ANCC certification exam latest version
entrance exam 2024/2025.
H2 antagonists - CORRECT ANSWERS-- famotidine
- cimetidine
- nizatidine
AE
- mental status changes with kidney disease
- avoid if kidney disease with creatinine clearance of < 50 mL/minute
PPI - CORRECT ANSWERS-- prazole
AE
- increased risk of fractures (postmenopausal women), pneumonia, C Diff,
hypomagnesemia, B12 and iron malabsorption, atrophic gastritis, kidney disease
- Interacts with Warfarin, diazepam, carbamazepine, phenytoin, ketoconazole
Vitamin K anatagonist - CORRECT ANSWERS-- warfarin
AE
- interacts with "G" herbs such as garlic, ginger, gingko, and ginseng, feverfew, green
tea, fish oil
- discontinue 7 days before surgery
INR
- a-fib, DVT, TIA, CVA 2.0 to 3.0
- mechanical mitral valves 2.5 to 3.5
- INR will increase 2-3 days after the warfarin dose but the full anticoagulation effect
takes longer 5-7 days
- check consistently stable INR q2-4 weeks up to 12 weeks
- single out of range <0.5 above or below repeat in 1-2 weeks
- INR < 5 with no significant risk of bleeding omit one dose and/or reduce maintenance
dose; recheck
- do NOT double up if missed dose
RARE: purple toe syndrome: skin necrosis located in subcutaneous fat, breasts,
extremities, trunk within first few days
TZDs - CORRECT ANSWERS-- pioglitazone (Actos)
- BLACK BOX: cause or exacerbate HF; do NOT use if class III or IV
- contraindicated in HX of MI, Stroke, bladder ca, type I diabetes, eye or liver problems
- Stop if dyspnea, weight gain, cough
Atypical antipsychotics - CORRECT ANSWERS-- risperidone
- olanzapine
- quetiapine
AE
- weight gain, metabolic syndrome, type II diabetes, monitor weight q3months
- BLACK BOX: higher mortality in elderly
- Monitor TSH, lipids, blood glucose, weight/BMI
Bisphosphonates - CORRECT ANSWERS-- alendronate
- risedronate
AE
,- erosive esophagitis (chest pain when eating, odonophagia, dysphagia, heartburn) stop
immediately if s/s of esophagitis (chest pain, difficulty swallowing, boring mid back) or
jaw pain (oestonecrosis)
- take upon waking with 8-oz glass of water before breakfast; do not lie down for 30
minutes afterward; do not mix with other drugs
Contraindications: Active GI disease (GERD, PUD), CKD, esophageal strictures/varices
Statins - CORRECT ANSWERS-- Do not mix with grapefruit juice, drug induced-
hepatitis or rhabdomyolysis higher if mixed with axle antifungals
- high dose simvastatin (zocor) 80mg has highest risk of rhabomyolysis
- CHINESE: higher risk of myopathy or rhabdomyolysis when taking simvastatin 40 mg
or higher with niacin
- CK elevated
lincosamides - CORRECT ANSWERS-- Clindamycin (Cleocin)
- higher risk of CDAD
Inhaled Corticosteroids - CORRECT ANSWERS-- adrenal insufficiency possible in
children (longterm > 6 months high dose in low BMI child)
- suspect if hypoglycemia, hypotension, altered mental status, weakness, and
cushingoid features
- growth decelerations or failure
systemic glucocorticoids - CORRECT ANSWERS-- cataracts, osteoporosis, skin
changes, (telangiectasia, easy bruising), emotional liability, weight gain, high BP
Phenytoin - CORRECT ANSWERS-- earliest sign of toxicity (horizontal nystagmus,
unsteady gait) if severe then slurred speech, lethargy, confusion, coma
- gingival hyperplasia
Digoxin - CORRECT ANSWERS-- second/third line tx for HF with reduced ejection
