therapy include: 1. Loss of wages while undergoing therapy 2. Inconvenience, pain, and suffering incurred with therapy 3. Cost of medical equipment in the laboratory used to monitor therapeutic drug levels 4. Cost of prescription drug coverage, such as Medicare Part D 38. When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy and compares the costs of each it is referred to as: 1. Cost-minimization analysis 2. Cost-of-illness analysis 3. Cost-effectiveness analysis 4. Cost-benefit analysis 39. When the costs of a specific treatment or intervention are calculated and then compared with the dollar value of the benefit received it is referred to as: 1. Cost-minimization analysis 2. Cost-of-illness analysis 3. Cost-effectiveness analysis 4. Cost-benefit analysis 40. Mary has a two-tiered prescription benefit plan, which means: 1. She can receive differing levels of care based on whether she chooses an “in-plan” provider or not. 2. She is eligible for the new Medicare Part D “donut hole” reduction of costs program. 3. She pays a higher copay for brand-name drugs than for generic drugs. 4. She must always choose to be treated with generic drugs first. 41. James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be: 1. Order cognitive testing to determine the source of his confusion. 2. Sit down with him and explain the whole Medicare Part D process. 3. Refer him to the Medicare specialist in his insurance plan to explain the benefit to him. 4. Request his son come to the next appointment so you can explain the benefit to him. 42. . Research has shown that when patients who are covered by Medicare Part D reach the “donut hole” in coverage they: 1. Ask for extra refills of medication to get them through the months of no coverage 2. Fill their prescriptions less frequently, including critical medications such as warfarin or a statin 3. Fill their critical medications, but hold off on filling less-critical medications 4. Demonstrate no change in their prescription filling pattern Infectious Disease Gonococcal conjunctivitis: IM ceftriaxone Chlamydial conjunctivitis in newborn: systemic erythromycin for 2-3 weeks CAP in health adult? Amoxicillin CAP in high risk pt? Augmentin CAP in pt with co morbidity? fluoroquinolones (Levaquin) Otitis Media? Amoxicillin Bacterial vaginosis in not pregnant: metronidazole Trichomonas: metronidazole UTI’s 1. Karina is a 28-year-old pregnant woman at 38 weeks' gestation who is diagnosed with a lower urinary tract infection (UTI). She is healthy with no drug allergies. Appropriate firstline therapy for her UTI would be: - Amoxicillin 2. Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection? - Laurel, a 24-year-old female 3. Carmin is a 4-year-old female with a febrile urinary tract infection (UTI). She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be: - Ceftriaxone 4. Janis is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be: - Trimethoprim/sulfamethoxazole 5. Laurel is a 24-year-old female with a urinary tract infection. She is healthy, afebrile, and her only drug allergy is sulfa, which gives her a rash. An appropriate first-line antibiotic choice for her would be: - Ciprofloxacin 6. When sam used clotrimazole he developed a red itchy rash, he know has athletes foot again, what medication should he use - Terbinafine Sinusitis not high risk? Amoxicillin Skin conditions Eczema- topical corticosteroids Contact dermatitis Fungal infectionsTopical immunomodulators