fraction (HFrEF)
- therapeutic range 0.5-2.0 ng/mL
- suspect intake of poisonous plants with cardiac glycosides (foxglove, oleander, lily of
the valley) refer to ED
- life threatening effects: severe bradycardia, HB, V-tach, v-fib
- overdose: GI (n/v), hyperkalemia, dysrhythmias, confusion, visual changes
(yellow/green)
reversal agents - CORRECT ANSWERS-warfarin- vit K
Dabigatran - idarucizumab
rivaroxban (Xarelto) or apixaban (eliquis) - anceexanet alfa
heparin - protamine sulfate
Thiazide diuretics - CORRECT ANSWERS-- HTN, HF, Edema, diabetes insipidus
- HTN accompanied by osteopenia or osteoporosis
- hydrochlorothiazide
- chlorthalidone
- Indapamide
Contradictions: Lithium/sulfa allergy (give K sparing instead)
AE: hyperglycemia, hyperlipidemia, hyperuricemia, hypokalemia
K+ sparing diuretics - CORRECT ANSWERS-- alternatives for sulfa allergy
- triamterene
- Amiloride
,- Spironolactone
- do NOT combine with ACEI/ARBs
BLACK BOX: increased risk of benign or malignant tumors
Loop diuretic - CORRECT ANSWERS-- Edema from HF, cirrhosis, renal disease, HTN
- more potent than thiazides but short duration of action
- Furosemide
- Bumetanide
BLACK BOX: excessive lassie may lead to profound diuresis
- contraindicated for sulfa allergy
AE: HYPO- kalemia, natremia, mg, chlorine
- hypovolemia, hypotension
- pancreatitis, jaundice rash
- ototoxicity
captopril - CORRECT ANSWERS-- ACEIs
- associated with agranulocytosis, neutropenia, and leukopenia
- monitor CBC
CCB - CORRECT ANSWERS-- HTN, angina pectoris, coronary artery spasm, supra
ventricular dysthymia's, pulmonary HTN, hypertrophic cardiomyopathy, Raynaud's
phenomenon (1st line)
Dihydropyridines (vascular selective- HTN)
- cause peripheral edema, HA, flushing, lightheadedness
-dipine
- amlodipine and nifedipine may cause positional pedal edema
-- reduce dose or take at night
Nondihydropyridines (myocardium selective- antiarthymic)
- may worsen CO and cause bradycardia and constipation
- verapamil ( do not mix with erythromycin or clarithromycin )
- diltiazem
contraindicated: AV block (2nd and 3rd degree), bradycardia, HFrEF
- may cause reflex tachycardia
Beta Blocker contraindications - CORRECT ANSWERS-- Cardioselective BB more
potent (atenolol and metoprolol)
- X asthma, chronic bronchitis, COPD, emphysema, bradycardia, and no abrupt
discontinuation
neprilysin inhibitor and angioneurotic angioedema - CORRECT ANSWERS--
sacubitril/valsartan (entresto)
- adult HF (class II-IV), pediatric HF > 1 yr
BLACK BOX: fetal toxicity
contraindications: ACEIs, Aliskiren in diabetes, angioedema, renal artery stenosis
AE: hyperkalemia, angioedema, dizziness, cough
Alpha- blockers - CORRECT ANSWERS-- relaxes smooth muscle on the bladder neck
and the prostate and improves s/s of BPH
- osin; recommended as initial therapy BUT terazosin and doxazosin can also lower BP
AE: orthostatic hypotension, dizziness, priapism (tamsulosin?Flomax)
, *Do NOT give during cataract or glaucoma surgery- floppy iris syndrome*
First generation cephalosporins - CORRECT ANSWERS-- Cephalexin (Reflex)
Skin: uncomplicated skin and soft tissue infections (not caused by MRSA) , impetigo
Pregnancy: UTI
Second generation cephalosporins - CORRECT ANSWERS-- cefuroxime
- cefprozil
- cefaclor
ENT: Rhinosinusitis, OM
Lungs: CAP, exacerbation of chronic bronchitis
avoid using cefaclor because it does not cover common pathogens
Third Generation Cephalosporins - CORRECT ANSWERS-- Ceftriaxone (Rocephin)
- Cefixime
- Cefdinir
STDs: Gonorrhea, PID
REnAL: polynephritis
ENT: OM in children, Rhinosinusitis, OM
GU: pyelonephritis
Lungs: CAP
pregnant women with UTI - CORRECT ANSWERS-- beta-lactams, nitrofurantoin, or
fosfomycin
Lincosamides - CORRECT ANSWERS-Clindamycin- bacteriostatic
- streptococcal, staphylococcal , anaerobi infections
- caution with patients receiving neuromuscular blockers
Indications: skin infections, bone and joint infections, lower RTI, intraabdominal
infections, sepsis, BV
AE: diarrhea, maculopapular rash, SJS, thrombophlebitis
Drugs with visual AE - CORRECT ANSWERS-- digoxin: yellow/green vision, blurred,
halos
- Ethambutol and linezolid: optic neuropathy
- corticosteroids: cataracts, glaucoma, optic neuritis
- flouroquinolones: retinal detachment
- viagra, cialis, Levitra: cataracts, blurred vision, ischemic optic neuropathy
- accutane: cataracts, decreased night vision, others
- topamax: acute angle closure glaucoma, increased ICP, mydriasis
- plaquenil: neuropathy and permanent loss of vision
theophylline - CORRECT ANSWERS-- 5-15 mcg/mL
- interactions: cimetidine, alprazolam, macrolides, fluvoxamine; avoid stimulants
- disorders worsened by stimulants: HTN, arrthymias, HD, stroke, seizures
BPH: urinary retention; worsening s/s
- suspect toxicity if vomiting
Shringrix - CORRECT ANSWERS-- preferred fro 50+; 2 injections 2 months apart
- recommended to those who previously took Zostavax
- if second dose delayed by more than 6 months do not restart
Risk for shingles:
- > 60
- immunocompromised
entrance exam 2024/2025.
H2 antagonists - CORRECT ANSWERS-- famotidine
- cimetidine
- nizatidine
AE
- mental status changes with kidney disease
- avoid if kidney disease with creatinine clearance of < 50 mL/minute
PPI - CORRECT ANSWERS-- prazole
AE
- increased risk of fractures (postmenopausal women), pneumonia, C Diff,
hypomagnesemia, B12 and iron malabsorption, atrophic gastritis, kidney disease
- Interacts with Warfarin, diazepam, carbamazepine, phenytoin, ketoconazole
Vitamin K anatagonist - CORRECT ANSWERS-- warfarin
AE
- interacts with "G" herbs such as garlic, ginger, gingko, and ginseng, feverfew, green
tea, fish oil
- discontinue 7 days before surgery
INR
- a-fib, DVT, TIA, CVA 2.0 to 3.0
- mechanical mitral valves 2.5 to 3.5
- INR will increase 2-3 days after the warfarin dose but the full anticoagulation effect
takes longer 5-7 days
- check consistently stable INR q2-4 weeks up to 12 weeks
- single out of range <0.5 above or below repeat in 1-2 weeks
- INR < 5 with no significant risk of bleeding omit one dose and/or reduce maintenance
dose; recheck
- do NOT double up if missed dose
RARE: purple toe syndrome: skin necrosis located in subcutaneous fat, breasts,
extremities, trunk within first few days
TZDs - CORRECT ANSWERS-- pioglitazone (Actos)
- BLACK BOX: cause or exacerbate HF; do NOT use if class III or IV
- contraindicated in HX of MI, Stroke, bladder ca, type I diabetes, eye or liver problems
- Stop if dyspnea, weight gain, cough
Atypical antipsychotics - CORRECT ANSWERS-- risperidone
- olanzapine
- quetiapine
AE
- weight gain, metabolic syndrome, type II diabetes, monitor weight q3months
- BLACK BOX: higher mortality in elderly
- Monitor TSH, lipids, blood glucose, weight/BMI
Bisphosphonates - CORRECT ANSWERS-- alendronate
- risedronate
AE
,- erosive esophagitis (chest pain when eating, odonophagia, dysphagia, heartburn) stop
immediately if s/s of esophagitis (chest pain, difficulty swallowing, boring mid back) or
jaw pain (oestonecrosis)
- take upon waking with 8-oz glass of water before breakfast; do not lie down for 30
minutes afterward; do not mix with other drugs
Contraindications: Active GI disease (GERD, PUD), CKD, esophageal strictures/varices
Statins - CORRECT ANSWERS-- Do not mix with grapefruit juice, drug induced-
hepatitis or rhabdomyolysis higher if mixed with axle antifungals
- high dose simvastatin (zocor) 80mg has highest risk of rhabomyolysis
- CHINESE: higher risk of myopathy or rhabdomyolysis when taking simvastatin 40 mg
or higher with niacin
- CK elevated
lincosamides - CORRECT ANSWERS-- Clindamycin (Cleocin)
- higher risk of CDAD
Inhaled Corticosteroids - CORRECT ANSWERS-- adrenal insufficiency possible in
children (longterm > 6 months high dose in low BMI child)
- suspect if hypoglycemia, hypotension, altered mental status, weakness, and
cushingoid features
- growth decelerations or failure
systemic glucocorticoids - CORRECT ANSWERS-- cataracts, osteoporosis, skin
changes, (telangiectasia, easy bruising), emotional liability, weight gain, high BP
Phenytoin - CORRECT ANSWERS-- earliest sign of toxicity (horizontal nystagmus,
unsteady gait) if severe then slurred speech, lethargy, confusion, coma
- gingival hyperplasia
Digoxin - CORRECT ANSWERS-- second/third line tx for HF with reduced ejection
fraction (HFrEF)
- therapeutic range 0.5-2.0 ng/mL
- suspect intake of poisonous plants with cardiac glycosides (foxglove, oleander, lily of
the valley) refer to ED
- life threatening effects: severe bradycardia, HB, V-tach, v-fib
- overdose: GI (n/v), hyperkalemia, dysrhythmias, confusion, visual changes
(yellow/green)
reversal agents - CORRECT ANSWERS-warfarin- vit K
Dabigatran - idarucizumab
rivaroxban (Xarelto) or apixaban (eliquis) - anceexanet alfa
heparin - protamine sulfate
Thiazide diuretics - CORRECT ANSWERS-- HTN, HF, Edema, diabetes insipidus
- HTN accompanied by osteopenia or osteoporosis
- hydrochlorothiazide
- chlorthalidone
- Indapamide
Contradictions: Lithium/sulfa allergy (give K sparing instead)
AE: hyperglycemia, hyperlipidemia, hyperuricemia, hypokalemia
K+ sparing diuretics - CORRECT ANSWERS-- alternatives for sulfa allergy
- triamterene
- Amiloride
,- Spironolactone
- do NOT combine with ACEI/ARBs
BLACK BOX: increased risk of benign or malignant tumors
Loop diuretic - CORRECT ANSWERS-- Edema from HF, cirrhosis, renal disease, HTN
- more potent than thiazides but short duration of action
- Furosemide
- Bumetanide
BLACK BOX: excessive lassie may lead to profound diuresis
- contraindicated for sulfa allergy
AE: HYPO- kalemia, natremia, mg, chlorine
- hypovolemia, hypotension
- pancreatitis, jaundice rash
- ototoxicity
captopril - CORRECT ANSWERS-- ACEIs
- associated with agranulocytosis, neutropenia, and leukopenia
- monitor CBC
CCB - CORRECT ANSWERS-- HTN, angina pectoris, coronary artery spasm, supra
ventricular dysthymia's, pulmonary HTN, hypertrophic cardiomyopathy, Raynaud's
phenomenon (1st line)
Dihydropyridines (vascular selective- HTN)
- cause peripheral edema, HA, flushing, lightheadedness
-dipine
- amlodipine and nifedipine may cause positional pedal edema
-- reduce dose or take at night
Nondihydropyridines (myocardium selective- antiarthymic)
- may worsen CO and cause bradycardia and constipation
- verapamil ( do not mix with erythromycin or clarithromycin )
- diltiazem
contraindicated: AV block (2nd and 3rd degree), bradycardia, HFrEF
- may cause reflex tachycardia
Beta Blocker contraindications - CORRECT ANSWERS-- Cardioselective BB more
potent (atenolol and metoprolol)
- X asthma, chronic bronchitis, COPD, emphysema, bradycardia, and no abrupt
discontinuation
neprilysin inhibitor and angioneurotic angioedema - CORRECT ANSWERS--
sacubitril/valsartan (entresto)
- adult HF (class II-IV), pediatric HF > 1 yr
BLACK BOX: fetal toxicity
contraindications: ACEIs, Aliskiren in diabetes, angioedema, renal artery stenosis
AE: hyperkalemia, angioedema, dizziness, cough
Alpha- blockers - CORRECT ANSWERS-- relaxes smooth muscle on the bladder neck
and the prostate and improves s/s of BPH
- osin; recommended as initial therapy BUT terazosin and doxazosin can also lower BP
AE: orthostatic hypotension, dizziness, priapism (tamsulosin?Flomax)
, *Do NOT give during cataract or glaucoma surgery- floppy iris syndrome*
First generation cephalosporins - CORRECT ANSWERS-- Cephalexin (Reflex)
Skin: uncomplicated skin and soft tissue infections (not caused by MRSA) , impetigo
Pregnancy: UTI
Second generation cephalosporins - CORRECT ANSWERS-- cefuroxime
- cefprozil
- cefaclor
ENT: Rhinosinusitis, OM
Lungs: CAP, exacerbation of chronic bronchitis
avoid using cefaclor because it does not cover common pathogens
Third Generation Cephalosporins - CORRECT ANSWERS-- Ceftriaxone (Rocephin)
- Cefixime
- Cefdinir
STDs: Gonorrhea, PID
REnAL: polynephritis
ENT: OM in children, Rhinosinusitis, OM
GU: pyelonephritis
Lungs: CAP
pregnant women with UTI - CORRECT ANSWERS-- beta-lactams, nitrofurantoin, or
fosfomycin
Lincosamides - CORRECT ANSWERS-Clindamycin- bacteriostatic
- streptococcal, staphylococcal , anaerobi infections
- caution with patients receiving neuromuscular blockers
Indications: skin infections, bone and joint infections, lower RTI, intraabdominal
infections, sepsis, BV
AE: diarrhea, maculopapular rash, SJS, thrombophlebitis
Drugs with visual AE - CORRECT ANSWERS-- digoxin: yellow/green vision, blurred,
halos
- Ethambutol and linezolid: optic neuropathy
- corticosteroids: cataracts, glaucoma, optic neuritis
- flouroquinolones: retinal detachment
- viagra, cialis, Levitra: cataracts, blurred vision, ischemic optic neuropathy
- accutane: cataracts, decreased night vision, others
- topamax: acute angle closure glaucoma, increased ICP, mydriasis
- plaquenil: neuropathy and permanent loss of vision
theophylline - CORRECT ANSWERS-- 5-15 mcg/mL
- interactions: cimetidine, alprazolam, macrolides, fluvoxamine; avoid stimulants
- disorders worsened by stimulants: HTN, arrthymias, HD, stroke, seizures
BPH: urinary retention; worsening s/s
- suspect toxicity if vomiting
Shringrix - CORRECT ANSWERS-- preferred fro 50+; 2 injections 2 months apart
- recommended to those who previously took Zostavax
- if second dose delayed by more than 6 months do not restart
Risk for shingles:
- > 60
- immunocompromised
